4A (Expenses $ 237698347 including grants of $ 221322) (Revenue $ 282142431)
See schedule O.

Schedule H, Part V, Section B, Line 3E
The publicly available community health needs assessment report details the prioritization process for the community's significant health needs as identified through the CHNA. The Community Health Assessment Team (CHAT), made up of community stakeholders, reviews all data and completes a prioritization survey. Through the survey, each CHAT member selects and ranks the most pertinent community needs. The data are combined and priorities are selected based on the highest weighted score of each need. Through this process, CHAT members prioritize needs according to the need's perceived burden, scope, severity or urgency; the importance the community places on addressing the need through survey responses and other interactions; and each member's unique perspective on community health.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Carilion New RIver Valley Medical Center. Carilion Clinic's Community Health Needs Assessments (CHNAs) are community-driven projects. Their success is highly dependent on engaging citizens, health and human service agencies, businesses and community leaders. Stakeholder collaborations known as Community Health Assessment Teams (CHATs) lead the CHNAs. The CHATs are a dynamic group that includes health and human service agency leaders, people with exceptional knowledge of, or expertise in, public health, and local health department officials. The CHATs obtain input from leaders, representatives or members of medically underserved populations who report low-income, are minorities and suffer from chronic diseases. The following organizations served on the CHAT for the 2021 New River Valley Community Health Needs Assessment (NRVCHNA): Carilion Clinic, Carilion New River Valley Medical Center, Children's Health Improvement Program (CHIP) of NRV, Community Foundation of the New River Valley, Community Health Center of the NRV, Edward Via College of Osteopathic Medicine (VCOM) - Virginia, Giles County Christian Service Mission, Montgomery County Health and Human Services (HHS), Montgomery County-Radford City-Floyd County Chapter of the National Association for the Advancement of Colored People (NAACP), Montgomery-Floyd Regional Library System, National Alliance on Mental Illness (NAMI), New River Valley Agency on Aging, New River Valley Community Services (NRVCS), Newport-Mt. Olivet United Methodist Church, NRV Cares, Planned Parenthood South Atlantic, Radford University School of Nursing, To Our House Thermal Shelter for Homeless Men Women in the NRV, Town of Christiansburg Parks and Recreation Department, University of Virginia (UVA), UVA Cancer Center, Virginia Department of Health (VDH) New River Health District, Virginia Organizing, Virginia Polytechnic Institute and State University (Virginia Tech), Virginia Tech Center for Public Health Practice and Research, Virginia Tech Cooperative Extension, and Virginia Tech Institute for Policy and Governance. To obtain input from the community, the NRVCHNA included five target population focus groups, one stakeholder focus group and a 40-question community health survey that was administered broadly across the service area. This occurred from October 1, 2020, through January 31, 2021. The survey was developed (in English and Spanish) with questions about socioeconomic factors; access to medical, dental and mental health care; health behaviors; physical environment; health outcomes; and demographics. The survey included commonly used questions and metrics from previously validated community surveys conducted by organizations such as the National Association of County and City Health Officials and Centers for Disease Control and Prevention. A team of Virginia Tech Public Health/Policy and Governance stakeholders participating on the CHAT took the lead in planning, conducting and analyzing four virtual and one in-person target population focus groups to gain further input from community members. During the CHNA process, community stakeholders, leaders and providers were encouraged to complete a stakeholder survey electronically to provide additional perspectives about our community's health needs and barriers. A focus group was held with the CHAT stakeholders to further discuss the data collected through the stakeholder survey. The CHAT assisted with survey distribution in an effort to reach particular target populations. The survey focused on New River Valley residents 18 years of age and older in the following service area: Montgomery County, Floyd County, Pulaski County, Radford City and Wythe County. Special efforts were made to include underserved/vulnerable populations disproportionately impacted by social determinants of health such as income, race/ethnicity, education and insurance status. Specific populations served by CHAT representatives include the un- or underinsured, the homeless, the food insecure, small business owners and low-income individuals and families with young children. The survey was also made available to all residents living in the New River Valley. Due to the COVID-19 pandemic, most survey responses were collected electronically, though the survey was also available by phone and on paper.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - Carilion New River Valley Medical Center. The 2021 New River Valley CHNA was conducted with: Children's Health Improvement Program (CHIP) of NRV, Community Foundation of the New River Valley, Community Health Center of the NRV, Edward Via College of Osteopathic Medicine (VCOM) - Virginia, Giles County Christian Service Mission, Montgomery County Health and Human Services (HHS), Montgomery County-Radford City-Floyd County Chapter of the National Association for the Advancement of Colored People (NAACP), Montgomery-Floyd Regional Library System, National Alliance on Mental Illness (NAMI), New River Valley Agency on Aging, New River Valley Community Services (NRVCS), Newport-Mt. Olivet United Methodist Church, NRV Cares, Planned Parenthood South Atlantic, Radford University School of Nursing, To Our House Thermal Shelter for Homeless Men Women in the NRV, Town of Christiansburg Parks and Recreation Department, University of Virginia (UVA), UVA Cancer Center, Virginia Department of Health (VDH) New River Health District, Virginia Organizing, Virginia Polytechnic Institute and State University (Virginia Tech), Virginia Tech Center for Public Health Practice and Research, Virginia Tech Cooperative Extension, and Virginia Tech Institute for Policy and Governance.

Schedule H, Part V, Section B, Line 7 Facility , 1
Facility , 1 - Carilion New River Valley Medical Center. The Community Health Assessment Team shared the 2021 New River Valley Community Health Needs Assessment (NRVCHNA) on partner websites and social media. The NRVCHNA was also shared through community presentations to groups including Radford University nursing students, the New River Valley Livability Initiative Health Forum and the New River Valley Long-Term Care Council.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - Carilion New River Valley Medical Center. The following information describes the implementation strategy used by Carilion New River Valley Medical Center (CNRV) to address the community health needs identified in the 2021 New River Valley Community Health Needs Assessment (NRVCHNA). The complete implementation strategy is available online at https://www.carilionclinic.org/community-health-assessments#new-river-valley. Per Regulation Section 1.501(r)-3(c)(5) the implementation strategy must be adopted before 4.5 months after the end of the taxable year in which the CHNA is completed. The implementation strategy was adopted on January 25, 2022 and applies for the 2020 tax year (fiscal year 9/30/2021). The top prioritized needs for the 2021 NRVCHNA were grouped into three overarching categories: mental health, socioeconomic factors and health behaviors. We plan to address prioritized needs with the following strategies and a commitment of financial resources, staff time and leadership. Strategies to address mental health include the continuation of the emergency department bridge program to ensure continuity of care despite provider shortages; the exploration of expansion of peer recovery support services to Saint Albans Hospital on CNRV's campus; the continued support of local networks and coalitions that advance mental health awareness and treatment; the exploration of expanding community programming for abuse/overdose prevention and first aid (REVIVE) training; and the continuation of programming/activities that increase community knowledge of medication disposal sites/methods. Progress made in 2022 on mental health strategies centered on maintaining what has been working well for our region and our hospital system and establishing infrastructure to scale and prioritize that work. We have hired and onboarded a system-wide community workforce manager. This position will provide continued management support and is currently working to hire a peer support specialist at Saint Albans. We have also backfilled the NRV community health educator position to maintain the capacity for community health interventions, and designated two of the three priority areas for community health interventions as ""mental health and ""substance use."" We continue to demonstrate commitment to the existing ED Bridge Program and the maintenance of strong, active relationships with our community partners working to advance mental health in our area. Strategies to address socioeconomic factors include continuing to provide coalition development support to the Community Foundation of the New River Valley; participation in Healthy Roots NRV; and participation in the Aging in Community leadership team. Progress made in 2022 to address socioeconomic factors has been driven by active coalition/network development participation and funding meaningful programs through our community grant process. In addition to continued commitment to the networks mentioned above, we have recently joined the NRV Housing Trust Fund Oversight Board-an effort spearheaded by the local Regional Commission to sustainably increase affordable housing across the region. Community grants awarded in our last funding cycle include efforts that address food insecurity and healthy eating, early childhood (including school readiness, mental/emotional health, and parenting), and transportation. Strategies to address health behaviors include providing and/or partnering to provide evidence-based and needs-focused health education and community outreach events such as health fairs, immunizations and health screenings; supporting local food access coalitions and organizations; implementing the Unite Us platform for social services referrals and integrating with electronic medical records internally and externally; continued participation on PATH and other healthy behavior community coalitions; and the exploration of a pathway for employees outside of Carilion Community Health and Outreach to participate in health education, screenings and immunizations in the community setting. Progress made in 2022 to address health behaviors has stemmed from the hiring and on-boarding of a system-wide health education manager position-increasing infrastructure to redesign health education departmental strategies to better meet community-identified needs, prioritize disadvantaged populations and maximize impact (including reach and outcomes). The NRV community health educator position was backfilled, providing the infrastructure necessary to enact these impact-driven strategies and maintain strong, active partnerships with organizations and coalitions committed to collaborative community programming. We continue our commitment to finding solutions for increased community-based resource coordination and plan to launch a pilot of Unite Us platform in March of 2023. Many of the programs funded by our community grants impact health behaviors, including preventative health services and healthy food choices. Additional strategies to more broadly address a culture of community health and its ties to each of the priority needs include developing a system-wide community health investment plan; further developing community health infrastructure; engaging employees in supporting community partnerships; and leveraging internal data to assess health disparities. Progress made in 2022 in our additional strategies category was also closely aligned with increasing infrastructure and strategic impact. Increased staffing infrastructure in the Planning and Community Development division has opened opportunities to evaluate and update current processes to better communicate initiative rationale, program outcomes and expected community impact. Community Health and Outreach's community health worker and peer support specialist programs have been integrated into the electronic medical record system-increasing provider capacity for referrals to community health services and streamlining CHW and Peer case management, tracking and reporting. Continuing our commitment to care, the Planning and Community Development division is working closely with Quality department and the office of Diversity, Equity, and Inclusion to identify and leverage internal data to identify any disparities in the communities we serve."

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - Carilion New River Medical Center. Policy changed for February 1, 2021, Individuals with out of network insurance are eligible for financial assistance. Previously, these individuals were not eligible unless their plan did not meet the Patient Protection and Affordable Care Act (PPACA) minimum essential coverage.

Schedule H, Part I, Line 3c Other Financial Assistance Eligibility Criteria
Financial assistance policy in effect for February 1, 2021: families with family income equal or below 300% of the FPG and assets equal or below $25,000 receive 100% adjustment under FAP. Families with family income greater than 300% of the FPG but less than or equal to 500% of the FPG or assets above $25,000 and less than or equal to $100,000 receive a partial adjustment under fap. The partial adjustment matches the highest AGB percentage determined.

Schedule H, Part I, Line 6a Public Avaliability of Community Benefit Report
Information about 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/cho-community-health-assessments#community-benefit-reports

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
14821535

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Line 7a and 7b: For activities reported on the Medicaid cost report, a cost-to-charge ratio as determined from the Medicaid cost report was used. For all other activities, a cost to charge ratio derived from Worksheet 2 of the 990 instructions was used. Lines 7e through 7i are reported at actual cost.

Schedule H, Part II Community Building Activities
Line 2 - Economic development: As the largest employer in Southwest Virginia, Carilion impacts economic development by investing in jobs, increased wages for employees and various capital building projects. In addition, Carilion had direct economic development expenses from programming and support of local chambers of commerce and pro-business advocacy. Carilion is active in local economic development endeavors, including participating in OnWARD NRV-a regional economic development organization working to attract jobs and talent to the New River Valley-and investing in research and technology. We also converse with local businesses about the region's current business climate and prospective companies. CNRV actively participates in the Blacksburg Partnership-a nonprofit, independent economic development organization focused on projects that attract visitors, developers and retail prospects to Blacksburg. These initiatives promote the community's health by improving economic vitality and making the region a vibrant place to live, work and play. Line 3 - Community support: Research demonstrates the strong connection between social determinants of health-such as transportation, housing and education-and communities' overall health and well-being. Carilion supports nonprofit organizations addressing barriers to good health arising from these social determinants in various ways. Carilion also collaborates with local partners to support better education and opportunities for children and families and improved housing, better nutrition and additional resources for our neighbors in need. These efforts help remove a range of obstacles to good health for our region's residents. For example, Carilion participates in PATH (Partnership for Access to Healthcare), the Aging in Community leadership team, and provides support for organizations such as the AARP, NAACP, the Christiansburg Institute, and the Women's Resource Center. Line 6 - Coalition building: Carilion believes in the power of collaboration and understands that we must address our most significant health issues in concert with the community. To ensure lasting impact from the health assessment and community health improvement process, Carilion participates in coalitions that address health, safety and social determinant needs in the New River Valley. We also partner with multiple community and business organizations around initiatives to improve health and wellness for everyone living in the New River Valley. Examples include Carilion's representation on the Radford Early Learning Center Board, the VCOM Advisory Board and the Safe Kids Coalition. Line 7 - Community health improvement advocacy: Carilion believes in leveraging our efforts to support community health improvement across our footprint, as well as across Virginia. As such, our President and CEO participates on the Governor's Medical Advisory Team focused on community health and resiliency in the wake of the COVID-19 pandemic. Line 8 - Workforce development: With the understanding that employment is directly linked to health and wellness, Carilion partners to provide workforce development and training for community members. These efforts also develop a pipeline of future health care workers. Carilion New River Valley Medical Center supports workforce development through service to the New River Community College Educational Foundation board, a nonprofit corporation that secures voluntary support and manages funds solely for the benefit of New River Community College. The foundation assists New River Community College in various ways, including endowing and distributing of scholarship funds, purchasing equipment and furnishings, and financially supporting academic and community enrichment programs. Support is also provided to the Southwest Virginia Governor's School-an institution which helps high school students excel in STEM learning-for student scholarships.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Carilion New River Valley Medical Center 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.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
Accounts receivable are stated at net realizable amounts due from patients, third-party payors, and other insurers for which Carilion New River Valley Medical Center expects to be entitled in exchange for providing patient care. In accordance with Accounting Standards Update (ASU) No. 2014-09, Revenue from Contracts with Customers (Topic 606) (ASU 2014-09), the estimated uncollectible amounts are generally considered implicit price concessions that are a direct reduction to patient accounts receivable.

Schedule H, Part III, Line 8 Community benefit methodology for determining medicare costs
Medicare allowable costs are determined from the Medicare cost report using the cost-to-charge 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 caring for patients 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.

Schedule H, Part V, Section B, Line 16a FAP website
- CARILION NEW RIVER VALLEY MEDICAL CENTER: Line 16a URL: https://www.carilionclinic.org/billing/financial-assistance;

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
When accounts receivable efforts are exhausted, the account may be placed with a collection agency and Extraordinary Collection Actions (ECAs) may be considered. Accounts will not be placed with a collection agency prior to 120 days from the date the first post-discharge 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 Financial Assistance Application (FAA) is received during the application period (within 240 days after the date the first post-discharge 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 post-discharge 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, in cases of a deceased patient, 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.

Schedule H, Part V, Section B, Line 16b FAP Application website
- CARILION NEW RIVER VALLEY MEDICAL CENTER: Line 16b URL: https://www.carilionclinic.org/billing/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- CARILION NEW RIVER VALLEY MEDICAL CENTER: Line 16c URL: https://www.carilionclinic.org/billing/financial-assistance;

Schedule H, Part VI, Line 2 Needs assessment
"In addition to conducting regular Community Health Needs Assessments (CHNAs), Carilion Clinic closely monitors community health indicators and responds to needs as they arise. Each year, Carilion updates scorecards with refreshed County Health Rankings indicators provided by the Robert Wood Johnson Foundation. Carilion is also responsive to needs identified through clinical data and internal departments. Carilion's call center, Carilion Direct, is available for community members to ask questions and connect with community resources. Community health workers (CHWs) are also utilized to help address needs, and data is reviewed periodically to identify trends in health care needs of patients served by CHWs. Needs are also identified through current collaborative relationships and community partnerships. Ongoing collaboration with stakeholders allows for regular communication of needs and gives our partners opportunities to respond cohesively. Carilion has adapted its community health improvement process from Associates in Process Improvement's Model for Improvement and the Plan-Do-Study-Act cycle developed by Walter Shewhart. It consists of five 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 fosters community development in its CHNA and community health improvement processes through the Strive Collective Impact Model for the Community Health Assessment Team. 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 toward shared strategies."

Schedule H, Part VI, Line 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 and provides information on 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, Eligibility staff are trained as Certified Application Counselors and will assist patients in enrollment in the Marketplace. Eligibility staff will also complete Carilion's financial assistance application and counsel patients on the requirements for financial assistance.

Schedule H, Part VI, Line 4 Community information
The New River Valley (NRV), home to Carilion New River Valley Medical Center (CNRV), is composed of the independent city of Radford and the counties of Floyd, Giles, Montgomery and Pulaski. It is nestled among the Blue Ridge and Appalachian Mountains in Southwest Virginia. The NRV is home to two universities, Virginia Tech and Radford University, and the New River Community College. Their presence enriches the local culture and workforce. A vibrant mix of urban and rural communities, the NRV boasts scenic views and thriving communities complete with restaurants, arts and culture offerings, and an abundance of outdoor recreation and relaxation opportunities. (https://www.newrivervalleyva.org/) In addition to Carilion Clinic's two hospitals located in the New River Valley, CNRV and Carilion Giles Community Hospital (CGCH), the region is also served by LewisGale Hospital-Montgomery, located in the town of Blacksburg. Key safety-net providers in the region include two federally qualified health centers with multiple locations, the Community Health Center of the New River Valley and Tri-Area Community Health Center; the Virginia Department of Health New River Health District clinics; the Pulaski Free Clinic; New River Valley Community Services; and other service organizations. The service area for the 2021 New River Valley Community Health Needs Assessment (NRVCHNA) includes the city of Radford and the counties of Floyd, Montgomery, Pulaski and Wythe, with secondary data included for Giles County. It is important to note that Giles County is also served by CGCH located in Pearisburg, Virginia. Giles County is not included as part of the service area for the 2021 NRVCHNA because CGCH also conducted its own CHNA of Giles County and Monroe County, West Virginia, concurrently. The 2017-2021 American Community Survey (ACS) found the total population of the complete service area to be 210,039-with 15,536 residents in Floyd, 16,764 in Giles, 99,294 in Montgomery, 33,893 in Pulaski, 28,347 in Wythe and 16,205 in Radford. Population density varied widely, from 41 persons per square mile in Floyd to 1,675 per square mile in Radford. Average household income varies by locality-starting at $60,628 in Radford, leveling around the mid-sixties for most of the localities, then jumping up to $79,801 in Montgomery. However, Montgomery is still well below the national ($97,196) and state ($111,013) averages. When considering the entire service area, the ACS shows that 14.20% of households in the service area are living below 100% of the federal poverty line, which equates to 38,003 individuals. The highest percentage of a locality's population living below the federal poverty line is in Montgomery County (24.77%). (US Census Bureau, ACS. 2017-2021.) Of the 194,171 population in the service area that is covered by any type of medical insurance, 14.46% of those individuals are receiving Medicaid. This is close to the state average of 14.48%. (US Census Bureau, ACS. 2017-2021.) The rate of uninsured population aged 18-64 is also similar to that of the states, at 10.87%. However, Giles County's percentage is currently 12.73%, exceeding both state and national averages. Wythe's rate of uninsured children is also higher than state and national averages, at 9.72%, compared to 4.88% for Virginia, 5.30% nationally, and 4.45% for the NRV service area. (US Census Bureau, ACS. 2017-2021.) Of the patients receiving care at CNRV during fiscal year 2022, 17.6% are receiving Medicaid while 2.3% are self-pay. (Strata internal data) In the NRV service area, Health Professional Shortage Areas (HPSAs) exist for primary care, dental and mental health services. Primary care HPSAs exist in the counties of Floyd and Giles. Dental health HPSAs exist in Wythe County and for low-income populations in all remaining localities in the service area. Mental health HPSAs exist for the high-needs population in the Mount Rogers service area, which includes Wythe County and the NRV's low-income population, encompassing the remainder of the service area. (HPSA Find. Accessed: https://data.hrsa.gov/tools/shortage-area/hpsa-find)

Schedule H, Part VI, Line 5 Promotion of community health
Carilion New River Valley Medical Center is part of the non-profit Carilion Clinic integrated health care system located among the Blue Ridge Mountains. Carilion provides quality care for nearly one million individuals through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers, and other complementary 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 community's health care needs. Today, Carilion is a vital anchor institution focused on health care and dedicated to our mission of improving the health of the communities we serve. With an enduring commitment to our region's health, care is advanced through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. Carilion invests in discovering and responding to local and regional health needs, understanding that we must involve additional stakeholders to address community health issues and create change effectively. Carilion recognizes the impact the environment has on the health of our communities. Efforts continue to make our hospitals and other facilities more energy-efficient, increase recycling and use of recyclable or bio-degradable materials, reduce waste materials and serve local, sustainable foods to patients and in our cafeterias. As the leading health care provider in the New River Valley, Carilion New River Valley Medical Center (CNRV) serves the Southwest Virginia counties of Montgomery, Pulaski, Floyd, Wythe, and Giles, in addition to the city of Radford (https://www.carilionclinic.org/locations/carilion-new-river-valley-medical-center). CNRV's history dates back to 1941, when Radford Community Hospital (RCH) was first established to serve the industrial developments in the area at the time. RCH continued to modernize and grow and became affiliated with the Roanoke Hospital Association in November of 1987, during the transition of the Roanoke Hospital Association into Carilion Health System (now Carilion Clinic). On March 20, 1999, RCH capitalized on its standing as a regional hospital and opened CNRV at its current location in Christiansburg, Virginia. The 146-bed acute care facility offers modern medical operating rooms and state of the art technology (including advanced imaging and robotic surgery). The current medical complex includes multiple surgical and medical care practices, Carilion Children's and Carilion Clinic Saint Albans Hospital for psychiatry and behavioral medicine. CNRV serves all patients regardless of their ability to pay. The hospital's governing board members are elected annually and reside in the region. The majority of members are neither hospital employees nor contractors. Medical staff privileges are extended to qualified providers. Surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. Reinvestments include providing free, discounted and subsidized care and critical medical services not otherwise offered in our region.

Schedule H, Part VI, Line 6 Affiliated health care system
"Carilion New River Valley Medical Center is wholly owned by Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. Carilion Clinic includes a comprehensive network of hospitals, primary and specialty physician practices, and complementary services consisting of six hospital entities, over 75 specialties and 282 practice sites across Southwest Virginia. All of these are centered on a common mission and shared values. In the mid-2000s, Carilion made the strategic decision to transform from a collection of hospitals to a physician-led, integrated health care system. Advances include developing a multi-specialty physician group, transforming our primary care practices into patient-centered medical homes, Implementing electronic health records system-wide, and creating a robust partnership with Virginia Tech, including developing the Virginia Tech Carilion (VTC) School of Medicine and the Fralin Biomedical Research Institute at VTC. Each decision and adaptation have fundamentally changed the way Carilion collaborates and provides care (https://www.carilionclinic.org/about-carilion-clinic). Carilion's community and population health infrastructure is the health system's engine for providing collaborative opportunities to improve and promote the community's health. Carilion's Community Health Assessment process helps identify the strengths and barriers impacting health. Our community-based programs reflect the Robert Wood Johnson Foundation's framework of four main influences of health: health behaviors, social and economic factors, clinical care access and quality, and physical environment. Our many partnerships with cross-sector organizations create a collaborative culture of health and wellness. Carilion has a long history of working with Radford University and Jefferson College to advance health professionals' education. Founded in 1914 as the Jefferson Hospital School of Nursing, what became known as the Jefferson College of Health Sciences merged with Radford University in early 2018 to form Radford University Carilion (RUC). Located on the campus of Carilion Roanoke Community Hospital, this higher education institution ""prepares, within a scholarly environment, ethical, knowledgeable, competent and caring healthcare professionals."" Today, RUC provides more than 1,100 students with opportunities to become part of the health care profession, serving communities ranging 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."