2024-11-11T12:42:47-06:00 2023-12-31 540618213 HANTZMON WIEBEL LLP PO BOX 1408 CHARLOTTESVILLE VA 22902 990 2023-01-01 541401355 MARTHA JEFFERSON HEALTH SERVICES CORPORA MART 4346548198 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 DEBORAH THEXTON DIRECTOR OF FINANCE 4346548199 2024-11-04 1 0 JEFFREY D ULMER P00147690 4342962156 2023 2024-10-15 13:58:12Z JONATHAN DAVIS 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 25875 0 X N/A X 1987 VA TO SUPPORT THE CHARITABLE PURPOSES OF SENTARA MARTHA JEFFERSON HOSPITAL 11 10 0 10 0 0 30035 25875 0 0 0 0 0 0 30035 25875 0 0 0 0 0 0 0 0 0 30035 25875 30035 25875 0 0 522341 498556 522341 498556 0 0 TO SUPPORT THE MEDICAL, CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSE OF SENTARA MARTHA JEFFERSON HOSPITAL AND THE BETTERMENT OF HEALTH CARE IN THE COMMUNITIES IT SERVES. 0 0 25875 THE CHARITABLE PURPOSE FOR WHICH MARTHA JEFFERSON HEALTH SERVICES CORPORATION (HEREIN THE "CORPORATION") IS ORGANIZED IS TO CARRY OUT THE OBLIGATIONS AND EXERCISE THE RIGHTS OF THE CORPORATION SPECIFIED IN THE AFFILIATION AGREEMENT DATED APRIL 1, 2011 BY AND AMONG SENTARA HEALTHCARE, THE CORPORATION, SENTATA MARTHA JEFFERSON HOSPITAL, MARTHA JEFFERSON HOSPITAL FOUNDATION, MJH FOUNDATION, MARTHA JEFFERSON MEDICAL ENTERPRISES, INC. AND MARTHA JEFFERSON MEDICAL GROUP, LLC IN SUPPORT OF THE MEDICAL, CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSE OF THE HOSPITAL AND THE BETTERMENT OF HEALTH CARE IN THE COMMUNITIES IT SERVES. 25875 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X THE ORGANIZATION 4346548198 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 DAVID BALABAN MD BOARD MEMBER 2.00 X 0 0 0 JOSH FISCHER MD BOARD MEMBER 2.00 X 0 0 0 LILLIAN BEVIER BOARD MEMBER 2.00 X 0 0 0 RAY MURPHY BOARD MEMBER 2.00 X 0 0 0 RICHARD HOWARD-SMITH BOARD MEMBER 2.00 X 0 0 0 LARRY MARTIN CHAIR, BOARD MEMBER 2.00 X X 0 0 0 KEVIN SCHUYLER BOARD MEMBER 2.00 X 0 0 0 DANA HARRIS BOARD MEMBER 2.00 X 0 0 0 CAROL HURT BOARD MEMBER 2.00 X 0 0 0 PEGGY ECHOLS BOARD MEMBER 2.00 X 0 0 0 DEBORAH THEXTON TREASURER, SECRETARY 2.00 40.00 X 0 243131 61017 0 243131 61017 0 0 1 0 0 25875 25875 25875 0 0 0 2090 2090 23760 23760 OTHER GENERAL AND ADMIN 25 25 25875 0 25875 0 522341 498556 522341 498556 2090 522341 496466 522341 498556 X 0 0 522341 498556 0 0 X 0 0 0 X X 1 SENTARA MARTHA JEFFERSON HOSPITAL 540261840 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FORM 990 SCHEDULE A, PART I LINE 12G MARTHA JEFFERSON HEALTH SERVICES CORPORATION SUPPORTS SENTARA MARTHA JEFFERSON HOSPITAL WITH NON-MONETARY OPERATIONAL OVERSIGHT. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 AFFILIATION COMMITMENT 496466 496466 0 1 0 0 0 0 0 0 0 DEBORAH THEXTON TREASURER, SECRETARY 0 203150 0 32054 0 7927 0 28005 0 33012 0 304148 0 0 FORM 990, PART VI, SECTION A, LINE 2 THE ORGANIZATION'S OFFICERS AND DIRECTORS SERVE TOGETHER ON THE BOARDS OF OTHER TAXABLE ORGANIZATIONS WITHIN THE SENTARA MARTHA JEFFERSON HOSPITAL SYSTEM, AS WELL AS JOINT VENTURES IN WHICH THE SYSTEM HAS AN OWNERSHIP INTEREST. SEE SCHEDULE R FOR A LISTING OF SUCH ENTITIES. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990 WITH THE IRS, IT IS REVIEWED BY THE FINANCE TEAM, INCLUDING THE CHIEF FINANCIAL OFFICER. MARTHA JEFFERSON HEALTH SERVICES CORPORATION WILL PROVIDE THE INTERNAL REVENUE SERVICE FORM 990 FOR THE PRECEEDING FISCAL YEAR TO THE BOARD OF DIRECTORS IN THE RESPECTIVE MEETING FOLLOWING THE FILING OF THE FORM 990. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. SENTARA MARTHA JEFFERSON HOSPITAL 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 540261840 PROVIDING HEALTHCARE TO THE COMMUNITY VA 501(C)(3) LINE 3 SENTARA HEALTHCARE 0 MJH FOUNDATION 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 541401357 INVESTMENT & MANAGEMENT SERVICES VA 501(C)(3) LINE 12A, I SENTARA MARTHA JEFFERSON HOSPITAL 0 MARTHA JEFFERSON HOSPITAL FOUNDATION 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 300041113 FUNDRAISING VA 501(C)(3) LINE 12B, II SENTARA MARTHA JEFFERSON HOSPITAL 0 PHYSICAL THERAPY ACAC LLC 501 ALBEMARLE SQUARE CHARLOTTESVILLE VA 22901 260080717 PHYSICAL THERAPY VA MARTHA JEFFERSON MEDICAL ENTERPRISESINC UNRELATED 0 0 MARTHA JEFFERSON MEDICAL ENTERPRISESINC 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 541841528 MEDICAL BILLING SERVICE VA SENTARA MARTHA JEFFERSON HOSPITAL C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MJH FOUNDATION C 25875 CORP BOOKS/RECORDS