FHI SERVICES: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- FHI SERVICES (EIN 54-0573701)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-15
- IRS object ID
- 201602289349300620
- Schema version
- 2014v6.0
- 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 | 2016-08-15T07:56:18-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1410 SPRING HILL ROAD 5TH FLOOR | AddressLine1Txt |
| City | TYSONS | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 540573701 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FHI SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FHIS | BusinessNameControlTxt |
| Phone | 5406804100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 98 ALEXANDRIA DRIVE NO 43 | AddressLine1Txt |
| City | WARRENTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 20186 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTY CONNOLLY | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 5406804100 | PhoneNum |
| Signature | 2016-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TAMARA VINEYARD | PreparerPersonNm |
| PTIN | P01775208 | PTIN |
| Phone | 7039790040 | PhoneNum |
| Preparation | 2016-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHRISTY CONNOLLY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 98 ALEXANDRIA PIKE SUITE 43 | AddressLine1Txt |
| City | WARRENTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 20186 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,058,373 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAUQUIERHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | OUR MISSION IS TO RESTORE, PROMOTE AND MAINTAIN THE HEALTH OF THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,834,251 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,779,894 | CYProgramServiceRevenueAmt |
| PY Investment Income | $43,567,278 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,013,195 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$4,471,543 | PYOtherRevenueAmt |
| CY Other Revenue | $265,284 | CYOtherRevenueAmt |
| PY Total Revenue | $64,929,986 | PYTotalRevenueAmt |
| CY Total Revenue | $11,058,373 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $359,700 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $428,677 | 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 | $23,848,700 | PYOtherExpensesAmt |
| CY Other Expenses | $246,275 | CYOtherExpensesAmt |
| PY Total Expenses | $24,277,377 | PYTotalExpensesAmt |
| CY Total Expenses | $605,975 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $40,652,609 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $10,452,398 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $213,472,622 | TotalAssetsBOYAmt |
| Total Assets EOY | $204,244,886 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,348,567 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,690,933 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $205,124,055 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $197,553,953 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OUR MISSION IS TO RESTORE, PROMOTE AND MAINTAIN THE HEALTH OF THE COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $359,700 | ExpenseAmt |
| Grant | $359,700 | GrantAmt |
| Revenue | $3,799,894 | RevenueAmt |
| Desc | FHI SERVICES UNDERTAKES SERVICES TO PROMOTE THE HEALTH OF ITS COMMUNITY. IN PARTICULAR, FHI SERVICES PROVIDES GRANTS RELATED TO THE FOUR PRIORITY AREAS OF SENIOR SERVICES, ACCESS TO HEALTHCARE, MENTAL HEALTH AND CHILDHOOD WELLNESS IN FAUQUIER, RAPPAHANNOCK AND NORTHERN CULPEPER COUNTIES. ADDITIONALLY, FHI SERVICES HAS A 20% OWNERSHIP INTEREST IN FAUQUIER HOLDING COMPANY, LLC, WHICH OPERATES FAUQUIER HOSPITAL ALONG WITH LIFEPOINT HEALTH WHICH MAINTAINS AN 80% OWNERSHIP INTEREST PURSUANT TO FHI SERVICES' 20% OWNERSHIP INTEREST IN FAUQUIER HOLDING COMPANY, LLC. FHI SERVICES APPOINTS 50% OF THE MEMBERS OF THE FAUQUIER HOLDING COMPANY, LLC GOVERNING BOARD. FAUQUIER HOSPITAL IS A 97-BED ACUTE-CARE HOSPITAL THAT PROVIDES COMPREHENSIVE HEALTH CARE SERVICES TO THE COMMUNITY. FAUQUIER HOSPITAL PROVIDES SIGNIFICANT COMMUNITY BENEFITS, AS DESCRIBED BELOW:FAUQUIER HOSPITAL HAS A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE CARE FOR RESIDENTS OF FAUQUIER AND RAPPAHANNOCK COUNTIES WHO ARE WITHIN 200% OF THE FEDERAL POVERTY GUIDELINES. THE FINANCIAL ASSISTANCE PROGRAM ALSO PROVIDES FEE CARE TO PATIENTS WHO RESIDE IN OTHER AREAS WHO ARE WITHIN 100% OF THE FEDERAL POVERTY GUIDELINES. ALL UNINSURED PATIENTS, REGARDLESS OF INCOME LEVEL OR COUNTY OF RESIDENCE, RECEIVE A 38% DISCOUNT ON HOSPITAL SERVICES AND THE OPTION FOR AN INTEREST-FREE PAYMENT PLAN FOR BALANCES. THROUGH THE CONTINUING CARE FUND, THE HOSPITAL OFFERS ASSISTANCE TO INDIVIDUALS WHO HAVE INADEQUATE FINANCIAL MEANS TO COVER THE COSTS OF POST-HOSPITALIZATION HEALTH SERVICES, SUCH AS NURSING CARE; THE COST OF THIS PROGRAM TO FH IN FY14 WAS $189,449.50.IN FY14, THE HOSPITAL PROVIDED $3,940,572 IN FREE MEDICAL CARE, WHICH INCLUDES $235,210 OF CARE PROVIDED TO FREE CLINIC PATIENTS.TO HELP TRAIN AND EDUCATE HEALTH CARE PROFESSIONALS, FAUQUIER HOSPITAL WORKS WITH LOCAL COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS. FAUQUIER HOSPITAL STAFF PROVIDED APPROXIMATELY 31,621 HOURS AT A COST OF APPROXIMATELY 1,082,948. FAUQUIER HOSPITAL SUPPORTS THE FAUQUIER FREE CLINIC (FFC). FFC PROVIDES PRIMARY HEALTH AND DENTAL CARE TO UNINSURED RESIDENTS OF FAUQUIER AND RAPPAHANNOCK COUNTIES. FAUQUIER HOSPITAL PROVIDED LABORATORY, CARDIOLOGY/NEUROLOGY/PULMONARY SERVICES, AND RADIOLOGY SERVICES AT NO CHARGE TO FFC PATIENTS FOR A TOTAL COST OF $235,210. TO HELP FFC EXPAND ITS SERVICES TO MEET THE NEEDS OF A GROWING POPULATION, IN ADDITION, FAUQUIER HOSPITAL CONTRIBUTED $5,000 IN UNRESTRICTED FUNDS. FHI SERVICES, ADDITIONALLY, PROVIDED A $35,000 OPERATIONS AND PLANNING GRANT TO THE FFC. FAUQUIER HOSPITAL PROFESSIONALS PROVIDED HEALTH EDUCATION, CLASSES, LECTURES AND HEALTH SCREENINGS AT 119 LOCAL EVENTS FOR 2,541. FH SPEAKERS FOR LOCAL SCHOOLS AND COMMUNITY ORGANIZATIONS TO BUILD RELATIONSHIPS WITHIN THE COMMUNITY, PROMOTE COLLABORATION IN MANAGING HEALTH AND WELLNESS, AND EDUCATE THE COMMUNITY ON THE HEALTH SYSTEM. THE TOTAL COMMUNITY BENEFIT FOR THESE SERVICES WAS $376,753.FAUQUIER HOSPITAL ALSO PROVIDES HEALTH EDUCATION THROUGH ADVERTISING, MEDIA, AND PUBLICATIONS: TWO OF FH PUBLICATIONS ARE A COMMUNITY NEWSLETTER, HEALTH HAPPENINGS, INTENDED TO EDUCATE THE PUBLIC ABOUT HEALTH ISSUES AND HEALTH CARE AND HOSPITAL SERVICES. PUBLISHED QUARTERLY, IT REACHES 101,000 HOMES IN FAUQUIER AND SURROUNDING COUNTIES.THE SENIOR LIVING PUBLICATION IS PUBLISHED TWICE A YEAR AND REACHES 42,000 INDIVIDUALS WHO ARE AGE 55 AND OLDER. THE COST TO FH FOR PUBLICATION AND DISTRIBUTION OF THESE NEWSLETTERS IN FY14 WAS $350,271.FAUQUIER HOSPITAL PROVIDES MEDICAL OVERSIGHT, DIRECTION AND ORDERS TO PARAMEDICS IN THE FIELD AND EN-ROUTE TO THE HOSPITAL. THE HOSPITAL'S EMERGENCY DEPARTMENT OFFERS 24-HOUR ACCESS TO MEDICAL SERVICES AND HELICOPTER TRANSPORT FOR CRITICALLY ILL OR INJURED INDIVIDUALS, AND ALSO RESTOCKS MEDICAL BOXES AND PROVIDES CLEAN LINENS FOR RESCUE SQUADS AT A COST TO THE HOSPITAL OF APPROXIMATELY $24,182.FAUQUIER HOSPITAL SPONSORED, ASSISTED, OR PROVIDED MEETING SPACE FOR THREE SUPPORT GROUPS THAT MET WEEKLY OR MONTHLY, AT A COST TO FH OF $4,155. ADDITIONALLY, FH PROVIDED MEETING SPACE OR CASH DONATIONS FOR SEVERAL NON-PROFIT COMMUNITY GROUPS,(E.G. THE AMERICAN RED CROSS, FAUQUIER FREE CLINIC AND AMERICAN CANCER SOCIETY FAUQUIER CHAPTER), WITH A FAIR MARKET VALUE OF THE MEETING SPACE OF $32,222 AND TOTAL CASH DONATIONS OF $15,200. THE HOSPITAL ASSISTED 1,802 PEOPLE THROUGH THE PHYSICIAN REFERRAL PROGRAM, WHICH HELPS THE COMMUNITY WITH QUESTIONS ON PHYSICIANS, APPOINTMENTS, CLASSES AND PROGRAMS REGISTRATION, AND HEALTH. FAUQUIER HOSPITAL ALSO PARTNERS WITH LOCAL NON-PROFIT ORGANIZATIONS (E.G. FAUQUIER FREE CLINIC, THE CHAMBER OF COMMERCE, SCHOOLS AND CHURCHES) AND NATIONAL ORGANIZATIONS (E.G THE AMERICAN CANCER SOCIETY) TO SUPPORT LOCAL EVENTS AND PROVIDE COMMUNITY HEALTH AND WELLNESS PROGRAMS. THESE COMMUNITY BENEFIT ACTIVITIES ARE COORDINATED BY A FULL-TIME COMMUNITY OUTREACH STAFF PERSON, SUPPORTED BY ADMINISTRATIVE AND CLINICAL DEPARTMENTS, AND OUR AUXILIARY VOLUNTEERS AS NEEDED. | Desc |
| Total Program Service Expenses | $359,700 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | 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 | 0 | 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 | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | Yes (1) | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | VA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LORNA MAGILL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5406804100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 98 ALEXANDRIA PIKE SUITE 43 | AddressLine1Txt |
| City | WARRENTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 20186 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| MARSHALL DOELLER | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN MCCARTHY | |||||||
| CHAIR | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| KEVIN CARTER | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| MARK VAN DE WATER | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| SUSAN RUBIN | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| MARY LEIGH MCDANIEL | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| JOSHUA JAKUM MD | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| ROBIN GULICK | |||||||
| VICE CHAIR | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| CHRISTINE CONNOLLY | |||||||
| PRESIDENT & CEO | 10.00 | 30.00 | Yes (X) | $0 | $175,790 | $30,023 | Yes (X) |
| RAYMOND KNOTT | |||||||
| SECRETARY/TREASURER | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JANELLE DOWNES | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| RICK GERHARDT | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| SUSAN STRITTMATTER | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| THOMAS TUCKER | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| KAREN WACHTMEISTER | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| PATRICIA WOODWARD | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| ADAM WINICK JR | |||||||
| TRUSTEE | 1.50 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $175,790 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $30,023 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| THIRD PARTY SETTLEMENTS | $1,851,773 | $1,851,773 |
| INCOME FROM HOSPITAL JOINT VENTUR | $1,825,499 | $1,825,499 |
| OTHER INCOME | $102,622 | $102,622 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,779,894 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,853,392 | TotalRevenueColumnAmt |
| Exclusion | $5,853,392 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,159,803 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,159,803 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,159,803 | TotalRevenueColumnAmt |
| Exclusion | $1,159,803 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| BAD DEBT RECOVERY | $178,369 | $178,369 |
| WORKERS COMPENSATION RECOVERY | $86,915 | $86,915 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $265,284 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,058,373 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,045,178 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,013,195 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $359,700 | TotalAmt |
| Program Services | $359,700 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,159 | TotalAmt |
| Management And General | $8,159 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,675 | TotalAmt |
| Management And General | $45,675 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,932 | TotalAmt |
| Management And General | $140,932 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71 | TotalAmt |
| Management And General | $71 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|
| INVESTMENT FUND FEES | $43,963 | $43,963 |
| TAXES & LICENSES | $7,450 | $7,450 |
| BUSINESS REGISTRATION F | $25 | $25 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $605,975 | TotalAmt |
| Program Services | $359,700 | ProgramServicesAmt |
| Management And General | $246,275 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,479,295 | BOYAmt |
| EOY | $30,302,891 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $28,431 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,955,914 | BOYAmt |
| EOY | $8,955,914 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,744 | BOYAmt |
| EOY | $11,708 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,294,333 | BOYAmt |
| EOY | $126,290,743 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,723,724 | BOYAmt |
| EOY | $9,064,881 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,408,916 | BOYAmt |
| EOY | $27,234,415 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,598,696 | BOYAmt |
| EOY | $2,355,903 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $213,472,622 | BOYAmt |
| EOY | $204,244,886 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,337 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,198,230 | BOYAmt |
| EOY | $6,690,933 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,348,567 | BOYAmt |
| EOY | $6,690,933 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $195,329,808 | BOYAmt |
| EOY | $188,458,835 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $248,020 | BOYAmt |
| EOY | $30,237 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,546,227 | BOYAmt |
| EOY | $9,064,881 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $205,124,055 | BOYAmt |
| EOY | $197,553,953 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $213,472,622 | BOYAmt |
| EOY | $204,244,886 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $10,452,398 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$17,541,815 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $661 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$481,346 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,546,225 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$481,344 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $9,064,881 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,058,046 | BeginningYearBalanceAmt |
| Contributions | $697 | ContributionsAmt |
| Investment Earnings Or Losses | $751,271 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $248,020 | OtherExpendituresAmt |
| Administrative Expenses | $15,769 | AdministrativeExpensesAmt |
| End Year Balance | $9,546,225 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,623,235 | BeginningYearBalanceAmt |
| Contributions | $519 | ContributionsAmt |
| Investment Earnings Or Losses | $689,130 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $238,906 | OtherExpendituresAmt |
| Administrative Expenses | $15,932 | AdministrativeExpensesAmt |
| End Year Balance | $9,058,046 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,688,981 | BeginningYearBalanceAmt |
| Contributions | $616 | ContributionsAmt |
| Investment Earnings Or Losses | $1,188,611 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $240,718 | OtherExpendituresAmt |
| Administrative Expenses | $14,255 | AdministrativeExpensesAmt |
| End Year Balance | $8,623,235 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,050,596 | BeginningYearBalanceAmt |
| Contributions | $739 | ContributionsAmt |
| Investment Earnings Or Losses | -$99,088 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $250,195 | OtherExpendituresAmt |
| Administrative Expenses | $13,071 | AdministrativeExpensesAmt |
| End Year Balance | $7,688,981 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN FAUQUIER HOLDING | Desc |
| Book Value | $27,234,415 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $27,234,415 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO THIRD PARTY PAYERS | $6,521,793 |
| PROFESSIONAL LIABILITY | $169,140 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,690,933 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE FAUQUIER HOSPITAL ENDOWMENT FUND (THE TRUST) IS AN IRREVOCABLE TRUST CREATED BY THE CHICHESTER DUPONT FOUNDATION IN 1959. A LOCAL BANK WAS DESIGNATED AS THE TRUSTEE AND REMITS INCOME FROM THE TRUST TO THE HOSPITAL SEMIANNUALLY. THE INCOME MAY BE EMPLOYED BY THE HOSPITAL TO FURTHER ITS WORK IN SUCH MANNER AS THE BOARD OF TRUSTEES OF THE HOSPITAL DETERMINES. |
| PART X, LINE 2: | THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. IN THE FOOTNOTE, FHS SERVICES REFERS TO THE CONSOLIDATED GROUP AS A WHOLE WHICH INCLUDES FHS SERVICES, FHI SERVICES, AND FAUQUIER HEALTH FOUNDATION. FHS SERVICES IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC AS A PUBLIC CHARITY PURSUANT TO IRC SECTIONS 509 (A)(3), TYPE II. FEDERAL TAX LAW REQUIRES THAT FHS SERVICES BE OPERATED IN A MANNER CONSISTENT WITH ITS INITIAL EXEMPTION APPLICATION TO MAINTAIN ITS EXEMPT STATUS. MANAGEMENT HAS ANALYZED THE OPERATIONS OF FHS SERVICES AND CONCLUDED THAT IT REMAINS IN COMPLIANCE WITH THE REQUIREMENTS FOR EXEMPTION. THE STATE IN WHICH FHS SERVICES OPERATES ALSO PROVIDES GENERAL EXCEPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, FHS SERVICES IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAX, IS SEPARATELY DETERMINED BY THE APPROPRIATE STATE TAXING AUTHORITIES. FHS SERVICES HAS NO UNRECOGNIZED TAX BENEFITS OR SUCH AMOUNTS WERE IMMATERIAL DURING THE PERIODS PRESENTED. MANAGEMENT HAS ALSO CONSIDERED THE IMPACT OF UNRELATED BUSINESS ACTIVITIES AND HAS CONCLUDED THAT FHS SERVICES IS NOT SUBJECT TO UNRELATED BUSINESS TAX OR ANY OTHER TAXES THAT COULD BE IMPOSED BY THE IRC OR STATE TAXING AUTHORITIES. AS SUCH, NO PROVISION IS MADE FOR INCOME TAXES AND NO ASSET OR LIABILITY HAS BEEN RECOGNIZED FOR DEFERRED TAXES. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $745,519 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $745,519 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03300 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,474,716 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,309,781 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $164,935 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00730 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,220,235 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,309,781 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $910,454 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04030 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $284,861 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,769 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $280,092 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01240 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $218,357 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $218,357 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00970 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,883,170 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,165,236 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $717,934 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03180 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,120 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,120 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00670 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,401,508 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,170,005 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,231,503 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06060 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,621,743 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,479,786 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,141,957 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10090 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,214 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,214 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $131 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $131 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,345 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,345 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $644,844 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $204,192 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,365,765 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,574,778 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,209,013 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE FAUQUIER HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 HOSPITAL DRIVE | AddressLine1Txt |
| City | WARRENTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 20186 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FHI SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.FAUQUIERHEALTH.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.FAUQUIERHEALTH.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.FAUQUIERHEALTH.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.FAUQUIERHEALTH.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.FAUQUIERHEALTH.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FHI SERVICES | PART V, SECTION B, LINE 5: FAUQUIER HOSPITAL CONSULTED WITH COMMUNITY HEALTH SOLUTIONS OF RICHMOND, VIRGINIA, TO CONDUCT THE HEALTH NEEDS ASSESSMENT. INPUT WAS REQUESTED FROM 60 COMMUNITY STAKEHOLDERS VIA AN ONLINE SURVEY INCLUDING PUBLIC AND PRIVATE SCHOOLS, THE LOCAL HEALTH DEPARTMENT, EMS, THE UNITED WAY, FAUQUIER FREE CLINIC, FAUQUIER FISH, PEOPLE HELPING PEOPLE AND THE LOCAL HEAD START PROGRAM. INFORMATION WAS RECEIVED FROM ORGANIZATIONS AND COMMUNITY LEADERS WITH PUBLIC HEALTH KNOWLEDGE. THIS INFORMATION HELPED DETERMINE THE HEATH NEEDS OF THE COMMUNITY AND THE FEEDBACK WAS INCLUDED IN THE IMPLEMENTATION STRATEGY. THE INFORMATION DISCUSSED INCLUDED COMMUNITY HEALTH CONCERNS, COMMUNITY SERVICE GAPS, VULNERABLE/AT-RISK POPULATIONS, HEALTH ASSETS IN THE COMMUNITY, SERIOUS HEALTH ISSUES ON THE HORIZON, AND WAYS TO PROMOTE BETTER HEALTH IN THE COMMUNITY. |
| FHI SERVICES | PART V, SECTION B, LINE 7D: IN ADDITION TO SHARING THE HEALTH NEEDS ASSESSMENT ON THE FAUQUIER HEALTH WEBSITE, IT WAS DISTRIBUTED TO: THE COMMUNITY STAKEHOLDERS WHO WERE INVITED TO TAKE PART IN THE ONLINE SURVEY; THE WARRENTON OFFICE OF THE RAPPAHANNOCK RAPIDAN HEALTH DEPARTMENT AS WELL AS ANYONE WHO REQUESTS A COPY OF THE ASSESSMENT. |
| FHI SERVICES | PART V, SECTION B, LINE 11: FAUQUIER HEALTH'S HEALTH NEEDS ASSESSMENT IDENTIFIED AND EVALUATED THE GLOBAL COMMUNITY HEALTH NEEDS OF OUR PRIMARY SERVICE AREA OF FAUQUIER AND RAPPAHANNOCK COUNTIES. OF THE MANY COMMUNITY SERVICE GAPS AND HEALTH NEEDS IDENTIFIED, FAUQUIER HEALTH CHOSE THE AREA OF GREATEST NEED AND WHERE THE GREATEST IMPACT COULD BE MADE. THOSE TOPICS ARE TRANSPORTATION, HEALTH EDUCATION, AGING SERVICES AND EARLY DETECTION AND SCREENING IN ADDITION TO LEADING CAUSES OF DEATH, WHICH ARE: CANCER, HEART DISEASE, DIABETES AND ALZHEIMER'S. CHILDHOOD OBESITY, A COMMUNITY HEALTH CONCERN IS ALSO BEING ADDRESSED. TO ADDRESS HEALTH EDUCATION AND LEADING CAUSES OF DEATH, THE HOSPITAL HOSTS FREE, MONTHLY HEALTH LECTURES ON VARIOUS TOPICS IDENTIFIED IN THE ASSESSMENT SUCH AS CANCER, HEART DISEASE, LYME DISEASE, MENOPAUSE, OSTEOPOROSIS, DIABETES, CONGESTIVE HEART FAILURE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE. THE ANNUAL HEALTH FAIR PROVIDES HEALTH SCREENINGS FOR B/P, CHOLESTEROL, BLOOD GLUCOSE, BMI, AND PSA SCREENINGS. FAUQUIER HEALTH ADDRESSES DIABETES, BY PROVIDING DIABETES EDUCATION INCLUDING SUPPORT GROUPS, SELF-MANAGEMENT CLASSES, SCREENINGS AND COUNSELING. FREE MAMMOGRAMS ARE PROVIDED TO WOMEN TURNING 40 TO PROVIDE BREAST CANCER SCREENINGS. TO ADDRESS AGING SERVICES, FAUQUIER HEALTH FACILITATES SUPPORT GROUPS FOR ALZHEIMER'S, DEMENTIA, CANCER, CAREGIVERS AND DIABETES. IN ADDITION, FAUQUIER PARTNERS WITH THE LOCAL COMMUNITY SERVICE BOARD AND AGING TOGETHER TO HOST MEDICARE/MEDICAID COUNSELING AND A FALLS SYMPOSIUM AND ALZHEIMER'S/DEMENTIA WORKSHOP. FAUQUIER HEALTH PARTNERED WITH THREE COMMUNITY ORGANIZATIONS TO ADDRESS CHILDHOOD OBESITY THROUGH AN 8 WEEK SUMMER CAMP PROGRAM THAT HIGHLIGHTED PHYSICAL ACTIVITY AND NUTRITION. OTHER HEALTH NEEDS IDENTIFIED THAT THE HOSPITAL IS NOT ADDRESSING ARE HANDLED BY OTHER LOCAL ORGANIZATIONS OR GOVERNMENT ENTITIES. EXAMPLES INCLUDE, LOW BIRTH WEIGHTS WHICH ARE ADDRESSED BY THE LOCAL HEALTH DEPARTMENT AND SOCIAL SERVICES. DENTAL CARE IS NOT THE EXPERTISE OF THE HOSPITAL SO IS ADDRESSED BY THE LOCAL HEALTH DEPARTMENT AND THE LOCAL FREE CLINIC. BEHAVIORAL HEALTH IS CURRENTLY ADDRESSED BY THE LOCAL COMMUNITY SERVICES BOARD, HOWEVER THE HOSPITAL IS EXPLORING INITIATIVES TO ADDRESS THE NEED IN THE COMMUNITY. THE HOSPITAL SUPPORTS THE LOCAL FREE CLINIC FINANCIALLY AND WITH DONATED LAB AND RADIOLOGY SERVICES TO PROVIDE CARE TO THE UNINSURED POPULATION.THE RESULTS OF THE HEALTH NEEDS ASSESSMENT ARE CONTINUALLY BEING REVIEWED AND CONSIDERED BY FAUQUIER HOSPITAL LEADERSHIP. |
| FHI SERVICES | PART V, SECTION B, LINE 16I: IN ADDITION TO PUBLISHING THE FINANCIAL ASSISTANCE POLICY ON THE HOSPITAL'S WEBSITE, SIGNAGE IS POSTED STRATEGICALLY THROUGHOUT THE HOSPITAL (INCLUDING ALL INPATIENT, OUTPATIENT, ANCILLARY AND EMERGENCY DEPARTMENT REGISTRATION OFFICES) WHICH INDICATES THAT FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDES CONTACT INFORMATION FOR FINANCIAL COUNSELORS WHO CAN HELP WITH THE APPLICATION PROCESS. NOTIFICATION REGARDING THE POLICY ARE AVAILABLE IN BOTH ENGLISH AND SPANISH, THE PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVED BY FAUQUIER HOSPITAL. REPRESENTATIVES OF OUR FINANCIAL ASSISTANCE ELIGIBILITY PARTNERS, ADVANCED-PATIENT ADVOCACY, ALSO DIRECT ALL PATIENTS WHO ARE SCREENED FOR STATE OR FEDERAL ASSISTANCE PROGRAMS BUT DO NOT QUALIFY TO THE HOSPITAL FINANCIAL COUNSELORS FOR HOSPITAL CHARITY SCREENING. |
| FHI SERVICES | PART V, SECTION B, LINE 22D: THE HOSPITAL DOES NOT CHARGE ANY PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. ALL PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE RECEIVE FREE CARE. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| FHI SERVICES PART V, SECTION B, LINE 16A WEBSITE: | WWW.FAUQUIERHEALTH.ORG |
| FHI SERVICES PART V, SECTION B, LINE 16B WEBSITE: | WWW.FAUQUIERHEALTH.ORG |
| FHI SERVICES PART V, SECTION B, LINE 16C WEBSITE: | WWW.FAUQUIERHEALTH.ORG |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 14 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| THE VILLA AT SUFFIELD MEADOWS | ||||
| 6735 SUFFIELD LANE | WARRENTON | VA | 20187 | ASSISTED LIVING |
| FAUQUIER HEALTH REHABILITATION AND NURSI | ||||
| 360 HOSPITAL DRIVE | WARRENTON | VA | 20186 | NURSING HOME |
| FAUQUIER HEALTH WELLNESS CENTER | ||||
| 419 HOLIDAY COURT SUITE 200 | WARRENTON | VA | 20186 | WELLNESS CENTER |
| FAUQUIER HEALTH HOME CARE SERVICES | ||||
| 170 W SHIRLEY AVE | WARRENTON | VA | 20186 | HOMECARE |
| FAUQUIER HEALTH SLEEP CENTER | ||||
| 493 BLACKWELL ROAD SUITE 317-A | WARRENTON | VA | 20186 | SLEEP CENTER |
| WOUND HEALING CENTER | ||||
| 493 BLACKWELL ROAD SUITE 101A | WARRENTON | VA | 20186 | WOUND CENTER |
| FAUQUIER HOSPITAL-MEDICAL IMAGING SERVIC | ||||
| 493 BLACKWELL ROAD SUITE 119 | WARRENTON | VA | 20186 | MEDICAL IMAGING |
| HEMATOLOGYONCOLOGY | ||||
| 500 HOSPITAL DRIVE | WARRENTON | VA | 20186 | PHYSICIAN SERVICE |
| INFECTIOUS DISEASESRHEUMATOLOGYENDOCRI | ||||
| 550 HOSPITAL DRIVE | WARRENTON | VA | 20186 | PHYSICIAN SERVICE |
| OBSTETRICS AND GYNECOLOGY | ||||
| 253 VETERANS DRIVE SUITE 210 | WARRENTON | VA | 20186 | PHYSICIAN SERVICE |
| FAMILY PRACTICE AT BEALETON | ||||
| 6200 STATION DRIVE | BEALETON | VA | 22712 | PHYSICIAN SERVICE |
| INTERNAL MEDICINE AT LAKE MANASSAS | ||||
| 7915 LAKE MANASSAS DR 101 | GAINESVILLE | VA | 20155 | PHYSICIAN SERVICE |
| NEUROLOGY | ||||
| 384 HOSPITAL DRIVE | WARRENTON | VA | 20186 | PHYSICIAN SERVICE |
| PIEDMONT INTERNAL MEDICINE | ||||
| 419 HOLIDAY COURT SUITE 160 | WARRENTON | VA | 20186 | PHYSICIAN SERVICE |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ALL PATIENTS WHO ARE RESIDENTS OF FAUQUIER OR RAPPAHANNOCK COUNTIES, WHOSE ANNUAL HOUSEHOLD INCOME LEVELS ARE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES, ARE ELIGIBLE FOR FREE CARE. THIS PROCESS REQUIRES AN APPLICATION AND VERIFICATION OF ALL SOURCES OF INCOME. IN ADDITION, ALL PATIENTS WHO ARE NON RESIDENTS OF FAUQUIER OR RAPPAHANNOCK COUNTIES AND WHOSE ANNUAL HOUSEHOLD INCOME FALLS AT OR BELOW 100% OF THE FEDERAL POVERTY GUIDELINES ARE ALSO ELIGIBLE FOR FREE CARE AFTER COMPLETING THE SAME APPLICATION AND INCOME VERIFICATION PROCESS.BEFORE FINAL COLLECTION ACTION, ACCOUNTS ARE PUT THROUGH CREDIT SCORING SOFTWARE TO HELP IDENTIFY THOSE PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAVE NOT CONTACTED OUR OFFICE UP TO THAT POINT. IF THE SOFTWARE INDICATES THAT THE PATIENT'S INCOME LEVEL MEETS FINANCIAL ASSISTANCE ELIGIBILITY, THE ACCOUNT IS PRESUMPTIVELY WRITTEN OFF TO CHARITY AND FURTHER COLLECTION ACTIVITY IS NOT PURSUED. |
| PART I, LINE 7: | THE HOSPITAL FACILITY WAS CONTRIBUTED TO FAUQUIER HOLDING COMPANY, LLC AS PART OF THE LIFEPOINT TRANSACTION IN TAX YEAR 2013. FHI SERVICES RETAINS A 20% OWNERSHIP INTEREST IN FAUQUIER HOLDING COMPANY, LLC, AS WELL AS APPOINTS 50% OF THE MEMBERS OF THE GOVERNING BOARD. FAUQUIER HOLDING COMPANY, LLC HAS A CALENDAR YEAR FISCAL YEAR AND ISSUES ITS FORM K-1 BASED UPON THE CALENDAR YEAR. AS A RESULT, THE INFORMATION PROVIDED IN PART I LINE 7 AND PART II REFLECTS THE OPERATIONS REFLECTED ON THE K-1 ISSUED BY FAUQUIER HOLDING COMPANY, LLC FOR ITS YEAR ENDING WITHIN FHI SERVICES' FISCAL YEAR (FROM JANUARY 1, 2014 THROUGH DECEMBER 31, 2014). |
| PART I, LINE 6A | FAUQUIER HOSPITAL PREPARES ITS OWN COMMUNITY BENEFIT REPORT, WHICH IT POSTS ON THE HOSPITAL WEBSITE. |
| PART I, LINE 7, COLUMN (F) | THE FIGURES INCLUDED IN PART I, LINE 7 ARE 20% OF THE TOTAL COSTS INCURRED BY FAUQUIER HOSPITAL WHICH EQUALS FHI SERVICES INTEREST IN THE FAUQUIER HOLDING COMPANY, LLC. THE PERCENTAGE OF TOTAL EXPENSES IN COLUMN (F) IS CALCULATED BASED ON 20% OF THE EXPENSE OF THE FAUQUIER HOLDING COMPANY, LLC FOR THE OPERATIONS FROM JANUARY 1, 2014 - DECEMBER 31, 2014. THE JOINT VENTURE IS A CALENDAR YEAR TAX FILER WITH THE 2014 TAX YEAR ENDING ON DECEMBER 31, 2014. |
| PART II | COMMUNITY BUILDING ACTIVITIES SUPPORT THE HEALTH OF THE COMMUNITY BY OFFERING ENVIRONMENTAL IMPROVEMENTS AND COMMUNITY SUPPORT. ENVIRONMENTAL IMPROVEMENTS - FAUQUIER HEALTH'S ANNUAL MEDICATION AND NEEDLES COLLECTION EVENT HELPS TO SAFELY DISPOSE OF 508 GALLONS OF NEEDLES AND 417 LBS OF MEDICATIONS. RATHER THAN COMMUNITY MEMBERS FLUSHING MEDICATIONS INTO THE GROUND WATER OR DISPOSING OF SHARPS AT THE LANDFILL, FAUQUIER HEALTH COLLECTS THEM AND WORKS WITH A MEDICAL WASTE MANAGEMENT COMPANY THAT DISPOSES OF THE ITEMS. THIS IS ALSO A MEANS TO HELP WITH THE OPIATE ISSUE IN THE REGION.LASTLY THE COMMUNITY SUPPORT ACTIVITIES INCLUDED MED NEEDLES AND THE EMERGENCY DRUG SUPPLIES & DISASTER ASSISTANCE.THE HOSPITAL FACILITY WAS CONTRIBUTED TO FAUQUIER HOLDING COMPANY, LLC AS PART OF THE LIFEPOINT TRANSACTION IN TAX YEAR 2013. FHI SERVICES RETAINS A 20% OWNERSHIP INTEREST IN FAUQUIER HOLDING COMPANY, LLC, AS WELL AS APPOINTS 50% OF THE MEMBERS OF THE GOVERNING BOARD. FAUQUIER HOLDING COMPANY, LLC HAS A CALENDAR YEAR FISCAL YEAR AND ISSUES ITS FORM K-1 BASED UPON THE CALENDAR YEAR. AS A RESULT, THE INFORMATION PROVIDED IN PART I LINE 7 AND PART II REFLECTS THE OPERATIONS REFLECTED ON THE K-1 ISSUED BY FAUQUIER HOLDING COMPANY, LLC, WHICH IS 20% TOTAL COSTS INCURRED BY FAUQUIER HOSPITAL, FOR ITS YEAR ENDING WITHIN FHI SERVICES' FISCAL YEAR (FROM JANUARY 1, 2014 THROUGH DECEMBER 31, 2014). FHI SERVICES' FISCAL YEAR WAS 10/1/2014 - 9/30/2015. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE REPORTED NET OF ALLOWANCES FOR THE EXCESS OF CHARGES OVER THE PAYMENTS ON PATIENT ACCOUNTS TO BE RECEIVED FROM THIRD PARTY PAYERS AND ESTIMATES OF UNCOLLECTIBLE AMOUNTS. THE SYSTEM'S POLICY IS TO WRITE-OFF ALL PATIENT ACCOUNTS THAT HAVE BEEN IDENTIFIED AS UNCOLLECTABLE. ANY ALLOWANCE FOR DOUBTFUL ACCOUNTS IS RECORDED FOR ACCOUNTS NOT YET WRITTEN OFF THAT MAY BECOME UNCOLLECTABLE IN FUTURE PERIODS BASED ON MANAGMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH OF ITS MAJOR PAYERS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THESUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED, AND INCLUDE ESTIMATED RETROACTIVE REVENUE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED, AND SUCH AMOUNTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS.FAUQUIER HOSPITAL PERIODICALLY EMPLOYED CREDIT SCORING SOFTWARE TO HELP IDENTIFY PATIENTS THAT MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, WHICH HAD NOT COMPLETED A FINANCIAL ASSISTANCE APPLICATION. IF THE SOFTWARE INDICATED THAT THE PATIENT'S INCOME LEVEL MET FINANCIAL ASSISTANCE ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THEN THE ACCOUNT WAS WRITTEN OFF TO CHARITY AND FURTHER COLLECTION ACTIVITY WAS NOT PURSUED. AS A RESULT OF THE PERIODIC USE OF SUCH CREDIT SCORING SOFTWARE THROUGHOUT THE YEAR, IT IS DIFFICULT TO ESTIMATE THE AMOUNT OF THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS THAT MIGHT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 8: | THE SHORTFALL FOR MEDICARE IS NOT CURRENTLY INCLUDED / CONSIDERED IN COMMUNITY BENEFIT. HOWEVER, THE SHORTFALL IS DUE TO THE REIMBURSEMENT FROM MEDICARE FALLING SHORT OF THE COST INCURRED TO PROVIDE CARE TO THE MEDICARE POPULATION SERVED BY THE FAUQUIER HOSPITAL. AS WITH THE SHORTFALL EXPERIENCED FOR THE MEDICAID POPULATION, THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT AS WELL. IT IS PART OF THE ORGANIZATION'S MISSION TO PROVIDE THE BEST POSSIBLE CARE TO PATIENTS WITHIN OUR COMMUNITY, AND THE ORGANIZATION BELIEVES PROVIDING SUCH CARE HAS IMPROVED THE OVERALL HEALTH OF THE COMMUNITY. BY PROVIDING SUCH CARE TO MEDICARE PATIENTS, THE GOVERNMENT'S BURDEN FOR CARING FOR SUCH INDIVIDUALS IS LESSENED.THE MEDICARE COST REPORT WAS UTILIZED AS OUTLINED IN THE SCHEDULE H, PART III, SECTION B, WORKSHEET B, WHICH UTILIZES THE COST TO CHARGE RATIO DEVELOPED WITHIN THE MEDICARE COST REPORT TO DETERMINE THE ALLOWABLE COST. |
| PART III, LINE 9B: | FAUQUIER HOSPITAL'S FINANCIAL ASSISTANCE POLICY CONTAINS THE FOLLOWING PROVISION ON COLLECTION PRACTICES FOR THOSE PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE: FAUQUIER HOSPITAL MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES (INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NON-PAYMENT, INCLUDING COLLECTIONS ACTION AND REPORTING TO CREDIT AGENCIES) THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY CARE OR DISCOUNTED CARE; A PATIENT'S GOOD FAITH EFFORTS TO APPLY FOR GOVERNMENTAL ASSISTANCE PROGRAMS OR FINANCIAL ASSISTANCE FROM FAUQUIER HOSPITAL, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH FAUQUIER HOSPITAL. FAUQUIER HOSPITAL WILL NOT IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS SUCH AS LAWSUITS, WAGE GARNISHMENTS, ARRESTS, BODY ATTACHMENTS, LIENS ON RESIDENCES, OR OTHER SIMILAR LEGAL ACTIONS AGAINST ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY. "REASONABLE EFFORTS" INCLUDE NOTIFICATIONS BY THE HOSPITAL OF THIS FINANCIAL ASSISTANCE POLICY UPON ADMISSION AND IN WRITTEN AND ORAL COMMUNICATIONS WITH THE PATIENT REGARDING THE PATIENT'S BILL, INCLUDING INVOICES AND TELEPHONE CALLS BEFORE COLLECTION ACTION OR REPORTING TO CREDIT AGENCIES IS INITIATED. IF A PATIENT IS FOUND TO QUALIFY FOR FINANCIAL ASSISTANCE AFTER COLLECTION ACTIONS HAVE STARTED, ALL COLLECTION ACTIVITY IS IMMEDIATELY STOPPED, NOTIFICATIONS ARE SENT TO THE CREDIT BUREAU IF NECESSARY AND PATIENTS ARE NOT CHARGED FOR COLLECTION FEES. IF A PATIENT IS FOUND TO QUALIFY FOR FINANCIAL ASSISTANCE AFTER MAKING PAYMENTS TOWARDS THEIR BALANCE, THE PAYMENTS ARE REFUNDED TO THE PATIENT. |
| PART VI, LINE 2: | FAUQUIER HEALTH ASSESSES THE HEALTH NEEDS OF THE COMMUNITY BY CONDUCTING A HEALTH NEEDS ASSESSMENT EVERY THREE YEARS AS WELL AS CONTINUALLY COMMUNICATING WITH THE COMMUNITY STAKEHOLDERS WHO ARE SERVING OUR AREAS RESIDENTS. FOR EXAMPLE, FAUQUIER HEALTH MEETS REGULARLY WITH THE FAUQUIER FREE CLINIC LEADERSHIP AND PROVIDES FINANCIAL AND IN-KIND ASSISTANCE TO THE CLINIC WHICH SERVES THE UNINSURED IN FAUQUIER AND RAPPAHANNOCK COUNTIES. |
| PART VI, LINE 3: | NOTIFICATION OF FAUQUIER HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS DISSEMINATED BY VARIOUS MEANS, INCLUDING NOTIFICATION OF CONTACT INFORMATION FOR FINANCIAL COUNSELORS ON ALL OF OUR BILLING STATEMENTS AND SIGNAGE IN ALL OF OUR PATIENT REGISTRATIONS AREAS. THE POLICY ITSELF IS AVAILABLE ON THE HOSPITAL WEBSITE, WHICH ALSO PROVIDES CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. REQUESTS FOR FINANCIAL ASSISTANCE MAY BE MADE AT ANY POINT IN THE COLLECTION CYCLE. EVERY BILLING STATEMENT RECEIVED BY A PATIENT INCLUDES THE FOLLOWING LANGUAGE: "IN MEETING YOUR FINANCIAL OBLIGATIONS FOR THE CARE PROVIDED BY FAUQUIER HOSPITAL WE ASK THAT YOU WORK WITH US ON ANY BILLS THAT YOU ARE HAVING DIFFICULTY PAYING. YOU WILL FIND OUR STAFF UNDERSTANDING AND EAGER TO HELP YOU." THIS MESSAGE IS FOLLOWED BY A LIST OF TELEPHONE NUMBERS THAT THE PATIENT MAY CALL TO REACH THE ORGANIZATION'S FINANCIAL COUNSELING STAFF, HOURS OF OPERATION, AND AN EMAIL ADDRESS. WHEN PATIENTS CALL THE FINANCIAL COUNSELING TELEPHONE NUMBER, THEY ARE PROMPTED TO SELECTIONS TO REACH THE STAFF MEMBER THAT IS MOST LIKELY ABLE TO HELP THEM I.E.: UNINSURED, SPANISH SPEAKING, BILLING QUESTIONS, ETC. IN ADDITION, UNINSURED INPATIENTS AND THOSE WITH MEDICARE INSURANCE AND NO SECONDARY CARRIER ARE CONTACTED (USUALLY A PERSONAL VISIT IN THEIR HOSPITAL ROOM) BY AN EMPLOYEE OF ONE OF OUR PARTNERS, ADVANCED PATIENT ADVOCACY (APA). THE APA PERSONNEL SCREEN THESE PATIENTS FOR ELIGIBILITY FOR AVAILABLE STATE OR FEDERAL PROGRAMS. THE FAUQUIER HOSPITAL TRANSITIONED VENDORS TO MEDASSIST IN CY 2014. IF THESE PATIENTS DO NOT MEET CRITERIA FOR THESE PROGRAMS, THEY ARE THEN REFERRED TO A FINANCIAL COUNSELOR FOR SCREENING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. OUTPATIENTS WHOSE ACCOUNTS MEET A THRESHOLD OF $750 IN CHARGES ARE ALSO CONTACTED BY APA BY EITHER TELEPHONE, LETTER OR BOTH. UNINSURED PATIENTS WHO VISIT OUR EMERGENCY DEPARTMENT ARE ALSO GIVEN A PACKET OF INFORMATION THAT INCLUDES A FINANCIAL ASSISTANCE APPLICATION AND A BUSINESS CARD WITH THE NAME AND CONTACT INFORMATION FOR ONE OF OUR FINANCIAL COUNSELORS. LASTLY, WE DO USE CREDIT SCORING SOFTWARE TO HELP IDENTIFY PATIENTS WHO MIGHT QUALIFY FOR FINANCIAL ASSISTANCE BUT HAVE NOT CONTACTED OUR OFFICE. OUR FINANCIAL ASSISTANCE POLICY STATES THAT WE MAY USE THIS KIND OF SOFTWARE, WHICH USES INFORMATION FROM CREDIT BUREAUS AND SCREENS PATIENTS AGAINST THE CRITERIA OF OUR FINANCIAL ASSISTANCE POLICY. |
| PART VI, LINE 4: | FAUQUIER HOSPITAL (FH) IS A 97-BED, NOT-FOR-PROFIT, ACUTE CARE FACILITY ESTABLISHED IN 1954 TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RURAL COMMUNITIES IT SERVES. OUR MISSION IS TO RESTORE, PROMOTE AND MAINTAIN THE HEALTH OF OUR COMMUNITY. FAUQUIER HOSPITAL IS THE ONLY HOSPITAL IN OUR PRIMARY SERVICE AREA, WHICH INCLUDES FAUQUIER AND MINOR PORTIONS OF FIVE SURROUNDING COUNTIES. THE PRIMARY SERVICE AREA HAS A POPULATION OF 79,862. THE AVERAGE HOUSEHOLD INCOME IS $112,493. 7.1% OF THE COMMUNITY RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY GUIDELINE. 17.9% OF FAUQUIER HOSPITAL'S PATIENTS ARE MEDICAID RECIPIENTS OR SELF-PAY. THE FOLLOWING DISTRICTS WITHIN FAUQUIER COUNTY ARE CONSIDERED MUA/P BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA): LEE DISTRICT AND MARSHALL DISTRICT. |
| PART VI, LINE 5: | FAUQUIER HEALTH PROMOTES THE HEALTH OF THE COMMUNITY BY:- ENSURING THAT THE MAJORITY (78%) OF THE INDIVIDUALS SERVING ON THE FAUQUIER HOSPITAL BOARD OF DIRECTORS RESIDE IN THE PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION- EXTENDING MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO ARE INTERESTED.- FAUQUIER HEALTH USES SURPLUS FUNDS TO IMPROVE PATIENT CARE BY UPGRADING THE TOOLS NEEDED TO CARE FOR OUR PATIENTS AND PLANNING FOR IMPROVEMENTS. FAUQUIER HEALTH CONTINUES TO SUPPORT TWENTY EMPLOYED PHYSICIANS, AN ENDOCRINOLOGIST, AND 2 OBSTETRICS/GYNECOLOGIST, 3 FAMILY MEDICINE PHYSICIANS, A RHEUMATOLOGIST, NEUROLOGIST, INFECTIOUS DISEASE, 7 INTERNISTS AND 2 GENERAL SURGERY; IMPLEMENTED A HOME HEALTH DISEASE MANAGEMENT TRAINING PROGRAM (TO INCLUDE CONGESTIVE HEART FAILURE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND DIABETES) FOR PATIENTS; DEVELOPMENT OF A TRANSITIONS TO HOME PROGRAM THAT ADDRESSES CHRONIC DISEASE MANAGEMENT AND READMISSION RATES FOR PATIENTS; FEASIBILITY STUDIES FOR A NEONATAL INTENSIVE CARE UNIT.- WE ALSO PARTNER WITH LOCAL NON-PROFIT ORGANIZATIONS (E.G. FAUQUIER FREE CLINIC, THE CHAMBER OF COMMERCE, SCHOOLS AND CHURCHES) AND NATIONAL ORGANIZATIONS (E.G. THE AMERICAN CANCER SOCIETY) TO SUPPORT LOCAL EVENTS AND PROVIDE COMMUNITY HEALTH AND WELLNESS PROGRAMS. THESE COMMUNITY BENEFITS ACTIVITIES ARE COORDINATED BY A FULL-TIME COMMUNITY OUTREACH STAFF PERSON, SUPPORTED BY ADMINISTRATIVE AND CLINICAL DEPARTMENTS, AND OUR AUXILIARY VOLUNTEERS AS NEEDED.- TO HELP TRAIN AND EDUCATE HEALTH CARE PROFESSIONALS, FH WORKS WITH LOCAL COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS; FH STAFF PROVIDED APPROXIMATELY 31,621 HOURS AT A COST OF APPROXIMATELY $1,082,948.- ADDITIONALLY, THE ORGANIZATION PROVIDES ASSISTANCE TO THE FAUQUIER FREE CLINIC (FFC). FFC PROVIDES PRIMARY HEALTH AND DENTAL CARE TO UNINSURED RESIDENTS OF FAUQUIER AND RAPPAHANNOCK COUNTIES. FH PROVIDED LABORATORY, CARDIOLOGY/NEUROLOGY/PULMONARY SERVICES, AND RADIOLOGY SERVICES AT NO CHARGE TO FCC PATIENTS FOR A TOTAL COST OF $232,261. A TOTAL OF 759 HOURS OF FREE CLINICAL CARE WERE PROVIDED BY COMMUNITY PHYSICIANS AND CLINICAL STAFF. IN ADDITION, FH CONTRIBUTED $5,000 IN UNRESTRICTED FUNDS.COMMUNITY HEALTH EDUCATION, SCREENINGS AND OUTREACH PROGRAMS. OUR HEALTH PROFESSIONALS PROVIDED HEALTH EDUCATION, CLASSES, LECTURES AND HEALTH SCREENINGS AT 119 LOCAL EVENTS FOR 2,541. FH ALSO OFFERS TOURS OF THE HOSPITAL AND SPEAKERS FOR LOCAL SCHOOLS AND COMMUNITY ORGANIZATIONS TO BUILD RELATIONSHIPS WITHIN THE COMMUNITY, PROMOTE COLLABORATION IN MANAGING HEALTH AND WELLNESS, AND EDUCATE THE COMMUNITY ON THE HEALTH SYSTEM. THE TOTAL COMMUNITY BENEFIT OF THESE SERVICES WAS $376,753HEALTH EDUCATION THROUGH ADVERTISING, MEDIA, AND PUBLICATIONS. TWO OF FH PUBLICATIONS ARE A COMMUNITY NEWSLETTER, HEALTHY HAPPENINGS, INTENDED TO EDUCATE THE PUBLIC ABOUT HEALTH ISSUES AND HEALTH CARE AND HOSPITAL SERVICES. PUBLISHED QUARTERLY, IT REACHES 101,000 HOMES IN FAUQUIER AND SURROUNDING COUNTIES. THE SENIOR LIVING PUBLICATION IS PUBLISHED TWICE A YEAR AND REACHES 42,000 INDIVIDUALS WHO ARE AGE 55 AND OLDER. THE COST TO FH FOR PUBLICATION AND DISTRIBUTION OF THESE NEWSLETTERS IN FY14 WAS $350,271. EMERGENCY SERVICES. FH PROVIDES MEDICAL OVERSIGHT, DIRECTION, AND ORDERS TO PARAMEDICS IN THE FIELD AND EN-ROUTE TO THE HOSPITAL. OUR EMERGENCY DEPARTMENT OFFERS 24-HOUR ACCESS TO MEDICAL SERVICES AND HELICOPTER TRANSPORT FOR CRITICALLY ILL OR INJURED INDIVIDUALS, AND ALSO RESTOCKS MEDICAL BOXES AND PROVIDES CLEAN LINENS FOR RESCUE SQUADS AT A COST TO THE HOSPITAL OF APPROXIMATELY $24,182.SUPPORT GROUPS AND COMMUNITY GROUPS. FH SPONSORED, ASSISTED, OR PROVIDED MEETING SPACE FOR THREE SUPPORT GROUPS THAT MET WEEKLY OR MONTHLY, AT A COST TO FH OF $4,155. ADDITIONALLY, FH PROVIDED MEETING SPACE OR CASH DONATIONS FOR SEVERAL NON-PROFIT COMMUNITY GROUPS, (E.G. THE AMERICAN RED CROSS, FAUQUIER FREE CLINIC AND AMERICAN CANCER SOCIETY FAUQUIER CHAPTER), WITH A FAIR MARKET VALUE OF THE MEETING SPACE OF $32,222 AND TOTAL CASH DONATIONS OF $15,200. FH EMPLOYEES PROVIDED REPRESENTATION ON COMMUNITY BOARDS AND COALITIONS AT AN EXPENSE OF $26,376.PHYSICIAN REFERRAL. THE HOSPITAL ASSISTED 1,802 PEOPLE THROUGH THE PHYSICIAN REFERRAL PROGRAM, WHICH HELPS THE COMMUNITY WITH QUESTIONS ON PHYSICIANS, APPOINTMENTS, CLASSES AND PROGRAMS REGISTRATION, AND HEALTH RESOURCES AVAILABLE THROUGH THE HOSPITAL OR IN THE COMMUNITY. IT COST FH $31,950 TO PROVIDE THIS SERVICE IN FY14. |
| PART VI, LINE 6: | FAUQUIER HOSPITAL IS PART OF LIFEPOINT HEALTH, A LEADING HEALTHCARE COMPANY DEDICATED TO MAKING COMMUNITIES HEALTHIER WITH FACILITIES IN 22 STATES. FHI SERVICES HAS A 20% OWNERSHIP INTEREST IN FAUQUIERHOLDING COMPANY, LLC, WHICH OPERATES FAUQUIER HOSPITAL ALONG WITH LIFEPOINT HEALTH WHICH MAINTAINS AN 80% OWNERSHIP INTEREST. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| AGING TOGETHER | |||||||
| P O BOX 367 | CULPEPER | VA | 22701 | 462046459 | 501(C)(3) | $32,000 | FUNDS FOR SENIOR SERVICES ORGANIZATION, ORGANIZING & MANAGING SENIOR TRANSPORTATION OPTION TRAINING |
| COMMUNITY TOUCH INC | |||||||
| 10499 JERICHO RD | BEALTON | VA | 22712 | 201369506 | 501(C)(3) | $20,000 | OPERATING FUNDS; KEY INITIATIVES INCLUDE HIRING NUTRITIONIST TO WORK WITH FAMILIES IN TRANSITIONAL HOUSING. |
| FAUQUIER COMMUNITY CHILD CARE INC | |||||||
| 400 HOLIDAY COURT SUITE 105 | WARRENTON | VA | 20186 | 541590790 | 501(C)(3) | $20,000 | OPERATING GRANT, KEY INITIATIVES INCLUDE REDESIGN AND EXPANSION OF NUTRITION AND STUDENT WELLNESS PROGRAM. |
| FAUQUIER COMMUNITY FOOD BANK AND THRIFT STORE INC | |||||||
| 249 EAST SHIRLEY AVENUE | WARRENTON | VA | 20186 | 900801730 | 501(C)(3) | $25,000 | GRANT TO SUPPORT PROCESS IMPROVEMENT AT LARGEST AREA FOOD BANK |
| FAUQUIER FREE CLINIC | |||||||
| P O BOX 3138 | WARRENTON | VA | 20188 | 541669652 | 501(C)(3) | $35,000 | GENERAL OPERATING SUPPORT |
| FAUQUIER HABITAT FOR HUMANITY | |||||||
| P O BOX 3189 | WARRENTON | VA | 20188 | 541595774 | 501(C)(3) | $20,000 | GENERAL OPERATING SUPPORT |
| HEADWATERS FOUNDATION | |||||||
| P O BOX 114 | SPERRYVILLE | VA | 22740 | 541844267 | 501(C)(3) | $25,000 | GENERAL OPERATING SUPPORT. KEY INITIATIVES INCLUDE STUDENT SPORTS AND FITNESS PROGRAM. |
| HOSPICE SUPPORT OF FAUQUIER COUNTY | |||||||
| 42 NORTH 5TH STREET | WARRENTON | VA | 20186 | 521250964 | 501(C)(3) | $15,000 | GENERAL OPERATING SUPPORT. KEY INITIATIVES INCLUDE PROMOTION AND MARKETING, FAMILY AND CAREGIVE EVENTS. |
| LORD FAIRFAX COMMUNITY COLLEGE EDUCATIONAL FOUNDATION | |||||||
| 173 SKIRMISHER LANE | MIDDLETON | VA | 226451745 | 510247624 | 501(C)(3) | $11,000 | GENERAL OPERATING SUPPORT. KEY INITIATIVE: EXPANSION OF CLINICAL MEDICAL ASSISTANT TRAINING. |
| MENTAL HEALTH ASSOCIATION OF FAUQUIER | |||||||
| P O BOX 3549 | WARRENTON | VA | 20188 | 521215685 | 501(C)(3) | $35,000 | OPERATING SUPPORT. KEY INITIATIVES INCLUDE MENTAL HEALTH FIRST AID AND PRIDE SURVEY IN PARTNERSHIP WITH CADRE. |
| RAPPAHANNOCK-RAPIDAN REGIONAL COMMISSION | |||||||
| 420 SOUTHRIDGE PARKWAY | CULPEPER | VA | 22701 | 540944913 | 501(C)(3) | $28,500 | PLANNING GRANT FOR HOUSING NEEDS TO SUPPORT CHRONICALLY HOMELESS. |
| CHILD CARE AND LEARNING CENTER | |||||||
| 12763 LEE HIGHWAY | WASHINGTON | VA | 22747 | 541061820 | 501(C)(3) | $15,000 | GENERAL OPERATING SUPPORT FOR NATURE BASED CURRICULUM. |
| TRINITY EPISCOPAL CHURCH | |||||||
| 370 GAY STREET | WASHINGTON | VA | 227470299 | 546056050 | 501(C)(3) | $39,800 | PLANNING GRANT FOR DESIGN AND LAUNCH OF RURAL SENIOR VILLAGE. |
| VERDUN ADVENTURE BOUND | |||||||
| 17044 ADVENTURE BOUND TRAIL | RIXEYVILLE | VA | 22737 | 541937517 | 501(C)(3) | $12,400 | GENERAL OPERATING SUPPORT FOR FAMILY MENTAL HEALTH PROGRAM. |
| RRCS - BEHAVIORAL HEALTH | |||||||
| 420 SOUTHRIDGE PARKWAY | CULPEPER | VA | 22701 | 237238218 | 501(C)(3) | $16,000 | PLANNING GRANT TO ASSESS MENTAL HEALTH FACILITY NEEDS. |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ORGANIZATIONS SEEKING GRANT FUNDING MUST SUBMIT A PROPOSAL BUDGET, AND IN MOST CASES AN ORGANIZATION BUDGET, DURING THE APPLICATION PROCESS. APPLICANTS TO 12-MONTH GRANTS MUST SUBMIT ORGANIZATION FINANCIALS AND A FORM 990. THE GRANT AGREEMENT SPECIFIES THAT FUNDS MAY ONLY BE USED IN CONFORMITY WITH THE ORIGINAL PROPOSAL AND ANY SUBSTANTIAL CHANGES MUST BE REQUESTED AND APPROVED IN WRITING. DOCUMENTATION (SUCH AS VENDOR QUOTES, INVOICES AND RECEIPTS) ARE REQUESTED AT BOTH THE APPLICATION AND REPORTING PHASES. COMPETITIVE GRANTS REQUIRE GRANTEES TO FILE A WRITTEN SIX-MONTH INTERIM REPORT AND/OR FINAL REPORTS SPECIFYING HOW FUNDS WERE USED, FOLLOWING THE END OF THE GRANT TERM. RECIPIENTS OF SHORT TERM MAKE IT HAPPEN GRANTS FILE A FINAL REPORT DETAILING GRANT ACTIVITY AND EXPENDITURES WITHIN THIRTY DAYS OF GRANT CLOSURE. IN THE CASE OF A SUCCESSFUL PROPOSAL, THE PROJECT AND ITS BUDGET SUBMITTED AT THE TIME OF APPLICATION FORM THE BASIS OF THE GRANT AGREEMENT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTINE CONNOLLY | PersonNm |
| Title | PRESIDENT & CEO | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $175,790 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $20,000 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $10,023 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $205,813 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE CEO IS COMPENSATED BY THE FAUQUIER HEALTH FOUNDATION. THE ORGANIZATIONS BOARD ADOPTED A COMPENSATION POLICY FOR ITS CEO. AN EXECUTIVE COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS OF THE BOARD OF THE FOUNDATION WAS ESTABLISHED TO REVIEW THE COMPENSATION FOR ALL EMPLOYEES SPECIFIED AS HAVING A SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION AND WHO RECEIVE REMUNERATION FROM THE ORGANIZATION. THE EXECUTIVE COMPENSATION COMMITTEE IS ADVISED BY AN INDEPENDENT COMPENSATION CONSULTANT, WHICH OPINES TO THE COMPENSATION COMMITTEE THAT THE LEVEL OF COMPENSATION PAID AND THE PROCESS BY WHICH COMPENSATION IS ESTABLISHED MEET APPLICABLE IRS REASONABLENESS AND "SAFE HARBOR' STANDARDS. THE OUTSIDE COMPENSATION CONSULTANT PROVIDES DATA OF COMPENSATION PROVIDED AT SIMILAR ORGANIZATIONS TO ENSURE THAT THE ORGANIZATION DOES NOT COMPENSATE IN EXCESS OF MARKET NORMS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | FHS SERVICES IS THE SOLE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE FHS SERVICES BOARD OF DIRECTORS, AS SOLE MEMBER OF FHI SERVICES, ELECT THE MEMBERS OF FHI SERVICES |
| FORM 990, PART VI, SECTION A, LINE 7B | 1. GENERAL POWERS. THE BUSINESS AND AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY THE BOARD OF DIRECTORS, WHICH SHALL HAVE ALL VOTING POWER EXCEPT THE POWER TO VOTE ON ELECTING, APPOINTING OR REMOVING DIRECTORS AND ON IMPLEMENTING AMENDMENTS TO THE ARTICLES OF INCORPORATION AFFECTING THE VOTING RIGHTS OF MEMBERS, WHICH POWER IS VESTED IN THE SOLE MEMBER OF THE CORPORATION. 2. NUMBER AND QUALIFICATION OF DIRECTORS. THE NUMBER OF DIRECTORS MAY BE CHANGED BY AMENDMENT OF THESE BY-LAWS BUT SHALL NOT BE LESS THAN THREE. 3. ELECTION OF DIRECTORS. ALL DIRECTORS SHALL BE ELECTED BY FHI SERVICES. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION PREPARES THE FORM 990 WITH ASSISTANCE FROM AN OUTSIDE ACCOUNTING FIRM. ONCE A DRAFT OF THE FORM 990 IS COMPLETED, IT IS SUBMITTED TO MANAGEMENT OF THE ORGANIZATION FOR REVIEW AND COMMENTS. AFTER INCORPORATING CHANGES FROM MANAGEMENT, MATERIALLY COMPLETE DRAFT FORMS 990 ARE MADE AVAILABLE TO THE BOARD OF THE ORGANIZATION. COMMENTS OR QUESTIONS RECEIVED FROM THE BOARD ARE INCORPORATED INTO A FINAL FORM 990, WHICH IS SIGNED BY THE PERSIDENT/CEO OF FHS SERVICES, CHRISTY CONNOLLY. |
| FORM 990, PART VI, SECTION B, LINE 12C | UNDER THE CONFLICT OF INTEREST POLICY, ALL BOARD MEMBERS, MANAGEMENT, AND KEY EMPLOYEES COMPLETE AN ANNUAL DISCLOSURE FORM REGARDING BUSINESS RELATIONSHIPS THAT HE OR SHE, OR ANY FAMILY MEMBER, HAS WITH ANY OTHER COMPANY THAT DOES BUSINESS WITH THE ORGANIZATION, AS WELL AS ANY BUSINESS RELATIONSHIPS BETWEEN AND AMONG THE BOARD MEMBERS, MANAGEMENT, AND KEY EMPLOYEES. THE ANNUAL DISCLOSURE STATEMENTS ARE REVIEWED BY INDEPENDENT LEGAL COUNSEL, AND THE AUDIT AND COMPLIANCE COMMITTEE, WHO IS ULTIMATELY RESPONSIBLE IF A CONFLICT EXISTS. ANY SUCH CONFLICTS WOULD BE REPORTED TO THE FULL BOARD. IN ADDITION, ANY PERSON WHO IS COVERED BY THE CONFLICT OF INTEREST POLICY HAS AN ONGOING OBLIGATION TO DISCLOSE THE EXISTENCE OF ANY ACTUAL OR POTENTIAL CONFLICT TO THE BOARD OR THE BOARD COMMITTEE IN WHICH THE MATTER ARISES. FINALLY, THE ORGANIZATION MONITORS BOARD MEMBER ELIGIBILITY FOR ANY POTENTIAL CONFLICTS, IN ORDER TO AVOID SUCH CONFLICTS FROM OCCURRING IN THE FIRST PLACE. AN OPPORTUNITY IS GIVEN AT THE START OF EACH MEETING TO DISCLOSE ANY CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO IS COMPENSATED BY THE FAUQUIER HEALTH FOUNDATION. THE ORGANIZATIONS BOARD ADOPTED A COMPENSATION POLICY FOR ITS CEO. AN EXECUTIVE COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS OF THE BOARD OF THE FOUNDATION WAS ESTABLISHED TO REVIEW THE COMPENSATION FOR ALL EMPLOYEES SPECIFIED AS HAVING A SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION AND WHO RECEIVE REMUNERATION FROM THE ORGANIZATION. THE EXECUTIVE COMPENSATION COMMITTEE IS ADVISED BY AN INDEPENDENT COMPENSATION CONSULTANT, WHICH OPINES TO THE COMPENSATION COMMITTEE THAT THE LEVEL OF COMPENSATION PAID AND THE PROCESS BY WHICH COMPENSATION IS ESTABLISHED MEET APPLICABLE IRS REASONABLENESS AND "SAFE HARBOR' STANDARDS. THE OUTSIDE COMPENSATION CONSULTANT PROVIDES DATA OF COMPENSATION PROVIDED AT SIMILAR ORGANIZATIONS TO ENSURE THAT THE ORGANIZATION DOES NOT COMPENSATE IN EXCESS OF MARKET NORMS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN ENDOWMENT INVESTMENTS -481,346. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| FHS SERVICES | ||||||||||
| 98 ALEXANDRIA PIKE SUITE 43 | WARRENTON | VA | 20186 | 541416705 | MANAGEMENT COORDINATION | VA | 501(C)(3) | LINE 11B, II | NONE | 0 |
| FAUQUIER HEALTH FOUNDATION INC DBA PATH FOUNDATION | ||||||||||
| 98 ALEXANDRIA PIKE SUITE 43 | WARRENTON | VA | 20186 | 300219424 | COMMUNITY HEALTH | VA | 501(C)(3) | LINE 7 | FHS SERVICES | Yes (1) |
| FHSL SERVICES | ||||||||||
| 98 ALEXANDRIA PIKE SUITE 43 | WARRENTON | VA | 20186 | 541416703 | SKILLED CARE | VA | 501(C)(3) | LINE 9 | FHS SERVICES | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAUQUIER HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | S | TransactionTypeTxt |
| Involved | $785,894 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |
Unrelated Org Txbl Partnership UnrelatedOrgTxblPartnershipGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAUQUIER HOLDING COMPANY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 SEVEN SPRINGS WAY | AddressLine1Txt |
| City | BRENTWOOD | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37027 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 901001620 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Predominate Income | RELATED | PredominateIncomeDesc |
| All Partners C3 S | Yes (1) | AllPartnersC3SInd |
| Share Of Total Income | $3,732,782 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $33,392,800 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.20000 | OwnershipPct |
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