2012-08-15T09:18:19-05:00 2011-06-30 DIXON HUGHES GOODMAN LLP PO BOX 1556 MORGANTOWN WV 265071556 990 2010-07-01 311524546 CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION CAMD 3044242202 800 GARFIELD AVENUE PARKERSBURG WV 26101 ALLEN R BUTCHER 3044242635 2012-08-15 1 SUSAN S DULL 3042927343 2010 2016-02-24 21:20:13Z CAMDEN CLARK MEDICAL CENTER MICHAEL A KING 800 GARFIELD AVE PARKERSBURG WV 26102 258812865 0 X WWW.CCMH.ORG X 1997 WV TO OPERATE AN ACUTE CARE AND EMERGENCY HOSPITAL FACILITY. 6 5 1735 450 3057656 561355 290515 600434 165218470 187334388 4355868 7155188 1828114 29180590 171692967 224270600 29600 52250 0 0 70209369 80850969 0 0 0 106243143 117590016 176482112 198493235 -4789145 25777365 260632900 384699358 170531779 262515526 90101121 122183832 THE MISSION OF CAMDEN-CLARK MEMORIAL HOSPITAL IS TO MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY FOR A LIFETIME. 0 0 183145085 52250 211872766 SEE SCHEDULE O 183145085 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 214 0 1735 1 1 1 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WV X X BRIAN R STANDLEY 3044242635 800 GARFIELD AVENUE PARKERSBURG WV 26102 LAURENCE MALLORY 1.00 X 0 0 0 TERRY CAPEL MD 1.00 X 0 0 0 KATHY G EDDY 1.00 X X 0 0 0 RONALD ROBERTS 1.00 X 0 0 0 MICHAEL MOREHEAD MD 1.00 X 0 0 0 GREG GORE 1.00 X 0 0 0 JENNIFER LEAVITT DO 1.00 X 0 0 0 MICHAEL A KING 40.00 X 654956 0 54876 ALLEN R BUTCHER 40.00 X 370532 0 15011 TODD A KRUGER 40.00 X 339031 0 18966 DAVID MCCLURE 40.00 X 211361 0 11532 TOM HELLER 40.00 X 241471 0 13470 CYNTHIA KERN 40.00 X 152047 0 9570 PAMELA MINCKS 40.00 X 125220 0 8482 GENE SEXTON 40.00 X 124497 0 10699 JOSHUA WOODS 40.00 X 116346 0 9221 SHAUN CARTER 40.00 X 118131 0 11283 BRIAN STANDLEY 40.00 X 112157 0 9152 PAUL MODIE MD 1.00 X 0 0 0 2565749 0 172262 17 0 1 0 ECLIPSYS CORPORATION THREE RAVINIA DRIVE ATLANTA GA 30346 SOFTWARE CONSULTING 3268996 CANDESCENT HEALING LLC 32 ELM PLACE SUITE 1 SOUTH RYE NY 10580 WOUND CARE SERVICES 1452837 HMP OF WOOD COUNTY 4535 DRESSLER RD NW CANTON OH 47718 HOSPITALISTS 1245979 QUEST DIAGNOSTICS 12436 COLLECTION CENTER DRIVE CHICAGO IL 60693 LABORATORY SERVICES 1111898 JARVIS DOWNING AND EMCH INC PO BOX 6253 WHEELING WV 26003 CONTRACTOR 1092198 23 600434 600434 PATIENT SERVICE,NET 621500 187071707 184667874 2403833 AMBULANCE FEES 621910 235110 235110 COMMUNITY SERVICE 624200 27571 27571 187334388 2455623 2455623 28254 28254 867487 457070 410417 410417 410417 38755630 876 34085195 4670435 876 4671311 4671311 GAIN ON ASSET ACQUISIT 900099 26414074 26414074 CAFETERIA 624200 1156553 1156553 FAMILY FITNESS CENTER 713940 653823 653823 545723 528137 17586 28770173 224270600 211872766 3057656 8739744 52250 52250 2092823 547171 1545652 59936250 55141350 4794900 3059795 2815011 244784 10925337 10051310 874027 4836764 4449823 386941 1512178 1391204 120974 239568 239568 350946 350946 9246597 8506869 739728 585488 538649 46839 41275292 37973269 3302023 2770662 2549009 221653 4475113 4117104 358009 2997 2757 240 43712 40215 3497 6351932 5843777 508155 14371291 13221588 1149703 6581911 6055358 526553 PATIENT CHARGES 12363240 12363240 PROVISION FOR BAD DEBTS 7671387 7671387 DIAGNOSTIC TESTING 3191801 3191801 6555901 6031429 524472 198493235 183145085 15348150 0 76829 1586700 9843323 4015681 17017894 34799058 17972 1393564 1353423 3607758 7243062 2059143 2196301 392377756 165585350 125329531 226792406 96153755 102540449 258743 347336 4874388 3824942 260632900 384699358 10599648 20713596 62476 62792 110720610 192486219 3886981 528248 45262064 48724671 170531779 262515526 X 90101121 122183832 90101121 122183832 260632900 384699358 X 25777365 6305345 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11870134 11870134 137989309 37004714 100984595 239594619 125028163 114566456 2923694 3552473 -628779 226792406 SELF-FUNDED INSURANCE RESERVE 12124203 PENSION LIABILITY 10984066 BOND INTEREST SWAP LIABILITY 13132024 OTHER 12484378 48724671 PART X, LINE 2: EFFECTIVE JULY 1, 2009, THE ORGANIZATION ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ("FASB") AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVIDUAL TAX POSITIONS IN THE FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST AS OF JUNE 30, 2010, AND THE ADOPTION OF THE GUIDANCE DID NOT HAVE A MATERIAL EFFECT ON THE FINANCIAL POSITION OR RESULTS OF OPERATIONS. 1 1 X 1 X 1 X 1 1 1 0 0 13643285 13643285 0.07150 25089473 16369426 8720047 0.04880 38732758 16369426 22363332 0.12030 822189 822189 0.00430 827562 652663 174899 0.00090 110680 110680 0.00060 1760431 652663 1107768 0.00580 40493189 17022089 23471100 0.12610 0 2913911 582782 78102484 70607111 7495373 X 1 1 1 LHC HOME HEALTH AND HOSPICE 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 1 0 1 1 200.000000000000 1 350.000000000000 1 X X X X X 1 1 X X X X X 1 X X X 1 X X X X X X X 1 X 0 0 PART I, LINE 7: WORKSHEET 2, "RATIO OF PATIENT CARE, COST TO CHARGES" WAS USED TO COMPLETE THE COST-TO-CHARGE RATIO IN PART 1, 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, L7 COL(F): THE AMOUNT OF TOTAL EXPENSE REPORTED ON FORM 990, PART IX, LINE 25 INCLUDES A BAD DEBT EXPENSE OF $14,084,474 WHICH HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENT OF TOTAL EXPENSE IN COLUMN (F). PART I, LINE 7E THIS AMOUNT INCLUDES THE EXPENSES OF THE FOLLOWING ACTIVITIES ALONG WITH MANY MORE: MAY FAIR HEALTH FAIR, COMMUNITY HEALTH FORUM, CHILDBIRTH CLASSES, HEARTSAVER AED, RELAY FOR LIFE, ROTARY BLOOD SCREENING, AND SHRINER'S CLINIC. PART I LINE 6A-B FOR FISCAL YEAR END 6/30/2010, A COMMUNITY BENEFIT REPORT WAS PREPARED. THE ORGANIZATION IS IN THE PROCESS OF PREPARING INFORMATION TO COMPLY WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT REQUIREMENTS OF SECTION 501(R) FOR YEARS BEGINNING AFTER 5/23/2012. PART III, LINE 4: BAD DEBT EXPENSE AT COST IS CALCULATED BY MULTIPLYING THE INTERNAL FINANCIAL STATEMENT AMOUNT OF BAD DEBT EXPENSE ($7,671,387) BY THE COST TO CHARGE RATIO (37.98%) WHICH WAS DETERMINED BY USING IRS WORKSHEET 2 FROM THE SCHEDULE H INSTRUCTIONS. THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY IS CALCULATED BASED ON AN ESTIMATE OF 20% OF THE BAD DEBT AT COST. THE RATIONALE FOR THIS IS THAT SELF-PAY BALANCES AFTER INSURANCE ARE NOT ACCOUNTS THAT WE FOCUS A LOT OF EFFORT ON. WE FOCUS OUR EFFORTS IN 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 8: THE ORGANIZATION USED INFORMATION FROM THEIR COST REPORT TO COMPLETE THIS SECTION AS WELL AS THEIR INTERNAL REPORTS. 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 6 MONTHS, SO ANY SUBSEQUENT VISITS DURING THAT 6 MONTH PERIOD WOULD ALSO QUALIFY FOR CHARITY CARE AND NOT BE SUBJECT TO COLLECTION ACTIVITY. CAMDEN-CLARK MEMORIAL HOSPITAL PART V, SECTION B, LINE 11H: THE ORGANIZATION HAS POSTED KEY EXCERPTS OF ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE ALONG WITH SOME FREQUENTLY ASKED QUESTIONS AND RELATED ANSWERS. CAMDEN-CLARK MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IS STATE REGULATED. WEST VIRGINIA IS A RATE-REGULATED STATE. THE WV HEALTH CARE AUTHORITY HAS PRESCRIBED REVENUE LIMITS FOR CERTAIN GROUPS OF PAYORS, INCLUDED UNINSURED INDIVIDUALS. 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. PART VI, LINE 3: THE ORGANIZATION PROVIDES IN WRITING ALL OPTIONS FOR POSSIBLE FINANCIAL ASSISTANCE. THE ORGANIZATION ALSO HAS FINANCIAL REPRESENTATIVES THAT ARE AVAILABLE TO DISCUSS OPTIONS WITH INPATIENTS AND OUTPATIENTS ON A DAILY BASIS AS WELL AS HAVING THIS INFORMATION POSTED ON THE ORGANIZATION'S WEBSITE. WE ALSO HAVE A STATE MEDICAID WORKER ONSITE TO HELP DETERMINE PATIENT ELIGIBILITY AND HELP PATIENTS THROUGH THE ELIGIBILITY PROCESS. PART VI, LINE 4: CAMDEN CLARK, LOCATED IN PARKERSBURG, WV, SERVICES THE MID-OHIO VALLEY REGION OF WEST VIRGINIA AND OHIO. THE PRIMARY SERVICE AREA CONSISTS PRIMARILY OF 4 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, OUR COMMUNITY INCLUDEDS SEVERAL FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS. PART VI, LINE 6: 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 7: CAMDEN-CLARK MEMORIAL HOSPITAL IS PART OF THE WV UNITED HEALTH SYSTEM. CAMDEN-CLARK MEMORIAL HOSPITAL PLAYS A SIGNIFICANT ROLE IN IMPROVING THE GENERAL HEALTH CARE OF THE COMMUNITY. THE STRATEGIC 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 HOSPITAL, INC. WHICH ARE LOCATED IN THE EASTERN PANHANDLE OF WEST VIRGINIA AND WEST VIRGINIA UNIVERSITY HOSPITALS LOCATED IN MORGANTOWN, WV. REPORTS FILED WITH STATES PART VI, LINE 7 WV 1 WOOD COUNTY DEVELOPMENT AUTHORITY PO BOX 1683 PARKERSBURG WV 26102 550575873 501(C)4 5500 ANNUAL PLEDGE GOOD SAMARITAN CLINIC INC 418 GRAND PARK DRIVE SUITE 311 PARKERSBURG WV 261054000 550708491 501(C)3 15000 DONATION TO CLINIC OPERATIONS PARKERSBURG AREA COMMUNITY FOUNDATION PO BOX 1762 PARKERSBURG WV 26102 550748246 501(C)3 10000 ANNUAL PLEDGE BOY SCOUTS OF AMERICA 1340 JULIANA STREET PARKERSBURG WV 26101 501(C)3 5000 FUNDRAISING DINNER DONATION ELITE SPORTS CENTER 2000 1ST AVENUE PARKERSBURG WV 26101 10000 SCOREBOARD SPONSORSHIP/SIGNAGE 3 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CONTRIBUTIONS AND GRANTS ARE DISCRETIONARY AND DECISIONS ON WHICH ORGANIZATIONS TO SUPPORT ARE MADE BY THE SENIOR LEADERSHIP TEAM IN CONJUNCTION WITH THE BOARD OF DIRECTOR OF MARKETING. A VICE PRESIDENT OF THE ORGANIZATION SITS ON THE WOOD COUNTY DEVELOPMENT AUTHORITY'S BOARD OF DIRECTORS. THE DIRECTOR OF FINANCE SITS ON THE GOOD SAMARATIN CLINIC'S BOARD OF DIRECTORS. X X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 MICHAEL A KING 616456 0 0 0 38500 0 50933 0 3943 0 709832 0 0 0 ALLEN R BUTCHER 337532 0 0 0 33000 0 11274 0 3737 0 385543 0 0 0 TODD A KRUGER 306031 0 0 0 33000 0 16094 0 2872 0 357997 0 0 0 DAVID MCCLURE 189361 0 0 0 22000 0 8525 0 3007 0 222893 0 0 0 TOM HELLER 202971 0 0 0 38500 0 10931 0 2539 0 254941 0 0 0 CYNTHIA KERN 141042 0 0 0 11005 0 8330 0 1240 0 161617 0 0 0 SUPPLEMENTAL INFORMATION PART III 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 CERTAIN NEWLY HIRED CHIEF NURSING OFFICERS WHO DID NOT LIVE LOCALLY. THESE WERE DOCUMENTED IN THE EMPLOYMENT OFFER LETTERS. WV HOSPITAL FINANCE AUTHORITY 621256910 956622VY7 2004-06-30 96695947 SEE SCHEDULE O 0 0 0 WV HOSPITAL FINANCE AUTHORITY 621256910 956622A87 2009-10-16 25063291 REFUND PRIOR ISSUE (9/13/2007) 0 0 0 WV HOSPITAL FINANCE AUTHORITY 621256910 956622D35 2011-03-01 73555712 PURCHASE ASSETS OF ST. JOSEPHS HOSPITAL 0 0 0 96250000 6484456 5856926 957082 4364162 54490515 24666322 264472 2008 1 0 1 1 25063291 1651274 220575 328403 29661003 2875516 2012 1 0 0 1 73555712 435854 68026812 5093143 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 1 1 UBS AG 29.600000000000 0 0 1 LEHMAN BROTHERS SPECIAL FINANCING 29.600000000000 1 1 1 0 0 0 0 1 1 0 1 0 0 0 0 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 CENTER, INC. (CAMDEN-CLARK) EIN 31-1524546 ARE MEMBERS OF THE WEST VIRGINIA UNITED HEALTH SYSTEM OBLIGATED GROUP AND HAVE ISSUED TAX-EXEMPT BONDS UNDER WEST VIRGINIA UNITED HEALTH SYSTEM. HOWEVER, THESE BOND ISSUANCES WERE IN TURN REALLOCATED BY WEST VIRGINIA UNITED HEALTH SYSTEM TO ITS SYSTEM SUBSIDIARIES. PARKERSBURG NEUROLOGICAL ASSOCIATES BUSINESS ENTITY OWNED, IN PART, BY BOARD MEMBER, DR.MICHAEL MOREHEAD 93122 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 50017 REVENUE RECEIVED FROM PARKERSBURG NEUROLOGICAL ASSOCIATES FOR LEASE OF THE ORGANIZATION'S OFFICE SPACE 0 FORM 990, PART I, LINE 5 AFTER CAMDEN CLARK MEDICAL CENTER MERGED WITH ST. JOSEPH'S HOSPITAL ON MARCH 1, 2011, THE ORGANIZATION HAD 2,108 TOTAL EMPLOYEES, WHICH IS DIFFERENT THAN THE AMOUNT THAT WAS REPORTED ON THE 2010 FORM W-3 OF 1,735. FORM 990, PART III, LINE 4A: 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 COMMUNITY RECOGNIZING 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 $25,095,194 OF CHARITY CARE FOR THE YEAR ENDED JUNE 30, 2011. 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. 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 WEST VIRGINIA UNITED HEALTH SYSTEM (WVUHS), THE SOLE MEMBER OF CAMDEN CLARK HEALTH SERVICES, INC. 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 REVIEWED THE COMPLETED FORM PRIOR TO FILING. A DRAFT COPY OF THE FORM IS REVIEWED WITH THE BOARD OF DIRECTORS AND A FULL AND COMPLETE FORM IS FORWARDED TO THE BOARD 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. FORM 990, PART VIII, LINE 11A IN CONJUNCTION WITH THE ACQUISITION OF THE ASSETS OF ST. JOSEPH'S HOSPITAL, AN INDEPENDENT APPRAISAL WAS OBTAINED ON BOTH FACILITIES. THE VALUE ARRIVED AT IN THE APPRAISAL WAS HIGHER THAN THE CARRYING VALUE OF THE ASSETS ACQUIRED, RESULTING IN A GAIN BEING RECORDED OF $26,414,074. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: ANNUAL PENSION LIABILITY VALUATION ADJUSTMENT 4,310,193. ANNUAL ADJUSTMENT TO VALUATION OF INTEREST RATE SWAP LIABILITY 7,153,297. UNREALIZED GAIN OR LOSS -743,497. INTERCOMPANY TRANSFERS -4,414,648. TOTAL TO FORM 990, PART XI, LINE 5: 6,305,345. FAMILY FITNESS CENTER LLC 2804 BIRCH STREET PARKERSBURG WV 26101 550774193 PROVIDE AN EXERCISE FACILITY FOR THE COMMUNITY WV 656131 1791146 N/A 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 N/A 0 CAMDEN-CLARK FOUNDATION 800 GARFIELD AVENUE PARKERSBURG WV 26102 550667789 RAISE AND MANAGE FUNDS FOR CAMDEN-CLARK MEMORIAL HOSPITAL. WV 501(C)3 LINE 7 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 1 1 1 0 0 0 0 1 1 0 0 0 1 0 0 1 1 0