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 540622371 UVA CULPEPER MEDICAL CENTER UVAC 5712841163 501 SUNSET LANE CULPEPER VA 22701 CHARLES CODER CFO 5712841163 2025-05-15 1 0 MARY TORRETTA P00847851 7038477500 2023 2025-03-06 01:10:19Z X UVA CULPEPER MEDICAL CENTER L ERIK SHANNON 501 SUNSET LANE CULPEPER VA 22701 194141117 0 X WWW.UVAHEALTH.COM X 1956 VA SEE SCHEDULE O 12 9 908 9 0 0 0 89827 161065017 194936202 25048 -8191 1002761 -898969 162092826 194118869 331405 129994 0 0 57940711 60456449 0 0 0 87792905 106096354 146065021 166682797 16027805 27436072 230225474 189186091 82230552 10024315 147994922 179161776 X SEE SCHEDULE O 0 0 139803339 129994 193752782 UVA CULPEPER MEDICAL CENTER ("UVACMC") PROVIDES PROGRAMS AND ACTIVITIES THAT PROVIDE ACCESS TO HEALTHCARE AND IMPROVE HEALTH IN OUR COMMUNITY. UVACMC IS A 70-BED NON-PROFIT, ACUTE CARE HOSPITAL LOCATED IN CULPEPER, VA WITH COMPREHENSIVE SERVICES PROVIDING A 24 HOUR, PHYSICIAN STAFFED EMERGENCY DEPARTMENT, FAMILY BIRTH CENTER, SURGICAL SERVICES, INTENSIVE CARE UNIT 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. UVACMC PROVIDES MEDICAL AND OTHER HEALTHCARE SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ALL UNINSURED PATIENTS, REGARDLESS OF INCOME LEVEL OR COUNTY OF RESIDENCE, RECEIVE A SELF-PAY DISCOUNT ON HOSPITAL SERVICES.(SEE SCHEDULE O) WE ALSO PARTNER WITH LOCAL NON-PROFIT AND GOVERNMENTAL ORGANIZATIONS TO SUPPORT LOCAL EVENTS AND PROVIDE HEALTH AND WELLNESS PROGRAMS. UVACMC WORKS WITH LOCAL HIGH SCHOOLS AND COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS. DURING FISCAL YEAR 2024, THERE WERE 14,139 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 4 DAYS. THERE WERE 5,035 DISCHARGES, 3,656 INPATIENT AND OUTPATIENT SURGERIES, 106,504 OUTPATIENT ENCOUNTERS AND 39,133 EMERGENCY DEPARTMENT VISITS. 139803339 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 69 0 1 908 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 - UCB / TRUSTEE INC 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 STEVE 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 MATT GUILFOYLE TRUSTEE 0.20 0.60 X 0 0 0 PAM KINCHELOE RN JD TRUSTEE 0.20 0.60 X 0 0 0 JACKIE 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 DONNA STATON SYSTEM CEO & CMC PRESIDENT 25.00 25.20 X 380332 0 58574 L ERIK SHANNON CEO (UVACH SYSTEM) 0.20 50.00 X 0 715381 336325 CHARLES CODER CFO (UVACH SYSTEM) 0.20 50.00 X 0 491371 52293 NAEL HASAN CHIEF MEDICAL OFFICER 50.00 0.00 X 295977 0 12205 SARA WHITE SR DIR FINANCE / SYSTEM CONTROLLER 10.00 40.00 X 220702 0 33213 TIMOTHY W MARTIN DIR PROF & ANCILLARY SVCS 45.00 0.00 X 196005 0 12536 DENNIS SMITH DIRECTOR OF NURSING 45.00 0.00 X 194844 0 25932 PHYLLIS COBBINAH RN (ER) 45.00 0.00 X 191349 0 9696 PATRICIA SLATER DIRECTOR OF COMPLIANCE (THRU 10/23) 25.00 25.00 X 237387 0 9914 MICHELLE STRIDER FMR CHIEF QUALITY OFFICER CMC / SYSTEM VP CNO 0.00 50.00 X 256858 0 38620 1973454 3112921 748075 84 1 1 0 AMERICAN ANESTHESIOLOGY OF VIRGINIA PC PO BOX 936824 ATLANTA GA 311936824 HEALTH SERVICES 1078425 ENVIRONMENTS FOR HEALTH LLC PO BOX 779062 CHICAGO IL 606779062 CONSULTING SERVICES 232274 NOVA ACCESS SURGERY PLLC 9905 S PARK CIR FAIRFAX STATION VA 22039 HEALTH SERVICES 190513 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 158264 PREMIER TURF AND LANDSCAPING INC 16800 BEVERLEY MILL DRIVE BROAD RUN VA 20137 LANDSCAPE SERVICES 105278 5 89827 89827 NET PATIENT REVENUE 622110 194441632 194441632 PROVIDER BASED CLINICS 622110 494570 494570 194936202 10598 10598 287910 3459 284451 284451 284451 18789 -18789 -18789 -18789 MISCELLANEOUS REVENUE 900099 122190 122190 EQUITY IN SUBSIDIARIES 900099 -1305610 -1305610 -1183420 194118869 193752782 0 276260 X 124617 124617 5377 5377 1142619 742702 399917 321287 208837 112450 47300806 30745524 16555282 1879738 1221830 657908 6377722 4145519 2232203 3434277 2232280 1201997 27312794 22396491 4916303 239589 186879 52710 274745 274745 2219250 1731015 488235 26175 17014 9161 53549 34807 18742 27472 27472 5672812 5445900 226912 21405 20549 856 PHARMACEUTICALS 29232463 29232463 MEDICAL SUPPLIES 17170280 17170280 CORPORATE ALLOCATION 12409345 12409345 BAD DEBT 10683123 10683123 753352 746570 6782 166682797 139803339 26879458 0 1144 0 17373793 1037442 15780747 18819092 95256 0 4123408 4496966 383752 119479 64557980 10831331 53439892 53726649 1100890 4831673 23400358 23400358 114526234 82754432 230225474 189186091 81807557 8084715 190450 342031 232545 1597569 82230552 10024315 X 0 0 0 0 147994922 179161776 147994922 179161776 230225474 189186091 X 27436072 3730782 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 10752 0 0 10752 0 PART II-B, LINE 1: LINE 1G: A PORTION OF ONE INDIVIDUAL'S SALARY IS ALLOCATED TO LOBBYING ACTIVITIES. 6192308 6192308 12641429 2117056 10524373 38174193 8379035 29795158 7550050 335240 7214810 53726649 DUE FROM AFFILIATES 62596870 THIRD PARTY PAYMENT RECEIVABLE 18172556 RIGHT OF USE ASSET 1637992 LEASE RECEIVABLE 347014 82754432 LEASE LIABILITY 1597569 1597569 1 1 1 X 1 X 0 1 1 0 0 8717775 6723547 1994228 0.01280 25289394 24530713 758682 0.00490 34007169 31254260 2752910 0.01770 35907 0 35907 0.00020 120510 0 120510 0.00080 94057 0 94057 0.00060 250474 250474 0.00160 34257643 31254260 3003384 0.01930 842 0 842 0.00000 89 0 89 0.00000 2288 0 2288 0.00000 3219 3219 0.00000 0 10683123 37239275 44209207 -6969932 X 1 1 1 1 UVACMC DBA UVA CULPEPER MEDICAL CENTER 501 SUNSET LANE CULPEPER VA 22701 SEE SUPPLEMENTAL INFORMATION H1848 X X X UVA CULPEPER MEDICAL CENTER 0 0 1 X X X X X X X X 23 1 0 0 1 X SEE SECTION C X X 1 23 1 SEE SECTION C 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: HTTPS://UVAHEALTH.COM/LOCATIONS/CULPEPER-MEDICAL-CENTER-5597271 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. PART V, SECTION B, LINE 7B: HTTPS://UVAHEALTH.COM/SERVICES/COMMUNITY-RELATIONS 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 SUPPORT OUR EFFORTS TO ADDRESS THE IDENTIFIED NEEDS AND TO SUPPORT OUR COMMUNITIES IN GENERAL. PART V, SECTION B, LINE 10A: HTTPS://UVAHEALTH.COM/SERVICES/COMMUNITY-RELATIONS 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 HOSPITAL FACILITY IS A PART OF THE COMMUNITY HEALTH SYSTEM. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE COMMUNITY ENGAGEMENT TEAM, THE ORGANIZATIONS EXECUTIVE LEADERSHIP TEAM, AND SUBSEQUENTLY THE BOARD. UVA COMMUNITY HEALTH, INC. AND EACH OF ITS HOSPITAL FACILITIES HAVE ADOPTED AND EXECUTED AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE PRIORITIZED COMMUNITY HEALTH NEEDS FROM THE CHNAS. THE IMPLEMENTATION STRATEGIES OUTLINE 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 OF THE SCOPE OF TRADITIONAL HEALTHCARE (I.E., QUALITY OF EDUCATION) AND OTHERS ARE CANDIDATES FOR COLLABORATIVE WORK AND HAVE 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 URL GIVEN PREVIOUSLY FOR THE POSTING OF THE INFORMATION. PART V, SECTION B, 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 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. 10 1 - UVA OUTPATIENT IMAGING CULPEPER LLC 509 SOUTH MAIN STREET CULPEPER VA 22701 IMAGING CENTER 2 - CULPEPER SURGERY CENTER 541 SUNSET LANE STE 201 CULPEPER VA 22701 AMBULATORY SURGERY CENTER 3 - UVA HEALTH OBGYN PART OF CMC 633 SUNSET LANE CULPEPER VA 22701 PHYSICIAN OFFICE 4 - UVA HEALTH CARDIOLOGY PART OF CMC 501 SUNSET LANE CULPEPER VA 22701 PHYSICIAN OFFICE 5 - UVA HEALTH SURGICAL CARE (UROLOGY) 541 SUNSET LANE SUITE 101 CULPEPER VA 22701 PHYSICIAN OFFICE 6 - UVA HEALTH CANCER CARE PART OF CMC 545 SUNSET LANE CULPEPER VA 22701 PHYSICIAN OFFICE 7 - UVA HEALTH ORTHOPEDICS PART OF CMC 541 SUNSET LANE SUITE 305 CULPEPER VA 22701 PHYSICIAN OFFICE 8 - UVA HEALTH SURGICAL CARE PART OF CMC 541 SUNSET LANE SUITE 103 CULPEPER VA 22701 PHYSICIAN OFFICE 9 - UVA HEALTH THERAPY SERVICES POWELL 1005 GOLF DRIVE CULPEPER VA 22701 REHABILITATION SERVICES 10 - UVA HEALTH THERAPY SERVICES MEADOWBROOK 425 MEADOWBROOK SHOPPING CENTER CULPEPER VA 22701 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 BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $10,683,123. 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 HOSPITAL MAY TAKE FOR NONPAYMENT INCLUDING INTERNAL AND EXTERNAL COLLECTION PRACTICES AND REPORTING TO CREDIT AGENCIES. THE POLICY STATES THAT REASONABLE EFFORTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE MUST BE MADE BEFORE THE ORGANIZATION, OR ANY EXTERNAL ORGANIZATION, ENGAGE IN AN EXTRAORDINARY COLLECTION ACTION.FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, THE ORGANIZATION MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS. PART VI, LINE 2: THE ORGANIZATION 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 WORK 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 CULPEPER 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 INFORMATIONTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA FOR UVA CULPEPER MEDICAL CENTER IS DEFINED BY THE ZIP CODES THAT REPRESENT 75% TO 85% OF THE HOSPITAL'S IN-PATIENT POPULATION. THESE ZIP CODES ALL FALL WITHIN CULPEPER, FAUQUIER, ORANGE AND MADISON COUNTIES IN VIRGINIA. BASED ON 2021 ESTIMATES, CULPEPER COUNTY HAD AN ESTIMATED 52,021 RESIDENTS. SPREAD ACROSS THE FOOTHILLS OF THE BLUE RIDGE MOUNTAINS' FIELDS OF THE NORTH CENTRAL PIEDMONT REGION, CULPEPER COUNTY, VIRGINIA POSSESSES A RURAL CHARACTER DISPLAYING THE NATURAL SPLENDOR OF RUSTIC VIRGINIA. CULPEPER COUNTY HAD SLIGHT POPULATION GROWTH OF ROUGHLY 12.7% SINCE THE 2010 US CENSUS.CHILDREN AND ADOLESCENTS (AGE 0-18) MAKE UP CLOSE TO ONE-QUARTER (24.6%) OF THE POPULATION IN CULPEPER COUNTY AND SENIORS (AGE 65 AND OVER) MAKE UP 15.4% OF THE POPULATION, WHICH IS SIMILAR TO THE SENIOR POPULATION ESTIMATE FOR THE STATE OF VIRGINIA. NONWHITE MINORITIES CURRENTLY MAKE UP MORE THAN ONE QUARTER (27.8%) OF THE RACIAL DEMOGRAPHIC IN CULPEPER COUNTY AND 13.6% IN MADISON. THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS: WHITE NON-HISPANIC 72.2%; BLACK/AFRICAN-AMERICAN 13.5%; HISPANIC OR 11.9%; OTHER 6.5%. DATA TAKEN FROM THE 2020 US CENSUS BUREAU INCLUDES INDIVIDUALS THAT IDENTIFIED WITH TWO OR MORE RACES IS 6.4% IN CULPEPER. ACCORDING TO THE US CENSUS BUREAU DATA, THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $85,274, IN FAQUIER $111,368 AND IN MADISON COUNTY $72,349. ORANGE COUNTY INCOME IS $79,211. THE POVERTY RATE FOR CULPEPER COUNTY IS 8.4%. THIS IS THE ONLY ACUTE CARE FACILITY IN THE COMMUNITY.STATISTICAL INFORMATION WAS GATHERED FROM VARIOUS STATE AND FEDERAL SOURCES BUT PRIMARILY THE US CENSUS BUREAU. SPECIFIC REFERENCES AND OTHER SUPPORTING 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: THE 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 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: THE ORGANIZATION 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.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 CULPEPER 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 CULPEPER CHAMBER OF COMMERCE 629 SPERRYVILLE PIKE STE 100 CULPEPER VA 22701 540640609 501(C)(6) 15005 0 COMMUNITY OUTREACH HERO'S BRIDGE 98 ALEXANDRIA PIKE STE 41 WARRENTON VA 201862849 812827604 501(C)(3) 7500 0 COMMUNITY OUTREACH ORANGE FREE CLINIC DBA ORANGE COUNTY FREE CLINIC 101C WOODMARK STREET ORANGE VA 22960 251922019 501(C)(3) 10000 0 COMMUNITY OUTREACH PIEDMONT REGIONAL DENTAL CLINIC 13296 JAMES MADISON HWY STE B ORANGE VA 22960 270625764 501(C)(3) 10000 0 COMMUNITY OUTREACH RX DRUG ACCESS PARTNERSHIP DBA RX PARTNERSHIP (RXP) 1500 FOREST AVE STE 201 RICHMOND VA 23229 571186937 501(C)(3) 7500 0 COMMUNITY OUTREACH VIRGINIA REGIONAL TRANSIT PO BOX 2665 PURCELLVILLE VA 20134 621441965 501(C)(3) 7000 0 COMMUNITY OUTREACH 5 1 SCHOLARSHIPS 4 4000 MEDICATION/DME FUND 2 370 PATIENT TRANSPORTATION 10 1007 COST TRANSPORT FOR PATIENTS 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 L ERIK SHANNON CEO (UVACH SYSTEM) 0 712593 0 0 0 2788 0 298688 0 37637 0 1051706 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) 0 371199 0 78116 0 42056 0 15797 0 36496 0 543664 0 0 MARY FRANCES SOUTHERLAND INTERIM SECRETARY/TRUSTEE 0 400540 0 80000 0 424 0 22730 0 18972 0 522666 0 0 CHRIS HEATON MD TRUSTEE - UCB / TRUSTEE INC 0 327454 0 12115 0 105475 0 18985 0 38781 0 502810 0 0 DONNA STATON SYSTEM CEO & CMC PRESIDENT 313697 0 65385 0 1250 0 19500 0 39074 0 438906 0 0 0 NAEL HASAN CHIEF MEDICAL OFFICER 268597 0 26780 0 600 0 8652 0 3553 0 308182 0 0 0 MICHELLE STRIDER FMR CHIEF QUALITY OFFICER CMC / SYST 206253 0 49778 0 827 0 13306 0 25314 0 295478 0 0 0 SARA WHITE SR DIR FINANCE / SYSTEM CONTROLLER 191346 0 29356 0 0 0 11742 0 21471 0 253915 0 0 0 PATRICIA SLATER DIRECTOR OF COMPLIANCE (THRU 10/23) 137896 0 16582 0 82909 0 8227 0 1687 0 247301 0 0 0 DENNIS SMITH DIRECTOR OF NURSING 182713 0 7166 0 4965 0 11501 0 14431 0 220776 0 0 0 TIMOTHY W MARTIN DIR PROF & ANCILLARY SVCS 163754 0 32251 0 0 0 0 0 12536 0 208541 0 0 0 PHYLLIS COBBINAH RN (ER) 158830 0 15769 0 16750 0 9648 0 48 0 201045 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 CULPEPER 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. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. - PATRICIA SLATER - $82,909 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 CULPEPER 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 CULPEPER MEDICAL CENTER IS LOCATED IN CULPEPER, VA. THE HOSPITAL FOCUSES ON CULTIVATING HEALTH COMMUNITIES BY PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT CARE, AND A REMARKABLE WORK ENVIRONMENT FOR OUR TEAM MEMBERS. WE ARE COMMITTED TO MEETING THE HEALTH CARE NEEDS OF RESIDENTS OF CULPEPER, ORANGE, MADISON, 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 WORK 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 CULPEPER 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 THE MENTAL HEALTH ASSOCIATION OF FAUQUIER COUNTY, HERO'S BRIDGE, CULPEPER FOOD CLOSET, THE ARC OF NORTH CENTRAL VIRGINIA INC., HOSPICE OF PIEDMONT, PEOPLE INCORPORATED OF VIRGINIA, LIVING THE DREAM FOUNDATION, CASA, AND AGING TOGETHER CORPORATION. IN 2023 AND 2024, CULPEPER MEDICAL CENTER HOSTED EDUCATION SESSIONS AND SCREENINGS FOR THE COMMUNITY WHICH INCLUDED: - HEALTHCARE CAREER DAYS WHICH INCLUDE MOCK INTERVIEWS AND INTERVIEW SEMINARS. - PROVIDING EDUCATIONAL INFORMATION ON MEDICAID RENEWALS, HEART HEALTHY TIPS, INFORMATION ON MEDICAL GROUP CLINICS, AND ADMINISTERING BLOOD PRESSURE CHECKS AT VARIOUS LOCAL EVENTS. - MEN'S HEALTH LET'S TALK PROSTATE HEALTH IN CULPEPER. - PHYSICAL, OCCUPATION AND SPEECH THERAPY CLINIC AT MADISON DAY IN MADISON COUNTY, PROVIDING SCREENING AND EDUCATION ABOUT BALANCE. - EDUCATION PROVIDED AT OUTREACH EVENTS WITH A FOCUS ON ETHNIC COMMUNITIES THAT HAVE HIGHER RISK FACTORS FOR CHRONIC DISEASE SUCH AS BLACK, AFRICAN AMERICAN, AND HISPANIC/LATINO. - EDUCATION ON PREVENTION OF CHRONIC DISEASE AT REMINGTON HEALTH FAIR. - SUPPORT STUDENT STEM+H HEALTH CAREER PROGRAMS THROUGH A PARTNERSHIP WITH CULPEPER COUNTY PUBLIC SCHOOLS AND CAREER PARTNERS. - COHOSTING PAMPER ME PINK EVENT TO RAISE AWARENESS FOR BREAST CANCER AND RAISE MONEY TO FUND FREE MAMMOGRAMS FOR UNDERSERVED INDIVIDUALS. - PROMOTING MENTAL HEALTH AND HEALTHY HABITS FOR CHILDREN AT CHILDREN'S DAY IN THE PARK HOSTED BY HEALTHY CULPEPER. - SENIOR DINNERS HOSTED AT CULPEPER MEDICAL CENTER WITH HEALTH EDUCATION INFORMATION FOR OLDER ADULTS. - LIGHTS OF LOVE TREE LIGHTING CEREMONY. CULPEPER MEDICAL CENTER PROVIDED MULTIPLE 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: - PROVIDED FUNDING TO SUPPORT MADISON FREE CLINIC TO EXPAND HEALTHCARE ACCESS. - THE LIVING DREAM FOUNDATION GRANT TO SUPPORT MENTAL HEALTH GATEKEEPER TRAINING AND SCHOLARSHIPS. - AGING TOGETHER SUPPORT TO PROVIDE DEMENTIA TOOLBOX TRAINING FOR CAREGIVERS. - GRANT FUNDING TO HELP THOSE WITH DEVELOPMENTAL DISABILITIES ENTER THE WORKFORCE THROUGH CULPEPER COUNTY PARKS AND RECREATION. - 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. CULPEPER MEDICAL CENTER CONTINUES TO PROVIDE FINANCIAL AND HUMAN RESOURCES TO CARE FOR PATIENTS AT THE CULPEPER FREE CLINIC, ORANGE FREE CLINIC, AND THE MADISON FREE CLINIC. 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. - CULPEPER MEDICAL CENTER EXPANDED ITS ORTHOPEDIC SPACE. - UVA HEALTH SURGICAL CARE CULPEPER ADDED UROLOGIC SURGERY. - UVA HEALTH OUTPATIENT IMAGING CULPEPER INSTALLED A NEW 3D MAMMOGRAPHY UNIT. AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATIONS - THE LEAPFROG GROUP A GRADE FOR PATIENT SAFETY IN SPRING AND FALL 2024 GRADING PERIOD. - HEALTHGRADES AMERICA'S 100 BEST HOSPITALS FOR: - JOINT REPLACEMENT - ORTHOPEDIC SURGERY - VIRGINIA MATERNITY CENTER BREASTFEEDING FRIENDLY DESIGNATION, "BABY-FRIENDLY" DESIGNATION BY UNICEF AND THE WHO. - BABY FRIENDLY DESIGNATION BY THE WORLD HEALTH ORGANIZATION AND THE UNITED NATIONS CHILDREN'S FUND. - BEST MATERNITY HOSPITALS IN 2022 FROM MONEY MAGAZINE & THE LEAPFROG GROUP - GET WITH THE GUIDELINES RESUSCITATION SILVER AWARD. - VIRGINIA MATERNITY CENTER BREASTFEEDING-FRIENDLY DESIGNATION BY THE VIRGINIA DEPARTMENT OF HEALTH. - EARNED A PERFECT SCORE IN THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S MATERNITY PRACTICES IN INFANT NUTRITION AND CARE (MPINC) SURVEY. ACCREDITATION THE JOINT COMMISSION TRIENNIAL ACCREDITATION SURVEY WAS COMPLETED IN MAY 2023. CULPEPER MEDICAL CENTER IS FULLY ACCREDITED BY THE JOINT COMMISSION, AN INDEPENDENT ORGANIZATION THAT EVALUATES A HEALTHCARE ORGANIZATION'S PERFORMANCE IN AREAS THAT MOST AFFECT PATIENT HEALTH AND SAFETY. ADDITIONALLY, CULPEPER MEDICAL CENTER MAINTAINS THE FOLLOWING CERTIFICATIONS OR ACCREDITATIONS FROM THE JOINT COMMISSION: - THE JOINT COMMISSION ACUTE HEART ATTACK READY INITIAL ACCREDITATION - THE JOINT COMMISSION TOTAL HIP/KNEE RECERTIFICATION - THE JOINT COMMISSION ACUTE STROKE READY INITIAL ACCREDITATION CULPEPER MEDICAL CENTER'S BREAST CARE CENTER IS ACCREDITED BY THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS BY THE AMERICAN COLLEGE OF SURGEONS. ACCREDITATION IS GRANTED TO CENTERS THAT HAVE VOLUNTARILY COMMITTED TO PROVIDE THE HIGHEST QUALITY OF CARE TO PATIENTS WITH BREAST DISEASES AND THAT UNDERGO A RIGOROUS EVALUATION AND REVIEW OF ITS PERFORMANCE AND COMPLIANCE WITH THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS. CULPEPER MEDICAL CENTER IS ACCREDITED BY THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF VASCULAR LABORATORIES, ENSURING QUALITY PATIENT CARE FOR VASCULAR TESTING. COLLEGE OF AMERICAN PATHOLOGIST ACCREDITATION LABORATORY ACCREDITATION PROGRAM COMPLETED FEBRUARY 2023. BABY FRIENDLY DESIGNATION COMPLETED MAY 2023. FOR MORE INFORMATION, VISIT: UVA CULPEPER MEDICAL CENTER IN VIRGINIA (UVAHEALTH.COM) HTTPS://UVAHEALTH.COM/LOCATIONS/UVA-HEALTH-CULPEPER-MEDICAL-CENTER-55972 71 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 CLASSES OF MEMBERS OR STOCKHOLDERS THE SOLE MEMBER, UVA COMMUNITY HEALTH, INC., HAS CERTAIN RIGHTS AND POWERS WITH REGARDS TO THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS AS THE SOLE MEMBER, UVA COMMUNITY HEALTH, INC. HAS THE POWER TO APPOINT ALL MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER, UVA COMMUNITY HEALTH, INC. 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 ORGANIZATION'S PROCESS TO REVIEW FORM 990 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 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 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 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 CONTRACTUAL SVS - COR: PROGRAM SERVICE EXPENSES 13,560,899. MANAGEMENT AND GENERAL EXPENSES 2,976,783. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,537,682. HEALTH PRO SER: PROGRAM SERVICE EXPENSES 8,022,820. MANAGEMENT AND GENERAL EXPENSES 1,761,107. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,783,927. PURCHASED SERV. & OTH: PROGRAM SERVICE EXPENSES 302,889. MANAGEMENT AND GENERAL EXPENSES 66,488. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 369,377. HOSPITAL SERV: PROGRAM SERVICE EXPENSES 509,883. MANAGEMENT AND GENERAL EXPENSES 111,925. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 621,808. FORM 990, PART XI, LINE 9: INTERCOMPANY DISTRIBUTIONS/TRANSFERS 3,730,782. CULPEPER SURGERY CENTER LLC (AS OF 062024) 501 SUNSET LANE CULPEPER VA 22701 541975624 INACTIVE VA 0 0 UVA CULPEPER MEDICAL CENTER UNIVERSITY OF VIRGINIA MEDICAL CENTER 1201 LEE STREET CHARLOTTESVILLE VA 22902 546001796 HEALTHCARE VA G0VERNMENTAL LINE 6 N/A 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 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 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 UVA PRINCE WILLIAM MEDICAL CENTER 8700 SUDLEY RD STE 411 MANASSAS VA 20110 540696355 HEALTHCARE VA 501(C)(3) LINE 3 UVA PRINCE WILLIAM HEALTH SYSTEM 0 CULPEPER SURGERY CENTER LLC (THRU 062024) 541 SUNSET LANE CULPEPER VA 22701 541975624 HEALTHCARE VA UVA CULPEPER MEDICAL CENTER INC RELATED -219003 1676042 0 0 UVA OUTPATIENT IMAGING CULPEPER LLC 800 CRESCENT CENTRE DR SUITE 400 FRANKLIN TN 37076 843646484 HEALTHCARE TN UVA CULPEPER MEDICAL CENTER INC RELATED 1137017 5475996 0 1 0.80000 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 1