2016-11-01T07:58:50-05:00 2015-12-31 560747981 DIXON HUGHES GOODMAN LLP PO BOX 1747 CHARLESTON WV 25326 990 2015-01-01 264058719 CAMDEN-CLARK PHYSICIAN CORPORATION CAMD 3044242817 800 GARFIELD AVENUE PARKERSBURG WV 26102 CAROLYN ALLEN CFO 3044242202 2016-09-29 1 SUSAN S DULL P00233523 3043430168 2016-09-29 2015 2017-02-10 21:41:12Z CAROLYN ALLEN 800 GARFIELD AVENUE PARKERSBURG WV 26102 24089790 0 X WWW.CCMH.ORG X 2008 WV TO SUPPORT, MANAGE, AND FURNISH FACILITIES, PERSONNEL, AND MEDICAL SERVICES TO INDIVIDUALS IN NEED. 5 3 218 3 0 0 0 0 19822951 24047429 169551 0 9237 42361 20001739 24089790 2500 300 0 0 22796169 26058392 0 0 0 8241456 10092954 31040125 36151646 -11038386 -12061856 3944725 2850612 21382805 2392154 -17438080 458458 X 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. 0 0 2641078 3607930 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. 2884872 5644190 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. 2706901 6110644 CAMDEN CLARK PHYSICIAN CORPORATION OFFERS OB/GYN SERVICES THROUGH A TEAM OF EMPLOYED PHYSICIANS AND IN COLLABORATION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION. 26931198 300 8727026 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. 26931198 300 8727026 35164049 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 31 0 218 1 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X X MARY F RUSSELL 3044242817 800 GARFIELD AVENUE PARKERSBURG WV 26102 X KATHY G EDDY CHAIRMAN 1.00 2.00 X X 0 0 0 TERRY CAPEL MD BOARD MEMBER (VICE CHAIRMAN) 1.00 2.00 X X 0 0 0 DR DANIEL MCGRAW BOARD MEMBER 39.70 0.30 X 944016 0 55584 JOSEPH CAMPBELL BOARD MEMBER 1.00 2.00 X 0 0 0 DAVID MCCLURE EX OFFICIO 1.00 39.00 X 0 517095 36964 SEAN SMITH EXEC DIR./SECRETARY 40.00 X 114232 0 26079 CAROLYN ALLEN VP FINANCE 5.00 35.00 X 0 290428 26650 TODD A KRUGER VICE PRESIDENT 4.00 36.00 X 0 383564 15865 THOMAS R HELLER VICE PRESIDENT 4.00 36.00 X 0 319586 50655 DR JOSE CRUZZAVALA PHYSICIAN 40.00 X 751779 0 36975 DR NIK SHAH PHYSICIAN 40.00 X 896983 0 40355 DR STEVEN MILLER PHYSICIAN 40.00 X 788612 0 45120 DR ABIY KELIL PHYSICIAN 40.00 X 642129 0 20131 DR PATRICK DUGAN PHYSICIAN 40.00 X 617948 0 33606 MICHAEL KING FORMER CEO 5.00 2.00 X 0 294281 6089 4755699 1804954 394073 47 1 1 0 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 STAFFING SERVICES 1090990 1 NET PATIENT REVENUE 621110 24047429 24047429 24047429 OTHER REVENUE 621110 42361 42361 42361 24089790 24089790 0 0 X 300 300 5013550 4943394 70156 19038144 18447962 590182 68 66 2 1183038 1146364 36674 823592 798061 25531 6293772 6098665 195107 2634 2634 152219 147500 4719 3226 3126 100 30407 29464 943 44767 43379 1388 130434 126391 4043 778432 754301 24131 PROVISION FOR BAD DEBTS 1000553 1000553 RENT/LEASE EQUIPMENT 647578 627503 20075 MEDICAL SUPPLIES 539697 539697 REPAIRS AND MAINTENANCE 140161 135816 4345 329074 318873 10201 36151646 35164049 987597 0 1 872443 743916 1857653 1699779 40000 822025 100597 1379730 1113411 392604 266319 3944725 2850612 4259381 2392154 17123424 0 21382805 2392154 X -17438080 458458 -17438080 458458 3944725 2850612 X -12061856 29958394 X 0 1 X 1 0 X SCHEDULE A, PART I, LINE 3 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. 1379730 1113411 266319 266319 X PART X, LINE 2: 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. X 1 0 0 0 0 1 0 0 0 0 0 DR DANIEL MCGRAW BOARD MEMBER 859016 0 0 0 85000 0 38941 0 16643 0 999600 0 0 0 DAVID MCCLURE EX OFFICIO 0 459792 0 57303 0 0 0 24000 0 12964 0 554059 0 0 CAROLYN ALLEN VP FINANCE 0 290428 0 0 0 0 0 24000 0 2650 0 317078 0 0 TODD A KRUGER VICE PRESIDENT 0 304248 0 79316 0 0 0 0 0 15865 0 399429 0 0 THOMAS R HELLER VICE PRESIDENT 0 268405 0 51181 0 0 0 42000 0 8655 0 370241 0 0 DR JOSE CRUZZAVALA PHYSICIAN 751779 0 0 0 0 0 24000 0 12975 0 788754 0 0 0 DR NIK SHAH PHYSICIAN 759589 0 137394 0 0 0 24000 0 16355 0 937338 0 0 0 DR STEVEN MILLER PHYSICIAN 662260 0 126352 0 0 0 42000 0 3120 0 833732 0 0 0 DR ABIY KELIL PHYSICIAN 500639 0 141490 0 0 0 18000 0 2131 0 662260 0 0 0 DR PATRICK DUGAN PHYSICIAN 617948 0 0 0 0 0 18000 0 15606 0 651554 0 0 0 MICHAEL KING FORMER CEO 0 22027 0 0 0 272254 0 0 0 6089 0 300370 0 0 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. 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. 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 N/A 0 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 N/A 0 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 N/A 0 WV UNITED HEALTH SYSTEM 3040 UNIVERSITY AVENUE MORGANTOWN WV 26505 550175471 HEALTHCARE ACCESS WV 501(C)(3) LINE 11A, I N/A 0 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 N/A 0 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 N/A 0 UNITED HOSPITAL FOUNDATION 327 MEDICAL PARK DRIVE BRIDGEPORT WV 26330 550621706 HOSPITAL SUPPORT WV 501(C)(3) LINE 11A, I N/A 0 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 N/A 0 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 OHIO VALLEY AMBULATORY SURGERY CENTER 608 WASHINGTON BLVD BELPRE OH 45714 208671724 OUTPATIENT SURGICAL SERVICES WV N/A 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 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 1 CAMDEN CLARK MEMORIAL HOSPITAL S 8331612 CASH