Form 990 for tax year 2024

Revenue

Part VIII, the statement of revenue.

• 1d · Related organizations

  $538,132

• 1e · Government grants (contributions)

  $6,736,702

• 1f · All other contributions, gifts and grants

  $2,017,418

• 2a · Program service revenue: NET PATIENT REVENUE

  total $2,093,045,593 · related or exempt $2,093,045,593

• 2b · Program service revenue: PROGRAM RELATED INVESTMENTS

  total $8,310,623 · related or exempt $8,310,623

• 2c · Program service revenue: PATIENT PHARMACY REVENUE

  total $102,298,939 · related or exempt $102,298,939

• 2d · Program service revenue: AFFILIATE RENT INCOME

  total $522,850 · related or exempt $522,850

• 2e · Program service revenue: CLINICAL RESEARCH

  total $2,588,306 · related or exempt $2,588,306

• 2f · All other program service revenue

  total $2,595,671 · related or exempt $2,595,671 · unrelated business $0 · excluded $0

• 3 · Investment income

  total $10,807,669 · unrelated business $19,530 · excluded $10,788,139

• 4 · Income from investment of tax-exempt bond proceeds

  total $4,768 · excluded $4,768

• 6a · Gross rents

  real property $5,393,103

• 6c · Rental income or loss

  real property $5,393,103 · personal property $0

• 6d · Net rental income or loss

  total $5,393,103 · excluded $5,393,103

• 7a · Gross sales of assets other than inventory

  securities $84,166,221 · other assets $70,139

• 7b · Less cost or other basis and sales expenses

  securities $14,659,972 · other assets $49,734

• 7c · Gain or loss

  securities $69,506,249 · other assets $20,405

• 7d · Net gain or loss

  total $69,526,654 · excluded $69,526,654

• 11a · Other revenue: AFFILIATE SUBSIDY & OTHER INCOME

  total $5,355,311 · related or exempt $5,355,311

• 11b · Other revenue: DINING SERVICES

  total $4,119,360 · excluded $4,119,360

• 11c · Other revenue: ROANOKE CITY STUDENT HEALTH

  total $2,373,898 · related or exempt $2,373,898

• 11d · All other revenue

  total $8,031,134 · related or exempt $8,031,134 · unrelated business $0 · excluded $0

• 11e · Other revenue, total

  $19,879,703

Functional expenses

Part IX, the statement of functional expenses.

• 1 · Grants to domestic organizations and governments

  total $7,176,461 · program services $7,176,461

• 2 · Grants to domestic individuals

  total $330,836 · program services $330,836

• 5 · Compensation of officers, directors and key employees

  total $6,335,355 · program services $5,732,007 · management and general $603,348

• 6 · Compensation of disqualified persons

  total $3,332,828 · program services $3,332,828

• 7 · Other salaries and wages

  total $760,338,818 · program services $759,843,467 · management and general $435,660 · fundraising $59,691

• 8 · Pension plan contributions

  total $31,710,021 · program services $31,691,852 · management and general $18,169

• 9 · Other employee benefits

  total $53,212,070 · program services $53,106,708 · management and general $90,439 · fundraising $14,923

• 10 · Payroll taxes

  total $50,253,698 · program services $50,187,921 · management and general $61,877 · fundraising $3,900

• 11a · Fees: management

  total $318,435,177 · management and general $318,435,177

• 11b · Fees: legal

  total $173,386 · management and general $173,386

• 11d · Fees: lobbying

  total $7,744 · program services $7,744

• 11f · Fees: investment management

  total $1,231,500 · management and general $1,231,500

• 11g · Fees: other

  total $219,575,871 · program services $207,348,053 · management and general $12,224,511 · fundraising $3,307

• 12 · Advertising and promotion

  total $23,763 · program services $23,731 · fundraising $32

• 13 · Office expenses

  total $35,416,950 · program services $34,615,738 · management and general $791,793 · fundraising $9,419

• 14 · Information technology

  total $4,617,807 · program services $4,612,093 · management and general $5,673 · fundraising $41

• 16 · Occupancy

  total $39,871,681 · program services $39,850,315 · management and general $21,366

• 17 · Travel

  total $3,818,779 · program services $3,810,430 · management and general $1,507 · fundraising $6,842

• 20 · Interest

  total $8,014,449 · program services $8,014,449

• 22 · Depreciation, depletion and amortization

  total $52,600,230 · program services $52,600,230

• 23 · Insurance

  total $15,746,602 · program services $10,601,488 · management and general $5,145,114

• 24a · Other expenses: MEDICAL SUPPLIES

  total $315,517,323 · program services $315,517,323

• 24b · Other expenses: ASSESSMENT FEES

  total $120,122,206 · program services $120,122,206

• 24c · Other expenses: BAD DEBT

  total $95,294,644 · program services $95,294,644

• 24d · Other expenses: AFFILIATE PRACTICE SUBSIDY

  total $7,916,919 · program services $7,916,919

• 24e · All other expenses

  total $8,911,963 · program services $8,698,683 · management and general $25,647 · fundraising $187,633

Balance sheet

Part X, book values.

• 1 · Cash, non-interest-bearing

  beginning of year $14,720 · end of year $15,560

• 2 · Savings and temporary cash investments

  beginning of year $6,029,263 · end of year $3,241,112

• 3 · Pledges and grants receivable

  beginning of year $0

• 4 · Accounts receivable

  beginning of year $364,382,883 · end of year $470,859,659

• 5 · Loans and receivables from officers and key people

  beginning of year $0 · end of year $0

• 6 · Loans and receivables from disqualified persons

  beginning of year $0 · end of year $0

• 7 · Other notes and loans receivable

  beginning of year $93,228 · end of year $57,877

• 8 · Inventories for sale or use

  beginning of year $13,565,513 · end of year $17,452,282

• 9 · Prepaid expenses and deferred charges

  beginning of year $24,832,907 · end of year $20,873,145

• 10a · Land, buildings and equipment: cost or other basis

  $1,923,450,410

• 10b · Land, buildings and equipment: accumulated depreciation

  $1,069,865,767

• 10c · Land, buildings and equipment, net

  beginning of year $742,216,444 · end of year $853,584,643

• 11 · Investments: publicly traded securities

  beginning of year $383,201,443 · end of year $282,911,365

• 12 · Investments: other securities

  beginning of year $669,442,369 · end of year $711,361,336

• 13 · Investments: program-related

  beginning of year $11,167,187 · end of year $18,838,090

• 14 · Intangible assets

  beginning of year $341,728 · end of year $300,307

• 15 · Other assets

  beginning of year $1,947,877 · end of year $708,425

• 17 · Accounts payable and accrued expenses

  beginning of year $304,535,156 · end of year $253,169,156

• 18 · Grants payable

  beginning of year $176,250 · end of year $290,000

• 19 · Deferred revenue

  beginning of year $30,506,778 · end of year $14,821,274

• 20 · Tax-exempt bond liabilities

  beginning of year $593,434,651 · end of year $582,474,689

• 22 · Loans and payables to officers and key people

  beginning of year $0 · end of year $0

• 24 · Unsecured notes and loans payable

  beginning of year $182,000 · end of year $91,000

• 25 · Other liabilities

  beginning of year $269,352,916 · end of year $264,067,008

• 27 · Net assets without donor restrictions

  beginning of year $989,520,655 · end of year $1,233,440,015

• 28 · Net assets with donor restrictions

  beginning of year $29,527,156 · end of year $31,850,659

The filer's explanations (Part III)

SCHEDULE J, PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS

EMPLOYEES ARE OCCASIONALLY PROVIDED SMALL GIFTS, PRIZES OR AWARDS WHICH ARE INCLUDED IN TAXABLE COMPENSATION AT GROSSED UP AMOUNTS TO COVER TAXES. DURING THE REPORTING PERIOD, DR. HASKINS AND DR. TERSHAK RECEIVED SUCH BENEFIT.

SCHEDULE J, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES

ALL DIRECTORS ARE OFFERED A FREE FAMILY OR INDIVIDUAL MEMBERSHIP TO A HEALTH CLUB OWNED BY A RELATED ORGANIZATION IF THEY CHOOSE TO ACCEPT IT. THREE REPORTED INDIVIDUALS RECEIVED THIS BENEFIT, THE VALUE OF WHICH IS INCLUDED IN REPORTED COMPENSATION.

SCHEDULE J, PART I, LINE 1B WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF EXPENSES

PROVISION OF THE HEALTH CLUB BENEFIT IS DOCUMENTED IN BOARD MEETING MINUTES AND CARILION INTERNALLY TRACKS THE MEMBERSHIPS AND PAYS THE HEALTH CLUB DIRECTLY. MANAGEMENT MAKES TAX GROSS-UP DECISIONS AT ITS DISCRETION FOR NON-ROUTINE SMALL GIFTS, PRIZES OR AWARDS CONSIDERING IRS REQUIREMENTS, AMOUNT, AND NON-CASH STATUS.

SCHEDULE J, PART I, LINE 3 ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION

THE ORGANIZATION HAS A SINGLE MEMBER, CARILION CLINIC, A CHARITABLE TAX-EXEMPT ORGANIZATION WHICH SERVES AS THE PARENT COMPANY OF THE CARILION CLINIC INTEGRATED HEALTH CARE DELIVERY SYSTEM. EXECUTIVE COMPENSATION, INCLUDING THAT OF THE ORGANIZATION'S PRESIDENT, IS REVIEWED ANNUALLY BY THE CARILION CLINIC BOARD OF DIRECTORS COMPENSATION COMMITTEE. THIS COMMITTEE IS MADE UP OF BOARD MEMBERS OF CARILION CLINIC WHO DO NOT HAVE A CONFLICT OF INTEREST WITH ANY OF THE EXECUTIVES BEING REVIEWED. IN ADDITION, THE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE COMPENSATION PHILOSOPHY FOR ALL EXECUTIVE LEADERS. THIS REVIEW INCLUDED REVIEW OF A COMPREHENSIVE REPORT FROM AN INDEPENDENT, OUTSIDE COMPENSATION CONSULTANT SPECIALIZING IN HEALTHCARE ORGANIZATIONS FOR SELECT POSITIONS AND THE PRIOR YEAR'S REPORT ON ALL OF THE REVIEWED POSITIONS. THE REPORTS REVIEWED BY THE COMMITTEE INCLUDED A COMPARISON OF TOTAL COMPENSATION AND EACH ELEMENT THEREOF, INCLUDING BASE SALARY, BONUS, 'AT-RISK OTHER CASH COMPENSATION, AND BENEFITS, INCLUDING DEFERRED AND RETIREMENT BENEFITS. COMPENSATION WAS COMPARED TO BOTH A NATIONAL AND REGIONAL PEER GROUP OF ORGANIZATIONS SIMILAR IN SIZE AND STRUCTURE TO THE ORGANIZATION, WHICH LIST WAS REVIEWED BY THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE MAINTAINED MINUTES OF ITS MEETINGS, SETTING FORTH THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE REGARDING THE COMPENSATION OF THESE EXECUTIVES.

SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN

MR. ABBOTT, MR. ARNER, MR. CONTE, MR. HALLIWILL, DR. MOSKAL, DR. NUSSBAUM, DR. HASKINS, DR. JANE, DR. SWEET, DR. SEUPAUL AND MR. VAUGHAN PARTICIPATE IN A DEFINED CONTRIBUTION SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (DC SERP). CONTRIBUTIONS TO THE PLAN ARE AT THE DISCRETION OF CARILION CLINIC'S COMPENSATION COMMITTEE. AMOUNTS VEST AND BECOME NON-FORFEITABLE AND PAYABLE UPON THE FIRST OF THE FOLLOWING (1) ATTAINMENT OF SCHEDULED VESTING DATE (2) ATTAINMENT OF AGE AND YEARS OF SERVICE REQUIREMENTS (3) DISABILITY OR DEATH WHILE AN ELIGIBLE EMPLOYEE OR (4) ENTITLEMENT TO SEVERANCE BENEFITS FROM AN INVOLUNTARY TERMINATION WITHOUT REASONABLE CAUSE OR RESIGNATION WITH GOOD REASON. UNVESTED CONTRIBUTIONS MADE TO THE DC SERP IN THE REPORTING PERIOD ARE INCLUDED IN PART II, COLUMN C OF THIS SCHEDULE WITH "RETIREMENT AND OTHER DEFERRED COMPENSATION," WHILE VESTED CONTRIBUTIONS PAID OUT DURING THE YEAR ARE INCLUDED IN PART II, COLUMN B(III). THE FOLLOWING DISTRIBUTIONS WERE MADE TO THESE INDIVIDUALS UNDER THIS PLAN IN THE REPORTING YEAR. DEFERRED IN PRIOR YEAR AND PAID OUT IN CURRENT YEAR: $269,399 - DONALD HALLIWILL $244,219 - STEVEN ARNER $80,547 - G. ROBERT VAUGHAN, JR. $227,408 - NICHOLAS CONTE $30,339-MICHAEL ABBOTT VESTED AND PAID IN CURRENT YEAR: $75,000 - JOSEPH MOSKAL $75,000 - MICHAEL NUSSBAUM MS. AGEE PARTICIPATES IN AN EXECUTIVE FLEXIBLE BENEFIT PLAN, UNDER WHICH SHE RECEIVES AN ALLOWANCE WHICH CAN BE USED TO OBTAIN CERTAIN BENEFITS, WITH THE EXCESS DEFERRED UNTIL THE APPLICABLE VESTING DATE. AMOUNTS RECEIVED UNDER THIS PLAN NOW VEST IMMEDIATELY AND THUS ARE NO LONGER DEFERRED. $202,495 WAS DISTRIBUTED UNDER THIS PLAN IN THE REPORTING YEAR.

SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS

THE ORGANIZATION PAYS ANNUAL 'AT RISK' COMPENSATION TO CERTAIN MEMBERS OF MANAGEMENT AND PHYSICIANS BASED ON PERFORMANCE OF APPLICABLE SCORECARD METRICS. WHILE THE SCORECARD CONTAINS A FORMULA AS A BASIS FOR DETERMINING OVERALL PERFORMANCE, IN CERTAIN CASES, SENIOR MANAGERS HAVE DISCRETION TO INCLUDE ADDITIONAL ELEMENTS IN THEIR ASSESSMENT OF MANAGERS OR PHYSICIANS REPORTING TO THEM. IN ADDITION, FOR TOP MANAGEMENT, THE ACTUAL NON FIXED PAYMENT AWARDED IS DETERMINED IN THE DISCRETION OF THE CARILION CLINIC BOARD OF DIRECTORS AND ITS COMPENSATION COMMITTEE.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

• RMH EMERGENCY SERVICES LLC

  PHYSICIAN BILLING · VA · income $0 · assets $0

  Directly controlled by CARILION MEDICAL CENTER

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

• FRANKLIN COUNTY VENTURES LLC

  RELATED · REAL ESTATE · VA · 10% owned · share of income -$94 · share of assets $0

  Directly controlled by CARILION CLINIC

• CARILION CLINIC MEDICARE SHARED SAVINGS COMPANY LLC

  RELATED · MEDICARE ACO · VA · 50% owned · share of income $8,082,878 · share of assets $17,811,169

  Directly controlled by CARILION CLINIC

• ROANOKE AMBULATORY SURGERY CENTER LLC

  RELATED · SURGERY · VA · 50% owned · share of income $641,572 · share of assets $1,601,374

  Directly controlled by CARILION MEDICAL CENTER

• SOUTHWEST VIRGINIA HEALTH PROPERTIES LLC

  RELATED · REAL ESTATE · VA · 53% owned · share of income $128,341 · share of assets $1,190,250

  Directly controlled by CARILION MEDICAL CENTER

• RAVEN ASSET-BASED OPPORTUNITY FUND IV LP

  N/A · PRIVATE EQUITY · DE

  Directly controlled by NA

• STARWOOD VEP II CO-INVEST LLC

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• TI PLATFORM CC SMA LP

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• TI FBV GR LP

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• TI PLATFORM DCI SPV LP

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• TRANSPOSE PLATFORM ZIPPEDI SPV LP

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• TRANSPOSE PLATFORM GORGIAS SPV LP

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• TRANSPOSE PLATFORM FINTECH FUND II LP

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• OPERA INVESTMENT TWO SCSP

  N/A · INVESTMENTS · LU

  Directly controlled by NA

• VTC INNOVATION FUND III LP

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• L2 VENTURES GP LLC

  N/A · INVESTMENTS · DE

  Directly controlled by NA

• SAGE RESIDENTIAL MSROF IV LP

  N/A · INVESTMENTS · DE

  Directly controlled by NA

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

• CHS INC

  C CORPORATION · SERVICES · VA · controlled entity

  Directly controlled by NA

• CARILION BEHAVIORAL HEALTH INC

  C CORPORATION · HEALTHCARE · VA · controlled entity

  Directly controlled by NA

• CARILION EMERGENCY SERVICES INC

  C CORPORATION · HEALTHCARE · VA · controlled entity

  Directly controlled by NA

• SCA CREDIT SERVICES INC

  C CORPORATION · COLLECTION AGENCY · VA · controlled entity

  Directly controlled by NA

• CARILION HEALTHCARE CORPORATION

  C CORPORATION · HEALTHCARE · VA · controlled entity

  Directly controlled by NA

• MEDKEY INC

  C CORPORATION · FINANCING SERVICES · VA · controlled entity

  Directly controlled by NA

• CARILION DTC SERVICES INC

  C CORPORATION · HEALTHCARE · VA · controlled entity

  Directly controlled by NA