2015-08-15T13:53:34-05:00 2014-09-30 990 2013-10-01 540506332 CARILION MEDICAL CENTER CARI 5402245112 PO BOX 12385 ROANOKE VA 240252385 Donald Halliwill Chief Financial Officer 5402245112 2015-08-15 2013 2016-03-07 17:11:31Z Nancy Howell Agee PO BOX 12385 ROANOKE VA 240252385 1827531527 0 X www.carilionclinic.org X 1899 VA See Schedule O.Carilion Medical Center, comprised of Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital, is committed to a common purpose of better patient care, better community health, and lower cost. One of the largest hospitals in Virginia, Carilion Roanoke Memorial Hospital is a 703-bed hospital and additional 60-bed Neonatal Intensive Care Unit. The Medical Center provides Level 1 Trauma care, medical residency and fellowship programs, and advanced specialty care. 15 7 7936 538 -27105 -27105 8251503 5512909 1006170318 1075207539 35907354 35677479 24992274 25082891 1075321449 1141480818 565382 615745 0 0 486483508 509615920 0 0 345084 513804035 534507325 1000852925 1044738990 74468524 96741828 1065046581 1170440385 636793452 747300084 428253129 423140301 X See Schedule O.Carilion Medical Center, that includes Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital, is part of Carilion Clinic, a not-for-profit healthcare organization serving one million people in Virginia through hospitals, outpatient specialty centers and advanced primary care practices. Led by multi-specialty physician teams with a shared philosophy that puts the patient first, Carilion is committed to improving health outcomes for every patient while advancing the quality of care through medical education and research. 0 0 927175718 615745 1095879148 See Schedule O.Carilion Medical Center exists to serve the health care needs of its community and region, regardless of patient ability to pay. CMC admitted 36,472 patients and provided 186,736 days of care during the year. Hospital programs include provision of nursing care; an extensive cardiac and vascular program, including cardiac surgery, implants, angioplasty and heart failure programs; neurology, neurosurgery and stroke programs; labor and delivery services (delivering 3,240 babies); the areas only neonatal intensive care unit; inpatient and outpatient psychiatric services; a comprehensive rehabilitation unit; extensive outpatient and inpatient surgical and endoscopic services; oncology services; geriatric services; and diagnostic imaging services including CT, MRI, PET, and mammography. Housing a childrens specialty wing, CMC provides specialists in pediatric neurosurgery, cardiology, oncology, gastroenterology, pulmonology, and child development, among others. CMC is a Level I trauma center, providing full trauma services to the region. CMC provides a number of services targeting the specific health needs of the area, including diabetes management; home health and hospice; physical, speech, and occupational therapy programs; and cardiac and respiratory rehab. CMC also provides an emergency department with 24-hour care, emergency transportation, a pediatric department, and chest pain and stroke protocol programs. With 80,501 visits, CMCs emergency services are a critical component of the health safety net in its service area, acting as a key health provider for a significant number of uninsured patients, who comprise 21% percent of ED visits. CMCs urgent care centers also provide access points for cost effective care at an appropriate level. CMC employs a number of specialty physicians to ensure an effective, integrated approach to serving its patients; including pulmonologists, oncologists, obstetricians, orthopedic surgeons, cardiologists, neurosurgeons, general surgeons, and psychiatrists. As a teaching hospital with over 350 full-time faculty members, CMC hosts residency programs in family medicine, internal medicines, obstetrics and gynecology, psychiatry, general surgery, neurosurgery. In addition, the Jefferson College of Health Sciences, a division of CMC, offers nursing, physician assistant, occupational therapy, and other high-need programs. CMC also supports community screenings and education on chronic disease prevention and management, sponsoring 884 events touching over 54,954 people. CMC supports a cancer registry program, and participates in a number of other research projects. In furtherance of its mission, CMC provides extensive uncompensated care. Stated at cost, charity, and charity-eligible bad debt for the year exceeded $49.4 million. 927175718 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 0 0 1 0 0 1 7936 1 1 1 0 0 0 0 1 1 0 0 0 0 X 15 7 1 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 VA X The Corporation Attn J Wright 5402245112 213 S Jefferson St Roanoke VA 24011 John H Burton MD Director/Chair/VP Medical Affair 50.00 0.00 X 445950 0 22270 Katherine A Elam Director 2.00 0.00 X 0 0 0 George B Cartledge III Director 2.00 0.00 X 0 0 0 Elizabeth Doughty Director 2.00 0.00 X 0 0 0 Cynda A Johnson MD Director 2.00 48.00 X 0 542688 37917 Stephen A Musselwhite Director 2.00 2.50 X 0 0 0 Clifford A Nottingham MD Director 2.00 48.00 X 0 334473 10322 Patrice M Weiss MD Director/EVP/Chair 50.00 0.00 X 487592 0 14812 Ralph E Whatley MD Director/Chair/SVP/Chief Quality 49.50 0.50 X 510887 0 33426 Damon Williams Director 2.00 0.00 X 0 0 0 Victor Iannello ScD Director/Chair 4.00 2.00 X X 0 9141 0 R Steve Blanks Director/Vice Chair 3.00 2.40 X X 0 8700 0 Nancy Howell Agee Director/President/CEO 3.00 47.00 X X 0 1129437 750057 Steve C Arner Director/President/SVP/COO 24.40 25.60 X X 172770 183736 1542 James S Cain MD Diretor/Chief of Medical Staff 2.00 0.00 X X 0 0 0 Tracey W Criss MD Director/Chief of Medical Staff 50.00 0.00 X X 214184 0 -13466 Thomas D Denberg MD PhD EVP/Chief Strategy Officer 1.10 48.90 X 0 272891 13937 Briggs W Andrews SVP/General Counsel/Secretary 1.50 48.50 X 0 404300 46042 G Robert Vaughan Jr SVP/Treasurer 0.20 49.80 X 0 255568 -13062 R Wayne Gandee MD EVP/Chief Medical Officer 48.40 1.60 X 733197 0 29321 Maxine M Lee MD VP of Medical Affairs 48.80 1.20 X 319188 0 17991 Donald B Halliwill EVP/CFO/Assistant Treasurer 1.50 48.50 X 0 343160 -13889 David S Hagadorn Assistant Treasurer 0.10 49.90 X 0 118987 -5323 Lauren J Chen Assistant Secretary 8.00 42.00 X 0 68855 7219 Rachel Mabe Assistant Secretary 0.50 39.50 X 0 69609 89 Jonathan Carmouche MD Physician 50.00 0.00 X 1345283 0 18392 Cay Mierisch MD Physician 50.00 0.00 X 1028557 0 9067 Joseph Moskal MD Physician 50.00 0.00 X 1221200 0 36609 Nicholas Qandah MD Physician 50.00 0.00 X 1256014 0 19533 Gary Simonds MD Physician 50.00 0.00 X 1281377 0 17673 Donald E Lorton Former EVP 0.00 50.00 X 0 3772316 -29521 Mark Werner Former EVP 0.00 0.00 X 344249 0 -22080 9360448 7513861 988878 665 1 1 0 Solstas Lab Partners Group LLC PO Box 751337 Charlotte NC 282751337 Laboratory Services 28176099 Siemens Medical Solutions USA Inc 51 Valley Stream Parkway Malvern PA 19355 Equipment Maintenance 3842595 Foodservice Partners of Virginia 2823 Franklin Road - Building B Roanoke VA 24014 Food Services 2060340 Anesthesiology Consultants of Virginia PO Box 13306 Roanoke VA 240323306 Anesthesiology Services 1534040 GJ Hopkin Inc 714 5th St NE Roanoke VA 24016 Construction Services 1442200 107 563967 115650 22380 4438891 372021 37429 5512909 Net Patient Revenue 900099 1039874195 1039874195 College Tuition/Other 900099 24533043 24533043 Program-related Investments 900099 9133074 9133074 0 Clinical Research 900099 1062695 1062695 Other Health Eductaion 900099 604532 604532 1075207539 7308614 -27105 7335719 67 67 1500184 0 1500184 1500184 1500184 714161343 188895 685874193 107247 28287150 81648 28368798 28368798 44869 115650 60104 -15235 -15235 10000 9165 835 835 Other Revenues 900099 9060120 9060120 Other Affiliate Income 900099 8775693 8775693 Cafeteria & Vending Income 900099 2925498 2925498 2835796 2835796 23597107 1141480818 1095879148 -27105 40115866 265920 265920 349825 349825 2740315 2740315 429620236 429274796 161093 184347 24656651 24656651 25404972 25304890 67888 32194 27193746 27193746 109877300 109877300 36185 36185 26381 26381 65458 65458 565517 565517 82868112 80978656 1888465 991 266790 243498 23292 15893878 15676326 204724 12828 1908456 1908456 22841577 22727292 101461 12824 2496808 2478143 12928 5737 15944155 15944155 40414448 40414448 13271016 9619177 3651839 Medical Supplies 137798855 137800492 -1637 Bad Debt 79707661 79707661 College Expense 4968950 4968950 Dues & Subscriptions 2136473 1729983 342509 63981 3419305 3126880 283535 8890 1044738990 927175718 117218188 345084 22624 23061 4541445 4826236 1161316 1619356 148860087 155452822 416942 6829241 5180565 6051740 6465957 5098696 982353984 727197384 249218793 255156600 615949861 681489415 26213104 33074888 1000 1000 60947 65123 6953940 20752207 1065046581 1170440385 119482454 139926168 6063277 6178361 376424317 375034053 50000 134773404 226161502 636793452 747300084 X 408293768 402444251 8083452 8820141 11875909 11875909 428253129 423140301 1065046581 1170440385 X 96741828 10367308 -112221964 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 65458 65458 0 Part II-B, Line 1: Portion of dues paid to American Hospital Association, Virginia Hospital and Healthcare Association and Association of American Medical Colleges spent on lobbying. 15977885 1448538 -898328 16528095 14955835 1798131 -776080 15977886 14218996 1514015 -777176 14955835 14308087 540534 -629626 14218995 14015347 1036467 -743727 14308087 0.28150 0.71850 0.00000 0 0 3616529 3616529 435729291 272383708 163345583 2745643 2495439 250203 528936529 446123995 82812534 11325992 6194242 5131751 255156600 Qualified Pension Liability 187490164 Unrealized Swap losses 23286161 Nonqualified Pension Liability 15382847 Other 2330 226161502 X Part V, Line 4: Income from the endowment funds are used for the following: (1) Pediatric programs, both internal and external and/or pediatric equipment. (2) Patient indigent care. Part X, Line 2: Carilion had no material unrecognized tax benefits and no adjustments to its consolidated financial statements were required as of and for the years ended September 30, 2014 and 2013. Carilion does not expect that unrecognized tax benefits will materially increase within the next 12 months. CMN Gala 47932 34632 13300 12630 160 13524 CMN Luncheon 48227 41767 6460 6639 100 13189 3 64360 39251 25109 2920 4753 3631 2558 160519 115650 44869 2920 4753 22900 260 29271 60104 -15235 1 1 X 1 X 133.000000000000 1 X 1 1 0 1 1 43550143 0 43550143 0.04510 90439313 84559967 5879346 0.00610 133989456 84559967 49429489 0.05120 672 29698 3522444 1135130 2387314 0.00250 13 881 30176216 9410735 20765481 0.02150 2 3306 934758 934758 0.00100 33 4986 357031 357031 0.00040 720 38871 34990449 10545865 24444584 0.02540 720 38871 168979905 95105832 73874073 0.07660 1 105 10000 10000 0.00000 7 9760 65174 65174 0.00010 49 1960 109002 109002 0.00010 2 0 23000 23000 0.00000 96 2255 16636 16636 0.00000 4 2000 15102 15102 0.00000 5 3 87083 87083 0.00010 164 16083 325997 325997 0.00030 0 79707661 17425158 230844659 249143112 -18298453 X 1 1 1 Roanoke Ambulatory Surgery Center LLC Ambulatory surgery 0.48310 0.49030 2 Southwest Virginia Health Properties LLC Real estate 0.48310 0.49030 2 1 Carilion Medical Center- DBA CRMH 1906 Belleview Avenue Roanoke VA 24019 www.carilionclinic.org X X X X X X A 2 Carilion Medical Center- DBA CRCH 101 Elm Avenue Roanoke VA 24019 www.carilionclinic.org X Rehabilitation Unit; Urgent Care A Facility Group A 1 X X X X X X X X X 11 1 0 1 X See Section C, Line 5d: X www.carilionclinic.org/about/chna X X X X X X X X X 0 0 1 1 133.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X 1 X 1 X X X 1 X 1 1 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Carilion Medical Center- DBA CRMH, - Facility 2: Carilion Medical Center- DBA CRCH Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 3: The Roanoke Community Health Needs Assessment (RCHNA) focused on high levels of community engagement involving health and human services leaders, stakeholders, and providers; the target population; and the community as a whole. A Community Health Assessment Team (CHAT) consisting of project management staff and representatives from area health and human services, faith-based communities, and schools led the year-long initiative. The majority of CHAT members serve the low-income, uninsured, underserved and other vulnerable populations in the Roanoke Valley. Beginning in December 2011, the CHAT met monthly to oversee the RCHNA. Please see the list of organizations that served on the CHAT below: Bethany Hall, Inc., Blue Ridge Behavioral Health, Bradley Free Clinic, CHIP of the Roanoke Valley, CommunityWorks, Council of Community Services, Family Service of the Roanoke Valley, Jefferson College of Health Sciences, LOA Local Office on Aging, Mental Health America, New Horizons Healthcare, Loudon Christian Church, Planned Parenthood Health Systems, Inc., Presbyterian Community Center, Project Access, Rescue Mission Ministries- Fralin Clinic, Roanoke City Health Department, Roanoke City Public Schools, Roanoke Department of Social Services, Roanoke Redevelopment & Housing Authority, Salem Veterans Administration Medical Center and the United Way of the Roanoke Valley. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 5d: Line 5a: www.carilionclinic.org/hospitals/carilion-roanoke-memorial-hospital Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 6i: In tax year 2013, the hospital provided grant funding to several organizations that address need aligned with the 2012 CHNA. The hospital provided $25,000 for the United Way of Roanoke Valley to support Healthy Roanoke Valley (HRV), a coalition of over 50 health and human service agencies that address the needs identified in the 2012 Roanoke CHNA. Carilion funded Mental Health America of the Roanoke Valley $32,000 operational support of the Roanoke Valley Mental Health Care Collaborative to cover rising costs of medications, transcription and client transportation for the underserved that suffer from mental illness. Carilion provided $20,000 in funding to Happy Healthy Cooks program to encourage healthy eating in children by hands on demonstrations in Roanoke City Schools and Head Start programs. Carilion funded Leap for Local Foods $10,000 to support the double the value SNAP-EBT program at local community farmers markets. Finally, Carilion funded the Roanoke Community Garden Association $10,000 for its Seed2Feed educational program expansion providing education to Roanoke area youth and adults about basic gardening practices, how to grow organic food, and the impacts these make on nutrition and wellness. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 7: Carilion Medical Center (CMC) is not addressing barriers to transportation and language barriers in this implementation strategy. While these issues will be monitored, they have been determined to not be as pressing as the identified priority needs. Additionally, Carilion Medical Center provides funding to The Greater Roanoke Transit Company for a free trolley service for the community that operates in a continuous loop with stops that include Carilion Medical Center and Downtown Roanoke with goals of reducing the carbon footprint, transporting patients and staff, and enhancing the local economy by providing easier access to downtown. Also, vouchers for taxi and bus service are available for patients who are unable to afford transportation. Carilion Medical Center provides interpretive services for non-English speaking patients. During fiscal year 2013 more than $1,000,000 was expensed for these services at no cost to the patient. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 12i: Liquid assets and equity in real property. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 20d: FAP eligible uninsured patients are charged gross charges less an uninsured discount. FAP eligible insured patients are charged under terms of their insurance contract (never gross charges) and are also eligible for financial assistance. The discount rate is based on the system's dominant negotiated commercial insurance rate. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 21: The discount rate is based on the system's dominant negotiated commercial insurance rate. Facility 1 -- Carilion Medical Center dba CRMH Part V, Section B, line 22: FAP eligible uninsured patients are charged gross charges less an uninsured discount for the hospital's services. Certain physician services may be stated at gross charges. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 3: The Roanoke Community Health Needs Assessment (RCHNA) focused on high levels of community engagement involving health and human services leaders, stakeholders, and providers; the target population; and the community as a whole. A Community Health Assessment Team (CHAT) consisting of project management staff and representatives from area health and human services, faith-based communities, and schools led the year-long initiative. The majority of CHAT members serve the low-income, uninsured, underserved and other vulnerable populations in the Roanoke Valley. Beginning in December 2011, the CHAT met monthly to oversee the RCHNA.Please see the list of organizations that served on the CHAT below: Bethany Hall, Inc., Blue Ridge Behavioral Health, Bradley Free Clinic, CHIP of the Roanoke Valley, CommunityWorks, Council of Community Services, Family Service of the Roanoke Valley, Jefferson College of Health Sciences, LOA Local Office on Aging, Mental Health America, New Horizons Healthcare, Loudon Christian Church, Planned Parenthood Health Systems, Inc., Presbyterian Community Center, Project Access, Rescue Mission Ministries- Fralin Clinic, Roanoke City Health Department, Roanoke City Public Schools, Roanoke Department of Social Services, Roanoke Redevelopment & Housing Authority, Salem Veterans Administration Medical Center and the United Way of the Roanoke Valley. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 5d: Line 5a: www.carilionclinic.org/hospitals/carilion-roanoke-memorial-hospital Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 6i: In tax year 2013, the hospital provided grant funding to several organizations that address need aligned with the 2012 CHNA. The hospital provided $25,000 for the United Way of Roanoke Valley to support Healthy Roanoke Valley (HRV), a coalition of over 50 health and human service agencies that address the needs identified in the 2012 Roanoke CHNA. Carilion funded Mental Health America of the Roanoke Valley $32,000 operational support of the Roanoke Valley Mental Health Care Collaborative to cover rising costs of medications, transcription and client transportation for the underserved that suffer from mental illness. Carilion provided $20,000 in funding to Happy Healthy Cooks program to encourage healthy eating in children by hands on demonstrations in Roanoke City Schools and Head Start programs. Carilion funded Leap for Local Foods $10,000 to support the double the value SNAP-EBT program at local community farmers markets. Finally, Carilion funded the Roanoke Community Garden Association $10,000 for its Seed2Feed educational program expansion providing education to Roanoke area youth and adults about basic gardening practices, how to grow organic food, and the impacts these make on nutrition and wellness. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 7: Carilion Medical Center (CMC) is not addressing barriers to transportation and language barriers in this implementation strategy. While these issues will be monitored, they have been determined to not be as pressing as the identified priority needs. Additionally, Carilion Medical Center provides funding to The Greater Roanoke Transit Company for a free trolley service for the community that operates in a continuous loop with stops that include Carilion Medical Center and Downtown Roanoke with goals of reducing the carbon footprint, transporting patients and staff, and enhancing the local economy by providing easier access to downtown. Also, vouchers for taxi and bus service are available for patients who are unable to afford transportation. Carilion Medical Center provides interpretive services for non-English speaking patients. During fiscal year 2013 more than $1,000,000 was expensed for these services at no cost to the patient. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 12i: Liquid assets and equity in real property. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 20d: FAP eligible uninsured patients are charged gross charges less an uninsured discount. FAP eligible insured patients are charged under terms of their insurance contract (never gross charges) and are also eligible for financial assistance. The discount rate is based on the system's dominant negotiated commercial insurance rate. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 21: The discount rate is based on the system's dominant negotiated commercial insurance rate. Facility 2 -- Carilion Medical Center dba CRCH Part V, Section B, line 22: FAP eligible uninsured patients are charged gross charges less an uninsured discount for the hospital's services. Certain physician services may be stated at gross charges. 91 DBA - Carilion Roanoke Memorial Rehab 2017 South Jefferson Street Roanoke VA 24153 Psych Unit, Outpatient Rehabilitation Carilion Clinic Orthopaedics 4064 Postal Drive SW Roanoke VA 24018 Orthopaedic Services Carilion Clinic - Bone and Joint Center 3 Riverside Circle 1st Floor Roanoke VA 24016 Orthopedics CSC - Brambleton 3707 Brambleton Avenue Roanoke VA 24018 Surgical Services Carilion Clinic Orthopaedics 3 Riverside Circle Roanoke VA 24016 Orthopaedic Services Carilion Clinic Cardiology 127 McClanahan Street SW Suite 300 Roanoke VA 24014 Cardiology Carilion Clinic Cardiology 2001 Crystal Spring Avenue Suite 203 Roanoke VA 24014 Cardiology CNRV Emergency Services 2900 Lamb Circle Christiansburg VA 24073 Emergency Physicians Carilion Breast Care Center 102 Highland Ave Ste 202 Roanoke VA 24014 Breast Care Center CSC - Roanoke 213 McClanahan Suite 404 Roanoke VA 24014 Surgical Services Carilion Cardiothoracic Surgery 2001 Crystal Spring Avenue Suite 201 Roanoke VA 24014 Cardiac Surgery Office Carilion Obstetrics and Gynecology Clini 902 South Jefferson Street Upper Level Roanoke VA 24016 Obstetrics and Gynecology CES - Franklin 180 Floyd Avenue Rocky Mount VA 24017 Emergency Physicians Carilion Clinic Neurology 3 Riverside Circle Roanoke VA 24016 Neurosciences Carilion Clinic Internal Medicine 3 Riverside Circle Roanoke VA 24016 Internal Medicine Carilion Clinic Otolaryngology 1 Riverside Circle Suite 300M Roanoke VA 24016 Otolaryngology Services CES - Bedford 1613 Oakwood St Bedford VA 24153 Emergency Physicians CES - Giles 1611 Wenonah Avenue Pearisburg VA 24134 Emergency Physicians Roanoke Athletic Club 4508 Starkey Road Roanoke VA 24018 Physical Therapy Services Carilion Dermatology 1 Riverside Circle Suite 300M Roanoke VA 24016 Dermatology Carilion Pediatric Clinic 1030 S Jefferson Street Suite 106 Roanoke VA 24016 General Pediatrics CFM Roanoke Salem 1314 Peters Creek Road Roanoke VA 24017 Family Practice Carilion Clinic Obstetrics and Gynecolog 2900 Lamb Circle Suite 202 Christiansburg VA 24073 Obstetrics and Gynecology CES - Tazewell 141 Ben Bolt Ave Tazewell VA 24651 Emergency Physicians Brambleton Radiology Services 3707 Brambleton Avenue Roanoke VA 24018 Imaging Services CFM Southeast 2145 Mount Pleasant Boulevard Roanoke VA 24014 Family Practice Carilion Prenatal Diagnostic Center 102 Highland Ave Ste 455 Roanoke VA 24014 Prenatal Testing Carilion Department of Psychiatry and Be 2900 Tyler Road Christiansburg VA 24073 Behavioral Health Carilion Clinic Ortho-Spine 3 Riverside Circle 1st Floor Roanoke VA 24016 Orthopaedic Services Botetourt Athletic Center 105 Summerfield Court Roanoke VA 24019 Outpatient Therapy Services Daleville Imaging 46 Wesley Road Daleville VA 24014 Imaging Services Carilion Center for Healthy Aging 2001 Crystal Spring Avenue Suite 302 Roanoke VA 24014 Geriatrics CFM - Salem 2102 West Main Street Salem VA 24153 Family Practice Carilion Dentistry General Surgery 2017 S Jefferson Street 2nd Floor Roanoke VA 24014 Dental Service Department of Psychiatry & Behavioral Me 213 McClanahan Street Suite 310 Roanoke VA 24014 Behavioral Health Pediatric Gastroenterology 102 Highland Avenue Suite 305 Roanoke VA 24013 Gastroenterology Carilion Dentistry Pediatric Surgery 101 Elm Avenue 1st Floor Roanoke VA 24017 Dental Service Carilion Dental Care 2017 S Jefferson Street Roanoke VA 24014 Dental Service Carilion Department of Psychiatry Roanok 2017 S Jefferson Street Roanoke VA 24014 Behavioral Health Carilion Gynecological Oncology 1 Riverside Circle Suite 300 Roanoke VA 24016 Gynecological Oncology Carilion Anticoagulation Clinic 1030 S Jefferson St Ste G101 Roanoke VA 24014 Anticoagulation Clinic CRMH Rheumatology Clinic 3 Riverside Circle Roanoke VA 24016 Rheumatology Salem Family Practice - Spartan Drive 150 Spartan Drive Salem VA 24153 Family Practice Breast Mammography - North 6415 Peters Creek Road Roanoke VA 24014 Breast Mammography Carilion Pulmonary Clinic 2001 Crystal Spring Avenue Suite 205 Roanoke VA 24014 Pulmonary Services Carilion Clinic Neurological Care - Roan 1030 S Jefferson Street Roanoke VA 24016 Neurosciences Carilion Pediatric Neurology 102 Highland Avenue Suite 104 Roanoke VA 24013 Neurosciences Carilion Roanoke IP Psychiatry 2017 S Jefferson Street 1st Floor Roanoke VA 24014 Psychiatry Services Carilion Pain Mgmt 3 Riverside Circle Roanoke VA 24016 Pain Mgmt Services Carilion Clinic Gastroenterology 3 Riverside Circle Roanoke VA 24016 Gastroenterology Carilion Clinic TraumaCritical Care 3 Riverside Circle Roanoke VA 24016 Surgical Services Carilion Urgent Care Westlake 35 Medical Court Hardy VA 24101 Urgent Care Carilion Child and Adolescent Psychiatry 213 McClanahan Street Suite 310 Roanoke VA 24014 Child and Adolescent Psychiatry Services Department of Psychiatry & Behavioral Me 213 McClanahan Street Suite 310 Roanoke VA 24014 Behavioral Health Pediatric Cardiology Clinic 102 Highland Avenue Suite 101 Roanoke VA 24013 Cardiology Pediatric Pulmonology 102 Highland Avenue Suite 203 Roanoke VA 24013 Pulmonology Roanoke Ambulatory Center 1102 Jefferson St Roanoke VA 24016 Surgical Services Carilion Sleep Center 1030 Jefferson Plaza Ste G100 Roanoke VA 24016 Sleep Disorder Carilion Clinic Urogynecology 1030 S Jefferson Suite 109 Roanoke VA 24016 Urogynecological Services Carilion Clinic Pediatric Surgery Clinic 102 Highland Avenue Suite 404 Roanoke VA 24013 Surgical Services Carilion Cardiac Rehab 127 McClanahan Street Roanoke VA 24016 Cardiac Rehab Carilion ID Crystal Spring 2001 Crystal Spring Avenue Suite 301 Roanoke VA 24014 Infectious Disease Reproductive Endocrinology Clinic 102 Highland Avenue Suite 304 Roanoke VA 24013 Reproductive Endocrinology Carilion Imaging 3 Riverside Circle Roanoke VA 24016 Imaging Services CIM Crystal Spring 2001 Crystal Spring Avenue Suite 205 Roanoke VA 24014 Imaging Services Pediatric Developmental Clinic 1030 S Jefferson Street Suite 201 Roanoke VA 24016 Pediatrics Carilion Clinic Physiatry 3 Riverside Circle Roanoke VA 24016 Physical Medicine and Rehab Carilion Diabetic Education 1030 S Jefferson Suite G101 Roanoke VA 24016 Diabetic Education Carilion Pediatric Endocrinology Clinic 102 Highland Avenue MOB Suite 203 Roanoke VA 24013 Endocrinology Carilion Breast Care Center 1211 S Jefferson St Roanoke VA 24014 Breast Care Center Carilion Sleep Center Westlake 35 Medical Court Hardy VA 24101 Sleep Disorder Carilion Genetics 102 Highland Avenue Suite 104 Roanoke VA 24013 Genetic Counseling Carilion Surgery Westlake 35 Medical Court Hardy VA 24101 Surgical Services Carilion Cardiology Westlake 35 Medical Court Hardy VA 24101 Cardiology Services Carilion Heart Failure Clinic 127 McClanhan St Roanoke VA 24016 Heart Failure Services OBGYN Private - Roanoke 102 Highland Avenue Suite 455 Roanoke VA 24013 Obstetrics and Gynecology Carilion Clinic Cardiology 2001 Crystal Spring Ave Suite 300 Roanoke VA 24014 Cardiology Services Carilion Wound Care Center 101 Elm Ave SE Roanoke VA 24019 Wound Care Carilion Clinic Orthopaedics - NRV 2900 Lamb Circle - L 760 Christiansburg VA 24073 Orthopeadics Carilion Clinic Spine Surgery 304 Davis Street Independence VA 24348 Surgical Services Carilion Maternal Fetal Medicine 101 Elm Avenue Suite 400 Roanoke VA 24013 OB Services Community Care 101 Elm Avenue SE Roanoke VA 24013 Family Medicine Community Psychiatry 611 McDowell Avenue Roanoke VA 24016 Behavioral Health Carilion Clinic OBGYN Spartan Drive 150 Spartan Drive Salem VA 24153 Obstetrics and Gynecology Carilion Plastic Surgery 1 Riverside Circle Suite 300 Roanoke VA 24016 Plastic Surgery Carilion Clinic OBGYN Botetourt 150 Market Ridge Lane Daleville VA 24083 Obstetrics and Gynecology Carilion Imaging Professionals 1 Taylor Avenue Pearisburg VA 24134 Imaging Services Carilion Clinic Allergy and Immunology 46 Wesley Road Daleville VA 24083 Allergy Services Carilion Plastic and Reconstructive Surg 3 Riverside Circle Roanoke VA 24016 Plastic Surgery CNRVMC - Neurosciences 2900 Lamb Circle Christiansburg VA 24073 Neurology CNRVMC - Radiology 2900 Lamb Circle Christiansburg VA 24073 Radiology Part I, Line 3c: Asset test is used to determine free/discounted care. Equity value in real property is required for review/outcome. 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: Part I, Line 7 - Ratio of cost-to-charges was used to calculate the expense.Part I, Line 7(f) calculation - Bad debt expense subtracted from total expenses for the calculation is $79,707,661. Total bad debt expense on Form 990, Part IX includes $64,299 of non-patient bad debt.Part I, Line 7e - This line is reported at actual cost. Carilion Medical Center provides education to the public about health risks and steps that can be taken to improve health. Events include regularly scheduled health screenings such as blood pressure, blood glucose and cholesterol as well as seasonal stroke, vascular, prostate and facial sun damage detection screenings. Carilion Medical Center's community health education department serves as host of the local chapter of the National Safe Kids Coalition and provides education on injury prevention to the community and other providers. In addition, Carilion Medical Center's Safe Kids Coalition coordinator provided training, through a program offered by the Virginia Department of Health on proper car seat installation for other health and safety providers free of charge. Children learn about healthcare careers through Caring Careers, an educational program for school aged children provided onsite at local schools and community centers. Additional health improvement services include non-billed clinical services for women such as mammograms and cervical cancer screenings, medical care for HIV/AIDs patients, substance abuse counseling for juveniles, and physician coverage at the Bradley Free Clinic. Additional services include blood drives, assistance with enrollment in public medical programs such as Medicaid and interpreter services for non-English speaking patients. Community benefit operations includes expenses related to support of Healthy Roanoke Valley, a collaboration of health and human service agencies developing initiatives to address prioritized community health needs and the cost associated with tracking community health improvement activities.Part I, Line 7f - This line is reported at actual cost. Carilion Medical Center financially supports Radford University's Bachelor of Science Nursing Program and mentors nursing students within Carilion Roanoke Memorial Hospital. Education is provided to non-employed health professionals such as school nurses, and staff who provide labor, delivery and emergency services.Part I, Line 7g - n/a.Part I, Line 7h - This line is reported at actual cost. Carilion Medical Center participates in clinical research projects which includes internal review board oversight. Additionally, community research is provided through a cancer registry to assist public health professionals in understanding and addressing the cancer burden more effectively. Information obtained is used in development of programs on cancer prevention, early detection, and successful treatment and care.Part I, Line 7i - This line is reported at actual cost. Financial contributions were made to the ALS Association, Alzheimer's Association, American Cancer Society, American Heart Association, American Red Cross, Arthritis Foundation, Bradley Free Clinic, Brain Injury Services, Children's Miracle Network, CHIP of Roanoke Valley, Cystic Fibrosis Foundation, Epilepsy Foundation of VA, Juvenile Diabetes Research Foundation, March of Dimes, Mental Health America, Multiple Sclerosis Society, Muscular Dystrophy Association, Planned Parenthood, Rett Syndrome Research and Susan B. Komen Foundation. Grant funding was provided to Child Health Investment Partnership of Roanoke Valley for operational expenses related to their early childhood home visiting program as they pair low-income children, ages birth to kindergarten-entry, with a community health nurse and family case manager for health care coordination, developmental education, kindergarten preparation and regular child assessment and monitoring; Children's Trust of Roanoke Valley for their regional program that provides child friendly interview room and forensic interviewer to perform interviews of children to be used by multi-disciplinary team investigating alleged child abuse cases; Rx Partnership for operations of the public-private partnership that solicits free drugs in bulk from participating pharmaceutical companies and arranges for their distribution to licensed pharmacies serving uninsured clients; Mental Health America of Roanoke Valley to increase access to mental health services for adults with no health insurance coverage or inadequate insurance for mental health care; New Horizons Healthcare for their Happy Healthy Cooks program with goal to impact dietary attitudes and increase knowledge among elementary and preschool children while inspiring them to have fun and be creative in their food choices; Local Agricultural Environment Project to double the SNAP EBT program for purchase of fresh fruit and vegetables at several local farmer's markets; Roanoke Community Garden Association for educational programs; and United Way of Roanoke Valley for support of Healthy Roanoke Valley. In-kind support was provided to the United Way during their local fundraising campaign. Additionally, Carilion Medical Center's Emergency Department replenishes medical supplies on ambulances owned by local Emergency Medical Services organizations. Part III, Line 2: Carilion Medical Center estimates bad debt expense 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. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible for charity care was determined as the amount of unprocessed financial assistance at September 30, 2014 that was subsequently granted to patients. Part II, 1. Financial support was provided to Rebuilding Roanoke Together for the healthy housing initiative to ensure safe, healthy environments in rehabilitated homes in lower income neighborhoods.2. Support was provided to the Vinton Chamber of Commerce, Roanoke Blacksburg Innovation, Salem Roanoke County Chamber of Commerce, Roanoke Regional Chamber of Commerce, New Century Technology Council, and Virginia Chamber of Commerce to strengthen the social and economic environment of the community. Grant funding was provided to the Greater Roanoke Transit Company for the Star Line Trolley.3. Support was provided to the American Heart Association, Rescue Mission Back to School Blast, Bethany Hall, Big Brothers Big Sisters, Boys and Girls Club, Carpenters Foundation, Commonwealth Catholic Charities, Depaul Community Resources, Down Syndrome Association, Fear 2 Freedom, Feeding America Southwest Virginia, Junior Achievement, Kiwanis Club, Lewis-Gale Foundation, Bradley Free Clinic, Virginia Science Festival, Rescue Mission of Roanoke Valley, Roanoke Academy of Medicine, Roanoke City Public Safety Days, Roanoke Valley Coalition on Youth, Roanoke Valley Endo of Life, Roanoke Valley Interfaith Hospitality House, Ronald McDonald House, Salvation Army, Total Action Against Poverty, Triumph Over Trauma, United Way, Virginia Association for Parks, and West End Center for Youth. Grant funding was provided to Smith Mountain Lake Good Neighbors to support a summer day camp program for children in Franklin and Bedford Counties who live near or under the poverty level and the Virginia Foundation for Community Colleges for an educational attainment initiative through staffing in local high schools. 4. Financial support was provided to Pathfinders for Greenways and Roanoke City Parks and Recreation. 5. n/a. 6. In-kind support was provided through representation on Roanoke Area Youth Substance Abuse Coalition and Roanoke Prevention Alliance, a group of concerned citizens, parents, youth, teachers, police officers, business people, judges, and other caring individuals that strive to keep the youth of the Roanoke Valley and Southwest Virginia alcohol, tobacco and drug-free; Southwest Virginia Alliance for Safe Babies, a multidisciplinary working to eliminate infant injury and deaths due to abusive head trauma and sudden infant death syndrome (SIDS); Positive Action Toward Health, promoting healthy behaviors in children; Salem Prevention Planning Team; Virginia Highway Safety Board representation; and YOVASO, a statewide youth leadership program dedicated to saving the lives of teenage drivers through educating, encouraging and empowering teenagers to be traffic safety advocates in their schools and communities. 7. In-kind support was provided for distribution of a newsletter on behalf of adolescent and student health services and representation on several state medical professional boards.8. Carilion Medical Center partnered with Goodwill Industries of the Roanoke Valley, the Department of Rehabilitative Services, Blue Ridge Behavioral Health, Blue Ridge Independent Living Center and local parent representatives to offer Project SEARCH, a one year high school transition program that provides employment and educational opportunities for individuals with significant disabilities and assist with finding long term employment in skilled positions for its participants. Additional expenses include recruitment of providers to underserved individuals in the Roanoke Valley. 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. 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: Patients are actively screened through a "Presumptive" eligibility process before moving accounts through Extraordinary Collection Actions as defined under the 501r regulations. In addition, individuals have been allowed to apply for financial assistance throughout the collection process. Part VI, Line 2: Carilion Medical Center partnered with community organizations to complete a community health needs assessment and develop a strategic implementation plan during fiscal year 2012. The Roanoke Community Health Needs Assessment (RCHNA) focused on high levels of community engagement involving health and human services leaders, stakeholders, and providers; the target population; and the community as a whole. A Community Health Assessment Team (CHAT) consisting of project management staff and representatives from area health and human services, faith-based communities, and schools led the year-long initiative. Included were representatives from Bethany Hall, Inc., Blue Ridge Behavioral Health, Bradley Free Clinic, CHIP of the Roanoke Valley, CommunityWorks, Council of Community Services, Family Service of the Roanoke Valley, Jefferson College of Health Sciences, LOA Local Office on Aging, Mental Health America, New Horizons Healthcare, Loudon Christian Church, Planned Parenthood Health Systems, Inc., Presbyterian Community Center, Project Access, Rescue Mission Ministries- Fralin Clinic, Roanoke City Health Department, Roanoke City Public Schools, Roanoke Department of Social Services, Roanoke Redevelopment & Housing Authority, Salem Veterans Administration Medical Center and the United Way of the Roanoke Valley. The majority of CHAT members serve the low-income, uninsured, underserved and other vulnerable populations in the Roanoke Valley. Additional support for this initiative was provided through a Federally Qualified Health Center Planning Grant awarded to Carilion Medical Center. Primary data was obtained through surveys and focus groups and analyzed with information acquired through secondary data sources. Part VI, Line 3: The organization informs and educates patients and persons who may be billed for patient care through an in-house eligibility assistance program (EAS) and will evaluate according to our organization's financial assistance policy when patients are eligible for the program. We inform the public through our Internet site, EAS Representatives and other Financial Representatives (Customer Service/Patient Access), and provide information regarding the programs above when patients ask. In addition, our statements comment regarding financial assistance availability. Part VI, Line 4: Carilion Medical Center, comprised of two hospitals, Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital, is located in Roanoke, Virginia. Roanoke is a 1,186 square mile valley located in southwest Virginia near the Blue Ridge and Allegheny Mountains. Carilion Medical Center primarily serves approximately 256,000 residents of Roanoke City and County, Salem, Botetourt County, Craig County and the Town of Vinton. More than 16% of adults under age 64 and 4% of children who live in the Roanoke Valley are uninsured. Additionally, 13% of residents live below the poverty level and 13% of adults 25 years of age or older did not graduate from high school. 17% Roanoke Valley residents are 65 years of age or older. Part VI, Line 5: Carilion Medical Center includes Carilion Roanoke Memorial Hospital, one of the largest hospitals in the state of Virginia with 703 beds and an additional 60-bed Neonatal Intensive Care Unit and pediatric emergency department. With a Level 1 Trauma Center and children's hospital, complete with pediatric emergency room, Carilion Roanoke Memorial Hospital treats residents throughout southwest Virginia. In addition to offering high-tech services, the hospital is also home to 11 residency programs and 12 fellowship programs. Carilion Medical Center 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. Part VI, Line 6: Carilion Medical Center is wholly owned by Carilion Clinic, a not-for-profit healthcare organization based in Roanoke, Virginia. Through a comprehensive network of hospitals, primary and specialty physician practices and other complementary services, quality care is provided close to home for more than 870,000 Virginians. With an enduring commitment to the health of the region, care is advanced through medical education and research, assistance is provided to help the community to stay healthy, and inspiration for the region to grow stronger. Carilion Clinic employees 650 physicians representing more than 70 specialties who provide care at 220 practice sites. 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 masters degree programs. During fiscal year 2014, 876 undergraduate and 255 graduate students were enrolled. The Virginia Tech Carilion School of Medicine enrolled 167 students and there were 649 appointed faculty members during fiscal year 2014. Carilion Clinic and Virginia Tech Carilion School of Medicine provide graduate medical education to 250 medical residents and fellows. There are 12 accredited residency programs (Dermatology, General Hospital Dentistry, Emergency Medicine, Family Medicine, Internal Medicine, Neurosurgery, Obstetrics/Gynecology, Pediatrics, Plastic Surgery, Podiatry, Psychiatry and Surgery) and 11 accredited fellowship programs (Addiction Psychology, Adult Joint Reconstruction, 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 Radiosurgery, 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 serves as 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 11,700 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. 1 Children's Trusts of Roanoke 541 Luck Ave Suite 308 Roanoke VA 24016 510235891 501(c)(3) 50000 Operational Support CHIP of Roanoke Valley 1201 3rd Street Roanoke VA 24016 541566451 501(c)(3) 50000 Operational Support Radford University 801 E Main St Radford VA 24142 546001789 State Govt. 86520 School of Nursing Support Taubman Museum of Art 110 Salem Ave SE Roanoke VA 24011 546026841 501(c)(3) 52700 General Support Jefferson College of Health Sciences Education Foundation 101 Elm Ave Roanoke VA 24013 541637118 501(c)(3) 5000 General Support Boys & Girls Club of Southwest Virginia Inc 1714 9th St SE Roanoke VA 24013 541867366 501(c)(3) 6200 General Support Virginia Business Higher Education Council 1108 E Main St 1100 Richmond VA 23219 541827038 501(c)(3) 10000 General Support Fear 2 Freedom PO Box 6104 Newport News VA 23606 452143034 501(c)(3) 6000 General Support Carilion New River Valley Medical Center 2900 Lamb Circle Christiansburg VA 24073 540553805 501(c)(3) 6113 Research 9 0 Endowment-funded indigent patient medical bills 19 230420 Scholarships 5 9000 Transportation Assistance 1840 110405 Schedule I, Part I, Line 2 The hospital donates funds to other 501(c)3 charitable organizations with a similar mission. Such organizations also have community boards which oversee the expenditure of such funds. The hospital also has a program under which funds are granted to community organizations with a focus on chidren's health and well-being. A committee of Carilion Medical Center employees and an independent physician reviews the applications and selects the recipients. Recipients sign a letter of agreement that delineates the terms and objectives of the project. One mid-year project report, a site visit and a final program evaluation reports on the program's services, outcomes and budget. Schedule I, Part III, Line 1 Grant requests for indigent patients are evaluated for eligibility based on the restrictino criteria placed by the grantor of the endowment, account payment status and funds available under the grant. Schedule I, Part III, Line 2 Scholarship applications are evaluated and awards made by an independent committee according to prescribed guidelines. 0 1 0 0 0 0 0 1 0 John H Burton MD Director/Chair/VP Medical Affair 378361 0 64959 0 2630 0 8494 0 13776 0 468220 0 0 0 Cynda A Johnson MD Director 0 535510 0 0 0 7178 0 27695 0 10222 0 580605 0 0 Clifford A Nottingham MD Director 0 286267 0 42428 0 5778 0 328 0 9994 0 344795 0 0 Patrice M Weiss MD Director/EVP/Chair 398163 0 86792 0 2637 0 776 0 14036 0 502404 0 0 0 Ralph E Whatley MD Director/Chair/SVP/Chief Quality 422540 0 81199 0 7148 0 23083 0 10343 0 544313 0 0 0 Nancy Howell Agee Director/President/CEO 0 901901 0 159389 0 68147 0 737684 0 12373 0 1879494 0 67731 Steve C Arner Director/President/SVP/COO 161300 125280 0 52500 11470 5956 -5963 -6341 6710 7136 173517 184531 0 0 Tracey W Criss MD Director/Chief of Medical Staff 162610 0 49873 0 1701 0 -26697 0 13231 0 200718 0 0 0 Thomas D Denberg MD PhD EVP/Chief Strategy Officer 0 198845 0 70373 0 3673 0 0 0 13937 0 286828 0 0 Briggs W Andrews SVP/General Counsel/Secretary 0 342584 0 60961 0 755 0 36388 0 9654 0 450342 0 0 G Robert Vaughan Jr SVP/Treasurer 0 211713 0 38988 0 4867 0 -27255 0 14193 0 242506 0 0 R Wayne Gandee MD EVP/Chief Medical Officer 542850 0 181896 0 8451 0 18675 0 10646 0 762518 0 0 0 Maxine M Lee MD VP of Medical Affairs 269323 0 47250 0 2615 0 15937 0 2054 0 337179 0 0 0 Donald B Halliwill EVP/CFO/Assistant Treasurer 0 284640 0 52500 0 6020 0 -27463 0 13574 0 329271 0 0 Jonathan Carmouche MD Physician 944354 0 398831 0 2098 0 4356 0 14036 0 1363675 0 0 0 Cay Mierisch MD Physician 768556 0 257363 0 2638 0 -4709 0 13776 0 1037624 0 0 0 Joseph Moskal MD Physician 1024829 0 191214 0 5157 0 22378 0 14231 0 1257809 0 0 0 Nicholas Qandah MD Physician 1053338 0 200579 0 2097 0 5497 0 14036 0 1275547 0 0 0 Gary Simonds MD Physician 716474 0 489700 0 75203 0 3897 0 13776 0 1299050 0 0 0 Donald E Lorton Former EVP 0 314369 0 67943 0 3390004 0 -34833 0 5312 0 3742795 0 3389344 Mark Werner Former EVP 0 0 0 0 344249 0 -22080 0 0 0 322169 0 344249 0 Part I, Line 3 See Schedule O disclosure for Form 990, Part VI, Section B, Line 15 Part I, Line 4b Select members of management participate in a split-dollar life insurance benefit. Under the program, participants purchase a life insurance policy. The Company pays the premium on the policy as an interest-bearing loan to the participant. The policy is collaterally assigned to the Company as security for the payment of the loan. Upon any payout from the policy, either at the death of the participant or some earlier terminating event, the Company is repaid its loan first, with the remainder of policy proceeds, if any, then payable to the participant or his or her beneficiaries. Select members of management participate in a Pension Restoration Plan. This plan provides a benefit equal to the normal retirement benefit that would be payable to the participant were it not for the Qualified plan's legislative restrictions on compensation and payable benefits, less the actual benefits under the Qualified plan. Entitlement to benefits and consequent lump sum payment occurs upon the earliest of (i) attaining age 65 while employed by Carilion Clinic, (ii) 24 months following involuntary separation from service without reasonable cause, (iii) disability, or (iv) voluntary separation or involuntary separation with reasonable cause prior to attaining age 65 if the participant does not enter into competition with Carilion Clinic during the 24-month period following the participant's separation from service. Upon the death of the participant, the plan shall pay the participant's beneficiary according to plan terms. Select members of management participate in an Executive Flexible Benefit Plan, in which an allowance is provided to the participant for use in obtaining certain insurance benefits. The allowance is determined annually as a percentage of salary at Carilion Clinic's discretion. The amount of allowance in excess of elected benefits is credited to a capital accumulation account (CAA) with a deferred vesting date of at least two years from the first day of the plan year. The CAA shall be distributed in a lump sum upon the earliest of (i) remaining employed by Carilion to the deferred vesting date for such account; (ii)disability; (iii) 24 months following involuntary separation from service without reasonable cause, except that Carilion at its discretion may make a partial tax distribution upon separation; or (iv) 24 months following voluntary or involuntary separation from service with reasonable cause if the participant does not enter into competition with Carilion Clinic during the 24-month period following separation from service. Upon the death of the participant, the plan shall pay the participant's beneficiary according to plan terms. Payments during the calendar year under these plans included the following: Nancy Agee $67,731 Donald Lorton $3,389,344 Mark Werner $344,249 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. A Industrial Development Authority of the City of Roanoke VA 541106038 770084EQ0 2005-12-14 230585000 Capital projects; Current Refunding of Series 2002 B-E, Costs of Issuance, B 0 0 0 B VA Small Business Industrial Development Authority of City of RoanokeVA 541300845 928101AE4 2008-07-09 11950000 Capital projects; Costs of Issuance 0 0 0 C Industrial Development Authority of the City of Roanoke VA 541106038 770082AA3 2010-10-13 93754000 Redemption of Series 2003A-C Bonds (8/03), costs of issuance. 0 0 0 D Industrial Development Authority of the City of Roanoke VA 541106038 770082AE5 2012-02-09 61563000 Redemption of Series 2000 and 2002A Bonds, costs of issuance, capital projec 0 0 0 A 27587000 230585000 1421576 3322861 122261974 103578589 2007 1 0 1 1 B 11950000 107259 11842741 2009 0 0 1 1 C 96404094 1229094 95175000 1 0 1 1 D 11711000 69968434 771282 5189198 64007954 2011 0 1 1 1 A 0 1 1 1 0 0.00200 0.00200 1 0 1 B 0 0 0 0 1 0 1 C 0 0 0 0 1 0 1 D 0 0 0 0 1 0 1 A 1 1 0 1 AIG 0.300000000000 1 0 1 B 1 1 0 0 0 1 C 1 0 0 0 0 1 D 1 0 0 0 0 1 A 1 B 1 C 1 D 1 Schedule K, Part II All bond issues- multiple entities across multiple jurisidctions; therefore, proceeds allocated to multiple hospitals. Schedule K, Part II Line 3 IDA bonds CUSP #770082AA3- the Total Proceeds of Issue of $96,404,094 includes the issue price of $93,754,000, as reported on Part I Column e, plus Bond Premium of $2,650,094. IDA bonds CUSP #770082AE5- the Total Proceeds of Issue of $69,968,434 includes the issue price of $61,563,000, as reported on Part I Column e, plus Bond Premium of $8,405,434. Roanoke Gas Company Utility Provider 291298 Utilities purchases 0 Solstas Lab Partners LLC Service Provider 28176099 Lab services 0 Eric H Chen See Part V 285589 Employee 0 Part IV, Line (1) Nancy Howell Agee, Director of Carilion Medical Center and President/CEO of Carilion Clinic, is a Director of Roanoke Gas Company, the local natural gas utility provider. Part IV, Line (2): Nancy Howell Agee, Director of Carilion Medical Center and President/CEO of Carilion Clinic, G. Robert Vaughan, Jr., Officer, and Donald Lorton, former officer, served on the Board of Solstas Lab Partners, LLC of which Carilion had a minority financial interest and from whom the organization purchased lab services. Part IV, Line (3) Family member of Lauren Chen, Officer. X 6 1075 sale of comparable items X 4127 sale of comparable items X 9 855 sale of comparable items X 6 2805 sale of comparable items X Gift certific 68 13292 sale of comparable i X Misc. COGS 34 10995 sale of comparable i X Jewelry 15 4280 sale of comparable i 0 1 0 Form 990, Part I, Line 6 The hospital operates a Customer Service-based program for volunteers and we do anything to make our patients and patient families comfortable in very uncomfortable circumstances. Tasks include delivering mail, delivering flowers, greeting and escorting patients and providing snacks in the hospital waiting rooms. Through Hospice, volunteers provide respite support for caregivers, assist patients with feeding, take care of patients' pets, sing to patients, help in the hospice office, assist with fundraisers, assist with bereavement support activities, deliver birthday gifts, and record patient's life stories. Form 990, Part VI, Section A, line 2 1. Nancy Howell Agee and G. Robert Vaughan, Jr. - Business relationship. 2. Nancy Howell Agee, Briggs W. Andrews, Lauren J. Chen, David S. Hagadorn, Donald B. Halliwill, Cynda A. Johnson, M.D., Rachel L. Mabe, and G. Robert Vaughan, Jr. - Business relationship. 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 4 Carilion Medical Center's Bylaws were amended to create a flexible number of Directors from 12 to 16. Form 990, Part VI, Section A, line 6 The organization has a single member. The sole member is Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. The sole member elects the directors of the organization and has certain other reserved powers. Form 990, Part VI, Section A, line 7a The sole member of the organization, Carilion Clinic, elects the members of the governing body of the organization periodically as terms expire. The sole member also has the right to remove directors and fill any vacancies on the board that may occur for any reason. Form 990, Part VI, Section A, line 7b The sole member of the organization, Carilion Clinic, holds reserved powers with respect to certain enumerated actions, including appointment of CEO, approval of borrowings, budgets and strategic plans and amendments of Articles of Incorporation and Bylaws. Approval by the Board of Directors of Carilion Clinic is required for such actions. In addition to the reserved powers, under the laws of the Commonwealth of Virginia certain extraordinary actions require member approval, such as mergers, consolidations, liquidations and the sale of substantially all of the assets of the organization. Form 990, Part VI, Section B, line 11 All Board Members were notified that the final Form 990 was posted on our Board portal several days prior to filing and 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 CEOs. This review was performed in September and October 2013. A similar review was last performed in October 2014. This review included review of a comprehensive report from an outside compensation consultant specializing in healthcare organizations for select positions and the prior year's report on all of the reviewed positions. The reports reviewed by the Committee included a detailed comparison of total compensation and each element thereof, including base salary, 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 web site and in our annual report to the community. Form 990, Part XI, line 9: Transfer to affiliates -35,500,000. Pension-related changes other than net periodic pension cost -76,600,942. Temporarily Restricted Fund Transfer to affiliates -121,022. The Center For Surgical Excellence LLC PO Box 12385 Roanoke VA 24025 562595597 Inactive- corporation cancelled during year VA 0 0 Carilion Medical Center Odyssey IV LLC PO Box 12385 Roanoke VA 24025 562354974 Inactive- corporation cancelled during year VA 0 0 Carilion Medical Center RMH Emergency Service LLC PO Box 12385 Roanoke VA 24025 541686589 Physician billing VA 0 0 carilion Medical Center Carilion Clinic PO Box 12385 Roanoke VA 24025 541190771 Supporting organization VA 501(c)(3) Line 11a, I N/A 0 Carilion Clinic Foundation PO Box 12385 Roanoke VA 24025 541190773 Supporting organization VA 501(c)(3) Line 11b, II Carilion Clinic 1 Carilion Franklin Memorial Hospital PO Box 12385 Roanoke VA 24025 540480606 Healthcare VA 501(c)(3) Line 3 Carilion Clinic 1 Carilion Giles Community Hospital PO Box 12385 Roanoke VA 24025 540549603 Healthcare VA 501(c)(3) Line 3 Carilion Clinic 1 Carilion New River Valley Medical Center PO Box 12385 Roanoke VA 24025 540553805 Healthcare VA 501(c)(3) Line 3 Carilion Clinic 1 Carilion Services Inc PO Box 12385 Roanoke VA 24025 541190879 Supporting organization VA 501(c)(3) Line 11a, I Carilion Clinic 1 Carilion Stonewall Jackson Hospital PO Box 12385 Roanoke VA 24025 540568001 Healthcare VA 501(c)(3) Line 3 Carilion Clinic 1 Carilion Tazewell Community Hospital PO Box 12385 Roanoke VA 24025 546074580 Healthcare VA 501(c)(3) Line 3 Carilion Clinic 1 Jefferson College of Health Sciences Education Foundation PO Box 12385 Roanoke VA 24025 541637118 Supporting organization VA 501(c)(3) Line 11b, II N/A 0 CHS Inc PO Box 12385 Roanoke VA 24025 541725732 Services VA Carilion Services Inc C 188827249 308040294 1.00000 1 Carilion Clinic Medicare Resources LLC PO Box 12385 Roanoke VA 24025 263729975 Medicare HMO VA Carilion Services Inc C 58220637 21979480 1.00000 1 1 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 0 Carilion Services Inc A 7984505 Cost CHS Incand Subsidiaries A 166817 Cost Carilion New River Valley Medical Center L 4132076 Cost Carilion Giles Community Hospital L 1225028 Cost Carilion Franklin Memorial Hospital L 1569336 Cost Carilion Stonewall Jackson Hospital L 1172603 Cost Carilion Tazewell Community Hospital L 1371571 Cost Carilion Services Inc L 195226 Cost CHS Incand Subsidiaries L 349247 Cost Carilion New River Valley Medical Center K 82590 Cost Carilion New River Valley Medical Center L 56843 Cost Carilion Clinic K 9228066 Cost Carilion Services Inc K 50588 Cost Carilion Services Inc M 126669475 Cost CHS Incand Subsidiaries K 3076916 Cost CHS Incand Subsidiaries H 69599 Cost CHS Incand Subsidiaries M 5043963 Cost Carilion Services Inc R 35500000 Cash