CONNECTVIRGINIA HIE INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CONNECTVIRGINIA HIE INC (EIN 46-4611149)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-08-01
- IRS object ID
- 201702139349300840
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-01T14:01:18-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 208426521 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIMBLE | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6806 PARAGON PLACE SUITE 250 | AddressLine1Txt |
| City | RICHMOND | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23230 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 464611149 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONNECTVIRGINIA HIE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CONN | BusinessNameControlTxt |
| Phone | 8049551790 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3163 | AddressLine1Txt |
| City | GLEN ALLEN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23058 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WILLIAM HAZEL JR MD | PersonNm |
| Person Title | CHAIRMAN | PersonTitleTxt |
| Phone | 8049551790 | PhoneNum |
| Signature | 2017-07-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | FABIOLA SANTANA | PreparerPersonNm |
| PTIN | P00238084 | PTIN |
| Phone | 8046124380 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 50.242.56.77 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-07-13 | IPDt |
| IP Tm | 13:50:23 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | D948DC5E9FE356E1E50339EEE7BF810D4ECACD6E | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | D948DC5E9FE356E1E50339EEE7BF810D4ECACD6E | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WILLIAM HAZEL JR MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3163 | AddressLine1Txt |
| City | GLEN ALLEN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23058 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,171,006 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CONNECTVIRGINIA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | FOSTER AND SUSTAIN TRUST, COLLABORATION AND INFORMATION SHARING AMONG CONSUMERS, PROVIDERS, AND PURCHASERS OF HEALTHCARE SERVICES IN THE COMMONWEALTH OF VIRGINIA, LEADING TO MEASURABLE IMPROVEMENT IN OUTCOMES AND COST-EFFECTIVE DELIVERY OF SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $175,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $183,267 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,108,275 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $982,067 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $33,016 | PYOtherRevenueAmt |
| CY Other Revenue | $5,672 | CYOtherRevenueAmt |
| PY Total Revenue | $1,316,291 | PYTotalRevenueAmt |
| CY Total Revenue | $1,171,006 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $898,393 | PYOtherExpensesAmt |
| CY Other Expenses | $998,777 | CYOtherExpensesAmt |
| PY Total Expenses | $898,393 | PYTotalExpensesAmt |
| CY Total Expenses | $998,777 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $417,898 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $172,229 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $516,813 | TotalAssetsBOYAmt |
| Total Assets EOY | $689,042 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $516,813 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $689,042 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | FOSTER AND SUSTAIN TRUST, COLLABORATION AND INFORMATION SHARING AMONG CONSUMERS, PROVIDERS, AND PURCHASERS OF HEALTHCARE SERVICES IN THE COMMONWEALTH OF VIRGINIA, LEADING TO MEASURABLE IMPROVEMENT IN OUTCOMES AND COST-EFFECTIVE DELIVERY OF SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $965,806 | ExpenseAmt |
| Revenue | $987,739 | RevenueAmt |
| Desc | CONNECTVIRGINIA HIE, INC. (THE ORGANIZATION) IS A NOT-FOR-PROFIT ENTITY, INCORPORATED IN 2014, TO PERFORM THE FUNCTIONS OF DEVELOPING AND GOVERNING THE OPERATION OF THE STATEWIDE HEALTH INFORMATION EXCHANGE FOR THE COMMONWEALTH OF VIRGINIA. WHEN FULLY DEVELOPED, THE HEALTH INFORMATION EXCHANGE WILL PROVIDE DIRECT PUBLIC HEALTH REPORTING, A QUERY AND RETRIEVAL SYSTEM, AND ADMISSION, DISCHARGE AND TRANSFER ALERTS. SINCE ITS INCORPORATION IN 2014, THE ORGANIZATION HAS DERIVED MOST OF ITS REVENUES FROM THE VIRGINIA DEPARTMENT OF HEALTH AND HOSPITAL SYSTEMS LOCATED IN VIRGINIA. THROUGH THE FIRST HALF OF 2016, HOSPITALS CONTRIBUTED TO THE ORGANIZATION AT A RATE OF $75 PER STAFFED BED PER YEAR TO SUPPORT THE ADVANCEMENT OF THE STATEWIDE HEALTH INFORMATION EXCHANGE. THE INITIAL COMMITMENT WAS FOR A 30 MONTH PERIOD THROUGH JULY 2016. A NEW MEMORANDUM OF UNDERSTANDING HAS BEEN DEVELOPED TO SEEK EXTENDED SUPPORT THROUGH 2018. THE NEW MEMORANDUM OF UNDERSTANDING SEEKS $59 PER STAFFED BED PER YEAR AND ADDITIONAL REVENUES ON A FEE-FOR-SERVICE BASIS. APPROXIMATELY HALF OF THE HOSPITALS LOCATED IN VIRGINIA HAVE EXECUTED THE NEW MEMORANDUM OF UNDERSTANDING AND PAID THE REQUISITE CORE SERVICE FEE THROUGH DECEMBER 31, 2016. SINCE 2014, THE VIRGINIA DEPARTMENT OF HEALTH (VDH) HAS PROVIDED $500,000 IN FUNDING TO SUPPORT THE ORGANIZATION'S DEVELOPMENT OF THE STATEWIDE HEALTH INFORMATION EXCHANGE, $112,500 OF WHICH WAS RECEIVED IN 2016. THE ORGANIZATION EXPECTS TO RECEIVE CONTINUED FUNDING OF $150,000 PER YEAR RELATING TO PUBLIC HEALTH REPORTING UNDER THE STATEWIDE HEALTH INFORMATION EXCHANGE.EFFECTIVE DECEMBER 8, 2015, THE ORGANIZATION BEGAN PROVIDING ADDITIONAL SERVICES TO VDH UNDER AN INITIATIVE TO IMPLEMENT AND MAINTAIN A NEW ADVANCE DIRECTIVES REGISTRY (ADR). VDH PAYMENTS RELATING TO ADR RELATED SERVICES ARE $24,000 ANNUALLY PLUS A PER CAPITA CHARGE FOR EACH REGISTRANT CREATED AND REMAINING ON THE ADR. VDH PAYMENTS RELATING TO ADR SERVICES WERE APPROXIMATELY $70,000 IN 2016. | Desc |
| Total Program Service Expenses | $965,806 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIM HUGGINS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8049551289 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3163 | AddressLine1Txt |
| City | GLEN ALLEN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23058 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| WILLIAM HAZEL JR MD | ||||||
| CHAIRMAN OF THE BOARD | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MARSHALL RUFFIN JR MD | ||||||
| VICE CHAIRMAN OF THE BOARD | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| TERRI RIPLEY | ||||||
| SECRETARY/TREASURER | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CHRISTOPHER BAILEY | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SANDY CHUNG MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| R NEAL GRAHAM | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| STERLING RANSONE JR MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CYNTHIA ROMERO MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARIANN YEAGER | ||||||
| DIRECTOR | 1.30 | Yes (X) | $0 | $0 | $0 | |
| DAVID YI MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MICHEAL MATTHEWS | ||||||
| FORMER CEO | 40.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ENVERA HEALTH | |||||
| 4900 COX RD SUITE 200 | GLEN ALLEN | VA | 23060 | ADMINISTRATION, ACCOUNTING, HUMAN RESOUR | $342,611 |
| MEDFX | |||||
| 150 LAVAN STREET | WARWICK | RI | 02888 | TECHNOLOGY DEVELOPMENT | $316,503 |
| CENTRAL VIRGINIA HEALTH NETWORK | |||||
| 2201 W BROAD STREET 202 | RICHMOND | VA | 23220 | ADMINISTRATION, ACCOUNTING, HUMAN RESOUR | $150,430 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $183,267 | GovernmentGrantsAmt |
| Total Contributions | $183,267 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HOSPITAL FEES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $982,067 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $982,067 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $982,067 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $5,672 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,672 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $5,672 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,171,006 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $987,739 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,430 | TotalAmt |
| Program Services | $375,430 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,230 | TotalAmt |
| Program Services | $46,230 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,350 | TotalAmt |
| Management And General | $12,350 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,015 | TotalAmt |
| Program Services | $28,833 | ProgramServicesAmt |
| Management And General | $182 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,284 | TotalAmt |
| Management And General | $1,284 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,455 | TotalAmt |
| Management And General | $1,455 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $515,313 | TotalAmt |
| Program Services | $515,313 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,635 | TotalAmt |
| Management And General | $1,635 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,733 | TotalAmt |
| Management And General | $15,733 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|
| MEALS - MEETINGS | $189 | $189 |
| OTHER EXPENSES | $58 | $58 |
| TAXES & LICENSES | $50 | $50 |
| BANK CHARGES | $35 | $35 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $998,777 | TotalAmt |
| Program Services | $965,806 | ProgramServicesAmt |
| Management And General | $32,971 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $516,813 | BOYAmt |
| EOY | $689,042 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $516,813 | BOYAmt |
| EOY | $689,042 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $516,813 | BOYAmt |
| EOY | $689,042 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $516,813 | BOYAmt |
| EOY | $689,042 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $516,813 | BOYAmt |
| EOY | $689,042 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $172,229 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $212,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $175,000 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $183,267 | CurrentTaxYearAmt |
| Total | $570,767 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $212,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $175,000 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $183,267 | CurrentTaxYearAmt |
| Total | $570,767 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $570,767 | PublicSupportTotal170Amt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $7,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $33,016 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,672 | CurrentTaxYearAmt |
| Total | $45,688 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $616,455 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $3,152,792 | GrossReceiptsRltdActivitiesAmt |
| First5 Years170 | Yes (X) | First5Years170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION WAS FORMED AS A NON-STOCK CORPORATION UNDER THE PROVISIONS OF CHAPTER 10 OF TITLE 13 OF THE CODE OF VIRGINIA AND IS ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, AS SUCH HAS NO OBLIGATIONS RELATING TO FEDERAL OR STATE INCOME TAXES. THE ORGANIZATION HAS EVALUATED ITS TAX POSITIONS AND DETERMINED THAT ITS POSITONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED ON EXAMINATION. ALL YEARS SINCE INCEPTION ON 2014 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL B MATTHEWS | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | CHIEF EXECUTIVE OFFICER | RelationshipDescriptionTxt |
| Transaction | $150,430 | TransactionAmt |
| Transaction | MR. MATTHEWS IS THE CEO OF CENTRAL VIRGINIA HEALTH NETWORK, INC. WHO HOLDS AN EXCLUSIVE MANAGEMENT SERVICES AGREEMENT WITH THE ORGANIZATION. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS A MANAGEMENT SERVICES AGREEMENT WITH CENTRAL VIRGINIA HEALTH NETWORK, INC. TO PROVIDE SALARIES, FRINGE BENEFITS AS WELL AS ALLOCATED OVERHEAD. CVHN PROVIDED ADMINISTRATION, ACCOUNTING, HUMAN RESOURCES, CUSTOMER REGISTRATION, PUBLIC RELATIONS, COMMUNICATIONS, AND COMPLIANCE. EFFECTIVE NOVEMBER 1, 2016, THE ORGANIZATION TERMINATED IT'S PRE-EXISTING CONTRACT WITH CVHN. ORGANIZATIONAL MANAGEMENT AND SUPPORT SERVICES ARE NOW PROVIDED BY NUMEROUS BOARD MEMBERS AND OTHER ORGANIZATIONS UNDER TERMS AND AGREEMENTS WHICH VARY BASED ON THE NATURE AND AMOUNT OF SERVICES REQUIRED. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PRESENTED TO THE BOARD AND REVIEWED BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL DISCLOSURES ARE MADE TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION ALLOWS ANYONE TO VIEW ALL THE FINANCIAL STATEMENTS, FORM 990S, AND OTHER ORGANIZATIONAL DOCUMENTS AT THE MAIN OFFICE. DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZTION HAS NOT CHANGED ITS OVERSIGHT PROCESS DURING THE TAX YEAR. |