2014-11-14T10:24:27-06:00 2013-12-31 560747981 DIXON HUGHES GOODMAN LLP PO BOX 1556 MORGANTOWN WV 265071556 990 2013-01-01 311524546 CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION CAMD 3044242202 800 GARFIELD AVENUE PARKERSBURG WV 26101 CAROLYN ALLEN CFO 3044242202 2014-11-14 1 SUSAN S DULL P00233523 3042927343 2013 2015-11-30 17:44:51Z CAMDEN CLARK MEDICAL CENTER DAVID K MCCLURE 800 GARFIELD AVE PARKERSBURG WV 26102 260567116 0 X WWW.CCMH.ORG X 1997 WV TO OPERATE AN ACUTE CARE AND EMERGENCY HOSPITAL FACILITY. 7 5 2342 450 3652450 656176 295809 221368 243609109 241853786 5297067 15176762 3592984 1885604 252794969 259137520 114665 324774 0 0 96472722 94018676 0 0 0 155914161 165866200 252501548 260209650 293421 -1072130 370251270 351297717 270486856 286649314 99764414 64648403 X THE MISSION OF CAMDEN-CLARK MEMORIAL HOSPITAL IS TO MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY FOR A LIFETIME. 0 0 133412490 129238943 AS PART OF CAMDEN CLARK MEMORIAL HOSPITAL'S MISSION OF MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY FOR A LIFETIME, IT OFFERS EMERGENCY ROOM SERVICES ON BOTH CAMPUSES. DUE TO THE COMMUNITY THAT IT SERVES, THE MAJORITY OF THE PATIENTS VISITING THE ER ARE EITHER UNDERINSURED OR UNINSURED. FOR THE REPORTING PERIOD, THERE WERE APPROXIMATELY 69,598 ER VISITS. OF THIS TOTAL, 9,631 OR 13.8% WERE ULTIMATELY ADMITTED TO THE HOSPITAL. THIS REPRESENTS 57.3% OF TOTAL HOSPITAL ADMISSIONS FOR 2013, SO A SIGNIFICANT PORTION OF THE HOSPITAL'S INPATIENT VOLUME COMES DIRECTLY FROM THE ER. 13960227 12738500 CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION 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 THAT INCLUDES SUPPORT GROUPS FOR PATIENTS/FAMILIES AND AESTHETIC SERVICES TO ENHANCE THE PATIENTS' PHYSICAL AND EMOTIONAL WELL-BEING. 4621524 7567673 CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION 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. 92210462 324774 92114811 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 IT'S 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 PROVIDED $17,347,032 OF CHARITY CARE FOR THE YEAR ENDED DECEMBER 31, 2013.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. 92210462 324774 92114811 244204703 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 1 1 1 1 0 0 1 181 0 2342 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 MARY F RUSSELL 3044242817 800 GARFIELD AVENUE PARKERSBURG WV 26102 X TERRY CAPEL MD CHAIRMAN 1.00 X X 0 0 0 KATHY G EDDY VICE CHAIRMAN 1.00 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 BOARD MEMBER 1.00 X X 0 0 0 JENNIFER LEAVITT MD BOARD MEMBER 1.00 X 81250 0 0 JOSEPH CAMPBELL BOARD MEMBER 1.00 X 0 0 0 MICHAEL A KING PRESIDENT/CEO 40.00 X 648718 0 -19528 ALLEN R BUTCHER TREASURER/CFO 40.00 X 393082 0 13889 TODD A KRUGER VICE PRESIDENT 40.00 X 356956 0 -40915 TOM HELLER VP OF HR 40.00 X 280513 0 10342 CYNTHIA KERN VP OF QUALITY 40.00 X 188548 0 8328 SHERRY SIMMONS CHIEF NURSING OFFICER 40.00 X 239096 0 8989 DAVID MCCLURE VP OF OPERATIONS 40.00 X 268916 0 12549 JOSHUA WOODS CIO 40.00 X 130789 0 3377 GENE SEXTON PHARMACIST 40.00 X 134140 0 11328 MICHAEL TRIMBLE PHARMACIST 40.00 X 141671 0 7320 SHAUN CARTER PHARMACY MANAGER 40.00 X 136010 0 -24951 BRIAN STANDLEY DIRECTOR OF FINANCE 40.00 X 145664 0 12922 3145353 0 3650 32 0 1 0 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PLACE CHICAGO IL 606731245 SOFTWARE HARDWARE SUPPORT & EQUIPMENT 3448596 CANDESCENT HEALING LLC P O BOX 634850 CINCINNATI OH 452634850 OP WOUND CARE & HYPERBARIC TREATEMENTS 1654830 HOSPITALIST MEDICINE PHYSICIAN 4535 DRESSLER ROAD NW CANTON OH 44718 HOSPITALISTS 1190912 PRICEWATERHOUSE COOPERS LLP P O BOX 7247-8001 PHILADELPHIA PA 191708001 VBO SERVICES 1025770 ALPHA TECHNOLOGIES P O BOX 1114 SCOTT DEPOT WV 25560 IT SUPPORT - SOFTWARE/HARDWARE 504061 28 221368 221368 PATIENT SERVICE,NET 621500 233981565 230837795 3143770 PASS-THROUGH INCOME - OVASC & HH 621910 1369419 1369419 6502802 6502802 241853786 15158032 14950 15143082 1672585 1429483 243102 243102 243102 1270 17573 0 113 1270 17460 18730 17460 1270 CAFETERIA 624200 988573 988573 FAMILY FITNESS CENTER 713940 493730 493730 160199 160199 1642502 259137520 239876248 3652450 15387454 324774 324774 2375827 907361 1468466 73783918 67881205 5902713 2358376 2169706 188670 9731057 8952572 778485 5769498 5307938 461560 104819 104819 46025 46025 17376775 15986633 1390142 481972 443414 38558 13235915 12177042 1058873 2586825 2379879 206946 4861445 4472529 388916 111191 102296 8895 7872454 7242658 629796 19437742 17882723 1555019 3244263 2984722 259541 MEDICAL SUPPLIES 33679520 33679520 PATIENT CHARGES 22393512 22393512 PROVISION FOR BAD DEBTS 21464700 21464700 REPAIRS & MAINTENANCE 6463865 5946756 517109 12505177 11504763 1000414 260209650 244204703 16004947 0 60312 263680 3762853 3094771 40894555 25990281 1972771 1629073 7163193 11026649 1689580 37792 286901558 121745655 217852197 165155903 87177770 123102072 311451 274091 9366588 20723405 370251270 351297717 18824287 31217962 46400 13664 189325321 220786341 454844 959317 61836004 33672030 270486856 286649314 X 99764414 64648403 99764414 64648403 370251270 351297717 X -1072130 -41678238 7634357 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22887 22887 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 $22,887, WAS RELATED TO LOBBYING ACTIVITIES OF THE AHA AND WVHA. 22327530 22327530 122305587 7197019 115108568 141375730 114548636 26827094 892711 892711 165155903 DUE FROM RELATED ORGANIZATIONS 8100145 UNAMORTIZED BORROWING COSTS 4522696 GOODWILL - OVASC 8100564 20723405 SELF-FUNDED INSURANCE RESERVE 7961000 PENSION LIABILITY 3724663 BOND INTEREST SWAP LIABILITY 12373185 OTHER 9613182 33672030 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 2013 AND 2012. 1 1 1 X 1 X 1 1 1 0 0 9574411 9574411 0.04010 35418688 23051396 12367292 0.05180 44993099 23051396 21941703 0.09190 786109 0 786109 0.00330 1438573 369423 1069150 0.00450 111974 111974 0.00050 2336656 369423 1967233 0.00830 47329755 23420819 23908936 0.10020 0 7721713 1544343 69690691 87878336 -18187645 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 1 X X X X X X X X 12 1 0 1 X HTTP://WWW.CAMDENCLARK.ORG/UPLOADS/PUBLIC X X X X X X X X X 1 0 1 1 200.000000000000 1 350.000000000000 1 X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 3: 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. 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 $21,464,700 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 ($21,464,700) BY THE COST TO CHARGE RATIO (35.85%) 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 2013 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 18.84% OF MEDICARE PATIENTS WERE DUALLY ELIGIBLE FOR MEDICARE/MEDICAID. THEREFORE, 18.84% OF THE SHORTFALL, OR $3,681,687, 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 PRIMARILY OF FOUR COUNTIES WITH AN ESTIMATED TOTAL POPULATION OF APPROXIMATELY 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) 5000 N/A N/A OPERATIONS PARKERSBURG HIGH SCHOOL WOOD COUNTY BOE 2101 DUDLEY AVENUE PARKERSBURG WV 26101 556000418 15000 N/A N/A STADIUM FUND GOOD SAMARITAN CLINIC 418 GRAND PARK DRIVE PARKERSBURG WV 26101 550708491 501(C)(3) 15000 N/A N/A OPERATIONS 3 3 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 X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 MICHAEL A KING PRESIDENT/CEO 515964 0 92734 0 40020 0 -24414 0 4886 0 629190 0 0 0 ALLEN R BUTCHER TREASURER/CFO 300224 0 57991 0 34867 0 9395 0 4494 0 406971 0 0 0 TODD A KRUGER VICE PRESIDENT 291248 0 57636 0 8072 0 -44591 0 3676 0 316041 0 0 0 TOM HELLER VP OF HR 211102 0 28911 0 40500 0 8869 0 1473 0 290855 0 0 0 CYNTHIA KERN VP OF QUALITY 150981 0 17067 0 20500 0 7166 0 1162 0 196876 0 0 0 SHERRY SIMMONS CHIEF NURSING OFFICER 188818 0 27278 0 23000 0 6358 0 2631 0 248085 0 0 0 DAVID MCCLURE VP OF OPERATIONS 211950 0 33966 0 23000 0 7492 0 5057 0 281465 0 0 0 BRIAN STANDLEY DIRECTOR OF FINANCE 136446 0 0 0 9218 0 4778 0 8144 0 158586 0 0 0 PART I, LINE 1A MEMBERSHIPS AT THE FAMILY FITNESS CENTER ARE OFFERED TO EACH MEMBER OF THE SENIOR LEADERSHIP TEAM. THESE ARE COVERED IN THE APPLICABLE EMPLOYMENT CONTRACTS. THE HOUSING ALLOWANCE WAS PROVIDED TO A CERTAIN NEWLY HIRED CHIEF NURSING OFFICER WHO DID NOT LIVE LOCALLY. THIS ALLOWANCE WAS DOCUMENTED IN THE EMPLOYMENT OFFER LETTER. A WV HOSPITAL FINANCE AUTHORITY 621256910 956622VY7 2004-06-30 96695947 SEE SCHEDULE O 0 0 0 B WV HOSPITAL FINANCE AUTHORITY 621256910 956622A87 2009-10-16 25063291 REFUND PRIOR ISSUE (9/13/2007) 0 0 0 C WV HOSPITAL FINANCE AUTHORITY 621256910 956622D35 2011-03-01 73555712 PURCHASE ASSETS OF ST. JOSEPHS HOSPITAL 0 0 0 D WV HOSPITAL FINANCE AUTHORITY 621256910 2012-08-01 50080000 REFUND 2011 SERIES A BONDS 0 0 0 A 96250000 6480328 5856926 957082 4364162 54490515 24666322 270826 2008 1 0 1 1 B 25063291 1652833 220575 328403 31197274 1278049 1 0 0 1 C 50000000 73555712 435854 70741634 0 0 0 1 D 50080000 80000 50000000 2012 1 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 1 0 1 1 UBS AG 29.600000000000 0 0 1 LEHMAN BROTHERS SPECIAL FINANCING 29.600000000000 1 1 0 B 0 0 1 0 0 0 0 1 0 C 0 1 0 0 1 0 0 0 0 D 0 1 0 0 1 0 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. (CITY HOSPITAL), EIN 55-0383321; THE CHARLES TOWN GENERAL HOSPITAL (D/B/A JEFFERSON MEMORIAL HOSPITAL), EIN 55-0359755; CITY HOSPITAL FOUNDATION, INC. (CITY HOSPITAL FOUNDATION), EIN 31-1118075; UNITED HOSPITAL CENTER, INC. (UNITED HOSPITAL CENTER), EIN 55-0525724; AND CAMDEN-CLARK MEMORIAL HOSPITAL, INC. (CAMDEN-CLARK), 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. A WV HOSPITAL FINANCE AUTHORITY 621256910 956622E91 2013-10-03 47037860 REFUND 2004 SERIES A BONDS 0 0 0 A 47037860 5335549 411600 12146948 30075085 2013 1 0 0 1 A 0 0 0 0 0 0 0 A 1 0 0 0 0 0 A 1 PARKERSBURG NEUROLOGICAL ASSOCIATES BUSINESS ENTITY OWNED, IN PART, BY BOARD MEMBER, DR.MICHAEL MOREHEAD 70232 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 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 OF THE 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 AND 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. PART VII, COLUMN F OFFICERS 8) MICHAEL A. KING AND 10) TODD A. KRUGER AS WELL AS ONE OF THE HIGHEST PAID EMPLOYEES 16) SHAUN CARTER REPORT NEGATIVE AMOUNTS FOR DEFERRED COMPENSATION. THESE AMOUNTS REPRESENT A DECREASE IN ACTUARIAL VALUE OF A DEFINED BENEFIT PLAN AND ARE NETTED WITH THE AMOUNT OF COMPENSATION REPORTED FOR 403(B) PLANS. THE INDIVIDUAL AMOUNTS ARE AS FOLLOWS: 8) MICHAEL A. KING: 403(B) PLAN COMPENSATION: $7,650 DECREASE IN ACTUARIAL VALUE OF DEFINED BENEFIT PLAN: $-32,064 10) TODD A. KRUGER 403(B) PLAN COMPENSATION: $4,023 DECREASE IN ACTUARIAL VALUE OF DEFINED BENEFIT PLAN: $-48,613 16) SHAUN CARTER DECREASE IN ACTUARIAL VALUE OF DEFINED BENEFIT PLAN: $-25,164 FORM 990, PART XI, LINE 9: ANNUAL PENSION LIABILITY VALUATION ADJUSTMENT 8,982,993. TRANSFERS TO RELATED ORGANIZATIONS 1,004,387. ANNUAL ADJUSTMENT TO VALUATION OF INTEREST RATE SWAP LIABILITY -1,115,581. CUMULATIVE CHANGE IN INTEREST RATE SWAP 132,098. PASS-THROUGH INCOME FROM OVASC & HH -1,369,540. FAMILY FITNESS CENTER LLC 2804 BIRCH STREET PARKERSBURG WV 26101 550774193 PROVIDE AN EXERCISE FACILITY FOR THE COMMUNITY WV 493730 1494277 CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION 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 OHIO VALLEY AMBULATORY SURGERY CENTER 608 WASHINGTON BLVD BELPRE OH 45714 208671724 OUTPATIENT SURGICAL SERVICES OH CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION RELATED 1316132 794722 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 2509955 COST WEST VIRGINIA UNIVERSITY HOSPITALS INC P 70998 COST WV UNITED INSURANCE SERVICES M 60000 COST ALLIED HEALTH SERVICES INC M 1014049 COST