TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Steve C Arner...................................................................... Director	1.20 ................. 48.80	X			0	483,909	123,786
(2) W Mark Church PhD...................................................................... Director	1.20 .................	X			0	0	0
(3) Katherine J Goff PhD...................................................................... Director	1.20 .................	X			0	0	0
(4) Barbara Jackman...................................................................... Director	1.20 .................	X			0	0	0
(5) Shannon V Moore...................................................................... Director	1.20 .................	X			0	0	0
(6) Dave A Peters...................................................................... Director	1.20 .................	X			0	0	0
(7) Jeff Powell...................................................................... Director	1.20 .................	X			0	0	0
(8) Sarah L Stubbs MD...................................................................... Director	1.20 ................. 48.80	X			0	322,556	18,761
(9) Lyne B Aigner MD...................................................................... Director/Chief of Medical Staff	1.20 ................. 48.80	X	X		0	297,524	85,888
(10) Craig L Bookout MD...................................................................... Director/Chief of Medical Staff	1.20 ................. 48.80	X	X		0	318,729	48,509
(11) Victoria L Gardner...................................................................... Director/Vice President	1.20 .................	X	X		0	0	0
(12) William D Jacobsen...................................................................... Dir./Sec./Treas./Hospital VP	50.00 .................	X	X		217,392	0	62,307
(13) William R Kingery Jr...................................................................... Director/President	2.50 ................. 2.90	X	X		0	0	0
(14) Lauren J Chen...................................................................... Assistant Secretary	1.00 ................. 49.00		X		0	74,469	14,801
(15) Donald B Halliwill...................................................................... Assistant Treasurer	0.30 ................. 49.70		X		0	550,507	120,070
(16) G Robert Vaughan Jr...................................................................... Assistant Treasurer	0.30 ................. 49.70		X		0	306,045	81,831
(17) Nancy Howell Agee...................................................................... CEO	2.00 ................. 48.00			X	0	1,621,601	2,168,199

(A) Name and business address	(B) Description of services	(C) Compensation
Solstas Lab Partners Group LLC PO Box 751337 Charlotte,NC28275	Laboratory Services	1,664,568
HTF Mechanical Services Inc PO Box 618 Moneta,VA24121	Equipment Maintenance Contracts	256,627
F & S Building Innovations Inc 2944 Orange Ave NE Roanoke,VA24012	Construction Services	226,335
Siemens Medical Solutions USA Inc 51 Valley Stream Parkway Malvern,PA19355	Equipment Maintenance Contracts	191,464

2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 4

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization CARILION FRANKLIN MEMORIAL HOSPITAL

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization CARILION FRANKLIN MEMORIAL HOSPITAL		Employer identification number 54-0480606

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization CARILION FRANKLIN MEMORIAL HOSPITAL			Employer identification number 54-0480606
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

2,988

Total. Add lines 1c through 1i ....................................................................................................

2,988

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	A portion of dues paid to various hospital industry associations is attributable to lobbying activities.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	226,092		226,092
b	Buildings	20,041,310	12,886,976	7,154,334
c	Leasehold improvements
d	Equipment ...	15,183,741	11,588,395	3,595,346
e	Other ...	1,044,230	762,167	282,063
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				11,257,835

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Qualified Pension Liability	13,143,339
Interest Rate Swap Liability	755,606
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	13,898,945
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Part X, Line 2:

Carilion recognizes a tax liability or asset for the estimated taxes payable or refundable on tax returns for current and prior years. Deferred tax assets and liabilities are recognized for the estimated future tax effects attributable to temporary differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. A tax benefit from an uncertain tax position is recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, based on the technical merits. Uncertain tax positions may include the characterization of income, such as characterization of income as passive, a decision to exclude reporting taxable income in a tax return, or a decision to classify a transaction, entity, or other position in a tax return as tax exempt.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			3,970,891	0	3,970,891	10.830 %
b	Medicaid (from Worksheet 3, column a) . . . . .			2,712,148	2,488,591	223,557	0.610 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			0	0
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			6,683,039	2,488,591	4,194,448	11.440 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	148	7,721	96,599	0	96,599	0.260 %
f	Health professions education (from Worksheet 5) . . .	3	110	1,555	0	1,555	0 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	76	11,011	119,454	0	119,454	0.330 %
j	Total. Other Benefits . .	227	18,842	217,608		217,608	0.590 %
k	Total. Add lines 7d and 7j .	227	18,842	6,900,647	2,488,591	4,412,056	12.030 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	0	0
2	Economic development	2	0	4,187	0	4,187	0.010 %
3	Community support	20	38	7,588	0	7,588	0.020 %
4	Environmental improvements	1	0	250	0	250	0 %
5	Leadership development and training for community members	0	0
6	Coalition building	56	87	26,012	0	26,012	0.060 %
7	Community health improvement advocacy	0	0
8	Workforce development	6	120	1,475	0	1,475	0 %
9	Other	0	0
10	Total	85	245	39,512		39,512	0.090 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,323,260

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

12,262,255

Enter Medicare allowable costs of care relating to payments on line 5.....

12,749,759

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-487,504

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Carilion Franklin Memorial Hospital 180 Floyd Avenue Rocky Mount,VA24151 www.carilionclinic.org H 1836	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Carilion Franklin Memorial Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V, Section C

Other website (list url): https://www.carilionclinic.org/about/chna

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): https://www.carilionclinic.org/about/chna

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Carilion Franklin Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Part V, Section C

The FAP application form was widely available on a website (list url):

See Part V, Section C

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	Carilion Franklin Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Carilion Franklin Memorial Hospital	Part V, Section B, Line 5: Carilion Clinic's CHNAs are community-driven projects and success is highly dependent on the involvement of citizens, health and human service agencies, businesses, and community leaders. Community stakeholder collaborations known at "Community Health Assessment Teams" (CHAT) lead the CHNA projects. The CHAT consists of health and human service agency leaders, persons with special knowledge of or expertise in public health, the local health department, and leaders, representatives, or members of medically underserved populations, low-income persons, minority populations, and populations with chronic disease.The following organizations served on the CHAT for the 2016 (tax year 2015) Franklin County Community Health Needs Assessment (FCCHNA): Family Preservation Services, Franklin County Department of Aging Services, Franklin County Family Resource Center, Franklin County Public Library, Franklin County Public Schools, Free Clinic of Franklin County, Helping Hands of Franklin County, Martinsville Henry County Coalition for Health and Wellness, Pigg River Community Association, Rocky Mount Police Department, Smith Mountain Lake Good Neighbors, Southern Area Agency on Aging, TW Controls, United Way of Franklin County, Virginia Department of Health, Young Audiences of Virginia.In addition to the CHAT, the FCCHNA conducted stakeholder surveys, target population focus groups, and a community health survey. Target population focus groups were conducted with participants from Bassett Library, an Essig Center Senior Group, a Henry Fork Center English learning class, and Tanyard Village residents. The community health survey was made available to residents living in Franklin County and Bassett, Virginia. Oversampling of the target populations occurred through targeted outreach efforts. In total, 306 surveys were collected.
Carilion Franklin Memorial Hospital	Part V, Section B, Line 6b: Family Preservation Services, Franklin County Department of Aging Services, Franklin County Family Resource Center, Franklin County Public Library, Franklin County Public Schools, Free Clinic of Franklin County, Helping Hands of Franklin County, Martinsville Henry County Coalition for Health and Wellness, Pigg River Community Association, Rocky Mount Police Department, Smith Mountain Lake Good Neighbors, Southern Area Agency on Aging, TW Controls, United Way of Franklin County, Virginia Department of Health, Young Audiences of Virginia.
Carilion Franklin Memorial Hospital	Part V, Section B, Line 7d: Line 7a-b: https://www.carilionclinic.org/hospitals/carilion-franklin-memorial- hospitalLine 7d: The 2016 FCCHNA was also posted to CHAT partner websites.
Carilion Franklin Memorial Hospital	Part V, Section B, Line 11: Carilion Clinic and Healthy Franklin County (HFC) partnered to conduct the 2016 FCCHNA. This process was community-driven and 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.In July 2016, the CHAT participated in a prioritization activity to determine the greatest needs in the service area based on the primary and secondary data collected during the assessment period. To quantitatively determine health needs, CHAT members were asked to rank the top ten pertinent community needs, with one being the most pertinent. Next, on a scale of 1-5, CHAT members were asked to assign a feasibility and potential impact score for each of the ranked needs. This information was used for the CHAT strategic planning retreat held later in July 2016.The top ten priority areas that emerged from these findings include:1. Access to primary care 2. Access to mental health counseling/substance abuse services3. Lack of reliable transportation 4. Access to adult dental care 5. Value not placed on preventive care and chronic disease management 6. High uninsured population7. High prevalence of substance abuse (alcohol, illegal & prescription drugs) 8. Alcohol and illegal drug use9. Improved coordination of care across the health and human service sector10. Stigma with mental health and substance abuse servicesThe CHAT participated in strategic planning on July 11, 2016. It reviewed and accepted the priority areas above, which can be categorized further into: access to services (primary care, mental health & substance abuse services, and oral health); coordination of care (improved coordination of care, high uninsured population); wellness (value not placed on preventive care and chronic disease management); transportation (lack of reliable transportation); and substance use/abuse (high prevalence of substance abuse, alcohol and illegal drug use, and stigma with mental health and substance abuse services).Significant Health Needs to be AddressedCarilion Franklin Memorial Hospital (CFMH) plans to address key community health needs identified in the 2016 assessment by focusing its efforts on partnering with community organizations to maintain, expand and streamline existing holistic wellness and prevention initiatives that are already working to address the identified major priorities as a result of the 2013 FCCHNA, and other community needs assessment findings. In addition, CFMH will be an integral partner in the community initiative focused on maximizing coordination of care through successful implementation of CharityTracker and other resources. Through greater access to clinical care, enhanced community outreach programs, creative community partnerships and focused financial and in-kind support of initiatives, CFMH plans to improve community health in Franklin County and Bassett, Virginia. A. Access to Services (Primary Care, Mental Health and Substance Abuse Services, and Dental Care)Carilion Clinic recognizes the need for additional primary care providers in Franklin County. As such, recruitment efforts are underway for primary care providers and Carilion Clinic continues to explore options for expanding primary care access in the community.Carilion Clinic also partners with the Free Clinic of Franklin County to improve access to primary care through financial support which allows them to maintain a position to meet the needs of the low-income patients. The Free Clinic of Franklin County continues to serve the poorest uninsured with primary medical care and prescription medications. The majority of their patient population suffers from one or more chronic diseases, requiring longer visits, frequent follow-up visits, and multiple medications. Through this partnership, not only is access to primary care made available to target populations, but ongoing education and follow-up is provided to patients with chronic diseases. This partnership also includes coordination between the Free Clinic of Franklin County and the CFMH Emergency Department to connect uninsured patients with primary care.The Health Efficiency Navigation Initiative (HENI) is a partnership with other providers in our community to address access to coverage and to care. CFMH hired a Community Healthcare Outreach Advocate (CHOA) to work in the Emergency Room during peak periods to connect with patients who have no medical home and/or no insurance and, together with HENI partners, navigate patients to more appropriate and lower cost care. As a result of these efforts, CFMH has seen a trend of decreasing Emergency Room visits and the visits are at a higher acuity. Carilion Clinic has just been awarded a USDA Distance Learning and Telemedicine grant to address the opioid epidemic in rural Appalachia. This grant will provide critical infrastructure for telemedicine provision in rural counties throughout Carilion Clinic's footprint. The infrastructure will provide the basis for the expansion of telepsychiatry services to patients in Franklin County. With the infrastructure in place, Carilion Clinic will work towards identifying means to supply enough psychiatry providers to meet the increased demand. Similar to many areas across the county, lack of sufficient supply of psychiatrists is a barrier for Carilion Clinic to provide increased access to mental health and substance abuse services. CFMH will begin conversations with community partners through Healthy Franklin County to find ways to take advantage of available Health Resources Services Administration (HRSA) dollars to bring affordable dental services to Franklin County.B. Coordination of Care:Carilion Clinic's family practices have adopted the medical home model and have added care coordinators to proactively work with its high risk, chronic care patients. Through the Better Living 65 initiative, Carilion Family Medicine is working with care coordinators to ensure better follow-up and communication with patients who have chronic diseases. The care coordinators work to ensure that patients understand their care plan and have someone to talk to between visits.In 2011, CFMH measured the number of high utilizing patients in the Emergency Room. The results demonstrated high utilization of the Emergency Room, most significantly among government paid patients and self-pay patients. At that time, CFMH spent several months studying the issue and performed an experiment. The hypothesis was that this was due to limited access to primary care and sub-optimal care coordination. This experiment was to work with the on-campus primary care group to open slots for non-emergent patients to be seen during their normal working hours. CFMH credentialed our Emergency Room Physician Assistants (PA's) to medically screen and stabilize low acuity patients, educate them on the importance of a medical home, then request for them to go to a primary care physician in our on-site practice rather than the Emergency Room. This worked well, but quickly depleted open slots for patients in the primary care practice.In 2014, with the availability of coverage through the Affordable Care Act, the community decided to create a Health Efficiency Navigation Initiative (HENI). This group was a partnership with other providers in our community to address access to coverage and to care. Members of the HENI are:o Carilion Franklin Memorial Hospitalo Carilion Clinic Primary Care Practices in our Region (5)o Tri-area Community Health Center at Ferrumo Free Clinic of Franklin Countyo Martinsville Henry County Health & Wellness Coalitiono Piedmont Services (Local Community Services Board)o Virginia Department of Health, West Piedmont DistrictThe HENI started in late 2014 and CFMH hired a Community Healthcare Outreach Advocate (CHOA). The CHOA works in the Emergency Room during peak periods to connect with patients who have no medical home and/or no insurance. This is done after the patient has been medically screened and stabilized. The CHOA works with contacts from all partner providers to navigate patients to more appropriate and lower cost care. As a result of these efforts, CFMH has seen a trend of decreasing Emergency Room visits and the visits are at a higher acuity.The HENI has also been successful in moving people from uninsured to reasonable coverage. This is done through the CFMH Emergency Room, members of the HENI, community events and learning opportunities, and coordination events with other navigation organizations across the state.Part V, Section B, Line 11: See Continuation Below
Carilion Franklin Memorial Hospital	Part V, Section B, Line 16i: Line 16a: https://www.carilionclinic.org/billing/financial-assistance.Line 16b: https://www.carilionclinic.org/billing/financial-assistance.Line 16c: https://www.carilionclinic.org/billing/financial-assistance.
Carilion Franklin Memorial Hospital	Part V, Section B, Line 20e: Presumptive eligibility based upon specific free clinic or indigent health access programs, other state or local assistance programs, and/or third party evaluation to determine ability to pay prior to transfer to bad debt.
Carilion Franklin Memorial Hospital	Part V, Section B, Line 22d: Maximum amounts that can be charged are determined based on average allowed amounts from Medicare and private insurance payers, calculated using the look-back method per 26 CFR section 1.501(r).
Part V, Section B, Line 11: Continued From Above	B. Coordination of Care: Continuation -CFMH will continue to strive to address access challenges and follow-through. The next challenge is coordinating this care. The HENI is implementing a community-wide, web-based system called CharityTracker to strengthen care coordination. CharityTracker is an online system that enables shared case management across various health and human service organizations. Through this system, organizations can communicate quickly and easily to coordinate all needed supports for an individual or family together and at one time. Other benefits include reduced duplication of services, increased client accountability, shared data and shared outcomes. This system will also be available to key United Way agencies in our community as we recognize the importance of social determinants of health beyond what healthcare providers can supply.C. Substance Use/Abuse:Carilion Clinic participates as a partner in the FRESH Coalition. FRESH (Focus on Response and Education to Stay Healthy) is a community coalition focused on changing behaviors and attitudes to prevent substance abuse among youth and families in Franklin County. The vision is to empower our community to make healthy choices. FRESH is made up of different representatives in the community representing 12 sectors: Youth, Parents, Media, Schools, Businesses, Healthcare Professionals, Law Enforcement, Civic and Volunteer Groups, Youth-Serving Organizations, State and Local Government, Religious Organizations, and Other Organizations Working to Prevent Substance Abuse. The youth representatives make up the CHILL (Communities Helping Improve Local Lives) Youth Task Force that is made up of students in 9-12th grade who are committed to making healthy, positive choices. It is a youth leadership and development program where students are trained in drug and alcohol prevention and are given opportunities to strengthen their personal skills while working to improve their school and community. FRESH has been working on the following:. Reducing alcohol related motor vehicle crashes. Reducing underage drinking. Increasing awareness about dangers of underage drinking and parents hosting . Providing education to the community on various drug issues (ex: synthetic marijuana, electronic cigarettes and vaping, prevention of marijuana legalization, opioid overdose reversal, safe disposal of prescription drugs) . Partnering with law enforcement for the Prescription Drug Take Back events in the community twice a year. Implementing a permanent prescription drug drop box for people to dispose of their unwanted meds at any time. Promoting responsible alcohol use for those over 21 though our "What's Your Plan?" campaign. Partnering with law enforcement to increase awareness about increased patrols and DUI enforcement. Recognizing organizations and businesses that are compliant with alcohol and tobacco laws. Providing drug-free alternative events for youth in the community (ex: After Prom Party). Promotion of National Family Day in September by providing dinner and fun activities for families to participate in together. CHILL has been working on the following:. Project Sticker Shock through the Virginia Department of Alcoholic Beverage Control where students place warning stickers on cases of alcohol to raise awareness about not providing alcohol to minors. . Providing interactive drug prevention activities in the 6th grade health classes and with other community groups (ex: Henry Fork Center, YMCA After School Program, churches) . Providing educational materials to the community around various drug topics (ex: providing Tobacco Merchant Education info to retailers selling tobacco products). Promoting school wide campaigns around drug prevention issues; especially around holidays, homecoming, prom, and graduation. Partnerships with local organizations for events (Souls to Soles shoe drive, Shine Without Shine, Come Home to a Franklin County Christmas). Attending various youth conferences to gain knowledge and skills in drug prevention. CHILL members have attended the YADAPP (Youth Alcohol and Drug Abuse Prevention Project) Conference for three years and the last two years our students won a mini-grant to implement a prevention project in their community during the following year. Carilion Clinic will also look into partnering with the public school system's family liaisons to provide resource education that can be shared with families when they identify a need. In addition, Carilion Clinic will explore the possibility for staff and community education on continuing to be sensitive with substance abuse patients.D. Transportation:CFMH is participating as a partner in a newly formed coalition called the Franklin County Transportation Task Force (FCTTF) which will focus on addressing transportation issues in Rocky Mount and Franklin County, specifically non-emergency transportation to health resources. This task force is in the planning stages of a program based on the Bedford Ride model currently operating in Bedford, Virginia.E. Wellness:Carilion Clinic has committed to continue its financial support of Healthy Franklin County (HFC) in 2016-2017. CFMH will continue to support and participate as a partner in HFC. HFC is a coalition that seeks to reduce obesity and related chronic diseases by mobilizing time, talent and financial resources to promote healthier lifestyles. The HFC Steering Committee and nutrition and fitness workgroups meet regularly to identify and measure results of key strategies including:o Healthy West Piedmont - Healthy West Piedmont is a regional lifestyle health program that was recently funded with a grant from the Centers for Disease Control. Two personnel will continue to collaborate with HFC. In addition to providing essential local timely data, the project will train and deploy a corps of Community Health Workers to assist in combating obesity in Henry and Patrick counties, as well as Franklin County. o Initiate Employee Wellness Activities - In partnership with Healthy West Piedmont and the Franklin County Family YMCA, HFC will engage local employers in employee wellness activities using the lifestyle modification model that has already begun in the community. Already, new hiking trails have been created and mapping and signage have been improved for existing trails. These maps label one-mile loops in Franklin County.o Create Community Giving Gardens - To stimulate interest in and knowledge of gardening and to help feed those who rely upon the food banks, HFC created a series of raised bed gardens in close proximity to fresh food deserts (i.e. areas with limited access to healthy food). Produce will continue to be distributed to food banks and via neighborhood pick-up to those most in need. The 5,000 pound goal for 2016 has already been exceeded and the donated pounds continue to grow, with the final number to be recorded in November. HFC will continue to expand this program and already has plans for additional gardens. o Diabetes Prevention Program - HFC partners will offer a diabetes prevention program. These classes will be hosted at the Free Clinic of Franklin County.o Establish Restaurant Collaborations - Lifestyle health initiatives cannot assume that participants will always eat at home. Making local restaurants aware of Healthy Franklin County food and drink standards is the first step. Healthy Franklin County partners will work with restaurants to add plant strong items to menus, focus on healthy drinks, and otherwise communicate healthy choices. A rewards system will be employed to recognize these efforts.o Engaging the Public School System - Franklin County High School students already participate in a semester-long plant strong lifestyle health program offered by Healthy Franklin County partners. HFC will expand the program to enable collaboration with the school lunch program, workbooks and a lifestyle health "graduation." Starting this fall, a pilot program will be run in one school for grades Pre-K through 5. This health education curriculum will include education on making healthy food choices, gardening and composting, and trying new foods, plus homework of bringing food home to parents along with a survey that parents can send back indicating what food support they might need.
Part V, Section B, Line 11: Continued	F. Focused Community Grants and Partnerships:Carilion Clinic funds health safety-net providers and causes identified through the FCCHNA. In-kind assistance is also provided through community partnerships that align with the FCCHNA. Carilion Clinic actively looks for opportunities to impact community health by providing outreach and educational support. Partnerships include Free Clinic of Franklin County, FRESH, HFC, HENI, Smith Mountain Lake Good Neighbors, Southern Virginia Child Advocacy Center, Transportation Task Force and United Way of Franklin County, to name a few. Carilion Clinic also provides education and information on numerous clinical services and prevention topics, as well as health screenings. Priority Areas Not being Addressed and the ReasonsA community approach to determine and address priority needs as described in Part V, Section C, Line 11 was used in determining which needs cannot be addressed immediately. The needs not identified as "priority" will not be actively addressed in this time period.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	1 - Imaging Services 35 Medical Court Hardy,VA24101	CT and Diagnostic Radiology
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 3c:	Asset test is used. Money in checking/savings, trust, retirement accounts, equity in real property.
Part I, Line 6a:	Community Benefit Reporting. Information on community benefit is reported annually through a consolidated report prepared by Carilion Clinic (54-1190771). Printed copies of this report are distributed throughout communities served by hospitals affiliated with Carilion Clinic. Additionally, the community benefit report is available on Carilion Clinic's website: www.carilionclinic.org/community-outreach.
Part I, Line 7:	Part I, Line 7a-b:Ratio of cost-to-charges was used to calculate the expense.Part I, Line 7:Column (f) Calculation-Bad debt expense in the amount of $4,323,260 is subtracted from total expenses for the calculation.Part I, Line 7e:Community Health Improvement- This line is calculated at actual cost. As part of its mission to educate the public about health risks and steps that can be taken to improve health, Carilion Clinic conducts and participates in health fairs, screenings, and presentations offered at various community locations. These events provide an opportunity to educate individuals about improving health and quality of life as well as determining one's risk of developing a chronic illness. Another way that Carilion Franklin Memorial Hospital (CFMH) touches the community is through Med Talk, a weekly radio program, providing listeners with an opportunity to learn more about a variety of health topics through a call-in show that provides answers to their specific questions. Coordinated by a local health educator, guests of the show include health professionals and representatives of local community service organizations. Additional health improvement services include blood drives and assistance with enrollment in public medical programs such as Medicaid. Community benefit operations include the cost associated with tracking community health improvement activities as well as conducting the Franklin County Community Health Needs Assessment (FCCHNA).Part I, Line 7f:Health Professions Education-Continuing health education was provided to local Emergency Medical Service (EMS) providers as well as participation in Virginia Commonwealth University (VCU) health administration graduate students evaluations.Part I, Line 7g:Subsidized Health Services-N/A.Part I, Line 7h:Research-N/A.Part I, Line 7i:Cash and In-Kind Contributions- At CostCarilion has long been committed to improving the health of the communities we serve. We know that significant change doesn't happen alone, but takes a community of partners working together towards common goals. Our dedication to this mission is evidenced by the support we provide to various nonprofit partners, furthering their efforts to positively impact health. Contributions of various amounts, both financial and in-kind, are made each year to organizations directly impacting the issues identified in our triennial Community Health Needs Assessment as well as to organizations addressing a variety of social determinants that impact people's health. Support provided helps with access to nutrient dense foods, promotion of exercise and healthy activity, child abuse prevention, and access to primary care and mental health in addition to a multitude of other community health improvement goals.
Part II, Lines 1-8	Part II, Line 1: Physical Improvements- N/A.Part II, Line 2: Economic Development- CFMH provided support to the Smith Mountain Lake Chamber of Commerce.Part II, Line 3: Community Support-Research demonstrates the strong connection between social determinants of health such as transportation, housing, and education and the overall health and well-being of communities. Support is provided in a variety of ways for non-profit organizations that address barriers to good health that arise from these social determinants. Through support of local partners, Carilion is able to help provide better education and opportunities for children and families as well as nutrition and resources for our neighbors in need, removing obstacles to good health. Part II, Line 4: Environmental Improvements-Support was provided to Friends of Smith Mountain Lake to protect and preserve the park. Part II, Line 5: Leadership Development- N/A.Part II, Line 6: Coalition Building-Support was provided for the Court Appointed Special Advocate (CASA) for volunteer training; Ferrum College; Franklin County Connects; the Franklin County Fatality Review Team; the Franklin County Joint Emergency Services group; the Franklin County Sheriff's Office Citizen's Academy; the Franklin County Transportation Coalition; FRESH (Focus on Response and Education to Stay Healthy) Coalition, a community coalition with a current focus on teen drug abuse; the Healthy Community Action Team; the Health Efficiency Navigation Initiative; Lion's Club; Education for Law Enforcement on working with victims of domestic violence; the SML Chamber of Commerce; Trinity Episcopal Church for a presentation on the future of healthcare; and Healthy Franklin County meetings organized by United Way of Franklin County. Part II, Line 7: Community Health Improvement- N/A.Part II, Line 8: Workforce Development-Support was provided in-kind for the Western VA Workforce Development Board, Centers for Applied Technology and Career Exploration and to provide career education at a high school.
Part III, Line 2:	Carilion Franklin Memorial Hospital 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.
Part III, Line 4:	Accounts receivable are reduced by an allowance for amounts that could become uncollectible in the future. Carilion Franklin Memorial Hospital 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. Carilion Franklin Memorial Hospital collects substantially all of its third-party insured receivables, which include receivables from governmental agencies and commercial insurers.
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:	When accounts receivable efforts are exhausted, the account may be placed with a collection agency and Extraordinary Collection Actions (ECA) may be considered. Accounts will not be placed with a collection agency prior to 120 days from the date the first billing statement is provided except when mailings are returned with no forwarding address and combining multiple accounts of varying age with those already transferred or for legal verification regarding other liabilities.When a Financial Assistance Application (FAA) is received during the application period (within 240 days after the date the first billing statement is provided), but after initiation of ECAs, all ECAs will be suspended. Best efforts will be made to process completed applications within 30 days of receipt of the application; financial assistance eligibility will be determined and communicated to the individual. Incomplete applications must be completed within 30 days of the initial notification of additional items required; otherwise, the application will be deemed incomplete and closed. If an individual is eligible for financial assistance, ECAs, other than the sale of debt, will be reversed and any payments related to eligible care refunded to the extent no longer owed. ECAs will be reinstated if the individual is not eligible for financial assistance or does not complete the FAA by the deadline.At least 30 days before initiating an ECA, Carilion will send the patient written notice of intended ECA(s), a plain language summary explaining financial assistance available and the process for determining eligibility, and the deadline for applying for assistance. Carilion will also attempt to call individuals at least 30 days before initiating an ECA to make them aware of the financial assistance available and how to obtain assistance with the application process.Carilion shall enter into a written contract with any collection agency to which it refers bad debt. The contract will obligate the collection agency to observe and comply with Carilion's obligations under this Policy and the Financial Assistance Policy. A collection agency to which bad debt is referred for collection may not engage in any ECAs without the prior written consent of Carilion.After making reasonable efforts to determine if a patient qualifies for Financial Assistance and if no positive patient response is received within 120 days from the date the first billing statement is provided, Carilion may engage in one or more of the following ECAs: 1. Place a lien on an individual's property; 2. Attach or seize an individual's bank account or any other personal property; 3. Commence a civil action against an individual; 4. Garnish an individual's wages; 5. Sell an individual's debt to another party; or 6. Report the account to credit agencies.Individual account balances greater than $5,000 are not sent to a collection agency. These are handled through the Debt Recovery Department (DRD) for verification of Financial Assistance status before further collection activity occurs. DRD will also investigate any accounts that require special handling. For example, when the billing office becomes aware that a patient is deceased, auto accident or any other unique circumstances requiring special handling, the accounts are placed with the Debt Recovery Department.When all collection efforts have been exhausted, all hospital accounts will be returned and closed as uncollectible. No further collection activity is taken at that time. Accounts with satisfactory payment arrangements, legal activity or accounts with pending payment will be considered active and are not returned.
Part VI, Line 2:	Needs AssessmentCarilion Clinic's community health improvement process was adapted from Associates in Process Improvement's the Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle developed by Walter Shewhart. It consists of five distinct steps: (1) conducting the CHNA, (2) strategic planning, (3) creating the implementation strategy, (4) program implementation, and (5) evaluation. This cycle is repeated every three years to comply with IRS requirements. Carilion Clinic fosters community development in its CHNA process and community health improvement process by using the Strive Collective Impact Model for the CHAT. This evidence-based model focuses on "the commitment of a group of important players from different sectors to a common agenda for solving a specific social problem(s) and has been proven to lead to large-scale changes. It focuses on relationship building between organizations and the progress towards shared strategies. As a result to the CHNA, Carilion Franklin Memorial Hospital (CFMH) partnered with the United Way of Franklin County to form Healthy Franklin County. Using the collective impact model, the partnership represents cross-sector stakeholders and leaders who are working to implement cost-effective programs resulting in improved health outcomes. Carilion Clinic also addresses community health needs through health safety-net partnerships, including financial and in-kind assistance through community grants and sponsorships.
Part VI, Line 3:	Eligibility AssistanceEducation of the Financial Assistance Policy is provided to patients at all hospital admission and ambulatory areas in the form of signage, in a summary of the policy which includes contact information, in available financial assistance applications, and is included in the inpatient handbook. Hospital social workers and customer service representatives provide patients with verbal and/or written information regarding availability of assistance. Each patient billing statement and letters regarding patient financial responsibility include information on the Financial Assistance Policy and who to contact for additional information. Applications, the policy, and Plain Language Summary are available free of charge to the patient. These items will be mailed to the patient if the patient failed to keep the documents at the time of service and they are also available on the Carilion Clinic website. Carilion Clinic also employs an Eligibility Assistance Team that counsels patients regarding federal and state programs. This department completes applications for Medicaid, Social Security, Social Security Disability, and Medicare and provides support services for ensuring the applications are processed correctly based on federal and state policy. In addition, the Eligibility Team members are all Certified Application Counselors and will assist patients with enrollment in insurance exchange marketplace products provided through the Affordable Care Act. Eligibility Team members will also complete Carilion's financial assistance application and explain the requirements for financial assistance eligibility.
Part VI, Line 4:	Community InformationCarilion Franklin Memorial Hospital (CFMH) is located in Rocky Mount, Virginia. In fiscal year 2015, CFMH served 21,118 unique patients. Patient origin data revealed that in fiscal year 2015, 74.40% of patients served by CFMH lived in the following localities:. Franklin County (69.24%). Bassett - Henry County (5.16%)Nestled in the beautiful Blue Ridge Mountains in southwest Virginia, Franklin County is mostly rural with 81.3 persons per square mile and a land area of 690.43 square miles. According to the 2011-2015 American Community Survey 5-Year Estimates, the total population of Franklin County is 56,315. 80.2% of residents are 18 years old or over and 20% are 65 years old or over. Franklin County is 90.9% White and 8.5% Black. 42.4% of Franklin County residents are not in the labor force, the median household income is $46,870, 13.1% of residents have no health insurance coverage, 14.9% of all people and 24.6% of people under 18 years old live below the federal poverty level, 84% of residents have graduated high school, and 20.5% of residents have a bachelor's degree or higher. Franklin County is a designated Medically Underserved Area (MUA) and a Health Professional Shortage Area (HPSA) for Primary Care, Dental, and Mental Health providers. The findings of the 2016 Franklin County / Bassett Community Health Needs Assessment revealed an underserved population in need of better access to primary care, mental health care, dental care and specialty services. The community expressed a need for more reliable transportation and coordination of care across the health and human services sector. Specifically, transportation concerns are exacerbated by the lack of access to primary and dental care, making trips into Roanoke necessary for many Franklin County residents. Stakeholders and community respondents also expressed sincere concern over the use and abuse of alcohol, illegal drugs and prescription drugs. Poverty rates were higher, academic attainment rates were lower, and unemployment rates continue to be greater than statewide averages impacting the social determinants of health.
Part VI, Line 5:	Promotion of Community HealthCarilion Franklin Memorial Hospital serves all patients regardless of their ability to pay. The Hospital's governing Board is elected annually and the majority of members are neither employees nor contractors of the Hospital. Medical staff privileges are extended to qualified providers. In addition to clinical care, the Hospital works to achieve its mission through the education of health professionals and the community. Any surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. This includes providing free, discounted and subsidized care as well as critical medical services that operate at a loss.
Part VI, Line 6:	Affiliated Health CareCarilion Franklin Memorial Hospital is wholly owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. Through our comprehensive network of hospitals, primary and specialty physician practices, and complementary services, we provide exceptional care for nearly 1 million Virginians. Our enduring commitment is to a healthier region. We advance care through medical education and research, help our community stay healthy, and inspire it to grow stronger.To advance education of health professionals, Jefferson College of Health Sciences is a private higher education institution that "prepares, within a scholarly environment, ethical, knowledgeable, competent and caring healthcare professionals." The College focuses on providing healthcare education and is a part of Carilion Clinic. Founded in 1914 as the Jefferson Hospital School of Nursing, Jefferson College now provides more than 1,100 students with opportunities to become part of the healthcare profession, serving communities from southwest Virginia to the Shenandoah Valley and beyond. The school's graduates are building healthier tomorrows in our region and across the country every day. More information is available at www.jchs.edu.The Virginia Tech Carilion School of Medicine joins the basic science, life science, bioinformatics, and engineering strengths of Virginia Tech with the medical practice and medical education experience of Carilion Clinic to develop the next generation of physician thought leaders. The school uses an innovative patient-centered curriculum that focuses on small-group learning and hands-on experiences, with extensive research and interprofessionalism training.

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number
54-0480606

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) Free Clinic of Franklin County 1171 Franklin St Rocky Mount,VA24151	54-1634138	501(c)(3)	26,000	Operational support
(2) Smith Mountain Lake Regional Chamber of Commerce 16430 Booker T Washington Hwy2 Moneta,VA24121	54-1654288	501(c)(6)	7,050	General Support
(3) SML Good Neighbors PO Box 2 Moneta,VA24121	26-1274000	501(c)(3)	10,000	Summer Camp
(4) United Way of Franklin County PO Box 446 Rocky Mount,VA24151	54-1246961	501(c)(3)	41,500	Healthy Franklin County
(5) Southern VA Child Advocacy Center 300 S Main St Rocky Mount,VA24151	54-1950268	501(c)(3)	10,000	Child Abuse Prevention

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

Part I, Line 2:

For Carilion Clinic's Community Grant Program, each grantee must sign a letter of agreement with Carilion Clinic that delineates the terms and specific objectives of the project. By accepting a Carilion award, grantees are asked to acknowledge the support of Carilion Clinic in all materials and/or related special events or fundraisers throughout the award cycle where other donors are publicly recognized. One mid-cycle progress report and a final program evaluation are required for every funded project. Site visits may be made to new grantees. Program evaluation includes organizational effectiveness, program impact and community benefit through collection of data including clients served, cost effectiveness of the program (cost per client or service), tangible community or client outcomes, and specific efforts to cultivate diverse funding sources for program sustainability. Each grantee must agree to submit requested data and reports on a timely basis and to complete the evaluation process as requested.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Steve C ArnerDirector	(i) (ii)	0 ------------- 404,698	0 ------------- 75,226	0 ------------- 3,985	0 ------------- 111,082	0 ------------- 12,704	0 ------------- 607,695	0 ------------- 0
2Sarah L Stubbs MDDirector	(i) (ii)	0 ------------- 162,794	0 ------------- 123,183	0 ------------- 36,579	0 ------------- 8,328	0 ------------- 10,433	0 ------------- 341,317	0 ------------- 0
3Lyne B Aigner MDDirector/Chief of Medical Staff	(i) (ii)	0 ------------- 234,250	0 ------------- 59,791	0 ------------- 3,483	0 ------------- 75,024	0 ------------- 10,864	0 ------------- 383,412	0 ------------- 0
4Craig L Bookout MDDirector/Chief of Medical Staff	(i) (ii)	0 ------------- 285,462	0 ------------- 28,972	0 ------------- 4,295	0 ------------- 38,510	0 ------------- 9,999	0 ------------- 367,238	0 ------------- 0
5William D JacobsenDir./Sec./Treas./Hospital VP	(i) (ii)	180,109 ------------- 0	35,095 ------------- 0	2,188 ------------- 0	51,118 ------------- 0	11,189 ------------- 0	279,699 ------------- 0	0 ------------- 0
6Donald B HalliwillAssistant Treasurer	(i) (ii)	0 ------------- 460,065	0 ------------- 86,171	0 ------------- 4,271	0 ------------- 108,666	0 ------------- 11,404	0 ------------- 670,577	0 ------------- 0
7G Robert Vaughan JrAssistant Treasurer	(i) (ii)	0 ------------- 248,071	0 ------------- 47,425	0 ------------- 10,549	0 ------------- 70,577	0 ------------- 11,254	0 ------------- 387,876	0 ------------- 0
8Nancy Howell AgeeCEO	(i) (ii)	0 ------------- 1,137,025	0 ------------- 332,354	0 ------------- 152,222	0 ------------- 2,158,081	0 ------------- 10,118	0 ------------- 3,789,800	0 ------------- 141,071
9Melina D PerdueEVP	(i) (ii)	0 ------------- 404,233	0 ------------- 74,860	0 ------------- 38,182	0 ------------- 422,692	0 ------------- 9,866	0 ------------- 949,833	0 ------------- 29,590
10Lori McClurePharmacy Manager	(i) (ii)	144,964 ------------- 0	1,500 ------------- 0	4,065 ------------- 0	28,637 ------------- 0	1,024 ------------- 0	180,190 ------------- 0	0 ------------- 0
11Sharon ScottPharmacist	(i) (ii)	157,062 ------------- 0	300 ------------- 0	477 ------------- 0	41,278 ------------- 0	940 ------------- 0	200,057 ------------- 0	0 ------------- 0
12Robin WoodDepartment Manager	(i) (ii)	105,608 ------------- 0	1,500 ------------- 0	4,213 ------------- 0	31,497 ------------- 0	8,380 ------------- 0	151,198 ------------- 0	0 ------------- 0
13Mikesh Shah MDFormer Officer	(i) (ii)	0 ------------- 236,633	0 ------------- 57,251	0 ------------- 3,198	0 ------------- 29,567	0 ------------- 1,857	0 ------------- 328,506	0 ------------- 0
14Donald E LortonFormer Officer	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 130,613	0 ------------- 0	0 ------------- 0	0 ------------- 130,613	0 ------------- 130,613

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Line 3	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 Hospital Vice 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. This review was performed in November 2015 and September 2016. In addition, the Compensation Committee annually reviews the compensation philosophy for all executive leaders. 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 both a national and regional peer group of organizations similar in size and structure to the organization, the list of which was reviewed by the Compensation Committee. The Compensation Committee maintained detailed minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives.
Part I, Line 4b	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 attaining age 65 while employed by Carilion Clinic, disability, or 24 months following certain qualifying separations 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 vesting while employed by Carilion, disability, or 24 months following certain qualifying separations 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 a Defined Contribution Supplemental Executive Retirement Plan (DC SERP) in which the employer at the discretion of Carilion Clinic's Compensation Committee makes a contribution to an account established on its books for each eligible participant. If a participant ceases to be a participant prior to the vesting date, the account shall be forfeited. A lump sum distribution shall be made upon the participant's vesting date, death, or disability. Payments during the calendar year under these plans included the following: Nancy Howell Agee $141,071 Donald Lorton $130,613 Melina Perdue $29,590
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 Board of Directors Compensation Committee, although it is based on the scorecard measures.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number
54-0480606

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Industrial Development Authority of the City of Roanoke VA	54-1106038	770082AB1	10-13-2010	2,101,036	Refunding of Series 2003A-C Bonds (8/03), Issuance Costs		X		X		X
B	Industrial Development Authority of the City of Roanoke VA	54-1106038	770084FU0	10-13-2010	5,311,002	Reoffering Circular and interest rate conversion to fixed, Issuance Cost		X		X		X
C	Economic Development Authority of the City of Roanoke VA	54-1106038	770082AW5	02-09-2012	4,266,137	Refunding of Series 2000 and 2002A Bonds, Issuance Cost, Capital Projects		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................			849,000		1,328,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	2,101,036		5,311,002		4,266,137
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	26,036		57,429		47,015
8 Credit enhancement from proceeds .............			2,240
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	2,075,000		5,251,333		4,219,122
12 Other unspent proceeds .............
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X		X			X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X	X
16 Has the final allocation of proceeds been made? ..........	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?					X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....					4.500 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........					0 %
6 Total of lines 4 and 5 .............					4.500 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X
b Exception to rebate? ........		X		X		X
c No rebate due? .........	X		X		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X	X			X
b Name of provider ..........			AIG
c Term of GIC .........			30.0000000000 %
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........			X
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: Industrial Development Authority of the City of Roanoke, VA Date the Rebate Computation was Performed: 04/29/2011 Issuer Name: Industrial Development Authority of the City of Roanoke, VA Date the Rebate Computation was Performed: 05/04/2011 Issuer Name: Economic Development Authority of the City of Roanoke, VA Date the Rebate Computation was Performed: 04/04/2013
Schedule K, Bond Issues	(a) Issuer Name: Part I Line A Industrial Development Authority of the City of Roanoke, VA, Hospital Revenue Bonds, Carilion Health System Obligated Group, Series 2010 (a) Issuer Name: Part I Line B Industrial Development Authority of the City of Roanoke, VA, Hospital Revenue Refunding Bonds, Carilion Clinic Obligated Group, Series 2005B & 2005C (a) Issuer Name: Part I Line C Economic Development Authority of the City of Roanoke, VA, Hospital Revenue Bonds, Carilion Clinic Obligated Group, Series 2012
Schedule K, Part II	All bond issues multiple entities across multiple jurisdictions; therefore, proceeds allocated to multiple hospitals.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Lettitia Furrow	See Part V	109,360	Employee		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
Part IV, Line (1):	Family member of William Kingery, Director.

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Return Reference	Explanation
Form 990, Part I, Line 6	Within the hospital, volunteers serve at the escort desk, decorate, handle vendor sales, provide fundraisers, assist with the stroke screening and Relay for Life, put together charts, plan conferences, stock medical supplies, make beds in the ED, stock linens, respond to comfort needs of patients, file and put together OR packets. Through Hospice, volunteers sit with patients, help in the office, assist with fundraising, and assist with special events.
Form 990 Part V, Line 1a	1099s are issued on Carilion Franklin Memorial Hospital's behalf by Carilion Services, Inc., a related organization providing management and administrative services, including payment processing.
Form 990, Part VI, Section A, line 2	1. Nancy Howell Agee, Lauren J. Chen, Donald B. Halliwill, Melina D. Perdue, G. Robert Vaughan, Jr., Lyne B. Aigner, M.D., Steven C. Arner, Sarah L. Stubbs, M.D., and Craig L. Bookout, M.D. - Business relationship due to each serving as officers, directors, and/or employees of the same related organizations.
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 and supporting organization of the filing organization. Compensation of the following individuals listed in Part VII, Section A was provided by Carilion Services Inc.: Nancy Howell Agee, Steven Arner, Lauren Chen, Donald Halliwill, Donald Lorton, Melina Perdue, G. Robert Vaughan.
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. See also Schedule O disclosure for Form 990 Part VI Section A Line 7a.
Form 990, Part VI, Section B, line 11	The Form 990 was prepared by Carilion's internal Tax Department with input from various Carilion departments as applicable, and reviewed by internal Accounting management. Several days prior to filing, all Board Members were notified via email of its availability on Carilion's Board portal, which is the mechanism used to disseminate meeting materials to the directors, and were encouraged to call with any questions they might have.
Form 990, Part VI, Section B, line 12c	Our organization monitors and reviews proposed and current transactions for conflicts of interest in a variety of ways. At the governing board level, we have board members complete an initial (upon appointment) and annual conflict of interest questionnaire to disclose actual or potential conflicts. Board members are required to update their disclosure as needed in between questionnaires. All disclosures are reviewed by the Organizational Integrity & Compliance Office and as needed escalated to the appropriate leaders/board members for further discussion/review. If a disclosure is viewed as an actual or potential conflict, an action is recommended to the Audit & Compliance Committee of the Carilion Clinic Board and implemented as approved. Actions can include recusal in discussion/voting at board meetings, limitation/termination of the transaction, removal from board appointment or other appropriate controls. In addition, at any time, board members are encouraged to disclose any potential conflicts as they arise at a board meeting and to recuse themselves as deemed appropriate. The same process takes place as described above for key employees (upon hire and annually thereafter), including all Officers, members of the management team, physicians/mid-level practitioners, pharmacists and key supply chain buyers. After review and further discussion as needed, action may be required to manage an actual conflict or to reduce the appearance of such as approved by Organizational Integrity & Compliance Office and other key management team members. As needed, the governing board leaders are notified of any conflicts which may impact board proceedings.
Form 990, Part VI, Section B, line 15	The organization has a single member, Carilion Clinic, a charitable tax-exempt organization which serves as the parent company of the Carilion Clinic integrated health care delivery system. Executive compensation is reviewed annually by the Carilion Clinic Board of Directors Compensation Committee. This Committee is made up of Board Members of Carilion Clinic who do not have a conflict of interest with any of the executives being reviewed. With respect to Carilion Clinic, the Compensation Committee reviews the compensation of the Board of Governors annually, which includes the President and Chief Executive Officer, Executive Vice Presidents, Chief Financial Officer, Chief Medical Officer, select Senior Vice Presidents, and physician Chairs of the Clinical Departments. This review was performed in November 2015 and September 2016. For the fiscal year covered by this return, the Compensation Committee also used the same process to review the compensation of all Senior Vice Presidents and other Disqualified Individuals, including the Hospital Vice Presidents. These reviews were performed in September and November 2015, and September 2016, respectively. In addition, the Compensation Committee annually reviews the compensation philosophy for all executive leaders, which includes Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, and the CEO, as well as the compensation philosophy for all employed physicians and physicians in leadership roles. Some officers of the organization who are not compensated in their capacity as an officer but rather in their role as employee in a position not mentioned above are not subject to Committee review. This review included review of a comprehensive report from an 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 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 detailed minutes of its meetings, setting forth the deliberations and decisions of the Committee regarding the compensation of these executives.
Form 990, Part VI, Section C, line 19	The organization's governing documents, conflict of interest statement, and financial statements are not generally available to the public, but are released from time to time upon request. The Articles of Incorporation are available from the Virginia State Corporation Commission. The consolidated audited financial statements of Carilion Clinic and of the Obligated Group are released annually to the local newspaper. Limited financial information is available on our website.
Form 990 Part IX, Line 11g, Column B	Reference Labs: $1,638,496 Physician/ Professional Services: $759,717 Repairs/ Maintenance: $693,159 Contract Fees/ Consulting: $228,272 Other Purchased Services: $1,075,774 Total Other Services Fees, Column B: $4,395,418
Form 990 Part IX, Line 11g, Column C	Contract Fees/ Consulting: $37,499 Other Purchased Services: $40,140 Total Other Services Fees, Column C: $77,639
Form 990, Part XI, line 9:	Pension-related changes other than net periodic pension cost -3,478,490. Transfer from/to Affiliates -432,491.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

CARILION FRANKLIN MEMORIAL HOSPITAL

Employer identification number

54-0480606

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Carilion Clinic PO Box 12385 Roanoke,VA24025 54-1190771	Supporting organization	VA	501(c)(3)	Line 11b, II	N/A		No
(2)Carilion Giles Community Hospital PO Box 12385 Roanoke,VA24025 54-0549603	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(3)Carilion Medical Center PO Box 12385 Roanoke,VA24025 54-0506332	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(4)Carilion New River Valley Medical Center PO Box 12385 Roanoke,VA24025 54-0553805	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(5)Carilion Services Inc PO Box 12385 Roanoke,VA24025 54-1190879	Supporting organization	VA	501(c)(3)	Line 11b, II	Carilion Clinic	Yes
(6)Carilion Stonewall Jackson Hospital PO Box 12385 Roanoke,VA24025 54-0568001	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(7)Carilion Tazewell Community Hospital PO Box 12385 Roanoke,VA24025 54-6074580	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(8)Carilion Clinic Foundation PO Box 12385 Roanoke,VA24025 54-1190773	Fundraising	VA	501(c)(3)	Line 7	Carilion Clinic	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Carilion Clinic Medicare Shared Savings Company LLC PO Box 12385 Roanoke,VA24025 45-5235473	Medicare HMO	VA	N/A
(2) Franklin County Ventures LLC PO Box 12385 Roanoke,VA24025 47-4365316	Real estate	VA	N/A
(3) Community Medical Associates LLP PO Box 12385 Roanoke,VA24025 54-1517662	Real estate	VA	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) Carilion Clinic Medicare Resources LLC PO Box 12385 Roanoke,VA24025 26-3729975	Medicare HMO	VA	N/A	C			Yes
(2) CHS Inc PO Box 12385 Roanoke,VA24025 54-1725732	Services	VA	N/A	C			Yes
(3) Carilion Behavioral Health Inc PO Box 12385 Roanoke,VA24025 20-3136891	Healthcare	VA	N/A	C			Yes
(4) Carilion Emergency Services Inc PO Box 12385 Roanoke,VA24025 54-2033006	Healthcare	VA	N/A	C			Yes
(5) SCA Credit Services Inc PO Box 12385 Roanoke,VA24025 54-1180398	Collection agency	VA	N/A	C			Yes
(6) Carilion Healthcare Corporation PO Box 12385 Roanoke,VA24025 54-1586601	Healthcare	VA	N/A	C			Yes
(7) MedKey Inc PO Box 12385 Roanoke,VA24025 54-1645357	Financing services	VA	N/A	C			Yes

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Carilion Medical Center	A	36,456	Cost
(2) Carilion Services Inc	A	7,776	Cost
(3) Carilion Healthcare Corporation	A	283,392	Cost
(4) Carilion Medical Center	M	1,804,068	Cost
(5) Carilion Services Inc	M	5,970,146	Cost
(6) CHS Inc	M	158,118	Cost
(7) Carilion Healthcare Corporation	M	1,017,475	Cost
(8) Carilion Services Inc	R	432,492	Cash
(9) SCA Credit Services Inc	M	69,484	Cost

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: We are committed to better patient care, better community health, and lower cost.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	396
6	Total number of volunteers (estimate if necessary) .............	6	73
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	33,454	36,120
9	Program service revenue (Part VIII, line 2g) .........	41,676,626	41,668,619
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	190,472	66,243
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	542,426	561,909
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	42,442,978	42,332,891
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	69,316	114,914
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	16,855,632	18,262,055
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	22,953,380	22,598,888
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	39,878,328	40,975,857
19	Revenue less expenses. Subtract line 18 from line 12.......	2,564,650	1,357,034
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	20,317,639	20,188,054
21	Total liabilities (Part X, line 26).............	24,543,969	26,921,604
22	Net assets or fund balances. Subtract line 21 from line 20.....	-4,226,330	-6,733,550

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 34,966,417 including grants of $ 114,914 ) (Revenue $ 41,814,721 )
	See Schedule O.Carilion Franklin Memorial 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.Located in Rocky Mount, VA, this 37-bed hospital offers a wide range of medical and surgical services, including convenient outpatient and emergency department services.Carilion Franklin Memorial Hospital exists to serve the health care needs of its community, regardless of patient ability to pay. Franklin's acute hospital admitted 1,398 patients and provided 4,703 days of care during the year. Hospital programs include provision of nursing care; extensive outpatient and inpatient surgical and endoscopic services; and diagnostic imaging services including CT, MRI, and mammography. Franklin provides a number of services targeting the specific health needs of its population, including diabetes management; home health and hospice; physical, speech, and occupational therapy programs; and cardiac and respiratory rehab. Franklin also provides an emergency department with 24-hour care, emergency transportation, and a chest pain and stroke program. With 20,728 visits, Franklin's emergency services are a critical component of the health safety net in its service area, acting as a primary health provider for a significant number of uninsured patients, who comprise 21% percent of ED visits. Franklin also supports community screenings and education on chronic disease prevention and management, sponsoring over 312 events touching over 19,087 people.In furtherance of its mission, Franklin provides extensive uncompensated care. Stated at cost, charity and unreimbursed Medicaid costs for the year exceeded $4.1 million.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses34,966,417

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Melina D Perdue........................................................................ EVP	2.00 .......................48.00	X			0	517,275	432,558
(19) Michelle Firebaugh........................................................................ Department Director	50.00 .......................		X		114,317	0	19,427
(20) Shirley Landon-King........................................................................ Occupational Therapist	50.00 .......................		X		125,559	0	17,194
(21) Lori McClure........................................................................ Pharmacy Manager	50.00 .......................		X		150,529	0	29,661
(22) Sharon Scott........................................................................ Pharmacist	50.00 .......................		X		157,839	0	42,218
(23) Robin Wood........................................................................ Department Manager	50.00 .......................		X		111,321	0	39,877
(24) Mikesh Shah MD........................................................................ Former Officer	0.00 .......................50.00			X	0	297,082	31,424
(25) Donald E Lorton........................................................................ Former Officer	0.00 .......................			X	0	130,613	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	876,957	4,920,310	3,336,511

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	22,600
e	Government grants (contributions)		1e	11,158

f	All other contributions, gifts, grants, and similar amounts not included above		1f	2,362

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		36,120

			Business Code
2a	Net Patient Revenues	622110	41,624,387	41,624,387
b	Program-Related Investments	900099	44,232	44,232
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			41,668,619

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			46,002			46,002
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		334,499
b	Less: rental expenses		0
c	Rental income or (loss)		334,499
d	Net rental income or (loss)......			334,499			334,499
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		2,951,068
b	Less: cost or other basis and sales expenses		2,930,827
c	Gain or (loss)		20,241
d	Net gain or (loss).....			20,241			20,241
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	EHR Incentive Income		900099	95,527	95,527
b	Cafeteria & Vending Revenue		722514	81,308			81,308
c	Court Cost Recovery		900099	17,754	17,754
d	All other revenue ....			32,821	32,821
e	Total. Add lines 11a–11d ......			227,410
12	Total revenue. See Instructions......			42,332,891	41,814,721	0	482,050

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	114,914	114,914
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	325,711		325,711
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	109,360	109,360
7	Other salaries and wages	13,669,464	13,667,895	1,569
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,340,189	1,340,189
9	Other employee benefits .......	1,810,749	1,756,702	54,047
10	Payroll taxes ...........	1,006,582	1,006,582
11	Fees for services (non-employees):
a	Management ......	5,362,963		5,362,963
b	Legal .........	603		603
c	Accounting ...........
d	Lobbying ...........	2,988	2,988
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	2,131		2,131
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	4,473,057	4,395,418	77,639
12	Advertising and promotion ....
13	Office expenses .......	532,442	511,972	20,470
14	Information technology ......	111,811	111,811
15	Royalties ..
16	Occupancy ...........	612,415	612,415
17	Travel ............	302,508	279,010	23,498
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	447,568	447,568
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	1,364,603	1,364,603
23	Insurance ...	354,877	222,790	132,087
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Bad Debt	4,323,260	4,323,260
b	Medical Supplies	2,474,280	2,474,280
c	I/C Practice Subsidy	2,154,023	2,154,023
d	Dues & Subscriptions	42,690	39,682	3,008
e	All other expenses	36,669	30,955	5,714
25	Total functional expenses. Add lines 1 through 24e	40,975,857	34,966,417	6,009,440	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			1,349	1	725
2	Savings and temporary cash investments .........			29,745	2	24,553
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			5,906,062	4	5,423,757
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			1,814	8	4,596
9	Prepaid expenses and deferred charges ......			89,825	9	99,848
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	36,495,373
b	Less: accumulated depreciation	10b	25,237,538	11,132,503	10c	11,257,835
11	Investments—publicly traded securities .			2,646,977	11	2,716,755
12	Investments—other securities. See Part IV, line 11 .....			449,364	12	599,985
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			60,000	15	60,000
16	Total assets. Add lines 1 through 15 (must equal line 34)...			20,317,639	16	20,188,054

17	Accounts payable and accrued expenses .....	4,650,231	17	3,924,504
18	Grants payable ...		18
19	Deferred revenue .........	117,586	19	166,070
20	Tax-exempt bond liabilities .........	9,451,495	20	8,932,085
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	10,324,657	25	13,898,945
26	Total liabilities. Add lines 17 through 25..	24,543,969	26	26,921,604

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	-4,262,148	27	-6,767,667
28	Temporarily restricted net assets ...........	35,818	28	34,117
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	-4,226,330	33	-6,733,550
34	Total liabilities and net assets/fund balances ........	20,317,639	34	20,188,054