2020-08-17T12:30:55-05:00 2019-09-30 440160260 BKD LLP 1201 WALNUT ST SUITE 1700 KANSAS CITY MO 641062246 990 2018-10-01 540480606 Carilion Franklin Memorial Hospital CARI 5402245112 PO BOX 12385 Roanoke VA 24025 G ROBERT VAUGHAN JR ASSISTANT TREASURER 2020-08-17 true MIKE ENGLE P00482834 8162216300 2020-08-14 2018 2020-11-06 18:47:13Z Carl Cline PO BOX 12385 Roanoke VA 24025 53201162 false X WWW.CARILIONCLINIC.ORG X 1956 VA Our mission is to improve the health of the communities we serve through our committment to a common purpose of better patient care, better community health and lower cost. 11 6 424 71 0 22435 23148 48295326 52056425 62879 52579 232634 400528 48613274 52532680 90548 76611 0 20137463 20491466 0 0 26542103 26990759 46770114 47558836 1843160 4973844 20888634 28015851 20726449 31821097 162185 -3805246 Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. false false 40748585 76611 52009637 Carilion Franklin Memorial Hospital, part of Carilion Clinic, is a not-for-profit healthcare organization committed to improving health outcomes for every patient while advancing the quality of care in the community it serves. Located in Rocky Mount, VA, this 37-bed hospital offers a wide range of medical and surgical services, including convenient outpatient and emergency department services. Carilion Franklin Memorial Hospital exists to serve the health care needs of its community, regardless of a patient's ability to pay. Franklin's acute hospital admitted 1,348 patients and provided 5,019 days of care during the year. Hospital programs include the provision of nursing care; extensive outpatient and inpatient surgical and endoscopic services; and diagnostic imaging services including CT, MRI, and mammography. Franklin provides several services targeting the specific health needs of its population, including diabetes management, home health and hospice, physical, speech, and occupational therapy programs, plastics & reconstructive, ENT, and cardiac and respiratory rehab. A desk area at the hospital's medical office building is staffed by volunteers who welcome patients and visitors. Franklin also provides an emergency department with 24-hour care, emergency transportation, and a chest pain and stroke program. With 19,966 visits, Franklin's emergency services are a critical component of the health safety net in its service area.It acts as a primary health provider for a significant number of uninsured patients, who comprise 15.3 percent of ED visits. Franklin also supports community screenings and education on chronic disease prevention and management, sponsoring over 310 events touching over 28,969 people. In furtherance of its mission, Franklin provides extensive uncompensated care. Stated at cost, charity and unreimbursed Medicaid costs for the year exceeded $2 million. 40748585 true true false true false false false false false true true false true true false false true false false false false false false false false true true true false true false false false false false false true false false false false false false true true true false false true X 0 0 424 true false false false false false false false false false false false false X 11 6 true true false false true true true true true false false true true true true true true true true false VA X THE CORPORATION ATTN H KIRK 5402245102 213 S JEFFERSON ST ROANOKE VA 24011 Carl Cline Dir./Sec./Treas./Hospital VP 50.0 0 X X 100604 0 13712 Victoria GARDNER Director/Vice Chair 1.2 0 X X 0 768 0 Bill Jacobsen Dir./Sec./Treas./Hospital VP 50.0 0 X X 232572 0 44309 William Kingery Jr Director/Chair 2.5 2.9 X X 0 8700 0 Steven Arner Director 2.0 48.0 X 0 617874 97360 CRAIG L BOOKOUT MD Director 1.2 48.8 X 0 358864 88285 W Mark Church PhD Director 1.2 0 X 0 0 0 Katherine GOFF PhD Director 1.2 0 X 0 0 0 Barbara Jackman Director 1.2 0 X 0 0 0 Shannon Moore Director 1.2 0 X 0 0 0 Dave Peters Director 1.2 0 X 0 768 0 Sarah Stubbs MD Director 1.2 48.8 X 0 286997 34586 Nicholas Conte Asst. Secretary 1.0 49.0 X 0 523989 136049 David Hagadorn Asst. Treasurer 0.5 49.5 X 0 143606 8062 Donald Halliwill Asst. Treasurer 0.5 49.5 X 0 591117 93970 Lauren Schantz Asst. Secretary 1.5 38.5 X 0 74069 12875 G Robert Vaughan Jr Asst. Treasurer 0.5 49.5 X 0 294528 26998 Nancy Howell Agee CEO, Carilion Clinic 2.0 48.0 X 0 1733867 125927 Michelle Firebaugh Department Director 50.0 0 X 113515 0 4824 Shirley Landon-King Occupational Therapist 50.0 0 X 132933 481 9249 Lori McClure Pharmacy Manager 50.0 0 X 169870 0 13209 Brenda Miller RN Lead 50.0 0 X 107773 0 23530 Carole Robertson Physical Therapist 50.0 0 X 107050 678 35771 964317 4636306 768716 11 false true false QUEST DIAGNOSTICS 500 PLAZA DRIVE SECAUCUS NJ 07094 LABORATORY SERVICES 710397 FRANKLIN HEALTH CARE CENTER 720 ORCHARD AVE ROCKY MOUNT VA 24151 PROFESSIONAL FEES 206203 SIEMENS MEDICAL SOLUTIONS USA INC 40 LIBERTY BLVD MALVERN PA 19355 EQUIPMENT MAINTENANCE 189519 BLUE RIDGE HEART CARE 263 FRANKLIN ST ROCKY MOUNT VA 24151 PROFESSIONAL FEES 124234 TRINITY MISSION OF ROCKY MOUNT 300 HATCHER ST ROCKY MOUNT VA 24151 PROFESSIONAL FEES 103127 6 X 23148 23148 Net Patient Revenue 622110 52011821 52011821 Program Related Investments 900099 44604 44604 0 0 0 0 52056425 40662 40662 345889 345889 0 345889 345889 680399 668482 11917 0 11917 11917 EHR Adjustment 900099 -85314 -85314 Cafeteria & Vending Revenue 722514 101427 101427 Court Cost Recovery 900099 21422 21422 17104 17104 0 0 54639 52532680 52009637 0 499895 X 76611 76611 355633 107879 247754 136383 136383 15661157 15635803 25354 1085171 1083414 1757 2102957 2064475 38482 1150165 1136995 13170 6137384 6137384 2500 2500 3372 3372 1009 1009 4811149 4711697 99452 0 212 212 588905 563827 25078 92242 92242 705870 705870 350781 306249 44532 362657 362657 1683577 1683577 369785 208343 161442 Med Supplies 3492320 3492320 Bad Debt 4420802 4420802 I/C Practice Subsidy 2869538 2869538 Assessment Fees 1050610 1050610 48046 35709 12337 0 47558836 40748585 6810251 0 722 717 70708 74590 4769934 10861918 0 0 85638 200648 40262802 30239158 11146390 10023644 139949 515344 1012793 2633208 0 3662500 3705782 20888634 28015851 3731961 7136315 191489 340205 7834100 7260798 0 8968899 17083779 20726449 31821097 X 128068 -3839363 34117 34117 162185 -3805246 20888634 28015851 X 4973844 -615936 -8325339 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3372 3372 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY A portion of dues paid to various hospital industry associations is attributable to lobbying activities. 226092 226092 20945810 14599620 6346190 0 0 0 17880466 14802615 3077851 1210434 836923 373511 10023644 386052 F Alternative Investments 1874935 F Comingled Funds 372221 F 2633208 Due from Carilion Services, Inc 3645782 Ladies Auxilary Fund 60000 3705782 Pension Liability 16145653 Interest Rate Swap Liability 938126 17083779 true true X true X true X false true false true true 2130483 2130483 0.0493 4541819 4645300 0 0.0 0 0.0 0 0 6672302 4645300 2130483 0.0493 145 2181 46563 45 46518 0.0011 2 368 368 0.0000 0 0.0 0 0.0 97 26639 99840 99840 0.0023 244 28820 146771 45 146726 0.0034 244 28820 6819073 4645345 2277209 0.0527 0 0.0 1 86 86 0.0000 27 149 7849 7849 0.0002 0 0.0 0 0.0 31 15406 15406 0.0004 5 299 299 0.0000 2 301 301 0.0000 0 0.0 66 149 23941 0 23941 0.0006 true 4384688 14743038 14172639 570399 X true true 1 1 CARILION FRANKLIN MEMORIAL HOSPITAL 180 FLOYD AVENUE ROCKY MOUNT VA 24151 https://carilionclinic.org/locations/carilion-franklin-memorial-hospital H 1836 X X X CARILION FRANKLIN MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 17 true false true true X https://www.carilionclinic.org/locations/carilion-franklin-memorial-hospital X https://www.carilionclinic.org/community-health-assessments#franklin-county X X true 17 true https://www.carilionclinic.org/community-health-assessments#franklin-county false true X 200.0 400.0 X X X true true X X X true X https://carilionclinic.org/billing/financial-assistance X https://carilionclinic.org/billing/financial-assistance X https://carilionclinic.org/billing/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E The Community Health Needs Assessment report prioritizes the community's significant health needs that were identified by the assessment, and explains how the health needs were prioritized. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - CARILION FRANKLIN MEMORIAL 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 who are medically underserved, low-income, minority, and suffer from chronic diseases. The following organizations served on the CHAT for the 2018 (tax year 2017) Franklin County Area Community Health Needs Assessment (FCACHNA): County of Franklin, Ferrum College-Health Sciences, Franklin County Public Schools, Free Clinic of Franklin County, Martinsville Henry County Health Coalition, Rocky Mount Lifestyle Center, Smith Mountain Lake Good Neighbors, Southern Virginia Child Advocacy Center, STEP, Inc. of Virginia, Tri Area Health, United Way of Roanoke Valley, Virginia Department of Health. In addition to the CHAT, the FCACHNA 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. Stakeholder focus groups were conducted with: the Community Health Assessment Team, the FRESH and CHILL coalitions of Franklin County, the Re-entry Program of Franklin County Martinsville and Henry County, a Franklin County HR group, staff from Franklin County Public Schools, Court Appointed Special Advocate volunteers, the Child Abuse Review Team of Franklin County, and the Franklin County Community Policy and Management 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. Five 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 the Franklin County Disabled American Veterans (DAV) group, students from an English for speakers of other languages (ESOL) class and from an adult high school equivalency group through the Franklin County Adult Education Center, a men's cancer support group, participants in STEP's Senior Congregate Meals program, and residents of Tanyard Village Apartments. 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, (CDC) (6) Martin County Community Health Assessment, Martin County, North Carolina (7) Previous Roanoke Valley 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 Franklin County and Henry County residents 18 years of age and older. The Franklin County Area included the CHNA service area of Franklin County and Henry County. 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 the Franklin County Area and oversampling of the target populations occurred through targeted outreach efforts. In total, 1,325 surveys were collected. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - CARILION FRANKLIN MEMORIAL HOSPITAL. County of Franklin, Ferrum College-Health Sciences, Franklin County Public Schools, Free Clinic of Franklin County, Martinsville Henry County Health Coalition, Rocky Mount Lifestyle Center, Smith Mountain Lake Good Neighbors, Southern Virginia Child Advocacy Center, STEP Inc. of Virginia, Tri Area Health, United Way of Roanoke Valley, Virginia Department of Health. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - CARILION FRANKLIN MEMORIAL HOSPITAL. The 2018 Franklin County Area 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 FRANKLIN MEMORIAL 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 Franklin Memorial Hospital (CFMH) plans to do to address the community health needs identified in the 2018 Franklin County Area Community Health Needs Assessment (FCACHNA). 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 finding of the 2018 FCACHNA revealed 10 priority health-related issues in the community, identified by the Community Health Assessment Team (CHAT) after review of the data collected. These include (1.) Access to primary care (2.)High cost of care (3.) Access to dental care (4.) Access to mental / behavioral health services (5.) Transportation / transit system (6.) Poverty / low average household income (7.) Alcohol and drug use (8.) Culture: healthy behaviors not a priority (9.) Lack of health literacy / lack of knowledge of healthy behaviors (10.) Coordination of care According to the Robert Wood Johnson Foundation's (RWJF) County Health Rankings, where an individual lives, works and plays is a strong predictor of their health outcomes. (http://www.countyhealthrankings.org/) 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. (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 "create social and physical environments that promote good health for all." (https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health) Carilion responds to community health needs in innovative ways by 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 factors 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 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 and provides financial and in-kind support to community health coalitions addressing health needs. Carilion partners with Healthy Franklin County in the Franklin County Area. In addition, Carilion partners with multiple community and business organizations on initiatives to improve health and wellness and to impact the social determinants of health for all who live in the Franklin County Area. Forming a true community collaborative with lasting impact is no small feat. Healthy Franklin County (HFC) is an initiative of United Way of Roanoke Valley brought forth from two reports, both developed to assess the needs of Franklin County. It is derived from the 2013 FCACHNA and also the Franklin County Prosperity Indicators Report. Carilion provides financial and in-kind support for HFC. HFC seeks to reduce obesity and related chronic diseases by mobilizing time, talent and financial resources to promote healthier lifestyles. The focus from its inception has been providing simple ways for people to take control of their health. HFC works by aligning resources to work together to improve the health and well-being of all Franklin County residents. This is done by integrating practices and coordinating improvements that provide collective impact and lead to positive change. Since 2014, HFC has led wellness work, mobilizing partners and leading efforts specifically targeting obesity and chronic disease management in the community by increasing access to healthy food and health education opportunities. HFC also administers the CharityTracker online system that helps facilitate referrals across 20 local agencies as part of the Health Efficiency Navigation Initiative (HENI). Carilion Clinic partnered with HFC to conduct the 2016 and 2018 FCACHNAs. In response to the health priorities identified in the 2018 FCACHNA, HFC will coordinate with the CHAT members to conduct action planning in fall 2018. CFMH will continue to participate as a key partner in HFC's work. Through HFC, programs and strategies have arisen in response to community needs, such as the Community Giving Gardens. Carilion provides additional support to implement these strategies in the Franklin County area. (CONTINUED IN PART VI) 1 IMAGING SERVICES 35 MEDICAL COURT HARDY VA 24101 CT AND DIAGNOSTIC RADIOLOGY Schedule H, Part V, Section B, Line 11 ADDRESSING NEEDS IDENTIFIED IN CHNA (Continued) (CONTINUED FROM PART V, SECTION C) The Community Giving Gardens program was developed by HFC partners to address the high prevalence of obesity and the need for prevention and chronic disease management programs, needs first identified in the 2013 FCACHNA. This program spearheaded the development of "giving gardens" throughout the community, especially at community centers and in low-income neighborhoods, in order to make fresh, healthy food accessible to those who need it most in Franklin County. This project not only provides healthy food, but also educates people about gardening and cooking with fresh produce and provides a fresh foods distribution system, infrastructure for gardeners throughout the community to share their excess with those in need, and ways for community centers in low income neighborhoods to have financial and labor assistance in establishing raised garden beds for use by the neighborhood. From the gardens, a supply of fresh produce is made available to the food bank distribution program where food boxes are thoughtfully made with medical conditions in mind. Food banks and soup kitchens throughout the county have also been provided with commercial refrigerators to prepare them to receive fresh produce during the growing season and other community partners have developed education about healthy eating and chronic disease management. Since spring 2016, through incredible support of many and varied partners, the project has produced and provided over 39,000 pounds of fresh food for the community. 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), $62,500 in grants were awarded to 4 programs in Franklin County to improve or provide access to primary care, disease prevention, child abuse and neglect services, and affordable healthy food access. -Significant Health Priorities to be Addressed- -Health Behaviors- Needs include alcohol and drug use, culture of healthy behaviors not a priority, lack of health literacy / lack of knowledge of healthy behaviors. Carilion Clinic addressed health behavior-related priorities from the 2018 FCACHNA. 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, screenings and flu immunizations 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, stress management, warning signs for heart attack and stroke and other topics as requested. The local health educator also leads guided public walks and hikes to increase access to exercise opportunities. Resources committed to these programs include staff time and often food and giveaway items that encourage healthy behaviors. In addition to community events, Carilion works to encourage healthy behaviors by offering classes to its employees and through partnerships with other employers in the Franklin County Area. As the largest employer in the region, efforts to engage employees and their families in their own health impact community health overall. Carilion has rolled out 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 diets. In addition, CFMH hosts a momentum studio with exercise equipment available for employees. 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. -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 is working 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 patients and community members; and providing locations for free, safe, prescription drug returns or deactivation bags. CFMH participates in the local Franklin County Opioid Task Force, supporting community efforts to address the Opioid Crisis. CFMH also participates as a partner in the FRESH (Focus on Response and Education to Stay Healthy) Coalition. FRESH is a community coalition focused on changing behaviors and attitudes to prevent substance abuse among youth and families in Franklin County. The vision is to empower our community to make healthy choices. FRESH is made up of different representatives in the community representing 12 sectors: Youth, Parents, Media, Schools, Businesses, Healthcare Professionals, Law Enforcement, Civic and Volunteer Groups, Youth-Serving Organizations, State and Local Government, Religious Organizations, and Other Organizations Working to Prevent Substance Abuse. CHILL (Communities Helping Improve Local Lives) Youth Task Force is made up of students in 9-12th grade who are committed to making healthy, positive choices. It is a youth leadership and development program where students are trained in drug and alcohol prevention and are given opportunities to strengthen their personal skills while working to improve their school and community. -Clinical Care- Needs include access to primary care, high cost of care, access to dental care, access to mental / behavioral health services, and coordination of care. Issues with access to care are a focus for CFMH 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. Carilion will explore opportunities to improve access to care through various types of telemedicine provisions, which are not currently offered in the area. In addition, through a comprehensive forensic nursing program, CFMH is engaged with the community for abuse prevention and review efforts. CFMH participates on and supports a variety of local child abuse, sexual abuse and fatality review teams. - Primary care - Carilion Clinic also partners with the Free Clinic of Franklin County to improve access to primary care through in-kind and financial support, which allows them to maintain a position to meet the needs of the low-income patients. The Free Clinic of Franklin County continues to serve the poorest uninsured with primary medical care and prescription medications. Through this partnership, not only is access to primary care made available to target populations, but ongoing education and follow-up is provided to patients with chronic diseases. This partnership also includes coordination between the Free Clinic of Franklin County and the CFMH Emergency Department to connect uninsured patients with primary care. - 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, Carilion worked diligently to help patients and community members with enrollment in Medicaid for newly eligible beneficiaries. - Mental / behavioral health services - 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 Rocky Mount. Service provision 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 the Franklin County Area. Schedule H, Part V, Section B, Line 11 ADDRESSING NEEDS IDENTIFIED IN CHNA (Continued) - Coordination of care - In fiscal year 2019 (tax year 2018) CFMH worked with community partners and Carilion Community Health and Outreach to expand the scope of the Franklin County Health Efficiency Navigation Initiative and integrate it with the Roanoke Valley Pathways HUB partnership, a national best practice to coordinating care and connecting people to resources. - Social and Economic Factors - Includes poverty and transportation needs. In its commitment to reducing inequity of care, Carilion provides financial support for people who cannot afford insurance or health care. Carilion also replenishes medication carried aboard emergency medical services vehicles. Support is also provided to a variety of not-for-profit organizations, helping to reduce the impacts of poverty on health through investments in social determinants such as housing, transportation, employment, education, access to healthy foods and many other important causes. Each year, Carilion Clinic coordinates a system-wide United Way campaign through which employees can provide additional support to these causes. CFMH supports programs that help individuals with social determinants of health, such as access to medical resources, food and school supplies. CFMH also participates as a partner in the Re-entry Councils of Franklin County and Martinsville and Henry County, helping people to get connected with resources, especially as they relate to healthcare, upon release from jail. CFMH also supports a local back-pack program and back to school efforts for local children. - Physical Environment - While physical environment did not necessarily arise as a top priority in the 2018 FCACHNA, 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 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 the entire Franklin County Area, but we understand that by the nature of County Health Rankings, improvements are relative to improvements in other communities within the Commonwealth of Virginia. - 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 to determine which needs cannot be immediately addressed. The needs not identified as "priority" will not be actively addressed in this time period. It is CFMH's intent to address most of the identified priority health issues through the aforementioned initiatives, programs and/or grants. Access to dental care and transportation are the two priorities not directly addressed by initiatives included in the Implementation Strategy. In the past, Carilion has provided grant funding to support transportation efforts. Carilion will continue to explore ways to provide support for access to dental care or transportation in the Franklin County area. At this time, CFMH does not have the local expertise to provide dental care or transportation services and is also not aware of local efforts ongoing in Franklin County to address these issues. Please visit https://carilionclinic.org/community-health-assessments#franklin-county to review the 2018 Franklin County Area 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 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 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 Community Benefit Reporting: Information about community benefit is reported annually through a consolidated report prepared by Carilion Clinic (EIN 54-1190771). Printed copies of this report are distributed throughout communities served by hospitals affiliated with Carilion Clinic. Additionally, the community benefit report is available on Carilion Clinic's website: https://carilionclinic.org/about-carilion-clinic#our-values. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Line 7, Column (f)- Bad debt expense of $4,384,688, as included in Part IX, Statement of Expenses on line 25, was excluded from the calculation of Part I Line 7 Column (f)- Percent of total expense. Line 7e - Community Health Improvement - This line is reported at actual 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 Franklin Memorial Hospital (CFMH) provides education to the public about health risks and steps that can be taken to improve health. Events include regularly scheduled health screenings for blood pressure, blood glucose and cholesterol as well as seasonal education on facial damage due to exposure to the sun. CFMH's community health education department provides education on childhood injury prevention to the community and other providers. 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 Franklin County Area Community Health Needs Assessment. This coordination includes participation in various community partnerships such as Healthy Franklin County, focused on addressing community health need, especially access to healthy food options. Line 7f - Health professions education - This line is reported at actual cost. Carilion Franklin Memorial Hospital provides continuing education training for local emergency services and for court appointed special advocates. 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 without collaboration; it takes a community of partners working toward 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 dozens of 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 helps with access to primary care, nutrient dense foods, chronic disease management, coordination of care, family prevention education and a multitude of other community health improvement goals. Schedule H, Part II Community Building Activities Line 1 - Physical improvements and housing - n/a Line 2 - Economic development - 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 Franklin Memorial Hospital is deeply involved with a variety of health and social determinant-related initiatives and supports local organizations through coordination of activities and participation as volunteers and on boards in addition to providing financial support. For example, Carilion leaders dedicate their time to impact domestic violence through support of the Franklin County Domestic Violence Awareness event and Southern Virginia Child Advocacy Center. In kind support in the form of paid employee hours were dedicated to United Way's Day of Action and Community Investment Process. 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 the Franklin County Area. 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 the Franklin County Area. An example is Carilion's representation and participation in FRESH, a coalition of organizations working to prevent substance abuse in youth. In addition, Carilion joins local non-profits organizations as part of the non-profit leaders group coordinated by the United Way. Line 7 - Community health improvement advocacy - In-kind support was provided for local efforts to address the need for fresh local produce. Line 8 - Workforce development - Carilion Franklin Memorial Hospital representatives provided support in-kind to students at Franklin County High School, and the Gereau Center for the New Tech program learning about science and healthcare careers. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Carilion Franklin Memorial 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 Franklin Memorial 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 relizable value. Susequent 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 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 efforts (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 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 FRANKLIN MEMORIAL HOSPITAL: Line 16a URL: https://carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - CARILION FRANKLIN MEMORIAL HOSPITAL: Line 16b URL: https://carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - CARILION FRANKLIN MEMORIAL 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 five distinct 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 fosters community development in its CHNA and community health improvement processes by using the Strive Collective Impact Model for the Community Health Assessment Team (CHAT). This evidence-based model focuses on solving problems together with coalitions of cross sector partners and has been proven to lead to large-scale changes. It focuses on relationship building between organizations and the progress towards shared strategies. Carilion Clinic and Healthy Franklin County (HFC) partnered to conduct the 2018 FCACHNA. This process was community-driven and focused on high levels of community engagement involving health and human services leaders, stakeholders, providers, the target population, and the community as a whole. Healthy Franklin County (HFC) is an initiative of United Way of Roanoke Valley brought forth from two reports, both developed to assess the needs of Franklin County. It is derived from the 2013 FCACHNA and also the Franklin County Prosperity Indicators Report. HFC seeks to reduce obesity and related chronic diseases by mobilizing time, talent and financial resources to promote healthier lifestyles. HFC works by aligning resources to work together to improve the health and well-being of all Franklin County residents. This is done by integrating practices and coordinating improvements that provide collective impact and lead to positive change. Since 2014, HFC has led wellness work, mobilizing partners and leading efforts specifically targeting obesity and chronic disease management in the community by increasing access to healthy food and health education opportunities. HFC also administers the CharityTracker online system that helps facilitate referrals across 20 local agencies as part of the Health Efficiency Navigation Initiative (HENI). Carilion Clinic partnered with HFC to conduct the 2016 and 2018 FCACHNAs. 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 The Franklin County area, including Franklin County and Henry County, is the service area for the Franklin County Area Community Health Needs Assessment (FCACHNA). Franklin and Henry Counties are part of the West Piedmont Health District. The western piedmont region of Virginia is full of beautiful scenery including the Blue Ridge Mountains, rolling hills, multiple communities developed around lakes and waterways, and quaint towns. Franklin County is mostly rural with 81.3 persons per square mile and a land area of 690.43 square miles (U.S. Census Bureau, 2017, QuickFacts. https://www.census.gov/quickfacts/fact/table/franklincountyvirginia/PST045217) and is part of the Roanoke Metropolitan Statistical Area (MSA) (Roanoke Metropolitan Statistical Area in USA. Retrieved from: https://www.citypopulation.de/php/usa-metro.php?cityid=40220 ). The County hosts a variety of distinct communities including many rural communities, the Smith Mountain Lake area and the town of Rocky Mount. Before settlers came to the area in the early 1700s, the land was home to Native American tribes. In 1786, Franklin County was formed from portions of Bedford and Henry Counties. Agriculture, mining and later the railroad, textile, wood and tobacco industries were prominent. Smith Mountain Lake and Philpott Lake are both located in parts of Franklin County and continue to drive activity and growth in the area. Today, Franklin County has a national monument at the birthplace of Booker T. Washington and offers an active music and outdoor activity scene. (About Franklin County. Retrieved from: https://www.visitfranklincountyva.org/about-franklin-county/). Henry County is mostly rural with 141.6 persons per square mile and a land area of 382.33 square miles (U.S. Census Bureau, 2017, QuickFacts. https://www.census.gov/quickfacts/fact/table/henrycountyvirginia/PST045217) and is part of the Martinsville-Henry County Micropolitan Statistical Area. (Virginia and Contiguous Areas Metropolitan and Micropolitan Statistical Areas and Components. Retrieved from http://www.vdh.virginia.gov/content/uploads/sites/76/2016/06/VirginiaMetropolitanandMicropolitanStatisticalAreas.pdf). Henry County has a rich history that helps to highlight its amenities and activities today. Motorsports, specifically NASCAR, has been a staple in the Martinsville-Henry County area dating back to the 1940s when the Martinsville Speedway was opened. (Martinsville Henry County Virginia. Motorsports Heritage. http://www.visitmartinsville.com/motorsports-heritage). Complementing and often replacing the early agricultural and tobacco industries, the furniture and textile industries were significant contributors to employment and the economy in the area during the 20th century. (Martinsville-Henry County Virginia Textiles Heritage. http://www.visitmartinsville.com/textiles-heritage). Today, in addition to motorsports, outdoor activities attract and engage visitors and residents. Franklin County is part of the Roanoke Valley MSA, a region flush with resources including food, health and human services, arts and culture and outdoor amenities. Additionally, within the service area, resources are accessible to residents in the City of Martinsville, the Town of Rocky Mount, the Smith Mountain Lake area and in other smaller communities. Health and human service organizations work to reduce the disparities in access to care and access to resources that still exist for many residents of the region. The 2018 FCACHNA revealed differences throughout the service area and significant disparities both in health and in social determinants. The 2014-2018 American Community Survey (ACS) found the total population of the counties of Franklin and Henry to be 56,233 and 51,588 respectively. (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 U.S. Census Bureau predicts positive future population change for Franklin County, predicting growth of 7.49% by 2040, similar to the Commonwealth of Virginia at 6.86%. (Virginia Employment Commission Community Profiles (2020). https://virginiaworks.com/community-profiles). Henry County's predicted population change by 2040 is a decrease of 9.04%. (Virginia Employment Commission Community Profiles (2020). https://virginiaworks.com/community-profiles). Median age is similar at 46.6 in Franklin County and 47.2 in Henry County. (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 both Franklin and Henry counties have a larger percentage of the population that is White (88.9% and 72.0%) than in the Commonwealth of Virginia (68.0%) as a whole. (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). Henry County also has a larger percentage of the population that is Black (22.3%) than in the Commonwealth of Virginia (19.2%). (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). All of Franklin and Henry Counties are designated as Medically Underserved Areas (MUA) and primary, dental and mental health Health Professional Shortage Areas (HPSA) for low income residents. (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 Franklin Memorial Hospital (CFMH) provides a full range of top-quality inpatient and outpatient care for residents of the Franklin County area. Patients served by the hospital receive care regardless of their ability to pay. The facility includes an inpatient hospital and medical offices for acute and specialty care. CFMH's team of health care professionals provides patients with reliable, safe care to get them on the road to recovery, close to home. For inpatient care, CFMH physicians diagnose and treat illnesses, anticipate problems and rapidly respond to changes in patient conditions. Emergency services are onsite 24/7, and CFMH offers direct access to Carilion's Level 1 Trauma Center if an advanced level of care is needed. With a mission to improve the health of the community it serves, CFMH is governed by a board of directors elected annually. The majority of board members live and work in the hospital's service region and are not employed by the hospital, nor are they contractors. Medical staff members are qualified professionals who have privileges to provide a full range of services at the hospital. Surplus funds are reinvested to benefit patients through new technology, specialty services, clinical initiatives, education and charitable efforts. Reinvestments include providing free, discounted and subsidized care and critical medical services that would not otherwise be offered in our region and operate at a loss. Schedule H, Part VI, Line 6 Affiliated health care system Carilion Franklin Memorial Hospital is wholly owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. Through a comprehensive network of hospitals, primary and specialty physician practices, and complementary services, Carilion provides exceptional care for nearly 1 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-2000's, 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) Carilion's Community Health and Outreach (CHO) department is the health system's engine for providing collaborative opportunities to improve and promote the health of the community. The department's Community Health Assessments process helps identify the strengths and barriers impacting health. It's community-based programs reflect the Robert Wood Johnson Foundation's framework of four main influences of health- health behaviors, social and economic factors, clinical care access and quality, and physical environment. CHO is also the driving force for the health system's many partnerships with cross-sector organizations that create a collaborative culture of community health and wellness. 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. true Free Clinic of Franklin County Inc 1171 Franklin Street Rocky Mount VA 24151 541634138 501 (c) (3) 25000 affordable primary care United Way of Roanoke Valley 325 Campbell Ave SE Roanoke VA 24016 540535302 501 (c) (3) 22500 Health collaboratives SML Good Neighbors Inc 10664 Moneta Road Moneta VA 24121 261274000 501 (c) (3) 5000 Summer camp nutrition/care (4) Children's Advocacy Programs of the Blue Ridge Inc 300 South Main Street Rocky Mount VA 24151 541950268 501 (c) (3) 10000 Child abuse prevention 4 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. 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. X X false true false true false false false false false true false Bill Jacobsen Dir./Sec./Treas./Hospital VP 195215 0 22303 0 15054 0 42412 0 1897 0 276881 0 0 0 Steven Arner Director 0 539549 0 73492 0 4833 0 80224 0 17136 0 715234 0 0 CRAIG L BOOKOUT MD Director 0 329783 0 23039 0 6042 0 81664 0 6621 0 447149 0 0 Sarah Stubbs MD Director 0 232018 0 52858 0 2121 0 17637 0 16949 0 321583 0 0 Nicholas Conte Asst. Secretary 0 455282 0 62409 0 6298 0 118913 0 17136 0 660038 0 0 David Hagadorn Asst. Treasurer 0 133333 0 1800 0 8473 0 7243 0 819 0 151668 0 0 Donald Halliwill Asst. Treasurer 0 515337 0 70983 0 4797 0 78134 0 15836 0 685087 0 0 G Robert Vaughan Jr Asst. Treasurer 0 259842 0 30582 0 4104 0 10275 0 16723 0 321526 0 0 Nancy Howell Agee CEO, Carilion Clinic 0 1242837 0 285745 0 205285 0 114597 0 11330 0 1859794 0 0 Lori McClure Pharmacy Manager 167926 0 1200 0 744 0 12190 0 1019 0 183079 0 0 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments Employees are occasionally awarded small gifts or prizes which are grossed up for taxes at management's discretion and included in taxable compensation. During the reporting period, Ms. Firebaugh received such benefit. Schedule J, Part I, Line 1a Health or social club dues or initiation fees ALL DIRECTORS ARE OFFERED A FREE FAMILY OR INDIVIDUAL MEMBERSHIP TO A HEALTH CLUB OWNED BY A RELATED ORGANIZATION IF THEY CHOOSE TO ACCEPT IT. MR. JACOBSEN RECEIVED THIS BENEFIT AND THE VALUE WAS INCLUDED IN TAXABLE COMPENSATION FROM THE ORGANIZATION. Schedule J, Part I, Line 1b Written policy regarding payment or reimbursement of expenses Management determines tax gross-up decisions based on IRS requirements, amount, and the non-cash status of the benefits. PROVISION OF THE HEALTH CLUB BENEFIT IS DOCUMENTED IN BOARD MEETING MINUTES AND CARILION INTERNALLY TRACKS THE MEMBERSHIPS AND PAYS THE HEALTH CLUB DIRECTLY. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation The organization has a single member, Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. Executive compensation, including that of the Hospital Vice President, is reviewed annually by the Carilion Clinic Board of Directors Compensation Committee. This Committee is made up of Board members of Carilion Clinic who do not have a conflict of interest with any of the executives being reviewed. In addition, the Compensation Committee annually reviews the compensation philosophy for all executive leaders. This review included review of a comprehensive report from an outside compensation consultant specializing in healthcare organizations for select positions and the prior year's report on all of the reviewed positions. The reports reviewed by the Committee included a detailed comparison of total compensation and each element thereof, including base salary, bonus, "at-risk" and other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to both a national and regional peer group of organizations similar in size and structure to the organization, the list of which was reviewed by the Compensation Committee. The Compensation Committee maintained detailed minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Mr. Arner, Mr. Conte, Mr. Halliwill, and Mr. Vaughan, participate in a Defined Contribution Supplemental Executive Retirement Plan (DC SERP) in which the employer, at the discretion of Carilion Clinic's Compensation Committee, makes a contribution to an account established on its books for each eligible participant. If a participant ceases to be a participant prior to the vesting date, the account shall be forfeited. A lump sum distribution shall be made upon the participant's vesting date, death, or disability. Unvested contributions made to the DC SERP in 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 J, Part I, Line 7 Non-fixed payments The organization pays annual "at-risk" compensation to certain members of management based on performance of an applicable scorecard. While the scorecard contains a formula as a basis for determining overall performance, in certain cases, senior managers have discretion to include additional elements in their assessment of managers reporting to them. In addition, for top management, the actual non-fixed payment awarded is in the discretion of the Carilion Clinic Board of Directors Compensation Committee, although it is based on the scorecard measures. LETTITIA FURROW FAMILY MEMBER OF WILLIAM KINGERY, DIRECTOR 136383 EMPLOYEE false Form 990, Part I, Line 6 VOLUNTEERS Within the hospital, volunteers serve at the escort desk, decorate, handle vendor sales, provide fundraisers, assist with Relay for Life, put together charts, plan conferences, and file and put together O.R. packets. Through Hospice, volunteers provide socialization and companionship to patients in the home and nursing facilities, provide caregiver relief, assist in the office with clerical duties, planning and executing fund-raising events, and make hand-made quilts and cards for patients. "We Honor Veteran" presentations are made by specially-trained veteran volunteers to veteran patients. 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 1099's are issued on Carilion Franklin Memorial 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, Steven Arner, Craig Bookout, M.D., Nicholas Conte, David Hagadorn, Donald Halliwill, Lauren Schantz, Sarah Stubbs, M.D., and G. Robert Vaughan, Jr. - Business relationship Form 990, Part VI, Line 3 Delegation of management duties Certain management and related services for the organization are provided by the management and employees of Carilion Services, Inc., a related and supporting organization of the filing organization. Some or all of the compensation of the following individuals listed in Part VII, Section A was provided by Carilion Services Inc.: Nancy Howell Agee, Steven Arner, Nicholas Conte, David Hagadorn, Donald Halliwill, Lauren 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 11b Review of form 990 by governing body The Form 990 was prepared by Carilion's internal Tax Department with input from various Carilion departments as applicable, and reviewed by internal Accounting management and an independent CPA firm. 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 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 MISCELLANEOUS - Total Revenue: 6243, Related or Exempt Function Revenue: 6243, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; SALE MEDICAL RECORDS - Total Revenue: 82, Related or Exempt Function Revenue: 82, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; OTHER REVENUE - Total Revenue: 422, Related or Exempt Function Revenue: 422, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; EMPL DRUG SALES TAXABLE - Total Revenue: 4882, Related or Exempt Function Revenue: 4882, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; RETURNED CHECK FEES - Total Revenue: 35, Related or Exempt Function Revenue: 35, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; CONTRACT REVENUE - Total Revenue: 5440, Related or Exempt Function Revenue: 5440, 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: 928250, Program Service Expense: 928250, Management and General Expenses: , Fundraising Expenses: ; Purchased Services - Total Expense: 1286904, Program Service Expense: 1265832, Management and General Expenses: 21072, Fundraising Expenses: ; Contract Fees/Consulting - Total Expense: 602941, Program Service Expense: 525224, Management and General Expenses: 77717, Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 443581, Program Service Expense: 442918, Management and General Expenses: 663, Fundraising Expenses: ; Reference Labs - Total Expense: 1320391, Program Service Expense: 1320391, Management and General Expenses: , Fundraising Expenses: ; Temporary Employment - Total Expense: 229082, Program Service Expense: 229082, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part X, Line 20 Tax Exempt Bond Liabilities The amount reported as Tax-Exempt Bonds is the portion of Carilion Clinic Bonds allocated to Carilion Franklin Memorial Hospital. Required information for the Bonds, including Schedule K, is reported in the Carilion Clinic (EIN: 54-1190771) IRS Form 990. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Pension-related changes other than net periodic pension cost - -7661205; Transfers (to)/from Affiliates - -664134; CARILION CLINIC PO BOX 12385 ROANOKE VA 24025 541190771 SUPPORTING ORGANIZATION VA 501(c)(3) Type II NA false CARILION CLINIC FOUNDATION PO BOX 12385 ROANOKE VA 24025 541190773 FUNDRAISING VA 501(c)(3) 7 CARILION CLINIC true CARILION GILES COMMUNITY HOSPITAL PO BOX 12385 ROANOKE VA 24025 540549603 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION MEDICAL CENTER PO BOX 12385 ROANOKE VA 24025 540506332 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION NEW RIVER VALLEY MEDICAL CENTER PO BOX 12385 ROANOKE VA 24025 540553805 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION SERVICES INC PO BOX 12385 ROANOKE VA 24025 541190879 SUPPORTING ORGANIZATION VA 501(c)(3) Type II CARILION CLINIC true CARILION STONEWALL JACKSON HOSPITAL PO BOX 12385 ROANOKE VA 24025 540568001 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION TAZEWELL COMMUNITY HOSPITAL PO BOX 12385 ROANOKE VA 24025 546074580 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true 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 CARILION CLINIC MEDICARE SHARED SAVINGS COMPANY LLC PO BOX 12385 ROANOKE VA 24025 455235473 MEDICARE HMO VA NA N/A SOUTHWEST VIRGINIA HEALTH PROPERTIES LLC 1102 Jefferson Street SE Roanoke VA 24016 010691570 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 TI PLATFORM CC SMA LP 1160 Battery St East San Francisco CA 94111 842852539 Investments DE NA N/A STARWOOD VEP II CO-INVEST LLC 591 W Putnam Avenue Greenwich CT 06930 833262407 Investments DE NA N/A SCA CREDIT SERVICES INC PO BOX 12385 ROANOKE VA 24025 541180398 COLLECTION AGENCY VA NA C Corporation true MEDKEY INC PO BOX 12385 ROANOKE VA 24025 541645357 FINANCING SERVICES VA NA C Corporation true CHS INC PO BOX 12385 ROANOKE VA 24025 541725732 SERVICES VA NA C Corporation true CARILION HEALTHCARE CORPORATION PO BOX 12385 ROANOKE VA 24025 541586601 HEALTHCARE VA NA C Corporation true CARILION EMERGENCY SERVICES INC PO BOX 12385 ROANOKE VA 24025 542033006 HEALTHCARE VA NA C Corporation true CARILION CLINIC MEDICARE RESOURCES LLC PO BOX 12385 ROANOKE VA 24025 263729975 MEDICARE HMO VA NA C Corporation true CARILION BEHAVIORAL HEALTH INC PO BOX 12385 ROANOKE VA 24025 203136891 HEALTHCARE VA NA C Corporation true SPROTT PRIVATE RESOURCE LENDING (C-CO-INVEST) LP 981378742 INVESTMENTS CA NA C Corporation true BLACKMOOR OWNERSHIP HOLDINGS LIMITED INVESTMENTS CJ NA C Corporation true MAGNITUDE SYSTEMATIC LONGSHORT FUND INVESTMENTS CJ NA C Corporation true TANGIBLE SEGREGATED PORTFOLIO OF THE SOUTH AFRICA ALPHA SPC INVESTMENTS CJ NA C Corporation true true false true true true false false false false true false true true false false false false true false Carilion Medical Center A 36720 Cost Carilion Healthcare Corporation A 283397 Cost Carilion Services Inc A 7884 Cost Carilion Medical Center M 2325562 Cost Carilion Services Inc M 6743094 Cost CHS Inc M 190018 Cost SCA Credit Services Inc M 64226 Cost Carilion Healthcare Corporation M 1313506 Cost Carilion Services Inc R 664134 Cash