2014-08-13T10:14:41-05:00 2013-09-30 861065772 Deloitte Tax LLP 424 Church Street Nashville TN 37219 990 2012-10-01 540566100 BEDFORD MEMORIAL HOSPITAL BEDF 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 Patti Jurkus PO BOX 12385 ROANOKE VA 240252385 59270061 0 X www.carilionclinic.org X 1957 VA See Schedule O.Bedford Memorial Hospital, jointly owned by Carilion Clinic and Centra Health, is committed to a common purpose of better patient care, better community health, and lower cost. The 50-bed hospital includes 110 long-term care and skilled beds in the Oakwood Health and Rehabilitation Center. 19 13 466 147 0 0 79142 31917 35148099 34285410 -37022 839099 1982188 1598454 37172407 36754880 16796 14120 0 0 16987780 16815856 0 0 0 18589009 18978993 35593585 35808969 1578822 945911 30762340 31513270 21594199 15772325 9168141 15740945 X See Schedule O.The mission of Bedford Memorial Hospital, a joint venture between exempt organizations Centra and Carilion Clinic (a related party), is to improve the health of the community it serves. The hospital provides inpatient and outpatient surgery, and emergency, geriatric and rehabilitative services.Our mission is to improve the health of the communities we serve. 0 0 30505433 14120 35342851 See Schedule O.Bedford Memorial Hospital exists to serve the health care needs of its community, regardless of patient ability to pay. Bedford's acute hospital admitted 1,305 patients and provided 4,214 days of care during the year. Hospital programs include provision of nursing care; extensive outpatient and inpatient surgical and endoscopic services; and diagnostic imaging services including CT, MRI, and mammography. Bedford Memorial is also home to Oakwood Manor, a long-term care facility providing 36,522 days of skilled and intermediate care. Bedford provides a number of services targeting the specific health needs of its population, including diabetes management; home health and hospice; physical, speech, and occupational therapy programs; an adult day care center; and cardiac and respiratory rehab. Bedford also provides an emergency department with 24-hour care, emergency transportation, and a chest pain and stroke program. With 14,803 visits, Bedford's emergency department services are a critical component of the health safety net in its service area, acting as a key health provider for a significant number of uninsured patients, who comprise 19% percent of ED visits. Bedford supports community screenings and education on chronic disease prevention and management, sponsoring 114 events touching over 5,200 people. In furtherance of its mission, Bedford provides extensive uncompensated care. Stated at cost, charity, charity-eligible bad debt, and unreimbursed Medicaid costs for the year exceeded $3.2 million. 30505433 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 466 1 0 1 CA BH EI 0 0 0 0 0 0 0 0 0 X 19 13 1 1 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 David Adams 2.00 0.00 X 0 0 0 Lewis Addison 2.00 0.00 X 0 0 0 Jeanne Armentrout 2.00 48.00 X 0 292439 201588 John Bond 2.00 0.00 X 0 13500 0 Michael Bryant 2.00 0.00 X 0 0 0 Brian Buchanan MD 2.00 0.00 X 0 0 0 Paul Davenport 2.00 48.00 X 0 195288 50077 Carolyn Jacques 2.00 0.00 X 0 0 0 Charles Kolakowski 2.00 0.00 X 0 0 0 Michael LeMaster 2.00 0.00 X 0 0 0 John Mack 2.00 0.00 X 0 0 0 Curtis Mills 2.00 48.00 X 0 651222 194110 Melina Perdue 2.00 48.00 X 0 399309 347954 Deborah Shipman 2.00 0.00 X 0 0 0 Amanda Stanley 2.00 0.00 X 0 0 0 Theodore Stryker 2.00 0.00 X 0 0 0 E W Tibbs 2.00 0.00 X 0 0 0 Consuella Woods 2.00 0.00 X 0 0 0 G E Murray Jr 2.00 0.00 X X 0 0 0 Patsy Dooley 2.00 0.00 X X 0 0 0 Johnson Kerr Jr MD 2.00 48.00 X X 0 376263 60187 Timothy Hellewell MD 2.00 0.00 X X 0 0 0 Patti Jurkus 50.00 0.00 X 181280 0 152349 Donald Lorton 2.00 48.00 X 0 756751 353047 Rachel Mabe 2.00 48.00 X 0 67010 32710 Jessica Saville 50.00 0.00 X 130258 0 12414 Dana Thompson 50.00 0.00 X 129023 0 44809 Phillip Gruber 50.00 0.00 X 126297 0 58707 Georgiann Watts 50.00 0.00 X 119886 0 101749 Linda Beahm MD 0.00 50.00 X 0 180872 63072 William Flattery 0.00 50.00 X 0 235278 63154 Donna Littlepage 0.00 50.00 X 0 264366 158296 Rayburn Thompson 0.00 0.00 X 0 697626 181304 Eugene Lowe MD 0.00 50.00 X 0 262584 47491 Donald Creech 0.00 50.00 X 0 253630 58550 686744 4646138 2181568 5 1 1 0 Soltas Lab Partners Group LLC PO Box 751337 Charlotte NC 28275 Laboratory Services 1373374 Heritage Healthcare 536 Old Howell Road Greenville SC 29615 Professional Fees 700114 NurseFinders 9120 Midlothian Turnpike Richmond VA 23235 Contract Labor 193488 Centra Health 1901 Tate Springs Road Lynchburg VA 24501 Consulting 164672 Foodservice Partners of Virginia 2823 Franklin Road - Building B Roanoke VA 24014 Food Service 150098 7 500 1998 29419 31917 Net Patient Service Revenues 900099 34285410 34285410 34285410 611126 611126 498507 0 498507 498507 498507 9281423 13461731 9188359 13326822 93064 134909 227973 227973 EHR Incentive Payment 900099 1001234 1001234 Cafeteria 900099 42506 42506 Court Cost Recovery 900099 18174 18174 38033 38033 1099947 36754880 35342851 0 1380112 X 14120 14120 184045 184045 12934777 12436399 498378 1455468 1455468 1328843 1160891 167952 912723 912723 1011252 1011252 34010 34010 31450 31450 2846 2846 20830 20830 4792489 4698719 93770 65310 61944 3366 1095427 1060308 35119 136265 122806 13459 960280 886451 73829 68477 52314 16163 403331 403331 983258 983258 512434 298153 214281 Bad Debt 3052935 3052935 I/C Practice Subsidy 3011101 3011101 Medical Supplies 2673193 2671110 2083 Other Expenses 84915 40143 44772 39190 7469 31721 35808969 30505433 5303536 0 1745 1996 10660 1891 5173058 5017936 7049 13436 333152 144034 39739476 30378845 9323292 9360631 15169148 16175384 576057 665523 168179 132439 30762340 31513270 3841694 3227665 11581 25120 7850197 7295646 9890727 5223894 21594199 15772325 X 9160937 15735374 7204 5571 9168141 15740945 30762340 31513270 X 945911 1182822 4444071 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2846 2846 0 Explanation of Lobbying Activities: Part II-B, Line 1: Portion of dues paid to American Hospital Association and Virginia Hospital Healthcare Association spent on lobbying. 476378 476378 19659976 12615968 7044008 24189 24189 0 19289848 17465969 1823879 289085 272719 16366 9360631 Qualified Pension Liability 4753924 2005 Fixed Payor Swap 468518 2005 Basis Swap -38915 2010 Barclay's Swap 1452 2010 PNC Swap -6868 Swap Contra 45783 5223894 X 34865570 1182822 -3050261 -1867439 36733009 20830 1041 21871 36754880 32735203 0 32735203 20830 3052936 3073766 35808969 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Hospital has determined that it does not have any material unrecognized tax benefits or obligations as of September 30, 2013. Part XI, Line 2d - Other Adjustments: Bad Debt -3,052,935. Released from Restricted Funds 2,674. Part XI, Line 4b - Other Adjustments: Contributions from Restricted Funds 1,041. Part XII, Line 4b - Other Adjustments: Bad Debt 3,052,935. Rounding 1. 1 1 X 1 X 133.000000000000 1 X 1 1 0 1 1 1708391 1708391 0.05220 5100498 3748159 1352339 0.04130 6808889 3748159 3060730 0.09350 114 5203 58907 58907 0.00180 4 61 3682 3682 0.00010 6 3005 33543 33543 0.00100 124 8269 96132 96132 0.00290 124 8269 6905021 3748159 3156862 0.09640 8 148 2175 2175 0.00010 3 988 988 0.00000 2 10 52 52 0.00000 8 168 3847 3847 0.00010 3 58 10149 10149 0.00030 24 384 17211 17211 0.00050 0 881424 143942 10723459 10286439 437020 X 1 1 1 1 Bedford Memorial Hospital

1613 Oakwood Street Bedford VA 24523

www.carilionclinic.org X X X Bedford Memorial Hospital 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X 0 0 1 1 133.000000000000 1 400.000000000000 1 X X X X X 1 1 X X 1 X 1 X X X 1 X 0 1 3 Oakwood Manor

1613 Oakwood Street Bedford VA 24523

Nursing Home Bedford Adult Day Center

1617 Oakwood Street Bedford VA 24523

Adult Day Care Blue Ridge Cardiovascular

37 Laymantown Road Troutville VA 24175

Cardiovascular testing Part I, Line 3c: Factors Used: Use of liquid assets and equity in real property (no more than $100,000 real estate equity and liquid assets less than $1,500). Part I, Line 6a: Information on community benefit is reported annually through a consolidated report prepared by Carilon Clinic, co-owner of Bedford Memorial Hospital. Printed copies of this report are distributed throughout the communities served by hospitals affiliated with Carilion Clinic. Additionally, the community benefit report is available on Carilion's website. Part I, Line 7: Ratio of cost-to-charges was used to calculate the expense.Part I, Line 7, column (f) calculation - Bad debt expense subtracted from total expenses for the calculation is $3,052,935.7e - This line is calculated at actual cost. As part of its mission to educate the public about health risks and steps that can be taken to improve health, events included health fairs, screenings, and presentations offered at various community locations. Monthly blood pressure and blood glucose screenings are offered at several post offices in the community. These screenings provide an opportunity to educate individuals about improving health and quality of life as well as determining one's risk of developing a chronic illness. Additional health improvement services include blood drives, assistance with enrollment in public medical programs such as Medicaid and interpreter services for non-English speaking patients. Community benefit operations expense includes costs associated with completing the community health needs assessment.7f - This line is calculated at actual cost. Bedford Memorial Hospital provides internships for nursing students of Lynchburg College.7g - n/a7h - n/a.7i - This line is calculated at actual cost. Cash contributions were made to Central Virginia Alzheimer's Association and the American Cancer Society. Grant funding was provided to Bedford Ride to provide transportation for medical services. Additionally, Bedford Memorial's Emergency Department replenishes medical supplies on ambulances owned by Emergency Medical Services organizations. Part I, L7 Col(f): An allowance for uncollectible accounts is recorded based on historical bad debt experience and management's evaluation of the accounts receivable. Balances are written off after all reasonable collection efforts have been made. Accounts receivable are reduced by an allowance for amounts that could become uncollectible in the future. The Hospital estimates the allowance for doubtful accounts by reserving a percentage of all self-pay accounts receivable by aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. The percentage used to reserve for all self-pay accounts is based on the Hospital's collection history. The Hospital collects substantially all of its third-party insured receivables, which include receivables from governmental agencies. Part II: Lines 1-9:1 - n/a.2 - Bedford Memorial Hospital provided representation on the Bedford Area Chamber of Commerce Board, an organization providing leadership programs and opportunities as well as volunteer programs, networking opportunities and other business-building initiatives that focus on the critical priorities of the community to improve economic vitality and quality of life.3 - Bedford Memorial Hospital provided financial support to the Bedford Area YMCA, committed to nurturing the potential of kids, promoting healthy living and fostering a sense of social responsibility; Bedford Pregnancy Center; and The Safe Surfin' Foundation, a leading organization in preventing children from being victimized by Internet predators.4 - n/a 5 - n/a6 - Bedford Memorial Hospital, as a community asset, allows community groups to use rooms for organizational meetings.7 - Bedford Memorial Hospital provided in-kind support to Energize Bedford Community Action Coalition, a grassroots initiative made up of interested and engaged individuals, representing various organizations within Bedford City/County and from the community at large, who are committed to helping improve the health and well being of Bedford families; and the Board of Directors for Bedford Hospice House, a unique assisted living facility specializing in end-of-life care where the terminally ill can die peacefully with support and dignity.8 - Bedford Memorial Hospital serves as a Goodwill Senior Community Service Employment Program partner, offering on-the-job training and employment to help those aged 55 and older update their jobs skills, build work experience and confidence, and continue to have economic security and well-being. Additionally, resources were provided to toward the Bedford Area Chamber of Commerce's workforce development initiative. Part III, Line 8: Medicare allowable costs are determined from the Medicare cost report using the cost-to-charges ratio. The Hospital does not consider a Medicare shortfall as a community benefit. Part III, Line 9b: Carilion Clinic is committed to providing quality health care to all, regardless of their ability to pay. The Financial Assistance Policy is designed to allow relief of all or part of the charges that exceed a patient's reasonable ability to pay. Carilion uses the Federal Poverty Guidelines (FPG) published and updated yearly in the Federal Register along with a Financial Needs Assessment Questionnaire (FNAQ) as developed by Carilion to determine eligibility. Together, the family income, number of family members living on that income, liquid assets and equity in real property are pertinent factors in determining how much, in the sole judgment of Carilion, a patient is reasonably able to pay for services. Patients with family income up to 133 percent of FPG with no more than $100,000 real estate equity and liquid assets of less than $1,500 are eligible to have their entire account covered under this policy. Patients with family income up to 400 percent of the FPG and no more than $100,000 real estate equity are eligible for financial assistance discounts. Financial Assistance applicants should complete a FNAQ in order to be considered for any discount beyond the discount given to all uninsured patients. Discounts will be reduced in cases where there is more than $100,000 of real estate equity or liquid assets in excess of $1,500. Additional information may be requested as part of the qualifying process.All patients who are able will be expected to pay for their own healthcare services to avoid shifting the burden for their care to other patients and the general public. The Financial Assistance Policy should have no impact on the collection policies and practices with regard to those balances that do not qualify. Failure to honor payment arrangements on amounts exceeding the discount given may result in the total discount being revoked.All qualified financial assistance patient balances are adjusted (use Trans Union to screen all accounts to identify potential financial assistance patients). Bedford Memorial Hospital Part V, Section B, Line 3: The Roanoke Community Health Needs Assessment (RCHNA) focused on high levels of community engagement involving health and human services leaders, stakeholders, and providers; the target population; and the community as a whole. A Community Health Assessment Team (CHAT) consisting of project management staff and representatives from area health and human services, faith-based communities, and schools led the year-long initiative. The majority of CHAT members serve the low-income, uninsured, underserved and other vulnerable populations in the Roanoke Valley. Beginning in December 2011, the CHAT met monthly to oversee the RCHNA. Please see the list of organizations that served on the CHAT below: Bethany Hall, Inc., Blue Ridge Behavioral Health, Bradley Free Clinic, CHIP of the Roanoke Valley, CommunityWorks, Council of Community Services, Family Service of the Roanoke Valley, Jefferson College of Health Sciences, LOA Local Office on Aging, Mental Health America, New Horizons Healthcare, Loudon Christian Church, Planned Parenthood Health Systems, Inc., Presbyterian Community Center, Project Access, Rescue Mission Ministries- Fralin Clinic, Roanoke City Health Department, Roanoke City Public Schools, Roanoke Department of Social Services, Roanoke Redevelopment & Housing Authority, Salem Veterans Administration Medical Center and the United Way of the Roanoke Valley Bedford Memorial Hospital Part V, Section B, Line 5c: (5b)Bedford memmorial Hospital also requested that organizations represented on the CHAT make the CHNA available on their websites. Bedford Memorial Hospital Part V, Section B, Line 6i: Bedford Memorial Hospital is working with the Energize Bedford to foster a community collaboration to address issues identified in the CHNA. Bedford Memorial Hospital Part V, Section B, Line 7: Multiple other needs were identified during the CHNA process, including high cost of living and preferences for necessities, access to adult dental care, and the need for urgent care services. Bedford Memorial Hospital will not focus on those initiatives in the scope of this project due to the fact that the CHAT did not identify those issues as being the most pertinent community needs. It would not be prudent to spread limited hospital and community resources across too many initiatives. Bedford Memorial Hospital Part V, Section B, Line 12h: Other (liquid assets and equity in real property). See Part III, line 9b narrative. Bedford Memorial Hospital Part V, Section B, Line 20d: All patients are charged the same amounts regardless of insurance coverage or not. Bedford Memorial Hospital Part V, Section B, Line 22: All patients are charged the same facility gross charge amounts. Part VI, Line 3: The organization informs and educates patients by reviewing high dollar outpatient and all inpatient "self pay" accounts in order to seek eligibility for federal/state programs foremost, and then toward the Carilion Financial Assistance Program. This involves contact directly with the patient and/or the patient's representative (family, etc.). This program is available upon request for any and all services, and is available through the Carilion internet site, and is also available through the patient information pamphlet available in the patient access points. Note: The FAP is currently being evaluated by a Carilion team (Compliance, Finance and Revenue Cycle) based on 501r and IRS proposed regulations. Part of that program includes further communication efforts throughout the organization to inform patients of opportunities to assist them with their financial needs/concerns. Part VI, Line 4: Bedford Memorial Hospital primarily serves approximately 75,000 residents of Bedford City and County. Bedford encompasses 776 square miles of Piedmont Plateau in the Western Central portion of Virginia and is bordered by the Blue Ridge Mountains to the west, the James River on its northeast and Smith Mountain Lake to the south. The terrain is rolling and hilly with elevations ranging from 800 to 4,200 feet above sea level. Bedford Memorial Hospital is a 50-bed hospital that also has 110 long term care and skilled beds in its Oakwood Health and Rehabilitation Center. Bedford County is growing at a faster rate than Virginia and has larger percent of older adults. 85.5% of Bedford City and County residents have at least a high school education compared to 86.6% in Virginia. 24.4% of Bedford City and County residence have at least a college degree compared to 34.4% statewide. Bedford City has a low median household income ($34,647) compared to Bedford County ($56,021) and the state of Virginia ($63,302). Part VI, Line 5: Bedford Memorial Hospital primarily serves approximately 75,000 residents of Bedford City and County. Bedford encompasses 776 square miles of Piedmont Plateau in the Western Central portion of Virginia and is bordered by the Blue Ridge Mountains to the west, the James River on its northeast and Smith Mountain Lake to the south. The terrain is rolling and hilly with elevations ranging from 800 to 4,200 feet above sea level. Bedford Memorial Hospital is a 50-bed hospital that also has 110 long term care and skilled beds in its Oakwood Health and Rehabilitation Center. Bedford County is growing at a faster rate than Virginia and has larger percent of older adults. 85.5% of Bedford City and County residents have at least a high school education compared to 86.6% in Virginia. 24.4% of Bedford City and County residence have at least a college degree compared to 34.4% statewide. Bedford City has a low median household income ($34,647) compared to Bedford County ($56,021) and the state of Virginia ($63,302). Part VI, Line 6: Bedford Memorial Hospital is jointly owned by Carilion Clinic and Centra Health. Management is provided by Carilion Clinic, a not-for-profit healthcare organization serving approximately one million people in Virginia through a comprehensive network of hospitals, primary and specialty physician practices, and other complementary services. Carilion Clinic is based in Roanoke, Virginia and serves the residents of 18 counties and six cities in Western Virginia and southern West Virginia. Over the past six years, Carilion Clinic has gone through a dramatic and transformative change as we transitioned from a hospital system to an integrated clinic with physician leadership. At the heart of our transformation is a passion and shared purpose to meaningfully change the way healthcare is delivered and experienced, resulting in higher value and better clinical outcomes. This has propelled a commitment to each other as providers and caregivers and working together in new and different ways. To fulfill our vision, we developed a new organizational structure for shared decision making and collaboration, implemented an enterprise-wide electronic health record, became NCQA medical homes in 27 of our primary care sites, established an accountable care organization, developed population health management infrastructure and developed the Virginia Tech Carilion School of Medicine and Research Institute. Carilion Clinic employees 650 physicians representing more than 60 specialties who provide care at 220 practice sites. During 2013, 168 students were enrolled in Virginia Tech Carilion School of Medicine and there were 549 appointed faculty members. To advance education of health professionals, Jefferson College of Health Sciences, within Carilion Medical Center, is a professional health sciences college offering associate, baccalaureate, and master's degree programs. Approximately 1,040 undergraduate students and 225 graduate students are enrolled annually. Carilion Clinic and Virginia Tech Carilion School of Medicine provide graduate medical education to 237 medical residents and fellows. Residency programs include Emergency Medicine, Family Medicine, Internal Medicine, Neurosurgery, Obstetrics/Gynecology, Psychiatry, General Surgery, Pediatrics, Podiatry and General Hospital Dentistry. Fellowship programs include Addiction Psychology, Adult Joint Reconstruction, Advanced Endoscopy, Cardiovascular Disease, Child and Adolescent Psychiatry, Gastroenterology, Geriatric Medicine, Geriatric Psychiatry, Hospice and Palliative Care, Infectious Disease, Interventional Cardiology, and Pulmonary Critical Care. Advanced Clinical Technology and Programs include Cyberknife Stereotactic Radiourgery, daVinci Robotic Surgical System, 60 bed neonatal intensive care unit, hybrid operating room, Carilion Clinic Children's Hospital, Cancer Center, Spine Center, and comprehensive cardiothoracic, vascular and orthopedic surgery programs. Carilion Roanoke Memorial Hospital includes a Level One Trauma Center with EMS services that include three EMS helicopters, four first-response vehicles and 50 Advanced Life Support Ambulances. An additional benefit to the community is Carilion Clinic's economic contribution to the region. As the area's largest employer, jobs are provided for more than 11,400 residents of the region. Research conducted at the Virginia Tech Carilion Research Institute (VTCRI) creates a bridge between basic science research at Virginia Tech and clinical expertise at Carilion Clinic and increases translational research opportunities for both partners. Research conducted by scientists at the institute is aimed at understanding the molecular basis for health and disease, and development of diagnostic tools, treatments, and therapies that will contribute to the prevention and solution of existing and emerging problems in contemporary medicine. Research areas of emphasis which presently align with areas of strength and active research at Virginia Tech include inflammation, infectious disease, neuroscience, and cardiovascular science and cardiology. X X 1 1 0 1 0 0 0 0 0 1 0 Jeanne Armentrout 0 241043 0 40455 0 10941 0 199494 0 2094 0 494027 0 0 Paul Davenport 0 158891 0 27073 0 9324 0 49131 0 946 0 245365 0 0 Curtis Mills 0 223655 0 413946 0 13621 0 186208 0 7902 0 845332 0 374549 Melina Perdue 0 337912 0 58467 0 2930 0 339674 0 8280 0 747263 0 0 Johnson Kerr Jr MD 0 267864 0 105441 0 2958 0 43160 0 17027 0 436450 0 0 Patti Jurkus 153098 0 27073 0 1109 0 144096 0 8253 0 333629 0 0 0 Donald Lorton 0 586044 0 170036 0 671 0 342823 0 10224 0 1109798 0 67752 Dana Thompson 124434 0 0 0 4589 0 33105 0 11704 0 173832 0 0 0 Phillip Gruber 118932 0 0 0 7365 0 49728 0 8979 0 185004 0 0 0 Georgiann Watts 115122 0 2500 0 2264 0 98206 0 3543 0 221635 0 0 0 Linda Beahm MD 0 153741 0 25436 0 1695 0 52423 0 10649 0 243944 0 0 William Flattery 0 194398 0 34436 0 6444 0 49879 0 13275 0 298432 0 0 Donna Littlepage 0 221509 0 37737 0 5120 0 153121 0 5175 0 422662 0 0 Rayburn Thompson 0 0 0 697626 0 0 0 181304 0 0 0 878930 0 529467 Eugene Lowe MD 0 218398 0 41512 0 2674 0 37248 0 10243 0 310075 0 0 Donald Creech 0 253630 0 0 0 0 0 58550 0 0 0 312180 0 0 Part I, Line 3 See Schedule O disclosure for Form 990, Part VI, Section B, Line 15 Part I, Line 4b Curtis Mills $263,875 Melina Perdue $130,244 Donald Lorton $53,644 Rayburn Thompson $453,452 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. A Industrial Development Authority of the City of Roanoke VA 541106038 770084ES6 2005-12-14 5790000 Capital projects,Current Refunding of Series 2002 B-E, Cost of Insurance, Bo 0 0 0 B Industrial Development Authority of the City of Roanoke VA 541106038 770082AE5 2012-02-09 3451000 Redemption of Series 2000 and 2002A Bonds; Costs of insurance, capital projc 0 0 0 A 2050000 5790000 35696 83437 5670867 1 0 1 1 B 469000 3910331 43496 3866835 0 1 1 1 A 0 0 0 0 1 0 1 B 0 0 0 0 1 0 1 A 1 1 1 UBS & Citigroup 27.000000000000 0 0 1 AIG 0.300000000000 1 0 1 B 1 0 0 0 0 1 A 1 B 1 Schedule K Part II Bond proceeds All bond issues multiple entities across multiple jurisdictions; therefore, proceeds allocated to multiple hospitals. Donald Lorton Assistant Treasurer 1356336 Lab services 0 Part IV, Line (1): Donald Lorton serves on the Board of Solstas Lab Partners, LLC, of which Carilion has a minority financial interest, and from whom the organization purchases lab services. Form 990, Part VI, Section A, line 2 1. David Adams, Lewis C. Addison, George Dawson, Carolyn Jacques, David Jividen and Consuella Woods - business relationship. 2. John Bond, Paul Davenport, Donna Littlepage, Curtis Mills, Melina Perdue - business relationship. Form 990, Part VI, Section A, line 3 Certain management and related services for the organization are provided by the management and employees of Carilion Services, Inc., a related organization and supporting organization of the organization. Form 990, Part VI, Section A, line 6 The organization has two members, Centra Health, a charitable tax-exempt healthcare organization, and Carilion Clinic a charitable tax-exempt healthcare organization. Each member elects one-third of the directors of the organization and the members have certain other reserved powers. Form 990, Part VI, Section A, line 7a The organization has two members. Each member of the organization elects one class of directors representing one-third of the members of the governing body of the organization periodically as terms expire. The members also have the right to remove directors they have elected and fill any vacancies on the board that may occur among their elected directors for any reason. The remaining class of directors came from the local community and these directors elect their own successors. Form 990, Part VI, Section A, line 7b The members of the organization hold reserved powers with respect to certain enumerated actions, including appointment of CEO, approval of borrowings, budgets, certain types of contracts and strategic plans and amendments of Articles of Incorporation and Bylaws. Approval by the members 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. Other Fees Form 990, Part IX, line 11g Other Service Fees: Program service expenses 4,698,719. Management and general expenses 93,770. Fundraising expenses 0. Total expenses 4,792,489. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Pension-Related Changes 4,444,071. Form 990, Part I Summary, Line 6: Within the hospital, volunteers staff the gift shop, greet patients at the Information Desk, Visitors Lounge, and Emergency Department; work with students providing activities in the nursing home and food and nutrition staff; enter data for nutritional services and assist staff in the following departments: Chaplains Services, Physical and Occupational Therapy, Security, Transport, Business Office and Gift Shop. For Hospice, volunteers sit with the patient so family members can run errands and keep appointments. They also provide clerical support, socialization for patients in facilities, assist with yard work, and call patients before the weekend to ensure they have everything needed. Assist with Healing Arts program, assist with fundraising activities and community events. Volunteer Chaplains provide services as needed/assigned. Carilion Clinic Foundation PO Box 12385 Roanoke VA 24025 541190773 Supporting organization VA 501(c)(3) Line 11a, I N/A 0 Carilion Services Inc PO Box 12385 Roanoke VA 24025 541190879 Supporting organization VA 501(c)(3) Line 11a, I N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0