Carilion Health System, now known as Carilion Clinic, is a large, Roanoke, Virginia-based not-for-profit health care organization. Carilion owns and operates eight hospitals in the western part of Virginia. The company also operates primary care clinics, residency and fellowship programs, laboratories, health clubs, an aeromedical program, and sub-specialty medical practices. Carilion originated with Roanoke Memorial Hospital, which is located at the base of Mill Mountain in southwest Roanoke. The hospital eventually expanded into related health care services and the acquisition of other hospitals. Most prominent was the acquisition of the competing Community Hospital of Roanoke Valley in downtown Roanoke. The deal took several years to complete because of anti-trust concerns by the United States Department of Justice that two of the three major hospitals in the Roanoke Valley would now be under the same ownership. In the early 1990s, Roanoke Memorial adopted the name Carilion for its consolidated health care business. Approximately 6,200 of Carilion's 9,600 employees are in the Roanoke Valley, making it the area's leading employer.In addition to traditional hospital-based services, Carilion has established the Carilion Biomedical Institute in Roanoke in association with Virginia Tech and the University of Virginia. The Institute is a business incubator designed to introduce advanced medical devices into the marketplace. A related goal is the development of a cluster of such firms in the Roanoke area. One such company is Luna Innovations, which is partially owned by Carilion and has oved its corporate headquarters to the Institute's business park. Carilion's management has warned that trends in the health care sector threaten to undermine the organization's financial position. Carilion has gross revenues of approximately $2 billion per year and ran a $93.6 million surplus in the last fiscal year. In response, Carilion has announced plans for a significant business reorganization which will change its emphasis from running hospitals to hiring more doctors in a larger number of medical specialties, with a primary goal of better coordination of patient care and an emphasis on medical education and research. There are currently no plans to sell its eight hospitals. The plan was developed after visits to the Mayo Clinic and other similar organizations. As part of the reorganization plan, Carilion has renamed itself Carilion Clinic. Some local doctors have expressed concern that their independence could be eliminated and that the scale of the reorganization, if it is not successful, could imperil the organization and the quality of health care in the Roanoke area and have formed the Coalition for Responsible Healthcare to express their concerns.As part of the Carilion Clinic's focus on education and research, Carilion and Virginia Tech recently announced plans to establish a small medical school in Roanoke. Carilion currently operates the Jefferson College of Health Sciences which offers a master of science in nursing and 13 associate and baccalaureate allied healthcare programs.