CAMDEN-CLARK PHYSICIAN CORPORATION: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CAMDEN-CLARK PHYSICIAN CORPORATION (EIN 26-4058719)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-14
- IRS object ID
- 201443189349303169
- Schema version
- 2013v3.0
- 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 | 2014-11-14T10:24:27-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1747 | AddressLine1 |
| City | CHARLESTON | City |
| State | WV | State |
| ZIP Code | 25326 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | 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 | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | PARKERSBURG | City |
| State | WV | State |
| ZIP Code | 26102 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CAROLYN ALLEN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3044242202 | PhoneNum |
| Signature | 2014-11-14 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | 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 | AddressLine1 |
| City | PARKERSBURG | City |
| State | WV | State |
| ZIP Code | 26102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,467,587 | 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 | 166 | TotalEmployeeCnt |
| Total Volunteers | 5 | 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 | $16,024,609 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,463,792 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $265,864 | PYOtherRevenueAmt |
| CY Other Revenue | $3,795 | CYOtherRevenueAmt |
| PY Total Revenue | $16,290,473 | PYTotalRevenueAmt |
| CY Total Revenue | $14,467,587 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,390,589 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,989,414 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,583,019 | PYOtherExpensesAmt |
| CY Other Expenses | $6,945,947 | CYOtherExpensesAmt |
| PY Total Expenses | $21,973,608 | PYTotalExpensesAmt |
| CY Total Expenses | $21,935,361 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$5,683,135 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$7,467,774 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,684,615 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,286,194 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,616,535 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,685,887 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,068,080 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$6,399,693 | 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 | $10,013,697 | ExpenseAmt |
| Revenue | $6,761,340 | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,362,618 | ExpenseAmt |
| Revenue | $4,971,307 | RevenueAmt |
| Desc | CAMDEN CLARK PHYSICIAN CORPORATION OFFERS SURGICAL SERVICES IN CONJUNCTION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION. THE ORGANIZATION EMPLOYS 6 SURGEONS WHO PROVIDE SURGICAL SERVICES IN A VARIETY OF DISCIPLINES, INCLUDING OPEN HEART, CARDIO-THORACIC, VASCULAR AND GENERAL SURGERY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,044,886 | ExpenseAmt |
| Revenue | $2,731,144 | 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) |
|---|---|---|
| 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, SURGICAL AND OB/GYN PROGRAMS DESCRIBED ABOVE, THE ORGANIZATION EMPLOYS PHYSICIANS WHO SPECIALIZE IN 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 Program Service Expenses | $21,421,201 | 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 | Yes (1) | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 56 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 166 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | 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 | 0 | 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 RUSSELL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3044242817 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 GARFIELD AVENUE | AddressLine1 |
| City | PARKERSBURG | City |
| State | WV | State |
| ZIP Code | 26102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| KATHY G EDDY | |||||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| TERRY CAPEL MD | |||||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| DR DANIEL MCGRAW | |||||||||
| BOARD MEMBER - SEE SCH. O | 40.00 | Yes (X) | $844,073 | $0 | $35,309 | ||||
| JOE CAMPBELL | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MICHAEL KING | |||||||||
| EX OFFICIO | 5.00 | Yes (X) | $0 | $648,718 | -$19,528 | 40.00 | |||
| ALLEN BUTCHER | |||||||||
| TREASURER | 5.00 | Yes (X) | $0 | $393,082 | $13,889 | 40.00 | |||
| HECTOR HAMILTON | |||||||||
| EXEC DIRECTOR/SECRETARY | 40.00 | Yes (X) | $121,042 | $0 | $3,600 | ||||
| DR LISA CASALENUOVO | |||||||||
| PHYSICIAN | 40.00 | $498,141 | $0 | $21,461 | Yes (X) | ||||
| DR MICHAEL GALLOWAY | |||||||||
| PHYSICIAN | 40.00 | $583,296 | $0 | $5,860 | Yes (X) | ||||
| DR GABOR ALTDORFER | |||||||||
| PHYSICIAN | 40.00 | $631,122 | $0 | $16,271 | Yes (X) | ||||
| DR JOSE CRUZZAVALA | |||||||||
| PHYSICIAN | 40.00 | $653,372 | $0 | $11,614 | Yes (X) | ||||
| DR NIK SHAH | |||||||||
| PHYSICIAN | 40.00 | $999,890 | $0 | $13,294 | Yes (X) | ||||
| DR SIVAMURTHY KYATHARI | |||||||||
| PHYSICIAN | 40.00 | $496,310 | $0 | $13,521 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,827,246 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,041,800 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $115,291 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 35 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MFC CORPORATION | |||||
| PO BOX 779 | PARKERSBURG | WV | 26101 | BILLING & COLLECTIONS | $581,166 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | STAFFING SERVICES | $399,083 |
| MEDPOWER STAFFING | |||||
| 22422 DOLOMITE HILLS DRIVE | ASHBURN | VA | 20148 | STAFFING SERVICES | $152,056 |
| COMPHEALTH ASSOCIATES INC | |||||
| PO BOX 972651 | DALLAS | TX | 75397 | STAFFING SERVICES | $141,903 |
| JACKSON & COKER LOCUM TENENS | |||||
| PO BOX 277638 | ATLANTA | GA | 30384 | STAFFING SERVICES | $123,691 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $14,463,792 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,463,792 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,463,792 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $3,795 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,795 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,795 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,467,587 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,467,587 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,948,175 | TotalAmt |
| Program Services | $4,885,854 | ProgramServicesAmt |
| Management And General | $62,321 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,366,950 | TotalAmt |
| Program Services | $8,107,575 | ProgramServicesAmt |
| Management And General | $259,375 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,532 | TotalAmt |
| Program Services | $173,967 | ProgramServicesAmt |
| Management And General | $5,565 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $874,984 | TotalAmt |
| Program Services | $847,860 | ProgramServicesAmt |
| Management And General | $27,124 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $619,773 | TotalAmt |
| Program Services | $600,560 | ProgramServicesAmt |
| Management And General | $19,213 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,983 | TotalAmt |
| Management And General | $38,983 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,414,174 | TotalAmt |
| Program Services | $1,370,335 | ProgramServicesAmt |
| Management And General | $43,839 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,651 | TotalAmt |
| Program Services | $12,651 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,821 | TotalAmt |
| Program Services | $112,231 | ProgramServicesAmt |
| Management And General | $3,590 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,160 | TotalAmt |
| Program Services | $8,876 | ProgramServicesAmt |
| Management And General | $284 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,003 | TotalAmt |
| Program Services | $50,391 | ProgramServicesAmt |
| Management And General | $1,612 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,818 | TotalAmt |
| Program Services | $74,437 | ProgramServicesAmt |
| Management And General | $2,381 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $214,644 | TotalAmt |
| Program Services | $207,990 | ProgramServicesAmt |
| Management And General | $6,654 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $706,069 | TotalAmt |
| Program Services | $684,181 | ProgramServicesAmt |
| Management And General | $21,888 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,490,763 | $2,490,763 | |
| PROVISION FOR BAD DEBTS | $1,126,827 | $1,126,827 | |
| RENT/LEASE EQUIPMENT | $518,639 | $502,560 | $16,079 |
| RECRUITMENT AND RETENTI | $67,246 | $65,161 | $2,085 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,149 | TotalAmt |
| Program Services | $98,982 | ProgramServicesAmt |
| Management And General | $3,167 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,935,361 | TotalAmt |
| Program Services | $21,421,201 | ProgramServicesAmt |
| Management And General | $514,160 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1 | BOYAmt |
| EOY | -$1 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $188,413 | BOYAmt |
| EOY | $483,716 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,535,682 | BOYAmt |
| EOY | $1,973,540 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,317 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $7,574 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $256,341 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,375,741 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $810,717 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $661,689 | BOYAmt |
| EOY | $565,024 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $285,513 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,684,615 | BOYAmt |
| EOY | $3,286,194 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,616,535 | BOYAmt |
| EOY | $2,401,532 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $7,284,355 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,616,535 | BOYAmt |
| EOY | $9,685,887 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,068,080 | BOYAmt |
| EOY | -$6,399,693 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,068,080 | BOYAmt |
| EOY | -$6,399,693 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,684,615 | BOYAmt |
| EOY | $3,286,194 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$7,467,774 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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 IV Form990ScheduleAPartIVGrp
| 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 | $1,375,741 | OtherCostOrOtherBasisAmt |
| Depreciation | $810,717 | DepreciationAmt |
| Book Value | $565,024 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $565,024 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED ORGANIZATIONS | Desc |
| Amt | $7,284,355 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,284,355 | TotalLiabilityAmt |
| 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 | WEST VIRGINIA UNITED HEALTH 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 2012 AND 2011. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (9 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 - SEE SCH. O | $804,573 | $0 | $0 | $0 | $39,500 | $0 | $27,165 | $0 | $8,144 | $0 | $879,382 | $0 | $0 | $0 |
| MICHAEL KING | ||||||||||||||
| EX OFFICIO | $0 | $515,964 | $0 | $92,734 | $0 | $40,020 | $0 | -$24,414 | $0 | $4,886 | $0 | $629,190 | $0 | $0 |
| ALLEN BUTCHER | ||||||||||||||
| TREASURER | $0 | $300,224 | $0 | $57,991 | $0 | $34,867 | $0 | $9,395 | $0 | $4,494 | $0 | $406,971 | $0 | $0 |
| DR LISA CASALENUOVO | ||||||||||||||
| PHYSICIAN | $480,641 | $0 | $0 | $0 | $17,500 | $0 | $8,506 | $0 | $12,955 | $0 | $519,602 | $0 | $0 | $0 |
| DR MICHAEL GALLOWAY | ||||||||||||||
| PHYSICIAN | $560,315 | $0 | $0 | $0 | $22,981 | $0 | $216 | $0 | $5,644 | $0 | $589,156 | $0 | $0 | $0 |
| DR GABOR ALTDORFER | ||||||||||||||
| PHYSICIAN | $608,122 | $0 | $0 | $0 | $23,000 | $0 | $8,316 | $0 | $7,955 | $0 | $647,393 | $0 | $0 | $0 |
| DR JOSE CRUZZAVALA | ||||||||||||||
| PHYSICIAN | $630,372 | $0 | $0 | $0 | $23,000 | $0 | $7,650 | $0 | $3,964 | $0 | $664,986 | $0 | $0 | $0 |
| DR NIK SHAH | ||||||||||||||
| PHYSICIAN | $976,890 | $0 | $0 | $0 | $23,000 | $0 | $7,650 | $0 | $5,644 | $0 | $1,013,184 | $0 | $0 | $0 |
| DR SIVAMURTHY KYATHARI | ||||||||||||||
| PHYSICIAN | $479,160 | $0 | $0 | $0 | $17,150 | $0 | $7,877 | $0 | $5,644 | $0 | $509,831 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | MEMBERSHIPS AT THE FAMILY FITNESS CENTER ARE OFFERED TO EACH MEMBER OF THE SENIOR LEADERSHIP TEAM. THESE DUES ARE COVERED IN THE APPLICABLE EMPLOYMENT CONTRACTS. |
| 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 (10 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, ELECTS NO LESS THAN FIVE BUT NO MORE THAN NINE INDIVIDUALS OF THE BOARD AT THE ANNUAL MEETING. THE TERM FOR EACH DIRECTOR IS THREE YEARS. |
| 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 AND DIRECTOR OF FINANCE REVIEW THE COMPLETED FORM PRIOR TO FILING. AFTER THE RETURN IS FILED, A COPY IS SENT TO THE BOARD OF DIRECTORS FOR THEIR REVIEW. |
| 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 EXECUTIVE DIRECTOR'S PAY IS REVIEWED AND APPROVED BY THE CAMDEN-CLARK MEMORIAL HOSPITAL (CCMH) BOARD OF DIRECTORS. A COMPENSATION COMMITTEE CONSISTING OF ALL NON-PHYSICIAN MEMBERS OF THE CCMH BOARD REVIEWS AND APPROVES PAY FOR THE PHYSICIANS. THEIR CONTRACTS ARE BASED ON MEDICAL GROUP MANAGEMENT ASSOCIATION STANDARDS. |
| 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, COLUMN F | BOARD MEMBER 5) MICHAEL A. KING REPORTS A NEGATIVE AMOUNT FOR RELATED ORGANIZATION DEFERRED COMPENSATION. THIS AMOUNT REPRESENTS A DECREASE IN ACTUARIAL VALUE OF A DEFINED BENEFIT PLAN AND IS NETTED WITH THE AMOUNT OF COMPENSATION REPORTED FOR 403(B) PLANS. THE INDIVIDUAL AMOUNTS ARE AS FOLLOWS: 6) MICHAEL A. KING: 403(B) PLAN COMPENSATION: $7,650 DECREASE IN ACTUARIAL VALUE OF DEFINED BENEFIT PLAN: $-32,064 |
| FORM 990, PART VII, SECTION A | DR. DANIEL MCGRAW IS COMPENSATED FOR HIS POSITION AS A PHYSICIAN WITH THE ORGANIZATION, NOT FOR SERVING ON THE BOARD OF DIRECTORS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | 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 | Yes (1) | |
| 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 | |||||||||||
| 1000 TECHNOLOGY DRIVE | FAIRMONT | WV | 26554 | 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 | Yes (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 | Yes (1) | |
| CITY HOSPITAL INC | |||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 550383321 | PATIENT CARE | WV | 501(C)(3) | LINE 3 | 0 | N/A | |
| JEFFERSON MEMORIAL HOSPITAL | |||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 550359755 | PATIENT CARE | WV | 501(C)(3) | LINE 3 | 0 | N/A | |
| CITY HOSPITAL FOUNDATION | |||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 311118075 | HOSPITAL SUPPORT | WV | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| JEFFERSON HEALTHCARE FOUNDATION | |||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 550768901 | 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 | Yes (1) | |
| 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 | |
| WVU HEALTHCARE CO-OP | |||||||||||
| PO BOX 8059 | MORGANTOWN | WV | 26506 | 550650441 | SUPPORT | WV | 501(C)(3) | LINE 11A, I | WEST VIRGINIA UNITED HEALTH SYSTEM | Yes (1) | |
| UNITED SUMMIT CENTER | |||||||||||
| 6 HOSPITAL PLAZA | CLARKSBURG | WV | 26301 | 550752788 | BEHAVIORAL HEALTH | WV | 501(C)(3) | LINE 3 | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| 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 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE R LINE 1R | CAMDEN CLARK MEMORIAL HOSPITAL (CCMH) PAYS CERTAIN BENEFITS/EXPENSES ON BEHALF OF CCPC. AN INTERCOMPANY CHARGE IS MADE TO RECORD THESE EXPENSES ON CCPC'S BOOKS, BUT NOT REIMBURSEMENT IS MADE TO CCMH. CCMH ALSO TRANSFERS CRASH ON A MONTHLY BASIS, AS NEEDED, TO ASSIST CCPC IN ITS CASH FLOW NEEDS. |
| SCHEDULE R LINE 1J | CCPC IS THE CONTROLLED ORGANIZATION. IT RENTS SPACE FROM CAMDEN CLARK MEMORIAL HOSPITAL, UTILIZES HOSPITAL EQUIPMENT, AND IS SUPPORTED BY THE HOSPITAL FROM A CASH FLOW STANDPOINT, AS NEEDED, TO MEET MONTHLY OBLIGATIONS SUCH AS PAYROLL AND ACCOUNTS PAYABLE. |