2012-11-09T09:31:05-06:00 2011-12-31 560747981 DIXON HUGHES GOODMAN LLP PO BOX 1556 MORGANTOWN WV 265071556 990 2011-01-01 550539692 WEST VIRGINIA MEDICAL INSTITUTE INC WEST 3043469864 3001 CHESTERFIELD AVENUE CHARLESTON WV 25304 KATHLEEN D MERRILL 3043469864 2012-11-07 1 SUSAN DULL P00233523 3042927343 2011 2016-02-24 21:20:13Z KATHLEEN D MERRILL 3001 CHESTERFIELD AVE CHARLESTON WV 25304 24546761 0 X WWW.WVMI.ORG X 1973 WV TO IMPROVE THE HEALTH OF THE PEOPLE WE SERVE. 5 4 175 0 0 0 0 0 21905711 24538188 358 2281 4343 2823 21910412 24543292 0 200936 0 0 12325433 13185212 0 0 0 10051117 10285586 22376550 23671734 -466138 871558 13216830 14869747 2558663 3344953 10658167 11524794 TO IMPROVE THE HEALTH OF THE PEOPLE WE SERVE. 0 0 23400761 200936 24541011 THE ORGANIZATION PROVIDED EDUCATIONAL AND QUALITY IMPROVEMENT PROGRAMS TO HEALTH CARE PROVIDERS PARTICIPATING IN MEDICARE, MEDICAID, VETERANS AFFAIRS AND OTHER GOVERNMENTAL HEALTH CARE PROGRAMS, AND TO OTHER HEALTH CARE RELATED ENTITIES. 23400761 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 165 0 175 1 0 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 DE WV X KATHLEEN D MERRILL 3043469864 3001 CHESTERFIELD AVENUE CHARLESTON WV 25304 X DERRICK L LATOS 1.00 X 3134 0 0 ROBERT A ROSE 1.00 X 3334 0 0 DANIEL LAUFFER 1.00 X 1917 0 0 WILLIAM C DAVIS 1.00 X 442 0 0 JOHN WIESENDANGER 24.00 X X 375475 0 43231 KATHLEEN MERRILL 27.00 X 244008 0 40533 SVEN BERG 24.00 X 14618 0 81 DAVID LAMBERT 49.00 X 171662 0 36612 CHARLES SCHADE 27.00 X 150932 0 28538 MARK STEPHENS 27.00 X 149366 0 18273 ANGELA GRAHAM 47.00 X 119518 0 33260 JOHN MARKS 41.00 X 132535 0 29432 AARON SPURLOCK 43.00 X 119875 0 33724 1486816 0 263684 12 0 1 0 LEAH BUIST 194 BUTLER STREET KINGSTON PA 18704 HOME CARE CONSULTANT 201635 GAY NICHOLSON DBA FOCUS CLINICAL AB 413 W CLINTON STREET ITHACA NY 14850 HOME CARE CONSULTANT 168811 PAUL T KURYLA 47 WILLIAMSBURG WAY HURRICANE WV 25526 PHYSICIAN RECORDS REVIEW CONSULTANT 135918 DIXON HUGHES GOODMAN LLP PO BOX 3049 ASHEVILLE NC 288023049 FINANCIAL AND A-133 AUDITORS 134775 TRACI HOFFMAN 443 KIMBERLY DRIVE MELBOURNE FL 23940 HOME CARE CONSULTANT 126358 10 CONTRACT REVENUE 541900 24538188 24538188 24538188 5750 5750 3469 -3469 -3469 -3469 2823 2823 2823 24543292 24541011 0 2281 200936 200936 935047 928502 6545 9271826 9206923 64903 893056 886805 6251 1315574 1306365 9209 769709 764321 5388 27601 27601 79828 79828 6962859 6914119 48740 569056 565073 3983 320150 317909 2241 570848 566852 3996 769367 763981 5386 58000 57594 406 304770 302637 2133 121013 120166 847 DUES AND SUBSCRIPTIONS 78788 78236 552 EDUCATION EXPENSES 68930 68447 483 354376 351895 2481 23671734 23400761 270973 0 5068534 5816188 5011233 6383490 364530 442949 4463112 3242761 1261742 1220351 1510791 1006769 13216830 14869747 2254720 2847890 303943 497063 2558663 3344953 X 10658167 11524794 10658167 11524794 13216830 14869747 X 871558 -4931 X X 0 1 1 X 1 1 X 21580897 21727811 21165291 21905711 24538188 110917898 21580897 21727811 21165291 21905711 24538188 110917898 0 8430737 8430737 8430737 8430737 102487161 356797 135359 10123 5769 5749 513797 356797 135359 10123 5769 5749 513797 8765 3953 6918 4343 2825 26804 21946459 21867123 21182332 21915823 24546762 111458499 0.91950 0.00460 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: INCLUDES MISCELLANEOUS REVENUE FROM PART VIII, LINE 11D OF FORM 990 0 0 0 0 0 0 0 0 1 52117 52117 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF WVMI'S AHQA (THE AMERICAN HEALTH QUALITY ASSOCIATION) MEMBERSHIP DUES, IN THE AMOUNT OF $2,117, WAS FOR LOBBYING EXPENSES. WVMI ALSO PAID $50,000 TO AN INDEPENDENT LOBBYIST, LARRY SWANN. WVMI RETAINED LARRY SWANN IN SEPTEMBER 2007. MR, SWANN PROVIDES GOVERNMENT RELATIONS CONSULTING IN ALL HEALTH RELATED TOPICS WITH A GOAL OF DEVELOPING STRATEGIC NEW BUSINESS INITIATIVES FOR WVMI WITHIN THE STATE OF WEST VIRGINIA. MR. SWANN ALSO WORKS WITH WVMI'S CEO TO BUILD STRONG RELATIONSHIPS WITH WEST VIRGINIA PUBLIC OFFICIALS INCLUDING KEY LEGISLATORS AND ADMINISTRATIVE OFFICIALS. 150005 150005 1861642 1302641 559001 55772 48009 7763 1661836 1332386 329450 733857 559725 174132 1220351 INVESTMENT PRUDENTIAL STOCK 15785 ALLOWANCE FOR MKT ADJUSTMENT 12984 INTERCOMPANY RECEIVABLES 978000 1006769 24543292 23671734 871558 -4931 -4931 866627 24541830 -4931 -4931 24546761 -3469 -3469 24543292 23675203 3469 3469 23671734 0 23671734 PART XII, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSET -3,469. PART XIII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSET 3,469. PART X, LINE 2: THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2011 AND 2010. 1 HEALTH CHOICE NETWORK 9064 NW 13 TERRACE MIAMI FL 33172 650504316 501(C)(3) 42750 PROVIDE EDUCATION, OUTREACH, AND DIRECT TECHNICAL ASSISTANCE TO ASSIST HEALTH CARE PROVIDERS TO ADOPT AND MAKE MEANINGFUL USE OF ELECTRONIC HEALTH RECORD (EHR) PROVIDE EDUCATION, OUTREACH, AND DIRECT TECHNICAL ASSISTANCE TO ASSIST HEALTH CARE PROVIDERS TO ADOPT AND MAKE MEANINGFUL USE OF ELECTRONIC HEALTH RECORD (EHR) UNIVERSITY PHYSICIANS & SURGEONS 1600 MEDICAL CENTER DRIVE HUNTINGTON WV 25701 550564945 501(C)(3) 153750 PROVIDE EDUCATION, OUTREACH, AND DIRECT TECHNICAL ASSISTANCE TO ASSIST HEALTH CARE PROVIDERS TO ADOPT AND MAKE MEANINGFUL USE OF ELECTRONIC HEALTH RECORD (EHR) 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SUBRECIPIENTS ARE REQUIRED TO COMPLY WITH ALL APPLICABLE GUIDELINES OF THE FEDERAL AWARD FOR WHICH FUNDS ARE GRANTED, AS WELL AS THOSE GOVERNING THEIR INSTITUTIONS IN OTHER ASPECTS OF BUSINESS. WE REQUEST DOCUMENTATION OF SAID COMPLIANCE, WHERE NECESSARY, AND REVIEW ORGANIZATION AUDIT REPORTS EFFECTING THIS AWARD, WHEN THE REPORTS ARE COMPLETED (IF REQUIRED). ADDITIONALLY, INVOICES RECEIVED UNDERGO A DESK AUDIT FOLLOWING OUR OWN INTERNAL POLICIES AND PROCEDURES BEFORE ANY FEDERAL FUNDS ARE PAID. 0 0 0 0 0 0 0 0 0 JOHN WIESENDANGER 369475 0 0 0 6000 0 29400 0 13831 0 418706 0 0 0 KATHLEEN MERRILL 219008 0 25000 0 0 0 26702 0 13831 0 284541 0 0 0 DAVID LAMBERT 171662 0 0 0 0 0 18025 0 18587 0 208274 0 0 0 CHARLES SCHADE 150932 0 0 0 0 0 19376 0 9162 0 179470 0 0 0 MARK STEPHENS 149366 0 0 0 0 0 17924 0 349 0 167639 0 0 0 ANGELA GRAHAM 119518 0 0 0 0 0 14848 0 18412 0 152778 0 0 0 JOHN MARKS 132535 0 0 0 0 0 16590 0 12842 0 161967 0 0 0 AARON SPURLOCK 119875 0 0 0 0 0 15258 0 18466 0 153599 0 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE COMPENSATION COMMITTEE OF QUALITY INSIGHTS HOLDINGS, INC., THE SOLE MEMBER OF THE ORGANIZATION, APPROVES THE COMPENSATION FOR THE FILING ORGANIZATION'S CEO. FORM 990, PART VI, SECTION A, LINE 6 QUALITY INSIGHTS HOLDINGS, INC. IS THE SOLE MEMBER OF WEST VIRGINIA MEDICAL INSTITUTE, INC. FORM 990, PART VI, SECTION A, LINE 7A QUALITY INSIGHTS HOLDINGS, INC. SHALL APPOINT ALL MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B QUALITY INSIGHTS HOLDINGS, INC. SHALL HAVE SOLE AUTHORITY AND POWER WITH RESPECT TO: (A) AMENDING THE CERTIFICATE OF INCORPORATION; (B) AMENDING THE BYLAWS; (C) ADOPTING AN AGREEMENT OF MERGER OR CONSOLIDATION; (D) APPROVING THE SALE, LEASE, OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S PROPERTY AND ASSETS; OR (E) APPROVING THE DISSOLUTION OF THE ORGANIZATION OR A REVOCATION OF A DISSOLUTION. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED FORM 990 IS PROVIDED ELECTRONICALLY FOR REVIEW BY THE ORGANIZATION'S BOARD. ADDITIONALLY, THE CONTROLLER AND THE CHIEF FINANCIAL OFFICER PERFORM A DETAILED REVIEW AND VERIFY ALL FINANCIAL INFORMATION AGAINST THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND SUPPORTING ACCOUNTING RECORDS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE ORGANIZATION'S CONFLICT DISCLOSURE POLICIES. ALL BOARD MEMBERS, OFFICERS AND EMPLOYEES COMPLETE AND SIGN A CONFLICT DISCLOSURE FORM THAT LISTS AFFILIATIONS AND COMPENSATION ARRANGEMENTS, FOR THEMSELVES AND FAMILY MEMBERS, THAT COULD CREATE A POTENTIAL CONFLICT OF INTEREST. THIS IS ACCOMPLISHED AS PART OF ANNUAL COMPLIANCE TRAINING. THE TRAINING ITSELF ADDRESSES CONFLICTS OF INTEREST. CONFLICT DISCLOSURE FORMS ARE REVIEWED BY THE CEO (IN THE CASE OF BOARD MEMBERS) AND THE CORPORATE COMPLIANCE OFFICER. ESTABLISHED PROCEDURES REQUIRE A BOARD MEMBER TO RECUSE HIMSELF/HERSELF FROM EVALUATION OF A PROPOSED BUSINESS ARRANGEMENT IF THE BOARD MEMBER HAS A POTENTIAL CONFLICT. IN THE CASE OF EMPLOYEES, THE COMPLIANCE OFFICER WORKS WITH THE EMPLOYEE'S SUPERVISOR TO DETERMINE WHETHER A POTENTIAL CONFLICT MAY BE MITIGATED. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: COMPENSATION ARRANGEMENTS ARE ESTABLISHED BASED ON INFORMATION OBTAINED FROM DIFFERENT DATA SOURCES AND OUTSIDE CONSULTANTS FOR SIMILARLY SITUATED TAXABLE OR TAX-EXEMPT ORGANIZATIONS PROVIDING SIMILAR SERVICES. THE COMPENSATION PLAN IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF QUALITY INSIGHTS HOLDINGS, INC'S BOARD ON AN ANNUAL BASIS. THIS PROCESS IS THE SAME FOR BOTH THE CEO AND ALL OFFICERS AND KEY EMPLOYEES. LINE 15B: COMPENSATION ARRANGEMENTS ARE ESTABLISHED BASED ON INFORMATION OBTAINED FROM DIFFERENT DATA SOURCES AND OUTSIDE CONSULTANTS FOR SIMILARLY SITUATED TAXABLE OR TAX-EXEMPT ORGANIZATIONS PROVIDING SIMILAR SERVICES. THE COMPENSATION PLAN IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF QUALITY INSIGHTS HOLDINGS, INC'S BOARD ON AN ANNUAL BASIS. THIS PROCESS IS THE SAME FOR BOTH THE CEO AND ALL OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAY MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, UPON REQUEST, ON A CASE-BY-CASE BASIS. FORM 990, PART VII, SECTION A IN ADDITION TO THE HOURS DEVOTED TO WEST VIRGINIA MEDICAL INSTITUTE, INC., DANIEL LAUFFER ALSO DEVOTES AN AVERAGE OF 1 HOUR PER WEEK TO QUALITY INSIGHTS HOLDINGS, INC., A RELATED ORGANIZATION. IN ADDITION TO THE HOURS DEVOTED TO WEST VIRGINIA MEDICAL INSTITUTE, INC., DERRICK LATOS ALSO DEVOTES AN AVERAGE OF 1 HOUR PER WEEK TO BOTH QUALITY INSIGHTS HOLDINGS, INC. AND MID-ATLANTIC RENAL COALITION, INC., BOTH OF WHICH ARE RELATED ORGANIZATIONS. IN ADDITION TO THE HOURS DEVOTED TO WEST VIRGINIA MEDICAL INSTITUTE, INC., JOHN WIESENDANGER ALSO DEVOTES AN AVERAGE OF 3, 11, 1, 1 AND 1 HOURS PER WEEK TO QUALITY INSIGHTS OF DELAWARE, INC., QUALITY INSIGHTS OF PENNSYLVANIA, INC., QUALITY INSIGHTS RENAL NETWORK, INC., QUALITY INSIGHTS HOLDINGS, INC., AND MID-ATLANTIC RENAL COALITION, INC. RESPECTIVELY, ALL OF WHICH ARE RELATED ORGANIZATIONS. IN ADDITION TO THE HOURS DEVOTED TO WEST VIRGINIA MEDICAL INSTITUTE, INC., KATHLEEN MERRILL ALSO DEVOTES AN AVERAGE OF 3, 12, 1, AND 1 HOURS PER WEEK TO QUALITY INSIGHTS OF DELAWARE, INC., QUALITY INSIGHTS OF PENNSYLVANIA, INC., QUALITY INSIGHTS RENAL NETWORK, INC., AND MID-ATLANTIC RENAL COALITION, INC. RESPECTIVELY, ALL OF WHICH ARE RELATED ORGANIZATIONS. IN ADDITION TO THE HOURS DEVOTED TO WEST VIRGINIA MEDICAL INSTITUTE, INC., ROBERT ROSE ALSO DEVOTES AN AVERAGE OF 1 HOUR PER WEEK TO QUALITY INSIGHTS HOLDINGS, INC., A RELATED ORGANIZATION. IN ADDITION TO THE HOURS DEVOTED TO WEST VIRGINIA MEDICAL INSTITUTE, INC., SVEN BERG ALSO DEVOTES AN AVERAGE OF 3, 11, 1, AND 1 HOURS PER WEEK TO QUALITY INSIGHTS OF DELAWARE, INC., QUALITY INSIGHTS OF PENNSYLVANIA, INC., QUALITY INSIGHTS RENAL NETWORK, INC., AND MID-ATLANTIC RENAL COALITION, INC. RESPECTIVELY, ALL OF WHICH ARE RELATED ORGANIZATIONS. IN ADDITION TO THE HOURS DEVOTED TO WEST VIRGINIA MEDICAL INSTITUTE, INC., WILLIAM DAVIS ALSO DEVOTES AN AVERAGE OF 1 HOUR PER WEEK TO QUALITY INSIGHTS HOLDINGS, INC., A RELATED ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -4,931. QUALITY INSIGHTS OF DELAWARE INC 3411 SILVERSIDE ROAD WILMINGTON DE 19810 541967588 TO IMPROVE THE HEALTH OF THE PEOPLE THE ORGANIZATION SERVES. DE 501(C)6 QUALITY INSIGHTS HOLDINGS INC 0 QUALITY INSIGHTS OF PENNSYLVANIA INC 2601 MARKET PLACE STREET HARRISBURG PA 17110 743051725 TO IMPROVE THE HEALTH OF THE PEOPLE THE ORGANIZATION SERVES. PA 501(C)6 QUALITY INSIGHTS HOLDINGS INC 0 QUALITY INSIGHTS RENAL NETWORK INC 3001 CHESTERFIELD AVENUE CHARLESTON WV 25304 270333640 TO IMPROVE THE HEALTH OF THE PEOPLE THE ORGANIZATION SERVES. WV 501(C)3 LINE 9 QUALITY INSIGHTS HOLDINGS INC 0 QUALITY INSIGHTS HOLDINGS INC 3001 CHESTERFIELD AVENUE CHARLESTON WV 25304 262480548 HOLDING COMPANY FOR HEALTHCARE QUALITY IMPROVEMENT ORGANIZATIONS. WV 501(C)3 LINE 11 N/A 0 MID-ATLANTIC RENAL COALITION INC 300 ARBORETUM PLACE SUITE 310 RICHMOND VA 23236 541431984 TO IMPROVE THE HEALTH OF THE PEOPLE THE ORGANIZATION SERVES. VA 501(C)3 LINE 9 QUALITY INSIGHTS HOLDINGS INC 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 QUALITY INSIGHTS OF DELAWARE INC K 1134564 INTERCOMPANY ACCOUNTING QUALITY INSIGHTS RENAL NETWORK INC K 374039 INTERCOMPANY ACCOUNTING QUALITY INSIGHTS OF DELAWARE INC P 1518320 INTERCOMPANY ACCOUNTING QUALITY INSIGHTS OF PENNSYLVANIA INC K 3800643 INTERCOMPANY ACCOUNTING QUALITY INSIGHTS OF PENNSYLVANIA INC L 585536 INTERCOMPANY ACCOUNTING QUALITY INSIGHTS OF PENNSYLVANIA INC P 3191128 INTERCOMPANY ACCOUNTING QUALITY INSIGHTS RENAL NETWORK INC P 400131 INTERCOMPANY ACCOUNTING QUALITY INSIGHTS RENAL NETWORK INC L 76968 INTERCOMPANY ACCOUNTING MID-ATLANTIC RENAL COALITION INC K 458235 INTERCOMPANY ACCOUNTING QUALITY INSIGHTS OF DELAWARE INC L 69079 INTERCOMPANY ACCOUNTING MID-ATLANTIC RENAL COALITION INC L 76399 INTERCOMPANY ACCOUNTING MID-ATLANTIC RENAL COALITION INC P 349011 INTERCOMPANY ACCOUNTING