2011-11-14T13:06:12-06:00 2010-12-31 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 60606 990 2010-01-01 550752636 CAMC Teays Valley Hospital Inc CAMC 3047571700 PO Box 1547 Charleston WV 253010000 Randy Hodges 3043886247 2011-11-11 1 ASHLEY SIWULA 3124861000 2010 2016-03-07 17:11:31Z Teays Valley Hospital Randy Hodges 501 Morris Street Charleston WV 253261547 61003046 0 X www.camc.org X 1996 WV CAMC Teays Valley Hospital, Inc.'s ("Teays") primary exempt purpose is to provide hospital services for the people residing in the geographical area of Putnam County, the State of West Virginia and elsewhere. These services promote legitimate methods for the prevention of disease and the positive promotion of personal and public health. Teays fosters and conducts education within the nursing and technical occupations, which contribute to the diagnosis, treatment and prevention of disease. 9 8 504 0 0 0 0 0 54428204 60019753 46075 38259 7986 945034 54482265 61003046 0 0 0 0 20946636 23149929 0 0 0 38229817 38172697 59176453 61322626 -4694188 -319580 35437298 34525070 39899739 39594249 -4462441 -5069179 X Striving to provide the best healthcare to every patient, every day. 0 0 33006636 60964787 Teays has over 355 employees and a medical staff of 134. The hospital is licensed for 70 beds, and our health care services focuses on providing a full range of inpatient and outpatient services. Inpatient days of 15,216, outpatient visits of 58,038, and emergency department visits of 16,390. We give back to our community because we understand the impact that medical care, charity care, education, corporate contributions and community partnerships have on the lives of the population we serve. 12384240 Teays provided un-reimbursed charity care at cost of $4,974,816 and bad debts at cost of $7,409,424 to the community in 2010. Teays does much more than just provide health care, being involved in nearly every aspect of the lives and well being of the community. Programs and services are available to our community to serve our community-particularly the needs of the low income, elderly, youth, 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. Teays benefit activities offered 7 programs which affected an estimated 1852 people. 0 45390876 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 36 0 1 504 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X Larry C Hudson 3043887603 501 Morris Street Charleston WV 253010000 X James A Akins MD 3.00 X 0 0 0 David W Bunger 3.00 X 0 0 0 Leonard A Fichter DO 3.00 X 0 0 0 David L Ramsey 3.00 X 0 824125 407533 Richard L Slater 3.00 X 0 0 0 Nancy R Smith 3.00 X 0 0 0 Diane E Duttine Sanders 3.00 X 0 0 0 Steven L Smith 3.00 X 0 0 0 Larry C Hudson 3.00 X 0 496244 84515 F Christian Gall Jr 3.00 X 0 174173 30369 Oshel B Craigo 3.00 X 0 0 0 Albert H Michaels 45.00 X 558791 0 39577 Randall H Hodges 45.00 X 262495 0 34440 Thomas Rittinger MD 40.00 X 410780 0 30136 Lance T Carney 40.00 X 126998 0 28423 Roy Messick 40.00 X 112466 0 3980 Mary Beth Mullins 40.00 X 162657 0 8049 Carrie L Palmer 40.00 X 105768 0 20794 Charles Lewis 2.50 X 0 0 0 1739955 1494542 687816 7 0 1 0 Pray Construction Company 4964 Teays Valley Road Scott Depot WV 25560 Construction 1371351 Siemens Medical Solutions Dept AT 40065 Atlanta GA 311920065 Information technology services 964114 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 Diagnostic imaging services 751863 Capital Medical Supplies PO Box 998 Poca WV 25159 Nursing services 366140 University Physicians and Surgeons 1249 15th St Ste 2000 Huntington WV 25701 Physician pulmonary services 334501 11 Patient Revenue 621990 59255748 59255748 Clinical Serv. Sold 621990 398697 398697 Cafeteria/ Vending 721000 232301 232301 Rental (Non-Res.) 531120 129689 129689 Medical Records Fees 812900 118 118 3200 3200 60019753 38259 38259 Affiliate Transfer 900099 945034 945034 945034 61003046 60732368 0 270678 895302 895302 16713442 15174307 1539135 446212 446212 3701389 17563 3683826 1393584 995291 398293 1809443 169461 1639982 128886 128886 36108 36108 5681 5681 3667817 2948914 718903 88107 1873 86234 11696757 10966875 729882 270314 33714 236600 1831493 1010923 820570 7108 2819 4289 15596 7901 7695 1192943 1192943 640958 640958 2247934 1676994 570940 978278 978278 Prov. for Uncollectible 7409425 7409425 Charity 4974816 4974816 Provider Tax 1171033 1171033 61322626 45390876 15931750 0 2700 2800 6471686 7296818 993399 1094065 193017 187450 29332964 8569626 20539157 20763338 4182293 2007069 3055046 3173530 35437298 34525070 5021077 7668327 25289635 24599567 6851065 6470764 2737962 855591 39899739 39594249 X -4462441 -5069179 -4462441 -5069179 35437298 34525070 X -319580 -287158 X X 0 1 1 X 0 X 5048901 5048901 12096524 1581334 10515190 12177123 6978501 5198622 10416 9791 625 20763338 Affiliate: Integrated Health Care Providers, Inc. 216474 Affiliate: Charleston Area Medical Center, Inc. 2552526 Long-term revievables - Phys & Student Loans 350616 Deferred Bond Costs 53914 3173530 Affiliate: Charleston Area Medical Center, Inc. 680961 Affiliate: Integrated Health Care Providers, Inc. 61374 Affiliate: CAMC Health Education and Research, Institute, Inc. 113256 855591 Description of Uncertain Tax Positions Under FIN 48: Part X: Teays is part of the consolidated audit for 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. The System does not have any material uncertain tax positions at December 31, 2010 and 2009. 1 1 X 1 X 1 X 1 1 0 1 1 1882968 0 1882968 0.03490 6949581 3271192 3678389 0.06820 571985 285721 286264 0.00530 9404534 3556913 5847621 0.10840 15125 0 15125 0.00030 15125 15125 0.00030 9419659 3556913 5862746 0.10870 7 555 15125 15125 0.00020 7 555 15125 15125 0.00020 0 2804467 1581719 14274877 22601914 -8327037 1 1 2 1 CAMC Teays Valley Hospital Inc

1400 Hospital Drive Hurricane WV 255260000

X X X 2 Physical Therapy and Wound Care

Putnam Medical Plaza 1201 Hospital Dr Hurricane WV 255260000

X NA 1 1 Doctor's Park

1204 Hospital Drive Hurricane WV 255260000

Physician Offices Part I, Line 7: Utilized Worksheet 2 provided in the instructions of Schedule H to determine cost-to-charge ratio. Part II: Teays community building activities promote the health of our community through community support, offering programs such as the cardiac project which assesses elementary school age children for potential heart problems and diabetes; the Putnam County Drug Endangered Children Task Force to help eliminate drugs in the community; and offering a Putnam County Breast Cancer Support Group for emotional and resource support for breast cancer patients in the community. 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 an operating expense in the statement of operations. In determining the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy, one month of actual bad debt write-off's was reviewed. From this one month, the amount of bad debt for uninsured patients was determined to be 60%. Then a sample of 100 of these uninsured patients was taken and run through a credit worthy calculator that determined 94% of the patients met the income eligibility guidelines under the organization's charity care policy. Part III, Line 8: The organization considers any government reimbursement that is insufficient to cover allocated costs as being a community benefit. We chose to serve the community by participating in the Medicare program and accepting Medicare reimbursement. Part III, Line 9b: Teays has a collection policy 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 will be given a 20% discount from charges. Part VI, Line 2: Teays board of trustees is comprised primarily of community leaders. These individuals are aware of the needs of the community and thus can most effectively help determine the direction Teays will take to address those needs. Representatives of Teays also meet with civic groups, such as the Putnam County Chamber of Commerce and local ministerial groups, to gain insight on what is needed in the local area in terms of programs offered. Part VI, Line 3: Teays 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 Teays charity care policy during the registration process. Brochures are available at each registration point with contact information and phone numbers for our Financial Counselors. WV state employees are also on site to accept and process Medicaid applications and notify patients if they qualify. Part VI, Line 4: Teays community and primary area of focus is defined as our primary and secondary service areas and includes Putnam County in West Virginia. Putnam County constitutes a population of 55,673, with a median age of 37.7 and household median income of $55,590. We provide, alone and in collaboration with, 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 6: Teays has a board of trustees comprised primarily of prominent civic and business leaders. Thirty percent of the members are hospital administrators, physicians or others professionally connected to the hospital. Admission to the hospital's medical staff is open to all qualified physicians in the area, consistent with the size and nature of the facility. Teays operates a full-time emergency room open to everyone, regardless of ability to pay. Teays serves a broad cross-section of the community through research or charity care. Teays applies any surplus funds toward improving facilities, equipment, patient care, medical training, and education. Part VI, Line 7: Teays is part of the CAMC Health System. A sister company to CAMC, CAMC Health Education and Research Institute, Inc. ("CHERI"), is actively engaged in clinical trials and has active research protocols in oncology, cardiology/cardiovascular medicine, medicine and medicine subspecialties, behavioral health community medicine, pediatrics, nursing research and trauma/pain. A majority of this research is conducted at CAMC hospitals. CHERI serves as the education and research arm of the CAMC Health System. 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. The Foundation is a sister company and support organization to CAMC. Integrated Health Care Providers, Inc., a sister company to Teays, is called upon to open a practice when determined that an essential physician need or access issues for patients is present. Reports Filed With States Part VI, Line 7 WV 1 1 0 0 0 1 1 0 0 David L Ramsey 0 581532 0 135748 0 106845 0 388321 0 19212 0 1231658 0 55420 Larry C Hudson 0 333290 0 71274 0 91680 0 66750 0 17765 0 580759 0 44411 F Christian Gall Jr 0 159536 0 9771 0 4866 0 10183 0 20186 0 204542 0 0 Albert H Michaels 87820 0 18912 0 452059 0 21765 0 17812 0 598368 0 362479 0 Randall H Hodges 175121 0 13177 0 74197 0 17534 0 16906 0 296935 0 0 0 Thomas Rittinger MD 398780 0 12000 0 0 0 9800 0 20336 0 440916 0 0 0 Lance T Carney 122326 0 4672 0 0 0 5247 0 23176 0 155421 0 0 0 Mary Beth Mullins 122326 0 25331 0 15000 0 5049 0 3000 0 170706 0 0 0 Supplemental Information Part III 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 CEO and the executive officers. The data is reviewed every two years or when a new person comes into an executive role. Supplemental Information Part III Part I, Line 4b: Supplemental Executive Retirement Plan: Participant paid in 2010 was Albert H. Michaels in the amount of $801,946. Terms & Conditions of SERP Plan: 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 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 five 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. Taxes due upon distribution, Subject to the Substantial Risk of Forfeiture. CEO Supplemental Executive Retirement Plan: Participant-CEO- Terms & 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 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 the 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 2008-09-30 26000000 See Part V 0 0 0 1400432 26094710 146457 2202074 21744205 2001788 1 0 0 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 Form 990, Part VI, Section A, line 6 CAMC Health System, Inc. ("CAMCHSI") is the organization's sole voting member. Form 990, Part VI, Section A, line 7a CAMCHSI is the organization's sole voting member and has authority to elect all voting trustees of the organization other than ex officio trustees names in the organization's governing documents. The sole voting member has the sole authority to amend the organization's governing documents. Form 990, Part VI, Section A, line 7b CAMCHSI is the organization's sole voting member and has reserved powers under the organization's governing documents, which provide that decisions of the organization's governing body such as election of officers, approval of annual budgets, and borrowings 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 The organization compiles necessary information for Form 990 with various officers and directors of the organization. The return is then prepared and reviewed by external consultant firm. This firm then reviews the completed 990 with Teays Board of Trustees. 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 resolution of same. Annual disclosure procedures are implemented and the board chair and CAMCHSI Nominating Committee periodically review conflict situations. Form 990, Part VI, Section B, line 15 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 companies (including Teays) and executives (including the CEO). The Committee uses the data to determine the total compensation of the CEO and the executive officers. This data is reviewed every two years or when a new person comes into an executive role. Form 990, Part VI, Section C, line 19 Teays 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. Form 990, Part VII, Section A: Some members of the board were compensated by related organizations for other duties as follows: CAMC - David L. Ramsey 45 hours, Larry C. Hudson 45 hours, F. Christian Gall Jr. 45 hours. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Loss on Derivative value -287,158. Total to Form 990, Part XI, Line 5: -287,158. Explanation of financial statements: Form 990, Part XII, Line 2a & 2b: Teays is part of a consolidated audit for CAMC Health System, Inc. and Subsidiaries. Charleston Area Medical Center Inc PO Box 1547 Charleston WV 253261547 550526150 Hospital WV Section 501(c)(3) Line 3 CAMC Health System Inc 1 CAMC Health System Inc PO Box 1547 Charleston WV 253261547 550664138 Parent Company WV Section 501(c)(3) Line 11c, III-FI N/A 1 CAMC Health Education and Research Institute Inc PO Box 1547 Charleston WV 253261547 550753754 Medical Research WV Section 501(c)(3) Line 11b, II CAMC Health System Inc 1 Charleston Area Medical Center Foundation Inc PO Box 1547 Charleston WV 253261547 310887133 Foundation WV Section 501(c)(3) Line 11b, II CAMC Health System Inc 1 Women and Children's Medical Office Building Partnership PO Box 1547 Charleston WV 253261547 550669065 Medical Office Building WV N/A N/A 0 0 General Division Medical Office Building Partnership PO Box 1547 Charleston WV 253261547 550623949 Medical Office Building WV N/A N/A 0 0 Integrated Health Care Providers Inc PO Box 1547 Charleston WV 253261547 550751010 Physician Offices WV N/A C 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 Integrated Health Care Providers Inc A 40112 Contract Integrated Health Care Providers Inc B 693642 Contract Charleston Area Medical Center Inc L 1639982 Contract Charleston Area Medical Center Inc O 3512739 FMV Charleston Area Medical Center Inc P 7391728 FMV Integrated Health Care Providers Inc P 1265724 FMV