2018-08-15T13:19:52-05:00 2017-09-30 222428965 CITRIN COOPERMAN & COMPANY LLP 2 BETHESDA METRO CENTER 11TH FLOOR BETHESDA MD 20814 990 2016-10-01 540573701 FHI SERVICES FHIS 5406804100 321 WALKER DRIVE NO 301 WARRENTON VA 20186 CHRISTINE M CONNOLLY PRESIDENT & CEO 5406804100 2018-08-14 1 BRIAN J GIGANTI P00646609 3016549000 2016 2022-09-23 18:48:47Z X CHRISTINE M CONNOLLY 321 WALKER DRIVE NO 301 WARRENTON VA 20186 62518899 0 X WWW.FAUQUIERHEALTH.ORG X 1954 VA OUR MISSION IS MAKING COMMUNITIES HEALTHIER. 14 14 0 14 0 0 0 0 8812189 4274056 14232081 5167628 2248541 2863769 25292811 12305453 1860398 2888607 0 0 0 0 0 0 0 343358 1212292 2203756 4100899 23089055 8204554 225399613 249991075 5313224 3246921 220086389 246744154 X OUR MISSION IS TO RESTORE, PROMOTE AND MAINTAIN THE HEALTH OF THE COMMUNITY. 0 0 3024521 2888607 7137825 FHI SERVICES IS A 501(C) (3) NON-PROFIT CORPORATION. FHI SERVICES IS GOVERNED BY THE SAME BOARD AND MANAGEMENT TEAM AS ITS PARENT ORGANIZATION, FHS SERVICES, AND ITS BROTHER/SISTER ORGANIZATION, THE FAUQUIER HEALTH FOUNDATION (DBA THE PATH FOUNDATION).THE THREE ENTITIES, COLLECTIVELY, ARE REFERRED TO AS THE ORGANIZATION". THE ORGANIZATION'S" MISSION IS TO STRENGTHEN THE HEALTH AND VITALITY OF THE COMMUNITIES OF FAUQUIER, RAPPAHANNOCK AND NORTHERN CULPEPER COUNTIES. FAUQUIER HEALTH IS OPERATED BY A JOINT VENTURE (FAUQUIER HOLDING COMPANY) OWNED IN PART BY FHI SERVICES (20%) AND LIFEPOINT HEALTH (80%). FHI SERVICES APPOINTS 50% OF THE MEMBERS OF THE FAUQUIER HOLDING COMPANY LLC'S GOVERNING BOARD AND FHI SERVICES HAS MAJORITY GOVERNANCE WITH RESPECT TO ITEMS/ISSUES IMPACTING THE TAX-EXEMPT PURPOSE OF FHI SERVICES (CHARITABLE OVERRIDE PROVISION).THE COMMUNITY BENEFIT CONTRIBUTION OF FHI SERVICES INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTHCARE AND IMPROVE HEALTH IN FAUQUIER, RAPPAHANNOCK AND NORTHERN CULPEPER COUNTIES. ORGANIZATIONAL COMMITMENT TO PROVIDING A COMMUNITY BENEFIT INCLUDES: FAUQUIER HEALTH (FH) IS A 97 BED NOT-FOR-PROFIT ACUTE CARE FACILITY THAT PROVIDES COMPREHENSIVE HEALTHCARE SERVICES TO THE COMMUNITIES IT SERVES. THE MISSION IS TO MAKE THE COMMUNITIES IT SERVES HEALTHIER. FH IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA OF FAUQUIER COUNTY WITH A POPULATION OF 109,986. THE SERVICE AREA IS GROWING AND AGING, WITH OVERALL PROJECTED GROWTH BETWEEN 2017-2022 OF 6.3% AND WITH A 45+ POPULATION COMPRISING 45% OF THE TOTAL IN 2022.TO ADDRESS THE GROWING AND CHANGING HEALTHCARE NEEDS RESULTING FROM THESE POPULATION CHANGES, FH CONTINUES TO SUPPORT FIFTEEN PHYSICIANS, TWO OBSTETRICS/GYNECOLOGISTS, TWO FAMILY MEDICINE PHYSICIANS, A RHEUMATOLOGIST, A NEUROLOGIST, AN INFECTIOUS DISEASE SPECIALIST, FIVE INTERNAL MEDICINE PHYSICIANS, TWO UROLOGISTS, AND A HEMATOLOGIST/ONCOLOGIST. ALL PATIENTS AT FH HAVE IMPARTIAL ACCESS TO TREATMENT OR ACCOMMODATIONS THAT ARE AVAILABLE OR MEDICALLY INDICATED, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, RELIGION, OR SOURCE OF PAYMENT FOR CARE. THE 24-HOUR EMERGENCY DEPARTMENT IS OPEN TO EVERYONE IN THE COMMUNITY, REGARDLESS OF ABILITY TO PAY, AND PARTICIPATES IN MEDICARE, MEDICAID, AND CHAMPUS/TRICARE STANDARD.FH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA.THE MAJORITY OF THE MEMBERS OF THE GOVERNING BODIES FOR FH ARE INDEPENDENT REPRESENTATIVES OF THE COMMUNITIES SERVED.FH PROVIDES MEDICAL OVERSIGHT, DIRECTION, AND ORDERS TO PARAMEDICS IN THE FIELD AND IN ROUTE TO THE HOSPITAL. OUR EMERGENCY DEPARTMENT OFFERS 24-HOUR ACCESS TO MEDICAL SERVICES AND HELICOPTER TRANSPORT FOR CRITICALLY ILL OR INJURED INDIVIDUALS.FH HAS A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE CARE FOR PATIENTS WITHIN 200% OF THE FEDERAL POVERTY GUIDELINES AND DISCOUNTED CARE FOR PATIENTS WITHIN 300% OF THE FEDERAL POVERTY GUIDELINES. THE FINANCIAL ASSISTANCE PROGRAM ALSO PROVIDES FREE CARE TO PATIENTS WHO RESIDE IN OTHER AREAS WHO ARE WITHIN 100% OF THE FEDERAL POVERTY GUIDELINES. IN ADDITION, THROUGH A CONTINUING CARE FUND, FAUQUIER HEALTH OFFERS ASSISTANCE TO INDIVIDUALS WHO HAVE INADEQUATE FINANCIAL MEANS TO COVER THE COST OF POST-HOSPITALIZATION HEALTH SERVICES, SUCH AS NURSING CARE.TO HELP TRAIN AND EDUCATE HEALTH CARE PROFESSIONALS, FH WORKS WITH LOCAL COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS. FH STAFF PROVIDED APPROXIMATELY 23,059 HOURS AT A COST OF APPROXIMATELY $779,920. IN ADDITION, PARTNERSHIPS HAVE BEEN ESTABLISHED WITH LOCAL NON-PROFITS (E.G. FAUQUIER FREE CLINIC, THE CHAMBER OF COMMERCE, SCHOOLS AND CHURCHES) AND NATIONAL ORGANIZATIONS (E.G. THE AMERICAN CANCER SOCIETY) TO SUPPORT LOCAL EVENTS AND PROVIDE COMMUNITY HEALTH AND WELLNESS PROGRAMS. THESE COMMUNITY BENEFIT ACTIVITIES ARE COORDINATED BY A FULL-TIME COMMUNITY OUTREACH STAFF PERSON, SUPPORTED BY ADMINISTRATIVE AND CLINICAL DEPARTMENTS, AND AUXILIARY VOLUNTEERS AS NEEDED.IN ADDITION TO THE CONTRIBUTIONS MADE BY THE HOSPITAL, FHI SERVICES INVESTS IN THE COMMUNITY BY PROVIDING GRANTS RELATED TO THE FOUR PRIORITY AREAS OF CHILDHOOD WELLNESS, MENTAL HEALTH, SENIOR SERVICES AND ACCESS TO HEALTH. FHI SERVICES OFFERS SEVERAL GRANT CYCLES DURING THE YEAR TO HELP NONPROFITS AND GOVERNMENT AGENCIES BETTER THE COMMUNITIES IT SERVES. IN THE CURRENT YEAR, COMPETITIVE PROGRAM AND PLANNING GRANTS, GENERAL OPERATIONS GRANTS, NON-COMPETITIVE HEALTH PRIORITY GRANTS, AND RESPONSIVE GRANTS, WERE FUNDED. PROGRAM AND PLANNING GRANTS THESE 12-MONTH GRANTS ARE DESIGNED TO SUPPORT CLEARLY DEFINED PROGRAM-BASED INITIATIVES AND/OR SPECIFIC ORGANIZATIONAL PLANNING STRATEGIES. OFFERED ANNUALLY, THE OBJECTIVES OF THESE GRANTS ARE TO PROVIDE ONGOING SUPPORT TO SIGNATURE PROGRAMS OF ESTABLISHED ORGANIZATIONS; ENCOURAGE INNOVATION IN CREATING AND INTRODUCING NEW INITIATIVES AND OFFERINGS; AND TO STRENGTHEN EVOLVING ORGANIZATIONS FOCUSED ON CAPACITY AND PROCESS IMPROVEMENT. PROGRAMS MAY BE NEW OR ONGOING AND FUNDS MAY BE USED TO CREATE, IMPLEMENT AND/OR SUSTAIN SPECIFIC PROGRAMS. PLANNING GRANTS MAY BE CONSIDERED FOR A VARIETY OF PROCESSES INCLUDING STRATEGIC PLANNING, BOARD DEVELOPMENT, MASTER FACILITY PLANS, SURVEYS AND EVALUATIONS, PILOT PROGRAMS AND OTHER CAPACITY-BUILDING ACTIVITY. ALL PROGRAM AND PLANNING GRANTS RELATE TO ONE OF FOUR KEY PRIORITIES: ACCESS TO HEALTH, CHILDHOOD WELLNESS, MENTAL HEALTH, SENIOR SERVICES TOTALING $505,583 IN FY2017. GENERAL OPERATIONS GRANTS OFFERED IN ALTERNATING YEARS, GENERAL OPERATIONS GRANTS ARE THE PATH FOUNDATION'S MOST COMPETITIVE AWARDS. A SMALL NUMBER OF GRANTS WERE MADE TO LOCAL NONPROFITS DEMONSTRATING THE HIGHEST STANDARDS AND PRINCIPLES IN OUR COMMUNITY TOTALING $501,283 IN FY2017. THE PURPOSE OF THESE GRANTS IS TWOFOLD: TO EMPOWER EXCEPTIONAL NONPROFITS TO EXPAND, IMPROVE OR PURSUE THEIR BEST IDEAS; AND TO ESTABLISH A SHARED STANDARD OF BEST PRACTICES THAT ANY NONPROFIT, REGARDLESS OF SIZE, CAN AIM FOR. FUNDS MAY BE USED FOR ANY DIRECT OR INDIRECT COSTS RELATED TO THE NONPROFIT'S ACTIVITIES, INCLUDING BUT NOT LIMITED TO PAYROLL, RENT, UTILITIES, SUPPLIES AND EQUIPMENT, PROJECT COSTS, PROFESSIONAL DEVELOPMENT, CAPITAL IMPROVEMENTS, PROGRAMS, PLANNING, MARKETING, AND PROFESSIONAL SERVICES.HEALTH PRIORITY GRANTS AND RESPONSIVE GRANTSHEALTH PRIORITY GRANTS ARE RESERVED FOR SPECIAL INITIATIVES, OFTEN DEVELOPED OR LED BY PATH WHICH INCLUDE MAJOR AND SOMETIMES MULTI-YEAR PROJECTS DESIGNED TO HAVE LONG-RANGE IMPACT ON OUR FOUR AREAS OF FOCUS. IN THE CURRENT YEAR, NOTABLE INITIATIVES INCLUDED FAUQUIER REACHES FOR EXCELLENCE IN SCHOOL HEALTH (FRESH), COMMIT TO BE FIT, AND SUPPORT FOR TELEHEALTH, BROADBAND, COMMUNITY DESIGN AND WALKABILITY. HEALTH PRIORITY GRANTS IN SUPPORT OF SPECIAL INITIATIVES TOTALED $1,699,299 IN FY 2017. A RESPONSIVE GRANT IN THE AMOUNT OF $265,000 WAS PROVIDED TO SUPPORT THE NORTHERN PIEDMONT COMMUNITY FOUNDATION. 3024521 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 10 0 1 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 VA X LORNA MAGILL 5406804100 321 WALKER DRIVE SUITE 301 WARRENTON VA 20186 JOHN MCCARTHY CHAIR 1.50 3.00 X X 0 0 0 ROBIN GULICK VICE CHAIR 1.50 3.00 X X 0 0 0 RAYMOND KNOTT SECRETARY/TREASURER 1.50 3.00 X X 0 0 0 MARSHALL DOELLER TRUSTEE 1.50 3.00 X 0 0 0 JANELLE DOWNES TRUSTEE 1.50 3.00 X 0 0 0 RICK GERHARDT TRUSTEE 1.50 3.00 X 0 0 0 JOSHUA JAKUM TRUSTEE 1.50 3.00 X 0 0 0 MARY LEIGH MCDANIEL TRUSTEE 1.50 3.00 X 0 0 0 SUSAN RUBIN TRUSTEE 1.50 3.00 X 0 0 0 SUSAN STRITTMATTER TRUSTEE 1.50 3.00 X 0 0 0 TOM TUCKER TRUSTEE 1.50 3.00 X 0 0 0 MARK VAN DE WATER TRUSTEE 1.50 3.00 X 0 0 0 KAREN WACHTMEISTER TRUSTEE 1.50 3.00 X 0 0 0 PATRICIA WOODWARD TRUSTEE 1.50 3.00 X 0 0 0 CHRISTINE M CONNOLLY PRESIDENT/CEO 8.00 32.00 X 0 311735 31116 LORNA M MAGILL CFO 8.00 32.00 X 0 159896 17233 0 471631 48349 0 0 1 0 0 INCOME FROM HOSPITAL VENTURE 900003 4274056 4274056 4274056 2394609 2394609 52986465 50213446 2773019 2773019 2773019 CHANGE IN RESERVE LIABILITY 900009 2863769 2863769 2863769 12305453 7137825 0 5167628 2888607 2888607 38496 2060 36436 55774 3010 52764 955898 955898 7705 7705 21537 21537 1046 30 1016 18720 10296 8424 WALKABILITY TRAILS 79141 79141 OTHER EXPENSES 33975 33672 303 4100899 3024521 1076378 0 17237509 10381665 8955914 8955914 151466887 70633054 106953308 33046604 34954219 14692699 18112915 225399613 249991075 46179 1164188 564000 0 4703045 2082733 5313224 3246921 X 210527098 236391891 13052 13052 9546239 10339211 220086389 246744154 225399613 249991075 8204554 18453211 0 X X 0 1 X 1 0 X 9546239 792972 10339211 9064881 481358 9546239 9546225 -481344 9064881 9058046 697 751271 248020 15769 9546225 8623235 519 689130 238906 15932 9058046 1.00000 1 0 0 WELLINGTON CTF RESEARCH EQUITY 11750860 F FARALLON EQUITY PARTNER LP 11783702 F PALO ALTO HEALTHCARE OFFSHORE II, LTD 6226630 F COATUE LONG ONLY OFFSHORE FUND, LP 6989926 F CANYON VALUE REALIZATION FUND 5930599 F DAVIDSON KEMPNER INSTITUTIONAL PARTNERS LP 5747347 F ANCHORAGE CAPITAL PARTNERS 5749635 F WELLINGTON SRA 8489224 F GQG PARTNERS EMERGING MARKETS EQUITY FUND 7594167 F INDUS SELECT FUND LTD 6125923 F MW EURAKA FUND 6337251 F NITORIUM OFFSHORE FUND LTD 6045359 F THE SANDERSON INTERNATIONAL VALUE FUND 10821625 F KABOUTER INTERNATIONAL OPPORTUNITIES OFFSHORE FUNDS 7361060 F 106953308 INVESTMENT IN FAUQUIER HOLDING 34954219 F 34954219 DUE FROM AFFILIATE 6601956 INTEREST RECEIVABLE 1171748 INTEREST IN PERPETUAL TRUST - DUPONT ENDOWMENT FUND 10339211 18112915 RESERVE LIABILITY 2082733 2082733 X PART V, LINE 4: THE FAUQUIER HOSPITAL ENDOWMENT FUND (THE TRUST) IS AN IRREVOCABLE TRUST CREATED BY THE CHICHESTER DUPONT FOUNDATION IN 1959. A LOCAL BANK WAS DESIGNATED AS THE TRUSTEE AND REMITS INCOME FROM THE TRUST TO THE HOSPITAL SEMIANNUALLY. THE INCOME MAY BE EMPLOYED BY THE HOSPITAL TO FURTHER ITS WORK IN SUCH MANNER AS THE BOARD OF TRUSTEES OF THE HOSPITAL DETERMINES. PART X, LINE 2: THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. IN THE FOOTNOTE, FHS SERVICES REFERS TO THE CONSOLIDATED GROUP AS A WHOLE WHICH INCLUDES FHS SERVICES,FHI SERVICES, AND FAUQUIER HEALTH FOUNDATION. FHS SERVICES, FHI SERVICES AND THE FAUQUIER HEALTH FOUNDATION (D/B/A PATH FOUNDATION) ARE ALL EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS A PUBLIC CHARITY PURSUANT TO IRC SECTION 509(A). FEDERAL TAX LAW REQUIRES THAT THESE ENTITIES BE OPERATED IN A MANNER CONSISTENT WITH THEIR INITIAL EXEMPTION APPLICATION TO MAINTAIN THEIR EXEMPT STATUS. MANAGEMENT HAS ANALYZED THE OPERATIONS OF THESE ENTITIES AND CONCLUDED THAT THESE ENTITIES REMAIN IN COMPLIANCE WITH THE REQUIREMENTS FOR EXEMPTION. THE STATE IN WHICH THESE ENTITIES OPERATE ALSO PROVIDES A GENERAL EXCEPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, THESE ENTITIES ARE SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON THEIR UNRELATED BUSINESS INCOME. THESE ENTITIES HAVE NO UNRECOGNIZED TAX BENEFITS. MANAGEMENT HAS ALSO CONSIDERED THE IMPACT OF UNRELATED BUSINESS ACTIVITIES AND HAS CONCLUDED THAT THESE ENTITIES ARE NOT SUBJECT TO UNRELATED BUSINESS TAX OR ANY OTHER TAXES THAT COULD BE IMPOSED BY THE IRC OR STATE TAXING AUTHORITIES. AS SUCH, NO PROVISION IS MADE FOR INCOME TAXES AND NO ASSET OR LIABILITY HAS BEEN RECOGNIZED FOR DEFERRED TAXES. 1 1 1 X 1 X 0 1 1 0 1 1 557038 557038 0.02330 1162726 1212411 0 0.00000 1719764 1212411 557038 0.02330 191360 3827 187533 0.00780 159146 159146 0.00660 3018966 3018966 0.12600 3369472 3827 3365645 0.14040 5089236 1216238 3922683 0.16370 148 148 0.00000 148 148 0.00000 1 530600 228423 6045236 8389125 -2343889 X 1 1 1 1 THE FAUQUIER HOSPITAL 500 HOSPITAL DRIVE WARRENTON VA 20186 WWW.FAUQUIERHEALTH.ORG X X X THE FAUQUIER HOSPITAL 1 0 0 1 X X X X X X X X 16 1 0 0 1 X WWW.FAUQUIERHEALTH.ORG X X 1 16 1 WWW.FAUQUIERHEALTH.ORG 0 1 X 200.000000000000 X X X X 1 1 X X X 1 X WWW.FAUQUIERHEALTH.ORG X WWW.FAUQUIERHEALTH.ORG X WWW.FAUQUIERHEALTH.ORG X X X X X X 1 0 1 X 0 0 THE FAUQUIER HOSPITAL PART V, SECTION B, LINE 5: OVER 90 INDIVIDUALS FROM 56 COMMUNITY AND HEALTH CARE ORGANIZATIONS COLLABORATED TO IMPLEMENT A COMPREHENSIVE CHNA PROCESS FOCUSED ON IDENTIFYING AND DEFINING SIGNIFICANT HEALTH NEEDS, ISSUES, AND CONCERNS OF FAUQUIER AND RAPPAHANNOCK COUNTIES. THE THREE-MONTH PROCESS CENTERED ON GATHERING AND ANALYZING DATA AS WELL AS RECEIVING INPUT FROM PERSONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY AND HAD SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH TO PROVIDE DIRECTION FOR THE COMMUNITY, THE FAUQUIER HEALTH FOUNDATION, THE VIRGINIA DEPARTMENT OF HEALTH, AND FH TO CREATE A PLAN TO IMPROVE THE HEALTH OF THE COMMUNITY.42 COMMUNITY MEMBERS, NOT-FOR-PROFIT ORGANIZATIONS (REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, ELDERLY AND CHILDREN), FOUNDATIONS, SCHOOLS, HEALTH PROVIDERS, AND GOVERNMENT REPRESENTATIVES PARTICIPATED IN THREE FOCUS GROUPS FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES ON APRIL 4 AND 5, 2017.INFORMATION GATHERING USING SECONDARY PUBLIC HEALTH SOURCES OCCURRED IN FEBRUARY AND MARCH OF 2017. TWENTY-FIVE COMMUNITY PHYSICIANS AND 285 FAUQUIER HEALTH EMPLOYEES WERE SURVEYED ELECTRONICALLY REGARDING THEIR PERSPECTIVES ON COMMUNITY HEALTH STATUS AND NEEDS FROM MARCH 1 THROUGH MARCH 27, 2017. 584 COMMUNITY SURVEYS WERE COMPLETED; 206 BY TELEPHONE (LANDLINE AND CELL PHONES), 268 ELECTRONIC SURVEYS, AND 124 PRINT SURVEYS IN ENGLISH AND 6 IN SPANISH WERE CONDUCTED BETWEEN MARCH 1 AND MARCH 31, 2017. COMMUNITY PARTNERS SENT THE SURVEY OUT TO CLIENTS AND EMPLOYEES. A COMMUNITY HEALTH TOWN HALL WAS CONDUCTED ON APRIL 6, 2017 WITH OVER 60 COMMUNITY STAKEHOLDERS. THE AUDIENCE CONSISTED OF HEALTHCARE PROVIDERS, BUSINESS LEADERS, LAW ENFORCEMENT, GOVERNMENT REPRESENTATIVES, NOT-FOR-PROFIT ORGANIZATIONS (MENTAL HEALTH, SUBSTANCE ABUSE, ELDERLY SERVICES, MINORITY POPULATIONS, ETC.), AND OTHER COMMUNITY MEMBERS.INPUT OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WAS RECEIVED DURING THE FOCUS GROUPS, THE COMMUNITY HEALTH TOWN HALL, AND THE COMMUNITY SURVEY. AGENCIES REPRESENTING THESE POPULATIONS WERE INTENTIONALLY INVITED TO THE FOCUS GROUPS AND TOWN HALL. NOT-FOR-PROFIT AND GOVERNMENT AGENCIES DISTRIBUTED THE COMMUNITY SURVEY TO THEIR CLIENTS TO ENSURE INPUT FROM THESE POPULATIONS. HOSPITAL EMPLOYEES AND COMMUNITY PHYSICIANS WERE ALSO SURVEYED, PROVIDING INSIGHT INTO THE HEALTH NEEDS OF THE MEDICALLY UNDERSERVED AND THE COMMUNITY AT-LARGE. THE FAUQUIER HOSPITAL PART V, SECTION B, LINE 7D: AS OF AUGUST 1, 2017, THIS REPORT WAS MADE WIDELY AVAILABLE TO THE COMMUNITY VIA FAUQUIER HEALTH'S WEBSITE, WWW.FAUQUIERHEALTH.ORG, AND THE FAUQUIER HEALTH FOUNDATION'S (DBA THE PATH FOUNDATION) WEBSITE, WWW.PATHFORYOU.ORG. OUTSIDE OF THE WEBSITES, PAPER COPIES ARE AVAILABLE FREE OF CHARGE AT BOTH FAUQUIER HOSPITAL AND THE FAUQUIER HEALTH FOUNDATION. THE FAUQUIER HOSPITAL PART V, SECTION B, LINE 11: AT THE COMMUNITY HEALTH TOWN HALL, ATTENDEES REVIEWED THE MOST SIGNIFICANT HEALTH NEEDS IN THE COMMUNITY FOR THE NEXT THREE-YEARS AS IDENTIFIED BY THE FOCUS GROUPS AND THE COMMUNITY SURVEY. THE COMMUNITY HEALTH TOWN HALL AFFIRMED THE PRIORITIES, LISTED BELOW.WITH THE FOLLOWING ISSUES PRIORITIZED, ATTENDEES BRAINSTORMED GOALS AND ACTIONS AT THE COMMUNITY HEALTH TOWN HALL, CREATING THE FOUNDATION FOR FAUQUIER AND RAPPAHANNOCK COUNTIES' HEALTH INITIATIVES.SUBSTANCE ABUSE (INCLUDING ALCOHOL, TOBACCO, AND DRUGS), MENTAL HEALTH SERVICES, HEALTHY EATING/ACTIVE LIVING (ADDRESSING GENERAL HEALTH AND OBESITY), SOCIOECONOMICS (HOUSING, JOBS), ACCESS TO CARE (UNINSURED, COST OF INSURANCE AND CARE, AND CATCHING PEOPLE IN THE SERVICE GAP), CHILDHOOD WELLNESS (MENTAL HEALTH, NUTRITION, AND PHYSICAL ACTIVITY) AND SENIOR SERVICES (HOME CARE, WELLNESS, AND CHRONIC DISEASE MANAGEMENT).TO ADDRESS HEALTH EDUCATION AND LEADING CAUSES OF DEATH, THE HOSPITAL HOSTS FREE, MONTHLY HEALTH LECTURES ON VARIOUS TOPICS IDENTIFIED IN THE ASSESSMENT SUCH AS CANCER, HEART DISEASE, STROKE AND TIA, CHOLESTEROL, DIABETES, OBESITY, CONGESTIVE HEART FAILURE AND NUTRITION. FREE BLOOD PRESSURE SCREENINGS WERE ALSO OFFERED AT THE FAUQUIER HOSPITAL BISTRO DURING TUESDAYS AND THURSDAYS SENIOR SUPPER HOURS. FAUQUIER HEALTH ADDRESSES DIABETES BY PROVIDING DIABETES EDUCATION INCLUDING SUPPORT GROUPS, SELF-MANAGEMENT CLASSES, SCREENINGS, COUNSELING, AND TALKS AT SCHOOLS ON DIABETES TO SCHOOL CHILDREN. FREE MAMMOGRAMS ARE PROVIDED TO WOMEN TURNING 40. TO ADDRESS AGING SERVICES, FAUQUIER HEALTH FACILITATES SUPPORT GROUPS FOR ALZHEIMER'S, DEMENTIA, CANCER, CAREGIVERS AND DIABETES. FAUQUIER HEALTH HOSTED A SENIOR RESOURCE FAIR FOR COMMUNITY MEMBERS. IN ADDITION, FAUQUIER PARTNERS WITH THE LOCAL COMMUNITY SERVICE BOARD AND AGING TOGETHER TO HOST MEDICARE/MEDICAID COUNSELING, A FALL SYMPOSIUM AND AN ALZHEIMER'S/DEMENTIA WORKSHOP.TO ADDRESS CHILDHOOD WELLNESS, FAUQUIER HEALTH OFFERS MONTHLY JUNIOR CHEF CLASSES. DURING THE CLASS, THE KIDS LEARN HOW TO COOK HEALTHY MEALS. TO ADDRESS SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES, FAUQUIER HEALTH PROVIDES FREE MEETING SPACE TO SEVERAL SUPPORT GROUPS, INCLUDING FAMILIES OVERCOMING DRUG ADDICTION, NAMI (NATIONAL ALLIANCE ON MENTAL ILLNESS), AND THE ADDICTION RECOVERY SUPPORT GROUP. ADDITIONAL SUPPORT GROUPS THAT MEET AT THE HOSPITAL INCLUDE RHEUMATOID ARTHRITIS, BEREAVEMENT, LYME DISEASE, AND BREASTFEEDING. OTHER HEALTH NEEDS IDENTIFIED THAT THE HOSPITAL IS NOT ADDRESSING ARE HANDLED BY LOCAL ORGANIZATIONS OR GOVERNMENT ENTITIES. EXAMPLES INCLUDE, SOCIOECONOMICS WHICH ARE ADDRESSED BY THE LOCAL HEALTH DEPARTMENT AND SOCIAL SERVICES.BEHAVIORAL HEALTH IS CURRENTLY ADDRESSED BY THE LOCAL COMMUNITY SERVICES BOARD AND THE FAUQUIER FREE CLINIC; HOWEVER, THE HOSPITAL IS EXPLORING INITIATIVES TO ADDRESS THE NEED IN THE COMMUNITY. THE HOSPITAL SUPPORTS THE LOCAL FREE CLINIC FINANCIALLY AND WITH DONATED LAB AND RADIOLOGY SERVICES TO PROVIDE CARE TO THE UNINSURED POPULATION. THE FAUQUIER HOSPITAL PART V, SECTION B, LINE 16J: IN ADDITION TO PUBLISHING THE FINANCIAL ASSISTANCE POLICY ON THE HOSPITAL'S WEBSITE, SIGNAGE IS POSTED STRATEGICALLY THROUGHOUT THE HOSPITAL (INCLUDING ALL INPATIENT, OUTPATIENT, ANCILLARY AND EMERGENCY DEPARTMENT REGISTRATION OFFICES) WHICH INDICATES THAT FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDES CONTACT INFORMATION FOR FINANCIAL COUNSELORS WHO CAN HELP WITH THE APPLICATION PROCESS. NOTIFICATION REGARDING THE POLICY ARE AVAILABLE IN BOTH ENGLISH AND SPANISH, THE PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVED BY FAUQUIER HEALTH. REPRESENTATIVES OF OUR FINANCIAL ASSISTANCE ELIGIBILITY PARTNERS AND MEDASSIST, ALSO DIRECT ALL PATIENTS WHO ARE SCREENED FOR STATE OR FEDERAL ASSISTANCE PROGRAMS BUT DO NOT QUALIFY TO THE HOSPITAL FINANCIAL COUNSELORS FOR HOSPITAL CHARITY SCREENING. 12 1 - THE VILLA AT SUFFIELD MEADOWS 6735 SUFFIELD LANE WARRENTON VA 20187 ASSISTED LIVING 2 - FAUQUIER HEALTH REHABILITATION AND NU 360 HOSPITAL DRIVE WARRENTON VA 20186 NURSING HOME 3 - FAUQUIER HEALTH WELLNESS CENTER 419 HOLIDAY COURT SUITE 200 WARRENTON VA 20186 WELLNESS CENTER 4 - FAUQUIER HEALTH SLEEP CENTER 493 BLACKWELL ROAD SUITE 317-A WARRENTON VA 20186 SLEEP CENTER 5 - WOUND HEALING CENTER 493 BLACKWELL ROAD SUITE 101-A WARRENTON VA 20186 WOUND CENTER 6 - FAUQUIER HOSPITAL-MEDICAL IMAGING SERVIC 493 BLACKWELL ROAD SUITE 119 WARRENTON VA 20186 MEDICAL IMAGING 7 - HEMATOLOGYONCOLOGY 500 HOSPITAL DRIVE WARRENTON VA 20186 PHYSICIAN SERVICE 8 - INFECTIOUS DISEASES RHEUMATOLOGY 550 HOSPITAL DRIVE WARRENTON VA 20186 PHYSICIAN SERVICE 9 - OBSTETRICS AND GYNECOLOGY 253 VETERNAS DRIVE SUITE 210 WARRENTON VA 20186 PHYSICIAN SERVICE 10 - FAMILY PRACTICE AT BEALETON 6200 STATION DRIVE BEALETON VA 22712 PHYSICIAN SERVICE 11 - NEUROLOGY 550 HOSPITAL DRIVE WARRENTON VA 20186 PHYSICIAN SERVICE 12 - PIEDMONT INTERNAL MEDICINE 419 HOLIDAY COURT SUITE 200 WARRENTON VA 20186 PHYSICIAN SERVICE PART I, LINE 3C: ALL PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME LEVELS ARE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG),ARE ELIGIBLE FOR FREE CARE. THIS PROCESS REQUIRES AN APPLICATION AND VERIFICATION OF ALL SOURCES OF INCOME. IN ADDITION,ALL PATIENTS WHOSE INCOME IS BETWEEN 200-300% OF FPG ARE ELIBLE FOR DISCOUNTED CARE. BEFORE FINAL COLLECTION ACTION, ACCOUNTS ARE PUT THROUGH CREDIT SCORING SOFTWARE TO HELP IDENTIFY THOSE PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAVE NOT CONTACTED FH OFFICE UP TO THAT POINT. IF THE SOFTWARE INDICATES THAT THE PATIENT'S INCOME LEVEL MEETS FINANCIAL ASSISTANCE ELIGIBILITY, THE ACCOUNT IS PRESUMPTIVELY WRITTEN OFF TO CHARITY AND FURTHER COLLECTION ACTIVITY IS NOT PURSUED.PART I, LINE 7THE HOSPITAL FACILITY WAS CONTRIBUTED TO FAUQUIER HOLDING COMPANY, LLC AS PART OF THE LIFEPOINT TRANSACTION IN TAX YEAR 2013. FHI SERVICESRETAINS A 20% OWNERSHIP INTEREST IN FAUQUIER HOLDING COMPANY, LLC, AND APPOINTS 50% OF THE MEMBERS OF THE GOVERNING BOARD AND MAINTAINS RESERVE POWERS OVER EXEMPT ACTIVITIES OF THE JOINT VENTURE. FAUQUIER HOLDING COMPANY, LLC HAS A CALENDAR YEAR FISCAL YEAR AND ISSUES ITSFORM K-1 BASED UPON THE CALENDAR YEAR. AS A RESULT, THE INFORMATION PROVIDED IN PART I LINE 7 AND PART II REFLECTS THE OPERATIONS REFLECTED ON THE K-1 ISSUED BY FAUQUIER HOLDING COMPANY, LLC, WHICH IS 20% OF THE TOTAL COSTS INCURRED BY FAUQUIER HOSPITAL, FOR ITS YEAR ENDING WITHIN FHI SERVICES' FISCAL YEAR ( FROM JANUARY 1, 2016 THROUGH DECEMBER 31, 2016). FHI SERVICES' FISCAL YEAR WAS 10/1/2016 - 9/30/2017. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES SUPPORT THE HEALTH OF THE COMMUNITY BY OFFERING ENVIRONMENTAL IMPROVEMENTS AND COMMUNITY SUPPORT.ENVIRONMENTAL IMPROVEMENTS - FAUQUIER HEALTH'S ANNUAL MEDICATION AND SHARPS COLLECTION EVENTS HELPED TO SAFELY DISPOSE OF 402 GALLONS OF SHARPS AND 842 POUNDS OF MEDICATIONS. RATHER THAN COMMUNITY MEMBERS FLUSHING MEDICATIONS INTO THE GROUND WATER OR DISPOSING OF SHARPS AT THE LANDFILL, FAUQUIER HEALTH COLLECTS THEM AND WORKS WITH A MEDICAL WASTE MANAGEMENT COMPANY THAT DISPOSES OF THE ITEMS.COMMUNITY SUPPORT ACTIVITIES INCLUDED MED SHARPS,EMERGENCY DRUG SUPPLIES AND DISASTER ASSISTANCE. PART III, LINE 2: THE AMOUNT OF ORGANIZATION'S BAD DEBT EXPENSE WAS ESTIMATED BY MULTIPLYING THE TOTAL BAD DEBT EXPENSE FOR FAUQUIER HEALTH BY THE COST-TO-CHARGE RATIO CALCULATED IN WORKSHEET II. THE AMOUNT REPORTED IS 20% OF THIS COST WHICH IS THE FHI SERVICES INTEREST IN THE FAUQUIER HOLDING COMPANY, LLC. PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS ESTIMATED BY USING THE TOTAL BAD DEBT EXPENSE FOR FAUQUIER HEALTH MULTIPLIED BY THE COST-TO-CHARGE RATIO TO CALCULATE COST. THE BAD DEBT EXPENSE AT COST IS MULTIPLIED BY 29% WHICH IS THE ESTIMATED PERCENTAGE ATTRIBUTABLE TO PATIENTS THAT WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY. THE AMOUNT REPORTED IS 20% OF THIS COST WHICH IS THE FHI SERVICES INTEREST IN THE FAUQUIER HOLDING COMPANY, LLC. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REPORTED NET OF ALLOWANCES FOR THE EXCESS OF CHARGES OVER THE PAYMENTS ON PATIENT ACCOUNTS TO BE RECEIVED FROM THIRD PARTY PAYERS AND ESTIMATES OF UNCOLLECTIBLE AMOUNTS. THE SYSTEM'S POLICY IS TO WRITE-OFF ALL PATIENT ACCOUNTS THAT HAVE BEEN IDENTIFIED AS UNCOLLECTABLE. ANY ALLOWANCE FOR DOUBTFUL ACCOUNTS IS RECORDED FOR ACCOUNTS NOT YET WRITTEN OFF THAT MAY BECOME UNCOLLECTABLE IN FUTURE PERIODS BASED ON MANAGMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH OF ITS MAJOR PAYERS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS , AND OTHERS FOR SERVICES RENDERED, AND INCLUDE ESTIMATED RETROACTIVE REVENUE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED, AND SUCH AMOUNTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGERSUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS. FAUQUIER HOSPITAL PERIODICALLY EMPLOYED CREDIT SCORING SOFTWARE TO HELP IDENTIFY PATIENTS THAT MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, WHICH HAD NOT COMPLETED A FINANCIAL ASSISTANCE APPLICATION. IF THE SOFTWARE INDICATED THAT THE PATIENT'S INCOME LEVEL MET FINANCIAL ASSISTANCE ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THEN THE ACCOUNT WAS WRITTEN OFFTO CHARITY AND FURTHER COLLECTION ACTIVITY WAS NOT PURSUED. BECAUSE OF THE PERIODIC USE OF SUCH CREDIT SCORING SOFTWARE THROUGHOUT THE YEAR, IT IS DIFFICULT TO ESTIMATE THE AMOUNT OF THE BAD DEBT EXPENSE ATTRIBUTABLETO PATIENTS THAT MIGHT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 8: THE SHORTFALL FOR MEDICARE IS NOT CURRENTLY INCLUDED/CONSIDERED IN COMMUNITY BENEFIT. HOWEVER, THE SHORTFALL IS DUE TO THE REIMBURSEMENT FROM MEDICARE FALLING SHORT OF THE COST INCURRED TO PROVIDE CARE TO THE MEDICARE POPULATION SERVED BY THE FAUQUIER HOSPITAL. AS WITH THE SHORTFALL EXPERIENCED FOR THE MEDICAID POPULATION, THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT AS WELL. IT IS PART OF THE ORGANIZATION'S MISSION TO PROVIDE THE BEST POSSIBLE CARE TO PATIENTS WITHIN OUR COMMUNITY, AND THE ORGANIZATION BELIEVES PROVIDING SUCH CARE HAS IMPROVED THE OVERALL HEALTH OF THE COMMUNITY. BY PROVIDING SUCH CARE TO MEDICARE PATIENTS, THE GOVERNMENT'S BURDEN FOR CARING FOR SUCH INDIVIDUALS IS LESSENED. THE MEDICARE COST REPORT WAS UTILIZED AS OUTLINED IN THE SCHEDULE H,PART III, SECTION B, WORKSHEET B, WHICH UTILIZES THE COST TO CHARGE RATIO DEVELOPED WITHIN THE MEDICARE COST REPORT TO DETERMINE THE ALLOWABLE COST. PART III, LINE 9B: FAUQUIER HEALTH'S (FH) FINANCIAL ASSISTANCE POLICY CONTAINS THE FOLLOWING PROVISION ON COLLECTION PRACTICES FOR THOSE PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE: FH'S MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES (INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NON-PAYMENT, INCLUDING COLLECTIONS ACTION AND REPORTING TO CREDIT AGENCIES) THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY CARE OR DISCOUNTED CARE; A PATIENT'S GOOD FAITH EFFORTS TO APPLY FOR GOVERNMENTAL ASSISTANCE PROGRAMS OR FINANCIAL ASSISTANCE FROM FH, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH FH. FH WILL NOT IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS SUCH AS LAWSUITS, WAGE GARNISHMENTS, ARRESTS, BODY ATTACHMENTS, LIENS ON RESIDENCES, OR OTHER SIMILAR LEGAL ACTIONS AGAINST ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY. "REASONABLE EFFORTS" INCLUDE NOTIFICATIONS BY THE HOSPITAL OF THIS FINANCIAL ASSISTANCE POLICY UPON ADMISSION AND IN WRITTEN AND ORAL COMMUNICATIONS WITH THE PATIENT REGARDING THE PATIENT'S BILL, INCLUDING INVOICES AND TELEPHONE CALLS BEFORE COLLECTION ACTION OR REPORTING TO CREDIT AGENCIES IS INITIATED. IF A PATIENT IS FOUND TO QUALIFY FOR FINANCIAL ASSISTANCE AFTER COLLECTION ACTIONS HAVE STARTED, ALL COLLECTION ACTIVITY IS IMMEDIATELY STOPPED, NOTIFICATIONS ARE SENT TO THE CREDIT BUREAU IF NECESSARY AND PATIENTS ARE NOT CHARGED FOR COLLECTION FEES. IF A PATIENT IS FOUND TO QUALIFY FOR FINANCIAL ASSISTANCE AFTER MAKING PAYMENTS TOWARDS THEIR BALANCE, THE PAYMENTS ARE REFUNDED TO THE PATIENT. PART VI, LINE 2: FAUQUIER HEALTH ASSESSES THE HEALTH NEEDS OF THE COMMUNITY BY CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS AS WELL AS CONTINUALLY COMMUNICATING WITH THE COMMUNITY STAKEHOLDERS WHO ARE SERVING OUR AREA'S RESIDENTS. FOR EXAMPLE, FAUQUIER HEALTH MEETS REGULARLY WITH THE FAUQUIER FREE CLINIC LEADERSHIP AND PROVIDES FINANCIAL AND IN-KIND ASSISTANCE TO THE CLINIC WHICH SERVES THE LOW INCOME AND UNINSURED IN FAUQUIER AND RAPPAHANNOCK COUNTIES. PART VI, LINE 3: NOTIFICATION OF FAUQUIER HEALTH'S FINANCIAL ASSISTANCE PROGRAM IS DISSEMINATED BY VARIOUS MEANS, INCLUDING NOTIFICATION OF CONTACT INFORMATION FOR FINANCIAL COUNSELORS ON ALL OUR BILLING STATEMENTS AND SIGNAGE IN ALL OUR PATIENT REGISTRATIONS AREAS. THE POLICY ITSELF IS AVAILABLE ON THE HOSPITAL WEBSITE, WHICH ALSO PROVIDES CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. REQUESTS FOR FINANCIAL ASSISTANCE MAY BE MADE AT ANY POINT IN THE COLLECTION CYCLE. EVERY BILLING STATEMENT RECEIVED BY A PATIENT INCLUDES THE FOLLOWING LANGUAGE: "IN MEETING YOUR FINANCIAL OBLIGATIONS FOR THE CARE PROVIDED BY FAUQUIER HEALTH WE ASK THAT YOU WORK WITH US ON ANY BILLS THAT YOU ARE HAVING DIFFICULTY PAYING. YOU WILL FIND OUR STAFF UNDERSTANDING AND EAGER, TO HELP YOU." THIS MESSAGE IS FOLLOWED BY A LIST OF TELEPHONE NUMBERS THAT THE PATIENT MAY CALL TO REACH THE ORGANIZATION'S FINANCIAL COUNSELING STAFF, HOURS OF OPERATION, AND AN EMAIL ADDRESS. WHEN PATIENTS CALL THE FINANCIAL COUNSELING TELEPHONE NUMBER, THEY ARE PROMPTED TO SELECTIONS TO REACH THE STAFF MEMBER THAT IS MOST LIKELY ABLE TO HELP THEM (E.G; UNINSURED, SPANISH SPEAKING, BILLING QUESTIONS, ETC.). IN ADDITION, UNINSURED INPATIENTS AND THOSE WITH MEDICARE INSURANCE AND NO SECONDARY CARRIER ARE CONTACTED (USUALLY WITH A PERSONAL VISIT IN THEIR HOSPITAL ROOM) BY AN EMPLOYEE OF ONE OF OUR PARTNERS, MEDASSIST. THE MEDASSIST PERSONNEL SCREEN THESE PATIENTS FOR ELIGIBILITY FOR AVAILABLE STATE OR FEDERAL PROGRAMS. IF THESE PATIENTS DO NOT MEET CRITERIA FOR THESE PROGRAMS, THEY ARE THEN REFERRED TO A FINANCIAL COUNSELOR FOR SCREENING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. UNINSURED PATIENTS WHO VISIT OUR EMERGENCY DEPARTMENT ARE ALSO GIVEN A PACKET OF INFORMATION THAT INCLUDES A FINANCIAL ASSISTANCE APPLICATION AND A BUSINESS CARD WITH THE NAME AND CONTACT INFORMATION FOR ONE OF OUR FINANCIAL COUNSELORS. LASTLY, WE DO USE CREDIT SCORING SOFTWARE TO HELP IDENTIFY PATIENTS WHO MIGHT QUALIFY FOR FINANCIAL ASSISTANCE BUT HAVE NOT CONTACTED OUR OFFICE. OUR FINANCIAL ASSISTANCE POLICY STATES THAT WE MAY USE THIS KIND OF SOFTWARE, WHICH USES INFORMATION FROM CREDIT BUREAUS AND SCREENS PATIENTS AGAINST THE CRITERIA OF OUR FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4: FAUQUIER HEALTH (FH) IS A 97-BED, NOT-FOR-PROFIT, ACUTE CARE FACILITY ESTABLISHED IN 1954 TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RURAL COMMUNITIES IT SERVES. OUR MISSION IS TO MAKE COMMUNITIES HEALTHIER. FAUQUIER HEALTH IS THE ONLY HOSPITAL IN OUR PRIMARY SERVICE AREA, WHICH INCLUDES FAUQUIER AND MINOR PORTIONS OF FIVE SURROUNDING COUNTIES. THE PRIMARY SERVICE AREA HAS A POPULATION OF 109,986. THE AVERAGE HOUSEHOLD INCOME IS $102,185. 6.2% OF THE COMMUNITY RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY GUIDELINE. 17.5% OF FAUQUIER HEALTH'S PATIENTS ARE MEDICAID RECIPIENTS OR SELF-PAY. THE FOLLOWING DISTRICTS WITHIN FAUQUIER COUNTY ARE CONSIDERED MEDICALLY UNDERSERVED AREAS AND POPULATIONS (MUA/P) BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA): LEE DISTRICT AND MARSHALL DISTRICT. PART VI, LINE 5: FAUQUIER HEALTH PROMOTES THE HEALTH OF THE COMMUNITY BY: - ENSURING THAT THE MAJORITY OF THE INDIVIDUALS SERVING ON THE FAUQUIER HOSPITAL BOARD OF DIRECTORS RESIDE IN THE PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION.- EXTENDING MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO ARE INTERESTED. - FAUQUIER HEALTH USES SURPLUS FUNDS TO IMPROVE PATIENT CARE BY UPGRADING THE TOOLS NEEDED TO CARE FOR PATIENTS AND PLANNING FOR IMPROVEMENTS. FAUQUIER HEALTH CONTINUES TO SUPPORT FIFTEEN EMPLOYED PHYSICIANS, TWO OBSTETRICS/GYNECOLOGISTS, TWO FAMILY MEDICINE PHYSICIANS, A RHEUMATOLOGIST, A NEUROLOGIST, AN INFECTIOUS DISEASE SPECIALIST, FIVE INTERNAL MEDICAL PHYSICIANS, TWO UROLOGISTS AND A HEMATOLOGIST/ONCOLOGIST. A HOME HEALTH DISEASE MANAGEMENT TRAINING PROGRAM (TO INCLUDE CONGESTIVE HEART FAILURE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND DIABETES) WAS IMPLEMENTED FOR PATIENTS. A TRANSITIONS TO HOME PROGRAM WAS DEVELOPED TO ADDRESS CHRONIC DISEASE MANAGEMENT AND READMISSION RATES FOR PATIENTS. FEASIBILITY STUDIES FOR A NEONATAL INTENSIVE CARE UNIT WERE ALSO PERFORMED.- FH PARTNERS WITH LOCAL NON-PROFIT ORGANIZATIONS(E.G. FAUQUIER FREE CLINIC, THE CHAMBER OF COMMERCE, SCHOOLS AND CHURCHES) AND NATIONAL ORGANIZATIONS (E.G. THE AMERICAN CANCER SOCIETY) TO SUPPORT LOCAL EVENTSAND PROVIDE COMMUNITY HEALTH AND WELLNESS PROGRAMS. THESE COMMUNITY BENEFITS ACTIVITIES ARE COORDINATED BY A FULL-TIME COMMUNITY OUTREACH STAFF PERSON, SUPPORTED BY ADMINISTRATIVE AND CLINICAL DEPARTMENTS, AND OUR AUXILIARY VOLUNTEERS AS NEEDED. - TO HELP TRAIN AND EDUCATE HEALTH CARE PROFESSIONALS, FH WORKS WITH LOCAL COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS; FH STAFF PROVIDED APPROXIMATELY 23,059 HOURS AT A COST OF APPROXIMATELY $779,920. -ADDITIONALLY, THE ORGANIZATION PROVIDES ASSISTANCE TO THE FAUQUIER FREE CLINIC (FFC). FFC PROVIDES PRIMARY HEALTH AND DENTAL CARE TO UNINSURED RESIDENTS OF FAUQUIER AND RAPPAHANNOCK COUNTIES. FAUQUIER HEALTH PROVIDED LABORATORY, CARDIOLOGY/NEUROLOGY/PULMONARY SERVICES AND RADIOLOGY SERVICES AT NO CHARGE TO FFC PATIENTS FOR A TOTAL COST OF $30,253. A TOTAL OF 1,221 HOURS OF FREE CLINICAL CARE WERE PROVIDED BY COMMUNITY PHYSICIANS AND CLINICAL STAFF. IN ADDITION, FAUQUIER HEALTH CONTRIBUTED $2,500 IN UNRESTRICTED FUNDS. COMMUNITY HEALTH EDUCATION, SCREENINGS AND OUTREACH PROGRAMS:FAUQUIER HEALTH PROVIDED 71 HEALTH EDUCATION SEMINARS (WHICH INCLUDE CLASSES AND LECTURES) AND HEALTH SCREENINGS AT 11 LOCAL EVENTS. COLON CANCER EDUCATION AND PROSTATE SCREENING WAS PROVIDED TO THE COMMUNITY. FAUQUIER HEALTH ALSO PROVIDES SPEAKERS FOR LOCAL SCHOOLS AND COMMUNITY ORGANIZATIONS TO BUILD RELATIONSHIPS WITHIN THE COMMUNITY, PROMOTE COLLABORATION IN MANAGING HEALTH AND WELLNESS, AND EDUCATE THE COMMUNITY ON THE HEALTH SYSTEM.HEALTH EDUCATION THROUGH ADVERTISING, MEDIA, AND PUBLICATIONS:TWO OF FAUQUIER HEALTH'S PUBLICATIONS ARE A COMMUNITY NEWSLETTER, HEALTHY HAPPENINGS, INTENDED TO EDUCATE THE PUBLIC ABOUT HEALTH ISSUES AND HEALTH CARE AND HOSPITAL SERVICES. PUBLISHED QUARTERLY, IT REACHES 103,000 HOMES IN FAUQUIER AND SURROUNDING COUNTIES. THE SENIOR LIVING PUBLICATION IS PUBLISHED TWICE A YEAR AND REACHES 47,700 INDIVIDUALS WHO ARE AGE 55 AND OLDER. THE COST TO FAUQUIER HEALTH FOR PUBLICATION AND DISTRIBUTION OF THESE NEWSLETTERS IN FY16 WAS $340,519. EMERGENCY SERVICES:FAUQUIER HEALTH PROVIDES MEDICAL OVERSIGHT, DIRECTION, AND ORDERS TO PARAMEDICS IN THE FIELD AND IN ROUTE TO THE HOSPITAL. OUR EMERGENCY DEPARTMENT OFFERS 24-HOUR ACCESS TO MEDICAL SERVICES AND HELICOPTER TRANSPORT FOR CRITICALLY ILL OR INJURED INDIVIDUALS. SUPPORT GROUPS AND COMMUNITY GROUPS:FAUQUIER HEALTH SPONSORED, ASSISTED, OR PROVIDED MEETING SPACE FOR FIVE SUPPORT GROUPS THAT MET WEEKLY OR MONTHLY, AT A COST TO FAUQUIER HEALTH OF $10,446.73. ADDITIONALLY, FAUQUIER HEALTH PROVIDED MEETING SPACE OR CASH DONATIONS FOR SEVERAL NON-PROFIT COMMUNITY GROUPS, (E.G. THE AMERICAN RED CROSS, NATIONAL ALLIANCE FOR PUBLIC HEALTH AND AMERICAN CANCER SOCIETY FAUQUIER CHAPTER), WITH A FAIR MARKET VALUE OF $57,829 FOR THE MEETING SPACE AND TOTAL CASH DONATIONS IN THE AMOUNT OF $12,550. FAUQUIER HEALTH EMPLOYEES PROVIDED REPRESENTATION ON COMMUNITY BOARDS AND COALITIONS AT AN EXPENSE OF $6,903.PHYSICIAN REFERRAL:THE HOSPITAL ASSISTED 858 PEOPLE THROUGH THE PHYSICIAN REFERRAL PROGRAM, WHICH HELPS THE COMMUNITY WITH QUESTIONS ON PHYSICIANS, APPOINTMENTS, CLASSES AND PROGRAMS REGISTRATION, AND HEALTH RESOURCES AVAILABLE THROUGH THE HOSPITAL OR IN THE COMMUNITY. PART VI, LINE 6: THE 80% OWNER OF FAUQUIER HEALTH IS LIFEPOINT HEALTH, A LEADING HEALTHCARE COMPANY DEDICATED TO MAKING COMMUNITIES HEALTHIER WITH FACILITIES IN 22 STATES. FHI SERVICES HAS A 20% OWNERSHIP INTEREST IN FAUQUIER HOLDING COMPANY, LLC. TOGETHER THEY OPERATE FAUQUIER HEALTH. 1 AGING TOGETHER PO BOX 367 CULPEPER VA 22701 462046459 501 (C)(3) 25000 HEALTH PRIORITY GRANT TO PROVIDE FUNDING TO SUPPORT THE ORGANIZATION DURING DIRECTION AND LEADERSHIP TRANSITION. CULPEPER COUNTY 302 N MAIN STREET CULPEPER VA 22701 546001236 CULPEPER COUNTY 50000 PROJECT & PLANNING GRANT TO BUILD AN INCLUSIVE PLAYGROUND AT THE CULPEPER COUNTY SPORTS COMPLEX, AS A COLLABORATIVE COMMUNITY EFFORT THAT INCLUDED A NUMBER OF COMMUNITY PARTNERS. ECONOMIC DEVELOPMENT AUTHORITY OF FAUQUIER COUNTY 35 CULPEPER STREET WARRENTON VA 20186 546001274 FAUQUIER COUNTY 50000 HEALTH PRIORITY GRANT TO EXPAND ACCESS TO AFFORDABLE BROADBAND IN UNSERVED AND UNDERSERVED AREAS OF FAUQUIER COUNTY. THE GRANT ALLOWED FOR A BETA TEST EFFORT THAT UTILIZED EXISTING SWITCHING STATIONS AUGMENTED WITH ROUTERS TO PROVIDE HIGH SPEED DSL CONNECTIONS TO 300 HOUSEHOLDS. FAUQUIER COMMUNITY CHILD CARE INC 26 ASHBY STREET WARRENTON VA 20186 541590790 501 (C)(3) 50000 GENERAL OPERATIONS GRANT TO PROVIDE FUNDS TO UNDERTAKE MARKETING THE WORK FCCC DOES TO SUPPORT THE COMMUNITY, FUNDING FOR TECHNOLOGY ENHANCEMENTS AND SECURING OFFICE SPACE FOR THE ADMINISTRATIVE OFFICE. FAUQUIER COMMUNITY CHILD CARE INC 26 ASHBY STREET WARRENTON VA 20186 541590790 501 (C)(3) 33000 PROJECT & PLANNING GRANT TO ENHANCE AND REFINE THE IMPLEMENTATION OF THE HEALTHY EATING AND PHYSICAL ACTIVITY STANDARDS (HEPA) TO ADDRESS THE NEEDS OF THE FAMILIES OF FCCC. FAUQUIER COMMUNITY FOOD BANK AND THRIFT STORE INC 249 E SHIRLEY AVENUE WARRENTON VA 20186 900801730 501 (C)(3) 67000 GENERAL OPERATIONS GRANT TO PROVIDE FUNDING FOR CAPITAL IMPROVEMENTS INCLUDING THE INSTALLATION OF NEW WINDOWS AND A SUSPENDED (DROP) CEILING FOR THE FOOD BANK BUILDING. FAUQUIER COUNTY PUBLIC SCHOOLS 320 HOSPITAL DRIVE SUITE 40 WARRENTON VA 20186 546001276 FAUQUIER COUNTY 781429 HEALTH PRIORITY GRANT FOR THE SECOND ALLOCATION TO FUND THE 2017-2018 ACADEMIC YEAR OF THE FRESH PROGRAM. THIS IS A MULTI-YEAR PROGRAM WHOSE FOCUS IS TO ELEVATE NUTRITION, EXERCISE AND AFTER SCHOOL ENRICHMENT ACROSS THE FCPS SCHOOL DISTRICT. FAUQUIER COUNTY PUBLIC SCHOOLS 320 HOSPITAL DRIVE SUITE 40 WARRENTON VA 20186 546001276 FAUQUIER COUNTY 26762 GENERAL SUPPORT PROVIDED FOR THE PROMOTIONAL ITEMS FOR THE FRESH PROGRAM TO INCLUDE; STATIONARY, WEB-SITE DEVELOPMENT, T-SHIRTS, VIDEO PRODUCTION, CANNING LABELS, PENCILS, AND BUTTONS. FAUQUIER COUNTY PUBLIC SCHOOLS 320 HOSPITAL DRIVE SUITE 40 WARRENTON VA 20186 546001276 FAUQUIER COUNTY 14750 GENERAL SUPPORT TO PROVIDE EVALUATION MEASURES AND CRITERIA FOR THE FRESH PROGRAM. FAUQUIER COUNTY PUBLIC SCHOOLS 320 HOSPITAL DRIVE SUITE 40 WARRENTON VA 20186 546001276 FAUQUIER COUNTY 40000 HEALTH PRIORITY GRANT WHICH PROVIDED FOR A BRIDGE PAYMENT NEEDED TO FUND THE GAP PERIOD CAUSED BY A SHIFT IN THE PROGRAM YEAR TO ALIGN WITH THE PATH FISCAL YEAR FOR THE FRESH, PROGRAM. THIS IS A MULTI-YEAR PROGRAM WHOSE FOCUS IS TO ELEVATE NUTRITION, EXERCISE AND AFTER SCHOOL ENRICHMENT ACROSS THE FCPS SCHOOL DISTRICT. FAUQUIER COUNTY PUBLIC SCHOOLS 320 HOSPITAL DRIVE SUITE 40 WARRENTON VA 20186 546001276 FAUQUIER COUNTY 40300 HEALTH PRIORITY GRANT TO PROVIDE MATCHING FUNDS TO SUPPORT RENOVATION OF A PORTION OF MARSHALL COMMUNITY CENTER FOR USE AS AN AFTERSCHOOL TEEN CENTER. FAUQUIER COUNTY PUBLIC SCHOOLS 320 HOSPITAL DRIVE SUITE 40 WARRENTON VA 20186 546001276 FAUQUIER COUNTY 100000 PROJECT & PLANNING GRANT FOR THE ESTABLISHMENT OF THE FAUQUIER ENVIRONMENTAL STUDIES ACADEMY WHICH WILL PROVIDE FCPS STUDENTS WITH A FOUR-YEAR INTEGRATED PROGRAM EMPHASIZING ENVIRONMENTAL STUDIES. FAUQUIER EDUCATION FARM 24 PELHAM STREET WARRENTON VA 20186 900662914 501 (C)(3) 11600 GENERAL OPERATIONS GRANT FUNDING TO ALLOW FOR THE HIRING OF A PART-TIME ADMINISTRATIVE ASSISTANT AND TO INCREASE THE EXECUTIVE DIRECTOR'S HOURS FROM A 32 HOUR/WEEK POSITION TO A 40 HOUR/WEEK POSITION. THIS WILL ALLOW FOR THE EXECUTIVE DIRECTOR TO INCREASE HIS ABILITY TO PROFESSIONALLY MANAGE THE CROPS AND INCREASE TEACHING OPPORTUNITIES, AS WELL AS INCREASE PRODUCTION, WHICH WILL INCREASE DONATIONS TO LOCAL FOOD BANKS. FAUQUIER EDUCATION FARM 24 PELHAM STREET WARRENTON VA 20186 900662914 501 (C)(3) 7600 PROJECT & PLANNING GRANT FUNDS PROVIDED FOR THE PLANTING MATERIALS NEEDED FOR THE 2018 AGRICULTURAL DEMONSTRATION PROJECTS AND WORKSHOP SERIES. THIS PROGRAM WILL CREATE OPPORTUNITIES FOR VOLUNTEERS, INCREASE PRODUCTION AND DONATIONS FOR LOCAL FOOD BANKS THROUGH AGRICULTURE EDUCATION. THESE EDUCATIONAL PROGRAMS WILL HELP CREATE AND STRENGTHEN NEW HOME GARDENERS AND FARMERS, HELPING TO MAKE THE ENTIRE COMMUNITY MORE FOOD SECURE AND SUSTAINABLE. FAUQUIER FISH 24 PELHAM STREET WARRENTON VA 20186 541271237 501 (C)(3) 15000 GENERAL OPERATIONS GRANT FUNDS PROVIDED TO INCREASE CAPACITY BY LEASING A MORE SPACIOUS LOCATION AND DEVELOPING A STRATEGIC FUNDRAISING EFFORT. FAUQUIER FISH 24 PELHAM STREET WARRENTON VA 20186 541271237 501 (C)(3) 30067 PROJECT & PLANNING GRANT - TO SUPPORT THE WEEKEND POWER PACK PROGRAM WHICH PROVIDES BACKPACK MEALS TO CHILDREN WHO ARE AT RISK OF HUNGER DURING THE WEEKENDS, SCHOOL HOLIDAYS, AND SNOW DAYS. FAUQUIER FREE CLINIC INC PO BOX 3138 WARRENTON VA 20188 541669652 501 (C)(3) 133000 HEALTH PRIORITY GRANT FUNDS TO CONTINUE INCREASED ACCESS TO BEHAVIORAL HEALTHCARE THROUGH THE IMPLEMENTATION OF INTEGRATED MENTAL HEALTH IN PRIMARY CARE SETTINGS, USE OF TELE-PSYCHIATRY AND REMOTE MENTAL HEALTH SERVICES, AND A PART-TIME NURSING POSITION TO SUPPORT PATIENTS. FAUQUIER FREE CLINIC INC PO BOX 3138 WARRENTON VA 20188 541669652 501 (C)(3) 99350 GENERAL OPERATIONS GRANTS FUNDING TO ADVANCE THE FREE CLINICS MISSION TO PROVIDE COMPREHENSIVE MEDICAL, DENTAL, AND MENTAL HEALTH CARE TO ELIGIBLE RESIDENTS. CURRENT OPERATIONAL OBJECTIVES INCLUDE FINALIZING THE STRATEGIC PLANNING, MENTAL HEALTH SERVICE EXPANSION, REVIEW AND IMPROVE MEDICATION ACCESS PROGRAMS AND DEVELOP FUNDRAISING METHODS TO SCALE WITH THE GROWTH OF THE CLINIC. FAUQUIER FREE CLINIC INC PO BOX 3138 WARRENTON VA 20188 541669652 501 (C)(3) 69200 PROJECT AND PLANNING GRANT TO SUPPORT THE EXPANSION OF THE 2017 DENTAL CARE PROGRAM. DENTIST COVERAGE WILL INCREASE TO 3 DAYS A WEEK AND ALLOW FOR A NEW SHIFT FOR A DENTIST DURING THE DENTAL HYGIENE CLINIC DAY. FAUQUIER HABITAT FOR HUMANITY PO BOX 3189 WARRENTON VA 20188 541595774 501 (C)(3) 62500 GENERAL OPERATIONS GRANT FUNDS TO ALLOW FOR ADDING HOME BUILDING SERVICES TO INCREASE THE NUMBER OF NEW FAMILIES THAT CAN BE SERVED BY THE ORGANIZATION. DEVELOP A PLAN TO GROW THE RESTORE OPERATION TO HELP INCREASE OPERATING FUNDS. FOOTHILLS FORUM PO BOX 153 WASHINGTON VA 22747 521071448 501 (C)(3) 7500 PROJECT & PLANNING GRANT TO SUPPORT A MULTI-PART RESEARCH/REPORTING PROJECT TO DELVE INTO CRITICAL HEALTH AND TRANSPORTATION ISSUES FACING THE COUNTY'S AGING POPULATION AND FORGE NEW NONPROFIT PARTNERSHIPS VIA POST-PUBLICATION FORUMS. FRIENDS OF THE RAPPAHANNOCK 3219 FALL HILL AVENUE FREDERICKSBURG VA 22401 541381671 501 (C)(3) 10000 GENERAL OPERATIONS GRANT FUNDS TO SUPPORT THE RAPPAHANNOCK HEADWATERS EDUCATION EXPANSION, SPECIFICALLY TO EXPAND THE EDUCATION AND RESTORATION PROGRAMS. GIRLS ON THE RUN PIEDMONT PO BOX 245 WARRENTON VA 20188 463737841 501 (C)(3) 7000 GENERAL OPERATIONS GRANT TO PROVIDE CRITICAL SUPPORT FOR THE EXPANSION INTO RAPPAHANNOCK COUNTY AND THE CONTINUED EXPANSION AND DEVELOPMENT OF THE PROGRAM IN FAUQUIER AND CULPEPER COUNTIES. THE GRANT SUPPORTS PLANS TO CONTINUE AND EXPAND SCHOLARSHIP AND TUITION FUNDING, PROVIDE UPDATED LESSON MATERIALS FOR COACHES AND PARTICIPANTS AND EXPAND MARKETING EFFORTS TO MIDDLE SCHOOLS AND ADDITIONAL ELEMENTARY SCHOOLS. HEADWATERS FOUNDATION PO BOX 114 SPERRYVILLE VA 22740 541844267 501 (C)(3) 10000 PROJECT & PLANNING GRANT FUNDING FOR AN AFTER SCHOOL ENRICHMENT PROGRAM FOR PUBLIC SCHOOL STUDENTS IN RAPPAHANNOCK COUNTY. FUNDS WOULD SUPPORT PAYING INSTRUCTORS AND PROGRAM STAFF WHO WORK DIRECTLY WITH STUDENTS, SUPPLIES FOR THE PROGRAM, TRAINING AND BACKGROUND CHECKS ON PROGRAM STAFF AND INSTRUCTORS, AND OTHER COSTS INCURRED IN DIRECT SERVICES TO STUDENTS. HEALTHY CULPEPER PO BOX 1355 CULPEPER VA 22701 200772064 501 (C)(3) 8000 GENERAL OPERATIONS GRANT TO SUPPORT NON-PROFIT PARTNERS WITH IMPROVED EMAIL AND MARKETING TECHNIQUES, COALITION OUTREACH THROUGH A REGIONAL COALITION CONFERENCE AND INCREASED HOURS OF OPERATION TO SUPPORT PARTNERING ORGANIZATIONS. HOSPICE SUPPORT OF FAUQUIER COUNTY 42 N 5TH STREET WARRENTON VA 20186 521250964 501 (C)(3) 15000 GENERAL OPERATIONS GRANT GENERAL OPERATING SUPPORT TO PROVIDE THE MEANS TO UTILIZE MEDIA OUTLETS TO MAKE RESIDENTS AWARE OF FREE SERVICES. PUBLISH THE VOLUNTEER TRAINING CURRICULUM IN PRINT AND ON SOCIAL MEDIA. HOLD AWARENESS ACTIVITIES BY PARTNERING WITH OTHER ORGANIZATIONS TO INCREASE BOTH VOLUNTEER RANKS AND LOAN CLOSET DONATIONS. MM PIERCE ELEMENTARY SCHOOL 12074 JAMES MADISON ST REMINGTON VA 22701 546001276 FAUQUIER COUNTY 9100 PROJECT & PLANNING GRANT TO CONTINUE SERVICING THE ECONOMICALLY DISADVANTAGED PIERCE COMMUNITY WITH THE LAMP MOBILE PROGRAM. THE LAMP PROGRAM PROVIDED WEEKLY OPPORTUNITIES FOR CHILDREN TO READ BOOK, TAKE HOME BOOKS, EXPLORE EDUCATIONAL APPS ON IPADS, ENGAGE IN PHYSICAL ACTIVITY THROUGH A VARIETY OF PE ACTIVITIES, CREATE ART PROJECTS USING NUMEROUS MEDIUMS, AND MAKE MUSIC USING VARIOUS INSTRUMENTS. MENTAL HEALTH ASSOCIATION OF FAUQUIER COUNTY PO BOX 3549 WARRENTON VA 20188 521215685 501 (C)(3) 18280 GENERAL OPERATIONS GRANT TO FOCUS ON IMPROVING MENTAL HEALTH AND SUBSTANCE USE RESOURCES THROUGH COLLABORATION, BUILDING ON EXISTING PARTNERSHIPS AND NEW COLLABORATIONS TO LEAD THE COMMUNITY IN SETTING AND IMPLEMENTING A SHARED AGENDA FOR IMPROVING ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE SUPPORTS/TREATMENT. MENTAL HEALTH ASSOCIATION OF FAUQUIER COUNTY PO BOX 3549 WARRENTON VA 20188 521215685 501 (C)(3) 64000 PROJECT & PLANNING GRANT TO IMPLEMENT A COLLABORATIVE COMMUNITY RESPONSE TO DOCUMENTED CONCERNS ABOUT MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES AMONG LOCAL YOUTH, INCLUDING STRATEGIES TO REDUCE STIGMA, PROMOTE PREVENTION PROGRAMS, INCREASE TREATMENT AND HELP FAMILIES. NORTHERN PIEDMONT COMMUNITY FOUNDATION PO BOX 182 WARRENTON VA 20188 311742955 501 (C)(3) 35000 GENERAL OPERATIONS GRANT TO STRENGTHEN COMMUNITY CONNECTIONS BY PROSPECTING; INCREASING PUBLIC AWARENESS; ENGAGING PROFESSIONAL ADVISORS; INCREASING COMMITTEE INVOLVEMENT AND BROADEN OUTREACH ACTIVITIES. NORTHERN PIEDMONT COMMUNITY FOUNDATION PO BOX 182 WARRENTON VA 20188 311742955 501 (C)(3) 100000 HEALTH PRIORITY GRANT TO ESTABLISH THE ROGER BAKER SCHOLARSHIP FUND HONORING RETIRING FAUQUIER HEALTH CEO. NORTHERN PIEDMONT COMMUNITY FOUNDATION PO BOX 182 WARRENTON VA 20188 311742955 501 (C)(3) 15000 RESPONSIVE GRANT TO PROVIDE ASSISTANCE WITH ADMINISTRATIVE COSTS ASSOCIATED WITH ADMINISTRATING THE COMMUNITY ASSISTANCE GRANT. NORTHERN PIEDMONT COMMUNITY FOUNDATION PO BOX 182 WARRENTON VA 20188 311742955 501 (C)(3) 250000 RESPONSIVE GRANT FOR THE CREATION OF A RESPONSIVE FUND TO SUPPORT LOCAL INITIATIVES PROVIDING ASSISTANCE FOR URGENT NEED AND BENEVOLENT RELIEF REQUESTS THAT FALL OUTSIDE THE PATH FOUNDATION'S CORE MISSION. RAPP AT HOME PO BOX 193 WASHINGTON VA 22747 475254378 501 (C)(3) 40000 PROJECT & PLANNING GRANT TO SUPPORT EXPLORATION OF A PROGRAM TO DEVELOP INNOVATIVE WAYS TO ADDRESS THE IMPACTS RESULTING FROM THE AGING DEMOGRAPHIC IN RAPPAHANNOCK COUNTY. THE GOAL OF THE PROGRAM IS TO DEVELOP A LONG TERM PLAN FOR AGING RESIDENTS TO STAY IN THEIR HOMES BY CREATING STRONGER, MORE SUPPORTIVE COMMUNITIES OF SENIORS ASSISTING ONE ANOTHER THROUGH SOCIAL PROGRAMS, TRANSPORTATION AND PERSONALIZED PROBLEM SOLVING ASSISTANCE. RAPPAHANNOCK COUNTY HIGH SCHOOL 12576 LEE HIGHWAY WASHINGTON VA 22747 546001554 RAPPAHANNOCK COUNTY 22500 PROJECT & PLANNING GRANTS TO ESTABLISH PRIDE, A SCHOOL-WIDE APPROACH TO STRUCTURING A SCHOOL CLIMATE AND CULTURE THAT PROVIDES MULTIPLE OPPORTUNITIES TO DISPLAY AND RECEIVE POSITIVE REINFORCEMENT FOR PRO-SOCIAL BEHAVIORS. RAPPAHANNOCK COUNTY SCHOOLS 6 SCHOOLHOUSE ROAD WASHINGTON VA 22747 546001554 RAPPAHANNOCK COUNTY 162500 HEALTH PRIORITY GRANT TO CONTINUE THE COMMIT TO BE FIT PROGRAM FOR THE 2017-2018 ACADEMIC YEAR. THE PROGRAM WORKS TO IMPROVE THE OVERALL HEALTH AND WELLNESS OF THE RAPPAHANNOCK COUNTY PUBLIC SCHOOLS COMMUNITY. THE PRIMARY GOAL IS TO INSPIRE STUDENTS TO MAKE HEALTHIER NUTRITIONAL CHOICES AS WELL AS TO UNDERSTAND THE IMPORTANCE OF BECOMING PHYSICALLY FIT, THEREBY IMPROVING THE OVERALL HEALTH AND WELLNESS OF THE COMMUNITY. RAPPAHANNOCK COUNTY SCHOOLS 6 SCHOOLHOUSE ROAD WASHINGTON VA 22747 546001554 RAPPAHANNOCK COUNTY 149000 HEALTH PRIORITY GRANT TO CONTINUE THE COMMIT TO BE FIT PROGRAM BY PROVIDING BRIDGE FUNDING FOR THE PERIOD OF JULY, 2017-SEPTEMBER, 2017. RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES PO BOX 1568 CULPEPER VA 22701 237238218 501 (C)(3) 30000 HEALTH PRIORITY GRANT FUNDING FOR A PRELIMINARY STUDY FOR A NEW BEHAVIORAL HEALTH FACILITY IN WARRENTON. RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES, FAUQUIER COUNTY GOVERNMENT AND PATH FOUNDATION ARE WORKING IN CONCERT TO IDENTIFY NEW SPACE OPTIONS FOR A BEHAVIORAL HEALTH FACILITY. RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES P O BOX 1568 CULPEPER VA 22701 237238218 501 (C)(3) 20000 PROJECT & PLANNING GRANT TO FOSTER THE DEVELOPMENT OF TWO (ONE MALE, ONE FEMALE) OXFORD HOUSE MODEL ADDICTION RECOVERY PROGRAMS FOR FAUQUIER COUNTY USING THE OXFORD HOUSE MODEL AND A PARENT EDUCATION AND SUPPORT PROGRAM. RAPPAHANNOCK-RAPIDAN REGIONAL COMMISSION PO BOX 1568 CULPEPER VA 22701 540944913 RAPPAHANNOCK COUNTY 13500 HEALTH PRIORITY GRANT FUNDING TO SUPPORT THE FAMS PROJECT WHICH WILL PROVIDE SUPPORT TO ALL LOW INCOME RESIDENTS TO INCLUDE; TAXI CAB VOUCHERS, GAS CARDS AND MARKETING MATERIALS TO RESIDENTS IN THE RAPPAHANNOCK-RAPIDAN REGION. THE CHILD CARE AND LEARNING CENTER (CCLC) PO BOX 520 WASHINGTON VA 22747 541061820 501 (C)(3) 85053 GENERAL OPERATIONS GRANT FUNDING TO IMPROVE THE QUALITY OF EXISTING PROGRAMS AND FACILITIES, OFFER ACCESS TO CCLC AND IT'S PROGRAMS TO A GREATER NUMBER OF LOCAL CHILDREN IN NEED, SUPPORT THE ORGANIZATION'S ASSESSMENT OF FUTURE ENDEAVORS, AND ENHANCE THE SAFETY AND SECURITY OF THE CHILDREN. TOWN OF WARRENTON - COMMUNITY DEVELOPMENT DEPARTMENT PO BOX 341 WARRENTON VA 20188 546001664 TOWN OF WARRENTON 45000 HEALTH PRIORITY GRANT TO ADDRESS PEDESTRIAN SAFETY THROUGH PERMANENT CHANGE AND IMPROVE INTERSECTION WITH RECOMMENDED BULB-OUTS. VOLTRAN 320 HOSPITAL DRIVE SUITE 11 WARRENTON VA 20186 271352660 501 (C)(3) 20000 PROJECT & PLANNING GRANT TO CONTRACT WITH A COORDINATOR TO BUILD FUNDRAISING AND OUTREACH PROGRAMS, RECRUIT AND MANAGE VOLUNTEERS, COORDINATE RIDES AND MAINTAIN RECORDS. WARRENTON LIONS CLUB CHARITIES INC 7770 PICADILLY DRIVE WARRENTON VA 20187 810807317 501 (C)(3) 8616 PROJECT & PLANNING GRANT TO IMPROVE CAPABILITY TO SCREEN AN INCREASING NUMBER OF STUDENTS FOR SIGHT AND HEARING DEFICIENCIES. WINDMORE FOUNDATION FOR THE ARTS INC PO BOX 38 CULPEPER VA 22701 521366827 501 (C)(3) 10000 PROJECT & PLANNING GRANT FUNDING FOR FOUR EVENTS FOR THE YOUNG AT HEART SERIES. THE SERIES FOSTERS THE CELEBRATION OF SENIORITY THROUGH CREATIVITY AND SELF-EXPRESSION WITH THE LITERARY, VISUAL, AND PERFORMING ARTS. WINDY HILL FOUNDATION PO BOX 1593 MIDDLEBURG VA 20118 541244012 501 (C)(3) 16500 GENERAL OPERATIONS GRANT THAT WILL HELP ADD STAFF TO GROW & ENHANCE BEST PRACTICES. 46 PART I, LINE 2: ORGANIZATIONS SEEKING GRANT FUNDING MUST SUBMIT A PROPOSAL BUDGET AND, IN MOST CASES, AN ORGANIZATION BUDGET, DURING THE APPLICATION PROCESS. APPLICANTS TO 12-MONTH GRANTS MUST SUBMIT ORGANIZATION FINANCIALS AND A FORM 990. THE GRANT AGREEMENT SPECIFIES THAT FUNDS MAY ONLY BE USED IN CONFORMITY WITH THE ORIGINAL PROPOSAL AND ANY SUBSTANTIAL CHANGES MUST BE REQUESTED AND APPROVED IN WRITING. TWELVE-MONTH COMPETITIVE GRANTS REQUIRE GRANTEES TO FILE A WRITTEN SIX-MONTH INTERIM REPORT AND/OR FINAL REPORTS SPECIFYING HOW FUNDS WERE USED, FOLLOWING THE END OF THE GRANT TERM. IN THE CASE OF A SUCCESSFUL PROPOSAL, THE PROJECT AND ITS BUDGET SUBMITTED AT THE TIME OF APPLICATION FORM THE BASIS OF THE GRANT AGREEMENT. THE REPORTING SUBMITTED IS REVIEWED AND EVALUATED BY THE ORGANIZATION'S PROGRAM STAFF. 0 0 0 0 0 0 0 0 0 CHRISTINE M CONNOLLY PRESIDENT/CEO 0 221350 0 88765 0 1620 0 8908 0 22208 0 342851 0 0 LORNA M MAGILL CFO 0 142005 0 16825 0 1066 0 5753 0 11480 0 177129 0 0 PART I, LINE 3 THE CEO AND CFO ARE COMPENSATED BY THE FAUQUIER HEALTH FOUNDATION (DBA THE PATH FOUNDATION). THE ORGANIZATIONS" BOARD ADOPTED A COMPENSATION POLICY FOR ITS CEO AND CFO. AN EXECUTIVE COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS OF THE BOARD OF THE ORGANIZATION" WAS ESTABLISHED TO REVIEW THE COMPENSATION FOR ALL EMPLOYEES SPECIFIED AS HAVING A SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION AND WHO RECEIVE REMUNERATION FROM THE ORGANIZATION". THE EXECUTIVE COMPENSATION COMMITTEE IS ADVISED BY AN INDEPENDENT COMPENSATION CONSULTANT, WHICH OPINES TO THE COMPENSATION COMMITTEE THAT THE LEVEL OF COMPENSATION PAID AND THE PROCESS BY WHICH COMPENSATION IS ESTABLISHED MEET APPLICABLE IRS REASONABLENESS AND "SAFE HARBOR" STANDARDS. THE OUTSIDE COMPENSATION CONSULTANT PROVIDES DATA OF COMPENSATION PROVIDED AT SIMILAR ORGANIZATIONS TO ENSURE THAT THE ORGANIZATION DOES NOT COMPENSATE MORE THAN MARKET NORMS. FORM 990, PART VI, SECTION A, LINE 6 FHS SERVICES IS THE PARENT OF THE ORGANIZATION AND THE FAUQUIER HEALTH FOUNDATION (DBA THE PATH FOUNDATION) IS A BROTHER/SISTER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE FHS SERVICES BOARD OF DIRECTORS ELECTS THE MEMBERS OF FHI SERVICES. FORM 990, PART VI, SECTION A, LINE 7B FHI SERVICES REQUIRES THE APPROVAL OF THE FHS SERVICES BOARD, TO ELECT, APPOINT, OR REMOVE DIRECTORS AND IMPLEMENT AMENDMENTS TO THE ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION PREPARES THE FORM 990 WITH ASSISTANCE FROM AN OUTSIDE ACCOUNTING FIRM. ONCE A DRAFT OF THE FORM 990 IS COMPLETED, IT IS SUBMITTED TO THE MANAGEMENT OF THE ORGANIZATION FOR REVIEW AND COMMENTS. AFTER INCORPORATING CHANGES FROM MANAGEMENT, MATERIALLY COMPLETE DRAFT FORMS 990 ARE MADE AVAILABLE TO THE BOARD OF THE ORGANIZATION. COMMENTS OR QUESTIONS RECEIVED FROM THE BOARD ARE INCORPORATED INTO A FINAL FORM 990 WHICH IS SIGNED BY THE PRESIDENT/CEO, CHRISTINE M. CONNOLLY. FORM 990, PART VI, SECTION B, LINE 12C UNDER THE CONFLICT OF INTEREST POLICY, ALL BOARD MEMBERS, MANAGEMENT, AND KEY EMPLOYEES COMPLETE AN ANNUAL DISCLOSURE FORM REGARDING BUSINESS RELATIONSHIPS THAT HE OR SHE, OR ANY FAMILY MEMBER, HAS WITH ANY OTHER COMPANY THAT DOES BUSINESS WITH THE ORGANIZATION, AS WELL AS ANY BUSINESS RELATIONSHIPS BETWEEN AND AMONG THE BOARD MEMBERS, MANAGEMENT, AND KEY EMPLOYEES. THE ANNUAL DISCLOSURE STATEMENTS ARE REVIEWED BY INDEPENDENT LEGAL COUNSEL/CORPORATE COMPLIANCE OFFICER, AND THE AUDIT AND COMPLIANCE COMMITTEE, WHO ARE ULTIMATELY RESPONSIBLE IF A CONFLICT EXISTS. ANY SUCH CONFLICTS WOULD BE REPORTED TO THE FULL BOARD. IN ADDITION, ANY PERSON WHO IS COVERED BY THE CONFLICT OF INTEREST POLICY HAS AN ONGOING OBLIGATION TO DISCLOSE THE EXISTENCE OF ANY ACTUAL OR POTENTIAL CONFLICT TO THE BOARD OR THE BOARD COMMITTEE IN WHICH THE MATTER ARISES. FINALLY, THE ORGANIZATION MONITORS BOARD MEMBER ELIGIBILITY FOR ANY POTENTIAL CONFLICTS, IN ORDER TO AVOID SUCH CONFLICTS FROM OCCURRING IN THE FIRST PLACE. AN OPPORTUNITY IS GIVEN AT THE START OF EACH MEETING TO DISCLOSE ANY CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND CFO ARE COMPENSATED BY THE FAUQUIER HEALTH FOUNDATION (DBA THE PATH FOUNDATION). THE ORGANIZATION'S" BOARD ADOPTED A COMPENSATION POLICY FOR ITS CEO AND CFO. AN EXECUTIVE COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS OF THE BOARD OF THE ORGANIZATION" WAS ESTABLISHED TO REVIEW THE COMPENSATION FOR ALL EMPLOYEES SPECIFIED AS HAVING A SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION AND WHO RECEIVE REMUNERATION FROM THE ORGANIZATION". THE EXECUTIVE COMPENSATION COMMITTEE IS ADVISED BY AN INDEPENDENT COMPENSATION CONSULTANT, WHICH OPINES TO THE COMPENSATION COMMITTEE THAT THE LEVEL OF COMPENSATION PAID AND THE PROCESS BY WHICH COMPENSATION IS ESTABLISHED MEET APPLICABLE IRS REASONABLENESS AND "SAFE HARBOR" STANDARDS. THE OUTSIDE COMPENSATION CONSULTANT PROVIDES DATA OF COMPENSATION PROVIDED AT SIMILAR ORGANIZATIONS TO ENSURE THAT THE ORGANIZATION DOES NOT COMPENSATE MORE THAN MARKET NORMS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART XII, LINE 2C THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS DURING THE TAX YEAR. FHS SERVICES 98 ALEXANDRIA PIKE WARRENTON VA 20186 541416705 MANAGEMENT COORDINATION VA 501(C)(3) LINE 11C, III-F1 NONE 0 FAUQUIER HEALTH FOUNDATION (DBA PATH FOUNDATION) 98 ALEXANDRIA PIKE WARRENTON VA 20186 300219424 COMMUNITY HEALTH VA 501(C)(3) LINE 7 FHS SERVICES 1 0 0 0 0 0 1 0 0 0 0 1 0 1 1 1 0 0 1 0 FAUQUIER HEALTH FOUNDATION(DBA PATH FOUNDATION) R 2295522 FMV FAUQUIER HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 901001620 HEALTHCARE TN RELATED 1 4532845 32012615 0 0 0.20000