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and external and/or purchase of pediatric equipment and indigent care patients. X 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, 2012 and 2011. Carilion does not expect that unrecognized tax benefits will materially increase within the next 12 months. expect that unrecognized tax benefits will materially increase within the next 12 months. 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1906 Belleview Avenue Roanoke VA 24019

X X X X X 2 Carilion Medical Center- DBA- Carilion Roanoke Community Hospital

101 Elm Avenue Roanoke VA 24011

X Rehabilitation Unit Urgent Care Carilion Medical Center- DBA- Carilion Roanoke Memorial Rehab 1 Carilion Clinic Orthopaedics 2 Carilion Clinic - Bone and Joint Center 3 CSC - Brambleton 4 Carilion Clinic Orthopaedics 5 Carilion Clinic Cardiology 6 CNRV Emergency Services 7 Carilion Breast Care Center 8 CSC - Roanoke 9 Carilion Cardiothoracic Surgery 10 Carilion Obstetrics and Gynecology Clinic 11 CES - Franklin 12 Carilion Clinic Neurology 13 Carilion Clinic Internal Medicine 14 Carilion Clinic Otolaryngology 15 CES - Bedford 16 Carilion Pain Management 17 CES - Giles 18 Roanoke Athletic Club 19 Carilion Dermatology 20 Carilion Pediatric Clinic 21 CFM Roanoke Salem 22 Carilion Clinic Obstetrics and Gynecology - NRV 23 CES - Tazewell 24 Brambleton Radiology Services 25 CFM Southeast 26 Carilion Clinic Trauma Critical Care 27 Carilion Prenatal Diagnostic Center 28 Carilion Department of Psychiatry and Behavioral Medicine 29 Carilion Clinic Ortho-Spine 30 Botetourt Athletic Center 31 Daleville Imaging 32 Carilion Center for Healthy Aging 33 CFM - Salem 34 Carilion Dentistry General Surgery 35 Department of Psychiatry & Behavioral Medicine 36 Pediatric Gastroenterology 37 Carilion Dentistry Pediatric Surgery 38 Carilion Dental Care 39 Carilion Department of Psychiatry Roanoke 40 Carilion Gynecological Oncology 41 Carilion Anticoagulation Clinic 42 CRMH Rheumatology Clinic 43 Salem Family Practice - Spartan Drive 44 Breast Mammography - North 45 Carilion Pulmonary Clinic 46 Carilion Clinic Neurological Care - Roanoke 47 Carilion Pediatric Neurology 48 Carilion Roanoke IP Psychiatry 49 Carilion Clinic Gastroenterology 50 Carilion Urgent Care Westlake 51 Carilion Child and Adolescent Psychiatry 52 Department of Psychiatry & Behavioral Medicine 53 Pediatric Cardiology Clinic 54 Pediatric Pulmonology 55 Roanoke Ambulatory Center LLC 56 Carilion Sleep Center 57 Carilion Clinic Urogynecology 58 Carilion Clinic Pediatric Surgery Clinic 59 Carilion Cardiology Westlake 60 Carilion Cardiac Rehab 61 Carilion ID Crystal Spring 62 Reproductive Endocrinology Clinic 63 Carilion Imaging 64 CIM Crystal Spring 65 Pediatric Developmental Clinic 66 Carilion Clinic Physiatry 67 Carilion Diabetic Education 68 Carilion Pediatric Endocrinology Clinic 69 Carilion Breast Care Center 70 Carilion Sleep Center Westlake 71 Carilion Genetics 72 Carilion Clinic Cardiology 73 Carilion Surgery Westlake 74 Carilion Wound Care Center 75 Carilion Heart Failure Clinic 76 OB-GYN Private - Roanoke 77 Carilion Clinic Orthopeadics- NRV 78 Carilion Clinic Spine Surgery 79 Carilion Maternal Fetal Medicine 80 Community Care 81 81 Carilion Medical Center- DBA- Carilion Roanoke Memorial Rehab

2017 South Jefferson Street Roanoke VA 24011

Rehabilitation Unit Urgent Care Carilion Clinic Orthopaedics

4064 Postal Drive SW Roanoke VA 24018

Psych Unit Outpatient Rehabilitation Carilion Clinic - Bone and Joint Center

3 Riverside Circle 1st Floor Roanoke VA 24016

Orthopaedic Services CSC - Brambleton

3707 Brambleton Avenue Roanoke VA 24018

Orthopedics Carilion Clinic Orthopaedics

3 Riverside Circle Roanoke VA 24014

Surgical Services Carilion Clinic Cardiology

127 McClanahan Street SW Roanoke VA 24014

Orthopaedic Services CNRV Emergency Services

2900 Lamb Circle Christiansburg VA 24073

Cardiology Carilion Breast Care Center

102 Highland Ave Ste 202 Roanoke VA 24014

Emergency Physicians CSC - Roanoke

213 McClanahan Suite 404 Roanoke VA 24014

Breast Care Center Carilion Cardiothoracic Surgery

2001 Crystal Spring Avenue Roanoke VA 24014

Surgical Services Carilion Obstetrics and Gynecology Clinic

902 South Jefferson Street Roanoke VA 24016

Cardiac Surgery Office CES - Franklin

180 Floyd Avenue Rocky Mount VA 24017

Obstetrics and Gynecology Carilion Clinic Neurology

3 Riverside Circle Roanoke VA 24016

Emergency Physicians Carilion Clinic Internal Medicine

3 Riverside Circle Roanoke VA 24016

Neurosciences Carilion Clinic Otolaryngology

1 Riverside Circle Suite 300M Roanoke VA 24016

Internal Medicine CES - Bedford

1613 Oakwood St Bedford VA 24153

Otolaryngology Services Carilion Pain Management

3 Riverside Circle Roanoke VA 24016

Emergency Physicians CES - Giles

1611 Wenonah Avenue Pearisburg VA 24134

Pain Management Services Roanoke Athletic Club

4508 Starkey Road Roanoke VA 24018

Emergency Physicians Carilion Dermatology

1 Riverside Circle Suite 300M Roanoke VA 24018

Physical Therapy Services Carilion Pediatric Clinic

1030 S Jefferson Street Suite 106 Roanoke VA 24014

Dermatology CFM Roanoke Salem

1314 Peters Creek Road Roanoke VA 24014

General Pediatrics Carilion Clinic Obstetrics and Gynecology - NRV

2900 Lamb Circle Suite 202 Christiansburg VA 24073

Family Practice CES - Tazewell

141 Ben Bolt Ave Tazewell VA 24651

Obstetrics and Gynecology Brambleton Radiology Services

3707 Brambleton Avenue Roanoke VA 24016

Emergency Physicians CFM Southeast

2145 Mount Pleasant Boulevard Roanoke VA 24014

Imaging Services Carilion Clinic Trauma Critical Care

3 Riverside Circle Roanoke VA 24016

Family Practice Carilion Prenatal Diagnostic Center

102 Highland Ave Ste 455 Roanoke VA 24014

Surgical Services Carilion Department of Psychiatry and Behavioral Medicine

2900 Tyler Road Christiansburg VA 24073

Prenatal Testing Carilion Clinic Ortho-Spine

3 Riverside Circle 1st Floor Roanoke VA 24017

Behavioral Health Botetourt Athletic Center

105 Summerfield Court Roanoke VA 24019

Orthopaedic Services Daleville Imaging

46 Wesley Road Daleville VA 24073

Outpatient Therapy Services Carilion Center for Healthy Aging

2001 Crystal Spring Avenue Roanoke VA 24014

Imaging Services CFM - Salem

2102 West Main Street Salem VA 24153

Geriatrics Carilion Dentistry General Surgery

2017 S Jefferson Street 2nd Floor Roanoke VA 24014

Family Practice Department of Psychiatry & Behavioral Medicine

213 McClanahan Street Suite 310 Roanoke VA 24014

Dental Service Pediatric Gastroenterology

102 Highland Avenue Suite 305 Roanoke VA 24014

Behavioral Health Carilion Dentistry Pediatric Surgery

101 Elm Avenue 1st Floor Roanoke VA 24017

Gastroenterology Carilion Dental Care

2017 S Jefferson Street Roanoke VA 24014

Dental Service Carilion Department of Psychiatry Roanoke

2017 S Jefferson Street Roanoke VA 24014

Dental Service Carilion Gynecological Oncology

1 Riverside Circle Suite 300 Roanoke VA 24016

Behavioral Health Carilion Anticoagulation Clinic

1030 S Jefferson St Ste G101 Roanoke VA 24014

Gynecological Oncology CRMH Rheumatology Clinic

3 Riverside Circle Roanoke VA 24016

Anticoagulation Clinic Salem Family Practice - Spartan Drive

150 Spartan Drive Salem VA 24153

Rheumatology Breast Mammography - North

6415 Peters Creek Road Roanoke VA 24014

Family Practice Carilion Pulmonary Clinic

2001 Crystal Spring Avenue Roanoke VA 24014

Breast Mammography Carilion Clinic Neurological Care - Roanoke

1030 S Jefferson Street Roanoke VA 24016

Pulmonary Services 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

Neurosciences Carilion Clinic Gastroenterology

3 Riverside Circle Roanoke VA 24016

Physical Medicine and Rehab Carilion Urgent Care Westlake

35 Medical Court Hardy VA 24101

Gastroenterology Carilion Child and Adolescent Psychiatry

213 McClanahan Street Suite 310 Roanoke VA 24014

Urgent Care Department of Psychiatry & Behavioral Medicine

213 McClanahan Street Suite 310 Roanoke VA 24014

Child and Adolescent Psychiatry Services Pediatric Cardiology Clinic

102 Highland Avenue Suite 101 Roanoke VA 24013

Behavioral Health Pediatric Pulmonology

102 Highland Avenue Suite 203 Roanoke VA 24013

Cardiology Roanoke Ambulatory Center LLC

1102 Jefferson Street Roanoke VA 24016

Pulmonology Carilion Sleep Center

1030 Jefferson Plaza Suite G100 Roanoke VA 24016

Surgical Services Carilion Clinic Urogynecology

1030 S Jefferson Suite 109 Roanoke VA 24016

Sleep Disorder Carilion Clinic Pediatric Surgery Clinic

102 Highland Avenue Suite 404 Roanoke VA 24013

Urogynecological Services Carilion Cardiology Westlake

35 Medical Court Hardy VA 24101

Surgical Services Carilion Cardiac Rehab

127 McClanahan Street Roanoke VA 24016

Cardiolgy Services Carilion ID Crystal Spring

2001 Crystal Spring Avenue Roanoke VA 24014

Cardiac Rehab Reproductive Endocrinology Clinic

102 Highland Avenue Suite 304 Roanoke VA 24013

Infectious Disease Carilion Imaging

3 Riverside Circle Roanoke VA 24016

Reproductive Endocrinology CIM Crystal Spring

2001 Crystal Spring Avenue Roanoke VA 24014

Imaging Services Pediatric Developmental Clinic

1030 S Jefferson Street Suite 201 Roanoke VA 24016

Imaging Services Carilion Clinic Physiatry

3 Riverside Circle Roanoke VA 24016

Pediatrics Carilion Diabetic Education

1030 S Jefferson Suite G101 Roanoke VA 24016

Physical Medicine and Reahb Carilion Pediatric Endocrinology Clinic

102 Highland Avenue MOB Roanoke VA 24013

Diabetic Eduation Carilion Breast Care Center

1211 S Jefferson St Roanoke VA 24014

Endocrinology Carilion Sleep Center Westlake

35 Medical Court Hardy VA 24101

Breast Care Center Carilion Genetics

102 Highland Avenue Suite 104 Roanoke VA 24013

Sleep Disorder Carilion Clinic Cardiology

2001 Crystal Spring Ave Suite 300 Roanoke VA 24014

Genetic Counseling Carilion Surgery Westlake

35 Medical Court Hardy VA 24101

Cardiolgy Services Carilion Wound Care Center

101 Elm Avenue SE Roanoke VA 24019

Surgical Services Carilion Heart Failure Clinic

127 McClanhan St Roanoke VA 24016

Wound Care OB-GYN Private - Roanoke

102 Highland Avenue Suite 455 Roanoke VA 24013

Heart Failure Services Carilion Clinic Orthopeadics- NRV

2900 Lamb Circle L760 Christiansburg VA 24073

Obstetrics and Gynecology Carilion Clinic Spine Surgery

304 Davis Street Indenpendence VA 24348

Orthopeadics Carilion Maternal Fetal Medicine

101 Elm Avenue Suite 400 Roanoke VA 24013

Surgical Services Community Care

101 Elm Avenue Roanoke VA 24013

OB Services Part I line 3c n/a 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 Clinics website. Part I line 7 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. 23,133 people were touched during 689 events that 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. Each Saturday morning Physicians on Foot, a program that encourages physical activity in the community, is led by a local primary care physician who walks with participants for two miles on a local greenway near the Roanoke River. Part I line 7 7e CONTINUED Carilion Medical Centers 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 fiscal year 2012, 326 individuals received car seat education or car seat safety checks during 34 events. In addition, Carilion Medical Centers 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. Approximately 1,000 children learned about healthcare careers through Caring Careers, an educational program for school aged children provided onsite at local schools and community centers. Part I line 7 7e CONTINUED Carilion Medical Center provides financial and in-kind support annually to the Mission of Mercy Dental event in Roanoke. Approximately 1,000 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. Part I line 7 7e CONTINUED 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 completion of the community health needs assessment and strategic implementation plan. Part I line 7 7f - This line is reported at actual cost. Carilion Medical Center financially supports Radford Universitys 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 7 7g - N/A Part I line 7 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 7 7i - This line is reported at actual cost. Financial contributions were made to the Susan B. Komen Breast Cancer Foundation, Project Access of Roanoke Valley, Presbyterian Community Center, Muscular Dystrophy Association, Mental Health America of Roanoke Valley, Juvenile Diabetes Research Foundation, International Rett Syndrome Foundation, Fibrosis Foundation, Child Health Investment Partnership of Roanoke Valley, Childrens Trust, Brain Injury Services, Arthritis Foundation, American Red Cross, American Heart Association and American Cancer Society. Part I line 7 7i CONTINUED - 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 Childrens Trust of Roanoke Valley 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 Part I line 7 7i CONTINUED - 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 and 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. The unique curriculum exposes children to a healthy lifestyle and healthy eating patterns at an early age, and offers them skills to make healthier choices. In-kind support was provided to the United Way during their local fundraising campaign. Additionally, Carilion Medical Centers Emergency Department replenishes medical supplies on ambulances owned by local Emergency Medical Services organizations. Part I line 7 Ratio of cost-to-charges was used to calculate the expense. Part I line 7 Column f - Bad debt expense subtracted from total expenses for the calculation is 52,025,328. 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 regions assets in order to achieve a rate of economic growth that provides excellent jobs while preserving the regions quality of life Salem-Roanoke County Chamber of Commerce to strengthen the business climate of the community and New Century Technology Council, a non-profit member-driven association of businesses and organizations in the greater Roanoke-Blacksburg region focused on building a technology community that is a catalyst for innovation, inspiration, success, and leadership within the region. Part II Line 2 CONTINUED - A grant was provided to 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 and enhancing the local economy by providing easier access to downtown. Part II Line 3 - Financial support was provided to the West End Center for Youth, a positive and nurturing child development community that enables local families and children with limited resources to lead more self-determined and enriched lives Total Action Against Poverty, to encourage self-reliance and self-determination by strengthening and empowering individuals, families and communities the Salvation Army for their womens shelter Senior Navigator, a one-stop internet resource for information and access to community programs and services for Virginia seniors and caregivers Roanoke Rescue Mission for their annual Back to School Blast, an event with other local non-profits and corporate sponsors to provide backpacks, school supplies and free haircuts for low-income children Part II Line 3 CONTINUED - Junior Achievement of SW Virginia, dedicated to giving young people the knowledge and skills they need to own their own economic success, plan for the future, and make smart academic and economic choices Goodwill Industries, to help people with disabilities and disadvantages overcome barriers to employment Foundation for Roanoke Valley to enhance funding of outreach programs and the Boys Girls Club, to enable and inspire all young people, especially those who need us most, to realize their full potential as productive, caring, responsible citizens.. 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 - N/A Part II Line 5 - N/A 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 Line 7 - N/a Part II Line 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 Carilions collection history. Part III line 4 CONTINUED Carilion collects substantially all of its third-party insured receivables, which include receivables from governmental agencies. Part III line 4 CONTINUED 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. Part III line 4 CONTINUED 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. Part III line 4 CONTINUED 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. Our Charity Care Policy is designed to allow relief of all or part of the charges that exceed a patients 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. Part III line 9b CONTINUED Together, the family income, number of family members living on that income, 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 400 percent of FPG with no more than 100,000 equity in real property are eligible for a Charity Care discount. Part III line 9b CONTINUED To apply for the Charity Care program complete a Financial Needs Assessment Questionnaire or contact our Billing Customer Service team with questions. 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. Part III line 9b CONTINUED The Charity Care Policy should have no impact on the collection policies and practices with regard to those balances that do not qualify for charity care. Failure to honor payment for amounts exceeding the charity adjustment may result in the total charity care being revoked. 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. Part V Section B, Line 3 CONTINUED 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, Part V Section B, Line 3 CONTINUED and 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, Part V Section B, Line 3 CONTINUED and Roanoke Redevelopment Housing Authority, Salem Veterans Administration Medical Center and the United Way of the Roanoke Valley. Part V Section B, 5a -- http//issuu.com/carilionclinic/docs/roanokevalleycommunityhealthneedsassessmente2081807/2271985 Part V Section B, 5c -- A community forum was held in August 2012 to present the results of the needs assessment to the public. Part V Section B, Line 7 -- Carilion Medical Center is not addressing barriers to transportation and language barriers in this implementation strategy. Part V Section B, Line 7 CONTINUED 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 Part V Section B, Line 7 CONTINUED and Downtown Roanoke with goals of reducing the carbon footprint and enhancing the local economy by providing easier access to downtown. Part V Section B, Line 7 CONTINUED 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 2012 more than 900,000 was expensed for these services at no cost to the patient. Part V Line 19d The maximum amount that can be charged to FAP-eligible individuals for necessary care is as follows Individuals at or below 100 of the Federal Poverty Guidelines FPG are eligible for a discount of their entire account balance. Individuals at 101 to 200 of FPG are eligible for a discount of the greater of 75 of the account balance or the discount necessary to lower their remaining balance to 10 of family income. Part V Line 19d CONTINUED Individuals at 201 to 250 of the FPG are eligible for a discount of the greater of 70 of the account balance or the discount necessary to lower their remaining balance to 15 of family income. Individuals at 251 to 300 of the FPG are eligible for a discount of the greater of 55 of the account balance or the discount necessary to lower their remaining balance to 20 of family income. Part V Line 19d CONTINUED Individuals at 301 to 350 of the FPG are eligible for a discount of the greater of 40 of the account balance or the discount necessary to lower their remaining balance to 25 of family income. Individuals at 351 to 400 of the FPG are eligible for a discount of the greater of 25 of the account balance or the discount necessary to lower their remaining balance to 30 of family income. Part V --- FOR Part VI, Lines 2, 3, 4, 5, 6 and 7 See Schedule O for the supplemental information. true Mill Mountain Theatre 1 Market Square Roanoke VA 24011 540792067 501c3 22000 General Support Radford University 801 E Main St Radford VA 24142 546001789 501c3 86520 Nursing Education Virginia Tech Foundation 1872 Pratt Dr 1000 Blacksburg VA 24060 540721690 501c3 30857 VTC Research Institute Virginia Business Higher Education Council 1108 E Main St 1100 Richmond VA 23219 541827038 501c3 10000 General Support Boys & Girls Clubs of Southwest Virginia Address1714 9TH St SE Roanoke VA 24013 541867366 501c3 7500 General Support Child Health Investment Partnership 1201 3rd St Roanoke VA 24016 541566451 501c3 20000 General Support Children's Trust Foundation 541 Luck Ave Ste 308 Roanoke VA 24016 540235891 501c3 25000 General Support Carilion Clinic Patient Transportation 431 McClanahan Roanoke VA 24014 541864693 501c3 285419 Pediatric Ambulance 8 Scholarships 6 9800 Endowment-funded indigent patient medical bills 45 328226 Patient transportation assistance 30 900 I 2 The Hospital donates funds to other 501c3 charitable organizations with a similar mission. Such organizations also have community boards which oversee the expenditure of such funds. I 2 The Hospital also has a grant program under which funds are granted to community organizations with a focus on childrens 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 report on the programs services, outcomes, budget. 1 2 Scholarship applications are evaluated and awards made by an independent committee according to prescribed guidelines. 1 2 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. X true true true true false false false false false true false William Dichtel Jr MD 216019 77530 3884 47505 3454 348392 Cynda Johnson MD 475286 88025 5940 44423 8720 622394 Clifford Nottingham MD 215932 72511 2252 106255 21054 418004 Philip Shiner MD 167459 32276 3554 26141 7155 236585 Patrice Weiss MD 345353 59776 1166 22501 12673 441469 Ralph Whatley III MD 360216 58612 3578 39526 9438 471370 Nancy Howell Agee 621900 164555 145494 538527 13009 1483485 144864 Briggs Andrews 299920 46066 2930 272403 9084 630403 Donald Lorton 486200 129425 64626 509034 19366 1208651 63526 R Wayne Gandee MD 492358 100899 7163 41592 8296 650308 Donald Halliwill 210112 33722 347 54139 11764 310084 G Robert Vaughan Jr 181941 29022 11252 50320 12068 284603 Jonathan Carmouche MD 771861 577393 809 8333 11605 1370001 Joseph Moskal MD 1033081 199887 3870 22734 11085 1270657 John Mann MD 731058 218841 2070 31807 11085 994861 Cay Mierisch MD 614643 317135 1350 26659 13083 972870 Gary Simonds MD 423388 408251 2070 48272 14409 896390 Edward Murphy MD 445000 348245 5327322 99185 19366 6239118 2503674 Mark Werner MD 74467 28435 83102 203482 3632 393118 82580 I 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. I 4b - Nancy Howell Agee 303,824, Briggs Andrews 85,406, Donald Lorton 250,129, Mark Werner 94,090. I 4a Edward Murphy 2,561,000 II 17 Edward Murphy, M.D. was employed by Carilion Clinic and related entities for 13 years, serving as President and CEO during the last 10 of those years. He left Carilion employment on June 30, 2011. Dr. Murphys 2011 base compensation for his employment during the six months of calendar 2011 is reported in column Bi. II 17 CONTINUED Bonus compensation in column B ii includes a scorecard bonus prorated for nine months of fiscal year 2011 which began on October 1, 2010 and prior period bonus accruals. In addition, Dr. Murphy was paid, or vested in, 5.3 million in other reportable compensation, reported in column B iii. II 17 CONTINUED Of that amount, 2.7 million represented retirement benefits through a pension restoration plan. Pursuant to that plan, Carilion accrued a benefit for Dr. Murphy throughout the 13 years of his employment, which benefit vested and became taxable on July 1, 2011. II 17 CONTINUED The pension restoration plan restored Dr. Murphys retirement benefit to the amount he would have received under Carilions pension plan but for restrictions imposed by the Internal Revenue Code on the amount any participant can receive from a tax qualified pension plan. II 17 CONTINUED The remaining amount in Column B iii includes ending compensation of 2.6 million received by Dr. Murphy in lieu of certain earned or expected benefits, plus some small non-taxable reimbursements and benefit plan contributions. Column C recognizes the accrual for the year of benefits under the qualified pension plan for Dr. Murphy. II 17 CONTINUED Finally, column F recognizes that, of the reportable compensation shown in column Biii, 2.5 million had previously been reported as deferred compensation on prior year Form 990s. All elements of Dr. Murphys compensation were approved by the Carilion Clinic Compensation Committee and/or Board of Directors in accordance with the process described in Schedule O in response to Form 990, Part VI, Section B, Line 15a. Industrial Development Authority of the City of Roanoke VA 541106038 770082AA3 2010-10-13 93754000 Redemptio fo Series 2003A-C bonds Costs of issuance false false false Industrial Development Authority of the City of Roanoke VA 541106038 770084EQ0 2005-12-14 224795000 Capital projects, Current Refunding of Series 2002 B-E bonds Costs of issuance, bond insurance false false false VA Small Business Financing Authority 541300845 928101AE4 2008-07-09 12000000 Capital projects Cost of issuance false false false Industrial Development Authority of the City of Roanoke VA 541106038 770082mul 2012-02-09 58111000 Redemptio of Series 2002A bonds Cost of issuance false false false 93754000 1229094 95175000 false true true 14285000 224795000 1385880 3239424 122261974 97907722 2007 true false true true 11950000 107259 11842741 2009 false false true true 3708000 58111000 728388 4823755 60108446 2011 true true true false false false false false true false true true false false 0.00200 0.00200 true false false false false true false false false false true true false false false false true true true true UBS and Citigroup 0000000027.000000000000 false false true AIG 0000000000.300000000000 true false true true true true UBS and Citigroup 0000000033.000000000000 false false false false true true X Nancy Howell Agee President/CEO 285850 Utilities purchases false Nancy Howell Agee President/CEO 30256172 lab services false Donald Lorton EVP/Treasurer 30256172 lab services false IV 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. IV 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 16 1604 sale of comparable property X 9398 sale of comparable property X 13 3800 sale of comparable property X 1 5525 Appraisal X Misc. 3236 sale of comparable property X Gift Certificates 87 26711 sale of comparable property 1 false true false Form 990 Part III 4a Carilion Medical Center exists to serve the health care needs of its community and region, regardless of patient ability to pay. CMC admitted 36,005 patients and provided 175,101 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 3,282 babies the areas 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. Form 990 Part III 4a CONTINUED 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. Form 990 Part III 4a CONTINUED With 76,117 visits, CMCs 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. CMCs 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 100 faculty members, CMC hosts residency programs in family medicine, internal medicine, obstetrics and gynecology, psychiatry, general surgery, and neurosurgery. Form 990 Part III 4a CONTINUED 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 689 events touching over 23,000 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, bad debt, and unreimbursed Medicaid costs for the year exceeded 63.7 million. Form 990 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, Form 990 2 CONTINUED 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. Form 990 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. Form 990 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 childrens 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 14 fellowship programs. Carilion Medical Center serves all patients regardless of their ability to pay. Form 990 5 CONTINUED The Hospitals 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. Form 990 6 - Carilion Medical Center is wholly owned by Carilion Clinic, a not-for-profit healthcare organization serving approximately one million people in Western Virginia through a physician specialty group, advanced primary care practices, hospitals and outpatient centers. 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. Form 990 6 CONTINUED 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. Form 990 6 CONTINUED Carilion Clinic employees 592 physicians representing more than 60 specialties who provide care at 195 practice sites. During 2012, 126 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 Masters of Science in Nursing, Physician Assistant and Occupational Therapy and 12 baccalaureate and associate healthcare programs. Approximately 900 undergraduate students and 190 graduate students are enrolled annually with 99 of undergraduates receiving some type of financial aid. Carilion Clinic and Virginia Tech Carilion School of Medicine provide graduate medical education to 215 residents and fellows. Form 990 6 CONTINUED Residency program include Emergency Medicine, Family Medicine, Internal Medicine, Neurosurgery, Obstetrics/Gynecology, Psychiatry, Surgery, Pediatrics, Podiatry and General Hospital Dentistry inaugural class July 2013. Additionally, the University of Virginia sponsors a residency program in Orthopaedics. Fellowship programs include Addiction Psychology, Adult Joint Reconstruction, Advanced Endoscopy, Cardiovascular Disease, Child and Adolescent Psychiatry, Gastroenterology inaugural class July 2013, Geriatric Medicine, Geriatric Psychiatry, Hospice and Palliative Care, Infectious Disease, Interventional Cardiology inaugural class July 2013, Medical Informatics, Orthopaedic-Hand and Pulmonary Critical Care. Form 990 6 CONTINUED Advanced Clinical Services in Cardiovascular and Vascular include a hybrid operating room, transcatheter aortic valve implantation TAVI, ventricular assist device VAD program using the Heartmate II, Medtronic CRYO balloon for atrial fibrillation epicardial ventricular tachycardia ablation, Heart Alert, therapeutic hypothermia, and Thoracic Oncology services with Pulmonary Medicine. In Neurosciences advanced services include Stroke Alert, an adult and pediatric Neurosurgery program, Neuro-interventional procedures, Brain Lab Navigation, Epilepsy Monitoring Inpatient Unit and Movement Disorders. Form 990 6 CONTINUED In Musculoskeletal, a joint replacement program, anterior approach hip replacements, computer-assisted knee replacements and advanced procedures for ankle replacements. Spine Center and Imaging Services include 64 slice CT and PET/CT, 3T MAGNETOM Verio MRI, MR Profusion and Enterography, advanced interventional procedures, and nationally-recognized Breast Care Center with large-format Pathology and digital mammography. Surgery services include plastic and reconstructive surgery, robotic-assisted surgery for cardiac, urology, and gynecology, and advanced laparoscopic techniques in general surgery. Form 990 6 CONTINUED In Pulmonary medicine, advanced interventional procedures are performed as well as thoracic oncology services. Carilion Clinic Cancer Center offers CyberKnife Stereotactic Radiosurgery for inoperable tumors, High Dose Radiation HDR Brachytherapy, Linear Accelerators with IMRT, Selective Internal Radiation SIR Spheres for treatment of liver cancer, Prostate Brachytherapy Radioactive Seed Implants and Mohs surgery. Advanced gynecologic oncology includes single site/port hysterectomy, minimally invasive surgery for gynecology, including the da Vinci Robotic Surgical System and in-office chemotherapy and industry-sponsored research trials as well as participation in National Cancer Institute sponsored research. Form 990 6 CONTINUED Advanced urogynecologic services include Interstim therapy for bladder incontinence and fecography for fecal incontinence. Carilion Clinic Childrens Hospital provides Sub-specialty physicians and clinics in surgery, cardiology, pulmonology, gastroenterology, dentistry, allergy immunology, rheumatology, orthopaedics, hematology oncology, neurosurgery, and developmental pediatrics. Additionally, neonatal and pediatric intensive care units are located within Carilion Roanoke Memorial Hospital. An inpatient childrens facility, pediatric emergency department and specialized transport team are included in this program. 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. Form 990 6 CONTINUED An additional benefit to the community is Carilion Clinics economic contribution to the region. As the areas largest employer, jobs are provided for more than 11,300 residents of the region. At the Virginia Tech Carilion VTC Research Institute, scientists are carrying out leading-edge research programs on autism, depression, post-traumatic stress disorder, traumatic brain injury, cerebral palsy, cardiovascular disease, Parkinsons disease, addiction, cancer, mental retardation, epilepsy, and infectious diseases, with state-of-the-art technologies and innovative interdisciplinary science. The research is characterized by computational and quantitative approaches, and modeling in conjunction with experimentation is a critical cornerstone. Form 990 6 CONTINUED The range of research going on today in the Institute includes facilities for a worldwide hub for interactive functional brain imaging, linking Roanoke to the United Kingdom, China, South Korea, Germany, and Norway as well as to other institutions throughout the United States, including Princeton, Caltech, and Emory University. This network, which includes the Institutes three research-dedicated magnetic resonance imaging scanners, is allowing Institute investigators to launch the worlds largest longitudinal study of brain function and decision-making. The Roanoke Brain Study will use functional imaging, genetic analysis, and behavior to uncover key aspects of human brain development in health and in a range of disorders. Form 990 Part III 1 -- 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 nearly 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 though medical education and research. Form 990 Part VI 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 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 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 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 11b -- 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 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. Form 990 Part VI 12c CONTINUED -- 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 15a and 15b -- 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 President and Chief Executive Officer, Executive Vice Presidents, which include the Chief Financial Officer and the Chief Medical Officer. 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 2011. A similar review was last performed in October 2012. Form 990 Part VI 15a and 15b CONTINUED -- 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. Form 990 Part VI 15a and 15b CONTINUED -- 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 19 -- The organizations 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. Form 990 Part VII Column B -- Directors and officers listed with less than 50 average hours per week who receive compensation from related organizations reported in column E also serve as directors and/or officers on other related organizations in the Carilion system. The difference between the hours shown in Column B and 50 hours would equal the hours worked by these individuals for related organizations. Form 990 Part XI 5 -- Other adjustments - unrealized gains on investments 34,926,844 transfer to Carilion Clinic for effect of pension-related changes 62,040,899 transfer to affiliates of 31,850,000 and transfer of property and equipment to affiliates of 8,637 for net of 58,972,692. 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 36,005 patients and provided 175,101 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 3,282 babies the areas 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. Form 990 Part III Line 4a CONTINUED 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. Form 990 Part III Line 4a CONTINUED With 76,117 visits, CMCs 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. CMCs 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 100 faculty members, CMC hosts residency programs in family medicine, internal medicine, obstetrics and gynecology, psychiatry, general surgery, and neurosurgery. Form 990 Part III Line 4a CONTINUED 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 689 events touching over 23,000 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, bad debt, and unreimbursed Medicaid costs for the year exceeded 63.7 million. Form 990 Section Schedule H, 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, Form 990 Section Schedule H, Part VI, Line 2 CONTINUED 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. Form 990 Section Schedule H, 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. Form 990 Section Schedule H, 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 childrens 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 14 fellowship programs. Carilion Medical Center serves all patients regardless of their ability to pay. Form 990 Section Schedule H, Part VI, Line 5 CONTINUED The Hospitals 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. Form 990 Section Schedule H, 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 Western Virginia through a physician specialty group, advanced primary care practices, hospitals and outpatient centers. 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. Form 990 Section Schedule H, Part VI, Line 6 CONTINUED 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. Form 990 Section Schedule H, Part VI, Line 6 CONTINUED Carilion Clinic employees 592 physicians representing more than 60 specialties who provide care at 195 practice sites. During 2012, 126 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 Masters of Science in Nursing, Physician Assistant and Occupational Therapy and 12 baccalaureate and associate healthcare programs. Approximately 900 undergraduate students and 190 graduate students are enrolled annually with 99 of undergraduates receiving some type of financial aid. 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