2024-05-15T12:17:35-05:00 2023-06-30 366055558 GRANT THORNTON LLP 1000 WILSON BOULEVARD SUITE 1500 ARLINGTON VA 22209 990 2022-07-01 541307595 UVA COMMUNITY HEALTH FOUNDATION PWHF 5712841163 8700 SUDLEY ROAD MANASSAS VA 20110 CHARLES CODER CFO 5712841163 2024-05-15 1 CHARLES CODER XXX-XX-XXXX 1 MARY TORRETTA P00847851 7038477500 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DR FELICIA BLOW 8700 SUDLEY ROAD MANASSAS VA 20110 518745 0 X HTTPS://GIVING.UVAHEALTH.COM/UVACOMMUNITYHEALTH X 1984 VA SEE SCHEDULE O 9 6 0 18 0 0 9706 424170 0 0 0 87675 58617 6900 68323 518745 12284 64981 0 0 0 0 0 0 8500 4010 27172 16294 92153 52029 426592 6870364 7301704 0 4748 6870364 7296956 X SEE SCHEDULE O 0 0 83653 64981 0 UVA COMMUNITY HEALTH FOUNDATION FOCUSES ITS EFFORTS TO RAISE COMMUNITY SUPPORT AND FUNDING THROUGH CHARITABLE GIVING FOR MUCH NEEDED PROGRAMS, IMPROVED FACILITIES, AND STATE OF THE ART TECHNOLOGY FOR UVA COMMUNITY HEALTH, AN INTEGRAL PART OF UVA HEALTH. UVA COMMUNITY HEALTH CONSISTS OF AN INTEGRATED NETWORK OF PRIMARY AND SECONDARY CARE FACILITIES, STAFF, AND MEDICAL CARE TEAMS SERVING COMMUNITIES ACROSS THE GREATER PRINCE WILLIAM, CULPEPER AND WARRENTON GEOGRAPHY, INCLUDING THREE MEDICAL CENTERS (CULPEPER, HAYMARKET, AND PRINCE WILLIAM), A CANCER CARE LOCATION IN GAINESVILLE, AND SEVERAL MEDICAL GROUP CLINIC LOCATIONS. 83653 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 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 1 1 0 0 0 0 0 0 X 9 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X CHARLES CODER 5712841163 8700 SUDLEY ROAD MANASSAS VA 20110 ERIK SHANNON PW CEO & PRES / CEO UCH SYSTEM 0.40 50.00 X 0 923136 2212 DOUGLAS MARKERT MD TRUSTEE / VP, CHIEF CLIN OFF 0.20 50.20 X 0 607809 42444 DONNA STATON TRUSTEE/SYSTEM CEO & CMC PRES 0.40 50.00 X 0 510722 47394 HEATHER ARAM TRUSTEE (THRU 4/23) 0.00 0.20 X 0 63469 1908 IVAN HARANGOZO MD SECRETARY (THRU 7/22) 0.20 0.00 X X 0 0 0 GARY JONES TREASURER 0.20 0.00 X X 0 0 0 MICHAEL PYBUS CHAIR 0.20 0.00 X X 0 0 0 MOLLY GROVE TRUSTEE (THRU 3/23) 0.20 0.00 X 0 0 0 ELIZABETH WARD TRUSTEE 0.20 0.00 X 0 0 0 STEPHEN WARD TRUSTEE 0.20 0.00 X 0 0 0 STEVE DANZIGER TRUSTEE 0.20 1.00 X 0 0 0 AMY KARR TRUSTEE 0.20 0.00 X 0 0 0 CAROLYN HAYS EXECUTIVE DIRECTOR (AS OF 10/22) 45.00 0.00 X 0 0 0 CHARLES CODER CH SYSTEM CFO & TREASURER 0.40 50.00 X 0 617644 45856 KEVIN CALLANAN EXECUTIVE DIRECTOR 45.00 0.00 X 0 109327 0 0 2832107 139814 0 1 1 0 0 9850 224377 189943 424170 87675 87675 6900 9850 0 6900 6900 518745 0 0 94575 X 30000 30000 34981 34981 10108 1608 8500 37 37 17027 17027 92153 83653 0 8500 6813336 548946 0 6752758 79847 79847 0 0 57028 0 6870364 7301704 0 4748 0 4748 X 0 0 0 0 6870364 7296956 6870364 7296956 6870364 7301704 426592 0 X X 0 1 X 0 0 X 210362 185090 28088 9706 353302 786548 210362 185090 28088 9706 353302 786548 127756 658792 62044 47422 13808 0 87675 210949 58617 58617 1056114 0.62380 0.64950 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: CONTRACT REVENUE - 2021 AMOUNT: $ 58,617. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 76232 76232 0 3615 3615 0 0 DUE TO AFFILIATES 4748 4748 1 UVA PRINCE WILLIAM MEDICAL CENTER 8700 SUDLEY ROAD MANASSAS VA 20110 540696355 501(C)(3) 30000 0 SUPPORT FOR UVA PRINCE WILLIAM MEDICAL CENTER 1 MEDICATION 1 169 MAMMOGRAMS 372 34812 PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE FOUNDATION IS AN INTEGRAL PART OF UVA COMMUNITY HEALTH ("UVA COMMUNITY HEALTH"), A NOT-FOR-PROFIT INTEGRATED SYSTEM OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. UVA COMMUNITY HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. UVA COMMUNITY HEALTH HAS ESTABLISHED A SYSTEM-WIDE CORPORATE POLICY WITH STANDARDIZED GUIDELINES THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE FILING ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS ARE MAINTAINED VIA THE GENERAL LEDGER. FUNDS ARE GENERALLY NOT TRACKED AFTER BEING GRANTED, AS THE ORIGINAL ELIGIBILITY AND SELECTION CRITERIA HAVE ALREADY BEEN MET. 0 1 0 0 0 0 0 0 0 ERIK SHANNON PW CEO & PRES / CEO UCH SYSTEM 0 83542 0 145000 0 694594 0 0 0 2212 0 925348 0 0 CHARLES CODER CH SYSTEM CFO & TREASURER 0 349433 0 254781 0 13430 0 17564 0 28292 0 663500 0 0 DOUGLAS MARKERT MD TRUSTEE / VP, CHIEF CLIN OFF 0 373353 0 188886 0 45570 0 18300 0 24144 0 650253 0 0 DONNA STATON TRUSTEE/SYSTEM CEO & CMC PRES 0 302605 0 169742 0 38375 0 15381 0 32013 0 558116 0 0 KEVIN CALLANAN EXECUTIVE DIRECTOR 0 0 0 0 0 109327 0 0 0 0 0 109327 0 0 PART I, LINE 3: UVA COMMUNITY HEALTH, INC. IS THE PARENT ENTITY OF A NOT-FOR-PROFIT INTEGRATED SYSTEM OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS, AND OTHER HEALTHCARE SERVICES PROVIDERS (COLLECTIVELY KNOWN AS "UVA COMMUNITY HEALTH"). UVACH, IN COMBINATION WITH ITS SOLE MEMBER, THE UNIVERSITY OF VIRGINIA MEDICAL CENTER ("THE MEDICAL CENTER"), COMPRISE UVA HEALTH. THE FILING ORGANIZATION IS AN INTEGRAL PART OF UVA COMMUNITY HEALTH AND UVA HEALTH. THE COMPENSATION OF THE UVA COMMUNITY HEALTH CEO IS ESTABLISHED USING A HOLISTIC SET OF COMPENSABLE FACTORS AND VARIABLE PAY OPTIONS INTENDED TO ASSIST WITH THE RECRUITMENT AND RETENTION OF EXCEPTIONAL OR MISSION-CRITICAL EMPLOYEES AND APPROVED BY THE CHIEF EXECUTIVE OFFICER OF UVA HEALTH ON BEHALF OF THE MEDICAL CENTER AND THE RECTOR AND VISITORS OF THE UNIVERSITY OF VIRGINIA. PART I, LINE 4B: SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") PAYMENTS MADE IN 2022 ARE THE FINAL PAYMENTS ATTRIBUTABLE TO PARTICIPATION IN THE PLAN OFFERED BY NOVANT HEALTH, INC. PRIOR TO THE UVA MEDICAL CENTER BECOMING THE SOLE MEMBER OF UVA COMMUNITY HEALTH, INC. ("UVACHI") AND THE INTEGRATION OF UVACHI AND ITS SUBSIDIARIES INTO UVA HEALTH. THE PLAN WAS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES AND TO OFFER COMPETITIVE TOTAL COMPENSATION. ELIGIBLE EXECUTIVES WERE NOMINATED BY THE CEO AND APPROVED BY THE NOVANT HEALTH COMPENSATION AND LEADERSHIP COMMITTEE ("THE COMMITTEE") FOR PARTICIPATION. ANNUAL CONTRIBUTIONS TO THE PLAN WERE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR AND WERE REPORTED IN COLUMN (C) OF SCHEDULE J. PRIOR TO MAKING THE CONTRIBUTIONS, THE COMMITTEE REVIEWED AND APPROVED AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WOULD APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. FOR THE FINAL PAYMENTS LISTED, VESTING OCCURRED ON JANUARY 1, 2022. - DOUGLAS MARKERT, MD: $40,570 ERIK SHANNON SERVED AS AN INDEPENDENT CONTRACTOR FROM JANUARY THROUGH NOVEMBER BEFORE BEING HIRED AS A FULL TIME EMPLOYEE, THIS PAYMENT IS REFLECTED IN SCHEDULE J, PART II, COLUMN (BIII). FORM 990, PART I, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES UVA COMMUNITY HEALTH FOUNDATION PROVIDES PHILANTHROPIC SUPPORT FOR ALL AREAS OF UVA COMMUNITY HEALTH, AN INTEGRAL PART OF UVA HEALTH. UVA COMMUNITY HEALTH CONSISTS OF AN INTEGRATED NETWORK OF PRIMARY AND SECONDARY CARE FACILITIES, STAFF, AND MEDICAL CARE TEAMS SERVING COMMUNITIES ACROSS THE GREATER PRINCE WILLIAM, CULPEPER AND WARRENTON GEOGRAPHY, INCLUDING THREE MEDICAL CENTERS (CULPEPER, HAYMARKET, AND PRINCE WILLIAM), A CANCER CARE LOCATION IN GAINESVILLE, AND SEVERAL MEDICAL GROUP CLINIC LOCATIONS. THE FOUNDATION SUPPORTS PEOPLE, PROGRAMS, CAPITAL NEEDS AND SERVICES WITHIN UVA COMMUNITY HEALTH, PROVIDING EXPANDED TREATMENT AND PREVENTION OPTIONS. THE FOUNDATION ALSO PROVIDES MISSION-ALIGNED GRANTS TO SUPPLEMENT HEALTHCARE AND PREVENTION PROGRAMS FOR UNDERSERVED PATIENTS. THE FOUNDATION'S DIVERSE BOARD OF COMMUNITY LEADERS IN PRINCE WILLIAM AND CULPEPER PROVIDES STEWARDSHIP AND OVERSIGHT OF THE ORGANIZATION'S OPERATIONS AND ACTIVITIES. COMMUNITY OUTREACH COMMUNITY OUTREACH IS A CRITICAL COMPONENT TO THE MISSION OF THE FOUNDATION. FUNDRAISING FROM INDIVIDUALS AND COMMUNITY PARTNERS HELP ENSURE THAT OUR PATIENTS CAN ACCESS WORLD-CLASS CLINICIANS, CARE AND TECHNOLOGY. EVENTS SUCH AS THE FRIENDS OF THE FOUNDATION GOLF TOURNAMENT AND PAMPER ME PINK RAISE FUNDS SPECIFICALLY FOR ENHANCED CANCER PATIENT CARE AND MENTAL HEALTH SUPPORT IN OUR COMMUNITIES. IN FISCAL YEAR 2023, FOUNDATION FUNDS PROVIDED FREE MAMMOGRAM SERVICES, PATIENT TRANSPORTATION, DURABLE MEDICAL EQUIPMENT, AND PROFESSIONAL EDUCATION SUPPORT FOR HEALTHCARE PROVIDERS. LEARN MORE ABOUT HOW GIFTS THROUGH UVA COMMUNITY HEALTH FOUNDATION SAVE AND IMPROVE THE LIVES OF THOSE IN THE COMMUNITIES WE SERVE, VISIT HTTPS://GIVING.UVAHEALTH.COM/UVACOMMUNITYHEALTH 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: RESPONSIBILITY AND CAREFULLY MANAGING OUR RESOURCES AND COMMITMENT TO CONTINUAL IMPROVEMENT AND LEARNING WHILE ACKNOWLEDGINGSHORTCOMINGS OR PROBLEMS IN OUR QUEST. - PROFESSIONALISM: APPROACHING ALL THAT WE DO IN A COLLABORATIVE WAYAND 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 2 FORM 990, PART VI, SECTION A, LINE 2: FAMILY OR BUSINESS RELATIONSHIPS ELIZABETH WARD AND STEPHEN WARD - FAMILY RELATIONSHIP 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, UVA PRINCE WILLIAM HEALTH SYSTEM 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, UVA PRINCE WILLIAM HEALTH SYSTEM HAS THE POWER TO APPOINT ALL MEMBERS OF THE GOVERNING BODY. 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, UVA PRINCE WILLIAM HEALTH SYSTEM 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 REVIEW OF THE 990 IS PERFORMED BY THE CHIEF FINANCIAL OFFICER. ALL BOARD MEMBERS HAVE RECEIVED A COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS. 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. ANNUALLY, ALL TRUSTEES ARE SENT A COPY OF THE CONFLICT OF INTEREST POLICY AND RECEIVE INSTRUCTION ON HOW TO DISCLOSE A CONFLICT OF INTEREST. AT THAT TIME, THEY MUST COMPLETE AN ATTESTATION STATEMENT AFFIRMING THEIR ADHERANCE TO THE POLICY. A SUPPLEMENTAL QUESTIONNAIRE IS SENT OUT ANNUALLY THAT INFORMS CERTAIN OF THE FORM 990 DISCLOSURES. IF THE TRUSTEE DISCLOSES A CONFLICT OF INTEREST, THEY MUST RECUSE THEMSELVES FROM DISCUSSIONS AND DELIBERATIONS RELATED TO THE CONFLICTED TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE UVA COMMUNITY HEALTH SYSTEM, INCLUDING THE FILING ORGANIZATION, ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE EXTENT REQUIRED BY LAW. FORM 990, PART IX, LINE 11G NH DEVELOPMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 8,500. TOTAL EXPENSES 8,500. BANK CHARGES: PROGRAM SERVICE EXPENSES 1,608. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,608. FORM 990, PART XII: THE UNIVERSITY OF VIRGINIA MEDICAL CENTER ("THE MEDICAL CENTER") BECAME THE SOLE MEMBER OF UVA COMMUNITY HEALTH, INC. ("UVACHI") EFFECTIVE JULY 1, 2021. AS A RESULT, UVACHI, AND ITS SUBSIDIARIES, INCLUDING THIS FILING ORGANIZATION, BECAME A FULLY OWNED BLENDED COMPONENT UNIT OF THE MEDICAL CENTER, A COMPONENT UNIT OF THE UNIVERSITY OF VIRGINIA HEALTH SYSTEM. THE MEDICAL CENTER IS A DIVISION OF THE UNIVERSITY OF VIRGINIA, A GOVERNMENTAL ENTITY. HISTORICALLY, THE ORGANIZATION'S FORM 990 PRESENTATION REFLECTED THE STANDARDS FOR GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AS PRESCRIBED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB). AFTER JULY 2021, AS A COMPONENT UNIT OF A GOVERNMENTAL ENTITY, THE STANDARDS FOR GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) ARE PRESCRIBED BY THE GOVERNMENTAL ACCOUNTING STANDARDS BOARD (GASB) FOR PROVIDERS OF HEALTHCARE SERVICES AND THE FORM 990 REFLECTS THAT CHANGE. UVA CULPEPER MEDICAL CENTER 501 SUNSET LANE CULPEPER VA 22701 540622371 HEALTHCARE VA 501(C)(3) LINE 3 UVA COMMUNITY HEALTH INC 0 UVA CATON MERCHANT HOUSE ASSISTED LIVING 8700 SUDLEY RD MANASSAS VA 20110 541291284 HEALTHCARE VA 501(C)(3) LINE 10 UVA PRINCE WILLIAM HEALTH SYSTEM 0 UVA PRINCE WILLIAM HEALTH SYSTEM 8700 SUDLEY RD MANASSAS VA 20110 541278944 HEALTHCARE VA 501(C)(3) LINE 12C, III-FI UVA COMMUNITY HEALTH INC 0 UVA COMMUNITY HEALTH INC 8700 SUDLEY RD MANASSAS VA 20110 810868533 HEALTHCARE VA 501(C)(3) LINE 12A, I UVA MEDICAL CENTER 0 UNIVERSITY OF VIRGINIA MEDICAL CENTER 1201 LEE STREET CHARLOTTESVILLE VA 22902 546001796 HEALTHCARE/HIGHER ED VA 501(C)(3) LINE 6 N/A 0 UVA PRINCE WILLIAM MEDICAL CENTER 8700 SUDLEY RD MANASSAS VA 20110 540696355 HEALTHCARE VA 501(C)(3) LINE 3 UVA PRINCE WILLIAM HEALTH SYSTEM 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0