2020-08-16T17:00:57-05:00 2019-09-30 990 2018-10-01 540553805 Carilion New River Valley Medical Center CARI 5402245112 PO BOX 12385 Roanoke VA 24025 G ROBERT VAUGHAN JR ASSISTANT TREASURER 2020-08-16 2018 2020-11-06 18:47:13Z WILLIAM J FLATTERY PO BOX 12385 Roanoke VA 24025 482947473 false X WWW.CARILIONCLINIC.ORG X 1941 VA Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. 15 8 1398 79 0 272963 329295 233436352 249899214 4981241 7095914 2245513 2391330 240936069 259715753 194648 314830 0 71588756 73038262 0 0 132747823 138328499 204531227 211681591 36404842 48034162 354911781 385032388 92882989 111620553 262028792 273411835 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 180306482 314830 250326323 See schedule O. 180306482 true true false true false false false false false true true false false true false false true false false false false false false false false true true true false true false false false false false false true false false false false false true true true true false false true X 0 0 1398 true false false false false false false false false false false false false X 15 8 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 William Flattery Director/Sec/Treas/Hosp. VP 46.3 3.7 X X 297508 0 15362 Lawrence Hincker Director/Chair 2.5 0 X X 0 336 0 Mark Rogers DO Director/Vice Chair 1.2 0 X X 0 480 0 William Aden Director 1.2 0 X 0 80 0 Diane Akers Director 1.2 0 X 0 480 0 Nathaniel Bishop DMin Director 1.2 48.8 X 0 341102 75153 Charles Bissell MD Director 1.2 48.8 X 0 621726 11350 Brian Hemphill PhD Director 1.2 0 X 0 0 0 Michael Hickman Ed D Director 1.2 0 X 0 0 0 TAMERA HOWELL MD Director 1.2 48.8 X 0 298169 19483 J Thomas Ryan MD Director 1.2 0 X 0 0 0 Joseph Scartelli PhD Director 1.2 2.4 X 0 8275 0 Joseph Sheffey Director 1.2 2.4 X 0 0 0 Bhairvi Trivedi MD Director 1.2 0 X 0 40 0 Cristina Whitaker Trout NP Director 1.2 48.8 X 2213 147044 11567 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 Steven Arner Executive Vice President 2.0 48.0 X 0 617874 97360 Ralph Brown MD Physician 50.0 0 X 238194 0 17387 Dale Bryant Pharmacist 50.0 0 X 163244 0 41579 MICHAEL CZAR Pharmacist 50.0 0 X 149454 0 24937 Donna Shelor Pharmacist 50.0 0 X 165689 0 -4562 Beth Wallace Pharmacist 50.0 0 X 154072 0 35336 1170374 5396782 748833 32 false true false ANESTHESIOLOGY ASSOCIATES OF RADFORD 2900 LAMB CIR STE 340 CHRISTIANSBURG VA 24073 ANESTHESIOLOGY SERVICES 4333348 QUEST DIAGNOSTICS 500 PLAZA DRIVE SECAUCUS NJ 07094 LABORATORY SERVICES 2554791 SIEMENS MEDICAL SOLUTIONS USA INC 40 LIBERTY BLVD MALVERN PA 19355 EQUIPMENT MAINTENANCE CONTRACTS 925688 TURNER LONG CONSTRUCTION INC 1807 MURRY ROAD SUITE G ROANOKE VA 24018 CONSTRUCTION SERVICES 740568 PEDIATRIX MEDICAL GROUP INC MEDNAX SERVICES INC 1301 CONCORD TERRACE SUNRISE FL 33323 PHYSICIAN SERVICES 615672 26 X 13535 245521 70239 329295 Net Patiemt Revenue 622110 249736854 249736854 Rent from Exempt Affiliates 531120 162360 162360 0 0 0 0 249899214 3122007 3122007 1131915 1131915 0 1131915 1131915 227205627 223226041 5679 3979586 -5679 3973907 3973907 Cafeteria 722514 832306 832306 Gift Shop 900099 242301 242301 Court Cost Recovery 900099 42599 42599 142209 142209 0 0 1259415 259715753 250326323 0 9060135 X 314830 314830 460042 460042 173872 173872 57400160 57331623 68537 3662031 3657658 4373 7271808 7174827 96981 4070349 4043979 26370 29415261 29415261 52225 52225 16051 16051 250221 250221 23026475 22915828 110647 0 11859 11859 2753640 2633797 119843 456720 456720 3417841 3379191 38650 701781 648515 53266 2304421 2304421 8996118 8996118 1402792 748125 654667 Medical Supplies 29652515 29652297 218 Bad Debt 14696748 14696748 Intercompany Practice Subsidy 15160846 15160846 Assessment Fees 5699015 5699015 313970 290162 23808 0 211681591 180306482 31375109 0 47078 3958 23163 56137 34658957 46873891 0 0 0 1179841 1883538 855685 1874942 202640492 131550945 68678242 71089547 45129553 45403674 190867652 199050153 0 13471610 18796548 354911781 385032388 19683761 22174754 0 215479 300080 50135461 47721375 0 597585 178868 22250703 41245476 92882989 111620553 X 261765887 273376350 262905 35485 262028792 273411835 354911781 385032388 X 48034162 -3657954 -32993165 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 16051 16051 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. 1887465 1887465 103485329 59823543 43661786 257609 249542 8067 88109974 69268263 18841711 8900115 2209597 6690518 71089547 1067491 F Alternative Investments 165188590 F Comingled Funds 32794072 F 199050153 Pension Liability 30016355 Interest Rate Swap Liability 11229121 41245476 true true X true X true X false true false true true 4729127 4729127 0.0240 26050396 23830703 2219693 0.0113 0 0.0 0 0 30779523 23830703 6948820 0.0353 938 10381 208098 33011 175087 0.0009 6 46 442884 200661 242223 0.0012 0 0.0 1 604 13717 13717 0.0001 17 2642 72129 72129 0.0004 962 13673 736828 233672 503156 0.0026 962 13673 31516351 24064375 7451976 0.0378 1 0 365 365 0.0000 3 0 21796 21796 0.0001 79 646 31015 31015 0.0002 0 0.0 0 0.0 5 0 17026 17026 0.0001 0 0.0 1 0 12500 12500 0.0001 0 0.0 89 646 82702 0 82702 0.0004 true 14553671 50998396 56759545 -5761149 X true true 1 1 CARILION NEW RIVER VALLEY MEDICAL CENTER 2900 LAMB CIRCLE CHRISTIANSBURG VA 24073 https://carilionclinic.org/locations/carilion-new-river-valley-medical-center H 1838 X X X CARILION NEW RIVER VALLEY MEDICAL CENTER 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-new-river-valley-medical-center X https://www.carilionclinic.org/community-health-assessments#new-river-valley X X true 17 true https://www.carilionclinic.org/community-health-assessments#new-river-valley 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 New RIver Valley Medical Center. 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) New River Valley Community Health Needs Assessment (NRVCHNA): CHIP of NRV; Community Health Center of the New River Valley; Community Housing Partners; New River Community Action; New River Valley Agency on Aging; New River Valley CARES; Virginia Department of Health - Mount Rogers Health District; Virginia Department of Health - New River Health District; Virginia Tech. In addition to the CHAT, the NRVCHNA 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 Montgomery County Sheriff's Office, the NRV CHIP staff, the Palliative Care Partnership of the NRV, and the Pulaski County Sheriff's Office. 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. Nine target population focus groups were held and participants discussed health needs and barriers to health, as well as access to primary, oral, and mental health care. Target population focus groups were conducted with Community Health Center of New River Valley patients in two different clinic locations, Children's Health Investment Partnership (CHIP) clients, Carilion New River Valley Medical Center Environmental Services Staff, New River Valley Agency on Aging Friendship Cafe groups in multiple localities and with the YMCA International Women's group. A 38-question Community Health 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 New River Valley residents 18 years of age and older. The New River Valley CHNA service area included Floyd County, Montgomery County, Pulaski County, Radford City, and Wythe 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, Insurance status. The survey was also made available to all residents living in the New River Valley and oversampling of the target populations occurred through targeted outreach efforts. In total, 1,068 surveys were collected. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Carilion New River Valley Medical Center. CHIP of NRV, Community Health Center of the New River Valley, Community Housing Partners, New River Community Action, New River Valley Agency on Aging, New River Valley CARES, Virginia Department of Health-Mount Rogers Health District, Virginia Department of Health-New River Health District, Virginia Tech. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - Carilion New River Valley Medical Center. The 2018 New River Valley 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 New River Valley Medical Center. 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 New River Valley Medical Center (CNRV) plans to do to address the community health needs identified in the 2018 New River Valley Community Health Needs Assessment (NRVCHNA). 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 findings of the 2018 NRVCHNA revealed 10 priority health-related issues in the community, identified by the CHAT after review of the data collected. (1) Transportation / transit system (2) Alcohol and drug use (3) Affordable / safe housing (4) Lack of knowledge of community resources (5) Tobacco use (6) Poverty / low average household income (7) High cost of care (8) Lack of health literacy / lack of knowledge of healthy behaviors (9) Access to mental / behavioral health services (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 to "create social and physical environments that promote good health for all." (https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health) Carilion responds to community health needs in innovative ways-making sure our 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, which includes 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 needs. 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 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 needs. 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 the New River Health District and PATH in the New River Valley. 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 New River Valley. Carilion New River Valley Medical Center partnered with PATH to serve as the CHAT for the 2018 NRVCHNA. "Since 1995 the New River Valley Partnership for Access to Health Care (PATH) has served as a collaborative community-focused alliance of 50+ Health and Human Service organizations, other community organizations and businesses. This partnership resulted from discussions and review of statistics from a 1994 New River Valley Health and Human Services Needs Assessment which indicated that the number one concern of residents in the New River Health District or Planning District Four - a 1,400 square mile multi-jurisdictional rural, urban and suburban region of Southwest Virginia including the localities of Floyd, Giles, Montgomery and Pulaski counties and the City of Radford - was lack of affordable health care. The mission of PATH is to maximize access to health care for all residents of the New River Valley." (http://www.vdh.virginia.gov/new-river/path/). In fiscal year 2019 (tax year 2018) CNRV partnered with the New River Health District, the Community Foundation of the NRV and other PATH partners to organize Healthy Roots-A Conversation to Improve Health and Wellbeing in the New River Valley, a planning retreat for key community stakeholder representatives to review the needs identified and determine action steps to take as a community to address key health priorities arising from the 2018 NRVCHNA. As a result, Carilion funded the Community Foundation of the New River Valley to develop a network of organizations to jointly address community needs. 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), $53,500 in grants were awarded to 4 programs to improve transportation and basic needs access, disease prevention, trauma-informed care, and unwanted pregnancy prevention efforts. (Continued in Part VI, Section C) 8 CARILION NEW RIVER VALLEY MEDICAL CENTER 2900 LAMB CIRCLE CHRISTIANSBURG VA 24073 PSYCHIATRIC UNIT CARILION NEW RIVER VALLEY REHABILITATION 118 BROAD STREET DUBLIN VA 24084 OUTPATIENT THERAPY CARILION NEW RIVER HOSPICEHOME HEALTH 707 RANDOLPH STREET SUITE 251 RADFORD VA 24141 HOSPICE AND HOME HEALTH NEW RIVER VALLEY AMBULATORY SURGERY CENTER 2901 LAMB CIRCLE CHRISTIANSBURG VA 24073 AMBULATORY SURGERY CENTER BLACKSBURG SPORTS MEDICINE AND REHABILITATION 213 GILBERT STREET BLACKSBURG VA 24060 PHYSICAL THERAPY PHYSICAL THERAPY CHRISTIANSBURG 120 PONDEROSA DRIVE CHRISTIANSBURG VA 24084 PHYSICAL THERAPY PHYSICAL THERAPY WYTHEVILLE 178 WEST MAIN STREET WYTHEVILLE VA 24382 PHYSICAL THERAPY HILLSVILLE PHYSICAL THERAPY 416 SOUTH MAIN STREET HILLSVILLE VA 24343 PHYSICAL THERAPY 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 Behavior Needs include alcohol and drug use, tobacco use, lack of knowledge of healthy behaviors. Carilion Clinic addressed health behavior-related priorities from the 2018 NRVCHNA. 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 by Trauma Outreach and select other departments. Health and wellness education topics include-general wellness, healthy eating and activity, infant and child safety, emergency care in the case of gun wound, exercise for balance and confidence building for seniors and other topics as requested. In fiscal year 2019, the health educator also hosted 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. 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 New River Valley. 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, CNRV hosts a momentum studio with exercise equipment available for employees. A key part of wellness is compliance with safety and preventive behaviors. CNRV coordinates child passenger safety trainings and child safety seat checks to reduce injuries from car accidents. As part of infant safe sleep classes, Carilion provides participants with a free Pack and Play and/or a free Sleep Sack, when available. Infants born in Carilion hospitals also receive a free Sleep Sack, when available, to encourage safe sleep practices. Carilion has also provided support for a health education program at the New River Valley Regional Jail. This program focuses on reducing unwanted pregnancies and neonatal abstinence syndrome through inmate education, on-site clinical family planning services, promotion of community resources and referrals for post-release follow-up care. Carilion remains committed to the Healthier Hospital Initiative pledge and continues to work to improve quantities 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 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 and treatment and standard orders in Carilion's electronic medical record system, 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. CNRV has been focused on addressing the opioid abuse crisis at a very local level. Through the efforts of one CNRV pharmacist, a program was developed internally that involves the identification of high-risk patients, provision of patient and family education on opioid risks and disposal sites for unused medications, and assistance acquiring Narcan. CNRV has also provided REVIVE trainings. -Tobacco Use- Carilion makes available a "Preparing to Quit" speakers bureau that can be requested by community groups or companies. Carilion employees and their dependents will now be eligible for a new, pharmacist-led smoking cessation program. This program includes group sessions, individual follow-up, resource referrals and free access to nicotine replacement therapy products. Another option includes free participation in the Quit for Life program. Employees are offered a financial incentive when they are tobacco free. -Clinical Care- Needs include access to mental and behavioral health services, high cost of care, coordination of care. Issues with access to care are a focus for CNRV 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. Schedule H, Part V, Section B, Line 11 Needs identified in CHNA (Continued) -Mental health and substance use services- Part of CNRV, Carilion Clinic Saint Albans Hospital offers comprehensive inpatient and outpatient psychiatric treatment and chemical dependency programs. In an effort to improve access to care for the community, Saint Albans plans to open an Office-based Opioid Treatment (OBOT) program. Through the OBOT, CNRV will provide patients with a robust offering of coordinated services including medication assisted treatment, group therapy, coordination of care and medication reconciliation. Saint Albans has designated a spaced for the OBOT, offering privacy for patients and rooms for group therapy. 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 Saint Albans. 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 New River Valley. -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. -Social and Economic Factors- Includes poverty, transportation, affordable / safe housing, lack of health literacy, lack of knowledge of community resources. In its commitment to reducing inequities in care, Carilion provides financial support for people who cannot afford insurance or health care. Carilion also makes available a Medication Assistance Program to help people gain access to affordable medication. 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 worthwhile causes. Each year, Carilion Clinic coordinates a system-wide United Way campaign through which employees can provide additional support to these causes. CNRV invites community partners to present at operations committee meetings to educate CNRV providers and staff on community resources available for patients. Carilion will explore opportunities to improve access to care through various types of telemedicine provision, which are not currently offered in the area. In addition, through a comprehensive forensic nursing program, CNRV is engaged with the community for abuse prevention and review efforts. CNRV participates on local abuse and fatality review teams. As a result of the Healthy Roots Conversation between community stakeholders, partners came together, organized by Community Foundation of the New River Valley, to develop a network of organizations that will together address broad spectrum community needs. This work will bring together existing community networks already addressing food access and quality early childhood education along with health issues and other community needs. -Physical Environment- While physical environment did not necessarily arise as a top priority in the 2018 NRVCHNA, 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. CNRV has also recently invested in a solar panel field to improve energy efficiency. -Implementation and Measurement- Carilion has invested in multiple systems to 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 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 New River Valley, 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" are those that will not be actively addressed in this time period. It is CNRV's intent to address many of the identified priority health issues through the aforementioned initiatives, partnerships, programs and/or grants. Of the top 10 identified priorities in the 2018 NRVCHNA, transportation, access to safe/affordable housing, tobacco use and coordination of care are not directly addressed by initiatives included in the Implementation Strategy. In the past, Carilion has provided grant funding to support transportation efforts in the New River Valley area. Carilion will continue to explore ways to provide support for improved transportation and housing, as well as for tobacco cessation and coordination of care in the New River Valley. At this time, CNRV does not have the local expertise to provide transportation or housing services. Please visit https://carilionclinic.org/community-health-assessments#about to review the 2018 New River Valley 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 theFPG 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 Avaliability of Community Benefit Report 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://www.carilionclinic.org/about-carilion-clinic#our-values. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Line 7, Column (f): Bad debt expense of $14,553,671 as included in Part IX, Statement of Expenses on line 25 was excluded from the calculation of Part I Line 7 Column (f) Percent of total expense. Line 7e - Community Health Improvement and Community Benefit Operations - This line is reported at actual cost. Carilion's commitment to community 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 New River Valley Medical Center (CNRV) 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 skin damage due to exposure to the sun. CNRV'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 and assistance accessing affordable prescriptions through Carilion's Medication Assistance Program. 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 New River Valley Community Health Needs Assessment. This coordination includes participation in various community partnerships such as PATH and the newly formed Healthy Roots NRV, a collaboration of health and human service agencies coming together to address prioritized community health needs. Line 7f - Health professions education - This line is reported at actual cost. Carilion Community Health and Outreach certified trainers educate community health professionals such as EMS and CHIP personnel on Child Passenger Safety. Line 7g - Subsidized Health Services - N/A Line 7h - Research - This line is reported at actual cost. Carilion New River Valley Medical Center provides community research through a cancer registry to assist public health professionals in understanding and addressing the cancer burden more effectively. The information collected is used to develop programs on cancer prevention, early detection, and successful treatment and care. 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 transportation and basic needs access, disease prevention, trauma-informed care, unwanted pregnancy prevention efforts, and a multitude of other community health improvement goals. Schedule H, Part II Community Building Activities Line 1 - Physical improvements and housing - In fiscal year 2019 (tax year 2018), Carilion New River Valley Medical Center leadership participated in a New River Valley Housing Study. 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. Carilion takes an active role in local economic development endeavors by investing in research and technology and conversing with local businesses about the region's current business climate and prospects. CNRV takes an active role in local economic development through participation in OnWARD NRV, a regional economic development organization working to attract jobs and talent to the New River Valley. 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 New River Valley Medical Center 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 the need for quality childhood education by participating on the First Steps, on the Montgomery County School Health Advisory Board, in the Alliance for Better Childcare Strategies and on the Montgomery County Prevention Partners coalition. Financial donations also support various causes and organizations including Alliance for Better Childcare Strategies, Radford Child Development Center, NAACP and others. 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, safety and social determinant needs in the New River Valley. 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 New River Valley. An example is Carilion's representation on the local Federally Qualified Health Center Board and associated volunteer hours donated. In addition, Carilion leadership led a walk for the American Heart Association. Line 7 - Community health improvement advocacy - n/a Line 8 - Workforce development - Carilion partners to provide workforce development efforts and training for community members both to develop a pipeline of future healthcare workers and with the understanding that employment is directly linked to health and wellness. In fiscal year 2019 (tax year 2018) Carilion New River Valley Medical Center provided scholarship support for students with an interest in nursing careers. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Carilion New River Valley Medical Center 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 New River Valley Medical Center 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 NEW RIVER VALLEY MEDICAL CENTER: Line 16a URL: https://carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - CARILION NEW RIVER VALLEY MEDICAL CENTER: Line 16b URL: https://carilionclinic.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - CARILION NEW RIVER VALLEY MEDICAL CENTER: 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. Needs are also identified through advisory boards and focus groups conducted, on occasion, in key neighborhoods or aligned with community initiatives. Through ongoing collaboration with community stakeholders, regular communication of community needs occurs and partners can respond cohesively. Carilion Clinic fosters community development in its CHNA and community health improvement processes by using the Strive Collective Impact Model for the 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, the New River Health District of the Virginia Department of Health and the New River Valley Partnership for Access to Health Care (PATH) partnered to conduct the 2018 New River Valley 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. "Since 1995 the New River Valley Partnership for Access to Health Care (PATH) has served as a collaborative community-focused alliance of 50+ Health and Human Service organizations, other community organizations and businesses. This partnership resulted from discussions and review of statistics from a 1994 New River Valley Health and Human Services Needs Assessment which indicated that the number one concern of residents in the New River Health District or Planning District Four - a 1,400 square mile multi-jurisdictional rural, urban and suburban region of southwest Virginia including the localities of Floyd, Giles, Montgomery and Pulaski counties and the City of Radford - was lack of affordable health care. The mission of PATH is to maximize access to health care for all residents of the New River Valley. " ( VDH, PATH. Retrieved from: http://www.vdh.virginia.gov/new-river/path/) 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 New River Valley, home to Carilion New River Valley Medical Center, is composed of the independent City of Radford and the counties of Floyd, Giles, Montgomery and Pulaski. It is nestled among the Blue Ridge and Appalachian Mountains in Southwest Virginia. The Valley is home to two universities, Virginia Tech and Radford University, and to New River Community College. Their presence enriches the local culture and workforce. A rich mix of urban and rural communities, the New River Valley boasts scenic views and thriving communities complete with restaurants, arts and culture offerings and an abundance of outdoor recreation and relaxation opportunities (https://www.newrivervalleyva.org/). Key safety net providers in the region in addition to Carilion Clinic include: the New River Health District; Community Health Center of the New River Valley, a federally qualified health center; free clinics; 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 New River Valley Community Health Needs Assessment (NRVCHNA) revealed distinct communities with significant differences in size and population and significant disparities both in health and in social determinants. The 2014-2018 American Community Survey (ACS) found the total population of the New River Valley to be 182,341 and the population of Wythe County to be 28,940 (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 City of Radford had 17,630 residents (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 counties of Floyd, Giles, Montgomery and Pulaski had 15,666, 16,814, 97,997 and 34,234 residents respectively (Virginia Employment Commission Community Profiles (2020). https://virginiaworks.com/community-profiles). The U.S. Census Bureau predicts positive future population change of varying degrees for all communities except Giles and Pulaski Counties. Median age in the MSA localities ranges from 22.9 in Radford City to 47 in Floyd County, as compared to the state median of 38.1 (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 for most of the New River Valley, a larger percentage of the population is White than in the Commonwealth of Virginia as a whole with percentages ranging all the way up to 95.7% in Floyd County and 96.6% in Giles County (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). Montgomery County and Radford City, the localities which host Virginia Tech and Radford University, are more racially and ethnically diverse than other parts of the New River Valley, with populations that are 85.9% and 84.5% White, 4.6% and 9.8% Black, and 6.6% and 1.5% Asian with 1.6% and 3.4% representing more than one race and the remainder representing small minorities of American Indian/Alaskan Native, Native Hawaiian/Pacific Islander or some other race. Of the population in both localities, 3.2% and 1.9% respectively are Hispanic or Latino (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). The Valley has many small-town communities, each with a different feel and array of resources. These small towns vary greatly in the demographic and economic make-up of the residents who live there. Schedule H, Part VI, Line 5 Promotion of community health As the leading health care provider in the New River Valley, Carilion New River Valley Medical Center (CNRV) serves the Southwest Virginia counties of Montgomery, Pulaski, Floyd, Wythe, and Giles in addition to the City of Radford. CNRV's history dates back to 1941, when Radford Community Hospital (RCH) was first established to serve the industrial developments in the area at the time. RCH continued to modernize and grow and became affiliated with the Roanoke Hospital Association in November of 1987, during the transition of the Roanoke Hospital Association into Carilion Health System (now Carilion Clinic). On March 20, 1999, RCH capitalized on its standing as a regional hospital and opened Carilion New River Valley Medical Center (CNRV) at its current location in Christiansburg, Virginia. The 109-bed acute care facility offers modern medical operating rooms and state of the art technology (including advanced imaging and robotic surgery). The Level III Trauma Center treats more than 30,000 cases per year and the OB/GYN and midwifery program delivers nearly 1,200 babies per year at The Birthplace. The current medical complex includes multiple surgical and medical care practices, Carilion Children's, and Carilion Clinic Saint Albans Hospital for psychiatry and behavioral medicine. Carilion New River Valley Medical Center serves all patients regardless of their ability to pay. The Hospital's governing Board is elected annually and the majority of members are neither employees nor contractors of the Hospital. Medical staff privileges are extended to qualified providers. Surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. This includes providing free, discounted and subsidized care as well as critical medical services that operate at a loss. (https://www.carilionclinic.org/locations/carilion-new-river-valley-medical-center) Schedule H, Part VI, Line 6 Affiliated health care system Carilion New River Valley Medical Center is wholly owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. Through a comprehensive network of hospitals, primary and specialty physician practices, and complementary services, Carilion provides exceptional care for nearly one million Virginians. With an enduring commitment to the 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) 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 systems 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 Floyd County High School 721 Baker St Floyd VA 24091 546001281 Floyd County 22333 Athletic Trainer Grant Giles County Public Schools 151 School Rd Pearisburg VA 24134 546001307 Giles County 44463 Athletic Trainer Grant The Blacksburg Partnership 506 South Main St Blacksburg VA 24060 043765864 501 (c) (3) 8409 Event Sponsorship (4) Alliance for Better Childcare Strategies 990 Cambria St NE Christiansburg VA 24068 825108334 501 (c) (3) 17500 Child Abuse prevention Blacksburg Country Club 1064 Clubhouse Rd Blacksburg VA 24060 540536604 7500 Blacksburg Battles Cancer (6) Edward Via College of Osteopathic Medicine 2265 Kraft Dr Blacksburg VA 24060 542052107 501 (c) (3) 50000 Certified athletic trainers Onward New River Valley 2020 Kraft Dr 2000 Blacksburg VA 24060 541545804 501 (c) (6) 25000 Economic development Radford Child Development 518 Meadow Ridge Radford VA 24141 461775838 501 (c) (3) 7500 Childcare, scholarships NRV Cares 205 W Main St Christiansburg VA 24073 541773419 501 (c) (3) 10380 Child abuse prevention Radford University Foundation 6226 University Park Dr Radford VA 24141 237219782 501 (c) (3) 28750 IT Consortium; sponsorship New River Health District 210 S Pepper St Christiansburg VA 24073 546001775 VIRGINIA 20000 Regional Jail intervention New River Valley Senior Services 141 E Main St Ste 500 Pulaski VA 24031 541022999 501 (c) (3) 20000 Senior Transportation Virginia Tech Foundation Inc 902 Prices Fork Rd Ste 4000 Blacksburg VA 24061 540721690 501 (c) (3) 24000 Community Health Education New River Community College Educational Foundation 5251 College Dr Dublin VA 24084 521203686 501 (c) (3) 12500 Nursing Scholarships (non-employee) 12 2 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. The Hospital donates funds to other tax-exempt organizations and public schools with a similar health or community improvement mission. Such organizations also have community boards which oversee the expenditure of such 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 false true false true false false false false false true false William Flattery Director/Sec/Treas/Hosp. VP 251926 0 28514 0 17068 0 13357 0 2005 0 312870 0 0 0 Nathaniel Bishop DMin Director 0 291503 0 42731 0 6868 0 72099 0 3054 0 416255 0 0 Charles Bissell MD Director 0 468275 0 137322 0 16129 0 6567 0 4783 0 633076 0 0 TAMERA HOWELL MD Director 0 252322 0 42418 0 3429 0 1240 0 18243 0 317652 0 0 Cristina Whitaker Trout NP Director 2213 132301 0 8295 0 6448 0 10919 0 648 2213 158611 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 Steven Arner Executive Vice President 0 539549 0 73492 0 4833 0 80224 0 17136 0 715234 0 0 Ralph Brown MD Physician 220094 0 15422 0 2678 0 1666 0 15721 0 255581 0 0 0 Dale Bryant Pharmacist 139397 0 13840 0 10007 0 28162 0 13417 0 204823 0 0 0 MICHAEL CZAR Pharmacist 143961 0 1800 0 3693 0 10166 0 14771 0 174391 0 0 0 Donna Shelor Pharmacist 152062 0 13328 0 299 0 -4757 0 195 0 161127 0 0 0 Beth Wallace Pharmacist 152146 0 400 0 1526 0 24864 0 10472 0 189408 0 0 0 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. Flattery 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 Provision of the 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 organization's Hospital Vice President, is reviewed annually by the Carilion Clinic Board of Directors Compensation Committee. This Committee is made up of Board members of Carilion Clinic who do not have a conflict of interest with any of the executives being reviewed. In addition, the Compensation Committee annually reviews the compensation philosophy for all executive leaders. This review included review of a comprehensive report from an 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, Dr. Bishop, 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 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. CHRISTOPHER ROGERS FAMILY MEMBER OF MARK ROGERS, D.O., DIRECTOR 80574 EMPLOYEE false KATHERINE ROGERS FAMILY MEMBER OF MARK ROGERS, D.O., DIRECTOR 93298 EMPLOYEE false Form 990, Part I, Line 6 Volunteers Within the hospital, volunteers provide wayfinding, escort patients, assist at the front desk, gift shop, emergency room, waiting room, and coffee shop as well as act as a service ambassador. The student volunteers are accompanied by adult volunteers and guest services staff and do a great job impacting our patient experience. The youth also participated in fund raising activities this past year. We are very proud of our volunteers and how their work enhances our patient and guest experience. Hospice volunteers serve in a variety of different roles. Patient care volunteers provide socialization and emotional support for patients and families. They provide respite so family members can run errands or just take a break from the caregiving role. We also have a "We Honor Veterans Program" which honors all veteran patients with a pinning ceremony performed by a veteran volunteer. Veteran volunteers also participate in local veteran days parades. We also present all WWII veteran patients with a patriotic quilt in recognition of their service. Our office volunteers help with stuffing envelopes, organizing and printing of manuals, assist with making patient birthday bags and then delivering them to the homes. Weekly tuck in calls are also made by volunteer staff to check in with our patients prior to the weekend related to any needs they may have. Bereavement Volunteers assist the Bereavement Coordinator to plan our annual memorial service and attend our weekly Grief Support groups. Form 990, Part III, Line 4a Program Accomplishments Carilion New River Valley Medical Center, 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. The medical center is a modern hospital facility with diagnostic and medical and surgical care, a Level III Trauma emergency department, and Carilion Clinic Saint Albans Hospital for psychiatry and behavioral medicine. Carilion New River Valley Medical Center exists to serve the health care needs of its community, regardless of a patient's ability to pay. New River admitted 8,208 patients and provided 33,638 days of care during the year; New River also delivered 949 babies. Hospital programs include the provision of nursing care; extensive outpatient and inpatient surgical and endoscopic services; comprehensive heart treatment with interventional cardiac catheterization, diagnostic, therapeutic and rehab solutions; and diagnostic imaging services including CT, MRI,PET/CT, mammography, x-ray and ultrasound. Additional specialty surgical care includes advanced surgery with robotics, vascular, urology, ENT care. Medical care in pulmonary, neurology and physical medicine support patient care. With approximately 24% of its inpatient admissions representing psychiatric admissions and a significant outpatient presence in behavioral medicine, New River plays a critical role in providing mental health services to the region. New River is a Level III trauma center and provides a home base for Lifeguard, the emergency medical air transport that serves the surrounding area. New River provides several inpatient and outpatient services targeting the specific health needs of its population, including diabetes management; home health and hospice; physical, speech, occupational and pediatric therapy programs; and cardiac and respiratory rehab. New River also provides an emergency department with 24-hour care, emergency transportation, and a chest pain program. With 32,339 visits, New River's emergency services are a critical component of the health safety net in its service area, acting as the primary health provider for a significant number of uninsured patients, who comprise 12 percent of ED visits. New River supports community screenings and education on chronic disease prevention and management; sponsoring 1,051 events touching more than 14,319 people. New River also champions and supports a Medication Assistance Program in partnership with community-based social services. In furtherance of its mission, New River provides extensive uncompensated care. Stated at cost, charity and unreimbursed Medicaid costs for the year exceeded $6.9 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 1099's 1099s are issued on Carilion New River Valley Medical Center's behalf by Carilion Services, Inc., a related supporting organization providing management and administrative services, including payment processing. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Nancy Howell Agee, Steve Arner, Nathaniel Bishop, Charles Bissell, Nicholas Conte, William Flattery, David Hagadorn, Donald Halliwill, Tamera Howell, Lauren Schantz, Cristina Whitaker Trout, and G. Robert Vaughan, Jr - Business relationship Form 990, Part VI, Line 3 Delegation of management duties Certain management and related services for the organization are provided by the management and employees of Carilion Services, Inc., a related and supporting organization of the filing organization. Some or all of the compensation of the following individuals listed in Part VII, Section A was provided by Carilion Services, Inc.: Nancy Howell Agee, Steve Arner, Nicholas Conte, David Hagadorn, Donald Halliwill, Lauren Schantz, and G. Robert Vaughan, Jr. Certain management and related services for Carilion New River Valley Surgery Center, LLC, a disregarded entity of the filing organization, are provided by the employees of Woodrum/Ambulatory Systems Development, LLC. None of the individuals listed in Part VII, Section A received compensation from Woodrum/Ambulatory Systems Development, LLC. 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. 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: 90357, Related or Exempt Function Revenue: 90357, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Work Order Revenue - Total Revenue: 27276, Related or Exempt Function Revenue: 27276, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Miscellaneous - Total Revenue: 24258, Related or Exempt Function Revenue: 24258, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Sale Medical Records - Total Revenue: 323, Related or Exempt Function Revenue: 323, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Returned Check Fees - Total Revenue: 245, Related or Exempt Function Revenue: 245, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Membership Fees - Total Revenue: -250, Related or Exempt Function Revenue: -250, 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: 9162545, Program Service Expense: 9162545, Management and General Expenses: , Fundraising Expenses: ; Billing & Collection Services - Total Expense: 690040, Program Service Expense: 690040, Management and General Expenses: , Fundraising Expenses: ; Laundry/Housekeeping Services - Total Expense: 1051658, Program Service Expense: 1051658, Management and General Expenses: , Fundraising Expenses: ; Other Purchased Services - Total Expense: 639309, Program Service Expense: 613699, Management and General Expenses: 25610, Fundraising Expenses: ; Contract Fees/Consulting - Total Expense: 1775007, Program Service Expense: 1690464, Management and General Expenses: 84543, Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 2895741, Program Service Expense: 2895247, Management and General Expenses: 494, Fundraising Expenses: ; Reference Labs - Total Expense: 4776358, Program Service Expense: 4776358, Management and General Expenses: , Fundraising Expenses: ; Temporary Employment - Total Expense: 2035817, Program Service Expense: 2035817, 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 New River Valley Medical Center. Required information for the Bonds, including Schedule K, is reported in the Carilion Clinic (EIN: 54-1190771) IRS Form 990. 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