2023-05-12T18:49:47-05:00 2022-06-30 366055558 GRANT THORNTON LLP 1301 INTERNATIONAL PARKWAY SUITE 300 FORT LAUDERDALE FL 33323 990 2022-01-01 541278944 UVA PRINCE WILLIAM HEALTH SYSTEM UVAP 5712841163 8700 SUDLEY ROAD MANASSAS VA 20110 CHARLES CODER CFO 5712841163 2023-05-12 1 CHARLES CODER 999009999 0 STEPHANIE LARSEN P01981731 9547689900 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z X ERIK SHANNON 8700 SUDLEY ROAD MANASSAS VA 20110 24153393 0 X N/A X 1997 VA SEE SCHEDULE O 11 7 0 17 0 0 13442 0 48461374 23458859 332461 -4132 88248 -18527 48895525 23436200 0 0 0 0 44728011 23133284 0 0 0 20506866 10181483 65234877 33314767 -16339352 -9878567 37023686 32078352 10885833 15769274 26137853 16309078 X SEE SCHEDULE O 0 0 28593884 21542832 DURING THE SHORT-PERIOD JANUARY 1, 2022 - JUNE 30, 2022, UVA COMMUNITY HEALTH PHYSICIAN PRACTICES OFFERED PHYSICIAN SERVICES TO THE COMMUNITY AT MULTIPLE VA LOCATIONS. THE PHYSICAN PRACTICES OF UVA PRINCE WILLIAM HEALTH SYSTEM HAD 116,739 OUTPATIENT ENCOUNTERS. THE ORGANIZATION'S OPERATIONS SERVE THE COMMUNITY BY PROVIDING ACCESS TO MUCH NEEDED HEALTHCARE SERVICES, REGARDLESS OF THE PATIENTS' ABILITY TO PAY. 393270 657756 UVA PRINCE WILLIAM HEALTH SYSTEM PROVIDES INTERMEDIARY ADMINISTRATIVE SUPPORT TO UVA HEALTH LOCATIONS IN NORTHERN VIRGINIA, AND CONTINUES TO PROVIDE CORPORATE REAL ESTATE ADMINISTRATION SUPPORT TO THESE SAME ENTITIES. 1334887 1258271 DURING THE SHORT-PERIOD JANUARY 1, 2022 - JUNE 30, 2022, UVA PRINCE WILLIAM HEALTH SYSTEM OFFERED DIAGNOSTIC IMAGING SERVICES TO THE CENTERVILLE, VA AREA AND SURROUNDING AREAS, WITH 4,484 OUTPATIENT ENCOUNTERS. 30322041 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 VA X CHARLES CODER 5712841163 8700 SUDLEY ROAD MANASAS VA 20110 X STEVEN M DANZIGER CHAIR 0.20 1.00 X X 0 0 0 STEPHEN SMITH MD PRES & COO / TRUSTEE (THRU 2/2022) 25.00 25.00 X X 0 0 0 CHARLES BARRELL TRUSTEE 0.20 0.80 X 0 0 0 CHRISTOPHER HEATON MD TRUSTEE 45.00 0.80 X 0 0 0 MARY FRANCES SOUTHERLAND TRUSTEE 0.20 0.80 X 0 0 0 KIRSTEN GREEN MD TRUSTEE 0.20 0.60 X 0 0 0 LISA ANN PEACOCK TRUSTEE 0.20 0.60 X 0 0 0 RICHARD HARRINGTON TRUSTEE 0.20 0.60 X 0 0 0 MICHELLE METZGAR TRUSTEE 0.20 0.60 X 0 0 0 PAM KINCHELOE RN JD TRUSTEE 0.20 0.60 X 0 0 0 BEN WAMPLER MD TRUSTEE 0.20 0.60 X 0 0 0 SHIV KHANDELWAL MD TRUSTEE 0.20 0.60 X 0 0 0 CHARLES CODER CFO & TREASURER 0.20 50.20 X 0 0 0 ERIK SHANNON INT. CEO 0.20 50.80 X 0 0 0 0 0 0 0 0 0 0 0 NET PATIENT REVENUE 621111 22514499 22514499 MOB RENTAL INCOME 531120 713061 713061 CARE COORDINATION FEES 900099 112289 112289 DIAGNOSTIC IMAGING SERVICES 621512 105900 105900 VALUE BASED INCENTIVE 900099 13110 13110 23458859 694534 713061 -18527 -18527 -18527 4132 -4132 -4132 -4132 23436200 23458859 0 -22659 19267716 18882362 385354 750585 735430 15155 1842524 1805673 36851 1272459 1247010 25449 2996241 1806750 1189491 193 193 264355 184733 79622 262814 262814 1760979 1748303 12676 40148 39736 412 13323 13056 267 254 6 248 591297 589314 1983 1261771 1167202 94569 BILLING FEES 914895 914895 PHARMACEUTICALS 623021 623021 BAD DEBT 467448 467448 984744 748990 235754 33314767 30322041 2992726 0 2070956 2132926 4322376 4476670 225826 230829 17920 17410 40101374 20456221 20082410 19645153 468282 468282 195561 193378 9640355 4913704 37023686 32078352 3748816 6120465 5903 11339 7131114 9637470 10885833 15769274 X 26137853 16309078 26137853 16309078 37023686 32078352 X -9878567 49792 X X 0 0 0 X X 3 UVA PRINCE WILLIAM MEDICAL CENTER 540696355 3 1 6822459 0 UVA CATON MERCHANT HOUSE ASSISTED LIVING 541291284 10 1 379026 0 UVA COMMUNITY HEALTH FOUNDATION 541307595 7 0 379026 0 3 7580511 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART I, LINE 12G: UVA PRINCE WILLIAM HEALTH SYSTEM PROVIDES INTERMEDIARY ADMINISTRATIVE SUPPORT TO THE RELATED ENTITIES LOCATED IN PRINCE WILLIAM COUNTY AND CONTINUES TO PROVIDE CORPORATE REAL ESTATE ADMINISTRATION SUPPORT TO THE SUPPORTED ORGANIZATIONS LISTED IN PART I. PART IV, SECTION A, LINE 1: THERE ARE OTHER PUBLICLY SUPPORTED ORGANIZATIONS WITHIN THE HEALTH SYSTEM THAT THE FILING ORGANIZATION SUPPORTS. THESE ORGANIZATIONS HAVE A CONTINUING RELATIONSHIP WITH THE FILING ORGANIZATION BY VIRTUE OF THEIR RELATIONSHIPS TO THE SPECIFIED SUPPORTED ORGANIZATIONS. BY REASON OF THIS RELATIONSHIP, A SUBSTANTIAL IDENTITY OF INTEREST HAS BEEN DEVELOPED BETWEEN THE ORGANIZATIONS THEREBY ESTABLISHING A HISTORIC AND CONTINUING RELATIONSHIP. PART IV, SECTION D, LINE 3: REPRESENTATIVES OF THE SUPPORTED ORGANIZATIONS PROVIDE ONGOING FEEDBACK AND GUIDANCE ON THE BUDGETING, OVERHEAD ALLOCATIONS, AND ASSET PURCHASING AND UTILIZATION. PART IV, SECTION E, LINE 3A: THE ORGANIZATION HAS THE POWER TO REGULARLY APPOINT OR ELECT A MAJORITY OF OFFICERS, DIRECTORS OR TRUSTEES OF UVA CATON MERCHANT HOUSE ASSISTED LIVING, A SUPPORTED ORGANIZATION LISTED IN PART I. PART IV, SECTION E, LINE 3B: BECAUSE OF THE RELATIONSHIP DESCRIBED ABOVE, THE SAME INDIVIDUALS WHO HAVE OVERSIGHT OVER THE SUPPORTING ORGANIZATION ARE DIRECTLY INVOLVED OR HAVE A SUBSTANTIAL DEGREE OF INFLUENCE IN THE OVERSIGHT, INCLUDING POLICY/PROGRAM DEVELOPMENT AND ACTIVITIES, OF THE SUPPORTED ORGANIZATIONS. 12692563 12692563 14782261 10039209 4743052 6215111 5020787 1194324 6152734 5226447 926287 258705 169778 88927 19645153 RIGHT OF USE ASSETS 4913704 4913704 OPERATING LEASE 5018679 DUE TO AFFILIATES 3401686 THIRD PARTY PAYMENT PAYABLE 511950 PATIENT REFUNDS 411463 OTHER LIABILITIES 293692 9637470 FORM 990, HEADER: CHANGE IN ACCOUNTING PERIOD FOR THE PERIOD 1/1/2022 - 6/30/2022. HURRICANE IAN DISASTER RELIEF DR-4673-FL. FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES UVA PRINCE WILLIAM HEALTH SYSTEM IS AN INTEGRAL PART OF UVA COMMUNITY HEALTH, INC. ("UVACH"). UVACH IS A NOT-FOR-PROFIT INTEGRATED SYSTEM OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS, AND OTHER HEALTHCARE SERVICES PROVIDERS (COLLECTIVELY KNOWN AS "UVA COMMUNITY HEALTH"). FORM 990, PART III, LINE 1: MISSION, VISION AND VALUES OUR MISSION TRANSFORMING HEALTH AND INSPIRING HOPE FOR ALL VIRGINIANS AND BEYOND OUR VISION TO BE THE NATION'S LEADING PUBLIC ACADEMIC HEALTH SYSTEM AND A BEST PLACE TO WORK WHILE TRANSFORMING PATIENT CARE, RESEARCH, EDUCATION, AND ENGAGEMENT WITH THE DIVERSE COMMUNITIES WE SERVE OUR VALUES: ASPIRE AT UVA HEALTH, WE PUT THE PATIENT AT THE CENTER OF EVERYTHING WE DO. WE ASPIRE TO CREATE A CULTURE OF EXCELLENCE, ENGAGEMENT, AND TRUST THROUGH OUR VALUES. - ACCOUNTABILITY: ACKNOWLEDGING AND ASSUMING RESPONSIBILITY FOR WHERE WE HAVE SUCCEEDED AND FAILED IN TERMS OF OUR ACTIONS, DECISIONS, POLICIES, AND RESULTS. - STEWARDSHIP: MANAGING OUR RESOURCES AND COMMITMENT TO CONTINUAL IMPROVEMENT AND LEARNING RESPONSIBLY AND CAREFULLY WHILE ACKNOWLEDGING SHORTCOMINGS OR PROBLEMS IN OUR QUEST. - PROFESSIONALISM: APPROACHING ALL THAT WE DO IN A COLLABORATIVE WAY AND DELIVERING EXCELLENT CARE THROUGH THE LENS OF HELPFULNESS, POSITIVITY, KINDNESS, AND COMPETENCY. - INTEGRITY: BEING HONEST, OPEN, AND FAIR THROUGH OUR BEHAVIORS, ATTITUDE, AND TREATMENT OF OTHERS. - RESPECT: VALUING EVERYONE THROUGH OUR COMPASSIONATE AND CARING WAYS. - EQUITY: FOSTERING AN ENVIRONMENT OF BELONGING THAT PROMOTES JUSTICE, EQUITY, DIVERSITY, INCLUSION, AND UNITY THROUGHOUT THE ORGANIZATION AND WITHIN THE COMMUNITIES WE SERVE. FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). THE SOLE MEMBER, UVACH HAS CERTAIN RIGHTS AND POWERS WITH REGARD TO THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF MEMBERS AND THEIR RIGHTS AS THE SOLE MEMBER OF THE ORGANIZATION, UVACH HAS THE POWER TO APPOINT ALL MEMBERS OF THE GOVERNING BODY OF UVA PRINCE WILLIAM HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS SUBJECT TO APPROVAL OF MEMBERS AS THE SOLE MEMBER, UVACH HAS THE POWER TO APPROVE CERTAIN TRANSACTIONS, ACTIONS AND CHANGES TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990, PART VI, SECTION B, LINE 11: ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO UVA COMMUNITY HEALTH'S BOARD OF TRUSTEES' AUDIT AND COMPLIANCE COMMITTEE ("THE COMMITTEE"), WHICH OVERSEES TAX MATTERS FOR ENTITIES IN THE UVA COMMUNITY HEALTH SYSTEM. THE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE UVA COMMUNITY HEALTH SYSTEM. THE COMMITTEE MEETS BEFORE THE FORM 990S ARE FILED WITH THE IRS AND AFTER ALL BOARD MEMBERS HAVE BEEN PROVIDED A PAPER OR ELECTRONIC COPY OF THE FORM 990 AND A SUMMARY OF ITS CONTENTS. THE VICE PRESIDENT OF TAX AND LEGAL COUNSEL FOR UVA COMMUNITY HEALTH ATTEND THE MEETING TO ANSWER ANY QUESTIONS AND ADDRESS ANY SIGNIFICANT DISCLOSURES WITHIN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C FORM 990, PART VI, SECTION B, LINE 12C: MONITORING AND ENFORCEMENT OF COI THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE QUESTIONNAIRE. THE BEGINNING OF EACH MEETING OF THE BOARD BEGINS WITH VOLUNTARY VERBAL SELF-DISCLOSURE OF ANY CONFLICTS WITH ANY ITEMS ON THE AGENDA. AS ADDITIONAL ISSUES ARISE DURING THE COURSE OF THE MEETING, A SIMILAR SELF-DISCLOSURE IS EXPECTED. CHALLENGES BY PARTICIPANTS ARE ENCOURAGED IF SELF-DISCLOSURES ARE NOT FORTH-COMING. DURING THE COURSE OF DOING BUSINESS, IF CONFLICTS ARE SUSPECTED BY ANYONE, THEY ARE ENCOURAGED TO NOTIFY THE CEO OF THEIR SUSPICIONS. THE CEO WILL INVESTIGATE, EMPLOYING LEGAL COUNSEL AS NECESSARY, AND WILL RESOLVE AS APPROPRIATE. ULTIMATELY IT IS THE RESPONSIBILITY OF THE CEO AND THE CHAIRMAN OF THE BOARD TO ENFORCE THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15A/15B: THE FILING ORGANIZATION IS AN INTEGRAL PART OF UVA COMMUNITY HEALTH INC. ("THE SYSTEM"). UVA COMMUNITY HEALTH INC.'S BOARD PROVIDES A COMPENSATION REVIEW AND APPROVAL PROCESS TO CERTAIN SYSTEM ENTITIES. THE PROCESS IS CONDUCTED BY AN INDEPENDENT AND DISINTERESTED THIRD PARTY. THE INDEPENDENT COMPENSATION CONSULTANT USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE UVA COMMUNITY HEALTH BOARD APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAIN ALL ORGANIZATIONS IN THE UVA COMMUNITY HEALTH SYSTEM ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE EXTENT REQUIRED BY LAW. FORM 990, PART VII: COMPENSATION INFORMATION THE ORGANIZATION IS NOT REPORTING ANY COMPENSATION INFORMATION ON FORM 990, PART VII IN COMPLIANCE WITH THE IRS INSTRUCTIONS FOR SHORT-PERIOD FILERS. FORM 990, PART XI, LINE 9: JOC DIVESTURE 49,792. FORM 990, PART XII: THE ORGANIZATION IS FILING THIS FORM 990 FOR THE SHORT-PERIOD JANUARY 1 THROUGH JUNE 30, 2022. THE ORGANIZATION DID NOT ISSUE AUDITED FINANCIAL STATEMENTS FOR THIS SHORT PERIOD, BUT THE ORGANIZATION WILL HAVE AUDITED FINANCIAL STATEMENTS FOR THE PERIOD JULY 1, 2021 - JUNE 30, 2022. SUCH FINANCIAL STATEMENTS ARE NOT AVAILABLE AT THE TIME OF FILING OF THIS RETURN. 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