Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
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.") .. | 28,088 | 9,706 | 353,302 | 177,636 | 1,520,124 | 2,088,856 |
| 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 | 28,088 | 9,706 | 353,302 | 177,636 | 1,520,124 | 2,088,856 |
| 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) .. | 1,238,507 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 850,349 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 28,088 | 9,706 | 353,302 | 177,636 | 1,520,124 | 2,088,856 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 13,808 | 0 | 87,675 | 366,148 | 357,777 | 825,408 |
| 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.).. | 58,617 | 12,450 | 17,834 | 88,901 | ||
| 11 | Total support. Add lines 7 through 10 | 3,003,165 | |||||
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.) | ||||||
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.).. | ||||||
| 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 | ||||
| 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..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 1, UNUSUAL GRANTS: | THE ORGANIZATION RECEIVED ONE GRANT OVER MULTIPLE YEARS WHICH MEETS THE QUALIFICATIONS OF AN 'UNUSUAL GRANT' AS DEFINED BY THE INSTRUCTIONS. THE AMOUNT OF THIS 'UNUSUAL GRANT' IS: 2022 AMOUNT: $69,037 2023 AMOUNT: $70,868 2024 AMOUNT: $68,238 |
| SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME: | CONTRACT REVENUE 2021 AMOUNT: $58,617 FUNDRAISING EVENTS 2023 AMOUNT: $12,450 2024 AMOUNT: $15,764 |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES | THE MISSION OF UVACHF IS TO RAISE COMMUNITY SUPPORT AND FUNDING THROUGH CHARITABLE GIVING FOR MUCH NEEDED PROGRAMS, IMPROVED FACILITIES, AND STATE OF THE ART TECHNOLOGY FOR UVA COMMUNITY HEALTH, AN INTEGRAL PART OF UVA HEALTH. UVA COMMUNITY HEALTH CONSISTS OF AN INTEGRATED NETWORK OF PRIMARY AND SECONDARY CARE FACILITIES, STAFF, AND MEDICAL CARE TEAMS SERVICING COMMUNITIES ACROSS THE GREATER PRINCE WILLIAM, CULPEPER AND WARRENTON GEOGRAPHY INCLUDING THREE MEDICAL CENTERS (CULPEPER, HAYMARKET AND PRINCE WILLIAM), A CANCER CARE LOCATION IN GAINESVILLE, AND SEVERAL MEDICAL GROUP CLINIC LOCATIONS. THE FOUNDATION'S BOARD OF COMMUNITY LEADERS IN PRINCE WILLIAM AND CULPEPER PROVIDES STEWARDSHIP AND OVERSIGHT OF THE ORGANIZATION'S OPERATIONS AND ACTIVITIES. COMMUNITY OUTREACH FUNDRAISING FROM INDIVIDUALS AND COMMUNITY PARTNERS HELP ENSURE THAT OUR PATIENTS CAN ACCESS WORLD-CLASS CLINICIANS, CARE AND TECHNOLOGY. EVENTS SUCH AS THE FRIENDS OF THE FOUNDATION GOLF TOURNAMENT AND PAMPER ME PINK RAISE FUNDS SPECIFICALLY FOR ENHANCED CANCER PATIENT CARE AND MENTAL HEALTH SUPPORT IN OUR COMMUNITIES. IN FISCAL YEAR 2025, FOUNDATION FUNDS PROVIDED FREE MAMMOGRAM SERVICES, PATIENT TRANSPORTATION, DURABLE MEDICAL EQUIPMENT, AND PROFESSIONAL EDUCATION SUPPORT FOR HEALTHCARE PROVIDERS. LEARN MORE ABOUT HOW GIFTS THROUGH UVA COMMUNITY HEALTH FOUNDATION SAVE AND IMPROVE THE LIVES OF THOSE IN THE COMMUNITIES WE SERVE, VISIT HTTPS://GIVING.UVAHEALTH.COM/ORGANIZATION/UVA-COMMUNITY-HEALTH 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 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 V, LINE 1A: INDEPENDENT CONTRACTORS THE 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. |
| FORM 990, PART VI, SECTION A, LINE 2 | FAMILY OR BUSINESS RELATIONSHIPS ELIZABETH WARD AND STEPHEN WARD - FAMILY RELATIONSHIP |
| FORM 990, PART VI, SECTION A, LINE 6 | CLASSES OF MEMBERS OR STOCKHOLDERS THE SOLE MEMBER, UVA PRINCE WILLIAM HEALTH SYSTEM HAS CERTAIN RIGHTS AND POWERS WITH REGARD TO THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF MEMBERS AND THEIR RIGHTS AS THE SOLE MEMBER OF THE ORGANIZATION, UVA PRINCE WILLIAM HEALTH SYSTEM HAS THE POWER TO APPOINT ALL MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS SUBJECT TO APPROVAL OF MEMBERS AS THE SOLE MEMBER, UVA PRINCE WILLIAM HEALTH SYSTEM 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 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. |
| Software ID: | |
| Software Version: |