2021-08-16T16:01:09-05:00 2020-09-30 440160260 BKD LLP 1201 WALNUT ST SUITE 1700 KANSAS CITY MO 641062246 990 2019-10-01 540506332 Carilion Medical Center CARI 5402245102 PO BOX 12385 Roanoke VA 240252385 G ROBERT VAUGHAN JR TREASURER 2021-08-16 true MIKE ENGLE P00482834 8162216300 2020-08-14 2019 2022-09-23 18:48:47Z STEVE ARNER PO BOX 12385 Roanoke VA 240252385 3588090333 false X WWW.CARILIONCLINIC.ORG X 1899 VA Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. 13 8 9680 271 60241 0 8626043 38181365 1427067490 1378831131 28386481 67040275 25470009 24159089 1489550023 1508211860 5882786 4561677 0 649129750 649613528 0 143848 727648180 749272389 1382660716 1403447594 106889307 104764266 1528858933 1930321569 1006971123 1347521886 521887810 582799683 Our mission is to improve the health of the communities we serve through our commitment to a common purpose of better patient care, better community health, and lower cost. false false 1200505343 4561677 1395317352 SEE SCHEDULE O. 1200505343 true true false true false false false false true true true false false true false false true false false false false false false false false true true true true true false false false false false false true false false false false false true true true true false false true X 0 0 9680 true true true false false false false false false false false false false false X 13 8 true true false false true true true true true false false true true true true true true true true true true VA X THE CORPORATION ATTN H KRK 5402245102 213 S JEFFERSON ST ROANOKE VA 24011 Damon Williams Director/Chair 2.0 4.5 X X 0 2175 0 Steven Arner Director/President/CEO 36.0 14.0 X X 0 877942 363619 George Cartledge III Director 2.0 0.0 X 0 1075 0 Isabel Thornton Director 2.0 0 X 0 0 0 James Drougas MD Director 4.3 0 X 12646 0 0 Janet Frantz Director 2.0 0.0 X 0 1075 0 Jason Bingham Director 2.0 2.9 X 0 8075 0 Katherin Elam Director 2.0 0 X 0 0 0 Kianna Price Marshall Director 2.0 0 X 0 1075 0 Lee Learman MD PhD Director 2.0 0 X 0 0 0 Michael Nussbaum MD Director 50.0 0 X 687909 0 170451 Neil Macdonald MD Director 2.0 0 X 0 0 0 Paul Haskins MD Director 50.0 0 X 371019 0 241634 David Hagadorn Asst. Treasurer 0.5 49.5 X 0 149339 99463 Donald Halliwill Asst. Treasurer 0.5 49.5 X 0 774298 360873 G Robert Vaughan Jr Treasurer 0.5 49.5 X 0 353112 316295 Nicholas Conte Secretary 3.0 47.0 X 0 709682 182512 Patrice Weiss MD Chief Medical Officer/EVP 46.0 4.0 X 0 817383 253428 Joseph Moskal MD SVP/Chair, Dept. of Orthopedics 50.0 0 X 1511003 0 141652 Michael Abbott Senior Vice President 50.0 0 X 248244 0 30084 Nancy Howell Agee CEO, Carilion Clinic 2.0 48.0 X 0 2254723 341866 Paul Skolnik MD SVP/Chair, Dept. of Medicine 50.0 0 X 539031 0 88390 ADEOLU OLASUNKANMI MD Physician 50.0 0 X 1100363 0 47716 Eric Marvin MD Physician 50.0 0 X 1429798 0 135761 Gregory Howes MD Physician 50.0 0 X 1647368 0 77090 Jesse Stem MD Physician 50.0 0 X 1296861 0 62355 Jonathan Carmouche MD Physician 50.0 0 X 1845598 0 142278 Bruce Long MD Physician 50.0 0 X 447580 0 195325 Jon Sweet MD Physician 50.0 0 X 323855 0 209773 Tracey Criss MD Physician 50.0 0 X 326080 0 290935 11787355 5949954 3751500 997 true true false QUEST DIAGNOSTICS 500 PLAZA DRIVE SECAUCUS NJ 07094 LABORATORY SERVICES 28894269 GE MEDICAL SYSTEMS 5517 COLLECTION CENTER DRIVE CHICAGO IL 60693 EQUIPMENT MAINTENANCE 6268513 F&S BUILDING INNOVATIONS INC 2944 ORANGE AVE NE ROANOKE VA 24012 CONSTRUCTION SERVICES 4480203 SIEMENS MEDICAL SOLUTIONS USA INC 40 LIBERTY BOULEVARD MALVERN PA 19355 EQUIPMENT MAINTENANCE 4223851 EARL SWENSSON ASSOCIATES INC 1033 DEMONBREUN STREET SUITE 800 NASHVILLE TN 37203 PROFESSIONAL SERVICES 3387983 171 78460 505223 35705281 1892401 38181365 Net Patient Revenue 622110 1329031130 1329031130 Program Related Investments 621999 6498658 6498658 Clinical Research 541715 914411 914411 Other Patient Revenue 900099 38610407 38610407 Affiliate Rent Income 531120 938906 938906 2837619 2837619 0 0 1378831131 15115978 60241 15055737 318939 318939 4783437 4783437 0 4783437 4783437 2131072448 411383 2079815416 63057 51257032 348326 51605358 51605358 Physician & Other Affiliate Income 621111 6739826 6739826 Cafeteria 722514 2889431 2889431 Roanoke City Student Health 621440 1817098 1817098 7929297 7929297 0 0 19375652 1508211860 1395317352 60241 74652902 4300548 4300548 261129 261129 4084457 3426887 657570 3584898 3584898 514020524 513595657 374878 49989 53690160 53651003 39157 38881928 38767214 101217 13497 35351561 35288835 62726 178278116 178278116 256819 256819 98107 98107 1275815 1275815 117663791 99826364 17823126 14301 341383 339759 1624 18475396 18390459 82353 2584 4920330 4919516 814 26896900 26891345 5555 2140639 2097045 41322 2272 16162902 16162902 46395824 46395824 15106033 11578682 3527351 Medical Supplies 194377992 194375127 2865 Bad Debt 81549017 81549017 Assessment Fees 39872605 39872605 Dues and Subscriptions 2275649 2016026 200042 59581 3185071 3116394 68677 0 1403447594 1200505343 202798403 143848 17586 17411 5005959 18923445 2463652 1423906 246865692 265679526 0 0 0 0 4208444 1349460 10573019 12775422 9165336 4300243 1195916839 885967227 283015465 309949612 204645171 591629581 771035206 725926201 -8317602 -1880475 65123 65123 115882 162114 1528858933 1930321569 182029352 211803738 13240000 7877994 3297074 160540791 323771290 467470376 0 0 223045 0 484410362 499828987 1006971123 1347521886 X 501315131 561406380 20572679 21393303 521887810 582799683 1528858933 1930321569 X 104764266 -31286438 -12565955 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 98107 98107 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY A portion of dues paid to various hospital industry associations is attributable to lobbying activities. 16881056 609120 696053 16794123 17033643 803774 956361 16881056 16731963 1278959 977279 17033643 15801516 1914128 983681 16731963 15705697 904944 809125 15801516 0.0 0.7071 0.2929 false false 6116287 6116287 516136612 362967459 153169153 960828 840573 120255 623292886 515469748 107823138 49410226 6689447 42720779 309949612 9628700 F 1347596 C Comingled Funds Alternative Investments 714949905 F 725926201 Due to Affiliates 22698903 Pension Liability 405755618 Deferred Comp Liability 30200579 Interest Rate Swap Liability 41173887 499828987 Schedule D, Part V, Line 4 Intended uses of endowment funds Income from endowment funds are used for the following. (1) Pediatric programs- both internal and external- and/or pediatric equipment. (2) Patient care assistance. true true X true X true X false true false true true 14736919 14736919 0.0112 245705831 271565484 0 0.0 0 0.0 0 0 260442750 271565484 14736919 0.0112 9481 22990 4865308 788640 4076668 0.0031 3 295 45970550 8339384 37631166 0.0285 0 0.0 2 1032 1903006 1903006 0.0014 65 5562 618205 110000 508205 0.0004 9551 29879 53357069 9238024 44119045 0.0334 9551 29879 313799819 280803508 58855964 0.0446 0 0.0 15 5000 247918 247918 0.0002 20 0 36380 36380 0.0000 0 0.0 0 0.0 81 357 30279 2246 28033 0.0000 7 0 18873 18873 0.0000 11 10 600615 600615 0.0005 0 0.0 134 5367 934065 2246 931819 0.0007 true 81553905 232055867 264524668 -32468801 X true true ROANOKE AMBULATORY SURGERY CENTER LLC AMBULATORY SURGERY 0.492 0.4648 SOUTHWEST VIRGINIA HEALTH PROPETIES LLC REAL ESTATE 0.5112 0.4648 2 1 CARILION MEDICAL CENTER -DBA CRMH 1906 BELLEVIEW AVE ROANOKE VA 24014 HTTPS://CARILIONCLINIC.ORG/LOCATIONS/CARILION-ROANOKE-MEMORIAL-HOSPITAL H 1840 X X X X X X A 2 CARILION MEDICAL CENTER -DBA CRCH 101 ELM AVE ROANOKE VA 24013 HTTPS://CARILIONCLINIC.ORG/LOCATIONS/CARILION-ROANOKE-COMMUNITY-HOSPITAL H 1839 X REHABILITATION UNIT A A false false true X X X X X X X X X 17 true true true true X HTTPS://WWW.CARILIONCLINIC.ORG/LOCATIONS/CARILION-ROANOKE-MEMORIAL-HOSPITAL HTTPS://WWW.CARILIONCLIN X HTTPS://WWW.CARILIONCLINIC.ORG/COMMUNITY-HEALTH-ASSESSMENTS#ROANOKE-VALLEY X X true 17 true HTTPS://WWW.CARILIONCLINIC.ORG/COMMUNITY-HEALTH-ASSESSMENTS#ROANOKE-VALLEY false true X 200.0 400.0 X X X X true true X X X true X HTTPS://WWW.CARILIONCLINIC.ORG/BILLING/FINANCIAL-ASSISTANCE X HTTPS://WWW.CARILIONCLINIC.ORG/BILLING/FINANCIAL-ASSISTANCE X HTTPS://WWW.CARILIONCLINIC.ORG/BILLING/FINANCIAL-ASSISTANCE X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT PRIORITIZES THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS THAT WERE IDENTIFIED BY THE ASSESSMENT, AND EXPLAINS HOW THE HEALTH NEEDS WERE PRIORITIZED. Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - GROUP A. Carilion Clinic's Community Health Needs Assessments (CHNAs) are community-driven projects and success is highly dependent on engaging citizens, health and human service agencies, businesses, and community leaders. Community stakeholder collaborations known as "Community Health Assessment Teams" (CHAT) lead the CHNA projects. The CHAT consists of health and human service agency leaders; persons with special knowledge of, or expertise in, public health; the local health department; and leaders, representatives, or members of populations who are medically underserved, low-income, minority, and suffer from chronic diseases. The following organizations served on the CHAT for the 2018 (tax year 2017) Roanoke Valley Community Health Needs Assessment (RVCHNA): Blue Blaze Consulting, Blue Ridge Behavioral Healthcare, Bradley Free Clinic, Carilion Clinic, CHIP of Roanoke Valley, City of Roanoke - Lead Safe Roanoke, Family Service of Roanoke Valley, Freedom First Credit Union, Healthy Roanoke Valley (HRV), High Street Baptist Church, Jefferson College of Health Sciences, Local Environmental Agricultural Project (LEAP), New Horizons Healthcare, Rescue Mission Ministries, Inc., Roanoke College, Roanoke Redevelopment and Housing Authority, Roanoke Regional Chamber of Commerce, Salem Veteran Affairs Medical Center, United Way of Roanoke Valley, and the Virginia Department of Health. To further obtain input from the community, the RVCHNA conducted focus groups among stakeholders and target populations and administered a community health survey. During the CHNA process, community stakeholders, leaders, and providers were encouraged to complete a Stakeholder Survey (print and electronic versions were available) to provide additional perspectives about our community's health needs and barriers. CHATs conducted stakeholder focus groups with the City of Roanoke (Fire/EMS Station #5 & #6, and Police Department), HRV partners and friends (brought together for a Stakeholder Forum), and the Roanoke Valley Palliative Care Partnership. Target population focus groups were conducted to capture the story of needs and barriers to health for the uninsured, underinsured, low-income, minority, senior, and chronically ill populations. Focus group locations were chosen based on their proximity and convenience to target populations. Ten target population focus groups were held and participants discussed health needs and barriers to health, as well as access to primary, oral, and mental health care. Target population focus groups were conducted with AARP members, a women's group comprised of former immigrants to the United States, a Blue Ridge Literacy English for Speakers of Other Languages (ESOL) class, Bradley Free Clinic patients, residents of Roanoke Redevelopment Housing Authority's Melrose Towers (in the NW Roanoke City Medically Underserved Area (MUA)) and Morningside Manor (in the SE Roanoke City MUA), certified peer recovery specialists, Presbyterian Community Center parents and staff, and Roanoke Rescue Mission guests. A 39-question survey was developed (in English and Spanish) including questions about socioeconomic factors, access to medical, dental, and mental health care, health behaviors, physical environment, health outcomes, and demographics. The survey included commonly used questions and metrics from previously validated community surveys conducted by organizations such as National Association of County and City Health Officials (NACCHO), and Centers for Disease Control and Prevention. The CHAT and HRV Data Tracking and Quality Improvement Action Team identified target populations, collection sites and survey distribution methods. The survey focused on Roanoke Valley residents 18 years of age and older in the following service area of Bedford, Botetourt, Craig and Roanoke counties, Roanoke City, and Salem City. Special efforts were made to include the subpopulations of underserved/vulnerable populations disproportionately impacted by the social determinants of health including Income, race/ethnicity, education, and insurance status. The survey was also made available to all residents living in the Roanoke Valley, and oversampling of the target populations occurred through targeted outreach efforts. In total, 2,308 surveys were collected. Schedule H, Part V, Section B, Line 6a Facility A, 1 Facility A, 1 - Group A. Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital (Group A), both owned by Carilion Medical Center and serving the same area, jointly conducted their CHNA. The Salem Veteran Affairs Medical Center also participated on the Community Health Assessment Team. Schedule H, Part V, Section B, Line 6b Facility A, 1 Facility A, 1 - GROUP A. Blue Blaze Consulting, Blue Ridge Behavioral Healthcare, Bradley Free Clinic, Carilion Clinic, CHIP of Roanoke Valley, City of Roanoke - Lead Safe Roanoke, Family Service of Roanoke Valley, Freedom First Credit Union, Healthy Roanoke Valley (HRV), High Street Baptist Church, Jefferson College of Health Sciences, Local Environmental Agricultural Project (LEAP), New Horizons Healthcare, Rescue Mission Ministries, Inc., Roanoke College, Roanoke Redevelopment and Housing Authority, Roanoke Regional Chamber of Commerce, Salem VA Medical Center, United Way of Roanoke Valley, Virginia Department of Health. Schedule H, Part V, Section B, Line 7 Facility A, 1 Facility A, 1 - Group A. The Community Health Assessment Team (CHAT) shared the 2018 Roanoke Valley CHNA on partner websites and social media. The RVCHNA was also shared through community forums, community presentations and media interviews. Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - Group A. The following information describes the implementation strategies used by Carilion Medical Center (CMC), comprised of Carilion Roanoke Memorial Hospital (CRMH) and Carilion Roanoke Community Hospital (CRCH), to address the community health needs identified in the 2018 Roanoke Valley Community Health Needs Assessment (RVCHNA). The complete implementation strategies are available online at https://www.carilionclinic.org/community-health-assessments#roanoke-valley According to the Robert Wood Johnson Foundation's (RWJF) County Health Rankings (http://www.countyhealthrankings.org), where an individual lives, works and plays is a strong predictor of their health outcomes. In the United States, a person's zip code can help predict their life expectancy due to its direct link to the social determinants of health such as poverty, race/ethnicity, education and employment status in these areas. (https://www.rwjf.org/en/library/interactives/whereyouliveaffectshowlongyoulive.html). These factors, part of the 10-year national Healthy People 2030 objectives, are crucial to our overall health because they "create social and physical environments that promote good health for all." (https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health) Carilion responds to community health needs in innovative ways- making sure our regions have access to state-of-the-art health care close to home, providing community grants and sponsorships to extend our mission and support other organizations addressing health needs, creating and implementing community-wide strategies to reduce barriers, coordinate resources and enhance community strengths, and providing community-based health and wellness programs. Commitment to community health is evident at all levels of the organization. Carilion's infrastructure includes a Planning and Community Development division dedicated to assessing and addressing community needs. The division is responsible for leading and facilitating the Community Health Improvement Plan (CHIP), CHNAs, Carilion's community grant process, community health education, community benefit collection, and neighborhood health initiatives. There are Community Health and Outreach (CHO) staff at the system level and each community hospital. They work with hospital Board of Directors and Carilion Clinic's Board of Governors to create health improvement strategies. A Community Benefit Council provides oversight and strategic guidance for Carilion's community health improvement work and for community benefit strategy, collection and submission. Carilion's response strategies follow the RWJF framework for what influences health, health behaviors, social and economic factors, clinical care access and quality and physical environment. With the onset of COVID-19, Carilion immediately recognized the prominent role we would play in both prevention and treatment for our region. The pandemic demanded a shift in operations and priorities. While some of our implementation strategies were delayed or altered, Carilion quickly responded to the new and unique health-related social needs arising from COVID-19. An addendum to the CMC implementation strategies was approved in July 2020 to reflect the organization's planning and response to the pandemic. The complete addendum is available online at https://www.carilionclinic.org/sites/default/files/2020-10/CMC%20IS%20COVID%20Addendum_0.pdf. -COVID-19 Community Response- Carilion worked with local media partners to provide expert advice and guidance to the community for COVID-19 prevention, detection and recovery. In a historic collaborative effort, competing hospitals and broadcasting organizations publicized a community town hall. We coordinated efforts to ensure the public received the most accurate and up-to-date information about the pandemic. We developed the COVID-19 Community Hotline as a dedicated phone line to answer community member questions about COVID-19 signs and symptoms, Carilion guidelines, and resources. We also established a recovery support phone line to ensure employees, patients, and community members have access to mental health and recovery support. Peer Recovery Specialists created five virtual peer support community groups. These provide options for individuals in recovery to maintain recovery-oriented support during stay-at-home orders. Carilion is actively providing counsel to community partners, businesses, universities and colleges regarding COVID-19 through consultation with our infectious disease physicians and our management team. This service, offered free of charge, aims to promote safety and reduces hospitalizations and deaths. -Home Alone and Patient Outreach- Because older adults are especially vulnerable to COVID-19, accessing essential resources presented another serious challenge for them during the pandemic. Amid stay-at-home orders, business closures and medical appointment cancellations, we made it our mission to check on seniors in need who were living alone. Carilion's Planning and Community Development, Geriatric Medicine, Home Care and Hospice and Accountable Care Organization departments coordinated efforts to establish Home Alone. Through this initiative, Carilion made more than 1,200 phone calls to provide up-to-date information and connect seniors with local governments and community resources. From delivering masks to offering support over the phone, the program helped meet a wide-range of needs head-on. Seniors were able to stay home safely, reduce their exposure to COVID and avoid the hospital -Community Partnerships- Carilion Clinic believes in the power of collaboration. Carilion also understands the most significant health issues are addressed through cooperation with the community. Carilion participates in and provides financial and in-kind support to community health coalitions addressing the Roanoke Valley health needs. We also partner with multiple community and business organizations to improve health and wellness and to impact the social determinants of health for everyone we serve. -Healthy Roanoke Valley (HRV)- Forming a true community collaborative with lasting impact is no small feat. In 2012, using the Strive Collective Impact model, Carilion and United Way brought together strategic community partners to create HRV. An initiative supported by United Way of Roanoke Valley, HRV is now a partnership of more than 50 organizations striving to enhance health equity and create a "culture of wellness" across our region. For years, HRV has been serving as a valuable partner with Carilion Clinic. The collaborative updated HRV's strategic framework to align with the triennial Community Health Needs Assessment (CHNA), a community-driven process and a significant component of Carilion's Health Improvement Implementation Strategy for the Roanoke Valley. Through strategic planning in response to the 2018 Roanoke Valley Community Health Needs Assessment priorities, HRV identified four goals- 1. Reduce barriers to resources that address the social determinants of health, 2. Expand access to quality care and support a culture of health, 3. Encourage and support lifestyle behaviors that result in improved health and wellbeing, 4. Support and advocate for natural and built environments that cultivate vibrant neighborhoods. Carilion provides in-kind support to HRV with representatives active on the HRV steering committee and action teams focused on wellness, mental health, primary care, oral health and coordination of care. In response to the COVID-19 pandemic, HRV focused on engaging partners and supporting the United Way of Roanoke Valley-led community response effort. HRV staff members were deeply involved in supporting community efforts around health care access and resources, personal protective equipment shortages and sourcing, community food resources, and financial education and literacy. HRV's Mental Health & Substance Use and Wellness Action Teams developed a shared message to address behavioral health issues in the community related to the pandemic and racial unrest. Meanwhile, the Healthy Start initiative pivoted its focus from family education to providing emergency supplies of fresh produce to families with children. (Continued in Schedule H, Part VI) Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - Group A. Individuals with Out of Network insurance are not eligible for Financial Assistance unless the plan does not meet minimum essential coverage as defined in PPACA or it is a governmental plan. 103 Carilion Roanoke Memorial Rehab 2017 South Jefferson Street Roanoke VA 24014 Psychiatry Services CNRV Emergency Services 2900 Lamb Circle Christiansburg VA 24073 Emergency Physicians CES - Franklin 180 Floyd Avenue Rocky Mount VA 24151 Emergency Physicians CES - Tazewell 388 Ben Bolt Avenue Tazewell VA 24651 Emergency Physicians Carilion Clinic Pain Management 1 Riverside Circle Roanoke VA 24016 Pain Management Carilion Clinic Genetic Counseling 1 Riverside Circle Roanoke VA 24016 Genetic Counseling Carilion GYN Oncology 1 Riverside Circle Suite 300 Roanoke VA 24016 Gynecological Oncology Carilion Clinic Dermatology & Mohs Surgery 1 Riverside Circle Suite 300M Roanoke VA 24016 Dermatology and Mohs Surgery Carilion Clinic Occupational Medicine Elm Ave 101 Elm Avenue SE Roanoke VA 24013 Occupational Medicine Carilion Wound Care Center Carilion Roanoke Community Hospital 101 Elm Avenue SE Roanoke VA 24013 Wound Care Carilion Dentistry Pediatric Surgery 101 Elm Avenue SE Roanoke VA 24013 Dental Service Community Care 101 Elm Avenue SE Roanoke VA 24013 Family Medicine Carilion Maternal Fetal Medicine 101 Elm Avenue Suite 400 Roanoke VA 24013 Maternal Fetal Medicine Carilion Clinic Urogynecology 101 Elm Avenue Suite 400 Roanoke VA 24013 Obstetrics Carilion Prenatal Diagnostic Center 102 Highland Ave Suite 455 Roanoke VA 24013 Prenatal Testing Carilion Breast Care Diagnostic Center 102 Highland Ave Ste 202 Roanoke VA 24013 Breast Care Center Pediatric Cardiology Clinic 102 Highland Avenue Suite 101 Roanoke VA 24013 Cardiology Carilion Genetics 102 Highland Avenue Suite 104 Roanoke VA 24013 Genetic Counseling Carilion Pediatric Neurology 102 Highland Avenue Suite 104 Roanoke VA 24013 Neurosciences Carilion Pediatric Pulmonology and Allergy Clinic 102 Highland Avenue Suite 203 Roanoke VA 24013 Pulmonology Carilion GYN Clinic 102 Highland Avenue Suite 303 Roanoke VA 24013 Gynecological Services Pediatric Gastroenterology 102 Highland Avenue Suite 305 Roanoke VA 24013 Gastroenterology Carilion Clinic Pediatric Surgery Clinic 102 Highland Avenue Suite 404 Roanoke VA 24013 Surgical Services Carilion Pediatric Endocrinology Clinic 102 Highland Avenue Suite 455 Roanoke VA 24013 Endocrinology Carilion Sleep Center 1030 S Jefferson St Ste G100 Roanoke VA 24016 Sleep Disorder Carilion Anticoagulation Clinic 1030 S Jefferson St Ste G101 Roanoke VA 24016 Anticoagulation Clinic Carilion Clinic Pediatric Child Developmental Clinic 1030 S Jefferson Street Roanoke VA 24016 Child Development Services Carilion General Pediatric Clinic 1030 S Jefferson Street Suite 106 Roanoke VA 24016 General Pediatrics Pediatric Developmental Clinic 1030 S Jefferson Street Suite 201 Roanoke VA 24016 Pediatric Development Carilion Diabetic Education 1030 S Jefferson Suite G101 Roanoke VA 24016 Diabetic Education Carilion Uro-Gynecology Associates 1030 S Jefferson St Ste 109 Roanoke VA 24016 Urogynecology Carilion Wellness-Botetourt 105 Summerfield Court Roanoke VA 24019 Outpatient Therapy Services Carilion Clinic Urology Christiansburg 120 Akers Farm Road NE Christiansburg VA 24073 Urology Carilion Clinic Reproductive Medicine and Fertility 1231 S Jefferson Street Roanoke VA 24016 Reproductive Endocrinology Carilion Clinic Vascular McClanahan 127 McClanahan Street Roanoke VA 24014 Vascular Services Carilion Cardiac Rehab 127 McClanahan Street Roanoke VA 24014 Cardiac Rehab Carilion Heart Failure Clinic 127 McClanahan Street Roanoke VA 24014 Heart Failure Services Physical Therapy Westlake 12970 Booker T Washington HWY Hardy VA 24101 Physical Therapy Services CFM Roanoke Salem 1314 Peters Creek Road Roanoke VA 24017 Family Practice Carilion Clinic OBGYN Daleville 150 Market Ridge Lane Daleville VA 24083 Obstetrics and Gynecology Daleville Imaging 150 Market Ridge Lane Daleville VA 24083 Imaging Services Pediatric Subspecialty Clinic 1620 Graves Mill Road Lynchburg VA 24502 Pediatrics General Surgery Clinic 180 Floyd Avenue Rocky Mount VA 24151 Surgical Services Carilion Clinic Cardiology Services - Rocky Mount 180 Floyd Avenue Rocky Mount VA 24151 Cardiology Physical Therapy West Salem 1955 West Main Street Salem VA 24153 Physical Therapy Services Carilion Clinic OBGYN Salem 1957 W Main Street Salem VA 24153 Obstetrics and Gynecology Carilion Clinic Imaging - Crystal Spring 2001 Crystal Spring Ave SW Roanoke VA 24014 Imaging Services Carilion Cardiothoracic Surgery 2001 Crystal Spring Avenue Suite 20 1 Roanoke VA 24014 Cardiac Surgery Services Carilion Clinic Cardiology 2001 Crystal Spring Avenue Suite 20 3 Roanoke VA 24014 Cardiology Services Carilion Clinic Pulmonary and Sleep Medicine 2001 Crystal Spring Avenue Suite 30 0 Roanoke VA 24014 Pulmonary and Sleep Services Carilion Infectious Disease Clinic 2001 Crystal Spring Avenue Suite 30 1 Roanoke VA 24014 Infectious Disease Carilion Center for Healthy Aging 2001 Crystal Spring Avenue Suite 30 2 Roanoke VA 24014 Geriatrics Carilion Clinic Dentistry General Surgery Jefferson 2017 S Jefferson St Roanoke VA 24014 Surgical Services Carilion Clinic Department of Psychiatry and Behavioral Medicine Adult Outp atient 2017 S Jefferson Street Roanoke VA 24014 Behavioral Health Carilion Dental Care 2017 S Jefferson Street Roanoke VA 24014 Dental Service Child and Adolescent Psychiatry 2017 S Jefferson Street Roanoke VA 24014 Child and Adolescent Psychiatry Services Community Psychiatry 2017 S Jefferson Street Roanoke VA 24014 Psychiatry Services CFM Southeast 2145 Mount Pleasant Boulevard Roanoke VA 24014 Family Practice Carilion Clinic Imaging ION 2331 Franklin Road Roanoke VA 24014 Imaging Services Carilion Clinic Neurosurgery - ION 2331 Franklin Road Roanoke VA 24014 Neurosurgery Carilion Clinic Pain Management - ION 2331 Franklin Road Roanoke VA 24014 Pain Management Carilion Physical Medicine and Rehabilitation 2331 Franklin Road Roanoke VA 24014 Physical Medicine Carilion Clinic Orthopaedics - ION 2331 Franklin Road SW Roanoke VA 24014 Orthopaedics Carilion Clinic Department of Psychiatry and Behavioral Medicine 2900 Lamb Circle Christiansburg VA 24073 Psychiatry and Behavioral Health Services CNRVMC - Neurosciences 2900 Lamb Circle Christiansburg VA 24073 Neurology CNRVMC - Radiology 2900 Lamb Circle Christiansburg VA 24073 Radiology Services Carilion Children's Pediatrics - New River 2900 Lamb Circle Christiansburg VA 24073 Pediatrics Carilion Clinic Sleep Center - New River Valley 2900 Lamb Circle Suite 7-700A Christiansburg VA 24073 Sleep Medicine Carilion Clinic Genetics - Lynchburg 2900 Old Forest Rd Lynchburg VA 24501 Pediatric Genetics Carilion Clinic Neuropsychology CCR3 3 Riverside Cir Roanoke VA 24016 Neuropsychology Services Carilion Clinic General Surgery 3 Riverside Circle Roanoke VA 24016 Surgical Services Carilion Clinic Internal Medicine 3 Riverside Circle Roanoke VA 24016 Internal Medicine Carilion Clinic Neurology 3 Riverside Circle Roanoke VA 24016 Neurology Carilion Clinic Orthopaedics Trauma 3 Riverside Circle Roanoke VA 24016 Orthopaedic Trauma Carilion Clinic TraumaCritical Care 3 Riverside Circle Roanoke VA 24016 Surgical Services Carilion Imaging 3 Riverside Circle Roanoke VA 24016 Imaging Services Carilion OBGYN - Riverside 3 Riverside Circle Roanoke VA 24016 Obstetrics and Gynecology CRMH Rheumatology Clinic 3 Riverside Circle Roanoke VA 24016 Rheumatology Carilion Clinic Gastroenterology 3 Riverside Circle Roanoke VA 24016 Gastroenterology Carilion Clinic Orthopaedics 3 Riverside Circle Roanoke VA 24016 Orthopaedics Carilion Clinic Endocrinology 3 Riverside Circle Roanoke VA 24016 Endocrinology Carilion OtolaryngologyENT 3 Riverside Circle 4th Floor Roanoke VA 24016 Otolaryngology and ENT Services Carilion Pediatric OtolaryngologyENT 3 Riverside Circle 4th Floor Roanoke VA 24016 Pediatric Otolaryngology and ENT Services Carilion Plastic and Reconstructive Surgery 3 Riverside Circle Suite 400 Roanoke VA 24016 Plastic and Reconstructive Surgery Carilion Cardiology Westlake 35 Medical Court Hardy VA 24101 Cardiology Services Carilion Sleep Center Westlake 35 Medical Court Hardy VA 24101 Sleep Disorder Carilion Surgery Westlake 35 Medical Court Hardy VA 24101 Surgical Services Urogynecology Westlake 35 Medical Court Hardy VA 24101 Urogynecology Carilion Clinic Dermatology and Mohs Surgery - Westlake 35 Medical Court Hardy VA 24101 Dermatology and Mohs Surgery Carilion Clinic Orthopaedic Surgery - Westlake 35 Medical Court Hardy VA 24101 Orthopaedics Carilion Clinic Otolaryngology and Audiology - Westlake 35 Medical Court Hardy VA 24101 Otolaryngology and ENT Services Carilion Clinic Imaging - Westlake 35 Medical Court Hardy VA 24101 Imaging Services Brambleton Radiology Services 3707 Brambleton Avenue Roanoke VA 24018 Radiology Services Carilion Clinic Family Medicine Tazewell 388 Ben Bolt Avenue Tazewell VA 24651 Family Medicine Carilion Clinic Orthopaedics - Franklin 390 S Main Street Suite 103 Rocky Mount VA 24151 Orthopaedics Carilion Clinic Plastic and Reconstructive Surgery 390 S Main Street Suite 103 Rocky Mount VA 24151 Plastic and Reconstructive Surgery General Surgery Rocky Mount 390 South Main Street Rocky Mount VA 24151 Surgical Services Carilion Wellness - Roanoke 4508 Starkey Road Roanoke VA 24018 Physical Therapy Services Carilion Clinic Allergy and Immunology 46 Wesley Road Daleville VA 24083 Allergy and Immunology Services Carilion Clinic Pediatric Medicine Rocky Mount 490 S Main St Rocky Mount VA 24151 Pediatric Medicine Breast Mammography - North 6415 Peters Creek Road Roanoke VA 24019 Breast Mammography Carilion Children's Pediatric Behavioral Medicine 902 Jefferson St Roanoke VA 24016 Pediatric Child Development Carilion Obstetrics and Gynecology Clinic 902 South Jefferson Street Upper Le vel Roanoke VA 24016 Obstetrics and Gynecology Schedule H, Part V, Section B, Line 11 Addressing Needs Identified in CHNA (Continued From Part V Section C) Through HRV, multiple programs and strategies have arisen in response to community needs, such as the Pathways Community HUB. This community-based care coordination system is anchored by Community Health Workers strategically located in two Carilion teaching practices in the City of Roanoke, at Carilion Community Care and Carilion Internal Medicine Riverside 3, and partners' clinics. Through a model addressing social determinants of health, Community Health Workers link clients and their families to resources and services. The program reduces barriers to good health for uninsured adults who regularly visit the CRMH Emergency Department and have chronic disease diagnoses. Community partners include Bradley Free Clinic, the Rescue Mission's G. Wayne Fralin Free Clinic, Mental Health America of Roanoke Valley, New Horizons Healthcare and HRV. -Community Grants - Carilion fulfills our commitment to addressing key health priorities through targeted grants for community health improvement programs and those affecting the social determinants of health. Carilion provides many community grants and community health sponsorships to help local charitable organizations fulfill their missions related to the health and well-being of our communities. Community grant dollars are allocated across the entire Carilion Clinic service area based on requests received. During the fall cycle of 2020 fiscal year (2019 tax year), $85,000 in grants were awarded to nine programs in the Roanoke Valley to improve mental health access, transportation, disease prevention, literacy services and to increase the availability of affordable healthy foods. Carilion's COVID-19 Community Health Fund replaced the traditional spring grant process, focusing on acute COVID-related health care needs and health-related social needs in our region. In the Roanoke Valley, we awarded $69,500 in funding to support a facility for people experiencing homelessness and recovering from COVID-19 to live and quarantine, programs addressing food insecurity throughout various Southwest Virginia communities, medication access and delivery for free clinic patients in Southwest Virginia, expanded access to mental health care through the free clinic and access to refurbished rehabilitation equipment. -Targeted Neighborhood Initiatives - CMC's community health goal is to improve health and well-being for the Roanoke Valley, especially for those individuals living in medically underserved areas (MUAs). The City of Roanoke tends to perform worse than other neighboring communities in many health and social determinant indicators. Efforts often focused on the Northwest and Southeast quadrants of the city-the MUAs most in need. CMC is addressing essential community health needs identified in the 2018 assessment by focusing additional investment in the Southeast MUA, located adjacent to CRMH. Through greater access to clinical care and community outreach programs, creative community partnerships and focused financial and in-kind support of initiatives, CMC is improving community health in the Southeast neighborhood. Key focus areas of this health improvement project include access to services, coordination of care and wellness. -LIFT Project- Carilion is working with Roanoke City Public Schools (RCPS) and other partners to expand access to health care services for families through Local Impact for Tomorrow (LIFT). LIFT is a partnership between Carilion, RCPS, Freedom First Credit Union, Delta Dental of Virginia and Roanoke Women's Foundation. Plans are underway to create a community health center in Southeast's Fallon Park Elementary School. The community health center will provide physical, mental and oral health care services and financial wellness programs for local students and families. Groundbreaking for the facility is scheduled for 2021. Additionally, LIFT's Asthma in Schools program at Fallon Park Elementary allows school nurses to administer medication to students with asthma. Roanoke City provided funding to extend care into the home, working with the Child Health Investment Partnership during the COVID-19 pandemic. -Significant Health Priorities to be Addressed- -Health Behaviors - Needs include a culture of healthy behaviors not a priority, and poor diet. Carilion Clinic continues to address health behavior-related priorities from the 2018 RVCHNA. To improve overall health culture and promote healthy diets, Carilion provides various free health education classes, screenings and flu immunizations in community settings. In fiscal year 2020, Carilion provided 393 health education, screening and immunization opportunities/events in the Roanoke Valley, serving 8,593 people. Community health education is provided by the Community Health and Outreach (CHO) department as well as by Trauma Outreach, dieticians, Carilion Wellness, homecare, hospice and select other departments. Health and wellness education topics include general wellness, healthy eating and exercise, stress management, and infant and child safety. During the COVID-19 pandemic, CHO transitioned to "Take a Break" virtual education sessions providing timely, relevant tips focused on improving well-being and maintaining a healthy lifestyle during an uncertain time. As the year progressed, we added well-being support groups, cooking videos, online gardening classes, guided walks and hikes, and limited in-person outdoor education. Resources committed to these programs include staff time, volunteer hours, and food and giveaway items that encourage healthy behaviors. Carilion remains committed to addressing poor diets. Through the Local Foods Program, Carilion provides hundreds of thousands of dollars of support to improve healthy food access. Community grants make healthy, wholesome foods more affordable and accessible in the Roanoke Valley, including one that doubles the value of the Supplemental Nutrition Assistance Program (SNAP) benefit. Carilion's Morningside Urban Farm brings fresh foods to the Southeast Roanoke City community. The farm offers health education and incentives to adopt healthy lifestyles. The farm's programs focused on wellness through gardening, nutrition, physical activity/movement, the arts and music. Produce grown at the farm is donated to those attending Morningside classes and events and community groups such as the Presbyterian Community Center, Boys and Girls Club, and the Rescue Mission. In addition to community events, Carilion fosters healthy behaviors by offering classes to employees and through partnerships with other Roanoke Valley employers. As the largest employer in the region, efforts to engage our employees and their families in healthy lifestyles impact community health overall. Carilion offers Virgin Pulse. The program enables employees to connect personal activity trackers and a platform to encourage daily healthy behaviors such as exercise, climbing stairs, and planning healthy meals. Additionally, CMC makes a Farm Share program available to employees and their families through payroll deduction. Farm Share widens the impact of nutritious fresh food and diets for our Carilion staff. Carilion remains committed to the Healthier Hospital Initiative pledge and continues to improve quantities of healthy, local, sustainable foods purchased and served through its cafeterias. Wellness comprises a multitude of factors, from mental and social support to prevention and safety. We offer support groups for grief and loss counseling, cancer treatment and recovery, and attention to diabetes and other chronic conditions. CMC also coordinates child passenger safety training and child safety seat checks to reduce injuries from car accidents. Carilion family practices offer gun locks for free to members of the community to encourage gun safety. As part of infant safe sleep classes, Carilion provides participants with a free Pack and Play and free Sleep Sack to promote safe sleep practices. Infants born in Carilion hospitals also receive a free Sleep Sack when available. Schedule H, Part V, Section B, Line 11 Addressing Needs Identified in CHNA (Continued) -Clinical Care - Needs include access to mental health and substance use services, access to dental care, high uninsured/underinsured population, high cost of care. Issues with access to care are essential to CMC when addressing community health needs. In addition to providing financial support to qualifying patients who cannot afford care, Carilion works to improve affordable access to care and resources. -Mental health and substance use services - Through the #AllIn program, Carilion provides additional access to non-traditional mental health and substance use services. A key component of #AllIn is peer support which has expanded the type of care people in the Roanoke Valley can access. Peer recovery specialists have a unique perspective and can connect with patients through shared experiences. In fiscal year 2020, Carilion trained 90 peer recovery specialists in the Roanoke Valley and taught more than 150 laypeople to utilize Narcan through the REVIVE program. We formed five peer recovery center groups pre-COVID. We also convened virtual groups for individuals in recovery to maintain support during the stay-at-home order. Carilion's Addiction Task Force brings together expertise from throughout the Carilion system to better understand and address the opioid epidemic in Southwest Virginia. Efforts include developing system-wide guidelines and a system dashboard for opioid prescriptions, developing treatment pathways for opioid addiction in specific high-risk groups, developing best practices for risk assessment, treatment and standard orders in Carilion's electronic medical record system, growing an inventory of community resources related to prevention, treatment and recovery services for patients and community members, and providing locations for free, safe, prescription drug returns or deactivation bags. Carilion provides both financial and in-kind support for the Bradley Free Clinic Mental Health Collaborative program to increase access to psychiatric care and medication for people without health insurance in the Roanoke Valley. Carilion psychiatry residents and physicians volunteer their time and provide in-kind services through this program. Physicians and residents also provide in-kind services to individuals through the Rescue Mission's Fralin Free Clinic. -Dental care - Carilion hosts pediatric and adult dental clinics in Roanoke and operates a dental residency program. Dental residents provide in-kind dental services through the Rescue Mission's Fralin Free Clinic. Located in Southeast Roanoke, the Rescue Mission is a comprehensive crisis intervention center for men, women and children. Additionally, oral health is also prioritized through the HRV Oral Health Action Team with the DentaQuest Foundation's support. -High uninsured / underinsured population and high cost of care - Carilion is committed to helping improve access to affordable medical care in our communities. Since the expansion of Medicaid in the Commonwealth of Virginia in 2019, Carilion has worked diligently on outreach and enrollment for newly eligible beneficiaries. By the end of fiscal year 2020 (tax year 2019), more than 15,754 people were newly enrolled in Medicaid in the Roanoke Valley. Community Health Workers and other partners also helped clients complete insurance pathways pairing them with appropriate services once they were enrolled. Carilion physicians regularly serve uninsured people through hours donated in-kind to the Bradley Free Clinic. Medication access for Bradley Free Clinic patients is improved by the RX Partnership, which Carilion supports financially. Additionally, Individuals can access regular care and medications as well as coordinate lab services through Carilion financial assistance. To increase access to primary care and resources for adolescents, CMC partners with RCPS to operate adolescent health clinics in Patrick Henry High School and William Fleming High School in the City of Roanoke, plus a stand-alone clinic in downtown Roanoke. Through parent waivers signed at the start of the school year, students can visit health professionals as needed at clinics conveniently located in the schools, regardless of their ability to pay. - Social and Economic Factors - Needs include poverty, transportation, affordable / safe housing, educational attainment. In its commitment to reducing inequities in care, Carilion provides financial support for people who cannot afford insurance or health care. Carilion also manages a Medication Assistance Program to increase access to affordable medication and replenishes medication carried aboard emergency medical services vehicles. Support is provided to various not-for-profit organizations. Our support reduces the impact of poverty on health through investments in social determinants such as housing, transportation, employment, education, access to healthy foods and many other worthwhile causes. Each year, Carilion Clinic coordinates a system-wide United Way campaign through which employees can provide additional support to these causes. The Virginia Tech Carilion (VTC) Health Sciences and Technology Campus is located in the City of Roanoke. The VTC partnership continues to spur economic growth for the region through job growth, spending at the campus, student populations and research grant funds. Growth is expected to continue through at least 2026. Community partners, including Carilion, start early outreach in schools to inspire future health care workers and to create educational pathways for all. Virginia Western Community College and local universities have partnered with the community to make it possible for local students to access affordable or no-cost education. - Transportation - Carilion recognizes the impact that lack of reliable transportation can have on health. To improve access to transportation for patients in need of regular health care, Carilion supports the City of Roanoke's trolleys. The trolleys provide free transportation from downtown Roanoke to Carilion Roanoke Memorial Hospital and points in between, including the Riverside Center campus that houses the Virginia Tech Carilion School of Medicine, the Fralin Biomedical Research Institute at Virginia Tech Carilion and many Carilion clinical services. Schedule H, Part V, Section B, Line 11 Addressing Needs Identified in CHNA, Continued - Physical Environment - While physical environment did not necessarily arise as a top priority in the 2018 RVCHNA, Carilion still recognizes the impact the environment has on the health of our communities. Efforts continue to make our hospitals and other facilities more energy efficient, increase recycling and the use of recyclable or bio-degradable materials, reduce waste materials and serve local, sustainable foods to patients and in our cafeterias. - Implementation and Measurement - Carilion has invested in multiple systems to manage data and track outcomes of our community work. We assessed program-level outcomes for community health education classes and screening events. We tracked these outcomes using pre- and post-tests for education and screening results such as blood pressure, cholesterol, diabetes risk assessments and glucose readings. Community programs supported by Carilion grants were responsible for regularly reporting program outcomes. Scorecards developed contain key secondary data points. They are updated annually to track the community health initiatives' impact. Specifically, Carilion tracked and measured impact on specific aligned indicators contributing to the RWJF County Health Factors Rankings and County Health Outcomes Rankings. Our goal is to improve County Health Rankings for the entire Roanoke Valley. Still, we understand that improvements are relative to progress in other communities in the Commonwealth of Virginia by these rankings' nature. The REDCap software program enabled internal data to be utilized at the aggregate level to display outcomes of targeted health initiatives for research teams. The initiatives included asthma interventions at Fallon Park Elementary School. The results will be used for future planning and decision-making. - Priority Areas Not being Addressed and the Reasons - Earlier, we described using a community approach to determine and address priority needs. We used a similar approach to determine which needs cannot be immediately addressed. We considered several needs during the prioritization process. However, we did not actively address these needs during this period due to low feasibility or low potential impact. These needs are alcohol and drug use, lack of exercise, lack of health literacy, lack of understanding of healthy behaviors, lack of knowledge of community resources, risky sexual activity, tobacco use, access to primary care, access to specialty care (general), communication barriers with providers, coordination of care, quality of care, child abuse/neglect, community safety/violence, domestic violence, lack of family / social support systems, unemployment, air quality, injury prevention/safety of the environment, outdoor recreation, water quality, high prevalence of chronic disease (general). Schedule H, Part I, Line 3c Financial Assistance Eligibility Criteria Patients' eligibility is determined by family size, family income, real property equity and liquid assets. Families with family income equal or below 200% of the Federal Poverty Guidelines (FPG) and assets equal or below $15,000 are eligible to receive 100% adjustment under the financial assistance policy (FAP). Families with family income greater than 200% of the FPG but less than or equal to 400% of the FPG or assets above $15,000 and less than or equal to $100,000 are eligible to receive a partial adjustment under FAP. The partial adjustment matches the amounts generally billed (AGB) percentage for each service area. Schedule H, Part I, Line 6a Community Benefit Report Information on community benefit is reported annually through a consolidated report prepared by Carilion Clinic (EIN 54-1190771). Printed copies of this report are distributed throughout communities served by hospitals affiliated with Carilion Clinic. Additionally, the community benefit report is available on Carilion Clinic's website: https://carilionclinic.org/about-carilion-clinic#our-values Schedule H, Part I, Line 7 Col (F) Percent of Total Expense Patient -related bad debt expense of $81,553,905 was excluded from the calculation of Part I Line 7 Column (f) Percent of total expense. Schedule H, Part I, Line 7e Community health improvement services and community benefit operations This line is reported at actual cost. Carilion's commitment to community health is evident at all levels of the organization. Our infrastructure includes a Planning and Community Health division dedicated to assessing and addressing community needs. The division leads and facilitates the Community Health Improvement Plan, Community Health Needs Assessments, community grants, community health education, collection of community benefit data and neighborhood health initiatives. Some Community Health and Outreach staff work with the hospital's Board of Directors and Carilion Clinic's Board of Governors to create health improvement strategies to address community health needs. The hospital also has a Community Benefit Council providing oversight for Carilion's community health improvement work and for community benefit strategy, data collection and submission. Carilion Medical Center educates the public about health risks and steps that can be taken to improve health. Events include regularly scheduled health screenings for blood pressure, blood glucose and cholesterol and seasonal screenings to detect facial damage due to sun exposure. Carilion Medical Center's community health education department hosts the local chapter of the National Safe Kids Coalition. The department also offers guidance about childhood injury prevention to the community and other providers. Carilion Medical Center's Safe Kids Coalition coordinator also provides free training and national certification on proper car seat installation for other health and safety providers. Due to COVID-19, work shifted from the typical health education and improvement programming to education and outreach aimed at lessening the impact of the pandemic. For many months, representatives across the organization were involved in the Home Alone program-an outreach effort to connect vulnerable patients to community resources and help them overcome any barriers caused by supply shortages, business closures, and cancellation of medical appointments. Carilion received federal relief funding that will offset the Community Benefit expenses generated by this and other similar work. In efforts to increase access to health care, Carilion physicians dedicate hours to providing ongoing care for patients of local free clinics. Carilion also connects patients to resources for enrollment in public health care programs such as Medicaid. Following the rollout of Medicaid expansion in Virginia, Carilion began contracting with MedAssist for Medicaid enrollment outreach, ensuring access to a wide range of health services across the community. MedAssist screens uninsured patients to identify eligibility and helps them with the application process, including documentation and substantiation of eligibility. Greater coverage increases access to benefits not only for general health, but for dental and mental health services as well. The increase in scope for Medicaid eligibility and enrollment led to an increase in Community Benefit dollars invested in this category. Community benefit operations include expenses associated with tracking community health improvement activities, and the cost associated with coordinating responses to community health needs identified through the most recent Roanoke Valley Community Health Assessment. This coordination includes participation in various community partnerships such as Healthy Roanoke Valley, a collaboration of health and human service agencies developing initiatives to address prioritized community health needs. Schedule H, Part I, Line 7f Health professions education This line is reported at actual cost. Carilion Medical Center mentors nursing students, provides continuing education opportunities for local providers and operates a residency program. Schedule H, Part I, Line 7g Subsidized Health Services N/A Schedule H, Part I, Line 7h Research This line is reported at cost. Carilion Medical Center participates in clinical research projects and provides a Human Research Protections Office, which includes the Institutional Review Board. The Human Research Protections Office is designed to protect the rights, dignity and welfare of individuals who are the subject of research conducted by the organization's clinicians, staff or students. The Health Analytics Research Team provides accurate and timely reporting, informatics and actionable analytics to forward the mission of Carilion, including clinical, financial, research, and claims data. Additionally, community research is provided through a cancer registry to assist public health professionals in understanding and addressing the cancer burden more effectively. The information collected is used to develop programs on cancer prevention, early detection, and successful treatment and care. Another example is an at-home pulmonary rehabilitation program developed to help patients with high-risk chronic obstructive pulmonary disease in rural areas improve health outcomes and healthy behaviors by engaging in at-home self-care. Schedule H, Part I, Line 7i Cash and in-kind contributions for community benefit At cost. Carilion's dedication to our mission of improving the health of the communities we serve is evidenced by the annual financial and in-kind contributions we provide to dozens of nonprofit partners. Our support directly impacts the issues identified in our triennial Community Health Needs Assessment and various social determinants that impact health. This support helps provide access to nutrient dense foods, promotion of exercise and healthy activities, chronic disease management, access to mental health services and coordination of care, and many other community health improvement goals. Schedule H, Part II Community Building Activities Line 1 - Physical improvements and housing - N/A Line 2 - Economic development - As the largest employer in Southwest Virginia, Carilion impacts economic development by investing in jobs, increased wages for employees and various capital building projects. In addition, Carilion had direct economic development expenses from programming and support of local Chambers of Commerce, the Better Business Bureau, and the Roanoke Regional Partnership, improving economic development efforts through pro-business advocacy. We supported the Partnership's Accelerate 2022 campaign to quicken the region's growth through leveraging livability, the outdoors, and higher education to achieve job growth, investment, qualified workforce and economic impact. Carilion is active in local economic development endeavors, including supporting the Valleys Innovation Council, investing in research and technology and communicating with local businesses about the region's current business climate and prospective companies. Funding provided to the Greater Roanoke Transit Company for the Star Line Trolley offers free transportation around downtown Roanoke. It serves as a critical link to the Carilion and Virginia Tech Carilion locations in Roanoke's Innovation Corridor along Jefferson Street. Line 3 - Community support - Research demonstrates the strong connection between social determinants of health such as transportation, housing and education, and communities' overall health and well-being. Carilion supports nonprofit organizations addressing barriers to good health arising from these social determinants in various ways. Carilion also collaborates with local partners to support better education and opportunities for children and families and improved housing, better nutrition and additional resources for its neighbors in need. These efforts make progress in removing a range of obstacles to good health for residents of our region. In fiscal year 2020 (tax year 2019), Carilion worked with the Rescue Mission homeless shelter to support the Back to School Blast, which provides around 1,000 area students with new backpacks containing school supplies at the start of the school year and engages Carilion physicians in providing physicals and immunizations. Through monetary donations and organizational support, Carilion reduces inequity, promotes community development and repair, provides for veterans and seniors' social needs, maintains essential community-building amenities, and supports events for organizations like the Boys and Girls Club of Southwest Virginia, the NAACP and Local Colors of Western Virginia. Line 4 - Environmental improvements - N/A Line 5 - Leadership development and training for community members - N/A Line 6 - Coalition building - Carilion believes in the power of collaboration and understands that we must address our most significant health issues in concert with the community. To ensure lasting impact from the health assessment and community health improvement process, Carilion participates in community health coalitions that address health, safety and social determinant needs in the Roanoke Valley. Also, we partner with multiple community and business organizations around initiatives to improve health and wellness for everyone living in the Roanoke Valley. An example is Carilion's representation and participation on the Injury and Violence Prevention Collaborative Network, a group of organizations across Virginia working to strengthen injury and violence prevention efforts and enforce positive change on one of the leading causes of hospitalizations and deaths for both children and adults. Carilion also works with Children's Trust on coalition-building efforts to decrease child abuse and neglect. Other coalition-building activities include board participation with the Child Health Investment Partnership of the Roanoke Valley, Feeding Southwest Virginia, the Boys and Girls Club of Southwest Virginia, DePaul Community Resources, the Virginia Rural Health Association, and many more. Line 7 - Community health improvement advocacy - Carilion's mission of community health improvement focuses not only on what the organization does directly but also on supporting advocacy through other organizations' work. During fiscal year 2020 (2019 tax year), Carilion worked with various groups. These included Equality Virginia, an organization focused on ensuring protection in legislation for LGBTQ Virginians and providing advocacy for transgender Virginians. We also worked with the Virginia Tech Carilion School of Medicine's Inclusivity Task Force, which advances inclusivity across all aspects of the student experience. Financial support also furthers our advocacy efforts. We contribute to many causes, including the Children's Trust "Save Jane" campaign, which brings awareness to child abuse in the Roanoke Valley; the Humble Hustle Company, which empowers black youth and connects diverse communities; and Girls on the Run, an organization that promotes running as a method of empowering young girls. Line 8 - Workforce development - With the understanding that employment is directly linked to health and wellness, Carilion partners to provide workforce development and training for community members. These efforts also develop a pipeline of future health care workers. In fiscal year 2020 (tax year 2019), Carilion Medical Center partnered to offer Project SEARCH, a one-year high school transition program providing employment and educational opportunities for individuals with significant disabilities. This collaborative program includes Goodwill Industries of the Valleys, the Virginia Department of Aging and Rehabilitative Services, and local school systems. Carilion was a founding partner in VA Ready. This new initiative focuses on helping Virginians impacted by the pandemic return to work through training for in-demand jobs in high-growth sectors. Carilion is involved in the Virginia Business Higher Education Council Growth4VA coalition, promoting reform and reinvestment in the higher education system. Through the Virginia Foundation for Independent Colleges, Carilion provided fellowship funds to help students strengthen their research experience and prepare them for a career in the sciences. In addition, Carilion deploys special recruitment efforts for specific types of providers to improve access to needed care and meet the needs of underserved individuals in the Roanoke Valley. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Carilion Medical Center estimates bad debt expense by reserving a percentage of all self-pay patient accounts receivable by aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Accounts receivable are stated at net realizable amounts due from patients, third-party payors, and other insurers for which Carilion Medical Center expects to be entitled in exchange for providing patient care. In accordance with Accounting Standards Update (ASU) No. 2014-09, Revenue from Contracts with Customers (Topic 606) (ASU 2014-09), the estimated uncollectible amounts are generally considered implicit price concessions that are a direct reduction to patient accounts receivable. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Medicare allowable costs are determined from the Medicare cost report using the cost-to-charge ratio. The Hospital believes our Medicare shortfall is a cost we incur as a benefit to the community. IRS Rev. Rul. 69-545 provides that one of the factors demonstrating community benefit is operating an emergency room open to all persons regardless of ability to pay and providing other hospital care for all patients able to pay, including those who pay their bills through public programs such as Medicare. In order to operate for the benefit of the broad community that we serve we must include our significant Medicare population, even if we are required to subsidize care to our Medicare patients due to being reimbursed at less than cost by Medicare's nonnegotiable rates. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance When accounts receivable efforts are exhausted, the account may be placed with a collection agency and extraodinary collection actions (ECAs) may be considered. Accounts will not be placed with a collection agency prior to 120 days from the date the first billing statement is provided except when mailings are returned with no forwarding address and combining multiple accounts of varying age with those already transferred or for legal verification regarding other liabilities. Reasonable efforts will be made to identify appropriate forwarding addresses. When a Financial Assistance Application (FAA) is received during the application period (within 240 days after the date the first billing statement is provided), but after initiation of ECAs, all ECAs will be suspended. Best efforts will be made to process completed applications within 30 days of receipt of the application; financial assistance eligibility will be determined and communicated to the individual. Incomplete applications must be completed within 30 days of the initial notification of additional items required; otherwise, the application will be deemed incomplete and closed. If an individual is eligible for financial assistance, ECAs, other than the sale of debt, will be reversed and any payments related to eligible care refunded to the extent no longer owed. ECAs will be reinstated if the individual is not eligible for financial assistance or does not complete the FAA by the deadline. At least 30 days before initiating an ECA, Carilion will send the patient written notice of intended ECA(s), a plain language summary explaining financial assistance available and the process for determining eligibility, and the deadline for applying for assistance. Carilion will also attempt to call individuals at least 30 days before initiating an ECA to make them aware of the financial assistance available and how to obtain assistance with the application process. Carilion shall enter into a written contract with any collection agency to which it refers bad debt. The contract will obligate the collection agency to observe and comply with Carilion's obligations under this Policy and the Financial Assistance Policy. A collection agency to which bad debt is referred for collection may not engage in any ECAs without the prior written consent of Carilion. After making reasonable efforts to determine if a patient qualifies for Financial Assistance and the patient either does not qualify for Financial Assistance or fails to submit an application as requested, within 240 days from the date the first billing statement is provided, Carilion may engage in one or more of the following ECAs: 1. Place a lien on an individual's property; 2. Attach or seize an individual's bank account or any other personal property; 3. Commence a civil action against an individual; 4. Garnish an individual's wages; 5. Sell an individual's debt to another party; or 6. Report the account to credit agencies. Individual account balances greater than $5,000 are not sent to a collection agency. These are handled through the Debt Recovery Department (DRD) for verification of Financial Assistance status before further collection activity occurs. DRD will also investigate any accounts that require special handling. For example, in cases of a deceased patient, auto accident, or any other unique circumstances requiring special handling, the accounts are placed with the DRD. When all collection efforts have been exhausted, all hospital accounts will be returned and closed as uncollectible. No further collection activity is taken at that time. Accounts with satisfactory payment arrangements, legal activity or accounts with pending payment will be considered active and are not returned. Schedule H, Part V, Section B, Line 16a FAP website A - CARILION MEDICAL CENTER -DBA CRMH: Line 16a URL: HTTPS://WWW.CARILIONCLINIC.ORG/BILLING/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website A - CARILION MEDICAL CENTER -DBA CRMH: Line 16b URL: HTTPS://WWW.CARILIONCLINIC.ORG/BILLING/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - CARILION MEDICAL CENTER -DBA CRMH: Line 16c URL: HTTPS://WWW.CARILIONCLINIC.ORG/BILLING/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment In addition to conducting regular Community Health Needs Assessments (CHNA), Carilion Clinic closely monitors community health indicators and responds to needs as they arise. Each year, Carilion updates scorecards with refreshed County Health Rankings indicators provided by the Robert Wood Johnson Foundation. Carilion is also responsive to needs identified through clinical data and internal departments. Carilion's call center, Carilion Direct, is available for community members to ask questions and connect with community resources. The Planning and Community Development department studies chronic disease incidence and prevalence rates, monitors health status indicators and assesses health disparities. Carilion adapted its community health improvement process from Associates in Process Improvement's Model for Improvement and the Plan-Do-Study-Act cycle developed by Walter Shewhart. It consists of five steps: (1) conducting the CHNA, (2) strategic planning, (3) creating the implementation strategy, (4) program implementation, and (5) evaluation. This cycle is repeated every three years. Needs are also identified through advisory boards and focus groups conducted in key neighborhoods or aligned with community initiatives. Ongoing collaboration with community stakeholders allows for regular communication of community needs and gives our partners opportunities to respond cohesively. Carilion fosters community development in its CHNA and community health improvement processes through the Strive Collective Impact Model for the Community Health Assessment Team. This evidence-based model focuses on "the commitment of a group of important players from different sectors to a common agenda for solving a specific social problem(s)" and has been proven to lead to large-scale changes. It focuses on relationship-building between organizations and the progress toward shared strategies. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Information on Financial Assistance is provided to the patient at hospital admission and ambulatory areas in the form of signage, a plain language summary which includes contact information, financial assistance application and documentation in the inpatient handbook. Patient Access staff, Hospital social workers and customer service representatives verbally inform patients on availability of assistance. Each patient statement and patient financial responsibility letter includes information on the Financial Assistance policy including who to contact for additional information and location of in-person assisters. The Application, the Policy, and the plain language summary are available free of charge to the patient. They are available by mail and on the web site if the patient did not receive written information at the time of service. Financial Assistance policy and application are also distributed to community partners through electronic mailing groups. Carilion Clinic employs an Eligibility staff that counsel patients on federal and state programs. The staff completes applications for Medicaid, Social Security, Social Security Disability and Medicare. The staff provides support services ensuring the applications are processed correctly based on federal and state policy. In addition, the Eligibility staff is trained as Certified Application Counselors and will assist patients in enrollment in the insurance exchange Marketplace. Eligibility staff will also complete Carilion's financial assistance application and counsel patient on the requirements for financial assistance. Schedule H, Part VI, Line 4 Community information The Roanoke Metropolitan Statistical Area (MSA) is home to Carilion Clinic's flagship hospital, Carilion Roanoke Memorial Hospital. The MSA is commonly known as the Roanoke Valley and comprises the independent cities of Roanoke and Salem and the counties of Botetourt, Craig, Franklin and Roanoke. It is nestled among the Blue Ridge Mountains with the City of Roanoke at its heart. Roanoke is a destination venue rich in cultural diversity, arts, shopping, recreational opportunities, natural beauty and services not available in the region's more rural areas. In addition to Carilion, key safety net providers in the region include Veterans Administrations; New Horizons, a federally qualified health center; free clinics; local offices of the Virginia Department of Health; and other human service organizations. Despite these entities' presence, however, thousands of low-income, uninsured and underinsured residents do not have access to affordable health care services. The 2018 RVCHNA revealed distinct communities with significant differences in size and population and significant disparities in health and social determinants. The 2015-2019 American Community Survey (ACS) found the Roanoke MSA's total population to be 313,009. The cities of Roanoke and Salem had 99,229 residents and 25,317 residents, respectively. The counties of Botetourt, Craig, Franklin and Roanoke had 33,343, 5,110, 56,187 and 93,823 residents, respectively. The median age in the MSA localities ranges from 37.8 in the City of Roanoke to 47.2 in Craig and Franklin Counties, all above the state median of 38.2 (U.S. Census Bureau, 2015-2019 5-year American Community Survey, Table S0101, https://data.census.gov/cedsci/table?q=S0101&tid=ACSST5Y2019.S0101&hidePreview=true). The Weldon Cooper Center for Public Service predicts positive population change by 2040 for all communities except Craig County, which may have very slight population loss (Weldon Cooper Center for Public Service, https://demographics.coopercenter.org/virginia-population-projections). The ACS finds that for most of the Roanoke MSA, a more significant percentage of the population is White than in the Commonwealth of Virginia as a whole, with rates ranging up to 98.6% in Craig County (U.S. Census Bureau, 2015-2019 5-year estimates, American Community Survey, Table DP05, https://data.census.gov/cedsci/table?tid=ACSDP5Y2019.DP05&hidePreview=true). The Roanoke Valley's urban hub, the City of Roanoke, is more racially and ethnically diverse than the rest of the MSA. Roanoke's population is 62.4% White, 29.0% Black, and 3.0% Asian, with 4.4% representing more than one race. The remainder represents small minorities of American Indian/Alaskan Native, Native Hawaiian/Pacific Islander or some other race. Of the population, 6.3% are Hispanic or Latino (U.S. Census Bureau, 2015-2019 5-year estimates, American Community Survey, Table DP05, https://data.census.gov/cedsci/table?tid=ACSDP5Y2019.DP05&hidePreview=true). The city is divided into quadrants (Northwest, Northeast, Southwest and Southeast) separated geographically by railroad tracks, the Roanoke River and Interstate 581. These quadrants vary significantly in the demographic and economic make-up of their residents. Specifically, two of the quadrants- Northwest and Southeast-have federal designations as Medically Underserved Areas. The quadrants are home to a large proportion of the low-income individuals and families in the city who may be uninsured, underinsured or are Medicaid recipients who face additional barriers due to cultural differences. Schedule H, Part VI, Line 5 Promotion of community health Carilion Clinic is a not-for-profit, integrated health care system located among the Blue Ridge Mountains. Our flagship hospital in the heart of the City of Roanoke, the largest urban hub in western Virginia. Carilion provides quality care for nearly one million individuals through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers, and other complementary services. Carilion's roots go back more than a century when a group of dedicated citizens came together and built a hospital to meet the community's health care needs. Today, Carilion is a vital anchor institution focused on health care and dedicated to our mission of improving the health of the communities we serve. With an enduring commitment to our region's health, care is advanced through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. Carilion invests in discovering and responding to local and regional health needs, understanding that we must involve additional stakeholders to address community health issues and create change effectively. Carilion Medical Center (CMC) includes Carilion's flagship facility, Carilion Roanoke Memorial Hospital (CRMH) (https://www.carilionclinic.org/locations/carilion-roanoke-memorial-hospital). A 703-bed hospital, CRMH consists of a Neonatal Intensive Care Unit, Carilion Children's Hospital, specialty and advanced clinical care, and the region's only Level 1 Trauma Center and Level 1 Pediatric Trauma Center. U.S. News & World Report ranks CRMH among Virginia's top five hospitals. CRMH provides access to the region's most experienced providers and specialty services while teaching and developing tomorrow's medical leaders through residencies and fellowships sponsored by the Virginia Tech Carilion School of Medicine. CMC serves patients regardless of their ability to pay. The hospital's governing board members are elected annually and reside in the region. The majority of members are neither hospital employees nor contractors. Medical staff privileges are extended to qualified providers. Surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. Reinvestments include providing free, discounted and subsidized care and critical medical services not otherwise offered in our region. Schedule H, Part VI, Line 6 Affiliated health care system Carilion Medical Center is wholly owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. Through a comprehensive network of hospitals, primary and specialty physician practices, and complementary services, Carilion provides exceptional care for nearly one million Virginians. With an enduring commitment to the region's health, Carilion advances care through medical education and research, helps its community stay healthy and inspires the region to grow stronger. In the mid-2000s, Carilion made the strategic decision to transform from a collection of hospitals to a physician-led, integrated health care system. Advances include developing a multi-specialty physician group, transforming our primary care practices into patient-centered medical homes, implementing electronic health records system-wide, and creating a robust partnership with Virginia Tech, including developing the Virginia Tech Carilion (VTC) School of Medicine and the Fralin Biomedical Research Institute at VTC. In addition, Carilion continues to evolve its long relationship with what is now Radford University Carilion to assist with educating students in various health professions. Each decision and adaptation have fundamentally changed the way Carilion collaborates and provides care (https://www.carilionclinic.org/about-carilion-clinic). Carilion's community and population health infrastructure is the health system's engine for providing collaborative opportunities to improve and promote the community's health. Carilion's Community Health Assessments process helps identify the strengths and barriers impacting health. Its community-based programs reflect the Robert Wood Johnson Foundation's framework of four main influences of health-health behaviors, social and economic factors, clinical care access and quality, and physical environment. The health system's many partnerships with cross-sector organizations create a collaborative culture of community health and wellness. true American Heart Association 4217 PARK PLACE COURT GLEN ALLEN VA 23060 135613797 501(c)3 18500 Event Sponsorship ARCH Roanoke 404 Elm Ave SW Roanoke VA 24016 237064477 501(c)3 17000 COVID Isolation Center Center in the Square 1 Market Square Roanoke VA 24011 510238900 501(c)3 50000 Children's Museum Children's Trust Roanoke Valley 541 Luck Avenue Roanoke VA 24016 510235891 501(c)3 70000 General Support Family Service of Roanoke Valley 360 Campbell Ave SW Roanoke VA 24016 540505946 501(c)3 12000 Mental Health Support Roanoke Symphony Orchestra 128 East Campbell Ave Roanoke VA 24011 546019736 501(c)3 20000 Corporate Sponsorship (7) Virginia Blue Ridge Affiliate of Susan G Komen 4910 Valley View Blvd Roanoke VA 24012 562619425 501(c)3 20000 Event sponsorship (8) Virginia Foundation for Independent Colleges 901 East Byrd St Richmond VA 23219 540554396 501(c)3 10000 General Support Virginia Health Care Foundation 707 E Main St Richmond VA 23219 541639924 501(c)3 50000 Leadership Partner Support Virginia Tech Foundation Inc 902 Prices Fork Rd Blacksburg VA 24061 540721690 501(c)3 8403 Regional Leadership Forum Virginia Tech 300 Turner St NW Blacksburg VA 24061 546001805 Virginia 52500 COVID Innovation United Way of Roanoke Valley 325 Campbell Ave SW Roanoke VA 24016 540535302 501(c)3 15000 Family Self-Sufficiency 2019 Commemoration Inc PO Box 1607 Williamsburg VA 23187 810703911 501(c)3 25000 Event Sponsorship National Academy of Sciences 500 Fifth Street NW Keck Ctr Rm 731 Washington DC 20001 530196932 501(c)3 25000 General Support The Roanoke-Blacksburg Innovation Network 1700 Kraft Dr Blacksburg VA 24060 462975294 501(c)3 100000 General Support VA Business Higher Education 1108 East Main Street Richmond VA 23219 541827038 501(c)3 50000 General Support Virginia Ready Initiative 107 S West Street Alexandria VA 22314 851103573 501(c)3 62500 General Support Ronald McDonald House Charities of SW VA 2224 S Jefferson St Roanoke VA 24014 541244769 501(c)3 263675 FMV Donated Rent Donated Rent CHIP of Roanoke Valley 1201 Third Street Roanoke VA 24016 541566451 501(c)3 50000 General Support Blue Ridge Literacy 706 S Jefferson Street Roanoke VA 24016 541377063 501(c)3 10000 English and Health Literacy Class Boys and Girls Club of SWVA 1714 9th Street SE Roanoke VA 24013 541867366 501(c)3 35000 Food Access Program and Van Bradley Free Clinic 1240 Third Street SW Roanoke VA 24016 237380491 501(c)3 25000 Continuity of Care & Behavioral Health Services City of Roanoke 215 Church Ave Roanoke VA 24011 546001569 City of Roanoke 20000 Financial Empowerment Center Kid's Soar 305 Mountain Ave SW Roanoke VA 24016 010583325 501(c)3 8500 Literacy initiative Local Environmental Agricultural Project PO Box 3249 Roanoke VA 24015 271050909 501(c)3 15000 Healthy Foods Incentive Greater Roanoke Transit Company 1108 Campbell Avenue Roanoke VA 24013 540982022 City of Roanoke 43831 General Support Renovation Alliance 530 Eighth St SW Roanoke VA 24016 541961045 501(c)3 10000 Repairs for Low Income Homeowners Virginia Tech Carilion School of Medicine 2 Riverside Circle Roanoke VA 24016 264556177 501(c)3 3126044 Medical School Support Radford University 232 Cook Hall Radford VA 24142 237219782 VIRGINIA 10200 Transfusion Project 29 0 PATIENTS 8 252129 SCHOLARSHIPS 5 9000 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. The hospital donates funds to other charitable organizations in support of health and community improvement. Such organizations also have community boards which oversee the expenditure of such funds. Carilion Clinic is committed to improving the health of the communities we serve by addressing key health priorities identified through our triennial Community Health Assessments. Carilion fulfills this commitment in many ways, one of which is through targeted grants for community health improvement programs and those that impact the social determinants of health. For Carilion Clinic's Community Grant Program, each grantee must sign a letter of agreement with Carilion Clinic that delineates the terms and specific objectives of the project. By accepting a Carilion award, grantees are asked to acknowledge the support of Carilion Clinic in all materials and/or related special events or fundraisers throughout the award cycle where other donors are publicly recognized. One mid-cycle progress report and a final program evaluation are required for each funded project. Site visits may be made to grantees. A grant cycle specifically addressing needs resulting from the impacts of COVID-19 was held in fiscal year 2020 (tax year 2019) and due to the nature of the funding, awardees were required to submit only one, final report. Program evaluation includes alignment with Community Health Assessment priorities, program impact, organizational effectiveness and community benefit through collection of data including clients served, cost effectiveness of the program (cost per client or service), tangible community or client outcomes, and specific efforts to cultivate diverse funding sources for program sustainability. Each grantee must agree to submit requested data and reports on a timely basis and to complete the evaluation process as requested. Carilion Medical Center also has a program under which endowment funds are granted to community organizations with a focus on children's health and well-being. A committee of Carilion Medical Center employees reviews the applications and selects the recipients. Recipients sign a letter of agreement that delineates the terms and objectives of the project. Recipients submit a mid-year report, and a final program evaluation to report on the program's services, outcomes and budget. Site visits may be made to grantees as needed. X false true false true false false false false false true false Steven Arner Director/President/CEO 0 647421 0 225708 0 4813 0 345071 0 18548 0 1241561 0 0 Paul Haskins MD Director 300894 0 65545 0 4580 0 221683 0 19951 0 612653 0 0 0 Michael Nussbaum MD Director 561198 0 116870 0 9841 0 155196 0 15255 0 858360 0 0 0 Tracey Criss MD Physician 247516 0 74302 0 4262 0 273662 0 17273 0 617015 0 0 0 Nicholas Conte Secretary 0 501457 0 201967 0 6258 0 163964 0 18548 0 892194 0 0 David Hagadorn Asst. Treasurer 0 138561 0 2000 0 8778 0 98598 0 865 0 248802 0 0 Donald Halliwill Asst. Treasurer 0 568290 0 201281 0 4727 0 343625 0 17248 0 1135171 0 0 G Robert Vaughan Jr Treasurer 0 270749 0 78415 0 3948 0 297970 0 18325 0 669407 0 0 Patrice Weiss MD Chief Medical Officer/EVP 0 592094 0 218870 0 6419 0 233397 0 20031 0 1070811 0 0 Bruce Long MD Physician 381683 0 60544 0 5353 0 177682 0 17643 0 642905 0 0 0 Jon Sweet MD Physician 235870 0 84626 0 3359 0 198007 0 11766 0 533628 0 0 0 Michael Abbott Senior Vice President 203065 0 43438 0 1741 0 23249 0 6835 0 278328 0 0 0 Nancy Howell Agee CEO, Carilion Clinic 0 1292284 0 555922 0 406517 0 329565 0 12301 0 2596589 0 195503 Joseph Moskal MD SVP/Chair, Dept. of Orthopedics 1059011 0 242434 0 209558 0 121621 0 20031 0 1652655 0 195000 0 Paul Skolnik MD SVP/Chair, Dept. of Medicine 420042 0 109178 0 9811 0 78752 0 9638 0 627421 0 0 0 Jonathan Carmouche MD Physician 1348131 0 494365 0 3102 0 124635 0 17643 0 1987876 0 0 0 Gregory Howes MD Physician 1053523 0 591012 0 2833 0 60747 0 16343 0 1724458 0 0 0 Eric Marvin MD Physician 968562 0 458733 0 2503 0 119418 0 16343 0 1565559 0 0 0 ADEOLU OLASUNKANMI MD Physician 747581 0 344332 0 8450 0 28514 0 19202 0 1148079 0 0 0 Jesse Stem MD Physician 756856 0 536452 0 3553 0 44712 0 17643 0 1359216 0 0 0 Schedule J, Part I, Line 1a Health or social club dues or initiation fees All Directors are offered a free family or individual membership to a health club owned by a related organization if they choose to accept it. Five reported individuals received this benefit, the value of which is included in reported compensation. Schedule J, Part I, Line 1b Written policy regarding payment or reimbursement of expenses Provision of the health club benefit is documented in Board meeting minutes and Carilion internally tracks the memberships and pays the health club directly. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation The organization has a single member, Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. Executive compensation, including that of the organization's Chief Executive Officer, is reviewed annually by the Carilion Clinic Board of Directors 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. In addition, the Compensation Committee annually reviews the compensation philosophy for all executive leaders. This review included review of a comprehensive report from an independent, outside compensation consultant specializing in healthcare organizations for select positions and the prior year's report on all of the reviewed positions. The reports reviewed by the Committee included a detailed comparison of total compensation and each element thereof, including base salary, bonus, "at-risk" and other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to both a national and regional peer group of organizations similar in size and structure to the organization, the list of which was reviewed by the Compensation Committee. The Compensation Committee maintained detailed minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Mr. Arner, Mr. Conte, Mr. Halliwill, Dr. Moskal, Dr. Nussbaum, Dr. Skolnik, Mr. Vaughan, and Dr. Weiss participate in a Defined Contribution Supplemental Executive Retirement Plan (DC SERP) in which the employer, at the discretion of Carilion Clinic's Compensation Committee, makes a contribution to an account established on its books for each eligible participant. If a participant ceases to be a participant prior to the vesting date, the account shall be forfeited. A lump sum distribution shall be made upon the participant's vesting date, death, or disability. Unvested contributions made to the DC SERP in the reporting period are included in Part II of this schedule with "retirement and other deferred compensation." $195,000 of prior year deferrals were paid to Dr. Moskal under this plan in the reporting year. Ms. Agee participated in an executive flexible benefit plan, in which an allowance is provided annually to the participant for use in obtaining certain insurance benefits. In prior years, the amount of allowance in excess of elected benefits was credited to a capital accumulation account (CAA) with various deferred vesting dates of at least two years from the first day of the plan year, distributable upon vesting while employed by a Carilion Clinic affiliate, death, disability, or 24 months following certain qualifying separations from service. Deferrals no longer occur under this plan. $195,503 was distributed under this plan in the reporting year. Schedule J, Part I, Line 7 Non-fixed payments The organization pays annual "at-risk" compensation to certain members of management based on performance of an applicable scorecard. While the scorecard contains a formula as a basis for determining overall performance, in certain cases, senior managers have discretion to include additional elements in their assessment of managers reporting to them. In addition, for top management, the actual non-fixed payment awarded is in the discretion of the Carilion Clinic Board of Directors and its Compensation Committee. MARY SWEET MD FAMILY MEMBER OF JON SWEET, FORMER KEY EMPLOYEE 374284 EMPLOYEE false Form 990, Part I, Line 6 Volunteers The hospital operates a Customer Service-based program for volunteers and we do anything to make our patients and patients families comfortable in very uncomfortable circumstances. Tasks include delivering mail, delivering flowers, greeting and escorting patients and providing snacks in the hospital waiting rooms. Through Hospice, volunteers provide respite support for caregivers, visits for socialization and comforting presence, check in calls, take care of patients' pets, sing to patients, pet therapy, deliver supplies, help in the hospice office, assist with fundraisers, assist with bereavement support activities, facilitate children's grief support groups, deliver birthday gifts, make holiday gifts and memory quilts and record patient's life stories. Total volunteer hours worked were 12,170. NOTE: THE VOLUNTEER PROGRAM WAS SUSPENDED ON MARCH 16,2020 DUE TO COVID WHICH AFFECTED THE AMOUNT OF VOLUNTEER HOURS WORKED. Form 990, Part III, Line 4a Program Service Description Carilion Medical Center (CMC) d/b/a Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital exists to serve the health care needs of its communities and region, regardless of the patient's ability to pay. CMC admitted 31,269 patients and provided 179,750 days of care during fiscal year 2020. Hospital programs and accomplishments include the Cardiovascular Institute. It includes extensive expertise in cardiology for advanced heart failure, structural heart disease, electrophysiology labs for complex arrhythmias and a robust cardiothoracic surgery program with advanced procedures for complex aortic and vascular disease. Our vascular program remains a leader in treatment and surgical intervention. CMC is known for tertiary level care with expertise in Level 1 trauma for adults and pediatric patients, primary and comprehensive stroke care, neurosurgery for adults and children, and women's services for obstetrics (3,070 babies delivered), high-risk pregnancy, urogynecology, gynecologic oncology and fertility and reproductive care. Another area of surgical excellence is orthopaedics. It includes joint replacement, ortho spine surgery, sports medicine, trauma surgery, foot and ankle, hand and upper extremity and pediatrics. Other medical programs include specialized intensive care units for neurotrauma, cardiac care and cardiac surgery, vascular, medical intensive care, and dedicated units for oncology and thoracic surgery patients. The programs are supported by our acclaimed Magnet nursing program, receiving four Magnet designations over the years. Additional programs include the region's only neonatal intensive care unit, advanced diagnostics and expertise for gastroenterology conditions, inpatient and outpatient psychiatric services, a comprehensive inpatient rehabilitation unit, and inpatient and outpatient surgical care utilizing advanced techniques in robotic and endovascular procedures. Diagnostic testing capabilities in radiology support all CMC programs, including advanced imaging in CT, MRI and PET/CT. We've expanded our field of experts in molecular imaging and nuclear medicine procedures and ultrasound and provide screening mammography and diagnostic breast imaging. Carilion Children's is our region's only pediatric center of excellence with an inpatient hospital within CMC, a pediatric intensive care unit, NICU, and trauma care. Pediatric sub-specialists support the facility in surgery, pulmonology, oncology, cardiology, gastroenterology, psychiatry, orthopaedics, neurosurgery, dentistry, neurology, and endocrinology. CMC provides several services and programs to target the specific health needs of the area, including diabetes management, medically supervised weight loss, urgent care, physical, speech and occupational therapy programs, cardiac and pulmonary rehab and home health and hospice care. Supporting our communities is our 24/7 Level 1 trauma center, full-service emergency department, three medical service helicopters and a highly advanced medical communications center to support the region's emergency transportation needs. Carilion Roanoke Memorial Hospital (CRMH) has been consistently ranked among the nation's top 100 hospitals by Becker's Hospital Review, among the top three hospitals in Virginia by U.S. News and World Report, and it is the region's preferred hospital according to surveys conducted by National Research Corporation (NRC) Health. With 75,712 visits, CMC's emergency services are a critical component of the health safety net in its service area, acting as a key health provider for a significant number of uninsured patients, who comprise nearly 9 percent of ED visits. The urgent care centers also provide access points for cost effective care at an appropriate level. CMC also supports community screenings and education on chronic disease prevention and management, sponsoring 9,685 events touching over 35,246 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, financial assistance for the year exceeded $14 million. Form 990, Part IV, Line 11f Disclosure of Uncertain Tax Positions Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. Form 990, Part V, Line 1a FORMS 1099 1099s are issued on Carilion Medical Center's behalf by Carilion Services, Inc., a related supporting organization providing management and administrative services, including payment processing. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Nancy Howell Agee, Steve Arner, Nicholas Conte, David Hagadorn, Donald Halliwill, G. Robert Vaughan, Jr., and Patrice Weiss. - Business relationship Form 990, Part VI, Line 3 Delegation of management duties Certain management and related services for the organization are provided by the management and employees of Carilion Services, Inc., a related and supporting organization of the filing organization. Some or all of the compensation of the following individuals listed in Part VII, Section A was provided by Carilion Services Inc.: Nancy Howell Agee, Steven Arner, Nicholas Conte, David Hagadorn, Donald Halliwill, G. Robert Vaughan, Jr., and Patrice Weiss. Form 990, Part VI, Line 6 Classes of members or stockholders 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, Line 7a Members or stockholders electing members of governing body 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, Line 7b Decisions requiring approval by members or stockholders 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. See also Schedule O disclosure for Form 990, Part VI, Section A, Line 7a. Form 990, Part VI, Line 11b Review of form 990 by governing body The Form 990 was prepared by Carilion's internal Tax Department with input from various Carilion departments as applicable, and reviewed by internal Accounting Management and an independent CPA firm. Several days prior to filing, all Board Members were notified by email of its availability on Carilion's Board portal, which is the mechanism used to disseminate meeting materials to the directors, and were encouraged to call with any questions they might have. Form 990, Part VI, Line 12c Conflict of interest policy Our organization monitors and reviews proposed and current transactions for conflicts of interest in a variety of ways. At the governing board level, we have board members complete an initial (upon appointment) and annual conflict of interest questionnaire to disclose actual or potential conflicts. Board members are required to update their disclosure as needed in between questionnaires. All disclosures are reviewed by the Organizational Integrity & Compliance Office and as needed escalated to the appropriate leaders/board members for further discussion/review. If a disclosure is viewed as an actual or potential conflict, an action is recommended to the Compliance Committee of the Carilion Clinic Board and implemented as approved. Actions can include recusal in discussion/voting at board meetings, limitation/termination of the transaction, removal from board appointment or other appropriate controls. In addition, at any time, board members are encouraged to disclose any potential conflicts as they arise at a board meeting and to recuse themselves as deemed appropriate. The same process takes place as described above for key employees (upon hire and annually thereafter), including all officers, members of the management team, physicians/mid-level practitioners, pharmacists and key supply chain buyers. After review and further discussion as needed, action may be required to manage an actual conflict or to reduce the appearance of such as approved by Organizational Integrity & Compliance Office and other key management team members. As needed, the governing board leaders are notified of any conflicts which may impact board proceedings. Form 990, Part VI, Line 15a Process to establish compensation of top management official The organization has a single member, Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. Executive compensation is reviewed annually by the Carilion Clinic Board of Directors Compensation Committee. This Committee is made up of Board Members of Carilion Clinic who do not have a conflict of interest with any of the executives being reviewed. With respect to Carilion Clinic, the Compensation Committee reviews the compensation of the Board of Governors annually, which includes the President and Chief Executive Officer, the Executive Vice Presidents (Chief Financial Officer, Chief Medical Officer, Chief Operating Officer, Chief Administrative Officer and Chief Legal Officer), and select Senior Vice Presidents who are the physician Chairs of the Clinical Departments. For the fiscal year covered by this return, the Compensation Committee also used the same process to review the compensation of other Disqualified Individuals, including the Hospital Vice Presidents. In addition, the Compensation Committee annually reviews the compensation philosophy for all executive leaders, which includes Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, and the CEO, as well as the compensation philosophy for employed physicians. Some officers of the organization who are not compensated in their capacity as an officer but rather in their role as employee in a position not mentioned above are not subject to Committee review. This review included review of a comprehensive report from an independent, outside compensation consultant specializing in healthcare organizations for select positions and the prior year's report on all of the reviewed positions. The reports reviewed by the Committee included a detailed comparison of total compensation and each element thereof, including base salary, bonus, 'at-risk' and other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to both a national and regional peer group of organizations similar in size and structure to the organization, the list of which was reviewed by the Compensation Committee. The Compensation Committee maintained detailed minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives. Form 990, Part VI, Line 15b Process to establish compensation of other employees See response to line 15A Form 990, Part VI, Line 19 Required documents available to the public The organization's governing documents, conflict of interest statement, and financial statements are released from time to time during the tax year upon request. The conflict of interest policy is included in our Code of Excellence which is available to the public on our website. The Articles of Incorporation are available from the Virginia State Corporation Commission. Limited financial information is available on our website. Form 990, Part VIII, Line 2f Other Program Service Revenue Other - Total Revenue: 2837619, Related or Exempt Function Revenue: 2837619, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Revenue - Total Revenue: 7929297, Related or Exempt Function Revenue: 7929297, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part X, Line 20 Tax Exempt Bond Liabilities The amount reported as Tax-Exempt Bonds is the portion of Carilion Clinic Bonds allocated to Carilion Medical Center. Required information for the Bonds, including Schedule K, is reported in the Carilion Clinic (EIN: 54-1190771) IRS Form 990. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfers from/(to) Affiliates - -9290109; Pension-related changes other than net periodic pension costs - -3078245; Transfer Accumulated FCV LLC Investment from Carilion Clinic - -197601; RMH EMERGENCY SERVICES LLC PO BOX 12385 ROANOKE VA 24025 541686589 PHYSICIAN BILLING VA 0 0 CARILION MEDICAL CENTER CARILION CLINIC PO BOX 12385 ROANOKE VA 24025 541190771 SUPPORTING ORGANIZATION VA 501(c)(3) Type II NA false CARILION CLINIC FOUNDATION PO BOX 12385 ROANOKE VA 24025 541190773 FUNDRAISING VA 501(c)(3) 7 CARILION CLINIC true CARILION FRANKLIN MEMORIAL HOSPITAL PO BOX 12385 ROANOKE VA 24025 540480606 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION GILES COMMUNITY HOSPITAL PO BOX 12385 ROANOKE VA 24025 540549603 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION NEW RIVER VALLEY MEDICAL CENTER PO BOX 12385 ROANOKE VA 24025 540553805 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION SERVICES INC PO BOX 12385 ROANOKE VA 24025 541190879 SUPPORTING ORGANIZATION VA 501(c)(3) Type II CARILION CLINIC true CARILION STONEWALL JACKSON HOSPITAL PO BOX 12385 ROANOKE VA 24025 540568001 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION TAZEWELL COMMUNITY HOSPITAL PO BOX 12385 ROANOKE VA 24025 546074580 HEALTHCARE VA 501(c)(3) 3 CARILION CLINIC true CARILION BIOMEDICAL INSTITUTE PO BOX 12385 ROANOKE VA 24025 541965057 SUPPORTING ORGANIZATION VA 501(c)(3) Type I CARILION CLINIC true FRANKLIN COUNTY VENTURES LLC PO BOX 12385 ROANOKE VA 24025 474365316 REAL ESTATE VA CARILION CLINIC Related -1497 201189 false false 0.1 CARILION CLINIC MEDICARE SHARED SAVINGS COMPANY LLC PO BOX 12385 ROANOKE VA 24025 455235473 MEDICARE HMO VA CARILION CLINIC Related 6471910 0 false false 0.5 SOUTHWEST VIRGINIA HEALTH PROPERTIES LLC 1102 Jefferson Street SE Roanoke VA 24016 010691570 REAL ESTATE VA Carilion Medical Center Related 86256 1299766 false false 0.5112 RAVEN ASSET BASED OPPORTUNITY FUND IV LP 110 Greene St Suite 9G New York NY 10012 824119491 Private Equity DE NA N/A TI PLATFORM CC SMA LP 1160 Battery Street East San Francisco CA 94111 842852539 Investments DE NA N/A STARWOOD VEP II CO-INVEST LLC 591 W Putman Avenue Greenwich CT 06830 833262407 Investments DE NA N/A CHS INC PO BOX 12385 ROANOKE VA 24025 541725732 SERVICES VA NA C Corporation true CARILION CLINIC MEDICARE RESOURCES LLC PO BOX 12385 ROANOKE VA 24025 263729975 MEDICARE HMO VA NA C Corporation true CARILION BEHAVIORAL HEALTH INC PO BOX 12385 ROANOKE VA 24025 203136891 HEALTHCARE VA NA C Corporation true CARILION EMERGENCY SERVICES INC PO BOX 12385 ROANOKE VA 24025 542033006 HEALTHCARE VA NA C Corporation true SCA CREDIT SERVICES INC PO BOX 12385 ROANOKE VA 24025 541180398 COLLECTION AGENCY VA NA C Corporation true CARILION HEALTHCARE CORPORATION PO BOX 12385 ROANOKE VA 24025 541586601 HEALTHCARE VA NA C Corporation true MEDKEY INC PO BOX 12385 ROANOKE VA 24025 541645357 FINANCING SERVICES VA NA C Corporation true SPROTT PRIVATE RESOURCE LENDING (C-CO-INVEST) LP 981378742 INVESTMENTS CA NA C Corporation true BLACKMOOR OWNERSHIP HOLDINGS LIMITED INVESTMENTS CJ NA C Corporation true MAGNITUDE SYSTEMATIC LONG SHORT FUND INVESTMENTS CJ NA C Corporation true TANGIBLE SEGREGATED PORTFOLIO OF THE SOUTH AFRICA ALPHA SPC INVESTMENTS CJ NA C Corporation true true true true true true false false false false true true true true false false false false true false CARILION CLINIC FOUNDATION A 38784 COST CARILION EMERGENCY SERVICES A 95940 COST CARILION HEALTHCARE CORPORATION A 27000 COST CHS INC A 56392 COST CARILION SERVICES INC A 720790 COST CARILION EMERGENCY SERVICES L 302902 COST CARILION FRANKLIN MEMORIAL HOSPITAL L 1943999 COST CARILION GILES COMMUNITY HOSPITAL L 487032 COST CARILION HEALTHCARE CORPORATION L 252764 COST CARILION NEW RIVER VALLEY MEDICAL CENTER L 2919690 COST CARILION SERVICES INC L 79638 COST CARILION STONEWALL JACKSON HOSPITAL L 709341 COST CARILION TAZEWELL COMMUNITY HOSPITAL L 1996945 COST CARILION BEHAVIORAL HEALTH M 133062 COST CHS INC K 1773512 COST CHS INC M 5237442 COST CARILION NEW RIVER VALLEY MEDICAL CENTER K 215495 COST CARILION SERVICES INC M 199125574 COST CARILION TAZEWELL COMMUNITY HOSPITAL K 152009 COST SCA CREDIT SERVICES INC M 883791 COST CARILION SERVICES INC R 9294593 CASH Carilion Clinic Foundation C 505223 CASH