2022-08-15T11:01:29-05:00 2021-09-30 990 2020-10-01 546074580 Carilion Tazewell Community Hospital CARI 5402245102 PO BOX 12385 Roanoke VA 24025 G ROBERT VAUGHAN JR ASSISTANT TREASURER 2022-08-15 G ROBERT VAUGHAN JR 999009999 2020 2022-09-23 18:48:47Z ALICIA BALES PO BOX 12385 Roanoke VA 24025 18782369 false X WWW.CARILIONCLINIC.ORG X 1968 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. 10 5 197 10 0 0 1208402 184206 15293546 18495888 7700 4679 -3427 97596 16506221 18782369 10586 5982 0 7484751 8885763 0 0 11406625 12631630 18901962 21523375 -2395741 -2741006 6326544 7452330 30577490 35002922 -24250946 -27550592 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 18282294 5982 18500449 See Schedule O. 18282294 true true false true false false false false false true false false false true false false true false false false false false false false false true true false false true false false false false false false true false false false false false false true true true false false true X 0 0 197 true false false false false false false false false false false false false X 10 5 true true false false true true true true false 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 Alicia Bales Director/Sr. Operations Director 36.0 14.0 X X 98387 0 21462 D Michael HYMES Director/Vice Chair 1.2 0 X X 0 0 0 James Thompson Director/Chair 2.5 2.4 X X 0 18950 0 Kristie Williams Director/Hospital VP 2.5 47.5 X X 0 204850 87942 Mandy French Director/Secretary/Treasurer 1.2 0 X X 0 0 0 Anthony Grills Director 1.2 0 X 0 0 0 Kevin Combs DO Director 1.2 48.8 X 0 263745 44670 Mark Mossey MD Director 1.2 48.8 X 0 303239 38369 Nellie Stillwell Director 1.2 0 X 0 0 0 William Flattery Director 1.2 48.8 X 0 278733 61522 David Hagadorn Asst. Treasurer 0.5 49.5 X 0 156550 43171 Donald Halliwill Asst. Treasurer 0.5 49.5 X 0 810340 217049 G Robert Vaughan Jr Asst. Treasurer 0.5 49.5 X 0 328415 129501 Nicholas Conte Asst. Secretary 1.0 49.0 X 0 578993 169751 Susan Lucas Asst. Secretary 0.5 49.5 X 0 56807 6179 Nancy Howell Agee CEO, Carilion Clinic 2.0 48.0 X 0 1947087 175699 Steven Arner Executive Vice President 2.0 48.0 X 0 843427 229064 Bethany Yoder Physical Therapist 49.0 1.0 X 105529 3863 588 DAVID VANCE Pharmacy Manager 50.0 0 X 130964 0 27823 334880 5794999 1252791 2 false true false QUEST DIAGNOSTICS 500 PLAZA DRIVE SECAUCUS NJ 07094 LABORATORY SERVICES 762015 MR RAMAKRISHNAN MD PC 1745 VALLEY VIEW DRIVE BIG STONE GAP VA 24219 PHYSICIAN SERVICES 262531 TRANE US INC 2301 TRANE DRIVE ROANOKE VA 24017 CONTRACTOR SERVICES 212788 DIRECT RADIOLOGY PLLC 1839 NORTH GOVERNMENT WAY COEUR DALENE ID 838143454 RADIOLOGY SERVICES 124276 4 184206 184206 Net Patient Revenue 622110 18341903 18341903 Rent From Affiliates 531120 153985 153985 0 0 0 0 18495888 4679 4679 53946 53946 0 53946 53946 0 0 Cafeteria 722514 39089 39089 4561 4561 0 0 43650 18782369 18500449 0 97714 X 5982 5982 134318 134318 108780 108780 6851250 6804365 46885 520472 517003 3469 770689 757561 13128 500254 489449 10805 2864846 2864846 1043 1043 2312535 2234937 77598 0 203082 196707 6375 31377 31377 377690 377690 149825 149800 25 312762 312762 719022 719022 148296 78392 69904 Medical Supplies 1203241 1203236 5 Bad Debt 1825231 1825231 Intercompany Practice Subsidy 1924594 1924594 Assessment Fees 526310 526310 31776 18053 13723 0 21523375 18282294 3241081 0 1175 1048 3825 3950 1997147 3333122 0 0 25601 25034 18518114 14442787 4298796 4075327 0 0 0 13849 6326544 7452330 1570971 2263517 4205957 2005942 0 24800562 30733463 30577490 35002922 -24250946 -27550592 -24250946 -27550592 6326544 7452330 X -2741006 -558640 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 1043 1043 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. 48753 48753 9179406 6307625 2871781 8450804 7747100 703704 839151 388062 451089 4075327 Due to Affiliate 30692216 Pension Liability 27398 Lease Liability 13849 30733463 true true X true X 300 true X 500 false true false true true 277660 277660 0.0141 4281606 2638498 1643108 0.0834 0 0.0 0 0 4559266 2638498 1920768 0.0975 42 570 167990 167990 0.0085 0 0.0 0 0.0 0 0.0 0 0.0 42 570 167990 0 167990 0.0085 42 570 4727256 2638498 2088758 0.1060 0 0.0 1 1204 1204 0.0001 13 130 1988 1988 0.0001 0 0.0 0 0.0 4 2418 2418 0.0001 0 0.0 0 0.0 0 0.0 18 130 5610 0 5610 0.0003 true 1825231 4052595 4220434 -167839 X true true 1 1 CARILION TAZEWELL COMMUNITY HOSPITAL 388 BEN BOLT AVENUE TAZEWELL VA 24651 https://carilionclinic.org/locations/carilion-tazewell-community-hospital H 1907 X X X CARILION TAZEWELL COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 20 true false true true X https://www.carilionclinic.org/locations/carilion-tazewell-community-hospital X https://www.carilionclinic.org/community-health-assessments#tazewell-county X X true 20 true https://www.carilionclinic.org/community-health-assessments#tazewell-county false true X 300.0 500.0 X X X X true true X X X true X https://carilionclinic.org/billing/financial-assistance X https://carilionclinic.org/billing/financial-assistance X https://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 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/community-health-assessments#tazewell-county. 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. 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. 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. 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. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - Carilion Tazewell Community Hospital. An individual with Out of Network insurance is not eligible for Financial Assistance unless the plan does not meet minimum essential coverage as defined in the Patient Protection and Affordable Care Act (PPACA) or it is a governmental plan. 0 Schedule H, Part I, Line 3c Other Financial Assistance Eligibility Criteria Patients' eligibility is determined by family size, family income, real property equity and liquid assets. Financial assistance policy (FAP) in effect for October 1, 2020 until January 31, 2021: Families with family income equal or below 200% of the Federal Poverty Guidelines (FPG) and assets equal or below $15,000 receive 100% adjustment under FAP. Families with family income greater than 200% of the FPG but less than or equal to 400% of the FPG or assets above $15,000 and less than or equal to $100,000 receive a partial adjustment under FAP. The partial adjustment matches the AGB percentage for each service area. 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/news/supporting-our-community/ Schedule H, Part I, Line 7 Column (F) Percent of Total Expense BAD DEBT EXPENSE OF $1,825,231 AS INCLUDED IN PART IX, STATEMENT OF EXPENSES ON LINE 25 WAS EXCLUDED FROM THE CALCULATION OF PART I LINE 7 COLUMN (F) PERCENT OF TOTAL EXPENSE. 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. 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 its neighbors in need. These efforts help to remove a range of obstacles to good health for residents of our region. Financial contributions and staff support impact health through Clinch Valley Community Action programs, engagement with the Tazewell Board of Supervisors, and offering hydration stations at various community events. 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 Tazewell County. We also partner with multiple community and business organizations on initiatives to improve health and wellness for everyone living in Tazewell County. Carilion participates on the Tazewell Coordinated Community Response Team-a collaborative focused on domestic violence-and representatives serve on the Four Seasons YMCA Board. Additionally, staff time and financial support is provided to Tazewell Rotary Club. 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 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 operating an emergency room open to all persons regardless of ability to pay and providing hospital care for all patients able to pay, including those 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. Medicare allowable costs are determined from the Medicare cost report using the cost-to-charge ratio. 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 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 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 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://carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - CARILION TAZEWELL COMMUNITY HOSPITAL: Line 16b URL: https://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://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 consists of distinct communities with significant disparities in health and social determinants compared to the Commonwealth of Virginia. The 2015-2019 U.S. Census Bureau's American Community Survey (ACS) found the total population of Tazewell County to be 41,603 with a median age of 45.2, compared to 38.2 in Virginia. The median household income in Tazewell County is $42,099, with 17.5% of the population living below the federal poverty level. (US Census Bureau, ACS. 2015-2019.) The percentage of Tazewell County residents with Medicaid is 23.52%, while 10.37% have no insurance at all. (US Census Bureau, Small Area Health Insurance Estimates. 2019.) Of all Carilion Tazewell Community Hospital (CTCH) patients in FY21, 28.3% were Medicaid recipients while 3% 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, 94.4% of the population is White and 3.2% of the population is Black. (US Census Bureau, ACS. 2015-2019.) No other hospital facilities are located within Tazewell County, but the population is also served by Ballad Health with their nearest facility, Smyth County Community Hospital, 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. false true false false false false false false false Kristie Williams Director/Hospital VP 0 164625 0 32500 0 7725 0 76709 0 11233 0 292792 0 0 Kevin Combs DO Director 0 249035 0 12850 0 1860 0 34213 0 10457 0 308415 0 0 William Flattery Director 0 251293 0 25330 0 2109 0 59493 0 2029 0 340254 0 0 Mark Mossey MD Director 0 290429 0 10000 0 2810 0 36298 0 2071 0 341609 0 0 Nicholas Conte Asst. Secretary 0 497735 0 75000 0 6258 0 156342 0 13409 0 748744 0 0 David Hagadorn Asst. Treasurer 0 136195 0 2830 0 17525 0 42306 0 865 0 199721 0 0 Donald Halliwill Asst. Treasurer 0 566317 0 75000 0 169023 0 200333 0 16716 0 1027389 0 164360 G Robert Vaughan Jr Asst. Treasurer 0 274535 0 30000 0 23879 0 111529 0 17972 0 457916 0 19407 Nancy Howell Agee CEO, Carilion Clinic 0 1344036 0 100000 0 503052 0 163761 0 11938 0 2122787 0 262135 Steven Arner Executive Vice President 0 641621 0 75000 0 126806 0 211048 0 18016 0 1072492 0 121506 DAVID VANCE Pharmacy Manager 128989 0 1800 0 174 0 12267 0 15556 0 158786 0 0 0 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 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 detailed 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) in which the employer, at the discretion of Carilion Clinic's Compensation Committee, makes a contribution to an account established on its books for each eligible participant. If a participant ceases to be a participant prior to the vesting date, the account shall be forfeited. A lump sum distribution shall be made upon the participant's vesting date, death, or disability. Unvested contributions made to the DC SERP are included in Part II of this schedule with "Retirement and other deferred compensation." The following distributions were made to these individuals under this plan in the reporting year. $121,506 - Steven Arner $164,360 - Donald Halliwill $19,407 - 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. $262,135 was distributed under this plan in the reporting year. Brian Bales Family member of Alicia Bales, Director 108780 Employee false 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 exists to serve its community's health care needs, regardless of a patient's ability to pay. Tazewell's acute hospital admitted 551 patients and provided 2,664 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. Tazewell also provides an emergency department with 24-hour care and emergency transportation. With 8,283 visits, Tazewell'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 5 percent of ED visits. Tazewell supports community events such as community screenings and education on chronic disease management. In furtherance of its mission, Tazewell provides extensive uncompensated care and community support. Stated at cost, financial assistance and other community benefits for the year exceeded $2 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, Mark Mossey, William Flattery, Kevin Combs, Kristie Williams, and Susan Lucas - 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, Susan Lucas 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. 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. Prior to filing, all Board Members were notified via email of its availability on Carilion'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 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 detailed 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: 4561, Related or Exempt Function Revenue: 4561, 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: 710322, Program Service Expense: 710322, Management and General Expenses: , Fundraising Expenses: ; Other Purchased Services - Total Expense: 370268, Program Service Expense: 345274, Management and General Expenses: 24994, Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 127174, Program Service Expense: 127174, Management and General Expenses: , Fundraising Expenses: ; Reference Labs - Total Expense: 917347, Program Service Expense: 917347, Management and General Expenses: , Fundraising Expenses: ; Billing and Collection Services - Total Expense: 52604, Program Service Expense: , Management and General Expenses: 52604, Fundraising Expenses: ; Laundry/Housekeeping Services - Total Expense: 134820, Program Service Expense: 134820, 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 - 6360; Unfunded Grant - -565000; 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 NEW RIVER VALLEY MEDICAL CENTER PO BOX 12385 ROANOKE VA 24025 540553805 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 CLINIC MEDICARE SHARED SAVINGS COMPANY LLC PO BOX 12385 ROANOKE VA 24025 455235473 MEDICARE HMO 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 110 Greene Street Suite 9G New York NY 10012 824119491 PRIVATE EQUITY 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 1160 Battery St East San Francisco CA 94111 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 CARILION CLINIC MEDICARE RESOURCES LLC PO BOX 12385 ROANOKE VA 24025 263729975 MEDICARE HMO VA NA C Corporation true 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 TANGIBLE SEGREGATED PORTFOLIO OF THE SOUTH AFRICA ALPHA SPC 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 false false true false false false false true false true true false false false false false false CHS INC E 5942855 CASH CARILION GILES COMMUNITY HOSPITAL A 153985 COST CARILION MEDICAL CENTER M 2072191 COST CARILION SERVICES INC M 2767759 COST CHS INC M 406648 COST