4A (Expenses $ 77098010 including grants of $ 88969) (Revenue $ 81711162)
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 Giles Community Hospital. 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 Giles County Area Community Health Needs Assessment (GCACHNA): Carilion Clinic, Carilion Giles Community Hospital, CHIP of the NRV-Giles County, Embrace Healthy Solutions, Giles Community Garden, Giles County Christian Service Mission, Giles County Special Projects, Goodwill Industries of the Valleys, Monroe County Health Department, New River Health District, New River Valley Community Services, NRV CARES, Pearisburg First United Methodist Church, Virginia Cooperative Extension, Virginia Department of Corrections, Virginia Polytechnic Institute and State University (Virginia Tech), Virginia Tech Center for Public Health Practice and Research, Virginia Tech Cooperative Extension, Virginia Tech Institute for Policy and Governance, Virginia Veteran and Family Support, and Women's Resource Center of the NRV. To obtain input from the community, the GCACHNA included six 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 six virtual 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 Giles County area residents 18 years of age and older in Giles County, Virginia, and Monroe County, West Virginia. 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 Giles County Area. 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 Giles Community Hospital. The 2021 Giles County Area Community Health Needs Assessment was conducted with: CHIP of the NRV-Giles County, Embrace Healthy Solutions, Giles Community Garden, Giles County Christian Service Mission, Giles County Special Projects, Goodwill Industries of the Valleys, Monroe County Health Department, New River Health District, New River Valley Community Services, NRV CARES, Pearisburg First United Methodist Church, Virginia Cooperative Extension, Virginia Department of Corrections, Virginia Polytechnic Institute and State University (Virginia Tech), Virginia Tech Center for Public Health Practice and Research, Virginia Tech Cooperative Extension, Virginia Tech Institute for Policy and Governance, Virginia Veteran and Family Support, and Women's Resource Center of the NRV.

Schedule H, Part V, Section B, Line 7 Facility , 1
Facility , 1 - Carilion Giles Community Hospital. The Community Health Assessment Team shared the 2021 Giles County Area Community Health Needs Assessment (GCACHNA) on partner websites and social media. The GCACHNA was also shared during local community presentations including the New River Valley Livability Initiative Health Forum and the Aging in Community Meet Yourself event in Giles.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - Carilion Giles Community Hospital. The following information describes the implementation strategy used by Carilion Giles Community Hospital (CGCH) to address the community health needs identified in the 2021 Giles County Area Community Health Needs Assessment (GCACHNA). The complete implementation strategy is available online at https://www.carilionclinic.org/sites/default/files/2022-02/2021%20CGCH%20Implementation%20Strategy_FINAL%20APPROVED.pdf. 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 26, 2022 and applies for the 2020 tax year (fiscal year 9/30/2021). The top prioritized needs for the 2021 GCACHNA were grouped into three overarching categories: mental health, culture and family, and socioeconomic factors. We plan to address prioritized needs with the following strategies and through a commitment of financial resources, staff time and leadership. Strategies to address mental health include the expansion of peer recovery services and continuation of support to partner agency services and office-based opioid treatment (OBOT) clinics; active participation in mental health and substance misuse collaboratives, specifically the Giles Youth-Adult Partnership; and the exploration of options to expand community programming for substance misuse prevention/overdose first-aid (REVIVE) with added provision of medication lock bags. Progress made in 2022 on mental health strategies centered on maintaining what has been working well for our region and 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 system-wide and is currently working to hire a peer support specialist at Saint Albans (located near CGCH at Carilion New River Valley Medical Center). We have also designated two of the three priority areas for community health interventions as ""mental health and ""substance use."" We demonstrate continued commitment to working well with existing partner agency services and OBOT clinics, and maintain strong, active relationships with our community partner coalitions working to advance area mental health resources. Strategies to address culture and family needs include continued participation in collaborative community networks that are working to address cross-cutting social needs such as the social determinants of health and health equity issues-including Giles County FOCUS, Healthy Roots NRV and Partnerships for Access to Healthcare (PATH); the implementation of the Unite Us/Unite Virginia platform for social service referrals-including internal integration with our electronic medical record system and encouraging adoption by external community partners; providing or partnering to provide evidence-based and needs-focused health education and participating in community events such as health fairs, immunization clinics and health screenings; participation on the advisory board of the New River Community Action's Children's Health Improvement Program; and participation in the regional Trauma-Informed Community Network. Progress made in 2022 to address culture and family is driven by participation in community coalitions, increasing capacity for strategic health education, and funding through our community grant process. We continue to maintain strong community relationships and participate the networks mentioned above. We have hired and on-boarded a system-wide health education manager position, increasing infrastructure to redesign the health education departmental strategies to better meet community-identified needs, prioritize disadvantage populations, and maximize impact (including reach and outcomes). We continue our commitment to finding solutions for increased community-based resource coordination and plan to launch a pilot of an external community resource referral resource, Unite Us, in March of 2023. Strategies to address socioeconomic factors include continued participation in collaborative community networks that are working to address cross-cutting social needs such as the social determinants of health and health equity issues-including Giles County FOCUS and Healthy Roots NRV; provision of coalition development support to the Community Foundation of the NRV for 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 and network development participation and funding meaningful programs through our community grant process. In addition 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. Additional strategies to 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 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 (CHW) and peer support specialist programs have been integrated into the EMR 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 the 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. Priority needs that are not being directly addressed by CGCH include child abuse, housing and transportation/transit system due to the limited ability to create impact with current resources. However, CGCH commits to contributing to work being done in these areas through the active, intentional building of and participation in coalitions and collaboratives looking to address these cross-cutting social issues."

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - Carilion Giles Community Hospital. 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) minimal 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 Availability of Community Benefit Report
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/cho-community-health-assessments#community-benefit-reports

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
4178422

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 in-kind economic development expenses from support of GO Virginia, Virginia's Initiative for Growth and Opportunity in each region, which aims to diversify and strengthen the economy across Virginia. Carilion also provided in-kind support for the Virginia Economic Development Partnership. 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. Through monetary donations and organizational support, Carilion Giles Community Hospital supported a summer reading program in partnership with the Pearisburg Public Library and provided support to Giles High School for various projects. Carilion also participates in the NRV Aging in Community leadership team, helping to address community factors impacting aging populations, and provided in-kind support to the Peterstown Rotary Club. Carilion also participates on the Giles Health and Family Center Board, working to increase support for families through childcare, transportation and adult day services. 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 Giles County Area. We also partner with multiple community and business organizations on initiatives to improve health and wellness for everyone living in the Giles County Area. For example, Carilion staff participate in the FOCUS Network and Safe Kids Southwest Virginia. 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. In commitment to these efforts, Carilion Giles Community Hospital provides scholarships for students pursuing post-secondary education with a focus on health sciences. Additionally, Carilion supports the Virginia Foundation for Independent Colleges, helping to ensure educational opportunities lead to a stronger workforce and thriving communities.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Carilion Giles Community 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.

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 Giles Community Hospital 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 GILES COMMUNITY HOSPITAL: Line 16a URL: https://www.carilionclinic.org/billing/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- CARILION GILES COMMUNITY HOSPITAL: Line 16b URL: https://www.carilionclinic.org/billing/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- CARILION GILES COMMUNITY HOSPITAL: Line 16c 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 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 Giles County Area, including Giles County, Virginia, and Monroe County, West Virginia, is the service area for the Giles County Area Community Health Needs Assessment (GCACHNA). Carilion Giles Community Hospital (CGCH) sits atop a hill in the town of Pearisburg, in Giles County. The county is a picturesque region of Appalachian America, with mountainous terrain, cliffs, rivers and streams. It is part of the New River Valley, which includes the counties of Floyd, Giles, Montgomery (including the towns of Christiansburg and Blacksburg) and Pulaski, and the independent city of Radford. Giles County is rural and topographically isolated with 47 persons per square mile compared 214 persons per square mile in Virginia as a whole. (US Census Bureau, ACS. 2017-2021.) The Giles County Area is comprised of distinct communities with disparities in size, population, and social determinants of health. The 2017-2021 ACS found the total population of the counties of Giles and Monroe to be 16,764 and 12,492, respectively, and median ages of 45.1 and 46.0, respectively. According to the Weldon Cooper Center for Public Service, Giles County is predicted to have slightly negative population change by 2040. The service area is predominately white, with results from the ACS reporting 4.30% of the population as persons of color. Average household income differs between the two counties and is well below the state of Virginia ($111,013) and national ($97,196) averages at $67,057 for Giles County and $58,736 for Monroe County. The service area also experiences a larger percentage of residents living below the federal poverty line-12.36% for the service area overall averages at 10.26% for Giles County and 14.45% for Monroe County (US Census Bureau, ACS. 2017-2021.) Overall, 13.06% of the Giles County population receives Medicaid while 8.45% have no medical insurance. In Monroe County, 35.22% are receiving Medicaid while 12.14% are uninsured. (US Census Bureau, ACS. 2017-2021.) During FY22, 18.7% of patients receiving care at CGCH were Medicaid recipients, while 2.6% were self-pay. (Strata internal data) In addition to Carilion Clinic's two hospitals located in the New River Valley, Carilion New River Valley Medical Center and CGCH, the region is also served by LewisGale Hospital-Montgomery, located in the town of Blacksburg. Key safety-net providers in the region include the Community Health Center of the New River Valley Giles Center, the Giles County Health Department, New River Valley Community Services-including Giles Clinic and the community service board-and other service organizations . Despite the services available in the region, all of Giles County is a designatedMedically Underserved Area (MUA) and a Health Professional Shortage Area (HPSA) for primary care, dental and mental health professionals. Monroe County is an MUA for primary care, an HPSA for dental care and an HPSA for primary care and mental health specific to the low-income population (https://data.hrsa.gov/tools/shortage-area).

Schedule H, Part VI, Line 5 Promotion of community health
Carilion Giles Community Hospital 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. Carilion Giles Community Hospital (CGCH) is a modern, 25-bed Critical Access hospital, offering emergency services recognized nationally for quality and patient satisfaction in addition to high-quality inpatient care and an extended care recovery program (Swing Bed) that gives eligible patients an opportunity to grow stronger before going home. The main entrance serves as the access point for all walk-in patients needing emergency care, diagnostics, rehabilitation and other outpatient services. CGCH works to bring new services to the community as the need is identified (https://www.carilionclinic.org/locations/carilion-giles-community-hospital). CGCH serves all patients regardless of their ability to pay. The hospital's governing board is elected annually, and most members are neither employees nor contractors of the hospital. Medical staff privileges are extended to qualified providers. Surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. This includes providing free, discounted and subsidized care as well as critical medical services that operate at a loss.

Schedule H, Part VI, Line 6 Affiliated health care system
"Carilion Giles Community Hospital 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."