Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 145,121 | 62,698 | 54,217 | 219,023 | 37,479 | 518,538 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | 0 | 0 | 0 | 0 | 0 | |
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | 0 | 0 | 0 | |
| 4 | Total. Add lines 1 through 3 | 145,121 | 62,698 | 54,217 | 219,023 | 37,479 | 518,538 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | 228,285 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 290,253 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 145,121 | 62,698 | 54,217 | 219,023 | 37,479 | 518,538 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 5,676 | 14,394 | 10,314 | 171 | 617 | 31,172 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | 549,710 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 4A | INTERN PROGRAM - THE FOUNDATION SUPPORTED TWELVE (12) INTERNS IN FY2018 - THE LARGEST CLASS YET - FOR ITS TWO-MONTH 2018 SUMMER INTERNSHIP PROGRAM. THE INTERNS WORKED IN DIFFERENT ORGANIZATIONS THROUGHOUT FAUQUIER, CULPEPER, AND RAPPAHANNOCK COUNTIES TO MAKE A DIFFERENCE IN THE COMMUNITY. THE ORGANIZATIONS INCLUDED: THE FAUQUIER FREE CLINIC, CULPEPER COUNTY PARKS AND REC, MENTAL HEALTH ASSOCIATION OF FAUQUIER COUNTY, RAPP AT HOME, THE WARRENTON FARMERS MARKET, RAPPAHANNOCK COUNTY PUBLIC SCHOOLS, AND OTHERS. INTERNS WORKED TOGETHER ON A GROUP PROJECT TO SUPPORT HEALTH AND VITALITY IN THE COMMUNITY. IN FY2018, THE INTERN TEAM CREATED THE BEALTON CAFE, A COFFEEHOUSE THAT PROVIDED REFRESHMENTS, ACTIVITIES AND AN ESCAPE FROM THE SUMMER HEAT. THEY ALSO CREATED MUSIC IN THE GARDEN, A GARDEN CONCERT AND COMMUNITY GATHERING IN THE REMINGTON COMMUNITY GARDEN. THESE EVENTS WORKED TO BRING MEMBERS OF THE COMMUNITY TOGETHER IN INNOVATIVE WAYS. THE FY2018 INVESTMENT WAS $43,338 FOR THIS PROGRAM. FACILITY SUPPORT - IN ORDER TO FOSTER A COLLABORATIVE SPACE, THE FOUNDATION, PROVIDES OFFICE SPACE TO HABITAT FOR HUMANITY, DSS, BOYS & GIRLS CLUB AND THE PIEDMONT DISPUTE RESOLUTION CENTER. IN FY2018 $20,752 WAS INVESTED IN THIS PROGRAM. ORGANIZATIONAL CAPACITY - THE FOUNDATION PROVIDED $40,000 IN SPONSORSHIP SUPPORT TO ORGANIZATIONS THAT ALIGN WITH OUR MISSION. THESE ORGANIZATIONS INCLUDE THE WASHINGTON REGIONAL FOOD FUNDERS, MISSION INVESTORS, THE CULPEPER WELLNESS FOUNDATIONS "A BALANCED APPROACH TO PAIN MANAGEMENT & OPIOIDS" EVENT AND THE NORTHERN PIEDMONT BUY FRESH BUY LOCAL GUIDE. ELEVATING PHILANTHROPY IS IMPORTANT TO THE FOUNDATION AND A GRANT IN THE AMOUNT OF $60,000 WAS PROVIDED TO THE NORTHERN PIEDMONT COMMUNITY FOUNDATION TO HELP SUPPORT THIS MISSION. COMMUNITY ENGAGEMENT GRANTS AND PROGRAMS ARE VOLUNTARY CONTRIBUTIONS AND EFFORTS TO FOSTER A SPIRIT OF PHILANTHROPY AND HONOR THE TRADITION OF VOLUNTEERISM IN OUR COMMUNITY. EXAMPLES INCLUDE LECTURES, GIVE LOCAL PIEDMONT CAMPAIGN, STUDENT PHILANTHROPY AND THE HOLIDAY MAGIC COMMUNITY INITIATIVE. COMMUNITY ENGAGEMENT GRANTS TOTALING $179,205 WERE MADE IN FY2018. THE COMMUNITY LECTURE SERIES FEATURED A PRESENTATION FROM CHRIS HERREN, A FORMER NBA PLAYER. BETWEEN NOVEMBER 2017 AND MAY 2018, MR. HERREN ADDRESSED MORE THAN 5,000 STUDENTS AT PUBLIC AND PRIVATE SCHOOLS, AS WELL AS A COMMUNITY FORUM FOR PARENTS. MR. HERREN STRUGGLED FOR YEARS WITH DRUG ADDICTION, AND HIS STORY WAS THE SUBJECT OF ESPN'S 30 FOR 30 DOCUMENTARY, "UNGUARDED." HE CONNECTED WITH STUDENTS ABOUT THE IMPORTANCE OF SELF-WORTH AND AVOIDING BEHAVIORS THAT CAN LEAD TO SUBSTANCE ABUSE. THE IMPACT OF HIS MESSAGE, WHICH CENTERS ON SELF-ESTEEM, WAS OVERWHELMING. THE COMMUNITY LECTURE SERIES ALSO FEATURED A PRESENTATION FROM DAN BUETTNER, NATIONAL GEOGRAPHIC FELLOW, AWARD-WINNING JOURNALIST AND PRODUCER, AND NEW YORK TIMES BESTSELLING AUTHOR, IN THE SECOND ANNUAL "PATH TO BETTER" EVENT, WHERE HE SHARED HIS FINDINGS ON HUMAN LONGEVITY WITH RESIDENTS OF FAUQUIER, RAPPAHANNOCK AND CULPEPER COUNTIES. HE DISCOVERED THE FIVE PLACES IN THE WORLD - DUBBED BLUE ZONES - WHERE PEOPLE LIVE THE LONGEST, HEALTHIEST LIVES. COPIES OF HIS BOOKS AND ADMISSION TO THE EVENT WERE FREE, WITH APPROXIMATELY 350 COMMUNITY MEMBERS IN ATTENDANCE. MR. BUETTNER ENCOURAGED ATTENDEES TO FIND INTENTIONAL WAYS TO INCREASE THEIR DAILY ACTIVITY, AS WELL AS IMPROVING THEIR NUTRITION AND DEVELOPING A STRONG SENSE OF COMMUNITY. AN INVESTMENT WAS MADE IN THE NORTHERN PIEDMONT COMMUNITY FOUNDATION'S MAY GIVE LOCAL PIEDMONT CAMPAIGN IN THE AMOUNT OF $100,000, WHICH BENEFITED NONPROFITS RECEIVING DONATIONS DURING THE CAMPAIGN. GIVE LOCAL PIEDMONT IS THE COMMUNITY'S ONE-DAY, ONLINE GIVING EVENT TO INSPIRE COMMUNITY MEMBERS TO GIVE GENEROUSLY TO THE NONPROFIT ORGANIZATIONS THAT ARE MAKING OUR REGION STRONGER, CREATING A THRIVING COMMUNITY FOR ALL. STUDENT PHILANTHROPY AMONGST HIGH SCHOOL SENIORS IN FAUQUIER, RAPPAHANNOCK AND CULPEPER COUNTIES IS ENCOURAGED. IN MAY 2017, THE FOUNDATION AWARDED HIGH SCHOOL SENIORS IN THE FOOTPRINT $25 EACH TO DONATE TO LOCAL NONPROFITS REGISTERED WITH GIVE LOCAL PIEDMONT, THE FUNDRAISING CAMPAIGN ORGANIZED BY THE NORTHERN PIEDMONT COMMUNITY FOUNDATION. IN ALL, 817 SENIORS IN PUBLIC AND PRIVATE SCHOOLS DONATED $32,050 TO 122 ORGANIZATIONS. SEVENTEEN ORGANIZATIONS WERE SUPPORTED WITH THE HOLIDAY MAGIC COMMUNITY INITIATIVE. THE FOUNDATION LAUNCHED A SURPRISE GRANT CYCLE DESIGNED TO GIVE A HELPING HAND WITH NONPROFIT'S HOLIDAY EFFORTS. PROJECTS INCLUDED; A HOLIDAY TOY DRIVE, GIFT CARDS TO FAUQUIER FREE CLINIC PATIENTS, A HOLIDAY PARTY FOR INCARCERATED FAMILY MEMBERS AND SENIOR TOTE BAGS. REGIONAL POPULATION HEALTH GRANTS REGIONAL POPULATION HEALTH GRANTS SUPPORT INITIATIVES DESIGNED TO ENHANCE OR CHANGE SYSTEMS THAT IMPACT THE HEALTH OUTCOMES OF A BROAD POPULATION. PROJECTS MAY ENCOMPASS POLICY DESIGN, EVALUATION, RESEARCH, AND COLLABORATION. INITIATIVES MAY BE MULTI-YEAR, MULTI-MODAL, AND INCLUDE A DIVERSITY OF PARTNERS AND CO-FUNDERS AT A STATE, REGIONAL OR NATIONAL SCALE. IN FY2018 SUPPORT FOR THE CREATION OF A COLLABORATIVE LEARNING CIRCLE OF NATIONAL HEALTH LEGACY FOUNDATIONS IN CONCERT WITH ROBERT WOOD JOHNSON FOUNDATION WAS FUNDED THROUGH ACTIVE LIVING BY DESIGN, AS WELL AS A POPULATION HEALTH GRANT TO INVESTIGATE MEDICAID EXPANSION IN THE STATE OF VIRGINIA. |
| FORM 990, PART V, LINE 13A | VA |
| FORM 990, PART VI, SECTION A, LINE 6 | FHS SERVICES IS THE PARENT ORGANIZATION AND FHI SERVICES IS A BROTHER/SISTER ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE FHS SERVICES BOARD OF DIRECTORS ELECTS THE MEMBERS OF FAUQUIER HEALTH FOUNDATION (DBA THE PATH FOUNDATION). |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FAUQUIER HEALTH FOUNDATION (D/B/A THE PATH FOUNDATION) REQUIRES THE APPROVAL OF THE FHS SERVICES BOARD, AS SOLE MEMBER, TO ELECT, APPOINT, OR REMOVE DIRECTORS AND IMPLEMENT AMENDMENTS TO THE ARTICLES OF INCORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | 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 PRESIDENT/CEO, CHRISTINE M. 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 ARE 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 AND CFO ARE COMPENSATED BY THE FAUQUIER HEALTH FOUNDATION (DBA THE PATH FOUNDATION). THE ORGANIZATIONS" BOARD ADOPTED A COMPENSATION POLICY FOR ITS CEO AND CFO. AN EXECUTIVE COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS OF THE BOARD OF THE ORGANIZATION" WAS ESTABLISHED TO REVIEW THE COMPENSATION FOR ALL EMPLOYEES SPECIFIED 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 TO 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. |
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| Software Version: |