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FHI SERVICES: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
FHI SERVICES (EIN 54-0573701)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-13
IRS object ID
201402259349301340
Schema version
2012v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-08-13T10:45:14-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 ROCKVILLE PIKE STE 600AddressLine1
CityROCKVILLECity
StateMDState
ZIP Code20850ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN540573701EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1The Fauquier Hospital IncorporatedBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% DARRYL WHITEInCareOfName
Name ControlFAUQNameControl
Phone5403165000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 Hospital DriveAddressLine1
Address Line2SuiteAddressLine2
CityWarrentonCity
StateVAState
ZIP Code20186ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameChristy ConnollyName
TitlePRESIDENT/CEOTitle
Phone5403162609Phone
Date Signed2014-08-07DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAaron D CohenName
Phone2404033700Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRodger H BakerNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 Hospital DrAddressLine1
CityWarrentonCity
StateVAState
ZIP Code20186ZIPCode
FieldValueIRS element (for citing)
Gross Receipts128395072GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.fauquierhealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1954YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionOUR MISSION IS TO RESTORE, PROMOTE AND MAINTAIN THE HEALTH OF THE COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees1122TotalNbrEmployees
Total Nbr Volunteers300TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year270244ContributionsGrantsPriorYear
Contributions Grants Current Year794388ContributionsGrantsCurrentYear
Program Service Revenue Prior Year134281386ProgramServiceRevenuePriorYear
Program Service Revenue CY120255314ProgramServiceRevenueCY
Investment Income Prior Year5188605InvestmentIncomePriorYear
Investment Income Current Year7212120InvestmentIncomeCurrentYear
Other Revenue Prior Year-3827OtherRevenuePriorYear
Other Revenue Current Year120571OtherRevenueCurrentYear
Total Revenue Prior Year139736408TotalRevenuePriorYear
Total Revenue Current Year128382393TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year63095GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY129629GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year63777051SalariesEtcPriorYear
Salaries Etc Current Year60159217SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year67611313OtherExpensePriorYear
Other Expenses Current Year59189977OtherExpensesCurrentYear
Total Expenses Prior Year131451459TotalExpensesPriorYear
Total Expenses Current Year119478823TotalExpensesCurrentYear
Revenues Less Expenses Prior Year8284949RevenuesLessExpensesPriorYear
Revenues Less Expenses CY8903570RevenuesLessExpensesCY
Total Assets BOY234682832TotalAssetsBOY
Total Assets EOY237338864TotalAssetsEOY
Total Liabilities BOY87820773TotalLiabilitiesBOY
Total Liabilities EOY81250261TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY146862059NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY156088603NetAssetsOrFundBalancesEOY
Mission DescriptionOUR MISSION IS TO RESTORE, PROMOTE AND MAINTAIN THE HEALTH OF THE COMMUNITY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense89865389Expense
Grants129629Grants
Revenue120255314Revenue
DescriptionTHE COMMUNITY BENEFIT CONTRIBUTION OF FAUQUIER HOSPITAL INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW: 1. ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFIT: THE FAUQUIER HOSPITAL, INC. (FH) IS A 97-BED, NOT-FOR-PROFIT, ACUTE CARE FACILITY ESTABLISHED IN 1954 TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES FOR THE COMMUNITIES IT SERVES. OUR MISSION IS TO RESTORE, PROMOTE AND MAINTAIN THE HEALTH OF OUR COMMUNITY. FH IS THE ONLY HOSPITAL IN OUR PRIMARY SERVICE AREA OF FAUQUIER COUNTY WITH A POPULATION OF 76,599. OUR SERVICE AREA IS GROWING AND AGING, WITH OVERALL PROJECTED GROWTH BETWEEN 2013-2018 OF 3.8% AND WITH THE 45+ POPULATION COMPRISING 47% OF THE TOTAL IN 2018. TO ADDRESS THE GROWING AND CHANGING HEALTH CARE NEEDS RESULTING FROM THESE POPULATION CHANGES, FH CONTINUES TO SUPPORT FIFTEEN EMPLOYED PHYSICIANS, AN ENDOCRINOLOGIST, AN OBSTETRICS/GYNECOLOGIST ,FAMILY MEDICINE PHYSICIANS, A RHEUMATOLOGIST, NEUROLOGIST, INFECTIOUS DISEASE, INTERNAL MEDICINE AND GENERAL SURGERY. THROUGH PARTNERSHIPS WITH OTHER HEALTH CARE ORGANIZATIONS WE OPERATE A RETAIL HOME HEALTH SUPPLIES STORE AND A CANCER CENTER. WE ALSO PARTNER WITH LOCAL NON-PROFIT ORGANIZATIONS (E.G. FAUQUIER FREE CLINIC, THE CHAMBER OF COMMERCE, SCHOOLS AND CHURCHES) AND NATIONAL ORGANIZATIONS (E.G. THE AMERICAN CANCER SOCIETY) TO SUPPORT LOCAL EVENTS AND PROVIDE COMMUNITY HEALTH AND WELLNESS PROGRAMS. THESE COMMUNITY BENEFITS ACTIVITIES ARE COORDINATED BY TWO FULL-TIME COMMUNITY OUTREACH STAFF, SUPPORTED BY ADMINISTRATIVE AND CLINICAL DEPARTMENTS, AND OUR AUXILIARY VOLUNTEERS AS NEEDED. WE HAVE A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE CARE FOR RESIDENTS OF FAUQUIER AND RAPPAHANNOCK COUNTIES WHO ARE WITHIN 200% OF THE FEDERAL POVERTY GUIDELINES. THE FINANCIAL ASSISTANCE PROGRAM ALSO PROVIDES FREE CARE TO PATIENTS WHO RESIDE IN OTHER AREAS WHO ARE WITHIN 100% OF THE FEDERAL POVERTY GUIDELINES. ALL UNINSURED PATIENTS, REGARDLESS OF INCOME LEVEL OR COUNTY OF RESIDENCE, RECEIVE A 38% DISCOUNT ON HOSPITAL SERVICES AND THE OPTION FOR AN INTEREST-FREE PAYMENT PLAN FOR BALANCES. EVERY UNINSURED PATIENT IS CONTACTED EITHER DURING THEIR STAY OR THE DAY AFTER AN OUTPATIENT VISIT TO DISCUSS FINANCIAL NEEDS. PATIENTS WHO DO NOT MEET THE REQUIREMENTS FOR STATE FUNDING ARE GIVEN A FINANCIAL AID FORM AND ASSISTANCE WITH COMPLETING THE NECESSARY PAPERWORK. THROUGH THE CONTINUING CARE FUND, THE HOSPITAL OFFERS ASSISTANCE TO INDIVIDUALS WHO HAVE INADEQUATE FINANCIAL MEANS TO COVER THE COSTS OF POST-HOSPITALIZATION HEALTH SERVICES, SUCH AS NURSING CARE; THE COST OF THIS PROGRAM TO FH IN FY13 WAS $96,846.64. IN FY13, WE PROVIDED $6,637,025 IN FREE MEDICAL CARE, WHICH INCLUDES $232,261 OF CARE PROVIDED TO FREE CLINIC PATIENTS. 2. ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTION: FH OFFERS ALL PATIENTS IMPARTIAL ACCESS TO TREATMENT OR ACCOMMODATIONS THAT ARE AVAILABLE OR MEDICALLY INDICATED, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, RELIGION, OR SOURCE OF PAYMENT FOR CARE. OUR 24-HOUR EMERGENCY DEPARTMENT IS OPEN TO EVERYONE IN THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. WE HAVE AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN OUR AREA. THE MAJORITY OF THE MEMBERS OF OUR GOVERNING BODIES FOR BOTH OUR HOSPITAL AND HEALTH SYSTEM ARE INDEPENDENT REPRESENTATIVES OF THE COMMUNITIES WE SERVE. TO HELP TRAIN AND EDUCATE HEALTH CARE PROFESSIONALS, FH WORKS WITH LOCAL COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS; FH STAFF PROVIDED APPROXIMATELY 17,063 HOURS AT A COST OF APPROXIMATELY $506,903. FH PARTICIPATES IN MEDICARE, MEDICAID, ANDCHAMPUS/TRICARE STANDARD. 3. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS: FAUQUIER FREE CLINIC (FFC). FFC PROVIDES PRIMARY HEALTH AND DENTAL CARE TO UNINSURED RESIDENTS OF FAUQUIER AND RAPPAHANNOCK COUNTIES. FH PROVIDED LABORATORY, CARDIOLOGY/NEUROLOGY/PULMONARY SERVICES, AND RADIOLOGY SERVICES AT NO CHARGE TO FCC PATIENTS FOR A TOTAL COST OF $232,261. A TOTAL OF 798 HOURS OF FREE CLINICAL CARE WERE PROVIDED BY COMMUNITY PHYSICIANS AND CLINICAL STAFF. TO HELP FFC EXPAND ITS SERVICES TO MEET THE NEEDS OF A GROWING POPULATION, FH LEASED A BUILDING IN APRIL 2006 TO THE FFC FOR $1 PER YEAR FOR 10 YEARS; THE RENTAL VALUE FY13 WAS $85,284. IN ADDITION, FH CONTRIBUTED $5,000 IN UNRESTRICTED FUNDS. COMMUNITY HEALTH EDUCATION, SCREENINGS AND OUTREACH PROGRAMS FAUQUIER HEALTH PROVIDED HEALTH EDUCATION AND HEALTH SCREENINGS AT 106 LOCAL EVENTS FOR 2,678 PEOPLE. FH ALSO OFFERS TOURS OF THE HOSPITAL AND SPEAKERS FOR LOCAL SCHOOLS AND COMMUNITY ORGANIZATIONS TO BUILD RELATIONSHIPS WITHIN THE COMMUNITY, PROMOTE COLLABORATION IN MANAGING HEALTH AND WELLNESS, AND EDUCATE THE COMMUNITY ON THE HEALTH SYSTEM. THE TOTAL COMMUNITY BENEFIT OF THESE SERVICES WAS $56,613. TWO OF SEVERAL FH PUBLICATIONS ARE A COMMUNITY NEWSLETTER, HEALTHY HAPPENINGS, INTENDED TO EDUCATE THE PUBLIC ABOUT HEALTH ISSUES AND HEALTH CARE AND HOSPITAL SERVICES. PUBLISHED QUARTERLY HEALTHY HAPPENINGS, REACHES 100,000 HOMES IN FAUQUIER AND SURROUNDING COUNTIES. The SENIOR LIVING publication is published twice a year and REACHES 37,000 individuals who are 55 and older. THE COST TO FH FOR PUBLICATION AND DISTRIBUTION OF THese NEWSLETTERs IN FY13 WAS $344,208. EMERGENCY SERVICES. FH PROVIDES MEDICAL OVERSIGHT, DIRECTION, AND ORDERS TO PARAMEDICS IN THE FIELD AND EN-ROUTE TO THE HOSPITAL. OUR EMERGENCY DEPARTMENT OFFERS 24-HOUR ACCESS TO MEDICAL SERVICES AND HELICOPTER TRANSPORT FOR CRITICALLY ILL OR INJURED INDIVIDUALS, AND ALSO RESTOCKS MEDICAL BOXES AND PROVIDES CLEAN LINENS FOR RESCUE SQUADS AT A COST TO THE HOSPITAL OF APPROXIMATELY $54,769. SUPPORT GROUPS AND COMMUNITY GROUPS. FH SPONSORED, ASSISTED, OR PROVIDED MEETING SPACE FOR THREE SUPPORT GROUPS THAT MET WEEKLY OR MONTHLY, at a cost to FH of $860. ADDITIONALLY, FH PROVIDED MEETING SPACE OR CASH DONATIONS FOR SEVERAL NON-PROFIT COMMUNITY GROUPS, (E.G. The American Red Cross, FAUQUIER FREE CLINIC AND American Cancer Society Fauquier Chapter), with a fair market VALUE OF THE MEETING SPACE of $29,963. CASH DONATIONS TOTALED $14,715. FH EMPLOYEES PROVIDED REPRESENTATION ON COMMUNITY BOARDS AND COALITIONS AT AN EXPENSE OF $73,814. PHYSICIAN REFERRAL. THE HOSPITAL ASSISTED 2,417 PEOPLE WITH THE PHYSICIAN REFERRAL PROGRAM, WHICH HELPS THE COMMUNITY WITH QUESTIONS ON PHYSICIANS, APPOINTMENTS, CLASSES AND PROGRAMS REGISTRATION, AND HEALTH RESOURCES AVAILABLE THROUGH THE HOSPITAL OR IN THE COMMUNITY. IT COST FH $31,733 TO PROVIDE THIS SERVICE IN FY13. 4. LINKS TO ADDITIONAL COMMUNITY BENEFIT INFORMATION * FAUQUIER HOSPITAL WEBSITE - WWW.FAUQUIERHEALTH.ORG * FAUQUIER ASSISTANCE INFORMATIONN - http://www.fauquierhealth.org/patients.financial-assistance-policyDescription
Total Program Service Expense89865389TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiestrueForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096187NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1122NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledVAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDARRYL WHITENamePerson
Telephone Number5403165000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1500 HOSPITAL DRAddressLine1
CityWarrentonCity
StateVAState
ZIP Code20186ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
RODGER BAKER
PRESIDENT/CEO29.011.0XX1087052072527
MARSHALL DOELLER
CHAIRMAN3.03.0XX000
REV JENNINGS HOBSON
VICE CHAIRMAN3.03.0XX000
JOHN MCCARTHY
TRUSTEE3.03.0X000
KEVIN CARTER
TRUSTEE3.03.0X000
MARK VAN DE WATER
TRUSTEE3.03.0X000
SUSAN RUBIN
TRUSTEE3.06.0X000
CAREN EASTHAM
TRUSTEE3.06.0X000
MARY LEIGH MCDANIEL
TRUSTEE3.03.0X000
ADAM WINICK MD
TRUSTEE3.03.0X000
JOSHUA JAKUM MD
TRUSTEE3.03.0X000
ROBIN GULICK
SECRETARY/TREASURER3.03.0XX000
RAYMOND KNOTT
TRUSTEE3.03.0X000
JANELLE DOWNES
TRUSTEE3.03.0X000
LYNN SAMUEL MD
MEDICAL STAFF PRESIDENT3.03.0X000
LIONEL PHILLIPS
VP FINANCE/CFO30.010.0X305716021251
LINDA SHARKEY
VP PATIENT CARE/CNE40.00.0188183013526X
KATHERINE REEVES
VP HUMAN RESOURCES30.010.01600140658X
GREGORY BENGSTON
VP BUS DEV & PROF SERVICES30.010.0180031020024X
MARY SMITH
VICE PRESIDENT SENIOR SERVICES30.010.019812807818X
TRACY TURMAN
VP SUPPORT SERVICES40.00.0134220018446X
CHRISTINE CONNOLLY
president faquier foundation0.040.0178450021554X
ANHTAI NGUYEN
chief medical officer40.00.0263838021638X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2695632TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation197442TotalOtherCompensation
Number Individuals GT100 K58NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
VIRGINIA EMERGENCY MEDICINE ASSOCIA
4094 MAJESTIC LNFAIRFAXVA22033HEALTH CARE1472541
TWIN CONTRACTING CORP
12700 SUNRISE VALLEY DRIVE STE 100RESTONVA20191SERVICES1199933
POINT TO POINT INC
23240 CHAGRIN BLVD STE 200CLEVELANDOH44122MARKETING SERVICES855401
API HEALTHCARE CORP
1550 INNOVVATION WAYHARTFORDWI530278720INFORMATION SYSTEMS838648
ALLIANCE HEALTHCARE SERVICES
PO BOX 96485CHICAGOIL606936485HEALTH CARE769611
FieldValueIRS element (for citing)
Number Of Contractors GT100 K20NumberOfContractorsGT100K
Related Organizations793869RelatedOrganizations
All Other Contributions519AllOtherContributions
Total Contributions794388TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REV116597971116597971
OTHER OPERATING26867522686752
THERAPY SERVICES941925941925
OTHER MISC2866628666
FieldValueIRS element (for citing)
Total Program Service Revenue120255314TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4671509TotalRevenueColumn
Exclusion$4,671,509ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2540611Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities2540611Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2540611TotalRevenueColumn
Exclusion$2,540,611ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory133250GrossSalesOfInventory
Cost Of Goods Sold12679CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column120571TotalRevenueColumn
Exclusion$120,571ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column128382393TotalRevenueColumn
Related Or Exempt Function Income120255314RelatedOrExemptFunctionIncome
Exclusion$7,332,691ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total129629Total
Program Services129629ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1781671Total
Program Services0ProgramServices
Management And General1781671ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total46885518Total
Program Services39201620ProgramServices
Management And General7683898ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1326833Total
Program Services1068770ProgramServices
Management And General258063ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6654376Total
Program Services5360127ProgramServices
Management And General1294249ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3510819Total
Program Services2827979ProgramServices
Management And General682840ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total838509Total
Management And General838509ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total98513Total
Management And General98513ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total208500Total
Management And General208500ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total582425Total
Management And General582425ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1105138Total
Program Services480657ProgramServices
Management And General624481ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total3477702Total
Management And General3477702ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2091008Total
Program Services1822478ProgramServices
Management And General268530ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total447504Total
Program Services144548ProgramServices
Management And General302956ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total2408963Total
Program Services2408963ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total9065302Total
Program Services7001280ProgramServices
Management And General2064022ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total611341Total
Program Services334722ProgramServices
Management And General276619ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BLOOD BANK745496745496
COLLECTION880948880948
CONTRACT SERVICES620014633947072805439
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Total10303495Total
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Management And General5172789ManagementAndGeneral

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BOY63687855BOY
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Intangible Assets IntangibleAssets

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Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

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Grants Payable GrantsPayable

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Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
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Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
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Loans From Officers Directors LoansFromOfficersDirectors

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FieldValueIRS element (for citing)
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EOY81250261EOY
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Unrestricted Net Assets UnrestrictedNetAssets

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Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
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EOY237338864EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses8903570ReconcilationRevenueExpenses
Reconciliation Unrealized Invest6481037ReconciliationUnrealizedInvest
Reconcilation Other Changes-6158063ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

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Financial Statement ConsolidatedXFinancialStatementConsolidated
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Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

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Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

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Contributor Name Business ContributorNameBusiness

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Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance8623235BeginningOfYearBalance
Contributions519Contributions
Investment Earnings Or Losses689130InvestmentEarningsOrLosses
Other Expenditures238906OtherExpenditures
Administrative Expenses15932AdministrativeExpenses
End Of Year Balance9058046EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance7688981BeginningOfYearBalance
Contributions616Contributions
Investment Earnings Or Losses1188611InvestmentEarningsOrLosses
Other Expenditures240718OtherExpenditures
Administrative Expenses14255AdministrativeExpenses
End Of Year Balance8623235EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
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Contributions739Contributions
Investment Earnings Or Losses-99088InvestmentEarningsOrLosses
Other Expenditures250195OtherExpenditures
Administrative Expenses13071AdministrativeExpenses
End Of Year Balance7688981EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance7627551BeginningOfYearBalance
Contributions699Contributions
Investment Earnings Or Losses648318InvestmentEarningsOrLosses
Other Expenditures213797OtherExpenditures
Administrative Expenses12175AdministrativeExpenses
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Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
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Investment Earnings Or Losses442346InvestmentEarningsOrLosses
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Administrative Expenses13422AdministrativeExpenses
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FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RtrueAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis584539OtherCostOrOtherBasis
Book Value584539BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis75521727OtherCostOrOtherBasis
Depreciation37062591Depreciation
Book Value38459136BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2353281OtherCostOrOtherBasis
Depreciation2331807Depreciation
Book Value21474BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis97627356OtherCostOrOtherBasis
Depreciation76681092Depreciation
Book Value20946264BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8026586OtherCostOrOtherBasis
Depreciation4432735Depreciation
Book Value3593851BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings63605264TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
DUE TO THIRD PARTY PAYERS$2,828,157
ACCRUED INTEREST PAYABLE$699,838
CAPITAL LEASE$726,634
PROFESSIONAL LIABILITY$2,383,330
FieldValueIRS element (for citing)
Total Of Amounts6637959TotalOfAmounts

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierSch D Part XIVIdentifier
ExplanationThe Fauquier Hospital Endowment Fund (the Trust) is an irrevocable trust created by the Chichester DuPont System in 1959. A local bank was designated as the trustee and remits income from the Trust to the Hospital semiannually. The income may be employed by the Hospital to further its work in such manner as the Board of Trustees of the Hospital determines.Explanation

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCentral America and the CaribbeanRegion
Type Of Activities ConductedInvestmentsTypeOfActivitiesConducted
Total Expenditures19304115TotalExpenditures
FieldValueIRS element (for citing)
Subtotal Amount Spent19304115SubtotalAmountSpent
Total Amount Spent19304115TotalAmountSpent
Transfer To Foreign CorptrueTransferToForeignCorp
Interest In Foreign TrustfalseInterestInForeignTrust
Own Foreign CorpfalseOwnForeignCorp
Passive Foreign Invest CofalsePassiveForeignInvestCo
Foreign PartnershipfalseForeignPartnership
Boycott CountriesfalseBoycottCountries

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigentfalseFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense6110727TotalCommunityBenefitExpense
Net Community Benefit Expense6110727NetCommunityBenefitExpense
Percent Of Total Expense0.05110PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense7826862TotalCommunityBenefitExpense
Direct Offsetting Revenue6488655DirectOffsettingRevenue
Net Community Benefit Expense1338207NetCommunityBenefitExpense
Percent Of Total Expense0.01120PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense13937589TotalCommunityBenefitExpense
Direct Offsetting Revenue6488655DirectOffsettingRevenue
Net Community Benefit Expense7448934NetCommunityBenefitExpense
Percent Of Total Expense0.06230PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1232988TotalCommunityBenefitExpense
Direct Offsetting Revenue28981DirectOffsettingRevenue
Net Community Benefit Expense1204007NetCommunityBenefitExpense
Percent Of Total Expense0.01010PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense565913TotalCommunityBenefitExpense
Net Community Benefit Expense565913NetCommunityBenefitExpense
Percent Of Total Expense0.00470PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense7666698TotalCommunityBenefitExpense
Direct Offsetting Revenue4080808DirectOffsettingRevenue
Net Community Benefit Expense3585890NetCommunityBenefitExpense
Percent Of Total Expense0.03000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense88529TotalCommunityBenefitExpense
Net Community Benefit Expense88529NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense9554128TotalCommunityBenefitExpense
Direct Offsetting Revenue4109789DirectOffsettingRevenue
Net Community Benefit Expense5444339NetCommunityBenefitExpense
Percent Of Total Expense0.04550PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
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Direct Offsetting Revenue10598444DirectOffsettingRevenue
Net Community Benefit Expense12893273NetCommunityBenefitExpense
Percent Of Total Expense0.10780PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Total Community Building Expense2135TotalCommunityBuildingExpense
Net Community Building Expense2135NetCommunityBuildingExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense564TotalCommunityBuildingExpense
Net Community Building Expense564NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense2699TotalCommunityBuildingExpense
Net Community Building Expense2699NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,905,145BadDebtExpenseAmount
Amount Reimbursed By Medicare37467346AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare51378937CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-13911591MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1The Fauquier Hospital IncorporatedBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1500 Hospital DriveAddressLine1
CityWarrentonCity
StateVAState
ZIP Code20186ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
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FieldValueIRS element (for citing)
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CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Needs Assessment Conducted11NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiesfalseOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.FPGFreePercent
Uses FPG DiscountedfalseUsesFPGDiscounted
Explains BasistrueExplainsBasis
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Asset LevelXAssetLevel
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
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Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

IdentifierIdentifierExplanationExplanation
Part I, Line 3cALL PATIENTS WHO ARE RESIDENTS OF FAUQUIER OR RAPPAHANNOCK COUNTIES, WHOSE ANNUAL HOUSEHOLD INCOME LEVELS ARE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES, ARE ELIGIBLE FOR FREE CARE. THIS PROCESS REQUIRES AN APPLICATION AND VERIFICATION OF ALL SOURCES OF INCOME. In addition, aLL PATIENTS WHO ARE NON RESIDENTS OF FAUQUIER OR RAPPAHANNOCK COUNTIES AND WHOSE ANNUAL HOUSEHOLD INCOME FALLS AT OR BELOW 100% OF THE FEDERAL POVERTY GUIDELINES ARE ALSO ELIGIBLE FOR FREE CARE AFTER COMPLETING THE SAME APPLICATION AND INCOME VERIFICATION PROCESS. BEFORE FINAL COLLECTION ACTION, ACCOUNTS ARE PUT THROUGH CREDIT SCORING SOFTWARE TO HELP IDENTIFY THOSE PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAVE NOT CONTACTED OUR OFFICE UP TO THAT POINT. IF THE SOFTWARE INDICATES THAT THE PATIENT'S INCOME LEVEL MEETS FINANCIAL ASSISTANCE ELIGIBILITY, THE ACCOUNT IS WRITTEN OFF TO CHARITY AND FURTHER COLLECTION ACTIVITY IS NOT PURSUED. Furthermore, all uninsured patients that do not qualify under the hospital's Financial assistance policy are eligible for a 38% discount on hospital Services and have the option of an interest free payment plan for any balances.
Part I, Line 6aFauquier Health prepares its own community benefit report, which it posts on the hospital and foundation's websites. In addition, a hard copy of the community benefit report is sent out to approximately 10,000 community leaders and donors.
Part I, Line 7PART I, LINE 7G FAUQUIER HEALTH, AS PART OF ITS MEDICAL STAFF DEVELOPMENT PLAN, IDENTIFIES SPECIFIC PHYSICIAN SPECIALTY SHORTAGES IN THE COMMUNITY AND RECRUITS PHYSICIANS TO THE COMMUNITY TO PROVIDE PATIENT SERVICES IN THOSE AREAS OF IDENTIFIED COMMUNITY NEED. THE PHYSICIANS ARE EMPLOYED BY A WHOLLY OWNED HOSPITAL AFFILIATE, FAUQUIER HEALTH PHYSICIANS SERVICES, LLC. THE COST OF OPERATING THIS PHYSICIAN PRACTICE AND MAKING THESE SPECIALTIES AVAILABLE TO THE COMMUNITY WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY EXCEEDS THE REVENUE COLLECTED. THE NECESSARY SUBSIDY IS PROVIDED BY THE FAUQUIER HOSPITAL. THESE SPECIALTIES INCLUDED INFECTIOUS DISEASE, RHUMATOLOGY, NEUROLOGY, ENDOCRINOLOGY, OBSTETRICS, ONCOLOGY, ENT AND PRIMARY CARE.
Part IIFAUQUIER HEALTH'S COMMUNITY BUILDING ACTIVITIES SUPPORT THE HEALTH OF THE COMMUNITY BY OFFERING COMMUNITY SUPPORT; ENVIRONMENTAL IMPROVEMENTS; AND PHYSICAL IMPROVEMENTS AND HOUSING. COMMUNITY SUPPORT - THE DISASTER READINESS SUPPLIES PREPARE OUR COMMUNITY FOR POTENTIAL DISASTERS SUCH AS NATURAL DISASTERS, ELECTRICITY OUTAGES OR DIRTY BOMBS FOR A TIME PERIOD OF 96 HOURS. IN ADDITION, THE HOSPITAL SERVES AS A DEFAULT SAFE HAVEN FOR HOME BOUND INDIVIDUALS WHO ARE ON OXYGEN. SUPPORT OF FIRST NIGHT HELPS SUPPORT HEALTHY AND SAFE ACTIVITIES FOR THE COMMUNITY TO BE INVOLVED IN FOR NEW YEARS EVE. IN ADDITION, CONTRIBUTIONS SUPPORTED EXERCISE ACTIVITIES AND PLAYGROUND EQUIPMENT FOR A LOCAL SCHOOL. ENVIRONMENTAL IMPROVEMENTS - FAUQUIER HEALTH'S ANNUAL MEDICATION AND SHARPS COLLECTION EVENT HELPS TO SAFELY DISPOSE OF 136 GALLONS OF SHARPS AND 330 LBS OF MEDICATIONS. RATHER THAN COMMUNITY MEMBERS FLUSHING MEDICATIONS INTO THE GROUND WATER OR DISPOSING OF SHARPS AT THE LANDFILL, FAUQUIER HEALTH COLLECTS THEM AND WORKS WITH A MEDICAL WASTE MANAGEMENT COMPANY THAT DISPOSES OF THE ITEMS. LASTLY THE PHYSICAL IMPROVEMENTS AND HOUSING ACTIVITIES HELPED ORGANIZE AND RENOVATE THE FACILITIES AT AT LOCAL NON-PROFIT THAT OFFERS SHELTER AND EDUCATION FOR THE HOMELESS; A FOOD PANTRY AND FREE CLOTHING TO INDIVIDUALS IN NEED.
Part III, Line 2The hospital's calculated ratio of cost to charge was applied to the total bad debt expense for the reporting year to arrive at the cost of the organization's bad debt expense. The ratio of patient care cost to total charges is developed in Schedule H, Worksheet 2 and applied to the total charges for Bad Debt Expense to arrive at the amount in Part III, Section A, Line 2. The cost from Line 2 is then adjusted down to represent the estimated portion of Bad Debt Expense that would qualify for the Hospital's financial assistance policy, i.e. Charity care. The corresponding cost should be included as a community benefit.
Part III, Line 4Accounts Receivable are reported net of allowances for the excess of charges over the payments on patient accounts to be received from third party payers and estimates of uncollectible amounts. The system's policy is to write-off all patient accounts that have been identified as uncollectable. Any allowance for doubtful accounts is recorded for accounts not yet written off that may become uncollectable in future periods based on managment's assessment of historical and expected net collections for each of its major payers. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payers, and others for services rendered, and include estimated retroactive revenue adjustments due to future audits, reviews and investigations. Retroactive adjustments are considered in the recognition of revenue on an estimated basis in the period the related services are rendered, and such amounts are adjusted in future periods as adjustments become known or as years are no longer subject to such audits, reviews and investigations. During the 2012 tax year, Fauquier Hospital periodically employed credit scoring software to help identify patients that might be eligible for financial assistance under the Hospital's financial assistance policy, which had not completed a financial assistance application. If the software indicated that the patient's income level met financial assistance eligibility under the Hospital's financial assistance policy, then the account was written off to charity and further collection activity was not pursued. As a result of the periodic use of such credit scoring software throughout the year, it is difficult to estimate the amount of the bad debt expense attributable to patients that might qualify for financial assistance under the Hospital's financial assistance policy. Therefore, the Hospital has reported $0.
Part III, Line 8The shortfall for Medicare is not currently included/considered in community benefit. However, the shortfall is due to the reimbursement from Medicare falling short of the cost incurred to provide care to the Medicare population served by The Fauquier Hospital. As with the shortfall experienced for the Medicaid population, the Medicare shortfall should be considered a community benefit as well. It is part of the organization's mission to provide the best possible care to elderly patients within our community, and the organization believes providing such care has improved the overall health of the community. By providing such care to Medicare patients, the governme nt's burden for caring for such individuals is lessened. The Medicare cost report was utilized as outlined in the Schedule H, Part III, Section B, Worksheet B, which utilizes the cost to charge ratio developed within the Medicare Cost Report to determine the allowable cost.
Part III, Line 9bFauquier Hospital's Financial Assistance policy contains the following provision on collection practices for those patients who qualify for financial assistance: Fauquier Hospital management shall develop policies and procedures for internal and external collection practices (including actions the hospital may take in the event of non-payment, including collections action and reporting to credit agencies) that take into account the extent to which the patient qualifies for charity care or discounted care; a patient's good faith efforts to apply for governmental assistance programs or financial assistance from Fauquier Hospital, and a patient's good faith effort to comply with his or her payment agreements with Fauquier Hospital. Fauquier Hospital will not impose extraordinary collections actions such as lawsuits, wage garnishments, arrests, body attachments, liens on residences, or other similar legal actions against any patient without first making reasonable efforts to determine whether that patient is eligible for financial assistance under this financial assistance policy. "Reasonable efforts" include notifications by the hospital of this financial assistance policy upon admission and in written and oral communications with the patient regarding the patient's bill, including invoices and telephone calls before collection action or reporting to credit agencies is initiated. If a patient is found to qualify for financial assistance after collection actions have started, all collection activity is immediately stopped, notifications are sent to the credit bureau if necessary and patients are not charged for collection fees. If a patient is found to qualify for financial assistance after making payments towards their balance, the payments are refunded to the patient.
Part V, Line 3FAUQUIER HOSPITAL CONSULTED WITH COMMUNITY HEALTH SOLUTIONS OF RICHMOND, VIRGINIA, TO CONDUCT THE HEALTH NEEDS ASSESSMENT. INPUT WAS REQUESTED FROM 60 COMMUNITY STAKEHOLDERS VIA AN ONLINE SURVEY INCLUDING LOCAL EMS, UNITED WAY, PUBLIC AND PRIVATE SCHOOLS.
Part V, Line 5cIn addition to sharing the Health Needs Assessment on the Fauquier Health website, it was distributed to the community stakeholders who were invited to take part in the online survey; the Warrenton office of the Rappahannock Rapidan Health Department as well as anyone who requests a copy of the assessment.
Part V, Line 7The Fauquier Hospital's health needs assessment identified and evaluated the global community health needs of our primary service area of Fauquier and Rappahannock Counties. Of the many community service gaps and health needs identified, Fauquier Health chose the area of greatest need and where the greatest impact could be made. Those topics are transportation, health education, aging services and early detection and screening in addition to leading causes of death, which are: cancer, heart disease, diabetes and Alzheimer's. Childhood obesity, a community health concern is also being addressed. To help address transportation, Fauquier Health supported with a donation, Voltran, a local nonprofit that coordinates volunteers who drive individuals to medical appointments. In addition Fauquier Health partnered with Virginia Regional Transit and Culpeper Hospital to contribute towards a bus route through the rural, southern part of the county to bring people to the hospital. To address health education and leading causes of death, the hospital hosts free, monthly health lectures on various topics identified in the assessment such as cancer, heart disease, Alzheimers, diabetes, congestive heart failure and chronic obstructive pulmonary disease. The annual health fair provides health screenings for b/p, cholesterol, blood glucose, breast and PSA screenings. Fauquier Health addresses diabetes, by providing diabetes education including lectures, support groups, self-management classes, screenings, counseling and cooking demos. Free mammograms are provided to women turning 40 to provide breast cancer screenings. To address aging services, Fauquier Health facilitates support groups for Alzheimer's, dementia, cancer, caregivers and diabetes. In addition, Fauquier partners with the local community service board and Aging Together to host Medicare/Medicaid counseling and a Falls Symposium and Alzheimer's/Dementia workshop. Fauquier Health partnered with three community organizations to address childhood obesity through an 8 week summer camp program that highlighted physical activity and nutrition. The health needs identified that the hospital is not addressing are those that the hospital believes are better handled by other local organizations or government entities. Examples include, low birth weights which are addressed by the local health department and social services. Dental care is not the expertise of the hospital so is addressed by the local health department and the local free clinic. Behavioral health is currently addressed by the local community services board, however the hospital is exploring initiatives to address the need in the community. The hospital supports the local free clinic financially and with donated lab and radiology services to provide care to the uninsured population. The results of the health needs assessment are continually being reviewed and considered by Fauquier Hospital leadership. They are considering options into incorporating the health needs identified into the hospital's strategic plan for the years to come.
Part V, Line 14gIn addition to publishing the Financial Assistance Policy on the hospital's website, signage is posted strategically throughout the hospital (including all inpatient, outpatient, ancillary and emergency department registration offices) which indicates that financial assistance is available and provides contact information for financial counselors who can help with the application process. Notifications regarding the policy are available in both English and Spanish, the primary languages spoken by the population served by Fauquier Hospital. Representatives of our Financial Assistance Eligibility partners, Advanced Patient Advocacy, also direct all patients who are screened for state or federal assistance programs but do not qualify to the hospital financial counselors for hospital charity screening.
Part VI, Line 2, Needs AssessmentFauquier Health assesses the health needs of the community by conducting a health needs assessment every three years as well as continually communicating with the community stakeholders who are serving our areas residents. For example, Fauquier Health meets regularly with the Fauquier Free Clinic leadership and provides financial and in-kind assistance to the Clinic which serves the uninsured in Fauquier and Rappahannock Counties.
Part VI, Line 3, Patient education of eligibility for assistanceNotification of Fauquier Hospital's financial assistance program is disseminated by various means, including notification of contact information for financial counselors on all of our billing statements and signage in all of our patient registrations areas. The policy itself is available on the hospital website, which also provides contact information for our financial counselors. Requests for financial assistance may be made at any point in the collection cycle. Every billing statement received by a patient includes the following language: "In meeting your financial obligations for the care provided by Fauquier Hospital we ask that you work with us on any bills that you are having difficulty paying. You will find our staff understanding and eager to help you." This message is followed by a list of telephone numbers that the patient may call to reach the organization's financial counseling staff, hours of operation, and an email address. When patients call the financial counseling telephone number, they are prompted to selections to reach the staff member that is most likely able to help them i.e.: uninsured, Spanish speaking, billing questions, etc. In addition, uninsured inpatients and those with Medicare insurance and no secondary carrier are contacted (usually a personal visit in their hospital room) by an employee of one of our partners, Advanced Patient Advocacy (APA). The APA personnel screen these patients for eligibility for available state or federal programs. If these patients do not meet criteria for these programs, they are then referred to a financial counselor for screening for the hospital's financial assistance program. Outpatients whose accounts meet a threshold of $750 in charges are also contacted by APA by either telephone, letter or both. Uninsured patients who visit our Emergency Department are also given a packet of information that includes a financial assistance application and a business card with the name and contact information for one of our financial counselors. Lastly, we do use Credit Scoring software to help identify patients who might qualify for financial assistance but have not contacted our office. Our financial assistance policy states that we may use this kind of software, which uses information from credit bureaus and screens patients against the criteria of our financial assistance policy.
Part VI, Line 4, Community InformationThe Fauquier Hospital, Inc. (FH) is a 97-bed, not-for-profit, acute care facility established in 1954 to provide comprehensive health care services to the rural communities it serves. Our mission is to restore, promote and maintain the health of our community. Fauquier Hospital is the only hospital in our primary service area, which includes Fauquier and minor portions of five surrounding counties. The primary service area has a population of 76,599. The average household income is $108,480. 8.1% of the community residents have incomes below the federal poverty guideline. 19.3% of Fauquier Hospital's patients are Medicaid recipients or self-pay. The following districts within Fauquier County are considered MUA/P by the Health Resources and Services Administration (HRSA): Lee District and Marshall District.
Part VI, Line 5, Promotion of community healthFauquier Health promotes the health of the community by: * Ensuring that the majority (92%) of the individuals serving on the Fauquier Hospital and Fauquier Health System Board of Directors reside in the primary service area and are not employees or contractors of the organization. * Extending medical staff privileges to all qualified physicians in the community who are interested. * Fauquier Health uses surplus funds to improve patient care by upgrading the tools needed to care for our patients and planning for improvements. Fauquier Health continues to support twelve employed physicians, an Endocrinologist, and Obstetrics/Gynecologist, family medicine physicians, a Rheumatologist, Neurologist, Infectious Disease, Internal Medicine and General Surgery. * THROUGH PARTNERSHIPS WITH OTHER HEALTH CARE ORGANIZATIONS WE OPERATE A RETAIL HOME HEALTH SUPPLIES STORE AND A CANCER CENTER. WE ALSO PARTNER WITH LOCAL NON-PROFIT ORGANIZATIONS (E.G. FAUQUIER FREE CLINIC, THE CHAMBER OF COMMERCE, SCHOOLS AND CHURCHES) AND NATIONAL ORGANIZATIONS (E.G. THE AMERICAN CANCER SOCIETY) TO SUPPORT LOCAL EVENTS AND PROVIDE COMMUNITY HEALTH AND WELLNESS PROGRAMS. THESE COMMUNITY BENEFITS ACTIVITIES ARE COORDINATED BY TWO FULL-TIME COMMUNITY OUTREACH STAFF, SUPPORTED BY ADMINISTRATIVE AND CLINICAL DEPARTMENTS, AND OUR AUXILIARY VOLUNTEERS AS NEEDED. * TO HELP TRAIN AND EDUCATE HEALTH CARE PROFESSIONALS, FH WORKS WITH LOCAL COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS; FH STAFF PROVIDED APPROXIMATELY 17,063 HOURS AT A COST OF APPROXIMATELY $506,903. * ADDITIONALLY, THE ORGANIZATION PROVIDES ASSISTANCE TO THE FAUQUIER FREE CLINIC (FFC). FFC PROVIDES PRIMARY HEALTH AND DENTAL CARE TO UNINSURED RESIDENTS OF FAUQUIER AND RAPPAHANNOCK COUNTIES. FH PROVIDED LABORATORY, CARDIOLOGY/NEUROLOGY/PULMONARY SERVICES, AND RADIOLOGY SERVICES AT NO CHARGE TO FCC PATIENTS FOR A TOTAL COST OF $232,261. A TOTAL OF 798 HOURS OF FREE CLINICAL CARE WERE PROVIDED BY COMMUNITY PHYSICIANS AND CLINICAL STAFF. TO HELP FFC EXPAND ITS SERVICES TO MEET THE NEEDS OF A GROWING POPULATION, FH LEASED A BUILDING IN APRIL 2006 TO THE FFC FOR $1 PER YEAR FOR 10 YEARS; THE RENTAL VALUE FY13 WAS $85,284. IN ADDITION, FH CONTRIBUTED $5,000 IN UNRESTRICTED FUNDS. * FAUQUIER HEALTH PROVIDED HEALTH EDUCATION AND HEALTH SCREENINGS AT 106 LOCAL EVENTS FOR 2,678 PEOPLE. FH ALSO OFFERS TOURS OF THE HOSPITAL AND SPEAKERS FOR LOCAL SCHOOLS AND COMMUNITY ORGANIZATIONS TO BUILD RELATIONSHIPS WITHIN THE COMMUNITY, PROMOTE COLLABORATION IN MANAGING HEALTH AND WELLNESS, AND EDUCATE THE COMMUNITY ON THE HEALTH SYSTEM. THE TOTAL COMMUNITY BENEFIT OF THESE SERVICES WAS $56,613. * TWO OF SEVERAL FH PUBLICATIONS ARE A COMMUNITY NEWSLETTER, HEALTHY HAPPENINGS AND SENIOR LIVING, INTENDED TO EDUCATE THE PUBLIC ABOUT HEALTH ISSUES AND HEALTH CARE AND HOSPITAL SERVICES. PUBLISHED QUARTERLY HEALTHY HAPPENINGS, REACHES 100,000 HOMES IN FAUQUIER AND SURROUNDING COUNTIES. The SENIOR LIVING publication is published twice a year and REACHES 37,000 individuals who are age 55 and older. THE COST TO FH FOR publication and distribution of these newletters in FY13 WAS $344,208. * FH PROVIDES MEDICAL OVERSIGHT, DIRECTION, AND ORDERS TO PARAMEDICS IN THE FIELD AND EN-ROUTE TO THE HOSPITAL. OUR EMERGENCY DEPARTMENT OFFERS 24-HOUR ACCESS TO MEDICAL SERVICES AND HELICOPTER TRANSPORT FOR CRITICALLY ILL OR INJURED INDIVIDUALS, AND ALSO RESTOCKS MEDICAL BOXES AND PROVIDES CLEAN LINENS FOR RESCUE SQUADS AT A COST TO THE HOSPITAL OF APPROXIMATELY $54,769. * FH SPONSORED, ASSISTED, OR PROVIDED MEETING SPACE FOR THREE SUPPORT GROUPS THAT MET WEEKLY OR MONTHLY, at a cost to FH of $860. ADDITIONALLY, FH PROVIDED MEETING SPACE OR CASH DONATIONS FOR SEVERAL NON-PROFIT COMMUNITY GROUPS, (E.G. the American Red Cross, FAUQUIER FREE CLINIC AND American Cancer Society Fauquier Chapter). THE fair market VALUE OF THE MEETING SPACE IS $29,963. CASH DONATIONS TOTALED $14,715. FH EMPLOYEES PROVIDED REPRESENTATION ON COMMUNITY BOARDS AND COALITIONS AT AN EXPENSE OF $73,814. * THE HOSPITAL ASSISTED 2,417 PEOPLE through THE PHYSICIAN REFERRAL PROGRAM, WHICH HELPS THE COMMUNITY WITH QUESTIONS ON PHYSICIANS, APPOINTMENTS, CLASSES AND PROGRAMS REGISTRATION, AND HEALTH RESOURCES AVAILABLE THROUGH THE HOSPITAL OR IN THE COMMUNITY. IT COST FH $31,733 TO PROVIDE THIS SERVICE IN FY13.
Part VI, Line 6, Affiliated health care systemTHE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. THE ORGANIZATION OPERATES A 97-BED ACUTE CARE HOSPITAL, WHICH PROVIDES GENERAL MEDICAL AND SURGICAL SERVICES AND OPERATES A 24/7 EMERGENCY ROOM. THE HOSPITAL IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA OF FAUQUIER COUNTY. THE FAUQUIER HEALTH SYSTEM ALSO OPERATES A 113 BED NURSING HOME AND 67 RESIDENT ASSISTED LIVING FACILITY THROUGH ITS RELATED ORGANIZATION FAUQUIER HEALTH SENIOR LIVING, INC. ADDITIONALLY, THE SYSTEM OPERATES A NUMBER OF PHYSICIAN PRACTICES. THE SYSTEM IDENTIFIES SPECIFIC PHYSICIAN SPECIALTY SHORTAGES IN THE COMMUNITY AND EMPLOYS PHYSICIANS IN THOSE SPECIALTY AREAS TO PROVIDE SUCH CARE TO THE COMMUNITY. THE COST OF OPERATING THESE PHYSICIAN PRACTICES, THEREBY MAKING THESE SPECIALTIES AVAILABLE TO THE COMMUNITY (INCLUDING TO THOSE PATIENTS THAT DO NOT HAVE THE ABILITY TO PAY), FAR EXCEEDS THE REVENUE COLLECTED FROM PROVIDING THE SERVICES. AMONG THE SPECIALTIES PROVIDED BY THE PHYSICIAN PRATICES ARE INFECTIOUS DISEASE, RHUMATOLOGY, NEUROLOGY, ENDOCRINOLOGY, OBSTETRICS, ONCOLOGY, ENT AND PRIMARY CARE. IN THE 2010 TAX YEAR, THE SYSTEM ADDED SIX EMPLOYED PHYSICIANS TO ITS STAFF: AN ENDOCRINOLOGIST, AND OBSTETRICS/GYNECOLOGIST AND THREE FAMILY MEDICINE PHYSICIANS. ADDITIONALLY, THE SYSTEM IMPLEMENTED A HOME HEALTH DISEASE MANAGEMENT TRAINING PROGRAM (TO INCLUDE CONGESTIVE HEART FAILURE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND DIABETES) FOR PATIENTS; DEVELOPED A TRANSITION TO HOME PROGRAM THAT ADDRESSES CHRONIC DISEASE MANAGEMENT AND READMISSION RATES FOR PATIENTS; AND UNDERTOOK FEASIBILITY STUDIES FOR A NEONATAL INTENSIVE CARE UNIT AND AN AMBULATORY SURGERY CENTER.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1The Fauquier Hospital AuxiliaryBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1500 Hospital DriveAddressLine1
CityWarrentonCity
StateVAState
ZIP Code20186ZIPCode
FieldValueIRS element (for citing)
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant129629AmountOfCashGrant
Purpose Of Grantto support auxiliary with profits from gift shopPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPART I, LINE 2Identifier
ExplanationTHE HOSPITAL PROVIDED A GRANT TO FAUQUIER HOSPITAL AUXILIARY. THE FAUQUIER HOSPITAL AUXILIARY IS A VOLUNTEER ORGANIZATION CLOSELY CONNECTED TO THE FAUQUIER HOSPITAL, WHICH OPERATES A GIFT SHOP, THRIFT SHOP AND ENGAGES IN FUNDRAISING ACTIVITIES ON BEHALF OF THE FAUQUIER HOSPITAL AND ITS TAX-EXEMPT AFFILIATES. THE FAUQUIER HOSPITAL AUXILIARY ALSO PROVIDES SCHOLARSHIPS TO LOCAL HIGH SCHOOL STUDENTS WITH IN THE FAUQUIER HOSPITAL COMMUNITY PERSUING DEGREES IN THE MEDICAL FIELD.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RODGER BAKER
PRESIDENT/CEO450363070000056668906043901208801159579000
LIONEL PHILLIPS
VP FINANCE/CFO232978054739017999012078091730326967000
LINDA SHARKEY
VP PATIENT CARE/CNE1783100009873000135260201709000
MARY SMITH
VICE PRESIDENT SENIOR SERVICES1821050001602300078180205946000
KATHERINE REEVES
VP HUMAN RESOURCES15170500083090006580160672000
GREGORY BENGSTON
VP BUS DEV & PROF SERVICES1707850009246000200240200055000
TRACY TURMAN
VP SUPPORT SERVICES1269790007241000184460152666000
CHRISTINE CONNOLLY
president faquier foundation16637100012079000215540200004000
ANHTAI NGUYEN
chief medical officer25082200013016000216380285476000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
net earningsline 6Fauquier Hospital has a "Management Performance Incentive Program" (MPIP) under which we award $ to our Director Team for accomplishing a pre-determined, measurable set of tasks related to clinical quality outcomes, patient satisfaction, community outreach and positive operating margins.
nonqualified retirement planline 4bFAUQUIER HOSPITAL MAINTAINED A SECTION 457(F) NONQUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EMPLOYEES. DURING THE 2011 TAX YEAR. THOSE EMPLOYEES THAT PARTICIPATED IN THE SECTION 457(F) PLAN WERE PERMITTED DEFERRALS INTO THE PLAN (THAT IS, NO CONTRIBUTIONS WERE MADE BY THE CORPORATION). RODGER BAKER $60,439 LIONEL PHILLIPS $12,078 During the 2012 tax year, the CEO/President of the organization received a distribution of $539,240.76 from a Section 457(f) Plan. The distribution from the Section 457(f) Plan stemmed entirely from employee contributions made, annually, to the Plan since its inception in 2006. The Section 457(f) Plan was approved by the Board of Directors and was considered by the Compensation Committee and Board of Directors when determining the reasonable compensation of the CEO/President.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
INDUSTRIAL DEVELOPMENT AUTHORITY FAUQUIER COUNTY
A546001274312066BXO2008-02-1322687593HOSPITAL BUILDING IMPROVEMENTSfalsefalsefalse
INDUSTRIAL DEVELOPMENT AUTHORITY FAUQUIER CTY VA
B5460012742012-11-07447586382012 refunding 2002 bondsfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCdAmount RetiredAmountRetiredAmount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
A002286573012348704003166970021200329002009falsefalsetruetrue
B00505978880003132980005028459002005falsetruetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUseBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropRemedial Action TakenRemedialActionTakenNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrsPrcntge Bond Financed PropPrcntgeBondFinancedProp
Afalsefalsefalsefalse0.000000.000000.00000falsefalsefalsefalse
Bfalsefalsefalsefalse0.000000.000000.00000falsefalsefalsefalse0.00000

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledRebate Not Due YetRebateNotDueYetException To RebateExceptionToRebateNo Rebate DueNoRebateDueVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line1NameOfGICProvider/BusinessNameLine1Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqs
0
AfalsefalsefalsetruefalsefalsetrueBB&T5.1truefalsefalse
0
Bfalsetruefalsefalsefalsefalsefalse0falsefalse

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
Afalse
Bfalse

Form990 Schedule K Part VI Form990ScheduleKPartVI (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part II0THE TOTAL PROCEEDS OF THE ISSUE EXCEED THE ISSUE PRICE BECAUSE THE TOTAL PROCEEDS REFLECT INVESTMENT EARNINGS ON THE SALES PROCEEDS.
Part II, Line 30Total proceeds of the issue are greater than the issue price because proceeds from the debt service reserve fund ($5,834,024) and principal and interest fund ($366,729) from the 2002 tax-exempt bond issue were allocated to the 2012 tax-exempt bonds.
Part IV, LIne 70Although written procedures have not been adopted, the organization engages a professional third party to regularly perform arbitrage rebate computations on its tax-exempt bonds in accordance with IRS regulations under Section 148. No rebatable arbitrage has been computed for any of the outstanding tax-exempt bonds of the organization.
Part IV, Line 2c, Column A0The 2008 bond rebate computation was performed on 2/27/13.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
990 Review ProcessPart VI, Line 11The organization prepares the Form 990 with assistance from an outside accounting firm. Once a draft of the Form 990 is completed, it is submitted to management of the organization for review and comments. After incorporating changes from management, materially complete draft Forms 990 are made available to the Board of the organization, as well as presented by the outside accounting firm to the organization's Audit & Finance Committee. Comments or questions received from the Board are incorporated into a final Form 990, which is signed by the Persident/CEO of the Fauquier Health System, Rodger Baker.
CONFLICTS MONITORING AND ENFORCEMENTPART VI, LINE 12CUnder the Conflict of Interest Policy, all Board members, management, and key employees complete an annual disclosure form regarding business relationships that he or she, or any family member, has with any other company that does business with the organization, as well as any business relationships between and among the Board members, management, and key employees. The annual disclosure statements are reviewed by independent legal counsel, the corporate compliance officer, and the audit and compliance committee, who are ultimately responsible if a conflict exists. Any such conflicts would be reported to the full Board. In addition, any person who is covered by the Conflict of Interest Policy has an ongoing obligation to disclose the existence of any actual or potential conflict to the Board or the Board Committee in which the matter arises. Finally, the organization monitors Board member eligibility for any potential conflicts, in order to avoid such conflicts from occurring in the first place.
PROCESS FOR DETERMINING COMPENSATIONPART VI, LINE 15THE ORGANIZATION UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO DETERMINE OFFICER COMPENSATION.
DOCUMENT AVAILABILITYPART VI, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
net assets reconciliationpart xi, line 5NET EQUITY TRANSFERS TO RELATED ORGS $(6,158,063)
corporate memberPart VI, Section A, Line 6Fauquier Health System Inc, is the sole member of the organization.
electing members of the boardPart VI, Section A, Line 71. General Powers. The business and affairs of the Corporation shall be managed by the Board of Directors, which shall have all voting power except the power to vote on electing, appointing or removing Directors and on implementing amendments to the Articles of Incorporation affecting the voting rights of members, which power is vested in the sole member of the Corporation. 2. Number and Qualification of Directors. The Board of Directors shall consist of no more than ten (10). The number of Directors may be changed by amendment of these By-laws but shall not be less than three. 3. Election of Directors. The President of The Fauquier Hospital, Incorporated (Hospital) shall serve ex officio as a voting director of the corporation and the President of Fauquier Health Senior Living, Inc. (Senior Living) and the Medical Director of Fauquier Health Rehabilitation and Nursing Center shall serve ex officio as non-voting directors of the corporation. All other directors shall be elected by Fauquier Health System, Inc. with one member from that Board also serving as a director of the corporation.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
FAUQUIER HEALTH SYSTEM INC
500 HOSPITAL DRWARRENTONVA20186541416705MGMT COORDINAVA501(C)(3)11 TYPE IIINONEfalse
FAUQUIER HEALTH FOUNDATION INC
500 HOSPITAL DRWARRENTONVA20186300219424FUNDRAISINGVA501(C)(3)7FAUQ HLTH SYtrue
FAUQUIER HEALTH SENIOR LIVING INC
500 HOSPITAL DRWARRENTONVA20186541416703SKILLED CAREVA501(C)(3)9FAQ HLTH SYStrue
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1FAUQUIER HEALTH FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved793869AmountInvolved
Method Of Amt DeterminationCOSTMethodOfAmtDetermination