2012-11-13T08:27:27-06:00 2011-12-31 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 60606 990 2011-01-01 550526150 Charleston Area Medical Center Inc CHAR PO Box 1547 Charleston WV 253261547 Larry Hudson 3043887603 2012-11-12 1 Laura Gillespie P00855604 3124861000 2011 2016-02-24 21:20:13Z CAMC Larry Hudson 501 Morris Street Charleston WV 253010000 944472963 0 X www.camc.org X 1971 WV Charleston Area Medical Center, Inc.'s ("CAMC") primary charitable exempt purpose is to provide hospital care, without distinction, for all the inhabitants of the City of Charleston, State of WV and elsewhere, to promote legitimate methods for the prevention of disease and positive promotion of health (both personal and public), and to foster and conduct education in medicine in all its branches and adjunct arts and sciences, such as nursing and technical occupations, which contribute to the diagnosis, treatment and prevention of disease. CAMC owns and operates three seperately-licensed hospitals as a tertiary-care academic medical center designed to provide care for community residents throughout every stage of life. CAMC patients depend on CAMC to provide convenient and compassionate care delivered regardless of a patient's ability to pay. 14 9 7776 211 8062086 734917 615798 1139543 865558794 887692859 6948634 3387772 1427342 2406414 874550568 894626588 9498371 1068694 0 0 341447981 337876186 0 0 0 501406264 526332209 852352616 865277089 22197952 29349499 664973877 694695545 486933205 500422847 178040672 194272698 X Striving to provide the best health care to every patient, every day. 0 0 524665589 275396 860761735 CAMC is West Virginia's largest medical center with over 6,100 employees and 578 medical staff. CAMC is licensed for 838 beds at three campuses and our health care services delivery focuses on providing a full range of inpatient and outpatient services as a tertiary regional referral center, teaching and safety net hospital. As a regional referral center, CAMC has one of only two state Level 1 Trauma Centers, a Level III Neonatal ICU, a Pediatric ICU, a TJC-Certified Primary Stroke Center, and Bariatric Center of Excellence. CAMC is the primary medical safety net provider of women and children's and trauma services in central and southern West Virginia and provides 23% of the charity care in the state. There were inpatient days of 209,118, outpatient visits of 486,751, emergency department visits of 76,103 and deliveries of 3,099 in 2011. CAMC gives back to the community because we understand the impact that high quality medical care, charity care, education, corporate contributions and community partnerships have on the lives of real people. 27255552 636610 CAMC has established medical and allied health education excellence as a core competency. Provision and support for education include training for interns and residents, nurses, anesthetists and other personnel. 78 WVU/WVSOM medical students trained at CAMC hospitals and 178 medical residents were employed by CAMC. CAMC provided faculty support to the University of Charleston helping educate 56 students, assisted 86 employees through student loan forgiveness, and distributed 281 scholarships. 131718906 156688 438069 CAMC does much more than just provide health care, being involved in nearly every aspect of the lives and well being of the community. CAMC offered 85 programs which served an estimated 176,585 people. CAMC provided acute inpatient and outpatient hospital services including unreimbursed charity care at cost of $39,030,011 and bad debts at cost of $21,625,068. Creative, state-of-the-art programs and services are provided to our community to serve our community-particularly the needs of the low income, elderly, and other vulnerable persons. Community benefits are programs or activities that provide treatment or promote health and healing as a response to identified community needs and meet at least one of the following community benefit criteria: 1) Improves access to health care services. 2) Enhances health of the community. 3) Advances medical or health care knowledge. 4) Relieves or reduces the burden of government or other community efforts. 683640047 1 1 0 1 0 0 0 0 1 1 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 504 0 1 7776 1 1 1 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WV X Larry Hudson 3043887603 501 Morris Street Charleston WV 253010000 David L Ramsey 50.00 X X 934889 0 178365 Nelle Ratrie Chilton 2.50 X 0 0 0 Carol A Egnatoff 2.50 X 0 0 0 James P Griffith MD 2.50 X 0 0 0 R Thomas Bowden III DO 2.50 X 0 0 0 John R Hoblitzell Esq 2.50 X X 0 0 0 Charles L Capito Jr 2.50 X 0 0 0 William R McDavid Esq 2.50 X 0 0 0 Thomas E Potter Esq 2.50 X 0 0 0 Linda J Powers 2.50 X 0 0 0 Karen S Price 2.50 X 0 0 0 Asif Rahman MD 2.50 X 10000 0 0 William A Rice Jr 2.50 X X 0 0 0 Mark A Chandler 2.50 X 0 0 0 Edwin H Welch Ph D 2.50 X 0 0 0 John A Willis MD 2.50 X 61507 0 0 Larry C Hudson 50.00 X 570523 0 89058 Glenn Crotty Jr MD 50.00 X 577559 0 79215 Marshall A McMullen Jr 50.00 X 323519 0 207019 Michael D Williams 50.00 X 303731 0 140569 S Andrew Weber 50.00 X 254476 0 90597 Stephen Z Bell 50.00 X 245041 0 125460 Robert D Whitler 50.00 X 212629 0 33520 Beth A Samples 50.00 X 1094566 0 48333 Lynn Y Brookshire 50.00 X 286549 0 170306 Elizabeth Spangler MD 50.00 X 383089 0 37003 Ronald E Moore 50.00 X 238713 0 150964 Robert B Danielson 50.00 X 186873 0 52425 Dale R Wood 50.00 X 330982 0 169344 Jeffrey H Goode 50.00 X 247485 0 77440 Jeff Oskin 50.00 X 207851 0 26132 James P Tierney DO 40.00 X 900117 0 10200 Daniel L Smith 40.00 X 502831 0 37218 Leon Ronen 40.00 X 455653 0 35458 Mark K Stephens 40.00 X 454604 0 35396 Robert J Crisalli 40.00 X 354396 0 29294 9137583 0 1823316 206 0 1 0 Siemens Medical Solutions Dept AT 40065 Atlanta GA 25304 IT Service & Support 15289030 West Virginia University 3110 MacCorkle SE Charleston WV 25304 GME/Physician Services 13636712 Air Methods PO Box 676592 Dallas TX 752676592 Medical Services 2368845 Comprehensive Pharmacy PO Box 102658 Atlanta GA 303682658 Management Services 1840058 Executive Health Resources PO Box 822688 Philadelphia PA 191822688 Consultants 1644246 110 415748 171792 552003 1139543 Patient Revenue 621990 850357631 850357631 Lab Services 621500 9308786 8012505 1296281 Pharmacy 446110 7716715 7716715 Cafeteria/Vending 721000 5550500 5550500 Rental (non residentia 531120 5050892 1524489 3526403 9708335 6484604 49581 3174150 887692859 4288087 427533 3860554 553273 553273 867 867 47266656 1126131 46794143 3052232 472513 -1926101 -1453588 -1453588 Affiliate Transfers 541610 859033 859033 Laundry 812300 833205 833205 Medical Center Inn 721110 437738 437738 275571 275571 2405547 894626588 861199804 8062086 24225155 693334 693334 375360 375360 12016325 101854 11914471 1185236 446213 739023 250407053 212332785 38074268 7134479 5827048 1307431 48598958 39884324 8714634 18534135 15068437 3465698 1512916 1317606 195310 2897446 2897446 479808 479808 102265 102265 862484 862484 62768234 38291431 24476803 1403289 89850 1313439 170352098 165690803 4661295 8360405 430625 7929780 18139955 12065008 6074947 1719853 1215539 504314 564298 287919 276379 14598432 14598432 27056124 27056124 35565384 16779557 18785827 9360074 16216 9343858 Prov. For Uncollectible 63270371 61734333 1536038 0 Charity Allowance 60444147 60444147 0 0 Provider Tax 17904979 17904979 0 0 Preventative Maintenanc 8493800 1314385 7179415 0 20475847 4272170 16203677 865277089 683640047 181637042 0 33736 38897 104204140 112557282 108974107 121033479 91562 1697529 14125910 16374675 7171928 4698753 837759756 570408036 271195719 267351720 20919842 20663276 41634841 42284436 5877267 96622092 102118231 664973877 694695545 105915710 114156647 10396783 9293323 302088734 299343331 -50833 164187 15544643 12328654 9470595 10187840 43567573 54948865 486933205 500422847 X 149918809 166598333 17238584 16552813 10883279 11121552 178040672 194272698 664973877 694695545 X 29349499 -13117473 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 5808 0 0 1 158961 0 1 1257 166026 0 Explanation of Lobbying Activities: Part II-B, Line 1: Legislative Dinner $1,257: Occasionally, individuals are asked by legislators for opinions on certain issues and the process of health-related legislation. There are periodic meetings and communications between CAMC representatives and legislative officials concerning health issues, usually in a general manner, rather than for or against any specific bill per se. 0 1 28121864 637036 -192637 888233 3665 27674365 25031594 865051 2980879 710409 45251 28121864 20516626 1047818 3812540 311551 33839 25031594 26766284 906169 -5868928 1268215 18684 20516626 0.41000 0.59000 0 1 1 20151669 20151669 309298525 188789913 120508612 6868943 4427979 2440964 480798911 371697160 109101751 20641708 5492984 15148724 267351720 Malpractice Fund 2747830 C Malpractice Fund 26106905 F Recruitment/Student Loan 5810432 C Workers Comp Self Insured Fund 54709 F RC Byrd Teaching Ctr Fund 7107 F Investments Other 122598 C Affiliate Receivables 7434855 C 42284436 Trustee Funds 5764258 Interest in Net Assets: CAMC Foundation 27514378 Bond Funds 47277673 Bond Collateral 17290000 Deferred Bond Costs 4000671 Investments other 271251 102118231 Federal Income Taxes 190097 Estimated Malpractice Claims 22360000 Estimated Worker's Comp Claims 1802045 Affiliate Payables 12101008 Settlements Due to 3rd Parties 3881328 Estimated Retiree Health 3742603 Umbrella Trust & SERP 10871784 54948865 Part IV, Line 2b: CAMC operates HealthCare Financial Services, which provides collections services to outside clients. Payments that are recovered by the collection department include both the commission portion and the amount due to the outside client. The amount listed in Part X Line 21 reflects the amount CAMC transmitted to the client. Description of Intended Use of Endowment Funds: Part V, Line 4: To further the mission of the organization. Description of Uncertain Tax Positions Under FIN 48: Part X: Part X, Line 2: CAMC's financial statements are audited as part of the audit of the financial statements of CAMC Health System, Inc and Subsidiaries (collectively, the "System"). Language regarding ASC 740 (FIN 48) included in the consolidated footnotes is as follows: "CAMC, the Foundation, the Institute and CAMC Teays, are exempt from income taxes under Section 501 (c)(3) of the Internal Revenue Code (the "Code") and applicable state statutes, but are subject to unrelated business income tax. A provision of $135,000 has been made in the accompanying consolidated financial statements for the year ended December 31, 2011, for estimated unrelated business income tax. The System does not have any material uncertain tax positions at December 31, 2011. 1 1 X 1 X 1 X 1 1 1 0 1 1 39030011 39030011 0.04510 136653834 90885000 45768834 0.05290 3770799 1478366 2292433 0.00260 179454644 92363366 87091278 0.10060 3051730 9190 3042540 0.00350 36583806 6907468 29676338 0.03430 689244 555796 133448 0.00020 0.00000 151760 151760 0.00020 40476540 7472454 33004086 0.03820 219931184 99835820 120095364 0.13880 0.00000 0.00000 69101 69101 0.00010 0.00000 0.00000 0.00000 0.00000 595 595 0.00000 149626 30648 118978 0.00010 219322 30648 188674 0.00020 0 61734333 34818164 255437475 297168328 -41730853 X 1 1 1 General Division Medical Office Building Partnership Medical Office space rental 0.79330 0.00000 0.20670 2 Women & Children's Medical Office Building Partnership Medical Office space rental 0.88510 0.00000 0.11490 3 1 CAMC Memorial Hospital

3200 MacCorkle Avenue Charleston WV 253040000

X X X X 2 CAMC General Hospital

501 Morris Street Charleston WV 253010000

X X X X 3 CAMC Women and Children's Hospital

800 Pennsylvania Avenue Charleston WV 253025302

X X X X X CAMC MEMORIAL HOSPITAL 1 1 1 200.000000000000 1 200.000000000000 1 X X X X 1 1 X X X 1 X 0 1 X 0 0 CAMC GENERAL HOSPITAL 2 1 1 200.000000000000 1 200.000000000000 1 X X X X 1 1 X X X 1 X 0 1 X 0 0 CAMC WOMEN AND CHILDREN'S HOSPITAL 3 1 1 200.000000000000 1 200.000000000000 1 X X X X 1 1 X X X 1 X 0 1 X 0 0 10 SVI Laboratory Services

3004 Chesterfield Charleston WV 25304

Laboratory Services CAMC Imaging Center (Kanawha City Locati

3416 MacCorkle Ave SE Charleston WV 25304

Outpatient Imaging Center CAMC Imaging Center (Trace Fork Location

60 RHL Boulevard South Charleston WV 25309

Outpatient Imaging Center CAMC Urgent Care Center

314 Goff Mountain Road Suite 3 Cross Lanes WV 25313

Urgent Care Facility CAMC Phys Therapy & Sport Med Center

200 Tracy Way Charleston WV 253111258

Rehabilitation Facility CAMC Wound Healing Center

600 Morris Street Suite 103 Charleston WV 25301

Wound Healing Center CAMC Ambulatory Infusion Center

3100 MacCorkle Ave Suite 101 Charleston WV 25304

Ambulatory Infusion Center CAMC Weight Loss Center

3100 MacCorkle Ave Suite 202 Charleston WV 25304

Weight Loss Center CAMC Occupational Lung Center

600 Morris Street Suite 100 Charleston WV 25301

Occupational Lung Center Cardiac Imaging Center

2335 Chesterfield Avenue Charleston WV 253041066

Cardiac Imaging Services Part I, Line 7: Utilized Worksheet 2 to determine cost-to-charge ratio. Part II: Community-building activites include programs and services that address root causes of health problems. Examples include CAMC's membership in the Partners in Health Network, Inc. ("Partners"), members of which comprise a network of mostly small and rural hospitals, clinics and health departments who work together to address quality and educational needs for improving care management, assistance with NCQA accreditation for patient centered medical homes and improved quality through addressing sepsis. Access to health care for 5,000 working uninsured individuals in central and southern West Virginia is provided through Partners' Community Access Program. Additionally, CAMC provides students enrolled in post-secondary education with related on-the-job training that is required for their graduation. Health Fairs for the community focusing on adults and children provide screening and health information to identify and address health issues. Part III, Line 4: There is no footnote describing bad debt, however, private pay accounts and amounts for deductibles and co-insurance that are deemed uncollectable that do not appear to meet the charity care guidelines, are written off as bad debt expense and appear as a deduction from patient service revenue in the audited financial statements. To estimate the amount of the bad debt expense attributable to patients eligible under the charity care policy, one month of actual bad debt written off was reviewed. Sixty percent of this was for uninsured patients. A sample of 100 of the uninsured patients from the month was taken and entered into a credit worthy calculator to determine that 94% of the patients met the income eligibility guidelines under the charity care policy. Part III, Line 8: CAMC treats any government reimbursement that is insufficient to cover allocated costs as being a community benefit. CAMC chooses to serve the community by participating in the Medicare program and accepting Medicaid reimbursement. Part III, Line 9b: CAMC's collection policy makes provisions for patients who qualify for charity care or financial assistance. Patients who receive charity assistance must meet the following requirements: income at 200% or less of Federal poverty income and resource guidelines, insufficient assets to pay for the care, and not eligible for any public programs. Patients without third-party coverage who do not qualify for charity are given a 20% discount from charges (which is greater than any commercial discount). In addition to charity and uninsured discounts, CAMC provides assistance with payment plans, government programs, and an Employee Assistance Program. CAMC MEMORIAL HOSPITAL Part V, Section B, Line 13g: A summary of the policy is provided to patients on admission, attached to billing invoices, and posted in areas of service. CAMC GENERAL HOSPITAL Part V, Section B, Line 13g: A summary of the policy is provided to patients on admission, attached to billing invoices, and posted in areas of service. CAMC WOMEN AND CHILDREN'S HOSPITAL Part V, Section B, Line 13g: A summary of the policy is provided to patients on admission, attached to billing invoices, and posted in areas of service. CAMC MEMORIAL HOSPITAL Part V, Section B, Line 15e: None of these actions are taken without first making a reasonable effort to determine eligibility. CAMC GENERAL HOSPITAL Part V, Section B, Line 15e: None of these actions are taken without first making a reasonable effort to determine eligibility. CAMC WOMEN AND CHILDREN'S HOSPITAL Part V, Section B, Line 15e: None of these actions are taken without first making a reasonable effort to determine eligibility. CAMC MEMORIAL HOSPITAL Part V, Section B, Line 19d: Patients who qualify for charity care are given a 100% discount. If a patient does not qualify for charity care but is uninsured, a 20% discount from billed charges is given, which is greater than the lowest negotiated commercial insurance discount. CAMC GENERAL HOSPITAL Part V, Section B, Line 19d: Patients who qualify for charity care are given a 100% discount. If a patient does not qualify for charity care but is uninsured, a 20% discount from billed charges is given, which is greater than the lowest negotiated commercial insurance discount. CAMC WOMEN AND CHILDREN'S HOSPITAL Part V, Section B, Line 19d: Patients who qualify for charity care are given a 100% discount. If a patient does not qualify for charity care but is uninsured, a 20% discount from billed charges is given, which is greater than the lowest negotiated commercial insurance discount. Part VI, Line 2: CAMC is an active sponsor of the community health survey completed every three years by the Kanawha Coalition for Community Health Improvement. This random telephone survey of Kanawha County residents provides information from our community on community health issues that is used in a county-wide open Community Forum to establish the top three health issues the community will address over the next three years. CAMC conducted its fifth triennial community health needs assessment through Kanawha Coalition for Community Health Improvement during 2011. CAMC participates on the Coalition's Steering Committee and oversees the Community Work Groups as they address these priority issues. Additionally, since 2006 the Kanawha Coalition for Community Health Improvement has been the coordinating body for addressing youth risks and interventions in Kanawha county. Part VI, Line 3: CAMC informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under CAMC's charity care policy during the registration process. Brochures are available at each registration point with contact information and phone numbers for our Financial Counselors. CAMC Financial Counselors are located in each Emergency Department and Admitting area. During registration, if a patient is uninsured, they may be referred to a Financial Counselor who provides education about Charity Care, Medicaid Eligibility and Federal Disability. WV state employees are also on site at each hospital to accept and process Medicaid applications and notify patients if they qualify. Part VI, Line 4: CAMCs community and primary area of focus is Kanawha County. Putnam, Boone, Fayette, Logan, Braxton, Jackson, Lincoln, Raleigh, Clay, Nicholas and Roane Counties are secondary service areas to CAMC. Kanawha County constitutes a population of 198,762 with a median age of 42 and household median income of 36,541. CAMC provides, alone and in collaboration, with others, a wide-ranging array of community benefit services designed to improve community health and the health of individuals, and to increase access to health care. This includes providing free and discounted services to people who are uninsured and underinsured. Part VI, Line 5: CAMC's governing board is its Board of Trustees, which is a predominately volunteer community board comprised of prominent civic leaders. A minority of board members are hospital administrators, physicians or others professionally connected to the hospital. Admission to the medical staff is open to all qualified physicians in the area, consistent with the size and nature of the facility. Each CAMC hospital operates a full-time emergency room open to everyone, regardless of ability to pay. CAMC serves a broad cross-section of the community through research or charity care. CAMC applies any surplus funds toward improving facilities, equipment, patient care, medical training, research and education. CAMC's community-building activities promote the health of the community through workforce development activities including educational and health care career presentations for youth, under-employed adults and those changing careers, and by providing work experiences for students enrolled in post-secondary programs with work-based experience needed for graduation. CAMC also provides community support through all-terrain vehicle ("ATV") safety education. Part VI, Line 6: CAMC Health Education and Research Institute, Inc. ("CHERI"), a sister company to CAMC, is actively engaged in clinical trials and has active research protocols in oncology, cardiology/cardiovascular medicine, internal medicine and medicine subspecialties, behavioral health community medicine, pediatrics, nursing and trauma/pain. The majority of this research is conducted at CAMC hospitals and in collaboration with CAMC. CHERI also manages CAMC's residency program and other educational programs conducted at CAMC's hospital facilities. Charleston Area Medical Center Foundation, Inc.'s ("the Foundation") mission is to support and promote CAMC's delivery of excellent and compassionate health services, and its contribution to the quality of life and economic vitality of the region, through accepting donations and raising funds. Integrated Health Care Providers, Inc., a sister company to CAMC, operates physician practices to meet CAMC's needs to speciality physicians to maintain adequate coverage for emergency and trauma services. CAMC Teays Valley Hospital, Inc., a sister company to CAMC, is a 68 bed rural hospital in Putnam County, WV and provides acute and emergency services to its community as well as community benefit to the residents in its county. CAMC's governing board is its Board of Trustees, which is a predominantly volunteer , community board comprised of prominent civic leaders. A minority of board members hospital administrators, physicians or others professionally connected to the hospital. Admission to medical staff is open to all qualified physicians in the area, consistent with the size and nature of the facility. Each CAMC hospital operates a full-time emergency room open to everyone, regardless of ability to pay. CAMC serves a broad cross-section of the community through research or charity care. CAMC applies any surplus funds toward improving facilities, equipment, patient care, medical training, research and education. Reports Filed With States Part VI, Line 7 WV 1 University of Charleston 2300 MacCorkle Avenue SE Charleston WV 253040000 550357039 501(c)(3) 261250 0 Nursing and Pharmacy Program Support WV Health Right Inc 1520 Washington Street Charleston WV 253110000 311066881 501(c)(3) 238839 General Program Support Ronald McDonald House Charities of Southern West Virginia Inc 302 30th St SE Charleston WV 253040000 550631080 501(c)(3) 12013 General Program Support Coalition to Protect America's Healthcare P O Box 30211 Bethesda MD 208240211 522253225 501(c)(3) 10000 General Program Support The Gabriel Project of West Virginia Inc P O Box 4663 Charleston WV 253640000 311504147 501(c)(3) 6000 General Program Support Fund for the Arts 803 Quarrier Street 100 Charleston WV 253010000 550614854 501(c)(3) 11500 General Program Support Clay Center for the Arts One Clay Square Charleston WV 253010000 550702471 501(c)(3) 8000 General Program Support 7 0 Nursing Scholarships 70 156075 Allied Health Scholarships 31 60975 Medical Scholarships 6 25975 Employee Dependent Scholarships 27 32645 Employee Scholarships 147 99690 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: CAMC provides nursing, allied health and medical student scholarships funded by the Foundation. An application portfolio is submitted by the candidate and reviewed and scored anonymously by the Foundation's Nursing Allied Health and Medical Student Scholarship committee co-chairs for subsequent scholarship award by the committee. CAMC provides employee and employee dependent scholarships. Candidates submit an application and required materials an a committee reviews applications based on scholarship guidelines and criteria and awards scholarships. Scholarship payments are submitted directly to the college or university on behalf of the recipient. CAMC provides support to the University of Charleston ("UC") nursing program and pharmacy school program. UC is a nonprofit, tax-exempt organization. UC provided CAMC with an acknowledgement letter along with a giving history report. CAMC provides assistance to various community programs which are reviewed by the Civic Affairs Council for award or at the discretion of the Chief Executive Officer. 0 1 0 0 0 0 0 0 0 David L Ramsey 592116 0 235000 0 107773 0 155318 0 23047 0 1113254 0 57392 0 Larry C Hudson 339999 0 125135 0 105389 0 68312 0 20746 0 659581 0 51021 0 Glenn Crotty Jr MD 387962 0 129183 0 60414 0 54033 0 25182 0 656774 0 37564 0 Marshall A McMullen Jr 214979 0 49413 0 59127 0 184956 0 22063 0 530538 0 29050 0 Michael D Williams 223442 0 43504 0 36785 0 119079 0 21490 0 444300 0 23048 0 S Andrew Weber 169432 0 39470 0 45574 0 65227 0 25370 0 345073 0 34871 0 Stephen Z Bell 163805 0 42541 0 38695 0 97590 0 27870 0 370501 0 26166 0 Robert D Whitler 153836 0 32694 0 26099 0 8055 0 25465 0 246149 0 0 0 Beth A Samples 184907 0 41792 0 867867 0 30170 0 18163 0 1142899 0 598275 0 Lynn Y Brookshire 193082 0 43860 0 49607 0 148436 0 21870 0 456855 0 20075 0 Elizabeth Spangler MD 251972 0 60655 0 70462 0 14700 0 22303 0 420092 0 0 0 Ronald E Moore 183492 0 41480 0 13741 0 141029 0 9935 0 389677 0 0 0 Robert B Danielson 149257 0 27616 0 10000 0 33699 0 18726 0 239298 0 0 0 Dale R Wood 238027 0 58211 0 34744 0 159248 0 10096 0 500326 0 22353 0 Jeffrey H Goode 165926 0 37714 0 43845 0 50410 0 27030 0 324925 0 28765 0 Jeff Oskin 195841 0 0 0 12010 0 20537 0 5595 0 233983 0 0 0 James P Tierney DO 892424 0 7693 0 0 0 9800 0 400 0 910317 0 0 0 Daniel L Smith 494256 0 8575 0 0 0 12948 0 24270 0 540049 0 0 0 Leon Ronen 452271 0 3382 0 0 0 11709 0 23749 0 491111 0 0 0 Mark K Stephens 451104 0 3500 0 0 0 11526 0 23870 0 490000 0 0 0 Robert J Crisalli 354271 0 125 0 0 0 11231 0 18063 0 383690 0 0 0 Part I, Line 3 The CAMCHSI Board of Directors Compensation Committee selects and supervises an independent consultant who advises the Committee on compensation arrangements and transactions between CAMCHSI companies and executives. The Committee uses the data to determine the total compensation of the CAMC's CEO and the other executives. The data is reviewed every two years or when a new person comes into an executive role. Part I, Line 4b Supplemental Executive Retirement Plan ("SERP"). Participants are members of the Executive group. Participant Beth Samples in 2011 was paid in the amount of $846,435 in SERP benefits. Terms & Conditions of SERP Plan: Defined Benefit. Vest at age 60, or later,if one time postponement is made prior to age 59. Deferred vesting date cannot be earlier than age 65 or later than age 68. Benefit at age 60 with 30 years of service is computed as the difference between 55% of Final Average Total compensation and sum of retirement benefits paid from: CAMC Health System, Inc. Qualified Retirement Plan, Non-Qualified Retirement Benefit Restoration Plan and 50% of projected age 62 Primary Social Security Benefit. Eligible to receive SERP benefits upon earliest of: normal retirement or date elected, if extended; death; disability; involuntary termination without cause. Early retirement at age 55 with at least 5 years of service reduced 1.83% for each year of service less than 30 and .5% reduction for each month prior to Normal Retirement Date (age 60). Taxes due upon distribution. Subject to the Substantial Risk of Forfeiture. CEO Supplemental Executive Retirement Plan ("SERP"): Participant-CEO Terms and Conditions of CEO SERP Plan: Defined Contribution. Vest at age 65. Benefit at age 65 projected as the difference between 60% of Final 5 Year Average Total compensation and sum of retirement benefits paid from: CAMC Health System, Inc. Qualified Retirement Plan and 50% of projected age 65 Primary Social Security Benefit. Actual benefits will depend upon simulated investment results based on investment options selected by participant. Eligible to receive SERP benefits upon earliest of: deferred vesting date; death; disability; involuntary termination without cause. Taxes due upon vesting. Subject to the Substantial Risk of Forfeiture. West Virginia Hospital Finance Authority 621256910 956624AQ3 2008-06-19 127355000 See Part V 0 0 0 West Virginia Hospital Finance Authority 621256910 956622ZV9 2009-09-10 177519271 See Part V 0 0 0 West Virginia Hospital Finance Authority 621256910 2010-11-01 8428228 Refund prior bonds issued 12/17/85. 0 0 0 1030000 129956617 2071347 773024 65455959 33084021 28867004 1 0 0 1 4745000 179662854 15468927 2455533 17301803 148894025 2941742 2009 1 0 0 1 2282657 8428228 60028 1 0 1 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 0 0 1 0 0 0 0 1 0 1 1 Merrill Lynch Capital 29.200000000000 0 0 0 1 1 0 0 0 1 Wachovia 23.000000000000 1 0 1 0 1 0 0 0 1 X Schedule K Supplental Information Part I. Line A (F) Description of purpose: The proceeds for the 2008A Bonds were used to (i) currently refund the Series 1995A Bonds originally issued on 9/26/95, (ii) pay the costs of certain capital expenditures made, or to be made, by CAMC, refinance a bank loan, and (iii) pay the costs of issuing the Series 2008A Bonds, including certain fees of the bank. Part I Line B (F) Description of purpose: The proceeds for the 2009A Bonds were used to (i) currently refund the outstanding principal amount of the 2002 Series A and B Bonds originally issued on 9/24/02, (ii) pay a portion of a termination payment as a result of termination of hedge agreement in connection with the 2002 Bonds (an extraordinary working capital expenditure), (iii) fund a debt service reserve fund, and (iv) pay the costs of issuing the 2009 Bonds. Part I Line C (F) Description of purpose: The proceeds for the 2010A Bonds were used to refund prior bonds issued 12/17/85. Part II Line 3: The total proceeds of issue includes accumulated interest earnings. Working capital expenditures reported in Part II, Line 9, column B consist of an extraordinary working capital expenditure consisting of a swap termination payment. Part III has not been completed with respect to the column B and column C bonds, since such bonds refunded pre-2003 bond issues. Regarding Part II, line 9, coulmn B, please see separate disclosure regarding purpose of bonds. Part IV, Line 5, column A - Such amounts were appropriately yield restricted. Rick Crotty Family member of Glenn Crotty, Officer 53612 employed by organization 0 Barbara Covelli Family member of Glenn Crotty, Officer 75098 employed by organization 0 Donna Bell Family member of Steve Bell, Officer 148544 employed by organization 0 Michael Samples Family member of Beth A Samples, Officer 74912 employed by organization 0 Glenda Bryant Family member of Ronald Moore, Officer 56119 employed by organization 0 TerraCare or TerraSalis Entity more than 35% owned by Nelle Chilton, Trustee 222985 Purchased Services 0 BBT Entity Board Members, Nelle Chilton & Edwin H Welch, Ph D, CAMC Trustees 2573957 Purchased Services 0 Kay Casto Chaney PLLC Parnership more than 5% owned by John R Hoblitzell, Trustee 167436 Purchased Services 0 Form 990, Part VI, Section A, line 6 CAMC Health System, Inc. ("CAMCHSI") is CAMC's sole voting member. Form 990, Part VI, Section A, line 7a CAMC Health System, Inc. ("CAMCHSI") is CAMC's sole voting member and has authority to elect all voting trustees of CAMC other than ex- officio trustees named in CAMC's governing documents. The sole voting member has the sole authority to amend CAMC's governing documents. Form 990, Part VI, Section A, line 7b CAMCHSI is CAMC's sole voting member and has reserved powers under CAMC's governing documents, which provide that decisions of CAMC's governing body such as election of officers, approval of annual budgets and borrownings are subject to approval by the sole voting member. The sole voting member also has all approval powers provided to members of West Virginia nonprofit corporations under state law. Form 990, Part VI, Section B, line 11 CAMC compiles necessary information for Form 990 through the efforts of various officers and trustees of the organization. The return is then prepared and reviewed by an external consultant firm. This firm then reviews the completed Form 990 with the CAMC Board of Trustees and its Audit Committee. Form 990, Part VI, Section B, line 12c Corporate officers including the President and Secretary develop the agendas for board meetings and identify potential conflict of interest issues relative to action items and assist the board chairs with resolutions of same. Annual disclosure procedures are implemented and the board chair and Nominating Committee periodically review conflict situations. Form 990, Part VI, Section B, line 15 The CAMCHSI Board of Directors Compensation Committee selects and supervises an independent consultant who advises the Committee on compensation arrangements and transactions between CAMC Health System, Inc. subsidiaries (including CAMC) and executives (including CAMC's CEO). The Committee uses the data to determine the total compensation of CAMC's CEO and other executive officers. This data is reviewed every two years or when a new person comes into a executive role. Form 990, Part VI, Section C, line 19 CAMC is part of a consolidated financial audit for CAMC Health System, Inc. and Subsidiaries. Consolidated audited financial statements are available on-line at CAMC.org. They are also filed with the WV Health Care Authority where they are available on-line and in person. There is no formal method of making the Bylaws and Conflict of Interest Policy publicly available, but they are available upon request. The Articles of Incorporation are publicly available at the WV Secretary of State's Office. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -5,549,476. Affiliate Transfers -6,523,306. Distribution to non-controlling interest -56,284. Increase/Decrease in beneficial interest in CAMC Foundation -355,680. Change in Temp Restricted Contributions 160,289. Change in Affiliate Receivable Balance 660,995. Change in retirement obligation -1,454,011. Total to Form 990, Part XI, Line 5: -13,117,473. Charleston Area Medical Center Foundation Inc PO BOX 1547 Charleston WV 253261547 310887133 Foundation WV 501(c)(3) Line 11, Type II: 50 CAMC Health SystemInc 1 CAMC Health System Inc PO BOX 1547 Charleston WV 253261547 550664138 Parent Company WV 501(c)(3) Line 11, Type III-FI N/A 0 CAMC Health Education and Research Institute Inc PO BOX 1547 Charleston WV 253261547 550753754 Medical Educational Research WV 501(c)(3) Line 11, Type II: 50 CAMC Health SystemInc 1 CAMC Teays Valley Hospital Inc PO BOX 1547 Charleston WV 253261547 550752636 Hospital WV 501(c)(3) Line 3: 170(b)(1)(a) CAMC Health SystemInc 0 Women & Children's Medical Office Building Partnership PO Box 1547 Charleston WV 253261547 550669065 Medical office Building WV CAMC Related 0 1 0.88510 General Division Medical Office Building Partnership PO Box 1547 Charleston WV 253261547 550623949 Medical office Building WV CAMC Related 0 1 0.79330 Integrated Health Care Providers Inc PO Box 1547 Charleston WV 253261547 550751010 Speciality Physician Practices WV C 0 1 1 1 0 1 1 0 1 1 1 1 0 1 1 1 1 0 CAMC Health Education and Research Institute Inc B 3659529 Contract Integrated Health Care Providers Inc B 23477367 Contract CAMC Health System Inc C 80772 Contract Charleston Area Medical Center Foundation Inc C 487675 Contract Women and Children's Medical Office Building Partnership D 316787 Contract General Division Medical Office Building Partnership D 86227 Contract Integrated Health Care Providers Inc F 138988 FMV Charleston Area Medical Center Foundation Inc G 3861343 Cost CAMC Health Education and Research Institute Inc I 252446 Contract Integrated Health Care Providers Inc I 802992 Contract Charleston Area Medical Center Foundation Inc J 930157 Contract Women and Children's Medical Office Building Partnership J 996059 Contract General Division Medical Office Building Partnership J 675949 Contract Integrated Health Care Providers Inc J 154906 Contract CAMC Health System Inc K 90613 Contract CAMC Teays Valley Hospital Inc K 1775754 Contract Charleston Area Medical Center Foundation Inc K 218253 Contract CAMC Health Education and Research Institute Inc K 341384 Contract Women and Children's Medical Office Building Partnership K 248608 Contract General Division Medical Office Building Partnership K 187094 Contract Integrated Health Care Providers Inc K 2834465 Contract CAMC Teays Valley Hospital Inc O 2081685 FMV CAMC Health Education and Research Institute Inc O 1810735 FMV Integrated Health Care Providers Inc O 997342 FMV CAMC Teays Valley Hospital Inc P 24801015 FMV Charleston Area Medical Center Foundation Inc P 283803 FMV CAMC Health Education and Research Institute Inc P 4243990 FMV Women and Children's Medical Office Building Partnership P 105420 FMV General Division Medical Office Building Partnership P 226338 FMV Integrated Health Care Providers Inc P 44621340 FMV CAMC Health System Inc Q 474335 FMV CAMC Teays Valley Hospital Inc Q 945034 FMV CAMC Health Education and Research Institute Inc Q 500000 FMV Integrated Health Care Providers Inc Q 5548970 FMV CAMC Health Education and Research Institute Inc L 11356267 fMV