2015-11-13T13:29:36-06:00 2014-12-31 560747981 DIXON HUGHES GOODMAN LLP PO BOX 1556 MORGANTOWN WV 265071556 990 2014-01-01 311524546 CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION CAMD 3044242202 800 GARFIELD AVENUE PARKERSBURG WV 26101 CAROLYN ALLEN CFO 3044242202 2015-11-13 1 SUSAN S DULL P00233523 3042927343 2014 2016-03-07 17:11:31Z CAMDEN CLARK MEDICAL CENTER DAVID K MCCLURE 800 GARFIELD AVE PARKERSBURG WV 26102 234803469 0 X WWW.CCMH.ORG X 1997 WV TO OPERATE AN ACUTE CARE AND EMERGENCY HOSPITAL FACILITY. 7 5 2410 422 3034864 670117 221368 96246 241853786 223729290 15176762 7601714 1885604 1735961 259137520 233163211 324774 275459 0 0 94018676 90045770 0 0 0 165866200 143483937 260209650 233805166 -1072130 -641955 351297717 326543610 286649314 289916466 64648403 36627144 X THE MISSION OF CAMDEN-CLARK MEMORIAL HOSPITAL IS TO MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY FOR A LIFETIME. 0 0 116507208 120264434 CAMDEN CLARK MEMORIAL HOSPITAL OFFERS EMERGENCY ROOM SERVICES AS PART OF THE HOSPITAL'S MISSION OF MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY FOR A LIFETIME. DUE TO THE COMMUNITY THAT IT SERVES, THE MAJORITY OF PATIENTS VISITING THE ER ARE EITHER UNDERINSURED OR UNINSURED. FOR THE REPORTING PERIOD, THERE WERE APPROXIMATELY 58,294 ER VISITS, OF THIS TOTAL, 9,645 OR 16.6% WERE ULTIMATELY ADMITTED TO THE HOSPITAL. THIS REPRESENTS 70.7% OF THE TOTAL HOSPITAL ADMISSIONS FOR 2014. THEREFORE, A SIGNIFICANT PORTION OF THE HOSPITAL'S INPATIENT VOLUME COMES DIRECTLY FROM THE ER. 12945570 13363050 CAMDEN-CLARK MEMORIAL HOSPITAL IS A LEADER IN CANCER CARE FOR THE MID-OHIO VALLEY, PROVIDING CANCER CARE TO PATIENTS IN A 45 MILE RADIUS FROM THE HOSPITAL. IN ADDITION TO A WIDE RANGE OF TREATMENT OPTIONS PROVIDED, THE HOSPITAL OFFERS A NUMBER OF RELATED SERVICES TO ITS PATIENTS. 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, THE HOSPITAL HAS ENHANCED THE EDUCATION, NAVIGATION AND SOCIAL SUPPORT OF ITS CANCER PATIENTS AND FAMILIES. THE HOSPITAL'S COMMUNITY AND SOCIAL SERVICES PROVIDE A HOLISTIC HEALING ENVIRONMENT WHICH INCLUDES SUPPORT GROUPS FOR PATIENTS/FAMILIES AND AESTHETIC SERVICES TO ENHANCE THE PATIENTS' PHYSICAL AND EMOTIONAL WELL-BEING. 4315082 4454238 CAMDEN-CLARK MEMORIAL HOSPITAL OFFERS BEHAVIORAL HEALTH SERVICES FOR ITS IMMEDIATE SERVICE AREA DIRECTLY THROUGH THE HOSPITAL. IN ADDITION, SERVICES ARE PROVIDED TO UNDERSERVED COUNTIES THROUGHOUT THE AREA VIA PHYSICIANS THAT ARE EMPLOYED BY CAMDEN CLARK PHYSICIAN CORPORATION, A RELATED ENTITY. THERE IS A SEVERE SHORTAGE OF BEHAVIORAL HEALTH SERVICES AVAILABLE IN THE MID-OHIO VALLEY, AND CAMDEN-CLARK HAS MADE EFFORTS TO BRIDGE THAT GAP. 84345208 275459 84466109 THE HOSPITAL STRIVES TO SUPPLY A COMPREHENSIVE RANGE OF INPATIENT, OUTPATIENT, OUTREACH CLINICS AND EMERGENCY ROOM SERVICES, INCLUDING PREVENTION, GUIDANCE, DIAGNOSIS, TREATMENT, RESTORATION, REHABILITATION AND OTHER EFFORTS AS MAY BE REQUIRED TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY AND AS THE HOSPITAL'S RESOURCES WILL PERMIT.ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING WITH THIS COMMITMENT TO SERVICE ALL MEMBERS OF THE COMMUNITY, CAMDEN-CLARK MEMORIAL HOSPITAL 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 COMMUNITYRECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARTITY CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. IN ADDITION, CHARITY CARE IS PROVIDED THROUGH MANY REDUCED-PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES THAT THE HOSPITAL BELIEVES WILL SERVE A BONAFIDE COMMUNITY HEALTH NEED.THE HOSPITAL ALSO PROVIDES NUMBEROUS OTHER BENEFITS FOR THE MID-OHIO VALLEY COMMUNITY, INCLUDING ECONOMIC BENEFITS, HEALTH EDUCATION, WELLNESS/OUTREACH PROGRAMS, AND PUBLIC SERVICES AND SUPPORT GROUPS. 84345208 275459 84466109 218113068 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 181 0 2410 1 1 1 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WV X CAROLYN ALLEN 3044242202 800 GARFIELD AVENUE PARKERSBURG WV 26102 TERRY CAPEL MD CHAIRMAN 1.00 3.00 X X 0 0 0 KATHY G EDDY VICE CHAIRMAN 1.00 3.00 X X 0 0 0 KARL BOELTER BOARD MEMBER 1.00 X 0 0 0 MICHAEL MOREHEAD MD BOARD MEMBER 1.00 X 0 0 0 GREGORY GORE SECRETARY 1.00 X X 0 0 0 JENNIFER LEAVITT DO BOARD MEMBER 1.00 X 56817 0 0 JOSEPH CAMPBELL BOARD MEMBER 1.00 3.00 X 0 0 0 MICHAEL A KING PRESIDENT/CEO 1/1/14-6/30/14 40.00 5.00 X 344048 0 34362 ALLEN R BUTCHER TREASURER/CFO 1/1/14-1/31/14 40.00 5.00 X 349971 0 9892 DAVID MCCLURE PRESIDENT/CEO 7/1/14-12/31/14 40.00 5.00 X 338121 0 28748 CAROLYN ALLEN TREASURER/CFO 10/1/14-12/31/14 40.00 5.00 X 69919 0 5098 TODD A KRUGER VICE PRESIDENT 40.00 5.00 X 366492 0 4156 TOM HELLER VP OF HR 40.00 X 298895 0 41188 CYNTHIA KERN VP OF QUALITY 40.00 X 203651 0 20411 SHERRY SIMMONS CHIEF NURSING OFFICER 40.00 X 165523 0 16200 JOSHUA WOODS CIO 40.00 X 126857 0 11689 GENE SEXTON PHARMACIST 40.00 X 131831 0 23898 MICHAEL TRIMBLE PHARMACIST 40.00 X 137983 0 18634 SHAUN CARTER PHARMACY MANAGER 40.00 X 136502 0 612 BRIAN STANDLEY DIRECTOR OF FINANCE 40.00 5.00 X 127415 0 14174 2854025 0 229062 31 0 1 0 ACCENTURE LLP 161 N CLARK STREET CHICAGO IL 60601 OPERATIONS 1635302 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PLACE CHICAGO IL 606731245 SOFTWARE HARDWARE SUPPORT & EQUIPMENT 646917 PRICEWATERHOUSE COOPERS LLP P O BOX 7247-8001 PHILADELPHIA PA 191708001 VBO SERVICES 607779 DIXON HUGHES GOODMAN LLP 6525 MORRISON BLVD CHARLOTTE NC 28211 CONSULTING 449941 COPIER WORD PROCESSING 2040 OHIO AVENUE PARKERSBURG WV 26101 COPIER SERVICES 328925 26 96246 96246 PATIENT SERVICE,NET 621500 218732977 216294461 2438516 PASS-THROUGH INCOME - OVASC & HH 621910 1226053 1226053 3770260 3770260 223729290 7443133 26634 7416499 157101 157101 1549448 1640258 -90810 -90810 -90810 253 1227 0 0 253 1227 1480 1480 CAFETERIA 624200 1149049 1149049 HEALTH AND WELLNESS CENTER 713940 569714 569714 OTHER 900099 108008 108008 1826771 233163211 222547831 3034864 7484270 275459 275459 2296677 841568 1455109 69014127 63473651 5540476 2007254 1846674 160580 10522045 9680281 841764 6205667 5709214 496453 103263 103263 43334 43334 17662339 16249352 1412987 619059 569534 49525 3795731 3492073 303658 1913344 1760276 153068 4779780 4397398 382382 79905 73513 6392 7638317 7027252 611065 18642264 17150883 1491381 3274256 3012316 261940 MEDICAL SUPPLIES 29805057 29805057 PATIENT CHARGES 22873268 22873268 PHYSICIAN FEES 10121496 9311776 809720 REPAIRS & MAINTENANCE 7282755 6700135 582620 14849769 13863388 986381 233805166 218113068 15692098 0 263680 426493 3094771 5622913 25990281 24146549 1629073 1675235 11026649 10835132 37792 54522 309380947 152591242 165155903 156789705 123102072 95737317 274091 917007 20723405 30338737 351297717 326543610 31217962 26295243 13664 220786341 216698577 959317 1400000 33672030 45522646 286649314 289916466 X 64648403 36627144 64648403 36627144 351297717 326543610 X -641955 24031955 -80000 -51331259 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 28186 28186 0 PART II-B, LINE 1: THE ORGANIZATION PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AS WELL AS THE WEST VIRGINIA HOSPITAL ASSOCIATION (WVHA). A PORTION OF THESE DUES, SPECIFICALLY $28,186, WAS RELATED TO LOBBYING ACTIVITIES OF THE AHA AND WVHA. 22998852 22998852 126015311 49499221 76516090 160366784 103092021 57274763 156789705 DUE FROM RELATED ORGANIZATIONS 18808107 UNAMORTIZED BORROWING COSTS 4202236 GOODWILL - OVASC 7229757 OTHER RECEIVABLES 98637 30338737 SELF-FUNDED INSURANCE RESERVE 8666000 PENSION LIABILITY 9880797 BOND INTEREST SWAP LIABILITY 17862384 OTHER 9113465 45522646 X PART X, LINE 2: WEST VIRGINIA UNITED HEALTH SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN NOT TO BE SUSTAINED 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 2014 AND 2013. 1 1 1 X 1 X 1 1 1 0 0 6103613 6103613 0.02640 36229924 30716963 5512961 0.02380 42333537 30716963 11616574 0.05020 910265 910265 0.00390 1600810 68765 1532045 0.00660 2511075 68765 2442310 0.01050 44844612 30785728 14058884 0.06070 0 911663 504002 70395896 88545318 -18149422 X 1 1 1 OHIO VALLEY AMBULATORY SURGERY CENTER LLC AMBULATORY SERVICES 0.62500 2 HOUSECALLS HOME HEALTH & HOSPICE LLC HOME HEALTH SERVICES 0.10000 1 1 CAMDEN-CLARK MEMORIAL HOSPITAL 800 GARFIELD AVENUE PARKERSBURG WV 26102 X X X X DISPROPORTIONATE SHARE HOSPITAL CAMDEN-CLARK MEMORIAL HOSPITAL CORP 1 0 0 1 X X X X X X X X 12 1 0 0 1 X WWW.CAMDENCLARK.ORG X 1 12 1 HTTP://WWW.CAMDENCLARK.ORG/UPLOADS/PUBLIC/COMMUNITY%20HEALTH%20NEEDS%20ASSE 0 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X 1 X X 1 X X X 0 X X X X 1 X X 0 0 CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 5: THE ORGANIZATION COLLECTED A VAST AMOUNT OF DEMOGRAPHIC DATA ON THE COMMUNITY SERVED, MET WITH UNITED WAY AGENCIES AND THE HEALTH DEPARTMENT, AND USED INFORMATION GARNERED FROM STUDIES PERFORMED BY THE SISTERS OF ST. JOSEPH. CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 11: CERTAIN NEEDS IDENTIFIED IN THE ORGANIZATION'S CHNA WERE NOT OR WILL NOT BE ADDRESSED AS IT WAS DETERMINED THAT THESE NEEDS ARE BEING ADDRESSED BY THE OTHER AGENCIES WITHIN THE COMMUNITY AND ANY EFFORT ON BEHALF OF CCMH WOULD BE DUPLICATIVE. CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 15E: A STATE MEDICAID REPRESENTATIVE WAS ON SITE TO HELP DETERMINE ELIGIBILITY AND HELP PATIENTS THROUGH THE ELIGIBILITY PROCESS. CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 18D: CCMH MAY ALSO TAKE ACTION WITH A LIEN ON RESIDENCES UNDER THE ORGANIZATION'S CURRENT FINANCIAL ASSISTANCE POLICY. HOWEVER, EVEN THOUGH THEY WERE PERMITTED TO UNDER THE POLICY, NO LIENS WERE ADMINISTERED. CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 22D: CAMDEN CLARK MEMORIAL HOSPITAL IS IN THE PROCESS OF DRAFTING A WRITTEN FINANCIAL ASSISTANCE POLICY USING THE LOOK-BACK METHOD WITH AN AVERAGE OF MEDICARE AND NON-MEDICARE. THE POLICY WILL TENTATIVELY BE FINALIZED BY THE END OF CALENDAR YEAR 2015. TENTATIVE CHANGES TO THE POLICY WILL INCLUDE BUT ARE NOT LIMITED TO:-PATIENTS ARE TO BE INFORMED OF FINANCIAL ASSISTANCE POLICY (FAP) AT REGISTRATION AND PRIOR TO DISCHARGE. THE FAP WILL BE ON THE PATIENTS STATEMENT, CCMH WEBSITE, AND AVAILABLE THROUGHOUT THE COMMUNITY.-PATIENTS WILL HAVE 30 DAYS TO RETURN NECESSARY INFORMATION TO COMPLETE THE FAP PROCESS.-ALL SELF PAY PATIENTS WILL RECEIVE A DISCOUNT BASED ON THE AMOUNTS GENERALLY BILLED. PART V, SECTION B, LINE 16A CAMDEN CLARK MEMORIAL HOSPITAL IS CURRENTLY IN THE PROCESS OF GETTING THEIR FINANCIAL ASSISTANCE POLICY ONLINE. THEIR WEBSITE CURRENTLY DISPLAYS THE PHONE NUMBER (304) 424-2258 TO CALL TO APPLY FOR FINANCIAL ASSISTANCE AT WWW.CAMDENCLARK.ORG/PATIENTS. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 16A WEBSITE: WWW.CAMDENCLARK.ORG/PATIENTS 4 CAMDEN CLARK PRIMARY CARE 2200 GRAND CENTRAL AVENUE SUITE 110 VIENNA WV 26105 PRIMARY CARE CAMDEN CLARK PRIMARY CARE 4 ROSEMAR MEDICAL PARKERSBURG WV 26101 PRIMARY CARE CAMDEN CLARK PRIMARY CARE 2838 PIKE STREET PARKERSBURG WV 26101 PRIMARY CARE CAMDEN CLARK PRIMARY CARE 602 DIVISION STREET PARKERSBURG WV 26101 PRIMARY CARE PART I, LINE 7: WORKSHEET 2, "RATIO OF PATIENT CARE, COST TO CHARGES' WAS USED TO COMPLETE THE COST-TO-CHARGE RATIO IN PART I, LINE 7. FOR "OTHER BENEFITS", ACTUAL EXPENSES OF THE ORGANIZATION AT COST WERE USED IN ADDITION TO SOME DONATED ITEMS VALUED AT FAIR MARKET VALUE. PART I, LN 7 COL(F): THE AMOUNT OF TOTAL EXPENSE REPORTED ON FORM 990, PART IX, LINE 25 INCLUDES A BAD DEBT EXPENSE OF $2,520,010 WHICH HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENT OF TOTAL EXPENSE IN COLUMN (F). PART III, LINE 4: PART III, LINE 2:BAD DEBT EXPENSE AT COST IS CALCULATED BY MULTIPLYING THE INTERNAL FINANCIAL STATEMENT AMOUNT OF BAD DEBT EXPENSE ($2,520,010) BY THE COST TO CHARGE RATIO (36.18%) WHICH WAS DETERMINED BY USING IRS WORKSHEET 2 FROM THE SCHEDULE H INSTRUCTIONS. PART III, LINE 3:THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY IS CALCULATED BASED ON THE ESTIMATE OF 20% OF THE BAD DEBT AT COST. THE RATIONALE FOR THIS IS THAT SELF-PAY BALANCES AFTER INSURANCE ARE NOT ACCOUNTS THAT THE ORGANIZATION FOCUSES A LOT OF EFFORT ON. THE ORGANIZATION FOCUSES THEIR EFFORTS ON QUALIFYING PATIENTS FOR CHARITY CARE ON PRIMARY SELF-PAY ACCOUNTS. NOT ALL PATIENTS TAKE THE INITIATIVE TO SEE IF THEY QUALIFY FOR CHARITY CARE.PART III, LINE 4:TO AUDITED FINANCIAL STATEMENTS PAGE 9 PART III, LINE 8: THE ORGANIZATION USED INFORMATION FROM THEIR COST REPORT TO COMPLETE THIS SECTION AS WELL AS THEIR INTERNAL REPORTS.THE ORGANIZATION RAN A REPORT FOR 2014 OF EVERY PATIENT THAT QUALIFIED FOR MEDICARE THAT WOULD ALSO HAVE QUALIFIED MEDICAID IF MEDICARE DID NOT EXIST. THE ORGANIZATION BELIEVES THAT IF A PERSON IS QUALIFIED FOR MEDICAID, THEY WOULD HAVE ALSO QUALIFIED UNDER THE ORGANIZATION'S CHAIRTY CARE GUIDELINES. THE ORGANIZATION FOUND THAT 21.52% OF MEDICARE PATIENTS WERE DUALLY ELIGIBLE FOR MEDICARE/MEDICAID. THEREFORE, 21.52% OF THE SHORTFALL, OR $3,905,756, WOULD QUALIFY AS COMMUNITY BENEFIT. PART III, LINE 9B: IF A PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THEN NO COLLECTION ACTIVITY WILL OCCUR ON THEIR ACCOUNT. THE CHARITY QUALIFICATION IS GOOD FOR SIX-MONTHS, SO ANY SUBSEQUENT VISITS DURING THAT SIX-MONTH PERIOD WOULD ALSO QUALIFY FOR CHARITY CARE AND WOULD NOT BE SUBJECT TO COLLECTION ACTIVITY. PART VI, LINE 2: THE ORGANIZATION IS PART OF THE MID-OHIO VALLEY RURAL HEALTH ALLIANCE. THE ALLIANCE MEMBERS JOINTLY ASSESS THE NEEDS OF THE REGION AND WORK WITH A CONSULTANT TO ENSURE THAT THOSE NEEDS ARE ADDRESSED. THE ORGANIZATION IS IN THE PROCESS OF PREPARING ITS OWN COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 3: THE ORGANIZATION PROVIDES, IN WRITING, ALL OPTIONS FOR POSSIBLE FINANCIAL ASSISTANCE. THIS INFORMATION IS ALSO AVAILABLE ON THE ORGANIZATION'S WEBSITE. THE ORGANIZATION ALSO HAS REPRESENTATIVES THAT ARE AVAILABLE TO DISCUSS OPTIONS WITH INPATIENTS AND OUTPATIENTS ON A DAILY BASIS. STATE MEDICAID WORKERS ARE ONSITE TO HELP DETERMINE PATIENT ELIGIBITY AND TO ASSIST PATIENTS THROUGH THE ELIGIBILITY PROCESS. PART VI, LINE 4: CAMDEN-CLARK MEDICAL CENTER, LOCATED IN PARKERSBURG, WV, SERVICES THE MID-OHIO VALLEY REGION OF WEST VIRGINIA AND OHIO. THE PRIMARY SERVICE AREA CONSISTS OF FOUR COUNTIES WITH AN ESTIMATED TOTAL POPULATION OF 164,000 PEOPLE AND A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $39,000. IT IS AN AGING POPULATION. THERE IS A DECLINING CORPORATE PRESENCE IN THE AREA WHICH HAS NEGATIVELY IMPACTED THE UNEMPLOYMENT RATE. THERE IS ONE OTHER HOSPITAL WITHIN THE PRIMARY SERVICE AREA, LOCATED IN MARIETTA, OH. IN ADDITION, THE COMMUNITY INCLUDES SEVERAL FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS. PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO MANY OF ITS DEPARTMENTS.ANY SURPLUS OF FUNDS IS USED PRIMARILY TO ENHANCE PATIENT CARE. WHILE NO RESEARCH IS DONE AT THE FACILITY, A RESIDENCY PROGRAM WAS STARTED IN 2009. PART VI, LINE 6: CAMDEN-CLARK MEMORIAL HOSPITAL IS PART OF THE WEST VIRGINIA UNITED HEALTH SYSTEM. CCMH PLAYS A SIGNIFICANT ROLE IN IMPROVING THE HEALTH OF THE COMMUNITY. THE STATEGIC PLAN OF THE SYSTEM STATES INTENT TO BUILD A REGIONAL HEALTH CARE DELIVERY SYSTEM IN ITS SERVICES AREA WHILE OFFERING A VARIETY OF OPTIONS FOR PROVIDERS WHO WANT TO PARTICIPATE. THE SYSTEM MAINTAINS A DEMONSTRATED COMMITMENT TO ASSIST RURAL COMMUNITIES IN PRESERVING AND IMPROVING THE HEALTH CARE AVAILABLE TO THE PATIENTS IT SERVES. SYSTEM MANAGEMENT IS FOCUSED ON RECRUITMENT OF STAFF AND EMPLOYEES TO MEET THE GROWING NEEDS OF THE AGING POPULATION IN THE SYSTEM'S SERVICES AREAS. OTHER HOSPITALS IN THE SYSTEM INCLUDE UNITED HEALTH CENTER, WHICH IS MORE CENTRALLY LOCATED IN THE STATE, JEFFERSON MEMORIAL HOSPITAL AND CITY HOSPITALS, INC., WHICH ARE LOCATED IN THE EASTERN PANHANDLE OF WEST VIRGINIA, AND WEST VIRGINIA UNIVERSITY HOSPITALS LOCATED IN MORGANTOWN, WV. THE SYSTEM ALSO INCLUDES THE PHYSICIAN PRACTICES OF UNITED PHYSICIANS CARE, INC. AND CAMDEN CLARK PHYSICIAN CORP THAT OPERATE IN CONJUNCTION WITH THE SYSTEM HOSPITALS. UNITED SUMMIT CENTER IS A BEHAVIORAL HEALTH CENTER LOCATED IN CLARKSBURG, WV. IN ADDITION TO THESE PRACTICES, THE SYSTEM ALSO INCLUDES WVUH-EAST, INC. AND CAMDEN CLARK HEALTH SERVICES WHICH OPERATE AS MANAGEMENT COMPANIES FOR THEIR RESPECTIVE HOSPITALS. THE SYSTEM ALSO HAS FOUNDATIONS THAT DO VARIOUS FUNDRAISING ACTIVITIES FOR THE HOSPITALS. CITY HOSPITAL FOUNDATION AND JEFFERSON HEALTHCARE FOUNDATION OPERATE IN THE EASTERN PANHANDLE, UNITED HEALTH FOUNDATION OPERATES IN CLARKSBURG, AND CAMDEN CLARK FOUNDATION OPERATES IN PARKERSBURG, WV. PART VI, LINE 7, REPORTS FILED WITH STATES WV 1 AMERICAN RED CROSS 250 JARI ROAD JOHNSTOWN PA 159046949 530196605 501(C)(3) 5100 N/A N/A OPERATIONS STATE GOVERNMENT - WOOD COUNTY DEVELOPMENT AUTHORITY PO BOX 1683 PARKERSBURG WV 26102 N/A 5500 ANNUAL PLEDGE WEST VIRGINIA UNITED HEALTH SYSTEM 1000 TECHNOLOGY DRIVE FAIRMONT WV 26554 550175471 501(C)(3) 196531 OPERATIONS THE OHIO UNIVERSITY FOUNDATION PO BOX 869 ATHENS OH 45701 316402269 501(C)(3) 66228 OPERATIONS 4 0 PART I, LINE 2: CONTRIBUTIONS ARE DISCRETIONARY AND DECISIONS ON WHICH ORGANIZATIONS CAMDEN-CLARK MEMORIAL HOSPITAL SUPPORTS ARE MADE BY THE CEO IN CONJUNCTION WITH THE DIRECTOR OF MARKETING. TYPICALLY, LOCAL ORGANIZATIONS ARE SUPPORTED THROUGHOUT THE YEAR AND THE DONATIONS ARE TYPICALLY NOT SPECIFICALLY RESTRICTED, SO THERE IS NO FOLLOW UP PROCESS FOR MONITORING THE USE OF THE FUNDS. X 1 1 X X X X X 1 0 0 0 0 0 0 0 0 MICHAEL A KING PRESIDENT/CEO 1/1/14-6/30/14 342600 0 1448 0 0 0 23088 0 11274 0 378410 0 0 0 ALLEN R BUTCHER TREASURER/CFO 1/1/14-1/31/14 58513 0 0 0 291458 0 6715 0 3177 0 359863 0 0 0 DAVID MCCLURE PRESIDENT/CEO 7/1/14-12/31/14 294910 0 43211 0 0 0 23000 0 5748 0 366869 0 0 0 TODD A KRUGER VICE PRESIDENT 292336 0 74156 0 0 0 0 0 4156 0 370648 0 0 0 TOM HELLER VP OF HR 253909 0 44986 0 0 0 40500 0 688 0 340083 0 0 0 CYNTHIA KERN VP OF QUALITY 179459 0 24192 0 0 0 17500 0 2911 0 224062 0 0 0 SHERRY SIMMONS CHIEF NURSING OFFICER 141145 0 24378 0 0 0 14400 0 1800 0 181723 0 0 0 GENE SEXTON PHARMACIST 131831 0 0 0 0 0 17500 0 6398 0 155729 0 0 0 MICHAEL TRIMBLE PHARMACIST 133329 0 4654 0 0 0 16002 0 2632 0 156617 0 0 0 PART I, LINE 1A MEMBERSHIPS AT THE HEALTH AND WELLNESS CENTER ARE OFFERED TO EACH MEMBER OF THE SENIOR LEADERSHIP TEAM. THESE ARE COVERED IN THE APPLICABLE EMPLOYMENT CONTRACTS. PART I, LINE 4A ALLEN BUTCHER RECEIVED SEVERANCE PAY IN THE AMOUNT OF $291,458. A WV HOSPITAL FINANCE AUTHORITY 621256910 956622VY7 2004-06-30 19350000 2004B SERIES - REFUND PRIOR ISSUANCES & FUND IMPROVEMENTS 0 0 0 B WV HOSPITAL FINANCE AUTHORITY 621256910 956622A87 2009-10-16 24600000 2009 SERIES - REISSUANCE (9/13/2007) 0 0 0 C WV HOSPITAL FINANCE AUTHORITY 621256910 956622D35 2011-03-01 23555712 2011B PURCHASE ASSETS OF ST. JOSEPHS HOSPITAL 0 0 0 D WV HOSPITAL FINANCE AUTHORITY 621256910 956622E26 2012-08-01 50080000 2012B SERIES - REFUND 2011A BOND 0 0 0 A 19350000 1618092 1167255 95902 11468751 5000000 2008 1 0 1 1 B 24600000 1643134 979089 21978242 2013 1 0 0 1 C 23555712 435854 14935920 8183938 2012 0 0 0 1 D 50080000 80000 50000000 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 RAYMOND JAMES 29.600000000000 0 0 1 LEHMAN BROTHERS SPECIAL FINANCING 29.600000000000 1 1 1 B 0 1 0 0 1 0 0 1 1 C 0 0 0 0 1 0 0 1 D 0 1 0 0 1 0 0 0 A 1 B 1 C 1 D 1 SCHEDULE K SUPPLENTAL INFORMATION WEST VIRGINIA UNIVERSITY HOSPITALS, INC. (WVUH), EIN 55-0643304; CITY HOSPITAL, INC. DBA BERKELEY MEDICAL CENTER (BMC), EIN 55-0383321; THE CHARLES TOWN GENERAL HOSPITAL DBA JEFFERSON MEMORIAL HOSPITAL (JMC), EIN 55-0359755; UNIVERSITY HEALTHCARE FOUNDATION, INC EIN 31-1118075, AND CAMDEN-CLARK MEMORIAL HOSPITAL, INC. (CCMH), EIN 31-1524546 ARE MEMBERS OF THE WEST VIRGINIA UNITED HEALTH SYSTEM OBLIGATED GROUP AND HAVE ISSUED TAX-EXEMPT BONDS AS THE WEST VIRGINIA UNITED HEALTH SYSTEM OBLIGATED GROUP. THESE BOND ISSUANCES ARE INTERNALLY ALLOCATED WITHIN THE WEST VIRGINIA UNITED HEALTH SYSTEM OBLIGATED GROUP TO THE MEMBER WHO WILL BE USING THE FUNDS. SCHEDULE K, PART II, COLUMN C THERE IS A $465 DIFFERENCE BETWEEN THE TOTAL PROCEEDS OF THE ISSUE AND THE GROSS PROCEEDS IN RESERVE FUNDS, ISSUANCE COSTS FROM PROCEEDS, AND OTHER SPENT PROCEEDS. THIS DIFFERENCE IS DUE TO INTEREST INCOME FROM THE DEBT RESERVE. A WV HOSPITAL FINANCE AUTHORITY 621256910 956622E91 2013-10-03 47037860 2013A SERIES - REFUND 2004A BONDS & FINANCE RENOVATIONS 0 0 0 B WV HOSPITAL FINANCE AUTHORITY 621256910 956622VY7 2004-06-30 57900000 2004C SERIES - REFUND PRIOR ISSUANCES & FUND IMPROVEMENTS 0 0 0 A 1120000 47037860 5335549 411600 6459124 12146948 23615961 1 0 0 1 B 57900000 4854274 3343149 286963 32615614 16800000 2008 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 1 B 0 0 1 0 1 1 RAYMOND JAMES 29.600000000000 0 0 1 LEHMAN BROTHERS SPECIAL FINANCING 29.600000000000 1 1 1 A 1 B 1 PARKERSBURG NEUROLOGICAL ASSOCIATES BUSINESS ENTITY OWNED, IN PART, BY BOARD MEMBER, DR. MICHAEL MOREHEAD 85763 PAYMENT REMITTED TO PARKERSBURG NEUROLOGICAL ASSOCIATES FOR THE ORGANIZATION'S USE OF EQUIPMENT, SUPPLIES, AND STAFF AND INTRAOPERATIVE MONITORING ON THE ORGANIZATION'S NEUROSURGERY CASES 0 PARKERSBURG NEUROLOGICAL ASSOCIATES BUSINESS ENTITY OWNED, IN PART, BY BOARD MEMBER, DR.MICHAEL MOREHEAD 29614 REVENUE RECEIVED FROM PARKERSBURG NEUROLOGICAL ASSOCIATES FOR LEASE OF THE ORGANIZATION'S OFFICE SPACE 0 DR JENNIFER LEAVITT DR. LEAVITT SERVES AS A MEMBER OF THE CCMH BOARD OF DIRECTORS 56817 DR. LEAVITT RECEIVED PAYMENT FOR OVERSEEING THE RESIDENT PROGRAM 0 FORM 990, PART IV, LINE 20B: THE ORGANIZATION MUST ATTACH A COPY OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS. ATTACHED ARE THE CONSOLIDATED FINANCIAL STATEMENTS OF WEST VIRGINIA UNITED HEALTH SYSTEM, INC. (WVUHS) AND CONTROLLED ENTITIES. WVUHS BECAME THE SOLE MEMBER OF CAMDEN CLARK HEALTH SERVICES, INC., THE PARENT CORPORATION OF CAMDEN-CLARK MEMORIAL HOSPITAL ON MARCH 1, 2011. THE FINANCIAL POSITION, RESULTS OF OPERATIONS, AND CASH FLOWS OF CAMDEN-CLARK MEMORIAL HOSPITAL ARE INCLUDED IN THE AFOREMENTIONED CONSOLIDATED AUDITED FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 6 CAMDEN-CLARK HEALTH SERVICES, INC., A NON-PROFIT, TAX-EXEMPT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBERS OF THE BOARD OF DIRECTORS ARE ELECTED BY CAMDEN CLARK HEALTH SERVICES, INC., SUBJECT TO APPROVAL BY WEST VIRGINIA UNITED HEALTH SYSTEM (WVUHS). FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER OF CAMDEN CLARK HEALTH SERVICES, INC., WVUHS THROUGH ITS AFFILIATION AGREEMENT, HOLDS POWER TO APPROVE CERTAIN DECISIONS SUCH AS: - ANNUAL BUDGET - CAPITAL EXPENDITURES OVER $1 MILLION - NEW DEBT OVER $1 MILLION - NEW PROGRAMS - EXTRAORDINARY FILINGS FORM 990, PART VI, SECTION B, LINE 11 THE CHIEF FINANCIAL OFFICER AND DIRECTOR OF FINANCE REVIEW THE COMPLETED FORM PRIOR TO FILING AND A DRAFT COPY OF THE FORM IS ALSO REVIEWED WITH THE BOARD OF DIRECTORS PRIOR TO BEING FILED. 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 THE ORGANIZATION UTILIZES AN EXECUTIVE COMPENSATION CONSULTANT TO SURVEY DATA AND MAKE RECOMMENDATIONS. THE COMPENSATION OF THE CEO IS DETERMINED BY USING AN INDEPENDENT COMPENSATION CONSULTANT, AS WELL AS A COMPENSATION SURVEY OR STUDY. IT IS SUPPORTED BY A WRITTEN EMPLOYMENT CONTRACT WHICH IS THEN REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE AND THE WVUHS BOARD OF DIRECTORS. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE ON REQUEST AND ARE ALSO AVAILABLE ON THE WEST VIRGINIA HEALTHCARE AUTHORITY WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ANNUAL PENSION LIABILITY VALUATION ADJUSTMENT -9,016,445. TRANSFERS TO RELATED ORGANIZATIONS -43,745,241. ANNUAL ADJUSTMENT TO VALUATION OF INTEREST RATE SWAP LIABILITY 204,213. PASS-THROUGH INCOME FROM OVASC & HH 1,226,214. 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 1 CAMDEN-CLARK FOUNDATION 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 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 3 N/A 0 CAMDEN-CLARK PHYSICIAN CORPORATION 604 ANN STREET PARKERSBURG WV 26102 264058719 FURNISHES FACILITIES AND SERVICES TO PROVIDE MEDICAL SERVICES. WV 501(C)3 LINE 11A, I N/A 0 WEST VIRGINIA UNITED HEALTH SYSTEM 1000 TECHNOLOGY DRIVE FAIRMONT WV 26554 550175471 HEALTHCARE ACCESS WV 501(C)3 LINE 11A, I N/A 0 WEST VRIGINIA UNIVERSITY HOSPITALS INC PO BOX 8034 MORGANTOWN WV 26506 550643304 PATIENT CARE WV 501(C)3 LINE 3 WEST VIRGINIA UNITED HEALTH SYSTEM 1 WEST VIRGINIA UNIVERSITY HOSPITALS EAST 2000 FOUNDATION WAY MARTINSBURG WV 25401 202337985 HEALTHCARE ACCESS WV 501(C)3 LINE 11A, I WEST VIRGINIA UNITED HEALTH SYSTEM 1 CITY HOSPITAL INC 2000 FOUNDATION WAY MARTINSBURG WV 25401 550383321 PATIENT CARE WV 501(C)3 LINE 3 N/A 0 JEFFERSON MEMORIAL HOSPITAL 2000 FOUNDATION WAY MARTINSBURG WV 25401 550359755 PATIENT CARE WV 501(C)3 LINE 3 N/A 0 CITY HOSPITAL FOUNDATION 2000 FOUNDATION WAY MARTINSBURG WV 25401 311118075 HOSPITAL SUPPORT WV 501(C)3 LINE 11A, I N/A 0 JEFFERSON HEALTHCARE FOUNDATION 2000 FOUNDATION WAY MARTINSBURG WV 25401 550768901 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 1 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 WVU HEALTHCARE CO-OP PO BOX 8059 MORGANTOWN WV 26506 550650441 SUPPORT WV 501(C)3 LINE 11A, I WEST VIRGINIA UNITED HEALTH SYSTEM 1 UNITED SUMMIT CENTER 6 HOSPITAL PLAZA CLARKSBURG WV 26301 550752788 BEHAVIORAL HEALTH WV 501(C)3 LINE 3 N/A 0 POTOMAC VALLEY HOSPITAL INC 100 PIN OAK LANE KEYSER WV 26726 550420956 PATIENT CARE WV 501(C)3 LINE 3 WVU HOSPITALS INC 1 OHIO VALLEY AMBULATORY SURGERY CENTER 608 WASHINGTON BLVD BELPRE OH 45714 208671724 OUTPATIENT SURGICAL SERVICES OH CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION RELATED 0 0 0.62500 ALLIED HEALTH SERVICES INC PO BOX 782 MORGANTOWN WV 26507 550652017 MEDICAL LAB WV WV UNITED HEALTH SYSTEM C 0 WEST VIRGINIA UNITED INSURANCE SERVICES 1000 TECHNOLOGY DRIVE SUITE 2320 FAIRMONT WV 26554 550756055 PROVIDER NETWORK WV WV UNITED HEALTH SYSTEM C 0 1 1 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 WEST VIRGINIA UNITED HEALTH SYSTEM P 3509986 COST WEST VIRGINIA UNIVERSITY HOSPITALS INC P 2803613 COST WV UNITED INSURANCE SERVICES M 87000 COST ALLIED HEALTH SERVICES INC M 1101864 COST CAMDEN CLARK PHYSICIANS CORPORATION R 9839069 COST