CARILION TAZEWELL COMMUNITY HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- CARILION TAZEWELL COMMUNITY HOSPITAL (EIN 54-6074580)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-08-16
- IRS object ID
- 202002299349300305
- Schema version
- 2018v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-08-16T19:30:44-05:00 | ReturnTs |
| Tax Period End | 2019-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 546074580 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carilion Tazewell Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARI | BusinessNameControlTxt |
| Phone | 5402245112 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12385 | AddressLine1Txt |
| City | Roanoke | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24025 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | G ROBERT VAUGHAN JR | PersonNm |
| Person Title | ASSISTANT TREASURER | PersonTitleTxt |
| Signature | 2020-08-16 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-11-19 02:30:22Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALICIA BALES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12385 | AddressLine1Txt |
| City | Roanoke | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24025 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,772,309 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CARILIONCLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1968 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 181 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $110,560 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,795,440 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,591,569 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,418 | PYInvestmentIncomeAmt |
| CY Investment Income | $6,842 | CYInvestmentIncomeAmt |
| PY Other Revenue | $78,847 | PYOtherRevenueAmt |
| CY Other Revenue | $59,871 | CYOtherRevenueAmt |
| PY Total Revenue | $14,878,705 | PYTotalRevenueAmt |
| CY Total Revenue | $15,768,842 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $14,900 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $22,384 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,841,658 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,936,393 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,272,180 | PYOtherExpensesAmt |
| CY Other Expenses | $11,724,940 | CYOtherExpensesAmt |
| PY Total Expenses | $18,128,738 | PYTotalExpensesAmt |
| CY Total Expenses | $18,683,717 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,250,033 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,914,875 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,071,301 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,897,849 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $25,953,225 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $28,752,779 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$18,881,924 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$21,854,930 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,920,712 | ExpenseAmt |
| Grant | $22,384 | GrantAmt |
| Revenue | $15,601,032 | RevenueAmt |
| Desc | See Schedule O. | Desc |
| Total Program Service Expenses | $15,920,712 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 181 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | false | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | VA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE CORPORATION ATTN H KIRK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5402245102 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 S JEFFERSON ST | AddressLine1Txt |
| City | ROANOKE | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24011 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Kathren Dowdy | ||||||||
| Director/Hospital CEO/CNO | 50.0 | 0 | Yes (X) | Yes (X) | $126,658 | $0 | $21,669 | |
| D Michael HYMES | ||||||||
| Director/Vice Chair | 1.2 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Peggy RILEY | ||||||||
| Director/Secretary/Treasurer | 1.2 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| James Thompson | ||||||||
| Director/Chair | 2.5 | 2.4 | Yes (X) | Yes (X) | $0 | $7,825 | $0 | |
| Kristie Williams | ||||||||
| Director/Hospital VP | 2.5 | 47.5 | Yes (X) | Yes (X) | $0 | $172,227 | $22,870 | |
| Kevin Combs MD | ||||||||
| Director | 1.2 | 48.8 | Yes (X) | $0 | $334,144 | $50,924 | ||
| William Flattery | ||||||||
| Director | 1.2 | 48.8 | Yes (X) | $0 | $297,508 | $15,362 | ||
| Mandy French | ||||||||
| Director | 1.2 | 0 | Yes (X) | $0 | $0 | $0 | ||
| Anthony Grills | ||||||||
| Director | 1.2 | 0 | Yes (X) | $0 | $0 | $0 | ||
| Antony Roop | ||||||||
| Director | 1.2 | 0 | Yes (X) | $0 | $0 | $0 | ||
| Michael Rorrer MD | ||||||||
| Director | 1.2 | 48.8 | Yes (X) | $0 | $256,314 | $9,311 | ||
| Nicholas Conte | ||||||||
| Asst. Secretary | 1.0 | 49.0 | Yes (X) | $0 | $523,989 | $136,049 | ||
| David Hagadorn | ||||||||
| Asst. Treasurer | 0.5 | 49.5 | Yes (X) | $0 | $143,606 | $8,062 | ||
| Donald Halliwill | ||||||||
| Asst. Treasurer | 0.5 | 49.5 | Yes (X) | $0 | $591,117 | $93,970 | ||
| Lauren Schantz | ||||||||
| Asst. Secretary | 1.5 | 38.5 | Yes (X) | $0 | $74,069 | $12,875 | ||
| G Robert Vaughan Jr | ||||||||
| Asst. Treasurer | 0.5 | 49.5 | Yes (X) | $0 | $294,528 | $26,998 | ||
| Nancy Howell Agee | ||||||||
| CEO, Carilion Clinic | 2.0 | 48.0 | $0 | $1,733,867 | $125,927 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $126,658 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,429,194 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $524,017 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| QUEST DIAGNOSTICS | |||||
| 500 PLAZA DRIVE | SECAUCUS | NJ | 07094 | LABORATORY SERVICES | $396,071 |
| MR RAMAKRISHNAN MD PC | |||||
| 1745 VALLEY VIEW DRIVE | BIG STONE GAP | VA | 24219 | PHYSICIAN SERVICES | $312,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Federated Campaigns | $0 | FederatedCampaignsAmt |
| Related Organizations | $0 | RelatedOrganizationsAmt |
| Government Grants | $10,560 | GovernmentGrantsAmt |
| All Other Contributions | $100,000 | AllOtherContributionsAmt |
| Total Contributions | $110,560 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Revenue | 622110 | $15,441,806 | $15,441,806 |
| Program Related Investments | 900099 | $149,763 | $149,763 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,591,569 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,175 | TotalRevenueColumnAmt |
| Exclusion | $5,175 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $44,542 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $44,542 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,542 | TotalRevenueColumnAmt |
| Exclusion | $44,542 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,134 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $3,467 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,134 | SecuritiesAmt |
| Other | -$3,467 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,667 | TotalRevenueColumnAmt |
| Exclusion | $1,667 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Affiliate Contract Revenue | 900099 | $4,480 | $4,480 | |
| Court Cost Recovery | 900099 | $5,729 | $5,729 | |
| Cafeteria | 722514 | $5,866 | $5,866 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$746 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$746 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $15,329 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,768,842 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,601,032 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $57,250 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,384 | TotalAmt |
| Program Services | $22,384 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,084 | TotalAmt |
| Management And General | $110,084 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,468,331 | TotalAmt |
| Program Services | $5,419,334 | ProgramServicesAmt |
| Management And General | $48,997 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,439 | TotalAmt |
| Program Services | $365,138 | ProgramServicesAmt |
| Management And General | $3,301 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598,463 | TotalAmt |
| Program Services | $586,374 | ProgramServicesAmt |
| Management And General | $12,089 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $391,076 | TotalAmt |
| Program Services | $379,945 | ProgramServicesAmt |
| Management And General | $11,131 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,443,900 | TotalAmt |
| Management And General | $2,443,900 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,755 | TotalAmt |
| Management And General | $1,755 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,343 | TotalAmt |
| Program Services | $1,343 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,969,263 | TotalAmt |
| Program Services | $1,933,613 | ProgramServicesAmt |
| Management And General | $35,650 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $251,869 | TotalAmt |
| Program Services | $238,109 | ProgramServicesAmt |
| Management And General | $13,760 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,650 | TotalAmt |
| Program Services | $18,650 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $209,511 | TotalAmt |
| Program Services | $209,511 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,539 | TotalAmt |
| Program Services | $132,937 | ProgramServicesAmt |
| Management And General | $1,602 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $866,315 | TotalAmt |
| Program Services | $866,315 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $710,961 | TotalAmt |
| Program Services | $710,961 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,199 | TotalAmt |
| Program Services | $75,065 | ProgramServicesAmt |
| Management And General | $69,134 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies | $767,095 | $767,095 |
| Bad Debt | $1,891,747 | $1,891,747 |
| Intercompany Practice Subsidy | $1,928,507 | $1,928,507 |
| Assessment Fees | $350,034 | $350,034 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,252 | TotalAmt |
| Program Services | $23,650 | ProgramServicesAmt |
| Management And General | $11,602 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,683,717 | TotalAmt |
| Program Services | $15,920,712 | ProgramServicesAmt |
| Management And General | $2,763,005 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $925 | BOYAmt |
| EOY | $1,175 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,075 | BOYAmt |
| EOY | $23,825 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,979,324 | BOYAmt |
| EOY | $2,092,794 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,675 | BOYAmt |
| EOY | $131,978 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,656,620 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,008,543 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,013,302 | BOYAmt |
| EOY | $4,648,077 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,071,301 | BOYAmt |
| EOY | $6,897,849 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,886,854 | BOYAmt |
| EOY | $1,514,857 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,223 | BOYAmt |
| EOY | $36,813 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,002,148 | BOYAmt |
| EOY | $27,201,109 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,953,225 | BOYAmt |
| EOY | $28,752,779 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$18,881,924 | BOYAmt |
| EOY | -$21,854,930 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$18,881,924 | BOYAmt |
| EOY | -$21,854,930 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,071,301 | BOYAmt |
| EOY | $6,897,849 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,914,875 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$58,131 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $1,343 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,343 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | A portion of dues paid to various hospital industry associations is attributable to lobbying activities. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $48,753 | OtherCostOrOtherBasisAmt |
| Book Value | $48,753 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,941,415 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,617,045 | DepreciationAmt |
| Book Value | $3,324,370 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,164,577 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,074,456 | DepreciationAmt |
| Book Value | $1,090,121 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $501,875 | OtherCostOrOtherBasisAmt |
| Depreciation | $317,042 | DepreciationAmt |
| Book Value | $184,833 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,648,077 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Affiliate | $27,063,604 |
| Pension Liability | $137,505 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $27,201,109 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | false | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $649,430 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $649,430 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0387 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,090,626 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,713,192 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $377,434 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0225 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $3,740,056 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,713,192 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,026,864 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0612 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 62 | ActivitiesOrProgramsCnt |
| Persons Served | 1179 | PersonsServedCnt |
| Total Community Benefit Expns | $13,332 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,332 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0008 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 2947 | PersonsServedCnt |
| Total Community Benefit Expns | $18,263 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,263 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0011 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 65 | ActivitiesOrProgramsCnt |
| Persons Served | 4126 | PersonsServedCnt |
| Total Community Benefit Expns | $31,595 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $31,595 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0019 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 65 | ActivitiesOrProgramsCnt |
| Persons Served | 4126 | PersonsServedCnt |
| Total Community Benefit Expns | $3,771,651 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,713,192 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,058,459 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0630 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $300 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 67 | PersonsServedCnt |
| Total Community Benefit Expns | $2,808 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,808 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0002 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,790 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,790 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $175 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $175 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 20 | ActivitiesOrProgramsCnt |
| Persons Served | 67 | PersonsServedCnt |
| Total Community Benefit Expns | $5,073 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,073 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0003 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,888,124 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,596,466 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,957,269 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$360,803 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARILION TAZEWELL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 141 BEN BOLT AVENUE | AddressLine1Txt |
| City | TAZEWELL | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24651 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://carilionclinic.org/locations/carilion-tazewell-community-hospital | WebsiteAddressTxt |
| State License | H 1907 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARILION TAZEWELL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://carilionclinic.org/locations/carilion-tazewell-community-hospital | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | https://www.carilionclinic.org/community-health-assessments#tazewell-county | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.carilionclinic.org/community-health-assessments#tazewell-county | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://carilionclinic.org/billing/financial-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://carilionclinic.org/billing/financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://carilionclinic.org/billing/financial-assistance | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 Tazewell Community Hospital. Carilion Clinic's Community Health Needs Assessments (CHNAs) are community-driven projects and success is highly dependent on engaging citizens, health and human service agencies, businesses, and community leaders. Community stakeholder collaborations known as "Community Health Assessment Teams" (CHAT) lead the CHNA projects. The CHAT consists of health and human service agency leaders, persons with special knowledge of, or expertise in, public health, the local health department, and leaders, representatives, or members of populations that are medically underserved, low-income, minority, and suffer from chronic diseases. The following organizations served on the CHAT for the 2018 (tax year 2017) Tazewell County Community Health Needs Assessment (TCCHNA)-Appalachian Agency for Senior Citizens, Tazewell Area Chamber of Commerce, Clinch Valley Community Action, Cumberland Plateau Health District, Cumberland Plateau Regional Housing Authority, Southwest Virginia Community Health Systems, Southwest Virginia Legal Aid Society, Inc. In addition to the CHAT, the TCCHNA conducted focus groups among stakeholders and target populations, and administered a community health survey. During the CHNA process, community stakeholders, leaders, and providers were encouraged to complete the Stakeholder Survey. (print and electronic versions available) This survey provided an additional perspective about the health needs and barriers facing our community. A stakeholder focus group was conducted with the Community Health Assessment Team. Target population focus groups were conducted to capture the story of needs and barriers to health for the uninsured, underinsured, low-income, minority, senior, and chronically ill populations. Focus group locations were chosen based on their proximity and convenience to target populations, and where existing groups meet. Four target population focus groups were held and were asked questions related to health needs and barriers to health, as well as access to primary, oral, and mental health care. Target population focus groups were conducted with Head Start parents, Labor of Love clients, the Tazewell Lions Club, and a veterans group at the Cumberland Mountain Community Services Board. A 38-question survey was developed including 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, including (1) Community Themes and Strengths Assessments, National Association of County and City Health Officials (NACCHO), Mobilizing for Action through Planning and Partnerships (MAPP) (2) Community Healthy Living Index, YMCA (3) Behavioral Risk Factor Surveillance System, Centers for Disease Control (CDC) (4) National Health Interview Survey, Centers for Disease Control (CDC) (5) Youth Risk Behavior Surveillance System, Centers for Disease Control (CDC) (6) Martin County Community Health Assessment, Martin County, North Carolina (7) Previous Carilion Clinic Community Health Surveys English and Spanish versions were available. The CHAT identified target populations, collection sites, and methods of survey distribution. The population of interest was Tazewell County residents 18 years of age and older. Special efforts were made to ensure inclusion of underserved/vulnerable populations disproportionately impacted by the social determinants of health including income, Race/ethnicity, Education, and Insurance status. The survey was also made available to all residents living in Tazewell County and oversampling of the target populations occurred through targeted outreach efforts. In total, 388 surveys were collected. |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - Carilion Tazewell Community Hospital. Appalachian Agency for Senior Citizens, Tazewell Area Chamber of Commerce, Clinch Valley Community Action, Cumberland Plateau Health District; Cumberland Plateau Regional Housing Authority, Southwest Virginia Community Health Systems, Southwest Virginia Legal Aid Society, Inc. |
| Schedule H, Part V, Section B, Line 7 Facility , 1 | Facility , 1 - Carilion Tazewell Community Hospital. The 2018 Tazewell County CHNA was also shared to be posted to Community Health Assessment Team partner websites and social media. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - Carilion Tazewell Community Hospital. Carilion Clinic is a not-for-profit, integrated healthcare system located in Virginia's Blue Ridge Mountains with its flagship hospital in the heart of the City of Roanoke, the largest urban hub in western Virginia. There, through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers and other complementary services, the system provides quality care close to home for nearly one million Virginians. Carilion's roots go back to 1899, when a group of dedicated citizens came together and built a hospital to meet the healthcare needs of the community. Today, Carilion is a key anchor institution focusing on more than just healthcare. Carilion is dedicated to its mission of improving the health of the communities we serve. With an enduring commitment to the health of our region, Carilion advances care through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. Through ongoing investment in discovering and responding to the health needs of the community comes the understanding that the involvement of additional stakeholders is essential to effectively address community health issues and create change. The purpose of this implementation strategy is to describe what Carilion Tazewell Community Hospital (CTCH) plans to do to address the community health needs identified in the 2018 Tazewell County Community Health Needs Assessment (TCCHNA). After all primary and secondary data collection was completed, the CHAT reviewed all data then identified and prioritized the ten most pertinent community needs using the Robert Wood Johnson Foundation framework for what influences health. The data were combined and overall priorities chosen based on the number of times a category was selected in the top 10, with the average ranking serving as a tie-breaker. Once the priorities were clearly identified, the CHAT rated the feasibility and potential impact of solutions for each health issue. The 2018 TCCHNA prioritized 10 health-related issues in the community, identified by the Community Health Assessment Team after the data was collected. (1) Alcohol and drug use (2) Access to mental / behavioral health services (3) Transportation / transit system (4) High uninsured / underinsured population (5) Poverty / low average household income (6) High prevalence of chronic disease (7) Access to substance use services (8) Poor diet (9) Access to primary care (10) Lack of health literacy / lack of knowledge of healthy behaviors 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. (County Health Ranking & Roadmaps. Retrieved from: http://www.countyhealthrankings.org/) Currently 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. (Robert Wood Johnson Foundation. Retrieved from: https://www.rwjf.org/en/library/interactives whereyouliveaffectshowlongyoulive.html) These factors are so important to our overall health, that they were added to the 10-year national Healthy People 2020 objectives with a goal to "create social and physical environments that promote good health for all." (Social Determinates of Health. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health) Carilion responds to community health needs in innovative ways-making sure our regions have 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, coordinate resources and enhance community strengths, and providing community-based health and wellness programs. Carilion Clinic's response strategies are organized by the RWJF framework for what influences health-health behaviors, social and economic factors, clinical care access and quality, and physical environment. Commitment to community service is evident at all levels of the organization. Carilion's commitment to community health is evidenced by its commitment to a population health infrastructure including an entire Community Health and Outreach (CHO) department dedicated to assessing and addressing community need. The department is responsible for leading and facilitating the Community Health Improvement Plan (CHIP), CHNAs, the system's community grant process, community health education, community benefit collection, and neighborhood health initiatives. CHO has staff at the system level and at each community hospital and works with each hospital's Board of Directors and Carilion Clinic's Board of Governors to create health improvement strategies to address community health need. Each Carilion Clinic hospital has a Community Benefit Team which oversees the local hospital's plan to address community need in partnership with the local CHAT. There is also a Community Benefit Council at the system level providing oversight for Carilion Clinic as a whole. This council is responsible for overseeing and strategically guiding Carilion's community health improvement work and for community benefit strategy, collection and submission. Carilion Clinic believes in the power of collaboration and understands community health issues must be addressed in cooperation with the community. To ensure lasting community impact from the health assessment and community health improvement process, Carilion participates in community health coalitions that address health needs in Tazewell County such as the Tazewell County CCRT. In addition, Carilion partners with community and business organizations around initiatives to improve health and wellness and to impact the social determinants of health for all who live in Tazewell County. CTCH is also participating in the Cumberland Plateau Health District's Community Health Assessment. The Tazewell County Coordinated Community Response Team (CCRT) consists of a multidisciplinary team of professionals and citizens who gather regularly to examine the response of our community systems to victims and offenders of the crimes of domestic violence, sexual assault, dating violence and stalking. The multidisciplinary team is led by the local Juvenile and Domestic Relations Court Judge Martha Ketron, five (5) law enforcement agencies, the Commonwealth's Attorney's office, Clinch Valley Community Action (the local Domestic Violence Service Provider), the Department of Social Services, other family service providers, local health care providers, the Housing Authority, the Area Agency on Aging (AASC), court personnel, local collegiate higher education officials, magistrates and legal aid attorneys. The CCRT model is meant to be adapted to the needs of the community to include the identification of the health needs of the community. In fiscal year 2019 (tax year 2018) the TCCCRT merged with the Tazewell County Domestic Violence Task Force. Carilion Clinic is committed to improving the health of the communities we serve by addressing key health priorities identified through our triennial Community Health Needs Assessments. Carilion fulfills this commitment in many ways, one of which is through targeted grants for community health improvement programs and those affecting the social determinants of health. Carilion provides a multitude of community grants and community health sponsorships to help local charitable organizations fulfill their missions related to the health and well-being of our communities. Community grant dollars are allocated across the entire Carilion Clinic service area based on requests received. During the 2019 fiscal year (2018 tax year), $10,000 was awarded as a grant to provide the local EMS toward the purchase of a CPR support machine to improve survival chances for community members after a heart attack. In addition, Carilion Tazewell Community Hospital helped cover the cost of Sexual Assault Nurse Examiner training for a local community partner. (Continued in Part VI) |
| Field | Value | IRS element (for citing) |
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| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (18 entries)
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| 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, high prevalence of chronic disease, poor diet, lack of knowledge of healthy behaviors. Carilion Clinic continues to address health behavior-related priorities from the 2018 TCCHNA. Improving poor diets and the general health culture served as a start to making healthy behaviors more of a priority. Carilion provides a variety of free health education classes, and screenings in community settings. Community health education is provided by the Community Health and Outreach department, as well as on occasion by other departments. Health and wellness education topics include general wellness, healthy eating and activity, exercise for balance and confidence building for seniors, and other topics as requested. The health educator also leads guided public walks and hikes increasing access to exercise opportunities. Resources committed to these programs include staff time and often food and giveaway items that encourage healthy behaviors. Carilion remains committed to the Healthier Hospital Initiative pledge and continues to work to improve the amount of healthy, local, sustainable foods purchased and served through its cafeterias. In addition to community events, Carilion fosters healthy behaviors by offering classes to employees and through partnerships with other employers in Tazewell County. As the largest employer in the region, efforts to engage employees and their families in healthy lifestyles impact community health overall. Carilion offers the Virgin Pulse program to employees. This program enables employees to connect personal activity trackers and include others on the platform to encourage daily healthy behaviors such as exercise, climbing stairs, and planning healthy meals. -Alcohol and drug use- Carilion's Opioid Task Force brings together expertise from throughout the Carilion system to better understand and address the opioid epidemic in Southwest Virginia. The Opioid Task Force works to address this epidemic internally and in the community. Efforts arising from this task force include: developing system-wide guidelines and a system dashboard for opioid prescriptions; developing 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; developing an inventory of community resources related to prevention, treatment and recovery services for opioid patients and community members; and providing locations for free, safe, prescription drug returns or deactivation bags. CTCH is 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 involves 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. (Virginia Rural Health Association. High Risk Patient Education Program. Retrieved from: http://vrha.org/hrpep.html) CTCH also participates as a partner on the Substance Abuse Taskforce in Rural Appalachia. This taskforce is working to promote healthy, safe and drug-free lifestyles in Tazewell County by working to educate and empower youth and caregivers about drug, alcohol and tobacco use, partnering with media, improving coordination among community sectors and to maintain resources on alcohol and drug prevention. -Clinical Care- Needs include access to mental health and substance use services, high uninsured / underinsured population, access to substance use services, access to primary care. Issues with access to care are a focus for CTCH when addressing community health needs. In addition to providing financial support to qualifying patients who cannot afford care, Carilion is working to improve affordable access to care and resources. -Mental health and substance use services- CTCH will be partnering with Cumberland Mountain Community Services to provide peer support services through the emergency department. The intent of the program is to link patients who come to the emergency department with an opioid overdose with recovery resources. 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 at Carilion Family Medicine Tazewell and for the VA Clinic. Service provision for Carilion Family Medicine Tazewell is currently limited by provider availability. Carilion is committed to serving the needs of its communities and continues to work toward providing telepsych services in Tazewell County. -High uninsured / underinsured population and high cost of care- Carilion is committed to helping improve access to affordable medical care in our communities. With expansion of Medicaid in the Commonwealth of Virginia, in 2019 (tax year 2018), Carilion worked diligently to develop a plan for outreach and enrollment in Medicaid for newly eligible beneficiaries. -Social and Economic Factors- Needs include transportation, poverty. In its commitment to reducing inequity of care, Carilion provides financial support for people who cannot afford insurance or health care. Each year, Carilion Clinic coordinates a system-wide United Way campaign through which employees can provide additional support to these causes. CTCH regularly participates in the United Way Backpack Program, providing support by coordinating food supply drives and packing backpacks for 24 elementary school children every six weeks. In an effort to help provide for the needs of community members, CTCH coordinates drives on occasion for various not for profit organizations and participates in a food bank walk. In response to the community need for transportation, the Town of Tazewell has begun providing rides home, when needed from CTCH as well as select other local transports to address need. CTCH has worked to educate staff that this resource is available for patients. -Physical Environment- While physical environment did not necessarily arise as a top priority in the 2018 TCCHNA, Carilion still recognizes the impact the environment has on the health of our communities. Therefore, efforts continue to improve the efficiency of Carilion's hospitals and other structures, the utilization of recycling and recyclable or bio-degradable materials where possible, the reduction of waste and the utilization of local, sustainable foods. -Implementation and Measurement- Carilion has invested in multiple systems to help manage data and track outcomes of our community work. In fiscal year 2019 (tax year 2018) Clear Impact software helped develop hospital-specific and project-specific scorecards with appropriate outcome measures. Community health education programs and screenings contained program level outcomes assigned based on the topic. These outcomes were tracked with pre- and post-tests as well as through screening results. Community programs supported by Carilion grants were responsible for regularly reporting program outcomes. Scorecards developed contain key secondary data points which are updated annually to track the impact of community health initiatives. Specifically, Carilion tracked and measured impact on certain aligned indicators contributing to the Robert Wood Johnson Foundation County Health Factors Ranking and County Health Outcomes Ranking. Our goal is to improve County Health Rankings for Tazewell County, but we understand that by the nature of County Health Rankings, improvements are relative to improvements in other communities within the Commonwealth of Virginia. |
| 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: www.carilionclinic.org/about-carilion-clinic#our-values |
| Schedule H, Part V, Section B, Line 11 Addressing Needs Identified in CHNA (Continued) | -Priority Areas Not being Addressed and the Reasons- A community approach to determine and address priority needs as described earlier in this document was used in determining which needs cannot be addressed immediately. The needs not identified as "priority" are those that will not be actively addressed in this time period. It is CTCH's intent to address many of the identified priority health issues through the aforementioned initiatives, programs and/or grants. Of the top 10 identified priorities in the 2018 TCCHNA, transportation and access to primary care are the two issues not directly addressed by initiatives included in the Implementation Strategy. In the past few years, Carilion has worked to address the need for primary care through additional provider recruitment. Carilion will continue to explore ways to provide support for improved transportation in Tazewell County. At this time, CTCH does not have the local expertise to provide transportation services. Please visit https://carilionclinic.org/community-health-assessments#about to review the 2018 Tazewell County Community Health Needs Assessment. Learn more about Carilion Clinic Community Health and Outreach at https://www.carilionclinic.org/community-health-outreach. |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | Line 7, Column (f) - Bad debt expense of $1,888,124 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 7 a-b - Ratio of cost to charges was used to calculate the expense. Line 7e - Community Health Improvement Services and Community Benefit Operations - At cost Carilion's commitment to community service is evident at all levels of the organization. Carilion's commitment to community health is evidenced by its population health infrastructure including its Community Health and Outreach (CHO) department dedicated to assessing and addressing community needs. The department is responsible for leading and facilitating the Community Health Improvement Plan, Community Health Needs Assessments, the system's community grants process, community health education, community benefit collection, and neighborhood health initiatives. CHO staff works 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 has a Community Benefit Team overseeing the hospital's plan to address community need in partnership with the local community health assessment team. There is also a Community Benefit Council providing oversight for Carilion's community health improvement work and for community benefit strategy, collection and submission. Carilion Tazewell Community Hospital (CTCH) educates the public about health risks and steps that can be taken to improve health. Health and wellness education topics include general wellness; healthy eating and activity; and tips on keeping kids safe. Other events include regularly scheduled community health screenings for blood pressure, blood glucose and cholesterol. Additional health improvement services include assistance with enrollment in public medical programs such as Medicaid. Community benefit operations include expenses associated with tracking community health improvement activities and the cost associated with coordinating responses to community health needs identified through the most recent Tazewell County Community Health Needs Assessment. This coordination includes participation in various community partnerships such as Tazewell County Coordinated Community Response Team and on the Community Health Assessment team for the local health department. Line 7f - Health professions education - n/a Line 7g - Subsidized Health Services - n/a Line 7h - Research -n/a Line 7i - Cash and In-Kind Contributions - At cost. Carilion has long been committed to improving the health of the communities we serve. We know significant change doesn't happen alone, but takes a community of partners working together towards common goals. Carilion's dedication to this mission is evidenced by the support provided annually to various nonprofit partners, furthering its efforts to positively impact health. Financial and in-kind contributions are made each year to organizations directly impacting the issues identified in our triennial Community Health Needs Assessment and a variety of social determinants that impact people's health. Support provided helped with access to life-saving equipment for Tazewell EMS to support CPR efforts and for Sexual Assault Nurse Examiner training for a community partner organization. |
| Schedule H, Part II Community Building Activities | Line 1 - Physical improvements and housing - n/a Line 2 - Economic development - As the largest employer in Southwest Virginia, Carilion participates in programming and supports local Chambers of Commerce, improving economic development efforts through pro-business advocacy. Line 3 - Community support - Research demonstrates the strong connection between social determinants of health such as transportation, housing and education, and the overall health and well-being of communities. Support is provided in a variety of ways for nonprofit organizations that address barriers to good health arising from these social determinants. Through support of local partners, Carilion can help provide better education and opportunities for children and families as well as improved housing, better nutrition and additional supportive resources for its neighbors in need, removing a range of obstacles to good health. Carilion Tazewell Community Hospital participates with a variety of health and social determinant-related programs and supports local organizations through coordination of activities and participation as volunteers in addition to providing financial support. For example, Carilion leaders dedicate their time to impact the need for nutrition for kids by coordinating the collection and donation of backpacks for the United Way Backpack program. Financial donations impact health through Clinch Valley Community Action programs and Lions Club activities. 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 community health issues must be addressed in concert with the community. To ensure lasting community impact from the health assessment and community health improvement process, Carilion participates in community health coalitions that address health and social determinant needs in Tazewell County. In addition, Carilion partners with multiple community and business organizations around initiatives to improve health and wellness and to impact the social determinants of health for all who live in Tazewell County. An example is Carilion's participation in the TRIAD coalition to reduce crime against the elderly. Carilion also participates on the Tazewell County Domestic Violence Task Force Line 7 - Community health improvement advocacy -n/a Line 8 - Workforce development - n/a |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | Carilion Tazewell Community Hospital estimates bad debt expense by reserving a percentage of all self-pay patient accounts receivable by aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | Accounts receivable are stated at net realizable amounts due from patients, third-party payors, and other insurers for which Carilion Tazewell Community Hospital expects to be entitled in exchange for providing patient care. For patient accounts receivable resulting from revenue recognized prior to October 1, 2018, an allowance for doubtful accounts was established to reduce the carrying value of such receivables to net realizable value. Subsequent to the adoption of 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 rather than an allowance for doubtful accounts. |
| 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, when the billing office becomes aware that a patient is deceased, auto accident or any other unique circumstances requiring special handling, the accounts are placed with the DRD. When all collection efforts have been exhausted, all hospital accounts will be returned and closed as uncollectible. No further collection activity is taken at that time. Accounts with satisfactory payment arrangements, legal activity or accounts with pending payment will be considered active and are not returned. |
| Schedule H, Part V, Section B, Line 16a FAP website | - CARILION TAZEWELL COMMUNITY HOSPITAL: Line 16a URL: https://carilionclinic.org/billing/financial-assistance; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - CARILION TAZEWELL COMMUNITY HOSPITAL: Line 16b URL: https://carilionclinic.org/billing/financial-assistance; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - CARILION TAZEWELL COMMUNITY HOSPITAL: Line 16c URL: https://carilionclinic.org/billing/financial-assistance; |
| Schedule H, Part VI, Line 2 Needs assessment | In addition to conducting regular Community Health Needs Assessments, Carilion 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 departments. Carilion's call center is available for community members to ask questions and to direct callers to community resources as issues are raised. The Planning department monitors data such as self-pay and Medicaid rates, patient origin and travel time, and age and income distributions to drive Carilion's access to care strategies. Carilion Clinic's community health improvement process was adapted from Associates in Process Improvement's Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle developed by Walter Shewhart. It consists of five steps: (1) conducting the CHNA, (2) strategic planning, (3) creating the implementation strategy, (4) program implementation, and (5) evaluation. This cycle is repeated every three years. Carilion Clinic and Tazewell County Coordinated Community Response Team (TCCCRT) partnered to conduct the 2018 Tazewell County Community Health Needs Assessment. This process was community-driven and focused on high levels of community engagement involving health and human services leaders, stakeholders, and providers, the target populations, and the community as a whole. The Tazewell County CCRT consisted of a multidisciplinary team of professionals and citizens who gathered regularly to examine the response of our community systems to victims and offenders of the crimes of domestic violence, sexual assault, dating violence and stalking. The multidisciplinary team was led by the local Juvenile and Domestic Relations Court Judge Martha Ketron, five (5) law enforcement agencies, the Commonwealth's Attorney's office, Clinch Valley Community Action (the local Domestic Violence Service Provider), the Department of Social Services, other family service providers, local health care providers, the Housing Authority, the Area Agency on Aging (AASC), court personnel, local collegiate higher education officials, magistrates and legal aid attorneys. The CCRT model is meant to be adapted to the needs of the community to include the identification of the health needs of the community. In fiscal year 2019 (tax year 2018), the TCCCRT merger with the Tazewell County Domestic Violence Task Force. |
| 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, the Eligibility staff is trained as Certified Application Counselors and will assist patients in enrollment in the insurance exchange Marketplace. Eligibility staff will also complete Carilion's financial assistance application and counsel patient on the requirements for financial assistance. |
| Schedule H, Part VI, Line 4 Community information | Tazewell County is nestled among the Appalachian Mountains in southwest Virginia and borders West Virginia to its north. Tazewell County has a land area of 518.85 square miles and about 86.9 persons per square mile. (US Census, Quick Facts, 2010) Historically, what is now Tazewell County was a hunting ground for Native American tribes. The area's abundance of wild game was a source of frequent skirmishes among these tribes. Tazewell County was chartered on December 19, 1799 and included five towns: Bluefield, Richlands, Tazewell, Cedar Bluff, and Pocahontas. The land for the county came from portions of the bordering Wythe and Russell counties. (Visit Tazewell County, Virginia. Retrieved from: http://visittazewellcounty.org/history/) Today, Tazewell County is home to an outstanding array of hiking, biking and ATV trails, scenic drives, including "Back of the Dragon," outdoor parks, including Cavitt's Creek Park, and venues for experiencing culture, art and history. (Visit Tazewell County, Virginia. Retrieved from: http://visittazewellcounty.org/) Key safety net providers in the region in addition to Carilion Clinic include the Cumberland Plateau Health District, Tazewell Community Health- a federally qualified health center, and other service organizations. Despite the presence of these entities, there remain thousands of low-income, uninsured, and underinsured residents who do not have access to affordable health care services. The 2018 TCCHNA revealed significant disparities both in health and in social determinants compared to the Commonwealth of Virginia. The 2014-2018 American Community Survey (ACS) found the total population of Tazewell County to be 42,080. (U.S. Census Bureau, 2014-2018 5-year American Community Survey, Table S0101: https://data.census.gov/cedsci/table?q=S0101&tid=ACSST5Y2018.S0101&hidePreview=true) For Tazewell County, the U.S. Census Bureau predicts negative future population change at -2.91% compared to the Commonwealth of Virginia at 6.86% by 2040. (U.S. Census Bureau, 2014-2018 5-year estimates, American Community Survey, Table DP05 https://data.census.gov/cedsci/table?tid=ACSDP5Y2018.DP05&hidePreview=true) Median age is 44.9 in Tazewell County compared to 38.1 in Virginia. (U.S. Census Bureau, 2014-2018 5-year American Community Survey, Table S0101: https://data.census.gov/cedsci/table?q=S0101&tid=ACSST5Y2018.S0101&hidePreview=true) The ACS finds that a larger percentage of the population is White in Tazewell County than in the Commonwealth of Virginia as a whole. In Tazewell County, 94.7% of the population is White and 3.2% of the population is Black. (Virginia Employment Commission Community Profiles (2020). https://virginiaworks.com/community-profiles) All of Tazewell County is a designated Medically Underserved Area (MUA). (Department of Health and Human Services, Health Resources and Services Administration Data Warehouse (2020) https://data.hrsa.gov/geo) |
| Schedule H, Part VI, Line 5 Promotion of community health | Carilion Tazewell Community Hospital (CTCH) is located in the beautiful mountains of southwest Virginia and primarily serves Tazewell County and the southern West Virginia counties of Mercer and McDowell. CTCH has private rooms and is equipped to treat patients needing medical care. They also support an extended care recovery program (Swing Bed) that gives eligible patients an opportunity to grow stronger before going home. CTCH hosts diagnostic services such as imaging, including screening mammography; and therapy services including physical therapy and respiratory therapy. CTCH offers 24/7 emergency services and can arrange access to higher levels of care if needed. Carilion Clinic Family Medicine and the Tazewell Veteran's Outpatient Clinic offer primary care on site at entrance 2. CTCH officially became part of Carilion Clinic in 2008, but has been under Carilion's management since 1981. CTCH is dedicated to community, history, and family, as exemplified through memorials and tributes throughout the hospital. |
| Schedule H, Part VI, Line 6 Affiliated health care system | Carilion Tazewell Community Hospital is wholly owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. It is mission-driven, focusing every day on improving the health of the communities they serve. 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 health of the region, Carilion also seeks to advance care through medical education and research, help its community stay healthy and inspire 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. It was a courageous move. In every moment since, Carilion has worked to evolve further-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, and opening a medical school and research institute. Each decision, each adaptation, has fundamentally changed the way Carilion collaborates and provides care. (https://www.carilionclinic.org/about-carilion-clinic) To advance the education of health professionals, Carilion Medical Center operated Jefferson College of Health Sciences a private higher education institution within the hospital that "prepares, within a scholarly environment, ethical, knowledgeable, competent and caring healthcare professionals." Jefferson College provided more than 1,100 students with opportunities to become part of the health care profession, serving communities ranging from southwest Virginia to the Shenandoah Valley and beyond. Jefferson College merged with Radford University July 1, 2019 and remains in partnership with Carilion Clinic, teaching students in our clinical setting on the campus of Carilion Medical Center to continue to meet the healthcare workforce needs in the community and beyond. Through a unique public-private partnership between Virginia Tech and Carilion Clinic, the Virginia Tech Carilion School of Medicine within Virginia Tech educates physician thought leaders through inquiry, research, and discovery on Carilion Clinic's main campus in Roanoke. Virginia Tech students learn, train, and work side by side with Carilion's highly experienced medical staff. This innovative approach stresses the importance of research, quality, safety, evidence-based medicine, interdisciplinary and interprofessional teamwork, chronic disease management, wellness and prevention and public health. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Town of Tazewell EMS | |||||||
| 211 Central Ave | Tazewell | VA | 24651 | 546001647 | Tazewell, VA | $10,000 | EMS equipment |
| Care Center of SW VA | |||||||
| PO Box 24 | Richlands | VA | 24641 | 824202466 | 501(c)(3) | $5,000 | Child abuse prevention |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. | FormAndLineReferenceDesc |
| Explanation | 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 every 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, and specific efforts to cultivate diverse funding sources for program sustainability. Each grantee must agree to submit requested data and reports on a timely basis and to complete the evaluation process as requested. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kristie Williams | ||||||||||||||
| Director/Hospital VP | $0 | $153,615 | $0 | $18,360 | $0 | $252 | $0 | $12,612 | $0 | $10,258 | $0 | $195,097 | $0 | $0 |
| Kevin Combs MD | ||||||||||||||
| Director | $0 | $313,626 | $0 | $17,928 | $0 | $2,590 | $0 | $41,075 | $0 | $9,849 | $0 | $385,068 | $0 | $0 |
| William Flattery | ||||||||||||||
| Director | $0 | $251,926 | $0 | $28,514 | $0 | $17,068 | $0 | $13,357 | $0 | $2,005 | $0 | $312,870 | $0 | $0 |
| Michael Rorrer MD | ||||||||||||||
| Director | $0 | $238,124 | $0 | $10,757 | $0 | $7,433 | $0 | $0 | $0 | $9,311 | $0 | $265,625 | $0 | $0 |
| Nicholas Conte | ||||||||||||||
| Asst. Secretary | $0 | $455,282 | $0 | $62,409 | $0 | $6,298 | $0 | $118,913 | $0 | $17,136 | $0 | $660,038 | $0 | $0 |
| David Hagadorn | ||||||||||||||
| Asst. Treasurer | $0 | $133,333 | $0 | $1,800 | $0 | $8,473 | $0 | $7,243 | $0 | $819 | $0 | $151,668 | $0 | $0 |
| Donald Halliwill | ||||||||||||||
| Asst. Treasurer | $0 | $515,337 | $0 | $70,983 | $0 | $4,797 | $0 | $78,134 | $0 | $15,836 | $0 | $685,087 | $0 | $0 |
| G Robert Vaughan Jr | ||||||||||||||
| Asst. Treasurer | $0 | $259,842 | $0 | $30,582 | $0 | $4,104 | $0 | $10,275 | $0 | $16,723 | $0 | $321,526 | $0 | $0 |
| Nancy Howell Agee | ||||||||||||||
| CEO, Carilion Clinic | $0 | $1,242,837 | $0 | $285,745 | $0 | $205,285 | $0 | $114,597 | $0 | $11,330 | $0 | $1,859,794 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 Chief Executive Officer, 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, which list was reviewed by the Compensation Committee.The Compensation Committee maintained detailed minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. |
| 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) 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 2018 are included on the Form 990 as "retirement and other deferred compensation." No distributions were made 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 a deferred vesting date 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. No distributions of prior deferred amounts were made under this plan in the reporting year. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part I, Line 6 Volunteers | Volunteers staff the gift shop and volunteer in various departments doing clerical work, supporting community events, and service related tasks. |
| Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS | Carilion Tazewell Community Hospital, part of Carilion Clinic, is a not-for-profit healthcare organization committed to improving health outcomes for every patient while advancing the quality of care in the community it serves. This hospital primarily serves the counties of Tazewell and Russell in Virginia and Mercer and McDowell in West Virginia. Carilion Tazewell Community Hospital exists to serve its community's health care needs, regardless of a patient's ability to pay. Tazewell's acute hospital admitted 574 patients and provided 2,125 days of care during the year. Hospital programs include an active primary care practice for the community, the provision of nursing care, and diagnostic imaging services including CT, MRI, mammography, x-ray and ultrasound. Tazewell provides several services targeting the specific health needs of its population, including physical, speech, and occupational therapy programs, home health services and bone density testing. Tazewell also provides an emergency department with 24-hour care and emergency transportation. With 9,740 visits, Tazewell's emergency services are a critical component of the health safety net in its service area. It acts as a vital health provider for a significant number of uninsured patients who comprise nearly 10% percent of ED visits. Tazewell supports community screenings and education on chronic disease management, sponsoring 85 events touching more than 4,193 people. In furtherance of its mission, Tazewell provides extensive uncompensated care. Stated at cost, charity and unreimbursed Medicaid costs for the year exceeded $1 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 | NANCY HOWELL AGEE, KEVIN COMBS, NICHOLAS CONTE, WILLIAM FLATTERY, DAVID HAGADORN, DONALD HALLIWILL, MICHAEL RORRER, LAUREN SCHANTZ, G. ROBERT VAUGHAN, JR., AND KRISTIE WILLIAMS - 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, Nicholas C. Conte, David S. Hagadorn, Donald B. Halliwill, Lauren J. Schantz, 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 8b Documentation of meetings held by committees of governing body | The filing organization has no committees. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The Form 990 was prepared by Carilion's internal Tax Department with input from various Carilion departments, as applicable, and reviewed by internal Accounting management. Several days prior to filing, all Board Members were notified via email 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, which list was reviewed by the Compensation Committee. The Compensation Committee maintained detailed minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | See response to line 15A |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization's governing documents, conflict of interest statement, and financial statements are released from time to time during the tax year upon request. The Articles of Incorporation are available from the Virginia State Corporation Commission. Limited financial information is available on our website. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | Other Revenue - Total Revenue: -746, Related or Exempt Function Revenue: -746, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part IX, Line 11g Other Fees | Physician/Professional Services - Total Expense: 431567, Program Service Expense: 431567, Management and General Expenses: , Fundraising Expenses: ; Other Purchased Services - Total Expense: 534385, Program Service Expense: 498735, Management and General Expenses: 35650, Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 253738, Program Service Expense: 253738, Management and General Expenses: , Fundraising Expenses: ; Reference Labs - Total Expense: 749573, Program Service Expense: 749573, Management and General Expenses: , Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Pension-related changes other than net periodic pension costs - -58131; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| CARILION CLINIC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541190771 | SUPPORTING ORGANIZATION | VA | 501(c)(3) | Type II | NA | false |
| CARILION CLINIC FOUNDATION | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541190773 | FUNDRAISING | VA | 501(c)(3) | 7 | CARILION CLINIC | Yes (true) |
| CARILION FRANKLIN MEMORIAL HOSPITAL | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540480606 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
| CARILION GILES COMMUNITY HOSPITAL | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540549603 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
| CARILION MEDICAL CENTER | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540506332 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
| CARILION NEW RIVER VALLEY MEDICAL CENTER | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540553805 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
| CARILION SERVICES INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541190879 | SUPPORTING ORGANIZATION | VA | 501(c)(3) | Type II | CARILION CLINIC | Yes (true) |
| CARILION STONEWALL JACKSON HOSPITAL | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 540568001 | HEALTHCARE | VA | 501(c)(3) | 3 | CARILION CLINIC | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt |
|---|---|---|---|---|---|---|---|---|
| CARILION CLINIC MEDICARE SHARED SAVINGS COMPANY LLC | ||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 455235473 | MEDICARE HMO | VA | NA | N/A |
| FRANKLIN COUNTY VENTURES LLC | ||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 474365316 | REAL ESTATE | VA | NA | N/A |
| COMMUNITY MEDICAL ASSOCIATES LLP | ||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541517662 | REAL ESTATE | VA | NA | N/A |
| RAVEN ASSET-BASED OPPORTUNITY FUND IV LP | ||||||||
| 110 Greene Street Suite 9G | New York | NY | 10012 | 824119491 | PRIVATE EQUITY | DE | NA | N/A |
| SOUTHWEST VIRGINIA HEALTH PROPERTIES LLC | ||||||||
| 1102 Jefferson Street SE | Roanoke | VA | 24016 | 010691570 | REAL ESTATE | VA | NA | N/A |
| STARWOOD VEP II CO-INVEST LLC | ||||||||
| 591 W Putnam Avenue | Greenwich | CT | 06830 | 833262407 | INVESTMENTS | DE | NA | N/A |
| TI PLATFORM CC SMA LP | ||||||||
| 1160 Battery St East | San Francisco | CA | 94111 | 842852539 | INVESTMENTS | DE | NA | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|
| CARILION CLINIC MEDICARE RESOURCES LLC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 263729975 | MEDICARE HMO | VA | NA | C Corporation | Yes (true) | |
| CHS INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541725732 | SERVICES | VA | NA | C Corporation | Yes (true) | |
| CARILION BEHAVIORAL HEALTH INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 203136891 | HEALTHCARE | VA | NA | C Corporation | Yes (true) | |
| CARILION EMERGENCY SERVICES INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 542033006 | HEALTHCARE | VA | NA | C Corporation | Yes (true) | |
| SCA CREDIT SERVICES INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541180398 | COLLECTION AGENCY | VA | NA | C Corporation | Yes (true) | |
| CARILION HEALTHCARE CORPORATION | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541586601 | HEALTHCARE | VA | NA | C Corporation | Yes (true) | |
| MEDKEY INC | ||||||||||
| PO BOX 12385 | ROANOKE | VA | 24025 | 541645357 | FINANCING SERVICES | VA | NA | C Corporation | Yes (true) | |
| SPROTT PRIVATE RESOURCE LENDING (C-CO-INVEST) LP | ||||||||||
| 981378742 | INVESTMENTS | NA | C Corporation | Yes (true) | CA | |||||
| BLACKMOOR OWNERSHIP HOLDINGS LIMITED | ||||||||||
| INVESTMENTS | NA | C Corporation | Yes (true) | CJ | ||||||
| MAGNITUDE SYSTEMATIC LONGSHORT FUND | ||||||||||
| INVESTMENTS | NA | C Corporation | Yes (true) | CJ | ||||||
| TANGIBLE SEGREGATED PORTFOLIO OF THE SOUTH AFRICA ALPHA SPC | ||||||||||
| INVESTMENTS | NA | C Corporation | Yes (true) | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CHS INC | ||
| E | $3,127,495 | CASH |
| CARILION MEDICAL CENTER | ||
| A | $149,763 | COST |
| CARILION MEDICAL CENTER | ||
| M | $1,906,577 | COST |
| CARILION SERVICES INC | ||
| M | $2,474,927 | COST |
| CHS INC | ||
| M | $933,621 | COST |