CARILION TAZEWELL COMMUNITY HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CARILION TAZEWELL COMMUNITY HOSPITAL (EIN 54-6074580)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-13
- IRS object ID
- 201442259349301634
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-13T11:51:49-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 424 Church Street | AddressLine1 |
| City | Nashville | City |
| State | TN | State |
| ZIP Code | 37219 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 546074580 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARILION TAZEWELL COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CARI | NameControl |
| Phone | 5402245112 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12385 | AddressLine1 |
| City | ROANOKE | City |
| State | VA | State |
| ZIP Code | 240252385 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Donald Halliwill | Name |
| Title | Chief Financial Officer | Title |
| Phone | 5402245112 | Phone |
| Date Signed | 2014-08-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Francis J Bedard | Name |
| PTIN | P00752421 | PTIN |
| Phone | 6152591811 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | William J Flattery | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12385 | AddressLine1 |
| City | ROANOKE | City |
| State | VA | State |
| ZIP Code | 240252385 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 15027652 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.carilionclinic.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1968 | YearFormation |
| State Legal Domicile | VA | StateLegalDomicile |
| Activity Or Mission Description | See Schedule O.Carilion Tazewell Community Hospital is committed to a common purpose of better patient care, better community health, and lower cost. This 56-bed hospital primarily serves the counties of Tazewell and Russell in Virginia, and Mercer and McDowell in West Virginia. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 140 | TotalNbrEmployees |
| Total Nbr Volunteers | 26 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 9112 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 12654739 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 13879009 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 19720 | InvestmentIncomePriorYear |
| Investment Income Current Year | 5445 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1130410 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1134086 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 13804869 | TotalRevenuePriorYear |
| Total Revenue Current Year | 15027652 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 9560 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2598 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4345901 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4876049 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9474694 | OtherExpensePriorYear |
| Other Expenses Current Year | 10617381 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 13830155 | TotalExpensesPriorYear |
| Total Expenses Current Year | 15496028 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -25286 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -468376 | RevenuesLessExpensesCY |
| Total Assets BOY | 6695725 | TotalAssetsBOY |
| Total Assets EOY | 7631121 | TotalAssetsEOY |
| Total Liabilities BOY | 14205299 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 15557460 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -7509574 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -7926339 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | See Schedule O.Carilion Tazewell Community Hospital, part of Carilion Clinic, is a not-for-profit healthcare organization committed to improving health outcomes for every patient while advancing the quality of care in the community it serves.Our mission is to improve the health of the communities we serve. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11968787 | Expense |
| Grants | 2598 | Grants |
| Revenue | 14979423 | Revenue |
| Description | See Schedule O. | Description |
| Total Program Service Expense | 11968787 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 140 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | VA | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Corporation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5402245112 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 S Jefferson St | AddressLine1 |
| City | Roanoke | City |
| State | VA | State |
| ZIP Code | 24011 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| Stephen Barrett | |||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| Nancye Howell | |||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| D Michael Hymes | |||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| Donald Halliwill | |||||||||
| Director/CFO | 2.00 | 48.00 | X | 0 | 261453 | 102501 | |||
| Melina Perdue | |||||||||
| Director/EVP | 2.00 | 48.00 | X | 0 | 399309 | 347954 | |||
| Peggy Riley | |||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| Stephen Rinehart MD | |||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | |||
| James Thompson | |||||||||
| Chairman/Director | 2.00 | 0.00 | X | 0 | 0 | 0 | X | ||
| Charles Green | |||||||||
| Vice Chairman/Director | 2.00 | 0.00 | X | 0 | 0 | 0 | X | ||
| John Piatkowski MD | |||||||||
| CEO/VP/Director | 2.00 | 48.00 | X | 0 | 295150 | 16230 | X | ||
| Dorid Turjman MD | |||||||||
| Chief of Staff/Director | 2.00 | 0.00 | X | 0 | 0 | 0 | X | ||
| Donald Lorton | |||||||||
| Treasurer | 2.00 | 48.00 | X | 0 | 756751 | 353047 | X | ||
| Rachel Mabe | |||||||||
| Asst. Secretary | 2.00 | 48.00 | X | 0 | 67010 | 32710 | X | ||
| Kathren Dowdy | |||||||||
| Nurse Manager | 50.00 | 0.00 | 116919 | 0 | 18831 | X | |||
| William Flattery | |||||||||
| Former Administrator | 0.00 | 50.00 | 0 | 235278 | 63154 | X | |||
| Randal Swatzyna | |||||||||
| Former Administrator/Director | 0.00 | 50.00 | 0 | 123441 | 60009 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 116919 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2138392 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 994436 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Soltas Lab Partners Group LLC | |||||
| PO Box 751337 | Charlotte | NC | 28275 | Laboratory Services | 843383 |
| GJ Hopkins Inc | |||||
| 714 5th Street NE | Roanoke | VA | 24016 | Construction Services | 605183 |
| Nickels Inc | |||||
| PO Box 347 | Tazewell | VA | 24651 | Construction Services | 552397 |
| Allied Health Services | |||||
| PO Box 97 | Tazewell | VA | 24651 | Professional Fees | 364540 |
| MR Ramakrishnan MD | |||||
| 1745 Valley View Drive | Big Stone Gap | VA | 24219 | Physician Services | 312000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Government Grants | 9112 | GovernmentGrants |
| Total Contributions | 9112 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Net Patient Revenue | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 13879009 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13879009 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 13879009 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5445 | TotalRevenueColumn |
| Exclusion | $5,445 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 33672 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 33672 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33672 | TotalRevenueColumn |
| Exclusion | $33,672 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| EHR Incentive Income | 900099 | 1095853 | 1095853 |
| Court Cost Recovery | 900099 | 4141 | 4141 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 420 | TotalRevenueColumn |
| Related Or Exempt Function Income | 420 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1100414 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15027652 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14979423 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $39,117 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2598 | Total |
| Program Services | 2598 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4067885 | Total |
| Program Services | 4021133 | ProgramServices |
| Management And General | 46752 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 253192 | Total |
| Program Services | 253192 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 269149 | Total |
| Program Services | 258574 | ProgramServices |
| Management And General | 10575 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 285823 | Total |
| Program Services | 285823 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1752688 | Total |
| Management And General | 1752688 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6127 | Total |
| Management And General | 6127 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2593 | Total |
| Program Services | 2593 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2616420 | Total |
| Program Services | 2581208 | ProgramServices |
| Management And General | 35212 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 361095 | Total |
| Program Services | 344666 | ProgramServices |
| Management And General | 16429 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14577 | Total |
| Program Services | 14577 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 199382 | Total |
| Program Services | 199382 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58247 | Total |
| Program Services | 55289 | ProgramServices |
| Management And General | 2958 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 149284 | Total |
| Program Services | 149284 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 638599 | Total |
| Program Services | 638599 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 264384 | Total |
| Program Services | 199777 | ProgramServices |
| Management And General | 64607 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt | 2310033 | 2310033 | |
| I/C Practice Subsidy | 1565574 | 1565574 | |
| Medical Supplies | 606550 | 606550 | |
| Dues & Subscriptions | 33744 | 33576 | 168 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38084 | Total |
| Program Services | 11933 | ProgramServices |
| Management And General | 26151 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15496028 | Total |
| Program Services | 11968787 | ProgramServices |
| Management And General | 3527241 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1125 | BOY |
| EOY | 926 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13254 | BOY |
| EOY | 24507 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2823575 | BOY |
| EOY | 2695727 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20000 | BOY |
| EOY | 5278 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43186 | BOY |
| EOY | 122494 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 14915756 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10144971 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3783181 | BOY |
| EOY | 4770785 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11404 | BOY |
| EOY | 11404 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6695725 | BOY |
| EOY | 7631121 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2407385 | BOY |
| EOY | 1163817 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48247 | BOY |
| EOY | 62609 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11749667 | BOY |
| EOY | 14331034 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14205299 | BOY |
| EOY | 15557460 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -7509574 | BOY |
| EOY | -7926339 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -7509574 | BOY |
| EOY | -7926339 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6695725 | BOY |
| EOY | 7631121 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -468376 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 51611 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $2,593 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2593 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1: | ReturnReference |
| Explanation | Portion of dues paid to American Hospital Association and Virginia Hospital and Healthcare Association spent on lobbying. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 48753 | OtherCostOrOtherBasis |
| Book Value | 48753 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6749200 | OtherCostOrOtherBasis |
| Depreciation | 3887138 | Depreciation |
| Book Value | 2862062 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7398833 | OtherCostOrOtherBasis |
| Depreciation | 6129255 | Depreciation |
| Book Value | 1269578 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 718970 | OtherCostOrOtherBasis |
| Depreciation | 128578 | Depreciation |
| Book Value | 590392 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4770785 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Due to Affiliate | $14,260,824 |
| Qualified Pension Liability | $55,210 |
| Accrued Pension | $15,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 14331034 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X, Line 2: | ReturnReference |
| Explanation | Carilion had no material unrecognized tax benefits and no adjustments to its consolidated financial statements were required as of and for the years ended September 30, 2013 and 2012. Carilion does not expect that unrecognized tax benefits will materially increase within the next 12 months. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 133.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 950676 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 950676 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07210 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 621450 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 521681 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 99769 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00760 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1572126 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 521681 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1050445 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07970 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 709 | PersonsServed |
| Total Community Benefit Expense | 18353 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 18353 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 450 | PersonsServed |
| Total Community Benefit Expense | 2720 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2720 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Persons Served | 1159 | PersonsServed |
| Total Community Benefit Expense | 21073 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 21073 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Persons Served | 1159 | PersonsServed |
| Total Community Benefit Expense | 1593199 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 521681 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1071518 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08130 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $689,977 | BadDebtExpenseAmount |
| Amount Attributable To | 140583 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 4075225 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4819882 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -744657 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carilion Tazewell Community Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 141 Ben Bolt Avenue | AddressLine1 |
| City | Tazewell | City |
| State | VA | State |
| ZIP Code | 24651 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.carilionclinic.org | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carilion Tazewell Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 133.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Uninsured Discount | X | UninsuredDiscount |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 3c: Factors Used: Use of liquid assets and equity in real property (no more than $100,000 real estate equity) and liquid assets of less than $1,500. | |
| Part I, Line 6a: Information on community benefit is reported annually through a consolidated report prepared by Carilion Clinic. Printed copies of this report are distributed throughout communities served by hospitals affiliated with Carilion Clinic. Additionally, the community benefit report is available on Carilion Clinic's website. | |
| Part I, Line 7: Ratio of cost-to-charges was used to calculate the expense.Part I, Line 7, column (f) calculation -- Bad debt expense subtracted from total expenses for the calculation is $2,310,033. | |
| Part I, Line 7e-7i:7e - This line is calculated at cost. Health education was provided to more than 700 people during the annual Main Street Heritage Festival and Tazewell County Fair Children's Day. Assistance with enrollment in public medical programs such as Medicaid is provided. Community benefit operations expense includes costs associated with completing the community health needs assessment.7f - n/a.7g - n/a.7h - n/a.7i - This line is calculated at cost. Financial support was provided to the American Cancer Society in support of research, patient services, early detection, treatment and education. In-kind support was provided during fundraising activities for the American Cancer Society and local United Way. | |
| Part II, Lines 1 thru 8:1 - n/a.2 - n/a.3 - n/a.4 - n/a.5 - n/a.6 - n/a.7 - n/a.8 - n/a. | |
| Part III, Line 4: Accounts receivable are reduced by an allowance for amounts that could become uncollectible in the future. Carilion estimates the allowance for doubtful accounts by reserving a percentage of all self-pay accounts receivable by aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. The percentage used to reserve for all self-pay accounts is based on Carilion's collection history. Carilion collects substantially all of its third-party insured receivables, which include receivables from governmental agencies.The bad debt expense reported on Line 2 was calculated using the cost-to-charges ratio applied to the provision for bad debt reported in the financial statements.The estimated amount of bad debt expense, reported on line 3, attributable to patients eligible for charity care was determined using external credit reporting data to identify the patients that were eligible and applying the cost-to-charges ratio to the charges of the patients so identified. Sufficient information was not available to make a definite determination of their eligibility.Patient account balances are reduced by discounts allowed and payments. | |
| Part III, Line 8: Medicare allowable costs are determined from the Medicare cost report using the cost-to-charges ratio. The Hospital does not consider a Medicare shortfall as a community benefit. | |
| Part III, Line 9b: Carilion Clinic is committed to providing quality health care to all, regardless of their ability to pay. The Financial Assistance Policy is designed to allow relief of all or part of the charges that exceed a patient's reasonable ability to pay. Carilion uses the Federal Poverty Guidelines (FPG) published and updated yearly in the Federal Register along with a Financial Needs Assessment Questionnaire (FNAQ) as developed by Carilion to determine eligibility.All qualified financial assistance patient balances are adjusted (use Trans Union to screen all accounts to identify potential financial assistance patients).Together, the family income, number of family members living on that income, liquid assets and equity in real property are pertinent factors in determining how much, in the sole judgment of Carilion, a patient is reasonably able to pay for services. Patients with family income up to 133 percent of FPG with no more than $100,000 real estate equity and liquid assets of less than $1,500 are eligible to have their entire account covered under this policy. Patients with family income up to 400 percent of the FPG and no more than $100,000 real estate equity are eligible for financial assistance discounts. Financial Assistance applicants should complete a FNAQ in order to be considered for any discount beyond the discount given to all uninsured patients. Discounts will be reduced in cases where there is more than $100,000 of real estate equity or liquid assets in excess of $1,500. Additional information may be requested as part of the qualifying process.All patients who are able will be expected to pay for their own healthcare services to avoid shifting the burden for their care to other patients and the general public. The Financial Assistance Policy should have no impact on the collection policies and practices with regard to those balances that do not qualify. Failure to honor payment arrangements on amounts exceeding the discount given may result in the total discount being revoked. | |
| Part V, Section B, Line 3: In January 2013, Carilion Tazewell Community Hospital began its seven-month Community Health Needs Assessment process. A Community Health Assessment Team (CHAT) was formed, inviting stakeholder agencies across Tazewell County involved in the health of the community, to advise and oversee the process. A total of about 30 indiviuals participated in the CHAT meetings. The process was led and informed by Carilion Clinic's Planning Team. Primary data collection took place in the spring of 2013. Primary data collection included the implementation of a broad-based Community Health Survey, four Focus Group meetings with the target populations and a Stakeholder Survey given to individuals working in health-related areas.CHAT members represented the following organizations and groups:Carilion Tazewell Community Hospital and Carilion Clinic, Appalachian Agency for Senior Citizens (AASC), Board of Supervisors, Southwest Virginia Community Health Clinic, general dentistry, Health Department, Clinch Valley Medical Center, Bluefield Regional Medical Center, family medicine, Veterans, Local Outpatient Clinic, Four Seasons YMCA, Clinch Valley Community Action, Tazewell County Schools, local pharmacy, Richlands News Press, Lillies of the Field, Department of Social Services, Carilion Tazewell Home Health, Family Crisis, Tazewell Chief of Police, TASK (Taking Action for Special Kids), Crisis Pregnancy (The Abel Crisis Center), Heritage Hall, SWVA Community College, and Tazewell Library. | Carilion Tazewell Community Hospital |
| Part V, Section B, Line 5c: 5a: http://issuu.com/carilionclinic/docs/chna_tazewell or www.carilionclinic.org/chnaCarilion Tazewell Community Hospital also requested that organizations represented on the CHAT make the CHNA available on their websites. | Carilion Tazewell Community Hospital |
| Part V, Section B, Line 7: Multiple other needs were identified during the CHNA process, including dental care for children, access to vision care, transportation and access to in-home care. Dental care is being addressed via the development of a new dental school, already under development. The process used by the CHAT to prioritize needs identified access to vision, transportation and in-home care as lower priorities. The number of items was limited to the top five so that resources are focused and effective. | Carilion Tazewell Community Hospital |
| Part V, Section B, Line 12h: Other (liquid assets and equity in real property) See Part III, Line 9b narrative. | Carilion Tazewell Community Hospital |
| Part V, Section B, Line 20d: All patients are charged the same amounts regardless of insurance coverage or not. | Carilion Tazewell Community Hospital |
| Part V, Section B, Line 22: All patients are charged the same facility gross charge amounts. | Carilion Tazewell Community Hospital |
| Part VI, Line 3: The organization informs and educates patients by reviewing high dollar outpatient and all inpatient "self pay" accounts in order to seek eligibility for federal/state programs foremost, and then toward the Carilion Financial Assistance Program. This involves contact directly with the patient and/or the patient's representative (family, etc.). This program is available upon request for any and all services, and is available through the Carilion internet site, and is also available through the patient information pamphlet available in the patient access points. Note: The FAP is currently being evaluated by a Carilion team (Compliance, Finance and Revenue Cycle) based on 501r and IRS proposed regulations. Part of that program includes further communication efforts throughout the organization to inform patients of opportunities to assist them with their financial needs/concerns. | |
| Part VI, Line 4: Carilion Tazewell Community Hospital is a 56-bed facility in Tazewell, the county seat and geographic center of this southwest Virginia County, also known as Tazewell. Tazewell County is within the valley and ridge province of the Appalachian Highlands between the Appalachian Mountains on the southeast and the Cumberland Plateau and the Allegheny mountains on the northwest. The county contains 520 square miles and a population of a little over 45,000. Approximately 20% of adults under age 64 and 10% of children who live in the Tazewell County are uninsured. Additionally, 18% of residents live below the poverty level and 22% of adults 25 years of age or older did not graduate from high school. 17% of residents are 65 years of age or older. | |
| Part VI, Line 5: Carilion Tazewell Community Hospital serves all patients regardless of their ability to pay. The Hospital's governing Board is elected annually and the majority of members are neither employees nor contractors of the Hospital. Medical staff privileges are extended to qualified providers. In addition to clinical care, the hospital works to achieve its mission through the education of health professionals and the community. Any surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. This includes providing free, discounted and subsidized care as well as critical medical services that operate at a loss. Carilion Tazewell Community Hospital has been very involved in the development and implementation of a wellness center through both financial and in-kind support over several years. The Four Seasons YMCA, located on a parcel of land adjacent to the hospital, provides fitness and social activities. | |
| Part VI, Line 6: Carilion Tazewell Community Hospital is a wholly owned hospital of Carilion Clinic, a not-for-profit healthcare organization serving approximately one million people in Virginia through a comprehensive network of hospitals, primary and specialty physician practices, and other complementary services. Carilion Clinic is based in Roanoke, Virginia and serves the residents of 18 counties and six cities in Western Virginia and southern West Virginia. Over the past six years, Carilion Clinic has gone through a dramatic and transformative change as we transitioned from a hospital system to an integrated clinic with physician leadership. At the heart of our transformation is a passion and shared purpose to meaningfully change the way healthcare is delivered and experienced, resulting in higher value and better clinical outcomes. This has propelled a commitment to each other as providers and caregivers and working together in new and different ways. To fulfill our vision, we developed a new organizational structure for shared decision making and collaboration, implemented an enterprise-wide electronic health record, became NCQA medical homes in 27 of our primary care sites, established an accountable care organization, developed population health management infrastructure and developed the Virginia Tech Carilion School of Medicine and Research Institute. Carilion Clinic employees 650 physicians representing more than 60 specialties who provide care at 220 practice sites. During 2013, 168 students were enrolled in Virginia Tech Carilion School of Medicine and there were 549 appointed faculty members. To advance education of health professionals, Jefferson College of Health Sciences, within Carilion Medical Center, is a professional health sciences college offering associate, baccalaureate, and master's degree programs. Approximately 1,040 undergraduate students and 225 graduate students are enrolled annually. Carilion Clinic and Virginia Tech Carilion School of Medicine provide graduate medical education to 237 medical residents and fellows. Residency programs include Emergency Medicine, Family Medicine, Internal Medicine, Neurosurgery, Obstetrics/Gynecology, Psychiatry, General Surgery, Pediatrics, Podiatry and General Hospital Dentistry. Fellowship programs include Addiction Psychology, Adult Joint Reconstruction, Advanced Endoscopy, Cardiovascular Disease, Child and Adolescent Psychiatry, Gastroenterology, Geriatric Medicine, Geriatric Psychiatry, Hospice and Palliative Care, Infectious Disease, Interventional Cardiology, and Pulmonary Critical Care. Advanced Clinical Technology and Programs include Cyberknife Stereotactic Radiourgery, daVinci Robotic Surgical System, 60 bed neonatal intensive care unit, hybrid operating room, Carilion Clinic Children's Hospital, Cancer Center, Spine Center, and comprehensive cardiothoracic, vascular and orthopedic surgery programs. Carilion Roanoke Memorial Hospital includes a Level One Trauma Center with EMS services that include three EMS helicopters, four first-response vehicles and 50 Advanced Life Support Ambulances. An additional benefit to the community is Carilion Clinic's economic contribution to the region. As the area's largest employer, jobs are provided for more than 11,400 residents of the region. Research conducted at the Virginia Tech Carilion Research Institute (VTCRI) creates a bridge between basic science research at Virginia Tech and clinical expertise at Carilion Clinic and increases translational research opportunities for both partners. Research conducted by scientists at the institute is aimed at understanding the molecular basis for health and disease, and development of diagnostic tools, treatments, and therapies that will contribute to the prevention and solution of existing and emerging problems in contemporary medicine. Research areas of emphasis which presently align with areas of strength and active research at Virginia Tech include inflammation, infectious disease, neuroscience, and cardiovascular science and cardiology. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Donald Halliwill | ||||||||||||||
| Director/CFO | 0 | 218246 | 0 | 38492 | 0 | 4715 | 0 | 91348 | 0 | 11153 | 0 | 363954 | 0 | 0 |
| Melina Perdue | ||||||||||||||
| Director/EVP | 0 | 337912 | 0 | 58467 | 0 | 2930 | 0 | 339674 | 0 | 8280 | 0 | 747263 | 0 | 0 |
| John Piatkowski MD | ||||||||||||||
| CEO/VP/Director | 0 | 240620 | 0 | 52951 | 0 | 1579 | 0 | 14301 | 0 | 1929 | 0 | 311380 | 0 | 0 |
| Donald Lorton | ||||||||||||||
| Treasurer | 0 | 586044 | 0 | 170036 | 0 | 671 | 0 | 342823 | 0 | 10224 | 0 | 1109798 | 0 | 67752 |
| William Flattery | ||||||||||||||
| Former Administrator | 0 | 194398 | 0 | 34436 | 0 | 6444 | 0 | 49879 | 0 | 13275 | 0 | 298432 | 0 | 0 |
| Randal Swatzyna | ||||||||||||||
| Former Administrator/Director | 0 | 108799 | 0 | 10126 | 0 | 4516 | 0 | 54288 | 0 | 5721 | 0 | 183450 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 3 | See Schedule O disclosure for Form 990, Part VI, Section B, Line 15 |
| Part I, Line 4b | Melina Perdue $130,244 Donald Lorton $53,644 |
| Part I, Line 7 | The organization pays annual bonus compensation to management based on scorecard performance. While the scorecard contains a formula as a basis for determining overall performance, senior managers have discretion to include additional elements in their assessment of managers reporting to them. In addition, for top management, the actual bonus awarded is in the discretion of the Carilion Clinic Compensation Committee, although it is based on the scorecard measures. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Donald Lorton | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Assistant Treasurer | Relationship |
| Amount Of Transaction | 896825 | AmountOfTransaction |
| Description Of Transaction | Lab services | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part IV, Line (1): | Identifier |
| Explanation | Donald Lorton serves on the Board of Solstas Lab Partners, LLC, of which Carilion has a minority financial interest, and from whom the organization purchases lab services. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 3 | Certain management and related services for the organization are provided by the management and employees of Carilion Services, Inc., a related organization and supporting organization of the organization. | |
| Form 990, Part VI, Section A, line 6 | The organization has a single member. The sole member is Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. The sole member is entitled to elect directors having 80% of the vote on any issue. | |
| Form 990, Part VI, Section A, line 7a | The organization has one member. The sole member, Carilion Clinic, is entitled to elect one class of directors having 80% of the vote on any issue. The remaining class of directors, which has 20% of the vote on any issue, came from the local community and elect their own successors. Certain actions require the majority vote of both classes. | |
| Form 990, Part VI, Section A, line 7b | Under the laws of the Commonwealth of Virginia certain extraordinary actions require member approval, such as mergers, consolidations, liquidations and the sale of substantially all of the assets of the organization. | |
| Form 990, Part VI, Section B, line 11 | The final Form 990 was emailed or delivered in hard copy to each member of the Board of Directors several days prior to filing and Board members were encouraged to call with any questions they might have. | |
| Form 990, Part VI, Section B, line 12c | A Conflict of Interest Questionnaire, along with a copy of the Policy, is sent out annually to all officers, directors, and key employees. In addition, such individuals are instructed to inform the organization of potential conflicts which arise during the year. Answers to the questionnaires are reviewed by the Internal Audit Department. Potential conflicts for officers and key employees are reviewed by an internal Conflict of Interest Committee, which follows up on any potential issues to ensure compliance with all policies of the organization. The answers for Directors are reviewed by the Carilion Clinic Audit and Compliance Committee. In addition, the governing body of the organization is provided with a list of the answers annually to make all Board members aware of potential conflicts in order to ensure compliance with policies on how to handle transactions with Board members that may involve potential conflict situations. | |
| Form 990, Part VI, Section B, line 15 | Executive compensation is reviewed annually by the Carilion Clinic Compensation Committee. This committee is made up of Board members of Carilion Clinic who do not have a conflict of interest with any of the executives being reviewed. With respect to Carilion Clinic, the Compensation Committee reviews the compensation of the Board of Governors which includes the President and Chief Executive Officer, Executive Vice Presidents, Chief Financial Officer, Chief Medical Officer, and Chairs of the Clinical Departments. For the fiscal year covered by this return, the Compensation Committee also used the same process to review the compensation of other Disqualified Individuals, including the Hospital Vice Presidents. This review was performed in October 2012. A similar review was last performed in October 2013.This review included a comprehensive report from an outside compensation consultant specializing in healthcare organizations. The report included a detailed comparison of total compensation and each element thereof, including base salary, bonuses and other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to a peer group of organizations similar in size and structure to the organization, which list was reviewed by the Compensation Committee. Detailed minutes of the meetings of the Compensation Committee are kept and approved at the next meeting of the Committee, setting forth the deliberations and decisions regarding the compensation of these executives. In addition, the Compensation Committee annually reviews the compensation plan and philosophy for all vice presidents and senior vice presidents, as well as all employed physicians and physicians in leadership roles. | |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents, conflict of interest statement and financial statements are not generally available to the public, but are released from time to time upon request. The Articles of Incorporation are available from the Virginia State Corporation Commission. The consolidated audited financial statements of Carilion Clinic and of the Obligated Group are released annually to the local newspaper. Limited financial information is available on our website. | |
| Form 990, Part IX, line 11g | Other Services: Program service expenses 2,581,208. Management and general expenses 35,212. Fundraising expenses 0. Total expenses 2,616,420. | Other Fees |
| Form 990, Part XI, line 9: | Pension-Related Changes 51,612. Rounding -1. | Changes in Net Assets or Fund Balances: |
| Form 990, Part I Summary, Line 6: Volunteers staff the gift shop and volunteer in various departments doing clerical work, supporting community events, and service related tasks. | ||
| Form 990, Part III, Line 4a - Carilion Tazewell Community Hospital exists to serve the health care needs of its community, regardless of patient ability to pay. Tazewell's acute hospital admitted 643 patients and provided 1,872 days of care during the year. Hospital programs include provision of nursing care; outpatient and inpatient surgical and endoscopic services; and diagnostic imaging services including CT, MRI, and mammography. Tazewell provides a number of services targeting the specific health needs of its population, including physical, speech, and occupational therapy programs; home health services; bone density testing; and a cardiac rehab program. Tazewell also provides an emergency department with 24-hour care and emergency transportation. With 10,361 visits, Tazewell'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 18% percent of ED visits. Tazewell supports community screenings and education on chronic disease management, touching more than 700 people. In furtherance of its mission, Tazewell provides extensive uncompensated care. Stated at cost, charity, charity-eligible bad debt, and unreimbursed Medicaid costs for the year of $1.2 million. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Carilion Clinic | ||||||||||
| PO Box 12385 | Roanoke | VA | 24025 | 541190771 | Supporting organization | VA | 501(c)(3) | Line 11a, I | N/A | 0 |
| Carilion Clinic Foundation | ||||||||||
| PO Box 12385 | Roanoke | VA | 24025 | 541190773 | Supporting organization | VA | 501(c)(3) | Line 11a, I | N/A | 0 |
| Carilion Franklin Memorial Hospital | ||||||||||
| PO Box 12385 | Roanoke | VA | 24025 | 540480606 | Healthcare | VA | 501(c)(3) | Line 3 | N/A | 0 |
| Carilion Giles Community Hospital | ||||||||||
| PO Box 12385 | Roanoke | VA | 24025 | 540549603 | Healthcare | VA | 501(c)(3) | Line 3 | N/A | 0 |
| Carilion Medical Center | ||||||||||
| PO Box 12385 | Roanoke | VA | 24025 | 540506332 | Healthcare | VA | 501(c)(3) | Line 3 | N/A | 0 |
| Carilion New River Valley Medical Center | ||||||||||
| PO Box 12385 | Roanoke | VA | 24025 | 540553805 | Healthcare | VA | 501(c)(3) | Line 3 | N/A | 0 |
| Carilion Services Inc | ||||||||||
| PO Box 12385 | Roanoke | VA | 24025 | 541190879 | Supporting organization | VA | 501(c)(3) | Line 11a, I | N/A | 0 |
| Carilion Stonewall Jackson Hospital | ||||||||||
| PO Box 12385 | Roanoke | VA | 24025 | 540568001 | Healthcare | VA | 501(c)(3) | Line 3 | N/A | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |