FURP.ORG / PUBLIC DATA EXPLORER

CARILION TAZEWELL COMMUNITY HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CARILION TAZEWELL COMMUNITY HOSPITAL (EIN 54-6074580)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-15
IRS object ID
201332279349302593
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-15T14:06:03-00:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1424 Church StreetAddressLine1
CityNashvilleCity
StateTNState
ZIP Code37219ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN546074580EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Carilion Tazewell Community HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCARINameControl
Phone5402245112Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 12385AddressLine1
CityRoanokeCity
StateVAState
ZIP Code24025ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDonald HalliwillName
TitleAssistant TreasurerTitle
Date Signed2013-08-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameFrancis J BedardName
Phone6152591811Phone
Date Prepared2013-08-15DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJohn Piatkowski MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO Box 12385AddressLine1
CityRoanokeCity
StateVAState
ZIP Code24025ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13804869GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.carilionclinic.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1968YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionCarilion 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees132TotalNbrEmployees
Total Nbr Volunteers23TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1500ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year8885552ProgramServiceRevenuePriorYear
Program Service Revenue CY12654739ProgramServiceRevenueCY
Investment Income Prior Year9951InvestmentIncomePriorYear
Investment Income Current Year19720InvestmentIncomeCurrentYear
Other Revenue Prior Year1874895OtherRevenuePriorYear
Other Revenue Current Year1130410OtherRevenueCurrentYear
Total Revenue Prior Year10771898TotalRevenuePriorYear
Total Revenue Current Year13804869TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year7402GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY9560GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4019528SalariesEtcPriorYear
Salaries Etc Current Year4345901SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8319118OtherExpensePriorYear
Other Expenses Current Year9474694OtherExpensesCurrentYear
Total Expenses Prior Year12346048TotalExpensesPriorYear
Total Expenses Current Year13830155TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1574150RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-25286RevenuesLessExpensesCY
Total Assets BOY5606511TotalAssetsBOY
Total Assets EOY6695725TotalAssetsEOY
Total Liabilities BOY13075731TotalLiabilitiesBOY
Total Liabilities EOY14205299TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-7469220NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-7509574NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCarilion 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense11037314Expense
Grants9560Grants
Revenue13752257Revenue
DescriptionSee Schedule ODescription
Total Program Service Expense11037314TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees132NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledVAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonThe OrganizationNamePerson
Telephone Number5402245112TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1213 S Jefferson StreetAddressLine1
CityRoanokeCity
StateVAState
ZIP Code24011ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Stephen Barrett
Treasurer/Director002.00X000
Charles Green
Vice Chairman/Director002.00X000
Nancye Howell
Secretary/Director002.00X000
Melina Perdue
Director002.00X0386382266044
Peggy Riley
Director002.00X000
Stephen Rinehart MD
Director002.00X000
James Thompson
Chairman/Director002.00X000
William Flattery
Administrator/Director002.00X023557236621X
Randal Swatzyna
Administrator/Director002.00X017715047168X
John Piatkowski MD
CEO/Director002.00X01310871094X
Donald Lorton
Assistant Treasurer002.000680251528400X
Rachel Mabe
Assistant Secretary002.0006799125993X
Kathren Dowdy
Nurse Manager050.00109896012478X
FieldValueIRS element (for citing)
Total Reportable Comp From Org109896TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1678433TotalReportableCompFrmRltdOrgs
Total Other Compensation917798TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensationAddress Line1AddressOfContractor/AddressForeign/AddressLine1CityAddressOfContractor/AddressForeign/CityProvince Or StateAddressOfContractor/AddressForeign/ProvinceOrStateCountryAddressOfContractor/AddressForeign/CountryPostal CodeAddressOfContractor/AddressForeign/PostalCode
MR Ramakrishnan MD PC
1745 Valley View DrBig Stone GapVA24219Physician services264000
GJ Hopkins Inc
714 5th St NERoanokeVA24016Construction Contractor119645
Heartland Rehabilitation Services
Dept L 3281ColumbusOH432600001Rehabilitation services154569
Solstas Lab Partners Group LLC
Laboratory Services790674PO Box 751337CharlotteNCAF282751337
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNet Patient RevenuesDescription
Business Code900099BusinessCode
Total Revenue Column12654739TotalRevenueColumn
Related Or Exempt Function Income12654739RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue12654739TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column7320TotalRevenueColumn
Exclusion$7,320ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real32892Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real32892Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column32892TotalRevenueColumn
Exclusion$32,892ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other12400Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other12400Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column12400TotalRevenueColumn
Exclusion$12,400ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionEHR Incentive PaymentDescription
Business Code900099BusinessCode
Total Revenue Column1081800TotalRevenueColumn
Related Or Exempt Function Income1081800RelatedOrExemptFunctionIncome

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column15718TotalRevenueColumn
Related Or Exempt Function Income15718RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1097518TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13804869TotalRevenueColumn
Related Or Exempt Function Income13752257RelatedOrExemptFunctionIncome
Exclusion$52,612ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total9560Total
Program Services9560ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3614843Total
Program Services3533792ProgramServices
Management And General81051ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total163340Total
Program Services163340ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total303617Total
Program Services285806ProgramServices
Management And General17811ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total264101Total
Program Services264101ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1526835Total
Program Services320727ProgramServices
Management And General1206108ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total105Total
Management And General105ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total3033Total
Program Services3033ProgramServices
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2400127Total
Program Services1029866ProgramServices
Management And General1370261ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total66Total
Program Services66ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total498801Total
Program Services485170ProgramServices
Management And General13631ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2919Total
Program Services2919ProgramServices

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total168209Total
Program Services164609ProgramServices
Management And General3600ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total63908Total
Program Services57277ProgramServices
Management And General6631ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total134250Total
Program Services134250ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total576744Total
Program Services576744ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total238613Total
Program Services148548ProgramServices
Management And General90065ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies5191035191021
Bad Debt20190622019062
I/C Practice Subsidy12901501290150
Dues Subscriptions1367113014657

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total19098Total
Program Services16178ProgramServices
Management And General2920ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13830155Total
Program Services11037314ProgramServices
Management And General2792841ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY875BOY
EOY1125EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY29056BOY
EOY13254EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2636641BOY
EOY2823575EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY6040BOY
EOY20000EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY56992BOY
EOY43186EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis14304429LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10521248LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2865502BOY
EOY3783181EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY11405BOY
EOY11404EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5606511BOY
EOY6695725EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1062174BOY
EOY2407385EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY15667BOY
EOY48247EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY11997890BOY
EOY11749667EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY13075731BOY
EOY14205299EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-7469220BOY
EOY-7509574EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-7469220BOY
EOY-7509574EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5606511BOY
EOY6695725EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-25286ReconcilationRevenueExpenses
Reconcilation Other Changes-15068ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$3,033OtherActivitiesAmount
Total Lobbying Expenditures IIB3033TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierII-BIdentifier
Return Reference1iReturnReference
ExplanationPortion of dues paid to American Hospital Assn. and Virginia Hospital and Healthcare Assn. spent on lobbying.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Included On FSfalseIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis48753OtherCostOrOtherBasis
Book Value48753BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4889989OtherCostOrOtherBasis
Depreciation3638196Depreciation
Book Value1251793BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis7818426OtherCostOrOtherBasis
Depreciation6774562Depreciation
Book Value1043864BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1547261OtherCostOrOtherBasis
Depreciation108490Depreciation
Book Value1438771BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3783181TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Due to Affiliate$11,699,424
Qualified Pension Liability$50,243
FieldValueIRS element (for citing)
Total Of Amounts11749667TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierXIdentifier
Return Reference2ReturnReference
ExplanationCarilion had no material unrecognized tax benefits and no adjustments to its consolidated financial statements were required as of and for the years ended September 30, 2012 and 2011. Carilion does not expect that unrecognized tax benefits will materially increase within the next 12 months.Explanation

Schedule H IRS990ScheduleH

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

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense879443TotalCommunityBenefitExpense
Net Community Benefit Expense879443NetCommunityBenefitExpense
Percent Of Total Expense0.07450PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense773001TotalCommunityBenefitExpense
Direct Offsetting Revenue602378DirectOffsettingRevenue
Net Community Benefit Expense170623NetCommunityBenefitExpense
Percent Of Total Expense0.01440PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense1652444TotalCommunityBenefitExpense
Direct Offsetting Revenue602378DirectOffsettingRevenue
Net Community Benefit Expense1050066NetCommunityBenefitExpense
Percent Of Total Expense0.08890PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served362PersonsServed
Total Community Benefit Expense3031TotalCommunityBenefitExpense
Net Community Benefit Expense3031NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Total Community Benefit Expense1439TotalCommunityBenefitExpense
Net Community Benefit Expense1439NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served362PersonsServed
Total Community Benefit Expense4470TotalCommunityBenefitExpense
Net Community Benefit Expense4470NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served362PersonsServed
Total Community Benefit Expense1656914TotalCommunityBenefitExpense
Direct Offsetting Revenue602378DirectOffsettingRevenue
Net Community Benefit Expense1054536NetCommunityBenefitExpense
Percent Of Total Expense0.08930PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Building Expense1000TotalCommunityBuildingExpense
Net Community Building Expense1000NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served262PersonsServed
Total Community Building Expense3361TotalCommunityBuildingExpense
Net Community Building Expense3361NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served262PersonsServed
Total Community Building Expense4361TotalCommunityBuildingExpense
Net Community Building Expense4361NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$623,305BadDebtExpenseAmount
Amount Attributable To148660AmountAttributableTo
Amount Reimbursed By Medicare3921291AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare4434931CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-513640MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Carilion Tazewell Community HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1141 Ben Bolt AvenueAddressLine1
CityTazewellCity
StateVAState
ZIP Code24651ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI (31 entries)

IdentifierIdentifierExplanationExplanation
Part I line 6aInformation on community benefit is reported annually through a consolidated report prepared by Carilion Clinic. Printed copies of this report are distributed throughout communities served by hospitals affiliated with Carilion Clinic. Additionally, the community benefit report is available on Carilion Clinics website.
Part I line 77e -- This line is calculated at cost. Health education was provided to more 300 people during the annual Main Street Heritage Festival. Assistance with enrollment in public medical programs such as Medicaid is provided.
Part I line 77f -- N/A
Part I line 77g -- N/A
Part I line 77h -- N/A
Part I line 77i -- 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 I line 7Ratio of cost-to-charges was used to calculate the expense.
Part I line 7columnf calculation -- Bad debt expense subtracted from total expenses for the calculation is 2,019,062.
Part IILine 1 -- N/A
Part IILine 2 -- Financial support was provided to Tazewell Area Chamber of Commerce, with mission of promoting the interests of businesses in the Tazewell area through the development of civic, commercial, agriculture, educational and cultural life of the community and Greater Bluefield Chamber of Commerce, committed to strengthen economic development, stimulate growth of area businesses and enhance the quality of life for all its citizens.
Part IILine 3 -- Financial support was provided to the Four Seasons YMCA, with mission to put Christian principles into practice through programs that build healthy spirit, mind, and body for all and Tazewell Athletic Foundation, with purpose of promoting athletics at Tazewell, VA public schools in an atmosphere that is consistent with the educational philosophy of the school community.
Part IILine 3 CONTINUED In-kind support was provided during several food pantry and back to school drives that assist underserved individuals in the community. Additional in-kind support was provided for Step up to the Plate, a fundraiser for the non-profit Second Chance Learning Center, a program for at-risk young adults and teenagers in the community with educational needs.
Part IILine 4 -- N/A
Part IILine 5 -- N/A
Part IILine 6 -- N/A
Part IILine 7 -- N/A
Part IILine 8 -- N/A
Part III line 4Accounts receivable are reduced by an allowance for amounts that could become uncollectible in the future. Carilion estimates the allowance for doubtful accounts by reserving a percentage of all self-pay accounts receivable by aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. The percentage used to reserve for all self-pay accounts is based on Carilions collection history.
Part III line 4Continued Carilion collects substantially all of its third-party insured receivables, which include receivables from governmental agencies.
Part III line 4CONTINUED The bad debt expense reported on Line 2 was calculated using the cost-to-charges ratio applied to the provision for bad debt reported in the financial statements.
Part III line 4CONTINUED The estimated amount of bad debt expense, reported on line 3, attributable to patients eligible for charity care was determined using external credit reporting data to identify the patients that were eligible and applying the cost-to-charges ratio to the charges of the patients so identified. Sufficient information was not available to make a definite determination of their eligibility.
Part III line 4CONTINUED Patient account balances are reduced by discounts allowed and payments.
Part III line 8Medicare allowable costs are determined from the Medicare cost report using the cost-to-charges ratio. The Hospital does not consider a Medicare shortfall as a community benefit.
Part III line 9bCarilion Clinic is committed to providing quality health care to all regardless of their ability to pay. Our Charity Care Policy is designed to allow relief of all or part of the charges that exceed a patients reasonable ability to pay. Carilion uses the Federal Poverty Guidelines FPG published and updated yearly in the Federal Register along with a Financial Needs Assessment Questionnaire FNAQ as developed by Carilion to determine eligibility.
Part III line 9bCONTINUED Together, the family income, number of family members living on that income, and equity in real property are pertinent factors in determining how much, in the sole judgment of Carilion, a patient is reasonably able to pay for services. Patients with family income up to 400 percent of FPG with no more than 100,000 equity in real property are eligible for a Charity Care discount.
Part III line 9bCONTINUED To apply for the Charity Care program complete a Financial Needs Assessment Questionnaire or contact our Billing Customer Service team with questions. All patients who are able will be expected to pay for their own healthcare services to avoid shifting the burden for their care to other patients and the general public.
Part III line 9bCONTINUED The Charity Care Policy should have no impact on the collection policies and practices with regard to those balances that do not qualify for charity care. Failure to honor payment for amounts exceeding the charity adjustment may result in the total charity care being revoked.
Part VLine 19d The maximum amount that can be charged to FAP-eligible individuals for necessary care is as follows Individuals at or below 100 of the Federal Poverty Guidelines FPG are eligible for a discount of their entire account balance. Individuals at 101 to 200 of FPG are eligible for a discount of the greater of 75 of the account balance or the discount necessary to lower their remaining balance to 10 of family income.
Part VLine 19d CONTINUED Individuals at 201 to 250 of the FPG are eligible for a discount of the greater of 70 of the account balance or the discount necessary to lower their remaining balance to 15 of family income. Individuals at 251 to 300 of the FPG are eligible for a discount of the greater of 55 of the account balance or the discount necessary to lower their remaining balance to 20 of family income.
Part VLine 19d CONTINUED Individuals at 301 to 350 of the FPG are eligible for a discount of the greater of 40 of the account balance or the discount necessary to lower their remaining balance to 25 of family income. Individuals at 351 to 400 of the FPG are eligible for a discount of the greater of 25 of the account balance or the discount necessary to lower their remaining balance to 30 of family income.
Part V--- FOR Part VI, Lines 2, 3, 4, 5, 6 and 7 See Schedule O for the supplemental information.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained
No Grant More Than5000XNoGrantMoreThan5000

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
Identifier1Identifier
Return Reference2ReturnReference
ExplanationThe Hospital donates funds to other 501c3 charitable organizations with a similar mission. Such organizations also have community boards which oversee the expenditure of such funds.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Melina Perdue
293247496414349425109214952652426
William Flattery
19434130716105152299013631272193
Randal Swatzyna
145035229119204402236945224318
Donald Lorton
4862001294256462650903419366120865163526

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
I7 --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.
I4b- Donald Lorton 250,219, Melina Perdue 121,120.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonDonald LortonNamePerson
FieldValueIRS element (for citing)
RelationshipAssistant TreasurerRelationship
Amount Of Transaction954621AmountOfTransaction
Description Of Transactionlab servicesDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierIVIdentifier
Return Reference1 --ReturnReference
ExplanationDonald 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 (31 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990 Part III4aCarilion Tazewell Community Hospital exists to serve the health care needs of its community, regardless of patient ability to pay. Tazewell hospital admitted 704 patients and provided 2,050 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.
Form 990 Part III4a CONTINUEDTazewell also provides an emergency department with 24-hour care and emergency transportation. With 10,536 visits, Tazewells 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 22 percent of ED visits. Tazewell supports community screenings and education on chronic disease management, touching more than 300 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.
Form 9902 --Carilion Tazewell Community Hospital uses demographic information and data on patients treated to determine community health needs. Additionally, information from public databases compiled on the Virginia Atlas of Community Health website is reviewed for the entire geographic area served by Carilion Tazewell Community Hospital. A comprehensive community health needs assessment is scheduled for completion by September 30, 2013 along with a strategic implementation plan to address identified needs.
Form 9904 --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.
Form 9905 --Carilion Tazewell Community Hospital serves all patients regardless of their ability to pay. The Hospitals governing Board is elected annually and the majority of members are neither employees nor contractors of the Hospital. Medical staff privileges are extended to qualified providers. In addition to clinical care, the hospital works to achieve its mission through the education of health professionals and the community. Any surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. This includes providing free, discounted and subsidized care as well as critical medical services that operate at a loss.
Form 9905 CONTINUEDCarilion 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.
Form 9906 --Carilion Tazewell Community Hospital is a wholly owned hospital of Carilion Clinic, a not-for-profit healthcare organization serving approximately one million people in Western Virginia through a physician specialty group, advanced primary care practices, hospitals and outpatient centers. Carilion Clinic is based in Roanoke, Virginia and serves the residents of 18 counties and six cities in Western Virginia and southern West Virginia. Over the past six years, Carilion Clinic has gone through a dramatic and transformative change as we transitioned from a hospital system to an integrated clinic with physician leadership. 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.
Form 9906 CONTINUEDThis 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 592 physicians representing more than 60 specialties who provide care at 195 practice sites. During 2012, 126 students were enrolled in Virginia Tech Carilion School of Medicine and there were 549 appointed faculty members.
Form 9906 CONTINUEDTo advance education of health professionals, Jefferson College of Health Sciences, within Carilion Medical Center, is a professional health sciences college offering Masters of Science in Nursing, Physician Assistant and Occupational Therapy and 12 baccalaureate and associate healthcare programs. Approximately 900 undergraduate students and 190 graduate students are enrolled annually with 99 of undergraduates receiving some type of financial aid. Carilion Clinic and Virginia Tech Carilion School of Medicine provide graduate medical education to 215 residents and fellows. Residency program include Emergency Medicine, Family Medicine, Internal Medicine, Neurosurgery, Obstetrics/Gynecology, Psychiatry, Surgery, Pediatrics, Podiatry and General Hospital Dentistry inaugural class July 2013.
Form 9906 CONTINUEDAdditionally, the University of Virginia sponsors a residency program in Orthopaedics. Fellowship programs include Addiction Psychology, Adult Joint Reconstruction, Advanced Endoscopy, Cardiovascular Disease, Child and Adolescent Psychiatry, Gastroenterology inaugural class July 2013, Geriatric Medicine, Geriatric Psychiatry, Hospice and Palliative Care, Infectious Disease, Interventional Cardiology inaugural class July 2013, Medical Informatics, Orthopaedic-Hand and Pulmonary Critical Care.
Form 9906 CONTINUEDAdvanced Clinical Services in Cardiovascular and Vascular include a hybrid operating room, transcatheter aortic valve implantation TAVI, ventricular assist device VAD program using the Heartmate II, Medtronic CRYO balloon for atrial fibrillation epicardial ventricular tachycardia ablation, Heart Alert, therapeutic hypothermia, and Thoracic Oncology services with Pulmonary Medicine. In Neurosciences advanced services include Stroke Alert, an adult and pediatric Neurosurgery program, Neuro-interventional procedures, Brain Lab Navigation, Epilepsy Monitoring Inpatient Unit and Movement Disorders.
Form 9906 CONTINUEDIn Musculoskeletal, a joint replacement program, anterior approach hip replacements, computer-assisted knee replacements and advanced procedures for ankle replacements. Spine Center and Imaging Services include 64 slice CT and PET/CT, 3T MAGNETOM Verio MRI, MR Profusion and Enterography, advanced interventional procedures, and nationally-recognized Breast Care Center with large-format Pathology and digital mammography. Surgery services include plastic and reconstructive surgery, robotic-assisted surgery for cardiac, urology, and gynecology, and advanced laparoscopic techniques in general surgery.
Form 9906 CONTINUEDIn Pulmonary medicine, advanced interventional procedures are performed as well as thoracic oncology services. Carilion Clinic Cancer Center offers CyberKnife Stereotactic Radiosurgery for inoperable tumors, High Dose Radiation HDR Brachytherapy, Linear Accelerators with IMRT, Selective Internal Radiation SIR Spheres for treatment of liver cancer, Prostate Brachytherapy Radioactive Seed Implants and Mohs surgery. Advanced gynecologic oncology includes single site/port hysterectomy, minimally invasive surgery for gynecology, including the da Vinci Robotic Surgical System and in-office chemotherapy and industry-sponsored research trials as well as participation in National Cancer Institute sponsored research.
Form 9906 CONTINUEDAdvanced urogynecologic services include Interstim therapy for bladder incontinence and fecography for fecal incontinence. Carilion Clinic Childrens Hospital provides Sub-specialty physicians and clinics in surgery, cardiology, pulmonology, gastroenterology, dentistry, allergy immunology, rheumatology, orthopaedics, hematology oncology, neurosurgery, and developmental pediatrics. Additionally, neonatal and pediatric intensive care units are located within Carilion Roanoke Memorial Hospital. An inpatient childrens facility, pediatric emergency department and specialized transport team are included in this program. Carilion Roanoke Memorial Hospital includes a Level One Trauma Center with EMS services that include three EMS helicopters, four first-response vehicles and 50 Advanced Life Support Ambulances.
Form 9906 CONTINUEDAn additional benefit to the community is Carilion Clinics economic contribution to the region. As the areas largest employer, jobs are provided for more than 11,300 residents of the region. At the Virginia Tech Carilion VTC Research Institute, scientists are carrying out leading-edge research programs on autism, depression, post-traumatic stress disorder, traumatic brain injury, cerebral palsy, cardiovascular disease, Parkinsons disease, addiction, cancer, mental retardation, epilepsy, and infectious diseases, with state-of-the-art technologies and innovative interdisciplinary science. The research is characterized by computational and quantitative approaches, and modeling in conjunction with experimentation is a critical cornerstone.
Form 9906 CONTINUEDThe range of research going on today in the Institute includes facilities for a worldwide hub for interactive functional brain imaging, linking Roanoke to the United Kingdom, China, South Korea, Germany, and Norway as well as to other institutions throughout the United States, including Princeton, Caltech, and Emory University. This network, which includes the Institutes three research-dedicated magnetic resonance imaging scanners, is allowing Institute investigators to launch the worlds largest longitudinal study of brain function and decision-making. The Roanoke Brain Study will use functional imaging, genetic analysis, and behavior to uncover key aspects of human brain development in health and in a range of disorders.
Form 990 Part VI1a --The Board is composed of two classes of directors, the Carilion Class 3 directors and the Tazewell Class 7 directors. On all matters that come before the Board for a vote, other than a small number requiring a super-majority vote, the Carilion Class has 80 of the vote and the Tazewell Class has 20 of the vote, with a majority of the class members present and voting determining the vote of the class. In the case of those matters needing a super-majority vote, a majority of the members of each class must vote in favor of the action for it to be approved.
Form 990 Part VI3 --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 VI6 --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 VI7a --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 VI7b --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 VI11a and 11b --The final Form 990 was emailed or delivered in hard copy to each member of the Board of Directors several days prior to filing and Board members were encouraged to call with any questions they might have.
Form 990 Part VI12c --A Conflict of Interest Questionnaire, along with a copy of the Policy, is sent out annually to all officers, directors and key employees. In addition, such individuals are instructed to inform the organization of potential conflicts which arise during the year. Answers to the Questionnaires are reviewed by the Internal Audit Department. Potential conflicts for officers and key employees are reviewed by an internal Conflict of Interest Committee, which follows up on any potential issues to ensure compliance with all policies of the organization. The answers for Directors are reviewed by the Carilion Clinic Audit and Compliance Committee.
Form 990 Part VI12c CONTINUEDIn addition, the governing body of the organization is provided with a list of the answers annually to make all Board members aware of potential conflicts in order to ensure compliance with policies on how to handle transactions with Board members that may involve potential conflict situations.
Form 990 Part VI15a and 15b --Executive compensation is reviewed annually by the Carilion Clinic Compensation Committee. This committee is made up of Board members of Carilion Clinic who do not have a conflict of interest with any of the executives being reviewed. With respect to Carilion Clinic, the Compensation Committee reviews the compensation of the President and Chief Executive Officer, Executive Vice Presidents, which include the Chief Financial Officer and the Chief Medical Officer. For the fiscal year covered by this return, the Compensation Committee also used the same process to review the compensation of other Disqualified Individuals, including the Hospital Vice Presidents. This review was performed in October 2011. A similar review was last performed in October 2012.
Form 990 Part VI15 a and 15b CONTINUEDThis review included a comprehensive report from an outside compensation consultant specializing in healthcare organizations. The report included a detailed comparison of total compensation and each element thereof, including base salary, bonuses and other cash compensation, and benefits, including deferred and retirement benefits. Compensation was compared to a peer group of organizations similar in size and structure to the organization, which list was reviewed by the Compensation Committee. Detailed minutes of the meetings of the Compensation Committee are kept and approved at the next meeting of the Committee, setting forth the deliberations and decisions regarding the compensation of these executives.
Form 990 Part VI15a and 15b CONTINUEDIn 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 VI19 --The organizations governing documents, conflict of interest statement and financial statements are not generally available to the public, but are released from time to time upon request. The Articles of Incorporation are available from the Virginia State Corporation Commission. The consolidated audited financial statements of Carilion Clinic and of the Obligated Group are released annually to the local newspaper. Limited financial information is available on our web site.
Form 990 Part VIIColumn B --Directors and officers listed with less than 50 average hours per week who receive compensation from related organizations reported in column E also serve as directors and/or officers on other related organizations in the Carilion system. The difference between the hours shown in Column B and 50 hours would equal the hours worked by these individuals for related organizations.
Form 990 Part XI5 --Other adjustments - transfer to Carilion Clinic for effect of pension-related changes 15,068.
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 hospital admitted 704 patients and provided 2,050 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. Form 990 Part III Line 4a CONTINUED Tazewell also provides an emergency department with 24-hour care and emergency transportation. With 10,536 visits, Tazewells 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 22 percent of ED visits. Tazewell supports community screenings and education on chronic disease management, touching more than 300 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. Form 990 Section Schedule H, Part VI Line 2 -- Carilion Tazewell Community Hospital uses demographic information and data on patients treated to determine community health needs. Additionally, information from public databases compiled on the Virginia Atlas of Community Health website is reviewed for the entire geographic area served by Carilion Tazewell Community Hospital. A comprehensive community health needs assessment is scheduled for completion by September 30, 2013 along with a strategic implementation plan to address identified needs. Form 990 Section Schedule H, Part VI Line 4 -- Carilion 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. Form 990 Section Schedule H, Part VI Line 5 -- Carilion Tazewell Community Hospital serves all patients regardless of their ability to pay. The Hospitals governing Board is elected annually and the majority of members are neither employees nor contractors of the Hospital. Medical staff privileges are extended to qualified providers. In addition to clinical care, the hospital works to achieve its mission through the education of health professionals and the community. Any surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. This includes providing free, discounted and subsidized care as well as critical medical services that operate at a loss. Form 990 Section Schedule H, Part VI Line 5 CONTINUED 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. Form 990 Section Schedule H, 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 Western Virginia through a physician specialty group, advanced primary care practices, hospitals and outpatient centers. Carilion Clinic is based in Roanoke, Virginia and serves the residents of 18 counties and six cities in Western Virginia and southern West Virginia. Over the past six years, Carilion Clinic has gone through a dramatic and transformative change as we transitioned from a hospital system to an integrated clinic with physician leadership. 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. Form 990 Section Schedule H, Part VI Line 6 CONTINUED 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 592 physicians representing more than 60 specialties who provide care at 195 practice sites. During 2012, 126 students were enrolled in Virginia Tech Carilion School of Medicine and there were 549 appointed faculty members. Form 990 Section Schedule H, Part VI Line 6 CONTINUED To advance education of health professionals, Jefferson College of Health Sciences, within Carilion Medical Center, is a professional health sciences college offering Masters of Science in Nursing, Physician Assistant and Occupational Therapy and 12 baccalaureate and associate healthcare programs. Approximately 900 undergraduate students and 190 graduate students are enrolled annually with 99 of undergraduates receiving some type of financial aid. Carilion Clinic and Virginia Tech Carilion School of Medicine provide graduate medical education to 215 residents and fellows. Residency program include Emergency Medicine, Family Medicine, Internal Medicine, Neurosurgery, Obstetrics/Gynecology, Psychiatry, Surgery, Pediatrics, Podiatry and General Hospital Dentistry inaugural class July 2013. Form 990 Section Schedule H, Part VI Line 6 CONTINUED Additionally, the University of Virginia sponsors a residency program in Orthopaedics. Fellowship programs include Addiction Psychology, Adult Joint Reconstruction, Advanced Endoscopy, Cardiovascular Disease, Child and Adolescent Psychiatry, Gastroenterology inaugural class July 2013, Geriatric Medicine, Geriatric Psychiatry, Hospice and Palliative Care, Infectious Disease, Interventional Cardiology inaugural class July 2013, Medical Informatics, Orthopaedic-Hand and Pulmonary Critical Care. Form 990 Section Schedule H, Part VI Line 6 CONTINUED Advanced Clinical Services in Cardiovascular and Vascular include a hybrid operating room, transcatheter aortic valve implantation TAVI, ventricular assist device VAD program using the Heartmate II, Medtronic CRYO balloon for atrial fibrillation epicardial ventricular tachycardia ablation, Heart Alert, therapeutic hypothermia, and Thoracic Oncology services with Pulmonary Medicine. In Neurosciences advanced services include Stroke Alert, an adult and pediatric Neurosurgery program, Neuro-interventional procedures, Brain Lab Navigation, Epilepsy Monitoring Inpatient Unit and Movement Disorders. Form 990 Section Schedule H, Part VI Line 6 CONTINUED In Musculoskeletal, a joint replacement program, anterior approach hip replacements, computer-assisted knee replacements and advanced procedures for ankle replacements. Spine Center and Imaging Services include 64 slice CT and PET/CT, 3T MAGNETOM Verio MRI, MR Profusion and Enterography, advanced interventional procedures, and nationally-recognized Breast Care Center with large-format Pathology and digital mammography. Surgery services include plastic and reconstructive surgery, robotic-assisted surgery for cardiac, urology, and gynecology, and advanced laparoscopic techniques in general surgery. Form 990 Section Schedule H, Part VI Line 6 CONTINUED In Pulmonary medicine, advanced interventional procedures are performed as well as thoracic oncology services. Carilion Clinic Cancer Center offers CyberKnife Stereotactic Radiosurgery for inoperable tumors, High Dose Radiation HDR Brachytherapy, Linear Accelerators with IMRT, Selective Internal Radiation SIR Spheres for treatment of liver cancer, Prostate Brachytherapy Radioactive Seed Implants and Mohs surgery. Advanced gynecologic oncology includes single site/port hysterectomy, minimally invasive surgery for gynecology, including the da Vinci Robotic Surgical System and in-office chemotherapy and industry-sponsored research trials as well as participation in National Cancer Institute sponsored research. Form 990 Section Schedule H, Part VI Line 6 CONTINUED Advanced urogynecologic

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
Carilion Clinic
PO Box 12385RoanokeVA24025541190771Supporting organizationVA501c311 Type IN/Afalse
Carilion Clinic Foundation
PO Box 12385RoanokeVA24025541190773Supporting organizationVA501c311 Type IN/Afalse
Carilion Franklin Memorial Hospital
PO Box 12385RoanokeVA24025540480606HealthcareVA501c33N/Afalse
Carilion Giles Community Hospital
PO Box 12385RoanokeVA24025540549603HealthcareVA501c33N/Afalse
Carilion Medical Center
PO Box 12385RoanokeVA24025540506332HealthcareVA501c33N/Afalse
Carilion New River Valley Medical Center
PO Box 12385RoanokeVA24025540553805HealthcareVA501c33N/Afalse
Carilion Services Inc
PO Box 12385RoanokeVA24025541190879Supporting organizationVA501c311 Type IN/Afalse
Carilion Stonewall Jackson Hospital
PO Box 12385RoanokeVA24025540568001HealthcareVA501c33N/Afalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg