Check
if
self-employed
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
Check if
applicable:
Address
change
Name
change
Initial
return
Final
return/
termin-
ated
Gross receipts $
Amended
return
Applica-
tion
pending
Are all subordinates included?
032001 12-23-20
Beginning of Current Year
Paid
Preparer
Use Only
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
| Do not enter social security numbers on this form as it may be made public.
Open to Public
Inspection
| Go to www.irs.gov/Form990 for instructions and the latest information.
AFor the 2020 calendar year, or tax year beginningand ending
BCDEmployer identification number
E
G
H(a)
H(b)
H(c)
FYesNo
YesNo
I
J
K
Website: |
LM
1
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7
3
4
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7a
7b
a
b
Activities & Governance
Prior YearCurrent Year
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15
16
17
18
19
Revenue
a
b
Expenses
End of Year
20
21
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Sign
Here
YesNo
For Paperwork Reduction Act Notice, see the separate instructions.
(or P.O. box if mail is not delivered to street address)Room/suite
)
501(c)(3)501(c) ((insert no.)4947(a)(1) or527
|
CorporationTrustAssociationOther
Form of organization:Year of formation:State of legal domicile:
|
|
Net Assets or
Fund Balances
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Signature of officerDate
Type or print name and title
Date
PTIN
Print/Type preparer's namePreparer's signature
Firm's nameFirm's EIN
Firm's address
Phone no.
Form
Name of organization
Doing business as
Number and street Telephone number
City or town, state or province, country, and ZIP or foreign postal code
Is this a group return
for subordinates? Name and address of principal officer:~~
If "No," attach a list. See instructions
Group exemption number |
Tax-exempt status:
Briefly describe the organization's mission or most significant activities:
Check this boxif the organization discontinued its operations or disposed of more than 25% of its net assets.
Number of voting members of the governing body (Part VI, line 1a)
Number of independent voting members of the governing body (Part VI, line 1b)
Total number of individuals employed in calendar year 2020 (Part V, line 2a)
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
Total number of volunteers (estimate if necessary)
Total unrelated business revenue from Part VIII, column (C), line 12
Net unrelated business taxable income from Form 990-T, Part I, line 11
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
Contributions and grants (Part VIII, line 1h)~~~~~~~~~~~~~~~~~~~~~
Program service revenue (Part VIII, line 2g)~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Investment income (Part VIII, column (A), lines 3, 4, and 7d)
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)~~~~~~~~
Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12)
Grants and similar amounts paid (Part IX, column (A), lines 1-3)
Benefits paid to or for members (Part IX, column (A), line 4)
Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)
~~~~~~~~~~~
~~~~~~~~~~~~~
~~~
Professional fundraising fees (Part IX, column (A), line 11e)
Total fundraising expenses (Part IX, column (D), line 25)
~~~~~~~~~~~~~~
Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e)
Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 18 from line 12
~~~~~~~~~~~~~
~~~~~~~
Total assets (Part X, line 16)
Total liabilities (Part X, line 26)
Net assets or fund balances. Subtract line 21 from line 20
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~
May the IRS discuss this return with the preparer shown above? See instructions
LHAForm(2020)
Part ISummary
Signature Block
Part II
990
Return of Organization Exempt From Income Tax
990
2020
§
=
=
9
9
9
STMT 1
** PUBLIC DISCLOSURE COPY **
MARY WASHINGTON HEALTHCARE GROUP RETURN
20-1106426
540-741-2507 2300 FALL HILL AVENUE418
855,304,083.
X
FREDERICKSBURG, VA 22401
4243
X
MICHAEL P. MCDERMOTT MD
WWW.MARYWASHINGTONHEALTHCARE.COM
X1983VA
OUR MISSION IS TO IMPROVE THE
17
15
4257
326
2,709,558.
0.
22,702,333.
701,843,134.
15,263,218.
178,184.
734,167,988.739,986,869.
2,650,520.
0.
246,783,903.
0.
1,197,976.
457,908,110.
705,337,486.707,342,533.
28,830,502.32,644,336.
475,223,962.591,367,916.
312,091,360.390,180,318.
163,132,602.201,187,598.
SEAN T. BARDEN, SENIOR VP AND CFO
X
P00659678 JENNIFER N. FRENCH, CPA
54-0737372 PBMARES, LLP
725 JACKSON STREET, SUITE 210
FREDERICKSBURG, VA 22401540-371-3566
X
SAME AS C ABOVE
HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR
SEE SCHEDULE O FOR ORGANIZATION MISSION STATEMENT CONTINUATION
X
3,289,115.
726,985,153.
3,755,103.
138,617.
2,207,874.
0.
243,677,358.
0.
459,452,254.
JENNIFER N. FRENCH, 11/18/21
Code:Expenses $including grants of $Revenue $
Code:Expenses $including grants of $Revenue $
Code:Expenses $including grants of $Revenue $
Expenses $including grants of $Revenue $
032002 12-23-20
1
2
3
4
YesNo
YesNo
4a
4b
4c
4d
4e
Form 990 (2020)Page
Check if Schedule O contains a response or note to any line in this Part III
Briefly describe the organization's mission:
Did the organization undertake any significant program services during the year which were not listed on the
prior Form 990 or 990-EZ?
If "Yes," describe these new services on Schedule O.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization cease conducting, or make significant changes in how it conducts, any program services?
If "Yes," describe these changes on Schedule O.
~~~~~~
Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.
Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and
revenue, if any, for each program service reported.
() ()()
() ()()
() ()()
Other program services (Describe on Schedule O.)
()()
Total program service expenses |
Form(2020)
2
Statement of Program Service Accomplishments
Part III
990
OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE
X
X
SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT
658,859,723.2,650,520.699,317,895.
PSYCHIATRIC HOSPITAL SERVICES, HOME HEALTH AND HOSPICE SERVICES,
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
HOSPITAL SERVICES AND OTHER MEDICAL SERVICES.
PROVISION OF INPATIENT AND OUTPATIENT GENERAL ACUTE CARE HOSPITAL,
IMAGING AND AMBULATORY SURGERY SERVICES AND PHYSICIAN SERVICES.
PRIMARY SERVICE AREAS ARE FREDERICKSBURG, PRINCE WILLIAM, STAFFORD,
SPOTSYLVANIA, CAROLINE, KING GEORGE, AND WESTMORELAND COUNTIES IN
VIRGINIA AND SECONDARY SERVICE AREAS INCLUDE MANASSAS, FAUQUIER,
CULPEPER, ORANGE, LOUISA, HANOVER, ESSEX AND RICHMOND COUNTIES IN
VIRGINIA. WE SERVED 97,066 PATIENTS IN OUR EMERGENCY ROOMS, 302,112
OUTPATIENTS, 18,574 SURGICAL CASES AND 26,639 PATIENT DISCHARGES.
658,859,723.
3
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032003 12-23-20
YesNo
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
1
2
3
4
5
6
7
8
9
10
Section 501(c)(3) organizations.
a
b
c
d
e
f
a
b
11a
11b
11c
11d
11e
11f
12a
12b
13
14a
14b
15
16
17
18
19
20a
20b
21
a
b
20
21
a
b
If "Yes," complete Schedule A
Schedule B, Schedule of Contributors
If "Yes," complete Schedule C, Part I
If "Yes," complete Schedule C, Part II
If "Yes," complete Schedule C, Part III
If "Yes," complete Schedule D, Part I
If "Yes," complete Schedule D, Part II
If "Yes," complete
Schedule D, Part III
If "Yes," complete Schedule D, Part IV
If "Yes," complete Schedule D, Part V
If "Yes," complete Schedule D,
Part VI
If "Yes," complete Schedule D, Part VII
If "Yes," complete Schedule D, Part VIII
If "Yes," complete Schedule D, Part IX
If "Yes," complete Schedule D, Part X
If "Yes," complete Schedule D, Part X
If "Yes," complete
Schedule D, Parts XI and XII
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
If "Yes," complete Schedule E
If "Yes," complete Schedule F, Parts I and IV
If "Yes," complete Schedule F, Parts II and IV
If "Yes," complete Schedule F, Parts III and IV
If "Yes," complete Schedule G, Part I
If "Yes," complete Schedule G, Part II
If "Yes,"
complete Schedule G, Part III
If "Yes," complete Schedule H
If "Yes," complete Schedule I, Parts I and II
Form 990 (2020)Page
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization required to complete ?
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for
public office?
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization engage in lobbying activities, or have a section 501(h) election in effect
during the tax year?
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or
similar amounts as defined in Revenue Procedure 98-19?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to
provide advice on the distribution or investment of amounts in such funds or accounts?
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures?
Did the organization maintain collections of works of art, historical treasures, or other similar assets?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for
amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?
Did the organization, directly or through a related organization, hold assets in donor-restricted endowments
or in quasi endowments?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X
as applicable.
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for investments - other securities in Part X, line 12, that is 5% or more of its total
assets reported in Part X, line 16?
Did the organization report an amount for investments - program related in Part X, line 13, that is 5% or more of its total
assets reported in Part X, line 16?
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for other assets in Part X, line 15, that is 5% or more of its total assets reported in
Part X, line 16?
Did the organization report an amount for other liabilities in Part X, line 25?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)?
Did the organization obtain separate, independent audited financial statements for the tax year?
~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization included in consolidated, independent audited financial statements for the tax year?
~~~~~
Is the organization a school described in section 170(b)(1)(A)(ii)?
Did the organization maintain an office, employees, or agents outside of the United States?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,
investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000
or more?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any
foreign organization?
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to
or for foreign individuals?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,
column (A), lines 6 and 11e? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines
1c and 8a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization operate one or more hospital facilities? ~~~~~~~~~~~~~~~~~
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?~~~~~~~~~~
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or
domestic government on Part IX, column (A), line 1?
~~~~~~~~~~~~~~
Form (2020)
3
Part IV
Checklist of Required Schedules
990
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
4
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032004 12-23-20
YesNo
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
22
23
24a
24b
24c
24d
25a
25b
26
27
28a
28b
28c
29
30
31
32
33
34
35a
35b
36
37
38
a
b
c
d
a
b
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations.
a
b
c
a
b
Section 501(c)(3) organizations.
Note:
YesNo
1a
b
c
1a
1b
1c
(continued)
If "Yes," complete Schedule I, Parts I and III
If "Yes," complete
Schedule J
If "Yes," answer lines 24b through 24d and complete
Schedule K. If "No," go to line 25a
If "Yes," complete Schedule L, Part I
If "Yes," complete
Schedule L, Part I
If "Yes," complete Schedule L, Part II
If "Yes," complete Schedule L, Part III
If
"Yes," complete Schedule L, Part IV
If "Yes," complete Schedule L, Part IV
If
"Yes," complete Schedule L, Part IV
If "Yes," complete Schedule M
If "Yes," complete Schedule M
If "Yes," complete Schedule N, Part I
If "Yes," complete
Schedule N, Part II
If "Yes," complete Schedule R, Part I
If "Yes," complete Schedule R, Part II, III, or IV, and
Part V, line 1
If "Yes," complete Schedule R, Part V, line 2
If "Yes," complete Schedule R, Part V, line 2
If "Yes," complete Schedule R, Part VI
Form 990 (2020)Page
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on
Part IX, column (A), line 2? ~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current
and former officers, directors, trustees, key employees, and highest compensated employees?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the
last day of the year, that was issued after December 31, 2002?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease
any tax-exempt bonds?
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~
Did the organization engage in an excess benefit
transaction with a disqualified person during the year?
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and
that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report any amount on Part X, line 5 or 22, for receivables from or 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?~~~~~~~~~~~~~
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee,
creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled
entity (including an employee thereof) or family member of any of these persons? ~~~
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV
instructions, for applicable filing thresholds, conditions, and exceptions):
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A family member of any individual described in line 28a?
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b?
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization receive more than $25,000 in non-cash contributions?
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation
contributions?
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization liquidate, terminate, or dissolve and cease operations?
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?
~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3?
Was the organization related to any tax-exempt or taxable entity?
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity
within the meaning of section 512(b)(13)?
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Did the organization make any transfers to an exempt non-charitable related organization?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? ~~~~~~~~
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19?
All Form 990 filers are required to complete Schedule O
Check if Schedule O contains a response or note to any line in this Part V
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable~~~~~~~~~~~
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable~~~~~~~~~~
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners?
Form (2020)
4
Part IV
Checklist of Required Schedules
Part V
Statements Regarding Other IRS Filings and Tax Compliance
990
X
X
X
X
X
X
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
0
0
X
X
X
X
X
X
X
X
X
X
X
X
X
5
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032005 12-23-20
YesNo
2
3
4
5
6
7
a
b
2a
Note:
2b
3a
3b
4a
5a
5b
5c
6a
6b
7a
7b
7c
7e
7f
7g
7h
8
9a
9b
a
b
a
b
a
b
c
a
b
Organizations that may receive deductible contributions under section 170(c).
a
b
c
d
e
f
g
h
7d
8
9
10
11
12
13
14
15
16
Sponsoring organizations maintaining donor advised funds.
Sponsoring organizations maintaining donor advised funds.
a
b
Section 501(c)(7) organizations.
a
b
10a
10b
Section 501(c)(12) organizations.
a
b
11a
11b
a
b
Section 4947(a)(1) non-exempt charitable trusts. 12a
12b
Section 501(c)(29) qualified nonprofit health insurance issuers.
Note:
a
b
c
a
b
13a
13b
13c
14a
14b
15
16
(continued)
e-file
If "No" to line 3b, provide an explanation on Schedule O
If "No," provide an explanation on Schedule O
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?
Form (2020)
Form 990 (2020)Page
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,
filed for the calendar year ending with or within the year covered by this return~~~~~~~~~~
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
If the sum of lines 1a and 2a is greater than 250, you may be required to (see instructions)
~~~~~~~~~~
~~~~~~~~~~~
Did the organization have unrelated business gross income of $1,000 or more during the year?
If "Yes," has it filed a Form 990-T for this year?
~~~~~~~~~~~~~~
~~~~~~~~~~
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a
financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~
If "Yes," enter the name of the foreign country
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
~~~~~~~~~~~~
~~~~~~~~~
If "Yes" to line 5a or 5b, did the organization file Form 8886-T?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit
any contributions that were not tax deductible as charitable contributions?
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts
were not tax deductible?
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization notify the donor of the value of the goods or services provided?
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
to file Form 8282?
~~~~~~~~~~~~~~~
If "Yes," indicate the number of Forms 8282 filed during the year
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
~~~~~~~~~~~~~~~~
~~~~~~~
~~~~~~~~~
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
~
Did a donor advised fund maintained by the
sponsoring organization have excess business holdings at any time during the year?~~~~~~~~~~~~~~~~~~~
Did the sponsoring organization make any taxable distributions under section 4966?
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Enter:
Initiation fees and capital contributions included on Part VIII, line 12
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
~~~~~~~~~~~~~~~
~~~~~~
Enter:
Gross income from members or shareholders
Gross income from other sources (Do not net amounts due or paid to other sources against
amounts due or received from them.)
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization filing Form 990 in lieu of Form 1041?
If "Yes," enter the amount of tax-exempt interest received or accrued during the year
Is the organization licensed to issue qualified health plans in more than one state?
See the instructions for additional information the organization must report on Schedule O.
~~~~~~~~~~~~~~~~~~~~~
Enter the amount of reserves the organization is required to maintain by the states in which the
organization is licensed to issue qualified health plans
Enter the amount of reserves on hand
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization receive any payments for indoor tanning services during the tax year?
If "Yes," has it filed a Form 720 to report these payments?
~~~~~~~~~~~~~~~~
~~~~~~~~~
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment(s) during the year?
If "Yes," see instructions and file Form 4720, Schedule N.
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~
5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
990
J
X
X
X
X
X
X
X
X
X
X
X
X
X
X
4257
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
6
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032006 12-23-20
YesNo
1a
1b
1
2
3
4
5
6
7
8
9
a
b
2
3
4
5
6
7a
7b
8a
8b
9
a
b
a
b
YesNo
10
11
a
b
10a
10b
11a
12a
12b
12c
13
14
15a
15b
16a
16b
a
b
12a
b
c
13
14
15
a
b
16a
b
17
18
19
20
For each "Yes" response to lines 2 through 7b below, and for a "No" response
to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes on Schedule O. See instructions.
If "Yes," provide the names and addresses on Schedule O
(This Section B requests information about policies not required by the Internal Revenue Code.)
If "No," go to line 13
If "Yes," describe
in Schedule O how this was done
(explain on Schedule O)
If there are material differences in voting rights among members of the governing body, or if the governing
body delegated broad authority to an executive committee or similar committee, explain on Schedule O.
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
Form (2020)
Form 990 (2020)Page
Check if Schedule O contains a response or note to any line in this Part VI
Enter the number of voting members of the governing body at the end of the tax year
Enter the number of voting members included on line 1a, above, who are independent
~~~~~~
~~~~~~
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other
officer, director, trustee, or key employee?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization delegate control over management duties customarily performed by or under the direct supervision
of officers, directors, trustees, or key employees to a management company or other person?
~~~~~~~~~~~~~~~
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
Did the organization become aware during the year of a significant diversion of the organization's assets?
Did the organization have members or stockholders?
~~~~~
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or
more members of the governing body?
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or
persons other than the governing body?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The governing body?
Each committee with authority to act on behalf of the governing body?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the
organization's mailing address?
Did the organization have local chapters, branches, or affiliates?
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,
and branches to ensure their operations are consistent with the organization's exempt purposes?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
Describe in Schedule O the process, if any, used by the organization to review this Form 990.
Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the organization regularly and consistently monitor and enforce compliance with the policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a written whistleblower policy?
Did the organization have a written document retention and destruction policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
Did the process for determining compensation of the following persons include a review and approval by independent
persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
The organization's CEO, Executive Director, or top management official
Other officers or key employees of the organization
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
taxable entity during the year?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation
in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's
exempt status with respect to such arrangements?
List the states with which a copy of this Form 990 is required to be filed
Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A, if applicable), 990, and 990-T (Section 501(c)(3)s only) available
for public inspection. Indicate how you made these available. Check all that apply.
Own websiteAnother's websiteUpon requestOther
Describe on Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial
statements available to the public during the tax year.
State the name, address, and telephone number of the person who possesses the organization's books and records |
6
Part VI
Governance, Management, and Disclosure
Section A. Governing Body and Management
Section B. Policies
Section C. Disclosure
990
J
17
15
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
SANDRA W. BROWN - 540-741-2507
2300 FALL HILL AVENUE, NO. 418, FREDERICKSBURG, VA 22401
X
NONE
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
X
7
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Individual trustee or director
Institutional trustee
Officer
Key employee
Highest compensated
employee
Former
(do not check more than one
box, unless person is both an
officer and a director/trustee)
032007 12-23-20
current
Section A.Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a
current
current
former
former directors or trustees
(A)(B)(C)(D)(E)(F)
Form 990 (2020)Page
Check if Schedule O contains a response or note to any line in this Part VII
Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.
¥ List all of the organization's officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.
Enter -0- in columns (D), (E), and (F) if no compensation was paid.
¥ List all of the organization's key employees, if any. See instructions for definition of "key employee."
¥ List the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received report-
able compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations.
¥ List all of the organization's officers, key employees, and highest compensated employees who received more than $100,000 of
reportable compensation from the organization and any related organizations.
¥ List all of the organization's that received, in the capacity as a former director or trustee of the organization,
more than $10,000 of reportable compensation from the organization and any related organizations.
See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
Position
Name and titleAverage
hours per
week
(list any
hours for
related
organizations
below
line)
Reportable
compensation
from
the
organization
(W-2/1099-MISC)
Reportable
compensation
from related
organizations
(W-2/1099-MISC)
Estimated
amount of
other
compensation
from the
organization
and related
organizations
Form(2020)
7
Part VII
Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors
990
(1) MICHAEL P. MCDERMOTT, MD, MBA
PRESIDENT AND CEO
(2) SANG HO NA, MD
(3) CHRISTOPHER NEWMAN, MD
(4) AGOSTINO VISIONI, MD
(5) J. T. SHERWOOD, MD
(6) SEAN T. BARDEN BSBA, MBA
(7) TRAVIS TURNER, BS, MBA
(8) THERESA CONOLOGUE, MD
(9) STEPHEN MANDELL, MD
(10) BRADFORD KING, MD
(11) ELIESE K. BERNARD
(12) KATHRYN WALL, BA, MA
(13) EILEEN DOHMANN, RN, BSN, MBA, N
(14) ERIC FLETCHER, MBA, APR
(15) DAVID YI, MD
(16) GEOFFREY LAWSON
(17) ALAN EDWARDS
PHYSICIAN
SVP, COO & CMO
PHYSICIAN
PHYSICIAN
SR VP & CFO
SVP & CPHO
PHYSICIAN
VICE PRESIDENT
PHYSICIAN/TRUSTEE
VICE PRESIDENT
SVP & CHRO
SVP & CNO
SVP & CSO
VICE PRESIDENT
SVP & CIO
VICE PRESIDENT
4.00
40.00
2.00
40.00
40.00
4.00
2.00
40.00
40.00
40.00
40.00
2.00
2.00
2.00
2.00
2.00
2.00
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
0.
845,251.
0.
813,563.
772,639.
0.
0.
681,814.
587,531.
591,165.
497,438.
0.
0.
0.
0.
0.
0.
1,603,506.
0.
817,435.
0.
0.
713,426.
685,129.
0.
0.
0.
0.
512,272.
510,138.
437,827.
456,649.
425,305.
375,520.
42,691.
26,233.
41,774.
38,698.
44,353.
33,619.
35,176.
26,073.
30,663.
7,605.
34,183.
18,581.
10,077.
38,169.
7,780.
16,909.
36,985.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
40.00
40.00
40.00
40.00
2.00
2.00
2.00
40.00
40.00
40.00
40.00
40.00
40.00
8
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Former
Individual trustee or director
Institutional trustee
Officer
Highest compensated
employee
Key employee
(do not check more than one
box, unless person is both an
officer and a director/trustee)
032008 12-23-20
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(B)(C)
(A)(D)(E)(F)
1b
c
d
Subtotal
Total from continuation sheets to Part VII, Section A
Total (add lines 1b and 1c)
2
YesNo
3
4
5
former
3
4
5
Section B. Independent Contractors
1
(A)(B)(C)
2
(continued)
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such person
Page
Form 990 (2020)
Position
Average
hours per
week
(list any
hours for
related
organizations
below
line)
Name and titleReportable
compensation
from
the
organization
(W-2/1099-MISC)
Reportable
compensation
from related
organizations
(W-2/1099-MISC)
Estimated
amount of
other
compensation
from the
organization
and related
organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|
~~~~~~~~~~|
|
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization|
Did the organization list any officer, director, trustee, key employee, or highest compensated employee on
line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization
and related organizations greater than $150,000? ~~~~~~~~~~~~~
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization?
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from
the organization. Report compensation for the calendar year ending with or within the organization's tax year.
Name and business addressDescription of servicesCompensation
Total number of independent contractors (including but not limited to those listed above) who received more than
$100,000 of compensation from the organization|
Form (2020)
8
Part VII
990
(18) BRIAN JENKINS
VICE PRESIDENT
40.00
X377,280.0.28,124.
(19) RICHARD LEWIS, MD
VICE PRESIDENT
2.00
X0.379,768.25,442.
(20) MARIE FREDRICK, R.T. (R), CRA,
VICE PRESIDENT
2.00
X0.371,326.26,808.
(21) XAVIER RICHARDSON BA, MBA
SVP & CDO
2.00
X0.339,318.16,468.
(22) CATHLEEN YABLONSKI, BS, MS
VICE PRESIDENT
40.00
X313,507.0.25,799.
(23) CODY BLANKENSHIP
VICE PRESIDENT
2.00
X0.300,184.32,842.
(24) LAUREN BLALOCK
VICE PRESIDENT
2.00
X0.287,534.34,176.
(25) SANDRA BROWN, CPA
VICE PRESIDENT
2.00
X0.289,430.26,546.
(26) TINA ERVIN
VICE PRESIDENT
2.00
X0.272,849.25,020.
5,480,188.8,777,616.730,794.
0.594,175.18,638.
2.00
40.00
40.00
40.00
2.00
40.00
3310 FALL HILL AVENUE, FREDERICKSBURG, VA
PO BOX 17125, FERNANDINA BEACH, FL 32034
DAVIS HWY, FREDERICKSBURG, VA 22405
SPOTSYLVANIA PKWY, STE 201,
521 PARK HILL DRIVE, FREDERICKSBURG, VA
339
34
SEE PART VII, SECTION A CONTINUATION SHEETS
40.00
40.00
40.00
5,480,188.9,371,791.749,432.
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN
X
20-1106426
FREDERICKSBURG ORTHOPAEDIC ASSOCIATES,
ARMG LLC
GAERTNER PSYCHIATRIC PC, 621 JEFFERSON
COMMONWEALTH SPINE & REHAB, 4710
PULMONARY ASSOCIATES OF FREDERICKSBURG,
PHYSICIAN SERVICES
SERVICES - PHYSICAL
PROFESSIONAL
PHYSICIAN SERVICES
PHYSICIAN SERVICES
PHYSICIAN SERVICES
8,953,021.
3,595,968.
2,657,704.
2,626,036.
2,414,369.
9
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Individual trustee or director
Institutional trustee
Officer
Key employee
Highest compensated employee
Former
032201
04-01-20
Section A.Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(A)(B)(C)(D)(E)(F)
(continued)
Form 990
Name and titleAverage
hours
per
week
(list any
hours for
related
organizations
below
line)
Position
(check all that apply)
Reportable
compensation
from
the
organization
(W-2/1099-MISC)
Reportable
compensation
from related
organizations
(W-2/1099-MISC)
Estimated
amount of
other
compensation
from the
organization
and related
organizations
Total to Part VII, Section A, line 1c
Part VII
(27) KATHLEEN BOURGAULT, MS, CPAM
VICE PRESIDENT (THRU 5/9/2020)
(28) SARAH OGLE
(29) DOUGLAS SCHULTE, MD
(30) WILLIAM M. BOLDON, MBA
(31) RONALD W. BRANSCOME, MS
(32) BRUCE L. DAVIS, BA
(33) JANAMITRA DEVAN
(34) MATTHEW D. DUMONT, MD
(35) REV. ALLEN H. FISHER, JR. , BA,
(36) JEFFREY A. FRAZIER, MD
(37) DAVID M. GARTH, MD
(38) MARGARET F. HARDY
(39) DERMAINE A. LEWIS
(40) FRED M. MESSING, MBA, LFACHE
(41) JOHN F. ROWLEY, BS, JD
(42) CATHERINE M. WACK
(43) MARTIN A. WILDER, JR., ED.D.
VICE PRESIDENT (AS OF 5/10/2020)
FORMER VICE PRESIDENT, THRU 10/19
CHAIR
VICE CHAIR
BOARD TRUSTEE
BOARD TRUSTEE
BOARD TRUSTEE
BOARD TRUSTEE
BOARD TRUSTEE
BOARD TRUSTEE
BOARD TRUSTEE
BOARD TRUSTEE
BOARD TRUSTEE
SECRETARY/TREASURER
BOARD TRUSTEE
BOARD TRUSTEE
2.00
40.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
257,645.
222,841.
113,689.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
12,206.
5,892.
540.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
(44) LINDA D. WORRELL
BOARD TRUSTEE
2.00
X0.0.0.
594,175.18,638.
40.00
2.00
40.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
10
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Noncash contributions included in lines 1a-1f
032009 12-23-20
Business Code
Business Code
Total revenue.
(A)(B)(C)(D)
1a
b
c
d
e
f
1
1
1
1
1
1
1
a
b
c
d
e
f
g g
Contributions, Gifts, Grants
and Other Similar Amounts
hTotal.
a
b
c
d
e
f
g
2
Program Service
Revenue
Total.
3
4
5
6a
b
c
d
6a
6b
6c
7a
7a
7b
7c
b
c
d
a
b
c
8
8a
8b
9a
b
c
9a
9b
10a
b
c
10a
10b
Other Revenue
11a
b
c
d
e
Miscellaneous
Revenue
Total.
12
Revenue excluded
from tax under
sections 512 - 514
All other contributions, gifts, grants, and
similar amounts not included above
Gross amount from sales of
assets other than inventory
cost or other basis
and sales expenses
Gross income from fundraising events
See instructions
Form (2020)
Page
Form 990 (2020)
Check if Schedule O contains a response or note to any line in this Part VIII
Total revenue
Related or exempt
function revenue
Unrelated
business revenue
Federated campaigns
Membership dues
~~~~~
~~~~~~~
Fundraising events
Related organizations
~~~~~~~
~~~~~
Government grants (contributions)
~
$
Add lines 1a-1f|
All other program service revenue~~~~~
Add lines 2a-2f|
Investment income (including dividends, interest, and
other similar amounts)
Income from investment of tax-exempt bond proceeds
~~~~~~~~~~~~~~~~~|
|
Royalties|
(i) Real(ii) Personal
Gross rents
Less: rental expenses
Rental income or (loss)
Net rental income or (loss)
~~~~~
~
|
(i) Securities(ii) Other
Less:
Gain or (loss)
~~~
~~~~~
Net gain or (loss)|
(not
including $
of
contributions reported on line 1c). See
Part IV, line 18~~~~~~~~~~~~
Less: direct expenses~~~~~~~~~
Net income or (loss) from fundraising events|
Gross income from gaming activities. See
Part IV, line 19~~~~~~~~~~~~
Less: direct expenses
Net income or (loss) from gaming activities
~~~~~~~~
|
Gross sales of inventory, less returns
and allowances~~~~~~~~~~~~
Less: cost of goods sold
Net income or (loss) from sales of inventory
~~~~~~~
|
All other revenue~~~~~~~~~~~~~
Add lines 11a-11d|
|
9
Part VIII
Statement of Revenue
990
235,111.
922,262.
18,899,608.
681,259,397.
2,645,352.
22,702,333.
INCOME FROM PARTNERSHIPS/LLCS9000996,812.
701,843,134.
10,023,136.
4,362,933.
2,989,008.
2,702,746.
MARY WASHINGTON HEALTHCARE GROUP RETURN
177,507.
505,914.
739,986,869.699,317,895.2,709,558.15,257,083.
20-1106426
NET PATIENT SERVICES REVENUE623000681,259,397.
PROGRAM RENTAL INCOME53112010,023,136.
MANAGEMENT SERVICES623000
1,846,362.1,846,362.
4,362,933.
OTHER OPERATING REVENUE623000
128,675,616.
115,305,380.
13,370,236.
46,620.
0.
46,620.
13,416,856.13,416,856.
5,699.
11,834.
-6,135.-6,135.
235,111.
184,319.
184,319.
2,989,008.
LAB FEES6215002,702,746.
623000505,914.
11
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Check here
if following SOP 98-2 (ASC 958-720)
032010 12-23-20
Total functional expenses.
Joint costs.
(A)(B)(C)(D)
1
2
3
4
5
6
7
8
9
10
11
a
b
c
d
e
f
g
12
13
14
15
16
17
18
19
20
21
22
23
24
a
b
c
d
e
25
26
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Grants and other assistance to domestic organizations
and domestic governments. See Part IV, line 21
Compensation not included above to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B)
Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)
Professional fundraising services. See Part IV, line 17
(If line 11g amount exceeds 10% of line 25,
column (A) amount, list line 11g expenses on Sch O.)
Other expenses. Itemize expenses not covered
above (List miscellaneous expenses on line 24e. If
line 24e amount exceeds 10% of line 25, column (A)
amount, list line 24e expenses on Schedule O.)
Add lines 1 through 24e
Complete this line only if the organization
reported in column (B) joint costs from a combined
educational campaign and fundraising solicitation.
Form 990 (2020)Page
Check if Schedule O contains a response or note to any line in this Part IX
Total expensesProgram service
expenses
Management and
general expenses
Fundraising
expenses
~
Grants and other assistance to domestic
individuals. See Part IV, line 22~~~~~~~
Grants and other assistance to foreign
organizations, foreign governments, and foreign
individuals. See Part IV, lines 15 and 16~~~
Benefits paid to or for members~~~~~~~
Compensation of current officers, directors,
trustees, and key employees~~~~~~~~
~~~
Other salaries and wages~~~~~~~~~~
Other employee benefits~~~~~~~~~~
Payroll taxes~~~~~~~~~~~~~~~~
Fees for services (nonemployees):
Management
Legal
Accounting
Lobbying
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Investment management fees
Other.
~~~~~~~~
Advertising and promotion
Office expenses
Information technology
Royalties
~~~~~~~~~
~~~~~~~~~~~~~~~
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Occupancy~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Travel
Payments of travel or entertainment expenses
for any federal, state, or local public officials
~
Conferences, conventions, and meetings~~
Interest
Payments to affiliates
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~
Depreciation, depletion, and amortization
Insurance
~~
~~~~~~~~~~~~~~~~~
All other expenses
|
Form(2020)
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
10
Statement of Functional Expenses
Part IX
990
2,611,020.
39,500.
1,894,524.
208,593,068.
4,020,291.
17,627,022.
14,648,998.
110,355,590.
16,963.
9,350.
105,151,242.
216,173.
4,482,062.
1,218,350.
19,544,887.
1,616,009.
173,152.
688,985.
27,106,873.
3,233,297.
116,442,941.
35,118,029.
22,826,611.
5,234,842.
4,324,652.
707,342,533.
148,102.
2,611,020.
39,500.
1,767,401.127,123.
194,596,473.13,996,595.
3,750,529.269,762.
16,444,249.1,182,773.
13,666,050.982,948.
102,343,593.7,404,860.607,137.
15,796.1,138.29.
8,707.627.16.
137,912.9,938.252.
97,916,836.7,055,648.178,758.
201,300.14,505.368.
4,173,697.300,747.7,618.
1,134,528.81,751.2,071.
18,200,199.1,311,462.33,226.
1,504,828.108,434.2,747.
161,240.11,618.294.
641,583.46,231.1,171.
25,241,920.1,818,871.46,082.
3,010,846.216,954.5,497.
108,431,667.7,813,321.197,953.
32,701,908.2,356,420.59,701.
21,256,140.1,531,666.38,805.
4,874,685.351,258.8,899.
4,027,116.290,184.7,352.
658,859,723.47,284,834.1,197,976.
MEDICAL AND HOSPITAL SU
BAD DEBT EXPENSE
OTHER MEDICAL & HOSPITA
REPAIRS AND MAINTENANCE
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
12
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032011 12-23-20
(A)(B)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
1
2
3
4
5
6
7
8
9
10c
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
a
b
10a
10b
Assets
Total assets.
Liabilities
Total liabilities.
Organizations that follow FASB ASC 958, check here
and complete lines 27, 28, 32, and 33.
27
28
Organizations that do not follow FASB ASC 958, check here
and complete lines 29 through 33.
29
30
31
32
33
Net Assets or Fund Balances
Form 990 (2020)Page
Check if Schedule O contains a response or note to any line in this Part X
Beginning of yearEnd of year
Cash - non-interest-bearing
Savings and temporary cash investments
Pledges and grants receivable, net
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
Accounts receivable, net~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from 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~~~~~~~~~
Loans and other receivables from other disqualified persons (as defined
under section 4958(f)(1)), and persons described in section 4958(c)(3)(B)~~
Notes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Land, buildings, and equipment: cost or other
basis. Complete Part VI of Schedule D
Less: accumulated depreciation
~~~
~~~~~~
Investments - publicly traded securities
Investments - other securities. See Part IV, line 11
Investments - program-related. See Part IV, line 11
Intangible assets
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other assets. See Part IV, line 11~~~~~~~~~~~~~~~~~~~~~~
Add lines 1 through 15 (must equal line 33)
Accounts payable and accrued expenses
Grants payable
Deferred revenue
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tax-exempt bond liabilities
Escrow or custodial account liability. Complete Part IV of Schedule D
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~
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
~~~~~~~~~
Secured mortgages and notes payable to unrelated third parties~~~~~~
Unsecured notes and loans payable to unrelated third parties~~~~~~~~
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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines 17 through 25
|
Net assets without donor restrictions
Net assets with donor restrictions
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
|
Capital stock or trust principal, or current funds
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds
~~~~~~~~~~~~~~~
~~~~~~~~
~~~~
Total net assets or fund balances~~~~~~~~~~~~~~~~~~~~~~
Total liabilities and net assets/fund balances
Form(2020)
11
Balance Sheet
Part X
990
515,459.657,953.
89,972,204.189,837,696.
17,350,747.19,661,850.
2,960.3,141.
15,576,170.18,716,344.
4,536,057.4,892,578.
57,220,668.63,460,979.
755,642,443.
463,876,003.288,562,630.291,766,440.
475,223,962.591,367,916.
63,296,275.139,428,391.
246,036.10,480,018.
29,936,330.31,556,996.
312,091,360.390,180,318.
X
145,805,130.181,528,035.
17,327,472.19,659,563.
163,132,602.201,187,598.
475,223,962.591,367,916.
218,612,719.208,714,913.
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
1,364,762.
122,305.2,370,935.
13
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032012 12-23-20
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
YesNo
1
2
3
a
b
c
2a
2b
2c
a
b
3a
3b
Form 990 (2020)Page
Check if Schedule O contains a response or note to any line in this Part XI
Total revenue (must equal Part VIII, column (A), line 12)
Total expenses (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 2 from line 1
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A))
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Net unrealized gains (losses) on investments
Donated services and use of facilities
Investment expenses
Prior period adjustments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other changes in net assets or fund balances (explain on Schedule O)
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32,
column (B))
~~~~~~~~~~~~~~~~~~
Check if Schedule O contains a response or note to any line in this Part XII
Accounting method used to prepare the Form 990:CashAccrualOther
If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O.
Were the organization's financial statements compiled or reviewed by an independent accountant?~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a
separate basis, consolidated basis, or both:
Separate basisConsolidated basisBoth consolidated and separate basis
Were the organization's financial statements audited by an independent accountant?~~~~~~~~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,
consolidated basis, or both:
Separate basisConsolidated basisBoth consolidated and separate basis
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,
review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~
If the organization changed either its oversight process or selection process during the tax year, explain on Schedule O.
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit
Act and OMB Circular A-133?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why on Schedule O and describe any steps taken to undergo such audits
Form(2020)
12
Part XI
Reconciliation of Net Assets
Part XII
Financial Statements and Reporting
990
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
739,986,869.
707,342,533.
32,644,336.
163,132,602.
9,544,570.
201,187,598.
X
-4,133,910.
X
X
X
X
X
14
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
(iv) Is the organization listed
in your governing document?
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
032021 01-25-21
(i)(iii)(v)(vi) (ii)
Name of supported
organization
Type of organization
(described on lines 1-10
above (see instructions))
Amount of monetary
support (see instructions)
Amount of other
support (see instructions)
EIN
(Form 990 or 990-EZ)
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
| Attach to Form 990 or Form 990-EZ.
| Go to www.irs.gov/Form990 for instructions and the latest information.
Open to Public
Inspection
Name of the organizationEmployer identification number
1
2
3
4
5
6
7
8
9
10
11
12
section 170(b)(1)(A)(i).
section 170(b)(1)(A)(ii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iv).
section 170(b)(1)(A)(v).
section 170(b)(1)(A)(vi).
section 170(b)(1)(A)(vi).
section 170(b)(1)(A)(ix)
section 509(a)(2).
section 509(a)(4).
section 509(a)(1)section 509(a)(2)section 509(a)(3).
a
b
c
d
e
f
g
Type I.
You must complete Part IV, Sections A and B.
Type II.
You must complete Part IV, Sections A and C.
Type III functionally integrated.
You must complete Part IV, Sections A, D, and E.
Type III non-functionally integrated.
You must complete Part IV, Sections A and D, and Part V.
YesNo
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule A (Form 990 or 990-EZ) 2020
(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
A school described in (Attach Schedule E (Form 990 or 990-EZ).)
A hospital or a cooperative hospital service organization described in
A medical research organization operated in conjunction with a hospital described in 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
(Complete Part II.)
A federal, state, or local government or governmental unit described in
An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in
(Complete Part II.)
A community trust described in (Complete Part II.)
An agricultural research organization described in 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 33 1/3% 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 33 1/3% of its support from gross investment
income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.
See (Complete Part III.)
An organization organized and operated exclusively to test for public safety. See
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 or . See Check the box in
lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.
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.
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).
A supporting organization operated in connection with, and functionally integrated with,
its supported organization(s) (see instructions).
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).
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).
LHA
SCHEDULE A
Part IReason for Public Charity Status.
Public Charity Status and Public Support
2020
X
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
15
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Subtract line 5 from line 4.
032022 01-25-21
Calendar year (or fiscal year beginning in)
Calendar year (or fiscal year beginning in) |
2
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
Total.
6
Public support.
(a) (b) (c) (d) (e) (f)
7
8
9
10
11
12
13
Total support.
12
First 5 years.
stop here
14
15
14
15
16
17
18
a
b
a
b
33 1/3% support test - 2020.
stop here.
33 1/3% support test - 2019.
stop here.
10% -facts-and-circumstances test - 2020.
stop here.
10% -facts-and-circumstances test - 2019.
stop here.
Private foundation.
Schedule A (Form 990 or 990-EZ) 2020
|
Add lines 7 through 10
Schedule A (Form 990 or 990-EZ) 2020Page
(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
fails to qualify under the tests listed below, please complete Part III.)
20162017201820192020Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.")
~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf
~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge
~
Add lines 1 through 3~~~
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)
~~~~~~~~~~~~
20162017201820192020Total
Amounts from line 4~~~~~~~
Gross income from interest,
dividends, payments received on
securities loans, rents, royalties,
and income from similar sources~
Net income from unrelated business
activities, whether or not the
business is regularly carried on~
Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part VI.)~~~~
Gross receipts from related activities, etc. (see instructions)~~~~~~~~~~~~~~~~~~~~~~~
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
|
~~~~~~~~~~~~
Public support percentage for 2020 (line 6, column (f), divided by line 11, column (f))
Public support percentage from 2019 Schedule A, Part II, line 14
%
% ~~~~~~~~~~~~~~~~~~~~~
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
The organization qualifies as a publicly supported organization~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|
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 The organization qualifies as a publicly supported organization~~~~~~~~~~~~~~~~~~~~~~~~~~~~|
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 Explain in Part VI how the organization
meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization~~~~~~~~~~~~~~~|
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 Explain in Part VI how the
organization meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization~~~~~~~~|
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions|
Part IISupport Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
16
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
(Subtract line 7c from line 6.)
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
(Add lines 9, 10c, 11, and 12.)
032023 01-25-21
Calendar year (or fiscal year beginning in) |
Calendar year (or fiscal year beginning in) |
Total support.
3
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
6
7
Total.
a
b
c
8Public support.
(a) (b) (c) (d) (e) (f)
9
10a
b
c
11
12
13
14
First 5 years.
stop here
15
16
15
16
17
18
19
20
2020
2019
17
18
a
b
33 1/3% support tests - 2020.
stop here.
33 1/3% support tests - 2019.
stop here.
Private foundation.
Schedule A (Form 990 or 990-EZ) 2020
Unrelated business taxable income
(less section 511 taxes) from businesses
acquired after June 30, 1975
Schedule A (Form 990 or 990-EZ) 2020Page
(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.)
20162017201820192020Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.")
~~
Gross receipts from admissions,
merchandise sold or services per-
formed, or facilities furnished in
any activity that is related to the
organization's tax-exempt purpose
Gross receipts from activities that
are not an unrelated trade or bus-
iness under section 513
~~~~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf
~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge
~
~~~
Add lines 1 through 5
Amounts included on lines 1, 2, and
3 received from disqualified persons
~~~~~~
Add lines 7a and 7b~~~~~~~
20162017201820192020Total
Amounts from line 6~~~~~~~
Gross income from interest,
dividends, payments received on
securities loans, rents, royalties,
and income from similar sources~
~~~~
Add lines 10a and 10b~~~~~~
Net income from unrelated business
activities not included in line 10b,
whether or not the business is
regularly carried on
~~~~~~~
Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part VI.)
~~~~
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
|
Public support percentage for 2020 (line 8, column (f), divided by line 13, column (f))
Public support percentage from 2019 Schedule A, Part III, line 15
~~~~~~~~~~~%
%
Investment income percentage for (line 10c, column (f), divided by line 13, column (f))
Investment income percentage from Schedule A, Part III, line 17
~~~~~~~~%
% ~~~~~~~~~~~~~~~~~~
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 The organization qualifies as a publicly supported organization~~~~~~~~~~|
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 The organization qualifies as a publicly supported organization~~~~|
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions|
Part IIISupport Schedule for Organizations Described in Section 509(a)(2)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
Section D. Computation of Investment Income Percentage
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
17
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032024 01-25-21
4
YesNo
1
2
3
4
5
6
7
8
9
10
Part VI
1
2
3a
3b
3c
4a
4b
4c
5a
5b
5c
6
7
8
9a
9b
9c
10a
10b
Part VI
a
b
c
a
b
c
a
b
c
a
b
c
a
b
Part VI
Part VI
Part VI
Part VI
Part VI,
Type I or Type II only.
Substitutions only.
Part VI.
Part VI.
Part VI.
Part VI.
Schedule A (Form 990 or 990-EZ) 2020
If "No," describe in how the supported organizations are designated. If designated by
class or purpose, describe the designation. If historic and continuing relationship, explain.
If "Yes," explain in how the organization determined that the supported
organization was described in section 509(a)(1) or (2).
If "Yes," answer
lines 3b and 3c below.
If "Yes," describe in when and how the
organization made the determination.
If "Yes," explain in what controls the organization put in place to ensure such use.
If
"Yes," and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
If "Yes," describe in how the organization had such control and discretion
despite being controlled or supervised by or in connection with its supported organizations.
If "Yes," explain in 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.
If "Yes,"
answer lines 5b and 5c below (if applicable). Also, provide detail in 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).
If "Yes," provide detail in
If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ).
If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ).
If "Yes," provide detail in
If "Yes," provide detail in
If "Yes," provide detail in
If "Yes," answer line 10b below.
(Use Schedule C, Form 4720, to
determine whether the organization had excess business holdings.)
Schedule A (Form 990 or 990-EZ) 2020Page
(Complete only if you checked a box in line 12 on Part I. If you checked box 12a, Part I, complete Sections A
and B. If you checked box 12b, Part I, complete Sections A and C. If you checked box 12c, Part I, complete
Sections A, D, and E. If you checked box 12d, Part I, complete Sections A and D, and complete Part V.)
Are all of the organization's supported organizations listed by name in the organization's governing
documents?
Did the organization have any supported organization that does not have an IRS determination of status
under section 509(a)(1) or (2)?
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)?
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)?
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B)
purposes?
Was any supported organization not organized in the United States ("foreign supported organization")?
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign
supported organization?
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)?
Did the organization add, substitute, or remove any supported organizations during the tax year?
Was any added or substituted supported organization part of a class already
designated in the organization's organizing document?
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?
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor
(as 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?
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7?
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))?
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?
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?
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)?
Did the organization have any excess business holdings in the tax year?
Part IV
Supporting Organizations
Section A. All Supporting Organizations
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
18
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032025 01-25-21
5
YesNo
11
a
b
c
11a
11b
11c Part VI.
YesNo
1
2
Part VI
1
2
Part VI
YesNo
1
Part VI
1
YesNo
1
2
3
1
2
3
Part VI
Part VI
1
2
3
(see instructions).
a
b
c
line 2
line 3
Part VI
Answer lines 2a and 2b below.YesNo
a
b
a
b
Part VI identify
those supported organizations and explain
2a
2b
3a
3b
Part VI
Answer lines 3a and 3b below.
Part VI.
Part VI
Schedule A (Form 990 or 990-EZ) 2020
If "Yes" to line 11a, 11b, or 11c, provide
detail in
If "No," describe in 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 officers, directors, or trustees were allocated among the
supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
If "Yes," explain in
how providing such benefit carried out the purposes of the supported organization(s) that operated,
supervised, or controlled the supporting organization.
If "No," describe inhow control
or management of the supporting organization was vested in the same persons that controlled or managed
the supported organization(s).
If "No," explain in how
the organization maintained a close and continuous working relationship with the supported organization(s).
If "Yes," describe in the role the organization's
supported organizations played in this regard.
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year
Complete below.
Completebelow.
Describe in how you supported a governmental entity (see instructions).
If "Yes," then in
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.
If "Yes," explain in
the reasons for the organization's position that its supported organization(s) would have engaged in
these activities but for the organization's involvement.
If "Yes" or "No" provide details in
If "Yes," describe inthe role played by the organization in this regard.
Schedule A (Form 990 or 990-EZ) 2020Page
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 lines 11b and
11c below, the governing body of a supported organization?
A family member of a person described in line 11a above?
A 35% controlled entity of a person described in line 11a or 11b above?
Did the governing body, members of the governing body, officers acting in their official capacity, or membership of one or
more supported organizations have the power to regularly appoint or elect at least a majority of the organization's officers,
directors, or trustees at all times 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?
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)?
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?
By reason of the relationship described in line 2, above, 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?
The organization satisfied the Activities Test.
The organization is the parent of each of its supported organizations.
The organization supported a governmental entity.
Activities Test.
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?
Did the activities described in line 2a, above, constitute activities that, but for the organization's involvement,
one or more of the organization's supported organization(s) would have been engaged in?
Parent of Supported Organizations.
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?
Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each
of its supported organizations?
(continued)
Part IVSupporting Organizations
Section B. Type I Supporting Organizations
Section C. Type II Supporting Organizations
Section D. All Type III Supporting Organizations
Section E. Type III Functionally Integrated Supporting Organizations
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1Part VISee instructions.
Section A - Adjusted Net Income
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8 Adjusted Net Income
Section B - Minimum Asset Amount
1
2
3
4
5
6
7
8
a
b
c
d
e
1a
1b
1c
1d
2
3
4
5
6
7
8
Total
Discount
Part VI
Minimum Asset Amount
Section C - Distributable Amount
1
2
3
4
5
6
7
1
2
3
4
5
6
Distributable Amount.
Schedule A (Form 990 or 990-EZ) 2020
explain in
explain in detail in
Schedule A (Form 990 or 990-EZ) 2020Page
Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 ().
All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
(B) Current Year
(optional)
(A) Prior Year
Net short-term capital gain
Recoveries of prior-year distributions
Other gross income (see instructions)
Add lines 1 through 3.
Depreciation and depletion
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)
Other expenses (see instructions)
(subtract lines 5, 6, and 7 from line 4)
(B) Current Year
(optional)
(A) Prior Year
Aggregate fair market value of all non-exempt-use assets (see
instructions for short tax year or assets held for part of year):
Average monthly value of securities
Average monthly cash balances
Fair market value of other non-exempt-use assets
(add lines 1a, 1b, and 1c)
claimed for blockage or other factors
( ):
Acquisition indebtedness applicable to non-exempt-use assets
Subtract line 2 from line 1d.
Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount,
see instructions).
Net value of non-exempt-use assets (subtract line 4 from line 3)
Multiply line 5 by 0.035.
Recoveries of prior-year distributions
(add line 7 to line 6)
Current Year
Adjusted net income for prior year (from Section A, line 8, column A)
Enter 0.85 of line 1.
Minimum asset amount for prior year (from Section B, line 8, column A)
Enter greater of line 2 or line 3.
Income tax imposed in prior year
Subtract line 5 from line 4, unless subject to
emergency temporary reduction (see instructions).
Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see
instructions).
Part VType III Non-Functionally Integrated 509(a)(3) Supporting Organizations
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Section D - DistributionsCurrent Year
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Part VI
Part VI
Total annual distributions.
Part VI
(i)
Excess Distributions
(ii)
Underdistributions
Pre-2020
(iii)
Distributable
Amount for 2020
Section E - Distribution Allocations
1
2
3
4
5
6
7
8
Part VI
a
b
c
d
e
f
g
h
i
j
Total
a
b
c
Part VI.
Part VI
Excess distributions carryover to 2021.
a
b
c
d
e
Schedule A (Form 990 or 990-EZ) 2020
provide details in
describe in
provide details in
explain in
explain in
explain in
Schedule A (Form 990 or 990-EZ) 2020Page
Amounts paid to supported organizations to accomplish exempt purposes
Amounts paid to perform activity that directly furthers exempt purposes of supported
organizations, in excess of income from activity
Administrative expenses paid to accomplish exempt purposes of supported organizations
Amounts paid to acquire exempt-use assets
Qualified set-aside amounts (prior IRS approval required - )
Other distributions ( ). See instructions.
Add lines 1 through 6.
Distributions to attentive supported organizations to which the organization is responsive
( ). See instructions.
Distributable amount for 2020 from Section C, line 6
Line 8 amount divided by line 9 amount
(see instructions)
Distributable amount for 2020 from Section C, line 6
Underdistributions, if any, for years prior to 2020 (reason-
able cause required - ). See instructions.
Excess distributions carryover, if any, to 2020
From 2015
From 2016
From 2017
From 2018
From 2019
of lines 3a through 3e
Applied to underdistributions of prior years
Applied to 2020 distributable amount
Carryover from 2015 not applied (see instructions)
Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
Distributions for 2020 from Section D,
line 7:$
Applied to underdistributions of prior years
Applied to 2020 distributable amount
Remainder. Subtract lines 4a and 4b from line 4.
Remaining underdistributions for years prior to 2020, if
any. Subtract lines 3g and 4a from line 2. For result greater
than zero, See instructions.
Remaining underdistributions for 2020. Subtract lines 3h
and 4b from line 1. For result greater than zero,
. See instructions.
Add lines 3j
and 4c.
Breakdown of line 7:
Excess from 2016
Excess from 2017
Excess from 2018
Excess from 2019
Excess from 2020
(continued)
Part VType III Non-Functionally Integrated 509(a)(3) Supporting Organizations
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Schedule A (Form 990 or 990-EZ) 2020
Schedule A (Form 990 or 990-EZ) 2020Page
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.)
Part VI
Supplemental Information.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
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Department of the Treasury
Internal Revenue Service
023451 11-25-20
For Paperwork Reduction Act Notice, see the instructions for Form 990, 990-EZ, or 990-PF.Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
OMB No. 1545-0047
(Form 990, 990-EZ,
or 990-PF)
| Attach to Form 990, Form 990-EZ, or Form 990-PF.
| Go to www.irs.gov/Form990 for the latest information.
Employer identification number
Organization type
Filers of:Section:
not
General Rule Special Rule.
Note:
General Rule
Special Rules
(1) (2)
General Rule
Caution:
must
exclusively
exclusively
nonexclusively
Name of the organization
(check one):
Form 990 or 990-EZ501(c)() (enter number) organization
4947(a)(1) nonexempt charitable trust treated as a private foundation
527 political organization
Form 990-PF501(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 or a
Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
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
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.
For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33 1/3% 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 $5,000; or 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 (entering
"N/A" in column (b) instead of the contributor name and address), 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 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 religious, charitable, etc.,
purpose. Don't complete any of the parts unless the applies to this organization because it received
religious, charitable, etc., contributions totaling $5,000 or more during the year~~~~~~~~~~~~~~~|$
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 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 990-PF, Part I, line 2, to
certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA
Schedule B
Schedule of Contributors
2020
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
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X
** PUBLIC DISCLOSURE COPY **
023452 11-25-20
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
2
Part IContributors
1X
2,461,464.
2X
200,000.
3X
59,166.
4X
50,000.
5X
20,317.
6X
19,250.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
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023452 11-25-20
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
2
Part IContributors
7X
19,000.
8X
17,019.
9X
16,200.
10X
16,000.
11X
15,000.
12X
12,725.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
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023452 11-25-20
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
2
Part IContributors
13X
11,500.
14X
11,000.
15X
10,392.
16X
10,100.
17X
10,000.
18X
10,000.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
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Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
2
Part IContributors
19X
10,000.
20X
10,000.
21X
9,393.
22X
8,491.
23X
7,668.
24X
7,500.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
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023452 11-25-20
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
2
Part IContributors
25X
7,500.
26X
7,288.
27X
7,092.
28X
7,007.
29X
6,195.
30X
5,760.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
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Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
2
Part IContributors
31X
5,600.
32X
5,463.
33X
5,428.
34X
5,148.
35X
5,000.
36X
5,000.
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Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
2
Part IContributors
37X
5,000.
38X
5,000.
39X
5,000.
40X
5,000.
41X
5,000.
42X
5,000.
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Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
$
(Complete Part II for
noncash contributions.)
2
Part IContributors
43X
5,000.
44X
5,000.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
31
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
023453 11-25-20
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Employer identification number
(a)
No.
from
Part I
(c)
FMV (or estimate)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(b)
Description of noncash property given
(d)
Date received
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
(see instructions). Use duplicate copies of Part II if additional space is needed.
(See instructions.)
$
(See instructions.)
$
(See instructions.)
$
(See instructions.)
$
(See instructions.)
$
(See instructions.)
$
3
Part IINoncash Property
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
32
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
(Enter this info. once.)
completing Part III, enter the total of exclusively religious,charitable, etc., contributions of for the year.
023454 11-25-20
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.(a)(e) and
$1,000 or less
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Complete columns through the following line entry. For organizations
Employer identification number
(a) No.
from
Part I
(b) Purpose of gift(c) Use of gift(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4Relationship of transferor to transferee
(a) No.
from
Part I
(b) Purpose of gift(c) Use of gift(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4Relationship of transferor to transferee
(a) No.
from
Part I
(b) Purpose of gift(c) Use of gift(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4Relationship of transferor to transferee
(a) No.
from
Part I
(b) Purpose of gift(c) Use of gift(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4Relationship of transferor to transferee
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)Page
Name of organization
| $
Use duplicate copies of Part III if additional space is needed.
4
Part III
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
33
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}
MARY WASHINGTON HEALTHCARE GROUP RETURN 20-1106426
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
STATEMENT 1 FORM 990 LINE H(B) - LIST OF AFFILIATED
ORGANIZATIONS INCLUDED IN GROUP RETURN
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
NAME OF ORGANIZATION ORGANIZATION'S ADDRESS EMPLOYER ID
}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}
STAFFORD HOSPITAL, LLC2300 FALL HILL AVE, SUITE 509
- FREDERICKSBURG, VA 22401
13-4316364
MARY WASHINGTON HEALTHCARE
PHYSICIANS
2300 FALL HILL AVE, SUITE 509
- FREDERICKSBURG, VA 22401
26-2546097
MARY WASHINGTON HOSPITAL
FOUNDATION
2300 FALL HILL AVE, SUITE 509
- FREDERICKSBURG, VA 22401
52-1342371
MEDICORP PROPERTIES INC.2300 FALL HILL AVE, SUITE 509
- FREDERICKSBURG, VA 22401
52-1342372
MARY WASHINGTON HOSPITAL INC.2300 FALL HILL AVE, SUITE 509
- FREDERICKSBURG, VA 22401
54-0519577
MARY WASHINGTON HEALTHCARE
CLINICAL SERVICES, INC.
2300 FALL HILL AVE, SUITE 509
- FREDERICKSBURG, VA 22401
54-1552324
STAFFORD HOSPITAL FOUNDATION,
INC.
2300 FALL HILL AVE, SUITE 509
- FREDERICKSBURG, VA 22401
64-0963570
STATEMENT(S) 1
34
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
032051 12-01-20
Held at the End of the Tax Year
(Form 990)| 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.
| Attach to Form 990.
|Go to www.irs.gov/Form990 for instructions and the latest information.
Open to Public
Inspection
Name of the organizationEmployer identification number
(a) (b)
1
2
3
4
5
6
YesNo
YesNo
1
2
3
4
5
6
7
8
9
a
b
c
d
2a
2b
2c
2d
YesNo
YesNo
1
2
a
b
(i)
(ii)
a
b
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule D (Form 990) 2020
Complete if the
organization answered "Yes" on Form 990, Part IV, line 6.
Donor advised fundsFunds and other accounts
Total number at end of year
Aggregate value of contributions to (during year)
Aggregate value of grants from (during year)
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?~~~~~~~~~~~~~~~~~~
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?
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 (for example, recreation or education)
Protection of natural habitat
Preservation of open space
Preservation of a historically important land area
Preservation of a certified historic structure
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.
Total number of conservation easements
Total acreage restricted by conservation easements
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Number of conservation easements on a certified historic structure included in (a)
Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure
listed in the National Register
~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year |
Number of states where property subject to conservation easement is located |
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds?~~~~~~~~~~~~~~~~~~~~~~~~~
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
|
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
|$
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)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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.
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:
Revenue included on Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~|$
$ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|
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
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|$
$ |
LHA
Part IOrganizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Part IIConservation Easements.
Part IIIOrganizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
SCHEDULE D
Supplemental Financial Statements
2020
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
35
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032052 12-01-20
3
4
5
a
b
c
d
e
YesNo
1
2
a
b
c
d
e
f
a
b
YesNo
1c
1d
1e
1f
YesNo
(a) (b) (c) (d) (e)
1
2
3
4
a
b
c
d
e
f
g
a
b
c
a
b
YesNo
(i)
(ii)
3a(i)
3a(ii)
3b
(a) (b) (c) (d)
1a
b
c
d
e
Total.
Schedule D (Form 990) 2020
(continued)
(Column (d) must equal Form 990, Part X, column (B), line 10c.)
Two years backThree years backFour years back
Schedule D (Form 990) 2020Page
Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its
collection items (check all that apply):
Public exhibition
Scholarly research
Preservation for future generations
Loan or exchange program
Other
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?
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?
If "Yes," explain the arrangement in Part XIII and complete the following table:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amount
Beginning balance
Additions during the year
Distributions during the year
Ending balance
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided on Part XIII
~~~~~
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
Current yearPrior year
Beginning of year balance
Contributions
Net investment earnings, gains, and losses
Grants or scholarships
~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~
Other expenditures for facilities
and programs
Administrative expenses
End of year balance
~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
Board designated or quasi-endowment
Permanent endowment
Term endowment
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:
Unrelated organizations
Related organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" on line 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.
~~~~~~~~~~~~~~~~~~~~
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of propertyCost or other
basis (investment)
Cost or other
basis (other)
Accumulated
depreciation
Book value
Land
Buildings
Leasehold improvements
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Equipment
Other
~~~~~~~~~~~~~~~~~
Add lines 1a through 1e. |
2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets
Part IV
Escrow and Custodial Arrangements.
Part VEndowment Funds.
Part VILand, Buildings, and Equipment.
6,199,920.
247,772.
1,407,372.
29,581.
7,825,483.
.0000
100
.0000
X
X
28,899,231.
347,864,114.
20,452,182.
290,868,020.
67,558,896.
180,838,845.
16,003,450.
241,508,543.
25,525,165.
28,899,231.
167,025,269.
4,448,732.
49,359,477.
42,033,731.
291,766,440.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
6,017,627.
218,934.
36,641.
6,199,920.
4,752,228.
1,269,839.
45,316.
49,757.
6,017,626.
1,258,210.
52,539.
40,909.
1,269,840.
1,258,210.
44,259.
44,259.
1,258,210.
36
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
(including name of security)
032053 12-01-20
Total.
Total.
(a) (b) (c)
(1)
(2)
(3)
(a) (b) (c)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(a) (b)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total.
(a) (b)
1.
Total.
2.
Schedule D (Form 990) 2020
(Column (b) must equal Form 990, Part X, col. (B) line 15.)
(Column (b) must equal Form 990, Part X, col. (B) line 25.)
Description of security or category
(Col. (b) must equal Form 990, Part X, col. (B) line 12.) |
(Col. (b) must equal Form 990, Part X, col. (B) line 13.) |
Schedule D (Form 990) 2020Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
Book valueMethod of valuation: Cost or end-of-year market value
Financial derivatives
Closely held equity interests
Other
~~~~~~~~~~~~~~~
~~~~~~~~~~~
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Complete if the organization answered "Yes" on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
Description of investmentBook valueMethod of valuation: Cost or end-of-year market value
Complete if the organization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
DescriptionBook value
|
Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
Description of liabilityBook value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Federal income taxes
|
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 FASB ASC 740. Check here if the text of the footnote has been provided in Part XIII
3
Part VIIInvestments - Other Securities.
Part VIII
Investments - Program Related.
Part IXOther Assets.
Part XOther Liabilities.
MARY WASHINGTON HEALTHCARE GROUP RETURN
ACCRUED LOSS-PROFESSIONAL
LIABILIES
CAPITAL LEASE OBLIGATIONS
20-1106426
3,625,875.
27,931,121.
31,556,996.
X
37
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032054 12-01-20
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d2e
3 2e 1
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d
2e 1
2e
3
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
Schedule D (Form 990) 2020
(This must equal Form 990, Part I, line 12.)
(This must equal Form 990, Part I, line 18.)
Schedule D (Form 990) 2020Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.
Total revenue, gains, and other support per audited financial statements
Amounts included on line 1 but not on Form 990, Part VIII, line 12:
~~~~~~~~~~~~~~~~~~~
Net unrealized gains (losses) on investments
Donated services and use of facilities
Recoveries of prior year grants
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part VIII, line 12, but not on line 1:
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total revenue. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.
Total expenses and losses per audited financial statements
Amounts included on line 1 but not on Form 990, Part IX, line 25:
~~~~~~~~~~~~~~~~~~~~~~~~~~
Donated services and use of facilities
Prior year adjustments
Other losses
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through
Subtract line from line
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part IX, line 25, but not on line 1:
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total expenses. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, 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.
4
Part XIReconciliation of Revenue per Audited Financial Statements With Revenue per Return.
Part XIIReconciliation of Expenses per Audited Financial Statements With Expenses per Return.
Part XIIISupplemental Information.
THE INTEREST EARNED FROM THE ENDOWMENT FUNDS IS USED TO FUND SCHOLARSHIPS
AND GRANTS IN FUTHERANCE OF OUR MISSION.
PART X, LINE 2:
MWHC WAS RECOGNIZED AS A PUBLIC CHARITY GENERALLY EXEMPT FROM FEDERAL
INCOME TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO A
DETERMINATION LETTER ISSUED BY THE IRS IN MARCH 1992. MWHC IS ENTITLED TO
PART V, LINE 4:
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
RELY ON THIS DETERMINATION AS LONG AS THERE ARE NO SUBSTANTIAL CHANGES IN
ITS CHARACTER, PURPOSES, OR METHODS OF OPERATION. MANAGEMENT HAS CONCLUDED
THAT THERE HAVE BEEN NO SUCH CHANGES AND, THEREFORE, MWHC'S STATUS AS A
PUBLIC CHARITY EXEMPT FROM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE
38
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032055 12-01-20
5
Schedule D (Form 990) 2020
(continued)
Schedule D (Form 990) 2020Page
Part XIII
Supplemental Information
STATE IN WHICH MWHC OPERATES ALSO PROVIDES GENERAL EXEMPTION FROM STATE
INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME
TAXATION.
HOWEVER, MWHC IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT
CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER
STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAXES, IS SEPARATELY
DETERMINED. CERTAIN ENTITIES UNDER MWHC ARE TAXABLE ENTITIES.
MWHC HAD NO UNRECOGNIZED TAX BENEFITS OR LIABILITIES, OR SUCH AMOUNTS WERE
IMMATERIAL DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO
WHICH NO UNRELATED BUSINESS INCOME WAS RECOGNIZED, NO TAX RETURN WAS
REQUIRED. TAX PERIODS FOR WHICH NO RETURN IS FILED REMAIN OPEN FOR
EXAMINATION INDEFINITELY. GENERALLY, TAX RETURNS FOR THE YEARS
ENDED DECEMBER 31, 2017, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY
FEDERAL AND STATE TAX AUTHORITIES. ALL REQUIRED TAX FILINGS HAVE BEEN
FILED ON A TIMELY BASIS.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
39
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
Did
fundraiser
have custody
or control of
contributions?
032081 11-25-20
Go to
(Form 990 or 990-EZ)Complete if the organization answered "Yes" on Form 990, Part IV, line 17, 18, or 19, or if the
organization entered more than $15,000 on Form 990-EZ, line 6a.
Open to Public
Inspection
| Attach to Form 990 or Form 990-EZ.
| www.irs.gov/Form990 for instructions and the latest information.
Employer identification number
1
a
b
c
d
a
b
e
f
g
2
YesNo
(i)
(ii)
(iii)
(iv)
(v)
(i)
(vi)
YesNo
Total
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule G (Form 990 or 990-EZ) 2020
Name of the organization
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.
Mail solicitations
Internet and email solicitations
Phone solicitations
In-person solicitations
Solicitation of non-government grants
Solicitation of government grants
Special fundraising events
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?
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.
Name and address of individual
or entity (fundraiser)
Activity
Gross receipts
from activity
Amount paid
to (or retained by)
fundraiser
listed in col.
Amount paid
to (or retained by)
organization
|
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.
LHA
Supplemental Information Regarding Fundraising or Gaming Activities
SCHEDULE G
Part IFundraising Activities.
2020
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
40
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032082 11-25-20
2
(d)
(a)
(c)
(a) (b) (c)
1
2
3
4
5
6
7
8
9
10
11
(a)
(b)
(c)
(d)
(a) (c)
1
2
3
4
5
6
7
8
YesYesYes
NoNoNo
9
10
a
b
YesNo
a
b
YesNo
Schedule G (Form 990 or 990-EZ) 2020
Pull tabs/instant
bingo/progressive bingo
Schedule G (Form 990 or 990-EZ) 2020Page
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.
Total events
(add col. through
col. )
Revenue
Event #1Event #2Other events
(event type)(event type)(total number)
Gross receipts
Less: Contributions
~~~~~~~~~~~~~~
~~~~~~~~~~~
Gross income (line 1 minus line 2)
Direct Expenses
Cash prizes
Noncash prizes
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Rent/facility costs
~~~~~~~~~~~~
Food and beverages
Entertainment
~~~~~~~~~~
~~~~~~~~~~~~~~
Other direct expenses~~~~~~~~~~
Direct expense summary. Add lines 4 through 9 in column (d)
Net income summary. Subtract line 10 from line 3, column (d)
~~~~~~~~~~~~~~~~~~~~~~~~|
|
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.
Revenue
BingoOther gaming
Total gaming (add
col. through col. )
Direct Expenses
Gross revenue
Cash prizes
Noncash prizes
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Rent/facility costs
Other direct expenses
~~~~~~~~~~~~
%%%
Volunteer labor
~~~~~~~~~~~~~
Direct expense summary. Add lines 2 through 5 in column (d)
Net gaming income summary. Subtract line 7 from line 1, column (d)
~~~~~~~~~~~~~~~~~~~~~~~~|
|
Enter the state(s) in which the organization conducts gaming activities:
Is the organization licensed to conduct gaming activities in each of these states?
If "No," explain:
~~~~~~~~~~~~~~~~~~~~
Were any of the organization's gaming licenses revoked, suspended, or terminated during the tax year?
If "Yes," explain:
~~~~~~~~~
Part IIFundraising Events.
Part IIIGaming.
120,983.
115,583.
5,400.
60,001.
60,001.
59,826.
59,527.
299.
299.
500.
240,810.
235,111.
5,699.
299.
500.
12,134.
-6,435.
HOSPITAL CUP
STAFFORD
OPEN
MWHF GOLF
4
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
4,555.25.6,755.11,335.
41
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032083 11-25-20
3
11
12
13
14
15
YesNo
YesNo
a
b
13a
13b
YesNo
a
b
c
16
17
a
b
YesNo
Schedule G (Form 990 or 990-EZ) 2020
Schedule G (Form 990 or 990-EZ) 2020Page
Does the organization conduct gaming activities with nonmembers?
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?
~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Indicate the percentage of gaming activity conducted in:
The organization's facility
An outside facility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~%
% ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name |
Address|
Does the organization have a contract with a third party from whom the organization receives gaming revenue?
If "Yes," enter the amount of gaming revenue received by the organization |
~~~~~~
$and the amount
of gaming revenue retained by the third party | $
If "Yes," enter name and address of the third party:
Name |
Address |
Gaming manager information:
Name |
Gaming manager compensation |
Description of services provided |
$
Director/officerEmployeeIndependent contractor
Mandatory distributions:
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the
organization's own exempt activities during the tax year |$
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.
Part IVSupplemental Information.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
42
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032084 04-01-20
4
Schedule G (Form 990 or 990-EZ)
(continued)
Schedule G (Form 990 or 990-EZ)Page
Part IV
Supplemental Information
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
43
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
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.
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'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"?
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
Number of
activities or
programs (optional)
Persons
served
(optional)
Total community
benefit expense
Direct offsetting
revenue
Net community
benefit expense
Percent
of total
expense
Financial Assistance and
Means-Tested Government Programs
032091 12-02-20
Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
Open to Public
Inspection
Attach to Form 990.
| Go to www.irs.gov/Form990 for instructions and the latest information.
Name of the organizationEmployer identification number
YesNo
1
2
3
a
b
1a
1b
3a
3b
4
5a
5b
5c
6a
6b
a
b
c
4
5
6
7
a
b
c
a
b
(a) (b) (c) (d) (e) (f)
Financial Assistance and
Means-Tested Government Programs
a
b
c
d
Total.
Other Benefits
e
f
g
h
i
j
k
Total.
Total.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule H (Form 990) 2020
free
discounted
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year?
|
|
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a
If "Yes," was it a written policy?
~~~~~~~~~~~
Applied uniformly to all hospital facilities
Generally tailored to individual hospital facilities
Applied uniformly to most hospital facilities
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:~~~~~~~~~~~~~
100%150%200%Other%
Did the organization use FPG as a factor in determining eligibility for providing care? If "Yes," indicate which
of the following was the family income limit for eligibility for discounted care:~~~~~~~~~~~~~~~~~~~~~~~~
200%250%300%350%400%Other%
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.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligible for free or discounted care?
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization prepare a community benefit report during the tax year?
If "Yes," did the organization make it available to the public?
~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance at cost (from
Worksheet 1)
Medicaid (from Worksheet 3,
column a)
~~~~~~~~~~
~~~~~~~~~~~
Costs of other means-tested
government programs (from
Worksheet 3, column b)
~~~~~
Community health
improvement services and
community benefit operations
(from Worksheet 4)~~~~~~~
Health professions education
(from Worksheet 5)~~~~~~~
Subsidized health services
(from Worksheet 6)~~~~~~~
Research (from Worksheet 7)
Cash and in-kind contributions
for community benefit (from
Worksheet 8)
~~
~~~~~~~~~
Other Benefits
Add lines 7d and 7j
~~~~~~
LHA
SCHEDULE H
(Form 990)
Part IFinancial Assistance and Certain Other Community Benefits at Cost
Hospitals
2020
20-1106426
X
X
X
X
X
X
X
X
X
X
X
X
14872058.
14872058.
1116959.
1195051.
95765140.
468,941.
1662823.
100208914
115080972
63710848.
66,556.
63777404.
63777404.
14872058.
14872058.
1116959.
1195051.
32054292.
402,385.
1662823.
36431510.
51303568.
2.11%
2.11%
.16%
.17%
4.55%
.06%
.24%
5.18%
7.29%
500
MARY WASHINGTON HEALTHCARE GROUP RETURN
44
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Number of
activities or programs
(optional)
Persons
served (optional)
Total
community
building expense
Direct
offsetting revenue
Net
community
building expense
Percent of
total expense
(owned 10% or more by officers, directors, trustees, key employees, and physicians - see instructions)
032092 12-02-20
2
(a)
(b)
(c)
(d) (e) (f)
1
2
3
4
5
6
7
8
9
10Total
YesNo
Section A. Bad Debt Expense
1
2
3
4
1
2
3
Section B. Medicare
5
6
7
8
5
6
7
Section C. Collection Practices
9a
b
9a
9b
(a) (b) (c) (d) (e)
Schedule H (Form 990) 2020
Physical improvements and housing
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
Schedule H (Form 990) 2020Page
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.
Economic development
Community support
Environmental improvements
Leadership development and
training for community members
Coalition building
Community health improvement
advocacy
Workforce development
Other
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association
Statement No. 15?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount of the organization's bad debt expense. Explain in Part VI the
methodology used by the organization to estimate this amount
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
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
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.
Enter total revenue received from Medicare (including DSH and IME)
Enter Medicare allowable costs of care relating to payments on line 5
Subtract line 6 from line 5. This is the surplus (or shortfall)
~~~~~~~~~~~~
~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Describe in Part VI the extent to which any shortfall reported on 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 systemCost to charge ratioOther
Did the organization have a written debt collection policy during the tax year?~~~~~~~~~~~~~~~~~~~~~~~
Name of entityDescription of primary
activity of entity
Organization's
profit % or stock
ownership %
Officers, direct-
ors, trustees, or
key employees'
profit % or stock
ownership %
Physicians'
profit % or
stock
ownership %
Part IICommunity Building Activities
Part IIIBad Debt, Medicare, & Collection Practices
Part IVManagement Companies and Joint Ventures
0.
856,633.
856,633.
856,633.
856,633.
.12%
.12%
X
12,682,135.
3,170,534.
211,550,783.
242,506,239.
-30,955,456.
51.00%
55.13%
12.50%
39.50%
60.00%
49.00%
44.87%
37.50%
47.40%
40.00%
1 MEDICAL IMAGING OF
FREDERICKSBURG
2 FREDERICKSBURG
AMBULATORY SURGERY
CENTER
3 COWAN INVESTMENT
PARTNERS
4 MEDICAL PLAZA AT
COSNER CORNER
5 FREDERICKSBURG
ENDOSCOPY CENTER
HOLDINGS, LLC
OUTPATIENT IMAGING
AMBULATORY SERGICAL
SERVICES
MEDICAL OFFICE BUILDING
MEDICAL OFFICE BUILDING
OUTPATIENT ENDOSCOPY
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
45
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Facility
reporting
group
032093 12-02-20
3
Section A. Hospital Facilities
Schedule H (Form 990) 2020
Gen. medical & surgical
Schedule H (Form 990) 2020Page
(list in order of size, from largest to smallest)
How many hospital facilities did the organization operate
during the tax year?
Name, 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)
Licensed hospital
Children's hospital
Teaching hospital
Critical access hospital
Research facility
ER-24 hours
ER-other
Other (describe)
Part VFacility Information
1 MARY WASHINGTON HOSPITAL, INC.
2 STAFFORD HOSPITAL, LLC
1101 SAM PERRY BLVD
101 HOSPITAL CENTER BLVD
FREDERICKSBURG, VA 22401
STAFFORD, VA 22554
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
TRAUMA
100 BED HOSPITAL
X
X
X
X
471 BED ACUTE CARE
HOSPITAL LEVEL 2
X
X
2
46
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032094 12-02-20
4
Section B. Facility Policies and Practices
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):
YesNo
Community Health Needs Assessment
1
2
3
1
2
3
a
b
c
d
e
f
g
h
i
j
4
5
6
7
5
6a
6b
7
a
b
a
b
c
d
8
9
10
11
12
8
10
10b
a
b
a
b
c
12a
12b
$
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
(complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the hospital facility's CHNA conducted with one or more other hospital facilities? If "Yes," list the other
hospital facilities in Section C~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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?
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):
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~~~~~~~~~~~~~~~~~~~~~~~~
Indicate the tax year the hospital facility last adopted an implementation strategy:20
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?~~~~~~~~~~~
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.
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)?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?~~~~~~~~~~~~~~~~
If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720
for all of its hospital facilities?
Part VFacility Information
X
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
X
19
X
X
X
X
X
X
19
X
X
MARY WASHINGTON HOSPITAL, INC.
X
HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/
X
X
X
X
1
47
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032095 12-02-20
5
Financial Assistance Policy (FAP)
Name of hospital facility or letter of facility reporting group
YesNo
1313
a
b
c
d
e
f
g
h
14
15
14
15
a
b
c
d
e
1616
a
b
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020Page
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?
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
and FPG family income limit for eligibility for discounted care of
Income level other than FPG (describe in Section C)
Asset level
Medical indigency
Insurance status
%
%
Underinsurance status
Residency
Other (describe in Section C)
Explained the basis for calculating amounts charged to patients?
Explained the method for applying for financial assistance?
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?
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
~~~~~~~~~~~~~~~~~~~~~~~~
The FAP was widely available on a website (list url):
The FAP application form was widely available on a website (list url):
A plain language summary of the FAP was widely available on a website (list url):
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 Limited English Proficiency (LEP) populations
Other (describe in Section C)
(continued)
Part VFacility Information
MARY WASHINGTON HOSPITAL, INC.
500
X
X
SEE PART V, PAGE 8
SEE PART V, PAGE 8
X
X
X
X
X
X
X
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
X
X
SEE PART V, PAGE 8
X
200
X
X
48
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032096 12-02-20
6
Billing and Collections
Name of hospital facility or letter of facility reporting group
YesNo
17
18
19
17
19
a
b
c
d
e
f
a
b
c
d
e
20
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21
21
a
b
c
d
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
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?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
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?~~~~~~~~~~~~~~~
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)
Part VFacility Information
X
MARY WASHINGTON HOSPITAL, INC.
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
49
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032097 12-02-20
7
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Name of hospital facility or letter of facility reporting group
YesNo
22
a
b
c
d
23
24
23
24
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
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.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Part VFacility Information
X
MARY WASHINGTON HOSPITAL, INC.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
X
50
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032094 12-02-20
4
Section B. Facility Policies and Practices
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):
YesNo
Community Health Needs Assessment
1
2
3
1
2
3
a
b
c
d
e
f
g
h
i
j
4
5
6
7
5
6a
6b
7
a
b
a
b
c
d
8
9
10
11
12
8
10
10b
a
b
a
b
c
12a
12b
$
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
(complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the hospital facility's CHNA conducted with one or more other hospital facilities? If "Yes," list the other
hospital facilities in Section C~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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?
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):
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~~~~~~~~~~~~~~~~~~~~~~~~
Indicate the tax year the hospital facility last adopted an implementation strategy:20
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?~~~~~~~~~~~
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.
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)?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?~~~~~~~~~~~~~~~~
If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720
for all of its hospital facilities?
Part VFacility Information
X
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
X
19
X
X
X
X
X
X
19
X
X
STAFFORD HOSPITAL, LLC
X
HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/
X
X
X
X
2
51
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5
Financial Assistance Policy (FAP)
Name of hospital facility or letter of facility reporting group
YesNo
1313
a
b
c
d
e
f
g
h
14
15
14
15
a
b
c
d
e
1616
a
b
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020Page
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?
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
and FPG family income limit for eligibility for discounted care of
Income level other than FPG (describe in Section C)
Asset level
Medical indigency
Insurance status
%
%
Underinsurance status
Residency
Other (describe in Section C)
Explained the basis for calculating amounts charged to patients?
Explained the method for applying for financial assistance?
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?
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
~~~~~~~~~~~~~~~~~~~~~~~~
The FAP was widely available on a website (list url):
The FAP application form was widely available on a website (list url):
A plain language summary of the FAP was widely available on a website (list url):
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 Limited English Proficiency (LEP) populations
Other (describe in Section C)
(continued)
Part VFacility Information
STAFFORD HOSPITAL, LLC
500
X
X
SEE PART V, PAGE 8
SEE PART V, PAGE 8
X
X
X
X
X
X
X
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
X
X
SEE PART V, PAGE 8
X
200
X
X
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6
Billing and Collections
Name of hospital facility or letter of facility reporting group
YesNo
17
18
19
17
19
a
b
c
d
e
f
a
b
c
d
e
20
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21
21
a
b
c
d
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
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?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
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?~~~~~~~~~~~~~~~
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)
Part VFacility Information
X
STAFFORD HOSPITAL, LLC
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
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7
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Name of hospital facility or letter of facility reporting group
YesNo
22
a
b
c
d
23
24
23
24
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
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.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Part VFacility Information
X
STAFFORD HOSPITAL, LLC
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
X
X
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Section C. Supplemental Information for Part V, Section B.
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
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.
Part VFacility Information
MARY WASHINGTON HOSPITAL, INC.:
PART V, SECTION B, LINE 5: MWHC'S COMMITMENT AND LEADERSHIP IN INVESTING
IN THE HEALTH OF THE COMMUNITIES IT SERVES ARE CENTERED AROUND AN OVERALL
COMMUNITY BENEFIT STRATEGY. A KEY VALUE OF MWHC IS TO DIRECTLY UTILIZE
COMMUNITY INPUT TO DRIVE INITIATIVES THAT WILL IMPROVE THE OVERALL HEALTH
OF THE COMMUNITY. MWHC WORKED WITH BE WELL RAPPAHANNOCK (BWR) TO CONDUCT A
COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY.
BWR IS A COLLABORATIVE COMPRISED OF AGENCIES REPRESENTATIVE OF THE
COMMUNITY, WITH A DEEP CONCERN FOR THE HEALTH AND WELL-BEING OF THE
RESIDENTS OF THE RAPPAHANNOCK REGION. THE PURPOSE OF THE COUNCIL IS TO
IDENTIFY AND PRIORITIZE COMMUNITY NEEDS, PROVIDE GUIDANCE AND OVERSIGHT
OVER PLANNED COMMUNITY IMPROVEMENTS, AND MONITOR PROGRESS ON PRIORITY
HEALTH AND SOCIAL CONCERNS IMPACTING THE RAPPAHANNOCK REGION.
BE WELL RAPPAHANNOCK REPRESENTATIVE ORGANIZATIONS
-COMMUNITY COLLABORATIVE FOR YOUTH AND FAMILIES
-DEPARTMENTS OF SOCIAL SERVICES
-BUSINESS REPRESENTATIVE
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
-LOCAL GOVERNMENT REPRESENTATIVE
-HIGHER EDUCATION
-MARY WASHINGTON HEALTHCARE
-MARY WASHINGTON HOSPITAL FOUNDATION
-MENTAL HEALTH AMERICA
-PHYSICIAN REPRESENTATIVE
-PUBLIC DEFENDERS
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Section C. Supplemental Information for Part V, Section B.
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
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.
Part VFacility Information
-RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD
-RAPPAHANNOCK AREA HEALTH DISTRICT
-RAPPAHANNOCK UNITED WAY
-SCHOOL ADMINISTRATOR
-SCHOOL SYSTEMS (PUBLIC)
MARY WASHINGTON HOSPITAL, INC.:
PART V, SECTION B, LINE 6A: STAFFORD HOSPITAL AND SPOTSYLVANIA REGIONAL
MEDICAL CENTER
STAFFORD HOSPITAL, LLC:
PART V, SECTION B, LINE 6A: MARY WASHINGTON HOSPITAL AND SPOTSYLVANIA
REGIONAL MEDICAL CENTER
MARY WASHINGTON HOSPITAL, INC.:
PART V, SECTION B, LINE 7D: PRESENTED AT NUMEROUS COMMUNITY MEETINGS,
SUCH AS THE ROTARY MEETINGS, CHAMBER OF COMMERCE, AND THE MARY WASHINGTON
HEALTHCARE CITIZEN ADVISORY COMMITTEE MEETINGS.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
STAFFORD HOSPITAL, LLC:
PART V, SECTION B, LINE 7D: PRESENTED AT NUMEROUS COMMUNITY MEETINGS,
SUCH AS THE ROTARY MEETINGS, CHAMBER OF COMMERCE, AND THE MARY WASHINGTON
HEALTHCARE CITIZEN ADVISORY COMMITTEE MEETINGS.
56
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8
Section C. Supplemental Information for Part V, Section B.
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
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.
Part VFacility Information
MARY WASHINGTON HOSPITAL, INC.:
PART V, SECTION B, LINE 11: SEE IMPLEMENTATION STRATEGY ATTACHED TO THE
RETURN
STAFFORD HOSPITAL, LLC:
PART V, SECTION B, LINE 11: SEE IMPLEMENTATION STRATEGY ATTACHED TO THE
RETURN.
MARY WASHINGTON HOSPITAL, INC.
PART V, LINE 16A, FAP WEBSITE:
HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX
STAFFORD HOSPITAL, LLC
PART V, LINE 16A, FAP WEBSITE:
HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX
MARY WASHINGTON HOSPITAL, INC.
PART V, LINE 16B, FAP APPLICATION WEBSITE:
HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
STAFFORD HOSPITAL, LLC
PART V, LINE 16B, FAP APPLICATION WEBSITE:
HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX
MARY WASHINGTON HOSPITAL, INC.
PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:
57
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Section C. Supplemental Information for Part V, Section B.
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
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.
Part VFacility Information
HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX
STAFFORD HOSPITAL, LLC
PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:
HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX
MARY WASHINGTON HOSPITAL, INC.:
PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS MADE
AVAILABLE ON THE ORGANIZATION'S WEBSITE. SIGNS ARE POSTED IN ALL PATIENT
REGISTRATION AREAS AND NOTES INCLUDED ON ALL PATIENT STATEMENTS INFORMING
PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT
FOR MORE INFORMATION. BILLING OFFICE PERSONNEL EXPLAIN THE MATERIALS TO
ALL PATIENTS REQUESTING ADDITIONAL INFORMATION.
STAFFORD HOSPITAL, LLC:
PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS MADE
AVAILABLE ON THE ORGANIZATION'S WEBSITE. SIGNS ARE POSTED IN ALL PATIENT
REGISTRATION AREAS AND NOTES INCLUDED ON ALL PATIENT STATEMENTS INFORMING
PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
FOR MORE INFORMATION. BILLING OFFICE PERSONNEL EXPLAIN THE MATERIALS TO
ALL PATIENTS REQUESTING ADDITIONAL INFORMATION.
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Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
Schedule H (Form 990) 2020
(continued)
Schedule H (Form 990) 2020Page
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?
Name and addressType of Facility (describe)
Part VFacility Information
1 MEDICAL IMAGING OF FREDERICKSBURG
2 FREDERICKSBURG AMBULATORY SURGERY CENT
3 MARY WASHINGTON URGENT CARE
4 REGIONAL CANCER CENTER AT MONTROSS
5 MARY WASHINGTON EYE CARE CENTER
1201 SAM PERRY BLVD, SUITE 102 ASC BUI
1201 SAM PERRY BLVD, SUITE 101
11131 JOURNAL PARKWAY, SUITE A
15394 KINGS HIGHWAY
4710 SPOTSYLVANIA PARKWAY
FREDERICKSBURG, VA 22401-4490
FREDERICKSBURG, VA 22401-4490
KING GEORGE, VA 22485
MONTROSS, VA 22520
FREDERICKSBURG, VA 22407
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
IMAGING SERVICES
AMBULATORY SURGERY CENTER
URGENT CARE
RADIATION THERAPY
EYE CARE CENTER
5
59
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1
2
3
4
5
6
7
Required descriptions.
Needs assessment.
Patient education of eligibility for assistance.
Community information.
Promotion of community health.
Affiliated health care system.
State filing of community benefit report.
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020Page
Provide the following information.
Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and
9b.
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.
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.
Describe the community the organization serves, taking into account the geographic area and demographic
constituents it serves.
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.).
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.
If applicable, identify all states with which the organization, or a related organization, files a
community benefit report.
Part VISupplemental Information
PART I, LN 7 COL(F):
MWHC UTILIZED THE SERVICES OF SEARCHAMERICA TO IDENTIFY
PFAP ELIGIBLE PATIENTS WHOSE ACCOUNTS HAD FALLEN INTO BAD DEBT.
SEARCHAMERICA PROVIDED A LIST UTILIZING VARIOUS MARKET RESEARCH TO
APPROXIMATE THE FEDERAL POVERTY LEVEL OF EACH ACCOUNT HOLDER. WITH THIS
INFORMATION WE WERE ABLE TO DETERMINE ACCOUNTS THAT MAY HAVE BEEN ELIGIBLE
FOR FREE CARE OR DISCOUNTED CARE UNDER OUR FINANCIAL ASSISTANCE POLICY.
FORM 990, SCHEDULE H, PART I, LINE 7B.
THE COMMONWEALTH OF VIRGINIA ELECTED TO EXPAND MEDICAID COVERAGE IN
2018 WITH 2019 BEING THE FIRST FULL YEAR OF IMPACT. THIS PROGRAM IS
FUNDED THROUGH AN ASSESSMENT LEVIED ON ALL HOSPITALS IN THE
COMMONWEALTH BASED ON THEIR TOTAL PATIENT SERVICE REVENUE. ADDITIONAL
PROVIDER PAYMENTS ARE DISTRIBUTED BACK TO HOSPITALS WHICH PROVIDE
SERVICES TO MEDICAID PATIENTS BASED ON THEIR PERCENTAGE OF NET PATIENT
SERVICE REVENUE FROM THE MEDICAID PROGRAM.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
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10
Schedule H (Form 990)
Schedule H (Form 990)Page
(Continuation)
Part VI
Supplemental Information
PART II, COMMUNITY BUILDING ACTIVITIES:
IN FURTHERANCE OF ITS MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY IT
SERVES THE ORGANIZATION PROMOTES WORKFORCE DEVELOPMENT FOR THE RECRUITMENT
OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN AREAS IDENTIFIED AS
SHORTAGE AREAS THROUGH ITS COMMUNITY NEEDS ASSESSMENTS AND MEDICAL STAFF
DEVELOPMENT PLANS. RECRUITMENT OF PHYSICIANS TO PRACTICE IN MWHC'S
SERVICE AREA IMPROVES ACCESS TO CARE RESULTING IN GREATER AVAILABILITY OF
PHYSICIAN SPECIALISTS, LESS TRAVEL TO OBTAIN CARE, AND SHORTER WAIT TIMES
FOR APPOINTMENTS. ADDITIONALLY MWHC, PROVIDES FACILITIES FREE OF CHARGE TO
RAPPAHANNOCK EMERGENCY MEDICAL SERVICES WHICH IS VALUED AT APPROXIMATELY
$100,000.
PART III, LINE 4:
MWHC PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED
PATIENTS A DISCOUNT FROM STANDARD CHARGES. PATIENTS WHO ARE COVERED BY
THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND
COINSURANCE. MWHC ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH
DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON
HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. SUBSEQUENT CHANGES
THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE FOR THE
YEARS ENDED DECEMBER 31, 2020 AND 2019, WERE NOT CONSIDERED MATERIAL.
PATIENTS WHO MEET MWHC'S CRITERIA FOR CHARITY CARE ARE PROVIDED CARE
WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. SUCH AMOUNTS
DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE.
PART III, LINE 8:
61
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10
Schedule H (Form 990)
Schedule H (Form 990)Page
(Continuation)
Part VI
Supplemental Information
AS A NOT-FOR-PROFIT HOSPITAL IT IS OUR MISSION TO IMPROVE THE HEALTH
STATUS OF ALL PEOPLE WITHIN OUR COMMUNITY AND TO PROVIDE HEALTHCARE TO ALL
PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS.
MWHC ACCEPTS MEDICARE AND MEDICAID AND IT IS A WELL ESTABLISHED FACT THAT
NOT-FOR-PROFIT FACILITIES DO NOT RECOUP THE COST OF CARING FOR THOSE
PATIENTS UTILIZING THESE PROGRAMS. UNDER IRS GUIDELINES MEDICARE AND
MEDICAID BENEFICIARIES ARE CONSIDERED TO BE MEMBERS OF A CHARITABLE CLASS,
THEREFORE BY ASSISTING THESE PATIENTS AND ACCEPTING THE SHORTFALLS IN
REPAYMENT, THE ORGANIZATION IS IN FACT RELIEVING GOVERNMENT BURDEN AND
PROVIDING A SIGNIFICANT COMMUNITY BENEFIT TO OUR SERVICE AREA.
PART III, LINE 9B:
PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY POINT IN THE COLLECTION
CYCLE AND MODIFICATIONS OF ABILITY TO PAY MAY BE ADJUSTED SHOULD FINANCIAL
OR INSURANCE STATUS CHANGE SINCE THE FIRST DAY OF CARE. MWHC DOES NOT
ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE THEY HAVE MADE
REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR
ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS
CONSTITUTE NOTIFICATION BY MWHC OF ITS FINANCIAL ASSISTANCE POLICY BY
WRITTEN AND/OR ORAL COMMUNICATIONS TO ALL UNINSURED/UNDERINSURED PATIENTS
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
AS WELL AS CONSIDERATION OF ELIGIBILITY BASED UPON THE PRESUMPTIVE
ELIGIBILITY GUIDELINES DESCRIBED IN THE FINANCIAL ASSISTANCE POLICY.
PART VI, LINE 2:
MARY WASHINGTON HEALTHCARE AND ITS AFFILIATES (MARY WASHINGTON HOSPTIAL,
MARY WASHINGTON HOSPITAL FOUNDATION, STAFFORD HOSPITAL, LLC, STAFFORD
HOSPITAL FOUNDATION, MEDICORP PROPERTIES, INC., AND MARY WASHINGTON
HEALTHCARE CLINICAL SERVICES, INC.) HAS AS ITS MISSION TO IMPROVE THE
62
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032271 04-01-20
10
Schedule H (Form 990)
Schedule H (Form 990)Page
(Continuation)
Part VI
Supplemental Information
HEALTH OF MEMBERS OF THE COMMUNITIES IT SERVES: FREDERICKSBURG, VA AND THE
SURROUNDING SIX (6) COUNTIES. THE ORGANIZATION ASSESSES THE HEALTH CARE
NEEDS OF THESE COMMUNITIES IN NUMEROUS WAYS INCLUDING:
1.) WORKING COLLABORATIVELY WITH BE WELL RAPPAHANNOCK (BWR). BWR IS A
COLLABORATIVE COMPRISED OF AGENCIES REPRESENTATIVE OF THE COMMUNITY, WITH
A DEEP CONCERN FOR THE HEALTH AND WELL-BEING OF THE RESIDENTS OF THE
RAPPAHANNOCK REGION. THE PURPOSE OF THE COUNCIL IS TO IDENTIFY AND
PRIORITIZE COMMUNITY NEEDS, PROVIDE GUIDANCE, AND OVERSIGHT OVER PLANNED
COMMUNITY IMPROVEMENTS, AND MONITOR PROGRESS ON PRIORITY HEALTH AND SOCIAL
CONCERNS IMPACTING THE RAPPAHANNOCK REGION. BE WELL RAPPAHANNOCK
REPRESENTATIVE ORGANIZATIONS INCLUDE COMMUNITY COLLABORATIVE FOR YOUTH AND
FAMILIES, DEPARTMENTS OF SOCIAL SERVICES, AREA BUSINESSES, LOCAL
GOVERNMENT, HIGHER EDUCATION, RAPPAHANNOCK AREA HEALTH DISTRICT,
RAPPAHANNOCK UNITED WAY, RAPPAHANNOCK COMMUNITY SERVICE BOARD, COMMUNITY
MENTAL HEALTH, AND AREA SCHOOL DISTRICTS.
2.) RESPONDING TO INFORMATION GATHERED FROM AREA COMMUNITY-BASED
ORGANIZATIONS.
THE COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES A FOUNDATION FOR WORKING
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
COLLABORATIVELY WITH KEY STAKEHOLDERS IN THE COMMUNITY TO IMPROVE HEALTH.
SPECIAL ATTENTION HAS BEEN GIVEN TO IDENTIFY HEALTH DISPARITIES, NEEDS OF
VULNERABLE POPULATIONS, AND UNMET HEALTH NEEDS OR GAPS IN SERVICES THROUGH
COMMUNITY INPUT.
PART VI, LINE 3:
MARY WASHINGTON HEALTHCARE AFFILIATES PROVIDE INFORMATION TO PATIENTS
ABOUT ITS FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNAGE AT INTAKE AREAS,
63
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032271 04-01-20
10
Schedule H (Form 990)
Schedule H (Form 990)Page
(Continuation)
Part VI
Supplemental Information
FLYERS AT ADMISSIONS, NOTICES ON BILLS AND COLLECTION STATEMENTS.
FINANCIAL COUNSELORS ARE ALSO AVAILABLE TO ASSIST PATIENTS IN OBTAINING
FINANCIAL ASSISTANCE.
PART VI, LINE 4:
MARY WASHINGTON HEALTHCARE PROVIDES EXCEPTIONAL MEDICAL SERVICES TO THE
CITY OF FREDERICKSBURG AND THE SURROUNDING "COMMUNITY" THAT CONSIST OF THE
PRIMARY SERVICE AREA COUNTIES OF STAFFORD, KING GEORGE, SPOTSYLVANIA,
WESTMORELAND, ORANGE, PRINCE WILLIAM, AND SECONDARY SERVICE AREA COUNTIES
OF MANASSAS, FAUQUIER, CULPEPER, LOUISA, ESSEX, AND RICHMOND. ESTABLISHED
IN 1899, MARY WASHINGTON HOSPITAL (MWH), A 471 BED ACUTE CARE FACILITY,
OFFERS COMPREHENSIVE HEALTHCARE AND MULTIPLE CENTERS OF EXCELLENCE
INCLUDING CARDIOLOGY AND CARDIOVASCULAR SURGERY, PSYCHIATRY, AND WOMEN AND
INFANT HEALTH. STAFFORD HOSPITAL, LLC, A 100 BED ACUTE CARE FACILITY,
ALSO OFFERS COMPREHENSIVE HEALTHCARE SERVICES. BOTH MWH AND SH ARE
ACCREDITED BY THE JOINT COMMISSION AND LICENSED BY THE COMMONWEALTH OF
VIRGINIA DEPARTMENT OF HEALTH AND THE DEPARTMENT OF MENTAL HEALTH, MENTAL
RETARDATION AND SUBSTANCE ABUSE SERVICES. MWH ALSO PROVIDES ADVANCE
RADIATION THERAPY THROUGH THE CANCER CENTER OF VIRGINIA AND HOME HEALTH
SERVICES THROUGH MARY WASHINGTON HOME HEALTH.
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
AS OF THE MOST RECENT CENSUS WITHIN THE RESPECTIVE COUNTIES THE MAJORITY
OF THE GEOGRAPHIC SERVICE AREAS IN WHICH BOTH HOSPITALS SERVE ARE MADE UP
OF ABOUT 4,164.5 SQUARE MILES OF SUBURBAN AND RURAL LAND. COMMUNITY
RESIDENTS IN THE PRIMARY SERVICE AREAS EARN A MEDIAN INCOME PER HOUSEHOLD
OF $57,088/YEAR, WITH A COLLECTIVE AVERAGE OF 7.2% OF THE ENTIRE PRIMARY
SERVICE AREA LIVING BELOW THE FEDERAL POVERTY GUIDELINES. THE PRIMARY
SERVICE AREA HAS AN ESTIMATED POPULATION OF 657,718 INDIVIDUALS AND
64
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032271 04-01-20
10
Schedule H (Form 990)
Schedule H (Form 990)Page
(Continuation)
Part VI
Supplemental Information
187,202 HOUSEHOLDS.
PART VI, LINE 5:
MARY WASHINGTON HOSPITAL, INC. AND STAFFORD HOSPITAL, LLC EACH OPERATE AN
EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY;
HAVE OPEN MEDICAL STAFFS WITH PRIVILEGES TO ALL QUALIFIED PHYSICIANS WHO
APPLY, HAVE A GOVERNING BODY WITH A MAJORITY OF INDEPENDENT TRUSTEES, AND
PARTICIPATE IN MEDICAID, MEDICARE AND OTHER GOVERNMENT SPONSORED HEALTH
CARE PROGRAMS. MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC. THROUGH
ITS SUBSIDIARIES, PROVIDES ANCILLARY HEALTH SERVICES INCLUDING PHYSICIAN
PRACTICES, OUTPATIENT AND AMBULATORY SURGERY, AND HOME HEALTH/HOSPICE
SERVICES.
THE ORGANIZATION UTILIZES SURPLUS FUNDS TO EXPAND SERVICES PROVIDED TO THE
COMMUNITY (IN RESPONSE TO THE COMMUNITY NEEDS ASSESSMENTS), UPGRADE
FACILITIES AND EQUIPMENT TO ENHANCE CLINICAL CARE AND PHYSICIAN
CONNECTIVITY TO PATIENT ELECTRONIC HEALTH RECORDS, AND HEALTH EDUCATION
PROGRAMS.
PART VI, LINE 6:
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
MARY WASHINGTON HEALTHCARE AFFILIATES INCLUDE TWO (2) HOSPITALS, OTHER
CLINICAL SERVICES THAT INCLUDE AN AMBULATORY SURGERY CENTER, HOSPICE/HOME
HEALTH, INDEPENDENT DIAGNOSTIC TESTING FACILITIES, AND PHYSICIAN
PRACTICES; TWO (2) FOUNDATIONS AND A PROPERTY DIVISION. ALL ACTIVITIES OF
THIS GROUP ARE COORDINATED AND OVERSEEN BY THE PARENT'S (MARY WASHINGTON
HEALTHCARE) BOARD OF TRUSTEES. THE AFFILIATED GROUP'S ACTIVITIES ARE
CLOSELY PLANNED/INTEGRATED THROUGH INTERLOCKING BOARDS TO ENSURE THE MOST
EFFECTIVE DELIVERY OF CARE. EACH MEMBER OF THE AFFILIATED GROUP FOCUSES
65
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10
Schedule H (Form 990)
Schedule H (Form 990)Page
(Continuation)
Part VI
Supplemental Information
EFFORTS IN ITS PARTICULAR AREA OF RESPONSIBILITY AND IS ACCOUNTABLE TO THE
PARENT'S BOARD FOR ACHIEVING ITS MISSION AND GOALS FOR THE PROVISION OF
HEALTH CARE. THE DIVISION OF SERVICES ABOVE ALLOWS PATIENTS TO ACCESS
CARE IN THE MOST APPROPRIATE SETTING. THE GOVERNANCE OVERSIGHT PROVIDED
BY THE PARENT GUARANTEES OPTIMAL COORDINATION OF THE VARIOUS SEGMENTS OF
CARE AND ENSURES HIGH QUALITY SERVICE AS ECONOMICALLY AS POSSIBLE.
PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT:
VA
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
66
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OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
032101 11-02-20
SCHEDULE I
(Form 990)
Complete if the organization answered "Yes" on Form 990, Part IV, line 21 or 22.
| Attach to Form 990.
| Go to www.irs.gov/Form990 for the latest information.
Open to Public
Inspection
Employer identification number
General Information on Grants and Assistance
Part I
1
2
YesNo
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments.
(f)
1 (a) (b) (c) (d) (e) (g) (h)
2
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Schedule I (Form 990) 2020
Name of the organization
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?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
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.
Method of
valuation (book,
FMV, appraisal,
other)
Name and address of organization
or government
EINIRC section
(if applicable)
Amount of
cash grant
Amount of
non-cash
assistance
Description of
noncash assistance
Purpose of grant
or assistance
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table
Enter total number of other organizations listed in the line 1 table
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|
|
LHA
Grants and Other Assistance to Organizations,
Governments, and Individuals in the United States
2020
MARY WASHINGTON HEALTHCARE GROUP RETURN
LLOYD F. MOSS FREE CLINIC
PROGRAM
54-1677934
20-4044884
54-6001775
54-2061482
51-0635977
54-0887287
PROGRAM
UNINSURED PATIENT PROGRAM
RESIDENTIAL RECOVERY
AND HIGH RISK MATERNITY
CARE/EVERY WOMAN'S LIFE
501(C)(3)
501(C)(3)
115
501(C)(3)
501(C)(3)
501(C)(3)
GUADALUPE FREE CLINIC
CASE MANAGEMENT
825,000.
130,000.
112,400.
100,000.
70,000.
45,000.
PATIENT EDUCATION AND
0.
0.
0.
0.
0.
0.
FREE HEALTH CLINIC
MICAH ECUMENICAL MINISTRY
COMMONWEALTH OF VIRGINIA STATE
FREDERICKSBURG CHRISTIAN HEALTH
COMPLICATED OBSTETRICAL
GUADALUPE FREE CLINIC OF COLONIAL
CENTRAL VA HEALTH SERVICES
26.
2.
X
1301 SAM PERRY BLVD.
P.O. BOX 3277
BOARD HEALTH - 608 JACKSON ST -
CENTER - 1129 HEATHERSTONE DR -
BEACH - PO BOX 275 - COLONIAL
PO BOX 220
20-1106426
FREDERICKSBURG, VA 22401
FREDERICKSBURG, VA 22402
FREDERICKSBURG, VA 22401
FREDERICKSBURG, VA 22407
BEACH, VA 22443
NEW CANTON, VA 25892
67
032241
11-05-20
Part IIContinuation of Grants and Other Assistance to Domestic Organizations and Domestic Governments
(a)(b)(c)(d)(e)(f)(g)(h)
Schedule I (Form 990)
Schedule I (Form 990)Page 1
(Schedule I (Form 990), Part II.)
Name and address of
organization or government
EIN IRC section
if applicable
Amount of
cash grant
Amount of
non-cash
assistance
Method of
valuation
(book, FMV,
appraisal, other)
Description of
non-cash assistance
Purpose of grant
or assistance
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
CITY OF FREDERICKSBURGCOMMUNITY BASED
PO BOX 967ELIGIBILITY
FREDERICKSBURG, VA 2240454-600129311541,000.0.WORKER/TRANSPORTATION
VIRGINIA COMMUNITY FOOD
CONNECTIONS - PO BOX 7664 -FRESH FOOD ACCESS FOR
FREDERICKSBURG, VA 2240481-1346510501(C)(3)30,000.0.COMMUNITY HEALTH
RAPPAHANNOCK AREA AGENCY ON AGING,COMPASS (CARE OPTIONS
INC. - 460 LENDALL LANE -MAKE FOR PREFERRED
FREDERICKSBURG, VA 2240554-1027651501(C)(3)27,000.0.SOLUTIONS)
FREDERICKSBURG COUNSELING SVCS
305 HANSON AVE
FREDERICKSBURG, VA 2240154-0844464501(C)(3)26,500.0.GENERAL SUPPORT
NUTRITION CONSULTANT
STAFFORD COUNTY SCHOOLSPROJECT/CHILDREN'S
1739 JEFFERSON DAVIS HWYINSURANCE OUTREACH AND
STAFFORD, VA 2255454-6001628501(C)(3)20,000.0.ELIGIBILITY PROJECT
CITY OF FREDERICKSBURG TRANSIT
715 PRINCESS ANNE ST
FREDERICKSBURG, VA 2240154-6001293501(C)(3)20,000.0.LOCAL TRANSPORTATION
STAFFORD JUNCTION, INC.
791 TRUSLOW RDHEALTHY LIVING PAYS
FREDERICKSBURG, VA 2240620-3036072501(C)(3)23,000.0.PROGRAM
RX PARTNERSHIP
2924 EMERYWOOD PARKWAYPRESCRIPTION MEDICATION
RICHMOND, VA 2329457-1186937501(C)(3)16,500.0.PROGRAM
GWYNETH'S GIFT FOUNDATION
2217 PRINCESS ANNE STCPR EDUCATION AND AED
FREDERICKSBURG, VA 2240147-4428397501(C)(3)16,000.0.ACCESS
68
032241
11-05-20
Part IIContinuation of Grants and Other Assistance to Domestic Organizations and Domestic Governments
(a)(b)(c)(d)(e)(f)(g)(h)
Schedule I (Form 990)
Schedule I (Form 990)Page 1
(Schedule I (Form 990), Part II.)
Name and address of
organization or government
EIN IRC section
if applicable
Amount of
cash grant
Amount of
non-cash
assistance
Method of
valuation
(book, FMV,
appraisal, other)
Description of
non-cash assistance
Purpose of grant
or assistance
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
STAFFORD COUNTY SOCIAL SERVICES
PO BOX 7HEALTH INSURANCE
STAFFORD, VA 2255454-6001626501(C)(3)30,000.0.ENROLLMENT PROGRAM
HAZEL HILL HEALTHCARE PROJECT
225 BUTLER RDHAZEL HILL HEALTHCARE
FREDERICKSBURG, VA 2240127-1744104501(C)(3)15,000.0.PROJECT
RAPPAHANNOCK AREA YMCA
212 BUTLER RD
FREDERICKSBURG, VA 2240554-0965826501(C)(3)12,500.0.GENERAL SUPPORT
ACTION IN COMMUNITY THROUGH
SERVICE OF PRINCE WILLIAM INC. -
3900 ACTS LANE - FREDERICKSBURG,
VA 2202654-0897679501(C)(3)10,000.0.ACTS HELPLINE
DOWNTOWN GREENS INC.
206 CHARLES STREET
FREDERICKSBURG, VA 2240154-1853889501(C)(3)10,000.0.GENERAL SUPPORT
MENTAL HEALTH AMERICA OF
FREDERICKSBURG - 2217 PRINCESS
ANNE ST, STE 104-1 -
FREDERICKSBURG, VA 2240154-0678704501(C)(3)8,000.0.GENERAL SUPPORT
POTTER'S HOUSE PRESCHOOL C/O
FREDERICKSBURG BAPTIST CHURCH -
1019 PRINCESS ANNE ST -
FREDERICKSBURG, VA 2240130-0523302501(C)(3)5,000.0.GENERAL SUPPORT
SERVANTS AT WORK, INC. - VIRGINIA
3102 PLANK RD
FREDERICKSBURG, VA 2240783-3751081501(C)(3)5,000.0.BUILDING WHEELCHAIR RAMPS
FREDERICKSBURG AREA FOOD BANK
3631 LEE HILL DR
FREDERICKSBURG, VA 2240854-1255013501(C)(3)5,000.0.GENERAL SUPPORT
69
032241
11-05-20
Part IIContinuation of Grants and Other Assistance to Domestic Organizations and Domestic Governments
(a)(b)(c)(d)(e)(f)(g)(h)
Schedule I (Form 990)
Schedule I (Form 990)Page 1
(Schedule I (Form 990), Part II.)
Name and address of
organization or government
EIN IRC section
if applicable
Amount of
cash grant
Amount of
non-cash
assistance
Method of
valuation
(book, FMV,
appraisal, other)
Description of
non-cash assistance
Purpose of grant
or assistance
MARY WASHINGTON HEALTHCARE GROUP RETURN
LOISANN'S HOPE HOUSE
902 LAFAYETTE BLVD
FREDERICKSBURG, VA 2240154-1419314501(C)(3)5,000.0.GENERAL SUPPORT
DISABILITY RESOURCE CENTER
409 PROGRESS ST
FREDERICKSBURG, VA 2240154-1687677501(C)(3)10,000.0.GENERAL SUPPORT
GEORGE WASHINGTON REGIONAL
COMMISSION - 406 PRINCESS ANNE
STREET - FREDERICKSBURG, VA 2240154-0715969501(C)(3)9,923.0.GENERAL SUPPORT
STAFFORD FOOD SECURITY, INC.
282 DEACON ROAD SUITE 102BACKPACK MEALS FOR
FREDERICKSBURG, VA 2240582-0784445501(C)(3)10,000.0.CHILDREN
20-1106426
70
032102 11-02-20
2
Part III
Grants and Other Assistance to Domestic Individuals.
(e)
(a) (b) (c) (d) (f)
Part IVSupplemental Information.
Schedule I (Form 990) 2020
Schedule I (Form 990) 2020Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
Method of valuation
(book, FMV, appraisal, other)
Type of grant or assistanceNumber of
recipients
Amount of
cash grant
Amount of non-
cash assistance
Description of noncash assistance
Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
APRIL JETT WILLS MEMORIAL NURSING SCHOLARSHIP1
1
5
1
1
BARBARA KANE NURSING SCHOLARSHIP
1,000.
1,000.
5,000.
1,000.
1,000.
CHARLES AND VIOLA JONES NURSING SCHOLARSHIP
0.
0.
0.
0.
0.
CHARLES M. "PETE" HEARN FELLOWSHIP
CORA GRAVES ALLISON NURSING SCHOLARSHIP
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
71
032242
11-05-20
2
Part IIIContinuation of Grants and Other Assistance to Domestic Individuals
(a)(b)(c)(d)(e)(f)
Schedule I (Form 990)
Schedule I (Form 990)Page
(Schedule I (Form 990), Part III.)
Type of grant or assistance Number of
recipients
Amount of
cash grant
Amount of non-
cash assistance
Method of
valuation (book, FMV,
appraisal, other)
Description of noncash assistance
DIANE BROTHERS MEMORIAL SCHOLARSHIP1.1,000.0.
ELEANOR HEYCOCK PETTIT NURSING SCHOLARSHIP1.1,000.0.
ELIZABETH BRUNELLE RYAN AND CATHERINE RYAN LEGATH
SCHOLARSHIP1.1,000.0.
FREDERICKSBURG EMERGENCY MEDICAL ALLIANCE
SCHOLARSHIP2.2,000.0.
HAROLD AND FRANCES SCHILZ NURSING SCHOLARSHIP1.1,000.0.
HEWETSON NURSING SCHOLARSHIP2.2,000.0.
IDA RICHARDSON JENKINS MEMORIAL SCHOLARSHIP1.1,000.0.
JANICE HUNT SCHOLARSHIP3.3,000.0.
JEANE BULLOCK NURSING SCHOLARSHIP1.1,000.0.
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
72
032242
11-05-20
2
Part IIIContinuation of Grants and Other Assistance to Domestic Individuals
(a)(b)(c)(d)(e)(f)
Schedule I (Form 990)
Schedule I (Form 990)Page
(Schedule I (Form 990), Part III.)
Type of grant or assistance Number of
recipients
Amount of
cash grant
Amount of non-
cash assistance
Method of
valuation (book, FMV,
appraisal, other)
Description of noncash assistance
JENNIE MAE BENSON NURSING SCHOLARSHIP1.1,000.0.
LAURA LUMPKIN MEMORIAL SCHOLARSHIP1.1,500.0.
MARIE LACY ROLLINS SCHOLARSHIP1.1,000.0.
MARY FRANCES WILLIS & JAMES G. WILLIS MEMORIAL
SCHOLARSHIP3.3,000.0.
MARY WASHINGTON HOSPITAL AUXILIARY SCHOLARSHIP2.2,000.0.
REBECCA BENNETT NURSING SCHOLARSHIP1.1,000.0.
SAL KIWALL MEMORIAL SCHOLARSHIP FOR CLINICAL
EDUCATION1.1,000.0.
STAFFORD HOSPITAL AUXILIARY SCHOLARSHIP2.2,000.0.
SUE HALL NURSING SCHOLARSHIP1.1,000.0.
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
73
032242
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2
Part IIIContinuation of Grants and Other Assistance to Domestic Individuals
(a)(b)(c)(d)(e)(f)
Schedule I (Form 990)
Schedule I (Form 990)Page
(Schedule I (Form 990), Part III.)
Type of grant or assistance Number of
recipients
Amount of
cash grant
Amount of non-
cash assistance
Method of
valuation (book, FMV,
appraisal, other)
Description of noncash assistance
THE VICKIE GRAVES PITTMAN GERMANNA NURSING
SCHOLARSHIP2.2,000.0.
WILLIAM AND VIOLA ADRIAN NURSING SCHOLARSHIP2.2,000.0.
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
74
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
032111 12-07-20
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Open to Public
Inspection
Attach to Form 990.
| Go to www.irs.gov/Form990 for instructions and the latest information.
Employer identification number
YesNo
1a
b
1b
2
2
3
4
a
b
c
4a
4b
4c
Only section 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
5a
5b
6a
6b
7
8
9
a
b
6
a
b
7
8
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule J (Form 990) 2020
|
|
Name of the organization
Check the appropriate 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
Travel for companions
Housing allowance or residence for personal use
Payments for business use of personal residence
Tax indemnification and gross-up payments
Discretionary spending account
Health or social club dues or initiation fees
Personal services (such as 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, and officers, including the CEO/Executive Director, regarding the items checked on line 1a?~~~~~~~~~~~~
Indicate which, if any, of the following the 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
Independent compensation consultant
Form 990 of other organizations
Written employment contract
Compensation survey or study
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?
Participate in or receive payment from a supplemental nonqualified retirement plan?
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.
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 on lines 5 and 6? If "Yes," describe in Part III
Were any amounts reported on Form 990, Part VII, paid or accrued 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)?
LHA
SCHEDULE J
(Form 990)
Part IQuestions Regarding Compensation
Compensation Information
2020
20-1106426
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
MARY WASHINGTON HEALTHCARE GROUP RETURN
75
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032112 12-07-20
2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Note:
(B) (C) (D) (E) (F)
(i) (ii) (iii)
(A)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
Schedule J (Form 990) 2020
Schedule J (Form 990) 2020Page
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 aren't listed on Form 990, Part VII.
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.
Breakdown of W-2 and/or 1099-MISC compensationRetirement and
other deferred
compensation
Nontaxable
benefits
Total of columns
(B)(i)-(D)
Compensation
in column (B)
reported as deferred
on prior Form 990
Base
compensation
Bonus &
incentive
compensation
Other
reportable
compensation
Name and Title
MARY WASHINGTON HEALTHCARE GROUP RETURN
0.0.0.0.0.0.0.
PRESIDENT AND CEO1,052,210.330,004.221,292.8,550.34,141.1,646,197.0.
759,477.85,000.774.9,038.17,195.871,484.0.
PHYSICIAN0.0.0.0.0.0.0.
0.0.0.0.0.0.0.
SVP, COO & CMO603,773.197,952.15,710.7,043.34,731.859,209.0.
724,613.75,000.13,950.5,098.33,600.852,261.0.
PHYSICIAN0.0.0.0.0.0.0.
706,019.60,000.6,620.7,069.37,284.816,992.0.
PHYSICIAN0.0.0.0.0.0.0.
0.0.0.0.0.0.0.
SR VP & CFO527,220.164,885.21,321.6,966.26,653.747,045.0.
0.0.0.0.0.0.0.
SVP & CPHO412,503.100,302.172,324.5,055.30,121.720,305.0.
523,624.157,500.690.4,367.21,706.707,887.0.
PHYSICIAN0.0.0.0.0.0.0.
364,344.86,762.136,425.4,808.25,855.618,194.0.
VICE PRESIDENT0.0.0.0.0.0.0.
425,210.51,384.114,571.5,852.1,753.598,770.0.
PHYSICIAN/TRUSTEE0.0.0.0.0.0.0.
386,635.88,592.22,211.4,869.29,314.531,621.0.
VICE PRESIDENT0.0.0.0.0.0.0.
0.0.0.0.0.0.0.
SVP & CHRO325,535.85,694.101,043.5,412.13,169.530,853.0.
0.0.0.0.0.0.0.
SVP & CNO333,885.82,075.94,178.4,203.5,874.520,215.0.
0.0.0.0.0.0.0.
SVP & CSO335,932.86,780.15,115.5,235.32,934.475,996.0.
0.0.0.0.0.0.0.
VICE PRESIDENT350,382.79,342.26,925.5,271.2,509.464,429.0.
0.0.0.0.0.0.0.
SVP & CIO320,470.87,856.16,979.5,735.11,174.442,214.0.
20-1106426
(1) MICHAEL P. MCDERMOTT, MD, MBA
(2) SANG HO NA, MD
(3) CHRISTOPHER NEWMAN, MD
(4) AGOSTINO VISIONI, MD
(5) J. T. SHERWOOD, MD
(6) SEAN T. BARDEN BSBA, MBA
(7) TRAVIS TURNER, BS, MBA
(8) THERESA CONOLOGUE, MD
(9) STEPHEN MANDELL, MD
(10) BRADFORD KING, MD
(11) ELIESE K. BERNARD
(12) KATHRYN WALL, BA, MA
(13) EILEEN DOHMANN, RN, BSN, MBA, N
(14) ERIC FLETCHER, MBA, APR
(15) DAVID YI, MD
(16) GEOFFREY LAWSON
76
032112 12-07-20
2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Note:
(B) (C) (D) (E) (F)
(i) (ii) (iii)
(A)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
Schedule J (Form 990) 2020
Schedule J (Form 990) 2020Page
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 aren't listed on Form 990, Part VII.
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.
Breakdown of W-2 and/or 1099-MISC compensationRetirement and
other deferred
compensation
Nontaxable
benefits
Total of columns
(B)(i)-(D)
Compensation
in column (B)
reported as deferred
on prior Form 990
Base
compensation
Bonus &
incentive
compensation
Other
reportable
compensation
Name and Title
MARY WASHINGTON HEALTHCARE GROUP RETURN
0.0.0.0.0.0.0.
VICE PRESIDENT212,002.45,677.117,841.3,903.33,082.412,505.0.
295,741.72,498.9,041.0.28,124.405,404.0.
VICE PRESIDENT0.0.0.0.0.0.0.
0.0.0.0.0.0.0.
VICE PRESIDENT282,009.66,004.31,755.0.25,442.405,210.0.
0.0.0.0.0.0.0.
VICE PRESIDENT242,555.56,607.72,164.4,432.22,376.398,134.0.
0.0.0.0.0.0.0.
SVP & CDO252,629.69,195.17,494.4,537.11,931.355,786.0.
248,548.56,222.8,737.2,217.23,582.339,306.0.
VICE PRESIDENT0.0.0.0.0.0.0.
0.0.0.0.0.0.0.
VICE PRESIDENT237,940.45,554.16,690.4,152.28,690.333,026.0.
0.0.0.0.0.0.0.
VICE PRESIDENT218,546.45,614.23,374.3,891.30,285.321,710.0.
0.0.0.0.0.0.0.
VICE PRESIDENT224,202.56,566.8,662.4,118.22,428.315,976.0.
0.0.0.0.0.0.0.
VICE PRESIDENT214,890.49,774.8,185.3,045.21,975.297,869.0.
0.0.0.0.0.0.0.
VICE PRESIDENT (THRU 5/9/2020)95,488.57,387.104,770.2,848.9,358.269,851.0.
0.0.0.0.0.0.0.
VICE PRESIDENT (AS OF 5/10/2020)200,990.16,627.5,224.3,309.2,583.228,733.0.
0.0.0.0.0.0.0.
FORMER VICE PRESIDENT, THRU 10/1914,670.0.99,019.453.87.114,229.0.
20-1106426
(17) ALAN EDWARDS
(18) BRIAN JENKINS
(19) RICHARD LEWIS, MD
(20) MARIE FREDRICK, R.T. (R), CRA,
(21) XAVIER RICHARDSON BA, MBA
(22) CATHLEEN YABLONSKI, BS, MS
(23) CODY BLANKENSHIP
(24) LAUREN BLALOCK
(25) SANDRA BROWN, CPA
(26) TINA ERVIN
(27) KATHLEEN BOURGAULT, MS, CPAM
(28) SARAH OGLE
(29) DOUGLAS SCHULTE, MD
77
032113 12-07-20
3
Part III
Supplemental Information
Schedule J (Form 990) 2020
Schedule J (Form 990) 2020Page
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.
PART I, LINE 1A:
PART I, LINE 1A - TRUSTEES WHO ARE UNCOMPENSATED VOLUNTEERS TRAVELING FOR
BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR
REIMBURSED AND REPORTED AS INCOME ON A FORM 1099 IN THE YEAR PAID.
ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL MEALS PROVIDED AND THE
THE COST OF SPOUSAL TRAVEL. REIMBURSEMENTS PAID FOR SPOUSAL TRAVEL ARE
EXECUTIVES WHO ARE TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE
AMOUNT IS REPORTED AS INCOME ON THE EXECUTIVE'S W-2.
PART I, LINES 4A-B:
MICHAEL MCDERMOTT RECEIVED A 457(F) DISTRIBUTION OF $162,390.
EILEEN DOHMANN RECEIVED A 457(F) DISTRIBUTION OF $75,309.
TRAVIS TURNER RECEIVED A 457(F) DISTRIBUTION OF $156,958.
KATHRYN WALL RECEIVED A 457(F) DISTRIBUTION OF $59,214.
ELIESE BERNARD RECEIVED A 457(F) DISTRIBUTION OF $13,840.
LAUREN BLALOCK RECEIVED A 457(F) DISTRIBUTION OF $15,304.
CODY BLANKENSHIP RECEIVED A 457(F) DISTRIBUTION OF $8,676.
KATHLEEN BOURGAULT RECEIVED A 457(F) DISTRIBUTION OF $99,729.
ALAN EDWARDS RECEIVED A 457(F) DISTRIBUTION OF $104,407.
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
78
032113 12-07-20
3
Part III
Supplemental Information
Schedule J (Form 990) 2020
Schedule J (Form 990) 2020Page
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.
MARIE FREDERICK RECEIVED A 457(F) DISTRIBUTIONS OF $61,143.
RICHARD LEWIS RECEIVED A 457(F) DISTRIBUTION OF $16,287.
STEPHEN MANDELL RECEIVED A 457(F) DISTRIBUTION OF $118,531.
DAVID YI RECEIVED A 457(F) DISTRIBUTION OF $18,650.
PART I, LINE 7:
VARIABLE COMPONENT SUCH THAT THEY ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF
DOUGLAS SCHULTE RECEIVED A 457(F) DISTRIBUTION OF $98,590.
PART I, LINE 7 - ALL EXECUTIVES HAVE AS A PART OF THEIR COMPENSATION A
THEIR BASE PAY AS AN INCENTIVE FOR THE ACHIEVEMENT OF INDIVIDUAL AND
CORPORATE GOALS AND OBJECTIVES.
SCHEDULE J
INDEPENDENT BOARD TRUSTEES RECEIVE NO COMPENSATION.
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
79
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
032121 12-01-20
SCHEDULE K
(Form 990)
| Complete if the organization answered "Yes" on Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
Open to Public
Inspection
|Attach to Form 990. |Go to www.irs.gov/Form990 for instructions and the latest information.
Employer identification number
Part IBond Issues
(a) (b) (c) (d) (e) (f) (g) (h)(i)
YesNoYesNoYesNo
A
B
C
D
Part IIProceeds
ABCD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
YesNoYesNoYesNoYesNo
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule K (Form 990) 2020
DefeasedOn behalf
of issuer
Name of the organization
Issuer nameIssuer EINCUSIP #Date issuedIssue priceDescription of purposePooled
financing
Amount of bonds retired
Amount of bonds legally defeased
Total proceeds of issue
Gross proceeds in reserve funds
Capitalized interest from proceeds
Proceeds in refunding escrows
Issuance costs from proceeds
Credit enhancement from proceeds
Working capital expenditures from proceeds
Capital expenditures from proceeds
Other spent proceeds
Other unspent proceeds
Year of substantial completion
Were the bonds issued as part of a refunding issue of tax-exempt bonds (or,
if issued prior to 2018, a current refunding issue)?
Were the bonds issued as part of a refunding issue of taxable bonds (or, if
issued prior to 2018, an advance refunding issue)?
Has the final allocation of proceeds been made?
Does the organization maintain adequate books and records to support the
final allocation of proceeds?
LHA
Supplemental Information on Tax-Exempt Bonds
2020
20-1106426
AUTHORITY
ECONOMIC DEVELOPMENT
AUTHORITY
ECONOMIC DEVELOPMENT
AUTHORITY
ECONOMIC DEVELOPMENT
AUTHORITY
ECONOMIC DEVELOPMENT
52-1303430
52-1303430
54-1244413
52-1303430
355849AS9
355849BC3
852431BM6
NONE
05/10/07
05/28/14
05/02/16
11/22/16
86868312.
59254492.
128486132.
30405000.
X MWH BONDS
REFUNDING OF 1996
BONDS
REFUNDING OF 2002
BONDS
REFUNDING OF 2006
BONDS
REFUNDING OF 2013
X
X
X
X
X
XX
X
X
X
X
60,200,000.
86,868,312.
583,010.
2007
59,254,492.
630,794.
2014
128,486,132.
2,100,667.
2016
30,405,000.
2016
2,050,000.4,045,000.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
86,285,302.58,623,698.126,385,465.30,405,000.
MARY WASHINGTON HEALTHCARE GROUP RETURN
80
032122 12-01-20
2
Part IIIPrivate Business Use
ABCD
1
2
YesNoYesNoYesNoYesNo
3a
b
c
d
4
5
6
7
8
9
a
b
c
Part IVArbitrage
ABCD
1
2
3
YesNoYesNoYesNoYesNo
a
b
c
Schedule K (Form 990) 2020
Schedule K (Form 990) 2020Page
Was the organization a partner in a partnership, or a member of an LLC,
which owned property financed by tax-exempt bonds?
Are there any lease arrangements that may result in private business use of
bond-financed property?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Are there any management or service contracts that may result in private
business use of bond-financed property?
If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside
counsel to review any management or service contracts relating to the financed property?
Are there any research agreements that may result in private business use of
bond-financed property?
If "Yes" to line 3c, does the organization routinely engage bond counsel or other
outside counsel to review any research agreements relating to the financed property?
Enter the percentage of financed property used in a private business use by entities
other than a section 501(c)(3) organization or a state or local government|%%%%
Enter the percentage of financed property used in a private business use as a
result of unrelated trade or business activity carried on by your organization,
another section 501(c)(3) organization, or a state or local government|%%%%
Total of lines 4 and 5%%%%
Does the bond issue meet the private security or payment test?
Has there been a sale or disposition of any of the bond-financed property to a non-
governmental person other than a 501(c)(3) organization since the bonds were issued?
If "Yes" to line 8a, enter the percentage of bond-financed property sold or
disposed of%%%%
If "Yes" to line 8a, was any remedial action taken pursuant to Regulations
sections 1.141-12 and 1.145-2?
Has the organization established written procedures to ensure that all
nonqualified bonds of the issue are remediated in accordance with the
requirements under Regulations sections 1.141-12 and 1.145-2?
Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and
Penalty in Lieu of Arbitrage Rebate?
If "No" to line 1, did the following apply?
Rebate not due yet?
Exception to rebate?
No rebate due?
If "Yes" to line 2c, provide in Part VI the date the rebate computation was
performed
Is the bond issue a variable rate issue?
XXXX
X
X
X
X
X
X
X
X
X
X
XXX
X XX
XXXX
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
XXXX
XXXX
XX
XXXX
XX
XXXX
XXXX
XXXX
032123 12-01-20
3
Part IVArbitrage
ABCD
4a
b
c
d
e
YesNoYesNoYesNoYesNo
a
b
c
d
5
6
7
Part VProcedures To Undertake Corrective Action
ABCD
YesNoYesNoYesNoYesNo
Part VISupplemental Information.
Schedule K (Form 990) 2020
(continued)
Schedule K (Form 990) 2020Page
Has the organization or the governmental issuer entered into a qualified
hedge with respect to the bond issue?
Name of provider
Term of hedge
Was the hedge superintegrated?
Was the hedge terminated?
Were gross proceeds invested in a guaranteed investment contract (GIC)?
Name of provider
Term of GIC
Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied?
Were any gross proceeds invested beyond an available temporary period?
Has the organization established written procedures to monitor the
requirements of section 148?
Has the organization established written procedures to ensure that violations
of federal tax requirements are timely identified and corrected through the
voluntary closing agreement program if self-remediation isn't available under
applicable regulations?
Provide additional information for responses to questions on Schedule K. See instructions.
XXXX
XXXX
XXXX
XXXX
XXXX
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
Loan to or
from the
organization?
032131 12-09-20
(Form 990 or 990-EZ)
| Complete if the organization answered "Yes" on Form 990, Part IV, line 25a, 25b, 26, 27, 28a,
28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
Open To Public
Inspection
| Attach to Form 990 or Form 990-EZ.
| Go to www.irs.gov/Form990 for instructions and the latest information.
Employer identification number
1(b) (d)
(a) (c)
YesNo
2
3
(a) (c) (e) (g)
(h)
(i)
(d)
(b)
(f)
YesNoYesNoYesNo
Total
(b)
(a) (c) (d) (e)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule L (Form 990 or 990-EZ) 2020
Approved
by board or
committee?
Written
agreement?
Relationship
with organization
Name of the organization
(section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
Relationship between disqualified
person and organization
Corrected?
Name of disqualified personDescription of transaction
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under
section 4958~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|
|
$
$ Enter the amount of tax, if any, on line 2, above, reimbursed by the organization~~~~~~~~~~~~~~~~
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a or Form 990, Part IV, line 26; or if the organization
reported an amount on Form 990, Part X, line 5, 6, or 22.
Name of
interested person
Purpose
of loan
Original
principal amount
In
default?
Balance due
ToFrom
|$
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
Relationship between
interested person and
the organization
Name of interested personAmount of
assistance
Type of
assistance
Purpose of
assistance
LHA
SCHEDULE L
Part IExcess Benefit Transactions
Part IILoans to and/or From Interested Persons.
Part IIIGrants or Assistance Benefiting Interested Persons.
Transactions With Interested Persons
2020
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
83
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032132 12-09-20
2
(e)
(a) (b) (c) (d)
YesNo
Schedule L (Form 990 or 990-EZ) 2020
Schedule L (Form 990 or 990-EZ) 2020Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
Sharing of
organization's
revenues?
Name of interested personRelationship between interested
person and the organization
Amount of
transaction
Description of
transaction
Provide additional information for responses to questions on Schedule L (see instructions).
Part IVBusiness Transactions Involving Interested Persons.
Part V
Supplemental Information.
20-1106426
SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS:
(A) NAME OF PERSON: BRIAN MCDERMOTT, MD
(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:
BROTHER OF PRESIDENT & CEO
(D) DESCRIPTION OF TRANSACTION: ORTHOPEDIC CALL COVERAGE THRU APRIL 2020
FOR MWH AND SH
X 10,800. BRIAN MCDERMOTT, MDBROTHER OF PRESIDENORTHOPEDIC
MARY WASHINGTON HEALTHCARE GROUP RETURN
84
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
032211 11-20-20
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
| Attach to Form 990 or 990-EZ.
| Go to www.irs.gov/Form990 for the latest information.
(Form 990 or 990-EZ)
Open to Public
Inspection
Employer identification number
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule O (Form 990 or 990-EZ) 2020
Name of the organization
LHA
SCHEDULE O
Supplemental Information to Form 990 or 990-EZ
2020
FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:
SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND
OTHER MEDICAL SERVICES.
FORM 990, PART VI, SECTION A, LINE 6:
MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER,
ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC).
FORM 990, PART VI, SECTION A, LINE 7A:
MARY WASHINTON HEALTHCARE (MWHC) HAS THE POWER TO APPOINT BOARD OF TRUSTEES
FOR THE GROUP.
FORM 990, PART VI, SECTION A, LINE 7B:
MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER,
ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). MWHC HAS RESERVED CERTAIN
POWERS TO ITSELF WITHIN EACH OF ITS SUBSIDIARIES' ORGANIZING DOCUMENTS.
THESE RESTRICTIONS INCLUDE AMENDING THE GOVERNING DOCUMENTS, BUDGETING,
EXPENDITURES OVER CERTAIN THRESHOLDS.
FORM 990, PART VI, SECTION B, LINE 11B:
MANAGEMENT COMPLETES A DRAFT OF THE INTERNAL REVENUE SERVICE (IRS) FORM 990
INFORMATION RETURN FOR MARY WASHINGTON HEALTHCARE AND ITS SUBSIDIARIES.
THIS DRAFT IS SUBMITTED TO THE FINANCE COMMITTEE OF THE ORGANIZATION'S
BOARD OF TRUSTEES. THE FORM 990 AND UNDERLYING INFORMATION ARE PRESENTED
TO AND REVIEWED BY THIS COMMITTEE. IF THE CONTENTS OF THE 990 RETURN ARE
DEEMED ACCURATE AND ACCEPTABLE BY THE COMMITTEE, THIS BODY RECOMMENDS
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
85
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
032212 11-20-20
2
Employer identification number
Schedule O (Form 990 or 990-EZ) 2020
Schedule O (Form 990 or 990-EZ) 2020Page
Name of the organization
ACCEPTANCE OF THE RETURN BY THE FULL BOARD OF TRUSTEES. THE FORM 990
RETURN IS SUBSEQUENTLY PRESENTED TO AND REVIEWED BY THE ORGANIZATION'S
BOARD OF TRUSTEES. IF DEEMED ACCURATE AND ACCEPTABLE THE BOARD ACCEPTS THE
RETURN THROUGH A FORMAL MOTION. AS PART OF THIS PROCESS, THE DRAFT RETURN
IS POSTED ON THE BOARD'S WEBSITE WHERE IT REMAINS AVAILABLE FOR REVIEW EVEN
AFTER FORMAL ACCEPTANCE BY THE BOARD. THE FORM 990 RETURN IS ALSO
AVAILABLE TO MEMBERS OF THE BOARD OF TRUSTEES AS WELL AS THE GENERAL PUBLIC
ON MARY WASHINGTON HEALTHCARE'S WEBSITE (WWW.MARYWASHINGTONHEALTHCARE.COM).
FORM 990, PART VI, SECTION B, LINE 12C:
EVERY TRUSTEE AND EXECUTIVE IS REQUIRED TO DISCLOSE ANY AND ALL CONFLICTS.
THE DISCLOSURES ARE MADE ANNUALLY AND SUBMITTED TO THE MARY WASHINGTON
HEALTHCARE CHIEF COMPLIANCE OFFICER (CCO). THE CCO PRESENTS ALL CONFLICTS
TO THE ENTERPRISE RISK MANAGEMENT COMMITTEE OF THE BOARD OF TRUSTEES. THE
CHAIRMAN OF THE ENTERPRISE RISK MANAGEMENT COMMITTEE REPORTS ALL CONFLICTS
TO THE FULL BOARD.
CONFLICTS ARE CONTINUALLY AND ACTIVELY MANAGED. AT EACH MEETING, THE CHAIR
ASKS IF ANYONE AT THE MEETING HAS A CONFLICT TO DISCLOSE. INDIVIDUALS WITH
CONFLICTS DISCLOSE THEIR CONFLICTS AND THE RELATED TOPIC. THE INDIVIDUAL
THEN RECUSES HIM/HERSELF FROM ANY DECISION RELATED TO THAT TOPIC. THE
CONFLICT OF INTERESTS POLICY IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 15:
MARY WASHINGTON HEALTHCARE UTILIZES AN EXECUTIVE COMPENSATION COMMITTEE
WITH THE PURPOSE AND AUTHORITY TO ESTABLISH PROCESSES TO ENSURE FAIR AND
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
COMMERCIALLY REASONABLE COMPENSATION FOR THE CEO AND EXECUTIVE LEADERSHIP.
IN ORDER TO ENSURE COMPENSATION PAID IS SET AT FAIR MARKET VALUE, THE
86
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032212 11-20-20
2
Employer identification number
Schedule O (Form 990 or 990-EZ) 2020
Schedule O (Form 990 or 990-EZ) 2020Page
Name of the organization
EXECUTIVE COMPENSATION COMMITTEE UTILIZES COMPENSATION SURVEY DATA, FORM
990 INFORMATION FROM COMPARABLE HEALTH SYSTEMS, AND THE SERVICES OF AN
INDEPENDENT COMPENSATION CONSULTANT. SUCH INDEPENDENT THIRD PARTY DATA
POINTS PROVIDE ASSURANCE THAT EXECUTIVE COMPENSATION IS COMMERCIALLY
REASONABLE AND AT A FAIR MARKET VALUE.
FORM 990, PART VI, SECTION C, LINE 19:
THE AUDITED FINANCIALS STATEMENTS ARE POSTED ON THE MARY WASHINGTON
HEALTHCARE WEBSITE FOR PUBLIC VIEW.
FORM 990, PART IX, LINE 11G, OTHER FEES:
CONTRACT PERSONNEL:
PROGRAM SERVICE EXPENSES 11,845,197.
MANAGEMENT AND GENERAL EXPENSES 853,536.
FUNDRAISING EXPENSES 21,625.
TOTAL EXPENSES 12,720,358.
CONSULTING SERVIES:
PROGRAM SERVICE EXPENSES 46,165,552.
MANAGEMENT AND GENERAL EXPENSES 3,326,577.
FUNDRAISING EXPENSES 84,280.
TOTAL EXPENSES 49,576,409.
BILLNG AND COLLECTION SERVICES:
PROGRAM SERVICE EXPENSES 471,015.
MANAGEMENT AND GENERAL EXPENSES 33,940.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
FUNDRAISING EXPENSES 860.
TOTAL EXPENSES 505,815.
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2
Employer identification number
Schedule O (Form 990 or 990-EZ) 2020
Schedule O (Form 990 or 990-EZ) 2020Page
Name of the organization
ASP SERVICES:
PROGRAM SERVICE EXPENSES 110,102.
MANAGEMENT AND GENERAL EXPENSES 7,934.
FUNDRAISING EXPENSES 201.
TOTAL EXPENSES 118,237.
MAINTENANCE SERVICES:
PROGRAM SERVICE EXPENSES 4,898,380.
MANAGEMENT AND GENERAL EXPENSES 352,965.
FUNDRAISING EXPENSES 8,943.
TOTAL EXPENSES 5,260,288.
STORAGE SERVICES:
PROGRAM SERVICE EXPENSES 20,815.
MANAGEMENT AND GENERAL EXPENSES 1,500.
FUNDRAISING EXPENSES 38.
TOTAL EXPENSES 22,353.
WASTE DISPOSAL:
PROGRAM SERVICE EXPENSES 339,651.
MANAGEMENT AND GENERAL EXPENSES 24,474.
FUNDRAISING EXPENSES 620.
TOTAL EXPENSES 364,745.
MANAGMENT CONTRACTS:
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
PROGRAM SERVICE EXPENSES 33,808,680.
MANAGEMENT AND GENERAL EXPENSES 2,436,171.
88
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2
Employer identification number
Schedule O (Form 990 or 990-EZ) 2020
Schedule O (Form 990 or 990-EZ) 2020Page
Name of the organization
FUNDRAISING EXPENSES 61,721.
TOTAL EXPENSES 36,306,572.
TENENT COVERAGE:
PROGRAM SERVICE EXPENSES 257,444.
MANAGEMENT AND GENERAL EXPENSES 18,551.
FUNDRAISING EXPENSES 470.
TOTAL EXPENSES 276,465.
TOTAL OTHER FEES ON FORM 990, PART IX, LINE 11G, COL A 105,151,242.
FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS:
UNCOLLECTED PLEDGES 277,092.
ELIMINATION OF EQUITY FOR CONSOLIDATED ENTITIES 9,267,478.
TOTAL TO FORM 990, PART XI, LINE 9 9,544,570.
FORM 990, PART XII, LINE 2C
THE COMPANIES IN THE GROUP RETURN ARE INCLUDED IN THE CONSOLIDATED
AUDITED FINANCIAL STATEMENTS OF MWHC. RESPONSIBILITY FOR OVERSIGHT OF
THE AUDIT AND SELECTION OF AUDITORS RESTS WITH THE FINANCE COMMITTEE OF
THE BOARD OF TRUSTEES.
FORM 990, PART V, Q2A
NO ENTITY WITHIN THE GROUP FILES W-2S WITH THE IRS. ALL PAYROLL IS
PAID THROUGH AN AGENCY AGREEMENT WITH MARY WASHINGTON HEALTHCARE.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
FORM 990, SCHEDULE R
ABBREVIATIONS:
89
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032212 11-20-20
2
Employer identification number
Schedule O (Form 990 or 990-EZ) 2020
Schedule O (Form 990 or 990-EZ) 2020Page
Name of the organization
MWHC - MARY WASHINGTON HEALTHCARE
MPI - MEDICORP PROPERTIES, INC.
MWHC CLINICAL - MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC.
MWHC SERVICES, INC. - MARY WASHINGTON HEALTHCARE SERVICES, INC.
MEDIDOCTORS H.C. - MEDIDOCTORS HOLDING COMPANY
FORM 990, PART V, Q3A AND Q3B
MARY WASHINGTON HOSPITAL AND MARY WASHINTON HOSPITAL FOUNDATON FILE
SEPARATE 990T'S RELATED TO UNRELATED BUSINESS INCOME.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
90
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OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
Section 512(b)(13)
controlled
entity?
032161 10-28-20
SCHEDULE R
(Form 990)
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Open to Public
Inspection
| Go to www.irs.gov/Form990 for instructions and the latest information.
Employer identification number
Part IIdentification of Disregarded Entities.
(a)(b)(c)(d)(e)(f)
Identification of Related Tax-Exempt Organizations.
Part II
(a)(b)(c)(d)(e)(f)(g)
YesNo
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule R (Form 990) 2020
|
|
Name of the organization
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
Name, address, and EIN (if applicable)
of disregarded entity
Primary activityLegal domicile (state or
foreign country)
Total incomeEnd-of-year assetsDirect controlling
entity
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.
Name, address, and EIN
of related organization
Primary activityLegal domicile (state or
foreign country)
Exempt Code
section
Public charity
status (if section
501(c)(3))
Direct controlling
entity
LHA
Related Organizations and Unrelated Partnerships
2020
MARY WASHINGTON HEALTHCARE GROUP RETURN
MEDIDOCTORS, LLC - 54-1990805
MARY WASHINGTON MEDICAL GROUP - HOSPITALIST
MARY WASHINGTON EYE CARE LLC - 27-1248032
MWHC URGENT CARE, LLC - 83-4378864
FREDERICKSBURG, VA 22401
AVE, STE 418, FREDERICKSBURG, VA 22401
STAFFORD HOSPITAL AUXILIARY - 26-2704632
MARY WASHINGTON HOSPITAL AUXILIARY -
MARY WASHINGTON HEALTHCARE - 54-1240646
FREDERICKSBURG, VA 22401
FREDERICKSBURG, VA 22401
FREDERICKSBURG, VA 22401
2300 FALL HILL AVE, STE 418
SERVICES, LLC - 57-1172752, 2300 FALL HILL
2300 FALL HILL AVE, STE 418
2300 FALL HILL AVE, STE 418
FREDERICKSBURG, VA 22401
FREDERICKSBURG, VA 22401
2300 FALL HILL AVE, SUITE 418
75-2985923, 2300 FALL HILL AVE, SUITE 418,
2300 FALL HILL AVE, SUITE 418
MEDICAL2,451,603.
34,647,759.
1,803,231.
4,203,711.
MEDICAL
15,195.
529,633.
111,025.
1,555,042.
MEDICAL
MEDICAL
LINE 12D,
LINE 12D,
LINE 12C,
MEDICAL SERVICES
MEDICAL SERVICES
SUPPORT SERVICES
HEALTHCARE CLINICAL
VIRGINIA
VIRGINIA
VIRGINIA
VIRGINIA
SERVICES, INC.
HEALTHCARE CLINICAL
VIRGINIA
VIRGINIA
VIRGINIA
SERVICES, INC.
MARY WASHINGTON
MARY WASHINGTON
20-1106426
501(C)(3)III-O
501(C)(3)III-O
501(C)(3)III-FI
X
X
X
91
Disproportionate
allocations?
Legal
domicile
(state or
foreign
country)
General or
managing
partner?
Section
512(b)(13)
controlled
entity?
Legal domicile
(state or
foreign
country)
032162 10-28-20
2
Identification of Related Organizations Taxable as a Partnership.
Part III
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k)
YesNoYesNo
Identification of Related Organizations Taxable as a Corporation or Trust.
Part IV
(a)(b)(c)(d)(e)(f)(g)(h)(i)
YesNo
Schedule R (Form 990) 2020
Predominant income
(related, unrelated,
excluded from tax under
sections 512-514)
Schedule R (Form 990) 2020Page
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.
Name, address, and EIN
of related organization
Primary activityDirect controlling
entity
Share of total
income
Share of
end-of-year
assets
Code V-UBI
amount in box
20 of Schedule
K-1 (Form 1065)
Percentage
ownership
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.
Name, address, and EIN
of related organization
Primary activityDirect controlling
entity
Type of entity
(C corp, S corp,
or trust)
Share of total
income
Share of
end-of-year
assets
Percentage
ownership
FREDERICKSBURG AMBULATORY
MEDICAL IMAGING OF
COWAN INVESTMENT PARTNERS,
SPOTSYLVANIA PARKWAY MEDICAL
2300 FALL HILL AVE, STE 418,
FREDERICKSBURG, VA 22401
2300 FALL HILL AVE, STE 418,
SURGERY CENTER - 56-2322548,
FREDERICKSBURG - 54-1364028,
LLC - 65-1294835, 2300 FALL
PLAZA, LLC - 26-2656396, 2300
FREDERICKSBURG, VA 22401
HILL AVE, STE 418,
FREDERICKSBURG, VA 22401
FREDERICKSBURG PROFESSIONAL RISK EXCHANGE -
MARY WASHINGTON HEALTHCARE SERVICES, INC. -
MARY WASHINGTON HEALTH PLAN - 82-3693765
PINNACLE HEALTH CORPORATION - 31-1636492
FALL HILL AVE, STE 418,
FREDERICKSBURG, VA 22401
33-1095956, 2300 FALL HILL AVE, SUITE 418,
54-1244509, 2300 FALL HILL AVE, SUITE 418,
2300 FALL HILL AVE, SUITE 418
2300 FALL HILL AVE, SUITE 418
VA
VA
VA
VA
MWHC CLINICAL
MWHC CLINICAL
MEDICORP
VT
VA
VA
VA
PROPERTIES,
MEDICORP
PROPERTIES,
RELATED
RELATED
RELATED
RELATED
C CORP
C CORP
C CORP
C CORP
FREDERICKSBURG, VA 22401
FREDERICKSBURG, VA 22401
1,768,133.
7,449,377.
10,334.
159,518.
FREDERICKSBURG, VA 22401
FREDERICKSBURG, VA 22401
-201,044.
8,295,637.
-3,931,406.
12,751.
CAPTIVE INSURANCE
356,821.
2,479,565.
35,489.
-699,646.
RETAIL MEDICAL
968,770.
22,428,500.
15,774,732.
247,677.
HEALTH MAINTENANCE
HEALTH MANAGEMENT
100%
100%
100%
100%
MWHC
MWHC
X
X
X
X
MWHC
MWHA
X
X
X
X
SURGERY CTR
IMAGING
REAL ESTATE
REAL ESTATE
SERVICES INC.
SERVICES INC.
INC.
INC.
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
N/A
N/A
N/A
N/A
55.13%
51.00%
12.50%
42.78%
X
X
X
X
92
Legal
domicile
(state or
foreign
country)
General or
managing
partner?
Disproportion-
ate allocations?
032223
04-01-20
Part IIIContinuation of Identification of Related Organizations Taxable as a Partnership
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k)
YesNoYesNo
Predominant income
(related, unrelated,
excluded from tax under
sections 512-514)
Schedule R (Form 990)
Name, address, and EIN
of related organization
Primary activityDirect controlling
entity
Share of total
income
Share of
end-of-year
assets
Code V-UBI
amount in box
20 of Schedule
K-1 (Form 1065)
Percentage
ownership
COMMONWEALTH IMAGING, LLC -
05-0622704, 2300 FALL HILL
AVE, STE 418, FREDERICKSBURG,
VA 22401VA
MWHC SERVICES,
RELATED82,423.99,603.XX
MWHC ENDOSCOPY HOLDINGS, LLC
- 83-4407938, 2300 FALL HILL
AVE, STE 418, FREDERICKSBURG,
VA 22401VA
MWHC CLINICAL
RELATED-129,251.222,649.XX
FREDERICKSBURG ENDOSCOPY
CENTER, LLC - 83-4398314,
2300 FALL HILL AVE, STE 418,
FREDERICKSBURG, VA 22401VA
MWHC ENDOSCOPY
RELATED-203,592.382,908.XX
IMAGING
ENDOSCOPY
ENDOSCOPY
INC.
SERVICES INC.
HOLDINGS, LLC
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
N/A
N/A
N/A
33.33%
60.00%
51.00%
93
032163 10-28-20
3
Part VTransactions With Related Organizations.
Note:YesNo
1
a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
q
r
s
(i) (ii) (iii) (iv) 1a
1b
1c
1d
1e
1f
1g
1h
1i
1j
1k
1l
1m
1n
1o
1p
1q
1r
1s
2
(a)(b)(c)(d)
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
Receipt of interest, annuities, royalties, or rent from a controlled entity~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gift, grant, or capital contribution to related organization(s)
Gift, grant, or capital contribution from related organization(s)
Loans or loan guarantees to or for related organization(s)
Loans or loan guarantees by related organization(s)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dividends from related organization(s)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sale of assets to related organization(s)
Purchase of assets from related organization(s)
Exchange of assets with related organization(s)
Lease of facilities, equipment, or other assets to related organization(s)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lease of facilities, equipment, or other assets from related organization(s)
Performance of services or membership or fundraising solicitations for related organization(s)
Performance of services or membership or fundraising solicitations by related organization(s)
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sharing of paid employees with related organization(s)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Reimbursement paid to related organization(s) for expenses
Reimbursement paid by related organization(s) for expenses
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other transfer of cash or property to related organization(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.
Name of related organization
Transaction
type (a-s)
Amount involvedMethod of determining amount involved
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
X
94
Are all
partners sec.
501(c)(3)
orgs.?
Dispropor-
tionate
allocations?
General or
managing
partner?
032164 10-28-20
YesNoYesNoYesN
4
Part VIUnrelated Organizations Taxable as a Partnership.
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k)
o
Schedule R (Form 990) 2020
Predominant income
(related, unrelated,
excluded from tax under
sections 512-514)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
Schedule R (Form 990) 2020Page
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.
Name, address, and EIN
of entity
Primary activityLegal domicile
(state or foreign
country)
Share of
total
income
Share of
end-of-year
assets
Percentage
ownership
20-1106426 MARY WASHINGTON HEALTHCARE GROUP RETURN
95
032165 10-28-20
5
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020Page
Provide additional information for responses to questions on Schedule R. See instructions.
Part VII
Supplemental Information
MARY WASHINGTON HEALTHCARE GROUP RETURN20-1106426
96
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Department of the Treasury
Internal Revenue Service
File by the
due date for
filing your
return. See
instructions.
023841 04-01-20
| File a separate application for each return.
| Go to www.irs.gov/Form8868 for the latest information.
Electronic filing (e-file).
Type or
print
Application
Is For
Return
Code
Application
Is For
Return
Code
1
2
3a
b
c
3a
3b
3c
$
$
$
Balance due.
Caution:
For Privacy Act and Paperwork Reduction Act Notice, see instructions.8868
www.irs.gov/e-file-providers/e-file-for-charities-and-non-profits.
Form
(Rev. January 2020)
OMB No. 1545-0047
You can electronically file Form 8868 to request a 6-month automatic extension of time to file any of the
forms listed below with the exception of Form 8870, Information Return for Transfers Associated With Certain Personal Benefit
Contracts, for which an extension request must be sent to the IRS in paper format (see instructions). For more details on the electronic
filing of this form, visit
All corporations required to file an income tax return other than Form 990-T (including 1120-C filers), partnerships, REMICs, and trusts
must use Form 7004 to request an extension of time to file income tax returns.
Name of exempt organization or other filer, see instructions.Taxpayer identification number (TIN)
Number, street, and room or suite no. If a P.O. box, see instructions.
City, town or post office, state, and ZIP code. For a foreign address, see instructions.
Enter the Return Code for the return that this application is for (file a separate application for each return)
Form 990 or Form 990-EZ
Form 990-BL
Form 4720 (individual)
Form 990-PF
01
02
03
04
05
06
Form 990-T (corporation)07
08
09
10
11
12
Form 1041-A
Form 4720 (other than individual)
Form 5227
Form 6069
Form 8870
Form 990-T (sec. 401(a) or 408(a) trust)
Form 990-T (trust other than above)
¥The books are in the care of|
Telephone No.|Fax No.|
¥If the organization does not have an office or place of business in the United States, check this box~~~~~~~~~~~~~~~~~|
¥If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN)
. If this is for the whole group, check this
box. If it is for part of the group, check this boxand attach a list with the names and TINs of all members the extension is for.
||
I request an automatic 6-month extension of time until, to file the exempt organization return for
the organization named above. The extension is for the organization's return for:
|
|
calendar yearor
tax year beginning, and ending.
If the tax year entered in line 1 is for less than 12 months, check reason:Initial returnFinal return
Change in accounting period
If this application is for Forms 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less
any nonrefundable credits. See instructions.
If this application is for Forms 990-PF, 990-T, 4720, or 6069, enter any refundable credits and
estimated tax payments made. Include any prior year overpayment allowed as a credit.
Subtract line 3b from line 3a. Include your payment with this form, if required, by
using EFTPS (Electronic Federal Tax Payment System). See instructions.
If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 8453-EO and Form 8879-EO for payment
instructions.
LHAForm (Rev. 1-2020)
Automatic 6-Month Extension of Time.
Only submit original (no copies needed).
8868Application for Automatic Extension of Time To File an
Exempt Organization Return
2020
MARY WASHINGTON HEALTHCARE GROUP RETURN
4243
X
SANDRA W. BROWN - 2300 FALL HILL AVENUE, NO. 418 -
X
0.
0.
0.
540-741-2507
C/O PBMARES - 725 JACKSON ST, #210
FREDERICKSBURG, VA 22401
20-1106426
540-741-3534
NOVEMBER 15, 2021
FREDERICKSBURG, VA 22401
01
1
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Electronic Filing PDF Attachment
97
14181118 758849 F8573-303 2020.05000 MARY WASHINGTON HEALTHCAR F8573-31
Mary Washington Healthcare Community Benefit Implementation Strategy
2019-2022
1
Mary Washington Healthcare, in compliance with the Internal Revenue Service regulations related to
section 501(r) of the Affordable Care Act, created the following document to provide a road map on how it
will use the findings of the Rappahannock Region Health Needs Assessment to ensure it is meeting the
needs of the communities it serves.
Community Health Needs Assessment Summary
Mary Washington Healthcare and the Rappahannock Area Health District launched the Rappahannock
Region Community Health Needs Assessment in January 2015. The Rappahannock Region was charged
with completing a Community Health Needs Assessment to identify high priority healthcare needs within
the regional Mary Washington Healthcare service area. The Rappahannock Region is financially supported
by Mary Washington Healthcare, the Rappahannock United Way, the Rappahannock Area Community
Services Board, GEICO, Rappahannock Area Health District, Mary Washington Hospital Foundation, and
Spotsylvania Regional Medical Center. The Health Communities Institute out of Stanford University was
contracted to facilitate planning meetings, gather and analyze related data, and manage project timelines
and schedules.
The Rappahannock Region established two committees: Advisory and Steering, The Rappahannock
Region Advisory Committee comprises 40 community volunteers representing regional hospitals, health
departments and insurers, private businesses, community-based organizations, and healthcare and
mental health services providers. The Rappahannock Region Steering Committee includes
representatives from Mary Washington Healthcare, the United Way, GEICO, the Moss Free Clinic, the
University of Mary Washington, Spotsylvania Regional Medical Center, and the Rappahannock Area
Health District.
Data Collection for the Rappahannock Region Community Health Needs Assessment focused on the
following areas: community input, vital statistics, reasons for doctor and clinic visits, risk factors for
common illness, lifestyle improvements, and localities where residents were not meeting established
health targets. Some data is available only on the countywide level but still provides valuable information.
Both qualitative and quantitative data were collected between April and August 2015.
Qualitative primary research:
The qualitative primary research for the 2015 Community Health Needs Assessment was conducted by
key informant interviews with community leaders from public and private organizations selected for the
Rappahannock Region Advisory Committee and engagement of Mary Washington Healthcare’s Citizen
Advisory Council, along with solicited community input.
Secondary data and information sources:
Information was obtained from a number of different sources such as the Healthy Communities
Institute’s Community Health Information Resource tool (CHIR), the Virginia Department of Health, the
American Community Survey, the Urban Institute, Healthy People 2020, and information supplied directly
from a sample of healthcare service providers within the defined community.
Mary Washington Healthcare Community Benefit Implementation Strategy
2019-2022
2
Prioritizing Health Needs
The Steering Committee of the Rappahannock Region reviewed and established decision-making criteria
to guide their discussions regarding identification of the region’s highest priority healthcare needs. The
criteria that follow are not listed in order of priority:
1. Magnitude of the identified priority
2. Severity of the problem – the risk of morbidity and mortality associated with the problem
3. Alignment of the priority with the community’s strengths and health priorities
4. Impact of the identified priority on vulnerable populations – health care disparity
5. Importance of the priority to the community
6. Existing resources addressing the identified priority
7. Relationship of the priority to other community issues
8. Affordability of intervention strategies
9. Potential for short-term and long-term impact on the community
The criteria yielded The Top Three Health Priorities identified through the Rappahannock Region
Community Health Needs Assessment:
1. Access to Health Services and Preventative Care
2. Behavioral Health and Behavioral Disorders
3. Exercise, Nutrition and Weight
Addressing the Top Three Health Needs
Mary Washington Hospital and Stafford Hospital organized its implementation strategy around Mary
Washington Healthcare’s core Community Benefit objectives established for years 2019-2022. Utilizing
the resources of Mary Washington Hospital and Mary Washington Healthcare’s Centers of Excellence, all
Top Three Health Needs will be addressed during the three-year period. The Mary Washington Hospital
Implementation Strategy will target persons living in the City of Fredericksburg and the counties of
southern Stafford, Spotsylvania, Caroline, King George, Westmoreland, and eastern Orange. Not all
Community Benefit Programs listed in the implementation strategy will be held on the campus of Mary
Washington Hospital. Promotion of activities and data collection will reflect the targeted communities
described above and may result in the development of new sites based upon interest and need.
Internal and external strategies (See Note) along with related anticipated outcomes, identified
community partnerships, and specific programs/activities for each Community Benefit outcome describe
how the health needs are being addressed. The utilization of the Community Health Information
Resource (CHIR) tool is encouraged to provide the ability to benchmark those specific diseases and
conditions where a measurement or comparison is available to objectively evaluate the effectiveness of
these strategies.
The implementation strategy is reviewed by the Mary Washington Healthcare Board of Trustees. Findings
from formal evaluations of each Community Benefit program and continuous engagement of community
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2019-2022
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stakeholders influence modifications to the implementation strategy. The implementation strategy is
approved annually by the Mary Washington Healthcare’s Board of Trustees.
Note: Mary Washington Healthcare considers efforts to support its patients and Associates part of its
commitment to the community. Therefore, while programs/activities that are open to the broader
community (external strategies) are only reportable to the Internal Revenue Service, Mary Washington
Healthcare includes internal strategies targeting only its patients and Associates in addition to reportable
external strategies.
Mary Washington Healthcare Community Benefit Objectives
Create, promote, and make available educational programs to community groups. These presentations
will specifically address health needs identified in the Rappahannock Region Community Health Needs
Assessment.
1. Facilitate access to preventative health-related services for uninsured/underinsured, while
supporting a stronger community referral process and creating population health programs.
1. MWHC supports programs that are continuing to expand our understanding of the many
different social, economic and environmental factors which shape our communities health,
and empowering communities nationwide with the data, knowledge and tools they need
to enable everyone to live the healthiest life possible. MWHC will work to help identify and
address the root causes of our communities’ health disparities.
2. MWHC will focus on eliminating racial/ ethnic health disparities in maternal-fetal health for
our PD 16 residents
2. Improve access to behavioral health and behavioral disorders, both directly and in providing support
for community initiatives.
1. Inform seniors and their caregivers of relevant issues including understanding of mental
changes associated with aging, end-of-life decisions, and community resources.
2. Support the initiatives of community outreach programs that address behavioral health in
youth and young adults.
3. Increase focus on exercise, nutrition, and weight for improving and maintaining health.
1. Increase diabetes education and screening opportunities targeting both pre-
diabetes/diabetes populations with a focus on programming that addresses nutrition and
obesity from birth through adulthood.
2. Increase healthy food options to targeted PD 16 food deserts.
3. Strengthen existing community partnerships to increase access to exercise programs and
facilities in PD 16.
Mary Washington Healthcare Community Benefit Implementation Strategy
2019-2022
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Community Benefit Objective 1: Facilitate access to health-related services for
uninsured/underinsured, while supporting a stronger community referral process and population
management.
Top Health Need:
Objective 1 will specifically explore ways to improve access to primary care providers in the Mary
Washington Hospital community as well as develop processes to improve the coordination of care for
uninsured and/or underinsured patients.
Internal Strategies:
1. Explore opportunities to partner with local primary care physicians and safety net providers to
establish referral patterns for all unassigned patients being discharged from the emergency and
inpatient departments at Mary Washington Hospital.
2. Provide community resources information to all identified, uninsured/underinsured MWHC
patients.
3. Work with internal departments to collect Social Determinants of Health data (including language
Race, Ethnicity).
External Strategies:
1. Collaborate with various community service groups and safety-net providers to streamline
enrollment processes for financial assistance programs taking into consideration current criteria
for various social service programs
2. Host information sessions for community groups and advocates to raise awareness of MWHC’s
Patient Financial Assistance Programs (PFAP).
3. Raise awareness of community resources, including education related to insurance access
4. Partner with community stakeholders to create initiatives that address the Social Determinants of
Health (SDoH) to the health outcomes and reduce readmission rates.
Anticipated Primary Outcomes:
➢ Improve health status of patients by establishing medical homes resulting in reduced readmission
rates for patients seeking primary care follow-up in emergency departments.
➢ Better understanding of community health-related services in the community and appropriate use
of medical services
➢ Increased participation in Medicaid/Medicare Expansion products, MWHC’s Patient Financial
Assistance Programs as compared to last year.
➢ Increased coordination of care for uninsured/underinsured patients navigating various free or
reduced-fee community services.
➢ Increase transition care plans for all eligible patients.
Community Benefit Tactic(s) 2019-2022
1. Develop a partnership between MWHC,
key safety- net providers, willing community physicians, and other community partners that will
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2019-2022
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encourage a coordinated continuum of care for uninsured/underinsured.
2. Collaborate with The MWHC Alliance to create an intentional plan to address transitional care
plans for our patients and the community.
Potential Core Evaluation Metrics
Access to Care Health Coverage
• Children without health coverage
• Adults without health coverage
• Adults without dental coverage
• Access to Services Adults who delayed care due to cost
• Population in poverty living in primary care shortage areas
• Adults without a usual primary care provider
• Avoidable hospitalizations
• Average travel distance to hospital-based birthing services
OUTCOMES TO DATE
Due to COVID-19 Pandemic this and all plans are being re-evaluated to address the needs of the
pandemic.
Community Benefit Objective 2: Improve access to behavioral health services, both directly as well as
in providing support for community initiatives.
Top Health Need:
Mental health and mental disorders will be addressed in Objective 2. Resources at Mary Washington
Hospital and Snowden at Fredericksburg will play a critical role in addressing this objective.
Internal Strategies:
1. Increase capacity and services provided to promote access at Snowden of Fredericksburg to
reduce referrals to other facilities due to the lack of beds or specialty services.
2. Continued mental health assessment and physician-requested consultations for disposition with
referrals for appropriate services
3. Provide expertise and awareness about mental health and mental disorders as they address
specific community mental health concerns.
External Strategies:
1. Continue community-based collaborations with such organizations as the Rappahannock Area
Community Services Board, regional utilization management teams, and Mental Health of America
and to improve coordination of care and increase access to behavioral health services
2. Continue to provide free mental health assessments and screenings to individuals in the
community with appropriate referrals to services offered in the community.
3. Continued grant support for 24-hour Crisis Hotline with professional therapists to address
immediate, behavioral health needs of community, including referrals to appropriate programs.
5. Continue to partner with Be Well Rappahannock to continue the Opioid crisis taskforce and
continue to align with the initiatives.
6. Support the development of a strong mental health workforce with trainings and internships
Mary Washington Healthcare Community Benefit Implementation Strategy
2019-2022
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Anticipated Primary Outcomes:
➢ Community members will have increased knowledge and awareness of key mental health signs
and symptoms as well as a better understanding of services available.
➢ To have a more resilient community that can support one another through mental health trauma
and substance abuse.
Potential Core Evaluation Metrics
Substance Use Disorder
• Drug Overdose
Deaths
• Drug Overdose
Hospitalizations
• Substance Use
Disorder
Hospitalizations
• Liver Disease Deaths
• Alcohol-Impaired
Driving Deaths
Mental Health
• Depression
• Suicide
• Suicide attempts
OUTCOMES TO DATE
Due to COVID-19 Pandemic this and all plans are being re-evaluated to address the needs of the
pandemic.
Community Benefit Objective 3: Exercise, Nutrition, and Weight Increase diabetes education and
screening opportunities targeting both pre-diabetes/diabetes population with a focus on programming
that addresses nutrition and obesity from birth through adulthood.
Objective 3 will address both diabetes and obesity through its strategies and programs. Resources from
MWHC’s Diabetes Management Program will be critical in implementing the following strategies.
Internal Strategies:
1. Provide referrals to Community Benefit programs that address diabetes and obesity prevention
to/management to adult patients
Mary Washington Healthcare Community Benefit Implementation Strategy
2019-2022
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2. Promotion of Health & Wellness initiatives related to nutrition and fitness for MWHC Associates
External Strategies:
1. Conduct diabetes-related health screenings in the community
2. Provide diabetes and obesity related support
3. Raise awareness and provide access to healthy food seminars, classes and town halls
4. Advocate for area-wide “health living” campaign
5. Supply educational training related to nutrition counseling for the community
6. Provide community-wide blood pressure screens
Anticipated Primary Outcomes:
➢ Improved understanding of nutritional needs to reduce on-set of diabetes, as measured by pre-
and post-test analysis with Community Benefit program participants.
➢ Increased knowledge of new and healthy foods to low-income youths and their families using
access to free fruits and vegetables, recipe/cooking tips and social media reminders.
➢ Improved self-efficacy of diabetes management, as measured by pre/post-test analysis
Community Benefit Tactics 2019-2022:
1. Continue to host “Kids for a Cure Diabetes” Summer Camp in order to promote healthy
management of diabetes and provide educational resources to help children manage their
health. (MWHC Diabetes Management Program and Diabetes and Obesity work group)
2. Participate in the “Balanced Living with Diabetes" program
3. Work with the area YMCA to enroll eligible patients into the YMCA LEAN and Exercise program
Potential Core Evaluation Metrics
Cardiovascular Disease
• Adults with hypertension Hospitalizations for hypertension
• Hospitalizations for stroke Deaths due to stroke
• Preventable deaths from heart disease, stroke, or hypertensive disease
Diabetes
• Adults with diabetes
• Adults with pre-diabetes Hospitalizations for diabetes
Mary Washington Healthcare Community Benefit Implementation Strategy
2019-2022
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Diet, Exercise, and Weight
• Adults consuming 5+ servings of fruits and/or vegetables per day
• Physical activity
• Adult overweight and obesity
Tobacco, e-cigarettes, and Vaping Smoke tobacco
• Adults using e-cigarette or vaping delivery systems
OUTCOMES TO DATE*
Due to COVID-19 Pandemic this and all plans are being re-evaluated to address the needs of the
pandemic.
