POTOMAC HEALTH FOUNDATION: Form 990PF, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
POTOMAC HEALTH FOUNDATION (EIN 52-1340920)
Tax period
2015-11-01 to 2016-10-31
Filed
2017-03-15
IRS object ID
201730749349100803
Schema version
2015v3.0
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

FieldValueIRS element (for citing)
Return2017-03-15T11:14:49-05:00ReturnTs
Tax Period End2016-10-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1901 N GLEBE ROAD SUITE 200AddressLine1Txt
CityARLINGTONCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22203ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2015-11-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN521340920EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1POTOMAC HEALTH FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPOTOBusinessNameControlTxt
Phone7035230620PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12296 OPITZ BLVD NO 200AddressLine1Txt
CityWOODBRIDGECityNm
State AbbreviationVAStateAbbreviationCd
ZIP22191ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSUSIE LEEPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone7035230620PhoneNum
Signature2017-03-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDAVID TRIMNERPreparerPersonNm
PTINP00444822PTIN
Phone5712279500PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$104,092,473FMVAssetsEOYAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$5,406,722ContriRcvdRevAndExpnssAmt
Interest On Sav Rev And Expnss$349InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$349InterestOnSavNetInvstIncmAmt
Dividends Rev And Expnss$5,209,013DividendsRevAndExpnssAmt
Dividends Net Invst Incm$5,515,308DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss-$1,046,213NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$28,985,647GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$0CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss$9,569,871TotalRevAndExpnssAmt
Total Net Invst Incm$5,515,657TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$125,221CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$18,783CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$106,438CompOfcrDirTrstDsbrsChrtblAmt
Oth Empl Slrs Wgs Rev And Expnss$146,202OthEmplSlrsWgsRevAndExpnssAmt
Oth Empl Slrs Wgs Net Invst Incm$0OthEmplSlrsWgsNetInvstIncmAmt
Oth Empl Slrs Wgs Dsbrs Chrtbl$103,180OthEmplSlrsWgsDsbrsChrtblAmt
Pension Empl Bnft Rev And Expnss$56,999PensionEmplBnftRevAndExpnssAmt
Pension Empl Bnft Net Invst Incm$3,944PensionEmplBnftNetInvstIncmAmt
Pension Empl Bnft Dsbrs Chrtbl$53,055PensionEmplBnftDsbrsChrtblAmt
Legal Fees Rev And Expnss$1,289LegalFeesRevAndExpnssAmt
Legal Fees Net Invst Incm$0LegalFeesNetInvstIncmAmt
Legal Fees Dsbrs Chrtbl$1,289LegalFeesDsbrsChrtblAmt
Accounting Fees Rev And Expnss$49,561AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$0AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps$52,194AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$530,845OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$477,756OtherProfFeesNetInvstIncmAmt
Other Prof Fees Dsbrs Chrtbl$72,059OtherProfFeesDsbrsChrtblAmt
Taxes Rev And Expnss$39,264TaxesRevAndExpnssAmt
Taxes Net Invst Incm$0TaxesNetInvstIncmAmt
Taxes Dsbrs Chrtbl$0TaxesDsbrsChrtblAmt
Deprec And Dpltn Rev And Expnss$5,229DeprecAndDpltnRevAndExpnssAmt
Deprec And Dpltn Net Invst Incm$0DeprecAndDpltnNetInvstIncmAmt
Occupancy Rev And Expnss$30,658OccupancyRevAndExpnssAmt
Occupancy Net Invst Incm$0OccupancyNetInvstIncmAmt
Occupancy Dsbrs Chrtbl$0OccupancyDsbrsChrtblAmt
Trav Conf Meeting Rev And Expnss$12,462TravConfMeetingRevAndExpnssAmt
Trav Conf Meeting Net Invst Incm$0TravConfMeetingNetInvstIncmAmt
Trav Conf Meeting Dsbrs Chrtbl$12,462TravConfMeetingDsbrsChrtblAmt
Other Expenses Rev And Expnss$52,779OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$42,654OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$50,466OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$1,050,509TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$543,137TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$451,143TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$4,876,925ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$4,845,853ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$5,927,434TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$543,137TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$5,296,996TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$3,642,437ExcessRevenueOverExpensesAmt
Net Investment Income$4,972,520NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$155,096SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$76,653SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$76,653SavAndTempCashInvstEOYFMVAmt
Acct Rcvbl$47,446AcctRcvblAmt
Acct Rcvbl BOY$46,835AcctRcvblBOYAmt
Acct Rcvbl EOY$47,446AcctRcvblEOYAmt
Acct Rcvbl EOYFMV$47,446AcctRcvblEOYFMVAmt
Pledges Rcvbl$314,054PledgesRcvblAmt
Pledges Rcvbl BOY$396,770PledgesRcvblBOYAmt
Pledges Rcvbl EOY$314,054PledgesRcvblEOYAmt
Pledges Rcvbl EOYFMV$314,054PledgesRcvblEOYFMVAmt
Prepaid Expenses BOY$26,500PrepaidExpensesBOYAmt
Prepaid Expenses EOY$38,889PrepaidExpensesEOYAmt
Prepaid Expenses EOYFMV$38,889PrepaidExpensesEOYFMVAmt
Other Investments BOY$99,208,896OtherInvestmentsBOYAmt
Other Investments EOY$103,612,750OtherInvestmentsEOYAmt
Other Investments EOYFMV$103,612,750OtherInvestmentsEOYFMVAmt
Land Bldg Equip Cost Or Other Bss$36,148LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$33,467LandBldgEquipAccumDeprecAmt
Land BOY$7,910LandBOYAmt
Land EOY$2,681LandEOYAmt
Land EOYFMV$2,681LandEOYFMVAmt
Total Assets BOY$99,842,007TotalAssetsBOYAmt
Total Assets EOY$104,092,473TotalAssetsEOYAmt
Total Assets EOYFMV$104,092,473TotalAssetsEOYFMVAmt
Accounts Payable BOY$138,361AccountsPayableBOYAmt
Accounts Payable EOY$169,032AccountsPayableEOYAmt
Grants Payable BOY$1,840,212GrantsPayableBOYAmt
Grants Payable EOY$1,877,020GrantsPayableEOYAmt
Other Liabilities BOY$98,154OtherLiabilitiesBOYAmt
Other Liabilities EOY$113,071OtherLiabilitiesEOYAmt
Total Liabilities BOY$2,076,727TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,159,123TotalLiabilitiesEOYAmt
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind
Unrestricted BOY$97,765,280UnrestrictedBOYAmt
Unrestricted EOY$101,933,350UnrestrictedEOYAmt
Tot Net Ast Or Fund Balances BOY$97,765,280TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$101,933,350TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$99,842,007TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$104,092,473TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$97,765,280TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$3,642,437ExcessRevenueOverExpensesAmt
Other Increases$525,748OtherIncreasesAmt
Subtotal$101,933,465SubtotalAmt
Other Decreases$115OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$101,933,350TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (2 entries)

PropertyPropertyDescGross Sales PriceGrossSalesPriceAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmtCost Or Other BasisCostOrOtherBasisAmt
SEI CORE PROPERTY FUND, LLC$57,277$57,277$57,277
PUBLICLY TRADED SECURITIES$28,985,647-$1,046,213-$1,046,213$30,031,860
FieldValueIRS element (for citing)
Capital Gain Net Income-$988,936CapitalGainNetIncomeAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 Tax0LiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$4,980,260AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$100,254,131NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.049676DistributionYr1Rt
Adjusted Qlfy Distri Yr2$4,672,707AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$100,774,355NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.046368DistributionYr2Rt
Adjusted Qlfy Distri Yr3$4,370,054AdjustedQlfyDistriYr3Amt
Net Vl Noncharitable Assets Yr3$95,756,146NetVlNoncharitableAssetsYr3Amt
Distribution Yr30.045637DistributionYr3Rt
Adjusted Qlfy Distri Yr4$3,863,779AdjustedQlfyDistriYr4Amt
Net Vl Noncharitable Assets Yr4$90,901,681NetVlNoncharitableAssetsYr4Amt
Distribution Yr40.042505DistributionYr4Rt
Adjusted Qlfy Distri Yr5$4,515,859AdjustedQlfyDistriYr5Amt
Net Vl Noncharitable Assets Yr5$92,210,303NetVlNoncharitableAssetsYr5Amt
Distribution Yr50.048973DistributionYr5Rt
Total Distribution0.233159TotalDistributionRt
Average Distribution0.046632AverageDistributionRt
Net Vl Noncharitable Assets$98,321,142NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$4,584,911AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$49,725NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$4,634,636AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$5,296,996QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eYes (X)DomesticOrgMeetingSect4940eInd
Investment Income Excise Tax$49,725InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$49,725SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$49,725TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$49,072EstimatedPlusOvpmtIncmTxAmt
Total Payments And Credits$49,072TotalPaymentsAndCreditsAmt
Form2220 AttachedYes (X)Form2220AttachedInd
Es Penalty$24EsPenaltyAmt
Tax Due$677TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateVAOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial Contributors0NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressWWW.POTOMACHEALTHFOUNDATION.ORGWebsiteAddressTxt
Individual With BooksSUSIE LEEIndividualWithBooksNm
Phone7035230620PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line12296 OPITZ BLVD STE 200AddressLine1Txt
CityWOODBRIDGECityNm
State AbbreviationVAStateAbbreviationCd
ZIP22191ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
SUSIE LEE
2296 OPITZ BLVD 200WOODBRIDGEVA22191EXECUTIVE DIRECTOR40.00$125,221$26,296$776
CAROL S SHAPIRO MD
2296 OPITZ BLVD 200WOODBRIDGEVA22191VICE-CHAIR4.00$0$0$0
R MICHAEL SORENSEN
2296 OPITZ BLVD 200WOODBRIDGEVA22191TREASURER3.00$0$0$0
WAYNE MALLARD
2296 OPITZ BLVD 200WOODBRIDGEVA22191SECRETARY2.00$0$0$0
MARION M WALL
2296 OPITZ BLVD 200WOODBRIDGEVA22191CHAIR4.00$0$0$0
HOWARD L GREENHOUSE
2296 OPITZ BLVD 200WOODBRIDGEVA22191DIRECTOR1.00$0$0$0
DONNIE HYLTON
2296 OPITZ BLVD 200WOODBRIDGEVA22191DIRECTOR1.00$0$0$0
DEBORAH JOHNSON
2296 OPITZ BLVD 200WOODBRIDGEVA22191DIRECTOR1.00$0$0$0
SARAH PITKIN PHD
2296 OPITZ BLVD 200WOODBRIDGEVA22191DIRECTOR1.00$0$0$0
WILLIAM M MOSS
2296 OPITZ BLVD 200WOODBRIDGEVA22191DIRECTOR1.00$0$0$0
CARLOS CASTRO
2296 OPITZ BLVD 200WOODBRIDGEVA22191DIRECTOR1.00$0$0$0
SAM HILL EDD
2296 OPITZ BLVD 200WOODBRIDGEVA22191DIRECTOR1.00$0$0$0
MEGAN PERRY
2296 OPITZ BLVD 200WOODBRIDGEVA22191DIRECTOR1.00$0$0$0

Compensation Highest Paid Empl CompensationHighestPaidEmplGrp

FieldValueIRS element (for citing)
PersonTIMOTHY MCCUEPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12296 OPITZ BLVD SUITE 200AddressLine1Txt
CityWOODBRIDGECityNm
State AbbreviationVAStateAbbreviationCd
ZIP22191ZIPCd
FieldValueIRS element (for citing)
TitleDIRECTOR OF GRANTS PTitleTxt
Average Hrs Per Wk Devoted To Pos40.00AverageHrsPerWkDevotedToPosRt
Compensation$103,180CompensationAmt
Employee Benefits$22,649EmployeeBenefitsAmt
Expense Account$0ExpenseAccountAmt
FieldValueIRS element (for citing)
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SEI GLOBAL INSTITUTIONAL GROUPBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 FREEDOM VALLEY DRIVEAddressLine1Txt
CityOAKSCityNm
State AbbreviationPAStateAbbreviationCd
ZIP19456ZIPCd
FieldValueIRS element (for citing)
Service TypeINVESTMENT MANAGEMENTServiceTypeTxt
Compensation$477,756CompensationAmt
FieldValueIRS element (for citing)
Contractor Paid Over50k0ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$99,221,796AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$596,622AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$99,818,418TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$99,818,418AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$1,497,276CashDeemedCharitableAmt
Net Vl Noncharitable Assets$98,321,142NetVlNoncharitableAssetsAmt
Minimum Investment Return$4,916,057MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$4,916,057MinimumInvestmentReturnAmt
Tax Based On Investment Income$49,725TaxBasedOnInvestmentIncomeAmt
Total Tax$49,725TotalTaxAmt
Distributable Before Adj$4,866,332DistributableBeforeAdjAmt
Recoveries Qualfied Distri$5,736RecoveriesQualfiedDistriAmt
Distributable Before Ded$4,872,068DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$4,872,068DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$5,296,996ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$5,296,996QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$49,725PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$5,247,271AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$4,872,068DistributableAsAdjustedAmt
Undistributed Income PY$4,909,212UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Total Excess Distribution Cyov$0TotalExcessDistributionCyovAmt
Qualifying Distributions$5,296,996QualifyingDistributionsAmt
Applied To Year1$4,909,212AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$387,784AppliedToCurrentYearAmt
Remaining Distri From Corpus$0RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$0TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$4,484,284UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$0ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$0ExcessDistriCyovToNextYrAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonTIMOTHY MCCUERecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line12296 OPITZ BLVD STE 200AddressLine1Txt
CityWOODBRIDGECityNm
State AbbreviationVAStateAbbreviationCd
ZIP22191ZIPCd
FieldValueIRS element (for citing)
Recipient Phone7035230630RecipientPhoneNum
Recipient Email AddressTIMOTHY@POTOMACHEALTHFOUNDATION.ORGRecipientEmailAddressTxt
Form And Info And MaterialsLETTER OF INTENT TO INCLUDE NARRATIVE AND BUDGET PLAN, COMPLETED AND SUBMITTED ONLINE.FormAndInfoAndMaterialsTxt
Submission DeadlinesJANUARY 22, 2016SubmissionDeadlinesTxt
Restrictions On AwardsTHE FOUNDATION AWARDS GRANTS TO TAX-EXEMPT ORGANIZATIONS THAT SERVE INDIVIDUALS IN EASTERN PRINCE WILLIAM COUNTY, LORTON, NORTH STAFFORD IN VIRGINIA. PROJECTS MUST WORK TOWARD IMPROVING THE HEALTH OF THE COMMUNITY. PROJECTS ARE FUNDED FOR A 12 MONTH PERIOD. THE FOUNDATION DOES NOT FUND SPONSORSHIPS, INCLUDING FUNDRAISING EVENTS, ENDOWMENTS, LOBBYING, DIRECT SUPPORT TO INDIVIDUALS, PROGRAMS OF RELIGIOUS, FRATERNAL, ATHLETIC, OR VETERANS GROUPS WHEN THE PRIMARY BENEFICIARIES OF SUCH UNDERTAKINGS WOULD BE THEIR MEMBERS EXCLUSIVELY, GRANTS TO RETIRE ANY FORM OF DEBT, SCIENTIFIC RESEARCH GRANTS, AND INDIRECT COST PERCENTAGES.RestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (102 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmtAddress Line2RecipientUSAddress/AddressLine2Txt
ACTION IN COMMUNITY THROUGH SERVICE
3900 ACTS LANEDUMFRIESVA22026NONEPC15 MAP HELPLINE ASSISTANCE AND OUTREACH PROJECT & MEDICAL CAREGIVER PRGM$2,500
AMERICAN HEART ASSOCIATION
4301 FAIRFAX DRIVE SUITE 530ARLINGTONVA22203NONEPCCPR ANYTIME$35,133
AMERICAN HEART ASSOCIATION
4301 FAIRFAX DRIVE SUITE 530ARLINGTONVA22203NONEPCCPR ANYTIME$65,625
BRAIN INJURY SERVICES
8136 OLD KEENE MILL ROADSPRINGFIELDVA22152NONEPCCREST: COLLABORATIVE REHABILITATION TO ENHANCE STROKE TREATMENT$67,544
BRAIN INJURY SERVICES
8136 OLD KEENE MILL ROADSPRINGFIELDVA22152NONEPCCREST: COLLABORATIVE REHABILITATION TO ENHANCE STROKE TREATMENT$101,170
CHANGE IN ACTION INC
128884 HARBOR DRIVE SUITE 203WOODBRIDGEVA22192NONEPCMAP$12,016
CHANGE IN ACTION INC
128884 HARBOR DRIVE SUITE 203WOODBRIDGEVA22192NONEPCBEHAVIORAL MANAGEMENT FOR TRAUMATIC EXPOSURE$74,634
CHANGE IN ACTION INC
128884 HARBOR DRIVE SUITE 203WOODBRIDGEVA22192NONEPCBEHAVIORAL MANAGEMENT FOR TRAUMATIC EXPOSURE$100,959
CHANGE IN ACTION INC
128884 HARBOR DRIVE SUITE 203WOODBRIDGEVA22192NONEPC15 MAP$1,838
CONSUMER HEALTH FOUNDATION
1400 16TH ST NW SUITE 710WASHINGTONDC20036NONEPCREGIONAL PRIMARY CARE COALITION$15,000
EMPOWERHOUSE
PO BOX 1007FREDRICKSBURGVA22402NONEPCINTERPERSONAL VIOLENCE HEALTHCARE PARTNERSHIP PROGRAM$30,402
EMPOWERHOUSE
PO BOX 1007FREDRICKSBURGVA22402NONEPCINTERPERSONAL VIOLENCE HEALTHCARE PARTNERSHIP PROGRAM$45,602
EMPOWERHOUSE
PO BOX 1007FREDRICKSBURGVA22402NONEPCMAP$13,188
GANG RESPONSE INTERVENTION TEAM (GRIT)
4379 RIDGEWOOD CENTER DRIVE SUITEWOODBRIDGEVA22192NONEPCMAC TATTOO REMOVAL PROGRAM$4,844102
GEORGE MASON UNIVERSITY
10900 UNIVERSITY BLVD MS 4E5MANASSASVA20110NONEPCMIDDLE SCHOOL ACHIEVES$75,000
GEORGE MASON UNIVERSITY
10900 UNIVERSITY BLVD MS 4E5MANASSASVA20110NONEPCPOISED (PRECISION OUTREACH INTERVENTION , SCREENING SURVEILLANCE & EXERCISE FOR FALLS PREVENTION/ PRINCE WILLIAM$99,200
GEORGE MASON UNIVERSITY
10900 UNIVERSITY BLVD MS 4E5MANASSASVA20110NONEPCMIDDLE SCHOOL ACHIEVES (ADVANCING HEALTHCARE INITIATIVES FOR UNDERSERVED STUDENTS)$154,200
GEORGE MASON UNIVERSITY
10900 UNIVERSITY BLVD MS 4E5MANASSASVA20110NONEPCPOISED (PRECISION OUTREACH INTERVENTION, SCREENING, SURVEILLANCE AND EXERCISE FOR FALLS PREVENTION IN DIABETES) PRINCE WILLIAM$130,007
GEORGE WASHINGTON REGIONAL COMMISSIONTHE FARMER'S MARKET
406 PRINCESS ANNE STFREDRICKSBURGVA22402NONEPCFRESH FOOD ACCESS FOR COMMUNITY HEALTH$25,853
GEORGE WASHINGTON REGIONAL COMMISSIONTHE FARMER'S MARKET
406 PRINCESS ANNE STFREDRICKSBURGVA22402NONEPCFRESH FOOD ACCESS FOR COMMUNITY HEALTH$15,558
GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
4379 RIDGEWOOD CENTER DRIVE SUITEWOODBRIDGEVA22192NONEPCINCREASED ACCESS TO INTEGRATED CARE AT OUR MEDICAL HOME IN DUMFRIES$90,000102
GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
4379 RIDGEWOOD CENTER DRIVE SUITEWOODBRIDGEVA22192NONEPC15 HSN$1,703102
GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
4379 RIDGEWOOD CENTER DRIVE SUITEWOODBRIDGEVA22192NONEPC15 MAP$15,000102
INSTITUTE FOR PUBLIC HEALTH INNOVATION
1301 CONNECTICUT AVENUE NWWASHINGTONDC20016NONEPCBUILDING AND STRENGTHENING A SUSTAINABLE AND EFFECTIVE COMMUNITY HEALTH WORKER (CHW) WORKFORCE IN THE COMMONWEALTH OF VIRGINIA$20,000
LLOYD F MOSS FREE CLINIC
1301 SAM PERRY BLVDFREDERICKSBURGVA22401NONEPC15 MAP$2,496
LLOYD F MOSS FREE CLINIC
1301 SAM PERRY BLVDFREDERICKSBURGVA22401NONEPC15 HSN - GENERAL OPERATING FUNDS$15,096
LLOYD F MOSS FREE CLINIC
1301 SAM PERRY BLVDFREDERICKSBURGVA22401NONEPCGENERAL OPERATING FUNDS$136,890
LLOYD F MOSS FREE CLINIC
1301 SAM PERRY BLVDFREDERICKSBURGVA22401NONEPCGENERAL OPERATING FUNDS$91,260
MEDICAL CARE FOR CHILDREN'S PARTNERSHIP FOUNDATION
1616 ANDERSON ROADMCLEANVA22102NONEPCMCCP FOUNDATION PROJECT PEARLY WHITES - LORTON$16,290
METROPOLITAN WASHINGTON COUNCIL OF GOVERNMENTS
777 N CAPITOL ST NE SUITE 300WASHINGTONDC20002NONEPCREGION FORWARD HEALTH INDICATORS: LIFE EXPECTANCY AND QUALITY OF LIFE$7,289
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPCPOISON CONTROL SERVICES TO FOUNDATION'S SERVICE AREA$111,065
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPCWEBPOISONCONTROL: ENHANCEMENT OF AN ON-LINE PROTOTYPE TRIAGE APPLICATION TO INCREASE ACCESS TO POISON CONTROL SERVICES AND MINIMIZE INJURY FROM POISONINGS.$150,000
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPCPOISON CONTROL SERVICES TO FOUNDATION'S SERVICE AREA$65,552
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPCWEB POISON CONTROL$100,000
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPC15 HSN POISON CTRL SVCS TO THE FDN'S SVC AREA$16,500
NATIONAL COALITION OF 100 BLACK WOMEN
PO BOX 1166DUMFRIESVA22026NONEPCCOLON CANCER PROJECT$68,600
NATIONAL COALITION OF 100 BLACK WOMEN
PO BOX 1166DUMFRIESVA22026NONEPCINCREASE AWARENESS ON PREVENTION, EARLY DETECTION, TREATMENT PROSTATE CANCER$39,200
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPC15 HSN KIDS CONNECT$3,500
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCIMPROVING NUTRITION FOR LOW-INCOME FAMILIES$73,200
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCIMPROVING NUTRITION FOR LOW-INCOME FAMILIES$115,348
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCHEALTHLINK$41,896
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCKIDS CONNECT$31,500
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCKIDS CONNECT$21,000
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCPRINCE WILLIAM HEALTHLINK$27,931
NOVA SCRIPTSCENTRAL INC
6400 ARLINGTON BLVD SUITE 120FALLS CHURCHVA22042NONEPC15 MAP$2,800
NOVA SCRIPTSCENTRAL INC
6400 ARLINGTON BLVD SUITE 120FALLS CHURCHVA22042NONEPC15 HSN - IMPROVING HLTH ACCESS IN PW, STAFFORD & LORTON$22,141
NOVA SCRIPTSCENTRAL INC
6400 ARLINGTON BLVD SUITE 120FALLS CHURCHVA22042NONEPCIMPROVING HEALTH ACCESS IN PRINCE WILLIAM, STAFFORD AND LORTON; PRESCRIPTION MEDICATIONS FOR THE LOW-INCOME AND UNINSURED$199,269
NOVA SCRIPTSCENTRAL INC
6400 ARLINGTON BLVD SUITE 120FALLS CHURCHVA22042NONEPCIMPROVING HEALTH ACCESS IN PRINCE WILLIAM, STAFFORD AND LORTON; PRESCRIPTION MEDICATIONS FOR THE LOW-INCOME AND UNINSURED$132,846
NUEVA VIDA INC
5225 WISCONSIN AVE NW SUITE 503WASHINGTONDC20015NONEPCINCREASING CANCER PREVENTION AND IMPROVING CONTINUITY OF CARE TO UNDERSERVED LATINAS IN PWC$75,000
NUEVA VIDA INC
5225 WISCONSIN AVE NW SUITE 503WASHINGTONDC20015NONEPCREDUCING FRAGMENTATION AND IMPROVING CONTINUITY OF CARE ACROSS THE BREAST CANCER CONTINUUM$37,888
PATHWAY HOMES
10201 FAIRFAX BLVDFAIRFAXVA22030NONEPCPERMANENT SUPORTIVE HOUSING FOR FORMERLY HOMELESS W/SERIOUS MENTAL ILLNESS$24,000
PATHWAY HOMES
10201 FAIRFAX BLVDFAIRFAXVA22030NONEPCPERMANENT SUPPORTIVE HOUSING FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS$75,000
PATHWAY HOMES
10201 FAIRFAX BLVDFAIRFAXVA22030NONEPCMAP$10,000
POTOMAC AND RAPPAHANNOCK TRANSPORTATION COMMISSION
14700 POTOMAC MILLS ROADWOODBRIDGEVA22192NONEPCMWCOG MATCHING GRANT$125,000
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191NONEPC15 HSN UNIFIED HLTH CENTER$18,160
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191NONEPCPRINCE WILLIAM AREA FREE CLINIC NAVIGATION$18,903
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191NONEPCPRINCE WILLIAM AREA FREE CLINIC UNIFIED HEALTH CENTER$171,026
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191NONEPCPWAFC NAVIGATION$29,137
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191NONEPCPRINCE WILLIAM AREA FREE CLINIC UNIFIED HEALTH CENTER$114,017
PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
14715 BRISTOW ROADMANASSASVA20112NONEPCBIOMEDICAL SCIENCE/PROJECT LEAD THE WAY$23,040
PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
14715 BRISTOW ROADMANASSASVA20112NONEPCHUMAN TRAFFICKING PREVENTION, IDENTIFICATION, AND REFERRAL$29,888
PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
14715 BRISTOW ROADMANASSASVA20112NONEPCCOORDINATED MENTAL HEALTH SUPPORT FOR AT-RISK YOUTH$34,494
PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
14715 BRISTOW ROADMANASSASVA20112NONEPCCOORDINATED MENTAL HEALTH SUPPORT FOR AT-RISK YOUTH$51,742
PRINCE WILLIAM HEALTH DISTRICT
9301 LEE AVENUEMANASSASVA20110NONEPCBEAT CANCER BREAST EDUCATION AWARENESS & TREATMENT$24,717
PRINCE WILLIAM SOCCER INC
14716 MINNIEVILLE RDWOODBRIDGEVA22193NONEPC2016 MAP$6,750
PRINCE WILLIAM SOCCER INC
14716 MINNIEVILLE RDWOODBRIDGEVA22193NONEPCTHE COURAGE F.U.N. PROJECT$41,313
PRINCE WILLIAM SOCCER INC
14716 MINNIEVILLE RDWOODBRIDGEVA22193NONEPCTHE COURAGE F.U.N. PROJECT$27,542
PROJECT MEND-A-HOUSE INC
9500 TECHNOLOGY DRIVE SUITE 101MANASSASVA20110NONEPCPREVENTING HEALTH COMPLICATIONS THROUGH PARTICIPATION IN THE STANFORD CHRONIC DISEASES SELF-MANAGEMENT PROGRAM AND THE DIABETES SELF- MANAGEMENT PROGRAM$24,000
PROJECT MEND-A-HOUSE INC
9500 TECHNOLOGY DRIVE SUITE 101MANASSASVA20110NONEPC15 MAP$2,300
RAPPAHANNOCK AREA AGENCY ON AGING
460 LENDALL LANEFREDERICKSBURGVA22405NONEPCTHE RAAA AQUIA GARRISONVILLE HEALTHCARE PROJECT$9,101
RX PARTNERSHIP
2924 EMERYWOOD PARKWAY SUITE 300RICHMONDVA23294NONEPC15 HSN MEDICATION ACCESS FOR THE UNINSURED$2,500
RX PARTNERSHIP
2924 EMERYWOOD PARKWAY SUITE 300RICHMONDVA23294NONEPC15 MAP$1,675
RX PARTNERSHIP
2924 EMERYWOOD PARKWAY SUITE 300RICHMONDVA23294NONEPCMEDICATION ACCESS FOR THE UNINSURED$22,500
RX PARTNERSHIP
2924 EMERYWOOD PARKWAY SUITE 300RICHMONDVA23294NONEPCMEDICATION ACCESS FOR THE UNINSURED$15,000
SCAN OF NORTHERN VIRGINIA
205 S WHITING STREET SUITE 205ALEXANDRIAVA22304NONEPCMAP$6,000
SCAN OF NORTHERN VIRGINIA
205 S WHITING STREET SUITE 205ALEXANDRIAVA22304NONEPCSAFE BABIES AND CHILD ABUSE PREVENTION$10,000
SCAN OF NORTHERN VIRGINIA
205 S WHITING STREET SUITE 205ALEXANDRIAVA22304NONEPCSAFE BABIES AND CHILD ABUSE PREVENTION$15,000
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCCYCLE 14A FAMILY HEALTH CONNECTION MOBILE VANS$15,000
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCYR3 HISPANIC DIABETES OUTREACH PROGRAM$6,065
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCYR3 SENTARA POTOMAC WOMEN'S HEALTH MAMMOVAN$36,046
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCDIABETES PREVENTION PROGRAM$18,567
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCIN PERSON INTERPRETING SERVICES$60,390
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCFAMILY HEALTH CONNECTION MOBILE CLINIC$135,000
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCSNVMC DIABETES PREVENTION PROGRAM$37,605
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCFAMILY HEALTH CONNECTION MOBILE CLINIC$90,000
STAFFORD SCHOOLS HEAD STARTVPI EARLY HEAD START
610 GAYLE STREETFALMOUTHVA22405NONEPCSTAFFORD CHILDREN'S INSURANCE OUTREACH PROGRAM$11,594
STAFFORD SCHOOLS HEAD STARTVPIEARLY HEAD START
610 GAYLE STREETFALMOUTHVA22405NONEPCSTAFFORD CHILDREN'S INSURANCE OUTREACH PROGRAM$7,729
STREET LIGHT COMMUNITY OUTREACH MINISTRIES
1550 PRINCE WILLIAM PKWY SUITE BWOODBRIDGEVA22191NONEPCPERMANENT SUPPORTED HOUSING & RESPITE CARE FOR MEDICALLY FRAGILE HOMELESS ADULTS$14,997
STREET LIGHT COMMUNITY OUTREACH MINISTRIES
1550 PRINCE WILLIAM PKWY SUITE BWOODBRIDGEVA22191NONEPC15 MAP$2,500
STREET LIGHT COMMUNITY OUTREACH MINISTRIES
1550 PRINCE WILLIAM PKWY SUITE BWOODBRIDGEVA22191NONEPC2016 MAP$1,950
THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
13505 HILLENDALE DRIVEDALE CITYVA22193NONEPCMEDICAL CASE MANAGEMENT$40,800
THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
13505 HILLENDALE DRIVEDALE CITYVA22193NONEPCMEDICAL CASE MANAGEMENT$25,826
THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
13505 HILLENDALE DRIVEDALE CITYVA22193NONEPCVOSAC III DAY SUPPORT FOR THE MEDICALLY FRAGILE$75,000
THE CITY OF MANASSAS PARK
1 PARK CENTER COURTMANASSASVA20111NONEPCMASON AND PARTNERS BRIDGE CLINIC$75,000
THE DOORWAYS
612 E MARSHALL STRICHMONDVA23219NONEPCPATIENT AND FAMILY ACCESS PROGRAM$22,800
THE HOUSE INC STUDENT LEADERSHIP CENTER
14001 CROWN COURTWOODBRIDGEVA22193NONEPCPROJECT PLAY$124,200
THE HOUSE INC STUDENT LEADERSHIP CENTER
14001 CROWN COURTWOODBRIDGEVA22193NONEPCPROJECT PLAY$88,000
VIRGINIA FOUNDATION FOR COMMUNITY COLLEGE
101 N14TH STRICHMONDVA23219NONEPCCYCLE 14A FELLOWS PROGRAM$37,500
VIRGINIA FOUNDATION FOR COMMUNITY COLLEGE
101 N14TH STRICHMONDVA23219NONEPCPOTOMAC HEALTH FOUNDATION FELLOWS PROGRAM$75,000
VIRGINIA ORAL HEALTH COALITION
4200 INNSLAKE DR SUITE 103GLEN ALLENVA23060NONEPCREGIONAL ORAL HEALTH WORKGROUP - NORTHERN VIRGINIA$19,946
YOUNG INVINCIBLES
1411 K ST NWWASHINGTONDC20005NONEPCHEALTHY YOUNG AMERICA$30,000
YOUNG INVINCIBLES
1411 K ST NWWASHINGTONDC20005NONEPCHEALTHY YOUNG AMERICA - NORTHERN VIRGINIA CAMPAIGN$60,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$4,845,853TotalGrantOrContriPdDurYrAmt

Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp (52 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmtAddress Line2RecipientUSAddress/AddressLine2Txt
AMERICAN HEART ASSOCIATION
4301 FAIRFAX DRIVE SUITE 530ARLINGTONVA22203NONEPCCPR ANYTIME$43,750
BRAIN INJURY SERVICES
8136 OLD KEENE MILL ROADSPRINGFIELDVA22152NONEPCCREST: COLLABORATIVE REHABILITATION TO ENHANCE STROKE TREATMENT$67,447
CHANGE IN ACTION INC
128884 HARBOR DRIVE SUITE 203WOODBRIDGEVA22192NONEPCMAP$8,010
CHANGE IN ACTION INC
128884 HARBOR DRIVE SUITE 203WOODBRIDGEVA22192NONEPCBEHAVIORAL MANAGEMENT FOR TRAUMATIC EXPOSURE$67,304
CONSUMER HEALTH FOUNDATION
1400 16TH ST NW SUITE 710WASHINGTONDC20036NONEPCREGIONAL PRIMARY CARE COALITION$10,000
EMPOWERHOUSE
PO BOX 1007FREDRICKSBURGVA22402NONEPCINTERPERSONAL VIOLENCE HEALTHCARE PARTNERSHIP PROGRAM$30,402
EMPOWERHOUSE
PO BOX 1007FREDRICKSBURGVA22402NONEPCMAP$8,792
GANG RESPONSE INTERVENTION TEAM (GRIT)
4379 RIDGEWOOD CENTER DRIVE SUITEWOODBRIDGEVA22192NONEPCMAC TATTOO REMOVAL PROGRAM$1,615102
GEORGE MASON UNIVERSITY
10900 UNIVERSITY BLVD MS 4E5MANASSASVA20110NONEPCMIDDLE SCHOOL ACHIEVES$24,013
GEORGE MASON UNIVERSITY
10900 UNIVERSITY BLVD MS 4E5MANASSASVA20110NONEPCMIDDLE SCHOOL ACHIEVES (ADVANCING HEALTHCARE INITIATIVES FOR UNDERSERVED STUDENTS)$102,800
GEORGE MASON UNIVERSITY
10900 UNIVERSITY BLVD MS 4E5MANASSASVA20110NONEPCPOISED (PRECISION OUTREACH INTERVENTION, SCREENING, SURVEILLANCE AND EXERCISE FOR FALLS PREVENTION IN DIABETES) PRINCE WILLIAM$84,336
GEORGE WASHINGTON REGIONAL COMMISSIONTHE FARMER'S MARKET
406 PRINCESS ANNE STFREDRICKSBURGVA22402NONEPCFRESH FOOD ACCESS FOR COMMUNITY HEALTH$15,080
GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
4379 RIDGEWOOD CENTER DRIVE SUITEWOODBRIDGEVA22192NONEPCINCREASED ACCESS TO INTEGRATED CARE AT OUR MEDICAL HOME IN DUMFRIES$60,000102
LLOYD F MOSS FREE CLINIC
1301 SAM PERRY BLVDFREDERICKSBURGVA22401NONEPCGENERAL OPERATING FUNDS$15,210
LLOYD F MOSS FREE CLINIC
1301 SAM PERRY BLVDFREDERICKSBURGVA22401NONEPCGENERAL OPERATING FUNDS$60,840
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPCPOISON CONTROL SERVICES TO FOUNDATION'S SERVICE AREA$12,341
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPCWEBPOISONCONTROL: ENHANCEMENT OF AN ON-LINE PROTOTYPE TRIAGE APPLICATION TO INCREASE ACCESS TO POISON CONTROL SERVICES AND MINIMIZE INJURY FROM POISONINGS.$100,000
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPCPOISON CONTROL SERVICES TO FOUNDATION'S SERVICE AREA$43,702
NATIONAL CAPITAL POISON CENTER
3201 NEW MEXICO AVENUE SUITE 310WASHINGTONDC20016NONEPC15 HSN POISON CTRL SVCS TO THE FDN'S SVC AREA$29,400
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCIMPROVING NUTRITION FOR LOW-INCOME FAMILIES$76,898
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCHEALTHLINK$27,931
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCKIDS CONNECT$3,500
NORTHERN VIRGINIA FAMILY SERVICE
10455 WHITE GRANITE DRIVE SUITE 100OAKTONVA22124NONEPCKIDS CONNECT$14,000
NOVA SCRIPTSCENTRAL INC
6400 ARLINGTON BLVD SUITE 120FALLS CHURCHVA22042NONEPCIMPROVING HEALTH ACCESS IN PRINCE WILLIAM, STAFFORD AND LORTON; PRESCRIPTION MEDICATIONS FOR THE LOW-INCOME AND UNINSURED$22,141
NOVA SCRIPTSCENTRAL INC
6400 ARLINGTON BLVD SUITE 120FALLS CHURCHVA22042NONEPCIMPROVING HEALTH ACCESS IN PRINCE WILLIAM, STAFFORD AND LORTON; PRESCRIPTION MEDICATIONS FOR THE LOW-INCOME AND UNINSURED$88,564
NUEVA VIDA INC
5225 WISCONSIN AVE NW SUITE 503WASHINGTONDC20015NONEPCINCREASING CANCER PREVENTION AND IMPROVING CONTINUITY OF CARE TO UNDERSERVED LATINAS IN PWC$50,000
PATHWAY HOMES
10201 FAIRFAX BLVDFAIRFAXVA22030NONEPCPERMANENT SUPPORTIVE HOUSING FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS$50,000
PATHWAY HOMES
10201 FAIRFAX BLVDFAIRFAXVA22030NONEPCMAP$5,000
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191NONEPCPRINCE WILLIAM AREA FREE CLINIC UNIFIED HEALTH CENTER$19,003
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191NONEPCPWAFC NAVIGATION$19,425
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191NONEPCPRINCE WILLIAM AREA FREE CLINIC UNIFIED HEALTH CENTER$76,012
PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
14715 BRISTOW ROADMANASSASVA20112NONEPCCOORDINATED MENTAL HEALTH SUPPORT FOR AT-RISK YOUTH$34,494
PRINCE WILLIAM SOCCER INC
14716 MINNIEVILLE RDWOODBRIDGEVA22193NONEPCTHE COURAGE F.U.N. PROJECT$27,542
PROJECT MEND-A-HOUSE INC
9500 TECHNOLOGY DRIVE SUITE 101MANASSASVA20110NONEPCPREVENTING HEALTH COMPLICATIONS THROUGH PARTICIPATION IN THE STANFORD CHRONIC DISEASES SELF-MANAGEMENT PROGRAM AND THE DIABETES SELF- MANAGEMENT PROGRAM$16,000
RX PARTNERSHIP
2924 EMERYWOOD PARKWAY SUITE 300RICHMONDVA23294NONEPCMEDICATION ACCESS FOR THE UNINSURED$2,500
RX PARTNERSHIP
2924 EMERYWOOD PARKWAY SUITE 300RICHMONDVA23294NONEPCMEDICATION ACCESS FOR THE UNINSURED$10,000
SCAN OF NORTHERN VIRGINIA
205 S WHITING STREET SUITE 205ALEXANDRIAVA22304NONEPCMAP$4,000
SCAN OF NORTHERN VIRGINIA
205 S WHITING STREET SUITE 205ALEXANDRIAVA22304NONEPCSAFE BABIES AND CHILD ABUSE PREVENTION$10,000
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCIN PERSON INTERPRETING SERVICES$20,130
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCFAMILY HEALTH CONNECTION MOBILE CLINIC$15,000
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCSNVMC DIABETES PREVENTION PROGRAM$25,070
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCFAMILY HEALTH CONNECTION MOBILE CLINIC$60,000
SENTARA NORTHERN VIRGINIA MEDICAL CENTER
2300 OPITZ BLVDWOODBRIDGEVA22191NONEPCIN PERSON INTERPRETING SERVICES (1/1/2017 - 6/30/2017)$97,600
STAFFORD SCHOOLS HEAD STARTVPI EARLY HEAD START
610 GAYLE STREETFALMOUTHVA22405NONEPCSTAFFORD CHILDREN'S INSURANCE OUTREACH PROGRAM$7,728
THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
13505 HILLENDALE DRIVEDALE CITYVA22193NONEPCMEDICAL CASE MANAGEMENT$27,200
THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
13505 HILLENDALE DRIVEDALE CITYVA22193NONEPCCOMPLETION OF THERAPEUTIC SERVICES$44,240
THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
13505 HILLENDALE DRIVEDALE CITYVA22193NONEPCVOSAC III DAY SUPPORT FOR THE MEDICALLY FRAGILE$25,000
THE CITY OF MANASSAS PARK
1 PARK CENTER COURTMANASSASVA20111NONEPCMASON AND PARTNERS BRIDGE CLINIC$25,000
THE DOORWAYS
612 E MARSHALL STRICHMONDVA23219NONEPCPATIENT AND FAMILY ACCESS PROGRAM$15,200
THE HOUSE INC STUDENT LEADERSHIP CENTER
14001 CROWN COURTWOODBRIDGEVA22193NONEPCPROJECT PLAY$82,800
VIRGINIA FOUNDATION FOR COMMUNITY COLLEGE
101 N14TH STRICHMONDVA23219NONEPCPOTOMAC HEALTH FOUNDATION FELLOWS PROGRAM$50,000
YOUNG INVINCIBLES
1411 K ST NWWASHINGTONDC20005NONEPCHEALTHY YOUNG AMERICA - NORTHERN VIRGINIA CAMPAIGN$40,000
FieldValueIRS element (for citing)
Total Grant Or Contri Apprv Fut$1,877,020TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$349ExclusionAmt

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$5,209,013ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion-$1,046,213ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$4,163,149ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$4,163,149TotalIncomeProducingActyAmt

Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp

Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp

FieldValueIRS element (for citing)
Line Number11LineNumberTxt
Relationship StatementAMOUNTS PAID FOR GRANTS IN PRIOR YEAR AND RETURNED IN THE CURRENT YEARRelationshipStatementTxt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Schedule B IRS990ScheduleB

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
General RuleYes (X)GeneralRuleInd

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
Contributor1ContributorNum
Contributor PersonSENTARA HEALTHCAREContributorPersonNm

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line16015 POPLAR HALL DR STE 300AddressLine1Txt
CityNORFOLKCityNm
State AbbreviationVAStateAbbreviationCd
ZIP23502ZIPCd
FieldValueIRS element (for citing)
Total Contributions$5,406,722TotalContributionsAmt
Person ContributionYes (X)PersonContributionInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTINGCategoryTxt
Amt$49,561Amt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$52,194DisbursementsCharitablePrpsAmt

Investments Other Schedule2 InvestmentsOtherSchedule2

Investments Other InvestmentsOtherGrp (15 entries)

Category Or ItemCategoryOrItemTxtListed At Cost Or FMVListedAtCostOrFMVCdBook ValueBookValueAmtEOYFMVEOYFMVAmt
SEI CORE FIXED INCOME FUND 1,279,256.134 SHARESFMV$12,293,365$12,293,365
SEI SPECIAL SITUATIONS FUND LTD 2,903.787 SHARESFMV$3,776,634$3,776,634
SEI SMALL CAP FUND (SLPAX) 164,674.78 SHARESFMV$4,063,186$4,063,186
SEI INSTITUTIONAL INVESTMENT TRUST 307,131.879 SHARESFMV$2,853,362$2,853,362
SIIT EMERGING MARKETS DEBT FUND SEDAX 484,173.825 SHARESFMV$5,067,301$5,067,301
SIIT ULTRA SHORT DURATION BOND FUND 254,758.322 SHARESFMV$4,577,510$4,577,510
SEI CORE PROPERTY FUND 7,875.893 SHARESFMV$15,332,382$15,332,382
SEI US MANAGED VOL FUND 280,043.855 SHARESFMV$4,061,664$4,061,664
SIIT MULTI ASSET REAL RETURN FUND 775,881.785 SHARESFMV$3,706,766$3,706,766
GLOBAL MANAGED VOL FUND (SVTAX) 644,560.532 SHARESFMV$7,597,826$7,597,826
SEI LARGE CAP FUND (SLCAX) 715,312.62 SHARESFMV$17,852,536$17,852,536
SEI SIIT OPPORTUNISTIC INCOME FD-A 624,165.876 SHARESFMV$5,273,896$5,273,896
SEI WORLD EQUITY EX-US FUND (WEUSX) 796,509.739 SHARESFMV$9,325,300$9,325,300
EMERGING MARKETS EQUITY FUND (SIEMX) 271,852.311 SHARESFMV$2,770,315$2,770,315
SEI DYNAMIC ASSET ALLOC FUND 300,530.3480 SHARESFMV$5,060,707$5,060,707

Land Etc Schedule2 LandEtcSchedule2

Land Etc LandEtcGrp

FieldValueIRS element (for citing)
Category Or ItemFURNITURE & EQUIPMENTCategoryOrItemTxt
Cost Or Other Basis$36,148CostOrOtherBasisAmt
Accumulated Depreciation$33,467AccumulatedDepreciationAmt
Book Value$2,681BookValueAmt
EOYFMV$2,681EOYFMVAmt

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFeesGrp

FieldValueIRS element (for citing)
CategoryLEGALCategoryTxt
Legal Fees$1,289LegalFeesAmt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$1,289DisbursementsCharitablePrpsAmt

Other Decreases Schedule OtherDecreasesSchedule

Other Decreases Detail OtherDecreasesDetail

FieldValueIRS element (for citing)
DescPRIOR PERIOD ADJUSTMENTDesc
Amt$115Amt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (5 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
PROFESSIONAL DEVELOPMENT$27,022$0$50,430
TECH EXPENSE$16,332$0$16,757
OTHER EXPENSE$7,246$0-$18,900
INSURANCE$2,179$0$2,179
SEI CORE PROPERTY FUND, LP OTHER DEDUCTIONS$0$42,654$0

Other Increases Schedule OtherIncreasesSchedule

Other Increases Detail OtherIncreasesDetail

FieldValueIRS element (for citing)
DescUNREALIZED GAINDesc
Amt$525,748Amt

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail (2 entries)

DescDescBOY Book ValueBOYBookValueAmtEOY Book ValueEOYBookValueAmt
DUE TO RELATED PARTY$23,496$24,084
DEFERRED TAX LIABILITY$74,658$88,987

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
INVESTMENT MANAGEMENT FEES$477,756$477,756$18,970
CONSULTANT FEES$53,089$0$53,089

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail

FieldValueIRS element (for citing)
CategoryEXCISE TAXCategoryTxt
Amt$39,264Amt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

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