2018-11-15T08:41:49-06:00 2017-12-31 990 2017-01-01 540622371 CULPEPER MEMORIAL HOSPITAL INC CULP 3367182803 501 SUNSET LANE CULPEPER VA 22701 JEFF HETMANSKI PRESIDENT 5408298803 2018-11-14 170.98.106.254 2018-11-14 13:26:01 ES P 78A4C4F87B604C240469A634FCB01368FEDB2C97 2BE301797771FA56319AFE83B3D82A6B47BB15DE 2017 2019-02-21 02:37:17Z NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER PETER BERNARD 501 SUNSET LANE CULPEPER VA 22701 107671258 0 X WWW.NOVANTHEALTHUVA.ORG X 1956 VA SEE SCHEDULE O 7 7 790 219 25710 13922 74862 140534 91308935 106159792 70167 202571 1761516 975809 93215480 107478706 665763 697819 0 0 37360549 39337926 0 0 0 55581019 65513928 93607331 105549673 -391851 1929033 111950276 111305148 13737521 12367790 98212755 98937358 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. 0 0 79788106 697819 106486907 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. (SEE SCHEDULE O FOR CONTINUATION.)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 2017, THERE WERE 10,542 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 3 DAYS, AND AN AVERAGE DAILY CENSUS OF 29. THERE WERE 3,159 DISCHARGES, 2,139 INPATIENT AND OUTPATIENT SURGERIES, 86,264 OUTPATIENT ENCOUNTERS AND 33,935 EMERGENCY DEPARTMENT VISITS. 79788106 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 84 0 1 790 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 VA X X KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 BARBER SALLY NAN TRUSTEE 2.00 X 0 0 0 BARRELL CHARLES CHAIR 2.00 X X 0 0 0 CLARK SHARON TRUSTEE 2.00 X 0 0 0 FERGUSON JAMES MD TRUSTEE 2.00 X 0 0 0 FITZGERALD LARRY VICE CHAIR & TREAS 2.00 X X 0 0 0 LANE BRANDON TRUSTEE 2.00 X 0 0 0 SHANNON RICHARD MD TRUSTEE 2.00 X 0 0 0 SYVERUD SCOTT MD TRUSTEE 2.00 X 0 0 0 HETMANSKI JEFF CEO 60.00 X 49427 0 4376 NAPPS C GREG FMR CEO 60.00 X 255242 110266 47402 CONKLIN MAGGIE CNO 60.00 X 193299 0 23693 REYNOLDS THOMAS MD CHIEF MEDICAL OFFICER 60.00 X 207854 0 25627 SMITH DENNIS DIRECTOR OF PHARMACY NH UVA 40.00 X 186065 0 25605 COATES TEMPLE DIRECTOR REHAB SERVICES 40.00 X 156568 0 30762 WHITE SARA ADMIN DIRECTOR OF FINANCE 40.00 X 138268 0 20928 SHIFFLETT MINDI ADMIN DIRECTOR OF NURSING OPERATIONS 40.00 X 140074 0 9551 SHIFFLETT TRACEY DIRECTOR OF REVENUE CYCLE 40.00 X 140673 0 11454 1467470 110266 199398 36 0 1 0 UVA PHYSICIANS GROUP 500 RAY C HUNT DR CHARLOTTESVILLE VA 22903 CLINICAL SUPPORT 4020623 UVA MEDICAL CENTER PO BOX 800778 CHARLOTTESVILLE VA 22908 CLINICAL SUPPORT 3590885 CRENSHAW CONSTRUCTION CO INC PO BOX 1805 CULPEPER VA 22701 ARCHITECTURE/CONST. 1438927 AMERICAN ANESTHESIOLOGY PO BOX 281034 ATLANTA GA 30384 PHYSICIAN SERVICES 981162 ANESTHESIA PROFESSIONALS LLC 1302 RISING RIDGE RD STE 1 MOUNT AIRY MD 21771 PHYSICIAN SUPPORT 843591 24 140534 140534 NET PATIENT REVENUE 622310 105539195 105539195 SURGICAL CENTER INCOME 622310 620597 620597 106159792 185496 185496 322885 22856 0 11114 322885 11742 334627 11742 322885 198513 181438 17075 17075 17075 MISCELLANEOUS INCOME 900099 327115 327115 CAFETERIA MEALS 722514 300099 300099 CATERING 722320 13968 13968 641182 107478706 106486907 25710 825555 X 647212 647212 50607 50607 949906 949906 30611784 19897660 10714124 1101392 715905 385487 4420792 2873515 1547277 2254052 1465134 788918 431005 431005 13510721 8887299 4623422 113286 73636 39650 1468932 954806 514126 886459 576198 310261 1449261 942020 507241 28257 18367 9890 96989 63043 33946 728 473 255 7318476 4757009 2561467 539125 441958 97167 UBI TAXES 14661 14661 BAD DEBT 11969204 11969204 DRUGS 11408284 11408284 MEDICAL SUPPLIES 8599590 8599590 7678950 5446186 2232764 105549673 79788106 25761567 0 7954056 11188911 15111972 13556936 1897546 1931880 1123630 1128342 122185543 68688306 56453007 53497237 3157689 4301032 859101 949619 25030674 24751191 362601 0 111950276 111305148 10716676 9860342 3020845 2507448 13737521 12367790 X 97850155 98474853 362600 462505 98212755 98937358 111950276 111305148 X 1929033 296981 -1501411 X 0 1 X 1 0 X 2830000 2830000 27394461 13908859 13485602 114364 76243 38121 85272508 52100346 33172162 6574210 2602858 3971352 53497237 711 LEASE PAYABLE 5799 CH - DUE TO CWF LT COMMITMENT 2500000 OTHER LIABILITIES 938 2507448 1 1 1 X 1 X 0 1 1 0 1 1 5472478 5472478 0.05850 9374048 6966451 2407597 0.02570 14846526 6966451 7880075 0.08420 165439 165439 0.00180 627761 627761 0.00670 793200 793200 0.00850 15639726 6966451 8673275 0.09270 250 250 0.00000 2600 2600 0.00000 1000 1000 0.00000 3850 3850 0.00000 1 11969204 31833029 43013508 -11180479 X 1 1 1 CULPEPER SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.55670 0.44330 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 17 1 0 0 1 X HTTPS://WWW.NOVANTHEALTHUVA.ORG X 1 17 1 HTTPS://WWW.NOVANTHEALTHUVA.ORG 0 1 X 100.000000000000 200.000000000000 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 CULPEPER MEMORIAL HOSPITAL PART V, SECTION B, LINE 3J: CULPEPER MEMORIAL HOSPITAL:PART V, SECTION B, LINE 3E:SEVERAL 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. CULPEPER MEMORIAL HOSPITAL 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. CULPEPER MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE 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. CULPEPER MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: CULPEPER MEMORIAL HOSPITAL:PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPXPART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPXPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPX 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 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-INVOLVEMENT/COMMUNITY-BENEFIT.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, LN 7 COL(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 $11,969,204 PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESSES 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: THE ALLOWANCE FOR BAD DEBT IS DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF SEVERAL FACTORS, INCLUDING HISTORICAL COLLECTION RESULTS, THE AGE OF THE ACCOUNTS, CHANGES IN COLLECTION PATTERNS AND GENERAL INDUSTRY CONDITIONS. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST) 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 7 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 EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A COST TO CHARGE RATION ("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 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 EDUCATESPATIENTS WHO MAY BE IN NEED AND ARE ELIGIBLE FOR ASSISTANCE. WHEN STAFF(CASHIER, FINANCIAL COUNSELOR, AND REGISTERS) ARE SPEAKING WITH A PATIENTTHAT STATES THEY ARE NOT ABLE TO PAY, THE PATIENT IS ENCOURAGED TO APPLYFOR FINANCIAL ASSISTANCE. BROCHURES DESCRIBING THE FINANCIAL ASSISTANCEPOLICY 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 THEFINANCIAL ASSISTANCE POLICY, ARE HANDED OUT TO PATIENTS UPON REGISTRATION.THE HOSPITAL'S WEBSITE POSTS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICYAND 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, WHICH IS COMPRISED OF THE FOLLOWING 13 ZIP CODES: 20106 (AMISSVILLE, VIRGINIA); 22701 (CULPEPER, VIRGINIA); 22713 (BOSTON, VIRGINIA); 22714 (BRANDY STATION, VIRGINIA); 22718 (ELKWOOD, VIRGINIA); 22724 (JEFFERSONTON, VIRGINIA); 22726 (LIGNUM, VIRGINIA); 22729 (MITCHELLS, VIRGINIA); 22733 (RAPIDAN, VIRGINIA); 22735 (REVA, VIRGINIA); 22736 (RICHARDSVILLE, VIRGINIA); 22737 (RIXEYVILLE, VIRGINIA); AND 22741 (STEVENSBURG, VIRGINIA).THERE IS ONE NONPROFIT HOSPITAL IN THE COMMUNITY WHICH IS THE ORGANIZATION. ACCORDING TO SG2 DATA, THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS: WHITE NON-HISPANIC (39,101) 72.1%; BLACK NON-HISPANIC (7,647) 14.1%; HISPANIC (4,934) 9.1%; OTHERS (1,848) 3.4%; ASIAN AND PACIFIC ISLAND NON-HISPANIC (722) 1.3%; FOR A TOTAL POPULATION OF 54,252.ACCORDING TO US CENSUS BUREAU DATA, THE AVERAGE MEDIAN HOUSEHOLD INCOME LEVEL WAS $70,606.ACCORDING TO SG2 DATA, THE AGE BREAKDOWN IS AS FOLLOWS: 0-17 YEARS (13,349) 24.6%; 18-64 YEARS (32,474) 59.9%; 65+ YEARS (8,429) 15.5%. 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 PROVIDES 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 AT HTTP://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL-PROFILE/COMMUNITY-BENEFIT-REPORT.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 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://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL-PROFILE/COMMUNITY-BENEFIT-REPORT.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 OTHER OUTPATIENT FACILITIES; ALL DEDICATED TO PROMOTING THE HEALTH OF THEIR RESPECTIVE COMMUNITIES. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT CULPEPER 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. 0 CULPEPER COUNTY CHAMBER OF COMMERCE 629 SPRETTYVILLE PIKE STE 100 CULPEPER VA 22701 540640609 501(C)(6) 5595 COMMUNITY OUTREACH CULPEPER WELLNESS FOUNDATION 311 S EAST STREET STE 100 CULPEPER VA 22701 521366700 501(C)(3) 502900 COMMUNITY OUTREACH CULPEPER COUNTY RESCUE SQUAD INC PO BOX 731 CULPEPER VA 22701 521322216 501(C)(3) 89743 COST MEDICAL SUPPLIES & NARCAN AMBULANCE SUPPLIES COUNTY OF ORANGE VIRGINIA 112 WEST MAIN ST ORANGE VA 22960 546001486 GOVERNMENT 19731 COST MEDICAL SUPPLIES & NARCAN AMBULANCE SUPPLIES MADISON COUNTY RESCUE SQUAD INC PO BOX 23 MADISON VA 22727 510250532 501(C)(3) 6218 COST MEDICAL SUPPLIES & NARCAN AMBULANCE SUPPLIES 4 1 BOOKS FOR PEDIATRIC PATIENTS 200 812 COST CHILDREN'S BOOKS FOR PEDIATRIC PATIENTS PATIENT ASSISTANCE 1 471 EMPLOYEE EMERGENCY ASSISTANCE 7 2914 MAMMOGRAMS 61 22107 PATIENT ASSISTANCE - MEDICINE 12 1526 FMV MEDICATION FOR INDIGENT PATIENTS PATIENT TRANSPORTATION 29 1201 FMV TRANSPORTATION SCHOLARSHIPS/TUITION ASSISTANCE 18 21576 PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE FILING ORGANIZATION DOES NOT PROVIDE GRANTS. X X X 0 0 0 0 0 0 0 0 0 NAPPS C GREG FMR CEO 228442 70293 26800 37500 0 2473 12651 6689 19548 8514 287441 125469 0 0 CONKLIN MAGGIE CNO 188299 0 5000 0 0 0 6597 0 17096 0 216992 0 0 0 REYNOLDS THOMAS MD CHIEF MEDICAL OFFICER 207854 0 0 0 0 0 12474 0 13153 0 233481 0 0 0 SMITH DENNIS DIRECTOR OF PHARMACY NH UVA 186065 0 0 0 0 0 11294 0 14312 0 211671 0 0 0 COATES TEMPLE DIRECTOR REHAB SERVICES 156568 0 0 0 0 0 9618 0 21145 0 187331 0 0 0 WHITE SARA ADMIN DIRECTOR OF FINANCE 138268 0 0 0 0 0 8452 0 12475 0 159195 0 0 0 SHIFFLETT TRACEY DIRECTOR OF REVENUE CYCLE 140673 0 0 0 0 0 8336 0 3118 0 152127 0 0 0 FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES CULPEPER MEMORIAL HOSPITAL DOING BUSINESS AS NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER 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 HEALTH UVA HEALTH SYSTEM. GENERAL INFORMATION NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER LOCATED IN CULPEPER, VA 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 AND MADISON 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 ASSISTANCE PROGRAM. WE WORK WITH PATIENTS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, DISCOUNT THEIR BILL, OR PROVIDE FREE CARE FOR THOSE THAT QUALIFY FOR FINANCIAL ASSISTANCE. 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 THE UNINSURED AND THE OVERALL COMMUNITY. SOME OF THE ORGANIZATIONS INCLUDE THE CULPEPER WELLNESS FOUNDATION, PIEDMONT REGIONAL DENTAL CLINIC, THE CRISIS INTERVENTION TEAM WITH THE RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES, THE CULPEPER COUNTY HEALTH DEPARTMENT, THE AMERICAN HEART ASSOCIATION AND THE AMERICAN CANCER SOCIETY. CULPEPER MEDICAL CENTER OFFERED SUPPORT GROUPS FOR WOMEN WHO HAVE LOST A NEWBORN OR PREGNANCY, AS WELL AS FOR CANCER PATIENTS. IT ALSO PROVIDED COMMUNITY EDUCATION ABOUT ACCESS TO HEALTHCARE SERVICES, CANCER SERVICES, HEART DISEASE AND STROKE AND DIABETES. PART OF OUR ONGOING COMMITMENT TO PATIENTS AND THE COMMUNITY IS OFFERING FREE OR LOW-COST SCREENINGS FOR GLUCOSE, BODY COMPOSITION, BLOOD PRESSURE AND HEMOGLOBIN A1C AS WELL AS PARTNERING WITH OUR PHYSICIAN SPECIALISTS IN THE FIELDS OF ENDOCRINOLOGY, OPHTHALMOLOGY AND PODIATRY TO PROVIDE QUESTION AND ANSWER SESSIONS FOR PERSONS WITH DIABETES. 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 CULPEPER MEDICAL CENTER. NEW TECHNOLOGY & SERVICES CARDIOLOGY SERVICE EXPANDED AT NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER WITH TWO NEW CARDIOLOGISTS HIRED TO MEET THE HEALTH CARE NEEDS OF THE CULPEPER AND SURROUNDING COMMUNITIES. IN FEBRUARY 2017, CULPEPER MEDICAL CENTER HOSTED A RIBBON CUTTING CEREMONY TO CELEBRATE COMPLETION OF ITS NEWLY RENOVATED LOBBY AND CARDIOLOGY CLINIC WITH SEVEN EXAM ROOMS AND FOUR DIAGNOSTIC ROOMS FOR ECHOCARDIOGRAPHY, EXERCISE STRESS TESTS, NUCLEAR STRESS TESTS AND VASCULAR ULTRASOUND. THE CARDIOLOGY CLINIC IS STAFFED BY TWO BOARD-CERTIFIED AND FELLOWSHIP-TRAINED CARDIOLOGISTS. IN 2017, CULPEPER MEDICAL CENTER PARTNERED WITH UVA HEALTH SYSTEM TO HAVE ALL PROFESSIONAL RADIOLOGY SERVICES EXCLUSIVELY PROVIDED BY THE UVA HEALTH SYSTEM DEPARTMENT OF RADIOLOGY. UVA HEALTH SYSTEM'S TEAM OF BOARD-CERTIFIED, FELLOWSHIP TRAINED SUBSPECIALTY RADIOLOGISTS PROVIDED AN ARRAY OF SPECIALTIES: FROM ROUTINE DIAGNOSTIC SCANS TO HIGHLY-ADVANCED INTERVENTIONAL RADIOLOGY SERVICES. IN ADDITION, UVA HEALTH SYSTEM HAS PARTNERED WITH FOUNDATION RADIOLOGY GROUP TO PROVIDE TELE-RADIOLOGY SERVICES, INCLUDING FINAL REPORTS AND INTERPRETED REPORTS BY FELLOWSHIP TRAINED SUBSPECIALISTS. AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATIONS -IN 2017, NOVANT HEALTH UVA HEALTH SYSTEM CULPEPER MEDICAL CENTER WAS RECOGNIZED BY THE MARCH OF DIMES FOR GIVING MORE BABIES A HEALTHY START IN LIFE. AT THE CULPEPER MEDICAL CENTER FAMILY BIRTH CENTER, PROVIDERS HAVE SUCCESSFULLY REDUCED THE NUMBER OF ELECTIVE INDUCTIONS AND CESAREAN DELIVERIES PERFORMED BEFORE 39 WEEKS OF PREGNANCY TO ZERO PERCENT. -CULPEPER MEDICAL CENTER RECEIVED ITS 11TH CONSECUTIVE GRADE "A" IN PATIENT SAFETY FROM THE LEAPFROG HOSPITAL GROUP, A NATIONAL HEALTH CARE RATINGS ORGANIZATION THAT EVALUATES HOSPITALS ON MEASURES RELATED TO SAFE CARE. -VIRGINIA MATERNITY CENTER BREASTFEEDING-FRIENDLY DESIGNATION BY THE VIRGINIA DEPARTMENT OF HEALTH -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. 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. COMMUNITY BENEFIT REPORT HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-INVOLVEMENT/ COMMUNITY-BENEFIT.ASPX THE COMMUNITY BENEFIT 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 $794,000,000, INCLUDING $138,000,000 IN FINANCIAL ASSISTANCE FOR 2017. FORM 990, PART I, LINE 6: THE NUMBER OF VOLUNTEERS REPORTED INCLUDES THOSE VOLUNTEERS SERVINGS AS BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 2 FAMILY AND/OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIP RICHARD SHANNON SALLY NAN BARBER BUSINESS RELATIONSHIP RICHARD SHANNON SCOTT SYVERUD BUSINESS RELATIONSHIP SCOTT SYVERUD LARRY FITZGERALD FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). FORM 990, PART VI, SECTION A, LINE 7A 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 FORM 990, PART VI, SECTION B, LINE 11: ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE REVIEW OF THE 990 IS PERFORMED BY THE CHIEF FINANICAL OFFICER AND CONTROLLER, THE FINANCE COMMITTEE AND THEN BY THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. THE CEO BEING THE ONE RESPONSIBLE FOR SIGNING THE 990. FORM 990, PART VI, SECTION B, LINE 12C FORM 990, PART VI, SECTION B, LINE 12C: MONITORING AND ENFORCEMENT OF COI THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE QUESTIONNAIRE. AT THE BEGINNING OF EACH MEETING OF THE BOARD BEGINS WITH VOLUNTARY VERBAL SELF-DISCLOSURE OF ANY CONFLICTS WITH ANY ITEMS ON THE AGENDA. AS ADDITONAL ISSUES ARISE DURING THE COURSE OF THE MEETING, A SIMILAR SELF-DISCLOSURE IS EXPECTED TO BE MADE. 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 RESPONSIBILTY OF THE CEO AND THE CHAIRMAN OF THE BOARD TO ENFORCE THE POLICY. FORM 990, PART VI, SECTION C, LINE 19 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 8,859,990. MANAGEMENT AND GENERAL EXPENSES 4,452,694. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,312,684. CONSULTING FEES : PROGRAM SERVICE EXPENSES 18,643. MANAGEMENT AND GENERAL EXPENSES 10,038. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,681. CREDENTIALING FEES : PROGRAM SERVICE EXPENSES 8,666. MANAGEMENT AND GENERAL EXPENSES 4,666. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,332. COLLECTION SERVICE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 156,024. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 156,024. FORM 990, PART XI, LINE 9: CONTRIBUTIONS: 514,485. PARTNERSHIPS: -104,619. AFFILIATE TRANSFERS: -1,911,274. ROUNDING: -3. 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