CAMDEN-CLARK PHYSICIAN CORPORATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CAMDEN-CLARK PHYSICIAN CORPORATION (EIN 26-4058719)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-01
- IRS object ID
- 201623069349300207
- Schema version
- 2015v2.1
- 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 | 2016-11-01T07:58:50-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1747 | AddressLine1Txt |
| City | CHARLESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25326 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | 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 | 800 GARFIELD AVENUE | AddressLine1Txt |
| City | PARKERSBURG | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26102 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CAROLYN ALLEN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3044242202 | PhoneNum |
| Signature | 2016-09-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SUSAN S DULL | PreparerPersonNm |
| PTIN | P00233523 | PTIN |
| Phone | 3043430168 | PhoneNum |
| Preparation | 2016-09-29 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CAROLYN ALLEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 GARFIELD AVENUE | AddressLine1Txt |
| City | PARKERSBURG | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,089,790 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CCMH.ORG | WebsiteAddressTxt |
| 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 | 3 | VotingMembersIndependentCnt |
| Total Employee | 218 | TotalEmployeeCnt |
| Total Volunteers | 3 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,822,951 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,047,429 | CYProgramServiceRevenueAmt |
| PY Investment Income | $169,551 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $9,237 | PYOtherRevenueAmt |
| CY Other Revenue | $42,361 | CYOtherRevenueAmt |
| PY Total Revenue | $20,001,739 | PYTotalRevenueAmt |
| CY Total Revenue | $24,089,790 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $300 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $22,796,169 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,058,392 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,241,456 | PYOtherExpensesAmt |
| CY Other Expenses | $10,092,954 | CYOtherExpensesAmt |
| PY Total Expenses | $31,040,125 | PYTotalExpensesAmt |
| CY Total Expenses | $36,151,646 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$11,038,386 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$12,061,856 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,944,725 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,850,612 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $21,382,805 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,392,154 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$17,438,080 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $458,458 | 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, THERAPEUTIC, WELLNESS, HEALTH PROMOTION, SURGICAL, AND OTHER PROFESSIONAL MEDICAL SERVICES TO SICK, INJURED, OR DISABLED PERSONS 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,641,078 | ExpenseAmt |
| Revenue | $3,607,930 | RevenueAmt |
| Desc | CAMDEN CLARK PHYSICIAN CORPORATION EMPLOYS TWO MEDICAL ONCOLOGISTS AND TWO RADIATION ONCOLOGISTS, AND IN CONJUNCTION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION, THESE PHYSICIANS PROVIDE A WIDE VARIETY OF CANCER TREATMENT OPTIONS AS WELL AS EDUCATION TO RESIDENTS OF THE MID-OHIO VALLEY SERVICE AREA. THROUGH THE HOSPITAL'S COLLABORATION WITH THE AMERICAN CANCER SOCIETY, THE DEVELOPMENT OF THE ORGANIZATION'S CANCER RESOURCE CENTER, A HAIR RESTORATION SALON, A PATIENT NAVIGATOR AND AN ONCOLOGY SOCIAL WORKER, THESE PHYSICIANS ARE ABLE TO HELP PROVIDE A HOLISTIC HEALING ENVIRONMENT THAT INCLUDES SUPPORT GROUPS FOR PATIENTS AND THEIR FAMILIES. CAMDEN CLARK PHYSICIAN CORPORATION PERFORMED 246,887 PROCEDURES AND 120,151 PATIENT VISITS IN 2015. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,884,872 | ExpenseAmt |
| Revenue | $5,644,190 | RevenueAmt |
| Desc | CAMDEN CLARK PHYSICIANS CORPORATION OFFERS UROLOGICAL SERVICES THROUGH A TEAM OF EMPLOYED PHYSICIANS AND IN COLLABORATION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION. THE TEAM OF PHYSICIANS SPECIALIZES IN KIDNEY STONES, EVALUATION AND TREATMENT OF PROSTATE RELATED ISSUES, VASECTOMY, ERECTILE DYSFUNCTION, KIDNEY/BLADDER/PROSTATE CANCER, URINARY TRACT INFECTIONS, AND MALE AND FEMALE INCONTINENCE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,706,901 | ExpenseAmt |
| Revenue | $6,110,644 | RevenueAmt |
| Desc | CAMDEN CLARK PHYSICIAN CORPORATION OFFERS OB/GYN SERVICES THROUGH A TEAM OF EMPLOYED PHYSICIANS AND IN COLLABORATION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $26,931,198 | ExpenseAmt |
| Grant | $300 | GrantAmt |
| Revenue | $8,727,026 | RevenueAmt |
| Desc | CAMDEN CLARK PHYSICIAN CORPORATION 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 CANCER, UROLOGICAL AND OB/GYN PROGRAMS DESCRIBED ABOVE, THE ORGANIZATION EMPLOYS PHYSICIANS WHO SPECIALIZE IN SURGERY, DIABETES AND NUTRITIONAL MANAGEMENT, BEHAVIORAL HEALTH AND HAS BEGUN TO BUILD 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 CRITICAL 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 MEMORIAL HOSPITAL, IS TO SERVE THE COMMUNITY BY PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. IN KEEPING WITH THIS COMMITMENT TO SERVICE ALL MEMBERS OF THE COMMUNITY, THE ORGANIZATION WILL PROVIDE THE FOLLOWING WHERE THE INDIVIDUAL'S NEED AND/OR AN INABILITY TO PAY COEXIST:* FREE CARE AND/OR SUBSIDIZED CARE* CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST* HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITYSERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE ORGANIZATION RECOGNIZES THESE AMOUNTS AS CHARITY CARE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $26,931,198 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $300 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $8,727,026 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $35,164,049 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 218 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WV | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARY F RUSSELL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 26102 | 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 | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| KATHY G EDDY | |||||||||
| CHAIRMAN | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| TERRY CAPEL MD | |||||||||
| BOARD MEMBER (VICE CHAIRMAN) | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DR DANIEL MCGRAW | |||||||||
| BOARD MEMBER | 39.70 | 0.30 | Yes (X) | $944,016 | $0 | $55,584 | |||
| JOSEPH CAMPBELL | |||||||||
| BOARD MEMBER | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID MCCLURE | |||||||||
| EX OFFICIO | 1.00 | 39.00 | Yes (X) | $0 | $517,095 | $36,964 | |||
| SEAN SMITH | |||||||||
| EXEC DIR./SECRETARY | 40.00 | Yes (X) | $114,232 | $0 | $26,079 | ||||
| CAROLYN ALLEN | |||||||||
| VP FINANCE | 5.00 | 35.00 | Yes (X) | $0 | $290,428 | $26,650 | |||
| TODD A KRUGER | |||||||||
| VICE PRESIDENT | 4.00 | 36.00 | Yes (X) | $0 | $383,564 | $15,865 | |||
| THOMAS R HELLER | |||||||||
| VICE PRESIDENT | 4.00 | 36.00 | Yes (X) | $0 | $319,586 | $50,655 | |||
| DR JOSE CRUZZAVALA | |||||||||
| PHYSICIAN | 40.00 | $751,779 | $0 | $36,975 | Yes (X) | ||||
| DR NIK SHAH | |||||||||
| PHYSICIAN | 40.00 | $896,983 | $0 | $40,355 | Yes (X) | ||||
| DR STEVEN MILLER | |||||||||
| PHYSICIAN | 40.00 | $788,612 | $0 | $45,120 | Yes (X) | ||||
| DR ABIY KELIL | |||||||||
| PHYSICIAN | 40.00 | $642,129 | $0 | $20,131 | Yes (X) | ||||
| DR PATRICK DUGAN | |||||||||
| PHYSICIAN | 40.00 | $617,948 | $0 | $33,606 | Yes (X) | ||||
| MICHAEL KING | |||||||||
| FORMER CEO | 5.00 | 2.00 | $0 | $294,281 | $6,089 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,755,699 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,804,954 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $394,073 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 47 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEATHERBY LOCUMS INC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 972633 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75397 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | STAFFING SERVICES | ServicesDesc |
| Compensation | $1,090,990 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $24,047,429 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,047,429 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,047,429 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $42,361 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $42,361 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $42,361 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,089,790 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,089,790 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | 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 | $300 | TotalAmt |
| Program Services | $300 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,013,550 | TotalAmt |
| Program Services | $4,943,394 | ProgramServicesAmt |
| Management And General | $70,156 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,038,144 | TotalAmt |
| Program Services | $18,447,962 | ProgramServicesAmt |
| Management And General | $590,182 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68 | TotalAmt |
| Program Services | $66 | ProgramServicesAmt |
| Management And General | $2 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,183,038 | TotalAmt |
| Program Services | $1,146,364 | ProgramServicesAmt |
| Management And General | $36,674 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $823,592 | TotalAmt |
| Program Services | $798,061 | ProgramServicesAmt |
| Management And General | $25,531 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,293,772 | TotalAmt |
| Program Services | $6,098,665 | ProgramServicesAmt |
| Management And General | $195,107 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,634 | TotalAmt |
| Program Services | $2,634 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,219 | TotalAmt |
| Program Services | $147,500 | ProgramServicesAmt |
| Management And General | $4,719 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,226 | TotalAmt |
| Program Services | $3,126 | ProgramServicesAmt |
| Management And General | $100 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,407 | TotalAmt |
| Program Services | $29,464 | ProgramServicesAmt |
| Management And General | $943 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,767 | TotalAmt |
| Program Services | $43,379 | ProgramServicesAmt |
| Management And General | $1,388 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,434 | TotalAmt |
| Program Services | $126,391 | ProgramServicesAmt |
| Management And General | $4,043 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $778,432 | TotalAmt |
| Program Services | $754,301 | ProgramServicesAmt |
| Management And General | $24,131 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | $1,000,553 | $1,000,553 | |
| RENT/LEASE EQUIPMENT | $647,578 | $627,503 | $20,075 |
| MEDICAL SUPPLIES | $539,697 | $539,697 | |
| REPAIRS AND MAINTENANCE | $140,161 | $135,816 | $4,345 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,074 | TotalAmt |
| Program Services | $318,873 | ProgramServicesAmt |
| Management And General | $10,201 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,151,646 | TotalAmt |
| Program Services | $35,164,049 | ProgramServicesAmt |
| Management And General | $987,597 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $872,443 | BOYAmt |
| EOY | $743,916 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,857,653 | BOYAmt |
| EOY | $1,699,779 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $40,000 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $822,025 | BOYAmt |
| EOY | $100,597 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,379,730 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,113,411 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $392,604 | BOYAmt |
| EOY | $266,319 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,944,725 | BOYAmt |
| EOY | $2,850,612 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,259,381 | BOYAmt |
| EOY | $2,392,154 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,123,424 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,382,805 | BOYAmt |
| EOY | $2,392,154 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$17,438,080 | BOYAmt |
| EOY | $458,458 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$17,438,080 | BOYAmt |
| EOY | $458,458 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,944,725 | BOYAmt |
| EOY | $2,850,612 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$12,061,856 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $29,958,394 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | ALTHOUGH THE ORGANIZATION QUALIFIES AS A HOSPITAL UNDER IRC SECTION 170(B)(1)(A)(III) 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,379,730 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,113,411 | DepreciationAmt |
| Book Value | $266,319 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $266,319 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | WVUHS, WVUH, PVH, CCHS, CCMC, CCF, CCPC, UNIVERSITY HEALTHCARE, BMC, JMC,UNIVERSITY HEALTHCARE FOUNDATION, UHC, USC, UHF, UPC, SJH AND SJF ARE TAX-EXEMPT ORGANIZATIONS AND NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ON SUCH BASIS, THEY WILL NOT INCUR ANY LIABILITY FOR INCOME TAXES, EXCEPT FOR POSSIBLE UNRELATED BUSINESS INCOME. AHS AND WVUIS ARE ORGANIZATIONS SUBJECT TO FEDERAL AND/OR STATE INCOME TAXES. THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2015 AND 2014. THE SYSTEM'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR DANIEL MCGRAW | ||||||||||||||
| BOARD MEMBER | $859,016 | $0 | $0 | $0 | $85,000 | $0 | $38,941 | $0 | $16,643 | $0 | $999,600 | $0 | $0 | $0 |
| DAVID MCCLURE | ||||||||||||||
| EX OFFICIO | $0 | $459,792 | $0 | $57,303 | $0 | $0 | $0 | $24,000 | $0 | $12,964 | $0 | $554,059 | $0 | $0 |
| CAROLYN ALLEN | ||||||||||||||
| VP FINANCE | $0 | $290,428 | $0 | $0 | $0 | $0 | $0 | $24,000 | $0 | $2,650 | $0 | $317,078 | $0 | $0 |
| TODD A KRUGER | ||||||||||||||
| VICE PRESIDENT | $0 | $304,248 | $0 | $79,316 | $0 | $0 | $0 | $0 | $0 | $15,865 | $0 | $399,429 | $0 | $0 |
| THOMAS R HELLER | ||||||||||||||
| VICE PRESIDENT | $0 | $268,405 | $0 | $51,181 | $0 | $0 | $0 | $42,000 | $0 | $8,655 | $0 | $370,241 | $0 | $0 |
| DR JOSE CRUZZAVALA | ||||||||||||||
| PHYSICIAN | $751,779 | $0 | $0 | $0 | $0 | $0 | $24,000 | $0 | $12,975 | $0 | $788,754 | $0 | $0 | $0 |
| DR NIK SHAH | ||||||||||||||
| PHYSICIAN | $759,589 | $0 | $137,394 | $0 | $0 | $0 | $24,000 | $0 | $16,355 | $0 | $937,338 | $0 | $0 | $0 |
| DR STEVEN MILLER | ||||||||||||||
| PHYSICIAN | $662,260 | $0 | $126,352 | $0 | $0 | $0 | $42,000 | $0 | $3,120 | $0 | $833,732 | $0 | $0 | $0 |
| DR ABIY KELIL | ||||||||||||||
| PHYSICIAN | $500,639 | $0 | $141,490 | $0 | $0 | $0 | $18,000 | $0 | $2,131 | $0 | $662,260 | $0 | $0 | $0 |
| DR PATRICK DUGAN | ||||||||||||||
| PHYSICIAN | $617,948 | $0 | $0 | $0 | $0 | $0 | $18,000 | $0 | $15,606 | $0 | $651,554 | $0 | $0 | $0 |
| MICHAEL KING | ||||||||||||||
| FORMER CEO | $0 | $22,027 | $0 | $0 | $0 | $272,254 | $0 | $0 | $0 | $6,089 | $0 | $300,370 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | MEMBERSHIPS AT THE HEALTH AND WELLNESS CENTER ARE OFFERED TO EACH MEMBER OF THE SENIOR LEADERSHIP TEAM. THESE DUES ARE COVERED IN THE APPLICABLE EMPLOYMENT CONTRACTS. |
| PART I, LINE 3 | COMPENSATION IS ESTABLISHED BY WEST VIRGINIA HEALTH SYSTEM (WVUHS) FOR CAMDEN-CLARK PHYSICIAN CORPORATION |
| PART I, LINE 5 | EACH PHYSICIAN HAS A PRODUCTIVITY BONUS IN THEIR CONTRACT. THIS BONUS IS BASED ON PRODUCING OVER A SET RELATIVE VALUE UNIT (RVU) DURING THE YEAR. THERE IS ALSO A COMPONENT FOR EACH PHYSICIAN BASED ON COLLECTIONS. AS AN EXAMPLE, IF THE PHYSICIAN PRODUCES IN EXCESS OF THEIR ESTABLISHED RVU NUMBER AT THE 90TH PRECENTILE, BUT COLLECTS AT THE 75TH PERCENTILE, THE BONUS IS THEN BASED ON THE 75TH PERCENTILE. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | DR. MCGRAW AND MICHAEL KING ARE NOT INDEPENDENT. DR. MCGRAW WAS COMPENSATED BY CCPC, AND MICHAEL KING WAS COMPENSATED AS CEO BY THE RELATED ORGANIZATION CAMDEN CLARK MEMORIAL HOSPITAL. |
| 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 ORGANIZATION'S 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 ORGANIZATION'S SOLE MEMBER, SHALL APPROVE ALL MATTERS REGARDING CAMDEN-CLARK PHYSICIAN CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHIEF FINANCIAL OFFICER, DIRECTOR OF FINANCE AND THE BOARD OF DIRECTORS REVIEW THE COMPLETED FORM 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 ORGANIZATION'S CODE OF ETHICS AND BUSINESS CONDUCT ALSO EXISTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | QUESTION 15A: THE SYSTEM'S CEO AND TOP MANAGEMENT OFFICIALS ARE EMPLOYED BY CAMDEM-CLARK MEMORIAL HOSPITAL (CCMH) AND HAVE ROLES THROUGHOUT CAMDEN-CLARK HEALTH SERVICES (CCHS) WHICH IS ALSO AFFILIATED WITH WEST VIRGINIA UNITED HEALTH SYSTEM (WVUHS). THIS ORGANIZATION DOES NOT HAVE A CEO. THE EXECUTIVE DIRECTOR'S PAY AND OTHER TOP MANAGEMENT OFFICIAL'S PAY IS REVIEWED AND APPROVED BY THE CCMH/CCHS BOARD OF DIRECTORS. QUESTION 15B: FOR THE PHYSICIANS, THEIR CONTRACTS ARE BASED ON INDIVIDUAL FAIR MARKET EVALUATIONS UTILIZING MEDICAL GROUP MANAGEMENT ASSOCIATION STANDARDS AND OTHER DATA. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON THE WV HEALTHCARE AUTHORITY'S WEBSITE. |
| FORM 990, PART VII | DR. MCGRAW AND MICHAEL KING ARE COMPENSATED FOR THEIR WORK FOR THEIR RESPECTIVE ORGANIZATIONS, NOT FOR SERVING ON THE BOARD OF DIRECTORS. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 6,058,163. MANAGEMENT AND GENERAL EXPENSES 193,811. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,251,974. BANKING AND COLLECTION FEES: PROGRAM SERVICE EXPENSES 40,502. MANAGEMENT AND GENERAL EXPENSES 1,296. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,798. |
| FORM 990, PART XI, LINE 9: | FUNDING FROM CAMDEN CLARK MEMORIAL HOSPITAL FOR PRIOR ACTIVITIES 17,123,424. FUNDING FROM CAMDEN CLARK MEMORIAL HOSPITAL FOR CURRENT ACTIVITIES 12,834,970. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 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 | 26102 | 550769602 | AIDS, STRENGTHENS, AND SUPPORTS CAMDEN-CLARK MEMORIAL HOSPITAL. | WV | 501(C)(3) | LINE 11A, I | WEST VIRGINIA UNITED HEALTH SYSTEM | 0 | |
| CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION | |||||||||||
| 800 GARFIELD AVENUE | PARKERSBURG | WV | 26102 | 311524546 | OPERATES AN ACUTE CARE AND EMERGENCY HOSPITAL FACILITY. | WV | 501(C)(3) | LINE 3 | 0 | N/A | |
| AUXILIARY OF CAMDEN-CLARK MEMORIAL HOSPITAL OF PARKERSBURG | |||||||||||
| 800 GARFIELD AVENUE | PARKERSBURG | WV | 26102 | 550386283 | PROMOTES ADVANCEMENT AND WELFARE OF CAMDEN-CLARK MEMORIAL HOSPITAL. | WV | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| CAMDEN-CLARK FOUNDATION INC | |||||||||||
| 800 GARFIELD AVENUE | PARKERSBURG | WV | 26102 | 550667789 | RAISE AND MANAGE FUNDS FOR CAMDEN-CLARK MEMORIAL HOSPITAL. | WV | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| WV UNITED HEALTH SYSTEM | |||||||||||
| 3040 UNIVERSITY AVENUE | MORGANTOWN | WV | 26505 | 550175471 | HEALTHCARE ACCESS | WV | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| WEST VIRGINIA UNIVERSITY HOSPITALS INC | |||||||||||
| PO BOX 8034 | MORGANTOWN | WV | 26506 | 550643304 | PATIENT CARE | WV | 501(C)(3) | LINE 3 | WEST VIRGINIA UNITED HEALTH SYSTEM | 0 | |
| WEST VIRGINIA UNIVERSITY HOSPITALS EAST | |||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 202337985 | HEALTHCARE ACCESS | WV | 501(C)(3) | LINE 11A, I | WEST VIRGINIA UNIVERSITY HOSPITALS INC | 0 | |
| CITY HOSPITAL INC | |||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 550383321 | PATIENT CARE | WV | 501(C)(3) | LINE 3 | WEST VIRGINIA UNIVERSITY HOSPITALS EAST | 0 | |
| JEFFERSON MEMORIAL HOSPITAL | |||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 550359755 | PATIENT CARE | WV | 501(C)(3) | LINE 3 | WEST VIRGINIA UNIVERSITY HOSPITALS EAST | 0 | |
| UNIVERSITY HEALTHCARE FOUNDATION | |||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 311118075 | HOSPITAL SUPPORT | WV | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| UNITED HOSPITAL CENTER INC | |||||||||||
| 327 MEDICAL PARK DRIVE | BRIDGEPORT | WV | 26330 | 550525724 | PATIENT CARE | WV | 501(C)(3) | LINE 3 | WEST VIRGINIA UNITED HEALTH SYSTEM | 0 | |
| UNITED PHYSICIANS CARE INC | |||||||||||
| 686 SOUTH PIKE STREET | SHINNSTON | WV | 26431 | 550638563 | PATIENT CARE | WV | 501(C)(3) | LINE 3 | 0 | N/A | |
| UNITED HOSPITAL FOUNDATION | |||||||||||
| 327 MEDICAL PARK DRIVE | BRIDGEPORT | WV | 26330 | 550621706 | HOSPITAL SUPPORT | WV | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| WV HEALTHCARE CO-OP | |||||||||||
| PO BOX 8059 | MORGANTOWN | WV | 26506 | 550650441 | SUPPORT | WV | 501(C)(3) | LINE 11A, I | WEST VIRGINIA UNITED HEALTH SYSTEM | 0 | |
| UNITED SUMMIT CENTER | |||||||||||
| 6 HOSPITAL PLAZA | CLARKSBURG | WV | 26301 | 550752788 | BEHAVIORAL HEALTH | WV | 501(C)(3) | LINE 3 | 0 | N/A | |
| POTOMAC VALLEY HOSPITAL OF W VA INC | |||||||||||
| 100 PIN OAK LANE | KEYSER | WV | 26726 | 550420956 | PATIENT CARE | WV | 501(C)(3) | LINE 3 | WEST VIRGINIA UNIVERSITY HOSPITALS INC | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OHIO VALLEY AMBULATORY SURGERY CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 608 WASHINGTON BLVD | AddressLine1Txt |
| City | BELPRE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45714 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208671724 | EIN |
| Primary Activities | OUTPATIENT SURGICAL SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
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 | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| ALLIED HEALTH SERVICES INC | |||||||||
| PO BOX 782 | MORGANTOWN | WV | 26507 | 550652017 | MEDICAL LAB | WV | N/A | C | 0 |
| WEST VIRGINIA UNITED INSURANCE SERVICES | |||||||||
| 3040 UNIVERSITY AVENUE SUITE 3040 | MORGANTOWN | WV | 26505 | 550756055 | PROVIDER NETWORK | WV | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMDEN CLARK MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | S | TransactionTypeTxt |
| Involved | $8,331,612 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |