2024-08-15T21:44:10+00:00 2023-09-30 990 2022-10-01 540568001 Carilion Rockbridge Community Hospital CARI 5402245102 PO BOX 12385 Roanoke VA 24025 G ROBERT VAUGHAN JR TREASURER 5402245102 2024-08-16 true 2022 2024-08-08 14:25:15Z GREGORY T MADSEN PO BOX 12385 Roanoke VA 24025 106629934 false X WWW.CARILIONCLINIC.ORG X 1955 VA Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. 15 11 543 10 0 0 2823707 1078194 65663812 73612630 1427816 547549 553302 641879 70468637 75880252 549895 388780 0 27779142 28522132 0 0 36977685 41320921 65306722 70231833 5161915 5648419 76023109 85418994 23656624 27441837 52366485 57977157 Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. false false 57987522 388780 73870159 See schedule O. 57987522 true true false true false false false false false true true false true true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true X 0 0 543 true false false false false false false false false false false false false X 15 11 true true false false true true true true true false false true true true true true true true true false VA X MATTHEW BARR 5402245021 213 S JEFFERSON ST ROANOKE VA 24011 Cheryl Wright Director/Secretary 1.2 0 X X 0 0 0 Greg Madsen Director/Hospital VP 50.0 0 X X 224756 0 -12505 James Williams Jr Director/Chair 2.5 2.4 X X 0 10575 0 Juliet Gibson Director/Vice Chair 1.2 0 X X 0 0 0 Alicia Devine MD Director 1.2 48.8 X 0 319096 -11805 Amy DeHart Director 1.2 0 X 0 0 0 Ayesha Kelly MD Director 1.2 48.8 X 0 339339 -141919 Josh Elrod Director 1.2 0 X 0 0 0 Kim Shaw Director 1.2 0 X 0 0 0 Lisa Sprinkel Director 1.2 48.8 X 0 188238 -220308 Marylin Alexander Director 1.2 0 X 0 0 0 Nathan Ramsey Director 1.2 0 X 0 0 0 P Duaine Fitzgerald Director 1.2 0 X 0 0 0 Reginald Early Director 1.2 0 X 0 0 0 Tracy Lyons Director 1.2 0 X 0 0 0 David Hagadorn Asst. Treasurer 0.5 49.5 X 0 160104 -121301 Donald Halliwill Asst. Treasurer 0.5 49.5 X 0 988973 -138321 G Robert Vaughan Jr Asst. Treasurer 0.5 49.5 X 0 409821 -254014 Julie Smith-Hamilton Asst. Secretary 0.5 49.5 X 0 61128 12403 Nicholas Conte Asst. Secretary 1.0 49.0 X 0 817822 83882 Steven Arner Asst. Secretary/COO, Carilion Clinic 2.0 48.0 X 0 1120207 -113754 Nancy Howell Agee CEO, Carilion Clinic 2.0 48.0 X 0 2186283 1001688 Aaron Glenn Nursing Senior Director 50.0 0 X 122402 0 -4572 Jessica Saville Pharmacy Manager 47.0 3.0 X 174950 0 -55647 Latoya Bonney Physician Assistant 50.0 0 X 119350 0 -11118 Phyllis Snyder RN Lead 50.0 0 X 158673 0 -18148 Tracy Higgins Nursing Unit Director 50.0 0 X 171194 0 -130242 971325 6601586 -135681 18 false true false QUALIVIS LLC 1601 ASSEMBLY ST UNIT 1439 COLUMBIA SC 29201 TEMPORARY STAFFING 3456484 QUEST DIAGNOSTICS 500 PLAZA DRIVE SECAUCUS NJ 07094 LABORATORY SERVICES 1268073 F & S BUILDING INNOVATIONS INC 2944 ORANGE AVE NE ROANOKE VA 24012 CONTRACTOR SERVICES 1184010 OEC MEDICAL SYSTEMS INC 2984 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACTOR SERVICES 191223 GJ HOPKINS INC 3635 PETERS CREEK RD ROANOKE VA 24019 CONTRACTOR SERVICES 180592 6 540016 276567 261611 1078194 Net Patient Revenue 622110 70249976 70249976 Rent from affiliates 531120 70984 70984 Patient Pharmacy Revenue 446110 3291670 3291670 0 0 0 0 73612630 615290 615290 188971 188971 0 188971 188971 30681941 30749682 -67741 0 -67741 -67741 School Health Services 621399 240863 240863 Cafeteria 722514 195379 195379 Medical Director Fees 621399 13900 13900 2766 2766 0 0 452908 75880252 73870159 0 931899 X 388780 388780 270509 270509 22999346 22825595 173751 437030 433728 3302 3557208 3472834 84374 1258039 1235432 22607 10128089 10128089 5237 5237 135207 135207 9288690 8205375 1083315 0 9190 9190 1077373 979894 97479 166551 166551 1290162 1290162 76161 74020 2141 88330 88330 2728377 2728377 655874 444988 210886 Med Supplies 7458073 7458073 Bad Debt 5222230 5222230 Affiliate Practice Subsidy 2837135 2837135 Dues & Subscriptions 47244 47244 106998 74347 32651 0 70231833 57987522 12244311 0 1249 1899 454 615 13150532 13430992 0 0 0 0 593676 611639 140931 239507 72081635 49564620 19270093 22517015 13896183 12657722 22750908 27947208 0 6219083 8012397 76023109 85418994 7354631 11568702 108426 11822863 11826727 0 0 457852 437208 3912852 3609200 23656624 27441837 51485977 57728089 880508 249068 52366485 57977157 76023109 85418994 X 5648419 3576971 -3614718 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5237 5237 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY A portion of dues paid to various healthcare industry associations is attributable to lobbying activities. 1117453 1117453 36778245 24040941 12737304 664673 650055 14618 27250611 22128033 5122578 6270653 2745591 3525062 22517015 230790 F Alternative Investments 27716418 F 27947208 Due From Affiliate 7724139 Right of Use Asset 288258 8012397 Pension Liability 60261 Deferred Comp Swap Liability 135304 Due to Affiliate 0 Lease Liability 3413635 3609200 true true X true X 300 true X 500 false true false true true 747091 747091 0.0115 8747911 6649127 2098784 0.0323 0 0.0 0 0 9495002 6649127 2845875 0.0438 138481 138481 0.0021 0 0.0 0 0.0 0 0.0 404160 360605 43555 0.0007 0 0 542641 360605 182036 0.0028 0 0 10037643 7009732 3027911 0.0466 0 0.0 12669 12669 0.0002 5720 5720 0.0001 0 0.0 0 0.0 1795 1795 0.0000 0 0.0 1367 1367 0.0000 0 0.0 0 0 21551 0 21551 0.0003 true 5222230 17048997 17336490 -287493 X true true 1 1 Carilion Rockbridge Community Hospital 1 HEALTH CIRCLE LEXINGTON VA 24450 https://carilionclinic.org//locations/carilion-rockbridge-community-hospital H 1906 X X X X Carilion Rockbridge Community Hospital 1 false false true X X X X X X X X X 20 true false true true X https://www.carilionclinic.org/cho-community-health-assessments#reports X https://issuu.com/carilionclinic/docs/2021_rockbridge_area_cha_report_final X X true 21 true https://www.carilionclinic.org/cho-community-health-assessments#reports false true X 300.0 500.0 X X X true true X X X true X https://www.carilionclinic.org/billing/financial-assistance X https://www.carilionclinic.org/billing/financial-assistance X https://www.carilionclinic.org/billing/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E The publicly available community health needs assessment report details the prioritization process for the community's significant health needs as identified through the CHNA. The Community Health Assessment Team (CHAT), made up of community stakeholders, reviews all data and completes a prioritization survey. Through the survey, each CHAT member selects and ranks the most pertinent community needs. The data are combined, and priorities are selected based on the highest weighted score of each need. Through this process, CHAT members prioritize needs according to the need's perceived burden, scope, severity or urgency; the importance the community places on addressing the need through survey responses and other interactions; and each member's unique perspective on community health. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Carilion Rockbridge Community Hospital. Carilion Clinic's Community Health Needs Assessments (CHNAs) are community-driven projects. Their success is highly dependent on engaging citizens, health and human service agencies, businesses and community leaders. Stakeholder collaborations known as Community Health Assessment Teams (CHATs) lead the CHNAs. The CHATs are a dynamic group that includes health and human service agency leaders, people with exceptional knowledge of, or expertise in, public health, and local health department officials. The CHATs obtain input from leaders, representatives, or members of medically underserved populations who report as low-income, are minorities and suffer from chronic diseases. The following organizations served on the CHAT for the 2021 Rockbridge Area Community Health Needs Assessment (RACHNA): Carilion Clinic, Carilion Rockbridge Community Hospital, City of Lexington, Rockbridge Area Health Center, Rockbridge Baths Community Organization, Trinity United Methodist Church, Project Horizon, Rockbridge Community Health Foundation (formerly the SJH Community Health Foundation), Washington & Lee University, Lexington Office on Youth, Rockbridge County Economic Development, Rockbridge Area Relief Association, Southern Virginia University, Virginia Department of Health, Chamber of Commerce Serving Lexington Rockbridge and Buena Vista, Rockbridge Area Transportation System, Natural Bridge State Park, Rockbridge Area Community Services, Rockbridge Area YMCA, Grace Episcopal Church, Anthem Medicaid, and Virginia Cooperative Extension. To obtain input from the community, the RACHNA conducted a focus group among CHAT stakeholders, three focus groups among target populations (African-American) and administered a 40-question community health survey broadly across the service area. This occurred from October 1, 2020, through January 31, 2021. The community health survey was developed (in English and Spanish) with questions about socioeconomic factors; access to medical, dental and mental health care; health behaviors; physical environment; health outcomes; and demographics. The survey included commonly used questions and metrics from previously validated community surveys conducted by organizations such as the National Association of County and City Health Officials and Centers for Disease Control and Prevention. During the CHNA process, community stakeholders, leaders and providers were encouraged to complete a stakeholder survey electronically to provide additional perspectives about our community's health needs and barriers. A focus group was held with the CHAT stakeholders to further discuss the data collected through the stakeholder survey. The CHAT assisted with survey distribution in an effort to reach particular target populations. The survey focused on Rockbridge Area residents 18 years of age and older in the following service area: Rockbridge County, Lexington City and Buena Vista City. Special efforts were made to include underserved and vulnerable populations disproportionately impacted by social determinants of health such as income, race/ethnicity, education and insurance status. Specific populations served by CHAT representatives include the un- or underinsured, the homeless, the food insecure, small business owners, and low-income individuals and families with young children. Due to the COVID-19 pandemic, most responses were collected electronically, though the survey was also available by phone and on paper. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Carilion Rockbridge Community Hospital. The 2021 Rockbridge Area Community Health Needs Assessment was conducted with: City of Lexington, Rockbridge Area Health Center, Rockbridge Baths Community Organization, Trinity United Methodist Church, Project Horizon, Rockbridge Community Health Foundation (formerly the SJH Community Health Foundation), Washington & Lee University, Lexington Office on Youth, Rockbridge County Economic Development, Rockbridge Area Relief Association, Southern Virginia University, Virginia Department of Health, Chamber of Commerce serving Lexington Rockbridge and Buena Vista, Rockbridge Area Transportation System, Natural Bridge State Park, Rockbridge Area Community Services, Rockbridge Area YMCA, Grace Episcopal Church, Anthem Medicaid, and Virginia Cooperative Extension. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - Carilion Rockbridge Community Hospital. The Community Health Assessment Team shared the 2021 Rockbridge Area Community Health Needs Assessment (RACHNA) on partner websites and social media. The RACHNA was also shared through community presentations to groups including Washington & Lee University students and staff, the Rockbridge Area YMCA Board of Directors and staff, Lexington's Green Infrastructure Workgroup, and others across internal and external audiences. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Carilion Rockbridge Community Hospital. The following information describes the implementation strategy used by Carilion Rockbridge Community Hospital (CRBH) to address the community health needs identified in the 2021 Rockbridge Area Community Health Needs Assessment (RACHNA). The complete implementation strategy is available online at https://www.carilionclinic.org/sites/default/files/2022-02/2021%20CRBH%20Implementation%20Strategy_FINAL%20APPROVED.pdf. The top prioritized needs for the 2021 RACHNA were grouped into four overarching categories: mental health, socioeconomic factors, health behaviors and COVID-19. We have been addressing prioritized needs with the following strategies and a commitment of financial resources, staff time and leadership. Strategies to address mental health include hosting Mental Health First Aid and Youth Mental Health First Aid trainings; providing a permanent medication drop box in the CRBH emergency department waiting area; providing grant funding and staff time to support an annual prevention conference hosted by and for local student leaders, as well as an annual prevention forum for parents, teachers and other adults who work with youth; working with community partners to host and promote REVIVE! trainings; and continuing participation with the local crisis intervention team. All strategies in the mental health category are done in partnership with the Rockbridge Area Prevention Coalition and Rockbridge Area Community Services. Strategies to address socioeconomic factors include targeting health education initiatives toward low-income populations; and supporting and promoting economic development initiatives in the Rockbridge Area through continued involvement with the Chamber of Commerce, Main Street Lexington, Rockbridge County and the cities of Lexington and Buena Vista. Strategies to address health behaviors include providing grant funding to support renovations at Rockbridge Area Relief Association (next to the hospital) to improve the shopping experience for food pantry clients; providing community health education and participating in community events by providing immunizations and health screenings; promoting the adoption of Unite Us, a social resource referral platform that will be integrated with medical records for clinical utilization; and participating in Lexington's Green Infrastructure Workgroup to improve the city's walkability and bikeability. Strategies to address COVID-19 include providing quality care and treatment for COVID patients, disease prevention, providing monoclonal antibody infusion clinics, and aiding in the community's economic recovery. Additional strategies to more broadly address a culture of community health and its ties to each of the priority needs include developing a system-wide community health investment plan; further developing community health infrastructure; engaging employees in supporting community partnerships; and leveraging internal data to assess health disparities. Progress made in 2023 to further develop a culture of community health continued to build upon increasing infrastructure and strategic impact. Infrastructure is being built across the organization to screen patients for Social Determinants of Health and make referrals to Community Health and Outreach and to community-based organizations through EPIC. The Community Health and Development division continues working closely with the Clinical Advancement and Patient Safety department, the office of Diversity, Equity, and Inclusion, Health Analytics, and others on a health equity steering committee to identify and address health disparities in the communities we serve. A Community Health Worker (CHW) was hired at CRBH to facilitate patient referrals to community health services. In addition to the activities listed above, Carilion works closely with the Rockbridge Community Health Foundation, the hospital's supporting foundation, to provide community grants to local organizations addressing needs identified in the CHNA. In spring of 2023 a total of 25 grants were awarded: 10 to address mental health issues, 10 to address socioeconomic issues, and 5 to address health behaviors. 6 CARILION CLINIC FAMILY & INTERNAL MEDICINE 108 HOUSTON STREET SUITE A C LEXINGTON VA 24450 PHYSICIAN OFFICES CARILION CLINIC FAMILY MEDICINE-SOUTH MAIN 146 SOUTH MAIN STREET LEXINGTON VA 24450 PHYSICIAN OFFICES CARILION CLINIC FAMILY MEDICINE - BEDFORD 548 BLUE RIDGE AVE BEDFORD VA 24523 PHYSICIAN OFFICES CARILION CLINIC FAMILY MEDICINE - BUCHANAN 18080 MAIN STREET BUCHANAN VA 24066 PHYSICIAN OFFICES CARILION CLINIC FAMILY MEDICINE - CLIFTON FORGE 609 CHURCH STREET CLIFTON FORGE VA 24422 PHYSICIAN OFFICES CARILION CLINIC FAMILY MEDICINE - BUENA VISTA 2252 MAGNOLIA AVENUE BUENA VISTA VA 24416 PHYSICIAN OFFICES Schedule H, Part I, Line 3c Other Financial Assistance Eligibility Criteria Financial assistance policy in effect for fiscal year 2023: families with family income equal or below 300% of the Federal Poverty Guidelines and countable assets equal or below $25,000 receive 100% adjustment under FAP. Families with family income greater than 300% of the Federal Poverty Guidelines but less than or equal to 500% of the Federal Poverty Guidelines or countable assets above $25,000 and less than or equal to $100,000 receive a partial adjustment under FAP. The partial adjustment matches the highest AGB percentage determined for all facilities. Schedule H, Part I, Line 6a Public Availability of Community Benefit Report Information on community benefit is reported annually through a consolidated report prepared by Carilion Clinic (EIN 54-1190771). Printed copies of this report are distributed throughout communities served by hospitals affiliated with Carilion Clinic. Additionally, the community benefit report is available on Carilion Clinic's website: https://www.carilionclinic.org/cho-community-health-assessments#community-benefit-reports Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 5222230 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Line 7a and 7b: For activities reported on the Medicaid Cost Report, a cost-to-charge ratio as determined from the Medicaid Cost Report was used. For all other activities, a cost to charge ratio derived from Worksheet 2 of the 990 instructions was used. Lines 7e-7i are reported at actual cost. Schedule H, Part II Community Building Activities Line 2 - Economic development: As the largest employer in Southwest Virginia, Carilion impacts economic development by investing in jobs, increased wages for employees and various capital building projects. In addition, Carilion has direct economic development expenses from programming and support of the local Chamber of Commerce, Main Street Lexington and pro-business advocacy. These initiatives promote the community's health by improving economic vitality and making the region a vibrant place to live, work and play. Line 3 - Community support: Research demonstrates the strong connection between social determinants of health-such as transportation, housing and education and communities' overall health and well-being. Carilion supports nonprofit organizations addressing barriers to good health arising from these social determinants in various ways. Carilion also collaborates with local partners to support better education and opportunities for children and families and improved housing, better nutrition and additional resources for our neighbors in need. Through monetary donations and organizational support, Carilion is involved with various health and social determinant-related initiatives. For example, Carilion provides support for local Ruritan groups, CARE Rockbridge (Community Anti-Racism Effort), the local YMCA and serves on the Local Emergency Preparedness Council, working to improve the community's resiliency with emergency situations. Line 6 - Coalition building: Carilion believes in the power of collaboration and understands that we must address our most significant health issues in concert with the community. To ensure lasting impact from the health assessment and community health improvement process, Carilion participates in coalitions that address health, safety and social determinant needs in the Rockbridge area. We also partner with multiple community and business organizations on initiatives to improve health and wellness for everyone living in the Rockbridge area. Carilion participates in Live Well Alleghany, a health coalition in a neighboring county, as well as serves on the board for the Community Foundation Serving Bath and Alleghany. Line 8 - Workforce development: With the understanding that employment is directly linked to health and wellness, Carilion partners to provide workforce development and training for community members. By participating in the local Chamber of Commerce, Carilion works to ensure our workforce and communities are vibrant. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Carilion Rockbridge Community Hospital estimates bad debt expense by reserving a percentage of all self-pay patient accounts receivable by aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Patient accounts receivable are stated at net realizable amounts due from patients, third-party payors, and other insurers for which Carilion Rockbridge Community Hospital expects to be entitled in exchange for providing patient care. In accordance with Accounting Standards Update (ASU) No. 2014-09, Revenue from Contracts with Customers (Topic 606) (ASU 2014-09), the estimated uncollectible amounts are generally considered implicit price concessions that are a direct reduction to patient accounts receivable. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Medicare allowable costs are determined from the Medicare cost report using the cost-to-charge ratio. The hospital believes our Medicare shortfall is a cost we incur as a benefit to the community. IRS REV. RUL. 69-545 provides that one of the factors demonstrating community benefit is caring for patients who pay their bills through public programs such as Medicare. In order to operate for the benefit of the broad community that we serve we must include our significant Medicare population, even if we are required to subsidize care to our Medicare patients due to being reimbursed at less than cost by Medicare's nonnegotiable rates. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance When accounts receivable efforts are exhausted, the account may be placed with a collection agency and Extraordinary Collection Actions (ECAs) may be considered. Accounts will not be placed with a collection agency prior to 120 days from the date the first post-discharge billing statement is provided except when mailings are returned with no forwarding address and combining multiple accounts of varying age with those already transferred or for legal verification regarding other liabilities. Reasonable efforts will be made to identify appropriate forwarding addresses. When a Financial assistance application (FAA) is received during the application period (within 240 days after the date the first post-discharge billing statement is provided), but after initiation of ECAs, all ECAs will be suspended. Best efforts will be made to process completed applications within 30 days of receipt of the application, financial assistance eligibility will be determined and communicated to the individual. Incomplete applications must be completed within 30 days of the initial notification of additional items required, otherwise, the application will be deemed incomplete and closed. If an individual is eligible for financial assistance, ECAs, other than the sale of debt, will be reversed and any payments related to eligible care refunded to the extent no longer owed. ECAs will be reinstated if the individual is not eligible for financial assistance or does not complete the FAA by the deadline. At least 30 days before initiating an ECA, Carilion will send the patient written notice of intended ECA(s), a plain language summary explaining financial assistance available and the process for determining eligibility, and the deadline for applying for assistance. Carilion will also attempt to call individuals at least 30 days before initiating an ECA to make them aware of the financial assistance available and how to obtain assistance with the application process. Carilion shall enter into a written contract with any collection agency to which it refers bad debt. The contract will obligate the collection agency to observe and comply with Carilion's obligations under this Policy and the Financial Assistance Policy. A collection agency to which bad debt is referred for collection may not engage in any ECAs without the prior written consent of Carilion. After making reasonable efforts to determine if a patient qualifies for Financial Assistance and the patient either does not qualify for Financial Assistance or fails to submit an application as requested, within 240 days from the date the first post-discharge billing statement is provided, Carilion may engage in one or more of the following ECAs - (1) Place a lien on an individual's property, (2) Attach or seize an individual's bank account or any other personal property, (3) Commence a civil action against an individual, (4) Garnish an individual's wages, (5) Sell an individual's debt to another party, or (6) Report the account to credit agencies. Individual account balances greater than $5,000 are not sent to a collection agency. These are handled through the Debt Recovery Department (DRD) for verification of financial assistance status before further collection activity occurs. DRD will also investigate any accounts that require special handling. For example, in cases of a deceased patient, auto accident, or any other unique circumstances requiring special handling, the accounts are placed with the DRD. When all collection efforts have been exhausted, all hospital accounts will be returned and closed as uncollectible. No further collection activity is taken at that time. Accounts with satisfactory payment arrangements, legal activity or accounts with pending payment will be considered active and are not returned. Schedule H, Part V, Section B, Line 16a FAP website - Carilion Rockbridge Community Hospital: Line 16a URL: https://www.carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - Carilion Rockbridge Community Hospital: Line 16b URL: https://www.carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Carilion Rockbridge Community Hospital: Line 16c URL: https://www.carilionclinic.org/billing/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment In addition to conducting regular Community Health Needs Assessments (CHNAs), Carilion Clinic closely monitors community health indicators and responds to needs as they arise. Each year, Carilion updates scorecards with refreshed County Health Rankings indicators provided by the Robert Wood Johnson Foundation. Carilion is also responsive to needs identified through clinical data and internal departments. Carilion's call center, Carilion Direct, is available for community members to ask questions and connect with community resources. Needs are also identified through current collaborative relationships and community partnerships. Ongoing collaboration with stakeholders allows for regular communication of needs and gives our partners opportunities to respond cohesively. Carilion has adapted its community health improvement process from Associates in Process Improvement's Model for Improvement and the Plan-Do-Study-Act cycle developed by Walter Shewhart. It consists of five steps: (1) conducting the CHNA, (2) strategic planning, (3) creating the implementation strategy, (4) program implementation and (5) evaluation. This cycle is repeated every three years. Carilion fosters community development in its CHNA and community health improvement processes through the Strive Collective Impact Model for the Community Health Assessment Team. This evidence-based model focuses on "the commitment of a group of important players from different sectors to a common agenda for solving a specific social problem(s) has been proven to lead to large-scale changes. It focuses on relationship-building between organizations and the progress toward shared strategies. Working through the Collective Impact Model, Carilion works with members of the Live Healthy Rockbridge coalition to develop a community-wide strategic plan to address community needs. This strategic plan is reviewed and updated twice each year to reflect completed and ongoing initiatives as well as emerging needs. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Information on Financial Assistance is provided to the patient at hospital admission and ambulatory areas in the form of signage, a plain language summary which includes contact information, financial assistance application and documentation in the inpatient handbook. Patient Access staff, Hospital social workers and customer service representatives verbally inform patients on availability of assistance. Each patient statement and patient financial responsibility letter includes information on the Financial Assistance policy including who to contact for additional information and location of in-person assisters. The Application, the Policy, and the plain language summary are available free of charge to the patient. They are available by mail and on the web site if the patient did not receive written information at the time of service. Financial Assistance policy and application are also distributed to community partners through electronic mailing groups. Carilion Clinic employs an Eligibility staff that counsel patients on federal and state programs. The staff completes applications for Medicaid and provides information on Social Security, Social Security Disability and Medicare. The staff provides support services ensuring the applications are processed correctly based on federal and state policy. In addition, Eligibility staff are trained as Certified Application Counselors and will assist patients in enrollment in the Marketplace. Eligibility staff will also complete Carilion's financial assistance application and counsel patients on the requirements for financial assistance. Schedule H, Part VI, Line 4 Community information The Rockbridge Area is comprised of distinct communities with significant disparities in size, population and social determinants of health. The 2018-2022 American Community Survey (ACS) found the total population of the cities of Lexington and Buena Vista to be 7,346 and 6,639, respectively, and the population of Rockbridge County to be 22,673. The Weldon Cooper Center for Public Service predicts positive future population change for Rockbridge County and Lexington, but a slight population loss in Buena Vista by 2040. Median age in the Rockbridge Area localities ranges from 22.7 in Lexington to 49.4 in Rockbridge County. The ACS finds that for most of the Rockbridge Area, a more significant percentage of the population is White than in the Commonwealth of Virginia. In Rockbridge County, 91.35% of the population is White, 4.35% of the population is Black, 2.24% identify as more than one race and 2.14% identify as Hispanic or Latino (US Census Bureau, ACS, 2018-2022). Lexington and Buena Vista are slightly more racially and ethnically diverse than Rockbridge County, with populations that are 83.53% and 86.93% White, 5.17% and 4.14% Black, and 3.14% and 0.54% Asian. 6.03% and 6.99% of these population represent more than one race and the remainder represent small minorities of American Indian/Alaskan Native, Native Hawaiian/Pacific Islander or some other race. Of the population, 5.08% of Lexington and 1.48% of Buena Vista identify as Hispanic or Latino (US Census Bureau, ACS, 2018-2022). The region is divided into urban and rural areas, which vary greatly in the economic means of the residents who live there. The low-income population in the Rockbridge Area is designated as a Medically Underserved Area. The entire Rockbridge service area is designated as a low-income Health Professional Shortage Area for primary care, dental health and mental health. (https://data.hrsa.gov/tools/shortage-area). Carilion Rockbridge Community Hospital (CRBH) is the only hospital located within the service area. The 2018-2022 ACS states that the average income in Rockbridge County is $85,002, whereas in Lexington and Buena Vista it is $90,643 and $81,044 respectively. Lexington City has the lowest percentage of the population below the Federal Poverty Level (FPL) at 5.45%. In Rockbridge County and Buena Vista, the percentage of the population below the FPL is 5.45% and 5.97%. All three municipalities have higher poverty rates than Virginia (4.88%). The ACS also shows that 18.22% of the population in Rockbridge are receiving Medicaid and 6.17% have no insurance coverage. In Lexington City, 9.44% are receiving Medicaid and 2.12% have no insurance, and in Buena Vista City 22.98% are receiving Medicaid and 6.43% have no insurance (US Census Bureau, ACS, 2018-2022). Of the patients receiving care at CRBH in FY23, 20.05% have Medicaid coverage and 3.39% are self-pay (Strata internal data). Schedule H, Part VI, Line 5 Promotion of community health Carilion Rockbridge Community Hospital is part of the non-profit Carilion Clinic, integrated health care system located among the Blue Ridge Mountains. Carilion provides quality care for nearly one million individuals through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers, and other complementary services. Carilion's roots go back more than a century when a group of dedicated citizens came together and built a hospital to meet the community's health care needs. Today, Carilion is a vital anchor institution focused on health care and dedicated to our mission of improving the health of the communities we serve. With an enduring commitment to our region's health, care is advanced through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. Carilion invests in discovering and responding to local and regional health needs, understanding that we must involve additional stakeholders to address community health issues and create change effectively. Carilion recognizes the impact the environment has on the health of our communities. Efforts continue to make our hospitals and other facilities more energy-efficient, increase recycling and use of recyclable or bio-degradable materials, reduce waste materials and serve local, sustainable foods to patients and in our cafeterias. Carilion has an office of sustainability which leads these efforts and empowers employees to be involved in environmental health related projects. Carilion Rockbridge Community Hospital (CRBH) is a nonprofit, critical access hospital dedicated to quality care and patient comfort. Commitment and support through the last century allowed the hospital to grow, expand and in 1954 move across town to its present site. A new structure and enhanced patient care tower were completed on the same site in 2002. Carilion Health System (now Carilion Clinic) purchased 80% of Stonewall Jackson Hospital (now Carilion Rockbridge Community Hospital) in 2006. The other 20% was owned by the community in the trust of the Stonewall Jackson Hospital Community Health Foundation (now the Rockbridge Community Health Foundation). In 2021 Carilion purchased the remaining 20% from the foundation, which continues as a supporting organization for the hospital. The foundation continues to provide monies to Carilion Rockbridge Community Hospital. Approximately two-thirds of the monies provided annually are invested in the community through grants provided to local organizations working to address needs identified in the most recent Rockbridge Area Community Health Assessment. The remaining third is invested in hospital improvements such as equipment and supplies. CRBH provides a full range of top-quality inpatient and outpatient care for Rockbridge Area residents. CRBH's health care professionals provide patients with reliable, safe care to get them on the road to recovery, close to home. For inpatient care, CRBH physicians diagnose and treat illnesses, anticipate problems and rapidly respond to changes in patient conditions. Emergency services are onsite 24/7 and a medical transport helicopter is kept onsite if an advanced level of care is needed. Other onsite services include imaging services, inpatient and outpatient surgical services, sleep studies, swing bed/recovery care, therapy services (PT, OT, ST, RT), and laboratory. CRBH serves patients regardless of their ability to pay. The hospital's governing board members are elected annually and reside in the region. The majority of members are neither hospital employees nor contractors. Medical staff privileges are extended to qualified providers. Surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. Reinvestments include providing free, discounted and subsidized care and critical medical services not otherwise offered in our region (https://www.carilionclinic.org/locations/carilion-rockbridge-community-hospital). Schedule H, Part VI, Line 6 Affiliated health care system Carilion Rockbridge Community Hospital is wholly owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. Carilion Clinic includes a comprehensive network of hospitals, primary and specialty physician practices, and complementary services consisting of six hospital entities, 81 specialties, and 248 practice sites across Southwest Virginia. All of these are centered on a common mission and shared values. In the mid-2000s, Carilion made the strategic decision to transform from a collection of hospitals to a physician-led, integrated health care system. Advances include developing a multi-specialty physician group, transforming our primary care practices into patient-centered medical homes, implementing electronic health records system-wide, and creating a robust partnership with Virginia Tech, including developing the Virginia Tech Carilion (VTC) School of Medicine and the Fralin Biomedical Research Institute at VTC. Each decision and adaptation have fundamentally changed the way Carilion collaborates and provides care (https://www.carilionclinic.org/about-carilion-clinic). Carilion's community and population health infrastructure is the health system's engine for providing collaborative opportunities to improve and promote the community's health. Carilion's Community Health Assessment process helps identify the strengths and barriers impacting health. Our community-based programs reflect the Robert Wood Johnson Foundation's framework of four main influences of health: health behaviors, social and economic factors, clinical care access and quality, and physical environment. Our many partnerships with cross-sector organizations create a collaborative culture of health and wellness. Carilion has a long history of working with Radford University and Jefferson College to advance health professionals' education. Founded in 1914 as the Jefferson Hospital School of Nursing, what became known as the Jefferson College of Health Sciences merged with Radford University in early 2018 to form Radford University Carilion (RUC). Located on the campus of Carilion Roanoke Community Hospital, this higher education institution "prepares, within a scholarly environment, ethical, knowledgeable, competent and caring healthcare professionals." Today, RUC provides more than 1,100 students with opportunities to become part of the health care profession, serving communities ranging from Southwest Virginia to the Shenandoah Valley and beyond. The school's graduates are building healthier tomorrows in our region and across the country every day. true ConnectionsPlus HealthcareHospice 315 Myers Street Lexington VA 24450 541288305 501(c)(3) 25367 Grief support Boxerwood Education Association Inc 541937944 501(c)(3) 32000 Project NEST Bridge to Hope Food Pantry LLC 851347394 501(c)(3) 10000 Food insecurity Grtr Rockbridge Co Skateboarder COA 7 Wallace Street Lexington VA 24450 873586310 501(c)(3) 14000 Portable skatepark Commty Fdn RockbridgeBathAlleghany PO Box 20 Lexington VA 24450 273422429 501(c)(3) 18000 Program support Hoofbeats Therapeutic Riding Center 541699898 501(c)(3) 12000 Program support Rockbridge Area Relief Association 237303807 501(c)(3) 20000 Emergency Utilities Rockbridge Area Community Services 541234799 501(c)(3) 27535 Program support Yellow Brick Road Early Learning Ctr 410 Yellow Brick Rd Lexington VA 24450 541101888 501(c)(3) 16000 Program support Washington & Lee University 540505977 501(c)(3) 29200 Program support Rockbridge Area Transportation System 712 N Main Street Lexington VA 24450 043586915 501(c)(3) 16000 Public Transportation Valley Program for Aging Services 540958526 501(c)(3) 38750 Senior Transportation Expansion Rockbridge Christmas Basket Inc 541194522 501(c)(3) 10000 Healthy Food Boxes County of Rockbridge 546001578 Rockbridge County 25000 Industries Training Program for inmates Rockbridge Recovery Center 883542033 501(c)(3) 10000 Certified Peer Recovery Training Rockbridge Area Recreation Organization 546001392 Rockbridge County 20200 Pavilion at Athletic Field Virginia Institute of Autism Inc 541815297 501(c)(3) 10453 Technology access for students Rockbridge Area Conservation Council 510228197 501(c)(3) 20500 Healthy Green Neighborhoods 18 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. The hospital donates funds to other charitable organizations in support of health and community improvement. Such organizations also have community boards which oversee the expenditure of such funds. Carilion Clinic is committed to improving the health of the communities that we serve by addressing key health priorities identified through our triennial Community Health Assessments. Carilion fulfills this commitment in many ways, one of which is through targeted grants for community health improvement programs, and those that impact the social determinants of health. For Carilion Clinic's Community Grant Program, each grantee must sign a letter of agreement with Carilion Clinic that delineates the terms and specific objectives of the project. By accepting a Carilion award, grantees are asked to acknowledge the support of Carilion Clinic in all materials and/or related special events or fundraisers throughout the award cycle where other donors are publicly recognized. One mid-cycle progress report and a final program evaluation are required for each funded project. Site visits may be made to grantees. Program evaluation includes alignment with Community Health Assessment priorities, program impact, organizational effectiveness and community benefit through collection of data including clients served, cost effectiveness of the program (cost per client or service), tangible community or client outcomes, collaboration with other organizations, and specific efforts to cultivate diverse funding sources for program sustainability. Each grantee must agree to submit requested data and reports on a timely basis and to complete the evaluation process as requested. X false true false true false false false false false true false Greg Madsen Director/Hospital VP 200771 0 22096 0 1889 0 -31396 0 18891 0 212251 0 0 0 Alicia Devine MD Director 0 305904 0 8919 0 4273 0 -13874 0 2069 0 307291 0 0 Ayesha Kelly MD Director 0 306086 0 30891 0 2362 0 -162492 0 20573 0 197420 0 0 Lisa Sprinkel Director 0 162139 0 18258 0 7841 0 -233888 0 13580 0 -32070 0 0 Steven Arner Asst. Secretary/COO, Carilion Clinic 0 892203 0 149632 0 78372 0 -135050 0 21296 0 1006453 0 73054 Nicholas Conte Asst. Secretary 0 642289 0 107354 0 68179 0 68334 0 15548 0 901704 0 60115 David Hagadorn Asst. Treasurer 0 150264 0 2700 0 7140 0 -127993 0 6692 0 38803 0 0 Donald Halliwill Asst. Treasurer 0 745723 0 125641 0 117609 0 -159617 0 21296 0 850652 0 113415 G Robert Vaughan Jr Asst. Treasurer 0 341967 0 44219 0 23635 0 -275310 0 21296 0 155807 0 19258 Nancy Howell Agee CEO, Carilion Clinic 0 1567773 0 358583 0 259927 0 987742 0 13946 0 3187971 0 0 Tracy Higgins Nursing Unit Director 164423 0 2000 0 4771 0 -130873 0 631 0 40952 0 0 0 Jessica Saville Pharmacy Manager 165854 0 2000 0 7096 0 -62431 0 6784 0 119303 0 0 0 Phyllis Snyder RN Lead 153219 0 1300 0 4154 0 -33498 0 15350 0 140525 0 0 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments EMPLOYEES ARE OCCASIONALLY PROVIDED SMALL GIFTS, PRIZES OR AWARDS WHICH MAY BE INCLUDED IN TAXABLE COMPENSATION AT AMOUNTS GROSSED UP FOR TAXES. DURING THE REPORTING PERIOD, MR. Madsen RECEIVED SUCH BENEFIT. Schedule J, Part I, Line 1b Written policy regarding payment or reimbursement of expenses MANAGEMENT MAKES TAX GROSS-UP DECISIONS AT ITS DISCRETION FOR NON-ROUTINE SMALL GIFTS, PRIZES OR AWARDS CONSIDERING IRS REQUIREMENTS, AMOUNT, AND NON-CASH STATUS. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation The organization has a single member, Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. Executive compensation, including that of the Hospital Vice President, is reviewed annually by the Carilion Clinic Board of Directors Compensation Committee.This Committee is made up of independent Board Members of Carilion Clinic who do not have a conflict of interest with any of the executives being reviewed. In addition, the Compensation Committee annually reviews the compensation philosophy for all executive leaders. This review included review of a comprehensive report from an independent, outside compensation consultant specializing in healthcare organizations for select positions and the prior year's report on all of the reviewed positions. The reports reviewed by the Committee included a comparison of total compensation and each element thereof, including base salary, bonus, 'at-risk other cash compensation, and benefits, including deferred and retirement benefits.Compensation was compared to both a national and regional peer group of organizations similar in size and structure to the organization, the list of which was reviewed by the Compensation Committee. The Compensation Committee maintained minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Mr. Arner, Mr. Conte, Mr. Halliwill, and Mr. Vaughan participate in a Defined Contribution Supplemental Executive Retirement Plan (DC SERP). Contributions to the plan are at the discretion of Carilion Clinic's Compensation Committee. Amounts vest and become non-forfeitable and payable upon the first of the following (1) attainment of scheduled vesting date (2) attainment of age and years of service requirements (3) disability or death while an eligible employee or (4) entitlement to severance benefits from an involuntary termination without reasonable cause or resignation with good reason. Unvested contributions made to the DC SERP in the reporting period are included in Part II, Column C of this schedule with "retirement and other deferred compensation," while vested contributions paid out during the year are included in Part II, Column B(iii). The following distributions were made to these individuals under this plan in the reporting year. Deferred in prior year and paid out in current year: $113,415 - Donald Halliwill $73,054 - Steven Arner $19,258 - G. Robert Vaughan, Jr. $60,115 - Nicholas Conte Ms. Agee participates in an Executive Flexible Benefit Plan, under which she receives an allowance which can be used to obtain certain benefits, with the excess deferred until the applicable vesting date. Amounts now received under this plan vest immediately and thus are no longer deferred. $245,365 was distributed under this plan in the reporting year. Schedule J, Part I, Line 7 Non-fixed payments The organization pays annual 'at-risk' compensation to certain members of management based on performance of an applicable scorecard. While the scorecard contains a formula as a basis for determining overall performance, in certain cases, senior managers have discretion to include additional elements in their assessment of managers reporting to them. In addition, for top management, the actual non-fixed payment awarded is in the discretion of the Carilion Clinic Board of Directors and its Compensation Committee. Form 990, Part III, Line 4a PROGRAM ACCOMPLISHMENTS Carilion Rockridge Community Hospital, part of Carilion Clinic, is a not-for-profit healthcare organization committed to improving health outcomes for every patient while advancing the quality of care in the community it serves. Located in Lexington, Virginia, this 25-bed critical access hospital provides 24 hour emergency care and a full range of inpatient and outpatient services, including imaging, orthopaedic, surgical and therapies. Carilion Rockbridge Community Hospital (CRBH) exists to serve the health care needs of its community, regardless of a patient's ability to pay. The acute hospital admitted 1,252 patients and provided 4,911 days of care during the year. Hospital programs include the provision of nursing care, swing bed services, extensive outpatient and inpatient surgical and endoscopic services, respiratory therapy, and diagnostic imaging services including CT, MRI, mammography, ultrasound, DEXA scan and nuclear medicine, women's services and sleep medicine. The hospital also offers integrated and comprehensive primary care services through multiple Rural Health Clinics, serving over 45,000 patient visits. The hospital provides several services targeting the specific health needs of its population, including diabetes management, physical, speech, and occupational therapy programs, participation in cardiac rehabilitation, pulmonary rehabilitation and disease management programs. Further, the hospital served 13,549 patient visits in its emergency department, which provides 24-hour care, emergency transportation, and a chest pain program. Emergency services are a critical component of the health safety net in the hospital's service area, acting as a vital health provider for a significant number of uninsured patients, who comprise nearly 5 percent of ED visits. The hospital supports community screenings and education on chronic disease prevention and management. In furtherance of its mission, the hospital provides extensive uncompensated care and community support. Stated at cost, financial assistance and other community benefits for the year exceeded $3 million. Form 990, Part IV, Line 11f Disclosure of Uncertain Tax Positions Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. Form 990, Part V, Line 1a FORMS 1099 1099's are issued on Carilion Rockbridge Community Hospital's behalf by Carilion Services, Inc., a related organization providing management and administrative services, including payment processing. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Nancy Howell Agee, Steven Arner, Nicholas Conte, David Hagadorn, Donald Halliwill, G. Robert Vaughan, Jr, Julie Smith-Hamilton, Alicia Devine, Ayesha Kelly, and Lisa Sprinkel - Business relationship Form 990, Part VI, Line 3 Delegation of management duties Certain management and related services for the organization are provided by the management and employees of Carilion Services, Inc., a related and supporting organization of the filing organization. Some or all of the compensation of the following individuals listed in Part VII, Section A was provided by Carilion Services, Inc.: Nancy Howell Agee, Steve Arner, Nicholas C. Conte, David Hagadorn, Donald B. Halliwill, Julie Smith-Hamilton, Lisa T. Sprinkel, and G. Robert Vaughan, Jr. Form 990, Part VI, Line 6 Classes of members or stockholders The organization has a single member. The sole member is Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. The sole member elects the directors of the organization and has certain other reserved powers. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The sole member of the organization, Carilion Clinic, elects the members of the governing body of the organization periodically as terms expire. The sole member also has the right to remove directors and fill any vacancies on the Board that may occur for any reason. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The sole member of the organization, Carilion Clinic, holds reserved powers with respect to certain enumerated actions, including appointment of CEO; approval of borrowings, budgets, and strategic plans; and amendments of Articles of Incorporation and Bylaws, among others. Approval by the Board of Directors of Carilion Clinic is required for such actions. In addition to the reserved powers, under the laws of the Commonwealth of Virginia, certain extraordinary actions require member approval, such as mergers, consolidations, liquidations, and the sale of substantially all of the assets of the organization. See also Schedule O disclosure for Form 990, Part VI, Section A, Line 7a. Form 990, Part VI, Line 11b Review of form 990 by governing body The Form 990 was prepared by Carilion's internal Tax Department with input from various Carilion departments, as applicable, and reviewed by internal management. Several days prior to filing, all Board Members were notified via email that the final Form 990 was posted on the organization's Board portal, which is the mechanism used to disseminate meeting materials to the directors, and directors were encouraged to call with any questions they might have. Form 990, Part VI, Line 12c Conflict of interest policy Our organization monitors and reviews proposed and current transactions for conflicts of interest in a variety of ways. At the governing board level, we have board members complete an initial (upon appointment) and annual conflict of interest questionnaire to disclose actual or potential conflicts. Board members are required to update their disclosure as needed in between questionnaires. All disclosures are reviewed by the Compliance Office and as needed escalated to the appropriate leaders/board members for further discussion/review. If a disclosure is viewed as an actual or potential conflict, an action is recommended to the Compliance Committee of the Carilion Clinic Board and implemented as approved. Actions can include recusal in discussion/voting at board meetings, limitation/termination of the transaction, removal from board appointment or other appropriate controls. In addition, at any time, board members are encouraged to disclose any potential conflicts as they arise at a board meeting and to recuse themselves as deemed appropriate. The same process takes place as described above for key employees (upon hire and annually thereafter), including all officers, members of the management team, physicians/mid-level practitioners, pharmacists and key supply chain buyers. After review and further discussion as needed, action may be required to manage an actual conflict or to reduce the appearance of such as approved by the Compliance Office and other key management team members. As needed, the governing board leaders are notified of any conflicts which may impact board proceedings. Form 990, Part VI, Line 15a Process to establish compensation of top management official The organization has a single member, Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. Executive compensation is reviewed annually by the Carilion Clinic Board of Directors Compensation Committee. This Committee is made up of independent Board Members of Carilion Clinic who do not have a conflict of interest with any of the executives being reviewed. With respect to Carilion Clinic, the Compensation Committee reviews the compensation of the Board of Governors annually, which includes the President and Chief Executive Officer, the Executive Vice Presidents (Chief Financial Officer, Chief Medical Officer, Chief Operating Officer, Chief Administrative Officer and Chief Legal Officer), and select Senior Vice Presidents who are the physician Chairs of the Clinical Departments. For the fiscal year covered by this return, the Compensation Committee also used the same process to review the compensation of other Disqualified Individuals, including the Hospital Vice Presidents. In addition, the Compensation Committee annually reviews the compensation philosophy for all executive leaders, which includes Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, and the CEO, as well as the compensation philosophy for employed physicians. Some officers of the organization who are not compensated in their capacity as an officer but rather in their role as employee in a position not mentioned above are not subject to Committee review. This review included review of a comprehensive report from an independent, outside compensation consultant specializing in healthcare organizations for certain select positions and the prior year's report on all the reviewed positions. The reports reviewed by the Committee included a detailed comparison of total compensation and each element thereof, including base salary, bonus, 'at-risk other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to both a national and regional peer group of organizations similar in size and structure to the organization, the list of which was reviewed by the Compensation Committee. The Compensation Committee maintained minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. Form 990, Part VI, Line 15b Process to establish compensation of other employees See response to line 15A. Form 990, Part VI, Line 19 Required documents available to the public The organization's governing documents, conflict of interest statement, and financial statements are released from time to time during the tax year upon request. The conflict of interest policy is included in our Code of Excellence which is available to the public on our website. The Articles of Incorporation are available from the Virginia State Corporation Commission. Limited financial information is available on our website. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue - Total Revenue: 2766, Related or Exempt Function Revenue: 2766, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees CONTRACT LABOR - Total Expense: 3751598, Program Service Expense: 3751598, Management and General Expenses: , Fundraising Expenses: ; BILLING & COLLECTION - Total Expense: 926015, Program Service Expense: , Management and General Expenses: 926015, Fundraising Expenses: ; LAUNDRY & HOUSEKEEPING - Total Expense: 387942, Program Service Expense: 387942, Management and General Expenses: , Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 754971, Program Service Expense: 749687, Management and General Expenses: 5284, Fundraising Expenses: ; CONSULTING - Total Expense: 1388768, Program Service Expense: 1238878, Management and General Expenses: 149890, Fundraising Expenses: ; REPAIRS & MAINTENANCE - Total Expense: 535464, Program Service Expense: 533338, Management and General Expenses: 2126, Fundraising Expenses: ; REFERENCE LABS - Total Expense: 1543932, Program Service Expense: 1543932, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part X, Line 20 Tax-Exempt Bond Liabilities The amount reported as Tax-Exempt Bonds is the portion of Carilion Clinic Bonds allocated to Carilion Rockbridge Community Hospital. Required information for the Bonds, including Schedule K, is reported in the Carilion Clinic (EIN: 54-1190771) IRS Form 990. 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