2025-05-15T13:29:49-05:00 2024-06-30 991856619 GRANT THORNTON ADVISORS LLC 1000 WILSON BOULEVARD SUITE 1500 ARLINGTON VA 22209 990 2023-07-01 540696355 UVA PRINCE WILLIAM MEDICAL CENTER UVAP 5712841163 8700 SUDLEY ROAD MANASSAS VA 20110 CHARLES CODER CFO 5712841163 2025-05-15 1 1 MARY TORRETTA P00847851 7038477500 2023 2025-03-06 01:10:19Z UVA HEALTH PRINCE WILLIAM MEDICAL CENTER L ERIK SHANNON 8700 SUDLEY ROAD MANASSAS VA 20110 391090020 0 X WWW.UVAHEALTH.COM X 1964 VA SEE SCHEDULE O 12 9 1855 346 0 0 856682 79031 318283818 383067612 440685 201394 2736133 5459038 322317318 388807075 188320 267607 0 0 132090986 144965626 0 0 0 188807249 226223945 321086555 371457178 1230763 17349897 239486817 244663769 36180767 26266670 203306050 218397099 X SEE SCHEDULE O 0 0 343741838 267607 386082804 UVA PRINCE WILLIAM MEDICAL CENTER IS MADE UP OF TWO NON-PROFIT, ACUTE CARE HOSPITALS DOING BUSINESS AS UVA PRINCE WILLIAM MEDICAL CENTER ("UVAPMC") AND UVA HAYMARKET MEDICAL CENTER ("UVAHMC"). UVAPMC HAS 130 BEDS AND IS LOCATED IN MANASSAS, VA. UVAHMC IS 60 BEDS AND IS LOCATED IN HAYMARKET, VA. TOGETHER THEY PROVIDE PROGRAMS AND ACTIVITIES THAT PROVIDE ACCESS TO HEALTHCARE AND IMPROVE HEALTH IN OUR COMMUNITY. THEY PROVIDE COMPREHENSIVE SERVICES PROVIDING 24-HOUR, PHYSICIAN STAFFED EMERGENCY DEPARTMENT, FAMILY BIRTH CENTERS, SURGICAL SERVICES, INTENSIVE CARE UNITS AND MORE. OUR MISSION IS TO HELP PEOPLE ACHIEVE AND MAINTAIN OPTIMAL HEALTH BY PROVIDING THE BEST POSSIBLE HEALTHCARE SERVICES. WE ALWAYS MAKE THE NEEDS OF OUR PATIENTS OUR TOP PRIORITY. UVAPMC AND UVAHMC PROVIDE MEDICAL AND OTHER HEALTHCARE (SEE SCHEDULE O)SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ALL UNINSURED PATIENTS, REGARDLESS OF INCOME LEVEL OR COUNTY OF RESIDENCE, RECEIVE A 40% DISCOUNT ON HOSPITAL SERVICES. WE ALSO PARTNER WITH LOCAL NON-PROFIT AND GOVERNMENTAL ORGANIZATIONS TO SUPPORT LOCAL EVENTS AND PROVIDE HEALTH AND WELLNESS PROGRAMS. UVAPMC AND UVAHMC WORK WITH LOCAL HIGH SCHOOLS AND COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS.DURING FISCAL YEAR 2024, BETWEEN THE TWO MEDICAL CENTERS, THERE WERE 48,567 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 4 DAYS. THERE WERE 10,473 DISCHARGES, 8,608 INPATIENT AND OUTPATIENT SURGERIES, 91,835 OUTPATIENT ENCOUNTERS AND 84,799 EMERGENCY DEPARTMENT VISITS. 343741838 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 1855 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X CHARLES CODER 5712841163 8700 SUDLEY ROAD MANASSAS VA 20110 CHRIS HEATON MD TRUSTEE (PWHS EMPLOYEE) 0.20 45.20 X 0 445044 57766 MARY FRANCES SOUTHERLAND INTERIM SECRETARY/TRUSTEE 0.20 50.20 X X 0 480964 41702 KIRSTEN GREEN MD TRUSTEE 0.20 45.00 X 0 980161 59299 STEVEN M DANZIGER CHAIR 0.20 1.00 X X 0 0 0 CHARLES BARRELL VICE CHAIR (THRU 11/2023) 0.20 0.60 X X 0 0 0 RICHARD HARRINGTON SECRETARY/VICE CHAIR 0.20 0.60 X X 0 0 0 STEPHEN NELSON TREASURER 0.20 0.60 X X 0 0 0 LISA ANN PEACOCK TRUSTEE 0.20 0.60 X 0 0 0 MATTHEW GUILFOYLE TRUSTEE 0.20 0.60 X 0 0 0 PAM KINCHELOE RN JD TRUSTEE 0.20 0.60 X 0 0 0 JACQUELINE KRICK TRUSTEE 0.20 0.60 X 0 0 0 MICHELLE METZGAR TRUSTEE 0.20 0.60 X 0 0 0 VIPUL PARIKH MD TRUSTEE 0.20 0.60 X 0 0 0 ERIK SHANNON CEO (UVACH SYSTEM) 0.20 50.00 X 715381 0 336325 CHARLES CODER CFO (UVACH SYSTEM) 0.40 50.00 X 450817 40554 52293 CAROLYN MATTHEWS OB GYN ONCOLOGIST 45.00 0.00 X 304619 0 16661 KELI WILSON PHYSICIST 45.00 0.00 X 285059 0 30705 ZAN ZAIDI VP, CMO 0.00 50.00 X 455958 0 44207 JOSEPH SCOTT HAAS ASSOCIATE CMIO 45.00 0.00 X 334487 0 53199 CATHERINE KELLEY VP CHRO (UVACH SYSTEM) 0.00 50.00 X 265288 0 36299 STEPHEN SMITH MD FORMER PRESIDENT/COO 0.00 0.00 X 102010 0 0 DOUGLAS MARKERT VP, CHIEF CLINICAL OFFICER 0.20 50.00 X 469137 0 39834 3382756 1946723 768290 330 1 1 0 BLUE RIDGE ORTHOPAEDIC ASSOCIATES PC 52 WEST SHIRLEY AVENUE WARRENTON VA 20186 ORTHOPAEDIC SERVICES 113310 1 79031 79031 NET PATIENT REVENUE 622110 383039122 383039122 OTHER HEALTHCARE REV. 622110 28490 28490 383067612 259678 259678 2406270 224661 2181609 2181609 2181609 2000000 2058284 -58284 -58284 -58284 EQUITY IN SUBSIDIARIES 900099 2824958 2824958 AUXILIARY REVENUE 900099 262237 262237 MISCELLANEOUS REVENUE 900099 190234 190234 3277429 388807075 386082804 0 2645240 X 267607 267607 1536386 1536386 102010 102010 114378410 105228137 9150273 4954316 4557971 396345 14245573 13105927 1139646 9748931 8969017 779914 63807527 55945691 7861836 6989548 5032475 1957073 694742 680847 13895 3852303 3274458 577845 42809 33391 9418 165152 128819 36333 5521018 5521018 15003575 11852824 3150751 3478313 2539168 939145 MEDICAL SUPPLIES 48989433 48989433 BAD DEBT 34628171 34628171 CORPORATE ALLOCATION 23045927 23045927 PHARMACEUTICALS 10664588 10664588 9340839 9276369 64470 371457178 343741838 27715340 0 100776 414256 15322779 4841709 38811465 40918023 2415227 651863 6441639 6232884 4486208 1623199 476931762 337950943 139440118 138980819 731417 0 2625489 4546105 0 8744 29111699 46446167 239486817 244663769 20935960 9011049 9373200 13614244 5871607 3641377 36180767 26266670 X 0 0 0 0 203306050 218397099 203306050 218397099 239486817 244663769 X 17349897 102180 -2361028 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 21829 0 0 21829 0 PART II-B, LINE 1: LINE 1G: A PORTION OF ONE INDIVIDUAL'S SALARY IS ALLOCATED TO LOBBYING ACTIVITIES. 14323010 14323010 225592011 206522156 19069855 5013719 5013719 0 184180576 119549173 64631403 47822446 6865895 40956551 138980819 DUE FROM THIRD PARTIES 30536274 LEASE RECEIVABLE 9233676 RIGHT-OF-USE ASSET 4578634 DEFERRED PENSION COSTS 1897583 DUE FROM AFFILIATES 200000 46446167 DUE TO AFFILIATES 2401582 OTHER LIABILITIES 1239795 3641377 1 1 X 1 X 1 X 0 1 1 0 0 15318730 13337660 1981070 0.00590 58463047 56709155 1753892 0.00520 73781777 70046815 3734962 0.01110 183647 183647 0.00050 909569 40273 869296 0.00260 5168797 2498282 2670515 0.00800 190431 190431 0.00060 6452444 2538555 3913889 0.01170 80234221 72585370 7648851 0.02280 1602 1602 0.00000 1186 1186 0.00000 10177 10177 0.00000 12965 12965 0.00000 0 34628171 0 55626017 87224614 -31598597 X 1 1 1 NOVANTUVAUSP SURGERY CENTERS LLC HEALTHCARE 0.25000 0.00000 0.49000 2 1 UVAPWMC DBA UVA HEALTH PRINCE WILLIAM MEDICAL CENTER 8700 SUDLEY ROAD MANASSAS VA 20110 SEE SUPPLEMENTAL INFORMATION H1882 X X X A 2 UVAHMC DB UVA HEALTH HAYMARKET MEDICAL CENTER 15225 HEATHCOTE BLVD HAYMARKET VA 20169 SEE SUPPLEMENTAL INFORMATION H1938 X X X A UVA PRINCE WILLIAM MEDICAL CENTER 0 0 1 X X X X X X X X 22 1 0 0 1 X HTTPS://UVAHEALTH.COM/SERVICES/COMMUNITY-RELATIONS X X 1 22 1 HTTPS://UVAHEALTH.COM/SERVICES/COMMUNITY-RELATIONS 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X 1 X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X 1 X 0 X X X 1 X 0 0 PART V, SECTION A: LINE 1: HOSPITAL FACILITIES INFORMATIONHTTPS://UVAHEALTH.COM/LOCATIONS/PRINCE-WILLIAM-MEDICAL-CENTER-5597282LINE 2: HOSPITAL FACILITIES INFORMATIONHTTPS://UVAHEALTH.COM/LOCATIONS/UVA-HEALTH-HAYMARKET-MEDICAL-CENTER-5597284 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: UVAPWMC DBA UVA HEALTH PRINCE WILLIAM MEDICAL , - FACILITY 2: UVAHMC DB UVA HEALTH HAYMARKET MEDICAL CENTER UVA PRINCE WILLIAM MEDICAL CENTER PART V, SECTION B, LINE 5: WHILE CONDUCTING THE CHNA, THE HOSPITAL FACILITY SOLICITED INPUT FROM, AND CONSULTED WITH, A VARIETY OF COMMUNITY REPRESENTATIVES INCLUDING, BUT NOT LIMITED TO, REPRESENTATIVES OF CITY AND COUNTY GOVERNMENT INCLUDING HEALTH DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, AND OTHER SOCIAL SERVICE AGENCIES. INPUT WAS GATHERED THROUGH A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY AND DATA FROM THE VIRGINIA DEPARTMENT OF HEALTH. THE SCOPE OF EXPERTISE WAS BROAD AND INCLUDED SUCH AREAS AS PUBLIC HEALTH, MINORITY POPULATIONS, HEALTH DISPARITIES, AND SOCIAL SERVICES. WHERE POSSIBLE, WE HAVE LEVERAGED THE RESOURCES OF THE ORGANIZATION TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY AND CONSISTENT ACROSS COMMUNITIES. UVA PRINCE WILLIAM MEDICAL CENTER PART V, SECTION B, LINE 7D: COMMUNITY PARTNERS ARE PROACTIVELY NOTIFIED AND MADE AWARE OF THE AVAILABILITY OF THE CHNA, THE CBIP, AND FAP INFORMATION AND COPIES ARE AVAILABLE AT VARIOUS COMMUNITY EVENTS THAT SUPORT OUR EFFORTS TO ADDRESS THE IDENTIFIED NEEDS AND TO SUPPORT OUR COMMUNITIES IN GENERAL. UVA PRINCE WILLIAM MEDICAL CENTER PART V, SECTION B, LINE 11: THE HOSPITAL FACILITY IS PART OF THE UVA COMMUNITY HEALTH ENTERPRISE, AN INTEGRATED NETWORK OF NOT-FOR-PROFIT, TAX-EXEMPT ENTITIES THAT INCLUDES PHYSICIAN OFFICES, OUTPATIENT FACILITIES AND COMMUNITY MEDICAL CENTERS. UVA COMMUNITY HEALTH AND ITS COMPONENT ENTITIES, ALONG WITH THE UNIVERSITY OF VIRGINIA MEDICAL CENTER, THE UVA SCHOOL OF MEDICINE, UVA SCHOOL OF NURSING, UVA PHYSICIANS GROUP, AND THE CLAUDE MOORE HEALTH SCIENCES LIBRARY, COMPRISE UVA HEALTH. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE COMMUNITY ENGAGEMENT TEAM, THE ORGANIZATION'S EXECUTIVE LEADERSHIP TEAM, AND SUBSEQUENTLY THE BOARD. UVA COMMUNITY HEALTH, INC. AND EACH OF ITS HOSPITAL FACILITIES HAVE ADOPTED AND EXECUTED AN IMPLLEMENTATION STRATEGY THAT ADDRESSES THE PRIORITIZEIED COMMUNITY HEALTH NEEDS FORM THE CHNAS. NEEDS WERE EVALUATED BASED ON THE FACILITY'S SCOPE OF SERVICE, EXPERTISE, AVAILABILITY OF RESOURCES, AND THE FACILITY'S ABILITY TO IMPACT OVERALL POPULATION HEALTH. THE HOSPITAL FACILITY HAS ADOPTED AND EXECUTED AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE PRIORITIZED COMMUNITY HEALTH NEEDS FROM THE CHNA. THE IMPLEMENTATION STRATEGY OUTLINES THE ACTIVITIES THAT THE HOSPITAL FACILITY(IES) WILL UNDERTAKE TO MEET THOSE HEALTH NEEDS IN EACH OF ITS COMMUNITIES. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. CERTAIN OF THE NEEDS NOT ADDRESSED FALL OUTSIDE THE SCOPE OF TRADITIONAL HEALTHCARE (I.E. QUALITY OF EDUCATION) AND OTHERS ARE CANDIDATES FOR COLLABORATIVE WORK AND HAVE OTHER OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND SKILL SET. FOR MORE DETAILED INFORMATION, REFER TO THE TO THE URL GIVEN PREVIOUSLY FOR THE POSTING OF THE INFORMATION. PART V, LINE 16A, FAP WEBSITE:HTTPS://UVAHEALTH.COM/SERVICES/BILLING-INSURANCE/FINANCIAL-ASSISTANCE-INFORMATION/UVACH-POLICYPART V, LINE 16B, FAP APPLICATION:HTTPS://UVAHEALTH.COM/SERVICES/BILLING-INSURANCE/FINANCIAL-AIDPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY:HTTPS://UVAHEALTH.COM/SERVICES/BILLING-INSURANCE/UVACH-FINANCIAL-ASSISTANCE-SUMMARY UVA PRINCE WILLIAM MEDICAL CENTER PART V, SECTION B, LINE 20D: THE FILING ORGANIZATION IS A COMPONENT PART OF UVA HEALTH. UVA HEALTH, IN PARTICULAR, ITS MEDICAL CENTER, A GOVERNMENTAL ENTITY, IS SUBJECT TO GUIDANCE ISSUED BY THE STATE OF VIRGINIA. THE FINANCIAL ASSISTANCE GUIDELINES ARE APPROVED BY THE STATE OF VIRGINIA ANNUALLY. THE ABILITY TO PERFORM AND PROVIDE PRESUMPTIVE ELIGIBILITY HAS BEEN REQUESTED FROM THE STATE, BUT HAS NOT BEEN GRANTED TO DATE. 4 1 - UVA HEALTH IMAGING HAYMARKET MED CTR 15195 HEATHCOTE BLVD STE 110 HAYMARKET VA 20169 IMAGING CENTER 2 - HAYMARKET SURGERY CENTER LLC 15225 HEATHCOTE BLVD HAYMARKET VA 20169 AMBULATORY SURGERY CENTER 3 - PRINCE WILLIAM AMBULATORY SURGERY CTR 8650 SUDLEY ROAD SUITE 411 MANASSAS VA 20110 AMBULATORY SURGERY CENTER 4 - UVA HEALTH THERAPY SERVICES 15195 HEATHCOTE BLVD STE 340 HAYMARKET VA 20169 REHABILITATION SERVICES PART I, LINE 3C: OTHER CRITERIA BESIDES INCOME AND FPG USED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE INCLUDE WHETHER THE PATIENT HAS ANY OF THE FOLLOWING ASSETS VALUED IN EXCESS OF $50,000: BANK, INVESTMENT, AND RETIREMENT ACCOUNTS; LIFE INSURANCE (CASH TO LOAN VALUE); REAL PROPERTY OR PERSONAL PROPERTY SUCH AS HOMES (PRIMARY/SECONDARY), CAMPERS, OR MOBILE HOMES, VEHICLES, RECREATIONAL VEHICLES, BOATS; ALSO CONSIDERED, THE LIQUIDATED VALUE OF LAND (INCLUDING FARMLAND). PART I, LINE 4:THE FILING ORGANIZATION'S FAP DOES NOT ADDRESS MEDICAL INDIGENCY. HOWEVER, THE ORGANIZATION HAS A CATASTROPHIC DISCOUNT POLICY THAT APPLIES TO EMERGENCY CARE AND LIMITS AMOUNTS OWED TO NO MORE THAN 25% OF A FAMILY'S INCOME AND ASSETS. PART I, LINE 7: COSTS REPORTED IN THE TABLE FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (CCR). PART I, LINE 7, COLUMN (F): THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $34,628,171. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESS THE UNDERLYING CAUSES OF HEALTH PROBLEMS AND IMPACTS THE HEALTH OF OUR COMMUNITY THROUGH PARTNERSHIPS WITH LOCAL AGENCIES DEDICATED TO IMPROVING THE LIVES OF ALL INDIVIDUALS. OUTREACH INCLUDES PROVIDING SUPPORT TO ORGANIZATIONS SUCH AS CHAMBERS OF COMMERCE AND OTHER LOCAL COMMUNITY ORGANIZATIONS, AND PROVIDING EDUCATION SCHOLARSHIPS AND TRAINING FOR COMMUNITY WORKFORCES. PART III, LINE 2: BAD DEBT IS DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS, AND ECONOMIC CONDITIONS, THE AGE OF THE ACCOUNTS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PART III, LINE 3: THE ESTIMATED AMOUNT IS ZERO DOLLARS BASED ON FAP ELIGIBILITY. PART III, LINE 4: THE ORGANIZATION FILES ITS FINANCIAL STATEMENTS ON A GASB METHOD OF ACCOUNTING WHICH DO NOT SPECIFICALLY ADDRESS BAD DEBT. FOR FURTHER INFORMATION, SEE RESPONSE TO LINE 2. PART III, LINE 8: THE METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS DETERMINED BY FOLLOWING THE MEDICARE PRINCIPLES OF ALLOWABLE COSTS. COST FOR THE OVERHEAD DEPARTMENTS ARE STEPPED DOWN TO THE REMAINING COST CENTERS BASED ON STATISTICS FOR EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A COST TO CHARGE RATIO ("CCR") IS DEVELOPED FOR EACH COST CENTER. THE CCR IS THEN APPLIED TO THE MEDICARE REVENUE BY COST CENTER AND TOTALED.IT SHOULD BE NOTED THAT THE MEDICARE COST REPORTS DO NOT ADDRESS ANY MANAGED CARE MEDICARE REVENUES, COSTS, OR RELATED SHORTFALL. THE TOTAL REVENUES REPORTED AS RECEIVED FROM MEDICARE IN LINE 5 OF SECTION B ARE ONLY REPRESENTATIVE OF MEDICARE FEE FOR SERVICE PAYMENTS RECEIVED. THE ALLOWABLE COSTS ON LINE 6 ARE SIGNIFICANTLY LOWER THAN THE ACTUAL EXPENDITURES. AS SUCH, THE SHORTFALL IS UNDERESTIMATED.EVERY HOSPITAL TREATS MEDICARE PATIENTS. SOME HOSPITALS ARE LOCATED IN HIGH MEDICARE POPULATION AREAS; OTHERS PROVIDE SERVICES DISPROPORTIONATELY USED BY MEDICARE PATIENTS. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THIS SERVICE THESE PATIENTS WOULD BECOME AN OBLIGATION ON THE GOVERNMENT. ANY UNREIMBURSED COSTS OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: THE FILING ORGANIZATION HAS A POLICY THAT OUTLINES PROCEDURES THE HOSPITALMAY TAKE FOR NONPAYMENT INCLUDING INTERNAL AND EXTERNAL COLLECTIONPRACTICES AND REPORTING TO CREDIT AGENCIES. THE POLICY STATES THATREASONABLE EFFORTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE MUSTBE MADE BEFORE THE ORGANIZATION, OR ANY EXTERNAL ORGANIZATION, ENGAGE INAN EXTRAORDINARY COLLECTION ACTION.FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND WHO ARE COOPERATINGIN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, THE ORGANIZATIONMAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDECOLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS. PART VI, LINE 2: THE HOSPITAL FACILITY IS PART OF THE UVA COMMUNITY HEALTH ENTERPRISE, AN INTEGRATED NETWORK OF NOT-FOR-PROFIT, TAX-EXEMPT ENTITIES THAT INCLUDES PHYSICIAN OFFICES, OUTPATIENT FACILITIES AND COMMUNITY MEDICAL CENTERS. UVA COMMUNITY HEALTH AND ITS COMPONENT ENTITIES, ALONG WITH THE UNIVERSITY OF VIRGINIA MEDICAL CENTER, THE UVA SCHOOL OF MEDICINE, UVA SCHOOL OF NURSING, UVA PHYSICIANS GROUP, AND THE CLAUDE MOORE HEALTH SCIENCES LIBRARY, COMPRISE UVA HEALTH. UVA COMMUNITY HEALTH HAS A COMMUNITY ENGAGEMENT (CE) TEAM RESPONSIBLE FOR COORDINATING THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) FOR EACH HOSPITAL WITHIN THE SYSTEM.THE CE TEAM WORKS TO IDENTIFY ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY THAT CONTRIBUTE TO THE PROCESS. THESE ORGANIZATIONS AND RESOURCES INCLUDE PUBLIC HEALTH DEPARTMENTS, LOCAL COMMUNITY COALITIONS REPRESENTING THE MEDICALLY UNDERSERVED, UNITED WAY, LOCAL UNIVERSITIES, ETC. COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY ARE USED IN COMBINATION WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO PREPARE THE HOSPITAL'S CHNA. THROUGH PARTNERSHIPS WITH OTHER COMMUNITY ORGANIZATIONS, WE ARE ABLE TO DRAW INFERENCE OF THE NEEDS NOT MET WITHIN THE IMMEDIATE COMMUNITIES WE SERVE, AND MEET AND EXCEED THOSE COMMUNITY MEMBER'S NEEDS. IN ADDITION TO ADDRESSING NEEDS IDENTIFIED THROUGH THE CHNA, EACH HOSPITAL MAY RESPOND TO REQUESTS FOR SPECIFIC COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS. ORGANIZATIONAL PARTNERSHIPS ESTABLISHED BY THE COMMUNITY ENGAGEMENT TEAM ARE OFTEN LEVERAGED TO ADDRESS NEEDS THAT WERE IDENTIFIED IN THE CHNA, BUT WERE UNADDRESSED BY THE FACILITY IMPLEMENTATION PLAN. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEUVA PRINCE WILLIAM MEDICAL CENTER HAS SEVERAL WAYS THAT IT INFORMS AND EDUCATES PATIENTS WHO MAY BE IN NEED AND ARE ELIGIBLE FOR ASSISTANCE. WHEN STAFF (CASHIER, FINANCIAL COUNSELOR, AND REGISTRARS) ARE SPEAKING WITH A PATIENT THAT STATES THEY ARE NOT ABLE TO PAY, THE PATIENT IS ENCOURAGED TO APPLY FOR FINANCIAL ASSISTANCE. BROCHURES DESCRIBING THE FINANCIAL ASSISTANCE POLICY ARE PLACED IN OUR BILLING STATEMENTS, AS WELL AS THE APPLICABLE POVERTY GUIDELINES FOR QUALIFYING FOR FINANCIAL ASSISTANCE. INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN PROMINENT AREAS OF THE HOSPITALS INCLUDING THE EMERGENCY ROOMS, ADMISSIONS AND FINANCIAL COUNSELING. FINANCIAL COUNSELORS WORK WITH PATIENTS TO IDENTIFY AND APPLY FOR BENEFITS SUCH AS MEDICAID AND OTHER GOVERNMENT PROGRAMS.THE HOSPITAL'S WEBSITE POSTS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND GUIDELINES FOR APPLYING. AT THE POINT OF SCHEDULING, WE RUN ALL PATIENTS THROUGH A 3RD PARTY SERVICE TO DETERMINE POTENTIAL ELIGBILITY FOR FINANCIAL ASSITANCE BASED UPON AN ESTIMATED FPG PROVIDED BY THE VENDOR. WHEN POTENTIALLY ELIGIBLE PATIENTS ARE IDENTIFIED WE MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT AND ENCOURAGE COMPLETING IT. PART VI, LINE 4: COMMUNITY INFORMATIONUVA PRINCE WILLIAM MEDICAL CENTER FORM 990 INCLUDES THE OPERATIONS OF TWO LICENSED HOSPITAL: UVAPWMC DBA UVA HEALTH PRINCE WILLIAM MEDICAL CENTER AND AS UVAHMC DBA UVA HEALTH HAYMARKET MEDICAL CENTER.UVAPMCTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA FOR UVA PRINCE WILLIAM MEDICAL CENTER IS DEFINED BY THE ZIP CODES THAT REPRESENT MORE THAN 75% OF THE HOSPITAL'S INPATIENT POPULATION. THIS INCLUDES THE CITY OF MANASSAS, CITY OF MANASSAS PARK, PRINCE WILLIAM COUNTY, BRISTOW, AND GAINESVILLE, ALL LOCATED IN GREATER PRINCE WILLIAM.THE SECONDARY SERVICE AREA FOR UVA PRINCE WILLIAM MEDICAL CENTER COVERS A FOUR-COUNTY RADIUS, INCLUDING: CULPEPER, FAIRFAX, FAUQUIER AND WARRENTON COUNTIES IN VIRGINIA.UVAHMCTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA FOR UVA HAYMARKET MEDICAL CENTER IS DEFINED BY THE ZIP CODES THAT REPRESENT MORE THAN 75% OF THE HOSPITAL'S IN-PATIENT POPULATION. THIS INCLUDES THE CITY OF MANASSAS, BRISTOW, AND GAINESVILLE, HAYMARKET, NOKESVILLE, AND WARRENTON, ALL LOCATED WITHIN PRINCE WILLIAM COUNTY, MANASSAS CITY, AND FAUQUIER COUNTY.THE SECONDARY SERVICE AREA FOR UVA HAYMARKET MEDICAL CENTER COVERS FOUR COUNTIES, INCLUDING CULPEPER, FAIRFAX, LOUDOUN AND WARREN COUNTIES IN VIRGINIA.PRINCE WILLIAM COUNTY IS THE 10TH MOST DIVERSE COUNTY IN THE U.S. IT IS MORE URBAN IN NATURE. THE COUNTY CONSISTS OF A LARGE URBAN CENTER SURROUNDED BY SMALLER, MORE RURAL COMMUNITIES AND IS PART OF THE WASHINGTON ARLINGTON ALEXANDRIA METROPOLITAN STATISTICAL AREA. BASED ON 2021 CENSUS, PRINCE WILLIAM COUNTY REMAINED THE SECOND-MOST POPULOUS COUNTY IN THE STATE OF VIRGINIA WITH MORE THAN 540,000 RESIDENTS. THE CITY OF MANASSAS HAS AN ESTIMATED POPULATION OF 41,723 RESIDENTS. THE CITY OF MANASSAS PARK ESTIMATED POPULATION IS 17,095 AND PRINCE WILLIAM COUNTY'S POPULATION IS ESTIMATED AT 465,243 RESPECTIVELY. PRINCE WILLIAM COUNTY AND THE CITY OF MANASSAS HAVE EXPERIENCED STEADY POPULATION GROWTH. REGIONAL POPULATION PROJECTIONS ESTIMATE CITY OF MANASSAS WILL GROW 17%. AMD PRINCE WILLIAM COUNTY WILL GROW 41% BY 2040. CHILDREN UNDER 18 YEARS OLD MAKE UP ONE-FOURTH (25%) OF THE POPULATION IN GREATER PRINCE WILLIAM COUNTY. SENIORS MAKE UP 11.3% OF AND 11.2% OF THE POPULATION IN THE CIY OF MANASSAS AND PRINCE WILLIAM COUNTY, RESPECTIVELY. FAUQUIER COUNTY'S 65AND OLDER POPULATION IS HIGHER THAN THE STATE AVERAGE AT 18.3%. MEDIAN AGE CONTINUES TO INCREASE, AND WE CAN SEE A SHIFT IN THE POPULATION FROM ADOLESCENTS TO SENIORS AS OUR POPULATION CONTINUES TO AGE. THIS TREND MAY PUT A STRAIN ON HEALTHCARE SERVICES IN PRINCE WILLIAM COUNTY BECAUSE HEALTH CARE FOR OLDER INDIVIDUALS ARE DIFFERENT FROM THAT PROVIDED TO OTHER AGE GROUPS IN SEVERAL RESPECTS: GREATER RESOURCE DEMANDS, THE INTERTWINING OF PROFESSIONAL HEALTH SERVICES WITH SOCIAL SERVICES, THE FREQUENT OCCURRENCE OF IMPORTANT ETHICAL CONUNDRUMS, AND A HIGHER PREVALENCE OF PHYSICAL AND MENTAL DISABILITIES.NON-WHITE MINORITIES CURRENTLY MAKE UP 48.8% OF THE RACIAL DEMOGRAPHIC IN PRINCE WILLIAM COUNTY AND 45.1% OF THE RACIAL DEMOGRAPHIC IN THE CITY OF MANASSAS. THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS FOR PRINCE WILLIAM COUNTY: WHITE NON-HISPANIC 51.3%; BLACK/AFRICAN-AMERICAN 21.2%; HISPANIC 25.9%; OTHER 10.9%. THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS FOR CITY OF MANASSAS: WHITE NON-HISPANIC 54.9%; BLACK/AFRICAN-AMERICAN 14.3%; HISPANIC OR LATINO 40.1%; OTHER 18.6%.ACCORDING TO THE US CENSUS BUREAU DATA, THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $106,704 IN PRINCE WILLIAM, $84,376 IN MANASSAS CITY, AND $104,260 IN FAUQUIER. THE POVERTY RATE FOR PRINCE WILLIAM COUNTY AND CITY OF MANASSASARE 5.8%, AND 8.4%, RESPECTIVELY.THERE ARE THREE ACUTE CARE HOSPITALS IN THE COMMUNITY, TWO OF WHICH ARE THE ORGANIZATION. THE OTHER IS ANOTHER NON-PROFIT HOSPITAL. STATISTICAL INFORMATION WAS GATHERED FROM VARIOUS STATE AND FEDERAL SOURCES BUT PRIMARILY THE US CENSUS BUREAU. SPECIFIC REFERENCES AND OTHERSUPPORTING INFORMATION CAN BE FOUND IN THE STUDY REPORT THAT ACCOMPANIES THE ORGANIZATION'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT AT: HTTPS://UVAHEALTH.COM/SERVICES/COMMUNITY-RELATIONS PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION FURTHERS ITS EXEMPT PURPOSES BY DOING THE FOLLOWING:1. ADOPTING A FINANCIAL ASSISTANCE POLICY;2. REMAINING CERTIFIED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES TO PROVIDE SERVICES TO ALL BENEFICIARIES OF MEDICARE, MEDICAID, AND OTHER GOVERNMENT PAYMENT PROGRAMS, AND PROVIDING SERVICES IN A NONDISCRIMINATORY MANNER TO SUCH BENEFICIARIES;3. OPERATING A FULL-TIME EMERGENCY ROOM WHICH IS OPEN TO AND ACCEPTS ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY;4. MAINTAINING AN OPEN MEDICAL STAFF, SUBJECT TO EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, HOSPITALIST, AND EMERGENCY DEPARTMENT SERVICES, TO THE EXTENT AN EXCLUSIVE CONTRACT FOR THOSE SERVICES IS REQUIRED TO OBTAIN PROPER STAFFING COVERAGE OR TO PERMIT A MORE EFFICIENT DELIVERY OF THOSE SERVICES WITHIN THE HOSPITAL FACILITY;5. MAINTAINING A GOVERNING BOARD CONSISTING PRIMARILY OF A BROAD CROSS-SECTION OF LEADERS IN THE COMMUNITY;6. ADOPTING AND APPLYING A CONFLICT OF INTEREST POLICY, WHICH APPLIES TO THE GOVERNING BOARD AND ORGANIZATION OFFICERS;7. PROVIDING HEALTH EDUCATION LECTURES AND WORKSHOPS;8. PROVIDING HEALTH FAIRS, EDUCATION ON SPECIFIC DISEASES OR CONDITIONS, AND HEALTH PROMOTION AND WELLNESS PROGRAMS TO THE COMMUNITIES IT SERVES;9. PROVIDING SUPPORT GROUPS AND SELF HELP PROGRAMS TO THE COMMUNITIES IT SERVES;10. PROVIDING COMMUNITY-BASED CLINICAL SERVICES, INCLUDING WITHOUT LIMITATION, HEALTH SCREENINGS AND CLINICS FOR UNINSURED OR UNDERINSURED PERSONS TO THE COMMUNITIES IT SERVES;11. PROVIDING HEALTHCARE SUPPORT SERVICES, INCLUDING WITHOUT LIMITATION, INFORMATION AND REFERRAL TO COMMUNITY SERVICES, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PERSONS, TELEPHONE INFORMATION SERVICES AND ASSISTANCE TO ENROLL IN PUBLIC PROGRAMS, SUCH AS STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) AND MEDICAID TO THE COMMUNITIES IT SERVES;12. PROVIDING SUBSIDIZED HEALTH SERVICES AND CLINICAL PROGRAMS TO THE COMMUNITIES IT SERVES;13. PROVIDING CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND14. GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMTHE HOSPITAL FACILITY IS PART OF THE UVA COMMUNITY HEALTH ENTERPRISE, AN INTEGRATED NETWORK OF NOT-FOR-PROFIT, TAX-EXEMPT ENTITIES THAT INCLUDES PHYSICIAN OFFICES, OUTPATIENT FACILITIES AND COMMUNITY MEDICAL CENTERS. UVA COMMUNITY HEALTH AND ITS COMPONENT ENTITIES, ALONG WITH THE UNIVERSITY OF VIRGINIA MEDICAL CENTER, THE UVA SCHOOL OF MEDICINE, UVA SCHOOL OF NURSING, UVA PHYSICIANS GROUP, AND THE CLAUDE MOORE HEALTH SCIENCES LIBRARY, COMPRISE UVA HEALTH. THE SYSTEM CONSISTS OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. EACH HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES, AS REPORTED INDIVIDUALLY ON EACH HOSPITAL'S FORM 990, SCHEDULE H. IN ADDITION TO HOSPITALS, UVA COMMUNITY HEALTH INC. INCLUDES A PHYSICIAN ORGANIZATION WITH PRACTICES IN VIRGINIA AND A HOSPITAL FOUNDATION WHICH SUPPORTS AND ENHANCES THE ACTIVITIES IN THOSE HOSPITALS' COMMUNITIES. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT UVA PRINCE WILLIAM MEDICAL CENTER FILES COMMUNITY BENEFIT INFORMATION WITH THE VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION IN ACCORDANCE WITH THEIR REPORTING GUIDELINES FOR PURPOSES OF ADVOCACY AND THE STATE'S REPORTING REQUIREMENTS. 1 ART FACTORY CENTER FOR THE ARTS DBA CENTER FOR THE ARTS OF GREATER MANASSAS 9419 BATTLE STREET MANASSAS VA 20110 521338092 501(C)(3) 15593 0 COMMUNITY OUTREACH BRAIN INJURY SERVICES 8136 OLD KEENE MILL RD B-102 SPRINGFIELD VA 22152 541346045 501(C)(3) 10000 0 COMMUNITY OUTREACH CHRIS ATWOOD FOUNDATION INC PO BOX 9282 RESTON VA 20195 462749211 501(C)(3) 12000 0 COMMUNITY OUTREACH FUTURE KINGS 8170 FLANNERY CT MANASSAS VA 20110 204572642 501(C)(3) 10000 0 COMMUNITY OUTREACH GEORGE MASON UNIVERSITY FOUNDATION INC 4326 DALE BOULEVARD WOODBRIDGE VA 22193 541590421 501(C)(3) 7000 0 COMMUNITY OUTREACH HISTORIC MANASSAS INC 9431 WEST STREET MANASSAS VA 20110 541347862 501(C)(3) 12500 0 COMMUNITY OUTREACH NAMI PRINCE WILLIAM PO BOX 1423 WOODBRIDGE VA 22195 640958983 501(C)(3) 10000 0 COMMUNITY OUTREACH NORTHERN VIRGINIA FAMILY SERVICE 1173 W MAIN ST ABINGDON VA 24210 540763686 501(C)(3) 12500 0 COMMUNITY OUTREACH NORTHERN VIRGINIA FOOD RESCUE 1173 W MAIN ST ABINGDON VA 24210 540763686 501(C)(3) 16000 0 COMMUNITY OUTREACH NORTHERN VIRGINIA VETERANS ASSOCIATION PO BOX 7521 ARLINGTON VA 22207 263029233 501(C)(3) 10000 0 COMMUNITY OUTREACH PRINCE WILLIAM CHAMBER OF COMMERCE 9733 BUCHANAN LOOP MANASSAS VA 20110 272875613 501(C)(6) 20500 0 COMMUNITY OUTREACH PWCPS EDUCATION FOUNDATION (SPARK) PO BOX 389 MANASSAS VA 20108 541498824 501(C)(3) 6750 0 COMMUNITY OUTREACH THE HOUSE INC 14000 CROWN CT STE 105 WOODBRIDGE VA 22193 202947568 501(C)(3) 10000 0 COMMUNITY OUTREACH YOUTH FOR TOMORROW - NEW LIFE CENTER INC 11835 HAZEL CIRCLE DR BRISTOW VA 20136 521342268 501(C)(3) 20000 0 COMMUNITY OUTREACH 13 1 PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS UVA COMMUNITY HEALTH, INC. IS THE PARENT ORGANIZATION OF A NOT-FOR-PROFIT INTEGRATED SYSTEM OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS OF WHICH THE FILING ORGANIZATION IS A SUBSIDIARY. UVA COMMUNITY HEALTH IS AUTHORIZED TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. UVA COMMUNITY HEALTH HAS ESTABLISHED A SYSTEM-WIDE 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. 1 1 0 0 0 0 0 1 0 ERIK SHANNON CEO (UVACH SYSTEM) 712593 0 0 0 2788 0 298688 0 37637 0 1051706 0 0 0 KIRSTEN GREEN MD TRUSTEE 0 763203 0 154280 0 62678 0 27180 0 32119 0 1039460 0 0 CHARLES CODER CFO (UVACH SYSTEM) 371199 0 78116 0 1502 40554 15797 0 36496 0 503110 40554 0 0 MARY FRANCES SOUTHERLAND INTERIM SECRETARY/TRUSTEE 0 400540 0 80000 0 424 0 22730 0 18972 0 522666 0 0 DOUGLAS MARKERT VP, CHIEF CLINICAL OFFICER 395599 0 72000 0 1538 0 15185 0 24649 0 508971 0 0 0 CHRIS HEATON MD TRUSTEE (PWHS EMPLOYEE) 0 327454 0 12115 0 105475 0 18985 0 38781 0 502810 0 0 ZAN ZAIDI VP, CMO 394420 0 60000 0 1538 0 19800 0 24407 0 500165 0 0 0 JOSEPH SCOTT HAAS ASSOCIATE CMIO 292487 0 42000 0 0 0 17308 0 35891 0 387686 0 0 0 CAROLYN MATTHEWS OB GYN ONCOLOGIST 304619 0 0 0 0 0 0 0 16661 0 321280 0 0 0 KELI WILSON PHYSICIST 264058 0 14665 0 6336 0 6426 0 24279 0 315764 0 0 0 CATHERINE KELLEY VP CHRO (UVACH SYSTEM) 226784 0 37600 0 904 0 11811 0 24488 0 301587 0 0 0 STEPHEN SMITH MD FORMER PRESIDENT/COO 0 0 0 0 102010 0 0 0 0 0 102010 0 0 0 PART I, LINE 3: METHODS USED TO ESTABLISH COMPENSATION: UVA COMMUNITY HEALTH, INC. IS THE PARENT ENTITY OF A NOT-FOR-PROFIT INTEGRATED SYSTEM OF COMMUNITY HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS, AND OTHER HEALTHCARE SERVICES PROVIDERS (COLLECTIVELY KNOWN AS "UVA COMMUNITY HEALTH OR "UVACH"). UVACH, IN COMBINATION WITH ITS SOLE MEMBER, THE UNIVERSITY OF VIRGINIA MEDICAL CENTER ("THE MEDICAL CENTER"), THE UVA SCHOOL OF MEDICINE, UVA SCHOOL OF NURSING, UVA PHYSICIANS GROUP, AND THE CLAUDE MOORE HEALTH SCIENCES LIBRARY, COMPRISE UVA HEALTH. THE FILING ORGANIZATION, UVA PRINCE WILLIAM MEDICAL CENTER, 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 4A: SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS BASED ON ANNUAL COMPENSATION FOR A SPECIFIED PERIOD OF TIME. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. - STEPHEN SMITH, MD: $102,010 PART I, LINE 4B: SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: THE UVA COMMUNITY HEALTH 457F PLAN, IMPLEMENTED 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, IS INTENDED TO SUPPORT RETENTION OF THE CEO AND TO OFFER COMPETITIVE TOTAL COMPENSATION. ANNUAL CONTRIBUTIONS/DEFERRALS TO THE PLAN ARE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J ANNUALLY. AMOUNTS VEST AFTER 3 YEARS ON DECEMBER 31ST. - L. ERIK SHANNON: $296,888 PART I, LINE 7: NONFIXED PAYMENTS (BONUSES): DEPENDING ON INDIVIDUAL PERFORMANCE, SOME EMPLOYEES MAY BE ELIGIBLE FOR PERFORMANCE BONUSES IN ADDITION TO THEIR REGULAR COMPENSATION. THE AWARDING OF ANY COMPENSATION BONUS CONSIDERS THE INDIVIDUAL'S GOALS AND THE GOALS OF THE ORGANIZATION AS A WHOLE. ANY POTENTIAL BONUS IS CONSIDERED WHEN EVALUATING AN EMPLOYEE'S TOTAL COMPENSATION FOR REASONABLENESS. FORM 990, PART I, LINE 1 UVA PRINCE WILLIAM MEDICAL CENTER IS PART OF THE UVA COMMUNITY HEALTH ENTERPRISE, AN INTEGRATED NETWORK OF NOT-FOR-PROFIT, TAX-EXEMPT ENTITIES THAT INCLUDES PHYSICIAN OFFICES, OUTPATIENT FACILITIES AND COMMUNITY MEDICAL CENTERS. UVA COMMUNITY HEALTH AND ITS COMPONENT ENTITIES, ALONG WITH THE UNIVERSITY OF VIRGINIA MEDICAL CENTER, THE UVA SCHOOL OF MEDICINE, UVA SCHOOL OF NURSING, UVA PHYSICIANS GROUP, AND THE CLAUDE MOORE HEALTH SCIENCES LIBRARY, COMPRISE UVA HEALTH. GENERAL INFORMATION UVA HEALTH PRINCE WILLIAM MEDICAL CENTER IS LOCATED IN MANASSAS, VA., AND UVA HEALTH HAYMARKET MEDICAL CENTER IS LOCATED IN HAYMARKET, VA. THE MEDICAL CENTERS ARE FOCUSED ON CULTIVATING HEALTHY COMMUNITIES BY PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT SERVICES, AND AN EXCEPTIONAL WORK ENVIRONMENT FOR TEAM MEMBERS. THE MEDICAL CENTERS ARE COMMITTED TO MEETING THE HEALTH CARE NEEDS OF RESIDENTS OF MANASSAS, MANASSAS PARK, PRINCE WILLIAM, AND SURROUNDING COUNTIES IN VIRGINIA. IN ADDITION TO OUR QUALITY AND COMPREHENSIVE CATEGORIES OF SERVICES, UVA COMMUNITY HEALTH IS PROUD TO OFFER A PATIENT FINANCIAL ASSISTANCE PROGRAM. WE PARTNER WITH CUSTOMERS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, DISCOUNT THEIR BILL OR PROVIDE THEM WITH FREE CHARITY CARE. COMMUNITY ENGAGEMENT COMMUNITY ENGAGEMENT IS A CRITICAL COMPONENT TO THE UVA HEALTH MISSION OF PRINCE WILLIAM MEDICAL CENTER. BEYOND OUR PROVISION OF QUALITY HEALTHCARE SERVICES, WE SUPPORT OTHER COMMUNITY ORGANIZATIONS THAT PROVIDE HEALTH SERVICES, EDUCATION, AND ASSISTANCE TO UNINSURED AND VULNERABLE POPULATIONS, AS WELL AS THE OVERALL COMMUNITY. THIS SUPPORT INCLUDES ACCESS TO EDUCATION, ACCESS TO HEALTHY FOOD, AND INITIATIVES TO ADDRESS EARLY CHILDHOOD DEVELOPMENT, ENVIRONMENTAL AND SOCIAL INCLUSION, AND NON-DISCRIMINATION AS WELL AS UNDERLYING SOCIAL DETERMINANTS OF HEALTH. SOME OF THE ORGANIZATIONS INCLUDE NAMI, THERAPEUTIC RIDING FOR ADOLESCENTS WITH MENTAL HEALTH DIFFERENCES, CASA, YOUTH FOR TOMORROW, MANASSAS CITY PUBLIC SCHOOLS EDUCATION FOUNDATION, PRINCE WILLIAM COUNTY PUBLIC SCHOOL FOUNDATION (SPARK), THE ARTFACTORY, WELLNESS IN THE ARTS PROGRAM, BRAIN INJURY SERVICES, AND SERVING OUR WILLING WARRIORS. IN 2023 AND 2024, UVA PRINCE WILLIAM MEDICAL CENTER HOSTED EDUCATION SESSIONS AND SCREENINGS FOR THE COMMUNITY WHICH INCLUDED: - BLOOD PRESSURE SCREENINGS, BODY MASS INDEX SCREENINGS, AND HEART HEALTH EDUCATION AT MULTIPLE COMMUNITY EVENTS. - HEART HEALTH EDUCATION AND SCREENING AT EAST END MOBILE HOME PARK COMMUNITY WITH SPANISH LANGUAGE TRANSLATION SERVICES. - EDUCATION ON PREVENTATIVE CARE TO COMBAT CHRONIC DISEASE AT FESTIVALS, FARMERS MARKETS AND VARIOUS OUTREACH EVENTS WITH A FOCUS ON ETHNIC COMMUNITIES THAT HAVE HIGHER RISK FACTORS FOR CHRONIC DISEASE SUCH AS BLACK, AFRICAN AMERICAN, AND HISPANIC/LATINO. - FUTURE KINGS DIABETES RESEARCH FOCUSED ON WELLNESS AND PREVENTION FOR THE BLACK AND AFRICAN AMERICAN COMMUNITY. - CFH INC. & CROSSROADS CONNECTION FOR FOOD INSECURITY. - LIFE LONG LEARNING INSTITUTE PRESENTATIONS FOR SENIORS ON THE AGING HEART AND ACID REFLUX. PRINCE WILLIAM MEDICAL CENTER PROVIDED GRANTS TO SUPPORT NONPROFIT ORGANIZATIONS FOCUSED ON IMPROVING AREAS SUCH AS ACCESS TO MENTAL/BEHAVIORAL HEALTH RESOURCES, PREVENTION OF CHRONIC DISEASE, AND HEALTHCARE WORKFORCE PIPELINE. OTHER INITIATIVES INCLUDED: - VIRTUAL EVENT ON SUBSTANCE ABUSE AWARENESS & PREVENTION WITH MANASSAS CITY POLICE DEPARTMENT. - WORKFORCE PIPELINE PROGRAM SUPPORT FOR THE ORGANIZATION HIRE GROUND, FOCUSED ON MOTIVATING 11-12TH GRADERS AT RISK OF DROPPING OUT OF SCHOOL TO STAY ENROLLED UNTIL GRADUATION FROM HIGH SCHOOL. - SUPPORT PRINCE WILLIAM COUNTY SCHOOLS DISCOVERY ENRICHMENT SUMMER PROGRAM IN MATHEMATICS AND STEM-H. - DRUG TAKE BACK DAY EVENTS HELD IN PARTNERSHIP WITH LOCAL POLICE DEPARTMENTS AND DRUG ENFORCEMENT AGENCY. ADDITIONALLY, WE CREATED EDUCATION ABOUT STROKE PREVENTION IN ENGLISH AND SPANISH THAT WAS DISTRIBUTED THROUGH OUR COMMUNITY. BOTH PRINCE WILLIAM MEDICAL CENTER AND HAYMARKET MEDICAL CENTER CONTINUE TO PROVIDE FINANCIAL AND HUMAN RESOURCES TO CARE FOR PATIENTS AT THE MOTHER OF MERCY FREE CLINICS AND THE GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER. NEW TECHNOLOGY & SERVICES IN 2024, UVA COMMUNITY HEALTH FACILITIES CONTINUED FOCUS ON DELIVERING A REMARKABLE PATIENT EXPERIENCE WHILE MAKING HEALTHCARE MORE CONVENIENT AND EASIER TO ACCESS FOR THE COMMUNITY. - PRINCE WILLIAM MEDICAL CENTER OPENED ITS NEW CATHETERIZATION/EP LAB, THE FIRST OF ITS KIND IN THE UVA HEALTH SYSTEM. - PRINCE WILLIAM MEDICAL CENTER RENOVATED THE INTERVENTIONAL RADIOLOGY SUITE. ACCREDITATIONS, AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATIONS PRINCE WILLIAM MEDICAL CENTER: - THE LEAPFROG GROUP A GRADE FOR PATIENT SAFETY IN SPRING AND FALL 2024 GRADING PERIOD. - AMERICAN HEART ASSOCIATION GET WITH THE GUIDELINES BRONZE PLUS FOR CORONARY ARTERY DISEASE STEMI RECEIVING BRONZE PLUS. - AMERICAN STROKE ASSOCIATION GET WITH THE GUIDELINES STROKE GOLD PLUS WITH HONOR ROLL ELITE. - HIGH PERFORMING HOSPITAL FOR HEART ATTACK BY U.S. NEWS & WORLD REPORT. - GREAT COMMUNITY HOSPITALS 2024 BY BECKER'S HOSPITAL REVIEW. - NEWSWEEK HIGH PERFORMING HEART ATTACK CATEGORY FOR OUTSTANDING CARDIAC CARE. - 2024 TOP DOCTORS IN NORTHERN VA MAGAZINE. - FULLY ACCREDITED BY THE JOINT COMMISSION, AN INDEPENDENT ORGANIZATION THAT EVALUATES A HEALTHCARE ORGANIZATION'S PERFORMANCE IN AREAS MOST AFFECTING PATIENT HEALTH AND SAFETY: - THE JOINT COMMISSION PRIMARY HEART ATTACK CENTER INITIAL ACCREDITATION. - THE JOINT COMMISSION ADVANCED STROKE CENTER RECERTIFICATION. - AMERICAN NURSING CREDENTIALING CENTER MAGNET RECOGNITION, THE HIGHEST AND MOST PRESTIGIOUS DISTINCTION FOR NURSING EXCELLENCE AND HIGH-QUALITY PATIENT CARE. - AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION CERTIFICATION. - AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION GET WITH THE GUIDELINES RECOGNITION FOR STROKE GOLD PLUS WITH HONOR ROLL AND HEART FAILURE GOLD PLUS WITH HONOR ROLL. - COLLEGE OF AMERICAN PATHOLOGISTS ACCREDITATION LABORATORY ACCREDITATION PROGRAM. - AMERICAN COLLEGE OF SURGEONS COMMISSION CANCER PROGRAM CERTIFICATION. - LESLIE EBERT SYNERGY FOR LIFE AWARD, WASHINGTON REGIONAL TRANSPLANT COMMUNITY. - BLUE DISTINCTION CENTER FOR KNEE / HIP REPLACEMENT BY BCBS. - NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS ACCREDITATION. - FDA CERTIFICATION FOR EXCELLENCE IN MAMMOGRAPHY SERVICES FOR EARLY BREAST CANCER DETECTION. - AABB ACCREDITATION FOR DEMONSTRATING THE HIGHEST STANDARDS OF CARE IN ALL ASPECTS OF BLOOD SERVICES, INCLUDING TRANSFUSION MEDICINE, CELLULAR THERAPIES, TRANSPLANTATION AND TESTING. HAYMARKET MEDICAL CENTER: - FULLY ACCREDITED BY THE JOINT COMMISSION, AN INDEPENDENT ORGANIZATION THAT EVALUATES A HEALTHCARE ORGANIZATION'S PERFORMANCE IN AREAS MOST AFFECTING PATIENT HEALTH AND SAFETY. - NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS ACCREDITATION. - FDA CERTIFICATION FOR EXCELLENCE IN MAMMOGRAPHY SERVICES FOR EARLY BREAST CANCER DETECTION. - AMERICAN COLLEGE OF SURGEONS COMMISSION CANCER PROGRAM CERTIFICATION. - AMERICAN COLLEGE OF RADIOLOGY RECOGNITION FOR CT, MAMMOGRAPHY, MRI, NUCLEAR MEDICINE, BREAST ULTRASOUND, ULTRASOUND-GUIDED BIOPSY, AND VASCULAR ULTRASOUND. - PRESS GANEY HX GUARDIANS OF EXCELLENCE AWARD FOR UVA HEALTH THERAPY SERVICES HAYMARKET. - INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF VASCULAR LABORATORIES. - COLLEGE OF AMERICAN PATHOLOGISTS ACCREDITATION LABORATORY ACCREDITATION PROGRAM. - 2024 TOP DOCTORS IN NORTHERN VA MAGAZINE. - THE LEAPFROG GROUP A GRADE FOR PATIENT SAFETY IN SPRING AND FALL 2024 GRADING PERIOD. FOR MORE INFORMATION, VISIT: PRINCE WILLIAM MEDICAL CENTER IN PRINCE WILLIAM, VIRGINIA (UVAHEALTH.COM) HTTPS://UVAHEALTH.COM/LOCATIONS/UVA-HEALTH-PRINCE-WILLIAM-MEDICAL-CENTER -5597282 HAYMARKET MEDICAL CENTER IN NORTHERN VIRGINIA (UVAHEALTH.COM) HTTPS://UVAHEALTH.COM/LOCATIONS/UVA-HEALTH-HAYMARKET-MEDICAL-CENTER-5597 284 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 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 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 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 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 THE REVIEW OF THE 990 IS PERFORMED BY THE CHIEF FINANCIAL OFFICER OF UVA COMMUNITY HEALTH, INC. 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 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 ADHERENCE 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 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 HEALTH PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 43,986,400. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,986,400. ADMIN FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 7,778,072. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,778,072. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 7,377,997. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,377,997. FOOD SERVICE: PROGRAM SERVICE EXPENSES 3,617,995. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,617,995. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 963,299. MANAGEMENT AND GENERAL EXPENSES 83,764. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,047,063. FORM 990, PART XI, LINE 9: INTERCOMPANY DISTRIBUTIONS/TRANSFERS -2,361,028. 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 STE 411 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 STE 411 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 STE 411 MANASSAS VA 20110 810868533 HEALTHCARE VA 501(C)(3) LINE 12A, I UVA MEDICAL CENTER 0 UVA COMMUNITY HEALTH FOUNDATION 8700 SUDLEY RD STE 411 MANASSAS VA 20110 541307595 HEALTHCARE VA 501(C)(3) LINE 7 UVA PRINCE WILLIAM HEALTH SYSTEM 0 UNIVERSITY OF VIRGINIA MEDICAL CENTER 1201 LEE STREET CHARLOTTESVILLE VA 22902 546001796 HEALTHCARE VA GOVERNMENTAL LINE 6 N/A 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1