2017-07-26T17:09:27-05:00 2016-12-31 540737372 PBMARES LLP 558 SOUTH MAIN STREET HARRISONBURG VA 22801 990 2016-01-01 521366700 CULPEPER WELLNESS FOUNDATION INC CULP 5407122763 311 S EAST STREET NO 100 CULPEPER VA 22701 SHARI J LANDRY PRESIDENT 5407122763 2017-07-25 1 KEVIN HUMPHRIES P00168667 5404345975 2017-07-25 X 209.10.80.132 2017-07-25 16:45:38 ED P 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 5F959D9A16E0A040EA892075FF8FC87BA2D97E9E 2016 2021-01-29 14:40:06Z SHARI J LANDRY 311 S EAST STREET NO 100 CULPEPER VA 22701 4080095 0 X WWW.CULPEPERWELLNESSFOUNDATION.ORG X 1985 VA THE MISSION OF THE CULPEPER WELLNESS FOUNDATION IS TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED OF CULPEPER, ORANGE, AND MADISON COUNTIES BY ESTABLISHING AND/OR SUPPORTING INITIATIVES CENTERED ON IMPROVING THE PHYSICAL, BEHAVORIAL AND SOCIAL HEALTH OF THOSE SERVED. 12 12 112 58 0 0 218962 398274 456652 1819679 589924 437616 155775 531559 1421313 3187128 68282 151277 0 0 345512 1838844 0 0 1744 547477 1596342 961271 3586463 460042 -399335 33618402 33571108 270880 233378 33347522 33337730 X THE MISSION OF THE CULPEPER WELLNESS FOUNDATION IS TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED OF CULPEPER, ORANGE, AND MADISON COUNTIES BY ESTABLISHING AND/OR SUPPORTING INITIATIVES CENTERED ON IMPROVING THE PHYSICAL, BEHAVORIAL AND SOCIAL HEALTH OF THOSE SERVED. 0 0 2278923 1848233 POWELL WELLNESS CENTER HELPS INDIVIDUALS ACHIEVE PHYSICAL AND EMOTIONAL WELL-BEING THROUGH EXERCISE, PHYSICAL ACTIVITY, AND MEDICALLY INTEGRATED SERVICES. 557125 THE FREE CLINIC OF CULPEPER DELIVERS HIGH QUALITY MEDICAL CARE TO UNINSURED ADULTS IN CULPEPER COUNTY. 151277 151277 THE FOUNDATION SEEKS TO CULTIVATE AND SUPPORT HEALTHY LIVING GRANTS TO LOCAL COMMUNITY CHARITIES IN THE FURTHERENCE OF ITS MISSION. 2987325 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 27 0 112 1 0 0 0 0 0 1 1 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X DEBRA DODSON 5407122763 311 S EAST STREET SUITE 100 CULPEPER VA 22701 CATHY DALRYMPLE CHAIR 4.00 X X 0 0 0 RICHARD HARRINGTON VICE CHAIR 2.00 X X 0 0 0 CHARLES BARRELL TREASURER 4.00 X X 0 0 0 CONNIE KINCHELOE SECRETARY 2.00 X X 0 0 0 TRIPP BUTLER DIRECTOR 2.00 X 0 0 0 NANCY CANNON DIRECTOR 2.00 X 0 0 0 JAMIE CLANCEY DIRECTOR 2.00 X 0 0 0 LAURA GRIGSBY DIRECTOR 2.00 X 0 0 0 GREG NAPPS DIRECTOR 2.00 X 0 0 0 CHARLES PERRYMAN DIRECTOR 2.00 X 0 0 0 DR THOMAS REYNOLDS MD DIRECTOR 2.00 X 0 0 0 DR BREVARD WALLACE MD DIRECTOR 2.00 X 0 0 0 SHARI J LANDRY PRESIDENT 40.00 X 58238 0 4196 LILLY BUNCH ACTING EXECUTIVE DIRECTOR (UNTIL JULY 2016) 40.00 X 61013 0 0 119251 0 4196 0 0 0 0 0 8651 35773 15500 338350 164479 398274 MEMBERSHIP DUES 713940 1466146 1466146 OTHER FEE REVENUE 713940 353533 353533 1819679 312930 312930 719821 208866 510955 510955 510955 750036 598157 27193 151879 -27193 124686 124686 18147 35773 26097 -7950 -7950 61208 32654 28554 28554 3187128 1848233 0 940621 151277 151277 123447 123447 1434478 1363140 71338 19447 15125 4322 139627 138785 842 121845 95046 26799 3973 996 2977 96947 70736 26211 104385 104385 132724 62175 70549 57251 35448 20059 1744 76230 54903 21327 461973 391572 70401 28291 10364 17927 409475 390046 19429 70877 56334 14543 MEDICAL SUPPLIES AND DR 95305 95305 PROGRAM SUPPLIES 50076 50076 DUES & SUBSCRIPTIONS 5908 3070 2838 LAUNDRY 2927 2927 3586463 2987325 597394 1744 1361217 855562 100000 3833400 3349000 29529 23103 10000 19835 52576 43543 19108403 6635383 12159965 12473020 16171715 16707045 33618402 33571108 126570 162479 68282 34195 17745 9367 58283 27337 270880 233378 X 29054261 29988730 4293261 3349000 33347522 33337730 33618402 33571108 X -399335 424943 -35400 X X 0 1 X 1 0 X 430790 453777 861426 218962 398274 2363229 2878368 2754573 1808690 456652 1880888 9779171 3309158 3208350 2670116 675614 2279162 12142400 0 0 0 12142400 1155695 1198371 1077263 752913 1032751 5216993 1155695 1198371 1077263 752913 1032751 5216993 4464853 4406721 3747379 1428527 3311913 17359393 0.69950 0.30050 X PART III, SECTION D, LINE 19A CULPEPER WELLNESS FOUNDATION CHANGED ITS TAX YEAR ENDING FROM SEPTEMBER 30 TO DECEMBER 31, EFFECTIVE DECEMBER 31, 2015. THE FOUNDATION FILED A SHORT YEAR RETURN FOR THE PRIOR PERIOD (OCTOBER 1, 2015 THROUGH DECEMBER 31, 2015). THE FOUNDATION IS FILING THIS RETURN BASED ON A CALENDAR YEAR ENDING DECEMBER 31 AND WILL FILE FUTURE RETURNS BASED ON THIS SAME CALENDAR YEAR ENDING. THIS CHANGE IS IN ACCORDANCE WITH REV. PROC. 85-58. PART III, SECTION C, LINE 16 2016 IS THE FIRST YEAR FOR WHICH THE ORGANIZATION IS FILING AS A PUBLIC CHARITY UNDER SECTION 509(A)(2). AS SUCH, THE PUBLIC SUPPORT SCHEDULE WAS COMPILED USING THE ORGANIZATION'S FORM 990 FOR THE PAST FOUR YEARS AS WELL AS CURRENT YEAR ACCOUNTING RECORDS. BECAUSE THIS IS THE FIRST YEAR FOR THE PUBLIC SUPPORT CALCULATIONS THERE ARE NO PRIOR YEAR PERCENTAGES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2413628 216855 223699 2406784 2399295 28018 13685 2413628 201667 -201667 195052 6615 201667 197250 -2198 195052 1.00000 0 0 2378632 2378632 15505732 5754823 9750909 19798 824 18974 1060831 781676 279155 143410 98060 45350 12473020 ANNUITY PAYABLE 27337 27337 X 4408998 424943 633695 267617 1326255 3082743 104385 104385 3187128 4418790 633695 303017 936712 3482078 104385 104385 3586463 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER CODE SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE). IN ADDITION, CWF QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) OF THE CODE AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE ORGANIZATION UNDER CODE SECTION 509(A)(2). PWC IS A LIMITED LIABILITY COMPANY THAT HAS NOT ELECTED TO BE TAXED AS A CORPORATION UNDER CURRENT INTERNAL REVENUE SERVICE REGULATIONS. AS SUCH, PWC IS A DISREGARDED ENTITY FOR FEDERAL INCOME TAX PURPOSES AND DOES NOT HAVE TO FILE AN ANNUAL FEDERAL RETURN. RATHER, ITS TAX RESULTS ARE REFLECTED ON THE ANNUAL TAX FILINGS OF ITS MEMBER AS IF THE ACTIVITIES OF PWC WERE ACTIVITIES OF THE MEMBER. PRIOR TO OCTOBER 1, 2014, THE ORGANIZATION WAS CLASSIFIED AS A FUNCTIONALLY RELATED SUPPORTING ORGANIZATION OF CULPEPER REGIONAL HOSPITAL. DURING 2014, THE ORGANIZATION'S INTEREST IN THE HOSPITAL WAS ACQUIRED BY ANOTHER HOSPITAL SYSTEM. THE ORGANIZATION HAS SINCE TRANSITIONED TO SERVE A GREATER PUBLIC INTEREST AND RECEIVED A CHANGE IN EXEMPT CLASSIFICATION WITH THE INTERNAL REVENUE SERVICE TO ACCOMMODATE ITS CHANGE IN MISSION. MANAGEMENT EVALUATED THE ORGANIZATION'S TAX POSITIONS AND DETERMINED THAT THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AT DECEMBER 31, 2016. THE ORGANIZATION FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, ANNUALLY WITH THE UNITED STATES DEPARTMENT OF THE TREASURY. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 208,866. FUNDRAISING EVENT EXPENSES 26,097. COST OF GOODS SOLD 32,654. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 208,866. FUNDRAISING EVENT EXPENSES 26,097. COST OF GOODS SOLD 32,654. LOSS ON UNCOLLECTIBLE PLEDGES 35,400. SCHEDULE D, PART V, LINE 4 QUASI-ENDOWMENT FUNDS ARE INTENDED TO PROVIDE INCOME TO SUPPLEMENT GRANTS AWARDED AND OTHER GENERAL FOUNDATION OPERATIONS. OYSTER FEST 53920 35773 18147 5502 18346 500 1749 53920 35773 18147 5502 18346 500 1749 26097 -7950 1 AG RICHARDSON ELEMENTARY SCHOOL 18370 SIMMS DRIVE CULPEPER VA 22701 546001238 8576 PROJECT DRUMFIT: PHYSICAL ACTIVITY PROGRAM. CULPEPER WINTER HEAT SHELTER PROGRAM 1200 OLD RIXEYVILLE ROAD CULPEPER VA 22701 541704431 7500 INCREASE SHELTER CAPACITY: INCREASE CAPACITY AT THE WINTER HEAT SHELTER AT ST. LUKE'S. PIEDMONT REGIONAL DENTAL CLINIC 13296 JAMES MADISON HIGHWAY SUITE B ORANGE VA 22960 270625764 7600 EQUIPMENT FOR OFFSITE WORK: PROVIDE DENTAL HYGIENE SERVICES INCLUDING ADULT TEETH CLEANING AND EDUCATION OUTSIDE THE DENTAL CLINIC LOCATION ($2,600), DENTAL CARE ($5,000) RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES PO BOX 1568 CULPEPER VA 22701 237238218 17000 UNDER AGE TOBACCO & NICOTINE USE EDUCATION INITIATIVE ($10,000), CIT COORDINATOR ($7,000) THE MANNA MINISTRY 215 S MAIN STREET CULPEPER VA 22701 546044240 10000 KITCHEN EQUIPMENT: TO FACILITATE THE PREPARATION OF FOOD FOR THE WEEKLY MINISTRY, FACILITATE BETTER REFRIGERATION, AND ELIMINATE RECURRING REPAIR COSTS. VERDUN ADVENTURE BOUND 17044 ADVENTURE BOUND TRAIL RIXEYVILLE VA 22737 541937517 10000 PILOT PROGRAM FOR UPCOMING MIDDLE SCHOOL CHILDREN: TRANSITIONING CULPEPER COUNTY PUBLIC SCHOOLS 5TH GRADERS TO MIDDLE SCHOOL. CULPEPER COUNTY PUBLIC SCHOOLS 450 RADIO LANE CULPEPER VA 22701 546001238 14195 YOUTH RISK BEHAVIOR SURVEY 7 0 PART I, LINE 2: THE ORGANIZATION MAINTAINS CLEAR CRITERIA FOR THE HEALTHY LIVING GRANT PROGRAM AND STRATEGIC GRANTS ARE MADE ONLY BY BOARD APPROVAL. THE ORGANIZATION MANDATES THAT FUNDS AWARDED MUST BE USED WITHIN 90 DAYS OF BEING GRANTED AND STAYS IN CLOSE COMMUNICATION WITH GRANTEES TO MONITOR THEIR USE. GRANTEES MUST PROVIDE A FINAL ACCOUNTING ON THE USE OF FUNDS, INCLUDING THE POPULATION SERVED AND HEALTH IMPACT. REPORTS MUST BE COMPLETED WITHIN 30 DAYS OF PROJECT COMPLETION. X 28 164479 FREE CLINIC RECORDS 0 0 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING IN PART I, COLUMN (B), THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM, REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND MADE AVAILABLE TO THE BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO AFFIRM THEIR COMMITMENT TO UPHOLD THE CONFLICT OF INTEREST POLICY ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD WILL REVIEW AND DETERMINE ANNUALLY COMPENSATION OF OFFICERS OR KEY EMPLOYEES. FOR THIS REPORTING PERIOD, COMPENSATION WAS DETERMINED BY BOARD APPROVAL. 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 XI, LINE 9: LOSS ON UNCOLLECTIBLE PLEDGES -35,400. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS NOT CHANGED ITS PROCESS FOR THE SELECTION AND OVERSIGHT OF AN INDEPENDENT ACCOUNTANT. POWELL WELLNESS CENTER 1005 GOLF DRIVE CULPEPER VA 22701 204803079 WELLNESS CENTER VA 752687 8805175 CWF