CARILION TAZEWELL COMMUNITY HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CARILION TAZEWELL COMMUNITY HOSPITAL (EIN 54-6074580)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-14
- IRS object ID
- 202342269349303014
- Schema version
- 2021v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-14T21:32:22+00:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 546074580 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carilion Tazewell Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARI | BusinessNameControlTxt |
| Phone | 5402245102 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12385 | AddressLine1Txt |
| City | Roanoke | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24025 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | G ROBERT VAUGHAN JR | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 5402245102 | PhoneNum |
| Signature | 2023-08-14 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | G ROBERT VAUGHAN | PersonFirstNm |
| Person Last | JR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALICIA BALES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12385 | AddressLine1Txt |
| City | Roanoke | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24025 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $21,732,748 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CARILIONCLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1968 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 142 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $184,206 | PYContributionsGrantsAmt |
| CY Contributions Grants | $976,495 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,495,888 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,616,034 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,679 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,582 | CYInvestmentIncomeAmt |
| PY Other Revenue | $97,596 | PYOtherRevenueAmt |
| CY Other Revenue | $136,637 | CYOtherRevenueAmt |
| PY Total Revenue | $18,782,369 | PYTotalRevenueAmt |
| CY Total Revenue | $21,732,748 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,982 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $45,271 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,885,763 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,724,576 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,631,630 | PYOtherExpensesAmt |
| CY Other Expenses | $15,778,890 | CYOtherExpensesAmt |
| PY Total Expenses | $21,523,375 | PYTotalExpensesAmt |
| CY Total Expenses | $26,548,737 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,741,006 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,815,989 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,452,330 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,741,488 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $35,002,922 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $40,034,525 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$27,550,592 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$32,293,037 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $22,289,596 | ExpenseAmt |
| Grant | $45,271 | GrantAmt |
| Revenue | $20,618,819 | RevenueAmt |
| Desc | See Schedule O. | Desc |
| Total Program Service Expenses | $22,289,596 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 142 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | false | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | VA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE CORPORATION ATTN H KIRK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5402245102 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 S JEFFERSON ST | AddressLine1Txt |
| City | ROANOKE | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24011 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Alicia Bales | |||||||||
| Director/Sr. Operations Director | 50.0 | 0.0 | Yes (X) | Yes (X) | $106,051 | $0 | $21,914 | ||
| D Michael Hymes | |||||||||
| Director/Vice Chair | 1.2 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| James C Thompson | |||||||||
| Director/Chair | 2.5 | 2.4 | Yes (X) | Yes (X) | $0 | $9,458 | $0 | ||
| Mandy French | |||||||||
| Director/Sec./Treas. | 1.2 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Anthony Grills | |||||||||
| Director | 1.2 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Donald Linkous | |||||||||
| Director | 1.2 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Kevin Combs DO | |||||||||
| Director | 1.2 | 48.8 | Yes (X) | $0 | $233,770 | $58,409 | |||
| Kristie Williams | |||||||||
| Director/Hospital VP | 2.5 | 47.5 | Yes (X) | $0 | $238,150 | $108,508 | |||
| Mark Mossey MD | |||||||||
| Director | 1.2 | 48.8 | Yes (X) | $0 | $314,646 | $46,206 | |||
| Nellie Stillwell | |||||||||
| Director | 1.2 | 0 | Yes (X) | $0 | $0 | $0 | |||
| William Flattery | |||||||||
| Director | 1.2 | 48.8 | Yes (X) | $0 | $331,796 | $105,736 | |||
| David Hagadorn | |||||||||
| Asst. Treasurer | 0.5 | 49.5 | Yes (X) | $0 | $154,286 | $66,243 | |||
| Donald Halliwill | |||||||||
| Asst. Treasurer | 0.5 | 49.5 | Yes (X) | $0 | $1,027,399 | $266,876 | |||
| G Robert Vaughan Jr | |||||||||
| Asst. Treasurer | 0.5 | 49.5 | Yes (X) | $0 | $415,087 | $180,417 | |||
| Julie Smith-Hamilton | |||||||||
| Asst. Secretary | 0.5 | 49.5 | Yes (X) | $0 | $51,831 | $18,964 | |||
| Nicholas Conte | |||||||||
| Asst. Secretary | 1.0 | 49.0 | Yes (X) | $0 | $799,125 | $197,025 | |||
| Nancy Howell Agee | |||||||||
| CEO, Carilion Clinic | 2.0 | 48.0 | $0 | $2,498,861 | $158,310 | Yes (X) | |||
| Steven Arner | |||||||||
| Executive Vice President | 2.0 | 48.0 | $0 | $1,100,977 | $280,265 | Yes (X) | |||
| Anita Witt-Kinder | |||||||||
| RN | 50.0 | 0 | $149,005 | $0 | $43,016 | Yes (X) | |||
| Bethany Yoder | |||||||||
| Physical Therapist | 49.0 | 1.0 | $121,578 | $8,827 | $19,854 | Yes (X) | |||
| David Vance | |||||||||
| Pharmacy Manager | 50.0 | 0 | $134,959 | $0 | $34,442 | Yes (X) | |||
| Karen Beavers | |||||||||
| RN Team Lead | 50.0 | 0 | $104,070 | $0 | $25,788 | Yes (X) | |||
| Kathryn Sathre | |||||||||
| Physical Therapist | 50.0 | 0 | $103,778 | $0 | $29,231 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $719,441 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,184,213 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,661,204 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| QUEST DIAGNOSTICS | ||||||
| 500 PLAZA DRIVE | SECAUCUS | NJ | 07094 | LABORATORY SERVICES | $934,405 | |
| QUALIVIS LLC | ||||||
| 1601 ASSEMBLY STREET | COLUMBIA | SC | 29201 | TEMPORARY STAFFING | $265,243 | UNIT 1439 |
| MR RAMAKRISHNAN MD PC | ||||||
| 1745 VALLEY VIEW DR | BIG STONE GAP | VA | 24219 | PHYSICIAN SERVICES | $259,615 | |
| DOMINION DRIVEWAY PARKING LOT PAVING INC | ||||||
| 2927 ADRIA ROAD NORTH | TAZEWELL | VA | 24630 | CONTRACTOR SERVICES | $239,500 | |
| DIRECT RADIOLOGY | ||||||
| 2210 BOTHELL EVERETT HIGHWAY | BOTHELL | WA | 98021 | RADIOLOGY SERVICES | $193,962 | BUILDING C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $968,160 | GovernmentGrantsAmt |
| All Other Contributions | $8,335 | AllOtherContributionsAmt |
| Total Contributions | $976,495 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Revenue | 622110 | $20,457,429 | $20,457,429 |
| Rent From Affiliates | 531120 | $158,605 | $158,605 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,616,034 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,273 | TotalRevenueColumnAmt |
| Exclusion | $3,273 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $93,543 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $93,543 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $93,543 | TotalRevenueColumnAmt |
| Exclusion | $93,543 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $309 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $309 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $309 | TotalRevenueColumnAmt |
| Exclusion | $309 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Cafeteria | Desc |
| Business | 722514 | BusinessCd |
| Total Revenue Column | $40,309 | TotalRevenueColumnAmt |
| Exclusion | $40,309 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,785 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,785 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $43,094 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,732,748 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,618,819 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $137,434 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,271 | TotalAmt |
| Program Services | $45,271 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,089 | TotalAmt |
| Management And General | $130,089 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,304 | TotalAmt |
| Program Services | $109,304 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,314,296 | TotalAmt |
| Program Services | $8,265,359 | ProgramServicesAmt |
| Management And General | $48,937 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $572,172 | TotalAmt |
| Program Services | $568,781 | ProgramServicesAmt |
| Management And General | $3,391 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $999,980 | TotalAmt |
| Program Services | $986,277 | ProgramServicesAmt |
| Management And General | $13,703 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598,735 | TotalAmt |
| Program Services | $589,367 | ProgramServicesAmt |
| Management And General | $9,368 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,809,726 | TotalAmt |
| Management And General | $3,809,726 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,770 | TotalAmt |
| Program Services | $1,770 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,115,278 | TotalAmt |
| Program Services | $2,984,945 | ProgramServicesAmt |
| Management And General | $130,333 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120 | TotalAmt |
| Program Services | $120 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $485,412 | TotalAmt |
| Program Services | $471,491 | ProgramServicesAmt |
| Management And General | $13,921 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,328 | TotalAmt |
| Program Services | $35,328 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $447,628 | TotalAmt |
| Program Services | $447,628 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193,810 | TotalAmt |
| Program Services | $193,642 | ProgramServicesAmt |
| Management And General | $168 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $631,654 | TotalAmt |
| Program Services | $631,654 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $694,935 | TotalAmt |
| Program Services | $694,935 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,297 | TotalAmt |
| Program Services | $81,224 | ProgramServicesAmt |
| Management And General | $85,073 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies | $1,169,538 | $1,169,538 |
| Bad Debt | $2,077,330 | $2,077,330 |
| Affiliate Practice Subsidy | $2,181,282 | $2,181,282 |
| Assessment Fees | $717,862 | $717,862 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,920 | TotalAmt |
| Program Services | $36,488 | ProgramServicesAmt |
| Management And General | $14,432 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,548,737 | TotalAmt |
| Program Services | $22,289,596 | ProgramServicesAmt |
| Management And General | $4,259,141 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,048 | BOYAmt |
| EOY | $1,049 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,950 | BOYAmt |
| EOY | $3,950 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,333,122 | BOYAmt |
| EOY | $3,791,315 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,034 | BOYAmt |
| EOY | $141,944 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,959,056 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,165,554 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,075,327 | BOYAmt |
| EOY | $3,793,502 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,849 | BOYAmt |
| EOY | $9,728 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,452,330 | BOYAmt |
| EOY | $7,741,488 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,263,517 | BOYAmt |
| EOY | $2,233,475 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,005,942 | BOYAmt |
| EOY | $340,346 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,733,463 | BOYAmt |
| EOY | $37,460,704 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,002,922 | BOYAmt |
| EOY | $40,034,525 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$27,550,592 | BOYAmt |
| EOY | -$32,293,037 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$27,550,592 | BOYAmt |
| EOY | -$32,293,037 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,452,330 | BOYAmt |
| EOY | $7,741,488 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,815,989 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $73,544 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $1,170 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,170 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | A portion of dues paid to various healthcare industry associations is attributable to lobbying activities. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $48,753 | OtherCostOrOtherBasisAmt |
| Book Value | $48,753 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,294,606 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,654,243 | DepreciationAmt |
| Book Value | $2,640,363 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,802,658 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,069,007 | DepreciationAmt |
| Book Value | $733,651 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $813,039 | OtherCostOrOtherBasisAmt |
| Depreciation | $442,304 | DepreciationAmt |
| Book Value | $370,735 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,793,502 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Affiliate | $37,423,072 |
| Pension Liability | $27,902 |
| Lease Liability | $9,730 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $37,460,704 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 500 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | false | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $331,784 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $331,784 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0136 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,443,063 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,015,576 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,427,487 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0583 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,774,847 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,015,576 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,759,271 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0719 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $78,670 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $78,670 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0032 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,431 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $40,431 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0017 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $119,101 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $119,101 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0049 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,893,948 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,015,576 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,878,372 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0768 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,742 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,742 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,177 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,177 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $3,944 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,944 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0002 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,077,330 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,279,470 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,994,318 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$714,848 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARILION TAZEWELL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 388 BEN BOLT AVENUE | AddressLine1Txt |
| City | TAZEWELL | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24651 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://carilionclinic.org/locations/carilion-tazewell-community-hospital | WebsiteAddressTxt |
| State License | H 1907 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARILION TAZEWELL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 20 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.carilionclinic.org/cho-community-health-assessments#reports | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | https://issuu.com/carilionclinic/docs/2021_tazewell_county_cha_report_final | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.carilionclinic.org/sites/default/files/2022-02/2021%20CTCH%20Implementation%20Strategy_F | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 500.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.carilionclinic.org/billing/financial-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.carilionclinic.org/billing/financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.carilionclinic.org/billing/financial-assistance | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 Tazewell 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 low-income, are minorities and suffer from chronic diseases. The following organizations served on the CHAT for the 2021 Tazewell County Community Health Needs Assessment (TCCHNA): Clinch Valley Community Action, Main Street United Methodist Church, Four County Transit/Appalachian Agency for Senior Citizens, and Labor of Love Mission, in addition to representatives from multiple Carilion Clinic departments. To obtain input from the community, the TCCHNA conducted a focus group among CHAT stakeholders and administered a 40-question community health survey broadly across the service area. This occurred from October 1, 2020, through January 31, 2021. The 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 Tazewell County residents 18 years of age and older. Special efforts were made to include underserved/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. The survey was also made available to all residents living in Tazewell County. 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 Tazewell Community Hospital. Clinch Valley Community Action, Main Street United Methodist Church, Four County Transit/Appalachian Agency for Senior Citizens, and Labor of Love Mission, in addition to representatives from multiple Carilion Clinic departments. |
| Schedule H, Part V, Section B, Line 7 Facility , 1 | Facility , 1 - Carilion Tazewell Community Hospital. The Community Health Assessment Team shared the 2021 Tazewell County Community Health Needs Assessment (TCCHNA) on partner websites and social media. The TCCHNA was also shared through community presentations to groups including the local rotary club. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - Carilion Tazewell Community Hospital. The following information describes the implementation strategy used by Carilion Tazewell Community Hospital (CTCH) to address the community health needs identified in the 2021 Tazewell County Community Health Needs Assessment (TCCHNA). The complete implementation strategy is available online at https://www.carilionclinic.org/sites/default/files/2022-02/2021 CTCH Implementation Strategy_FINAL APPROVED.pdf. Per Regulation Section 1.501(r)-3(c)(5) the implementation strategy must be adopted before 4.5 months after the end of the taxable year in which the CHNA is completed. The implementation strategy was adopted on January 27, 2022 and applies for the 2020 tax year (fiscal year 9/30/2021). The top prioritized needs for the 2021 TCCHNA were grouped into four overarching categories: mental health, socioeconomic factors, culture and health behaviors. We plan to address prioritized needs with the following strategies and through a commitment of financial resources, staff time and leadership. Strategies to address mental health include exploring the establishment of a crisis receiving center and supporting operation of office-based opioid treatment on the hospital campus. Progress made in 2022 on mental health strategies centered on maintaining what has been working well for our region and our hospital system and establishing infrastructure to scale/prioritize that work. We have hired and onboarded a system-wide community workforce manager and a CTCH-based peer support specialist; we continue to provide support to the office-based opioid treatment (OBOT) center on CTCH's campus; Carilion Pharmacy Community Outreach provides education/outreach to local pharmacy providers to ensure patients have access to required prescriptions to utilize outpatient medicated assisted therapy treatment; and we have designated two of the three priority areas for community health interventions as "mental health and "substance use". Strategies to address socioeconomic factors include assessing patients' eligibility for Medicaid and assisting with enrollment; implementing the Unite Us platform for social service referrals; and establishing a virtual care center in Bluefield. Progress made in 2022 to address socioeconomic factors includes strengthening infrastructure to increase access to care, in addition to increased collaboration to address cross-cutting social issues. CTCH continues to grow the number of insured patients in our community by providing Medicaid eligibility and enrollment assistance on our campus. The establishment of the Bluefield virtual care center-which will reduce transportation/time barriers to accessing some health care services-is well underway with a tentative opening date in spring 2023. We continue our commitment to finding solutions for increased community-based resource coordination and plan to launch a pilot of an external community resource referral resource, Unite Us, in March of 2023. Strategies to address culture and health behaviors include providing community health education and participating in community events such as health fairs, immunizations and health screenings. Progress made in 2022 to address culture and health behaviors has stemmed from the hiring and on-boarding of a system-wide health education manager position and increasing infrastructure. Health education departmental strategies have been redesigned to better meet community-identified needs, prioritize disadvantage populations, and maximize impact (including reach and outcomes). The CTCH community health educator position was reinstated at .2 FTE, providing the infrastructure necessary to enact these impact-driven strategies and maintain strong, active partnerships with organizations and coalitions committed to collaborative community programming. 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 2022 in our additional strategies category was also closely aligned with increasing infrastructure and strategic impact. Increased staffing infrastructure in the Planning and Community Development division has opened opportunities to evaluate and update current processes to better communicate initiative rationale, program outcomes, and expected community impact. Community Health and Outreach's community health worker (CHW) and peer support specialist programs have been integrated into the electronic medical record system-increasing provider capacity for referrals to community health services and streamlining CHW and Peer case management, tracking, and reporting. Continuing our commitment to care, the Planning and Community Development division is working closely with the Quality team and the office of Diversity, Equity, and Inclusion to identify and leverage internal data to identify any disparities in the communities we serve. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - Carilion Tazewell Community Hospital. Policy changed for February 1, 2021, Individuals with out of network insurance are eligible for financial assistance. Previously, these individuals were not eligible unless their plan did not meet the the Patient Protection and Affordable Care Act (PPACA) minimum essential coverage. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 3c Other Financial Assistance Eligibility Criteria | Financial assistance policy in effect for February 1, 2021: families with family income equal or below 300% of the FPG and assets equal or below $25,000 receive 100% adjustment under FAP. Families with family income greater than 300% of the FPG but less than or equal to 500% of the FPG or 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. |
| 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 | 2077330 |
| 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 through 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 had direct economic development expenses from support of Tazewell Today, an economic revitalization initiative of the Tazewell Main Street community. This promotes the community's health by improving economic vitality, attracting visitors 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, such as the Four Seasons YMCA. Carilion also collaborates with local partners to support historic preservation including the Historic Crab Orchard Museum and Historic Pocahontas, Inc. These efforts help to increase history and culture for residents of the region, promoting a sense of belonging which impacts health. Lastly, financial contributions and staff support impact health through Clinch Valley Community Action programs and the Tazewell County Coordinated Community Response, a multidisciplinary team addressing domestic violence and similar safety issues in the community. Line 7 - Community health improvement and advocacy: Carilion believes in leveraging our efforts to support community health improvement across our footprint, as well as across Virginia. As such, our President and CEO participates on the Governor's Medical Advisory Team focused on community health and resiliency in the wake of the COVID-19 pandemic. Line 8 - Workforce development: One way Carilion improves community health is through support of workforce development in our region. By supporting the Virginia Foundation for Independent Colleges, Carilion helps to ensure that these educational opportunities lead to a stronger workforce and thriving communities. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | Carilion Tazewell 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 | Accounts receivable are stated at net realizable amounts due from patients, third-party payors, and other insurers for which Carilion Tazewell 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 TAZEWELL COMMUNITY HOSPITAL: Line 16a URL: https://www.carilionclinic.org/billing/financial-assistance; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - CARILION TAZEWELL 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 TAZEWELL 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. Community health workers (CHWs) are also utilized to help address needs, and data is reviewed periodically to identify trends in healthcare needs of patients served by CHWs. 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) and has been proven to lead to large-scale changes. It focuses on relationship-building between organizations and the progress toward shared strategies. |
| 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 | Tazewell County is a large, rural area in Southwest Virginia experiencing significant disparities in health and social determinants compared to the Commonwealth of Virginia. The 2017-2021 U.S. Census Bureau's American Community Survey (ACS) found the total population of Tazewell County to be 40,615 with a median age of 45.1, compared to 38.5 in Virginia. The median household income in Tazewell County is $42,937, with 17.60% of the population living below the federal poverty level. (US Census Bureau, ACS. 2017-2021.) The percentage of Tazewell County residents with Medicaid is 23.17%, while 7.34% have no insurance at all. (US Census Bureau, ACS. 2017-2021.) Of all Carilion Tazewell Community Hospital (CTCH) patients in FY22, 30.2% were Medicaid recipients while 2.5% were self-pay. (Strata internal data.) The Weldon Cooper Center for Public Service predicts a negative population change for Tazewell County by 2040. A more significant percentage of the population is White in Tazewell County than in the Commonwealth of Virginia as a whole. In Tazewell County, 93.8% of the population is White, 3.8% of the population is Black, and 1.10% is Hispanic or Latino. (US Census Bureau, ACS. 2017-2021.) No other hospital facilities are located within Tazewell County, but the population is also served by Ballad Health. Ballad's nearest facility, Smyth County Community Hospital, is located 35 miles or roughly one hour away from CTCH. All of Tazewell County is a designated Medically Underserved Area and a Health Professional Shortage Area (HPSA) for the low-income population regarding primary care and dental health. It is also considered a high-needs geographical HPSA for mental health by the Department of Health and Human Services. (https://data.hrsa.gov/tools/shortage-area.) |
| Schedule H, Part VI, Line 5 Promotion of community health | Carilion Tazewell 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 Tazewell Community Hospital (CTCH) is a 56-bed hospital with extended care recovery through the swing bed program-which allows patients with skilled care needs to grow stronger before going home. CTCH offers 24/7 emergency care, diagnostic services including imaging, mammography, and physical and respiratory therapy. It also provides on-site primary care services through Carilion Clinic Family Medicine and the Tazewell Veteran's Outpatient Clinic. CTCH 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. |
| Schedule H, Part VI, Line 6 Affiliated health care system | Carilion Tazewell 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, over 75 specialties, and 282 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|---|---|---|---|---|---|
| Tazewell County Sheriff's Office | ||||||||||
| 140 School St Suite 9 | Tazewell | VT | 24651 | 546001649 | Tazewell County | $10,000 | AEDs | |||
| Town of Tazewell | ||||||||||
| 403 Steeles Lane | Tazewell | VA | 24651 | 546001647 | Town of Tazewell | $9,026 | CPR Device | |||
| Southwest Virginia Community Health Systems Inc | ||||||||||
| PO Box 297 | Meadowview | VA | 24361 | 542046110 | 501(c)(3) | Facility Use | $20,623 | FMV | Donated rent | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | false | WrittenPolicyRefTAndEExpnssInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kevin Combs DO | ||||||||||||||
| Director | $0 | $231,325 | $0 | $195 | $0 | $2,250 | $0 | $47,012 | $0 | $11,397 | $0 | $292,179 | $0 | $0 |
| William Flattery | ||||||||||||||
| Director | $0 | $257,042 | $0 | $71,797 | $0 | $2,957 | $0 | $92,801 | $0 | $12,935 | $0 | $437,532 | $0 | $0 |
| Mark Mossey MD | ||||||||||||||
| Director | $0 | $289,606 | $0 | $22,426 | $0 | $2,614 | $0 | $44,411 | $0 | $1,795 | $0 | $360,852 | $0 | $0 |
| Kristie Williams | ||||||||||||||
| Director/Hospital VP | $0 | $174,795 | $0 | $55,892 | $0 | $7,463 | $0 | $96,597 | $0 | $11,911 | $0 | $346,658 | $0 | $0 |
| Nicholas Conte | ||||||||||||||
| Asst. Secretary | $0 | $552,419 | $0 | $240,712 | $0 | $5,994 | $0 | $182,985 | $0 | $14,040 | $0 | $996,150 | $0 | $0 |
| David Hagadorn | ||||||||||||||
| Asst. Treasurer | $0 | $144,952 | $0 | $3,120 | $0 | $6,214 | $0 | $60,261 | $0 | $5,982 | $0 | $220,529 | $0 | $0 |
| Donald Halliwill | ||||||||||||||
| Asst. Treasurer | $0 | $628,026 | $0 | $276,629 | $0 | $122,744 | $0 | $249,075 | $0 | $17,801 | $0 | $1,294,275 | $0 | $118,313 |
| G Robert Vaughan Jr | ||||||||||||||
| Asst. Treasurer | $0 | $291,047 | $0 | $98,416 | $0 | $25,624 | $0 | $161,498 | $0 | $18,919 | $0 | $595,504 | $0 | $21,586 |
| Nancy Howell Agee | ||||||||||||||
| CEO, Carilion Clinic | $0 | $1,469,225 | $0 | $788,983 | $0 | $240,653 | $0 | $145,721 | $0 | $12,589 | $0 | $2,657,171 | $0 | $0 |
| Steven Arner | ||||||||||||||
| Executive Vice President | $0 | $710,945 | $0 | $320,483 | $0 | $69,549 | $0 | $261,164 | $0 | $19,101 | $0 | $1,381,242 | $0 | $64,231 |
| David Vance | ||||||||||||||
| Pharmacy Manager | $132,379 | $0 | $2,400 | $0 | $180 | $0 | $17,482 | $0 | $16,960 | $0 | $169,401 | $0 | $0 | $0 |
| Anita Witt-Kinder | ||||||||||||||
| RN | $144,226 | $0 | $1,150 | $0 | $3,629 | $0 | $34,771 | $0 | $8,245 | $0 | $192,021 | $0 | $0 | $0 |
| Bethany Yoder | ||||||||||||||
| Physical Therapist | $112,306 | $8,827 | $9,150 | $0 | $122 | $0 | $19,304 | $0 | $550 | $0 | $141,432 | $8,827 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, Mrs. Beavers and Mrs. Witt-Kinder RECEIVED SUCH BENEFIT. |
| 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 and 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: $118,313 - Donald Halliwill $64,231 - Steven Arner $21,586 - G. Robert Vaughan, Jr. Ms. Agee participated in an executive flexible benefit plan, in which an allowance is provided annually to the participant for use in obtaining certain insurance benefits. In prior years, the amount of allowance in excess of elected benefits was credited to a capital accumulation account (CAA) with various deferred vesting dates of at least two years from the first day of the plan year, distributable upon vesting while employed by a Carilion Clinic affiliate, death, disability, or 24 months following certain qualifying separations from service. Deferrals no longer occur under this plan. $229,385 was distributed under this plan in the reporting year. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Brian Bales | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family member of Alicia Bales, Director | RelationshipDescriptionTxt |
| Transaction | $109,304 | TransactionAmt |
| Transaction | Employee | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS | Carilion Tazewell 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. This hospital primarily serves the counties of Tazewell and Russell in Virginia and Mercer and McDowell in West Virginia. Carilion Tazewell Community Hospital (CTCH) exists to serve its community's health care needs, regardless of a patient's ability to pay. CTCH's acute hospital admitted 608 patients and provided 3,410 days of care during the year. Hospital programs include an active primary care practice for the community, the provision of nursing care, and diagnostic imaging services including CT, MRI, mammography, x-ray and ultrasound. Tazewell provides several services targeting the specific health needs of its population, including physical, speech, and occupational therapy programs, home health services and bone density testing. CTCH also provides an emergency department with 24-hour care and emergency transportation. With 9,056 visits, CTCH's emergency services are a critical component of the health safety net in its service area. It acts as a vital health provider for a significant number of uninsured patients who comprise nearly 4 percent of ED visits. CTCH supports community events such as community screenings and education on chronic disease management. In furtherance of its mission, CTCH provides extensive uncompensated care and community support. Stated at cost, financial assistance and other community benefits for the year exceeded $1.8 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 | 1099s are issued on Carilion Tazewell Community Hospital's behalf by Carilion Services, Inc., a related organization providing management and administrative services, including payment processing. |
| Form 990, Part VI, Line 8b Committees With Authority To Act on Behalf of Governing Body | Carilion Tazewell Community Hospital has no committees. |
| 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, William Flattery, Julie Smith-Hamilton, Mark Mossey, Kevin Combs, and Kristie Williams - Business relationship, JAMES THOMPSON, NELLIE STILLWELL - 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 S. Hagadorn, Donald B. Halliwill, Julie Smith-Hamilton 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 Accounting 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 of 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 and 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, which list 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 | Other Revenue - Total Revenue: 2785, Related or Exempt Function Revenue: 2785, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part IX, Line 11g Other Fees | Physician/Professional Services - Total Expense: 802495, Program Service Expense: 802495, Management and General Expenses: , Fundraising Expenses: ; Other Purchased Services - Total Expense: 746247, Program Service Expense: 689260, Management and General Expenses: 56987, Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 198431, Program Service Expense: 198431, Management and General Expenses: , Fundraising Expenses: ; Reference Labs - Total Expense: 1151545, Program Service Expense: 1151545, Management and General Expenses: , Fundraising Expenses: ; Billing and Collection Services - Total Expense: 73346, Program Service Expense: , Management and General Expenses: 73346, Fundraising Expenses: ; Laundry/Housekeeping Services - Total Expense: 143214, Program Service Expense: 143214, Management and General Expenses: , Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Pension-related changes other than net periodic pension costs - 73544; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| CARILION CLINIC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541190771 | SUPPORTING ORGANIZATION | VA | 501(c)(3) | Type II | NA | false |
| CARILION CLINIC FOUNDATION | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541190773 | FUNDRAISING | VA | 501(c)(3) | 7 | CARILION CLINIC | Yes (true) |
| CARILION FRANKLIN MEMORIAL HOSPITAL | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540480606 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
| CARILION GILES COMMUNITY HOSPITAL | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540549603 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
| CARILION MEDICAL CENTER | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540506332 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
| CARILION NEW RIVER VALLEY MEDICAL CENTER | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540553805 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
| CARILION SERVICES INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541190879 | SUPPORTING ORGANIZATION | VA | 501(c)(3) | Type II | CARILION CLINIC | Yes (true) |
| CARILION ROCKBRIDGE COMMUNITY HOSPITAL | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540568001 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt |
|---|---|---|---|---|---|---|---|---|
| CARILION CLINIC MEDICARE SHARED SAVINGS COMPANY LLC | ||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 455235473 | MEDICARE ACO | VA | NA | N/A |
| FRANKLIN COUNTY VENTURES LLC | ||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 474365316 | REAL ESTATE | VA | NA | N/A |
| RAVEN ASSET-BASED OPPORTUNITY FUND IV LP | ||||||||
| 75 Spring St 6th FL | New York | NY | 10012 | 824119491 | Investments | DE | NA | N/A |
| SOUTHWEST VIRGINIA HEALTH PROPERTIES LLC | ||||||||
| 1102 Jefferson Street SE | Roanoke | VA | 24016 | 010691570 | REAL ESTATE | VA | NA | N/A |
| STARWOOD VEP II CO-INVEST LLC | ||||||||
| 591 W Putnam Avenue | Greenwich | CT | 06830 | 833262407 | INVESTMENTS | DE | NA | N/A |
| TI PLATFORM CC SMA LP | ||||||||
| 255 Kansas Street Suite 300 | San Francisco | CA | 94103 | 842852539 | INVESTMENTS | DE | NA | N/A |
| ROANOKE AMBULATORY SURGERY CENTER LLC | ||||||||
| 1102 JEFFERSON ST SE | ROANOKE | VA | 24016 | 010691564 | SURGERY CENTER | VA | NA | N/A |
| TI FBV GR LP | ||||||||
| 255 Kansas Street Suite 300 | San Francisco | CA | 94103 | 862597246 | INVESTMENTS | DE | NA | N/A |
| TI Platform DCI SPV LP | ||||||||
| 800 Town and Country Suite 500 | Houston | TX | 77024 | 871897835 | INVESTMENTS | DE | NA | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|
| CHS INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541725732 | SERVICES | VA | NA | C Corporation | Yes (true) | |
| CARILION BEHAVIORAL HEALTH INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 203136891 | HEALTHCARE | VA | NA | C Corporation | Yes (true) | |
| CARILION EMERGENCY SERVICES INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 542033006 | HEALTHCARE | VA | NA | C Corporation | Yes (true) | |
| SCA CREDIT SERVICES INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541180398 | COLLECTION AGENCY | VA | NA | C Corporation | Yes (true) | |
| CARILION HEALTHCARE CORPORATION | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541586601 | HEALTHCARE | VA | NA | C Corporation | Yes (true) | |
| MEDKEY INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541645357 | FINANCING SERVICES | VA | NA | C Corporation | Yes (true) | |
| SPROTT PRIVATE RESOURCE LENDING (C-CO-INVEST) LP | ||||||||||
| 981378742 | INVESTMENTS | NA | C Corporation | Yes (true) | CA | |||||
| BLACKMOOR OWNERSHIP HOLDINGS LIMITED | ||||||||||
| INVESTMENTS | NA | C Corporation | Yes (true) | CJ | ||||||
| Doubleblue Argentina Consumer Finance Fund II LP | ||||||||||
| 205 East 42nd St 20th FL | New York | NY | 10017 | INVESTMENTS | NA | C Corporation | Yes (true) | CJ | ||
| CARILION DTC SERVICES INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 872635239 | HEALTHCARE | VA | NA | C Corporation | Yes (true) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Carilion Giles Community Hospital | ||
| A | $158,605 | Cost |
| Carilion Medical Center | ||
| M | $2,340,284 | Cost |
| Carilion Services Inc | ||
| M | $3,840,709 | Cost |
| CHS Inc | ||
| M | $730,896 | Cost |
| CHS Inc | ||
| E | $6,730,856 | Cost |