TY 2024 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) MARY FRANCES SOUTHERLAND...................................................................... INTERIM SECRETARY/TRUSTEE	0.20 ................. 50.60	X	X		0	498,907	47,505
(2) CHRISTOPHER HEATON...................................................................... TRUSTEE (PWHS EMPLOYEE)	0.20 ................. 45.60	X			0	405,701	55,916
(3) STEVEN VON ELTEN BEG 0225...................................................................... TRUSTEE (PWHS EMPLOYEE)	0.20 ................. 45.40	X			0	166,572	9,488
(4) KIRSTEN GREEN MD...................................................................... TRUSTEE	0.20 ................. 45.40	X			0	990,008	115,997
(5) STEVE DANZIGER...................................................................... CHAIR / TRUSTEE	0.20 ................. 1.00	X	X		0	0	0
(6) RICHARD HARRINGTON...................................................................... SEC/ VICE CHAIR/ TRUSTEE	0.20 ................. 0.60	X	X		0	0	0
(7) MATTHEW GUILFOYLE...................................................................... TRUSTEE	0.20 ................. 0.40	X			0	0	0
(8) PAM KINCHELOE...................................................................... TRUSTEE	0.20 ................. 0.40	X			0	0	0
(9) JACQUELINE KRICK...................................................................... TRUSTEE	0.20 ................. 0.40	X			0	0	0
(10) MICHELLE METZGAR...................................................................... TRUSTEE	0.20 ................. 0.40	X			0	0	0
(11) STEPHEN NELSON...................................................................... TREASURER / TRUSTEE	0.20 ................. 0.40	X	X		0	0	0
(12) VIPUL PARIKH MD...................................................................... TRUSTEE	0.20 ................. 0.40	X			0	0	0
(13) LISA ANN PEACOCK...................................................................... TRUSTEE	0.20 ................. 0.40	X			0	0	0
(14) DONNA STATON...................................................................... CMC PRESIDENT / COO (UVACH SYSTEM)	25.00 ................. 25.20		X		376,205	0	59,980
(15) CHARLES CODER...................................................................... CFO (UVACH SYSTEM)	0.20 ................. 50.00		X		0	446,746	57,419
(16) L ERIK SHANNON...................................................................... CEO (UVACH SYSTEM)	0.20 ................. 50.00		X		0	980,212	178,791
(17) NAEL HASAN...................................................................... CHIEF MEDICAL OFFICER	50.00 ................. 0.00			X	296,101	0	6,558

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2024

Open to Public
Inspection

Name of the organization

UVA CULPEPER MEDICAL CENTER

Employer identification number

54-0622371

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2024

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
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) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
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

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2024 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2023 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2024. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2023. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2024. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2023. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2024

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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 on 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.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2024 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2023 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2024 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2023 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2024. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3 % support tests—2023. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2024

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2024

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2024

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
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)
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):
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 0.015 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 0.035	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2024

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2024 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2024	(iii) Distributable Amount for 2024
1 Distributable amount for 2024 from Section C, line 6
2 Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2024:
a From 2019.......
b From 2020.......
c From 2021.......
d From 2022.......
e From 2023.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2024 distributable amount
i Carryover from 2019 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2024 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2024 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2025. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2020.....
b Excess from 2021.....
c Excess from 2022.....
d Excess from 2023.....
e Excess from 2024.....

Schedule A (Form 990) (2024)

Schedule A (Form 990) 2024

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2024

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

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Complete if the organization is described below. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2024

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
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Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
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Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
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Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
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Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
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Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
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Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

UVA CULPEPER MEDICAL CENTER

Employer identification number

54-0622371

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... right arrow

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ right arrow

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... right arrow

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2024

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check right arrow

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check right arrow

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2021	(b) 2022	(c) 2023	(d) 2024	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2024

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

11,603

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

11,603

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	LINE 1G: PORTION OF ONE INDIVIDUAL'S SALARY IS ALLOCATED TO LOBBYING ACTIVITIES TO SUPPORT FUNDING AND OTHER ISSUES RELATED TO THE HEALTH NEEDS OF THE COMMUNITY.

Schedule C (Form 990) 2024

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
right arrow

Attach to Form 990.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public Inspection

Name of the organization

UVA CULPEPER MEDICAL CENTER

Employer identification number

54-0622371

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after July 25, 2006, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year right arrow

Number of states where property subject to conservation easement is located right arrow

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) (Rev. 1-2025)

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment right arrow

Permanent endowment right arrow

Term endowment right arrow

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	9,440,473		9,440,473
b	Buildings ....	23,273,691	3,394,923	19,878,768
c	Leasehold improvements
d	Equipment ....	29,393,669	12,110,919	17,282,750
e	Other .....	1,277,624	405,222	872,402
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				47,474,393

Schedule D (Form 990) (Rev. 1-2025)

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)DUE FROM AFFILIATES				93,049,939
(2)THIRD PARTY PAYMENT RECEIVABLE				12,274,815
(3)RIGHT OF USE ASSET				1,968,434
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				107,293,188

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
LEASE LIABILITY	1,948,242
OTHER LIABILITY	630,000







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	2,578,242
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) (Rev. 1-2025)

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ...........	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ...........	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2024

Open to Public Inspection

Name of the organization

UVA CULPEPER MEDICAL CENTER

Employer identification number

54-0622371

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	8,839,987	6,532,333	2,307,655	1.390 %
b	Medicaid (from Worksheet 3, column a) . . . . .	28,154,927	27,310,279	844,648	0.510 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	36,994,914	33,842,612	3,152,303	1.900 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	84,576	0	84,576	0.050 %
f	Health professions education (from Worksheet 5) . . .	142,141	600	141,541	0.090 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	67,500	0	67,500	0.040 %
j	Total. Other Benefits . .	294,217	600	293,617	0.180 %
k	Total. Add lines 7d and 7j .	37,289,131	33,843,212	3,445,920	2.080 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2024

Schedule H (Form 990) 2024

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support			620	0	620	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development			354	0	354	0 %
9	Other
10	Total			974		974	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

14,893,996

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

40,788,068

Enter Medicare allowable costs of care relating to payments on line 5.....

46,823,322

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-6,035,254

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2024

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	UVACMC DBA UVA CULPEPER MEDICAL CENTER 501 SUNSET LANE CULPEPER,VA22701 SEE SUPPLEMENTAL INFORMATION H1848	X	X	X

Schedule H (Form 990) 2024

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	UVA CULPEPER MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 25

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url):

Other website (list url): SEE SECTION C

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 25

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2024

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	UVA CULPEPER MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SECTION C

The FAP application form was widely available on a website (list url):

SEE SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2024

Page 6

Part VFacility Information (continued)

Billing and Collections

	UVA CULPEPER MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2024

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	UVA CULPEPER MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2024

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION A, LINE 1:	HTTPS://UVAHEALTH.COM/LOCATIONS/UVA-HEALTH-CULPEPER-MEDICAL-CENTER-5597271
PART V, SECTION B, LINE 5:	WHILE CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL FACILITY SOLICITED AND INCORPORATED INPUT FROM A BROAD RANGE OF COMMUNITY STAKEHOLDERS REPRESENTING HEALTHCARE, PUBLIC HEALTH, SOCIAL SERVICES, GOVERNMENT, EDUCATION, AND COMMUNITY-BASED ORGANIZATIONS. THE ORGANIZATION PARTNERED WITH AN OUTSIDE CONSULTANT TO CONDUCT THE STUDY INCLUDING THE COLLECTION OF COMMUNITY DATA AND THE COORDINATION OF INTERVIEWS/MEETINGS AND SURVEYS. MEETINGS WERE HELD IN OCTOBER 2024 WITH VIRGINIA DEPARTMENT OF HEALTH - RAPPAHANNOCK RAPIDAN HEALTH DISTRICT, ENCOMPASS COMMUNITY SUPPORT, CULPEPER WELLNESS FOUNDATION, AND PATH FOUNDATION. ADDITIONAL COMMUNITY PARTNERS PROVIDED INPUT THROUGH SURVEYS COLLECTED FROM SEPTEMBER TO DECEMBER 2024. COMMUNITY PARTNERS SERVING AT-RISK POPULATIONS THAT ARE CULTURALLY/MEDICALLY VULNERABLE WERE SOLICITED, INCLUDING BRAIN INJURY SERVICES, CASA BRUMAR FOUNDATION, CULPEPER FOOD CLOSET, CULPEPER HUMAN SERVICES, FAUQUIER FREE CLINIC, LITERACY COUNCIL OF MADISON COUNTY, LOWLINC, MADISON DSS, MENTAL HEALTH ASSOCIATION OF FAUQUIER COUNTY, MINORITY & VETERAN FARMERS OF PIEDMONT, MOM2MOM, PEOPLE INC. OF VIRGINIA, RAPP AT HOME, RAPPAHANNOCK RAPIDAN REGIONAL COMMISSION, AND VIRGINIA REGIONAL TRANSIT. ADDITIONAL INSIGHT WAS PROVIDED THROUGH COLLABORATION WITH AREA SCHOOL SYSTEMS AND EDUCATION FOCUSED PARTNERS; MEETINGS WITH CULPEPER COUNTY SCHOOLS AND GIRLS ON THE RUN FOCUSED ON THE UNMET BEHAVIORAL HEALTH NEEDS OF OUR YOUTH. TO FURTHER REACH DIVERSE AND UNDERSERVED POPULATIONS, SURVEYS WERE DISTRIBUTED THROUGH THE LOCAL FREE CLINICS AND IN-PERSON SURVEYS WERE CONDUCTED IN OCTOBER 2024 USING BI-LINGUAL MOBILE DEVICES (ENGLISH AND SPANISH) AT COMMUNITY EVENTS SUCH AS HEALTHY CULPEPER KIDS DAY IN THE PARK, AGING TOGETHER'S ART OF AGING EXPO, AND CULPEPER AIRFEST. COLLECTIVELY, THESE EFFORTS ENSURED MEANINGFUL REPRESENTATION OF PERSPECTIVES RELATED TO PUBLIC HEALTH, MINORITY AND UNDERSERVED POPULATIONS, HEALTH DISPARITIES, AND SOCIAL DETERMINANTS OF HEALTH. WHERE POSSIBLE, THE ORGANIZATION LEVERAGED INTERNAL AND EXTERNAL RESOURCES TO ADDRESS THE HIGHEST PRIORITY NEEDS THAT WERE CONSISTENTLY IDENTIFIED ACROSS COMMUNITIES AND ALIGNED WITH THE HOSPITAL'S MISSION AND RESOURCES.
PART V, SECTION B, LINE 7B:	HTTPS://WWW.UVAHEALTH.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-STUDY-REPORTS/
PART V, SECTION B, LINE 7D:	COMMUNITY PARTNERS ARE PROACTIVELY NOTIFIED AND MADE AWARE OF THE AVAILABILITY OF THE CHNA, THE CBIP, AND FAP INFORMATION AND COPIES ARE AVAILABLE AT VARIOUS COMMUNITY EVENTS THAT SUPPORT OUR EFFORTS TO ADDRESS THE IDENTIFIED NEEDS AND TO SUPPORT OUR COMMUNITIES IN GENERAL.
PART V, SECTION B, LINE 10A:	HTTPS://WWW.UVAHEALTH.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-STUDY-REPORTS/
PART V, SECTION B, LINE 11:	THE HOSPITAL FACILITY IS ONE OF THREE COMMUNITY HOSPITALS THAT ARE SUBSIDIARIES UNDER UVA COMMUNITY HEALTH, INC. (COLLECTIVELY "COMMUNITY HEALTH"), ALL OF WHICH ARE PART OF UVA HEALTH, AN INTEGRATED HEALTH SYSTEM THAT IS PART OF THE UNIVERSITY OF VIRGINIA. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITIES SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE COMMUNITY ENGAGEMENT TEAM, THE ORGANIZATION'S EXECUTIVE LEADERSHIP TEAM, AND SUBSEQUENTLY THE BOARD. UVA COMMUNITY HEALTH, INC. AND EACH OF ITS HOSPITAL FACILITIES HAVE ADOPTED AND EXECUTED AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE PRIORITIZED COMMUNITY HEALTH NEEDS FROM THE CHNAS. NEEDS WERE EVALUATED BASED ON THE FACILITY'S SCOPE OF SERVICE, EXPERTISE, AVAILABILITY OF RESOURCES, AND THE FACILITY'S ABILITY TO IMPACT OVERALL POPULATION HEALTH. THE IMPLEMENTATION STRATEGY OUTLINES THE ACTIVITIES THAT THE HOSPITAL FACILITY(IES) WILL UNDERTAKE TO MEET THOSE HEALTH NEEDS IN EACH OF ITS COMMUNITIES. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. CERTAIN OF THE NEEDS NOT ADDRESSED FALL OUTSIDE THE SCOPE OF TRADITIONAL HEALTHCARE (I.E. QUALITY OF EDUCATION) AND OTHERS ARE CANDIDATES FOR COLLABORATIVE WORK OR HAVE OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND SKILL SET. FOR MORE DETAILED INFORMATION, REFER TO THE TO THE URL GIVEN PREVIOUSLY FOR THE POSTING OF THE INFORMATION.
PART V, SECTION B, LINE 16A, FAP WEBSITE:	HTTPS://WWW.UVAHEALTH.COM/SUPPORT/BILLING-AND-INSURANCE/OMBUDS-POLICIESPART V, LINE 16B, FAP APPLICATION:HTTPS://WWW.UVAHEALTH.COM/SUPPORT/BILLING-AND-INSURANCE/FINANCIAL-AIDPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY:HTTPS://WWW.UVAHEALTH.COM/SUPPORT/BILLING-AND-INSURANCE/OMBUDS-POLICIES
PART V, SECTION B, LINE 20D:	THE FILING ORGANIZATION IS A COMPONENT PART OF UVA HEALTH. UVA HEALTH, IN PARTICULAR ITS MEDICAL CENTER, A GOVERNMENTAL ENTITY, IS SUBJECT TO GUIDANCE ISSUED BY THE STATE OF VIRGINIA. THE FINANCIAL ASSISTANCE GUIDELINES ARE APPROVED BY THE STATE OF VIRGINIA ANNUALLY. THE ABILITY TO PERFORM AND PROVIDE PRESUMPTIVE ELIGIBILITY HAS BEEN REQUESTED FROM THE STATE, BUT HAS NOT BEEN GRANTED TO DATE.

Schedule H (Form 990) 2024

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address		Type of Facility (describe)
1	1 - UVA OUTPATIENT IMAGING CULPEPER LLC 509 SOUTH MAIN STREET CULPEPER,VA22701	IMAGING CENTER
2	2 - UVA HEALTH OUTPATIENT SURGICAL SERVICES P 541 SUNSET LANE STE 201 CULPEPER,VA22701	AMBULATORY SURGERY CENTER
3	3 - UVA HEALTH THERAPY SERVICES MEADOWBROOK 425 MEADOWBROOK SHOPPING CENTER CULPEPER,VA22701	REHABILITATION SERVICES
4	4 - UVA HEALTH THERAPY SERVICES POWELL 1005 GOLF DRIVE CULPEPER,VA22701	REHABILITATION SERVICES
5	5 - UVA HEALTH SURGICAL CARE PART OF CMC 541 SUNSET LANE SUITE 103 CULPEPER,VA22701	PHYSICIAN OFFICE (PROVIDER BASED)
6	6 - UVA HEALTH ORTHOPEDICS PART OF CMC 541 SUNSET LANE SUITE 305 CULPEPER,VA22701	PHYSICIAN OFFICE (PROVIDER BASED)
7	7 - UVA HEALTH CANCER CARE PART OF CMC 545 SUNSET LANE CULPEPER,VA22701	PHYSICIAN OFFICE (PROVIDER BASED)
8	8 - UVA HEALTH UROLOGY PART OF CMC 663 SUNSET LN CULPEPER,VA22701	PHYSICIAN OFFICE (PROVIDER BASED)
9	9 - UVA HEALTH CARDIOLOGY PART OF CMC 501 SUNSET LANE CULPEPER,VA22701	PHYSICIAN OFFICE (PROVIDER BASED)
10	10 - UVA HEALTH OBGYN PART OF CMC 633 SUNSET LANE CULPEPER,VA22701	PHYSICIAN OFFICE (PROVIDER BASED)

Schedule H (Form 990) 2024

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	OTHER CRITERIA BESIDES INCOME AND FPG USED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE INCLUDE WHETHER THE PATIENT HAS ANY OF THE FOLLOWING ASSETS VALUED IN EXCESS OF $50,000: BANK (CHECKING, SAVING, CDS), DIGITAL PAYMENT ACCOUNTS, INVESTMENT (BONDS, STOCKS, OTHER SECURITIES), HSAS, TRUST FUNDS, AND RETIREMENT ACCOUNTS; LIFE INSURANCE (CASH TO LOAN VALUE); REAL PROPERTY OR PERSONAL PROPERTY SUCH AS HOMES (PRIMARY/SECONDARY), CAMPERS, OR MOBILE HOMES, VEHICLES, RECREATIONAL VEHICLES, BOATS; ALSO CONSIDERED, THE LIQUIDATED VALUE OF LAND (INCLUDING FARMLAND). PART I, LINE 4: THE FILING ORGANIZATION'S FAP DOES NOT ADDRESS MEDICAL INDIGENCY. HOWEVER, THE ORGANIZATION HAS A CATASTROPHIC DISCOUNT POLICY THAT APPLIES TO EMERGENCY CARE AND LIMITS AMOUNTS OWED TO NO MORE THAN 25% OF A FAMILY'S INCOME AND ASSETS.PART I, LINE 6B:A FORMAL COMMUNITY BENEFIT REPORT IS NOT PREPARED BY THE ORGANIZATION. HOWEVER, INFORMATION ABOUT THE ORGANIZATION'S COMMUNITY ACTIVITIES INCLUDING THE COMMUNITY HEALTH NEEDS ASSESSMENT, IMPLEMENTATION PLANS, COMMUNITY PARTNERSHIPS, AND OUTREACH PROGRAMS IS AVAILABLE ON THE WEBSITE AT HTTPS://WWW.UVAHEALTH.COM/ABOUT/COMMUNITY
PART I, LINE 7:	COSTS REPORTED IN THE TABLE FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (CCR).PART I, LINE 7, COLUMN (F): THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $14,893,996.
PART II, COMMUNITY BUILDING ACTIVITIES:	THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESS THE UNDERLYING CAUSES OF HEALTH PROBLEMS AND IMPACT THE HEALTH OF OUR COMMUNITY THROUGH PARTNERSHIPS WITH LOCAL AGENCIES DEDICATED TO IMPROVING THE LIVES OF ALL INDIVIDUALS. OUTREACH INCLUDES PROVIDING SUPPORT TO ORGANIZATIONS SUCH AS CHAMBERS OF COMMERCE AND OTHER LOCAL COMMUNITY ORGANIZATIONS, AND PROVIDING EDUCATION SCHOLARSHIPS AND TRAINING FOR COMMUNITY WORKFORCES.
PART III, LINE 2:	BAD DEBT IS DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS, AND ECONOMIC CONDITIONS, THE AGE OF THE ACCOUNTS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS.
PART III, LINE 3:	THE ESTIMATED AMOUNT IS ZERO DOLLARS BASED ON FAP ELIGIBILITY.
PART III, LINE 4:	THE ORGANIZATION FILES ITS FINANCIAL STATEMENTS ON A GASB METHOD OF ACCOUNTING WHICH DO NOT SPECIFICALLY ADDRESS BAD DEBT. FOR FURTHER INFORMATION, SEE RESPONSE TO LINE 2.
PART III, LINE 8:	THE METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS DETERMINED BY FOLLOWING THE MEDICARE PRINCIPLES OF ALLOWABLE COSTS. COST FOR THE OVERHEAD DEPARTMENTS ARE STEPPED DOWN TO THE REMAINING COST CENTERS BASED ON STATISTICS FOR EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A COST TO CHARGE RATIO ("CCR") IS DEVELOPED FOR EACH COST CENTER. THE CCR IS THEN APPLIED TO THE MEDICARE REVENUE BY COST CENTER AND TOTALED. IT SHOULD BE NOTED THAT THE MEDICARE COST REPORTS DO NOT ADDRESS ANY MANAGED CARE MEDICARE REVENUES, COSTS, OR RELATED SHORTFALL. THE TOTAL REVENUES REPORTED AS RECEIVED FROM MEDICARE IN LINE 5 OF SECTION B ARE ONLY REPRESENTATIVE OF MEDICARE FEE FOR SERVICE PAYMENTS RECEIVED. THE ALLOWABLE COSTS ON LINE 6 ARE SIGNIFICANTLY LOWER THAN THE ACTUAL EXPENDITURES. AS SUCH, THE SHORTFALL IS UNDERESTIMATED. EVERY HOSPITAL TREATS MEDICARE PATIENTS. SOME HOSPITALS ARE LOCATED IN HIGH MEDICARE POPULATION AREAS; OTHERS PROVIDE SERVICES DISPROPORTIONATELY USED BY MEDICARE PATIENTS. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THIS SERVICE THESE PATIENTS WOULD BECOME AN OBLIGATION ON THE GOVERNMENT. ANY UNREIMBURSED COSTS OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT.
PART III, LINE 9B:	THE FILING ORGANIZATION HAS A POLICY THAT OUTLINES PROCEDURES THE HOSPITAL MAY TAKE FOR NONPAYMENT INCLUDING INTERNAL AND EXTERNAL COLLECTION PRACTICES AND REPORTING TO CREDIT AGENCIES. THE POLICY STATES THAT REASONABLE EFFORTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE MUST BE MADE BEFORE THE ORGANIZATION, OR ANY EXTERNAL ORGANIZATION, ENGAGE IN AN EXTRAORDINARY COLLECTION ACTION.FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, THE ORGANIZATION MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS.
PART VI, LINE 2:	THE ORGANIZATION IS ONE OF THREE COMMUNITY HOSPITALS THAT ARE SUBSIDIARIES UNDER UVA COMMUNITY HEALTH, INC. (COLLECTIVELY "COMMUNITY HEALTH"), ALL OF WHICH ARE PART OF UVA HEALTH, AN INTEGRATED HEALTH SYSTEM THAT IS PART OF THE UNIVERSITY OF VIRGINIA. COMMUNITY HEALTH HAS A COMMUNITY ENGAGEMENT (CE) TEAM RESPONSIBLE FOR COORDINATING THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) FOR EACH HOSPITAL WITHIN THE SYSTEM.THE CE TEAM WORK TO IDENTIFY ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY THAT CONTRIBUTE TO THE PROCESS. THESE ORGANIZATIONS AND RESOURCES INCLUDE PUBLIC HEALTH DEPARTMENTS, LOCAL COMMUNITY COALITIONS REPRESENTING THE MEDICALLY UNDERSERVED, UNITED WAY, LOCAL UNIVERSITIES, ETC. COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY ARE USED IN COMBINATION WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO PREPARE THE HOSPITAL'S CHNA. THROUGH PARTNERSHIPS WITH OTHER COMMUNITY ORGANIZATIONS WE ARE ABLE TO DRAW INFERENCE OF THE NEEDS NOT MET WITHIN THE IMMEDIATE COMMUNITIES WE SERVE, AND MEET AND EXCEED THOSE COMMUNITY MEMBER'S NEEDS. IN ADDITION TO ADDRESSING NEEDS IDENTIFIED THROUGH THE CHNA, EACH HOSPITAL MAY RESPOND TO REQUESTS FOR SPECIFIC COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS. ORGANIZATIONAL PARTNERSHIPS ESTABLISHED BY THE COMMUNITY ENGAGEMENT TEAM ARE OFTEN LEVERAGED TO ADDRESS NEEDS THAT WERE IDENTIFIED IN THE CHNA, BUT WERE UNADDRESSED BY THE FACILITY IMPLEMENTATION PLAN.
PART VI, LINE 3:	THE HOSPITAL FACILITY HAS SEVERAL WAYS THAT IT INFORMS AND EDUCATES PATIENTS WHO MAY BE IN NEED AND ARE ELIGIBLE FOR ASSISTANCE. - THE HOSPITAL'S WEBSITE PROVIDES SIGNIFICANT INFORMATION INCLUDING, BUT NOT LIMITED TO, THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, APPLICATION, AND CONTACT INFORMATION.- INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN PROMINENT AREAS OF THE HOSPITALS INCLUDING THE EMERGENCY ROOMS, ADMISSIONS, AND FINANCIAL COUNSELING. PRINTED MATERIALS, INCLUDING APPLICATIONS, ARE AVAILABLE IN ALL REGISTRATION AREAS. - AT THE POINT OF SCHEDULING, WE RUN ALL PATIENTS THROUGH A THIRD PARTY SERVICE TO DETERMINE IF AN INDIVIDUAL IS POTENTIAL ELIGIBILITY FOR FINANCIAL ASSISTANCE BASED UPON AN ESTIMATED FPG PROVIDED BY THE VENDOR. ALL PATIENTS ESTIMATED AT 400% OR LESS RECEIVE A FINANCIAL ASSISTANCE APPLICATION IN THE MAIL WHEN AN APPOINTMENT IS SCHEDULED. PATIENTS CAN ALSO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION WITHIN MYCHART, THE ONLINE MEDICAL RECORD SYSTEM. - WHEN STAFF (CASHIER, FINANCIAL COUNSELOR, AND REGISTRARS) ARE SPEAKING WITH A PATIENT THAT STATES THEY ARE NOT ABLE TO PAY, THE PATIENT IS ENCOURAGED TO APPLY FOR FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS WORK WITH PATIENTS TO IDENTIFY AND APPLY FOR BENEFITS SUCH AS MEDICAID AND OTHER GOVERNMENT PROGRAMS. - ALL INPATIENT, OBSERVATION, SURGERY, AND EMERGENCY DEPARTMENT PATIENTS RECEIVE A HANDBOOK AS PART OF THEIR ADMISSION AND INSIDE THE HANDBOOK IS INFORMATION FOR COMPLETING A FINANCIAL ASSISTANCE APPLICATION AND CONTACTING A FINANCIAL COUNSELOR. THEY TAKE THIS INFORMATION WITH THEM UPON DISCHARGE. - BROCHURES DESCRIBING THE FINANCIAL ASSISTANCE POLICY AND PROCESS, INCLUDING THE PLAIN LANGUAGE SUMMARY, ARE PLACED IN OUR BILLING STATEMENTS, AS WELL AS THE APPLICABLE POVERTY GUIDELINES FOR QUALIFYING FOR FINANCIAL ASSISTANCE. THE BILLING STATEMENT INCLUDES AN APPLICATION, WEBSITE LINK, AND A CONTACT PHONE NUMBER IF PATIENTS WOULD LIKE TO APPLY UPON RECEIVING THEIR BILL.
PART VI, LINE 4:	COMMUNITY INFORMATIONTHE ORGANIZATION'S COMMUNITY COVERS NEARLY 1,300 SQUARE MILES AND INCLUDES CULPEPER COUNTY, MADISON COUNTY, ORANGE COUNTY, AND RAPPAHANNOCK COUNTY. IN DEFINING THE COMMUNITY IT SERVES, THE ORGANIZATION IDENTIFIED THE CITIES AND COUNTIES THAT REPRESENT 75% TO 85% OF THE HOSPITAL'S IN-PATIENT POPULATION IN ADDITION TO THE GEOGRAPHIC AREA OF ITS PATIENT POPULATION. THE COMMUNITY COMPRISES FOUR RURAL COUNTIES, COLLECTIVELY KNOWN AS "THE GREATER PIEDMONT REGION" WITH A RANGE OF DIVERSE, DISTINCT POPULATIONS AND DENSITY. THIS COMMUNITY INCLUDES THOSE EXPERIENCING ADVERSE HEALTH OUTCOMES, INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY, THE MEDICALLY UNDERSERVED AND LOW-INCOME HOUSEHOLDS.THE AGGREGATE POPULATION OF THE COMMUNITY IS 115,324 BROKEN DOWN AS FOLLOWS: CULPEPER COUNTY: 55,460, MADISON COUNTY: 14,174, ORANGE COUNTY: 38,249, AND RAPPAHANNOCK COUNTY: 7,441. THE POPULATION RATIO OF MALES TO FEMALES IS CONSISTENT WITH THE COMMONWEALTH OF VIRGINIA WITH ALMOST AN EQUAL PROPORTION OF MEN TO WOMEN. THE POPULATION IN THE GREATER PIEDMONT REGION IS 49.9% FEMALE AND 50.1% MALE RESPECTIVELY.THE MEDIAN AGE OF ADULTS IN VIRGINIA IS 39 YEARS OLD. THE MEDIAN ADULT AGE IN THE AREA IS 43 YEARS WITH RAPPAHANNOCK COUNTY HAVING THE HIGHEST MEDIAN AGE AT 53 YEARS AND CULPEPER HAVING THE YOUNGEST MEDIAN AGE OF 40 YEARS. CHILDREN, DEFINED AS THOSE UNDER 18, MAKE UP 21.5% OF THE POPULATION IN THE AREA AND OLDER ADULTS, DEFINED AS THOSE 65 AND OLDER, MAKE UP 21.5% OF THE POPULATION IN THE AREA. SOME 65 AND OLDER POPULATIONS MAY PLACE HIGHER DEMANDS FOR HEALTH SERVICES AND CARE. THE WORKING AGE POPULATION IS HIGHEST IN CULPEPER COUNTY. AS COMPARED TO THE COMMONWEALTH OF VIRGINIA'S POPULATION DENSITY OF 223.5, THE 4-COUNTY REGION IS WELL BELOW AVERAGE AT A DENSITY OF 88.2. RAPPAHANNOCK COUNTY IS THE LOWEST AT 27.9 AND CULPEPER COUNTY, THE HIGHEST AT 146.3, IS STILL WELL BELOW THE STATE AVERAGE. RESIDENTS IN LOW DENSITY AREAS MAY EXPERIENCE HEALTHIER LIFESTYLES WITH GREATER ACCESS TO OPEN SPACES AND NATURE, STRONGER SOCIAL CONNECTIONS, AND REDUCED ENVIRONMENTAL POLLUTION. THE NEGATIVE IMPACT OF RURAL LIVING MEANS SOME RESIDENTS OFTEN FACE CHALLENGES ACCESSING HEALTHCARE FACILITIES WITH FEWER CLINICS AND SPECIALIZED CARE. ACCORDING TO THE NATIONAL INSTITUTE OF HEALTH, ON AVERAGE, RURAL POPULATIONS HAVE RELATIVELY MORE ELDERLY PEOPLE AND CHILDREN, HIGHER UNEMPLOYMENT AND UNDEREMPLOYMENT RATES, AND LOWER POPULATION DENSITY WITH HIGHER PERCENTAGES OF POOR, UNINSURED, AND UNDERINSURED RESIDENTS. RURAL POPULATIONS ARE MORE VULNERABLE THAN THEIR URBAN COUNTERPARTS TO ECONOMIC DOWNTURNS BECAUSE OF THEIR CONCENTRATED ECONOMIC SPECIALIZATION.THE REGION OVERALL CONTINUES TO EXPERIENCE STEADY, BUT UNEVEN GROWTH. THE HIGHEST AREAS OF ANTICIPATED GROWTH OVER THE 5-YEAR PERIOD FROM 2024-2029, BASED ON POPULATION CHANGE, ARE CULPEPER COUNTY WITH 4.4% AND ORANGE COUNTY WITH 4.5%. BOTH OF THESE COUNTIES ARE EXCEEDING THE ANTICIPATED 1.9% GROWTH RATE FOR THE STATE. THE EXPECTED POPULATION GROWTH IS SLOWER IN MADISON COUNTY AT 1.6% AND RAPPAHANNOCK COUNTY AT 0.6% RESPECTIVELY.THE REGION IS PRIMARILY WHITE (73.7%), RANGING FROM 67.8% IN CULPEPER COUNTY TO 88% IN RAPPAHANNOCK COUNTY. THE HISPANIC POPULATION IS GROWING, PARTICULARLY IN CULPEPER COUNTY WHERE IT IS NOW 16.6% OF THE POPULATION. THAT IS CONSIDERABLY HIGHER THAN VIRGINIA'S 11.3%. POPULATIONS OF AMERICAN INDIAN, BLACK, AND PACIFIC ISLANDER ARE SIMILAR TO THE STATE OVERALL.SOCIAL DETERMINANTS OF HEALTH (SDOH) ARE THE CONDITIONS IN THE ENVIRONMENTS WHERE PEOPLE ARE BORN, LIVE, LEARN, WORK, PLAY, WORSHIP, AND AGE THAT AFFECT A WIDE RANGE OF HEALTH, FUNCTIONING, AND QUALITY-OF-LIFE OUTCOMES AND RISKS. SDOH CAN BE GROUPED INTO FIVE DOMAINS: ECONOMIC STABILITY, EDUCATION ACCESS AND QUALITY, HEALTHCARE ACCESS AND QUALITY, NEIGHBORHOOD AND BUILT ENVIRONMENT AND SOCIAL COMMUNITY.THE COMMUNITY'S MEDIAN HOUSEHOLD INCOME IS 3.6% HIGHER THAN VIRGINIA. THE MOST AFFLUENT HOUSEHOLDS ARE IN RAPPAHANNOCK COUNTY, AT $102,495, AND IN CULPEPER COUNTY, AT $97,155. MADISON COUNTY HAS THE LOWEST MEDIAN HOUSEHOLD INCOME OF $78,069 AND ORANGE COUNTY IS JUST BELOW THE VIRGINIA MEDIAN INCOME AT $89,779. THE REGION HAS A LOWER PREVALENCE (OR RATE) OF LOW-INCOME RESIDENTS COMPARED TO VIRGINIA OVERALL, ALTHOUGH HIGHER RATES OF LOW-INCOME CAN BE FOUND IN ORANGE COUNTY (100% OF THE POVERTY LEVEL) AND MADISON COUNTY (200% OF POVERTY LEVEL).IN 2022, THE PERCENTAGE OF VIRGINIA RENTERS WHOSE HOUSEHOLD GROSS RENT (INCLUDING UTILITIES) EXCEEDED 30% OF THEIR GROSS MONTHLY INCOME WAS 44.6%. THIS COMMON BENCHMARK FOR HOUSING AFFORDABILITY AND EXPENSES MAY INDICATE COMMUNITY MEMBERS ARE FINANCIALLY STRAINED BY HOUSING COSTS. THESE INDIVIDUALS ARE SPENDING A DISPROPORTIONATE PORTION OF THEIR INCOME ON HOUSING, LEAVING LESS INCOME TO PAY FOR OTHER NECESSITIES LIKE FOOD, HEALTHCARE, AND WELLNESS. RISING HOUSING COSTS HAVE IMPACTED THE AREA, BUT THE HOUSING COST BURDEN IN THE PIEDMONT AREA IS LESS THAN THE STATE PERCENTAGE WITH THE COUNTY PERCENTAGES BEING AS FOLLOWS: CULPEPER (42.6%), MADISON (36.8%), ORANGE (36.9%), AND RAPPAHANNOCK (31.6%). IN 2024, THE POPULATION AGE 25 OR OLDER WITH LESS THAN A HIGH SCHOOL DIPLOMA IS 9.6%, GREATER THAN VIRGINIA'S AVERAGE OF 7.6%, BEING NOTABLE HIGHER IN MADISON COUNTY AT 12.4%. ACCESS TO HEALTHCARE IS THE ABILITY OF INDIVIDUALS TO OBTAIN NECESSARY HEALTH SERVICES, INCLUDING PREVENTION, TREATMENT, AND MANAGEMENT OF HEALTH CONDITIONS. LIMITED ACCESS TO CARE PRESENTS A BARRIER TO GOOD HEALTH, IMPACTING BROADER HEALTH OUTCOMES. ACCESS ENSURES TIMELY CARE, REDUCES HEALTH DISPARITIES, AND ENHANCES THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY. AN ESTIMATED 5.5% OF RESIDENTS UNDER 19 AND 9.9% OF RESIDENTS AGE 18-64 WERE UNINSURED BASED ON POINT-IN-TIME ESTIMATES IN 2022. UNINSURED RATES WERE HIGHER FOR THE REGION COMPARED TO VIRGINIA OVERALL, ESPECIALLY IN CULPEPER COUNTY AND RAPPAHANNOCK COUNTY. RELATIVE TO POPULATION SIZE, THE NUMBER OF PRIMARY CARE PHYSICIANS, MENTAL HEALTH PROVIDERS, AND DENTISTS PER 100,000 POPULATION IS LOWER FOR THE REGION COMPARED TO VIRGINIA. THE LACK OF HEALTHCARE PROFESSIONS MAY DIMINISH ACCESS TO CARE FOR COMMUNITY MEMBERS. THIS IS REFLECTED IN THE RELATED DESIGNATIONS AS HEALTH PROFESSIONAL SHORTAGE AREAS BASED ON STATE-LEVEL APPLICATION OF FEDERAL CRITERIA.THIS IS THE ONLY ACUTE CARE FACILITY IN THE COMMUNITY. STATISTICAL INFORMATION WAS GATHERED FROM VARIOUS LOCAL, STATE, AND FEDERAL SOURCES.
PART VI, LINE 5:	THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSES BY DOING THE FOLLOWING:1. ADOPTING A FINANCIAL ASSISTANCE POLICY;2. REMAINING CERTIFIED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES TO PROVIDE SERVICES TO ALL BENEFICIARIES OF MEDICARE, MEDICAID, AND OTHER GOVERNMENT PAYMENT PROGRAMS, AND PROVIDING SERVICES IN A NONDISCRIMINATORY MANNER TO SUCH BENEFICIARIES;3. OPERATING A FULL-TIME EMERGENCY ROOM WHICH IS OPEN TO AND ACCEPTS ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY;4. MAINTAINING AN OPEN MEDICAL STAFF, SUBJECT TO EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, HOSPITALIST, AND EMERGENCY DEPARTMENT SERVICES, TO THE EXTENT AN EXCLUSIVE CONTRACT FOR THOSE SERVICES IS REQUIRED TO OBTAIN PROPER STAFFING COVERAGE OR TO PERMIT A MORE EFFICIENT DELIVERY OF THOSE SERVICES WITHIN THE HOSPITAL FACILITY;5. MAINTAINING A GOVERNING BOARD CONSISTING PRIMARILY OF A BROAD CROSS-SECTION OF LEADERS IN THE COMMUNITY;6. ADOPTING AND APPLYING A CONFLICT OF INTEREST POLICY, WHICH APPLIES TO THE GOVERNING BOARD AND ORGANIZATION OFFICERS;7. PROVIDING HEALTH EDUCATION LECTURES AND WORKSHOPS;8. PROVIDING HEALTH FAIRS, EDUCATION ON SPECIFIC DISEASES OR CONDITIONS, AND HEALTH PROMOTION AND WELLNESS PROGRAMS TO THE COMMUNITIES IT SERVES;9. PROVIDING SUPPORT GROUPS AND SELF HELP PROGRAMS TO THE COMMUNITIES IT SERVES;10. PROVIDING COMMUNITY-BASED CLINICAL SERVICES, INCLUDING WITHOUT LIMITATION, HEALTH SCREENINGS AND CLINICS FOR UNINSURED OR UNDERINSURED PERSONS TO THE COMMUNITIES IT SERVES;11. PROVIDING HEALTHCARE SUPPORT SERVICES, INCLUDING WITHOUT LIMITATION, INFORMATION AND REFERRAL TO COMMUNITY SERVICES, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PERSONS, TELEPHONE INFORMATION SERVICES AND ASSISTANCE TO ENROLL IN PUBLIC PROGRAMS, SUCH AS MEDICAID TO THE COMMUNITIES IT SERVES;12. PROVIDING SUBSIDIZED HEALTH SERVICES AND CLINICAL PROGRAMS TO THE COMMUNITIES IT SERVES;13. PROVIDING CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND14. GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST.
PART VI, LINE 6:	THE ORGANIZATION IS ONE OF THREE COMMUNITY HOSPITALS THAT ARE SUBSIDIARIES UNDER UVA COMMUNITY HEALTH, INC. (COLLECTIVELY "COMMUNITY HEALTH"), ALL OF WHICH ARE PART OF UVA HEALTH, AN INTEGRATED HEALTH SYSTEM THAT IS PART OF THE UNIVERSITY OF VIRGINIA. COMMUNITY HEALTH CONSISTS OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. EACH HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES, AS REPORTED INDIVIDUALLY ON EACH HOSPITAL'S FORM 990, SCHEDULE H. IN ADDITION TO HOSPITALS, COMMUNITY HEALTH INCLUDES A PHYSICIAN ORGANIZATION WITH PRACTICES IN VIRGINIA AND A HOSPITAL FOUNDATION WHICH SUPPORTS AND ENHANCES THE ACTIVITIES IN THOSE HOSPITALS' COMMUNITIES.
PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT	THE ORGANIZATION FILES COMMUNITY BENEFIT INFORMATION WITH THE VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION IN ACCORDANCE WITH THEIR REPORTING GUIDELINES FOR PURPOSES OF ADVOCACY AND THE STATE'S REPORTING REQUIREMENTS.

Schedule H (Form 990) 2024

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Schedule I
(Form 990)
(Rev. January 2025)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public
Inspection

Name of the organization
UVA CULPEPER MEDICAL CENTER

Employer identification number
54-0622371

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) AGING TOGETHER 1835 INDUSTRY DRIVE CULPEPER,VA22701	46-2046459	501(C)(3)	5,050	COMMUNITY OUTREACH / SUPPORT
(2) CULPEPER HUMAN SERVICES PO BOX 1355 CULPEPER,VA22701	54-6001236	501(C)(3)	25,000	COMMUNITY OUTREACH / SUPPORT
(3) CULPEPER SOCCER ASSOCIATION PO BOX 1105 CULPEPER,VA22701	74-3156626	501(C)(3)	8,500	COMMUNITY OUTREACH / SUPPORT
(4) CULPEPER WELLNESS FOUNDATION 19002 CROSSROAD PKWY CULPEPER,VA22701	52-1366700	501(C)(3)	10,000	COMMUNITY OUTREACH / SUPPORT
(5) FAUQUIER FISH PO BOX 891 WARRENTON,VA20188	54-1271237	501(C)(3)	7,500	COMMUNITY OUTREACH / SUPPORT
(6) FRIENDS OF THE CULPEPER LIBRARY 271 SOUTHGATE SHOPPING CENTER CULPEPER,VA22701	54-1870477	501(C)(3)	5,500	COMMUNITY OUTREACH / SUPPORT
(7) SAFE (SERVICES FOR ABUSED FAMILIES) PO BOX 402 CULPEPER,VA22701	52-1227834	501(C)(3)	5,300	COMMUNITY OUTREACH / SUPPORT
(8) ST STEPHEN'S EPISCOPAL CHURCH DBA CULPEPER FOOD CLOSET 120 N COMMERCE ST CULPEPER,VA22701	31-1629166	501(C)(3)	12,500	COMMUNITY OUTREACH / SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) Rev. 1-2025

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) PATIENT TRANSPORTATION	46	1,654	COST	TRANSPORT FOR PATIENTS
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

PART I, LINE 2:

PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS UVA COMMUNITY HEALTH, INC. IS THE PARENT ORGANIZATION OF A NOT-FOR-PROFIT INTEGRATED SYSTEM OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS OF WHICH THE FILING ORGANIZATION IS A SUBSIDIARY. UVA COMMUNITY HEALTH IS AUTHORIZED TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. UVA COMMUNITY HEALTH HAS ESTABLISHED A SYSTEM-WIDE POLICY WITH STANDARDIZED GUIDELINES THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE FILING ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS ARE MAINTAINED VIA THE GENERAL LEDGER. FUNDS ARE GENERALLY NOT TRACKED AFTER BEING GRANTED, AS THE ORIGINAL ELIGIBILITY AND SELECTION CRITERIA HAVE ALREADY BEEN MET.

Schedule I (Form 990) Rev. 1-2025

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Schedule J
(Form 990)
(Rev. January 2025)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public Inspection

Name of the organization

UVA CULPEPER MEDICAL CENTER

Employer identification number

54-0622371

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) (Rev. 1-2025)

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1L ERIK SHANNON CEO (UVACH SYSTEM)	(i) (ii)	0 ------------- 715,824	0 ------------- 217,500	0 ------------- 46,888	0 ------------- 140,137	0 ------------- 38,654	0 ------------- 1,159,003	0 ------------- 0
2KIRSTEN GREEN MD TRUSTEE	(i) (ii)	0 ------------- 902,575	0 ------------- 0	0 ------------- 87,433	0 ------------- 81,704	0 ------------- 34,293	0 ------------- 1,106,005	0 ------------- 0
3MARY FRANCES SOUTHERLAND INTERIM SECRETARY/TRUSTEE	(i) (ii)	0 ------------- 408,718	0 ------------- 82,400	0 ------------- 7,789	0 ------------- 23,513	0 ------------- 23,992	0 ------------- 546,412	0 ------------- 0
4CHARLES CODER CFO (UVACH SYSTEM)	(i) (ii)	0 ------------- 348,829	0 ------------- 62,493	0 ------------- 35,424	0 ------------- 17,583	0 ------------- 39,836	0 ------------- 504,165	0 ------------- 0
5CHRISTOPHER HEATON TRUSTEE (PWHS EMPLOYEE)	(i) (ii)	0 ------------- 319,848	0 ------------- 245	0 ------------- 85,608	0 ------------- 13,976	0 ------------- 41,940	0 ------------- 461,617	0 ------------- 0
6DONNA STATON CMC PRESIDENT / COO (UVACH SYSTEM)	(i) (ii)	308,036 ------------- 0	58,500 ------------- 0	9,669 ------------- 0	18,022 ------------- 0	41,958 ------------- 0	436,185 ------------- 0	0 ------------- 0
7MICHELLE STRIDER FMR CQO CMC / CNO (UVACH SYSTEM)	(i) (ii)	15,559 ------------- 232,129	1,200 ------------- 83,003	424 ------------- 42,961	1,064 ------------- 12,452	859 ------------- 29,277	19,106 ------------- 399,822	0 ------------- 0
8NAEL HASAN CHIEF MEDICAL OFFICER	(i) (ii)	265,803 ------------- 0	26,780 ------------- 0	3,518 ------------- 0	0 ------------- 0	6,558 ------------- 0	302,659 ------------- 0	0 ------------- 0
9SARA WHITE SR DIR FIN./CONTR. (UVACH SYSTEM)	(i) (ii)	193,164 ------------- 0	26,420 ------------- 0	292 ------------- 0	11,864 ------------- 0	22,620 ------------- 0	254,360 ------------- 0	0 ------------- 0
10TEMPLE COATES DIRECTOR THERAPY SERVICES	(i) (ii)	171,165 ------------- 0	24,250 ------------- 0	1,316 ------------- 0	10,828 ------------- 0	37,803 ------------- 0	245,362 ------------- 0	0 ------------- 0
11TIMOTHY W MARTIN DIR PROF & ANCILLARY SVCS	(i) (ii)	188,953 ------------- 0	37,428 ------------- 0	732 ------------- 0	0 ------------- 0	13,839 ------------- 0	240,952 ------------- 0	0 ------------- 0
12RANDY MITCHELL SR SURGICAL ASSISTANT	(i) (ii)	183,153 ------------- 0	0 ------------- 0	5,634 ------------- 0	0 ------------- 0	36,066 ------------- 0	224,853 ------------- 0	0 ------------- 0
13DENNIS SMITH PHARMACIST	(i) (ii)	181,223 ------------- 0	0 ------------- 0	6,349 ------------- 0	10,069 ------------- 0	14,560 ------------- 0	212,201 ------------- 0	0 ------------- 0
14STEVEN VON ELTEN BEG 0225 TRUSTEE (PWHS EMPLOYEE)	(i) (ii)	0 ------------- 136,124	0 ------------- 0	0 ------------- 30,448	0 ------------- 8,094	0 ------------- 1,394	0 ------------- 176,060	0 ------------- 0

Schedule J (Form 990) (Rev. 1-2025)

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3:	METHODS USED TO ESTABLISH COMPENSATION: UVA COMMUNITY HEALTH, INC. IS THE PARENT ENTITY OF THE COMMUNITY HEALTH ENTERPRISE, AN INTEGRATED NETWORK OF NOT-FOR-PROFIT, TAX-EXEMPT ENTITIES THAT INCLUDES PHYSICIAN OFFICES, OUTPATIENT FACILITIES, AND COMMUNITY MEDICAL CENTERS. UVA COMMUNITY HEALTH AND ITS COMPONENT ENTITIES, ALONG WITH UNIVERSITY OF VIRGINIA MEDICAL CENTER, THE UVA SCHOOL OF MEDICINE, UVA SCHOOL OF NURSING, UVA PHYSICIANS GROUP, AND THE CLAUDE MOORE HEALTH SCIENCES LIBRARY, COMPRISE UVA HEALTH. THE FILING ORGANIZATION IS AN INTEGRAL PART OF UVA COMMUNITY HEALTH AND UVA HEALTH. THE COMPENSATION OF THE UVA COMMUNITY HEALTH, INC. CEO IS ESTABLISHED USING A PROCESS THAT ADHERES TO THE REQUIREMENTS SET FORTH TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, USE OF AN INDEPENDENT COMPENSATION CONSULTANT AND THIRD-PARTY COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION.
PART I, LINE 4B:	THE UVA COMMUNITY HEALTH 457F PLAN, IMPLEMENTED AND APPROVED BY THE CHIEF EXECUTIVE OFFICER OF UVA HEALTH ON BEHALF OF THE MEDICAL CENTER AND THE RECTOR AND VISITORS OF THE UNIVERSITY OF VIRGINIA, IS INTENDED TO SUPPORT RETENTION OF THE CEO AND TO OFFER COMPETITIVE TOTAL COMPENSATION. ANNUAL CONTRIBUTIONS/DEFERRALS TO THE PLAN ARE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J ANNUALLY. AMOUNTS VEST AFTER 3 YEARS ON DECEMBER 31ST. L. ERIK SHANNON: $119,437
PART I, LINE 7:	NONFIXED PAYMENTS (BONUSES): DEPENDING ON INDIVIDUAL PERFORMANCE, SOME EMPLOYEES MAY BE ELIGIBLE FOR PERFORMANCE BONUSES IN ADDITION TO THEIR REGULAR COMPENSATION. THE AWARDING OF ANY COMPENSATION BONUS CONSIDERS THE INDIVIDUAL'S GOALS AND THE GOALS OF THE ORGANIZATION AS A WHOLE. ANY POTENTIAL BONUS IS CONSIDERED WHEN EVALUATING AN EMPLOYEE'S TOTAL COMPENSATION FOR REASONABLENESS.

Schedule J (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)
(Rev. January 2025)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public Inspection

Name of the organization

UVA CULPEPER MEDICAL CENTER

Employer identification number

54-0622371

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... $

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ $

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No




Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990) (Rev. 1-2025)

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) NOAH STATON	FAMILY MEMBER OF DONNA STATON, ORGANIZATION'S CEO	19,283	EMPLOYMENT		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)
(Rev. January 2025)
Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public
Inspection

Name of the organization

UVA CULPEPER MEDICAL CENTER

Employer identification number

54-0622371

Return Reference	Explanation
FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:	UVA CULPEPER MEDICAL CENTER IS PART OF THE UVA COMMUNITY HEALTH ENTERPRISE, AN INTEGRATED NETWORK OF NOT-FOR-PROFIT, TAX-EXEMPT ENTITIES THAT INCLUDES PHYSICIAN OFFICES, OUTPATIENT FACILITIES AND COMMUNITY MEDICAL CENTERS. UVA COMMUNITY HEALTH AND ITS COMPONENT ENTITIES, ALONG WITH THE UNIVERSITY OF VIRGINIA MEDICAL CENTER, THE UVA SCHOOL OF MEDICINE, UVA SCHOOL OF NURSING, UVA PHYSICIANS GROUP, AND THE CLAUDE MOORE HEALTH SCIENCES LIBRARY, COMPRISE UVA HEALTH. GENERAL INFORMATION UVA CULPEPER MEDICAL CENTER IS LOCATED IN CULPEPER, VA. THE HOSPITAL FOCUSES ON CULTIVATING HEALTH COMMUNITIES BY PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT CARE, AND A REMARKABLE WORK ENVIRONMENT FOR OUR TEAM MEMBERS. WE ARE COMMITTED TO MEETING THE HEALTH CARE NEEDS OF RESIDENTS OF CULPEPER, ORANGE, MADISON, AND SURROUNDING COUNTIES IN VIRGINIA. IN ADDITION TO OUR QUALITY AND COMPREHENSIVE CATEGORIES OF SERVICES, UVA COMMUNITY HEALTH IS PROUD TO OFFER A PATIENT FINANCIAL ASSISTANCE PROGRAM. WE WORK WITH CUSTOMERS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, DISCOUNT THEIR BILL, OR PROVIDE THEM WITH FREE CHARITY CARE. COMMUNITY ENGAGEMENT COMMUNITY ENGAGEMENT IS A CRITICAL COMPONENT TO THE UVA HEALTH MISSION OF CULPEPER MEDICAL CENTER. BEYOND OUR PROVISION OF QUALITY HEALTHCARE SERVICES, WE SUPPORT OTHER COMMUNITY ORGANIZATIONS THAT PROVIDE HEALTH SERVICES, EDUCATION, AND ASSISTANCE TO UNINSURED AND VULNERABLE POPULATIONS, AS WELL AS THE OVERALL COMMUNITY. THIS SUPPORT INCLUDES ACCESS TO EDUCATION, ACCESS TO HEALTHY FOOD, AND INITIATIVES TO ADDRESS EARLY CHILDHOOD DEVELOPMENT, ENVIRONMENTAL AND SOCIAL INCLUSION, AND NON-DISCRIMINATION AS WELL AS UNDERLYING SOCIAL DETERMINANTS OF HEALTH. SOME OF THE ORGANIZATIONS INCLUDE THE MENTAL HEALTH ASSOCIATION OF FAUQUIER COUNTY, HERO'S BRIDGE, CULPEPER FOOD CLOSET, THE ARC OF NORTH CENTRAL VIRGINIA INC., HOSPICE OF PIEDMONT, PEOPLE INCORPORATED OF VIRGINIA, LIVING THE DREAM FOUNDATION, CASA, AND AGING TOGETHER CORPORATION. IN 2025, CULPEPER MEDICAL CENTER HOSTED EDUCATION SESSIONS AND SCREENINGS FOR THE COMMUNITY WHICH INCLUDED: - TAUGHT HANDS-ONLY CPR TO MORE THAN 650 FIFTH GRADERS IN CULPEPER COUNTY AT STEM DAYS AT THE AIRPORT. - PROVIDED SUPPORT FOR AGING TOGETHER'S DEMENTIA CONFERENCE. - PROVIDED EDUCATION AND BLOOD PRESSURE SCREENINGS AT CULPEPERFEST. - PROVIDED PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY CLINIC AT MADISON DAY IN MADISON COUNTY, PROVIDING SCREENING AND EDUCATION ABOUT BALANCE. - COHOSTED PAMPER ME PINK EVENT TO RAISE AWARENESS FOR BREAST CANCER AND RAISE MONEY TO FUND FREE MAMMOGRAMS FOR UNDERSERVED INDIVIDUALS. - PROMOTED MENTAL HEALTH AND HEALTHY HABITS FOR CHILDREN AT CHILDREN'S DAY IN THE PARK HOSTED BY HEALTHY CULPEPER. - PROVIDED BLOOD PRESSURE SCREENINGS, BODY MASS INDEX SCREENINGS, AND HEART HEALTH EDUCATION AT MULTIPLE COMMUNITY EVENTS. CULPEPER MEDICAL CENTER PROVIDED MULTIPLE GRANTS TO SUPPORT NONPROFIT ORGANIZATIONS FOCUSED ON IMPROVING AREAS SUCH AS ACCESS TO MENTAL/BEHAVIORAL HEALTH RESOURCES, PREVENTION OF CHRONIC DISEASE, AND HEALTHCARE WORKFORCE PIPELINE. OTHER INITIATIVES INCLUDED: - AWARDED LIVING THE DREAM FOUNDATION GRANT TO SUPPORT MENTAL HEALTH GATEKEEPER TRAINING AND SCHOLARSHIPS. - PROVIDED SUPPORT FOR AGING TOGETHER'S DEMENTIA CONFERENCE. - DRUG TAKE BACK DAY EVENTS HELD IN PARTNERSHIP WITH LOCAL POLICE DEPARTMENTS AND DRUG ENFORCEMENT AGENCY. - LIGHTS OF LOVE TREE LIGHTING CEREMONY. ADDITIONALLY, WE CREATED EDUCATION ABOUT STROKE PREVENTION IN ENGLISH AND SPANISH THAT WAS DISTRIBUTED THROUGH OUR COMMUNITY. CULPEPER MEDICAL CENTER CONTINUES TO PROVIDE FINANCIAL AND HUMAN RESOURCES TO CARE FOR PATIENTS AT THE CULPEPER FREE CLINIC, ORANGE FREE CLINIC, AND THE MADISON FREE CLINIC. NEW TECHNOLOGY & SERVICES IN 2025, UVA COMMUNITY HEALTH FACILITIES CONTINUED FOCUS ON DELIVERING A REMARKABLE PATIENT EXPERIENCE WHILE MAKING HEALTHCARE MORE CONVENIENT AND EASIER TO ACCESS FOR THE COMMUNITY. - UVA COMMUNITY HEALTH MEDICAL GROUP OPENED ITS FIRST UVA HEALTH CHILDREN'S CLINIC IN CULPEPER: UVA HEALTH CHILDREN'S PEDIATRICS DOMINION. - UVA COMMUNITY HEALTH MEDICAL GROUP EXPANDED ITS SAME-DAY AND PRIMARY CARE SERVICES IN CULPEPER WITH THE OPENING OF UVA HEALTH SAME DAY AND FAMILY MEDICINE DOMINION. - UVA HEALTH LAUNCHED THE CLINICAL TRIALS NETWORK WITH ACCESS TO CULPEPER AND NORTHERN VIRGINIA. - UVA HEALTH CULPEPER MEDICAL CENTER WAS THE FIRST TO USE THE NEW AI-POWERED SECOND-GENERATION VERSION OF AQUABLATION FOR UROLOGY IN THE STATE OF VIRGINIA. AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATIONS - GRADE A IN QUALITY AND SAFETY FROM THE LEAPFROG GROUP IN THE SPRING 2025, GRADE B IN FALL 2025. - UVA HEALTH CULPEPER MEDICAL CENTER RECEIVED TOTAL HIP/KNEE REPLACEMENT AND ACUTE STROKE READY CARE REACCREDITATIONS BY THE JOINT COMMISSION. - UVA HEALTH CULPEPER MEDICAL CENTER RECEIVED "HIGH PERFORMING AND "MATERNITY CARE ACCESS" DESIGNATIONS FROM U.S. NEWS & WORLD REPORT. - UVA HEALTH CULPEPER MEDICAL CENTER RECEIVED THE FOLLOWING FROM THE AMERICAN HEART ASSOCIATION: - GET WITH THE GUIDELINES RURAL CORONARY ARTERY DISEASE STEMI BRONZE FOR THE HOSPITAL'S FAST, EVIDENCE-BASED CARE FOR PATIENTS EXPERIENCING AN ST-ELEVATION MYOCARDIAL INFARCTION (STEMI), A SEVERE TYPE OF HEART ATTACK. - GET WITH THE GUIDELINES RESUSCITATION PEDIATRIC BRONZE AWARD. - GET WITH THE GUIDELINES RESUSCITATION TARGET SURVIVAL AWARD. - GET WITH THE GUIDELINES RESUSCITATION TARGET CPR AWARD. - GET WITH THE GUIDELINES RESUSCITATION ADULT BRONZE AWARD. ACCREDITATION THE JOINT COMMISSION TRIENNIAL ACCREDITATION SURVEY WAS COMPLETED IN MAY 2023. CULPEPER MEDICAL CENTER IS FULLY ACCREDITED BY THE JOINT COMMISSION, AN INDEPENDENT ORGANIZATION THAT EVALUATES A HEALTHCARE ORGANIZATION'S PERFORMANCE IN AREAS THAT MOST AFFECT PATIENT HEALTH AND SAFETY. ADDITIONALLY, CULPEPER MEDICAL CENTER MAINTAINS THE FOLLOWING CERTIFICATIONS OR ACCREDITATIONS FROM THE JOINT COMMISSION: - THE JOINT COMMISSION ACUTE HEART ATTACK READY INITIAL ACCREDITATION - THE JOINT COMMISSION TOTAL HIP/KNEE RECERTIFICATION - THE JOINT COMMISSION ACUTE STROKE READY INITIAL ACCREDITATION CULPEPER MEDICAL CENTER'S BREAST CARE CENTER IS ACCREDITED BY THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS BY THE AMERICAN COLLEGE OF SURGEONS. ACCREDITATION IS GRANTED TO CENTERS THAT HAVE VOLUNTARILY COMMITTED TO PROVIDE THE HIGHEST QUALITY OF CARE TO PATIENTS WITH BREAST DISEASES AND THAT UNDERGO A RIGOROUS EVALUATION AND REVIEW OF ITS PERFORMANCE AND COMPLIANCE WITH THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS. CULPEPER MEDICAL CENTER IS ACCREDITED BY THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF VASCULAR LABORATORIES, ENSURING QUALITY PATIENT CARE FOR VASCULAR TESTING. COLLEGE OF AMERICAN PATHOLOGIST ACCREDITATION LABORATORY ACCREDITATION PROGRAM COMPLETED FEBRUARY 2023. BABY FRIENDLY DESIGNATION COMPLETED MAY 2023. FOR MORE INFORMATION, VISIT: HTTPS://UVAHEALTH.COM/LOCATIONS/UVA-HEALTH-CULPEPER-MEDICAL-CENTER-55972 71
FORM 990, PART III, LINE 1: MISSION, VISION AND VALUES	OUR MISSION TRANSFORMING HEALTH AND INSPIRING HOPE FOR ALL VIRGINIANS AND BEYOND. OUR VISION TO BE THE NATION'S LEADING PUBLIC ACADEMIC HEALTH SYSTEM AND A BEST PLACE TO WORK - WHILE TRANSFORMING PATIENT CARE, RESEARCH, EDUCATION, AND ENGAGEMENT WITH THE DIVERSE COMMUNITIES WE SERVE. OUR VALUES: - ASPIRE: AT UVA HEALTH, WE PUT THE PATIENT AT THE CENTER OF EVERYTHING WE DO. WE ASPIRE TO CREATE A CULTURE OF EXCELLENCE, ENGAGEMENT, AND TRUST THROUGH OUR VALUES. - ACCOUNTABILITY: ACKNOWLEDGING AND ASSUMING RESPONSIBILITY FOR WHERE WE HAVE SUCCEEDED AND FAILED IN TERMS OF OUR ACTIONS, DECISIONS, POLICIES, AND RESULTS. - STEWARDSHIP: MANAGING OUR RESOURCES AND COMMITMENT TO CONTINUAL IMPROVEMENT AND LEARNING WHILE ACKNOWLEDGING SHORTCOMINGS OR PROBLEMS IN OUR QUEST. - PROFESSIONALISM: APPROACHING ALL THAT WE DO IN A COLLABORATIVE WAY AND DELIVERING EXCELLENT CARE THROUGH THE LENS OF HELPFULNESS, POSITIVITY, KINDNESS, AND COMPETENCY. - INTEGRITY: BEING HONEST, OPEN, AND FAIR THROUGH OUR BEHAVIORS, ATTITUDE, AND TREATMENT OF OTHERS. - RESPECT: VALUING EVERYONE THROUGH OUR COMPASSIONATE AND CARING WAYS. - EMPATHY: FOSTERING AN ENVIRONMENT OF COMPASSION, ENGAGEMENT, AND UNDERSTANDING TO BUILD TRUST AND SUPPORT FOR OUR PATIENTS, FAMILIES, TEAM MEMBERS, AND COMMUNITIES. OUR GUIDING PRINCIPLES OUR PATIENTS ARE THE CENTER OF ALL WE DO. - CARE FOR, EMPOWER, AND SUPPORT OUR FELLOW TEAM MEMBERS IN EVERYTHING WE DO - STRIVE FOR EXCELLENCE ACROSS ALL MISSIONS - MAKE TRANSPARENT AND DATA-DRIVEN DECISIONS IN THE LONG-TERM BEST INTERESTS OF THE ORGANIZATION - PROVIDE THE HIGHEST QUALITY, UNPARALLELED SAFETY, AND AN EXCEPTIONAL CARE EXPERIENCE - BE A LEARNING ORGANIZATION COMMITTED TO INNOVATION AND CONTINUAL DEVELOPMENT OF OURSELVES AND OTHERS - BE RESPONSIBLE FOR MANAGERS OF OUR FINANCIAL, ENVIRONMENTAL, AND OTHER RESOURCES - HAVE CLEAR OBJECTIVES, MEASURE RESULTS, AND CELEBRATE SUCCESSES - DEEPEN COMMUNITY ENGAGEMENT AND FOSTER HEALTHY COMMUNITIES
FORM 990, PART VI, SECTION A, LINE 6	CLASSES OF MEMBERS OR STOCKHOLDERS THE SOLE MEMBER, UVA COMMUNITY HEALTH, INC., HAS CERTAIN RIGHTS AND POWERS WITH REGARDS TO THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A	ELECTION OF MEMBERS AND THEIR RIGHTS AS THE SOLE MEMBER, UVA COMMUNITY HEALTH, INC. HAS THE POWER TO APPOINT ALL MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7B	AS THE SOLE MEMBER, UVA COMMUNITY HEALTH, INC. HAS THE POWER TO APPROVE CERTAIN TRANSACTIONS, ACTIONS AND CHANGES TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS.
FORM 990, PART VI, SECTION B, LINE 11B	ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE REVIEW OF THE 990 IS PERFORMED BY THE CHIEF FINANCIAL OFFICER OF UVA COMMUNITY HEALTH, INC. ALL BOARD MEMBERS HAVE RECEIVED A COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	MONITORING AND ENFORCEMENT OF COI THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS. ANNUALLY, ALL TRUSTEES ARE SENT A COPY OF THE CONFLICT OF INTEREST POLICY AND RECEIVE INSTRUCTION ON HOW TO DISCLOSE A CONFLICT OF INTEREST. AT THAT TIME, THEY MUST COMPLETE AN ATTESTATION STATEMENT AFFIRMING THEIR ADHERENCE TO THE POLICY. A SUPPLEMENTAL QUESTIONNAIRE IS SENT OUT ANNUALLY THAT INFORMS CERTAIN OF THE FORM 990 DISCLOSURES. IF THE TRUSTEE DISCLOSES A CONFLICT OF INTEREST, THEY MUST RECUSE THEMSELVES FROM DISCUSSIONS AND DELIBERATIONS RELATED TO THE CONFLICTED TRANSACTION.
FORM 990, PART VI, SECTION B, LINE 15	UVA COMMUNITY HEALTH, INC. IS THE PARENT ENTITY OF THE COMMUNITY HEALTH ENTERPRISE, AN INTEGRATED NETWORK OF NOT-FOR-PROFIT, TAX-EXEMPT ENTITIES THAT INCLUDES PHYSICIAN OFFICES, OUTPATIENT FACILITIES, AND COMMUNITY MEDICAL CENTERS. UVA COMMUNITY HEALTH AND ITS COMPONENT ENTITIES, ALONG WITH UNIVERSITY OF VIRGINIA MEDICAL CENTER, THE UVA SCHOOL OF MEDICINE, UVA SCHOOL OF NURSING, UVA PHYSICIANS GROUP, AND THE CLAUDE MOORE HEALTH SCIENCES LIBRARY, COMPRISE UVA HEALTH. THE FILING ORGANIZATION IS AN INTEGRAL PART OF UVA COMMUNITY HEALTH AND UVA HEALTH. THE PROCESS USED TO ESTABLISH THE COMPENSATION OF THE UVA COMMUNITY HEALTH, INC. CEO RELIES UPON PROCESSES AND APPROVALS DESIGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS. INDEPENDENT AND DISINTERESTED MEMBERS OF THE UVA COMMUNITY HEALTH, INC.'S BOARD OF TRUSTEES, WHO COMPRISE THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD, REVIEW, APPROVE AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR UVA COMMUNITY HEALTH INC.'S CEO; IT IS ALSO APPROVED BY THE CHIEF EXECUTIVE OFFICER OF UVA HEALTH ON BEHALF OF THE MEDICAL CENTER AND THE RECTOR AND VISITORS OF THE UNIVERSITY OF VIRGINIA. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT AND USES THIRD PARTY COMPARABILITY DATA FROM FUNCTIONALLY SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS IS REASONABLE. THE PROCESS USED TO ESTABLISH THE COMPENSATION AND BENEFITS OF CERTAIN EXECUTIVES OTHER THAN THE UVA COMMUNITY HEALTH, INC. CEO IS MANAGED BY THE COMMUNITY HEALTH HUMAN RESOURCES TEAM. THE TEAM USES THIRD PARTY COMPARABILITY DATA FROM FUNCTIONALLY SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS IS REASONABLE. THE TEAM PRESENTS THE EXECUTIVES' COMPENSATION AND BENEFIT PACKAGES TO THE UVA COMMUNITY HEALTH, INC. CEO AND THE CHIEF EXECUTIVE OFFICER OF UVA HEALTH ANNUALLY FOR REVIEW AND APPROVAL. THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD REVIEWS THIS INFORMATION AS WELL.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE UVA COMMUNITY HEALTH SYSTEM, INCLUDING THE FILING ORGANIZATION, ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE EXTENT REQUIRED BY LAW.
FORM 990, PART IX, LINE 11G	CORPORATE ADMIN SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,556,513. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,556,513. HEALTH PRO SERVICES: PROGRAM SERVICE EXPENSES 18,382,839. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,382,839. FOOD SERVICE: PROGRAM SERVICE EXPENSES 1,241,126. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,241,126. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 572,925. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 572,925.
FORM 990, PART XI, LINE 9:	INTERCOMPANY DISTRIBUTIONS/TRANSFERS -946,521.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)
(Rev. January 2025)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public Inspection

Name of the organization

UVA CULPEPER MEDICAL CENTER

Employer identification number

54-0622371

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) CULPEPER SURGERY CENTER LLC (AS OF 062024) 501 SUNSET LANE CULPEPER,VA22701 54-1975624	INACTIVE	VA	0	0	UVA CULPEPER MEDICAL CENTER

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)UNIVERSITY OF VIRGINIA MEDICAL CENTER 1201 LEE STREET CHARLOTTESVILLE,VA22902 54-6001796	HEALTHCARE	VA	GOVERNMENTAL	LINE 6	N/A		No
(2)UVA PRINCE WILLIAM HEALTH SYSTEM 8700 SUDLEY RD STE 411 MANASSAS,VA20110 54-1278944	HEALTHCARE	VA	501(C)(3)	LINE 12C, III-FI	UVA COMMUNITY HEALTH INC		No
(3)UVA COMMUNITY HEALTH INC 8700 SUDLEY RD STE 411 MANASSAS,VA20110 81-0868533	HEALTHCARE	VA	501(C)(3)	LINE 12A, I	UVA MEDICAL CENTER		No
(4)UVA CATON MERCHANT HOUSE ASSISTED LIVING 8700 SUDLEY RD STE 411 MANASSAS,VA20110 54-1291284	HEALTHCARE	VA	501(C)(3)	LINE 10	UVA PRINCE WILLIAM HEALTH SYSTEM		No
(5)UVA COMMUNITY HEALTH FOUNDATION 8700 SUDLEY RD STE 411 MANASSAS,VA20110 54-1307595	HEALTHCARE	VA	501(C)(3)	LINE 7	UVA PRINCE WILLIAM HEALTH SYSTEM		No
(6)UVA PRINCE WILLIAM MEDICAL CENTER 8700 SUDLEY RD STE 411 MANASSAS,VA20110 54-0696355	HEALTHCARE	VA	501(C)(3)	LINE 3	UVA PRINCE WILLIAM HEALTH SYSTEM		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) (Rev. 1-2025)

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) UVA OUTPATIENT IMAGING CULPEPER LLC 800 CRESCENT CENTRE DR SUITE 400 FRANKLIN,TN37076 84-3646484	HEALTHCARE	TN	UVA CULPEPER MEDICAL CENTER INC	RELATED	1,604,320	5,018,895		No		Yes		80.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No

Schedule R (Form 990) (Rev. 1-2025)

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) (Rev. 1-2025)

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) (Rev. 1-2025)

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	89,827	0
9	Program service revenue (Part VIII, line 2g) .........	194,936,202	201,764,508
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-8,191	40,836
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-898,969	739,468
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	194,118,869	202,544,812
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	129,994	113,494
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	60,456,449	69,900,687
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	106,096,354	111,028,738
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	166,682,797	181,042,919
19	Revenue less expenses. Subtract line 18 from line 12.......	27,436,072	21,501,893
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	189,186,091	206,412,270
21	Total liabilities (Part X, line 26).............	10,024,315	7,901,108
22	Net assets or fund balances. Subtract line 21 from line 20.....	179,161,776	198,511,162

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 149,774,523 including grants of $ 113,494 ) (Revenue $ 202,047,617 )
	UVA CULPEPER MEDICAL CENTER ("UVACMC") PROVIDES PROGRAMS AND ACTIVITIES THAT PROVIDE ACCESS TO HEALTHCARE AND IMPROVE HEALTH IN OUR COMMUNITY. UVACMC IS A 70-BED NON-PROFIT, ACUTE CARE HOSPITAL LOCATED IN CULPEPER, VA WITH COMPREHENSIVE SERVICES PROVIDING A 24 HOUR, PHYSICIAN STAFFED EMERGENCY DEPARTMENT, FAMILY BIRTH CENTER, SURGICAL SERVICES, INTENSIVE CARE UNIT AND MORE. OUR MISSION IS TO HELP PEOPLE ACHIEVE AND MAINTAIN OPTIMAL HEALTH BY PROVIDING THE BEST POSSIBLE HEALTHCARE SERVICES. WE ALWAYS MAKE THE NEEDS OF OUR PATIENTS OUR TOP PRIORITY. UVACMC PROVIDES MEDICAL AND OTHER HEALTHCARE SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ALL UNINSURED PATIENTS, REGARDLESS OF INCOME LEVEL OR COUNTY OF RESIDENCE, RECEIVE A SELF-PAY DISCOUNT ON HOSPITAL SERVICES.(SEE SCHEDULE O) WE ALSO PARTNER WITH LOCAL NON-PROFIT AND GOVERNMENTAL ORGANIZATIONS TO SUPPORT LOCAL EVENTS AND PROVIDE HEALTH AND WELLNESS PROGRAMS. UVACMC WORKS WITH LOCAL HIGH SCHOOLS AND COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS. DURING FISCAL YEAR 2025, THERE WERE 16,776 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3.5 DAYS. THERE WERE 4,469 DISCHARGES, 5,718 INPATIENT AND OUTPATIENT SURGERIES, 104,053 OUTPATIENT ENCOUNTERS AND 34,539 EMERGENCY DEPARTMENT VISITS.FORM 990, PART V, LINE 1A / PART VII, SECTION B: INDEPENDENT CONTRACTORSTHE FILING ENTITY IS PART OF THE INTEGRATED HEALTHCARE SYSTEM KNOWN AS UVA HEALTH. UVA HEALTH REPRESENTS THE ACADEMIC MEDICINE ARM OF THE UNIVERSITY OF VIRGINIA (THE "UNIVERSITY"). THE UNIVERSITY IS RESPONSIBLE FOR CERTAIN CORPORATE SUPPORT FUNCTIONS INCLUDING ACCOUNTS PAYABLE AND ISSUES FORMS 1099 FOR CERTAIN ENTITIES IN THE SYSTEM INCLUDING THE FILING ENTITY.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses149,774,523

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) SARA WHITE........................................................................ SR DIR FIN./CONTR. (UVACH SYSTEM)	10.00 .......................40.00	X		219,876	0	34,484
(19) TIMOTHY W MARTIN........................................................................ DIR PROF & ANCILLARY SVCS	45.00 .......................0.00	X		227,113	0	13,839
(20) RANDY MITCHELL........................................................................ SR SURGICAL ASSISTANT	45.00 .......................0.00	X		188,787	0	36,066
(21) DENNIS SMITH........................................................................ PHARMACIST	45.00 .......................0.00	X		187,572	0	24,629
(22) TEMPLE COATES........................................................................ DIRECTOR THERAPY SERVICES	45.00 .......................0.00	X		196,731	0	48,631
(23) MICHELLE STRIDER........................................................................ FMR CQO CMC / CNO (UVACH SYSTEM)	0.00 .......................50.00		X	17,183	358,093	43,652

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	1,709,568	3,846,239	732,955

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2024 (Part V, line 2a) ......	5	961
6	Total number of volunteers (estimate if necessary) .............	6	13
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

(A) Name and business address	(B) Description of services	(C) Compensation
NORTHSTAR ANESTHESIA OF VIRGINIA LLC 6225 N STATE HIGHWAY 161 SUITE 20 IRVING,TX75038	HEALTH SERVICES	184,024




2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 1

1a	Federated campaigns..	1a
b	Membership dues..	1b
c	Fundraising events..	1c
d	Related organizations	1d
e	Government grants (contributions)	1e

f	All other contributions, gifts, grants, and similar amounts not included above	1f

g	Noncash contributions included in lines 1a - 1f:$	1g

h Total. Add lines 1a-1f.......

		Business Code
2a	NET PATIENT REVENUE	622110	201,600,326	201,600,326
b	PROVIDER BASED CLINICS	622110	91,009	91,009
c	PROV. PERFORMANCE REV.	622110	73,173	73,173
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		201,764,508

3 Investment income (including dividends, interest, and othersimilar amounts) ......			19,334			19,334
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	347,365
b	Less: rental expenses	6b	8,776
c	Rental income or (loss)	6c	338,589
d	Net rental income or (loss).......			338,589			338,589
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	21,502
b	Less: cost or other basis and sales expenses	7b	0
c	Gain or (loss)	7c	21,502
d	Net gain or (loss).........			21,502			21,502
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	14,485
b	Less: cost of goods sold ..		10b	3,064
c	Net income or (loss) from sales of inventory..			11,421			11,421

Business Code
11a	EQUITY IN SUBSIDIARIES		900099	279,489	279,489
b	MISCELLANEOUS REVENUE		900099	99,422			99,422
c	VENDING MACHINE REVENUE		722515	6,927			6,927
d	All other revenue ....			3,620	3,620
e	Total. Add lines 11a–11d ......			389,458
12	Total revenue. See instructions.....			202,544,812	202,047,617	0	497,195

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	111,840	111,840
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	1,654	1,654
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	765,255	497,416	267,839
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	162,011	105,307	56,704
7	Other salaries and wages........	55,397,326	36,008,262	19,389,064
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,115,425	1,375,026	740,399
9	Other employee benefits .......	7,407,696	4,815,002	2,592,694
10	Payroll taxes ...........	4,052,974	2,634,433	1,418,541
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	25,753,403	20,196,890	5,556,513
12	Advertising and promotion ....
13	Office expenses .......	976,600	761,748	214,852
14	Information technology ......	327,688	327,688
15	Royalties ..
16	Occupancy ...........	3,536,338	2,758,344	777,994
17	Travel ............	16,846	10,950	5,896
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	509	331	178
20	Interest ...........	116,434	116,434
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	5,659,782	5,433,391	226,391
23	Insurance ...
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PHARMACEUTICALS	24,003,450	24,003,450
b	MEDICAL SUPPLIES	19,677,791	19,677,791
c	BAD DEBT	14,893,996	14,893,996
d	CORPORATE ALLOCATION	13,623,662	13,623,662
e	All other expenses	2,442,239	2,420,908	21,331
25	Total functional expenses. Add lines 1 through 24e	181,042,919	149,774,523	31,268,396	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			1,037,442	2	808,167
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			18,819,092	4	19,248,380
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			4,496,966	8	5,093,288
9	Prepaid expenses and deferred charges ......			119,479	9	127,917
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	63,385,457
b	Less: accumulated depreciation	10b	15,911,064	53,726,649	10c	47,474,393
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			4,831,673	12	2,958,651
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			23,400,358	14	23,408,286
15	Other assets. See Part IV, line 11 ...........			82,754,432	15	107,293,188
16	Total assets. Add lines 1 through 15 (must equal line 33)...			189,186,091	16	206,412,270

17	Accounts payable and accrued expenses .....	8,084,715	17	5,322,866
18	Grants payable ...		18
19	Deferred revenue .........	342,031	19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	1,597,569	25	2,578,242
26	Total liabilities. Add lines 17 through 25..	10,024,315	26	7,901,108

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....	0	29	0
30	Paid-in or capital surplus, or land, building or equipment fund ...	0	30	0
31	Retained earnings, endowment, accumulated income, or other funds	179,161,776	31	198,511,162
32	Total net assets or fund balances ...........	179,161,776	32	198,511,162
33	Total liabilities and net assets/fund balances ........	189,186,091	33	206,412,270