2021-08-16T16:30:45-05:00 2020-09-30 440160260 BKD LLP 1201 WALNUT ST SUITE 1700 KANSAS CITY MO 641062246 990 2019-10-01 540549603 Carilion Giles Community Hospital CARI 5402245102 PO BOX 12385 Roanoke VA 240252385 G ROBERT VAUGHAN JR ASSISTANT TREASURER 2021-08-16 true MIKE ENGLE P00482834 8162216300 2021-08-13 2019 2022-09-23 18:48:47Z X KRISTIE WILLIAMS PO BOX 12385 Roanoke VA 240252385 54960251 false X WWW.CARILIONCLINIC.ORG X 1954 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. 18 13 330 31 0 0 37021 850185 35623201 40979417 192434 389656 436995 287083 36289651 42506341 59177 67426 0 14315597 20211253 0 0 21682191 20882190 36056965 41160869 232686 1345472 40889029 49015367 67251501 76947859 -26362472 -27932492 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 35846713 67426 41107033 See schedule O. 35846713 true true false true false false false false false true true false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true X 0 0 330 true false false false false false false false false false false false false X 18 13 true true false false true true true true true false false true true true true true true true true false VA X THE CORPORATION ATTN H KIRK 5402245102 213 S JEFFERSON ST ROANOKE VA 24011 C ANTHONY Needham II Director/Vice Chair 1.2 0 X X 0 0 0 Kristie Williams Director/Hospital VP 47.5 2.5 X X 195595 0 152584 Michael A McMahon MD Director/Chair 2.4 0 X X 0 0 0 William Flattery Director/Sec./Treas. 2.5 47.5 X X 0 326678 154080 ANDREW WAGNER Director 1.2 0 X 0 0 0 CHRIS MCKLARNEY Director 1.2 0 X 0 0 0 Christopher Hansen OD Director 1.2 0 X 0 0 0 George McGuire Director 1.2 0 X 0 0 0 James Hartley Director 1.2 7.5 X 0 21750 0 Jennifer Bennett Grube MD Director 1.2 48.8 X 0 227071 41279 Kenneth Walker MD Director 1.2 0 X 0 0 0 Melissa Stump Director 1.2 48.8 X 0 91000 49297 Michael Helvey DO Director 1.2 48.8 X 0 404672 88599 PRISCILLA MORRIS Director 1.2 0.0 X 0 480 0 Richard JENNELL Director 1.2 0 X 0 0 0 Richard McCoy Director 1.2 0 X 0 0 0 Shannon Lucas Director 1.2 0 X 0 0 0 Timothy Meredith Director 1.2 0 X 0 0 0 David Hagadorn Asst. Treasurer 0.5 49.5 X 0 149339 99463 Donald Halliwill Asst. Treasurer 0.5 49.5 X 0 774298 360873 G Robert Vaughan Jr Asst. Treasurer 0.5 49.5 X 0 353112 316295 Nicholas Conte Asst. Secretary 1.0 49.0 X 0 709682 182512 Nancy Howell Agee CEO, Carilion Clinic 2.0 48.0 X 0 2254723 341866 Steven Arner Executive Vice President 2.0 48.0 X 0 877942 363619 Amy Westmoreland Pharmacy Manager 50.0 0 X 169076 0 105300 ANGELA LILLY Nurse Practitioner 50.0 0 X 102980 0 9377 SHIRLEY PETREYE Nurse Practitioner 50.0 0 X 103856 0 21090 Veronica Stump Nursing Director 50.0 0 X 115026 0 104520 686533 6190747 2390754 5 false true false QUEST DIAGNOSTICS 500 PLAZA DRIVE SECAUCUS NJ 07094 LABORATORY SERVICES 803628 F & S BUILDING INNOVATIONS INC 2944 ORANGE AVENUE NE ROANOKE VA 24012 CONSTRUCTION SERVICES 427958 BLACKWELL HEALTHCARE STAFFING 2201 BROOKHOLLOW PLAZA DRIVE 165 ARLINGTON TX 76006 PHYSICIAN SERVICES 130035 TRANE US INC 2303 TRANE DRIVE ROANOKE VA 24017 CONTRACTOR SERVICES 119549 4 29000 743915 77270 850185 Net Patient Revenue 622110 40962140 40962140 Rent from Affiliates 531120 17277 17277 0 0 0 0 40979417 104707 104707 72988 72988 0 72988 72988 12738745 114 12453910 0 284835 114 284949 284949 Cafeteria 722514 86479 86479 Bond Costs/Premium Write-off 900099 66462 66462 Contract Revenue 900099 17491 17491 43663 43663 0 0 214095 42506341 41107033 0 549123 65926 65926 1500 1500 255494 255494 15782236 15782236 1260151 1260151 2070119 2029915 40204 843253 832376 10877 4337984 4337984 2383 2383 9302 9302 3609864 3100308 509556 0 1345 422 923 417988 381679 36309 44366 44216 150 590068 590068 58352 54499 3853 1037309 1037309 2069616 2069616 316379 212417 103962 Med Supplies 3375972 3375939 33 Bad Debt 3759215 3759215 Intercompany Practice Subsidy 1184380 1184380 Dues & Subscriptions 25790 25790 41877 36368 5509 0 41160869 35846713 5314156 0 1250 1250 125318 311339 0 6718454 8340188 0 0 0 0 0 0 122641 69045 55706210 25874601 26915480 29831609 987490 3917902 4568738 6542876 0 1449658 1158 40889029 49015367 3857215 5544663 0 215155 5938993 33638913 33472348 0 0 0 29540218 31991855 67251501 76947859 X -26496419 -28125312 133947 192820 -26362472 -27932492 40889029 49015367 X 1345472 -2071040 -844452 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 2383 2383 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY A portion of dues paid to various hospital industry associations is attributable to lobbying activities. 1849365 1849365 29188324 8750545 20437779 0 0 0 24145941 16941645 7204296 522580 182411 340169 29831609 403245 F Alternative Investments 6139631 F Comingled Funds 6542876 Pension Liability 19906140 Interest Rate Swap Liability 11879215 Due To Affiliate 206500 31991855 true true X true X true X false true false true true 588408 588408 0.0158 3059088 2785493 273595 0.0073 0 0.0 0 0 3647496 2785493 862003 0.0231 2544 5552 211235 38477 172758 0.0046 0 0 0 0.0 0 0.0 0 0.0 24 692 50598 50598 0.0014 2568 6244 261833 38477 223356 0.0060 2568 6244 3909329 2823970 1085359 0.0291 0 0.0 0 0.0 8 1789 1789 0.0000 0 0.0 0 0.0 18 4856 4856 0.0001 0 0.0 1 1500 1500 0.0000 0 0.0 27 0 8145 0 8145 0.0002 true 3759215 11964685 12402962 -438277 X true true 1 1 CARILION GILES COMMUNITY HOSPITAL 159 HARTLEY WAY PEARISBURG VA 24134 https://carilionclinic.org/locations/carilion-giles-community-hospital H 1837 X X X X CARILION GILES COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 17 true false true true X https://www.carilionclinic.org/locations/carilion-giles-community-hospital X https://www.carilionclinic.org/community-health-assessments#giles-county X X true 17 true https://www.carilionclinic.org/community-health-assessments#giles-county false true X 200.0 400.0 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 Community Health Needs Assessment report prioritizes the community's significant health needs that were identified by the assessment, and explains how the health needs were prioritized. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Carilion Giles 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, persons with exceptional knowledge of, or expertise in, public health, and local health department officials. The CHATs obtain input from leaders, representatives, or members among medically underserved populations who report as low-income, are minorities and suffer from chronic diseases. The following organizations served on the CHAT for the 2018 Giles County Area Community Health Needs Assessment (GCACHNA)-Giles County - Special Projects, Giles Day Report Program, Monroe County Health Center - Peterstown, Monroe County Health Centers, New River Community Action -CHIP, New River Community Action - Head Start, New River Valley Community Services, NRV CARES, Pembroke Management Inc. - Housing Voucher, Virginia Department of Health - New River Health District. To further obtain input from the community, the GCACHNA conducted focus groups among stakeholders and target populations and administered a community health survey. During the CHNA process, community stakeholders, leaders, and providers are encouraged to complete a Stakeholder Survey (print and electronic versions available) to provide additional perspectives about our community's health needs and barriers. CHATs conducted stakeholder focus groups with the Giles County Day Report Program staff and Narrows Head Start. CHATs conducted focus groups with target populations to capture the story of health needs and barriers for the uninsured, underinsured, low-income, minority, senior, and chronically ill populations. Two focus groups were held, located closely and conveniently to target populations. Participants discussed health needs and barriers and access to primary, oral, and mental health care. The groups included Community Health Center of New River Valley patients in Pearisburg and people at the Giles County Senior Center. A 39-question 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 (NACCHO) and Centers for Disease Control and Prevention (CDC). The CHAT identified target populations, collection sites, and survey distribution methods. The population of interest for the survey was Giles County (VA) and Monroe County (WV) residents 18 years of age and older. The Giles County Area included the CHNA service area of Giles County, VA, and Monroe County, WV. There were special efforts to include underserved/vulnerable populations disproportionately impacted by social determinants of health such as income, race/ethnicity, education, and insurance status. The survey was also made available to all residents living in the service area. The oversampling of the target populations occurred through targeted outreach efforts. In total, 481 surveys were collected. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Carilion Giles Community Hospital. Giles County - Special Projects, Giles Day Report Program, Monroe County Health Center - Peterstown, Monroe County Health Centers, New River Community Action - CHIP, New River Community Action - Head Start, New River Valley Community Services, NRV CARES, Pembroke Management Inc. - Housing Voucher, Virginia Department of Health - New River Health District. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - Carilion Giles Community Hospital. The Community Health Assessment Team shared the 2018 Giles County Area Community Health Needs Assessment (GCACHNA) on partner websites and social media. THE GCACHNA was also shared through community forums, community presentations and media interviews. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Carilion Giles Community Hospital. The following information describes the implementation strategies used by Carilion Giles Community Hospital (CGCH) to address the community health needs identified in the 2018 Giles County Area Community Health Needs Assessment (GCACHNA). The complete implementation strategies are available online at https://www.carilionclinic.org/community-health-assessments#giles-county. According to the Robert Wood Johnson Foundation's (RWJF) County Health Rankings, where an individual lives, works and plays is a strong predictor of their health outcomes (http://www.countyhealthrankings.org/). In the United States, a person's zip code can help predict their life expectancy due to its direct link to the social determinants of health such as poverty, race/ethnicity, education and employment status in these areas (https://www.rwjf.org/en/library/interactives/whereyouliveaffectshowlongyoulive.html). These factors, part of the 10-year national Healthy People 2030 objectives, are crucial to our overall health because they "create social and physical environments that promote good health for all." (https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health) Carilion responds to community health needs in innovative ways-making sure our region has access to state-of-the-art health care close to home, providing community grants and sponsorships to extend our mission and support other organizations addressing health needs, creating and implementing community-wide strategies to reduce barriers, coordinating resources and enhancing community strengths, and providing community-based health and wellness programs. Commitment to community health is evident at all levels of the organization. Carilion's infrastructure includes a Planning and Community Development division dedicated to assessing and addressing community needs. The division is responsible for leading and facilitating the Community Health Improvement Plan, CHNAs, Carilion's community grant process, community health education, community benefit collection, and neighborhood health initiatives. There are Community Health and Outreach (CHO) staff at the system level and each community hospital. They work with hospital Boards of Directors and Carilion Clinic's Board of Governors to create health improvement strategies. A Community Benefit Council provides oversight and strategic guidance for Carilion's community health improvement work and community benefit strategy, collection and submission. Carilion Clinic's response strategies follow the RWJF framework for what influences health, which includes health behaviors, social and economic factors, clinical care access and quality, and physical environment. With the onset of COVID-19, Carilion immediately recognized the prominent role we would play in both prevention and treatment for our region. The pandemic demanded a shift in operations and priorities. While some of our implementation strategies were delayed or altered, Carilion quickly responded to the new and unique health-related social needs arising from COVID-19. An addendum to the CGCH implementation strategies was approved in July 2020 to reflect the organization's planning and response to the pandemic. The complete addendum is available online at https://www.carilionclinic.org/sites/default/files/2020-10/CGCH%20IS%20COVID%20Addendum_0.pdf. -COVID-19 Community Response- Carilion worked with local media partners to provide expert advice and guidance to the community for COVID-19 prevention, detection and recovery. In a historic collaborative effort, competing hospitals and broadcasting organizations publicized a community town hall. We coordinated efforts to ensure the public received the most accurate and up-to-date information about the pandemic. We developed the COVID-19 Community Hotline as a dedicated phone line to answer community member questions about COVID-19 signs and symptoms, Carilion guidelines, and resources. We also established a recovery support phone line to ensure employees, patients, and community members have access to mental health and recovery support. Peer Recovery Specialists created five virtual peer support community groups. These provided options for individuals in recovery to maintain recovery-oriented support during stay-at-home orders. Carilion is actively providing counsel to community partners, businesses, universities and colleges regarding COVID-19 through consultation with our infectious disease physicians and our management team. This service, offered free of charge, aims to promote safety and reduces hospitalizations and deaths. Because older adults are especially vulnerable to COVID-19, accessing essential resources presented another serious challenge for them during the pandemic. Amid stay-at-home orders, business closures and medical appointment cancellations, we made it our mission to check on seniors in need who were living alone. Carilion's Planning and Community Development, Geriatric Medicine, Home Care and Hospice and Accountable Care Organization departments coordinated efforts to establish Home Alone. Through this initiative, Carilion made more than 1,200 phone calls to provide up-to-date information and connect seniors with local governments and community resources. From delivering masks to offering support over the phone, the program helped meet a wide range of needs head-on. Seniors were able to stay home safely, reduce their exposure to COVID-19 and avoid the hospital. Carilion Clinic believes in the power of collaboration. Carilion also understands the most significant health issues are addressed through cooperation with the community. Carilion participates in and provides financial and in-kind support to community health coalitions addressing the Giles County area's health needs. We also partner with multiple community and business organizations to improve health and wellness and impact the social determinants of health for everyone we serve. The Giles County FOCUS Program is a formalized network of service providers that interact extensively with underserved Giles citizens. Through focused and coordinated service provision, FOCUS addresses the physical, educational and economic well-being of individuals, families and communities. FOCUS's mission is to lead positive social change for families and individuals living in Giles County through the coordination of advocacy, information, opportunity and community involvement. Its vision is three fold-that every child is provided relationships to help them achieve his/her greatest potential and participate in and contribute to the community, that every parent is provided relationships to help them improve the quality of life for their families, and that every adult is provided the relationships to help them become responsible, participating citizens. FOCUS believes that to better impact the physical, social and economic well-being of Giles County citizens, it is important to identify locations of need, specifically neighborhoods, to focus its investments. (http://nrvlivability.org/creating-systemic-change-in-giles-county-focus/). CGCH is an active participant in FOCUS and supports the work of many FOCUS partners. In fiscal year 2020, CGCH assisted with the Giles County School Lunch program, donated supplies to the Giles County Christian Mission Food Pantry and provided mask education to employees and clients of the Giles County Christian Mission. Additionally, the Giles Community Garden Healthy Communities Action Team was awarded funding to focus on childhood obesity and support the Giles Community Garden. Carilion fulfills our commitment to addressing key health priorities through targeted grants for community health improvement programs and those that affect the social determinants of health. Carilion provides many community grants and health sponsorships to help local charitable organizations fulfill their missions related to our communities' health and well-being. Community grant dollars are allocated across the Carilion Clinic service area based on requests received. During the 2020 fiscal year (2019 tax year), $15,500 in grants were awarded to three programs serving both Giles County and the New River Valley broadly to improve transportation and basic needs access, regional health coalition efforts, and unwanted pregnancy prevention efforts. (Continued in Part VI) Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - Carilion Giles Community Hospital. Individuals with Out of Network insurance are not eligible for Financial Assistance unless the plan does not meet minimum essential coverage as defined in PPACA or it is a governmental plan. 18 CARILION CLINIC FAMILY MEDICINE - GILES 430 BOXWOOD LANE PEARISBURG VA 24134 RURAL HEALTH CLINIC CARILION CLINIC PULMONOLOGY-GILES 159 HARTLEY WAY PEARISBURG VA 24134 PULMONARY SERVICES CSC PEARISBURG 159 HARTLEY WAY PEARISBURG VA 24134 SURGICAL SERVICES CARILION CLINIC ORTHOPAEDICS-GILES 159 HARTLEY WAY PEARISBURG VA 24134 ORTHOPAEDICS CARILION CLINIC CARDIOLOGY -GILES 159 HARTLEY WAY PEARISBURG VA 24134 CARDIOLOGY SERVICES ENT - GILES 159 HARTLEY WAY PEARISBURG VA 24134 ENT Carilion - Urology 159 HARTLEY WAY PEARISBURG VA 24134 Urology Carilion Clinic Family & Internal Medicine - Martinsville 1107A Brookdale St Martinsville VA 24112 RURAL HEALTH CLINIC Carilion Clinic Multi-Practice Clinic 1107B Brookdale St Martinsville VA 24112 RURAL HEALTH CLINIC Carilion Clinic Family & Internal Medicine - Galax 544 East Stuart Drive Suite D Galax VA 24333 RURAL HEALTH CLINIC Carilion Clinic Family Medicine - Rocky Mount S Main 390 S Main St Suite 201 Rocky Mount VA 24151 RURAL HEALTH CLINIC Carilion Clinic Family Medicine - Rocky Mount 796 Old Franklin Turnpike Rocky Mount VA 24151 RURAL HEALTH CLINIC Carilion Clinic Family Medicine - Tazewell 388 Ben Bolt Ave Tazewell VA 24651 RURAL HEALTH CLINIC Carilion Clinic Family Medicine - Wytheville 1375 West Ridge Rd Wytheville VA 24382 RURAL HEALTH CLINIC Carilion Clinic Family & Internal Medicine - Westlake 282 Westlake Rd Hardy VA 24101 RURAL HEALTH CLINIC Carilion Clinic Family Medicine - Hillsville 416 S Main St Hillsville VA 24343 RURAL HEALTH CLINIC Carilion Clinic Family Medicine - Floyd 911 East Main St Floyd VA 24091 RURAL HEALTH CLINIC Carilion Clinic Family Medicine - Boones Mill 22890 Virgil Goode Highway Boones Mill VA 24065 RURAL HEALTH CLINIC Schedule H, Part V, Section B, Line 11 Addressing Needs Identified in CHNA (Continued) (Continued from Part V, Section C) -Significant Health Priorities to be Addressed- Health Behaviors - Needs include alcohol and drug use, poor diet, lack of health literacy / lack of knowledge of healthy behaviors, culture of healthy behaviors not a priority, lack of exercise. Carilion Clinic continues to address health behavior-related priorities from the 2018 GCACHNA. To improve overall health culture and promote healthy diets, Carilion provides various free health education classes, screenings and flu immunizations in community settings. In fiscal year 2020, Carilion provided 58 health education, screening and immunization opportunities/events in the Giles County area, serving 715 people. Community health education is provided by the CHO department and other select departments. Health and wellness education topics include general wellness, healthy eating and exercise, stress management, and infant and child safety. During the COVID-19 pandemic, CHO transitioned to "Take a Break" virtual education sessions providing timely, relevant tips focused on improving well-being and maintaining a healthy lifestyle during an uncertain time. As the year progressed, we added well-being support groups, cooking videos, online gardening classes, guided walks and hikes, and limited in-person outdoor education. Resources committed to these programs include staff time, volunteer hours, and food and giveaway items that encourage healthy behaviors. Carilion remains dedicated to addressing poor diets. We are committed to the Healthier Hospital Initiative pledge and continue to work to improve the amount of healthy, local, sustainable foods purchased and served through our cafeterias. In September 2020, CGCH and Carilion Pharmacy completed the A3 initiative, which connected diabetic patients with pharmacists to provide discharge medication education and coordinate after discharge in the clinic setting. The program aimed to reduce the number of diabetics who have A1C's greater than 9%. In addition to community events, Carilion fosters healthy behaviors by offering classes to its employees and through partnerships with other Giles County area employers. As the largest employer in the region, efforts to engage our employees and their families in healthy lifestyles impact community health overall. Carilion offers Virgin Pulse at no charge to employees and their spouses. The program enables employees to connect personal activity trackers and a platform to encourage daily healthy behaviors such as exercise, climbing stairs, and planning healthy meals. CGCH also hosts a momentum studio at the hospital with exercise equipment available for employees. Through partnership and support of the local Giles Wellness Center, CGCH encourages exercise and other healthy behaviors. CGCH has provided support for equipment at the Giles Wellness Center and partners to regularly offer free health screenings at their location. CGCH also partnered with Giles County to advertise local walking trails and encourage residents and visitors to utilize these free exercise opportunities. -Alcohol and drug use- Carilion's Addiction Task Force brings together expertise from throughout the Carilion system to better understand and address the opioid epidemic in Southwest Virginia. Efforts include-developing system-wide guidelines and a system dashboard for opioid prescriptions, creating treatment pathways for opioid addiction in specific high-risk groups, developing best practices for risk assessment, treatment and standard orders in Carilion's electronic medical record system, EPIC, growing an inventory of community resources related to prevention, treatment and recovery services for patients and community members, and providing locations for free, safe, prescription drug returns or deactivation bags. CGCH is a partner in the Giles County Recovery Court program helping participants learn about healthy behaviors as part of their recovery process. The Recovery Court is an alternative to prison, taking up to two years, through which an addicted person may have their charges dropped upon completion of the program (https://www.roanoke.com/news/local/giles_county/giles-county-recovery-court-graduation-celebrates-lives-put-back-in/article_75cb28ec-82f9-54ff-8251-73b06f56242e.html). CGCH will be participating in the Virginia Rural Health Association's High Risk Patient Education Program, focused on addressing the opioid abuse crisis at a local level. The program will involve identification of high-risk patients, provision of patient and family education on opioid risks and disposal sites for unused medications, assistance acquiring Narcan, referrals to pain management support, and REVIVE education for the public. -Tobacco Use- Carilion makes available a "Preparing to Quit" speakers bureau that can be requested by community groups or companies. Carilion employees and their dependents will now be eligible for a new, pharmacist-led smoking cessation program. This program includes group sessions, individual follow-up, resource referrals and free access to nicotine replacement therapy products. Another option includes free participation in the Quit for Life program. Employees are offered a financial incentive when they are tobacco free. CGCH is a participant in the Giles Youth Adult Partnership, through which partners work together with youth to prevent risky behaviors and encourage healthy choices for local youth. The Giles Youth Adult Partnership has put particular focus on reducing use of tobacco products. CGCH also partnered with Giles County to bring in a tobacco cessation expert to conduct health education in local schools and then educate hospital providers on tobacco use prevention. -Clinical Care- Needs include access to mental health and substance use services and access to specialty care. Issues with access to care are essential to CGCH when addressing community health needs. In addition to providing financial support to qualifying patients who cannot afford care, Carilion works to improve affordable access to care and resources. Carilion is committed to helping improve access to affordable medical care in our communities. Since the expansion of Medicaid in the Commonwealth of Virginia in 2019, Carilion has worked diligently on outreach and enrollment for newly eligible beneficiaries. By the end of fiscal year 2020 (tax year 2019), more than 1,078 people were newly enrolled in Medicaid in the Giles County area. Carilion remains dedicated to recruiting and retaining quality practitioners who provide access to care in the service area. CGCH will work to provide individualized recruitment in the Giles County area. In an ongoing effort to increase access to psychiatry and mental health services, the technological infrastructure to provide telepsych services has been put in place in the CGCH Emergency Department and at Carilion Family Medicine Giles. Telepsych is also being used at the Rural Health Clinic. To expand access to specialty care in the Giles County area, Carilion has built an addition adjacent to the hospital that houses orthopaedics, general surgery and other specialties. Carilion was able to increase access to OBGYN services as well as cardiology, pulmonology, urology, forensic nursing and other specialties in Giles. -Social and Economic Factors- Child abuse / neglect, transportation / transit system needs. In its commitment to reducing inequities in care, Carilion provides financial support for people who cannot afford insurance or health care. Carilion also manages a Medication Assistance Program to increase access to affordable medication and replenishes medication carried aboard emergency medical services vehicles. Support is provided to various not-for-profit organizations. Our support reduces the impact of poverty on health through investments in social determinants such as housing, transportation, employment, education, access to healthy foods and other worthwhile causes. Each year, Carilion coordinates a system-wide United Way campaign through which employees can provide additional financial support to these causes. CGCH participates on the Giles County Community Policy and Management Team, a committee responsible for the implementation of the Children's Services Act structure. It worked to address foster care needs within Giles County, including early intervention to reduce foster placements and increasing resources for foster families. Carilion has also provided support for the NRV CARES Parenting Young Children Course in an effort to reduce the potential for child abuse and neglect through enhanced parenting skills. Schedule H, Part V, Section B, Line 11 Needs identified in CHNA (Continued) -Physical Environment- While the physical environment did not necessarily arise as a top priority in the 2018 GCACHNA, Carilion still 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. -Implementation and Measurement- Carilion has invested in multiple systems to manage data and track outcomes of our community work. We assessed program-level outcomes for community health education classes and screening events. We tracked these outcomes using pre- and post-tests for education and screening results such as blood pressure, cholesterol, diabetes risk assessments and glucose readings. Community programs supported by Carilion grants were responsible for regularly reporting program outcomes. Scorecards developed contain key secondary data points. They are updated annually to track the community health initiatives' impact. Specifically, Carilion tracked and measured impact on specific aligned indicators contributing to the RWJF County Health Factors Rankings and County Health Outcomes Rankings. Our goal is to improve County Health Rankings for the entire Giles County area. Still, we understand that improvements are relative to progress in other communities in the Commonwealth of Virginia by these rankings' nature. -Priority Areas Not being Addressed and the Reasons- Earlier, we described using a community approach to determine and address priority needs. We used a similar approach to determine which needs cannot be immediately addressed. We considered several needs during the prioritization process. However, we did not actively address these needs during this period due to low feasibility or low potential impact. These needs are lack of knowledge of community resources, risky sexual activity, tobacco use, access to primary care, access to dental care, communication barriers with providers, coordination of care, high cost of care, quality of care, high uninsured/underinsured population, community safety/violence, domestic violence, educational attainment, lack of family / social support systems, poverty/low average household income, unemployment, air quality, affordable/safe housing, injury prevention/safety of the environment, outdoor recreation, water quality, high prevalence of chronic disease (general). Of the top 10 identified priorities in the 2018 GCACHNA, transportation is the only one not directly addressed by initiatives included in the implementation strategies. Carilion has provided grant funding to support transportation efforts in the Giles County area. Carilion will continue to explore ways to provide support for improved transportation in the Giles County area. At this time, CGCH does not have the local expertise to provide transportation services. 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. Families with family income equal or below 200% of the 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. 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/about-carilion-clinic#our-values. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Line 7, Column (F) - Bad debt expense of $3,759,215, 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. Line 7e - Community Health Improvement and Community Benefit Operations - This line is reported at actual cost. Carilion's commitment to community health is evident at all levels of the organization. Our infrastructure includes a Planning and Community Health division dedicated to assessing and addressing community needs. The division leads and facilitates the Community Health Improvement Plan, Community Health Needs Assessments, community grants, community health education, collection of community benefit data, and neighborhood health initiatives. Some Community Health and Outreach staff work with the hospital's Board of Directors and Carilion Clinic's Board of Governors to create health improvement strategies to address community health needs. The hospital also has a Community Benefit Council providing oversight for Carilion's community health improvement work and community benefit strategy, data collection and submission. Carilion Giles Community Hospital educates the public about health risks and steps to improve health. Events include regularly scheduled health screenings for blood pressure, blood glucose and cholesterol. Additional health improvement services include assistance with enrollment in public medical programs such as Medicaid and assistance accessing affordable prescriptions through Carilion's Medication Assistance Program. Due to COVID-19, work shifted from the typical health education and improvement programming to education and outreach to lessen the pandemic's impact. For many months, representatives across the organization were involved in the Home Alone program-an outreach effort to connect vulnerable patients to community resources and help them overcome any barriers caused by supply shortages, business closures and cancellation of medical appointments. Carilion received federal relief funding to offset the Community Benefit expenses generated by this and other similar work. Following the rollout of Medicaid expansion in Virginia, Carilion began contracting with MedAssist for Medicaid enrollment outreach, ensuring access to a wide range of health services across the community. MedAssist screens uninsured patients to identify eligibility and helps them with the application process, including documentation and substantiation of eligibility. Greater coverage increases access to benefits not only for general health, but for dental and mental health services as well. The increase in scope for Medicaid eligibility and enrollment led to an increase in Community Benefit dollars invested in this category. Community benefit operations include the expenses to track community health improvement activities and the cost associated with coordinating responses to community health needs identified through the most recent Giles County Area Community Health Needs Assessment. This coordination includes participation in community partnerships such as FOCUS. 7f - Health professions education - n/a 7g - Subsidized Health Services - n/a 7h - Research - n/a 7i - Cash and In-Kind Contributions - At cost. Carilion's dedication to our mission of improving the health of the communities we serve is evidenced by the annual financial and in-kind contributions we provide to dozens of nonprofit partners. Our support directly impacts the issues identified in our triennial Community Health Needs Assessment and various social determinants that impact health. Support provided in fiscal year 2020 (tax year 2019) helped with efforts to prevent youth vaping, efforts to prevent child abuse and neglect, advisory support for nursing in Giles County Public Schools, support for local emergency services and a multitude of other community health improvement goals. Schedule H, Part II Community Building Activities Line 1 - Physical improvements and housing - n/a Line 2 - Economic development - n/a 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 make progress in removing a range of obstacles to good health for residents of our region. Through monetary donations and organizational support, Carilion Giles Community Hospital is deeply involved with a variety of health and social determinant-related initiatives. For example, Carilion invests in student education and development by supporting local high schools. Carilion also impacts community health and safety through support for the Giles County Community Garden, and support of the Giles County Kiwanis Club's efforts to provide health and hygiene items to the community. Line 4 - Environmental improvements - n/a Line 5 - Leadership development and training for community members - n/a 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 community health coalitions that address health, safety and social determinant needs in the Giles Community Area. Also, we partner with multiple community and business organizations around initiatives to improve health and wellness for everyone living in the Giles County Area. An example is Carilion's representation on the New River Valley Community Services Board and associated volunteer hours donated. In addition, Carilion representatives participate in Giles Youth Adult Partnership, the Giles Community Garden's Healthy Communities Action Team and the FOCUS Network. Line 7 - Community health improvement advocacy - n/a Line 8 - Workforce development - With the understanding that employment is directly linked to health and wellness, Carilion partners to provide workforce development and training for community members. These efforts also develop a pipeline of future health care workers. In commitment to these efforts, Carilion Giles Community Hospital provides scholarships for students pursuing post-secondary education. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Carilion Giles 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 Giles 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 GILES COMMUNITY HOSPITAL: Line 16a URL: https://carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - CARILION GILES 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 GILES 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 (CHNA), 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. The Planning and Community Development department studies chronic disease incidence and prevalence rates, monitors health status indicators and assesses health disparities. 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. Needs are also identified through advisory boards and focus groups conducted in key neighborhoods or aligned with community initiatives. Ongoing collaboration with community stakeholders allows for regular communication of community needs and gives our partners opportunities to respond cohesively. 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, Social Security, Social Security Disability and Medicare. The staff provides support services ensuring the applications are processed correctly based on federal and state policy. In addition, Eligibility staff are trained as Certified Application Counselors and will assist patients in enrollment in the Marketplace. Eligibility staff will also complete Carilion's financial assistance application and counsel patients on the requirements for financial assistance. Schedule H, Part VI, Line 4 Community information The Giles County area, including Giles County, Virginia and Monroe County, West Virginia, is the service area for the GCACHNA. Giles County is a picturesque region of Appalachian America, with mountainous terrain, cliffs, rivers and streams. It is part of the New River Valley, which includes the counties of Floyd, Giles, Montgomery (including the towns of Christiansburg and Blacksburg), and Pulaski and the independent City of Radford. The County is rural and topographically isolated with 48.6 persons per square mile compared 202.6 persons per square mile in Virginia as a whole (https://www.census.gov/quickfacts/fact/table/va,gilescountyvirginia/PST045219). It is a part of the New River Valley Planning District (Health Planning District 4) and is commonly referred to as Rural Appalachia (https://www.vdh.virginia.gov/new-river/). The area is bordered on the south by the Blue Ridge Mountains and the north by the Alleghany Mountains. One of the oldest rivers in America, the New River, runs through this region (https://www.newriverwatertrail.com/NRWT/history-of-the-new-river/). Giles County is approximately 356 square miles (https://www.census.gov/quickfacts/fact/table/va,gilescountyvirginia/PST045219). The area is comprised of nine towns and is delineated by three voting districts-Pembroke, Eggleston, and Newport (Eastern District), Pearisburg, Staffordsville, and White Gate (Central District), and Glen Lyn, Rich Creek, and Narrows (Western District). Pearisburg is the county seat. Giles County is governed by a County Board of Supervisors that controls the county budget. It is the site of the majority of health and human services available to the residents of Giles County. GIles County has a mountanious topography with over 50 miles of the Appalachian Trail and the Great Eastern Trail (http://virginiasmtnplayground.com). Under the peak of Angel's Rest and surrounded by the beautiful mountains of Pearisburg, Virginia, lies Carilion Giles Community Hospital (CGCH). For more than 50 years, this hospital has served the residents, neighbors, and visitors of Giles County. In 2002, CGCH was granted a government designation of Critical Access in a rural setting. Today it is one of the leading hospitals of this kind in the nation. Secluded in the Allegheny Highlands, Monroe County was separated from Greenbrier County, West Virginia in 1799, where its economic basis has been farming and timber harvesting ever since (http://monroewvhistory.org/text/monroe.html). Monroe is similar to Giles, rural with 28.6 people per square mile and 472.75 square miles of land (https://www.census.gov/quickfacts/fact/table/monroecountywestvirginia/PST045219). The 2018 GCACHNA revealed differences in size and population and significant disparities both in health and social determinants. The 2015-2019 American Community Survey (ACS) found the total population of the counties of Giles and Monroe to be 16,772 and 13,401 respectively and median ages of 44.7 and 48.0 respectively (U.S. Census Bureau, 2015-2019 5-year ACS, Table S0101 https://data.census.gov/cedsci/table?q=S0101&tid=ACSST5Y2019.S0101&hidePreview=true). According to the Weldon Cooper Center for Public Service, Giles County is predicted to have slightly negative population change by 2040 (https://demographics.coopercenter.org/virginia-population-projections). Both areas have a larger percentage of the population that is White than in the Commonwealth of Virginia as a whole. In Giles County, 94.9% of the population is White and 2.2% of the population is Black (U.S. Census Bureau, 2015-2019 5-year ACS, Table DP05 https://data.census.gov/cedsci/table?tid=ACSDP5Y2019.DP05&hidePreview=true). All of Giles County is a designated Medically Underserved Area (MUA) and a Health Professional Shortage Area (HPSA) for primary care, dental and mental health professionals (https://data.hrsa.gov/tools/shortage-area). Giles County is part of the New River Valley, a region flush with resources including food, health and human services, arts and culture and outdoor amenities. Health and human service organizations work to reduce the disparities in access to care and access to resources that still exist for many residents of the region. Schedule H, Part VI, Line 5 Promotion of community health Carilion Clinic is a not-for-profit, integrated health care system located among the Blue Ridge Mountains. Our flagship hospital, in the heart of the City of Roanoke, which is the largest urban hub in western Virginia. 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 Giles Community Hospital (CGCH) is a modern, 25-bed Critical Access hospital, offering emergency services recognized nationally for quality and patient satisfaction. CGCH also provides high-quality inpatient care and an extended care recovery program (Swing Bed) that gives eligible patients an opportunity to grow stronger before going home. The main entrance serves as the access point for all walk-in patients needing emergency care, diagnostics, rehabilitation and other outpatient services. CGCH works to bring new services to the community as the need is identified. https://www.carilionclinic.org/locations/carilion-giles-community-hospital). CGCH serves all patients regardless of their ability to pay. The hospital's governing board members are elected annually and reside in the region. The majority of members are neither hospital employees nor contractors. Medical staff privileges are extended to qualified providers. Surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. Reinvestments include providing free, discounted and subsidized care and critical medical services not otherwise offered in our region. Schedule H, Part VI, Line 6 Affiliated health care system Carilion Giles Community Hospital is wholly owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. Through a comprehensive network of hospitals, primary and specialty physician practices, and complementary services, Carilion provides exceptional care for nearly one million Virginians. With an enduring commitment to the region's health, Carilion advances care through medical education and research, helps its community stay healthy and inspires the region to grow stronger. 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, 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. In addition, Carilion continues its long relationship with what is now Radford University Carilion to assist with educating students in various health professions. Each decision, each 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 Assessments process helps identify the strengths and barriers impacting health. Its 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. The health system's many partnerships with cross-sector organizations create a collaborative culture of community health and wellness. true Community Foundation of NRV PO Box 6009 Christiansburg VA 24068 541740455 501(c)(3) 8000 Detail on Part IV Free Clinic of New River Valley 215 Roanoke St Christiansburg VA 24073 510247098 501(c)(3) 42685 FMV Space in facility Use of space 2 0 Schedule I, Part II, Line 1(h) (1)- Community Foundation of NRV -Purpose of Grant/Assistance The grant purpose is for support of the regional coalition building in response to the 2018 Giles County Area Community Health Needs Assessment. 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 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. A grant cycle specifically addressing needs resulting from the impacts of COVID-19 was held in fiscal year 2020 ( tax year 2019) and due to the nature of the funding, awardees were required to submit only one, final report. 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, 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. false true false false false false true false William Flattery Director/Sec./Treas. 0 256357 0 52998 0 17323 0 152051 0 2029 0 480758 0 0 Kristie Williams Director/Hospital VP 158987 0 36365 0 243 0 141324 0 11260 0 348179 0 0 0 Jennifer Bennett Grube MD Director 0 160000 0 65038 0 2033 0 39600 0 1679 0 268350 0 0 Michael Helvey DO Director 0 339596 0 62271 0 2805 0 70956 0 17643 0 493271 0 0 Nicholas Conte Asst. Secretary 0 501457 0 201967 0 6258 0 163964 0 18548 0 892194 0 0 David Hagadorn Asst. Treasurer 0 138561 0 2000 0 8778 0 98598 0 865 0 248802 0 0 Donald Halliwill Asst. Treasurer 0 568290 0 201281 0 4727 0 343625 0 17248 0 1135171 0 0 G Robert Vaughan Jr Asst. Treasurer 0 270749 0 78415 0 3948 0 297970 0 18325 0 669407 0 0 Nancy Howell Agee CEO, Carilion Clinic 0 1292284 0 555922 0 406517 0 329565 0 12301 0 2596589 0 195503 Steven Arner Executive Vice President 0 647421 0 225708 0 4813 0 345071 0 18548 0 1241561 0 0 Veronica Stump Nursing Director 112458 0 2000 0 568 0 104231 0 289 0 219546 0 0 0 Amy Westmoreland Pharmacy Manager 166267 0 1500 0 1309 0 104294 0 1006 0 274376 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 organization's Hospital Vice President, is reviewed annually by the Carilion Clinic Board of Directors Compensation Committee. This Committee is made up of 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 in the reporting period are included in Part II of this schedule with "retirement and other deferred compensation." No distributions were made to these individuals under this plan in the reporting year. 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. $195,503 was distributed under this plan in the reporting year. Schedule J, Part I, Line 7 Non-fixed payments The organization pays annual "at-risk" compensation to certain members of management based on performance of an applicable scorecard. While the scorecard contains a formula as a basis for determining overall performance, in certain cases, senior managers have discretion to include additional elements in their assessment of managers reporting to them. In addition, for top management, the actual non-fixed payment awarded is in the discretion of the Carilion Clinic Board of Directors and its Compensation Committee. Form 990, Part I, Line 6 Volunteers Within the hospital, volunteers greet and escort patients, deliver flowers, mail and newspapers, and provide clerical assistance when called upon to do so. Volunteers also assist with general restocking of supplies on the Med Surg Unit as well as Clean Linen areas. They assist with the discharge process, patient surveys, and community health events. Volunteers staff the Gift Shop and provide volunteer support to all hospital departments. As part of their mission CGCH volunteers coordinate fundraising events to purchase hospital equipment and support outreach activities. Volunteer Hours worked are 3,202. NOTE: THE VOLUNTEER PROGRAM WAS SUSPENDED ON MARCH 16, 2020 DUE TO COVID WHICH AFFECTED THE VOLUNTEER WORK HOURS. Form 990, Part III, Line 4a Program Service Accomplishments Carilion Giles Community Hospital, part of Carilion Clinic, is a not-for-profit healthcare organization committed to improving health outcomes for every patient while advancing the quality of care in the community it serves. Located in Pearisburg, VA, this 25-bed critical access hospital provides 24-hour emergency care, advanced diagnostic procedures, minimally invasive surgery, nuclear medicine studies, respiratory services, and comprehensive rehabilitation programs. Carilion Giles Community Hospital, a critical access hospital, exists to serve the health care needs of its community, regardless of a patient's ability to pay. Giles acute hospital admitted 884 patients and provided 4,182 days of care during the year. Hospital programs include provision of nursing care; swing bed services; extensive outpatient and inpatient surgical and endoscopic services; and diagnostic imaging services including CT, MRI, and mammography. Several specialty practices and clinics for orthopaedics, general surgery, cardiology, urology, OBGYN, pulmonary, ENT are located at the hospital. Giles also provides integrated and comprehensive primary care services through multiple Rural Health Clinics. Giles delivers several services targeting the specific health needs of its population, including diabetes management, comprehensive physical, speech, occupational therapy programs, and participation in cardiac rehab and disease management programs. Giles provides an emergency department with 24-hour care and emergency transportation. With 10,440 visits, Giles emergency services are a critical component of the health safety net in its service area, acting as a primary health provider for a significant number of uninsured patients, who comprise nearly 6 percent of ED visits. Giles supports community screenings and education on chronic disease prevention and management, sponsoring 2,595 events that touch over 6,248 people, as well as providing essential support and coordination for a community-based medication assistance program. In furtherance of its mission, Giles provides extensive uncompensated care. Stated at cost, financial assistance and unreimbursed Medicaid costs for the year exceeded $862,000. Form 990, Part IV, Line 11f Disclosure of Uncertain Tax Positions Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. Form 990, Part V, Line 1a 1099's 1099s are issued on Carilion Giles Community Hospital's behalf by Carilion Services, Inc., a related supporting organization providing management and administrative services, including payment processing. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Nancy Howell Agee, Jennifer Bennett Grube, Nicholas Conte, William Flattery, David Hagadorn, Donald Halliwill, Melissa Stump, Steve Arner, Michael Helvey, and G. Robert Vaughan, Jr. - 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 Conte, David Hagadorn, Donald Halliwill, Melissa Stump, 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 and an independent CPA firm. Several days 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 Organizational Integrity & 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 Organizational Integrity & 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 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, 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. 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 MISCELLANEOUS - Total Revenue: -25770, Related or Exempt Function Revenue: -25770, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; COURT COST RECOVERY - Total Revenue: 6860, Related or Exempt Function Revenue: 6860, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; COMMUNITY HEALTH CLINIC - Total Revenue: 374, Related or Exempt Function Revenue: 374, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; OTHER REVENUE - Total Revenue: 16601, Related or Exempt Function Revenue: 16601, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; OUTSIDE PURCHASED SERVICE - Total Revenue: 3600, Related or Exempt Function Revenue: 3600, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; EMPLOYEE DRUG SALES TAXABLE - Total Revenue: 3493, Related or Exempt Function Revenue: 3493, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; MEDICAL RECORD TRANSCRIPT FEES - Total Revenue: 1500, Related or Exempt Function Revenue: 1500, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; RETURNED CHECK FEES - Total Revenue: 35, Related or Exempt Function Revenue: 35, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; OTHER CONTRACT REVENUE - Total Revenue: 3520, Related or Exempt Function Revenue: 3520, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; MEDICAID REV PRIOR YEAR CORRECTION - Total Revenue: 33450, Related or Exempt Function Revenue: 33450, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part X, Line 20 Tax-Exempt Bond Liabilities The amount reported as Tax-Exempt Bonds is the portion of Carilion Clinic Bonds allocated to Carilion Giles Community Hospital. Required information for the Bonds, including Schedule K, is reported in the Carilion Clinic (EIN: 54-1190771) IRS Form 990. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Pension-related changes other than net periodic pension costs - -150496; Transfers from/(to) Affiliates - -693956; Form 990 Heading, Box B Amended Return This Form 990 is amended by the original extended filing due date in order to attach a complete copy of the organization's consolidated audit which had some pages omitted on the original submission. 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