2016-11-01T07:58:49-05:00 2015-12-31 560747981 DIXON HUGHES GOODMAN LLP PO BOX 1556 MORGANTOWN WV 26507 990 2015-01-01 311524546 CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION CAMD 3044242202 800 GARFIELD AVENUE PARKERSBURG WV 26101 CAROLYN ALLEN CFO 3044242202 2016-09-29 1 SUSAN S DULL P00233523 3042927343 2016-09-29 2015 2017-02-10 21:41:12Z CAMDEN CLARK MEDICAL CENTER DAVID K MCCLURE 800 GARFIELD AVE PARKERSBURG WV 26102 240849538 0 X WWW.CCMH.ORG X 1997 WV TO OPERATE AN ACUTE CARE AND EMERGENCY HOSPITAL FACILITY. 7 5 2200 398 672245 717972 96246 64945 223729290 235020558 7601714 2647747 1735961 1389585 233163211 239122835 275459 284043 0 0 90045770 86849302 0 0 0 143483937 145522445 233805166 232655790 -641955 6467045 326543610 264673952 289916466 281417100 36627144 -16743148 X THE MISSION OF CAMDEN-CLARK MEMORIAL HOSPITAL IS TO MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY FOR A LIFETIME. 0 0 121680957 129274404 CAMDEN CLARK MEMORIAL HOSPITAL OFFERS EMERGENCY ROOM SERVICES AS PART OF THE HOSPITAL'S MISSION OF MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY FOR A LIFETIME. DUE TO THE COMMUNITY THAT IT SERVES, THE MAJORITY OF PATIENTS VISITING THE ER ARE EITHER UNDERINSURED OR UNINSURED. FOR THE REPORTING PERIOD, THERE WERE APPROXIMATELY 58,294 ER VISITS, OF THIS TOTAL, 9,645 OR 16.6% WERE ULTIMATELY ADMITTED TO THE HOSPITAL. THIS REPRESENTS 70.7% OF THE TOTAL HOSPITAL ADMISSIONS FOR 2014. THEREFORE, A SIGNIFICANT PORTION OF THE HOSPITAL'S INPATIENT VOLUME COMES DIRECTLY FROM THE ER. 12534037 11996967 CAMDEN-CLARK MEMORIAL HOSPITAL IS A LEADER IN CANCER CARE FOR THE MID-OHIO VALLEY, PROVIDING CANCER CARE TO PATIENTS IN A 45 MILE RADIUS FROM THE HOSPITAL. IN ADDITION TO A WIDE RANGE OF TREATMENT OPTIONS PROVIDED, THE HOSPITAL OFFERS A NUMBER OF RELATED SERVICES TO ITS PATIENTS. THROUGH THE HOSPITAL'S COLLABORATION WITH THE AMERICAN CANCER SOCIETY, THE DEVELOPMENT OF THE ORGANIZATION'S CANCER RESOURCE CENTER, A HAIR RESTORATION SALON, A PATIENT NAVIGATOR AND AN ONCOLOGY SOCIAL WORKER, THE HOSPITAL HAS ENHANCED THE EDUCATION, NAVIGATION AND SOCIAL SUPPORT OF ITS CANCER PATIENTS AND FAMILIES. THE HOSPITAL'S COMMUNITY AND SOCIAL SERVICES PROVIDE A HOLISTIC HEALING ENVIRONMENT WHICH INCLUDES SUPPORT GROUPS FOR PATIENTS/FAMILIES AND AESTHETIC SERVICES TO ENHANCE THE PATIENTS' PHYSICAL AND EMOTIONAL WELL-BEING. 6113630 7840537 CAMDEN-CLARK MEMORIAL HOSPITAL OFFERS BEHAVIORAL HEALTH SERVICES FOR ITS IMMEDIATE SERVICE AREA DIRECTLY THROUGH THE HOSPITAL. IN ADDITION, SERVICES ARE PROVIDED TO UNDERSERVED COUNTIES THROUGHOUT THE AREA VIA PHYSICIANS THAT ARE EMPLOYED BY CAMDEN CLARK PHYSICIAN CORPORATION, A RELATED ENTITY. THERE IS A SEVERE SHORTAGE OF BEHAVIORAL HEALTH SERVICES AVAILABLE IN THE MID-OHIO VALLEY, AND CAMDEN-CLARK HAS MADE EFFORTS TO BRIDGE THAT GAP. 77997755 284043 87048859 THE HOSPITAL STRIVES TO SUPPLY A COMPREHENSIVE RANGE OF INPATIENT, OUTPATIENT, OUTREACH CLINICS AND EMERGENCY ROOM SERVICES, INCLUDING PREVENTION, GUIDANCE, DIAGNOSIS, TREATMENT, RESTORATION, REHABILITATION AND OTHER EFFORTS AS MAY BE REQUIRED TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY AND AS THE HOSPITAL'S RESOURCES WILL PERMIT.ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING WITH THIS COMMITMENT TO SERVICE ALL MEMBERS OF THE COMMUNITY, CAMDEN-CLARK MEMORIAL HOSPITAL WILL PROVIDE THE FOLLOWING WHERE THE INDIVIDUAL'S NEED AND/OR AN INABILITY TO PAY COEXIST: - FREE CARE AND/OR SUBSIDIZED CARE - CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST - HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITYRECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARTITY CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. IN ADDITION, CHARITY CARE IS PROVIDED THROUGH MANY REDUCED-PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES THAT THE HOSPITAL BELIEVES WILL SERVE A BONAFIDE COMMUNITY HEALTH NEED.THE HOSPITAL ALSO PROVIDES NUMBEROUS OTHER BENEFITS FOR THE MID-OHIO VALLEY COMMUNITY, INCLUDING ECONOMIC BENEFITS, HEALTH EDUCATION, WELLNESS/OUTREACH PROGRAMS, AND PUBLIC SERVICES AND SUPPORT GROUPS. 77997755 284043 87048859 218326379 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 221 0 2200 1 1 1 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WV X CAROLYN ALLEN 3044242202 800 GARFIELD AVENUE PARKERSBURG WV 26102 TERRY CAPEL BOARD MEMBER (CHAIRMAN) 1.00 2.00 X X 0 0 0 JOSEPH CAMPBELL BOARD MEMBER 1.00 2.00 X 0 0 0 GREGORY GORE BOARD MEMBER (SECRETARY) 1.00 1.00 X X 0 0 0 MICHAEL MOREHEAD BOARD MEMBER 1.00 1.00 X 0 0 0 JENNIFER LEAVITT BOARD MEMBER 1.00 1.00 X 90384 0 0 KATHY G EDDY VICE CHAIRMAN 1.00 2.00 X X 0 0 0 KARL BOELTER BOARD MEMBER 1/1/2015-2/1/2015 1.00 1.00 X 0 0 0 RANDY SNIDER BOARD MEMBER 1.00 1.00 X 0 0 0 TODD A KRUGER VICE PRESIDENT 30.00 10.00 X 383564 0 15865 DAVID K MCCLURE PRESIDENT/CEO 38.00 2.00 X 517095 0 36964 THOMAS R HELLER VP OF HR 30.00 10.00 X 319586 0 50655 CYNTHIA A KERN VP QUALITY 40.00 X 226536 0 30458 CAROLYN ALLEN TREASURER 33.00 7.00 X 290428 0 26650 JOSHUA R WOODS CHIEF INFORMATION OFFICER 40.00 X 135689 0 21049 GENE A SEXTON PHARMACIST 40.00 X 133055 0 33559 MICHAEL D TRIMBLE PHARMACIST 40.00 X 131635 0 11956 SHAUN D CARTER PHARMACY MANAGER 40.00 X 139744 0 7793 PAMELA K MINCKS PHARMACIST 40.00 X 129582 0 25680 MICHAEL A KING FORMER CEO 1.00 6.00 X 294281 0 6089 2791579 0 266718 32 1 1 0 ACCENTURE LLP 161 N CLARK STREET CHICAGO IL 60601 OPERATIONS 3639378 RESTORIX HEALTH 445 HAMILTON AVE SUITE 800 WHITE PLAINS NY 10601 WOUND CARE 1498296 QUEST DIAG NICHOLS INSTITUTE 27027 TOURNEY ROAD VALENCIA CA 91355 LAB SERVICES 1127859 JACKSON KELLY PO BOX 553 CHARLESTON WV 25322 LAW FIRM 764695 AUREUS MEDICAL GROUP NURSING DIVISION 2425 S 171ST STREET OMAHA NE 68130 NURSING SERVICES 439724 42 64945 64945 PATIENT SERVICE,NET 621500 231227217 231227217 PASS-THROUGH INCOME - OVASC & HH 621910 1103525 1103525 2689816 2689816 235020558 2469506 4312 2465194 166771 166771 1308146 1726703 -418557 -418557 -418557 11470 0 11470 11470 11470 CAFETERIA 624200 1054293 1054293 HEALTH AND WELLNESS CENTER 713940 667933 667933 OTHER 900099 85916 85916 1808142 239122835 236160767 672245 2224878 284043 284043 1929301 632711 1296590 65338954 61254083 4084871 2235010 2056209 178801 11593911 10666398 927513 5752126 5291956 460170 205164 205164 133804 133804 19255835 17715368 1540467 639660 588487 51173 3464226 3187088 277138 1147699 1055883 91816 4739062 4359937 379125 119614 110045 9569 7785515 7162673 622842 16675321 15341295 1334026 3114562 2865397 249165 MEDICAL SUPPLIES 27191703 27191703 PATIENT CHARGES 20019979 20019979 PHYSICIAN FEES 10233365 9414696 818669 PROVISION FOR BAD DEBTS 9940587 9940587 20856349 19187841 1668508 232655790 218326379 14329411 0 426493 1139734 5622913 5895358 24146549 25994048 1675235 2932679 10835132 9977395 54522 1052673 288359390 157215266 156789705 131144124 95737317 73911592 917007 1012494 30338737 11613855 326543610 264673952 26295243 26736014 216698577 212592937 1400000 5960430 45522646 36127719 289916466 281417100 X 36627144 -16743148 36627144 -16743148 326543610 264673952 X 6467045 -28191809 80000 -31725528 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 28186 28186 0 PART II-B, LINE 1: THE ORGANIZATION PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AS WELL AS THE WEST VIRGINIA HOSPITAL ASSOCIATION (WVHA). A PORTION OF THESE DUES, SPECIFICALLY $28,186, WAS RELATED TO LOBBYING ACTIVITIES OF THE AHA AND WVHA. 5483505 5483505 133568755 54231076 79337679 149307130 102984190 46322940 131144124 SELF-FUNDED INSURANCE RESERVE 7873000 PENSION LIABILITY 852188 BOND INTEREST SWAP LIABILITY 17521892 OTHER 9880639 36127719 X PART X, LINE 2: WVUHS, WVUH, PVH, CCHS, CCMC, CCF, CCPC, UNIVERSITY HEALTHCARE, BMC, JMC, UNIVERSITY HEALTHCARE FOUNDATION, UHC, USC, UHF, UPC, SJH AND SJF ARE TAX-EXEMPT ORGANIZATIONS AND NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ON SUCH BASIS, THEY WILL NOT INCUR ANY LIABILITY FOR INCOME TAXES, EXCEPT FOR POSSIBLE UNRELATED BUSINESS INCOME. AHS AND WVUIS ARE ORGANIZATIONS SUBJECT TO FEDERAL AND/OR STATE INCOME TAXES. THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2015 AND 2014. THE SYSTEM'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. 1 1 X 1 X 1 X 1 1 1 0 0 4082035 4082035 0.01830 49143434 33685181 15458253 0.06940 53225469 33685181 19540288 0.08770 1618758 1618758 0.00730 1213249 14314 1198935 0.00540 2832007 14314 2817693 0.01270 56057476 33699495 22357981 0.10040 1 3575073 1988117 70395896 83550698 -13154802 X 1 1 1 OHIO VALLEY AMBULATORY SURGERY CENTER LLC AMBULATORY SERVICES 0.62500 2 HOUSECALLS HOME HEALTH & HOSPICE LLC HOME HEALTH SERVICES 0.10000 1 1 CAMDEN-CLARK MEMORIAL HOSPITAL 800 GARFIELD AVENUE PARKERSBURG WV 26102 X X X X DISPROPORTIONATE SHARE HOSPITAL CAMDEN-CLARK MEMORIAL HOSPITAL CORP 1 0 0 1 X X X X X X X X 15 1 0 0 1 X HTTP://WVUMEDICINE.ORG/CAMDEN-CLARK/WP-CONTENT/UPLOADS/SITES/6/2016/04/COMM X 1 15 1 HTTP://WWW.CAMDENCLARK.ORG/UPLOADS/PUBLIC/COMMUNITY%20HEALTH%20NEEDS%20ASSE 0 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X X X 1 X HTTP://WVUMEDICINE.ORG/CAMDEN-CLARK/WP-CONTENT/UPLOADS/SITES/6/2016/02/FINA X HTTP://WVUMEDICINE.ORG/CAMDEN-CLARK/WP-CONTENT/UPLOADS/SITES/6/2016/02/FINA X HTTP://WVUMEDICINE.ORG/WP-CONTENT/UPLOADS/2015/11/PLAIN-LANGUAGE-SUMMARY-10 X X X X X 1 0 X X X X 1 X 0 0 CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 5: THE ORGANIZATION COLLECTED A VAST AMOUNT OF DEMOGRAPHIC DATA ON THE COMMUNITY SERVED, MET WITH UNITED WAY AGENCIES AND THE HEALTH DEPARTMENT, AND USED INFORMATION GARNERED FROM STUDIES PERFORMED BY THE SISTERS OF ST. JOSEPH. CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 11: CERTAIN NEEDS IDENTIFIED IN THE ORGANIZATION'S CHNA WERE NOT OR WILL NOT BE ADDRESSED AS IT WAS DETERMINED THAT THESE NEEDS ARE BEING ADDRESSED BY THE OTHER AGENCIES WITHIN THE COMMUNITY AND ANY EFFORT ON BEHALF OF CCMH WOULD BE DUPLICATIVE. CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 15E: A STATE MEDICAID REPRESENTATIVE WAS ON SITE TO HELP DETERMINE ELIGIBILITY AND HELP PATIENTS THROUGH THE ELIGIBILITY PROCESS. CAMDEN-CLARK MEMORIAL HOSPITAL CORP. PART V, SECTION B, LINE 16I: IN ADDITION THE FINANCIAL ASSISTANCE POLICY IS LOCATED ON BILLING STATEMENTS AND IS AVAILABLE THROUGH IN PERSON AND TELEPHONE CONVERSATIONS REGARDING BILL PAYMENT. 3 1 - PATRIOT POINT DIAGNOSTIC 2838 PIKE STREET PARKERSBURG WV 26101 RADIOLOGY/LAB 2 - GARFIELD DIAGNOSTIC 2012 GARFIELD AVE BUILDING 2 SUITE 1 PARKERSBURG WV 26101 RADIOLOGY/LAB 3 - SLEEP LAB 19TH STREET CAMPUS PARKERSBURG WV 26101 DIAGNOSTIC PART I, LINE 7: WORKSHEET 2, "RATIO OF PATIENT CARE, COST TO CHARGES' WAS USED TO COMPLETE THE COST-TO-CHARGE RATIO IN PART I, LINE 7. FOR "OTHER BENEFITS", ACTUAL EXPENSES OF THE ORGANIZATION AT COST WERE USED IN ADDITION TO SOME DONATED ITEMS VALUED AT FAIR MARKET VALUE. PART I, LN 7 COL(F): THE AMOUNT OF TOTAL EXPENSE REPORTED ON FORM 990, PART IX, LINE 25 INCLUDES A BAD DEBT EXPENSE OF $9,940,587 WHICH HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENT OF TOTAL EXPENSE IN COLUMN (F). PART III, LINE 4: PART III, LINE 2:BAD DEBT EXPENSE AT COST IS CALCULATED BY MULTIPLYING THE INTERNAL FINANCIAL STATEMENT AMOUNT OF BAD DEBT EXPENSE ($9,940,587) BY THE COST TO CHARGE RATIO (35.96%) WHICH WAS DETERMINED BY USING IRS WORKSHEET 2 FROM THE SCHEDULE H INSTRUCTIONS. PART III, LINE 3:THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY IS CALCULATED BASED ON THE ESTIMATE OF 20% OF THE BAD DEBT AT COST. THE RATIONALE FOR THIS IS THAT SELF-PAY BALANCES AFTER INSURANCE ARE NOT ACCOUNTS THAT THE ORGANIZATION FOCUSES A LOT OF EFFORT ON. THE ORGANIZATION FOCUSES THEIR EFFORTS ON QUALIFYING PATIENTS FOR CHARITY CARE ON PRIMARY SELF-PAY ACCOUNTS. NOT ALL PATIENTS TAKE THE INITIATIVE TO SEE IF THEY QUALIFY FOR CHARITY CARE.PART III, LINE 4:TO AUDITED FINANCIAL STATEMENTS PAGE 9 PART III, LINE 8: THE ORGANIZATION USED INFORMATION FROM THEIR COST REPORT TO COMPLETE THIS SECTION AS WELL AS THEIR INTERNAL REPORTS.THE ORGANIZATION RAN A REPORT FOR 2015 OF EVERY PATIENT THAT QUALIFIED FOR MEDICARE THAT WOULD ALSO HAVE QUALIFIED MEDICAID IF MEDICARE DID NOT EXIST. THE ORGANIZATION BELIEVES THAT IF A PERSON IS QUALIFIED FOR MEDICAID, THEY WOULD HAVE ALSO QUALIFIED UNDER THE ORGANIZATION'S CHAIRTY CARE GUIDELINES. THE ORGANIZATION FOUND THAT 21.52% OF MEDICARE PATIENTS WERE DUALLY ELIGIBLE FOR MEDICARE/MEDICAID. THEREFORE, 21.52% OF THE SHORTFALL, OR $3,906,161, WOULD QUALIFY AS COMMUNITY BENEFIT. PART III, LINE 9B: IF A PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THEN NO COLLECTION ACTIVITY WILL OCCUR ON THEIR ACCOUNT. THE CHARITY QUALIFICATION IS GOOD FOR SIX-MONTHS, SO ANY SUBSEQUENT VISITS DURING THAT SIX-MONTH PERIOD WOULD ALSO QUALIFY FOR CHARITY CARE AND WOULD NOT BE SUBJECT TO COLLECTION ACTIVITY. PART VI, LINE 2: THE ORGANIZATION IS PART OF THE MID-OHIO VALLEY RURAL HEALTH ALLIANCE. THE ALLIANCE MEMBERS JOINTLY ASSESS THE NEEDS OF THE REGION AND WORK WITH A CONSULTANT TO ENSURE THAT THOSE NEEDS ARE ADDRESSED. THE ORGANIZATION IS IN THE PROCESS OF PREPARING ITS OWN COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 3: THE ORGANIZATION PROVIDES, IN WRITING, ALL OPTIONS FOR POSSIBLE FINANCIAL ASSISTANCE. THIS INFORMATION IS ALSO AVAILABLE ON THE ORGANIZATION'S WEBSITE. THE ORGANIZATION ALSO HAS REPRESENTATIVES THAT ARE AVAILABLE TO DISCUSS OPTIONS WITH INPATIENTS AND OUTPATIENTS ON A DAILY BASIS. STATE MEDICAID WORKERS ARE ONSITE TO HELP DETERMINE PATIENT ELIGIBITY AND TO ASSIST PATIENTS THROUGH THE ELIGIBILITY PROCESS. PART VI, LINE 4: CAMDEN-CLARK MEDICAL CENTER, LOCATED IN PARKERSBURG, WV, SERVICES THE MID-OHIO VALLEY REGION OF WEST VIRGINIA AND OHIO. THE PRIMARY SERVICE AREA CONSISTS OF FOUR COUNTIES WITH AN ESTIMATED TOTAL POPULATION OF 164,000 PEOPLE AND A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $39,000. IT IS AN AGING POPULATION. THERE IS A DECLINING CORPORATE PRESENCE IN THE AREA WHICH HAS NEGATIVELY IMPACTED THE UNEMPLOYMENT RATE. THERE IS ONE OTHER HOSPITAL WITHIN THE PRIMARY SERVICE AREA, LOCATED IN MARIETTA, OH. IN ADDITION, THE COMMUNITY INCLUDES SEVERAL FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS. PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO MANY OF ITS DEPARTMENTS.ANY SURPLUS OF FUNDS IS USED PRIMARILY TO ENHANCE PATIENT CARE. WHILE NO RESEARCH IS DONE AT THE FACILITY, A RESIDENCY PROGRAM WAS STARTED IN 2009. PART VI, LINE 6: CCMH IS A PART OF THE WV UNITED HEALTH SYSTEM (SYSTEM), A NOT-FOR-PROFIT CORPORATION FORMED TO SERVE AS PART OF AN INTEGRATED HEALTH SCIENCE AND HEALTHCARE DELIVERY TEAM. THE SYSTEM SERVES AS THE PARENT CORPORATION TO AN AFFILIATED GROUP OF HEALTHCARE PROVIDING ENTITIES. THE STRATEGIC PLAN OF THE SYSTEM STATES INTENT TO BUILD A REGIONAL HEALTH CARE DELIVERY SYSTEM IN ITS SERVICES AREA, WHILE OFFERING A VARIETY OF OPTIONS FOR PROVIDERS WHO WANT TO PARTICIPATE. THE SYSTEM MAINTAINS A DEMONSTRATED COMMITMENT TO ASSIST RURAL COMMUNITIES IN PRESERVING AND IMPROVING THE HEALTH CARE AVAILABLE TO THE PATIENTS IT SERVES. CCMH PLAYS A SIGNIFICANT ROLE IN IMPROVING THE HEALTH OF THE COMMUNITY. SYSTEM MANAGEMENT IS FOCUSED ON RECRUITMENT OF STAFF AND EMPLOYEES TO MEET THE GROWING NEEDS OF THE AGING POPULATION IN THE SYSTEM'S SERVICES AREAS. OTHER HOSPITALS IN THE SYSTEM INCLUDE WEST VIRGINIA UNIVERSITY HOSPITALS, INC., IN MORGANTOWN, WV, UNITED HOSPITAL CENTER, IN BRIDGEPORT, WV, CITY HOSPITAL, INC., IN MARTINSBURG, WV, JEFFERSON MEMORIAL HOSPITAL, IN RANSON, WV, POTOMAC VALLEY HOSPITAL IN KEYSER, WV, AND ST. JOSEPH'S HOSPITAL OF BUCKHANNON, INC.. ST. JOSEPH'S JOINED THE SYSTEM IN OCTOBER 2015. THE SYSTEM ALSO INCLUDES THE PHYSICIAN PRACTICES OF UNITED PHYSICIANS CARE, INC. AND CAMDEN-CLARK PHYSICIAN CORP THAT OPERATE IN CONJUNCTION WITH THE SYSTEM HOSPITALS. UNITED SUMMIT CENTER IS A BEHAVIORAL HEALTH CENTER LOCATED IN CLARKSBURG, WV. IN ADDITION TO THESE PRACTICES, THE SYSTEM ALSO INCLUDES WVUH-EAST, INC. AND CAMDEN-CLARK HEALTH SERVICES WHICH OPERATE AS MANAGEMENT COMPANIES FOR THEIR RESPECTIVE HOSPITALS. THE SYSTEM ALSO HAS FOUNDATIONS THAT DO VARIOUS FUNDRAISING ACTIVITIES FOR THE HOSPITALS. UNIVERSITY HEALTHCARE FOUNDATION IN MARTINSBURG, WV, UNITED HEALTH FOUNDATION IN CLARKSBURG, CAMDEN-CLARK FOUNDATION IN PARKERSBURG, WV, AND ST. JOSEPH'S FOUNDATION OF BUCKHANNON, INC. IN BUCKHANNON, WV. PART VI, LINE 7, REPORTS FILED WITH STATES WV 1 AMERICAN RED CROSS 250 8TH STREET PARKERSBURG WV 26101 530196605 501(C)(3) 5000 N/A N/A OPERATIONS WOOD COUNTY DEVELOPMENT PO BOX 1683 PARKERSBURG WV 26101 N/A 5500 ANNUAL PLEDGE WVU FOUNDATION PAID TO WVUHS AS AGENT 1000 TECHNOLOGY DRIVE FAIRMONT WV 26554 550175471 501(C)(3) 190118 OPERATIONS THE OHIO UNIVERSITY FOUNDATION PO BOX 869 ATHENS OH 45701 316402269 501(C)(3) 67915 OPERATIONS GOOD SAMARITAN CLINIC INC 418 GRAND PARK DRIVE NO 311 PARKERSBURG WV 26105 550708491 501(C)(3) 15000 OPERATIONS 5 5 PART I, LINE 2: CONTRIBUTIONS ARE DISCRETIONARY AND DECISIONS ON WHICH ORGANIZATIONS CAMDEN-CLARK MEMORIAL HOSPITAL SUPPORTS ARE MADE BY THE CEO IN CONJUNCTION WITH THE DIRECTOR OF MARKETING. TYPICALLY, LOCAL ORGANIZATIONS ARE SUPPORTED THROUGHOUT THE YEAR AND THE DONATIONS ARE TYPICALLY NOT SPECIFICALLY RESTRICTED, SO THERE IS NO FOLLOW UP PROCESS FOR MONITORING THE USE OF THE FUNDS. X 1 1 0 0 0 0 0 0 0 0 0 TODD A KRUGER VICE PRESIDENT 304248 0 79316 0 0 0 0 0 15865 0 399429 0 0 0 DAVID K MCCLURE PRESIDENT/CEO 459792 0 57303 0 0 0 24000 0 12964 0 554059 0 0 0 THOMAS R HELLER VP OF HR 268405 0 51181 0 0 0 42000 0 8655 0 370241 0 0 0 CYNTHIA A KERN VP QUALITY 188296 0 38240 0 0 0 18000 0 12458 0 256994 0 0 0 CAROLYN ALLEN TREASURER 290428 0 0 0 0 0 24000 0 2650 0 317078 0 0 0 JOSHUA R WOODS CHIEF INFORMATION OFFICER 135689 0 0 0 0 0 5450 0 15599 0 156738 0 0 0 GENE A SEXTON PHARMACIST 133055 0 0 0 0 0 18000 0 15559 0 166614 0 0 0 PAMELA K MINCKS PHARMACIST 129582 0 0 0 0 0 18000 0 7680 0 155262 0 0 0 MICHAEL A KING FORMER CEO 22027 0 0 0 272254 0 0 0 6089 0 300370 0 0 0 PART I, LINE 1A MEMBERSHIPS AT THE HEALTH AND WELLNESS CENTER ARE OFFERED TO EACH MEMBER OF THE SENIOR LEADERSHIP TEAM. THESE ARE COVERED IN THE APPLICABLE EMPLOYMENT CONTRACTS. PART I, LINE 3 COMPENSATION IS ESTABLISHED BY WEST VIRGINIA HEALTH SYSTEM (WVUHS) FOR CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION A WV HOSPITAL FINANCE AUTHORITY 621256910 956622VY7 2004-06-30 19350000 2004B SERIES - REFUND PRIOR ISSUANCES & FUND IMPROVEMENTS 0 0 0 B WV HOSPITAL FINANCE AUTHORITY 621256910 956622A87 2009-10-16 24600000 2009 SERIES - REISSUANCE (9/13/2007) 0 0 0 C WV HOSPITAL FINANCE AUTHORITY 621256910 956622D35 2011-03-01 23555712 2011B PURCHASE ASSETS OF ST. JOSEPHS HOSPITAL 0 0 0 D WV HOSPITAL FINANCE AUTHORITY 621256910 956622E26 2012-08-01 50080000 2012B SERIES - REFUND 2011A BOND 0 0 0 A 1300000 19350000 1618092 1167255 95902 11468751 5000000 2008 1 0 1 1 B 3175000 24600000 1643134 979089 21978242 2013 1 0 1 1 C 23555712 435854 14935920 8183938 2012 0 0 1 1 D 50080000 80000 50000000 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 UBS AG 29.600000000000 0 0 1 LEHMAN BROTHERS SPECIAL FINANCING 29.600000000000 1 1 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 1 0 0 1 A 1 B 1 C 1 D 1 SCHEDULE K SUPPLENTAL INFORMATION WEST VIRGINIA UNIVERSITY HOSPITALS, INC. (WVUH), EIN 55-0643304; CITY HOSPITAL, INC. DBA BERKELEY MEDICAL CENTER (BMC), EIN 55-0383321; THE CHARLES TOWN GENERAL HOSPITAL DBA JEFFERSON MEDICAL CENTER (JMC), EIN 55-0359755; UNIVERSITY HEALTHCARE FOUNDATION, INC EIN 31-1118075, AND CAMDEN-CLARK MEMORIAL HOSPITAL, INC. (CCMH), EIN 31-1524546 ARE MEMBERS OF THE WEST VIRGINIA UNITED HEALTH SYSTEM OBLIGATED GROUP AND HAVE ISSUED TAX-EXEMPT BONDS AS THE WEST VIRGINIA UNITED HEALTH SYSTEM OBLIGATED GROUP. THESE BOND ISSUANCES ARE INTERNALLY ALLOCATED WITHIN THE WEST VIRGINIA UNITED HEALTH SYSTEM OBLIGATED GROUP TO THE MEMBER WHO WILL BE USING THE FUNDS. SCHEDULE K, PART 1, 2009 BOND THE TOTAL ISSUE PRICE REPORTED ON LINE 3 FOR THE 2009 BONDS OF $24,600,000 VARIES FROM THE TOTAL OF LINES 4 THROUGH 12 BY $465, IS DUE TO INTEREST INCOME IN THE DEBT RESERVE ACCOUNT. SCHEDULE K, PART 1, 2013A BOND THE TOTAL ISSUE PRICE REPORTED ON LINE 3 VARIES FROM THE TOTAL OF LINES 4 THROUGH 12 BY $931,322, THE DIFFERENCE TO THE 2004 SERIES A BONDS THAT WERE DEFEASED VIA THE 2013 ISSUE. THESE WERE FUNDS SITTING IN DEBT SERVICE, INTEREST, AND PROJECT ACCOUNTS AT THE TIME OF THE 2013 ISSUE AND WERE ROLLED INTO THE 2013A FUNDS. A WV HOSPITAL FINANCE AUTHORITY 621256910 956622E91 2013-10-03 47037860 2013A SERIES - REFUND 2004A BONDS & FINANCE RENOVATIONS 0 0 0 B WV HOSPITAL FINANCE AUTHORITY 621256910 956622VY7 2004-06-30 57900000 2004C SERIES - REFUND PRIOR ISSUANCES & FUND IMPROVEMENTS 0 0 0 A 3730000 47037860 5335549 411600 11946624 12146948 18128462 1 0 0 1 B 57900000 4854274 3343149 286963 32615614 16800000 2008 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 1 B 0 0 1 0 1 1 UBS AG 29.600000000000 0 0 1 LEHMAN BROTHERS SPECIAL FINANCING 29.600000000000 1 1 1 A 1 B 1 PARKERSBURG NEUROLOGICAL ASSOCIATES BUSINESS ENTITY OWNED, IN PART, BY BOARD MEMBER, DR.MICHAEL MOREHEAD 56817 REVENUE RECEIVED FROM PARKERSBURG NEUROLOGICAL ASSOCIATES FOR LEASE OF THE ORGANIZATION'S OFFICE SPACE 0 DR JENNIFER LEAVITT DR. LEAVITT SERVES AS A MEMBER OF THE CCMH BOARD OF DIRECTORS 90384 DR. LEAVITT RECEIVED PAYMENT FOR OVERSEEING THE RESIDENT PROGRAM 0 FORM 990, PART IV, LINE 20B: THE ORGANIZATION MUST ATTACH A COPY OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS. ATTACHED ARE THE CONSOLIDATED FINANCIAL STATEMENTS OF WEST VIRGINIA UNITED HEALTH SYSTEM, INC. (WVUHS) AND CONTROLLED ENTITIES. WVUHS BECAME THE SOLE MEMBER OF CAMDEN CLARK HEALTH SERVICES, INC., THE PARENT CORPORATION OF CAMDEN-CLARK MEMORIAL HOSPITAL ON MARCH 1, 2011. THE FINANCIAL POSITION, RESULTS OF OPERATIONS, AND CASH FLOWS OF CAMDEN-CLARK MEMORIAL HOSPITAL ARE INCLUDED IN THE AFOREMENTIONED CONSOLIDATED AUDITED FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 6 CAMDEN-CLARK HEALTH SERVICES, INC., A NON-PROFIT, TAX-EXEMPT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A CAMDEN-CLARK HEALTH SERVICES INC., THE ORGANIZATION'S SOLE MEMBER, NOMINATES ALL BOARD MEMBERS OF THE ORGANIZATION. BOARD MEMBERS ARE ELECTED BY WEST VIRGINIA HEALTH SYSTEM,(WVUHS) FROM THE CCHS NOMINATIONS. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER OF CAMDEN CLARK HEALTH SERVICES, INC., WVUHS THROUGH ITS AFFILIATION AGREEMENT, HOLDS POWER TO APPROVE CERTAIN DECISIONS SUCH AS: - ANNUAL BUDGET - CAPITAL EXPENDITURES OVER $1 MILLION - NEW DEBT OVER $1 MILLION - NEW PROGRAMS - EXTRAORDINARY FILINGS FORM 990, PART VI, SECTION B, LINE 11 THE CHIEF FINANCIAL OFFICER, DIRECTOR OF FINANCE, AND THE BOARD OF DIRECTORS REVIEW THE COMPLETED FORM PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C TO IDENTIFY AND MONITOR ANY CONFLICTS, A SIGNED CONFLICT OF INTEREST STATEMENT IS REQUIRED FROM BOARD MEMBERS OF THE ORGANIZATION AND KEY INDIVIDUALS THAT ARE IN A POSITION TO MAKE OR INFLUENCE DECISIONS. IF AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST IS OBSERVED OR DISCLOSED, THE ORGANIZATION INVOKES THE PROCEDURES SET OUT IN THE POLICY/BYLAWS FOR ADDRESSING THE CONFLICT OF INTEREST. FOR KEY INDIVIDUALS (EMPLOYEES), A SPECIFIC CONFLICT OF INTEREST STANDARD IN THE ORGANIZATION'S CODE OF ETHICS AND BUSINESS CONDUCT ALSO EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION UTILIZES AN EXECUTIVE COMPENSATION CONSULTANT TO SURVEY DATA AND MAKE RECOMMENDATIONS. THE COMPENSATION OF THE CEO IS DETERMINED BY USING AN INDEPENDENT COMPENSATION CONSULTANT, AS WELL AS A COMPENSATION SURVEY OR STUDY. IT IS SUPPORTED BY A WRITTEN EMPLOYMENT CONTRACT WHICH IS THEN REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE AND THE WVUHS BOARD OF DIRECTORS. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE ON REQUEST AND ARE ALSO AVAILABLE ON THE WEST VIRGINIA HEALTHCARE AUTHORITY WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ANNUAL PENSION LIABILITY VALUATION ADJUSTMENT 1,755,564. TRANSFER TO RELATED ORGANIZATIONS -34,380,454. ANNUAL ADJUSTMENT TO VALUATION OF INTEREST RATE SWAP LIABILITY -204,213. PASS-THROUGH INCOME FROM OVASC & HH 1,103,575. CAMDEN-CLARK HEALTH SERVICES INC 800 GARFIELD AVENUE PARKERSBURG WV 26102 550769602 AIDS, STRENGTHENS, AND SUPPORTS CAMDEN-CLARK MEMORIAL HOSPITAL. WV 501(C)3 LINE 11A, I WEST VIRGINIA UNITED HEALTH SYSTEM 0 CAMDEN-CLARK FOUNDATION 800 GARFIELD AVENUE PARKERSBURG WV 26102 550667789 RAISE AND MANAGE FUNDS FOR CAMDEN-CLARK MEMORIAL HOSPITAL. WV 501(C)3 LINE 11A, I CAMDEN CLARK HEALTH SERVICES 0 AUXILIARY OF CAMDEN-CLARK MEMORIAL HOSPITAL OF PARKERSBURG 800 GARFIELD AVENUE PARKERSBURG WV 26102 550386283 PROMOTES ADVANCEMENT AND WELFARE OF CAMDEN-CLARK MEMORIAL HOSPITAL. WV 501(C)3 LINE 3 N/A 0 CAMDEN-CLARK PHYSICIAN CORPORATION 604 ANN STREET PARKERSBURG WV 26102 264058719 FURNISHES FACILITIES AND SERVICES TO PROVIDE MEDICAL SERVICES. WV 501(C)3 LINE 11A, I CAMDEN CLARK HEALTH SERVICES 0 WEST VIRGINIA UNITED HEALTH SYSTEM 3040 UNIVERSITY AVENUE MORGANTOWN WV 26505 550175471 HEALTHCARE ACCESS WV 501(C)3 LINE 11A, I N/A 0 WEST VRIGINIA UNIVERSITY HOSPITALS INC PO BOX 8034 MORGANTOWN WV 26506 550643304 PATIENT CARE WV 501(C)3 LINE 3 WEST VIRGINIA UNITED HEALTH SYSTEM 0 WEST VIRGINIA UNIVERSITY HOSPITALS EAST 2000 FOUNDATION WAY MARTINSBURG WV 25401 202337985 HEALTHCARE ACCESS WV 501(C)3 LINE 11A, I WEST VIRGINIA UNIVERSITY HOSPITALS INC 0 CITY HOSPITAL INC 2000 FOUNDATION WAY MARTINSBURG WV 25401 550383321 PATIENT CARE WV 501(C)3 LINE 3 WEST VIRGINIA UNIVERSITY HOSPITALS EAST INC 0 JEFFERSON MEMORIAL HOSPITAL 2000 FOUNDATION WAY MARTINSBURG WV 25401 550359755 PATIENT CARE WV 501(C)3 LINE 3 WEST VIRGINIA UNIVERSITY HOSPITALS EAST INC 0 UNIVERSITY HEALTHCARE FOUNDATION 2000 FOUNDATION WAY MARTINSBURG WV 25401 311118075 HOSPITAL SUPPORT WV 501(C)3 LINE 11A, I N/A 0 UNITED HOSPITAL CENTER INC 327 MEDICAL PARK DRIVE BRIDGEPORT WV 26330 550525724 PATIENT CARE WV 501(C)3 LINE 3 WEST VIRGINIA UNITED HEALTH SYSTEM 0 UNITED PHYSICIANS CARE INC 686 SOUTH PIKE STREET SHINNSTON WV 26431 550638563 PATIENT CARE WV 501(C)3 LINE 3 N/A 0 UNITED HOSPITAL FOUNDATION 327 MEDICAL PARK DRIVE BRIDGEPORT WV 26330 550621706 HOSPITAL SUPPORT WV 501(C)3 LINE 11A, I N/A 0 WV HEALTHCARE CO-OP PO BOX 8059 MORGANTOWN WV 26506 550650441 SUPPORT WV 501(C)3 LINE 11A, I WEST VIRGINIA UNITED HEALTH SYSTEM 0 UNITED SUMMIT CENTER 6 HOSPITAL PLAZA CLARKSBURG WV 26301 550752788 BEHAVIORAL HEALTH WV 501(C)3 LINE 3 N/A 0 POTOMAC VALLEY HOSPITAL INC 100 PIN OAK LANE KEYSER WV 26726 550420956 PATIENT CARE WV 501(C)3 LINE 3 WEST VIRGINIA UNIVERSITY HOSPITALS INC 0 OHIO VALLEY AMBULATORY SURGERY CENTER 608 WASHINGTON BLVD BELPRE OH 45714 208671724 OUTPATIENT SURGICAL SERVICES OH CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION RELATED 0 0 0.62500 ALLIED HEALTH SERVICES INC PO BOX 782 MORGANTOWN WV 26507 550652017 MEDICAL LAB WV WV UNITED HEALTH SYSTEM C 0 WEST VIRGINIA UNITED INSURANCE SERVICES 3040 UNIVERSTITY AVENUE SUITE 3200 MORGANTOWN WV 26505 550756055 PROVIDER NETWORK WV WV UNITED HEALTH SYSTEM C 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1