Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2015
Open to Public Inspection
For calendar year 2015, or tax year beginning 11-01-2015 , and ending 10-31-2016
Name of foundation
POTOMAC HEALTH FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)2296 OPITZ BLVD NO 200
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WOODBRIDGE, VA22191
A Employer identification number

52-1340920
B Telephone number (see instructions)

(703) 523-0620
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$104,092,473J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 5,406,722
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments 349 349  
4 Dividends and interest from securities... 5,209,013 5,515,308  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 -1,046,213
b Gross sales price for all assets on line 6a 28,985,647
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 9,569,871 5,515,657  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 125,221 18,783   106,438
14 Other employee salaries and wages...... 146,202 0   103,180
15 Pension plans, employee benefits....... 56,999 3,944   53,055
16a Legal fees (attach schedule)......... Click to see attachment 1,289 0   1,289
b Accounting fees (attach schedule)....... Click to see attachment 49,561 0   52,194
c Other professional fees (attach schedule).... Click to see attachment 530,845 477,756   72,059
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 39,264 0   0
19 Depreciation (attach schedule) and depletion... 5,229 0  
20 Occupancy.............. 30,658 0   0
21 Travel, conferences, and meetings....... 12,462 0   12,462
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 52,779 42,654   50,466
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 1,050,509 543,137   451,143
25 Contributions, gifts, grants paid....... 4,876,925 4,845,853
26 Total expenses and disbursements. Add lines 24 and 25 5,927,434 543,137   5,296,996
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 3,642,437
b Net investment income (if negative, enter -0-) 4,972,520
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2015)
Form 990-PF (2015)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing.............      
2 Savings and temporary cash investments......... 155,096 76,653 76,653
3 Accounts receivable bullet47,446
Less: allowance for doubtful accounts bullet   46,835 47,446 47,446
4 Pledges receivable bullet314,054
Less: allowance for doubtful accounts bullet   396,770 314,054 314,054
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges.......... 26,500 38,889 38,889
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 99,208,896 Click to see attachment103,612,750 103,612,750
14 Land, buildings, and equipment: basis bullet36,148
Less: accumulated depreciation (attach schedule) bullet33,467 7,910 Click to see attachment2,681 2,681
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 99,842,007 104,092,473 104,092,473
Liabilities 17 Accounts payable and accrued expenses.......... 138,361 169,032
18 Grants payable.................. 1,840,212 1,877,020
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet) Click to see attachment98,154 Click to see attachment113,071
23 Total liabilities (add lines 17 through 22)......... 2,076,727 2,159,123
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................. 97,765,280 101,933,350
25 Temporarily restricted...............    
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see instructions)..... 97,765,280 101,933,350
31 Total liabilities and net assets/fund balances (see instructions). 99,842,007 104,092,473
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year’s return) ...............
1
97,765,280
2
Enter amount from Part I, line 27a .....................
2
3,642,437
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
525,748
4
Add lines 1, 2, and 3 ..........................
4
101,933,465
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
115
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
101,933,350
Form 990-PF (2015)
Form 990-PF (2015)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.) 		(b) How acquired
P—Purchase
D—Donation 		(c) Date acquired
(mo., day, yr.) 		(d) Date sold
(mo., day, yr.)
1 a SEI CORE PROPERTY FUND, LLC      
b PUBLICLY TRADED SECURITIES      
c
d
e
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 57,277     57,277
b 28,985,647   30,031,860 -1,046,213
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       57,277
b       -1,046,213
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 -988,936
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2014 4,980,260 100,254,131 0.049676
2013 4,672,707 100,774,355 0.046368
2012 4,370,054 95,756,146 0.045637
2011 3,863,779 90,901,681 0.042505
2010 4,515,859 92,210,303 0.048973
2
Total of line 1, column (d) .....................
20.233159
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years . . .
3
0.046632
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
98,321,142
5
Multiply line 4 by line 3......................
5
4,584,911
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
49,725
7
Add lines 5 and 6........................
7
4,634,636
8
Enter qualifying distributions from Part XII, line 4.............
8
5,296,996
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form 990-PF (2015)
Form 990-PF (2015)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 49,725
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 49,725
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 49,725
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 49,072
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 49,072
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. Click to see attachment 8 24
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 677
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet   RefundedBullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for definition)?.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletVA
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletWWW.POTOMACHEALTHFOUNDATION.ORG
    14
    The books are in care ofbulletSUSIE LEE Telephone no.bullet (703) 523-0620

    Located atbullet2296 OPITZ BLVD STE 200WOODBRIDGEVA ZIP+4bullet22191
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.......bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 2015, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country?
    16   No
    See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country bullet  
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)? ........
    1b
     
     
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2015?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2015 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2015.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (Continued)
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? (see instructions)................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    SUSIE LEE EXECUTIVE DIRECTOR
    40.00     		125,221 26,296 776
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    CAROL S SHAPIRO MD VICE-CHAIR
    4.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    R MICHAEL SORENSEN TREASURER
    3.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    WAYNE MALLARD SECRETARY
    2.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    MARION M WALL CHAIR
    4.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    HOWARD L GREENHOUSE DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    DONNIE HYLTON DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    DEBORAH JOHNSON DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    SARAH PITKIN PHD DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    WILLIAM M MOSS DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    CARLOS CASTRO DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    SAM HILL EDD DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    MEGAN PERRY DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BLVD 200
    WOODBRIDGE,VA22191
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    TIMOTHY MCCUE DIRECTOR OF GRANTS P
    40.00     		103,180 22,649 0
    2296 OPITZ BLVD SUITE 200
    WOODBRIDGE,VA22191
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    SEI GLOBAL INSTITUTIONAL GROUP INVESTMENT MANAGEMENT 477,756
    1 FREEDOM VALLEY DRIVE
    OAKS,PA19456
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    99,221,796
    b
    Average of monthly cash balances.......................
    1b
    596,622
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    99,818,418
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    99,818,418
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    1,497,276
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    98,321,142
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    4,916,057
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    4,916,057
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    49,725
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    49,725
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    4,866,332
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    5,736
    5
    Add lines 3 and 4............................
    5
    4,872,068
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    4,872,068
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    5,296,996
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    5,296,996
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see instructions).................
    5
    49,725
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    5,247,271
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2014     		(c)
    2014     		(d)
    2015
    1 Distributable amount for 2015 from Part XI, line 7 4,872,068
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only....... 4,909,212
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2015:
    a From 2010......  
    b From 2011......  
    c From 2012......  
    d From 2013......  
    e From 2014......  
    fTotal of lines 3a through e........ 0
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 5,296,996
    a Applied to 2014, but not more than line 2a 4,909,212
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2015 distributable amount..... 387,784
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2015. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2016. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........     		4,484,284
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2011....  
    b Excess from 2012....  
    c Excess from 2013....  
    d Excess from 2014....  
    e Excess from 2015....  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2015, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2015 (b) 2014 (c) 2013 (d) 2012
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    TIMOTHY MCCUE
    2296 OPITZ BLVD STE 200
    WOODBRIDGE,VA22191
    (703) 523-0630
    TIMOTHY@POTOMACHEALTHFOUNDATION.ORG
    bThe form in which applications should be submitted and information and materials they should include:
    LETTER OF INTENT TO INCLUDE NARRATIVE AND BUDGET PLAN, COMPLETED AND SUBMITTED ONLINE.
    cAny submission deadlines:
    JANUARY 22, 2016
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    THE FOUNDATION AWARDS GRANTS TO TAX-EXEMPT ORGANIZATIONS THAT SERVE INDIVIDUALS IN EASTERN PRINCE WILLIAM COUNTY, LORTON, NORTH STAFFORD IN VIRGINIA. PROJECTS MUST WORK TOWARD IMPROVING THE HEALTH OF THE COMMUNITY. PROJECTS ARE FUNDED FOR A 12 MONTH PERIOD. THE FOUNDATION DOES NOT FUND SPONSORSHIPS, INCLUDING FUNDRAISING EVENTS, ENDOWMENTS, LOBBYING, DIRECT SUPPORT TO INDIVIDUALS, PROGRAMS OF RELIGIOUS, FRATERNAL, ATHLETIC, OR VETERANS GROUPS WHEN THE PRIMARY BENEFICIARIES OF SUCH UNDERTAKINGS WOULD BE THEIR MEMBERS EXCLUSIVELY, GRANTS TO RETIRE ANY FORM OF DEBT, SCIENTIFIC RESEARCH GRANTS, AND INDIRECT COST PERCENTAGES.
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    ACTION IN COMMUNITY THROUGH SERVICE
    3900 ACTS LANE
    DUMFRIES,VA22026     		NONE PC 15 MAP HELPLINE ASSISTANCE AND OUTREACH PROJECT & MEDICAL CAREGIVER PRGM 2,500
    AMERICAN HEART ASSOCIATION
    4301 FAIRFAX DRIVE SUITE 530
    ARLINGTON,VA22203     		NONE PC CPR ANYTIME 35,133
    AMERICAN HEART ASSOCIATION
    4301 FAIRFAX DRIVE SUITE 530
    ARLINGTON,VA22203     		NONE PC CPR ANYTIME 65,625
    BRAIN INJURY SERVICES
    8136 OLD KEENE MILL ROAD
    SPRINGFIELD,VA22152     		NONE PC CREST: COLLABORATIVE REHABILITATION TO ENHANCE STROKE TREATMENT 67,544
    BRAIN INJURY SERVICES
    8136 OLD KEENE MILL ROAD
    SPRINGFIELD,VA22152     		NONE PC CREST: COLLABORATIVE REHABILITATION TO ENHANCE STROKE TREATMENT 101,170
    CHANGE IN ACTION INC
    128884 HARBOR DRIVE SUITE 203
    WOODBRIDGE,VA22192     		NONE PC MAP 12,016
    CHANGE IN ACTION INC
    128884 HARBOR DRIVE SUITE 203
    WOODBRIDGE,VA22192     		NONE PC BEHAVIORAL MANAGEMENT FOR TRAUMATIC EXPOSURE 74,634
    CHANGE IN ACTION INC
    128884 HARBOR DRIVE SUITE 203
    WOODBRIDGE,VA22192     		NONE PC BEHAVIORAL MANAGEMENT FOR TRAUMATIC EXPOSURE 100,959
    CHANGE IN ACTION INC
    128884 HARBOR DRIVE SUITE 203
    WOODBRIDGE,VA22192     		NONE PC 15 MAP 1,838
    CONSUMER HEALTH FOUNDATION
    1400 16TH ST NW SUITE 710
    WASHINGTON,DC20036     		NONE PC REGIONAL PRIMARY CARE COALITION 15,000
    EMPOWERHOUSE
    PO BOX 1007
    FREDRICKSBURG,VA22402     		NONE PC INTERPERSONAL VIOLENCE HEALTHCARE PARTNERSHIP PROGRAM 30,402
    EMPOWERHOUSE
    PO BOX 1007
    FREDRICKSBURG,VA22402     		NONE PC INTERPERSONAL VIOLENCE HEALTHCARE PARTNERSHIP PROGRAM 45,602
    EMPOWERHOUSE
    PO BOX 1007
    FREDRICKSBURG,VA22402     		NONE PC MAP 13,188
    GANG RESPONSE INTERVENTION TEAM (GRIT)
    4379 RIDGEWOOD CENTER DRIVE SUITE
    102
    WOODBRIDGE,VA22192     		NONE PC MAC TATTOO REMOVAL PROGRAM 4,844
    GEORGE MASON UNIVERSITY
    10900 UNIVERSITY BLVD MS 4E5
    MANASSAS,VA20110     		NONE PC MIDDLE SCHOOL ACHIEVES 75,000
    GEORGE MASON UNIVERSITY
    10900 UNIVERSITY BLVD MS 4E5
    MANASSAS,VA20110     		NONE PC POISED (PRECISION OUTREACH INTERVENTION , SCREENING SURVEILLANCE & EXERCISE FOR FALLS PREVENTION/ PRINCE WILLIAM 99,200
    GEORGE MASON UNIVERSITY
    10900 UNIVERSITY BLVD MS 4E5
    MANASSAS,VA20110     		NONE PC MIDDLE SCHOOL ACHIEVES (ADVANCING HEALTHCARE INITIATIVES FOR UNDERSERVED STUDENTS) 154,200
    GEORGE MASON UNIVERSITY
    10900 UNIVERSITY BLVD MS 4E5
    MANASSAS,VA20110     		NONE PC POISED (PRECISION OUTREACH INTERVENTION, SCREENING, SURVEILLANCE AND EXERCISE FOR FALLS PREVENTION IN DIABETES) PRINCE WILLIAM 130,007
    GEORGE WASHINGTON REGIONAL COMMISSIONTHE FARMER'S MARKET
    406 PRINCESS ANNE ST
    FREDRICKSBURG,VA22402     		NONE PC FRESH FOOD ACCESS FOR COMMUNITY HEALTH 25,853
    GEORGE WASHINGTON REGIONAL COMMISSIONTHE FARMER'S MARKET
    406 PRINCESS ANNE ST
    FREDRICKSBURG,VA22402     		NONE PC FRESH FOOD ACCESS FOR COMMUNITY HEALTH 15,558
    GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
    4379 RIDGEWOOD CENTER DRIVE SUITE
    102
    WOODBRIDGE,VA22192     		NONE PC INCREASED ACCESS TO INTEGRATED CARE AT OUR MEDICAL HOME IN DUMFRIES 90,000
    GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
    4379 RIDGEWOOD CENTER DRIVE SUITE
    102
    WOODBRIDGE,VA22192     		NONE PC 15 HSN 1,703
    GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
    4379 RIDGEWOOD CENTER DRIVE SUITE
    102
    WOODBRIDGE,VA22192     		NONE PC 15 MAP 15,000
    INSTITUTE FOR PUBLIC HEALTH INNOVATION
    1301 CONNECTICUT AVENUE NW
    WASHINGTON,DC20016     		NONE PC BUILDING AND STRENGTHENING A SUSTAINABLE AND EFFECTIVE COMMUNITY HEALTH WORKER (CHW) WORKFORCE IN THE COMMONWEALTH OF VIRGINIA 20,000
    LLOYD F MOSS FREE CLINIC
    1301 SAM PERRY BLVD
    FREDERICKSBURG,VA22401     		NONE PC 15 MAP 2,496
    LLOYD F MOSS FREE CLINIC
    1301 SAM PERRY BLVD
    FREDERICKSBURG,VA22401     		NONE PC 15 HSN - GENERAL OPERATING FUNDS 15,096
    LLOYD F MOSS FREE CLINIC
    1301 SAM PERRY BLVD
    FREDERICKSBURG,VA22401     		NONE PC GENERAL OPERATING FUNDS 136,890
    LLOYD F MOSS FREE CLINIC
    1301 SAM PERRY BLVD
    FREDERICKSBURG,VA22401     		NONE PC GENERAL OPERATING FUNDS 91,260
    MEDICAL CARE FOR CHILDREN'S PARTNERSHIP FOUNDATION
    1616 ANDERSON ROAD
    MCLEAN,VA22102     		NONE PC MCCP FOUNDATION PROJECT PEARLY WHITES - LORTON 16,290
    METROPOLITAN WASHINGTON COUNCIL OF GOVERNMENTS
    777 N CAPITOL ST NE SUITE 300
    WASHINGTON,DC20002     		NONE PC REGION FORWARD HEALTH INDICATORS: LIFE EXPECTANCY AND QUALITY OF LIFE 7,289
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC POISON CONTROL SERVICES TO FOUNDATION'S SERVICE AREA 111,065
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC WEBPOISONCONTROL: ENHANCEMENT OF AN ON-LINE PROTOTYPE TRIAGE APPLICATION TO INCREASE ACCESS TO POISON CONTROL SERVICES AND MINIMIZE INJURY FROM POISONINGS. 150,000
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC POISON CONTROL SERVICES TO FOUNDATION'S SERVICE AREA 65,552
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC WEB POISON CONTROL 100,000
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC 15 HSN POISON CTRL SVCS TO THE FDN'S SVC AREA 16,500
    NATIONAL COALITION OF 100 BLACK WOMEN
    PO BOX 1166
    DUMFRIES,VA22026     		NONE PC COLON CANCER PROJECT 68,600
    NATIONAL COALITION OF 100 BLACK WOMEN
    PO BOX 1166
    DUMFRIES,VA22026     		NONE PC INCREASE AWARENESS ON PREVENTION, EARLY DETECTION, TREATMENT PROSTATE CANCER 39,200
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC 15 HSN KIDS CONNECT 3,500
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC IMPROVING NUTRITION FOR LOW-INCOME FAMILIES 73,200
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC IMPROVING NUTRITION FOR LOW-INCOME FAMILIES 115,348
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC HEALTHLINK 41,896
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC KIDS CONNECT 31,500
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC KIDS CONNECT 21,000
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC PRINCE WILLIAM HEALTHLINK 27,931
    NOVA SCRIPTSCENTRAL INC
    6400 ARLINGTON BLVD SUITE 120
    FALLS CHURCH,VA22042     		NONE PC 15 MAP 2,800
    NOVA SCRIPTSCENTRAL INC
    6400 ARLINGTON BLVD SUITE 120
    FALLS CHURCH,VA22042     		NONE PC 15 HSN - IMPROVING HLTH ACCESS IN PW, STAFFORD & LORTON 22,141
    NOVA SCRIPTSCENTRAL INC
    6400 ARLINGTON BLVD SUITE 120
    FALLS CHURCH,VA22042     		NONE PC IMPROVING HEALTH ACCESS IN PRINCE WILLIAM, STAFFORD AND LORTON; PRESCRIPTION MEDICATIONS FOR THE LOW-INCOME AND UNINSURED 199,269
    NOVA SCRIPTSCENTRAL INC
    6400 ARLINGTON BLVD SUITE 120
    FALLS CHURCH,VA22042     		NONE PC IMPROVING HEALTH ACCESS IN PRINCE WILLIAM, STAFFORD AND LORTON; PRESCRIPTION MEDICATIONS FOR THE LOW-INCOME AND UNINSURED 132,846
    NUEVA VIDA INC
    5225 WISCONSIN AVE NW SUITE 503
    WASHINGTON,DC20015     		NONE PC INCREASING CANCER PREVENTION AND IMPROVING CONTINUITY OF CARE TO UNDERSERVED LATINAS IN PWC 75,000
    NUEVA VIDA INC
    5225 WISCONSIN AVE NW SUITE 503
    WASHINGTON,DC20015     		NONE PC REDUCING FRAGMENTATION AND IMPROVING CONTINUITY OF CARE ACROSS THE BREAST CANCER CONTINUUM 37,888
    PATHWAY HOMES
    10201 FAIRFAX BLVD
    FAIRFAX,VA22030     		NONE PC PERMANENT SUPORTIVE HOUSING FOR FORMERLY HOMELESS W/SERIOUS MENTAL ILLNESS 24,000
    PATHWAY HOMES
    10201 FAIRFAX BLVD
    FAIRFAX,VA22030     		NONE PC PERMANENT SUPPORTIVE HOUSING FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS 75,000
    PATHWAY HOMES
    10201 FAIRFAX BLVD
    FAIRFAX,VA22030     		NONE PC MAP 10,000
    POTOMAC AND RAPPAHANNOCK TRANSPORTATION COMMISSION
    14700 POTOMAC MILLS ROAD
    WOODBRIDGE,VA22192     		NONE PC MWCOG MATCHING GRANT 125,000
    PRINCE WILLIAM AREA FREE CLINIC
    13900 CHURCH HILL DRIVE
    WOODBRIDGE,VA22191     		NONE PC 15 HSN UNIFIED HLTH CENTER 18,160
    PRINCE WILLIAM AREA FREE CLINIC
    13900 CHURCH HILL DRIVE
    WOODBRIDGE,VA22191     		NONE PC PRINCE WILLIAM AREA FREE CLINIC NAVIGATION 18,903
    PRINCE WILLIAM AREA FREE CLINIC
    13900 CHURCH HILL DRIVE
    WOODBRIDGE,VA22191     		NONE PC PRINCE WILLIAM AREA FREE CLINIC UNIFIED HEALTH CENTER 171,026
    PRINCE WILLIAM AREA FREE CLINIC
    13900 CHURCH HILL DRIVE
    WOODBRIDGE,VA22191     		NONE PC PWAFC NAVIGATION 29,137
    PRINCE WILLIAM AREA FREE CLINIC
    13900 CHURCH HILL DRIVE
    WOODBRIDGE,VA22191     		NONE PC PRINCE WILLIAM AREA FREE CLINIC UNIFIED HEALTH CENTER 114,017
    PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
    14715 BRISTOW ROAD
    MANASSAS,VA20112     		NONE PC BIOMEDICAL SCIENCE/PROJECT LEAD THE WAY 23,040
    PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
    14715 BRISTOW ROAD
    MANASSAS,VA20112     		NONE PC HUMAN TRAFFICKING PREVENTION, IDENTIFICATION, AND REFERRAL 29,888
    PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
    14715 BRISTOW ROAD
    MANASSAS,VA20112     		NONE PC COORDINATED MENTAL HEALTH SUPPORT FOR AT-RISK YOUTH 34,494
    PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
    14715 BRISTOW ROAD
    MANASSAS,VA20112     		NONE PC COORDINATED MENTAL HEALTH SUPPORT FOR AT-RISK YOUTH 51,742
    PRINCE WILLIAM HEALTH DISTRICT
    9301 LEE AVENUE
    MANASSAS,VA20110     		NONE PC BEAT CANCER BREAST EDUCATION AWARENESS & TREATMENT 24,717
    PRINCE WILLIAM SOCCER INC
    14716 MINNIEVILLE RD
    WOODBRIDGE,VA22193     		NONE PC 2016 MAP 6,750
    PRINCE WILLIAM SOCCER INC
    14716 MINNIEVILLE RD
    WOODBRIDGE,VA22193     		NONE PC THE COURAGE F.U.N. PROJECT 41,313
    PRINCE WILLIAM SOCCER INC
    14716 MINNIEVILLE RD
    WOODBRIDGE,VA22193     		NONE PC THE COURAGE F.U.N. PROJECT 27,542
    PROJECT MEND-A-HOUSE INC
    9500 TECHNOLOGY DRIVE SUITE 101
    MANASSAS,VA20110     		NONE PC PREVENTING HEALTH COMPLICATIONS THROUGH PARTICIPATION IN THE STANFORD CHRONIC DISEASES SELF-MANAGEMENT PROGRAM AND THE DIABETES SELF- MANAGEMENT PROGRAM 24,000
    PROJECT MEND-A-HOUSE INC
    9500 TECHNOLOGY DRIVE SUITE 101
    MANASSAS,VA20110     		NONE PC 15 MAP 2,300
    RAPPAHANNOCK AREA AGENCY ON AGING
    460 LENDALL LANE
    FREDERICKSBURG,VA22405     		NONE PC THE RAAA AQUIA GARRISONVILLE HEALTHCARE PROJECT 9,101
    RX PARTNERSHIP
    2924 EMERYWOOD PARKWAY SUITE 300
    RICHMOND,VA23294     		NONE PC 15 HSN MEDICATION ACCESS FOR THE UNINSURED 2,500
    RX PARTNERSHIP
    2924 EMERYWOOD PARKWAY SUITE 300
    RICHMOND,VA23294     		NONE PC 15 MAP 1,675
    RX PARTNERSHIP
    2924 EMERYWOOD PARKWAY SUITE 300
    RICHMOND,VA23294     		NONE PC MEDICATION ACCESS FOR THE UNINSURED 22,500
    RX PARTNERSHIP
    2924 EMERYWOOD PARKWAY SUITE 300
    RICHMOND,VA23294     		NONE PC MEDICATION ACCESS FOR THE UNINSURED 15,000
    SCAN OF NORTHERN VIRGINIA
    205 S WHITING STREET SUITE 205
    ALEXANDRIA,VA22304     		NONE PC MAP 6,000
    SCAN OF NORTHERN VIRGINIA
    205 S WHITING STREET SUITE 205
    ALEXANDRIA,VA22304     		NONE PC SAFE BABIES AND CHILD ABUSE PREVENTION 10,000
    SCAN OF NORTHERN VIRGINIA
    205 S WHITING STREET SUITE 205
    ALEXANDRIA,VA22304     		NONE PC SAFE BABIES AND CHILD ABUSE PREVENTION 15,000
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC CYCLE 14A FAMILY HEALTH CONNECTION MOBILE VANS 15,000
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC YR3 HISPANIC DIABETES OUTREACH PROGRAM 6,065
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC YR3 SENTARA POTOMAC WOMEN'S HEALTH MAMMOVAN 36,046
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC DIABETES PREVENTION PROGRAM 18,567
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC IN PERSON INTERPRETING SERVICES 60,390
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC FAMILY HEALTH CONNECTION MOBILE CLINIC 135,000
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC SNVMC DIABETES PREVENTION PROGRAM 37,605
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC FAMILY HEALTH CONNECTION MOBILE CLINIC 90,000
    STAFFORD SCHOOLS HEAD STARTVPI EARLY HEAD START
    610 GAYLE STREET
    FALMOUTH,VA22405     		NONE PC STAFFORD CHILDREN'S INSURANCE OUTREACH PROGRAM 11,594
    STAFFORD SCHOOLS HEAD STARTVPIEARLY HEAD START
    610 GAYLE STREET
    FALMOUTH,VA22405     		NONE PC STAFFORD CHILDREN'S INSURANCE OUTREACH PROGRAM 7,729
    STREET LIGHT COMMUNITY OUTREACH MINISTRIES
    1550 PRINCE WILLIAM PKWY SUITE B
    WOODBRIDGE,VA22191     		NONE PC PERMANENT SUPPORTED HOUSING & RESPITE CARE FOR MEDICALLY FRAGILE HOMELESS ADULTS 14,997
    STREET LIGHT COMMUNITY OUTREACH MINISTRIES
    1550 PRINCE WILLIAM PKWY SUITE B
    WOODBRIDGE,VA22191     		NONE PC 15 MAP 2,500
    STREET LIGHT COMMUNITY OUTREACH MINISTRIES
    1550 PRINCE WILLIAM PKWY SUITE B
    WOODBRIDGE,VA22191     		NONE PC 2016 MAP 1,950
    THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
    13505 HILLENDALE DRIVE
    DALE CITY,VA22193     		NONE PC MEDICAL CASE MANAGEMENT 40,800
    THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
    13505 HILLENDALE DRIVE
    DALE CITY,VA22193     		NONE PC MEDICAL CASE MANAGEMENT 25,826
    THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
    13505 HILLENDALE DRIVE
    DALE CITY,VA22193     		NONE PC VOSAC III DAY SUPPORT FOR THE MEDICALLY FRAGILE 75,000
    THE CITY OF MANASSAS PARK
    1 PARK CENTER COURT
    MANASSAS,VA20111     		NONE PC MASON AND PARTNERS BRIDGE CLINIC 75,000
    THE DOORWAYS
    612 E MARSHALL ST
    RICHMOND,VA23219     		NONE PC PATIENT AND FAMILY ACCESS PROGRAM 22,800
    THE HOUSE INC STUDENT LEADERSHIP CENTER
    14001 CROWN COURT
    WOODBRIDGE,VA22193     		NONE PC PROJECT PLAY 124,200
    THE HOUSE INC STUDENT LEADERSHIP CENTER
    14001 CROWN COURT
    WOODBRIDGE,VA22193     		NONE PC PROJECT PLAY 88,000
    VIRGINIA FOUNDATION FOR COMMUNITY COLLEGE
    101 N14TH ST
    RICHMOND,VA23219     		NONE PC CYCLE 14A FELLOWS PROGRAM 37,500
    VIRGINIA FOUNDATION FOR COMMUNITY COLLEGE
    101 N14TH ST
    RICHMOND,VA23219     		NONE PC POTOMAC HEALTH FOUNDATION FELLOWS PROGRAM 75,000
    VIRGINIA ORAL HEALTH COALITION
    4200 INNSLAKE DR SUITE 103
    GLEN ALLEN,VA23060     		NONE PC REGIONAL ORAL HEALTH WORKGROUP - NORTHERN VIRGINIA 19,946
    YOUNG INVINCIBLES
    1411 K ST NW
    WASHINGTON,DC20005     		NONE PC HEALTHY YOUNG AMERICA 30,000
    YOUNG INVINCIBLES
    1411 K ST NW
    WASHINGTON,DC20005     		NONE PC HEALTHY YOUNG AMERICA - NORTHERN VIRGINIA CAMPAIGN 60,000
    Total .................................bullet 3a 4,845,853
    bApproved for future payment
    AMERICAN HEART ASSOCIATION
    4301 FAIRFAX DRIVE SUITE 530
    ARLINGTON,VA22203     		NONE PC CPR ANYTIME 43,750
    BRAIN INJURY SERVICES
    8136 OLD KEENE MILL ROAD
    SPRINGFIELD,VA22152     		NONE PC CREST: COLLABORATIVE REHABILITATION TO ENHANCE STROKE TREATMENT 67,447
    CHANGE IN ACTION INC
    128884 HARBOR DRIVE SUITE 203
    WOODBRIDGE,VA22192     		NONE PC MAP 8,010
    CHANGE IN ACTION INC
    128884 HARBOR DRIVE SUITE 203
    WOODBRIDGE,VA22192     		NONE PC BEHAVIORAL MANAGEMENT FOR TRAUMATIC EXPOSURE 67,304
    CONSUMER HEALTH FOUNDATION
    1400 16TH ST NW SUITE 710
    WASHINGTON,DC20036     		NONE PC REGIONAL PRIMARY CARE COALITION 10,000
    EMPOWERHOUSE
    PO BOX 1007
    FREDRICKSBURG,VA22402     		NONE PC INTERPERSONAL VIOLENCE HEALTHCARE PARTNERSHIP PROGRAM 30,402
    EMPOWERHOUSE
    PO BOX 1007
    FREDRICKSBURG,VA22402     		NONE PC MAP 8,792
    GANG RESPONSE INTERVENTION TEAM (GRIT)
    4379 RIDGEWOOD CENTER DRIVE SUITE
    102
    WOODBRIDGE,VA22192     		NONE PC MAC TATTOO REMOVAL PROGRAM 1,615
    GEORGE MASON UNIVERSITY
    10900 UNIVERSITY BLVD MS 4E5
    MANASSAS,VA20110     		NONE PC MIDDLE SCHOOL ACHIEVES 24,013
    GEORGE MASON UNIVERSITY
    10900 UNIVERSITY BLVD MS 4E5
    MANASSAS,VA20110     		NONE PC MIDDLE SCHOOL ACHIEVES (ADVANCING HEALTHCARE INITIATIVES FOR UNDERSERVED STUDENTS) 102,800
    GEORGE MASON UNIVERSITY
    10900 UNIVERSITY BLVD MS 4E5
    MANASSAS,VA20110     		NONE PC POISED (PRECISION OUTREACH INTERVENTION, SCREENING, SURVEILLANCE AND EXERCISE FOR FALLS PREVENTION IN DIABETES) PRINCE WILLIAM 84,336
    GEORGE WASHINGTON REGIONAL COMMISSIONTHE FARMER'S MARKET
    406 PRINCESS ANNE ST
    FREDRICKSBURG,VA22402     		NONE PC FRESH FOOD ACCESS FOR COMMUNITY HEALTH 15,080
    GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
    4379 RIDGEWOOD CENTER DRIVE SUITE
    102
    WOODBRIDGE,VA22192     		NONE PC INCREASED ACCESS TO INTEGRATED CARE AT OUR MEDICAL HOME IN DUMFRIES 60,000
    LLOYD F MOSS FREE CLINIC
    1301 SAM PERRY BLVD
    FREDERICKSBURG,VA22401     		NONE PC GENERAL OPERATING FUNDS 15,210
    LLOYD F MOSS FREE CLINIC
    1301 SAM PERRY BLVD
    FREDERICKSBURG,VA22401     		NONE PC GENERAL OPERATING FUNDS 60,840
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC POISON CONTROL SERVICES TO FOUNDATION'S SERVICE AREA 12,341
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC WEBPOISONCONTROL: ENHANCEMENT OF AN ON-LINE PROTOTYPE TRIAGE APPLICATION TO INCREASE ACCESS TO POISON CONTROL SERVICES AND MINIMIZE INJURY FROM POISONINGS. 100,000
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC POISON CONTROL SERVICES TO FOUNDATION'S SERVICE AREA 43,702
    NATIONAL CAPITAL POISON CENTER
    3201 NEW MEXICO AVENUE SUITE 310
    WASHINGTON,DC20016     		NONE PC 15 HSN POISON CTRL SVCS TO THE FDN'S SVC AREA 29,400
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC IMPROVING NUTRITION FOR LOW-INCOME FAMILIES 76,898
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC HEALTHLINK 27,931
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC KIDS CONNECT 3,500
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		NONE PC KIDS CONNECT 14,000
    NOVA SCRIPTSCENTRAL INC
    6400 ARLINGTON BLVD SUITE 120
    FALLS CHURCH,VA22042     		NONE PC IMPROVING HEALTH ACCESS IN PRINCE WILLIAM, STAFFORD AND LORTON; PRESCRIPTION MEDICATIONS FOR THE LOW-INCOME AND UNINSURED 22,141
    NOVA SCRIPTSCENTRAL INC
    6400 ARLINGTON BLVD SUITE 120
    FALLS CHURCH,VA22042     		NONE PC IMPROVING HEALTH ACCESS IN PRINCE WILLIAM, STAFFORD AND LORTON; PRESCRIPTION MEDICATIONS FOR THE LOW-INCOME AND UNINSURED 88,564
    NUEVA VIDA INC
    5225 WISCONSIN AVE NW SUITE 503
    WASHINGTON,DC20015     		NONE PC INCREASING CANCER PREVENTION AND IMPROVING CONTINUITY OF CARE TO UNDERSERVED LATINAS IN PWC 50,000
    PATHWAY HOMES
    10201 FAIRFAX BLVD
    FAIRFAX,VA22030     		NONE PC PERMANENT SUPPORTIVE HOUSING FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS 50,000
    PATHWAY HOMES
    10201 FAIRFAX BLVD
    FAIRFAX,VA22030     		NONE PC MAP 5,000
    PRINCE WILLIAM AREA FREE CLINIC
    13900 CHURCH HILL DRIVE
    WOODBRIDGE,VA22191     		NONE PC PRINCE WILLIAM AREA FREE CLINIC UNIFIED HEALTH CENTER 19,003
    PRINCE WILLIAM AREA FREE CLINIC
    13900 CHURCH HILL DRIVE
    WOODBRIDGE,VA22191     		NONE PC PWAFC NAVIGATION 19,425
    PRINCE WILLIAM AREA FREE CLINIC
    13900 CHURCH HILL DRIVE
    WOODBRIDGE,VA22191     		NONE PC PRINCE WILLIAM AREA FREE CLINIC UNIFIED HEALTH CENTER 76,012
    PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
    14715 BRISTOW ROAD
    MANASSAS,VA20112     		NONE PC COORDINATED MENTAL HEALTH SUPPORT FOR AT-RISK YOUTH 34,494
    PRINCE WILLIAM SOCCER INC
    14716 MINNIEVILLE RD
    WOODBRIDGE,VA22193     		NONE PC THE COURAGE F.U.N. PROJECT 27,542
    PROJECT MEND-A-HOUSE INC
    9500 TECHNOLOGY DRIVE SUITE 101
    MANASSAS,VA20110     		NONE PC PREVENTING HEALTH COMPLICATIONS THROUGH PARTICIPATION IN THE STANFORD CHRONIC DISEASES SELF-MANAGEMENT PROGRAM AND THE DIABETES SELF- MANAGEMENT PROGRAM 16,000
    RX PARTNERSHIP
    2924 EMERYWOOD PARKWAY SUITE 300
    RICHMOND,VA23294     		NONE PC MEDICATION ACCESS FOR THE UNINSURED 2,500
    RX PARTNERSHIP
    2924 EMERYWOOD PARKWAY SUITE 300
    RICHMOND,VA23294     		NONE PC MEDICATION ACCESS FOR THE UNINSURED 10,000
    SCAN OF NORTHERN VIRGINIA
    205 S WHITING STREET SUITE 205
    ALEXANDRIA,VA22304     		NONE PC MAP 4,000
    SCAN OF NORTHERN VIRGINIA
    205 S WHITING STREET SUITE 205
    ALEXANDRIA,VA22304     		NONE PC SAFE BABIES AND CHILD ABUSE PREVENTION 10,000
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC IN PERSON INTERPRETING SERVICES 20,130
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC FAMILY HEALTH CONNECTION MOBILE CLINIC 15,000
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC SNVMC DIABETES PREVENTION PROGRAM 25,070
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC FAMILY HEALTH CONNECTION MOBILE CLINIC 60,000
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BLVD
    WOODBRIDGE,VA22191     		NONE PC IN PERSON INTERPRETING SERVICES (1/1/2017 - 6/30/2017) 97,600
    STAFFORD SCHOOLS HEAD STARTVPI EARLY HEAD START
    610 GAYLE STREET
    FALMOUTH,VA22405     		NONE PC STAFFORD CHILDREN'S INSURANCE OUTREACH PROGRAM 7,728
    THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
    13505 HILLENDALE DRIVE
    DALE CITY,VA22193     		NONE PC MEDICAL CASE MANAGEMENT 27,200
    THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
    13505 HILLENDALE DRIVE
    DALE CITY,VA22193     		NONE PC COMPLETION OF THERAPEUTIC SERVICES 44,240
    THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
    13505 HILLENDALE DRIVE
    DALE CITY,VA22193     		NONE PC VOSAC III DAY SUPPORT FOR THE MEDICALLY FRAGILE 25,000
    THE CITY OF MANASSAS PARK
    1 PARK CENTER COURT
    MANASSAS,VA20111     		NONE PC MASON AND PARTNERS BRIDGE CLINIC 25,000
    THE DOORWAYS
    612 E MARSHALL ST
    RICHMOND,VA23219     		NONE PC PATIENT AND FAMILY ACCESS PROGRAM 15,200
    THE HOUSE INC STUDENT LEADERSHIP CENTER
    14001 CROWN COURT
    WOODBRIDGE,VA22193     		NONE PC PROJECT PLAY 82,800
    VIRGINIA FOUNDATION FOR COMMUNITY COLLEGE
    101 N14TH ST
    RICHMOND,VA23219     		NONE PC POTOMAC HEALTH FOUNDATION FELLOWS PROGRAM 50,000
    YOUNG INVINCIBLES
    1411 K ST NW
    WASHINGTON,DC20005     		NONE PC HEALTHY YOUNG AMERICA - NORTHERN VIRGINIA CAMPAIGN 40,000
    Total .................................bullet 3b 1,877,020
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3
    Interest on savings and temporary cash investments ...........     		    14 349  
    4 Dividends and interest from securities....     14 5,209,013  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6
    Net rental income or (loss) from personal property     		         
    7 Other investment income.....          
    8
    Gain or (loss) from sales of assets other than inventory ............     		    18 -1,046,213  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 0 4,163,149 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    134,163,149
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    11 AMOUNTS PAID FOR GRANTS IN PRIOR YEAR AND RETURNED IN THE CURRENT YEAR
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2015)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
    OMB No. 1545-0047
    2015
    Name of the organization
    POTOMAC HEALTH FOUNDATION
     
    Employer identification number

    52-1340920
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
    Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
    Name of organization
    POTOMAC HEALTH FOUNDATION
          		Employer identification number
    52-1340920
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
     
     

    SENTARA HEALTHCARE  
    6015 POPLAR HALL DR STE 300
     
    NORFOLK, VA23502

    		$ 5,406,722


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 3
    Name of organization
    POTOMAC HEALTH FOUNDATION
          		Employer identification number

    52-1340920
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 4
    Name of organization
    POTOMAC HEALTH FOUNDATION
          		Employer identification number

    52-1340920
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2015 AccountingFeesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING 49,561 0   52,194

    TY 2015 InvestmentsOtherSchedule2
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    SEI CORE FIXED INCOME FUND 1,279,256.134 SHARES FMV 12,293,365 12,293,365
    SEI SPECIAL SITUATIONS FUND LTD 2,903.787 SHARES FMV 3,776,634 3,776,634
    SEI SMALL CAP FUND (SLPAX) 164,674.78 SHARES FMV 4,063,186 4,063,186
    SEI INSTITUTIONAL INVESTMENT TRUST 307,131.879 SHARES FMV 2,853,362 2,853,362
    SIIT EMERGING MARKETS DEBT FUND SEDAX 484,173.825 SHARES FMV 5,067,301 5,067,301
    SIIT ULTRA SHORT DURATION BOND FUND 254,758.322 SHARES FMV 4,577,510 4,577,510
    SEI CORE PROPERTY FUND 7,875.893 SHARES FMV 15,332,382 15,332,382
    SEI US MANAGED VOL FUND 280,043.855 SHARES FMV 4,061,664 4,061,664
    SIIT MULTI ASSET REAL RETURN FUND 775,881.785 SHARES FMV 3,706,766 3,706,766
    GLOBAL MANAGED VOL FUND (SVTAX) 644,560.532 SHARES FMV 7,597,826 7,597,826
    SEI LARGE CAP FUND (SLCAX) 715,312.62 SHARES FMV 17,852,536 17,852,536
    SEI SIIT OPPORTUNISTIC INCOME FD-A 624,165.876 SHARES FMV 5,273,896 5,273,896
    SEI WORLD EQUITY EX-US FUND (WEUSX) 796,509.739 SHARES FMV 9,325,300 9,325,300
    EMERGING MARKETS EQUITY FUND (SIEMX) 271,852.311 SHARES FMV 2,770,315 2,770,315
    SEI DYNAMIC ASSET ALLOC FUND 300,530.3480 SHARES FMV 5,060,707 5,060,707

    TY 2015 LandEtcSchedule2
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    FURNITURE & EQUIPMENT 36,148 33,467 2,681 2,681


    TY 2015 LegalFeesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL 1,289 0   1,289


    TY 2015 OtherDecreasesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Description Amount
    PRIOR PERIOD ADJUSTMENT 115


    TY 2015 OtherExpensesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PROFESSIONAL DEVELOPMENT 27,022 0   50,430
    TECH EXPENSE 16,332 0   16,757
    OTHER EXPENSE 7,246 0   -18,900
    INSURANCE 2,179 0   2,179
    SEI CORE PROPERTY FUND, LP OTHER DEDUCTIONS 0 42,654   0


    TY 2015 OtherIncreasesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Description Amount
    UNREALIZED GAIN 525,748


    TY 2015 OtherLiabilitiesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Description Beginning of Year - Book Value End of Year - Book Value
    DUE TO RELATED PARTY 23,496 24,084
    DEFERRED TAX LIABILITY 74,658 88,987


    TY 2015 OtherProfessionalFeesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT MANAGEMENT FEES 477,756 477,756   18,970
    CONSULTANT FEES 53,089 0   53,089


    TY 2015 TaxesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXCISE TAX 39,264 0   0