2017-08-01T14:01:18-05:00 2016-12-31 208426521 KIMBLE 6806 PARAGON PLACE SUITE 250 RICHMOND VA 23230 990 2016-01-01 464611149 CONNECTVIRGINIA HIE INC CONN 8049551790 PO BOX 3163 GLEN ALLEN VA 23058 WILLIAM HAZEL JR MD CHAIRMAN 8049551790 2017-07-13 1 FABIOLA SANTANA P00238084 8046124380 50.242.56.77 2017-07-13 13:50:23 ED P D948DC5E9FE356E1E50339EEE7BF810D4ECACD6E D948DC5E9FE356E1E50339EEE7BF810D4ECACD6E 2016 2021-01-29 14:40:06Z WILLIAM HAZEL JR MD PO BOX 3163 GLEN ALLEN VA 23058 1171006 0 X WWW.CONNECTVIRGINIA.ORG X 2014 VA 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. 10 10 0 0 0 0 175000 183267 1108275 982067 0 0 33016 5672 1316291 1171006 0 0 0 0 0 0 0 0 0 898393 998777 898393 998777 417898 172229 516813 689042 0 0 516813 689042 X 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. 0 0 965806 987739 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. 965806 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 0 0 0 X KIM HUGGINS 8049551289 PO BOX 3163 GLEN ALLEN VA 23058 X WILLIAM HAZEL JR MD CHAIRMAN OF THE BOARD 1.30 X X 0 0 0 MARSHALL RUFFIN JR MD VICE CHAIRMAN OF THE BOARD 1.30 X X 0 0 0 TERRI RIPLEY SECRETARY/TREASURER 1.30 X X 0 0 0 CHRISTOPHER BAILEY DIRECTOR 1.00 X 0 0 0 SANDY CHUNG MD DIRECTOR 1.00 X 0 0 0 R NEAL GRAHAM DIRECTOR 1.00 X 0 0 0 STERLING RANSONE JR MD DIRECTOR 1.00 X 0 0 0 CYNTHIA ROMERO MD DIRECTOR 1.00 X 0 0 0 MARIANN YEAGER DIRECTOR 1.30 X 0 0 0 DAVID YI MD DIRECTOR 1.00 X 0 0 0 MICHEAL MATTHEWS FORMER CEO 40.00 X 0 0 0 0 0 0 0 0 0 0 ENVERA HEALTH 4900 COX RD SUITE 200 GLEN ALLEN VA 23060 ADMINISTRATION, ACCOUNTING, HUMAN RESOUR 342611 MEDFX 150 LAVAN STREET WARWICK RI 02888 TECHNOLOGY DEVELOPMENT 316503 CENTRAL VIRGINIA HEALTH NETWORK 2201 W BROAD STREET 202 RICHMOND VA 23220 ADMINISTRATION, ACCOUNTING, HUMAN RESOUR 150430 3 183267 183267 HOSPITAL FEES 900099 982067 982067 982067 OTHER INCOME 900099 5672 5672 5672 1171006 987739 0 0 375430 375430 46230 46230 12350 12350 29015 28833 182 1284 1284 1455 1455 515313 515313 1635 1635 15733 15733 MEALS - MEETINGS 189 189 OTHER EXPENSES 58 58 TAXES & LICENSES 50 50 BANK CHARGES 35 35 998777 965806 32971 0 516813 689042 0 516813 689042 0 0 X 516813 689042 516813 689042 516813 689042 172229 0 X X 1 X 0 0 0 X 212500 175000 183267 570767 212500 175000 183267 570767 570767 7000 33016 5672 45688 616455 3152792 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X PART X, LINE 2: 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. MICHAEL B MATTHEWS CHIEF EXECUTIVE OFFICER 150430 MR. MATTHEWS IS THE CEO OF CENTRAL VIRGINIA HEALTH NETWORK, INC. WHO HOLDS AN EXCLUSIVE MANAGEMENT SERVICES AGREEMENT WITH THE ORGANIZATION. 0 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.