2014-08-13T10:37:25-05:00 2013-09-30 861065772 Deloitte Tax LLP 424 Church Street Nashville TN 37219 990 2012-10-01 540506332 CARILION MEDICAL CENTER 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 1856246897 0 X www.carilionclinic.org X 1899 VA See Schedule O.Carilion Medical Center, comprised of Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital, is committed to a common purpose of better patient care, better community health, and lower cost. One of the largest hospitals in Virginia, Carilion Roanoke Memorial Hospital is a 703-bed hospital and additional 60-bed Neonatal Intensive Care Unit. The Medical Center provides Level 1 Trauma care, medical residency and fellowship programs, and advanced specialty care. 13 6 7483 649 61940 0 3430284 8251503 922662801 1006170318 9721278 35907354 37512596 24992274 973326959 1075321449 828922 565382 0 0 457445622 486483508 0 0 381993 477968291 513804035 936242835 1000852925 37084124 74468524 979661849 1065046581 769565549 636793452 210096300 428253129 X See Schedule O.Carilion Medical Center, that includes Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital, is part of Carilion Clinic, a not-for-profit healthcare organization serving one million people in Virginia through hospitals, outpatient specialty centers and advanced primary care practices. Led by multi-specialty physician teams with a shared philosophy that puts the patient first, Carilion is committed to improving health outcomes for every patient while advancing the quality of care through medial education and research.Our mission is to improve the health of the communities we serve. 0 0 887331857 565382 1026823152 See Schedule O: 887331857 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 1 0 0 1 7483 1 1 1 1 CA CJ EI 0 0 0 1 1 0 0 0 0 X 13 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 VA X X The Corporation 5402245112 213 S Jefferson St Roanoke VA 24011 John Burton MD 50.00 0.00 X 403203 0 34140 James Cain MD 2.00 0.00 X 0 0 0 David Carson 2.00 0.00 X 0 0 0 George Cartledge III 2.00 0.00 X 0 0 0 Beth Doughty 2.00 0.00 X 0 0 0 Cynda Johnson MD 2.00 48.00 X 0 532725 69223 Stephen Musselwhite 2.00 0.00 X 0 0 0 Clifford Nottingham MD 2.00 48.00 X 0 349949 150757 Philip Shiner MD 50.00 0.00 X 203499 0 35477 Onzlee Ware 2.00 0.00 X 0 0 0 Patrice Weiss MD 50.00 0.00 X 444036 0 50494 Ralph Whatley MD 50.00 0.00 X 444630 0 62392 Damon Williams 2.00 0.00 X 0 0 0 Victor Iannello 2.00 0.00 X X 0 9441 0 R Steve Blanks 2.00 0.00 X X 0 9000 0 Nancy Howell Agee 2.00 48.00 X X 0 1124997 837490 Steve Arner 50.00 0.00 X 266239 0 77567 Thomas Denberg MD 50.00 0.00 X 0 0 0 Briggs Andrews 2.00 48.00 X 0 387488 344297 Donald Lorton 2.00 48.00 X 0 756751 353047 G Robert Vaughan Jr 2.00 48.00 X 0 234629 107885 R Wayne Gandee MD 50.00 0.00 X 689694 0 59113 Maxine Lee MD 50.00 0.00 X 267100 0 22561 Donald Halliwill 2.00 48.00 X 0 261453 102501 David Hagadorn 2.00 48.00 X 0 106141 26365 Rachel Mabe 2.00 48.00 X 0 67010 32710 Lauren Chen 2.00 48.00 X 0 2800 0 Gary Simonds MD 50.00 0.00 X 1376853 0 81789 Jonathan Carmouche MD 50.00 0.00 X 1339609 0 28203 Nicholas Qandah MD 50.00 0.00 X 1222179 0 20900 Joseph Moskal MD 50.00 0.00 X 1202806 0 46126 Cay Mierisch MD 50.00 0.00 X 1001548 0 57129 Rayburn Thompson 0.00 0.00 X 0 697626 181304 Hugh Thornhill 0.00 0.00 X 0 516527 372036 Joan Fisher MD 0.00 0.00 X 129784 0 74975 8991180 5056537 3228481 587 1 1 0 Soltas Lab Partners Group LLC PO Box 751337 Charlotte NC 28275 Laboratory Services 26318794 Siemens Medical Solutions USA Inc 51 Valley Stream Parkway Malvern PA 19355 Equipment Maintenance 3575614 Foodservice Partners of Virginia 2823 Franklin Road - Building B Roanoke VA 24014 Food Service 2049713 Anesthesiology Consultants of Virginia PO Box 13306 Roanoke VA 24032 Anesthesiology Services 1854353 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Physician Services 1847429 92 691934 128277 6806204 625088 36555 8251503 Net Patient Revenue 900099 970056949 970056949 College Tuition/Other 900099 22575914 22575914 Program-related Investments 900099 11870266 11870266 Clinical Research 900099 1065851 1065851 Other Health Eductaion 900099 601338 601338 1006170318 28029859 61940 27967919 59 59 1606363 0 1606363 1606363 1606363 788723469 12495 780818406 40122 7905063 -27627 7877436 7877436 56827 128277 66920 -10093 -10093 Other Revenues 900099 8022926 8022926 EHR Incentive Income 900099 5129791 5129791 Cafeteria & Vending Income 900099 2743170 2743170 7500117 7500117 23396004 1075321449 1026823152 61940 40184854 216792 216792 348590 348590 2880407 2880407 397113959 396709959 200411 203589 35608897 35608897 25684878 25564456 63029 57393 25195367 25195367 105452080 105452080 273870 273870 28393 28393 55116 55116 705766 705766 80824883 78936991 1885102 2790 275428 250470 24958 16859553 16605870 237634 16049 1726470 1726470 22276775 22117694 146187 12894 2332594 2274459 53443 4692 16944233 16944233 42228456 42228456 14077184 10232871 3844313 Medical Supplies 136453329 136451203 2126 Bad Debt 63637534 63637534 College Expense 4738431 4738431 Dues & Subscriptions 1936818 1685244 193931 57643 2977122 2922347 52790 1985 1000852925 887331857 113139075 381993 22574 22624 4351921 4541445 744167 1161316 121581669 148860087 1203257 416942 6091512 5180565 29234750 6465957 973940695 724721902 263180786 249218793 524032480 615949861 22055359 26213104 1000 60947 7163374 6953940 979661849 1065046581 105296871 119482454 5867148 6063277 383826690 376424317 100000 50000 274474840 134773404 769565549 636793452 X 191609666 408293768 6610725 8083452 11875909 11875909 210096300 428253129 979661849 1065046581 X 74468524 43130807 100557498 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 55116 55116 0 Explanation of Lobbying Activities: Part II-B, Line 1: Portion of dues paid to American Hospital Association, Virginia Hospital and Healthcare Association and Association of American Medical Colleges spent on lobbying. 14955835 1798131 776080 15977886 14218996 1514015 777176 14955835 14308087 540534 629626 14218995 14015347 1036467 743727 14308087 14692907 -147078 530482 14015347 0.25670 0.74330 0.00000 0 0 3616529 3616529 423671031 258682083 164988948 2690464 2451466 238998 536047307 457510430 78536877 7915364 6077923 1837441 249218793 Qualified Pension Liability 110992362 Unrealized Swap losses 23603239 Nonqualified Pension Liability 149766 Other 28037 134773404 X Description of Intended Use of Endowment Funds: Part V, Line 4: Income from the endowment funds are used for the following: (1) Pediatric programs, both internal and external and/or pediatric equipment. (2) Patient indigent care. 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. CMN Gala 73621 59646 13975 14184 150 22784 CMN Luncheon 43194 37614 5580 6028 100 12128 4 67689 31017 36672 1577 3385 650 5934 184504 128277 56227 1577 3385 20862 250 40846 66920 -10693 1 1 X 1 X 133.000000000000 1 X 1 1 0 1 1 53091237 53091237 0.05660 99709279 91103114 8606165 0.00920 152800516 91103114 61697402 0.06580 859 27212 2793917 2793917 0.00300 53 1196 31624777 9321697 22303080 0.02380 2 3162 1264300 1264300 0.00130 38 5320 442080 442080 0.00050 952 36890 36125074 9321697 26803377 0.02860 952 36890 188925590 100424811 88500779 0.09440 1 5 10000 10000 0.00000 5 9760 55545 55545 0.00010 39 1615 55232 55232 0.00010 2 50500 50500 0.00010 8 863 863 0.00000 96 1714 17364 17364 0.00000 1 500 158 158 0.00000 1 5 40825 40825 0.00000 153 13599 230487 230487 0.00030 0 22312169 1698771 222099370 214940544 7158826 X 1 1 1 Roanoke Ambulatory Surgery Center LLC Ambulatory surgery 0.48310 0.49030 2 Southwest Virginia Health Properties LLC Real estate 0.48310 0.49030 2 1 Carilion Medical Center- DBA CRMH

1906 Belleview Avenue Roanoke VA 24019

www.carilionclinic.org X X X X X X A 2 Carilion Medical Center- DBA CRCH

101 Elm Avenue Roanoke VA 24019

www.carilionclinic.org X Rehabilitation Unit; Urgent Care A Facility Group A 1 X X X X X X X X X 11 1 0 1 X X 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 87 DBA - Carilion Roanoke Memorial Rehab

2017 South Jefferson Street Roanoke VA 24153

Psych Unit, Outpatient Rehabilitation Carilion Clinic Orthopaedics

4064 Postal Drive SW Roanoke VA 24018

Orthopaedic Services Carilion Clinic - Bone and Joint Center

3 Riverside Circle 1st Floor Roanoke VA 24016

Orthopedics CSC - Brambleton

3707 Brambleton Avenue Roanoke VA 24018

Surgical Services Carilion Clinic Orthopaedics

3 Riverside Circle Roanoke VA 24016

Orthopaedic Services Carilion Clinic Cardiology

127 McClanahan Street SW Suite 300 Roanoke VA 24014

Cardiology CNRV Emergency Services

2900 Lamb Circle Christiansburg VA 24073

Emergency Physicians Carilion Breast Care Center

102 Highland Ave Ste 202 Roanoke VA 24014

Breast Care Center CSC - Roanoke

213 McClanahan Suite 404 Roanoke VA 24014

Surgical Services Carilion Cardiothoracic Surgery

2001 Crystal Spring Avenue Suite 201 Roanoke VA 24014

Cardiac Surgery Office Carilion Obstetrics and Gynecology Clini

902 South Jefferson Street Upper Level Roanoke VA 24016

Obstetrics and Gynecology CES - Franklin

180 Floyd Avenue Rocky Mount VA 24017

Emergency Physicians Carilion Clinic Neurology

3 Riverside Circle Roanoke VA 24016

Neurosciences Carilion Clinic Internal Medicine

3 Riverside Circle Roanoke VA 24016

Internal Medicine Carilion Clinic Otolaryngology

1 Riverside Circle Suite 300M Roanoke VA 24016

Otolaryngology Services CES - Bedford

1613 Oakwood St Bedford VA 24153

Emergency Physicians CES - Giles

1611 Wenonah Avenue Pearisburg VA 24134

Emergency Physicians Roanoke Athletic Club

4508 Starkey Road Roanoke VA 24018

Physical Therapy Services Carilion Dermatology

1 Riverside Circle Suite 300M Roanoke VA 24016

Dermatology Carilion Pediatric Clinic

1030 S Jefferson Street Suite 106 Roanoke VA 24016

General Pediatrics CFM Roanoke Salem

1314 Peters Creek Road Roanoke VA 24017

Family Practice Carilion Clinic Obstetrics and Gynecolog

2900 Lamb Circle Suite 202 Christiansburg VA 24073

Obstetrics and Gynecology CES - Tazewell

141 Ben Bolt Ave Tazewell VA 24651

Emergency Physicians Brambleton Radiology Services

3707 Brambleton Avenue Roanoke VA 24018

Imaging Services CFM Southeast

2145 Mount Pleasant Boulevard Roanoke VA 24014

Family Practice Carilion Prenatal Diagnostic Center

102 Highland Ave Ste 455 Roanoke VA 24014

Prenatal Testing Carilion Department of Psychiatry and Be

2900 Tyler Road Christiansburg VA 24073

Behavioral Health Carilion Clinic Ortho-Spine

3 Riverside Circle 1st Floor Roanoke VA 24016

Orthopaedic Services Botetourt Athletic Center

105 Summerfield Court Roanoke VA 24019

Outpatient Therapy Services Daleville Imaging

46 Wesley Road Daleville VA 24014

Imaging Services Carilion Center for Healthy Aging

2001 Crystal Spring Avenue Suite 302 Roanoke VA 24014

Geriatrics CFM - Salem

2102 West Main Street Salem VA 24153

Family Practice Carilion Dentistry General Surgery

2017 S Jefferson Street 2nd Floor Roanoke VA 24014

Dental Service Department of Psychiatry & Behavioral Me

213 McClanahan Street Suite 310 Roanoke VA 24014

Behavioral Health Pediatric Gastroenterology

102 Highland Avenue Suite 305 Roanoke VA 24013

Gastroenterology Carilion Dentistry Pediatric Surgery

101 Elm Avenue 1st Floor Roanoke VA 24017

Dental Service Carilion Dental Care

2017 S Jefferson Street Roanoke VA 24014

Dental Service Carilion Department of Psychiatry Roanok

2017 S Jefferson Street Roanoke VA 24014

Behavioral Health Carilion Gynecological Oncology

1 Riverside Circle Suite 300 Roanoke VA 24016

Gynecolgical Oncology Carilion Anticoagulation Clinic

1030 S Jefferson St Ste G101 Roanoke VA 24014

Anticoagulation Clinic CRMH Rheumatology Clinic

3 Riverside Circle Roanoke VA 24016

Rheumatology Salem Family Practice - Spartan Drive

150 Spartan Drive Salem VA 24153

Family Practice Breast Mammography - North

6415 Peters Creek Road Roanoke VA 24014

Breast Mammography Carilion Pulmonary Clinic

2001 Crystal Spring Avenue Suite 205 Roanoke VA 24014

Pulmonary Services Carilion Clinic Neurological Care - Roan

1030 S Jefferson Street Roanoke VA 24016

Neurosciences Carilion Pediatric Neurology

102 Highland Avenue Suite 104 Roanoke VA 24013

Neurosciences Carilion Roanoke IP Psychiatry

2017 S Jefferson Street 1st Floor Roanoke VA 24014

Physical Medicine and Rehab Carilion Pain Mgmt

3 Riverside Circle Roanoke VA 24016

Pain Mgmt Services Carilion Clinic Gastroenterology

3 Riverside Circle Roanoke VA 24016

Gastroenterology Carilion Clinic TraumaCritical Care

3 Riverside Circle Roanoke VA 24016

Surgical Services Carilion Urgent Care Westlake

35 Medical Court Hardy VA 24101

Urgent Care Carilion Child and Adolescent Psychiatry

213 McClanahan Street Suite 310 Roanoke VA 24014

Child and Adolescent Psychiatry Services Department of Psychiatry & Behavioral Me

213 McClanahan Street Suite 310 Roanoke VA 24014

Behavioral Health Pediatric Cardiology Clinic

102 Highland Avenue Suite 101 Roanoke VA 24013

Cardiology Pediatric Pulmonology

102 Highland Avenue Suite 203 Roanoke VA 24013

Pulmonology Roanoke Ambulatory Center

1102 Jefferson St Roanoke VA 24016

Surgical Services Carilion Sleep Center

1030 Jefferson Plaza Ste G100 Roanoke VA 24016

Sleep Disorder Carilion Clinic Urogynecology

1030 S Jefferson Sutie 109 Roanoke VA 24016

Urogynecological Services Carilion Clinic Pediatric Surgery Clinic

102 Highland Avenue Suite 404 Roanoke VA 24013

Surgical Services Carilion Cardiac Rehab

127 McClanahan Street Roanoke VA 24016

Cardiac Rehab Carilion ID Crystal Spring

2001 Crystal Spring Avenue Suite 301 Roanoke VA 24014

Infectious Disease Reproductive Endocrinology Clinic

102 Highland Avenue Suite 304 Roanoke VA 24013

Reproductive Endocrinology Carilion Imaging

3 Riverside Circle Roanoke VA 24016

Imaging Services CIM Crystal Spring

2001 Crystal Spring Avenue Suite 205 Roanoke VA 24014

Imaging Services Pediatric Developmental Clinic

1030 S Jefferson Street Suite 201 Roanoke VA 24016

Pediatrics Carilion Clinic Physiatry

3 Riverside Circle Roanoke VA 24016

Physical Medicine and Rehab Carilion Diabetic Education

1030 S Jefferson Suite G101 Roanoke VA 24016

Diabetic Eduation Carilion Pediatric Endocrinology Clinic

102 Highland Avenue MOB Suite 203 Roanoke VA 24013

Endocrinology Carilion Breast Care Center

1211 S Jefferson St Roanoke VA 24014

Breast Care Center Carilion Sleep Center Westlake

35 Medical Court Hardy VA 24101

Sleep Disorder Carilion Genetics

102 Highland Avenue Suite 104 Roanoke VA 24013

Genetic Counseling Carilion Surgery Westlake

35 Medical Court Hardy VA 24101

Surgical Services Carilion Cardiology Westlake

35 Medical Court Hardy VA 24101

Cardiology Services Carilion Heart Failure Clinic

127 McClanhan St Roanoke VA 24016

Heart Failure Services OBGYN Private - Roanoke

102 Highland Avenue Suite 455 Roanoke VA 24013

Obstetrics and Gynecology Carilion Clinic Cardiology

2001 Crystal Spring Ave Suite 300 Roanoke VA 24014

Cardiology Services Carilion Wound Care Center

101 Elm Ave SE Roanoke VA 24019

Wound Care Carilion Clinic Orthopaedics - NRV

2900 Lamb Circle - L 760 Christiansburg VA 24073

Orthopeadics Carilion Clinic Spine Surgery

304 Davis Street Independence VA 24348

Surgical Services Carilion Maternal Fetal Medicine

101 Elm Avenue Suite 400 Roanoke VA 24013

OB Services Community Care

101 Elm Avenue SE Roanoke VA 24013

Family Medicine Community Psychiatry

611 McDowell Avenue Roanoke VA 24016

Behavioral Health Carilion Clinic OBGYN Spartan Drive

150 Spartan Drive Salem VA 24153

Obstetrics and Gynecology Carilion Plastic Surgery

1 Riversde Circle Suite 300 Roanoke VA 24016

Plastic Surgery Carilion Clinic OBGYN Botetourt

150 Market Ridge Lane Daleville VA 24083

Obstetrics and Gynecology Carilion Imaging Professionals

1 Taylor Avenue Pearisburg VA 24134

Imaging Services Carilion Clinic Allergy and Immunology

46 Wesly Road Daleville VA 24083

Allergy Services 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 of less than $1,500. Part I, Line 6a: Information on community benefit is reported annually through a consolidated report prepared by Carilion Clinic. 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. Part I, Line 7: Ratio of cost-to-charges was used to calculate the expense.Part I, Line 7(f) calculation - Bad debt expense subtracted from total expenses for the calculation is $63,578,727. Total bad debt expense on Form 990, Part IX includes $58,807 of non-patient bad debt.Part I, Line 7e - This line is reported at actual cost. Carilion Medical Center provides education to the public about health risks and steps that can be taken to improve health. Events include regularly scheduled health screenings such as blood pressure, blood glucose and cholesterol as well as seasonal stroke, vascular, prostate and facial sun damage detection screenings. Carilion Medical Center's community health education department serves as host of the local chapter of the National Safe Kids Coalition and provides education on injury prevention to the community and other providers. In addition, Carilion Medical Center's Safe Kids Coalition coordinator provided training, through a program offered by the Virginia Department of Health on proper car seat installation for other health and safety providers free of charge. Children learn about healthcare careers through Caring Careers, an educational program for school aged children provided onsite at local schools and community centers. Carilion Medical Center provides financial and in-kind support annually to the Mission of Mercy Dental event in Roanoke. Approximately 660 residents of southwest Virginia received free dental services from volunteer dentists and Carilion Medical Center employees provided free medical screenings including health and medication histories, blood pressure, blood coagulation rates, and blood glucose levels for all patients. Additional health improvement services include non-billed clinical services for women such as mammograms and cervical cancer screenings, medical care for HIV/AIDs patients, substance abuse counseling for juveniles, and physician coverage at the Bradley Free Clinic. Additional 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 includes expenses related to support of Healthy Roanoke Valley, a collaboration of health and human service agencies developing initiatives to address priorities from the community health needs assessment completed in fiscal year 2012.Part I, Line 7f - This line is reported at actual cost. Carilion Medical Center financially supports Radford University's Bachelor of Science Nursing Program and mentors nursing students within Carilion Roanoke Memorial Hospital. Education is provided to non-employed health professionals such as school nurses, and staff who provide labor, delivery and emergency services.Part I, Line 7g - n/a.Part I, Line 7h - This line is reported at actual cost. Carilion Medical Center participates in clinical research projects which includes internal review board oversight. Additionally, community research is provided through a cancer registry to assist public health professionals in understanding and addressing the cancer burden more effectively. Information obtained is used in development of programs on cancer prevention, early detection, and successful treatment and care.Part I, Line 7i - This line is reported at actual cost. Financial contributions were made to Arthritis Foundation, Brain Injury Services, Childrens Miracle Network, CHIP of Roanoke Valley, Cystic Fibrosis Foundation, Huntington's Disease Society, International Rett Syndrome, Juvenile Diabetes, March of Dimes, Mental Health America, Multiple Sclerosis Society, Muscular Dystrophy Association, Project Access, Roanoke Area Brain Injury Connection, Susan B. Komen Foundation, Virginia Association of Free Clinics, and Virginia Public Health Association. Grant funding was provided to Child Health Investment Partnership of Roanoke Valley for operational expenses related to their early childhood home visiting program as they pair low-income children, ages birth to kindergarten-entry, with a community health nurse and family case manager for health care coordination, developmental education, kindergarten preparation and regular child assessment and monitoring; Children's Trust of Roanoke Valley Children's Trust for their regional program that provides child friendly interview room and forensic interviewer to perform interviews of children to be used by multi-disciplinary team investigating alleged child abuse cases; Rx Partnership for operations of the public-private partnership that solicits free drugs in bulk from participating pharmaceutical companies and arranges for their distribution to licensed pharmacies serving uninsured clients; Mental Health America of Roanoke Valley to increase access to mental health services for adults with no health insurance coverage or inadequate insurance for mental health care; New Horizons Healthcare for their Happy Healthy Cooks program with goal to impact dietary attitudes and increase knowledge among elementary and preschool children while inspiring them to have fun and be creative in their food choices; Local Agricultural Environment Project to double the SNAP EBT program for purchase of fresh fruit and vegetables at several local farmers markets; and United Way of Roanoke Valley for support of Healthy Roanoke Valley. In-kind support was provided to the United Way during their local fundraising campaign. Additionally, Carilion Medical Center's Emergency Department replenishes medical supplies on ambulances owned by local Emergency Medical Services organizations. Part II, Line 1 - Financial support was provided to Rebuilding Roanoke Together for remediation of houses in lower income neighborhoods.Part II, Line 2 - Financial support was provided to the Vinton Chamber of Commerce to strengthen the social and economic environment of the community; Roanoke Regional Partnership Foundation a leader in strategizing, planning, and implementing regional economic development programs and policies, the partnership aims to strengthen and market the region's assets in order to achieve a rate of economic growth that provides excellent jobs while preserving the region's quality of life; and Salem-Roanoke County Chamber of Commerce to strengthen the business climate of the community.Part II, Line 3 - Financial support was provided to the Adult Care Center of Roanoke, Apple Ridge Farm, Big Brothers Big Sisters, Boys and Girls Club, Council of Community Services, Depaul Community Resources, Down Syndrome Association, Easter Seals, Emmy Lane Foundation, Foundation for Roanoke Valley, Girls on the Run, Goodwill Industries, Healing Strides of VA, Junior Achievement of SW VA, Presbyterian Community Center, League of Older Americans, Military Family Support Center, Rescue Mission of Roanoke Valley, Ronald McDonald House, and Senior Navigator, a one-stop internet resource for information and access to community programs and services for Virginia seniors and caregivers. Grant funding was provided to Smith Mountain Lake Good Neighbors to support a summer day camp program for children in Franklin and Bedford Counties who live near or under the poverty level.Part II, Line 4 - Financial support was provided to Pathfinders for Greenways and Roanoke Valley Greenways.Part II, Line 5 - In-kind support was provided to the Human Resource Pro Bono Corps and Junior Achievement.Part II, Line 6 - In-kind support was provided through representation on Roanoke Area Youth Substance Abuse Coalition and Roanoke Prevention Alliance, a group of concerned citizens, parents, youth, teachers, police officers, business people, judges, and other caring individuals that strive to keep the youth of the Roanoke Valley and Southwest Virginia alcohol, tobacco and drug-free; Southwest Virginia Alliance for Safe Babies, a multidisciplinary working to eliminate infant injury and deaths due to abusive head trauma and sudden infant death syndrome (SIDS); and YOVASO, Youth of Virginia Speak Out About Traffic Safety, a statewide youth leadership program dedicated to saving the lives of teenage drivers through educating, encouraging and empowering teenagers to be traffic safety advocates in their schools and communities. Part II, 7 - In-kind support was provided for distribution of a newsletter on behalf of adolescent and student health services.Part II, 8 - Carilion Medical Center partnered with Goodwill Industries of the Roanoke Valley, the Department of Rehabilitative Services, Blue Ridge Behavioral Health, Blue Ridge Independent Living Center and local parent representatives to offer Project SEARCH, a one year high school transition program that provides employment and educational opportunities for individuals with significant disabilities and assist with finding long term employment in skilled positions for its participants. Part III, Line 4: Accounts receivable are reduced by an allowance for amounts that could become uncollectible in the future. Carilion 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 Carilion's collection history. Carilion collects substantially all of its third-party insured receivables, which include receivables from governmental agencies.The bad debt expense reported on Line 2 was calculated using the cost-to-charges ratio applied to the provision for bad debt reported in the financial statements.The estimated amount of bad debt expense, reported on line 3, attributable to patients eligible for charity care was determined using external credit reporting data to identify the patients that were eligible and applying the cost-to-charges ratio to the charges of the patients so identified. Sufficient information was not available to make a definite determination of their eligibility.Patient account balances are reduced by discounts allowed and payments. 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. Part VI, Line 2: Carilion Medical Center partnered with community organizations to complete a community health needs assessment and develop a strategic implementation plan during fiscal year 2012. 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. Included were representatives from 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. The majority of CHAT members serve the low-income, uninsured, underserved and other vulnerable populations in the Roanoke Valley. Additional support for this initiative was provided through a Federally Qualified Health Center Planning Grant awarded to Carilion Medical Center. Primary data was obtained through surveys and focus groups and analyzed with information acquired through secondary data sources. 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: Carilion Medical Center, comprised of two hospitals, Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital, is located in Roanoke, Virginia. Roanoke is a 1,186 square mile valley located in southwest Virginia near the Blue Ridge and Allegheny Mountains. Carilion Medical Center primarily serves approximately 252,500 residents of Roanoke City and County, Salem, Botetourt County, Craig County and the Town of Vinton. 20% of adults under age 64 and 8% of children who live in the Roanoke Valley are uninsured. Additionally, 13% of residents live below the poverty level and 13% of adults 25 years of age or older did not graduate from high school. 16% Roanoke Valley residents are 65 years of age or older. Part VI, Line 5: Carilion Medical Center includes Carilion Roanoke Memorial Hospital, one of the largest hospitals in the state of Virginia with 703 beds and an additional 60-bed Neonatal Intensive Care Unit and pediatric emergency department. With a level 1 trauma center and children's hospital, complete with pediatric emergency room, Carilion Roanoke Memorial Hospital treats residents throughout southwest Virginia. In addition to offering high-tech services, the hospital is also home to 11 residency programs and 12 fellowship programs. Carilion 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. In addition to clinical care, the hospital works to achieve its mission through the education of health professionals and the community. Any 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. Part VI, Line 6: Carilion Medical Center is wholly owned 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. Part V, Line 8 Facility Reporting Group A See below Facility 1 -- Carilion Medical Center dba CRMH 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. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 6i: In 2013, Carilion Clinic provided $25,000 for the United Way of Roanoke Valley to establish Healthy Roanoke Valley (HRV), a coalition of over 50 health and human service agencies that address the needs identified in the 2012 Roanoke CHNA. Additionally, Carilion provided in-kind support for HRV by developing a centralized database to host community health data that is shared among HRV partners to facilitate the collection of primary and secondary data. Starting in 2015, HRV partners will begin administering the community health survey annually to track the healthcare needs of the community. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 7: Carilion Medical Center (CMC) is not addressing barriers to transportation and language barriers in this implementation strategy. While these issues will be monitored, they have been determined to not be as pressing as the identified priority needs. Additionally, Carilion Medical Center provides funding to The Greater Roanoke Transit Company for a free trolley service for the community that operates in a continuous loop with stops that include Carilion Medical Center and Downtown Roanoke with goals of reducing the carbon footprint, transporting patients and staff, and enhancing the local economy by providing easier access to downtown. Also, vouchers for taxi and bus service are available for patients who are unable to afford transportation. Carilion Medical Center provides interpretive services for non-English speaking patients. During fiscal year 2013 more than $1,000,000 was expensed for these services at no cost to the patient. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 12h: Liquid assets and equity in real property. See Part III, Line 9b narrative. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 20d: All patients are charged the same amounts regardless of insurance coverage or not. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 22: All patients are charged the same facility gross charge amounts. Facility 2 -- Carilion Medical Center dba CRCH 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. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 6i: In 2013, Carilion Clinic provided $25,000 for the United Way of Roanoke Valley to establish Healthy Roanoke Valley (HRV), a coalition of over 50 health and human service agencies that address the needs identified in the 2012 Roanoke CHNA. Additionally, Carilion provided in-kind support for HRV by developing a centralized database to host community health data that is shared among HRV partners to facilitate the collection of primary and secondary data. Starting in 2015, HRV partners will begin administering the community health survey annually to track the healthcare needs of the community. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 7: Carilion Medical Center (CMC) is not addressing barriers to transportation and language barriers in this implementation strategy. While these issues will be monitored, they have been determined to not be as pressing as the identified priority needs. Additionally, Carilion Medical Center provides funding to The Greater Roanoke Transit Company for a free trolley service for the community that operates in a continuous loop with stops that include Carilion Medical Center and Downtown Roanoke with goals of reducing the carbon footprint, transporting patients and staff, and enhancing the local economy by providing easier access to downtown. Also, vouchers for taxi and bus service are available for patients who are unable to afford transportation. Carilion Medical Center provides interpretive services for non-English speaking patients. During fiscal year 2013 more than $1,000,000 was expensed for these services at no cost to the patient. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 12h: Liquid assets and equity in real property. See Part III, Line 9b narrative. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 20d: All patients are charged the same amounts regardless of insurance coverage or not. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 22: All patients are charged the same facility gross charge amounts. 1 Radford University 801 E Main Street Radford VA 24142 546001789 Virginia 86520 Nursing Education Children's Trust Foundation 541 Luck Avenue - Suite 308 Roanoke VA 24016 540235891 501(c)(3) 50000 General Support Child Health Investment Partners 1201 3rd Street Roanoke VA 24016 541566451 501(c)(3) 40000 General Support Virginia Business Higher Education 1108 E Main Street 1100 Richmond VA 23219 541827038 501(c)(3) 10000 General Support Jefferson College of Health Sciences Education Foundation 101 Elm Avenue SE Roanoke VA 24013 541637118 501(c)(3) 17622 General Support 5 0 Endowment-Funded Indigent Patient Medical Bills 28 292179 Scholarships 3 6000 Transportation Assistance 1740 50411 Schedule I, Part I, Line 2 The hospital donates funds to other 501(c)(3) charitable organizations with a similar mission. Such organizations also have community boards which oversee the expenditure of such funds. The hospital also has a grant program under which funds are granted to community organizations with a focus on children's health and well-being. A committee of Carilion Medical Center employees and an independent physician reviews the applications and selects the recipients. Recipients sign a letter of agreement that delineates the terms and objectives of the project. One mid-year project report, a site visit and a final program evaluation reports on the program's services, outcomes and budget. Schedule I, Part III, Line 1 Grant requests for indigent patients are evaluated for eligibility based on the restriction criteria placed by the grantor of the endowment, account payment status and funds available under the grant. Schedule I, Part III, Line 2 Scholarship applications are evaluated and awards made by an independent committee according to prescribed quidelines. X X 1 1 0 1 0 0 0 0 0 1 0 John Burton MD 350504 0 50143 0 2556 0 22277 0 11863 0 437343 0 0 0 Cynda Johnson MD 0 526628 0 0 0 6097 0 60432 0 8791 0 601948 0 0 Clifford Nottingham MD 0 281611 0 62944 0 5394 0 142207 0 8550 0 500706 0 0 Philip Shiner MD 168570 0 30411 0 4518 0 27841 0 7636 0 238976 0 0 0 Patrice Weiss MD 364748 0 76675 0 2613 0 38608 0 11886 0 494530 0 0 0 Ralph Whatley MD 377217 0 62323 0 5090 0 53601 0 8791 0 507022 0 0 0 Nancy Howell Agee 0 827518 0 297075 0 404 0 827266 0 10224 0 1962487 0 0 Steve Arner 220393 0 38529 0 7317 0 65892 0 11675 0 343806 0 0 0 Briggs Andrews 0 327213 0 56811 0 3464 0 335696 0 8601 0 731785 0 0 Donald Lorton 0 586044 0 170036 0 671 0 342823 0 10224 0 1109798 0 67752 G Robert Vaughan Jr 0 192198 0 34369 0 8062 0 96243 0 11642 0 342514 0 0 R Wayne Gandee MD 511598 0 169645 0 8451 0 50675 0 8438 0 748807 0 0 0 Maxine Lee MD 229533 0 35960 0 1607 0 21304 0 1257 0 289661 0 0 0 Donald Halliwill 0 218246 0 38492 0 4715 0 91348 0 11153 0 363954 0 0 Gary Simonds MD 576343 0 725376 0 75134 0 70163 0 11626 0 1458642 0 0 0 Jonathan Carmouche MD 943176 0 394335 0 2098 0 16577 0 11626 0 1367812 0 0 0 Nicholas Qandah MD 612601 0 607480 0 2098 0 9794 0 11106 0 1243079 0 0 0 Joseph Moskal MD 1011486 0 186162 0 5158 0 35020 0 11106 0 1248932 0 0 0 Cay Mierisch MD 746482 0 252428 0 2638 0 45243 0 11886 0 1058677 0 0 0 Rayburn Thompson 0 0 0 697626 0 0 0 181304 0 0 0 878930 0 529467 Hugh Thornhill 0 0 0 516527 0 0 0 372036 0 0 0 888563 0 516527 Joan Fisher MD 99523 0 28336 0 1925 0 69724 0 5251 0 204759 0 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 Donald Lorton $53,644 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 770084EQ0 2005-12-14 2245795000 Capital projects; Current Refunding of Series 2002 B-E, Costs of Issuance, B 0 0 0 B VA Small Business Industrial Development Authority of City of RoanokeVA 541300845 928101AE4 2008-07-09 12000000 Capital projects; Costs of Issuance 0 0 0 C Industrial Development Authority of the City of Roanoke VA 541106038 770082AA3 2010-10-13 93754000 Redemption of Series 2003A-C Bonds (8/03), costs of issuance 0 0 0 D Industrial Development Authority of the City of Roanoke VA 541106038 770082AE5 2012-02-09 58111000 Redemption of Series 2000 and 2002A Bonds, costs of issuance, capital projec 0 0 0 A 16844000 224795000 1385880 3239424 122261974 97907722 2007 1 0 1 1 B 11950000 107259 11842741 2009 0 0 1 1 C 93754000 1229094 95175000 1 0 1 1 D 7286000 65660589 728388 4823755 60108446 2011 0 1 1 1 A 0 1 1 0 0 0.00200 0.00200 1 0 1 B 0 0 0 0 1 0 1 C 0 0 0 0 1 0 1 D 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 1 1 UBS and Citigroup 33.000000000000 0 0 0 0 1 C 1 0 0 0 0 1 D 1 0 0 0 0 1 B 1 C 1 D 1 Schedule K Part II All bond issues- multiple entities across multiple jurisdictions; therefore, proceeds allocated to multiple hospitals. Nancy Howell Agee President/CEO 286276 Utilities purchases 0 Nancy Howell Agee President/CEO 27907885 Lab services 0 Donald Lorton EVP/Treasurer 27907885 Lab services 0 Part IV, Line (1) Nancy Howell Agee serves on the Roanoke Gas Company board and Carilion Medical Center purchases gas from Roanoke Gas Company, the gas provider in this area. Part IV, Line (2) and (3): Nancy Howell Agee and Donald Lorton serve on the Board of Solstas Lab Partners, LLC of which Carilion has a minority financial interest and from whom the organization purchases lab services. X 14 2383 sale of comparable items X 2027 sale of comparable items X 8 2125 sale of comparable items X 5 2140 sale of comparable items X Gift certificates 73 20109 sale of comparable items X Jewelry 8 3348 sale of comparable items X Misc. fundraising event items 34 4423 sale of comparable items 0 1 0 Form 990, Part I, Summary, Line 6: Within the hospital, volunteers greet and escort patients, deliver flowers, mail and newspapers, and provide clerical assistance. Through Hospice, volunteers provide respite support for caregivers, assist patients with feeding, take care of patients' pets, sing to patients, help in the hospice office, assist with fundraisers, assist with bereavement support activities, deliver birthday gifts, and record patient's life stories. Program Service Accomplishment Form 990, Part III, Line 4a Carilion Medical Center exists to serve the health care needs of its community and region, regardless of patient ability to pay. CMC admitted 36,440 patients and provided 182,071 days of care during the year. Hospital programs include provision of nursing care; an extensive cardiac and vascular program, including cardiac surgery, implants, angioplasty and heart failure programs; neurology, neurosurgery and stroke programs; labor and delivery services (delivering 3,408 babies); the area's only neonatal intensive care unit; inpatient and outpatient psychiatric services; a comprehensive rehabilitation unit; extensive outpatient and inpatient surgical and endoscopic services; oncology services; geriatric services; and diagnostic imaging services including CT, MRI, PET, and mammography. Housing a childrens specialty wing, CMC provides specialists in pediatric neurosurgery, cardiology, oncology, gastroenterology, pulmonology, and child development, among others. CMC is a Level I trauma center, providing full trauma services to the region. CMC provides a number of services targeting the specific health needs of the area, including diabetes management; home health and hospice; physical, speech, and occupational therapy programs; and cardiac and respiratory rehab. CMC also provides an emergency department with 24-hour care, emergency transportation, a pediatric department, and chest pain and stroke protocol programs. With 78,059 visits, CMC's emergency 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 22% percent of ED visits. CMC's urgent care centers also provide access points for cost effective care at an appropriate level. CMC employs a number of specialty physicians to ensure an effective, integrated approach to serving its patients; including pulmonologists, oncologists, obstetricians, orthopedic surgeons, cardiologists, neurosurgeons, general surgeons, and psychiatrists. As a teaching hospital with over 350 full-time faculty members, CMC hosts residency programs in family medicine, internal medicines, obstetrics and gynecology, psychiatry, general surgery, neurosurgery. In addition, the Jefferson College of Health Sciences, a division of CMC, offers nursing, physician assistant, occupational therapy, and other high-need programs. CMC also supports community screenings and education on chronic disease prevention and management, sponsoring 859 events touching over 27,212 people. CMC supports a cancer registry program, and participates in a number of other research projects. In furtherance of its mission, CMC provides extensive uncompensated care. Stated at cost, charity, charity-eligible bad debt, and unreimbursed Medicaid costs for the year exceeded $63.2 million. 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 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 A draft copy of the Form 990 was provided to the Audit and Compliance Committee of Carilion Clinic in advance of its August meeting and reviewed with Committee members at that meeting. 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 web site and in our annual report to the community. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer to affiliates -4,389,672. Transfer to Carilion Clinic for effect of pension-related changes 103,756,170. Distribution from CSJH to CMC 1,191,000. The Center For Surgical Excellence LLC PO Box 12385 Roanoke VA 24025 562595597 Inactive VA 0 0 N/A Odyssey IV LLC PO Box 12385 Roanoke VA 24025 562354974 Inactive VA 0 0 N/A RMH Emergency Service LLC PO Box 12385 Roanoke VA 24025 541686589 Physician billing VA 0 0 N/A 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 New River Valley Medical Center PO Box 12385 Roanoke VA 24025 540553805 Healthcare VA 501(c)(3) Line 3 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 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 Jefferson College of Health Sciences Education Foundation PO Box 12385 Roanoke VA 24025 541637118 Fundraising for Carilion Medical Center VA 501(c)(3) Line 11b, II N/A 0 Roanoke Ambulatory Surgery Center LLC 1102 Jefferson Street SE Roanoke VA 24016 010691564 Surgery VA Related 1092348 107365 0 0 0.51800 0 0 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 0