2016-11-15T03:33:07-06:00 2015-12-31 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 60606 990 2015-01-01 550526150 Charleston Area Medical Center Inc CHAR 3043885432 PO Box 1547 Charleston WV 253261547 Larry Hudson Executive VP & CFO 3043885432 2016-11-14 1 MARY RAUSCHENBERG P00172604 3124861000 2015 2017-02-10 21:41:12Z CAMC Larry Hudson 501 Morris Street Charleston WV 25301 1093603193 0 X www.camc.org X 1971 WV Striving to provide the best healthcare to every patient, every day. CAMC owns and operates four separately-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. 17 14 8390 350 8190502 752349 9303590 6804457 988230767 974303527 16048964 11182787 2009243 2105824 1015592564 994396595 1636064 1254437 0 0 399058500 420076656 0 0 0 550677666 556169032 951372230 977500125 64220334 16896470 977121830 984239646 602848935 605291610 374272895 378948036 X 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 West Virginia 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. 0 0 638806360 375130 975939621 CAMC is West Virginia's largest medical center with over 7,294 employees and 553 medical staff. CAMC is licensed for 908 beds at four 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 DNV-Certified Primary Stroke Center, a 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 20% of the charity care in the state. There were inpatient days of 203,866, outpatient visits of 513,262, emergency department visits of 98,195 and deliveries of 2,870 in 2015. 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. 35903279 726330 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. 141 WVU/WVSOM medical students trained at CAMC hospitals and 176 medical residents were employed by CAMC. CAMC provided faculty support to the University of Charleston helping educate pharmacy students, nursing students and physician assistance program. CAMC assisted 77 employees through student loan forgiveness, and distributed 338 scholarships. 73844164 152977 685676 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 92 programs which served an estimated 60,610 people. CAMC provided acute inpatient and outpatient hospital services including unreimbursed charity care at cost of $13,331,625. 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. 748553803 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 8390 1 1 1 0 0 0 0 0 0 0 0 0 X 17 14 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 WV X Larry C Hudson 3043887603 501 Morris Street Charleston WV 25301 David L Ramsey President, CEO & Trustee 50.00 6.50 X X 1319630 0 139643 John R Hoblitzell Esq Chairman 2.50 5.00 X X 0 0 0 William A Rice Jr Vice Chairman 3.00 3.50 X X 0 0 0 Gina R Busch MD Trustee 2.50 2.50 X 0 0 0 Charles L Capito Jr Trustee 2.50 2.50 X 0 0 0 Mark A Chandler Trustee 2.50 2.50 X 0 0 0 Fonda Elliot Trustee 2.50 2.50 X 0 0 0 James P Griffith MD Trustee 2.50 2.50 X 0 0 0 Samuel Shawn Groves MD Trustee 50.00 3.00 X 515127 0 40378 Melvin Jones Trustee 2.50 2.50 X 0 0 0 Brenda J Powell Trustee 2.50 2.50 X 0 0 0 Linda J Powers Trustee 2.50 2.50 X 0 0 0 Karen S Price Trustee 2.50 2.50 X 0 0 0 Bryan K Richmond MD Trustee 2.50 2.50 X 0 0 0 Steven L Smith Trustee 2.50 2.50 X 0 0 0 Kenneth L Tackett Trustee 2.50 2.50 X 0 0 0 Edwin H Welch Ph D Trustee 2.50 3.50 X 0 0 0 Larry C Hudson Executive VP & CFO 50.00 10.00 X 738621 0 27512 Glenn Crotty Jr MD Executive VP & COO 50.00 6.00 X 713689 0 102445 Marshall A McMullen Jr Secretary & Gen Counsel 50.00 5.00 X 422714 0 71145 Michael D Williams VP Administrator 50.00 0.00 X 383268 0 271115 S Andrew Weber VP Administrator 50.00 0.00 X 309521 0 161535 Stephen Z Bell VP Finance 50.00 0.00 X 1772891 0 60081 Robert D Whitler VP Gov't & Comm Affairs 50.00 1.00 X 249027 0 41910 Ronald E Moore VP Prof Prac & CNO 50.00 1.00 X 317532 0 230576 Robert B Danielson VP Compliance 50.00 5.00 X 231955 0 92735 Dale R Wood VP System Improv & CQO 50.00 0.00 X 390727 0 253498 Jeffrey H Goode VP Ambulatory Services 50.00 0.00 X 361455 0 170515 Jeffrey L Oskin VP Administrator 50.00 0.00 X 422393 0 145969 Thomas P McIlwain MD VP Med Affairs and CMO 50.00 5.00 X 527397 0 51319 Gregory M Veltri VP Info Svc & CIO 50.00 5.00 X 402728 0 40560 Kristi Snyder VP Human Resources 50.00 6.00 X 334674 0 171608 Randall H Hodges VP Administrator 50.00 0.00 X 1515334 0 55357 Rocky Blake Interim VP Info Svc & CIO 40.00 0.00 X 245594 0 37171 Robert B Shin MD Physician 40.00 0.00 X 1163985 0 14217 John T Deel MD Physician 40.00 0.00 X 1070553 0 47954 Scott M Ciaccia DO Physician 40.00 0.00 X 956887 0 40401 Samel C Rossi MD Physician 40.00 0.00 X 870438 0 36199 Aaron L Sop DO Physician 40.00 0.00 X 816176 0 38799 Lynn Brookshire Former Officer 0.00 0.00 X 160960 0 0 16213276 0 2342642 430 1 1 0 WVU Physicians of Charleston 3110 MacCorkle Ave SE Charleston WV 25304 GME/Physician Services 19927270 BBL Carlton LLC 600 Kanawha Blvd Suite 200 Charleston WV 25301 Contractor Services 16519923 Jackson Nurse Professionals PO Box 404118 Atlanta GA 30384 Nursing Services 7121354 Maynard C Smith Construction Company PO Box 11888 Charleston WV 25339 Contractor Services 6086849 Siemens Medical Solutions PO Box 12001 Dallas TX 75312 IT Service and Support 5100558 149 6693533 110924 6804457 Net Patient Revenue 621990 929841685 929841685 Pharmacy 446110 13007484 162333 12845151 Lab Services 621500 7815608 23477 7970992 -178861 Cafeteria/Vending 721000 6739993 6739993 Rental (Non Residentia 531120 6305797 1767126 0 4538671 10592960 8479748 57177 2056035 974303527 10664207 216149 10448058 332879 332879 203 203 99392299 99206598 185701 185701 185701 Laundry 812300 1360313 1360313 Medical Center Inn 721110 377967 377967 Management Fees 541610 344843 344843 22498 22498 2105621 994396595 942433806 8190502 36967830 813107 813107 441330 441330 13989195 13989195 890939 340411 550528 310545049 254435689 56109360 13077959 10264871 2813088 58730292 46289285 12441007 22843222 17858374 4984848 14236793 8511287 5725506 2643276 2643276 533578 533578 117629 117629 1341093 1341093 73159579 51352323 21807256 1507946 189634 1318312 8531041 4509649 4021392 13572847 867219 12705628 19651129 12099578 7551551 2589426 955911 1633515 59618 12931 46687 14650521 14650521 56155444 56155444 38940111 21127285 17812826 12940645 218450 12722195 Medical supplies 203694330 202907262 787068 Prov. For Uncollectible 28386454 28386454 Provider Tax 24452167 24452167 Sales & Use Tax 8360089 8360089 30645316 6365142 24280174 977500125 748553803 228946322 0 39200 42926 243140021 214137333 122901490 148851462 396653 4166 17861382 20651924 5443663 3641809 1013337820 633960546 344657299 379377274 29271412 29383029 115908525 88840745 4308670 8559296 93193515 90749682 977121830 984239646 120122518 140545421 11369636 11291758 309965940 301173311 28687 15856 90597372 87482112 6656711 8952183 64108071 55830969 602848935 605291610 X 337365435 341011553 25048938 25826606 11858522 12109877 374272895 378948036 977121830 984239646 X 16896470 -13671067 1449738 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 4895 0 0 1 112231 0 1 62313 179439 0 Part II-B, Line 1: Occasionally, individuals are asked by legislators at both the state and national levels for opinions on certain issues and the process of health-related legislation. At such times, CAMC representatives may hold discussions with legislative officials to present their information and perspectives regarding various health care issues. Such interactions do not typically involve CAMC expressing whether or not they support a particular bill, but rather consist of general discussions related to the pertinent health issues. CAMC is a member of the West Virginia Hospital Association, Association of American Medical Colleges, and Safety Net Hospitals for Pharmaceutical Access. A percentage of the membership dues paid are related to lobbying activities. 0 1 X 36907460 15881552 -1263368 12972453 616708 37936483 36316561 817450 1272837 1496226 3162 36907460 31115133 747434 5250714 793950 2770 36316561 27674365 751017 3451658 758744 3163 31115133 28121864 637036 -192637 888233 3665 27674365 0.32000 0.68000 0 1 1 28423226 28423226 433082213 228809680 204272533 10281406 6742408 3538998 474541110 389029961 85511149 67009865 9378497 57631368 379377274 Malpractice Fund 2747830 C Malpractice Fund 38920791 F Recruitment/Student Loan 2558637 C Workers Comp Self Insured Fund 105379 F Investments Other 6946959 C 2013 Note Project Fund 37561149 F 88840745 Trustee Funds 8035515 Interest In Net Assets: CAMC Foundation 37936483 Bond Funds 12812940 Bond Collateral 12860000 Deferred Bond Costs 3315598 Other Investments 991625 Derivative Asset Value 7769178 Affiliate Receivable - Foundation 429741 Affiliate Receivable - CHERI 278281 Affiliate Receivable - IHCPI 6320321 90749682 Estimated Malpractice Claims 22994681 Estimated Worker's Comp Claims 1571068 Affiliate Payable - Foundation 61321 Affiliate Payable - CHERI 1849810 Affiliate Payable - IHCPI 4903464 Settlements Due to 3rd Parties 8334908 Estimated Retiree Health 2560492 Umbrella Trust & SERP 13555225 55830969 X Part IV, Line 2b: CAMC operates HealthCare Financial Services, which provides collections services to outside clients. Payments that are not 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 needs transmitted to the client. Part V, Line 4: To further the mission of the organization. Part X, Line 2: CAMC's financial statements are audited as part 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: "The IRS has determined that CAMC, the Foundation, and the Institute are exempt from income taxes under Section 501 (c)(3) of the Code and applicable state statutes. The System does not have any material uncertain tax positions as of December 31, 2015." 1 1 X 1 X 1 X 1 1 1 0 1 1 13331625 13331625 0.01400 222634178 132658940 89975238 0.09470 1759780 1243671 516109 0.00050 237725583 133902611 103822972 0.10920 2358045 293214 2064831 0.00220 44873667 6863003 38010664 0.04000 794706 591374 203332 0.00020 342697 342697 0.00040 48369115 7747591 40621524 0.04280 286094698 141650202 144444496 0.15200 1564 1564 0.00000 101500 101500 0.00010 5520 5520 0.00000 8429 8429 0.00000 151519 51662 99857 0.00010 268532 51662 216870 0.00020 0 27235462 0 277678732 398609507 -120930775 1 1 1 General Division Medical Office Bldg Partnership Medical Office Space Rental 0.81930 0.18070 2 Charleston Area Radiation Therapy Centers LLC Radiation Therapy 0.20000 0.30000 4 1 CAMC Memorial Hospital 3200 MacCorkle Avenue Charleston WV 25304 www.camc.org 20 X X X X A 2 CAMC General Hospital 501 Morris Street Charleston WV 25301 www.camc.org 20 X X X X A 3 CAMC Women and Children's Hospital 800 Pennsylvania Avenue Charleston WV 253025302 www.camc.org 20 X X X X A 4 CAMC Teays Valley Hospital 1400 Hospital Drive Hurricane WV 25526 www.camc.org 20 X X X X B Facility Reporting Group - A 0 0 1 X X X X X X X X X 14 1 1 1 1 X www.camc.org/documents/community/2014/CBRG-Plan-2014-2016.pdf X www.healthykanawha.org X 1 14 1 www.camc.org/documents/community/2014/CBRG-Plan-2014-2016 0 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X www.camc.org/charity-uninsured-plan X www.camc.org/charity-uninsured-plan X www.camc.org/charity-uninsured-plan X X X X 1 X 0 X X X X 1 X 0 0 Facility Reporting Group - B 0 0 1 X X X X X X X X X 15 1 0 1 1 X See Part V, Section C X 1 15 1 See Part V, Section C 0 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X www.camc.org/charity-uninsured-plan X www.camc.org/charity-uninsured-plan X www.camc.org/charity-uninsured-plan X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B. Facility Reporting Group B Part V, Section B, line 7a: http://www.camc.org/documents/Community/2015-CAMC-Teays-Community-Benefit%20Needs-Assessment-and-Implementation-Strategies.pdfSchedule H, Part V, Section B. Facility Reporting Group BPart V, Section B, line 10a: http://www.camc.org/documents/Community/2015-CAMC-Teays-Community-Benefit%20Needs-Assessment-and-Implementation-Strategies.pdf Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: CAMC Memorial Hospital, - Facility 2: CAMC General Hospital, - Facility 3: CAMC Women and Children's Hospital Facility Reporting Group - A Part V, Section B, line 5: Household Telephone Survey: The household surveys were conducted using appropriate quality controls which included involving research experts in the design of the survey instrument, thorough and consistent training of interviewers, and the use of reputable survey-analysis software. The principal investigator provided oversight to the surveying process including data collection and entry. Data was collected and entered using a web-based survey. This report was compiled and verified for accuracy by members of the Kanawha Coalition for Community Health Improvement. This survey sample size results in a statistically significant 95% confidence interval with an error margin of plus or minus 5.63%. Not all respondents answered every question; therefore the margin of error was adjusted and reported for each question, based on the number of respondents. An independent sampling firm randomly selected landline telephone numbers for Kanawha County households. The random landline sample consisted of 4,000 numbers which was screened for disconnects and businesses, resulting in a list of 2,000 numbers. A total of 16 individuals received training and administered the phone survey.After learning that the number of American homes with only wireless telephones continues to grow and that 39.4% of American homes had only wireless telephones (January - June 2013 National Health Interview Survey), the Kanawha Coalition acquired a random address sample of 5,000 additional Kanawha County residents which included wireless and some unlisted numbers. The wireless sample received postcards in the mail directing them to the online survey or to call the Kanawha Coalition to arrange a convenient time to take the survey by telephone. The Kanawha Coalition process works to ensure that the survey sample size is valid, and that the sample is randomly selected. It also ensured that the fourth-year nursing students with the University of Charleston's School of Nursing were adequately trained in how to administer the phone survey. As with any telephone survey, there are certain limitations. The result of the survey depends on the accuracy of the responses given by the persons interviewed. Self-reported behavior must be interpreted with caution. To assure proper sampling distribution, the demographics of the survey respondents were compared to county demographics based on 2010 U.S. Census data. This comparison reveals an over-representation of respondents who were female, over 55 years of age, had no children in the home and were Caucasian. There was an under-representation of African Americans, people with lower-educational attainment (high school or less), those with children in the home, and those who had never been married. The Kanawha Coalition conducted focus groups among individuals from these underrepresented populations. Focus group findings are intentionally reported independently from those of the scientific random survey to maintain fidelity. Focus Groups Six focus groups were held in 2013. A total of 15 senior citizens, 14 single-parents, and 10 African Americans participated. Host sites for the focus groups included the Kanawha Institute for Social Research and Action (KISRA), Shiloh Baptist Church, the United Way of Central West Virginia (Retired Senior Volunteer Program), and the Martin Luther King Community Center (after school program). Focus group participants were asked to share their opinions about barriers and challenges facing their particular population regarding access to health services, social and economic factor (e.g. employment, education, access to technology, and community attitudes surrounding discrimination, racism), the physical "built" environment (e.g. housing, access to healthy foods, air and water quality) and any other top health issues and pressing concerns. Facility Reporting Group - A Part V, Section B, line 6a: Thomas Health System (Thomas Memorial Hospital and St. Francis Hospital); Highland HospitalPart V, Section B, line 6b: United Way of Central West Virginia; FamilyCare Health Center; Kanawha-Charleston Health Department; Kanawha County Schools; Wellness Council of West Virginia; Spilman Thomas & Battle, PLLC; Kanawha Coalition for Community Health Improvement; Charleston Area Alliance. Facility Reporting Group - A Part V, Section B, line 11: The following health issues are identified as community priorities and funded as part of operational planning by the CAMC Board of Trustees: Obesity, Drugs/Prescription and Illicit, Lack of Physical Activity, Heart Disease/High Blood Pressure, Tobacco Use/Second Hand Smoke Exposure, Unemployment Jobs/Poverty, Cancer, Lung Disease/Asthma. Community Benefit implementation strategies and examples of some of our 2015 outcomes include: 1.) Reducing utilization of the Emergency Room to address Unemployment/Jobs/Poverty through Telehealth for after hours and follow-up care. In 2014, grant funding was obtained. In 2015 site visits were conducted to select appropriate equipment set-up based on needs of each of the 11 participating sites. Equipment installation and training is scheduled for 2016. 2.) Physician Drug Diversion training addressed the community need of Drugs/Prescription and Illicit. In 2014, there were 2,365 physician and mid-level providers who participated with an evaluation of 4.5 and 80% with a post-test passing score. In 2015, 1,458 participants had an evaluation of 4.4 with an 80% pass rate. 3.) We addressed the community need of Cancer, Lung Cancer through continued growth in 2015 of our nurse navigator and survivorship program. The navigators had over 7,600 encounters in 2015 with overall satisfaction of 94%. The survivorship program provided care plans for 30 patients and saw 15-20 patients/week. 4.) Our HealthyKids Program addresses the community need of Obesity and in 2015 access has improved with decreasing third appointment time out for a new patient from 39 days in 2013 to 17 days in 2015. Total patient visit volume has also increased from 227 encounters to 320 encounters (this does not include the evening group visits). HealthyKids celebrates outstanding clinical outcomes with 96% of patients lowering their BMI from their first to last documented office visit. Group sessions occur each Tuesday evening with group nutrition education and group exercise. The kid's gym has been expanded to include more age appropriate portable physical activity equipment and a new A-frame Iron Range Training system. In 2015, increased services to our patients and families included guest speakers, grocery store tours, menu planning and monthly cooking classes which contributed to their success. 5.) Tobacco Use was addressed through "Tobacco Free for Baby and Me" cessation program for the 326 women who were identified as tobacco users in the CAMC Women's Medicine Center in 2015. The program had a 20% quit rate compared to the national quit rate of 13%. In addition, quit validation is 79%. Results for each of our Implementation Strategies and additional programs are described in detail in our 2015 Community Benefit Report and Report on 2014-2016 Implementation Strategies. The following program is not addressed by CAMC: High School Dropout. This issue is being addressed by United Way of Central WV, Kanwha County Schools and State Department of Education. Facility Reporting Group - A Part V, Section B, line 13h: Other criteria considered for financial assistance eligibility: A financial assistance estimation tool that utilizes public records; and whether or not a patient receives assistance from certain state agencies. Facility Reporting Group - A Part V, Section B, line 22d: Patients who qualify for financial assistance with income under 200% FPG are given a 100% discount. Patients who qualify for financial assistance with income between 201-300% FPG receive a 50% discount. If a patient does not qualify for financial assistance but is uninsured, a 50% discount from billed charges is given, which is greater than the highest negotiated commercial insurance discount. Part V, Section B Facility Reporting Group B Facility Reporting Group B consists of: - Facility 4: CAMC Teays Valley Hospital Facility Reporting Group - B Part V, Section B, line 5: United Way of Central WV completed a community survey in July 2015 to identify top health, education, income/economic and safety net issues for Putnam County. Survey Monkey web based tool was utilized. 105 responses were collected from Putnam County comprised of 75% female and 25% male. 2015 Putnam County Fair Survey on substance abuse with 91 adults and 120 youth completing the survey. In April 2015, 41 law enforcement officers responded to the question: What is the most concerning emerging trends with local youth substance abuse? Putnam Wellness Coalition completed Key Leader interviews with 10 participants on various issues. EnAct Community Action Agency conducted a needs assessment in Boone, Clay, Fayette, Kanawha and Putnam Counties. The project included surveying residents, interviewing community stakeholders, conducting secondary data research, facilitating an analysis retreat, and providing a summary report with key findings and recommendations. There were 131 responses from individuals who indicated residency in Putnam County. To further identify primary and chronic disease needs and other health issues of uninsured, low-income persons, and minority groups, the Advisory Committee reviewed Putnam County beneficiary utilization of United Way services. Dr. Michael Brumage, Executive Director/Health Officer of the Kanawha-Charleston Health Department was consulted on the health needs of Putnam County. The Kanawha-Charleston Health Department assumed responsibility for the Putnam County Heath Department after the 2012 Putnam County Needs Assessment was completed. A large percentage of Putnam County residents work and seek health care in Kanawha County, including at the Kanawha/Charleston Health Department. One of Dr. Brumage's staff now serves as administrator for both Kanawha-Charleston and Putnam County Health Departments. Although new to his job, Dr. Brumage is already an active and vital participant of the Kanawha Coalition for Community Health Improvement and is committed to working with the United Way Putnam County Advisory Committee and CAMC Teays Valley Hospital to identify and address identified health issues. In addition, Dr. Brumage identified partnership opportunities that were incorporated into the Implementation Strategies for CAMC Teays Valley Hospital. Facility Reporting Group - B Part V, Section B, line 6a: The hospital facility's CHNA was not conducted with one or more other hospital facilities.Part V, Sec tion B, line 6b: AEP, United Way of Central WV, Cummins Crosspoint, Putnam County Wellness Coalition, Teays Valley Church of the Nazarene, Putnam County Manager, Putnam County Schools Facility Reporting Group - B Part V, Section B, line 11: The following health issues are identified as community priorities in 2015 for 2015-2017: Physical Inactivity; Afterschool Hunger (children); Unhealthy Diet; Drugs (heroin, prescription drugs); Alcohol Use; Tobacco Use; Parental Oversight-overall and particularly after school; Melanoma; Lack of Food (associated with poverty); Lack of Affordable Child Care. CAMC Teays addresses (1.) Physical Inactivity through the CARDIAC Project, Camp Kno Koma, providing sports physicals to high school athletes, providing orthopedic coverage for area school sports and placing AEDs in all schools. (2.) Afterschool Hunger in Children is addressed through the Backpack Buddy Program where food is packaged and mailed to underprivileged children's homes during the summer to address hunger. (3.) Drug use is addressed through participation with the Putnam County Drug Court and Medical Explorers. (4.) Poverty is addressed through enrollment assistance for patients and families for health coverage and charity care.In addition, implementation strategies for 2015-2017 include: 1. Providing physical activity opportunities for the at risk cardiac population. In 2015, an exercise program was established for patients following the completion of cardiac rehab. 2. Provide access to primary and specialty health care for the service area through medical staff recruitment. In 2015, new physician recruitment included: Family Medicine and Hematology/Oncology. 3. Divert non-violent youth who abuse alcohol and drugs to a drug and alcohol free future. In 2015, financial support was provided to the Putnam County Juvenile Drug Court. 4. Provide medical supplies for each Putnam County Library for use in emergency situations. In 2015, all libraries were provided emergency kits. 5. Provide food to low income children during the summer through the Backpack Buddy Program. In 2015, CAMC Teays worked with United Way and other community providers to provide this program over the summer. Results for each of CAMC Teays Valley Hospital Implementation Strategies and additional programs are described in detail in the CAMC Teays Valley Hospital Community Needs Assessment and Implementation Strategies 2015-2017 report found at www.camc.org. The following needs are not addressed by CAMC Teays Valley Hospital: Unhealthy Diet. This need is addressed by the CAMC Weight Loss Center; Alcohol Use is addressed by Alcoholics Anonymous; Lack of Affordable Child Care is not addressed because CAMC Teays does not have the capacity or funding to address this issue. Facility Reporting Group - B Part V, Section B, line 13h: Other criteria considered for financial assistance eligibility: A financial assistance estimation tool that utilizes public records; and whether or not a patient receives assistance from certain state agencies. Facility Reporting Group - B Part V, Section B, line 22d: Patients who qualify for financial assistance with income under 200% FPG are given a 100% discount. Patients who qualify for financial assistance with income between 201-300% FPG receive a 50% discount. If a patient does not qualify for financial assistance but is uninsured, a 50% discount from billed charges is given, which is greater than the highest negotiated commercial insurance discount. 7 1 - CAMC Imaging Center 60 RHL Boulevard South Charleston WV 25309 Outpatient Imaging Center 2 - CAMC Urgent Care Center 314 Goff Mountain Road Suite 3 Cross Lanes WV 25313 Urgent Care Facility 3 - CAMC Phys Therapy & Med Center 200 Tracy Way Charleston WV 253111258 Rehabilitation Facility 4 - CAMC Solutions 2568 Pennsylvania Avenue Charleston WV 253024907 Pharmacy Compounding Center 5 - CAMC Pharmacy 314 Goff Mountain Road Cross Lanes WV 25313 Pharmacy 6 - St Mary's Laboratory Service 2900 First Ave Suite 607 Huntington WV 25702 Laboratory Services 7 - CAMC Weight Loss Center 600 Tracy Way Suite 2 Charleston WV 25311 Weight Loss Center Part I, Line 7: Utilized worksheet 2 to determine cost-to-charge ratio. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 27,235,462. Part I, Line 3c CAMC may screen private pay balances for pre-qualified eligibility by using financial assistance estimation tools that access public records. Using a proprietary algorithm (looking at tax records, bankruptcies, etc), the tool returns whether the patient is likely to qualify for the Financial Assistance Policy. In cases where pre-qualified eligibility does not qualify a patient for financial assistance, the patient may complete a financial assistance application where application material is evaluated to determine if the patient can qualify based on income and assets. If the patient meets income criteria for eligibility an inventory of available assets is evaluated. If the patients available assets fall below $50,000 excluding the patients primary residence and primary vehicle, the patient will qualify for financial assistance. If a patient is found to be receiving certain State agency assistance (i.e. WIC, SNAP, etc), such patient will be presumed eligible for CAMC financial assistance, and an application for assistance needed to determine income and asset eligibility criteria will be unnecessary. Part II, Community Building Activities: Community building activities improve the community's health and safety by addressing the root causes of health problems. CAMC is a member of the Partners in Health Network, Inc. ("Partners"), which is comprised of 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 and other health issues. 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. CAMC also partners with The Greater Kanawha Valley Foundation to create a value chain food system to support wealth creation for local growers. Part III, Line 2: This is the bad debt expense from the audited financial statements. Bad debt is the net of discounts, payments and recoveries. Part III, Line 3: There are no longer any amount of charity included in the bad debt expense due to all patients being run through a financial assistance estimator. Part III, Line 4: The footnote for Allowance for Uncollectible Accounts is on page 10 of CAMC Health System's audited financial statements. In summary, private pay accounts and amounts for deductibles and co-insurance that are deemed uncollectible 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. 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 Medicare reimbursement. Part III, Line 8: Cost to charge ratio from the Medicare costs report is used. Part III, Line 9b: CAMC's collection policy makes provisions for patients who qualify for financial assistance. Patients who receive financial assistance must have income at 300% or less of Federal Poverty Guidelines, insufficient assets to pay for the care, and may not be eligible for any public programs. Patients who qualify for financial assistance with income under 200% FPG are given a 100% discount. Patients who qualify for financial assistance with income between 201-300% FPG receive a 50% discount. All patient responsibility debt not approved for financial assistance is reviewed with a financial assistance estimator. This financial assistance estimator process is only used to approve assistance. It is not used to deny assistance. Accounts are only reviewed for Financial Assistance at the 100% discount category. This process is performed before extraordinary collection efforts. Patients without third-party coverage who do not qualify for charity are given a 50% 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. Part VI, Line 2: CAMC supports and strengthens its key communities through a systematic approach that begins with our mission, vision and values. Annually during our strategic planning process we review the community health needs assessment findings and priorities to develop our community strategy. This strategy is based on issues identified through the needs assessment process and supplemented with findings from our internal Environmental Analysis. Communities are identified, strategies are identified and plans are funded, implemented, tracked and measure. Our Board approves the plan and reviews plan progress annually. Because of the size and scope of our services, the approach we use to identify our key communities is based on the strategy, key stakeholders needs, and our capacity. Our community for the Kanawha Coalition Communtiy Health Improvement ("KCCHI") work groups is Kanawha County as determined by the KCCHI mission. For our CAMC community strategy, community is based on the need identified and population to be addressed. We develop Health Indicator Data Sheets for each of our service area counties and identify key issues to address for all or part of our service area. For example, our Perinatal Telemedicine Project includes 14 rural counties and our Child Advocacy Center and HIV program serve our entire service area. Each strategy is deployed through a planning process that addresses key stakeholder needs and is evaluated based on predetermined criteria for outcomes expected. Cycles of learning have ensured the Civic Affairs Council monetary contributions support community organizations in the service area that are clearly aligned with our community strategy. In addition to addressing community needs and contributing financially, our leadership team serves in key leadership roles for community activities, programs and organizations as well as supports the workforce in participating in many community benefit activities such as Day of Caring and HealthFest. CAMC Teays Valley Hospital supports and strengthens the Putnam County community through its annual planning process where the needs assessment findings and priorities are reviewed to develop its community strategy and the community(ies) within Putnam County that are impacted. This strategy is based on issues identified through the needs assessment process and supplemented with findings from review of internal data. Strategies are identified and plans are funded, implemented, tracked and measured. The CAMC Board Planning and Public Policy Committee and the CAMC Board of Trustees approve the plan and review plan progress annually. In addition to addressing community needs and contributing financially, CAMC Teays' Vice President and Associate Administrator serve in key leadership roles for community activities, programs and organizations as well as support the workforce in participating in many community benefit activities. As part of the strategic planning process, CAMC Teays determines if there are additional areas of support that can be provided to address the identified community health needs assessment issues. 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 Financial Assistance Policy during the registration process. Information is available through signage and a plain language summary of the policy is given to each patient. In addition, Financial Assistance applications are available at each registration location. 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: CAMC's community area of focus includes our Primary and Secondary Service area. Our PSA includes: Kanawha, Putnam, Fayette, Boone and Logan Counties. Our SSA is Jackson, Roane, Clay, Nicholas, Raleigh and Mercer Counties. Kanawha County constitutes a population of 190,359 (2015) with a median age of 43.7 and a household median income of $43,309. The PSA/SSA population is 594,570, with a median age of 43.3 and median income of $42,432. Teays' community and primary area of focus is Putnam County. Putnam County has a population of 53,553 with a median age of 43.4 and a household median income of $52,703 (2015 data). Demographic, health and socioeconomic information is provided in detail in the 2014 Community Benefit Reports found on www.camc.org. Part VI, Line 5: CAMC's governing board is its Board of Trustees, a 17 voting member volunteer community board that meets WV State law requirements for nonprofit board membership including community representation. 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 and charity care. CAMC applies any surplus funds toward improving facilities, equipment, patient care, medical training, research and education. CAMC's Community Health Improvement Services, Health Professions Education, Financial and In-kind Contributions, Community and Building Activities are detailed in the Community Benefit Report on our website at www.camc.org. Part VI, Line 6: CAMC Health Education and Research Institute serves as the education and research arm of the CAMC Health System. The Institute promotes the health of the community by sponsoring health professional training programs training the region's health professionals in the community, region and state, sponsoring management and leadership development programs, sponsoring community health education and prevention education programs for the community, conducting clinical and health services research targeted to improve health and health services delivery of our patients and community, pursuing special program funding and grants to support education and research programs, promoting economic development through its employment of approximately 80 full-time education, research and support staff and through its extramural and externally funded sponsored programs, promoting telehealth opportunities that link providers for health consultation and that improves access to health services to patients, creating linkages to education affiliates allowing approximately 800 learners to receive clinical training experiences at CAMC, sponsoring simulation training experiences for regional education affiliates, and promoting and sustaining networks and partnerships that improve access to clinical trials and research funding opportunities. The CAMC Foundation's mission is to support and promote CAMC's delivery of excellent and compassionate health services and CAMC's contribution to the quality of life and economic vitality of the region. This is accomplished through support of many services to CAMC patients and employees. Each year, the Foundation supports the Prevention First Program at CAMC Women and Children's Hospital. The Prevention First Program seeks to reduce medical costs, facilitate all aspects of health care, including support of the medical plan established by the primary care physician, while meeting the special needs of low-income children and families in the home environment. Specifically, the Prevention First Program promotes healthy outcomes that will decrease pre-term labor, infant mortality, unplanned C-Section rate, NICU/PICU length of stay and increase infant birth weight while promoting well-child care and immunizations. The Foundation also helps keep physicians and allied health care employees up-to-date by providing funding for many continuing education programs.Integrated Health Care Providers (IHCPI) is an affiliated company of the CAMC Health System existing to support the mission of CAMC in striving to provide the best healthcare to every patient every day. When the CAMC Health System identifies an essential patient need, an access issue for patients, or when the existing provider community cannot provide an essential service, IHCPI through its affiliation with the CAMC Health System works to fill the gaps. Currently, IHCPI operates a host of sub-specialty physician practices primarily operated to support the Level I trauma and tertiary care mission of CAMC. IHCPI practices see a disproportionate share of the underinsured in their physician practices. Part VI, Line 7, Reports Filed With States WV 1 WV Health Right Inc 1520 Washington Street Charleston WV 25311 311066881 501(c)(3) 146342 General Program Support Ronald McDonald House Charities of Southern West Virginia Inc 302 30th Street SE Charleston WV 25304 550631080 501(c)(3) 10135 General Program Support Braxton County Memorial Hospital 100 Hoylman Drive Gassaway WV 26624 550611919 501(c)(3) 200000 General Program Support Buckskin Council BSA 2829 Kanawha Blvd E Charleston WV 25311 550357013 501(c)(3) 6500 General Program Support Coalition to Protect America's Health Care PO Box 30211 Bethesda MD 208240211 522253225 501(c)(4) 10000 General Program Support University of Charleston 2300 MacCorkle Avenue SE Charleston WV 25304 550357039 501(c)(3) 301300 Nursing, Pharmacy and General Support Fund for the Arts 803 Quarrier Street 100 Charleston WV 25301 550614854 501(c)(3) 10000 General Program Support WV Medical Professional Health Program PO Box 40027 Charleston WV 25364 743226821 501(c)(3) 15000 General Program Support 7 1 Nursing Scholarhips 106 155375 Allied Health Scholarships 44 52125 Medical Scholarships 33 92500 Employee Dependent Scholarships 27 33750 Employee Scholarships 128 107580 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 and 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. 1 1 0 0 0 0 0 1 0 David L Ramsey President, CEO & Trustee 757699 0 296000 0 265931 0 99882 0 39761 0 1459273 0 76610 0 Samuel Shawn Groves MD Trustee 503613 0 0 0 11514 0 12523 0 27855 0 555505 0 0 0 Larry C Hudson Executive VP & CFO 431065 0 136074 0 171482 0 15900 0 11612 0 766133 0 58558 0 Glenn Crotty Jr MD Executive VP & COO 485540 0 158634 0 69515 0 64376 0 38069 0 816134 0 41931 0 Marshall A McMullen Jr Secretary & Gen Counsel 292538 0 52952 0 77224 0 41766 0 29379 0 493859 0 44207 0 Michael D Williams VP Administrator 279137 0 62939 0 41192 0 242228 0 28887 0 654383 0 25991 0 S Andrew Weber VP Administrator 222567 0 53467 0 33487 0 128964 0 32571 0 471056 0 22416 0 Stephen Z Bell VP Finance 198480 0 51626 0 1522785 0 47570 0 12511 0 1832972 0 902296 0 Robert D Whitler VP Gov't & Comm Affairs 178373 0 43937 0 26717 0 11204 0 30706 0 290937 0 0 0 Ronald E Moore VP Prof Prac & CNO 216662 0 49662 0 51208 0 207271 0 23305 0 548108 0 19296 0 Robert B Danielson VP Compliance 171896 0 32031 0 28028 0 67333 0 25402 0 324690 0 18025 0 Dale R Wood VP System Improv & CQO 260947 0 67970 0 61810 0 238843 0 14655 0 644225 0 30143 0 Jeffrey H Goode VP Ambulatory Services 257389 0 56953 0 47113 0 136880 0 33635 0 531970 0 19505 0 Jeffrey L Oskin VP Administrator 319006 0 61592 0 41795 0 129196 0 16773 0 568362 0 29569 0 Thomas P McIlwain MD VP Med Affairs and CMO 374077 0 93534 0 59786 0 25728 0 25591 0 578716 0 32010 0 Gregory M Veltri VP Info Svc & CIO 138116 0 22490 0 242122 0 10600 0 29960 0 443288 0 36916 0 Kristi Snyder VP Human Resources 237342 0 55484 0 41848 0 162689 0 8919 0 506282 0 29614 0 Randall H Hodges VP Administrator 204758 0 55934 0 1254642 0 25858 0 29499 0 1570691 0 919507 0 Rocky Blake Interim VP Info Svc & CIO 229094 0 0 0 16500 0 11907 0 25264 0 282765 0 0 0 Robert B Shin MD Physician 1163985 0 0 0 0 0 13250 0 967 0 1178202 0 0 0 John T Deel MD Physician 1070294 0 0 0 259 0 15900 0 32054 0 1118507 0 0 0 Scott M Ciaccia DO Physician 937978 0 0 0 18909 0 10600 0 29801 0 997288 0 0 0 Samel C Rossi MD Physician 870438 0 0 0 0 0 13250 0 22949 0 906637 0 0 0 Aaron L Sop DO Physician 802155 0 300 0 13721 0 13250 0 25549 0 854975 0 0 0 Lynn Brookshire Former Officer 101200 0 0 0 59760 0 0 0 0 0 160960 0 23407 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 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 an executive role. Part I, Line 4a Gregory Veltri received $145,000 severance in 2015. CAMC has a Mutual Severance Agreement with Mr. Veltri which states "Although Veltri will no longer be performing duties or exercising any responsibilities, CAMC will continue to pay Veltri his bi-weekly pay check through December 2016." Part I, Line 4b Supplemental Executive Retirement Plan ("SERP"). Participants are key officers of CAMCHSI and subsidiaries. Participant Randall H. Hodges in 2015 was paid $1,123,409 and Stephen Z. Bell was paid $1,465,004. Terms and 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 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 30 and 0.5% 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. Under the Execu-Flex Benefit Plan (409A), executives receive 11% of their salary in flex allowance. This flex allowance is used to elect executive benefits. Any remaining flex allowance is credited to a tax-deferred Capital Accumulation Account. The minimum vesting period is two years, maximum is age 68. A two year non-compete agreement (Substantial Risk of Forfeiture Agreement) applies if termination of employment occurs prior to the vesting date. Certain participants had amounts vested and included as reportable compensation this year, as detailed below: David L. Ramsey - $77,247 Dale R. Wood - $30,148 Larry C. Hudson - $126,272 Glenn Crotty Jr., MD - $41,937 Marshall A. McMullen Jr. - $44,214 Thomas P. McIlwain - $32,286 Jeffrey L. Oskin - $29,573 Michael D. Williams - $25,995 Ronald E. Moore - $19,299 Jeffrey H. Goode - $19,508 Gregory M. Veltri - $52,122 Randall H. Hodges - $93,444 S. Andrew Weber - $22,419 Stephen Z. Bell - $26,511 Kristi Snyder - $30,837 Robert D. Whitler - $13,570 Robert D. Danielson - $18,028 Lynn Brookshire - $44,677 Part I, Line 7 The organization provides incentive payments to certain employees after operating and performance goals are achieved. Incentive payment plans are reviewed and approved by the CAMC Health System, Inc. Board of Directors Compensation Committee. A West Virginia Hospital Finance Authority 621256910 956624AQ3 2008-06-19 127355000 See Part VI 0 0 0 B West Virginia Hospital Finance Authority 621256910 956622ZV9 2009-09-10 177519271 See Part VI 0 0 0 C West Virginia Hospital Finance Authority 621256910 956622F74 2014-07-24 50641160 See Part VI 0 0 0 D West Virginia Hospital Finance Authority 621256910 000000000 2008-09-30 26000000 See Part VI 0 0 0 A 5315000 130398907 2071347 773024 94470515 33084021 2015 1 0 1 1 B 69570000 178397572 9157652 842090 2455533 17301803 2926790 146196700 2013 1 0 1 1 C 50641160 3655288 640714 50000446 1 0 1 1 D 6112961 26105219 146457 4214556 21744205 2013 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 Merrill Lynch Capital 29.200000000000 0 0 0 1 1 B 0 0 0 1 0 0 1 Wachovia 23.000000000000 1 1 1 C 0 1 0 0 0 0 1 Wachovia 23.000000000000 1 0 1 D 0 0 0 1 1 0 0 1 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: West Virginia Hospital Finance Authority Date the Rebate Computation was Performed: 06/30/2013 Issuer Name: West Virginia Hospital Finance Authority Date the Rebate Computation was Performed: 06/30/2014 Issuer Name: West Virginia Hospital Finance Authority Date the Rebate Computation was Performed: 06/30/2013 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 2014A Bonds were used to (i) currently refund and extinguish a portion of the Series 2009 A Bonds issued 9/10/2009 and (ii) pay the costs of issuing the 2014 A Bonds. Part I Line D (F) Description of purpose: The proceeds of the 2008A Bonds were to refund a portion of a $30,000,000 temporary note used to finance the acquisition, construction and improvement of facility and to finance a project acquisition fund. Differences between the issue price (Part I) and total proceeds (Part II, line 3) are due to investment earnings. Working capital expenditures reported in Part II, Line 9, Column B consist of a swap termination payment. Part II, line 11, column B: Form 8038 reported that $148,894,025 of proceeds was to be used to retire the prior debt. The actual amount required for that purpose was $146,196,700. The remainder was deposited to a project fund and spent on capital expenditures eligible for tax-exempt financing. Part III has been completed for the column B bonds only with respect to the new money portion of the issue, as the refunding portion refunded pre-2003 debt. Part III has been completed for the column C bonds exactly the same as for the column B bonds, since the column C bonds current refunded a portion of the column B bonds. Part IV, Line 6, columns A, B, and D: Such amounts were appropriately yield restricted. Rick Crotty Family member of Glenn Crotty Jr., MD, Officer 61708 employed by organization 0 Barbara Covelli Family member of Glenn Crotty Jr., MD, Officer 97623 employed by organization 0 Donna Bell Family member of Stephen Z. Bell, Officer 176232 employed by organization 0 Matthew Griffith Family member of James P. Griffith, MD, Trustee 24535 employed by organization 0 Gloria Jean Morgan Family member of Kristi Snyder, Officer 40002 employed by organization 0 John Snyder Family member of Kristi Snyder, Officer 89115 employed by organization 0 Christine Oskin Family member of Jeffrey L. Oskin, Officer 121935 employed by organization 0 TerraCare Entity more than 35% owned by Nellie Rae Chilton, Former Trustee 293947 Purchased Services 0 Erik Reeder Family member of Glenn Crotty Jr., MD, Officer 44213 employed by organization 0 James Williams Family member of Gregory M. Veltri, Officer 31958 employed by organization 0 Kellie Teel Family member of S. Andrew Weber, Officer 84879 employed by organization 0 Form 990, Part VI, Section A, line 4 Article X, Medical Staff, Sections 10.1 and 10.2 expanding the list of caregivers who may be appointed to the medical staff to include oral surgeons, podiatrists and registered Ph.D. psychologists. 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 names 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 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 CAMC compiles necessary information for Form 990 through the efforts of various officers and trustees of the organization and its affiliates. 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 and resolve potential conflict of interest issues relative to action items. Annual disclosure procedures are implemented and the board chair and Nominating Committee periodically review conflict situations. The organization's conflict of interest policy requires all disclosed conflicts to be reported by the Chief Compliance Officer to the CAMC Health System Management Compliance Committee. The Compliance Officer will inform the Board of Trustees Audit Committee at their next scheduled meeting of all such activities approved by the CAMC Health System Management Compliance Committee. The Manager (the direct supervisor of a company representative) may concur with the Compliance Officer's decision or may ask that the CAMC Health System Management Compliance Committee review the Conflict of Interest Form in question. The CAMC Health System Management Compliance Committee will then review the conflict of interest in question at the next meeting and their decision is final. 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. The Committee uses the data to determine the total compensation of CAMC's CEO and the other executives. The data is reviewed every two years or when a new person comes into an executive role. Form 990, Part VI, Section C, line 19 The organization's audit is part of a consolidated financial audit for CAMC Health System, Inc. and Subsidiaries. Consolidated audited financial statements are available online at CAMC.org. They are also filed with the WV Health Care Authority where they are available online and in person. There is no formal method of making the organization's Bylaws and Conflict of Interest Policy publicly available, but they are available upon request. The organization's Articles of Incorporation are on file at and publicly available through the West Virginia Secretary of State's Office. Form 990, Part XI, line 9: Increase/Decrease in beneficial interest in CAMC Foundation 1,029,023. Change in Affiliate Receivable Balance 810,929. Affiliate Transfers: CAMC Health System, Inc. and Subsidiaries -1,583,948. Change in retirement obligation 1,096,032. Change s in Non-Controlling Interest 97,702. CAMC Health System Inc PO Box 1547 Charleston WV 253261547 550664138 Parent Company WV 501(c)(3) Line 11c, 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 System Inc 1 CAMC Foundation Inc PO Box 1547 Charleston WV 253261547 310887133 Fundraising WV 501(c)(3) Line 7 CAMC Health System Inc 1 Women and Children's Medical Office Building Partnership PO Box 1547 Charleston WV 253261547 550669065 Medical Office Building WV Charleston Area Medical Center Inc Related 346218 3325641 0 1 0.90440 General Division Medical Office Building Partnership PO Box 1547 Charleston WV 253261547 550623949 Medical Office Building WV Charleston Area Medical Center Inc Related 430483 697083 0 1 0.81930 Integrated Health Care Providers Inc PO Box 1547 Charleston WV 253261547 550751010 Specialty Physician Practices WV N/A C 1 0 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 CAMC Health System Inc L 98298 Fair Market Value CAMC Health System Inc R 704350 Fair Market Value CAMC Health Education and Research Institute Inc R 5850107 Fair Market Value CAMC Health Education and Research Institute Inc J 263584 Contract CAMC Health Education and Research Institute Inc M 16885096 Contract CAMC Health Education and Research Institute Inc L 437921 Fair Market Value CAMC Health Education and Research Institute Inc Q 3023602 Fair Market Value CAMC Health Education and Research Institute Inc P 1178169 Fair Market Value Integrated Health Care Providers Inc B 50186603 Contract Women and Children's Medical Office Building Partnership C 450489 Fair Market Value Integrated Health Care Providers Inc J 1746121 Contract Women and Children's Medical Office Building Partnership K 1216864 Contract General Division Medical Office Building Partnership K 986280 Contract Women and Children's Medical Office Building Partnership L 255503 Contract General Division Medical Office Building Partnership L 196563 Contract Integrated Health Care Providers Inc K 53174 Contract Integrated Health Care Providers Inc L 5012519 Contract Integrated Health Care Providers Inc P 6098607 Fair Market Value Integrated Health Care Providers Inc Q 74675716 Fair Market Value Integrated Health Care Providers Inc R 1000000 Fair Market Value Women and Children's Medical Office Building Partnership Q 209359 Fair Market Value General Division Medical Office Building Partnership Q 154560 Fair Market Value General Division Medical Office Building Partnership E 396987 Contract CAMC Foundation Inc C 6693533 Fair Market Value CAMC Foundation Inc K 591447 Contract CAMC Foundation Inc L 236065 Fair Market Value CAMC Foundation Inc Q 285661 Fair Market Value