TY 2017 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)
(1) Robert Berkstresser...................................................................... Director	1.20 .................	X		0	0	0
(2) Gregory M Cavallaro...................................................................... Director	1.20 .................	X		0	0	0
(3) James R Crews MD...................................................................... Director	1.20 .................	X		0	0	0
(4) Sidney S Evans...................................................................... Director	1.20 .................	X		0	0	0
(5) Randy A Gallagher MD...................................................................... Director	1.20 ................. 48.80	X		0	350,760	54,113
(6) Ayesha Kelly MD...................................................................... Director	1.20 ................. 48.80	X		0	324,024	52,517
(7) Tracy E Lyons...................................................................... Director	1.20 .................	X		0	0	0
(8) John Sedovy MD...................................................................... Director	1.20 ................. 48.80	X		0	492,913	52,160
(9) Lisa T Sprinkel...................................................................... Director	1.20 ................. 48.80	X		0	150,093	56,602
(10) Kerri L Thornton...................................................................... Director	1.20 ................. 48.80	X		0	257,557	106,265
(11) James L Williams Jr...................................................................... Director	1.20 .................	X		0	0	0
(12) Cheryl F Wright...................................................................... Director	1.20 .................	X		0	0	0
(13) H Laurent Boetsch Jr DML...................................................................... Director/Secretary/Treasurer	1.20 ................. 2.40	X	X	0	11,200	0
(14) Charles E Carr...................................................................... Director/Hospital VP	50.00 .................	X	X	210,319	0	52,764
(15) H E Derrick Jr...................................................................... Director/Chair	2.50 ................. 0.50	X	X	0	0	0
(16) Juliet D Gibson...................................................................... Director/Vice Chair	1.20 .................	X	X	0	0	0
(17) Joseph E Hess...................................................................... Director/Secretary/Treasurer	1.20 .................	X	X	0	0	0

(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
(18) Farris P Hotchkiss........................................................................ Director/Secretary/Treasurer	1.20 .......................	X	X				0	0	0
(19) Gregory T Madsen........................................................................ Director/Hospital VP	50.00 .......................	X	X				0	195,958	59,710
(20) Richard R Teaff PhD........................................................................ Director/Chair/Vice Chair	2.50 .......................	X	X				0	0	0
(21) Donald B Halliwill........................................................................ Assistant Treasurer	0.50 .......................49.50		X				0	537,739	127,331
(22) Lauren J Schantz........................................................................ Assistant Secretary	1.50 .......................48.50		X				0	72,129	15,236
(23) G Robert Vaughan Jr........................................................................ Assistant Treasurer	0.50 .......................49.50		X				0	280,967	79,903
(24) Nancy Howell Agee........................................................................ CEO, Carilion Clinic	2.00 .......................48.00			X			0	11,987,536	205,141
(25) Steven C Arner........................................................................ CEO, Carilion Medical Center	1.20 .......................48.80			X			0	497,909	119,052
(26) Lisa Craft........................................................................ Team Lead	50.00 .......................				X		126,328	0	27,581
(27) Regina Donald........................................................................ Department Manager	50.00 .......................				X		158,631	0	48,653
(28) Karen Lafon........................................................................ Department Director	50.00 .......................				X		123,161	0	30,805
(29) Phyllis Snyder........................................................................ Team Lead	50.00 .......................				X		116,180	0	36,202
(30) Tracy Higgins........................................................................ Team Lead	50.00 .......................				X		113,390	0	23,584
(31) Paul G Faucher MD........................................................................ Former Officer	0.00 .......................50.00					X	0	162,636	1,677
(32) Sinclair J Harcus MD........................................................................ Former Officer	0.00 .......................50.00					X	0	209,444	89,665
(33) Karen A Lyons MD........................................................................ Former Officer	2.00 .......................48.00					X	10,108	206,315	49,983

(A) Name and business address	(B) Description of services	(C) Compensation
Solstas Lab Partners Group LLC 4380 Federal Dr 100 Greensboro,NC27410	Laboratory Services	1,177,775
GE Medical Systems 5517 Collection Center Dr Chicago,IL60693	Maintenance Contracts	509,960
McNeil Roofing Inc 1921 Salem Avenue Roanoke,VA24016	Construction Services	182,243
GJ Hopkins Inc 714 5th Street NE Roanoke,VA24016	Contractor Services	128,231

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CARILION STONEWALL JACKSON HOSPITAL

Employer identification number

54-0568001

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

CARILION STONEWALL JACKSON HOSPITAL

Employer identification number

54-0568001

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization CARILION STONEWALL JACKSON HOSPITAL

Part I Contributors	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
		$	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization CARILION STONEWALL JACKSON HOSPITAL		Employer identification number 54-0568001

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization CARILION STONEWALL JACKSON HOSPITAL			Employer identification number 54-0568001
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) (2019)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 STONEWALL JACKSON HOSPITAL

Employer identification number

54-0568001

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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|No

(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

2,680

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

2,680

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) 2019

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CARILION STONEWALL JACKSON HOSPITAL

Employer identification number

54-0568001

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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

Term 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 .....	430,816		430,816
b	Buildings ....	28,499,068	19,970,983	8,528,085
c	Leasehold improvements
d	Equipment ....	20,872,618	15,159,683	5,712,935
e	Other .....	1,434,952	1,127,024	307,928
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				14,979,764

Schedule D (Form 990) 2019

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) Investment in Co-Op	12,869	C
(B) Investment - Stock	500	C
(C) Comingled Funds	4,804,307	F
(D) Hedge Funds	10,455,596	F
(E) Real Estate Ltd P'ships	2,077,404	F
(F) Private Equity Securities	4,790,839	F
(G) Fixed Income Alternative Investments	1,698,518	F
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	23,840,033

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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)Due from Affiliate				3,002,000
(2)Assets Held for Foundation				276,637
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				3,278,637

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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	133,411
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) 2019

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) 2019

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CARILION STONEWALL JACKSON HOSPITAL

Employer identification number

54-0568001

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) . . .			2,025,577		2,025,577	6.030 %
b	Medicaid (from Worksheet 3, column a) . . . . .			1,322,148	1,043,893	278,255	0.830 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			3,347,725	1,043,893	2,303,832	6.860 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	60	2,729	34,878		34,878	0.100 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	31	6	20,926		20,926	0.060 %
j	Total. Other Benefits . .	91	2,735	55,804		55,804	0.160 %
k	Total. Add lines 7d and 7j .	91	2,735	3,403,529	1,043,893	2,359,636	7.020 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	1	75	75	0 %
2	Economic development	3	14,249	14,249	0.040 %
3	Community support	16	1,579	1,579	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	26	3,681	3,681	0.010 %
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	46	19,584	19,584	0.050 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

4,192,079

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).....

13,313,625

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

13,722,471

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

-408,846

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) 2019

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?1Name, 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 Stonewall Jackson Hospital 1 Health Circle Lexington,VA24450 See Schedule O. H 1906	X	X	X	X

Schedule H (Form 990) 2019

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 Stonewall Jackson 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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 17

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): See Part V, Section C

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 17

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

Yes

If "Yes" (list url): See Part V, Section C

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Carilion Stonewall Jackson 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)

Was widely publicized 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):

Part V, Section C

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

Part V, Section C

A plain language summary of the FAP was widely available on a website (list url):
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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Carilion Stonewall Jackson Hospital
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	Carilion Stonewall Jackson Hospital
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
Part V, Section B	Line 3eThe Community Health Needs Assessment report prioritizes the community's significant health needs that were identified by the assessment, and explains how the health needs were prioritized.
Part V, Section B	Line 5Carilion Clinic's CHNAs are community-driven projects and success is highly dependent on involving citizens, health and human service agencies, businesses, and community leaders. Community stakeholder collaborations known as "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 populations that are medically underserved, low-income, minority, and suffer from chronic diseases. The following organizations served on the CHAT for the 2018 (tax year 2017) Rockbridge Area Community Health Needs Assessment (RACHNA): Lexington/Rockbridge County Chamber of Commerce; City of Buena Vista; HCAT/Live Healthy Rockbridge; RACI; Rockbridge Area Community Services; Rockbridge Area Health Center; Rockbridge Area Hospice; Rockbridge Area Transportation System; Valley Program for Aging Services, Maury River Senior Center; Virginia Cooperative Extension; Rockbridge Area YMCA; Central Shenandoah Health District of the Virginia Department of Health.In addition to the CHAT, the RACHNA conducted focus groups among stakeholders and target populations, and administered a community health survey.Stakeholders: Throughout the CHNA process, community stakeholders, leaders, and providers were encouraged to complete the Stakeholder Survey. This survey provided an additional perspective to the health needs and barriers facing our community. Stakeholder focus groups were held and Stakeholder Surveys distributed, to ensure all responses were captured. The survey was available online and in print, and was distributed at meetings and focus groups. Stakeholder focus groups were conducted with the Community Health Assessment Team and with groups of stakeholders that attended a Community Visioning event.Target populations: Target population focus groups were conducted to capture the needs and barriers to health for the uninsured, underinsured, low-income, minority, senior, and chronically ill populations. Focus group locations were chosen based on their proximity to target populations, and where existing groups meet. Six target population focus groups were held and were asked questions related to health needs and barriers to health, as well as access to primary, oral, and mental health care. Target population focus groups were conducted with Americare Plus; Rockbridge Area Hospice clinicians and volunteers; residents at a local retirement community, Kendal; two groups with different participants at the Maury River Senior Center; and a Women Small Business Owners Group.Community Survey: A 38-question survey instrument was developed including questions about: socioeconomic factors; access to medical, dental, and mental health care; health behaviors; physical environment; health outcomes; and demographics. The survey instrument included commonly used questions and metrics from previously validated community surveys: Community Themes and Strengths Assessments, National Association of County and City Health Officials (NACCHO), Mobilizing for Action through Planning and Partnerships (MAPP) Community Healthy Living Index, YMCA Behavioral Risk Factor Surveillance System, Centers for Disease Control (CDC) National Health Interview Survey, (CDC) Youth Risk Behavior Surveillance System, (CDC) Martin County Community Health Assessment, Martin County, North Carolina Previous Community Health Surveys Both English and Spanish versions were available. The CHAT identified target populations, collection sites, and methods of survey distribution. The population of interest was Rockbridge Area residents 18 years of age and older. The Rockbridge Area included the CHNA service area: Buena Vista City, Lexington City and Rockbridge County. Special efforts were made to ensure inclusion of these subpopulations: Underserved/vulnerable populations disproportionately impacted by the social determinants of health including:o Incomeo Race/ethnicityo Educationo Insurance statusThe survey was also made available to all residents living in the Rockbridge Area and oversampling of the target populations occurred through targeted outreach efforts. In total, 568 surveys were collected.
Part V, Section B	Line 6bLexington/Rockbridge County Chamber of Commerce; City of Buena Vista; HCAT/Live Healthy Rockbridge; RACI; Rockbridge Area Community Services; Rockbridge Area Health Center; Rockbridge Area Hospice; Rockbridge Area Transportation System; Valley Program for Aging Services, Maury River Senior Center; Virginia Cooperative Extension; Rockbridge Area YMCA; Central Shenandoah Health District of the Virginia Department of Health.
Part V, Section B	Line 7ahttps://www.carilionclinic.org/locations/carilion-stonewall-jackson-hospitalLine 7b:https://www.carilionclinic.org/community-health-assessmentsLine 7d: The 2018 Rockbridge Area CHNA was also shared to be posted to Community Health Assessment Team partner websites and social media.
Section V, Part B	Line 10ahttps://www.carilionclinic.org/community-health-assessments.
Part V, Section B, Line 11:	Carilion Clinic is a not-for-profit, integrated healthcare system located in Virginia's Blue Ridge Mountains with its flagship hospital in the heart of the City of Roanoke, the largest urban hub in western Virginia. There, through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers and other complimentary services, the system provides quality care close to home for nearly one million Virginians. Carilion's roots go back to 1899, when a group of dedicated citizens came together and built a hospital to meet the healthcare needs of the community. Today, Carilion is a key anchor institution focusing on more than just healthcare; Carilion is dedicated to its mission of improving the health of the communities we serve. With an enduring commitment to the health of our region, Carilion advances care through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. Through ongoing investment in discovering and responding to the health needs of the community comes the understanding that the involvement of additional stakeholders is essential to effectively address community health issues and create change. The purpose of this implementation strategy is to describe what Carilion Stonewall Jackson Hospital (CSJH) plans to do to address the community health needs identified in the 2018 Rockbridge Area Community Health Needs Assessment (RACHNA).After all primary and secondary data collection was completed, the CHAT reviewed all data then identified and prioritized the ten most pertinent community needs using the Robert Wood Johnson Foundation framework for what influences health. The data were combined and overall priorities chosen based on the number of times a category was selected in the top 10, with the average ranking serving as a tie-breaker. Once the priorities were clearly identified, the CHAT rated the feasibility and potential impact of solutions for each health issue.The 2018 RACHNA prioritized 10 health-related issues in the community, identified by the Community Health Assessment Team after the data was collected.1. Alcohol and drug use2. Poverty / low average household income3. Access to mental / behavioral health services4. Poor diet5. High prevalence of chronic disease6. Culture: healthy behaviors not a priority7. Lack of health literacy / lack of knowledge of healthy behaviors8. Access to primary care9. Access to specialty care10. Tobacco use Significant Health Needs to be AddressedCSJH Implementation PlanAccording to the Robert Wood Johnson Foundation's (RWJF) County Health Rankings , where an individual lives, works and plays is a strong predictor of their health outcomes. Currently in the United States, a person's zip code can help predict their life expectancy due to its direct link to the social determinants of health such as poverty, race/ethnicity, education and employment status in these areas . These factors are so important to our overall health, that they were added to the 10-year national Healthy People 2020 objectives with a goal to create social and physical environments that promote good health for all." Carilion responds to community health needs in innovative ways: making sure our regions have access to state-of-the-art health care close to home; providing community grants and sponsorships to extend our mission and support other organizations addressing health needs; creating and implementing community-wide strategies to reduce barriers, coordinate resources and enhance community strengths; and providing community-based health and wellness programs. Carilion Clinic's response strategies are organized by the RWJF framework for what influences health: health behaviors; social and economic factors; clinical care access and quality; and physical environment. CommitmentCommitment to community service is evident at all levels of the organization. Carilion's commitment to community health is evidenced by its commitment to a population health infrastructure including an entire Community Health and Outreach (CHO) department dedicated to assessing and addressing community need. The department is responsible for leading and facilitating the Community Health Improvement Plan (CHIP), CHNAs, the system's community grant process, community health education, community benefit collection, and neighborhood health initiatives. CHO has staff at the system level and at each community hospital and works with each hospital's Board of Directors and Carilion Clinic's Board of Governors to create health improvement strategies to address community health need. Each Carilion Clinic hospital has a Community Benefit Team which oversees the local hospital's plan to address community need in partnership with the local CHAT. There is also a Community Benefit Council at the system level providing oversight for Carilion Clinic as a whole. This council is responsible for overseeing and strategically guiding Carilion's community health improvement work and for community benefit strategy, collection and submission.Community Partnerships Carilion Clinic believes in the power of collaboration and understands community health issues must be addressed in cooperation with the community. To ensure lasting community impact from the health assessment and community health improvement process, Carilion participates in and provides financial and in-kind support to community health coalitions that address health needs. Carilion partners with the Rockbridge 2020 in the Rockbridge Area. In addition, Carilion partners with multiple community and business organizations on initiatives to improve health and wellness and to impact the social determinants of health for all who live in the Rockbridge Area.Rockbridge 2020Forming a true community collaborative with lasting impact is no small feat. Rockbridge 2020 was founded in 1995 by Stonewall Jackson Hospital. It brought together providers of health care and related services in the Rockbridge Area for the purpose of collaboration and planning for healthcare over the next quarter of a century. Informal monthly meetings allowed participants to network and educate each other about services available through each of the agencies represented. Through the early years a few surveys were conducted to identify needs in the community.The work of Rockbridge 2020 continued in 2006 when Stonewall Jackson Hospital became part of the Carilion Health System (now Carilion Clinic). In 2011, Carilion Stonewall Jackson Hospital partnered with the Rockbridge Area Free Clinic (now the Rockbridge Area Health Center) and the Central Shenandoah Health District to conduct a Community Health Assessment. The 12-month project defined and assessed the health of our community, and enabled members of Rockbridge 2020 to develop a 3-year strategic plan to address the most pressing needs (Access to Health Services; Nutrition, Physical Activity and Obesity; Oral Health; and Mental Health). The completed assessment and community-wide strategic plan were made available to the general public in 2012. One of the key outcomes from this assessment was the transition of the Rockbridge Area Free Clinic to the Rockbridge Area Health Center. Three years later, Rockbridge 2020 undertook a second assessment. The 2015 RACHNA identified the top priorities as a need for Urgent Care, General Wellness (including nutrition, physical activity and chronic disease management), Mental Health, and Coordination of Care. In the spring of 2016, Carilion Clinic opened Velocity Care in Lexington as a direct result of the assessment. Since that time, Rockbridge 2020 has been working to implement the 2015 strategic plan. Rockbridge 2020 continues to meet monthly to ensure we are implementing the community-wide strategic plan in the most efficient and effective manner. While each of the member organizations of Rockbridge 2020 has its own mission, as a coalition, its mission is working together for community well-being.
Part V, Section B, Line 11: Continued:	Community Grants Carilion Clinic is committed to improving the health of the communities we serve by addressing key health priorities identified through our triennial Community Health Needs Assessments. Carilion fulfills this commitment in many ways, one of which is through targeted grants for community health improvement programs and those affecting the social determinants of health. Carilion provides a multitude of community grants and community health sponsorships to help local charitable organizations fulfill their missions as they relate to the health and well-being of our communities. Community grant dollars are allocated across the entire Carilion Clinic service area based on requests received. During this three-year Implementation Strategy cycle, Carilion Clinic intends to target additional grant support by initiating a Request for Proposal (RFP) process, looking for organizations that can impact specific community health priorities in identified geographic areas.The Stonewall Jackson Hospital Community Health Foundation provides additional monies for grants to local organizations that aim to improve the health of our community. Members of the Board of Directors for the Foundation sit on a committee of the CSJH Board of Directors to determine which grants to award. For the next three years, all grants will go toward programs and initiatives aimed at addressing needs identified in this Community Health Needs Assessment.Significant Health Priorities to be Addressed:Health BehaviorsNeeds: alcohol and drug use; poor diet; high prevalence of chronic disease; culture: healthy behaviors not a priority; lack of knowledge of healthy behaviors; tobacco use.Carilion Clinic addressed health behavior-related priorities from the 2018 RACHNA. Improving poor diets and the general health culture served as a start to making healthy behaviors more of a priority. Carilion provides a variety of free health education classes, screenings and flu immunizations in community settings.Community health education is provided by the Community Health and Outreach department, as well as on occasion by other departments. Health and wellness education topics include: general wellness; healthy eating and activity; exercise for balance and confidence building for seniors; and other topics as requested. The local health educator also leads guided public walks and hikes to increase access to exercise opportunities. Resources committed to these programs include staff time and often food and giveaway items that encourage healthy behaviors. In addition to traditional health education, Carilion participates in health behavior related programs including: Veggie Brigade - a program put on in partnerships with Live Healthy Rockbridge Kids to encourage local elementary school children to try new fruits and vegetables. Eat Healthy Rockbridge - a collaborative program encouraging healthy eating through prescription vouchers to access healthy food paired with education and coaching. The pilot program was completed with patients in Glasgow this summer, and plans are in the works to conduct a 2nd program in Lexington this winter. Stop the Bleed - a program being coordinated with area schools, teaching lay people how to intervene in the case of an injury to quickly stop blood loss.In addition to community events, Carilion works to encourage healthy behaviors by offering classes to its employees and through partnerships with other employers in the Rockbridge Area. As the largest employer in the region, efforts to engage employees and their families in their own health impact community health overall. Carilion has rolled out the Virgin Pulse program to employees. This program enables employees to connect personal activity trackers and include others on the platform to encourage daily healthy behaviors such as exercise, climbing stairs, and planning healthy diets. Carilion remains committed to the Healthier Hospital Initiative pledge and continues to work to improve the amount of healthy, local, sustainable foods purchased and served through its cafeterias. Tobacco UseCarilion makes available a "Preparing to Quit" speakers bureau that can be requested by community groups or companies. Carilion employees and their dependents will now be eligible for a new, pharmacist-led smoking cessation program. This program includes group sessions, individual follow-up, resource referrals and free access to nicotine replacement therapy products. Another option includes free participation in the Quit for Life program. Employees are offered a financial incentive when they are tobacco free. Alcohol and drug useCarilion's Opioid Task Force brings together expertise from throughout the Carilion system to better understand and address the opioid epidemic in Southwest Virginia. The Opioid Task Force is working to address this epidemic internally and in the community. Efforts arising from this task force include: developing system-wide guidelines and a system dashboard for opioid prescriptions; developing treatment pathways for opioid addiction in specific high-risk groups; developing best practices for risk assessment, treatment and standard orders in Carilion's electronic medical record system, EPIC; developing an inventory of community resources related to prevention, treatment and recovery services for opioid patients and community members; and providing locations for free, safe, prescription drug returns or deactivation bags.CSJH is also a participant in the Rockbridge Area Prevention Coalition and provides space for weekly AA meetings. Clinical CareNeeds: access to mental / behavioral health services; access to primary care; access to specialty care.Issues with access to care are a focus for CSJH when addressing community health needs. In addition to providing financial support to qualifying patients who cannot afford care, Carilion is working to improve affordable access to care and resources.Carilion is committed to helping improve access to affordable medical care in our communities. With expansion of Medicaid in the Commonwealth of Virginia, Carilion is working diligently to reach out and encourage enrollment in Medicaid for newly eligible beneficiaries. Additionally, Carilion will work to find medical homes for those newly enrolled. Carilion also works closely with its FQHC partners to understand their Medicaid enrollment efforts.To improve access to care, impacting the need for access to primary care and specialty care, a new urgent care will be opening in Raphine, VA at White's Travel Center. In the 2015 Rockbridge Area Community Health Needs Assessment, access to urgent care services was the top need. Carilion responded by opening one urgent care in Lexington and now a second will open in Rockbridge County to serve residents and travelers. Carilion is actively recruiting for a Family Practice physician and continues to bring specialty service to Lexington on a rotating basis. CSJH will continue to work with the Carilion Clinic Planning department to explore the specific specialty care needs in the region. Mental health and substance use servicesIn an ongoing effort to increase access to psychiatry and mental health services, the technological infrastructure to provide telepsych services has been put in place in the CSJH Emergency Department. Carilion Family Medicine Lexington is also slated to offer this service in the future. Service provision is currently limited by provider availability. Carilion is committed to serving the needs of its communities and continues to work toward providing telepsych services in the Rockbridge Area. CSJH also continues to work with partners in the region to align patients and community members with available services, such as those available through the Rockbridge Area Health Center. CSJH also partners with Rockbridge Area Community Services, offering space to host free Mental Health First Aid classes. Additionally, CSJH participated on the planning committee for the Rockbridge Area Prevention Coalition's Prevention Forum geared toward parents, guardians and teachers and focused on risk factors for teens who might be inclined to use alcohol, tobacco and other drugs or self-harm.Social and Economic FactorsNeeds: poverty.In its commitment to reducing inequity of care, Carilion provides financial support for people who cannot afford insurance or health care. Carilion also replenishes medication carried aboard emergency medical services vehicles. Support is also provided to a variety of not-for-profit organizations, helping to reduce the impacts of poverty on health through investments in social determinants such as housing, transportation, employment, education, access to healthy foods and many other important causes. Each year, Carilion Clinic coordinates a system-wide United Way campaign through which employees can provide additional support to these causes.
Part V, Section B, Line 11: Continued:	Physical EnvironmentWhile physical environment did not necessarily arise as a top priority in the 2018 RACHNA, Carilion still recognizes the impact the environment has on the health of our communities. Therefore, efforts continue to improve the efficiency of Carilion's hospitals and other structures, the utilization of recycling and recyclable or bio-degradable materials where possible, the reduction of waste and the utilization of local, sustainable foods.Implementation and MeasurementCarilion has invested in multiple systems to help manage data and track outcomes of our community work. Clear Impact software will be utilized to develop community, system-wide, hospital-specific and project-specific scorecards with appropriate outcome measures. Community health education programs and screenings will contain program level outcomes assigned based on the topic. These outcomes will be tracked with pre- and post-tests as well as through screening results. Community programs supported by Carilion grants will be responsible for regularly reporting program outcomes. Scorecards will be developed with key secondary data points at the zip code and county level, with yearly updates to track impact of community health initiatives. Carilion will track and measure impact on certain aligned indicators contributing to the Robert Wood Johnson Foundation County Health Factors Ranking and County Health Outcomes Ranking. Our goal is to improve County Health Rankings for the entire Rockbridge Area, but we understand that by the nature of County Health Rankings, improvements are relative to improvements in other communities within the Commonwealth of Virginia. Priority Areas Not being Addressed and the ReasonsA community approach to determine and address priority needs as described earlier in this document was used to determine which needs cannot be immediately addressed. The needs not identified as "priority" are those that will not be actively addressed in this time period. It is CSJH's intent to address all identified priority health issues through the aforementioned initiatives, programs and/or grants if possible. This fall, CSJH will work with Rockbridge 2020 to develop a strategic plan for addressing key issues in the community and the focus of program provision will be to those living in poverty and/or in medically underserved areas.Please visit https://carilionclinic.org/community-health-assessments to review the 2018 Rockbridge Area Community Health Needs Assessment. Learn more about Carilion Clinic Community Health and Outreach at https://www.carilionclinic.org/community-health-outreach.
Section V, Part B	Line 16Line 16ahttps://www.carilionclinic.org/billing/financial-assistanceLine 16bhttps://www.carilionclinic.org/billing/financial-assistanceLine 16chttps://www.carilionclinic.org/billing/financial-assistance

Schedule H (Form 990) 2019

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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?2
Name and address		Type of Facility (describe)
1	1 - Lexington Medical Building West 108 Houston Street Lexington,VA24450	Physician Offices
2	2 - Carilion Clinic Family Medicine 146 South Main Street Lexington,VA24450	Physician Offices
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

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:	Patients' eligibility is determined by family size, family income, real property equity and liquid assets. Families with family income equal or below 200% of the FPG and assets equal or below $15,000 receive 100% adjustment under FAP. Families with family income greater than 200% of the FPG but less than or equal to 400% of the FPG or assets above $15,000 and less than or equal to $100,000 receive a partial adjustment under FAP. The partial adjustment matches the AGB percentage for each service area.
Part I, Line 6a:	Information on community benefit is reported annually through a consolidated report prepared by Carilion Clinic (EIN 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: https://www.carilionclinic.org/community-health-assessments.
Part I, Line 7:	7a-b:Ratio of cost-to-charges was used to calulate the expense.Line 7, Column F:Bad debt expense of $4,192,079 included in Part IX, Statement of Expenses on line 25 was excluded from the calculation of Part I line 7 column (f) Percent of total expense.7eCommunity Health Improvement: At Cost.Carilion's commitment to community health is evidenced by its population health infrastructure including its Community Health and Outreach (CHO) department dedicated to assessing and addressing community needs. The department is responsible for leading and facilitating the Community Health Improvement Plan, Community Health Needs Assessments, the system's community grants process, community health education, community benefit collection, and neighborhood health initiatives. CHO staff works with the hospital's Board of Directors and Carilion Clinic's Board of Governors to create health improvement strategies to address community health need. The hospital has a Community Benefit Team overseeing the hospital's plan to address community need in partnership with the local community health assessment team. There is also a Community Benefit Council providing oversight for Carilion's community health improvement work and for community benefit strategy, collection and submission.Carilion Stonewall Jackson Hospital (CSJH) provides education to the public about health risks and steps that can be taken to improve health. Events include regularly scheduled youth nutrition education events in schools such as Veggie Brigades and Healthy Youth Day as well as presentations on topics like sun safety. CSJH's community health education department also provides screenings for blood pressure. Community health improvement services include assistance with enrollment in public medical programs such as Medicaid. Community benefit operations include expenses associated with tracking community health improvement activities, the cost associated with conducting a Community Health Needs Assessment and resources spent facilitating the provision of financial support to partners in response to identified community health needs. 7f Health professions education n/a7g Subsidized Health Services n/a7h Research n/a 7i Cash and In-Kind Contributions: At cost.Carilion has long been committed to improving the health of the communities we serve. We know significant change doesn't happen alone, but takes a community of partners working together towards common goals. Carilion's dedication to this mission is evidenced by the support provided annually to various nonprofit partners, furthering its efforts to positively impact health. Financial and in-kind contributions are made each year to dozens of organizations directly impacting the issues identified in our triennial Community Health Needs Assessment and a variety of social determinants that impact people's health. Support provided helps with access to nutrient dense foods, promotion of exercise and healthy activities, chronic disease management, access to services and a multitude of other community health improvement goals.
Part II, Community Building Activities:	1 Physical improvements and housing Support was provided to the Friends of the Chessie Trail to maintain and promote the free outdoor exercise opportunity for all.2Economic development As the largest employer in Southwest Virginia, Carilion participates in programming and supports local Chambers of Commerce, improving economic development efforts through pro-business advocacy. Carilion takes an active role in local economic development endeavors by conversing with local businesses about the region's current business climate and prospects. 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 nonprofit organizations that address barriers to good health arising from these social determinants. Through support of local partners, Carilion can help provide better education and opportunities for children and families as well as improved housing, better nutrition and additional supportive resources for its neighbors in need, removing a range of obstacles to good health. Carilion Stonewall Jackson Hospital is deeply involved with a variety of health and social determinant-related initiatives and supports local organizations through coordination of activities and participation as volunteers and on boards in addition to providing financial support. For example, Carilion leaders dedicate their time to impact the need for access to exercise opportunities and health programming by providing support for the local YMCA. Financial support was also given to the YMCA, the Fellowship of Christian Athletes and the Lexington Police Department Foundation providing for the health and safety of the community.4Environmental improvements n/a5Leadership development and training for community members n/a6Coalition building Carilion believes in the power of collaboration and understands that community health issues must be addressed in concert with the community. To ensure lasting community impact from the health assessment and community health improvement process, Carilion participates in community health coalitions that address health and social determinant needs in the Rockbridge Area. In addition, Carilion partners with multiple community and business organizations around initiatives to improve health and wellness and to impact the social determinants of health for all who live in the Rockbridge Area. This includes Carilion's representation and participation in the Local Emergency Preparedness Committee, Live Healthy Rockbridge Kids, and the Rockbridge Area Prevention Coalition. 7 Community health improvement advocacy n/a8Workforce development - n/a
Part III, Line 2:	Carilion Stonewall Jackson Hospital estimates bad debt expense by reserving a percentage of all self-pay patient 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 Stonewall Jackson Hospital estimates the allowance for doubtful accounts by reserving a percentage of all self-pay patient accounts receivable by aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. Carilion Stonewall Jackson 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 believes our Medicare shortfall is a cost we incur as a benefit to the community. IRS Rev. Rul. 69-545, provides that one of the factors demonstrating community benefit is operating an emergency room open to all persons regardless of ability to pay and providing hospital care for all patients able to pay, including those who pay their bills through public programs such as Medicare. In order to operate for the benefit of the broad community that we serve we must include our significant Medicare population, even if we are required to subsidize care to our Medicare patients due to being reimbursed at less than cost by Medicare's nonnegotiable rates.
Part III, Line 9b:	When accounts receivable efforts are exhausted, the account may be placed with a collection agency and ECAs 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. Reasonable efforts will be made to identify appropriate forwarding addresses.When a 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 the patient either does not qualify for Financial Assistance or fails to submit an application as requested, within 240 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 DRD.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:	2. Needs AssessmentCarilion Clinic's community health improvement process was adapted from Associates in Process Improvement's Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle developed by Walter Shewhart. It consists 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.Carilion Clinic fosters community development in its CHNA and community health improvement processes 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. Carilion Clinic and Rockbridge 2020 partnered to conduct the 2018 Rockbridge Area Community Health Needs Assessment. 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.
Part VI, Line 3:	3. Patient Education of Eligibility for Assistance.Information on Financial Assistance is provided to the patient at hospital admission and ambulatory areas in the form of signage, a plain language summary which includes contact information, financial assistance application and documentation in the inpatient handbook. Patient Access staff, Hospital social workers and customer service representatives verbally inform patients on availability of assistance. Each patient statement and patient financial responsibility letter includes information on the Financial Assistance policy including who to contact for additional information and location of in-person assisters. The Application, the Policy, and the plain language summary are available free of charge to the patient. They are available by mail and on the web site if the patient did not receive written information at the time of service. Financial Assistance policy and application are also distributed to community partners through electronic mailing groups.Carilion Clinic employs an Eligibility staff that counsel patients on federal and state programs. The staff completes applications for Medicaid, Social Security, Social Security Disability and Medicare. The staff provides support services ensuring the applications are processed correctly based on federal and state policy. In addition, the Eligibility staff is trained as Certified Application Counselors and will assist patients in enrollment in the insurance exchange Marketplace. Eligibility staff will also complete Carilion's financial assistance application and counsel patient on the requirements for financial assistance.
Part VI, Line 4:	4. Community Information. The Rockbridge Area, home to Carilion Stonewall Jackson Hospital, is composed of the independent cities of Lexington and Buena Vista, and Rockbridge County. Located at the southern end of the Shenandoah Valley in west central Virginia, Rockbridge County is classified as a rural county. It is bounded on the west by the Alleghany Mountains and on the east by the Blue Ridge Mountains. The county's rolling hills and 58,000 acres of national forest comprise much of its 616 square miles. There are 37 persons per square mile, which is significantly lower than the state average of 203 persons per square mile . Rockbridge County is surrounded by the counties of Bath, Augusta, Amherst, Bedford, and Alleghany. Highways 81 and 64 provide ready access to neighboring markets and services. The independent cities of Buena Vista and Lexington lie within the county limits. Lexington, the county seat, is situated in the center of the county. It is the heart of much of the county's educational, retail, commercial and governmental activities. Buena Vista is located six miles east of Lexington and is considered the industrial and manufacturing core of the county. Both the cities of Buena Vista and Lexington are classified as mixed urban areas. With land areas of 7 square miles and 2.5 square miles respectively, there are 992 persons per square mile in Buena Vista and 2,820 persons per square mile in Lexington. The incorporated towns of Glasgow, Goshen, Brownsburg, Natural Bridge Station, Raphine and Fairfield are located within the county limits.Key safety net providers in the region in addition to Carilion Clinic include: the Central Shenandoah Health District; Rockridge Area Health Center, a federally qualified health center; and many other service organizations. Despite the presence of these entities, there remain thousands of low-income, uninsured, and underinsured residents who do not have access to affordable health care services.The 2018 RACHNA revealed distinct communities with significant differences in size and population and significant disparities both in health and in social determinants. The 2012-2016 American Community Survey (ACS) found the total population of the cities of Lexington and Buena Vista to be 7,036 and 6,610 respectively and the population of Rockbridge County to be 22,450. For all communities, the ACS predicts positive future population change, but to varying degrees. Median age in the Rockbridge Area localities ranges from 21.5 in the City of Lexington to 48.5 in Rockbridge County. The ACS finds that for most of the Rockbridge Area, a larger percentage of the population is White than in the State of Virginia as a whole. In Rockbridge County, 93.4% of the population is White, 2.6% of the population is Black and 2.4% identify as more than one race. All other races make up less than 1% of the population. Hispanic or Latino residents make up 1.6% of the population.Lexington and Buena Vista are slightly more racially and ethnically diverse than Rockbridge County, with a populations that are 84.5% and 89.8% White, 9.1% and 1.7% Black, and 4.0% and 7.3% Asian, with 2.3% and 1.2% respectively representing more than one race and the remainder representing small minorities of American Indian/Alaskan Native, Native Hawaiian/Pacific Islander or some other race at less than 1%. Of the population, 4.2% of Lexington and 1.3% of Buena Vista identify as Hispanic or Latino. The region is divided into urban and rural areas, which vary greatly in the economic means of the residents who live there. The low income population in the Rockbridge Area has a federal designation as a MUA. Many communities are designated as Primary and Dental Health Professional Shortage Areas (HPSA) and the entire Rockbridge Service Area is designated as a Mental Health HPSA.
Part VI, Line 5:	Community Health Promotion. Carilion Clinic is a not-for-profit, integrated health care system located among the Blue Ridge Mountains with its flagship hospital in the heart of the City of Roanoke, which serves as the largest urban hub in western Virginia. Quality care is provided for nearly one million individuals through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers and other complimentary services. Carilion's roots go back more than a century, when a group of dedicated citizens came together and built a hospital to meet the health care needs of the community. Today, Carilion is a key anchor institution focusing on more than just health care; Carilion is dedicated to its mission of improving the health of the communities it serves. With an enduring commitment to the health of our region, care is advanced through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. Through ongoing investment in discovering and responding to the health needs of its community comes the understanding that additional stakeholders must be involved to effectively address community health issues and create change. Carilion Stonewall Jackson Hospital (CSJH) is a non-profit, critical access hospital dedicated to quality care and patient comfort. The hospital was founded in 1907 by the United Daughters of the Confederacy, and was originally located in the former home of confederate general Thomas "Stonewall" Jackson. Commitment and support through the last century allowed the hospital to grow, expand, and in 1954 move across town to its present site. A new structure and enhanced patient care tower was completed on the same site in 2002. Carilion Health System (now Carilion Clinic) purchased 80% of Stonewall Jackson Hospital in 2006. The other 20% continues to be owned by the community in the trust of the SJH Community Health Foundation. The Foundation provides monies for grants to local organizations that aim to improve the health of our community. Members of the Board of Directors for the Foundation sit on a committee of the CSJH Board of Directors to determine which grants to award. For the next three years, all grants will go toward programs and initiatives aimed at addressing needs identified in this Community Health Needs Assessment.
Part VI, Line 6:	Affiliated health care system.Carilion Stonewall Jackson Hospital is 80% owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. It is mission-driven, focusing everyday on improving the health of the communities they serve. Through a comprehensive network of hospitals, primary and specialty physician practices, and complementary services, Carilion provides exceptional care for nearly one million Virginians. With an enduring commitment to the health of the region, Carilion also seeks to advance care through medical education and research, help its community stay healthy and inspire the region to grow stronger. In the mid-2000s, Carilion made the strategic decision to transform from a collection of hospitals to a physician-led, integrated health care system. It was a courageous move. In every moment since, Carilion has worked to evolve further-developing a multi-specialty physician group, transforming our primary care practices into patient-centered medical homes, implementing electronic health records system-wide, creating a robust partnership with Virginia Tech, and opening a medical school and research institute. Each decision, each adaptation, has fundamentally changed the way Carilion collaborates and cares. 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. 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 inter-professionalism training.

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CARILION STONEWALL JACKSON HOSPITAL

Employer identification number
54-0568001

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	(h) Purpose of grant or assistance
(1) YMCA of Virginia's Blue Ridge 790 N Lee Highway Lexington,VA24450	54-0515736	501(c)(3)	20,000	"Kids in the Kitchen" Project
(2) Washington & Lee University 204 W Washington St Lexington,VA24450	54-0505977	501(c)(3)	10,200	Fresh foods prescription program
(3) Lexington Farmer's Market 86 Moores Creek Rd Lexington,VA24450	54-6001392	Govt.	7,450	SNAP match for fresh foods
(4) Friends of Swimming Inc 194 Wallace Street Lexington,VA24450	20-2034004	501(c)(3)	5,000	Swim program assistance

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) 2019

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash 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 grantees. Program evaluation includes alignment with Community Health Assessment priorities, program impact, organizational effectiveness 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) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CARILION STONEWALL JACKSON HOSPITAL

Employer identification number

54-0568001

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 on 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 on Line 1a? ..

Yes

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 nonfixed
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) 2019

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)
1Randy A Gallagher MD Director	(i) (ii)	0 ------------- 330,472	0 ------------- 14,251	0 ------------- 6,037	0 ------------- 47,246	0 ------------- 6,867	0 ------------- 404,873	0 ------------- 0
2Ayesha Kelly MD Director	(i) (ii)	0 ------------- 304,220	0 ------------- 17,842	0 ------------- 1,962	0 ------------- 35,994	0 ------------- 16,523	0 ------------- 376,541	0 ------------- 0
3John Sedovy MD Director	(i) (ii)	0 ------------- 460,812	0 ------------- 28,548	0 ------------- 3,553	0 ------------- 35,246	0 ------------- 16,914	0 ------------- 545,073	0 ------------- 0
4Lisa T Sprinkel Director	(i) (ii)	0 ------------- 141,254	0 ------------- 600	0 ------------- 8,239	0 ------------- 47,122	0 ------------- 9,480	0 ------------- 206,695	0 ------------- 0
5Kerri L Thornton Director	(i) (ii)	0 ------------- 234,887	0 ------------- 19,793	0 ------------- 2,877	0 ------------- 99,801	0 ------------- 6,464	0 ------------- 363,822	0 ------------- 0
6Charles E Carr Director/Hospital VP	(i) (ii)	191,476 ------------- 0	16,196 ------------- 0	2,647 ------------- 0	46,119 ------------- 0	6,645 ------------- 0	263,083 ------------- 0	0 ------------- 0
7Gregory T Madsen Director/Hospital VP	(i) (ii)	0 ------------- 179,372	0 ------------- 15,802	0 ------------- 784	0 ------------- 43,123	0 ------------- 16,587	0 ------------- 255,668	0 ------------- 0
8Donald B Halliwill Assistant Treasurer	(i) (ii)	0 ------------- 483,869	0 ------------- 49,599	0 ------------- 4,271	0 ------------- 110,548	0 ------------- 16,783	0 ------------- 665,070	0 ------------- 0
9G Robert Vaughan Jr Assistant Treasurer	(i) (ii)	0 ------------- 254,802	0 ------------- 22,207	0 ------------- 3,958	0 ------------- 62,034	0 ------------- 17,869	0 ------------- 360,870	0 ------------- 0
10Nancy Howell Agee CEO, Carilion Clinic	(i) (ii)	0 ------------- 1,218,641	0 ------------- 208,987	0 ------------- 10,559,908	0 ------------- 191,766	0 ------------- 13,375	0 ------------- 12,192,677	0 ------------- 10,545,910
11Steven C Arner CEO, Carilion Medical Center	(i) (ii)	0 ------------- 447,471	0 ------------- 45,361	0 ------------- 5,077	0 ------------- 100,969	0 ------------- 18,083	0 ------------- 616,961	0 ------------- 0
12Lisa Craft Team Lead	(i) (ii)	121,133 ------------- 0	150 ------------- 0	5,045 ------------- 0	15,598 ------------- 0	11,983 ------------- 0	153,909 ------------- 0	0 ------------- 0
13Regina Donald Department Manager	(i) (ii)	148,031 ------------- 0	350 ------------- 0	10,250 ------------- 0	40,991 ------------- 0	7,662 ------------- 0	207,284 ------------- 0	0 ------------- 0
14Karen Lafon Department Director	(i) (ii)	121,791 ------------- 0	650 ------------- 0	720 ------------- 0	18,782 ------------- 0	12,023 ------------- 0	153,966 ------------- 0	0 ------------- 0
15Phyllis Snyder Team Lead	(i) (ii)	114,683 ------------- 0	150 ------------- 0	1,347 ------------- 0	24,258 ------------- 0	11,944 ------------- 0	152,382 ------------- 0	0 ------------- 0
16Paul G Faucher MD Former Officer	(i) (ii)	0 ------------- 140,620	0 ------------- 18,978	0 ------------- 3,038	0 ------------- 0	0 ------------- 1,677	0 ------------- 164,313	0 ------------- 0
17Sinclair J Harcus MD Former Officer	(i) (ii)	0 ------------- 197,523	0 ------------- 8,614	0 ------------- 3,307	0 ------------- 78,408	0 ------------- 11,257	0 ------------- 299,109	0 ------------- 0
18Karen A Lyons MD Former Officer	(i) (ii)	10,108 ------------- 169,445	0 ------------- 33,463	0 ------------- 3,407	0 ------------- 48,609	0 ------------- 1,374	10,108 ------------- 256,298	0 ------------- 0

Schedule J (Form 990) 2019

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 1a	Employees are occasionally awarded gifts or prizes which are grossed up for taxes at management's discretion and included in taxable compensation. During the reporting period, Ms. Lafon received such benefit.
Part I, Line 1b	Management determines tax gross-up decisions based on IRS requirements, amount, and the non-cash status of the benefits.
Part I, Line 3	The Organization's majority member, Carilion Clinic, 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 2017 and September 2018. 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	Nancy Howell Agee, President and Chief Executive Officer, participated in a pension restoration plan (Plan). The Plan was established in 1995 and its purpose is to restore the pension benefits that Ms. Agee would otherwise lose as a result of Internal Revenue Code limitations upon contributions to, and payment of benefits from, Carilion Clinic's tax qualified pension plan. In 2017, Ms. Agee became fully vested in the pension restoration benefit, requiring distribution of all benefits earned while participating in the Plan, which totaled $10,310,500 before taxes. The benefits earned under the Plan reflect the value accumulated over Ms. Agee's 45 years of service to the organization through progressive leadership roles, including ten years as Chief Operating Officer and eight years in her current position as President and Chief Executive Officer. As benefits were earned under the Plan, accruals were reported in each of the organization's prior Form 990 filings as "retirement and other deferred compensation." Although the pension restoration benefits were earned over the course of Ms. Agee's career, the Form 990 requires that they be reported again as "other reportable compensation" in total in the current year when vested and paid. The 2017 payment represents Ms. Agee's entire benefit under the Plan. After 2017, Ms. Agee will no longer receive or accrue Plan benefits. Ms. Agee also participated in an executive flexible benefit plan, in which an allowance is provided annually to the participant for use in obtaining certain insurance benefits. 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 a Carilion Clinic affiliate, 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 terms. In 2017, $235,410 in previously deferred amounts became vested under this plan and were paid. Although CAA contributions were previously reported on the Form 990 as "retirement and other deferred compensation" when allocated, the Form 990 requires that CAA amounts be reported again as "other reportable compensation" in the current year when vested and paid. The two deferred compensation plan payouts for Ms. Agee totaled $10,545,910, as reflected in Schedule J, Part II, column (F). Ms. Agee, Mr. Arner, Mr. Halliwill, and Mr. Vaughan 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. No distributions were made under this plan in the reporting year. Unvested contributions made to the DC SERP in 2017 are reported on the Form 990 as "retirement and other deferred compensation."
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) 2019

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CARILION STONEWALL JACKSON HOSPITAL

Employer identification number
54-0568001

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	Economic Development Authority of the City of Roanoke VA	54-1106038	770082AW5	02-09-2012	100,280,611	Refunding of Series 2000 and 2002A Bonds, Issuance Costs, Capital Projects		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	38,690,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	100,280,611
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,114,935
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	5,189,198
11 Other spent proceeds .............	93,976,478
12 Other unspent proceeds .............
13 Year of substantial completion .............	2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	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
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

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
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
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 ....
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 .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		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
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

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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	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
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

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
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	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

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: Economic Development Authority of the City of Roanoke, VA Date the Rebate Computation was Performed: 04/04/2013
Schedule K Part VI	Bond issuance total proceeds allocated to each entity.
Schedule K Part II	Bond Proceeds All bond issues multiple entities across multiple jurisdictions; therefore, proceeds allocated to multiple hospitals.

Schedule K (Form 990) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CARILION STONEWALL JACKSON HOSPITAL

Employer identification number

54-0568001

Return Reference	Explanation
Form 990, Part I, Line 6:	Volunteers greet and assist visitors, answer phones, help with general restocking of supplies, transport of patients, make up swing bed packages, make up IV kits for nursing. Volunteers take patients back to the pre-op rooms prior to surgery. Volunteers provide escort service; assist with mailings, resource materials, special projects; assist the Emergency Department staff by maintaining the waiting room desk and helping to facilitate good customer service; Volunteers run the gift shop, purchase all items they sell in gift shop. They stock inventory, answer the phone, maintaining records, decorating the shop and assuring tidiness. Voulnteers take fresh fruit around to all the break rooms three times a week. Areas the Volunteers assist in are: Physical Therapy, Cardiac Rehab; Visitor's Desk,waiting area desks, ED and Fit for Life.
Form 990, Part V, Line 1a	1099s are issued on Carilion Stonewall Jackson 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 1	The Board consists of eleven (11) to fifteen (15) members divided into two (2)classes: the Carilion Class which consists of three (3) members and the Stonewall Class which consists of eight (8) to twelve (12) members. The Carilion Class has 80% of the vote on any issue that properly comes before the Board and the Stonewall Class has 20% of the vote on any issue that properly comes before the Board.
Form 990, Part VI, Section A, line 2	Nancy Howell Agee, Randy A. Gallagher, M.D., Donald B. Halliwill, Ayesha Kelly, M.D., Lauren J. Schantz, John Sedovy, M.D., Lisa T. Sprinkel, Kerri L. Thornton, Greg Madsen, Steve Arner, and G. Robert Vaughan, Jr. - 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. Some or all of the compensation of the following individuals listed in Part VII, Section A was provided by Carilion Services Inc.: Nancy Howell Agee, Steve Arner, Donald B. Halliwill, Lauren J. Schantz, Lisa T. Sprinkel, Kerri L. Thornton, Greg Madsen, and G. Robert Vaughan, Jr.
Form 990, Part VI, Section A, line 6	The organization has two (2) members. Carilion Clinic, a charitable tax-exempt health care organization, has an 80% membership interest and is entitled to elect directors having 80% of the vote on any issue. The Stonewall Jackson Community Foundation, a tax-exempt community foundation which supports health care within the local community, has a 20% membership interest and is entitled to elect directors having 20% of the vote on any issue.
Form 990, Part VI, Section A, line 7a	The organization has two (2) members. Carilion Clinic, a charitable tax-exempt health care organization, has an 80% membership interest. Carilion Clinic is entitled to appoint all three (3) members of the Carilion Class of directors; the Carilion Class has 80% of the vote on any issue that properly comes before the Board. The Stonewall Jackson Community Health Foundation, a tax-exempt community foundation which supports health care within the local community, has a 20% membership interest. The Stonewall Jackson Community Health Foundation is entitled to appoint one (1) member of the Stonewall Class of directors. The remaining members of the Stonewall Class include one (1) ex officio director (Chief of the Carilion Stonewall Jackson Hospital Medical Staff) and six (6) to (10) members of the local community, who elect their own successors. The Stonewall Class has 20% of the vote on any issue that properly comes before the Board.
Form 990, Part VI, Section A, line 7b	Under the laws of the Commonwealth of Virginia, certain extraordinary actions require member approval, such as mergers, consolidations, liquidations, and the sale of substantially all of the assets of the organization. See also Schedule O disclosure for Form 990, Part VI, Section A, Line 7a.
Form 990, Part VI, Section B, line 11b	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. 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 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 two (2) members. Carilion Clinic, a charitable tax-exempt health care organization, has an 80% membership interest and is entitled to elect directors having 80% of the vote on any issue. The Stonewall Jackson Community Foundation, a tax-exempt community foundation which supports health care within the local community, has a 20% membership interest and is entitled to elect directors having 20% of the vote on any issue. 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 October and November 2017 (President and CEO) and November 2017 and September 2018 (all others). For the fiscal year covered by this return, the Compensation Committee also used the same process to review the compensation of Senior Vice Presidents and other Disqualified Individuals, including the Hospital Vice Presidents, which was performed in November 2017 and September 2018. 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 to the local newspaper when requested. Limited financial information is available on our website.
Form 990, Part XI, line 9:	Pension-related changes other than net periodic pension costs 47,627.
Form 990, Schedule H, Part V, Section A, Line 1:	https://carilionclinic.org/locations/carilion-stonewall-jackson-hospital

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CARILION STONEWALL JACKSON HOSPITAL

Employer identification number

54-0568001

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 12b, II	N/A		No
(2)Carilion Clinic Foundation PO Box 12385 Roanoke,VA24025 54-1190773	Fundraising	VA	501(c)(3)	Line 7	Carilion Clinic	Yes
(3)Carilion Franklin Memorial Hospital PO Box 12385 Roanoke,VA24025 54-0480606	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(4)Carilion Giles Community Hospital PO Box 12385 Roanoke,VA24025 54-0549603	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(5)Carilion Medical Center PO Box 12385 Roanoke,VA24025 54-0506332	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(6)Carilion New River Valley Medical Center PO Box 12385 Roanoke,VA24025 54-0553805	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(7)Carilion Services Inc PO Box 12385 Roanoke,VA24025 54-1190879	Supporting organization	VA	501(c)(3)	Line 12b, II	Carilion Clinic	Yes
(8)Carilion Tazewell Community Hospital PO Box 12385 Roanoke,VA24025 54-6074580	Healthcare	VA	501(c)(3)	Line 3	Carilion Clinic	Yes
(9)SJH Community Health Foundation 1 Health Circle Lexington,VA24450 20-3592795	Supporting organization	VA	501(c)(3)	Line 12c, III-FI	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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) Franklin County Ventures LLC PO Box 12385 Roanoke,VA24025 47-4365316	Real estate	VA	N/A
(2) Community Medical Associates LLP PO Box 12385 Roanoke,VA24025 54-1517662	Real estate	VA	N/A
(3) Carilion Clinic Medicare Shared Savings Company LLC PO Box 12385 Roanoke,VA24025 45-5235473	Medicare HMO	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) SCA Credit Services Inc PO Box 12385 Roanoke,VA24025 54-1180398	Collection Agency	VA	N/A	C			Yes
(2) MedKey Inc PO Box 12385 Roanoke,VA24025 54-1645357	Financing Services	VA	N/A	C			Yes
(3) CHS Inc PO Box 12385 Roanoke,VA24025 54-1725732	Services	VA	N/A	C			Yes
(4) Carilion Healthcare Corporation PO Box 12385 Roanoke,VA24025 54-1586601	Healthcare	VA	N/A	C			Yes
(5) Carilion Emergency Services Inc PO Box 12385 Roanoke,VA24025 54-2033006	Healthcare	VA	N/A	C			Yes
(6) Carilion Clinic Medicare Resources LLC PO Box 12385 Roanoke,VA24025 26-3729975	Medicare HMO	VA	N/A	C			Yes
(7) Carilion Behavioral Health Inc PO Box 12385 Roanoke,VA24025 20-3136891	Healthcare	VA	N/A	C			Yes
(8) Sprott Private Resource Lending (C-Co-Invest) LP 200 Bay Street Suite 2700 Toronto CA 98-1378742	Investments	CA	N/A	C				No

Schedule R (Form 990) 2019

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) ............................

Yes

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) ......................

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) ............................

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	2,040	Cost
(2) Carilion Healthcare Corporation	A	175,943	Cost
(3) Carilion Medical Center	L	75,006	Cost
(4) Carilion Medical Center	M	1,597,089	Cost
(5) Carilion Services Inc	M	5,342,368	Cost
(6) CHS Inc	M	166,515	Cost
(7) Carilion Healthcare Corporation	M	2,273,512	Cost
(8) Carilion Services Inc	A	73,159	Cost
(9) SJH Community Health Foundation	C	87,221	Cost

Schedule R (Form 990) 2019

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) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Our mission is to improve the health of the communities we serve.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	311
6	Total number of volunteers (estimate if necessary) .............	6	60
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 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	75,243	89,421
9	Program service revenue (Part VIII, line 2g) .........	37,065,048	39,881,816
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,500,239	612,038
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	739,972	1,580,998
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	39,380,502	42,164,273
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	51,798	63,997
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)	15,333,876	15,683,459
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)....	21,525,880	23,731,728
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	36,911,554	39,479,184
19	Revenue less expenses. Subtract line 18 from line 12.......	2,468,948	2,685,089
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	51,522,443	55,362,643
21	Total liabilities (Part X, line 26).............	23,226,278	23,173,575
22	Net assets or fund balances. Subtract line 21 from line 20.....	28,296,165	32,189,068

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 34,233,193 including grants of $ 63,997 ) (Revenue $ 41,018,701 )
	See Schedule O.Carilion Stonewall Jackson 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 Lexington VA, this 25-bed critical access facility provides a full range of inpatient and outpatient services, specializing in imaging services, surgical services and therapy services.Carilion Stonewall Jackson Hospital, a critical access hospital, exists to serve the health care needs of its community, regardless of patient ability to pay. Stonewall's acute hospital admitted 1,210 patients and provided 4,902 days of care during the year. Hospital programs include provision of nursing care; extensive outpatient and inpatient surgical and endoscopic services; respiratory therapy; and diagnostic imaging services including CT, MRI, mammography, ultrasound, DEXA scan and nuclear medicine. Stonewall also provides integrated and comprehensive primary care services through two Rural Health Clinics. Stonewall provides a number of services targeting the specific health needs of its population, including diabetes management; physical, speech, and occupational therapy programs; and cardiac and respiratory rehab. Stonewall also provides an emergency department with 24-hour care, emergency transportation, and a chest pain program. With 13,428 visits, Stonewall's emergency services are a critical component of the health safety net in its service area, acting as a key health provider for a significant number of uninsured patients, who comprise 18 percent of ED visits. Stonewall supports community screenings and education on chronic disease prevention and management, sponsoring 83 events touching over 1,185 people. In furtherance of its mission, Stonewall provides extensive uncompensated care. Stated at cost, charity and unreimbursed Medicaid costs for the year exceeded $2.3 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 expenses34,233,193

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	858,117	15,737,180	1,288,944

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	87,221
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	2,200

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		89,421

		Business Code
2a	Net Patient Revenue	622110	39,806,617	39,806,617
b	Rent from Exempt Affiliates	531120	75,199	75,199
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		39,881,816

3 Investment income (including dividends, interest, and othersimilar amounts) ......			243,825			243,825
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		266,375	6a
b	Less: rental expenses		0	6b
c	Rental income or (loss)		266,375	6c
d	Net rental income or (loss).......			266,375			266,375
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	9,990	25,120,120	7a
b	Less: cost or other basis and sales expenses	5,392	24,756,505	7b
c	Gain or (loss)	4,598	363,615	7c
d	Net gain or (loss).........			368,213			368,213
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	EHR Incentive Revenue		900099	719,994	719,994
b	Contract Revenue		900099	227,270	227,270
c	Cafeteria Revenue		722514	177,738			177,738
d	All other revenue ....			189,621	189,621
e	Total. Add lines 11a–11d ......			1,314,623
12	Total revenue. See instructions.....			42,164,273	41,018,701	0	1,056,151

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	63,997	63,997
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	350,739		350,739
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	11,905,224	11,905,224
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	987,655	987,655
9	Other employee benefits .......	1,621,111	1,561,174	59,937
10	Payroll taxes ...........	818,730	795,300	23,430
11	Fees for services (non-employees):
a	Management ......	4,515,544		4,515,544
b	Legal .........	91		91
c	Accounting ...........
d	Lobbying ...........	2,680	2,680
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	45,447		45,447
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	3,505,611	3,444,885	60,726
12	Advertising and promotion ....	2,147	1,022	1,125
13	Office expenses .......	697,315	682,022	15,293
14	Information technology ......	64,393	64,393
15	Royalties ..
16	Occupancy ...........	678,627	678,627
17	Travel ............	59,720	45,782	13,938
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	845,233	845,233
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,230,827	2,230,827
23	Insurance ...	326,120	198,784	127,336
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	4,192,079	4,192,079
b	I/C Practice Subsidy	3,366,142	3,366,142
c	Medical Supplies	3,115,100	3,115,100
d	Dues & Subscriptions	26,541	23,324	3,217
e	All other expenses	58,111	28,943	29,168
25	Total functional expenses. Add lines 1 through 24e	39,479,184	34,233,193	5,245,991	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 ........			1,220	1	1,199
2	Savings and temporary cash investments .........			23,106	2	23,678
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			5,505,726	4	6,627,763
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			416,036	8	393,807
9	Prepaid expenses and deferred charges ......			133,779	9	129,813
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	51,237,454
b	Less: accumulated depreciation	10b	36,257,690	14,728,816	10c	14,979,764
11	Investments—publicly traded securities .			10,651,953	11	6,087,949
12	Investments—other securities. See Part IV, line 11 .....			17,580,170	12	23,840,033
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			2,481,637	15	3,278,637
16	Total assets. Add lines 1 through 15 (must equal line 33)...			51,522,443	16	55,362,643

17	Accounts payable and accrued expenses .....	4,114,667	17	5,060,635
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	18,285,475	20	17,380,788
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	615,687	24	598,741
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	210,449	25	133,411
26	Total liabilities. Add lines 17 through 25..	23,226,278	26	23,173,575

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	28,296,165	32	32,189,068
33	Total liabilities and net assets/fund balances ........	51,522,443	33	55,362,643