CAMDEN-CLARK PHYSICIAN CORPORATION: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CAMDEN-CLARK PHYSICIAN CORPORATION (EIN 26-4058719)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-11
- IRS object ID
- 202143169349303659
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-11T09:31:19-00:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264058719 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Camden-Clark Physician Corporation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CAMD | BusinessNameControlTxt |
| Phone | 3044242817 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 604 Ann Street | AddressLine1Txt |
| City | Parkersburg | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26101 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kyle Pierson | PersonNm |
| Person Title | VP Finance | PersonTitleTxt |
| Phone | 3045984410 | PhoneNum |
| Signature | 2021-11-11 | SignatureDt |
| Discuss With Paid Preparer | false | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Kyle | PersonFirstNm |
| Person Last | Pierson | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Steve Altmiller | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Garfield Avenue | AddressLine1Txt |
| City | Parkersburg | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $54,761,661 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2008 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | To support, manage, and furnish facilities, personnel, and medical services to individuals in need. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 274 | TotalEmployeeCnt |
| Total Volunteers | 2 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $640 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $51,366,235 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $54,456,412 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $68,430 | PYOtherRevenueAmt |
| CY Other Revenue | $304,609 | CYOtherRevenueAmt |
| PY Total Revenue | $51,434,665 | PYTotalRevenueAmt |
| CY Total Revenue | $54,761,661 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $30,888,654 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $31,685,303 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,546,010 | PYOtherExpensesAmt |
| CY Other Expenses | $23,076,355 | CYOtherExpensesAmt |
| PY Total Expenses | $51,434,664 | PYTotalExpensesAmt |
| CY Total Expenses | $54,761,658 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,867,794 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,121,439 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,599,588 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,853,231 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,268,206 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,268,208 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The general purposes of the corporation are as follows to establish, support, manage, and furnish facilities, personnel, and services to provide diagnostic, therapeautic, wellness, health promotion, surgical, and other professional medical services to sick, injured, or disabled persons | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $11,639,062 | ExpenseAmt |
| Revenue | $4,423,769 | RevenueAmt |
| Desc | Camden Clark Physician Corporation offers Hospitalist coverage through a term of employed physicians and in collaboration with Camden Clark Medical Center. In 2020, Hospitalists reported 97,011 work relative value units wRVUs. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $9,301,072 | ExpenseAmt |
| Revenue | $4,954,179 | RevenueAmt |
| Desc | Camden Clark Physician Corporation offers Cardiac Services through Parkersburg Cardiology. This specialization works with top of the line heart care. In 2020, Cardiac Services reported 84,840 work relative value units wRVUs and had a total of 22,506 visits. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,281,306 | ExpenseAmt |
| Revenue | $6,165,670 | RevenueAmt |
| Desc | Camden Clark Physician Corporation offers 7 Primary Care clinics across Parkersburg, WV and into Belpre, OH. These clinics work with the general public to provide patient well being. In 2020, Primary Care reported 81,907 work relative value units wRVUs and had a total of 53,339 visits. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $24,017,207 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $39,212,567 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $53,238,647 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 40 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 103 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WV | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Mary F Russell | PersonNm |
| Phone | 3044242817 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Garfield Avenue | AddressLine1Txt |
| City | Parkersburg | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Nik Shah MD | ||||||||||
| Physician | 040.00 | Yes (X) | $873,198 | $0 | $34,524 | |||||
| Patrick Dugan MD | ||||||||||
| Physician | 040.00 | Yes (X) | $872,246 | $0 | $35,080 | |||||
| David Mendoza MD | ||||||||||
| Physician | 040.00 | Yes (X) | $845,559 | $0 | $35,080 | |||||
| Steve Altmiller | ||||||||||
| Ex Offico Director/ President CEO - CCMC | 001.00 | $0 | $804,711 | $29,098 | 039.00 | Yes (X) | Yes (X) | |||
| Abiy Kelil MD | ||||||||||
| Physician | 040.00 | Yes (X) | $787,406 | $0 | $34,362 | |||||
| Galal Gargodhi MD | ||||||||||
| Physician | 040.00 | Yes (X) | $718,151 | $0 | $35,364 | |||||
| Bairava Kuppuswamy MD | ||||||||||
| Director - Vice Chairman | 040.00 | $620,358 | $0 | $34,699 | Yes (X) | Yes (X) | ||||
| Heather Irvin MD | ||||||||||
| Director | 040.00 | $442,471 | $0 | $32,697 | Yes (X) | |||||
| John Forester | ||||||||||
| VP of Provider Network Services | 001.00 | $0 | $333,226 | $69,357 | 039.00 | Yes (X) | ||||
| Sean Smith | ||||||||||
| Board Secretary -non voting, VP Physician Enterprises Clinical Integration | 001.00 | $0 | $306,022 | $51,752 | 039.00 | Yes (X) | Yes (X) | |||
| Kyle Pierson | ||||||||||
| Board Treasurer - non voting, CCHS CFO | 001.00 | $0 | $296,075 | $49,307 | 039.00 | Yes (X) | Yes (X) | |||
| Brandon Koehler | ||||||||||
| VP of Finance - Provider Network Services | 020.00 | $0 | $276,799 | $53,330 | 015.00 | Yes (X) | ||||
| David McClure | ||||||||||
| Former Officer | $0 | $264,753 | $8,592 | 040.00 | Yes (X) | |||||
| Joe Campbell | ||||||||||
| Director - Chairman | 001.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||||
| Orton Armstrong MD | ||||||||||
| Director | 001.00 | $0 | $0 | $0 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,159,389 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,281,586 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $503,242 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 81 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Parkersburg Cardiology Assoc Inc | |||||
| 600 18th St Suite 512 | Parkersburg | WV | 261013236 | Cardiac Diagnostic Contracted Services | $8,657,641 |
| CHG Companies Inc | |||||
| PO Box 972651 | Dallas | TX | 753972651 | Healthcare Staffing Services | $1,257,614 |
| All Star Recruiting Locums LLC | |||||
| 800 Fairway Dr Suite 300 | Deerfield Beach | FL | 334411824 | Healthcare Staffing Services | $1,210,637 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 753972633 | Healthcare Staffing Services | $877,787 |
| Locumtenenscom LLC | |||||
| PO Box 405547 | Atlanta | GA | 303845547 | Healthcare Staffing Services | $814,496 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $640 | AllOtherContributionsAmt |
| Total Contributions | $640 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Revenue | 621110 | $31,133,127 | $31,133,127 |
| Hospital Support Revenue | 621110 | $22,422,904 | $22,422,904 |
| CARES Act Funding | 900099 | $895,974 | $895,974 |
| COVID-19 Relief Funding | 900099 | $4,407 | $4,407 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $54,456,412 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,824 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,824 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,824 | TotalRevenueColumnAmt |
| Exclusion | $3,824 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Other Miscellaneous Revenue | 900099 | $299,556 | $299,556 | |
| Intercompany Revenue | 900099 | $1,012 | $1,012 | |
| Cash Discounts | 900099 | $217 | $217 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $300,785 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $54,761,661 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $54,756,185 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $4,836 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,130,226 | TotalAmt |
| Program Services | $1,130,226 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,122,501 | TotalAmt |
| Program Services | $27,288,104 | ProgramServicesAmt |
| Management And General | $834,397 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $338,035 | TotalAmt |
| Program Services | $327,590 | ProgramServicesAmt |
| Management And General | $10,445 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,021,965 | TotalAmt |
| Program Services | $990,059 | ProgramServicesAmt |
| Management And General | $31,906 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,072,576 | TotalAmt |
| Program Services | $1,040,753 | ProgramServicesAmt |
| Management And General | $31,823 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50 | TotalAmt |
| Program Services | $50 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees For Services Prof Fundraising | FeesForServicesProfFundraising |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,261,641 | TotalAmt |
| Program Services | $15,005,017 | ProgramServicesAmt |
| Management And General | $256,624 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,434 | TotalAmt |
| Program Services | $8,434 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $364,040 | TotalAmt |
| Program Services | $323,847 | ProgramServicesAmt |
| Management And General | $40,193 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81 | TotalAmt |
| Program Services | $81 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,259,751 | TotalAmt |
| Program Services | $1,198,657 | ProgramServicesAmt |
| Management And General | $61,094 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,918 | TotalAmt |
| Program Services | $842 | ProgramServicesAmt |
| Management And General | $14,076 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,624 | TotalAmt |
| Program Services | $875 | ProgramServicesAmt |
| Management And General | $749 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $645,018 | TotalAmt |
| Program Services | $585,165 | ProgramServicesAmt |
| Management And General | $59,853 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,494 | TotalAmt |
| Program Services | $190,436 | ProgramServicesAmt |
| Management And General | $74,058 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $670,604 | TotalAmt |
| Program Services | $670,604 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Provision for Doubtful Accounts | $2,900,386 | $2,900,386 | |
| Medical Supplies | $1,341,881 | $1,341,881 | |
| Taxes, Licenses Fees | $148,040 | $46,749 | $101,291 |
| Educational Training | $139,999 | $139,024 | $975 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,394 | TotalAmt |
| Program Services | $49,867 | ProgramServicesAmt |
| Management And General | $5,527 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,761,658 | TotalAmt |
| Program Services | $53,238,647 | ProgramServicesAmt |
| Management And General | $1,523,011 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,204 | BOYAmt |
| EOY | $2,018,854 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $525,580 | BOYAmt |
| EOY | $119,561 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,575,041 | BOYAmt |
| EOY | $4,657,649 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,500 | BOYAmt |
| EOY | $33,000 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $305,955 | BOYAmt |
| EOY | $204,676 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,898,996 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,443,252 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $247,587 | BOYAmt |
| EOY | $455,744 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,927 | BOYAmt |
| EOY | $631,955 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,867,794 | BOYAmt |
| EOY | $8,121,439 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,153,112 | BOYAmt |
| EOY | $1,306,171 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,656,279 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,446,476 | BOYAmt |
| EOY | $1,890,781 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,599,588 | BOYAmt |
| EOY | $4,853,231 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,268,206 | BOYAmt |
| EOY | $3,268,208 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,268,206 | BOYAmt |
| EOY | $3,268,208 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,867,794 | BOYAmt |
| EOY | $8,121,439 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$1 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
| Facts And Circumstances Test | Part I Section A Line 3 Although the organization qualifies as a hospital under IRC Section 170B1AIII as shown on Schedule A, Part I, Line III, the organization is not a licensed hospital in the state of West Virginia, and therefore, it is not required to complete Form 990, Schedule H. | FactsAndCircumstancesTestTxt |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,750,258 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,443,252 | DepreciationAmt |
| Book Value | $307,006 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $148,738 | OtherCostOrOtherBasisAmt |
| Book Value | $148,738 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $455,744 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc |
|---|
| Financial derivatives and other financial products |
| Closely-held equity interests |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due to/from Related Organization - WVUHS | -$64,442 |
| Due to/from Related Organization - CCMC | $699,235 |
| Due to/from IC AHS | -$2,838 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $631,955 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| Federal income taxes | |
| Accrued wages, benefits, vacation, fringes and payroll taxes | $1,424,888 |
| Accrued pension benefits | |
| State income taxes payable | -$28,338 |
| Deferred FICA tax payable | $406,554 |
| Long term lease liability | $87,677 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,890,781 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $51,861,214 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$2,900,447 | OtherRevenueAmt |
| Revenue Not Reported | -$2,900,447 | RevenueNotReportedAmt |
| Revenue Subtotal | $54,761,661 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $54,761,661 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $51,861,211 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $51,861,211 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,900,447 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,900,447 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $54,761,658 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| X 2 | Most of the entities that comprise the System are tax-exempt organizations and not subject to federal or state income taxes in accordance with Section 501c3 of the Internal Revenue Code. On such basis, they will not incur any liability for income taxes, except for possible unrelated business income. AHS, WVUIS and GHC are organizations subject to federal and/or state income taxes. The System does not have any material uncertain tax positions as of December 31, 2020 and 2019. |
| XI 2d | The amount shown on line 2d consists of 2,900,386 provision for doubtful accounts and 61 of intercompany expense reported as an offset to revenue on the audited financial statements but is reported as an expense on Form 990. |
| XII 4b | The amount shown on line 4b consists of 2,900,386, provision for doubtful accounts and 61 of intercompany expense reported as an offset to revenue on the audited financial statements but is reported as an expense on Form 990. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | false | SubstantiationRequiredInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (true) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Heather Irvin MD | ||||||||||||
| Director | $394,093 | $48,378 | $5,997 | $26,700 | $475,168 | |||||||
| Steve Altmiller | ||||||||||||
| Ex Offico Director/ President CEO - CCMC | $502,928 | $179,100 | $122,683 | $9,033 | $20,065 | $833,809 | ||||||
| Bairava Kuppuswamy MD | ||||||||||||
| Director - Vice Chairman | $432,324 | $187,655 | $8,012 | $26,687 | $655,057 | $379 | ||||||
| Sean Smith | ||||||||||||
| Board Secretary -non voting, VP Physician Enterprises Clinical Integration | $241,356 | $59,988 | $4,677 | $25,482 | $26,271 | $357,774 | ||||||
| Kyle Pierson | ||||||||||||
| Board Treasurer - non voting, CCHS CFO | $229,360 | $61,984 | $4,731 | $28,388 | $20,919 | $345,382 | ||||||
| Brandon Koehler | ||||||||||||
| VP of Finance - Provider Network Services | $219,638 | $52,844 | $4,317 | $26,375 | $26,955 | $330,129 | ||||||
| Patrick Dugan MD | ||||||||||||
| Physician | $758,705 | $110,299 | $8,041 | $27,039 | $907,326 | $3,242 | ||||||
| Nik Shah MD | ||||||||||||
| Physician | $742,594 | $119,480 | $10,731 | $23,793 | $907,722 | $11,124 | ||||||
| David Mendoza MD | ||||||||||||
| Physician | $729,305 | $113,932 | $8,041 | $27,039 | $880,639 | $2,322 | ||||||
| Abiy Kelil MD | ||||||||||||
| Physician | $547,350 | $239,516 | $7,339 | $27,023 | $821,768 | $540 | ||||||
| Galal Gargodhi MD | ||||||||||||
| Physician | $480,438 | $237,226 | $7,593 | $27,772 | $753,515 | $486 | ||||||
| David McClure | ||||||||||||
| Former Officer | $128,078 | $102,005 | $34,670 | $4,811 | $3,781 | $273,345 | ||||||
| John Forester | ||||||||||||
| VP of Provider Network Services | $258,725 | $69,322 | $5,179 | $42,411 | $26,946 | $402,583 | ||||||
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I Line 3 | Compensation for CEOs is determined by the WV United Health System compensation committee. The System engages an independent group to perform an executive compensation review and compensation survey every two years. This information is provided to the committee, which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compensation package offered does not exceed fair market value. |
| Part I Line 4b | Brandon Koehler had 21,832 of deferred CAA contributions in 2020. John Forester had 38,379 of deferred CAA contributions in 2020. Sean Smith had deferred compensation contributions of 22,375 from a related organization. David McClure had cash distributions of 20,058 from a related party. Steve Altmiller had cash distributions of 88,571 from a related party. |
| Part I Line 5 | Some but not all physicians have a productivity bonus in their contract. This bonus is based on producing over a set relative value unit RVU during the year. Physician compensation is capped at the 90 MGMA or at an alternative amount as determined by an independent third party valuation firm. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4d | Program Service Expenses 24,017,207, Grants and allocations 0, Revenue 39,212,567 CCPC strives to offer a comprehensive range of inpatient, outpatient and outreach clinic services, including prevention, guidance, diagnosis, treatment, restoration, rehabilitation and other efforts as may be required to meet the health care needs of the community in which it serves. In addition to the Cardiac, Primary Care and Hospitalists program services described above, the organization employs physicians who specialize in surgery, diabetes and nutritional management, behavioral health. CCPC has started to grow a network of employed primary care physicians throughout the community in an effort to address what is believed to be a significant shortage of available primary care for the residents of the mid-ohio valley. Although reimbursement for services rendered is critica to the operation and stability of the organization, it is recognized that not all individuals possess the ability to purchase essential medical services. Our mission, in conjunction with Camden Clark Medical Hospital, is to serve the community by providing health care services and health care education. |
| Form 990, Part III, Line 1 | Without regard to race, creed, color, sex, national origin, or financial status, and to otherwise promote the quality, accessibility, and affordability of such professional medical services. |
| Form 990, Part VI, Section A, Line 6 | Camden-Clark Health Services, Inc. As of March 1, 2011, affiliated with West Virginia United Health System, a non-profit, tax-exempt corporation is the sole member of the organization. |
| Form 990, Part VI, Section A, Line 7a | Camden-Clark Health Services Inc., the organizations sole member, nominates all board members of the organization. Board members are elected by West Virginia Health System, WVUHS from the CCHS nominations. |
| Form 990, Part VI, Section A, Line 7b | Camden-Clark Health Services, Inc., the organizations sole member, approves certain reserved items regarding Camden-Clark Physician Corporation. |
| Form 990, Part VI, Section B, Line 11b | The VP of finance and the board of directors review the completed Form 990 prior to filing. |
| Form 990, Part VI, Section B, Line 12c | To identify and monitor any conflicts, a signed conflict of interest statement is required from board members of the organization and key individuals that are in a position to make or influence decisions. If an actual or possible conflict of interest is observed or disclosed, the organization invokes the procedures set out in the policy/bylaws for addressing the conflict of interest. For key individuals employees, a specific conflict of interest standard in the organizations code of ethics and business conduct also exists. |
| Form 990, Part VI, Section B, Line 15a | The compensation of the CEO if applicable is determined by the WV United Health System Compensation Committee based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. This information is provided to the compensation committee which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compensation package does not exceed fair market value based on the data from the consultant group. The minutes of the compensation committee are contemporaneously documented and retained. A full compensation survey was completed in 2019 for 2020 compensation amounts. |
| Form 990, Part VI, Section B, Line 15b | The compensation of all officers at the Vice President level and below is determined based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. This data is then interpreted and provided to an independent compensation committee. The independent compensation committee then uses this data to determine a fair and reasonable compensation package. All relevant data as well as minutes from each meeting are retained. |
| Form 990, Part VI, Section C, Line 19 | The organizations governing documents, conflict of interest policy, and financial statements are made available upon request. The organizations financial statements are also available on the WV Healthcare Authoritys website. |
| Form 990, Part VI, Section A, Line 1 | Steve Altmiller was compensated for holding the position of CEO at Camden Clark Memorial Hospital. This individual is compensated for their work for their respective organization, not for serving on the board of directors. |
| Form 990, Part IX, Line 11g | Expenses reported on line 11g consist of the following items Consulting and Professional Fees of 117 all of which is considered program service expense Contracted Labor of 3,763,790 of which 3,507,166 is considered program service expense and 256,624 is considered management and general expense Lab Fees of 180 all of which is considered program service expense Contracted Labor - Patient Care of 28,624 all of which is considered program service expense Contracted Med Staff Expense of 5,592,996 all of which is considered program service expense Contracted Physician Expense of 4,884,735 all of which is considered program service expense and Collection Agency Fees of 991,199 all of which is considered program service expense. |
| Form 990, Part XI, Line 9 | Other changes in net assets includes 1 of rounding. |
| Form 990, Part VII, Section A, Line 1-15 | In accordance with IRS regulations and Form 990 instructions Former officers, key employees, and Board of Directors have been listed as appropriate. |
| Form 990, Part I, Line 5 | Camden-Clark Physician Corporation has common paymaster agreements with related parties. Therefore, total employee count may differ from the total W-2 count reported on Form W-3. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Camden-Clark Health Services Inc | |||||||||||
| 800 Garfield Avenue | Parkersburg | WV | 26101 | 550769602 | Healthcare Access | WV | 501c3 | Line 12A | West Virginia United Health System | false | |
| Camden-Clark Memorial Hospital Corporation | |||||||||||
| 800 Garfield Avenue | Parkersburg | WV | 26101 | 311524546 | Patient Care | WV | 501c3 | Line 3 | Camden-Clark Health Services | false | |
| Camden-Clark Foundation Inc | |||||||||||
| 800 Garfield Avenue | Parkersburg | WV | 26101 | 550667789 | Hospital Support | WV | 501c3 | Line 7 | Camden-Clark Health Services | false | |
| WV United Health System | |||||||||||
| PO Box 8034 | Morgantown | WV | 26506 | 550754713 | Healthcare Access | WV | 501c3 | Line 12A | false | N/A | |
| West Virginia University Hospitals Inc | |||||||||||
| PO Box 8034 | Morgantown | WV | 26506 | 550643304 | Patient Care | WV | 501c3 | Line 3 | West Virginia United Health System | false | |
| West Virginia University Hospitals East | |||||||||||
| 2500 Foundation Way | Martinsburg | WV | 25401 | 202337985 | Healthcare Access | WV | 501c3 | Line 12A | West Virginia University Hospitals Inc | false | |
| City Hospital Inc | |||||||||||
| 2500 Foundation Way | Martinsburg | WV | 25401 | 550383321 | Patient Care | WV | 501c3 | Line 3 | West Virginia University Hospitals East | false | |
| Jefferson Memorial Hospital | |||||||||||
| 300 S Preston St | Ranson | WV | 25438 | 550359755 | Patient Care | WV | 501c3 | Line 3 | West Virginia University Hospitals East | false | |
| University Healthcare Foundation | |||||||||||
| 2500 Foundation Way | Martinsburg | WV | 25401 | 311118075 | Hospital Support | WV | 501c3 | Line 12A | West Virginia University Hospitals Inc | false | |
| United Hospital Center Inc | |||||||||||
| 327 Medical Park Drive | Bridgeport | WV | 26330 | 550525724 | Patient Care | WV | 501c3 | Line 3 | West Virginia United Health System | false | |
| United Physicians Care Inc | |||||||||||
| 686 South Pike Street | Shinnston | WV | 26431 | 550638563 | Patient Care | WV | 501c3 | Line 3 | United Hospital Center Inc | false | |
| United Health Foundation | |||||||||||
| 327 Medical Park Drive | Bridgeport | WV | 26330 | 550621706 | Hospital Support | WV | 501c3 | Line 12A | United Hospital Center Inc | false | |
| West Virginia Health Care Cooperative Inc | |||||||||||
| 400 Fairview Heights Rd | Summersville | WV | 26651 | 550650441 | Patient Care | WV | 501c3 | 3 | West Virginia University Hospitals Inc | false | |
| United Summit Center Inc | |||||||||||
| 6 Hospital Plaza | Clarksburg | WV | 26301 | 550752788 | Behavioral Health | WV | 501c3 | Line 3 | West Virginia University Hospitals Inc | false | |
| Potomac Valley Hospital of WVa Inc | |||||||||||
| 100 Pin Oak Lane | Keyser | WV | 26726 | 550420956 | Patient Care | WV | 501c3 | Line 3 | West Virginia University Hospitals Inc | false | |
| St Joseph's Hospital of Buckhannon Inc | |||||||||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | 550356996 | Patient Care | WV | 501c3 | Line 3 | West Virginia United Health System | false | |
| Reynolds Memorial Hospital Inc | |||||||||||
| 800 Wheeling Ave | Glen Dale | WV | 26038 | 550357045 | Patient Care | WV | 501c3 | Line 3 | West Virginia University Hospitals Inc | false | |
| Reynolds Memorial Foundation | |||||||||||
| 800 Wheeling Ave | Glen Dale | WV | 26038 | 550710402 | Hospital Support | WV | 501c3 | Line 12A | Reynolds Memorial Hospital Inc | false | |
| St Josephs Foundation of Buckhannon | |||||||||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | 550727650 | Hospital Support | WV | 501c3 | Line 12b | St Joseph's Hospital of Buckhannon Inc | false | |
| Braxton County Memorial Hospital | |||||||||||
| 100 Hoylman Drive | Gassaway | WV | 26624 | 550611919 | Patient Care | WV | 501c3 | Line 3 | West Virginia University Hospitals Inc | false | |
| Community Health Association | |||||||||||
| 122 Pinnell Street | Ripley | WV | 25271 | 550462730 | Patient Care | WV | 501c3 | Line 3 | West Virginia University Hospitals Inc | false | |
| Wetzel County Hospital Inc | |||||||||||
| 3 E Benjamin Drive | New Martinsville | WV | 26155 | 843480493 | Patient Care | WV | 501c3 | Line 3 | West Virginia University Hospitals Inc | false | |
| WVUHS Home Care LLC | |||||||||||
| PO Box 8059 | Morgantown | WV | 26506 | 852915642 | Home Health and Hospice | WV | 509a2 | West Virginia United Health System | false | ||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Allied Health Sourcing Solutions | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 8034 | AddressLine1Txt |
| City | Morgantown | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 842403526 | EIN |
| Primary Activities | Supply Chain Management | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | false | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Allied Health Services Inc | |||||||||
| PO Box 782 | Morgantown | WV | 26507 | 550652017 | Medical Lab | WV | WV United Health System | C Corp | false |
| West Virginia United Insurance Services | |||||||||
| 3040 University Avenue Suite 3200 | Morgantown | WV | 26505 | 550756055 | Provider Network | WV | WV United Health System | C Corp | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (true) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |