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CARILION FRANKLIN MEMORIAL HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CARILION FRANKLIN MEMORIAL HOSPITAL (EIN 54-0480606)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-14
IRS object ID
201222279349302407
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-14T13:51:43-00:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1424 Church StreetAddressLine1
CityNashvilleCity
StateTNState
ZIP Code37219ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN540480606EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Carilion Franklin Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCARINameControl
Phone5402245112Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 12385AddressLine1
CityRoanokeCity
StateVAState
ZIP Code240252385ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDonald LortonName
TitleAssistant TreasurerTitle
Date Signed2012-08-14DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameFrancis BedardName
Phone6152591811Phone
Date Prepared2012-08-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonWilliam JacobsenNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO Box 12385AddressLine1
CityRoanokeCity
StateVAState
ZIP Code24025ZIPCode
FieldValueIRS element (for citing)
Gross Receipts38310622GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.carilionclinic.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionCarilion Franklin Memorial Hospital, part of Carilion Clinic, is a not-for-profit healthcare organization committed to improving health outcomes for every patient while advancing the quality of care in the community it serves. Carilion Franklin Memorial Hospital, part of Carilion Clinic, is a not-for-profit healthcare organization committed to improving health outcomes for every patient while advancing the quality of care in the community it serves.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees363TotalNbrEmployees
Total Nbr Volunteers116TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year180661ContributionsGrantsPriorYear
Contributions Grants Current Year10221ContributionsGrantsCurrentYear
Program Service Revenue Prior Year36669870ProgramServiceRevenuePriorYear
Program Service Revenue CY34561621ProgramServiceRevenueCY
Investment Income Prior Year-192213InvestmentIncomePriorYear
Investment Income Current Year-122992InvestmentIncomeCurrentYear
Other Revenue Prior Year407084OtherRevenuePriorYear
Other Revenue Current Year2104025OtherRevenueCurrentYear
Total Revenue Prior Year37065402TotalRevenuePriorYear
Total Revenue Current Year36552875TotalRevenueCurrentYear
Grants And Similar Amnts CY62142GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year16260451SalariesEtcPriorYear
Salaries Etc Current Year15704403SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year23664517OtherExpensePriorYear
Other Expenses Current Year22396576OtherExpensesCurrentYear
Total Expenses Prior Year39924968TotalExpensesPriorYear
Total Expenses Current Year38163121TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-2859566RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1610246RevenuesLessExpensesCY
Total Assets BOY19013083TotalAssetsBOY
Total Assets EOY16246347TotalAssetsEOY
Total Liabilities BOY19427010TotalLiabilitiesBOY
Total Liabilities EOY21196503TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-413927NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-4950156NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCarilion Franklin Memorial Hospital, part of Carilion Clinic, is a not-for-profit healthcare organization committed to improving health outcomes for every patient while advancing the quality of care in the community it serves.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense31035222Expense
Grants62142Grants
Revenue36262500Revenue
DescriptionSee Schedule ODescription
Total Program Service Expense31035222TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees363NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccounttrueForeignFinancialAccount
Name Of Foreign CountryCANameOfForeignCountry
Name Of Foreign CountryCJNameOfForeignCountry
Name Of Foreign CountryICNameOfForeignCountry
Name Of Foreign CountryUKNameOfForeignCountry
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledVAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonThe OrganizationNamePerson
Telephone Number5402245112TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1213 S Jefferson Street Suite 827AddressLine1
CityRoanokeCity
StateVAState
ZIP Code24011ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Larry Heaton
Director002.00X000
Florella Johnson
Director002.00X000
Billy Kingery
Director002.00X000
David Peters
Director002.00X000
Susan Irby MD
Director050.00X013496122584
Mack Longmire III MD
Director050.00X015239632045
Jeff Powell
Director002.00X000
Chris Aylesworth PhD
Director002.00X000
Ronald Evans
President002.00X000X
Victoria Gardner
Vice President002.00X000X
William Jacobsen
CEO/Secreatry/Treasurer050.00X166216038513X
Donald Lorton
Assistant Treasurer050.000521051332850X
Rachel Mabe
Assistant Secretary050.0007094917506X
Charles Lane MD
Chief of Staff050.00X026357950872
Sharon Scott
Pharmacist050.00131185026640X
Lori McClure
Pharmacy Manager050.00125466032074X
Darrell Van Ness
Senior Director050.00109877031561X
FieldValueIRS element (for citing)
Total Reportable Comp From Org532744TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1142936TotalReportableCompFrmRltdOrgs
Total Other Compensation584645TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Carilion Labs LLC
213 S Jefferson 1202RoanokeVA24011Laboratory services1518226
Siemens Medical Solutions
51 Valley Stream PkwyMalvernPA19355Equipment and software maintenance370924
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Government Grants9071GovernmentGrants
All Other Contributions1150AllOtherContributions
Total Contributions10221TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNet Patient Service RevenuesDescription
Business Code900099BusinessCode
Total Revenue Column34561621TotalRevenueColumn
Related Or Exempt Function Income34561621RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue34561621TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column-156701TotalRevenueColumn
Exclusion-$156,701ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column91TotalRevenueColumn
Exclusion$91ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real318894Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real318894Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column318894TotalRevenueColumn
Exclusion$318,894ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1791365Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1711381Securities
Other46366Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities79984Securities
Other-46366Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column33618TotalRevenueColumn
Exclusion$33,618ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
EHR Incentive Payment90009916980351698035
Other Affiliate Income90009928442844
Miscellaneous Income90009984252$84,252
FieldValueIRS element (for citing)
Total Other Revenue1785131TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column36552875TotalRevenueColumn
Related Or Exempt Function Income36262500RelatedOrExemptFunctionIncome
Exclusion$280,154ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total62142Total
Program Services62142ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total169237Total
Program Services169237ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total12300815Total
Program Services12041990ProgramServices
Management And General258825ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total826514Total
Program Services826514ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1518516Total
Program Services1445373ProgramServices
Management And General73143ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total889321Total
Program Services889321ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total5196796Total
Management And General5196796ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total500Total
Management And General500ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total3954Total
Program Services3954ProgramServices
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1913Total
Management And General1913ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4439076Total
Program Services4367487ProgramServices
Management And General71589ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total318Total
Program Services318ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3164202Total
Program Services3132764ProgramServices
Management And General31438ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total171466Total
Program Services168548ProgramServices
Management And General2918ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total657746Total
Program Services657746ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total210583Total
Program Services201773ProgramServices
Management And General8810ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total669172Total
Program Services669172ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1449847Total
Program Services1449847ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total286769Total
Program Services190128ProgramServices
Management And General96641ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debt38843013884301
Practice Subsidy21242667715541352712
Dues Subscriptions678894039627493
Court Costs5812458124
Education707234683604

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2582Total
Program Services1065ProgramServices
Management And General1517ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total38163121Total
Program Services31035222ProgramServices
Management And General7127899ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1360BOY
EOY1399EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY10619BOY
EOY1080EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4948062BOY
EOY5172321EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY73942BOY
EOY149167EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis34455922LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec24045225LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11553445BOY
EOY10410697EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1030363BOY
EOY48468EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY653897BOY
EOY43308EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY741395BOY
EOY419907EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY19013083BOY
EOY16246347EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3280145BOY
EOY2911707EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY68252BOY
EOY76649EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY11674519BOY
EOY11339497EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4404094BOY
EOY6868650EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY19427010BOY
EOY21196503EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-459135BOY
EOY-4993192EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY45208BOY
EOY43036EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-413927BOY
EOY-4950156EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19013083BOY
EOY16246347EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1610246ReconcilationRevenueExpenses
Reconcilation Other Changes-2925983ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Pertcentage1700.00000PublicSupportPertcentage170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$3,954OtherActivitiesAmount
Total Lobbying Expenditures IIB3954TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierI-BIdentifier
Return Reference1 iReturnReference
ExplanationPortion of dues paid to American Hospital Assn. and Virginia Hospital and Healthcare Assn. spent on lobbying.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Included On FSfalseIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis226092OtherCostOrOtherBasis
Book Value226092BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis18093330OtherCostOrOtherBasis
Depreciation10197206Depreciation
Book Value7896124BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis16939OtherCostOrOtherBasis
Depreciation16939Depreciation

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis15229280OtherCostOrOtherBasis
Depreciation13167232Depreciation
Book Value2062048BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis890281OtherCostOrOtherBasis
Depreciation663848Depreciation
Book Value226433BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings10410697TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Qualifed Pension Liability$5,870,228
2001 Swap Unrealized Losses$164,487
2005 Fixed Payor Swap Unreal$816,855
2010 Barclays Swap Unreal Losses$17,080
FieldValueIRS element (for citing)
Total Of Amounts6868650TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierXIdentifier
Return Reference2ReturnReference
ExplanationCarilion 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, 2011 and 2010. Carilion does not expect that unrecognized tax benefits will materially increase within the next 12 months.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4324259TotalCommunityBenefitExpense
Net Community Benefit Expense4324259NetCommunityBenefitExpense
Percent Of Total Expense0.11330PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4289796TotalCommunityBenefitExpense
Direct Offsetting Revenue3491294DirectOffsettingRevenue
Net Community Benefit Expense798502NetCommunityBenefitExpense
Percent Of Total Expense0.02090PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense8614055TotalCommunityBenefitExpense
Direct Offsetting Revenue3491294DirectOffsettingRevenue
Net Community Benefit Expense5122761NetCommunityBenefitExpense
Percent Of Total Expense0.13420PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs204NumberOfActivitiesOrPrograms
Persons Served12851PersonsServed
Total Community Benefit Expense103876TotalCommunityBenefitExpense
Direct Offsetting Revenue258DirectOffsettingRevenue
Net Community Benefit Expense103618NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served588PersonsServed
Total Community Benefit Expense52792TotalCommunityBenefitExpense
Net Community Benefit Expense52792NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs210NumberOfActivitiesOrPrograms
Persons Served13439PersonsServed
Total Community Benefit Expense156668TotalCommunityBenefitExpense
Direct Offsetting Revenue258DirectOffsettingRevenue
Net Community Benefit Expense156410NetCommunityBenefitExpense
Percent Of Total Expense0.00410PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs210NumberOfActivitiesOrPrograms
Persons Served13439PersonsServed
Total Community Benefit Expense8770723TotalCommunityBenefitExpense
Direct Offsetting Revenue3491552DirectOffsettingRevenue
Net Community Benefit Expense5279171NetCommunityBenefitExpense
Percent Of Total Expense0.13830PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense750TotalCommunityBuildingExpense
Net Community Building Expense750NetCommunityBuildingExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served20PersonsServed
Total Community Building Expense793TotalCommunityBuildingExpense
Net Community Building Expense793NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served20PersonsServed
Total Community Building Expense1543TotalCommunityBuildingExpense
Net Community Building Expense1543NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$1,291,945BadDebtExpenseAmount
Amount Attributable To486427AmountAttributableTo
Amount Reimbursed By Medicare8908071AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare8955014CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-46943MedicareSurplusOrShortfall
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Carilion Franklin Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1180 Floyd AvenueAddressLine1
CityRocky MountCity
StateVAState
ZIP Code24151ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumber
Imaging Services
1
Imaging Services
2

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Imaging Services
35 Medical CourtHardyVA241010
Imaging Services
230 South Main StreetRocky MountVA24151CT and Radiology Service

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

IdentifierIdentifierExplanationExplanation
Part I line 3cN/A
Part I line 6aInformation 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 7gN/A
Part I line 7 column fBad debt expense subtracted from total expenses for the calculation is 3,884,301.
Part I line 7Ratio of cost-to-charges was used to calculate the expense.
Part III line 4The financial statements do not include a footnote on bad debt. The audited financial statements include a provision for bad debt. The provision is calculated based on historical bad debt experience and managements evaluation of the collectibility of the accounts receivable. Balances are written off after all reasonable collection efforts have been made.
Part III line 4Contd. 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 4Contd. 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 definitive determination of their eligibility.
Part III line 4Contd. Patient account balances are reduced by discounts allowed and payments.
Part III line 8Medicare 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 9bWhen an uninsured self pay patient registers for medically necessary services, the patients account is electronically marked as being potentially eligible for charity care. Carilion Clinics Eligibility Assistance Service EAS screens the patient to determine if charity care is appropriate. The patient must apply for all entitlement programs for which he or she may be eligible i.e. Medicaid, Social Security Disability, etc. EAS assists the patient with the applications.
Part III line 9bContd. If the patient does not qualify for one of the programs then the Federal Poverty Guidelines FPG are used to determine eligibility for charity care. A patient whose account balance is less than 1,500 and is at or below 100 of FPG is automatically given a 100 discount of their account.
Part III line 9bContd. For balances greater than 1,500 the patient must complete a Financial Assistance Application and provide appropriate documentation. A sliding scale of discounts is available for patients with incomes up to 400 of FPG.
Part III line 9bContd. An underinsured patient can apply for charity care. Applications are available at all Patient Access/Registration points, offices of EAS, Carilion Clinics Internet website or by calling for an application.
Part VN/A
Part VI Line 3The charity care policy is posted in all patient registration areas. At the time of registration all uninsured self pay patients are given a brochure explaining the charity care policy and how to apply. Also, see comments for Part III line 9b.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1CARILION CLINIC FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1213 S JEFFERSON ST 807AddressLine1
CityROANOKECity
StateVAState
ZIP Code24011ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient541190773EINOfRecipient
IRC Section501c3IRCSection
Amount Of Cash Grant53990AmountOfCashGrant
Purpose Of GrantCommunity grantsPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
Identifier1Identifier
Return Reference2ReturnReference
ExplanationAs part of the Carilion Clinic system, the organization donates funds to Carilion Clinic Foundation, which provides grants to other organizations in the Hospitals service area intended to further the health and well-being of the community. Expenditure of such funds is overseen and monitored by the Foundations independent community board.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBonus Related OrgsBonusRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Susan Irby MD
134992-31145698015157545
Mack Longmire III MD
140445-408293672267818444116033
William Jacobsen
1647278220-67311911019403204729
Donald Lorton
43680062760316614162368539012149161212
Charles Lane MD
250729-5227317951907731445118077
Sharon Scott
131082130-27246601980157825
Lori McClure
1224537219-42061816413910157540

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
I7The 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.
I4bDonald Lorton - 131,084

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
Industrial Development Authority of the City of Roanoke VA
541106038770084EK32010-10-131986000Redemptioof Series 2003A-C bonds Costs of issuancefalsefalsefalse
Industrial Development Authority of the City of Roanoke VA
541106038770084EQ02005-12-145605000Capital projects, current refunding of Series 2002 B-E bonds Costs of issuance, bond insurancefalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds1986000TotalProceeds
Issuance Costs From Proceeds26036IssuanceCostsFromProceeds
Other Spent Proceeds2075000OtherSpentProceeds
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedBusiness Name Line1NameOfGICProvider/BusinessNameLine1Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied
(no name)
truefalsefalsefalsefalsetrue
UBS & Citicorp
truetruetruetruefalsetrue0000000027.000000000000falsefalseAIG0000000000.300000000000true

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (29 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990 Part VI11bThe 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 VI12cA 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 VI12c Contd.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 VI15a and 15bExecutive 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 2010. A similar review was last performed in October 2011.
Form 990 Part VI15a and 15b Contd.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 VI15a and 15b Contd.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 VI19The 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 VI3Certain 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 VI6The 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 VI7aThe 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 VI7bThe 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 990Lines 1-10Carilion Franklin Memorial Hospital provided in-kind support of the local United Way campaign and the After Five Jive fundraiser. Additionally, financial and in-kind support was provided to The Community Partnership for Revitalization, a private, nonprofit organization whose mission is to improve the visual aspects, to increase the economic strengths, and to promote the unique assets of Rocky Mount and Franklin County by utilizing a preservation-based approach to community development. Carilion Franklin Memorial Hospital is working to reduce the overall carbon footprint through its recycling effort that includes light bulbs, batteries, printer cartridges, mixed paper and even cooking grease.
Form 9902Carilion Franklin Memorial Hospital uses demographic information and data on patients treated to determine community health needs. Additionally, information from public databases compiled on the Virginia Atlas of Community Health website is reviewed for the entire geographic area served by Carilion Franklin Memorial Hospital. With the large growth of uninsured seeking primary care through the hospital Emergency Room, Carilion Franklin Memorial Hospital contracted with the Virginia Tech Center for Public Health Practice and Research Institute for Society, Culture and Environment to provide an independent baseline assessment for coordinated care that was completed in January 2011. Additionally, a comprehensive community health needs assessment is scheduled for completion by September 30, 2013 along with a strategic implementation plan to address identified needs.
Form 9904Carilion Franklin Memorial Hospital, located in Rocky Mount, Virginia, primarily serves the 56,159 residents of Franklin County. The County is 712 square miles and situated in the foothills of the Blue Ridge Mountains of Central Virginia. While much of the County is rural, recreational interests are met with more than 24,000 acres comprised of public lakes. Approximately 16 of adults under age 64 and 9 of children who live in the County are uninsured. Additionally, 14 of residents live below the poverty level and 19 did not graduate from high school. 18 of residents are 65 years of age or older. Carilion Franklin Memorial Hospital has a very busy emergency room, treating more than 26,000 patients each year.
Form 9905Carilion Franklin Memorial Hospital serves all patients regardless of their ability to pay. 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 9905 Contd.Additionally, Carilion Franklin Memorial Hospital provided grant funding to support operations of the Free Clinic of Franklin County, a non-profit organization with mission to provide quality primary medical care for uninsured families of the poor, the working poor and elderly on fixed incomes and Southern Virginia Child Advocacy Center for the Child and Caretaker Interaction Program, a 15 hour hands-on, comprehensive approach to identifying strengths within caretaker/child relationships for reports that provide additional insight for Judges, Department of Social Service, or other agencies that consider placements for children.
Form 9905 Contd.Carilion Franklin Memorial Hospital provides support of the local EMS crews through replenishment of medications used for patient care or product with an expired use by date. Carilion Franklin Memorial Hospitals Emergency Department has specially trained nurses who deliver immediate crisis intervention to victims of sexual assaults and/or abuse. They offer victims a unique, thorough and objective medical and legal examination, comprised of both a physical examination and forensic evidence collection and documentation. Clinical Forensic Nurse Examiners are the link between the judicial system, law enforcement, community resources, and the laboratories that process the evidence. In addition, they educate colleagues and the community regarding issues and treatment of violence while upholding the mission of their facility.
Form 9905 Contd.As part of its mission to educate the public about health risks and steps that can be taken to improve health, in fiscal year 2011 Carilion Franklin Memorial Hospital touched 12,851 people during 204 events offered throughout the community. Individualized health information is provided through community screenings at several public locations, many in localities experiencing high unemployment such as Ferrum. Additionally health fairs and presentations are offered at various locations throughout the County.
Form 9905 Contd.Another way that Carilion Franklin Memorial Hospital touches the community is through Med Talk, a weekly radio program, providing listeners with an opportunity to learn more about a variety of health topics through a call in show that provides answers to their specific questions. Coordinated by local health educator, guests of the show include health professionals as well as representatives of local community service organizations. Additional health improvement services include assistance with enrollment in public medical programs such as Medicaid and interpreter services for non-English speaking patients.
Form 9906Carilion Franklin Memorial Hospital is a wholly owned hospital of Carilion Clinic, a not-for-profit healthcare organization serving nearly one million people in Virginia through a physician specialty group, advanced primary care practices, hospitals and outpatient centers. Led by clinical teams with a shared philosophy that puts the patient first, Carilion is committed to improving the communitys health while advancing the quality of care through medical education and research. Carilion Clinic is based in Roanoke, Virginia and serves the residents of 18 counties and six cities in Western Virginia and southern West Virginia. Carilion Clinic employees 575 physicians representing more than 60 specialties who provide care at 160 practice sites.
Form 9906 Contd.To advance the coordination of care and quality, an electronic medical record has been implemented in all Carilion Clinic affiliated hospitals and physician practices, allowing physicians to easily and efficiently collaborate through the use of shared patient records.
Form 9906 Contd.Additional improvements in medical programs and services include a nationally certified Stroke Alert protocol that speeds lifesaving care to stroke patients hypothermia therapy for the treatment of cardiac arrest patients a neonatal pediatric mobile ICU outfitted with life-saving, state of the art medical technology certification by the National Committee for Quality Assurance NCQA of 11 Carilion Clinic Family Medicine practices as Patient-Centered Medical Homes, a new model of care designed to keep patients healthy and prevent illness and MyChart, an online tool that gives patients secure access to their health information.
Form 9906 Contd.To advance education of health professionals, Jefferson College of Health Sciences, within Carilion Medical Center, is a professional health sciences college offering the Master of Science in Nursing, Physician Assistant and Occupational Therapy and 10 baccalaureate and associate healthcare programs. As one of few private healthcare colleges in the Southern United States, the students have demonstrated excellent licensure pass rates in professional programs. Approximately 1,000 undergraduate students and 80 graduate students are enrolled annually with 87 receiving some type of financial aid. Through a unique public-private partnership, in 2010 Virginia Tech and Carilion Clinic opened Virginia Tech Carilion School of Medicine and Research Institute in Roanoke. 84 students are enrolled in the first two classes and there are 421 appointed faculty members.
Form 9906 Contd.Additionally, graduate medical education is provided for 190 residents and 16 fellows. Included are ten residency programs, eight sponsored by Carilion Clinic Emergency Medicine, Family Medicine, Internal Medicine, Neurosurgery, Obstetrics/Gynecology, Psychiatry, Surgery, and Transitional Year and two by the University of Virginia Orthopaedics and Otolaryngology. Twelve fellowship programs include Addiction Psychology, Adult Joint Reconstruction, Advanced Endoscopy, Cardiovascular Disease, Child and Adolescent Psychiatry, Hospice and Palliative Care, Infectious Disease, Medical Informatics, Pulmonary Critical Care and Surgery Critical Care.
Form 9906 Contd.At the Virginia Tech Carilion VTC Research Institute, senior researchers recruited from across the country are working to unlock the secrets of the human brain as part of the Roanoke Brain Study, which examines the neural basis of human decision-making and its impact on health over a lifetime. The projects goal is to predict illnesses such as Alzheimers and other brain diseases. An additional benefit to the community is Carilion Clinics economic contribution to the region. As the areas largest employer, jobs are provided for nearly 11,000 residents of the region, with a payroll of more than 600 million in 2011.
Form 990 Part XI5Increase for unrealized gains on investments of 1,339 decrease for transfer of cash to related organization of 675,000, decrease for transfer to Carilion Clinic for effect of pension related changes of 2,252,322.
Form 990 Part III4aCarilion Franklin Memorial Hospital exists to serve the health care needs of its community, regardless of patient ability to pay. Franklins acute hospital admitted 1,752 patients and provided 5,947 days of care during the year. Hospital programs include provision of nursing care extensive outpatient and inpatient surgical and endoscopic services and diagnostic imaging services including CT, MRI, and mammography. Franklin provides a number of services targeting the specific health needs of its population, including diabetes management home health and hospice physical, speech, and occupational therapy programs and cardiac and respiratory rehab.
Form 990 Part III4a Contd.Franklin also provides an emergency department with 24-hour care, emergency transportation, and a chest pain and stroke program. With 23,111 visits, Franklins emergency services are a critical component of the health safety net in its service area, acting as a primary health provider for a significant number of uninsured patients, who comprise 21 percent of ED visits. Franklin also supports community screenings and education on chronic disease prevention and management, sponsoring over 200 events touching 12,851 people. In furtherance of its mission, Franklin provides extensive uncompensated care. Stated at cost, charity, charity-eligible bad debt, and unreimbursed Medicaid costs for the year exceeded 5.6 million.
Form 990 Part VI Section B Line 11b 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. Form 990 Part VI Section B Line 12c Contd. 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 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 2010. A similar review was last performed in October 2011. Form 990 Part VI Section B Line 15a and 15b Contd. 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 Section B Line 15a and 15b Contd. 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 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 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 Section Schedule H, Part II Line Lines 1-10 Carilion Franklin Memorial Hospital provided in-kind support of the local United Way campaign and the After Five Jive fundraiser. Additionally, financial and in-kind support was provided to The Community Partnership for Revitalization, a private, nonprofit organization whose mission is to improve the visual aspects, to increase the economic strengths, and to promote the unique assets of Rocky Mount and Franklin County by utilizing a preservation-based approach to community development. Carilion Franklin Memorial Hospital is working to reduce the overall carbon footprint through its recycling effort that includes light bulbs, batteries, printer cartridges, mixed paper and even cooking grease. Form 990 Section Schedule H, Part VI Line 2 Carilion Franklin Memorial Hospital uses demographic information and data on patients treated to determine community health needs. Additionally, information from public databases compiled on the Virginia Atlas of Community Health website is reviewed for the entire geographic area served by Carilion Franklin Memorial Hospital. With the large growth of uninsured seeking primary care through the hospital Emergency Room, Carilion Franklin Memorial Hospital contracted with the Virginia Tech Center for Public Health Practice and Research Institute for Society, Culture and Environment to provide an independent baseline assessment for coordinated care that was completed in January 2011. Additionally, a comprehensive community health needs assessment is scheduled for completion by September 30, 2013 along with a strategic implementation plan to address identified needs. Form 990 Section Schedule H, Part VI Line 4 Carilion Franklin Memorial Hospital, located in Rocky Mount, Virginia, primarily serves the 56,159 residents of Franklin County. The County is 712 square miles and situated in the foothills of the Blue Ridge Mountains of Central Virginia. While much of the County is rural, recreational interests are met with more than 24,000 acres comprised of public lakes. Approximately 16 of adults under age 64 and 9 of children who live in the County are uninsured. Additionally, 14 of residents live below the poverty level and 19 did not graduate from high school. 18 of residents are 65 years of age or older. Carilion Franklin Memorial Hospital has a very busy emergency room, treating more than 26,000 patients each year. Form 990 Section Schedule H, Part VI Line 5 Carilion Franklin Memorial Hospital serves all patients regardless of their ability to pay. 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 5 Contd. Additionally, Carilion Franklin Memorial Hospital provided grant funding to support operations of the Free Clinic of Franklin County, a non-profit organization with mission to provide quality primary medical care for uninsured families of the poor, the working poor and elderly on fixed incomes and Southern Virginia Child Advocacy Center for the Child and Caretaker Interaction Program, a 15 hour hands-on, comprehensive approach to identifying strengths within caretaker/child relationships for reports that provide additional insight for Judges, Department of Social Service, or other agencies that consider placements for children. Form 990 Section Schedule H, Part VI Line 5 Contd. Carili

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
Carilion Clinic
PO Box 12385RoanokeVA24025541190771Supporting organizationVA501c311 Type IN/Afalse
Carilion Clinic Foundation
PO Box 12385RoanokeVA24025541190773Supporting organizationVA501c311 Type IN/Afalse
Carilion Giles Community Hospital
PO Box 12385RoanokeVA24025540549603HealthcareVA501c33N/Afalse
Carilion Medical Center
PO Box 12385RoanokeVA24025540506332HealthcareVA501c33N/Afalse
Carilion New River Valley Medical Center
PO Box 12385RoanokeVA24025540553805HealthcareVA501c33N/Afalse
Carilion Services Inc
PO Box 12385RoanokeVA24025541190879Supporting organizationVA501c311 Type IN/Afalse
Carilion Stonewall Jackson Hospital
PO Box 12385RoanokeVA24025540568001HealthcareVA501c33N/Afalse
Carilion Tazewell Community Hospital
PO Box 12385RoanokeVA24025546074580HealthcareVA501c33N/Afalse
Hugh Trout Memorial Foundation
PO Box 12385RoanokeVA24025510236357Supporting organizationVA501c311 Type IN/Afalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg