2023-08-14T21:31:00+00:00 2022-09-30 990 2021-10-01 540553805 Carilion New River Valley Medical Center CARI 5402245102 PO BOX 12385 Roanoke VA 24025 G ROBERT VAUGHAN JR TREASURER 5402245102 2023-08-14 G ROBERT VAUGHAN JR 999009999 2021 2023-04-26 12:10:37Z WILLIAM J FLATTERY PO BOX 12385 Roanoke VA 24025 448458120 false X WWW.CARILIONCLINIC.ORG X 1941 VA Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. 14 9 1480 45 0 0 17286830 6298098 266634890 281747116 27712446 10640972 1216004 1571101 312850170 300257287 271864 221322 0 85341215 92402011 0 0 163060827 191219250 248673906 283842583 64176264 16414704 461004073 425753311 124063801 93866158 336940272 331887153 Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. false false 237698347 221322 282142431 See schedule O. 237698347 true true false true false false false false false true true false false true false false true false false false false false false false false true true true false true false false false false false false true false false false false false true true true true false false true X 3 0 true 1480 true false false false false false false false false false false false false X 14 9 true true false false true true true true true false false true true true true true true true true false VA X THE CORPORATION ATTN H KIRK 5402245102 213 S JEFFERSON ST ROANOKE VA 24011 Diane Akers Director/Vice Chair 1.2 0 X X 0 80 0 J Thomas Ryan MD Director/Chair 2.5 0 X X 0 0 0 William Flattery Director/Sec/Treas./Hosp. VP 46.3 3.7 X X 331796 0 105736 Charles Bissell MD Director 1.2 48.8 X 0 671183 105042 Cristina Trout NP Director 5.0 0 X 15811 1480 0 Eric Stanley MD Director 1.2 48.8 X 0 321891 69841 James McAlister Director 1.2 0 X 0 0 0 Kevin Byrd Director 1.2 0 X 0 0 0 Lawrence Hincker Director 1.2 0.0 X 0 336 0 Mark Rogers DO Director 1.2 0 X 0 0 0 Michael Hickman Ed D Director 1.2 0 X 0 0 0 Nathaniel Bishop DMin Director 1.2 48.8 X 0 450718 99264 Sandra Davis Director 1.2 0 X 0 0 0 William Aden Director 1.2 0 X 0 480 0 David Hagadorn Asst. Treasurer 0.5 49.5 X 0 154286 66243 Donald Halliwill Asst. Treasurer 0.5 49.5 X 0 1027399 266876 G Robert Vaughan Jr Asst. Treasurer 0.5 49.5 X 0 415087 180417 Julie Smith-Hamilton Asst. Secretary 0.5 49.5 X 0 51831 18964 Nicholas Conte Asst. Secretary 1.0 49.0 X 0 799125 197025 Nancy Howell Agee CEO, Carilion Clinic 2.0 48.0 X 0 2498861 158310 Steven Arner Executive Vice President 2.0 48.0 X 0 1100977 280265 Dale Bryant Pharmacist 50.0 0 X 161370 0 110389 Donna Shelor Pharmacist 50.0 0 X 172529 0 49344 Kathleen Tickle Pharmacist 50.0 0 X 163626 0 72217 Michael Czar Pharmacy Director 50.0 0 X 158178 0 59479 Ralph Brown MD Physician 50.0 0 X 276762 0 104493 1280072 7493734 1943905 52 false true false QUEST DIAGNOSTICS 500 PLAZA DRIVE SECAUCUS NJ 07094 LABORATORY SERVICES 5445784 QUALIVIS LLC 1601 ASSEMBLY STREET UNIT 1439 COLUMBIA SC 29201 TEMPORARY EMPLOYMENT 4873749 ANESTHESIOLOGY ASSOC OF RADFORD 2900 LAMB CIRCLE SUITE 340 CHRISTIANSBURG VA 24073 ANESTHESIOLOGY SERVICES 4636481 AVANT HEALTHCARE PROFESSIONALS LLC 1211 SEMORAN BLVD SUITE 227 CASSELBERRY FL 32707 TEMPORARY EMPLOYMENT 1960797 SIEMENS MEDICAL SOLUTIONS USA INC 221 GREGSON DRIVE CARY NC 27511 EQUIPMENT MAINTENANCE 977379 24 13535 6250949 33614 6298098 Net Patient Revenue 622110 280638964 280638964 Rent from Affiliates 531120 1108152 1108152 0 0 0 0 281747116 4983717 4983717 192516 192516 0 192516 192516 153856288 1800 148200833 5655455 1800 5657255 5657255 Cafeteria 722514 677576 677576 Gift Shop 900099 305694 305694 Insurance Proceeds 900099 207802 207802 187513 187513 0 0 1378585 300257287 282142431 0 11816758 X 221322 221322 0 0 0 0 447099 37066 410033 105621 105621 71386864 71211617 175247 5697026 5683040 13986 9790453 9652247 138206 4974948 4937432 37516 42850548 42850548 31643 31643 19302 19302 621374 621374 39097322 38212924 884398 0 1753 1753 4554329 4374994 179335 540379 540379 4341044 4300112 40932 703791 700354 3437 1722035 1722035 8997193 8997193 1514435 805347 709088 Medical Supplies 38357951 38357616 335 Bad Debt 14821535 14821535 Intercompany Practice Subsidy 19923498 19923498 Assessment Fees 12746771 12746771 374347 326189 48158 0 283842583 237698347 46144236 0 3458 3458 6896 23229 10000 30000 48706086 50241788 0 0 0 0 1782679 1501884 757551 2598773 222060763 158581204 66422805 63479559 148103376 117057145 194212262 190723270 0 998960 94205 461004073 425753311 27894490 25914109 19888818 3152291 46552842 46175074 0 0 25984 15933 29701667 18608751 124063801 93866158 X 336922613 331870308 17659 16845 336940272 331887153 461004073 425753311 X 16414704 -27898627 6430804 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 19302 19302 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY A portion of dues paid to various healthcare industry associations is attributable to lobbying activities. 1887465 1887465 113357029 70836705 42520324 257609 257505 104 102021545 84481807 17539738 4537115 3005187 1531928 63479559 505114 F Alternative Investments 190218156 F 190723270 Pension Liability 2905342 Interest Rate Swap Liability 3188544 Lease Liability 1853369 Due to CSI 10661496 18608751 true true X true X 300 true X 500 false true false true true 3610371 3610371 0.0134 45914855 50313715 0 0.0 0 0.0 0 0 49525226 50313715 3610371 0.0134 560288 33615 526673 0.0020 622162 235596 386566 0.0014 0 0.0 18250 18250 0.0001 128198 128198 0.0005 0 0 1328898 269211 1059687 0.0039 0 0 50854124 50582926 4670058 0.0174 0 0.0 25937 25937 0.0001 19034 19034 0.0001 0 0.0 0 0.0 5391 5391 0.0000 312 312 0.0000 2745 2745 0.0000 0 0.0 0 0 53419 0 53419 0.0002 true 14821536 51356213 65690115 -14333902 X true true 1 1 CARILION NEW RIVER VALLEY MEDICAL CENTER 2900 LAMB CIRCLE CHRISTIANSBURG VA 24073 https://carilionclinic.org/locations/carilion-new-river-valley-medical-center H 1838 X X X CARILION NEW RIVER VALLEY MEDICAL CENTER 1 false false true X X X X X X X X X 20 true false true true X https://www.carilionclinic.org/cho-community-health-assessments#reports X https://issuu.com/carilionclinic/docs/2021_cnrv_cha_report_final X X true 20 true https://www.carilionclinic.org/sites/default/files/2022-02/2021%20CNRV%20Implementation%20Strategy_F false true X 300.0 500.0 X X X X true true X X X true X https://www.carilionclinic.org/billing/financial-assistance X https://www.carilionclinic.org/billing/financial-assistance X https://www.carilionclinic.org/billing/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E The publicly available community health needs assessment report details the prioritization process for the community's significant health needs as identified through the CHNA. The Community Health Assessment Team (CHAT), made up of community stakeholders, reviews all data and completes a prioritization survey. Through the survey, each CHAT member selects and ranks the most pertinent community needs. The data are combined and priorities are selected based on the highest weighted score of each need. Through this process, CHAT members prioritize needs according to the need's perceived burden, scope, severity or urgency; the importance the community places on addressing the need through survey responses and other interactions; and each member's unique perspective on community health. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Carilion New RIver Valley Medical Center. 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 New River Valley Community Health Needs Assessment (NRVCHNA): Carilion Clinic, Carilion New River Valley Medical Center, Children's Health Improvement Program (CHIP) of NRV, Community Foundation of the New River Valley, Community Health Center of the NRV, Edward Via College of Osteopathic Medicine (VCOM) - Virginia, Giles County Christian Service Mission, Montgomery County Health and Human Services (HHS), Montgomery County-Radford City-Floyd County Chapter of the National Association for the Advancement of Colored People (NAACP), Montgomery-Floyd Regional Library System, National Alliance on Mental Illness (NAMI), New River Valley Agency on Aging, New River Valley Community Services (NRVCS), Newport-Mt. Olivet United Methodist Church, NRV Cares, Planned Parenthood South Atlantic, Radford University School of Nursing, To Our House Thermal Shelter for Homeless Men Women in the NRV, Town of Christiansburg Parks and Recreation Department, University of Virginia (UVA), UVA Cancer Center, Virginia Department of Health (VDH) New River Health District, Virginia Organizing, Virginia Polytechnic Institute and State University (Virginia Tech), Virginia Tech Center for Public Health Practice and Research, Virginia Tech Cooperative Extension, and Virginia Tech Institute for Policy and Governance. To obtain input from the community, the NRVCHNA included five target population focus groups, one stakeholder focus group and a 40-question community health survey that was administered 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. A team of Virginia Tech Public Health/Policy and Governance stakeholders participating on the CHAT took the lead in planning, conducting and analyzing four virtual and one in-person target population focus groups to gain further input from community members. 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 New River Valley residents 18 years of age and older in the following service area: Montgomery County, Floyd County, Pulaski County, Radford City and Wythe County. 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 the New River Valley. Due to the COVID-19 pandemic, most survey 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 New River Valley Medical Center. The 2021 New River Valley CHNA was conducted with: Children's Health Improvement Program (CHIP) of NRV, Community Foundation of the New River Valley, Community Health Center of the NRV, Edward Via College of Osteopathic Medicine (VCOM) - Virginia, Giles County Christian Service Mission, Montgomery County Health and Human Services (HHS), Montgomery County-Radford City-Floyd County Chapter of the National Association for the Advancement of Colored People (NAACP), Montgomery-Floyd Regional Library System, National Alliance on Mental Illness (NAMI), New River Valley Agency on Aging, New River Valley Community Services (NRVCS), Newport-Mt. Olivet United Methodist Church, NRV Cares, Planned Parenthood South Atlantic, Radford University School of Nursing, To Our House Thermal Shelter for Homeless Men Women in the NRV, Town of Christiansburg Parks and Recreation Department, University of Virginia (UVA), UVA Cancer Center, Virginia Department of Health (VDH) New River Health District, Virginia Organizing, Virginia Polytechnic Institute and State University (Virginia Tech), Virginia Tech Center for Public Health Practice and Research, Virginia Tech Cooperative Extension, and Virginia Tech Institute for Policy and Governance. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - Carilion New River Valley Medical Center. The Community Health Assessment Team shared the 2021 New River Valley Community Health Needs Assessment (NRVCHNA) on partner websites and social media. The NRVCHNA was also shared through community presentations to groups including Radford University nursing students, the New River Valley Livability Initiative Health Forum and the New River Valley Long-Term Care Council. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Carilion New River Valley Medical Center. The following information describes the implementation strategy used by Carilion New River Valley Medical Center (CNRV) to address the community health needs identified in the 2021 New River Valley Community Health Needs Assessment (NRVCHNA). The complete implementation strategy is available online at https://www.carilionclinic.org/community-health-assessments#new-river-valley. 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 25, 2022 and applies for the 2020 tax year (fiscal year 9/30/2021). The top prioritized needs for the 2021 NRVCHNA were grouped into three overarching categories: mental health, socioeconomic factors and health behaviors. We plan to address prioritized needs with the following strategies and a commitment of financial resources, staff time and leadership. Strategies to address mental health include the continuation of the emergency department bridge program to ensure continuity of care despite provider shortages; the exploration of expansion of peer recovery support services to Saint Albans Hospital on CNRV's campus; the continued support of local networks and coalitions that advance mental health awareness and treatment; the exploration of expanding community programming for abuse/overdose prevention and first aid (REVIVE) training; and the continuation of programming/activities that increase community knowledge of medication disposal sites/methods. 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 and prioritize that work. We have hired and onboarded a system-wide community workforce manager. This position will provide continued management support and is currently working to hire a peer support specialist at Saint Albans. We have also backfilled the NRV community health educator position to maintain the capacity for community health interventions, and designated two of the three priority areas for community health interventions as "mental health and "substance use." We continue to demonstrate commitment to the existing ED Bridge Program and the maintenance of strong, active relationships with our community partners working to advance mental health in our area. Strategies to address socioeconomic factors include continuing to provide coalition development support to the Community Foundation of the New River Valley; participation in Healthy Roots NRV; and participation in the Aging in Community leadership team. Progress made in 2022 to address socioeconomic factors has been driven by active coalition/network development participation and funding meaningful programs through our community grant process. In addition to continued commitment to the networks mentioned above, we have recently joined the NRV Housing Trust Fund Oversight Board-an effort spearheaded by the local Regional Commission to sustainably increase affordable housing across the region. Community grants awarded in our last funding cycle include efforts that address food insecurity and healthy eating, early childhood (including school readiness, mental/emotional health, and parenting), and transportation. Strategies to address health behaviors include providing and/or partnering to provide evidence-based and needs-focused health education and community outreach events such as health fairs, immunizations and health screenings; supporting local food access coalitions and organizations; implementing the Unite Us platform for social services referrals and integrating with electronic medical records internally and externally; continued participation on PATH and other healthy behavior community coalitions; and the exploration of a pathway for employees outside of Carilion Community Health and Outreach to participate in health education, screenings and immunizations in the community setting. Progress made in 2022 to address health behaviors has stemmed from the hiring and on-boarding of a system-wide health education manager position-increasing infrastructure to redesign health education departmental strategies to better meet community-identified needs, prioritize disadvantaged populations and maximize impact (including reach and outcomes). The NRV community health educator position was backfilled, providing the infrastructure necessary to enact these impact-driven strategies and maintain strong, active partnerships with organizations and coalitions committed to collaborative community programming. We continue our commitment to finding solutions for increased community-based resource coordination and plan to launch a pilot of Unite Us platform in March of 2023. Many of the programs funded by our community grants impact health behaviors, including preventative health services and healthy food choices. 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 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 Quality department 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 New River Medical Center. 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 Patient Protection and Affordable Care Act (PPACA) minimum essential coverage. 8 CARILION NEW RIVER VALLEY REHABILITATION 118 BROAD STREET DUBLIN VA 24084 OUTPATIENT THERAPY CARILION NEW RIVER HOSPICEHOME HEALTH 707 RANDOLPH STREET SUITE 251 RADFORD VA 24141 HOSPICE AND HOME HEALTH NEW RIVER VALLEY AMBULATORY SURGERY CENTER 2901 LAMB CIRCLE CHRISTIANSBURG VA 24073 AMBULATORY SURGERY CENTER BLACKSBURG SPORTS MEDICINE AND REHABILITATION 213 GILBERT STREET BLACKSBURG VA 24060 PHYSICAL THERAPY PHYSICAL THERAPY CHRISTIANSBURG 120 PONDEROSA DRIVE CHRISTIANSBURG VA 24084 PHYSICAL THERAPY PHYSICAL THERAPY WYTHEVILLE 178 WEST MAIN STREET WYTHEVILLE VA 24382 PHYSICAL THERAPY HILLSVILLE PHYSICAL THERAPY 416 SOUTH MAIN STREET HILLSVILLE VA 24343 PHYSICAL THERAPY 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 Avaliability of Community Benefit Report Information about 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 14821535 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 programming and support of local chambers of commerce and pro-business advocacy. Carilion is active in local economic development endeavors, including participating in OnWARD NRV-a regional economic development organization working to attract jobs and talent to the New River Valley-and investing in research and technology. We also converse with local businesses about the region's current business climate and prospective companies. CNRV actively participates in the Blacksburg Partnership-a nonprofit, independent economic development organization focused on projects that attract visitors, developers and retail prospects to Blacksburg. These initiatives promote the community's health by improving economic vitality and making the region a vibrant place to live, work and play. Line 3 - Community support: Research demonstrates the strong connection between social determinants of health-such as transportation, housing and education-and communities' overall health and well-being. Carilion supports nonprofit organizations addressing barriers to good health arising from these social determinants in various ways. Carilion also collaborates with local partners to support better education and opportunities for children and families and improved housing, better nutrition and additional resources for our neighbors in need. These efforts help remove a range of obstacles to good health for our region's residents. For example, Carilion participates in PATH (Partnership for Access to Healthcare), the Aging in Community leadership team, and provides support for organizations such as the AARP, NAACP, the Christiansburg Institute, and the Women's Resource Center. Line 6 - Coalition building: Carilion believes in the power of collaboration and understands that we must address our most significant health issues in concert with the community. To ensure lasting impact from the health assessment and community health improvement process, Carilion participates in coalitions that address health, safety and social determinant needs in the New River Valley. We also partner with multiple community and business organizations around initiatives to improve health and wellness for everyone living in the New River Valley. Examples include Carilion's representation on the Radford Early Learning Center Board, the VCOM Advisory Board and the Safe Kids Coalition. Line 7 - Community health improvement 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: With the understanding that employment is directly linked to health and wellness, Carilion partners to provide workforce development and training for community members. These efforts also develop a pipeline of future health care workers. Carilion New River Valley Medical Center supports workforce development through service to the New River Community College Educational Foundation board, a nonprofit corporation that secures voluntary support and manages funds solely for the benefit of New River Community College. The foundation assists New River Community College in various ways, including endowing and distributing of scholarship funds, purchasing equipment and furnishings, and financially supporting academic and community enrichment programs. Support is also provided to the Southwest Virginia Governor's School-an institution which helps high school students excel in STEM learning-for student scholarships. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Carilion New River Valley Medical Center 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 New River Valley Medical Center 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 NEW RIVER VALLEY MEDICAL CENTER: Line 16a URL: https://www.carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - CARILION NEW RIVER VALLEY MEDICAL CENTER: Line 16b URL: https://www.carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - CARILION NEW RIVER VALLEY MEDICAL CENTER: 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 health care 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 The New River Valley (NRV), home to Carilion New River Valley Medical Center (CNRV), is composed of the independent city of Radford and the counties of Floyd, Giles, Montgomery and Pulaski. It is nestled among the Blue Ridge and Appalachian Mountains in Southwest Virginia. The NRV is home to two universities, Virginia Tech and Radford University, and the New River Community College. Their presence enriches the local culture and workforce. A vibrant mix of urban and rural communities, the NRV boasts scenic views and thriving communities complete with restaurants, arts and culture offerings, and an abundance of outdoor recreation and relaxation opportunities. (https://www.newrivervalleyva.org/) In addition to Carilion Clinic's two hospitals located in the New River Valley, CNRV and Carilion Giles Community Hospital (CGCH), the region is also served by LewisGale Hospital-Montgomery, located in the town of Blacksburg. Key safety-net providers in the region include two federally qualified health centers with multiple locations, the Community Health Center of the New River Valley and Tri-Area Community Health Center; the Virginia Department of Health New River Health District clinics; the Pulaski Free Clinic; New River Valley Community Services; and other service organizations. The service area for the 2021 New River Valley Community Health Needs Assessment (NRVCHNA) includes the city of Radford and the counties of Floyd, Montgomery, Pulaski and Wythe, with secondary data included for Giles County. It is important to note that Giles County is also served by CGCH located in Pearisburg, Virginia. Giles County is not included as part of the service area for the 2021 NRVCHNA because CGCH also conducted its own CHNA of Giles County and Monroe County, West Virginia, concurrently. The 2017-2021 American Community Survey (ACS) found the total population of the complete service area to be 210,039-with 15,536 residents in Floyd, 16,764 in Giles, 99,294 in Montgomery, 33,893 in Pulaski, 28,347 in Wythe and 16,205 in Radford. Population density varied widely, from 41 persons per square mile in Floyd to 1,675 per square mile in Radford. Average household income varies by locality-starting at $60,628 in Radford, leveling around the mid-sixties for most of the localities, then jumping up to $79,801 in Montgomery. However, Montgomery is still well below the national ($97,196) and state ($111,013) averages. When considering the entire service area, the ACS shows that 14.20% of households in the service area are living below 100% of the federal poverty line, which equates to 38,003 individuals. The highest percentage of a locality's population living below the federal poverty line is in Montgomery County (24.77%). (US Census Bureau, ACS. 2017-2021.) Of the 194,171 population in the service area that is covered by any type of medical insurance, 14.46% of those individuals are receiving Medicaid. This is close to the state average of 14.48%. (US Census Bureau, ACS. 2017-2021.) The rate of uninsured population aged 18-64 is also similar to that of the states, at 10.87%. However, Giles County's percentage is currently 12.73%, exceeding both state and national averages. Wythe's rate of uninsured children is also higher than state and national averages, at 9.72%, compared to 4.88% for Virginia, 5.30% nationally, and 4.45% for the NRV service area. (US Census Bureau, ACS. 2017-2021.) Of the patients receiving care at CNRV during fiscal year 2022, 17.6% are receiving Medicaid while 2.3% are self-pay. (Strata internal data) In the NRV service area, Health Professional Shortage Areas (HPSAs) exist for primary care, dental and mental health services. Primary care HPSAs exist in the counties of Floyd and Giles. Dental health HPSAs exist in Wythe County and for low-income populations in all remaining localities in the service area. Mental health HPSAs exist for the high-needs population in the Mount Rogers service area, which includes Wythe County and the NRV's low-income population, encompassing the remainder of the service area. (HPSA Find. Accessed: https://data.hrsa.gov/tools/shortage-area/hpsa-find) Schedule H, Part VI, Line 5 Promotion of community health Carilion New River Valley Medical Center 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. As the leading health care provider in the New River Valley, Carilion New River Valley Medical Center (CNRV) serves the Southwest Virginia counties of Montgomery, Pulaski, Floyd, Wythe, and Giles, in addition to the city of Radford (https://www.carilionclinic.org/locations/carilion-new-river-valley-medical-center). CNRV's history dates back to 1941, when Radford Community Hospital (RCH) was first established to serve the industrial developments in the area at the time. RCH continued to modernize and grow and became affiliated with the Roanoke Hospital Association in November of 1987, during the transition of the Roanoke Hospital Association into Carilion Health System (now Carilion Clinic). On March 20, 1999, RCH capitalized on its standing as a regional hospital and opened CNRV at its current location in Christiansburg, Virginia. The 146-bed acute care facility offers modern medical operating rooms and state of the art technology (including advanced imaging and robotic surgery). The current medical complex includes multiple surgical and medical care practices, Carilion Children's and Carilion Clinic Saint Albans Hospital for psychiatry and behavioral medicine. CNRV serves all 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 New River Valley Medical Center 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. true Floyd County High School 722 Baker Street Floyd VA 24092 546001282 Floyd County 6926 Event athletic trainers Radford University PO Box 6922 Radford VA 24142 546001789 Virginia 115225 Event Sponsorships Blacksburg Country Club Charitable Foundation 1064 Clubhouse Road Blacksburg VA 24060 474776644 501(c)(3) 11120 Event sponsorship Radford Child Development Inc 518 Meadow Ridge Radford VA 24141 461775838 501(c)(3) 8000 Child care sponsorships Onward New River Valley 2020 Kraft Drive Blacksburg VA 24060 541545804 501(c)(6) 25000 Economic development NRV Cares 201 W Main Street Office B-1 Christiansburg VA 24073 541773419 501(c)(3) 5100 Parenting courses Calfee Community and Cultural Center Inc PO Box 62 Pulaski VA 24301 843476958 501(c)(3) 10000 Program support New River Senior Services Inc 141 E Main Street Suite 500 Pulaski VA 24301 541022999 501(c)(3) 10000 Transportation services United Way of Southwest Virginia 1906 Ole Berry Drive Abingdon VA 24210 540718860 501(c)(3) 10000 Program support 8 1 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. The hospital donates funds to other charitable organizations in support of health and community improvement. Such organizations also have community boards which oversee the expenditure of such funds. Carilion Clinic is committed to improving the health of the communities that we serve by addressing key health priorities identified through our triennial Community Health Assessments. Carilion fulfills this commitment in many ways, one of which is through targeted grants for community health improvement programs, and those that impact the social determinants of health. For Carilion Clinic's Community Grant Program, each grantee must sign a letter of agreement with Carilion Clinic that delineates the terms and specific objectives of the project. By accepting a Carilion award, grantees are asked to acknowledge the support of Carilion Clinic in all materials and/or related special events or fundraisers throughout the award cycle where other donors are publicly recognized. One mid-cycle progress report and a final program evaluation are required for each funded project. Site visits may be made to grantees. Program evaluation includes alignment with Community Health Assessment priorities, program impact, organizational effectiveness and community benefit through collection of data including clients served, cost effectiveness of the program (cost per client or service), tangible community or client outcomes, collaboration with other organizations, and specific efforts to cultivate diverse funding sources for program sustainability. Each grantee must agree to submit requested data and reports on a timely basis and to complete the evaluation process as requested. X false true false true false false false false false true false William Flattery Director/Sec/Treas./Hosp. VP 257042 0 71797 0 2957 0 92801 0 12935 0 437532 0 0 0 Nathaniel Bishop DMin Director 0 307164 0 97718 0 45836 0 96737 0 2527 0 549982 0 0 Charles Bissell MD Director 0 500954 0 164396 0 5833 0 102753 0 2289 0 776225 0 0 Eric Stanley MD Director 0 288040 0 31780 0 2071 0 51650 0 18191 0 391732 0 0 Nicholas Conte Asst. Secretary 0 552419 0 240712 0 5994 0 182985 0 14040 0 996150 0 0 David Hagadorn Asst. Treasurer 0 144952 0 3120 0 6214 0 60261 0 5982 0 220529 0 0 Donald Halliwill Asst. Treasurer 0 628026 0 276629 0 122744 0 249075 0 17801 0 1294275 0 118313 G Robert Vaughan Jr Asst. Treasurer 0 291047 0 98416 0 25624 0 161498 0 18919 0 595504 0 21586 Nancy Howell Agee CEO, Carilion Clinic 0 1469225 0 788983 0 240653 0 145721 0 12589 0 2657171 0 0 Steven Arner Executive Vice President 0 710945 0 320483 0 69549 0 261164 0 19101 0 1381242 0 64231 Ralph Brown MD Physician 231499 0 41678 0 3585 0 87916 0 16577 0 381255 0 0 0 Dale Bryant Pharmacist 139087 0 15150 0 7133 0 94711 0 15678 0 271759 0 0 0 Michael Czar Pharmacy Director 150063 0 3120 0 4995 0 42409 0 17070 0 217657 0 0 0 Donna Shelor Pharmacist 152500 0 13975 0 6054 0 49175 0 169 0 221873 0 0 0 Kathleen Tickle Pharmacist 158024 0 1370 0 4232 0 71338 0 879 0 235843 0 0 0 Schedule J, Part I, Line 1a Health or social club dues or initiation fees All Directors are offered a free family or individual membership to a health club owned by a related organization if they choose to accept it. Mr. Flattery received this benefit and the value was included in taxable compensation from the organization. Schedule J, Part I, Line 1b Written policy regarding payment or reimbursement of expenses Provision of the benefit is documented in Board meeting minutes and Carilion internally tracks the memberships and pays the health club directly. 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 organization's 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, Dr. Bishop, 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. Vested and paid in current year: $38,100 - Nathaniel Bishop 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 J, Part I, Line 7 Non-fixed payments The organization pays annual 'at-risk' compensation to certain members of management based on performance of an applicable scorecard. While the scorecard contains a formula as a basis for determining overall performance, in certain cases, senior managers have discretion to include additional elements in their assessment of managers reporting to them. In addition, for top management, the actual non-fixed payment awarded is in the discretion of the Carilion Clinic Board of Directors and its Compensation Committee. KATHERINE ROGERS FAMILY MEMBER OF MARK ROGERS, D.O., DIRECTOR 105621 EMPLOYEE false Form 990, Part I, Line 6 Volunteers As the COVID-19 pandemic began to stabilize, CNRV welcomed Adult volunteers back to the front desk in January. We also invited musical groups to hold programs during the Holidays, while social distancing and masking. We onboarded several new volunteers and implemented Pet Pals on the units. We look forward to the time when all restrictions are lifted and we can open our waiting rooms to volunteer services, as well as reinstate our Youth Volunteer Program. Hospice volunteers started back in office at first helping with Tuck in Calls and Grief support letters. Later in the year, we slowly introduced volunteers back in the homes for caregiver, respite visits and Socialization for the patients. This went well, so lastly, we introduced volunteers back into facilities. For hours that were not counted volunteers made quilts for Veterans and also assisted in Veteran events. Volunteer hours worked totaled 242. Form 990, Part III, Line 4a Program Accomplishments Carilion New River Valley Medical Center, 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. The medical center is a modern hospital facility with diagnostic and medical and surgical care, a Level III Trauma emergency department, and Carilion Clinic Saint Albans Hospital for psychiatry and behavioral medicine. Carilion New River Valley Medical Center (CNRV) exists to serve the health care needs of its community, regardless of a patient's ability to pay. CNRV admitted 6,816 patients, provided 33,943 days of care during the year, and delivered 856 babies. Hospital programs include the provision of nursing care, extensive outpatient and inpatient surgical and endoscopic services, comprehensive heart treatment with interventional cardiac catheterization, diagnostic, therapeutic and rehab solutions, and diagnostic imaging services including CT, MRI,PET/CT, mammography, x-ray and ultrasound. Additional specialty surgical care includes advanced surgery with robotics, vascular, orthopedics, urology, gynecologic, and ENT care. Medical care in pulmonary, neurology, physical medicine and pediatrics support patient care. With 14% of its inpatient admissions representing psychiatric admissions and a significant outpatient presence in behavioral medicine, CNRV plays a critical role in providing mental health services to the region. CNRV is a Level III trauma center and provides a home base for Lifeguard, the emergency medical air transport that serves the surrounding area. CNRV provides several inpatient and outpatient services targeting the specific health needs of its population, including diabetes management, home health and hospice, physical, speech, occupational and pediatric therapy programs, and cardiac and respiratory rehab. CNRV also provides an emergency department with 24-hour care and emergency transportation. With 27,516 visits, CNRV's emergency services are a critical component of the health safety net in its service area, acting as the primary health provider for a significant number of uninsured patients, who comprise nearly 5 percent of ED visits. In furtherance of its mission, CNRV provides extensive uncompensated care and community support. Activities include numerous community screening events and education on chronic disease prevention and management. CNRV also champions and supports a Medication Assistance Program in partnership with community-based social services. Stated at cost, total financial assistance and other community benefits for the year exceeded $4.6 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 1099's 1099s are issued on Carilion New River Valley Medical Center's behalf by Carilion Services, Inc., a related supporting organization providing management and administrative services, including payment processing. Carilion New River Valley Medical Center's disregarded entity, Carilion New River Valley Surgery Center, LLC, issued 3 1099s for the year. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Nancy Howell Agee, Steven Arner, Nicholas Conte, David Hagadorn, Donald Halliwill, G. Robert Vaughan, Jr, Julie Smith-Hamilton, Charles Bissell, and Nathaniel Bishop - Business relationship, Nancy Howell Agee and Nathaniel Bishop - 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, Nathaniel Bishop, Nicholas Conte, David Hagadorn, Donald Halliwill, Julie Smith-Hamilton and G. Robert Vaughan, Jr. Certain management and related services for Carilion New River Valley Surgery Center, LLC, a disregarded entity of the filing organization, are provided by the employees of ASD Management. None of the individuals listed in Part VII, Section A received compensation from ASD Management. 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, the list of which was reviewed by the Compensation Committee. The Compensation Committee maintained minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. Form 990, Part VI, Line 15b Process to establish compensation of other employees See response to line 15A. Form 990, Part VI, Line 19 Required documents available to the public The organization's governing documents, conflict of interest statement, and financial statements are released from time to time during the tax year upon request. The conflict of interest policy is included in our Code of Excellence which is available to the public on our website. The Articles of Incorporation are available from the Virginia State Corporation Commission. Limited financial information is available on our website. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Revenue - Total Revenue: 148368, Related or Exempt Function Revenue: 148368, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Work Order Revenue - Total Revenue: 30182, Related or Exempt Function Revenue: 30182, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Miscellaneous - Total Revenue: 1008, Related or Exempt Function Revenue: 1008, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Court Cost Recovery - Total Revenue: 7935, Related or Exempt Function Revenue: 7935, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Returned Check Fees - Total Revenue: 20, Related or Exempt Function Revenue: 20, 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: 10228870, Program Service Expense: 10228870, Management and General Expenses: , Fundraising Expenses: ; Billing Collection Services - Total Expense: 801002, Program Service Expense: , Management and General Expenses: 801002, Fundraising Expenses: ; Laundry/Housekeeping Services - Total Expense: 1052467, Program Service Expense: 1052467, Management and General Expenses: , Fundraising Expenses: ; Other Purchased Services - Total Expense: 1316928, Program Service Expense: 1301973, Management and General Expenses: 14955, Fundraising Expenses: ; Contract Fees/Consulting - Total Expense: 2212298, Program Service Expense: 2147853, Management and General Expenses: 64445, Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 2605769, Program Service Expense: 2601773, Management and General Expenses: 3996, Fundraising Expenses: ; Reference Labs - Total Expense: 5997651, Program Service Expense: 5997651, Management and General Expenses: , Fundraising Expenses: ; Temporary Employment - Total Expense: 14882337, Program Service Expense: 14882337, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part X, Line 20 Tax-Exempt Bond Liabilities The amount reported as Tax-Exempt Bonds is the portion of Carilion Clinic Bonds allocated to Carilion New River Valley Medical Center. Required information for the Bonds, including Schedule K, is reported in the Carilion Clinic (EIN: 54-1190771) IRS Form 990. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Pension-related changes other than net periodic pension costs - 16561444; Transfers from/(to) Affiliates - -10130640; CARILION NEW RIVER VALLEY SURGERY CENTER LLC 2901 LAMB CIRCLE CHRISTIANSBURG VA 24073 800091329 SURGERY VA 4542240 5073475 CARILION NEW RIVER VALLEY MEDICAL CENTER 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 true CARILION FRANKLIN MEMORIAL HOSPITAL PO BOX 12385 ROANOKE VA 24025 540480606 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION GILES COMMUNITY HOSPITAL PO BOX 12385 ROANOKE VA 24025 540549603 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION MEDICAL CENTER PO BOX 12385 ROANOKE VA 24025 540506332 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION SERVICES INC PO BOX 12385 ROANOKE VA 24025 541190879 SUPPORTING ORGANIZATION VA 501(c)(3) Type II CARILION CLINIC true CARILION ROCKBRIDGE COMMUNITY HOSPITAL PO BOX 12385 ROANOKE VA 24025 540568001 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION TAZEWELL COMMUNITY HOSPITAL PO BOX 12385 ROANOKE VA 24025 546074580 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true NEW RIVER VALLEY HEALTH FOUNDATION PO Box 40032 Roanoke VA 24022 521349560 Supporting Organization VA 501(c)(3) Type I NA true FRANKLIN COUNTY VENTURES LLC PO BOX 12385 ROANOKE VA 24025 474365316 REAL ESTATE VA NA N/A CARILION CLINIC MEDICARE SHARED SAVINGS COMPANY LLC PO BOX 12385 ROANOKE VA 24025 455235473 MEDICARE ACO 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 CHS INC PO BOX 12385 ROANOKE VA 24025 541725732 SERVICES VA NA C Corporation true CARILION BEHAVIORAL HEALTH INC PO BOX 12385 ROANOKE VA 24025 203136891 HEALTHCARE VA NA C Corporation true CARILION EMERGENCY SERVICES INC PO BOX 12385 ROANOKE VA 24025 542033006 HEALTHCARE VA NA C Corporation true SCA CREDIT SERVICES INC PO BOX 12385 ROANOKE VA 24025 541180398 COLLECTION AGENCY VA NA C Corporation true CARILION HEALTHCARE CORPORATION PO BOX 12385 ROANOKE VA 24025 541586601 HEALTHCARE VA NA C Corporation true MEDKEY INC PO BOX 12385 ROANOKE VA 24025 541645357 FINANCING SERVICES VA NA C Corporation true SPROTT PRIVATE RESOURCE LENDING (C-CO-INVEST) LP 981378742 INVESTMENTS CA NA C Corporation true BLACKMOOR OWNERSHIP HOLDINGS LIMITED INVESTMENTS CJ NA C Corporation true Doubleblue Argentina Consumer Finance Fund II LP 205 East 42nd St 20th FL New York NY 10017 INVESTMENTS CJ NA C Corporation true CARILION DTC SERVICES INC PO BOX 12385 ROANOKE VA 24025 872635239 HEALTHCARE VA NA C Corporation true true false true true true false false false false true true true true false false false false true true Carilion Medical Center A 258923 Cost Carilion Behavioral Health Inc A 16525 Cost CHS Inc A 57986 Cost Carilion Healthcare Corporation A 772649 Cost Carilion Medical Center M 3256853 Cost Carilion Services Inc M 47612984 Cost CHS Inc K 390801 Market Rate CHS Inc M 821041 Cost SCA Credit Services Inc M 268759 Cost Carilion Healthcare Corporation M 16715017 Cost Medkey Inc M 64427 Cost Carilion Services Inc R 10130641 Cash Carilion Services Inc S 10000000 Cash