2021-11-11T11:05:59-06:00 2020-12-31 366055558 GRANT THORNTON LLP 1000 WILSON BOULEVARD SUITE 1400 ARLINGTON VA 22209 990 2020-01-01 540622371 CULPEPER MEMORIAL HOSPITAL INC CULP 3367182803 501 SUNSET LANE CULPEPER VA 22701 DONNA STATON PRESIDENT 3367182803 2021-11-11 1 DONNA STATON XXX-XX-XXXX MARY TORRETTA P00847851 7038477500 2021-11-09 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER CHARLES CODER 28 BLACKWELL PARK SUITE 303 WARRENTON VA 20186 116183075 0 X WWW.NOVANTHEALTHUVA.ORG X 1956 VA SEE SCHEDULE O 8 8 888 176 1399 0 197988 13669278 117643000 101074270 20700 157248 986964 1128321 118848652 116029117 606522 577208 0 0 48776792 50053711 0 0 0 67125951 61841504 116509265 112472423 2339387 3556694 116694297 139556597 14288478 31884680 102405819 107671917 X THE MISSION OF NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER IS TO HELP PEOPLE ACHIEVE AND MAINTAIN OPTIMAL HEALTH BY PROVIDING THE BEST POSSIBLE HEALTH CARE SERVICES. WE WILL ALWAYS MAKE THE NEEDS OF OUR PATIENTS OUR TOP PRIORITY. 1 0 89636372 577208 101785479 CULPEPER MEMORIAL HOSPITAL, INC., DOING BUSINESS AS NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER ("NHUVACMC") PROVIDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTHCARE AND IMPROVE HEALTH IN OUR COMMUNITY. NHUVACMC 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. NHUVACMC PROVIDES MEDICAL AND OTHER HEALTHCARE SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 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. (CONTINUED IN SCHEDULE O)WE ALSO PARTNER WITH LOCAL NON-PROFIT ORGANIZATIONS (THE CHAMBER OF COMMERCE AND LOCAL SCHOOLS), TO SUPPORT LOCAL EVENTS AND PROVIDE HEALTH AND WELLNESS PROGRAMS. ALL UNINSURED PATIENTS, REGARDLESS OF INCOME LEVEL OR COUNTY OF RESIDENCE, RECEIVE A 20% DISCOUNT ON HOSPITAL SERVICES AND AN ADDITIONAL 15% DISCOUNT FOR PAYMENT WITHIN 30 DAYS. NHUVACMC WORKS WITH LOCAL COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS. NHUVACMC PUBLISHES TWO MAJOR COMMUNITY NEWSLETTERS. "SIMPLY HEALTH AND "AGING WELL" ARE PUBLISHED 3 TIMES A YEAR; THEY REACH 50,000 HOMES IN CULPEPER AND SURROUNDING COUNTIES. DURING 2020, THERE WERE 11,807 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 4 DAYS, AND AN AVERAGE DAILY CENSUS OF 32. THERE WERE 3,104 DISCHARGES, 2,000 INPATIENT AND OUTPATIENT SURGERIES, 93,830 OUTPATIENT ENCOUNTERS AND 29,441 EMERGENCY DEPARTMENT VISITS. 89636372 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 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 0 1 1 1 0 0 1 76 0 1 888 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 VA X X CHARLES CODER 5712841163 28 BLACKWELL PARK SUITE 303 WARRENTON VA 20186 ALFRED PILONG SVP & CEO NH-UVA HS 0.00 50.00 X 0 847203 137280 JONATHAN D'SOUZA CHIEF MEDICAL OFFICER 50.00 0.00 X 388241 0 25399 DONNA STATON PRESIDENT 50.00 0.00 X 257869 0 12726 MINDI SHIFFLETT CHIEF NURSING OFFICER 50.00 0.00 X 194780 0 32559 SUSAN EDWARDS CHIEF HUMAN RESOURCE OFFICER 50.00 0.00 X 174385 0 33044 DENNIS SMITH PHARMACY MANAGER 45.00 0.00 X 180881 0 20483 SARA WHITE ADMIN DIRECTOR OF FINANCE 50.00 0.00 X 175623 0 22126 TEMPLE COATES DIR. PROF. & ANCILLARY SVC. 45.00 0.00 X 164778 0 32328 STEVEN SPEELMAN ADMIN DIRECTOR INFORMATION SYS 45.00 0.00 X 167059 0 26903 MARK UTZ DIR. OF PLANT ENGINEERING SVC. 45.00 0.00 X 158978 0 22133 MARK CHANEY DIRECTOR OF NURSING 45.00 0.00 X 156742 0 22608 MICHELLE STRIDER CHIEF QUALITY OFFICER 50.00 0.00 X 153869 0 22078 CHARLES BARRELL CHAIR 0.20 0.20 X X 0 0 0 SALLY NAN BARBER VICE CHAIR 0.20 0.00 X X 0 0 0 DOUG LISCHKE TREASURER 0.20 0.00 X X 0 0 0 HORTENSE HINTON-JACKSON SECRETARY 0.20 0.00 X X 0 0 0 RICHARD HARRINGTON TRUSTEE 0.20 0.00 X 0 0 0 JAMES FERGUSON MD TRUSTEE 0.20 0.00 X 0 0 0 THOMAS REYNOLDS TRUSTEE 0.20 0.00 X 0 0 0 SCOTT SYVERUD MD TRUSTEE 0.20 0.00 X 0 0 0 2173205 847203 409667 49 0 1 0 UNIVERSITY OF VIRGINIA PHYSICIANS GROUP 500 RAY C HUNT DR CHARLOTTESVILLE VA 22903 CLINICAL SUPPORT 3185355 OUTPATIENT IMAGING CULPEPER 840 CRESCENT CENTRE DR SUITE 200 FRANKLIN TN 37067 CLINICAL SUPPORT 2830708 UVA MEDICAL CENTER PO BOX 800778 CHARLOTTESVILLE VA 22908 CLINICAL SUPPORT 2339460 AMERICAN ANESTHESIOLOGY PO BOX 281034 ATLANTA GA 30384 PHYSICIAN SUPPORT 1749625 MOORE'S ELECTRICAL & MECHANICAL CONSTR 916 N POPLAR ST CHARLOTTE NC 28206 PURCHASED SERVICES 826147 21 13636253 33025 13669278 NET PATIENT REVENUE 622110 104392768 104392768 PASS-THRU PATIENT LOSS 621111 -3318498 -3318498 101074270 9939 9939 216806 0 216806 216806 216806 301267 153958 147309 147309 147309 MISCELLANEOUS REVENUE 900099 711209 711209 CAFETERIA MEALS 722514 198907 198907 CATERING 722320 1399 1399 911515 116029117 101785479 1399 572961 X 551275 551275 25933 25933 1492700 1492700 38184455 24717886 13466569 1353208 879585 473623 6279670 4081785 2197885 2743678 1783391 960287 520030 520030 17521574 15173573 2348001 94282 94282 1639092 1259665 379427 1094534 1094534 1581479 1518220 63259 1795 1167 628 64156 41701 22455 6371897 6128200 243697 420522 64379 356143 PHARMACEUTICALS 14010418 14010418 MEDICAL SUPPLIES 9059717 9014797 44920 BAD DEBT 5825525 5825525 REPAIRS AND MAINTENANCE 1983614 1959243 24371 1652869 1410813 242056 112472423 89636372 22836051 0 13831182 33613208 13780393 15064646 2693244 2463799 1078581 1004429 78910928 21490875 57321558 57420053 1194266 3404716 26795073 23912743 0 2673003 116694297 139556597 10160314 26103302 4128164 5781378 14288478 31884680 X 102245289 107511485 160530 160432 102405819 107671917 116694297 139556597 X 3556694 1709404 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4187 4187 0 PART II-B, LINE 1: LINE 1I DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 6192309 6192309 25969580 12015438 13954142 114364 114364 0 39744300 6749222 32995078 6890375 2611851 4278524 57420053 0 OPERATING LEASE 2687179 THIRD PARTY PAYMENT PAYABLE 2046435 DUE TO AFFILIATES 1000000 PATIENT REFUNDS 47753 OTHER LIABILITIES 11 5781378 X PART X, LINE 2: LIABILITY UNDER FIN 48 (ASC 740) FOOTNOTE THE AUDIT FOR NOVANT HEALTH UVA HEALTH SYSTEM AND ITS AFFILIATES IS PREPARED ON A CONSOLIDATED BASIS. THE COMPANY IS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019. 1 1 1 X 1 X 0 1 0 1 1 3739516 0 3739516 0.03510 24070796 19558992 4511804 0.04230 0 0 0.00000 27810312 19558992 8251320 0.07740 45333 0 45333 0.00040 0 0 0.00000 0 0 0.00000 0 0 0.00000 500000 0 500000 0.00470 545333 545333 0.00510 28355645 19558992 8796653 0.08250 0 0 0 0 20300 0 20300 0.00020 0 0 0 0 0 0 0 0 2000 0 2000 0.00000 0 0 22300 22300 0.00020 1 5825525 0 36195044 50291867 -14096823 X 1 1 1 CULPEPER SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.62670 0.00000 0.37330 1 1 CMH DBA NHUVAHS CULPEPER MEDICAL CENTER 501 SUNSET LANE CULPEPER VA 22701 WWW.NOVANTHEALTHUVA.ORG H1848 X X X CULPEPER MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 20 1 0 0 1 X SEE SECTION C X 1 20 1 SEE SECTION C 0 1 X 200.000000000000 400.000000000000 X 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 X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B, LINE 3E: CULPEPER MEMORIAL HOSPITALSEVERAL SOCIAL, BEHAVIORAL, AND CLINICAL HEALTH NEEDS WERE IDENTIFIED THROUGH A COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. ONCE THE HEALTH NEEDS WERE IDENTIFIED, SURVEYS AND COMMUNITY MEETINGS WERE CONDUCTED TO ASK COMMUNITY MEMBERS AND STAKEHOLDERS TO RANK THE TOP HEALTH ISSUES ACCORDING TO YEARS OF POTENTIAL LIFE LOST AND MAGNITUDE OF THESE ISSUES. THE SCORES ARE CALCULATED TO RANK THE FOCUS AREAS AND PRIORITIZE THE IDENTIFIED HEALTH NEEDS. PART V, SECTION B, LINE 5: CULPEPER MEMORIAL HOSPITALWHILE 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: CULPEPER MEMORIAL HOSPITALHTTPS://WWW.NOVANTHEALTHUVA.ORG/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNITY-BENEFIT.ASPX PART V, SECTION B, LINE 10A: CULPEPER MEMORIAL HOSPITALHTTPS://WWW.NOVANTHEALTHUVA.ORG/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNITY-BENEFIT.ASPX PART V, SECTION B, LINE 11: CULPEPER MEMORIAL HOSPITALTHE HOSPITAL FACILITY IS A PART OF NOVANT HEALTH UVA HEALTH SYSTEM, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY HOSPITAL LEADERSHIP AND BOARD OF TRUSTEE MEMBERS; AS WELL AS, THE UVA MEDICAL CENTER AND UNIVERSITY OF VIRGINIA PHYSICIANS GROUP. 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 PLAN THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET THOSE HEALTH NEEDS IN ITS COMMUNITY. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. IT WAS DETERMINED THAT THERE ARE 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 PUBLICLY AVAILABLE IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE; REFER TO THE URL GIVEN PREVIOUSLY FOR THE POSTING OF THE PLAN. PART V, LINE 16A, FAP WEBSITE: CULPEPER MEMORIAL HOSPITALHTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPX PART V, LINE 16B, FAP APPLICATION: CULPEPER MEMORIAL HOSPITALHTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPX PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY: CULPEPER MEMORIAL HOSPITALHTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPX 2 1 - CULPEPER SURGERY CENTER LLC 541 SUNSET LANE STE 201 CULPEPER VA 22701 AMBULATORY SURGERY CENTER 1 - NHUVA HEALTH SYSTEM IMAGING CULPEPER 501 SUNSET LANE CULPEPER VA 22701 IMAGING CENTER 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: CHECKING OR SAVINGS ACCOUNTS, STOCKS, BONDS, IRAS, 401KS, CDS, LIFE INSURANCE (CASH TO LOAN VALUE), REAL PROPERTY, OR PERSONAL PROPERTY SUCH AS VEHICLES, CAMPERS, OR MOBILE HOMES. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY A RELATED ORGANIZATION. NOVANT HEALTH, INC. IS A MEMBER ORGANIZATION OF THE NOVANT HEALTH UVA HEALTH SYSTEM. IT PRODUCES A COMMUNITY BENEFIT REPORT, REFERRED TO AS A COMMUNITY IMPACT REPORT, REPRESENTING THE HEALTH SYSTEM AS A WHOLE INCLUDING THE FILING ORGANIZATION. THE REPORT CAN BE FOUND AT HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/OUR-IMPACT.ASPX. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990 SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE AMOUNTS REPORTED IN LINE 7 WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.PART I, LINE 7 COL(F):THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS$5,825,525. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESS THE UNDERLYING CAUSES OF HEALTH PROBLEMS AND IMPACT 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 SEMINARS AND TRAINING FOR COMMUNITY WORKFORCES. PART III, LINE 2: IMPLICIT PRICE CONCESSIONS (ANALOGOUS TO BAD DEBT EXPENSE) ARE 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 4: THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS (ANALOGOUS TO BAD DEBT EXPENSE) ON LINE 2 IS CALCULATED USING THE SAME METHODOLOGY AS CHARITY CARE AND OTHER COMMUNITY BENEFITS USING AN ENTITY SPECIFIC COST TO CHARGE RATIO (CCR). FOOTNOTE 2 (ACCOUNTS RECEIVABLE) ON PAGE 6 OF THE AUDITED FINANCIAL STATEMENTS DESCRIBES THE BAD DEBT EXPENSE. 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 EACHOVERHEAD 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. THEALLOWABLE 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 NOVANT HEALTH UVA HEALTH SYSTEM, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. NOVANT HEALTH, INC. IS A MEMBER ORGANIZATION OF THE NOVANT HEALTH UVA HEALTH SYSTEM. NOVANT HEALTH, INC. HAS A COMMUNITY BENEFIT DEPARTMENT ("CB DEPARTMENT") COMPRISED OF COMMUNITY BENEFIT PROFESSIONALS AND AN ASSOCIATED ADVISORY WORKING GROUP ("THE COMMUNITY BENEFIT GROUP") THAT INCLUDES REPRESENTATIVES FROM INTERNAL AUDIT, LEGAL, AND TAX. THE CB DEPARTMENT IS RESPONSIBLE FOR COORDINATING THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) REPORTED IN PART V, SECTION B, FOR EACH HOSPITAL WITHIN THE NOVANT HEALTH SYSTEM AS WELL AS FOR THE FILING ORGANIZATION. EACH HOSPITAL AND THE COMMUNITY BENEFIT GROUP WORK TOGETHER 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. 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. PART VI, LINE 3: CULPEPER HOSPITAL 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 REGISTERS) 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. IN ADDITION, FINANCIAL ASSISTANCE APPLICATIONS, AS WELL AS FAQS WITH RESPECT TO THE FINANCIAL ASSISTANCE POLICY, ARE HANDED OUT TO PATIENTS UPON REGISTRATION. THEHOSPITAL'S WEBSITE POSTS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND GUIDELINES FOR APPLYING. PART VI, LINE 4: CULPEPER MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTERTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA FOR NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER IS DEFINED BY THE ZIP CODES THAT REPRESENT MORE THAN 75% OF THE HOSPITAL'S IN-PATIENT POPULATION. THESE ZIP CODES ALL FALL WITHIN CULPEPER COUNTY, VIRGINIA.BASED ON 2020 ESTIMATES, CULPEPER COUNTY IS THE 37TH OUT OF 133 COUNTIES IN THE STATE OF VIRGINIA WITH JUST OVER 53,428 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 HAS EXPERIENCED SMALL, BUT STEADY POPULATION GROWTH (12.7%) SINCE THE 2010 US CENSUS.CHILDREN AND ADOLESCENTS (AGE 0-18) MAKE UP AN ESTIMATE OF ONE-QUARTER (24%) OF THE POPULATION IN CULPEPER COUNTY AND SENIORS (AGE 65 AND OVER) MAKE UP 16% OF THE POPULATION. NONWHITE MINORITIES CURRENTLY MAKE UP 39% OF THE RACIAL DEMOGRAPHIC IN CULPEPER COUNTY. THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS: WHITE NON-HISPANIC 7.4%; BLACK/AFRICAN-AMERICAN 1.4%; HISPANIC OR LATINO 1.2%; OTHER 2%. DATA TAKEN FROM THE 2019 US CENSUS BUREAU INCLUDES INDIVIDUALS THAT IDENTIFIED WITH MULTIPLE RACES; THEREFORE, THE PERCENTAGES EXCEED 100%.ACCORDING TO THE US CENSUS BUREAU DATA, THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $67,696. THE POVERTY RATE FOR CULPEPER COUNTY IS 8%. 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 ORGANIZATION'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT AT: HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/OUR-IMPACT.ASPX. 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. PARTICIPATING IN HEALTH FAIRS, AND PROVIDING 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 CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND13. GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST.FOR SPECIFIC EXAMPLES OF THIS ORGANIZATION'S COMMUNITY BENEFIT ACTIVITIES, WHICH FURTHER THE ORGANIZATION'S EXEMPT PURPOSES (AND THOSE OF ALL HOSPITALS AND HEALTHCARE FACILITIES IN THE SAME HEALTHCARE SYSTEM), PLEASE SEE THE NOVANT HEALTH COMMUNITY BENEFIT REPORT, LOCATED ATHTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/OUR-IMPACT.ASPX.PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. PART VI, LINE 6: THE ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH UVA HEALTH SYSTEM AND NOVANT HEALTH (COLLECTIVELY KNOWN AS "THE SYSTEM"), BOTH OF WHICH ARE NOT-FOR-PROFIT INTEGRATED GROUPS 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. THE SYSTEM'S COMMUNITY BENEFIT AS A WHOLE IS DOCUMENTED IN A SYSTEM-WIDE COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/OUR-IMPACT.ASPX.PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. THERE ARE SIGNIFICANT COMMUNITY BENEFIT ACTIVITIES WITHIN NOVANT HEALTH WHICH MAY NOT BE REPORTABLE ON A SCHEDULE H BECAUSE THEY ARE NOT CONDUCTED BY AN ENTITY WHICH OWNS OR OPERATES A HOSPITAL.IN ADDITION TO HOSPITALS, NOVANT HEALTH UVA HEALTH SYSTEM INCLUDES A PHYSICIAN ORGANIZATION WITH PRACTICES IN VIRGINIA AND A HOSPITAL FOUNDATION WHICH SUPPORTS AND ENHANCES THE ACTIVITIES IN THOSE HOSPITALS' COMMUNITIES. FURTHER, NOVANT HEALTH UVA HEALTH SYSTEM INCLUDES AMBULATORY SURGERY CENTERS, IMAGING CENTERS, REHABILITATION CENTERS, AND OTHEROUTPATIENT FACILITIES; ALL DEDICATED TO PROMOTING THE HEALTH OF THEIR RESPECTIVE COMMUNITIES. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORTCULPEPER MEMORIAL HOSPITAL FILES A COMMUNITY BENEFIT REPORT 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 WELLNESS FOUNDATION INC 19002 CROSSROAD PKWY CULPEPER VA 22701 521366700 501(C)(3) 500000 COMMUNITY OUTREACH ORANGE COUNTY FREE CLINIC INC 101 C WOODMARK STREET ORANGE VA 22960 251922019 501(C)(3) 15000 COMMUNITY OUTREACH THE BOYS & GIRLS CLUB OF FAUQUIER INC 169 KEITH STREET WARRENTON VA 20186 541815587 501(C)(3) 10000 COMMUNITY OUTREACH GIRLS ON THE RUN PIEDMONT PO BOX 245 WARRENTON VA 20186 463737841 501(C)(3) 6000 COMMUNITY OUTREACH 4 EMPLOYEE EMERGENCY FUND 2 2319 0 SCHOLARSHIPS 4 2000 0 MAMMOGRAMS 48 19724 0 PATIENT ASSISTANCE 5 196 0 PATIENT TRANSPORTATION 32 0 1694 FMV TRANSPORTATION PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE FILING ORGANIZATION IS PART OF THE INTEGRATED HEALTHCARE SYSTEM OPERATED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), THE PARENT ORGANIZATION. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. NOVANT 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 ALFRED PILONG SVP & CEO NH-UVA HS 0 524656 0 281458 0 41089 0 97672 0 39608 0 984483 0 0 JONATHAN D'SOUZA CHIEF MEDICAL OFFICER 295836 0 92405 0 0 0 14653 0 10746 0 413640 0 0 0 DONNA STATON PRESIDENT 224484 0 23000 0 10385 0 600 0 12126 0 270595 0 0 0 MINDI SHIFFLETT CHIEF NURSING OFFICER 179188 0 15592 0 0 0 9584 0 22975 0 227339 0 0 0 SUSAN EDWARDS CHIEF HUMAN RESOURCE OFFICER 159375 0 15010 0 0 0 10251 0 22793 0 207429 0 0 0 DENNIS SMITH PHARMACY MANAGER 164384 0 16497 0 0 0 10144 0 10339 0 201364 0 0 0 SARA WHITE ADMIN DIRECTOR OF FINANCE 159989 0 13651 0 1983 0 9916 0 12210 0 197749 0 0 0 TEMPLE COATES DIR. PROF. & ANCILLARY SVC. 148796 0 14004 0 1978 0 9513 0 22815 0 197106 0 0 0 STEVEN SPEELMAN ADMIN DIRECTOR INFORMATION SYS 151791 0 13269 0 1999 0 9601 0 17302 0 193962 0 0 0 MARK UTZ DIR. OF PLANT ENGINEERING SVC. 142851 0 14141 0 1986 0 8502 0 13631 0 181111 0 0 0 MARK CHANEY DIRECTOR OF NURSING 141647 0 13095 0 2000 0 8848 0 13760 0 179350 0 0 0 MICHELLE STRIDER CHIEF QUALITY OFFICER 139074 0 12795 0 2000 0 8928 0 13150 0 175947 0 0 0 PART I, LINE 3 THE FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH UVA HEALTH SYSTEM ("THE SYSTEM") AND RELIES UPON NOVANT HEALTH, INC., A SUPPORTING ORGANIZATION OF THE SYSTEM, TO USE THE PROCESS DESCRIBED IN PART VI, LINE 15 OF THIS RETURN TO ESTABLISH COMPENSATION FOR CERTAIN EXECUTIVES. THIS PROCESS ADHERES TO THE REQUIREMENTS SET FORTH TO SECURE THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, THE UTILIZATION OF THIRD-PARTY COMPARABILITY DATA SUCH AS PUBLISHED COMPENSATION SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. ELIGIBLE EXECUTIVES WILL BE NOMINATED BY THE CEO AND APPROVED BY THE NOVANT HEALTH COMPENSATION AND LEADERSHIP COMMITTEE ("THE COMMITTEE") TO PARTICIPATE. GENERALLY, ANNUAL CONTRIBUTIONS TO THE PLAN OR PAYMENTS TO PARTICIPANTS WILL BE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J. PRIOR TO MAKING THE CONTRIBUTIONS OR PAYMENTS, THE COMMITTEE WILL APPROVE THE AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WILL APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. OTHERWISE, VESTING WILL OCCUR ON JANUARY 1ST OF EACH YEAR FOR THE APPROPRIATE CLASS-YEAR VESTING PERIOD. THE COMMITTEE REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS. FORM 990, PART I, LINE 1 CULPEPER MEMORIAL HOSPITAL DOING BUSINESS AS NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER ("NHUVACMC") IS AN INTEGRAL PART OF THE NOVANT HEALTH UVA HEALTH SYSTEM ("NHUVAHS"). NHUVAHS WAS FORMED IN 2016 BY NOVANT HEALTH AND THE UNIVERSITY OF VIRGINIA HEALTH SYSTEM, AND IS A REGIONAL NONPROFIT, INTEGRATED HEALTHCARE NETWORK OF PHYSICIAN CLINICS, OUTPATIENT CENTERS, AND HOSPITALS THAT SERVES PATIENTS AND COMMUNITIES IN VIRGINIA. NHUVACMC RECEIVES STRATEGIC PLANNING, ADMINISTRATIVE AND OTHER SUPPORT FROM NOVANT HEALTH, INC., A MEMBER OF THE NOVANT HEATH UVA HEALTH SYSTEM. GENERAL INFORMATION NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER, LOCATED IN CULPEPER, VA, IS PART OF A JOINT OPERATING COMPANY KNOWN AS NOVANT HEALTH UVA HEALTH SYSTEM, WHICH WAS FORMED IN 2016 BETWEEN NOVANT HEALTH AND UVA HEALTH. THE HOSPITAL IS FOCUSED ON 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, ONE PERSON AT A TIME. IN ADDITION TO OUR QUALITY OF SERVICES AND COMPREHENSIVE CATEGORIES OF SERVICES, WE'RE VERY PROUD OF OUR PATIENT FINANCIAL SERVICES 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. SOCIAL RESPONSIBILITY AND COMMUNITY OUTREACH COMMUNITY OUTREACH IS A CRITICAL COMPONENT TO THE MISSION OF NOVANT HEALTH UVA HEALTH SYSTEM 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. SOME RECIPIENT ORGANIZATIONS INCLUDE CULPEPER WELLNESS FOUNDATION, CULPEPER FREE CLINIC, ORANGE COUNTY FREE CLINIC, GIRLS ON THE RUN PIEDMONT, CULPEPER LITERACY COUNCIL, SAFE, GERMANNA FOUNDATION GUARANTEE, CRUSH AND TEAM JORDAN. IN 2020, CULPEPER MEDICAL CENTER HOSTED VIRTUAL EDUCATION SESSIONS FOR THE COMMUNITY WHICH INCLUDED THE FOLLOWING: - WHAT'S UP, DOC? - FALL PREVENTION - PEDIATRIC HEALTHY EATING AND WEIGHT MANAGEMENT - WOMEN'S HEALTH CULPEPER MEDICAL CENTER ALSO OFFERED VIRTUAL SUPPORT GROUPS FOR WOMEN WHO HAVE LOST A NEWBORN OR PREGNANCY AND CANCER PATIENTS AND THEIR CAREGIVERS. IT PROVIDED COMMUNITY EDUCATION ABOUT ACCESS TO HEALTHCARE SERVICES, CANCER SERVICES, HEART DISEASE, STROKE, DIABETES AND COVID-19. WE ALSO OFFERED A SUPPORT GROUP SESSION FOR THOSE SEEKING HELP WITH STRESS MANAGEMENT AND DEPRESSION. OTHER INITIATIVES INCLUDED: - TWO AMERICAN RED CROSS BLOOD DRIVES THAT RECEIVED DONATIONS - COVID-19 COMMUNITY TESTING PART OF OUR ONGOING COMMITMENT TO PATIENTS AND THE COMMUNITY IS OFFERING FREE HEALTH SCREENINGS AND PARTNERING WITH OUR PHYSICIAN SPECIALISTS IN THE FIELDS OF CARDIOLOGY, ORTHOPEDICS, AND WOMEN'S HEALTH TO PROVIDE FREE EDUCATION TO MEMBERS OF OUR COMMUNITY. MAMMOGRAPHY SCREENINGS FOR COMMUNITY MEMBERS IN NEED, REGARDLESS OF THEIR ABILITY TO PAY, IS MADE POSSIBLE THROUGH THE PAMPER ME PINK MAMMOGRAPHY FUND, BASED AT NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER. NEW TECHNOLOGY & SERVICES IN JANUARY 2020, CULPEPER MEDICAL CENTER OPENED A THIRD PHYSICAL THERAPY AND REHAB SERVICES LOCATION THAT SPECIALIZES IN TREATING ORTHOPEDIC CONDITIONS SUCH AS LOWER-BACK PAIN, SHOULDER PAIN, POST-SURGERY RECOVERY, JOINT REPLACEMENT AND ARTHRITIS. THE CLINIC ALSO INCLUDES SPORTS REHAB FOR SPRAINS AND STRAINS, POST-OPERATIVE LIGAMENT SURGERIES AND OTHER SPORTS INJURIES. IN ADDITION, THE NEW LOCATION OFFERS GENERAL PHYSICAL THERAPY SERVICES AND SPECIALTY SERVICES INCLUDING LSVT BIG FOR PARKINSON'S DISEASE AND DRY NEEDLING. IN AUGUST 2020, NOVANT HEALTH UVA HEALTH SYSTEM OUTPATIENT IMAGING CULPEPER OPENED IN THE HEART OF DOWNTOWN CULPEPER, SUPPORTING THE TOWN'S MAIN STREET REVITALIZATION PROJECT. THE NEW FREESTANDING IMAGING CENTER PROVIDES RESIDENTS OF CULPEPER AND SURROUNDING COUNTIES WITH INCREASED OPTIONS FOR IMAGING SERVICES. IN SEPTEMBER 2020, TWO NEW SURGEONS JOINED CULPEPER MEDICAL CENTER. UVA ORTHOPEDICS, A DEPARTMENT OF CULPEPER MEDICAL CENTER WELCOMED A NEW HAND AND UPPER EXTREMITY ORTHOPEDIST, SHERIFF AKINLEYE, MD. TREATMENTS INCLUDE JOINT REPLACEMENT, ARTHROSCOPY AND SOFT TISSUE MANAGEMENT. ALL SURGERY, REHABILITATION AND POSTOPERATIVE FOLLOW-UP VISITS ARE PERFORMED AT CULPEPER MEDICAL CENTER. DR. AKINLEYE IS THE FIRST PROVIDER IN MORE THAN 15 YEARS TO OFFER THIS LEVEL OF SPECIALIZED SERVICE TO THE CULPEPER AREA. UVA SURGICAL SERVICES, A DEPARTMENT OF CULPEPER MEDICAL CENTER, WELCOMED A NEW GENERAL SURGEON, TIFFANY STODDARD. EXPANDED TREATMENTS INCLUDE MINIMALLY INVASIVE SURGERY OPTIONS. AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATIONS - RECEIVED AN 'A' GRADE IN THE LEAPFROG GROUP'S FALL 2020 HOSPITAL SAFETY GRADE - BABY FRIENDLY DESIGNATION BY THE WORLD HEALTH ORGANIZATION AND THE UNITED NATIONS CHILDREN'S FUND - NAMED ONE OF THE 100 BEST "HOSPITALS FOR SPECIALTY CARE" BY HEALTHGRADES FOR TWO AREAS OF ORTHOPEDICS: JOINT REPLACEMENT AND ORTHOPEDIC SURGERY - NAMED BY NEWSWEEK (IN PARTNERSHIP WITH THE LEAPFROG GROUP) AS ONE OF THE NATION'S BEST MATERNITY HOSPITALS FOR 2020 - EARNED A PERFECT SCORE IN THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S MATERNITY PRACTICES IN INFANT NUTRITION AND CARE (MPINC) SURVEY ACCREDITATION NOVANT HEALTH UVA HEALTH SYSTEM 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. NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER BREAST 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. NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER IS ACCREDITED BY THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF VASCULAR LABORATORIES, ENSURING QUALITY PATIENT CARE FOR VASCULAR TESTING. COMMUNITY BENEFIT REPORT HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/OUR-IMPA CT.ASPX THE COMMUNITY BENEFIT REPORT, REFERRED TO AS A COMMUNITY IMPACT REPORT, PREPARED BY NOVANT HEALTH IS A SYSTEM-WIDE REPORT THAT INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $1,018,000,000, INCLUDING $179,000,000 IN FINANCIAL ASSISTANCE FOR 2020. FORM 990, PART III, LINE 2 SERVING COMMUNITY IN THE PANDEMIC LEARN ABOUT HOW WE ARE SERVING OUR COMMUNITIES IN THE PANDEMIC BY VISITING HTTPS://WWW.NOVANTHEALTH.ORG/PORTALS/92/ASSETS/DOCUMENTS/ANNUAL-FINANCIA L-INFORMATION/NOVANT-HEALTH-2020-ANNUAL-REPORT_RISING-UP.PDF. 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 CORPORATION HAS NOVANT HEALTH UVA HEALTH SYSTEM AS ITS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS THE BOARD OF NOVANT HEALTH UVA HEALTH SYSTEM APPOINTS THE BOARD OF CULPEPER MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE REVIEW OF THE 990 IS PERFORMED BY THE CONTROLLER AND CHIEF FINANCIAL OFFICER AND THEN BY THE PRESIDENT; THE PRESIDENT BEING THE ONE RESPONSIBLE FOR SIGNING THE 990. A COPY OF THE 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING THE FORM 990 WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCEMENT OF CONFLICT OF INTEREST THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE QUESTIONNAIRE. THE BEGINNING OF EACH MEETING OF THE BOARD BEGINS WITH VOLUNTARY VERBAL SELF-DISCLOSURE OF ANY CONFLICTS WITH ANY ITEMS ON THE AGENDA. AS ADDITIONAL ISSUES ARISE DURING THE COURSE OF THE MEETING, A SIMILAR SELF-DISCLOSURE IS EXPECTED. CHALLENGES BY PARTICIPANTS ARE ENCOURAGED IF SELF-DISCLOSURES ARE NOT FORTH-COMING. DURING THE COURSE OF DOING BUSINESS, IF CONFLICTS ARE SUSPECTED BY ANYONE, THEY ARE ENCOURAGED TO NOTIFY THE CEO OF THEIR SUSPICIONS. THE CEO WILL INVESTIGATE, EMPLOYING LEGAL COUNSEL AS NECESSARY, AND WILL RESOLVE AS APPROPRIATE. ULTIMATELY IT IS THE RESPONSIBILITY OF THE CEO AND THE CHAIRMAN OF THE BOARD TO ENFORCE THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION IS AN INTEGRAL PART OF THE NOVANT HEALTH UVA HEALTH SYSTEM ("THE SYSTEM"), WHICH IS SUPPORTED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), ONE OF ITS MEMBERS. NOVANT HEALTH SUPPORTS THE SYSTEM BY PROVIDING A COMPENSATION REVIEW AND APPROVAL PROCESS TO CERTAIN SYSTEM ENTITIES. THE PROCESS IS CONDUCTED BY THE INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH, INC. BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) WHO REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR CERTAIN LEADERS AND EXECUTIVES ("EXECUTIVES") SERVING AS OFFICERS, INCLUDING THE TOP MANAGEMENT OFFICIAL, OR KEY EMPLOYEES FOR CERTAIN ENTITIES WITHIN THE SYSTEM. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT AND USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 5,079,254. MANAGEMENT AND GENERAL EXPENSES 1,106,376. TOTAL EXPENSES 6,185,630. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 140,368. MANAGEMENT AND GENERAL EXPENSES 5,849. TOTAL EXPENSES 146,217. COLLECTION SERVICES: MANAGEMENT AND GENERAL EXPENSES 194,782. TOTAL EXPENSES 194,782. PROFESSIONAL PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 8,020,675. TOTAL EXPENSES 8,020,675. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,933,276. MANAGEMENT AND GENERAL EXPENSES 1,040,994. TOTAL EXPENSES 2,974,270. FORM 990, PART XI, LINE 9: PARTNERSHIPS 3,116,794. NET ASSETS RELEASED FROM RESTRICTION 510,609. BOOK ADJUSTMENT -479,972. AFFILIATE TRANSFERS -1,438,027. 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