2025-08-15T18:08:03+00:00 2024-09-30 440160260 FORVIS MAZARS LLP 1201 WALNUT ST SUITE 1700 KANSAS CITY MO 641062246 990 2023-10-01 546074580 Carilion Tazewell Community Hospital CARI 5402245102 PO BOX 12385 Roanoke VA 24025 G ROBERT VAUGHAN JR TREASURER 5402245102 2025-08-15 true MIKE ENGLE P00482834 8162216300 2025-08-15 2023 2025-03-06 01:10:19Z ALICIA BALES PO BOX 12385 Roanoke VA 24025 23842204 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. 12 7 215 7 0 0 596611 8978 20295525 23653263 -6556 -1181 154461 179055 21040041 23840115 77442 49595 0 10255954 10355556 0 0 17600304 19600798 27933700 30005949 -6893659 -6165834 8471871 8806285 47651186 54013568 -39179315 -45207283 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 25208743 49595 23658451 See Schedule O. 25208743 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 true false true false false false false false false true false false false false false false true true true false false true X 0 0 215 true false false false false false false false false false false false false X 12 7 true true false false true true true true true false false true true true true true true true true false VA X MATTHEW BARR 5402245021 213 S JEFFERSON ST ROANOKE VA 24011 Alicia Bales Director/Sec./Treas./Hospital CEO 50.0 0 X X 121367 0 2121 D Michael Hymes Director/Vice Chair 1.2 0 X X 0 0 0 James C Thompson Director/Chair 2.5 2.4 X X 0 10250 0 Anthony Grills Director 1.2 0 X 0 0 0 Donald Linkous Director 1.2 0 X 0 0 0 Kevin Combs DO Director 1.2 48.8 X 0 241779 23726 Kristie Williams Director/Hospital VP 2.5 47.5 X 0 250738 15407 Mandy French Director 1.2 0 X 0 0 0 Mark Mossey MD Director 1.2 48.8 X 0 365288 17924 Michael Hoops Director 1.2 0 X 0 0 0 Nellie Stillwell Director 1.2 0 X 0 0 0 William Flattery Director 1.2 48.8 X 0 319259 54007 Donald Halliwill Asst. Treasurer 0.5 49.5 X 0 1119248 167911 G Robert Vaughan Jr Asst. Treasurer 0.5 49.5 X 0 458008 71002 J Harrison Lapuasa Asst. Treasurer 0.5 39.5 X 0 34109 -1202 Julie Smith-Hamilton Asst. Secretary 0.5 39.5 X 0 60728 18375 Nicholas Conte Asst. Secretary 1.0 49.0 X 0 1023717 174893 Anita Witt-Kinder RN 40.0 0 X 107694 0 26037 David Vance Pharmacy Manager 40.0 0.0 X 142052 0 22003 Elizabeth Myers Imaging Services Manager 40.0 0 X 101644 0 3860 Kimberly Brown Nursing Unit Director/Manager 40.0 0 X 108359 0 12047 Sabrina Earls RN Team Lead 40.0 0 X 107121 0 18003 David Hagadorn Former Officer 0.0 0.0 X 0 159104 25072 688237 4042228 651186 6 true true false QUEST DIAGNOSTICS 500 PLAZA DRIVE SECAUCUS NJ 07094 LABORATORY SERVICES 1198887 F & S BUILDING INNOVATIONS INC 2944 ORANGE AVE NE ROANOKE VA 24012 CONTRACTOR SERVICES 476862 GJ HOPKINS INC 1708 SEIBEL DR NE ROANOKE VA 24012 CONTRACTOR SERVICES 293472 MR RAMAKRISHNAN MD PC 1745 VALLEY VIEW DR BIG STONE GAP VA 24219 PHYSICIAN SERVICES 259135 DIRECT RADIOLOGY 22100 BOTHELL EVERETT HWY BLDG C BOTHELL WA 98021 PHYSICIAN SERVICES 227031 6 8978 8978 Net Patient Revenue 622110 23486633 23486633 Rent From Affiliates 531120 166630 166630 0 0 0 0 23653263 908 908 99295 99295 0 99295 99295 2089 0 -2089 -2089 -2089 Dining Services 722514 74572 74572 Other Revenue 900099 5188 5188 0 0 0 0 79760 23840115 23658451 0 172686 49595 49595 148915 148915 101196 101196 8344584 8292220 52364 146602 145682 920 999420 986286 13134 614839 600628 14211 4234653 4234653 93 93 2246 2246 2872685 2673588 199097 0 342 342 505247 487971 17276 124809 124809 580095 580095 180148 180034 114 3096002 3096002 752719 752719 165871 67572 98299 Bad Debt 2374379 2374379 Intercompany Practice Subsidy 2224827 2224827 Medical Supplies 1250411 1250236 175 Assessment Fees 1194224 1194224 42047 24092 17955 0 30005949 25208743 4797206 0 1051 424 3950 4575 3266084 3357663 0 0 0 0 201504 150576 20533407 15241679 4993731 5291728 0 0 5551 1319 8471871 8806285 2643810 2190116 19945 5340 0 0 44987431 51818112 47651186 54013568 X -39179315 -45207283 -39179315 -45207283 8471871 8806285 X -6165834 137866 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 2246 2246 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 11211931 7434262 3777669 8519365 7267131 1252234 753358 540286 213072 5291728 Due to Affiliate 52012391 Pension Liability -195606 Lease Liability 1327 51818112 true true X true X 300 true X 500 true true false true true 321580 321580 0.0116 6413640 4915159 1498481 0.0542 0 0.0 0 0 6735220 4915159 1820061 0.0659 161052 161052 0.0058 0 0.0 0 0.0 0 0.0 73240 73240 0.0027 0 0 234292 0 234292 0.0085 0 0 6969512 4915159 2054353 0.0743 0 0.0 3334 3334 0.0001 1948 1948 0.0001 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 5282 0 5282 0.0002 true 2374379 3820315 4656550 -836235 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 23 true false true true X https://www.carilionclinic.org/cho-community-health-assessments#reports X https://issuu.com/carilionclinic/docs/2024_ctch_cha_final_report X X true 24 true https://www.carilionclinic.org/cho-community-health-assessments#reports 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 (CHNA) report details the prioritization process for the community's significant health needs identified through the CHNA. The Community Health Assessment Team (CHAT), comprised of community stakeholders, reviews all data and completes a prioritization survey. Through the survey, each CHAT member selects the most pertinent community needs. Following the survey, CHAT members can further refine the priorities through a consensus-building activity. CHAT members prioritize needs according to the 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 depends highly 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 include other individuals or organizations serving or representing the community's medically underserved, low-income and minority populations. The following organizations served on the CHAT for the 2024 Tazewell County Community Health Needs Assessment (TCCHNA): Appalachian Agency for Senior Citizens, Carilion Planning and Community Development, Carilion Tazewell Community Hospital, Clinch Valley Community Action, Cumberland Plateau Health District, Cumberland Plateau Planning District, Department of Social Services, Four County Transit, Industrial Development Authority (IDA), Project13Three, Tactical Retreat Unplugged, Tazewell Chamber of Commerce, Tazewell County Public Library, Tazewell County Public Schools, Tazewell County Sheriff's Office, Town of Tazewell Sheriff's Office, VA Cooperative Extension and Vibrant Health & Wellness Coaching. To obtain input from the community, the TCCHNA included one stakeholder listening session, a follow-up stakeholder survey and a 27-question community health survey administered broadly across the service area. These efforts occurred from October 1, 2023, through December 31, 2023. The survey was developed (in English and Spanish) and asked questions about access to care and other services, health status, community strengths, quality of life, subjective well-being 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 the Centers for Disease Control and Prevention. Community members were invited to participate in a Community Listening Session to collect qualitative data to understand health-related needs better. The CHAT subsequently canceled the event after no one registered. As a result, Carilion staff increased targeted efforts to connect with safety net providers and improve community health survey distribution in the area. CHAT members could offer additional perspectives on our community's needs and barriers to health. Carilion staff from across the organization facilitated small group discussions. Participants could complete the Stakeholder Survey to quantify focus group data. Carilion staff shared the online survey via email and at the CHAT meetings. The CHAT assisted with survey distribution to reach particular target populations. The survey focused on Tazewell County residents 18 years of age and older. There were special efforts to include underserved/vulnerable populations disproportionately impacted by social determinants of health such as poverty, race/ethnicity, education and lack of insurance. Specific populations served by CHAT representatives include people who are uninsured or underinsured; people experiencing low income, homelessness, and/or food insecurity; people who own businesses; and families with young children. The CHAT also made the survey available to all Tazewell County residents. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Carilion Tazewell Community Hospital. Appalachian Agency for Senior Citizens, Clinch Valley Community Action, Cumberland Plateau Health District, Cumberland Plateau Planning District, Department of Social Services, Four County Transit, Industrial Development Authority (IDA), Project13Three, Tactical Retreat Unplugged, Tazewell Chamber of Commerce, Tazewell County Public Library, Tazewell County Public Schools, Tazewell County Sheriff's Office, Town of Tazewell Sheriff's Office, VA Cooperative Extension and Vibrant Health & Wellness Coaching. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - Carilion Tazewell Community Hospital. The Community Health Assessment Team shared the 2024 (Tax year 2023) Tazewell County Community Health Needs Assessment (TCCHNA) on partner websites, social media, and regional news coverage. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Carilion Tazewell Community Hospital. The following information describes the implementation strategy Carilion Tazewell Community Hospital (CTCH) used to address the community health needs identified in the 2024 Tazewell County Community Health Needs Assessment (TCCHNA). The complete implementation strategy is available online at https://issuu.com/carilionclinic/docs/implementation_strategy_final_ctch The hospital is working to address all significant health needs prioritized through the CHNA. The top prioritized needs for the 2024 TCCHNA were grouped into three overarching categories: chronic disease, mental health and substance use, and interpersonal violence. We also focus on layered interventions that address multiple priority areas through place-based strategies. We are addressing prioritized needs with the following strategies and committing financial resources, staff time and leadership. Strategies to address chronic disease include implementing the Healthy Heart Ambassadors program, a fruit and vegetable prescription program, and other evidence-based health and nutrition programs. Strategies to address mental health and substance use include expanding Carilion's peer support specialist workforce and implementing evidence-based mental health education and well-being workshops. Strategies to address interpersonal violence include working with the forensic nursing program to support transitioning patients from acute care to the community. Place-based strategies addressing multiple priority areas include developing an employee volunteer program to support the capacity of local organizations working to address CHA-identified needs, evaluating a pop-up clinic model supporting safety net partnerships, expanding Carilion's community health workforce and facilitating the development of a sustaining collaborative focused on improving health and well-being in Tazewell County. 0 Schedule H, Part I, Line 3c Other Financial Assistance Eligibility Criteria Financial assistance policy in effect for fiscal year 2024: families with family income equal or below 300% of the Federal Poverty Guidelines and countable assets equal or below $25,000 receive 100% adjustment under FAP. Families with family income greater than 300% of the Federal Poverty Guidelines but less than or equal to 500% of the Federal Poverty Guidelines or countable assets above $25,000 and less than or equal to $100,000 receive a partial adjustment under FAP. The partial adjustment matches the highest AGB percentage determined for all facilities. Schedule H, Part I, Line 6a Public Availability of Community Benefit Report Information on community benefit is reported annually through a consolidated report prepared by Carilion Clinic (EIN 54-1190771). Printed copies of this report are distributed throughout communities served by hospitals affiliated with Carilion Clinic. Additionally, the community benefit report is available on Carilion Clinic's website: https://www.carilionclinic.org/cho-community-health-assessments#community-impact-reports Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 2374379 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 and 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, higher wages for employees and various construction projects. In addition, Carilion had direct economic development expenses from supporting Tazewell Today, an economic revitalization initiative of the Tazewell Main Street community. This promotes the community's health by improving economic vitality, attracting visitors and making the region a vibrant place to live, work and play. Line 3 - Community support: Research demonstrates the strong connection between social determinants of health-such as transportation, housing and education-and communities' overall health and well-being. Carilion supports nonprofit organizations addressing barriers to good health arising from these social determinants in various ways, such as supporting the Four Seasons YMCA, Tazewell Rotary Club, and Clinch Valley Community Action. Carilion also collaborates with local partners to support historic preservation, including the Historic Crab Orchard Museum and Historic Pocahontas, Inc. These efforts help to increase the history and cultural opportunities for residents of the region, promoting a sense of belonging that impacts health. 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 Patient accounts receivable are stated at net realizable amounts due from patients, third-party payors, and other insurers for which Carilion Tazewell Community Hospital expects to be entitled in exchange for providing patient care. In accordance with Accounting Standards Update (ASU) No. 2014-09, Revenue from Contracts with Customers (Topic 606) (ASU 2014-09), the estimated uncollectible amounts are generally considered implicit price concessions that are a direct reduction to patient accounts receivable. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Medicare allowable costs are determined from the Medicare cost report using the cost-to-charge ratio. The hospital believes our Medicare shortfall is a cost we incur as a benefit to the community. IRS REV. RUL. 69-545 provides that one of the factors demonstrating community benefit is caring for patients who pay their bills through public programs such as Medicare. In order to operate for the benefit of the broad community that we serve we must include our significant Medicare population, even if we are required to subsidize care to our Medicare patients due to being reimbursed at less than cost by Medicare's nonnegotiable rates. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance When accounts receivable efforts are exhausted, the account may be placed with a collection agency and extraordinary collection actions (ECAs) may be considered. Accounts will not be placed with a collection agency prior to 120 days from the date the first post-discharge billing statement is provided except when mailings are returned with no forwarding address and combining multiple accounts of varying age with those already transferred or for legal verification regarding other liabilities. Reasonable efforts will be made to identify appropriate forwarding addresses. When a financial assistance application (FAA) is received during the application period (within 240 days after the date the first post-discharge billing statement is provided), but after initiation of ECAs, all ECAs will be suspended. Best efforts will be made to process completed applications within 30 days of receipt of the application; financial assistance eligibility will be determined and communicated to the individual. Incomplete applications must be completed within 30 days of the initial notification of additional items required; otherwise, the application will be deemed incomplete and closed. If an individual is eligible for financial assistance, ECAs, other than the sale of debt, will be reversed and any payments related to eligible care refunded to the extent no longer owed. ECAs will be reinstated if the individual is not eligible for financial assistance or does not complete the FAA by the deadline. At least 30 days before initiating an ECA, Carilion will send the patient written notice of intended ECA(s), a plain language summary explaining financial assistance available and the process for determining eligibility, and the deadline for applying for assistance. Carilion will also attempt to call individuals at least 30 days before initiating an ECA to make them aware of the financial assistance available and how to obtain assistance with the application process. Carilion shall enter into a written contract with any collection agency to which it refers bad debt. The contract will obligate the collection agency to observe and comply with Carilion's obligations under this policy and the Financial Assistance Policy. A collection agency to which bad debt is referred for collection may not engage in any ECAs without the prior written consent of Carilion. After making reasonable efforts to determine if a patient qualifies for financial assistance and the patient either does not qualify for financial assistance or fails to submit an application as requested, within 240 days from the date the first post-discharge billing statement is provided, Carilion may engage in one or more of the following ECAs: 1. Place a lien on an individual's property; 2. Attach or seize an individual's bank account or any other personal property; 3. Commence a civil action against an individual; 4. Garnish an individual's wages; 5. Sell an individual's debt to another party; or 6. Report the account to credit agencies. Individual account balances greater than $5,000 are not sent to a collection agency. These are handled through the Debt Recovery Department (DRD) for verification of financial assistance status before further collection activity occurs. DRD will also investigate any accounts that require special handling. For example, in cases of a deceased patient, auto accident, or any other unique circumstances requiring special handling, the accounts are placed with the DRD. When all collection efforts have been exhausted, all hospital accounts will be returned and closed as uncollectible. No further collection activity is taken at that time. Accounts with satisfactory payment arrangements, legal activity or accounts with pending payment will be considered active and are not returned. Schedule H, Part V, Section B, Line 16a FAP website - CARILION TAZEWELL COMMUNITY HOSPITAL: Line 16a URL: https://www.carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - CARILION TAZEWELL COMMUNITY HOSPITAL: Line 16b URL: https://www.carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - CARILION TAZEWELL COMMUNITY HOSPITAL: Line 16c URL: https://www.carilionclinic.org/billing/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment In addition to conducting regular Community Health Needs Assessments (CHNAs), Carilion Clinic closely monitors community health indicators and responds to needs as they arise. Each year, Carilion updates scorecards with refreshed health data from various secondary sources and County Health Rankings indicators provided by the Robert Wood Johnson Foundation. Carilion also responds to needs identified through clinical data and internal departments, including data collected through social determinants of health screenings. A health equity and social determinants of health steering committee exists to provide oversight and guidance related to health equity and screenings, and a resource navigation subcommittee tackles more nuanced topics around current community needs as seen in the patient population. Carilion's call center, Carilion Direct, allows community members to ask questions and connect with community resources. Community health workers (CHWs) help address needs and data is reviewed periodically to identify trends in the healthcare needs of patients served by CHWs. Healthcare needs are also identified through current collaborative relationships and community partnerships, including collaboration with the Virginia Department of Health and local safety net partners. Ongoing collaboration with stakeholders allows for regular communication 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 repeats every three years. Continuous quality improvement is a key principle of the process. The Strive Collective Impact Model for the Community Health Assessment Team helps Carilion foster community development in its CHNA and community health improvement processes. 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) can 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 billing statement and patient financial responsibility letter includes information on the Financial Assistance policy including who to contact for additional information and location of in-person assisters. The Application, the Policy, and the plain language summary are available free of charge to the patient. They are available by mail and on the web site if the patient did not receive written information at the time of service. Financial Assistance policy and application are also distributed to community partners through electronic mailing groups. Carilion Clinic employs an Eligibility staff that counsel patients on federal and state programs. The staff completes applications for Medicaid and provides information on Social Security, Social Security Disability and Medicare. The staff provides support services ensuring the applications are processed correctly based on federal and state policy. In addition, Eligibility staff are trained as Certified Application Counselors and will assist patients in enrollment in the Marketplace. Eligibility staff will also complete Carilion's financial assistance application and counsel patients on the requirements for financial assistance. Schedule H, Part VI, Line 4 Community information Tazewell County is a largely rural area in Southwest Virginia experiencing significant health and social determinants disparities compared to the Commonwealth of Virginia. The 2019-2023 U.S. Census Bureau's American Community Survey (ACS) found the total population of Tazewell County to be 39,933, with a median age of 45.0, compared to 38.8 in Virginia. The average household income in Tazewell County is $68,404, while the median income is $45,788, with 19.27% of the population living below the federal poverty level (U.S. Census Bureau, ACS, 2019-2023). The percentage of Tazewell County residents with Medicaid is 25.96%, while 4.70% have no insurance (U.S. Census Bureau, ACS, 2019-2023). Of all Carilion Tazewell Community Hospital (CTCH) patients in FY24, 30.50% were Medicaid recipients, while 4.45% were self-pay, a proxy for uninsured (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. In Tazewell County, 93.31% of the population is White, 3.65% is Black, and 1.30% is Hispanic or Latino (U.S. Census Bureau, ACS, 2019-2023). Clinch Valley Medical Center is also in Tazewell County, and Ballad Health also serves the population. Ballad's nearest facility, Smyth County Community Hospital, is 35 miles or roughly one hour from CTCH. Tazewell County is a federally-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 healthcare system located in 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 125 years, when a group of dedicated citizens came together and built a hospital to meet the community's healthcare needs. Today, Carilion is a vital anchor institution focused on healthcare and dedicated to our mission of improving the health of the communities we serve. With an enduring commitment to our region's health, care is advanced through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. Carilion invests in discovering and responding to local and regional health needs, understanding that we must involve additional stakeholders to address community health issues and create change effectively. Carilion recognizes the impact the environment has on the health of our communities. Efforts continue to make our hospitals and other facilities more energy-efficient, increase recycling and use of recyclable or bio-degradable materials, reduce waste materials and serve local, sustainable foods to patients and in our cafeterias. Carilion has an office of sustainability that leads these efforts and empowers employees to be involved in environmental health-related projects. Carilion Tazewell Community Hospital (CTCH) is in Tazewell County in Southwest Virginia. CTCH is a not-for-profit, 56-bed hospital dedicated to quality care and patient comfort. We support an extended care recovery program (Swing Bed) that allows eligible patients to grow stronger before going home. CTCH hosts diagnostic services such as advanced imaging, including screening mammography, and therapy services, including physical and respiratory therapy. CTCH offers 24/7 emergency services and can arrange access to higher levels of care if needed. Medicated Assisted Therapy (MAT) services are available on our campus through the local Federal Qualified Health Center's (FQHC) New Day Recovery Program. Primary care is available through Carilion Clinic Family and Community Medicine and the Tazewell Veteran's Outpatient Clinic. CTCH serves patients regardless of their ability to pay. The hospital's governing board members reside in the region and are elected to 3-year terms, with board officers elected annually. 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, staff development, and charitable efforts. Reinvestments include 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 healthcare organization based in Roanoke, Virginia. Carilion Clinic includes a comprehensive network of hospitals, primary and specialty physician practices, and complementary services comprising six hospital entities, 86 specialties and 295 practice sites across Southwest Virginia. All are centered on a common mission and shared values. In the mid-2000s, Carilion decided to transform from a collection of hospitals to a physician-led, integrated healthcare 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,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 and hosting Radford University Carilion's healthcare professional educational offerings on-site of a Carilion hospital. Each decision and adaptation has fundamentally changed how 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. true Communities in Sch Appalachian Hghlds 280 Lee Street Bristol VA 24201 461775208 501(c)(3) 15000 At-risk student support Tactical Retreat Unplugged 415 Montclair Cir Rd N Tazewell VA 24630 922634551 501(c)(3) 8000 Forest boardwalk SWVA Community Health Systems PO Box 297 Meadowview VA 24361 542046110 501(c)(3) 21035 FMV Donated rent Program support 3 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds The hospital donates funds to other charitable organizations in support of health and community improvement. Such organizations also have community boards which oversee the expenditure of such funds. Carilion Clinic is committed to improving the health of the communities that we serve by addressing key health priorities identified through our triennial Community Health Assessments. Carilion fulfills this commitment in many ways, one of which is through targeted grants for community health improvement programs, and those that impact the social determinants of health. For Carilion Clinic's Community Grant Program, each grantee must sign a letter of agreement with Carilion Clinic that delineates the terms and specific objectives of the project. By accepting a Carilion award, grantees are asked to acknowledge the support of Carilion Clinic in all materials and/or related special events or fundraisers throughout the award cycle where other donors are publicly recognized. One mid-cycle progress report and a final program evaluation are required for each funded project. Site visits may be made to grantees. Program evaluation includes alignment with Community Health Assessment priorities, program impact, organizational effectiveness and community benefit through collection of data including clients served, cost effectiveness of the program (cost per client or service), tangible community or client outcomes, collaboration with other organizations, and specific efforts to cultivate diverse funding sources for program sustainability. Each grantee must agree to submit requested data and reports on a timely basis and to complete the evaluation process as requested. X false true false true false false false false false true false Kevin Combs DO Director 0 239434 0 0 0 2345 0 6972 0 16754 0 265505 0 0 William Flattery Director 0 277504 0 26691 0 15064 0 36986 0 17021 0 373266 0 0 Mark Mossey MD Director 0 349586 0 12657 0 3045 0 15850 0 2074 0 383212 0 0 Kristie Williams Director/Hospital VP 0 201112 0 41163 0 8463 0 3409 0 11998 0 266145 0 0 David Hagadorn Former Officer 0 120679 0 0 0 38425 0 13363 0 11709 0 184176 0 0 Nicholas Conte Asst. Secretary 0 731687 0 111366 0 180664 0 156813 0 18080 0 1198610 0 172601 Donald Halliwill Asst. Treasurer 0 767976 0 117511 0 233761 0 142915 0 24996 0 1287159 0 227735 G Robert Vaughan Jr Asst. Treasurer 0 353161 0 41359 0 63488 0 46006 0 24996 0 529010 0 57282 David Vance Pharmacy Manager 141855 0 0 0 197 0 -937 0 22940 0 164055 0 0 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments EMPLOYEES ARE OCCASIONALLY PROVIDED SMALL GIFTS, PRIZES OR AWARDS WHICH MAY BE INCLUDED IN TAXABLE COMPENSATION AT AMOUNTS GROSSED UP FOR TAXES. DURING THE REPORTING PERIOD MS. BALES RECEIVED SUCH BENEFIT. Schedule J, Part I, Line 1b Written policy regarding payment or reimbursement of expenses MANAGEMENT MAKES TAX GROSS-UP DECISIONS AT ITS DISCRETION FOR NON-ROUTINE SMALL GIFTS, PRIZES OR AWARDS CONSIDERING IRS REQUIREMENTS, AMOUNT, AND NON-CASH STATUS. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation The organization has a single member, Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. The Carilion Clinic Board of Directors Compensation Committee reviews the compensation philosophy for all executive leaders in the health system, including the filing organization's top management official. An independent, outside compensation consultant specializing in healthcare organizations conducted a detailed analysis of total compensation and each element thereof, including base salary, bonus, 'at-risk other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to both a national and regional peer group of organizations similar in size and structure to the organization, which list was reviewed by the Compensation Committee. The study's data and findings were shared with the health system's EVP/COO. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan 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: $227,735 - Donald Halliwill $172,601 - Nicholas Conte $57,282 - G. Robert Vaughan, Jr. Schedule J, Part I, Line 7 Non-fixed payments The organization pays annual 'at risk' compensation to certain members of management and physicians based on performance of applicable scorecard metrics. 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 or physicians reporting to them. In addition, for top management, the actual non fixed payment awarded is determined in the discretion of the Carilion Clinic Board of Directors and its compensation committee. Brian Bales Family member of Alicia Bales, Director 101196 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 (CTCH) exists to serve its community's health care needs, regardless of a patient's ability to pay. CTCH's acute hospital admitted 664 patients and provided 3,083 days of care during the year. Hospital programs include an active primary care practice for the community, the provision of nursing care, and diagnostic imaging services including CT, MRI, mammography, x-ray and ultrasound. Tazewell provides several services targeting the specific health needs of its population, including physical, speech, and occupational therapy programs, home health services and bone density testing. CTCH also provides an emergency department with 24-hour care and emergency transportation. With 10,483 visits, CTCH's emergency services are a critical component of the health safety net in its service area. It acts as a vital health provider for a significant number of uninsured patients who comprise nearly 5 percent of ED visits. CTCH supports community events such as community screenings and education on chronic disease management. In furtherance of its mission, CTCH provides extensive uncompensated care and community support. Stated at cost, financial assistance and other community benefits for the year exceeded $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 2 Family/business relationships amongst interested persons Nicholas Conte, Donald Halliwill, G. Robert Vaughan, Jr, William Flattery, Julie Smith-Hamilton, J. Harrison Lapuasa, Mark Mossey, Kevin Combs, and Kristie Williams - Business relationship, JAMES THOMPSON, NELLIE STILLWELL - Business relationship Form 990, Part VI, Line 3 Delegation of management duties Certain management and related services for the organization are provided by the management and employees of Carilion Services, Inc., a related and supporting organization of the filing organization. Some or all of the compensation of the following individuals listed in Part VII, Section A was provided by Carilion Services, Inc.: Nicholas C. Conte, David Hagadorn, Donald B. Halliwill, Julie Smith-Hamilton, J. Harrison Lapuasa and G. Robert Vaughan, Jr. Form 990, Part VI, Line 6 Classes of members or stockholders The organization has a single member. The sole member is Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. The sole member elects the directors of the organization and has certain other reserved powers. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The sole member of the organization, Carilion Clinic, elects the members of the governing body of the organization periodically as terms expire. The sole member also has the right to remove directors and fill any vacancies on the Board that may occur for any reason. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The sole member of the organization, Carilion Clinic, holds reserved powers with respect to certain enumerated actions, including appointment of CEO; approval of borrowings, budgets, and strategic plans; and amendments of Articles of Incorporation and Bylaws, among others. Approval by the Board of Directors of Carilion Clinic is required for such actions. In addition to the reserved powers, under the laws of the Commonwealth of Virginia, certain extraordinary actions require member approval, such as mergers, consolidations, liquidations, and the sale of substantially all of the assets of the organization. See also Schedule O disclosure for Form 990, Part VI, Section A, Line 7a. Form 990, Part VI, Line 11b Review of form 990 by governing body The Form 990 was prepared by Carilion's internal Tax Department with input from various Carilion departments as applicable, and reviewed by internal management and an independent CPA firm. Several days prior to filing, all Board Members were notified via email that the final Form 990 was available for their access on the organization's Board portal and were provided contact information to reach out to for any questions. 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. The Carilion Clinic Board of Directors Compensation Committee reviews the compensation of the Carilion Clinic Board of Governors annually, which includes the Carilion Clinic President and Chief Executive Officer, Executive Vice Presidents (Chief Financial Officer, Chief Physician Executive, Chief Operating Officer, Chief Administrative Officer and Chief Legal Officer), and select Senior Vice Presidents who are the physician Chairs of the Clinical Departments. Certain of these same individuals also hold roles as officers of the filing organization. The Compensation 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. The Compensation Committee also annually reviews the compensation philosophy for all executive leaders in the health system, which includes Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, and the CEO, among them the filing organization's top management official and certain other officers. This review included review of a comprehensive report from an independent, outside compensation consultant specializing in healthcare organizations for certain select positions and the prior year's report on all the reviewed positions . The reports reviewed by the Committee included a detailed comparison of total compensation and each element thereof, including base salary, bonus, 'at-risk other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to both a national and regional peer group of organizations similar in size and structure to the organization, which list was reviewed by the Compensation Committee. The Compensation Committee maintained minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. For the filing organization's top management official and certain officers who are not directly reviewed by the Compensation Committee, the independent external compensation consultant conducts the same analysis and shares the data/findings with the system EVP/COO. Certain assistant 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 or consultant review but are compared to market benchmarks by the Human Resources department. 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 consolidated 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 consolidated financial information is available on our website. 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