2014-08-13T11:28:46-05:00 2013-09-30 861065772 Deloitte Tax LLP 424 Church Street Nashville TN 37219 990 2012-10-01 541190879 CARILION SERVICES INC CARI 5402245112 PO BOX 12385 ROANOKE VA 240252385 Donald Halliwill 5402245112 2014-08-13 1 Francis J Bedard P00752421 6152591811 2012 2015-11-30 17:44:51Z Nancy Howell Agee PO BOX 12385 ROANOKE VA 240252385 210899841 0 X www.carilionclinic.org X 1982 VA See Schedule O.The organization supports the activities of Carilion Clinic, a healthcare organization in western Virginia that includes a large multi-specialty physician group, hospitals and ancillary services, focused on the goal of providing the best possible health outcome and health care experience for each patient. 4 0 1608 0 7786294 -1625456 377990 0 174282167 173028103 1847450 4898215 767361 9919445 177274968 187845763 792744 2370308 0 0 109615325 118452836 0 0 14647 68074915 66430286 178482984 187253430 -1208016 592333 490813240 547369880 125598892 117823043 365214348 429546837 X See Schedule O.The principal purpose of this corporation is to generate, through subsidiaries engaged in both taxable and tax-exempt activities, funds for contribution to parent or affiliated organizations in the provision of quality health care services and to promote physical fitness and preventive medicine.Our mission is to improve the health of the communities we serve. 0 0 181142787 2370308 175161254 See Schedule O.By providing management services and administrative functions with an emphasis on cost effectiveness, compliance, and quality, Carilion Services, Inc. supports Carilion's mission to improve the health of the communities it serves. CSI supports Carilion Clinic's core hospital business and related activities by providing technology; human resources; legal services; patient billing; accounting and finance; internal audit and compliance; materials management; and strategic planning services. This assisted the Clinic's hospitals in admitting 47,568 patients and providing 222,532 days of care during the year, and supporting numerous programs designed to serve the health needs of the area. Honoring its commitment to serving the health care needs of the region regardless of patient ability to pay, Carilion provided extensive uncompensated care. Stated at cost, charity, charity-eligible bad debt, and unreimbursed Medicaid costs for the year exceeded $82.7 million. 181142787 1 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 710 0 1 1608 1 1 1 1 CA CJ EI 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X X The Corporation 5402245112 213 S Jefferson St Roanoke VA 24011 Jeanne Armentrout 50.00 0.00 X 292439 0 201588 Kerri Thornton 50.00 0.00 X 225726 0 166646 Nancy Howell Agee 50.00 0.00 X X 1124997 0 837490 Donald Halliwill 50.00 0.00 X X 261453 0 102501 G Robert Vaughan Jr 50.00 0.00 X 234629 0 107885 David Hagadorn 50.00 0.00 X 106141 0 26365 Briggs Andrews 50.00 0.00 X 387488 0 344297 Lauren Chen 50.00 0.00 X 2800 0 0 Curtis Mills 50.00 0.00 X 651222 0 194110 Melina Perdue 50.00 0.00 X 399309 0 347954 Kay Hix 50.00 0.00 X 286602 0 183495 Donna Littlepage 50.00 0.00 X 264366 0 158296 Shirley Holland 50.00 0.00 X 234275 0 189339 Donald Lorton 0.00 0.00 X 756751 0 353047 Rayburn Thompson 0.00 0.00 X 697626 0 181304 Hugh Thornhill 0.00 0.00 X 0 516527 372036 R Wayne Gandee 0.00 0.00 X 0 689694 59113 5925824 1206221 3825466 68 1 1 0 Epic Systems Corporation Box 88314 Milwaukee WI 532880314 Software Maintenance 2780418 Avaya Inc Po Box 5332 New York NY 100875332 Maintenance Contracts 1752582 Mainline Information Systems Inc PO Box 11407 Dept1659 Birmingham AL 352461659 Software Maintenance 1692496 S3 Telecom Inc PO Box 2888 Coppell TX 75019 Communications Contractor 1318058 Microsoft Corporation PO Box 844510 Dallas TX 752844510 Software Maintenance 1284198 5 Management Fees 900099 152297431 152297431 Carilion Patient Transportation S 900099 11426375 11426375 Unrelated Business Income 561000 7786294 7786294 Net Patient Revenue 900099 1518003 1518003 173028103 3068029 3068029 23287470 1596794 22598068 456010 689402 1140784 1830186 1830186 Other Affiliate Revenue 900099 9137944 9137944 Purchase Discounts 900099 271754 271754 509747 509747 9919445 187845763 175161254 7786294 4898215 2370308 2370308 4804578 4804578 86349030 85817045 531985 11395588 11395588 10010560 9850298 160262 5893080 5893080 201257 201257 819017 819017 616940 616940 61220 61220 4422 4422 9575021 9406998 168023 2080692 2080692 19078264 19028854 34763 14647 11296104 11296104 7576374 5603898 1972476 729306 707476 21830 7283406 7283406 2443821 1495686 948135 Education 1240010 1239885 125 Dues & Subscriptions 1175419 633574 541845 Recruitment 754011 753570 441 Business Fees 565167 491834 73333 929835 928693 1142 187253430 181142787 6095996 14647 4188 3873 184540208 193569612 11000879 2989626 1914950 2049139 37339942 47397 3501890 3916535 6779120 7482606 154282032 124640930 25221490 29641102 794955 34857301 218453856 218464088 1261762 54348601 490813240 547369880 51844879 52361082 370204 5698371 5505281 2383877 3028646 65671765 56557830 125598892 117823043 X 365214348 429546837 365214348 429546837 490813240 547369880 X 592333 1024857 -7650657 70365956 X 0 1 X 1 0 X X X X 0 0 0 Carilion Medical Center 540506332 501(c)(3) 1 1 1 4389672 Carilion New River Valley Medical Center 540553805 501(c)(3) 0 1 1 11188963 Carilion Giles Community Hospital 540549603 501(c)(3) 0 1 1 3282466 Carilion Franklin Memorial Hospital 540480606 501(c)(3) 0 1 1 3234620 Bedford Memorial Hospital 540566100 501(c)(3) 0 1 1 0 Carilion Stonewall Jackson Hospital 540568001 501(c)(3) 0 1 1 0 Carilion Tazewell Community Hospital 546074580 501(c)(3) 0 1 1 0 7 22095721 0 1 0 0 0 0 1 60785 0 1 435 61220 0 Explanation of Lobbying Activities: Part II-B, Line 1: Portion of dues paid to American Hospital Association and Virginia Hospital and Healthcare Association spent on lobbying. 2539232 2539232 13307535 9096146 4211389 94074 80263 13811 137035508 115058821 21976687 1305683 405700 899983 29641102 Minor Investments 54289 F Investments - CCMR 90000 C Investments - CHS, INC 307544556 C Investment Minority Interest 1234605 C Investment - BRIC 33458 C Unrecorded Intercompany Losses -90492820 C 218464088 Interco Loan Receivable 50583064 Excess Unbrella Reinsurance 1112672 Other Long Term Assets 31000 Due from CCMR 1743266 Other Investments 878599 54348601 Qualified Pension Laibility 29675128 Nonqualified Pension Liability 4898840 OSLR Reserves 8013755 LAE Reserves 635819 IBRN Reserves 9663201 Losses Payable 3247400 Losses Payable-LPT 423687 56557830 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Carilion had no material unrecognized tax benefits and no adjustments to its consolidated financial statements were required as of and for the years ended September 30, 2013 and 2012. Carilion does not expect that unrecognized tax benefits will materially increase within the next 12 months. 1 Carilion New River Valley Medical Center 2900 Lamb Circle Christiansburg VA 24073 540553805 501(c)(3) 28500 Medication Assistance Program United Way of Roanoke Valley 325 Campbell Avenue Roanoke VA 24016 540535302 501(c)(3) 45793 General Support Roanoke Symphony Orchestra 128 East Campbell Ave SE Roanoke VA 24011 546016736 501(c)(3) 20000 Performance Sponsor Junior Achievement of Roanoke Valley 3433 Brambleton Avenue 202B Roanoke VA 24018 540628293 501(c)(3) 13300 General Support Southwest Virginia Ballet PO Box 3275 Roanoke VA 24015 541563448 501(c)(3) 11950 Outreach Performance Scott Robertson Memorial Junior Golf Academy 3707 Densmore Road Roanoke VA 24017 201237999 501(c)(3) 11000 General Support Project Access of the Roanoke Valley 541 Luck Avenue 230 Roanoke VA 24011 200549137 501(c)(3) 20000 General Support American Heart Association 4217 Park Place Court Glen Allen VA 23060 135613797 501(c)(3) 10750 Event Sponsorship American Cancer Society 2840 Electric Road 106A Roanoke VA 24018 580659875 501(c)(3) 15500 Event Sponsorship Virginia Western Community College PO Box 14007 Roanoke VA 24016 521200913 501(c)(3) 10000 General Support Susan G Komen for the Cure 4910 Valley View Blvd Roanoke VA 24012 562619425 501(c)(3) 10000 Event Sponsorship March of Dimes Greater Roanoke 2840 Electric Road - Suite 102A Roanoke VA 24018 131846366 501(c)(3) 10000 General Support Presbyterian Community Center 1228 Jamison Avenue SE Roanoke VA 24013 541610899 501(c)(3) 10000 Event Sponsorship JDRF International 3959 Electric Road Roanoke VA 24018 231907729 501(c)(3) 8000 Event Sponsorship SeniorNavigatorcom 7501 Boulder View Drive 201 Richmond VA 23219 541977334 501(c)(3) 8000 General Support Smith Mountain Lake Regional Chamber of Commerce 16430 Booker T Washington Hwy Moneta VA 24121 541654288 501(c)(3) 6200 Event Sponsorship The Rescue Mission of Roanoke PO Box 11525 Roanoke VA 24022 540573900 501(c)(3) 5500 Event Sponsorship National Multiple Sclerosis Society 1 Morton Drive 106 Charlotte VA 22903 540834654 501(c)(3) 5000 Event Sponsorship Virginia Amateur Sports 711C 5th Street NE Roanoke VA 24016 541500181 501(c)(3) 5000 Event Sponsorship Jefferson Center Foundation 541 Luck Avenue 221 Roanoke VA 24016 621392982 501(c)(3) 5000 Event Sponsorship RAMA Foundation PO Box 8602 Roanoke VA 24014 510218435 501(c)(3) 5000 Event Sponsorship Virgina Tech 150 Student Services Building Blacksburg VA 24061 546001805 501(c)(3) 5000 Event Sponsorship Alzheimers Association 1160 Pepsi Place - Suite 306 Charlottesville VA 22901 133039601 501(c)(3) 5000 Event Sponsorship Boys & Girls Club of SW Virginia 1714 9th Street SE Roanoke VA 24013 541867366 501(c)(3) 5000 General Support Blacksburg Country Club 1064 Clubhouse Road Blacksburg VA 24060 540536604 5000 Support of Susan B. Komen for the Cure Foundation a 501(c)(3) organization. Virgina Tech Carilion School of Medicine 1 Riverside Circle Roanoke VA 24016 264556177 501(c)(3) 1596794 General Support Mill Mountain Theatre One Market Square SE - 2nd Floor Roanoke VA 24011 540792067 501(c)(3) 5000 Event Sponsorship The Salvation Army PO Box 12088 Roanoke VA 24022 580660607 501(c)(3) 6000 Event Sponsorship SML Good Neighbors PO Box 2 Moneta VA 24121 261274000 501(c)(3) 10000 Summer Day Camp Southern VA Child Advocacy Center 1171 Franklin St Rocky Mount VA 24151 541950268 501(c)(3) 4800 Health Resources Free Clinic of NRV 215 Roanoke St Christiansburg VA 24073 510247098 501(c)(3) 45000 Operational support Roanoke Outside 111 Franklin Road SE Suite 333 Roanoke VA 24011 451648056 501(c)(3) 10000 Event sponsorship Central VA Area Agency of Aging 1613 Oakwood Street Bedford VA 24523 510189604 501(c)(3) 20000 Wheelchair Transport Free Clinic of Franklin County 490 S Main Street Rocky Mount VA 24151 541634138 501(c)(3) 20000 Operational support NRV Cares 205 W Main Street Christiansburg VA 24073 541773419 501(c)(3) 10000 Parenting Program Mental Health of America Rke Valley 10 E Church Ave 300 Roanoke VA 24015 540703132 501(c)(3) 32000 Operational support Greater Roanoke Transit 1108 Campbell Ave SE Roanoke VA 24013 540982022 Roanoke, VA 51672 Trolley service New Horizons 3716 Melrose Ave Roanoke VA 24017 541937835 501(c)(3) 20000 Nurition education Rebuilding Together Roanoke PO Box 4532 Roanoke VA 24015 541961045 501(c)(3) 10000 Safe housing Local Environmental Agriculture Project PO Box 3249 Roanoke VA 24015 271050909 501(c)(3) 10000 Double SNAP EBT Benefit Rockbridge Area Free Clinic Inc PO Box 1573 Lexington VA 24450 541642220 501(c)(3) 20000 Operational support RX Partnership 2924 Emerywood Pky Richmond VA 23294 541186937 501(c)(3) 20000 Medication assistance VA Health Care Foundation 707 E Main Street Richmond VA 23219 541639924 501(c)(3) 100000 Access to healthcare 42 1 Schedule I, Part I, Line 2 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 fo the project. By accepting a Carilion award, grantees must publicly 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 project report, a site visit for new grantees and a final program evaluation will be required for every funded project. Among other things, program evaluation will address organizational effectiveness, program impact and community benefit through collection of data measuring such items as 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 1 1 0 1 0 0 0 0 0 1 0 Jeanne Armentrout 241043 0 40455 0 10941 0 199494 0 2094 0 494027 0 0 0 Kerri Thornton 191779 0 33189 0 758 0 161824 0 4822 0 392372 0 0 0 Nancy Howell Agee 827518 0 297075 0 404 0 827266 0 10224 0 1962487 0 0 0 Donald Halliwill 218246 0 38492 0 4715 0 91348 0 11153 0 363954 0 0 0 G Robert Vaughan Jr 192198 0 34369 0 8062 0 96243 0 11642 0 342514 0 0 0 Briggs Andrews 327213 0 56811 0 3464 0 335696 0 8601 0 731785 0 0 0 Curtis Mills 223655 0 413946 0 13621 0 186208 0 7902 0 845332 0 374549 0 Melina Perdue 337912 0 58467 0 2930 0 339674 0 8280 0 747263 0 0 0 Kay Hix 238782 0 41295 0 6525 0 178292 0 5203 0 470097 0 0 0 Donna Littlepage 221509 0 37737 0 5120 0 153121 0 5175 0 422662 0 0 0 Shirley Holland 191016 0 34061 0 9198 0 178018 0 11321 0 423614 0 0 0 Donald Lorton 586044 0 170036 0 671 0 342823 0 10224 0 1109798 0 67752 0 Rayburn Thompson 0 0 697626 0 0 0 181304 0 0 0 878930 0 529467 0 Hugh Thornhill 0 0 0 516527 0 0 0 372036 0 0 0 888563 0 516527 R Wayne Gandee 0 511598 0 169645 0 8451 0 50675 0 8438 0 748807 0 0 Part I, Line 3 See Schedule O disclosure for Form 990, Part VI, Section B, Line 15 Part I, Line 4b Nancy Howell Agee $472,651 Briggs Andrews $119,656 Curtis Mills $263,875 Melina Perdue $130,244 Donald Lorton $53,644 Rayburn Thompson $453,452 Hugh Thornhill $202,629 Part I, Line 7 The organization pays annual bonus compensation to management based on scorecard performance. While the scorecard contains a formula as a basis for determining overall performance, senior managers have discretion to include additional elements in their assessment of managers reporting to them. In addition, for top management, the actual bonus awarded is in the discretion of the Carilion Clinic Compensation Committee, although it is based on the scorecard measures. 1 Nancy Howell Agee Officer Split-dollar ins. premium X 7875 192082 0 1 1 2 Briggs Andrews Officer Split-dollar ins. premium X 6220 157309 0 1 1 3 Briggs Andrews Officer Split-dollar ins. premium X 2550 130662 0 1 1 4 Keith K Hunt Former officer Split-dollar ins. premium X 19200 473983 0 1 1 5 Donald E Lorton Officer Split-dollar ins. premium X 6200 302700 0 1 1 6 Curtis Mills Officer Split-dollar ins. premium X 3000 132281 0 1 1 7 Curtis Mills Officer Split-dollar ins. premium X 2300 54500 0 1 1 8 Edward G Murphy Former Officer Split-dollar ins. premium X 17025 472871 0 1 1 9 Lucas A Snipes Former Employee Split-dollar ins. premium X 625 82886 0 1 1 10 Lucas A Snipes Former Employee Split-dollar ins. premium X 2100 49865 0 1 1 2049139 Form 990, Part VI, Section A, line 6 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, Section A, line 7a 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, Section A, line 7b 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. Form 990, Part VI, Section B, line 11 The final Form 990 was emailed or delivered in hard copy to each member of the Board of Directors several days prior to filing and Board members were encouraged to call with any questions they might have. Form 990, Part VI, Section B, line 12c A Conflict of Interest Questionnaire, along with a copy of the Policy, is sent out annually to all officers, directors, and key employees. In addition, such individuals are instructed to inform the organization of potential conflicts which arise during the year. Answers to the questionnaires are reviewed by the Internal Audit Department. Potential conflicts for officers and key employees are reviewed by an internal Conflict of Interest Committee, which follows up on any potential issues to ensure compliance with all policies of the organization. The answers for Directors are reviewed by the Carilion Clinic Audit and Compliance Committee. In addition, the governing body of the organization is provided with a list of the answers annually to make all Board members aware of potential conflicts in order to ensure compliance with policies on how to handle transactions with Board members that may involve potential conflict situations. Form 990, Part VI, Section B, line 15 Executive compensation is reviewed annually by the Carilion Clinic 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 which includes the President and Chief Executive Officer, Executive Vice Presidents, Chief Financial Officer, Chief Medical Officer and 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. This review was performed in October 2012. A similar review was last performed in October 2013.This review included a comprehensive report from an outside compensation consultant specializing in healthcare organizations. The report included a detailed comparison of total compensation and each element thereof, including base salary, bonuses and other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to a peer group of organizations similar in size and structure to the organization, which list was reviewed by the Compensation Committee. Detailed minutes of the meetings of the Compensation Committee are kept and approved at the next meeting of the Committee, setting forth the deliberations and decisions regarding the compensation of these executives. In addition, the Compensation Committee annually reviews the compensation plan and philosophy for all vice presidents and senior vice presidents, as well as all employed physicians and physicians in leadership roles. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest statement and financial statements are not generally available to the public, but are released from time to time upon request. The Articles of Incorporation are available from the Virginia State Corporation Commission. The consolidated audited financial statements of Carilion Clinic and of the Obligated Group are released annually to the local newspaper. Limited financial information is available on our website. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfers from Affiliates 42,540,664. Pension-Related Changes 27,825,292. Blue Ridge Indemnity Company LLC 76 St Paul Street Suite 500 Burlington VT 05401 270927178 Insurance VT 17023050 35451544 Carilion Services Inc Carilion Clinic Patient Transportation Services LLC PO Box 12385 Roanoke VA 24025 541864693 Transportation VA 11064328 3251664 Carilion Services Inc Carilion Professional Services LLC PO Box 12385 Roanoke VA 24025 542030773 CRNAs VA 10651364 354635 Carilion Services Inc Carilion Clinic PO Box 12385 Roanoke VA 24025 541190771 Supporting organization VA 501(c)(3) Line 11a, I N/A 0 Carilion Clinic Foundation PO Box 12385 Roanoke VA 24025 541190773 Supporting organization VA 501(c)(3) Line 11a, I N/A 0 Carilion Franklin Memorial Hospital PO Box 12385 Roanoke VA 24025 540480606 Healthcare VA 501(c)(3) Line 3 N/A 0 Carilion Giles Community Hospital PO Box 12385 Roanoke VA 24025 540549603 Healthcare VA 501(c)(3) Line 3 N/A 0 Carilion Medical Center PO Box 12385 Roanoke VA 24025 540506332 Healthcare VA 501(c)(3) Line 3 N/A 0 Carilion New River Valley Medical Center PO Box 12385 Roanoke VA 24025 540553805 Healthcare VA 501(c)(3) Line 3 N/A 0 Carilion Stonewall Jackson Hospital PO Box 12385 Roanoke VA 24025 540568001 Healthcare VA 501(c)(3) Line 3 N/A 0 Carilion Tazewell Community Hospital PO Box 12385 Roanoke VA 24025 546074580 Healthcare VA 501(c)(3) Line 3 N/A 0 CHS Inc and Subsidiaries PO Box 12385 Roanoke VA 24025 541725732 Services VA Carilion Services Inc C 164481226 275506897 1.00000 1 Carilion Clinic Medicare Resources LLC PO Box 12385 Roanoke VA 24025 263729975 Medicare HMO VA Carilion Services Inc C 48876974 18042461 1.00000 1 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 CHS Inc and Subsidiaries K 219038 Market rates CHS Inc and Subsidiaries L 13781355 Cost CHS Inc and Subsidiaries M 454497 Cost CHS Inc and Subsidiaries R 177723760 Cash Carilion Clinic Medicare Resources LLC A 2290518 Cost Carilion Clinic Medicare Resources LLC D 50583064 Cost Carilion Clinic Medicare Resources LLC L 255573 Cost Carilion Clinic Medicare Resources LLC R 90000 Cash