2014-11-14T10:24:27-06:00 2013-12-31 560747981 DIXON HUGHES GOODMAN LLP PO BOX 1747 CHARLESTON WV 25326 990 2013-01-01 264058719 CAMDEN-CLARK PHYSICIAN CORPORATION CAMD 3044242817 800 GARFIELD AVENUE PARKERSBURG WV 26102 CAROLYN ALLEN CFO 3044242202 2014-11-14 1 SUSAN S DULL P00233523 3043430168 2013 2015-11-30 17:44:51Z CAROLYN ALLEN 800 GARFIELD AVENUE PARKERSBURG WV 26102 14467587 0 X WWW.CCMH.ORG X 2008 WV TO SUPPORT, MANAGE, AND FURNISH FACILITIES, PERSONNEL, AND MEDICAL SERVICES TO INDIVIDUALS IN NEED. 5 3 166 5 0 0 0 0 16024609 14463792 0 0 265864 3795 16290473 14467587 0 0 0 0 12390589 14989414 0 0 0 9583019 6945947 21973608 21935361 -5683135 -7467774 2684615 3286194 1616535 9685887 1068080 -6399693 X THE GENERAL PURPOSES OF THE CORPORATION ARE AS FOLLOWS: TO ESTABLISH, SUPPORT, MANAGE, AND FURNISH FACILITIES, PERSONNEL, AND SERVICES TO PROVIDE DIAGNOSTIC, THERAPEUTIC, WELLNESS, HEALTH PROMOTION, SURGICAL, AND OTHER PROFESSIONAL MEDICAL SERVICES TO SICK, INJURED, OR DISABLED PERSONS WITHOUT REGARD TO RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, OR FINANCIAL STATUS, AND TO OTHERWISE PROMOTE THE QUALITY, ACCESSIBILITY, AND AFFORDABILITY OF SUCH PROFESSIONAL MEDICAL SERVICES. 0 0 10013697 6761340 CAMDEN CLARK PHYSICIAN CORPORATION EMPLOYS TWO MEDICAL ONCOLOGISTS AND TWO RADIATION ONCOLOGISTS, AND IN CONJUNCTION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION, THESE PHYSICIANS PROVIDE A WIDE VARIETY OF CANCER TREATMENT OPTIONS AS WELL AS EDUCATION TO RESIDENTS OF THE MID-OHIO VALLEY SERVICE AREA. 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, THESE PHYSICIANS ARE ABLE TO HELP PROVIDE A HOLISTIC HEALING ENVIRONMENT THAT INCLUDES SUPPORT GROUPS FOR PATIENTS AND THEIR FAMILIES. 7362618 4971307 CAMDEN CLARK PHYSICIAN CORPORATION OFFERS SURGICAL SERVICES IN CONJUNCTION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION. THE ORGANIZATION EMPLOYS 6 SURGEONS WHO PROVIDE SURGICAL SERVICES IN A VARIETY OF DISCIPLINES, INCLUDING OPEN HEART, CARDIO-THORACIC, VASCULAR AND GENERAL SURGERY. 4044886 2731144 CAMDEN CLARK PHYSICIAN CORPORATION OFFERS OB/GYN SERVICES THROUGH A TEAM OF EMPLOYED PHYSICIANS AND IN COLLABORATION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION. CAMDEN CLARK PHYSICIAN CORPORATION STRIVES TO OFFER A COMPREHENSIVE RANGE OF INPATIENT, OUTPATIENT AND OUTREACH CLINIC SERVICES, INCLUDING PREVENTION, GUIDANCE, DIAGNOSIS, TREATMENT, RESTORATION, REHABILITATION AND OTHER EFFORTS AS MAY BE REQUIRED TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY IN WHICH IT SERVES. IN ADDITION TO THE CANCER, SURGICAL AND OB/GYN PROGRAMS DESCRIBED ABOVE, THE ORGANIZATION EMPLOYS PHYSICIANS WHO SPECIALIZE IN DIABETES AND NUTRITIONAL MANAGEMENT, BEHAVIORAL HEALTH AND HAS BEGUN TO BUILD A NETWORK OF EMPLOYED PRIMARY CARE PHYSICIANS THROUGHOUT THE COMMUNITY IN AN EFFORT TO ADDRESS WHAT IS BELIEVED TO BE A SIGNIFICANT SHORTAGE OF AVAILABLE PRIMARY CARE FOR THE RESIDENTS OF THE MID-OHIO VALLEY.ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE ORGANIZATION, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR MISSION, IN CONJUNCTION WITH CAMDEN CLARK MEMORIAL HOSPITAL, IS TO SERVE THE COMMUNITY BY PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. IN KEEPING WITH THIS COMMITMENT TO SERVICE ALL MEMBERS OF THE COMMUNITY, THE ORGANIZATION 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 COMMUNITYSERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE ORGANIZATION RECOGNIZES THESE AMOUNTS AS CHARITY CARE. 21421201 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 56 0 1 166 0 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WV X X MARY RUSSELL 3044242817 800 GARFIELD AVENUE PARKERSBURG WV 26102 X KATHY G EDDY CHAIRMAN 1.00 X X 0 0 0 TERRY CAPEL MD VICE CHAIRMAN 1.00 X X 0 0 0 DR DANIEL MCGRAW BOARD MEMBER - SEE SCH. O 40.00 X 844073 0 35309 JOE CAMPBELL BOARD MEMBER 1.00 X 0 0 0 MICHAEL KING EX OFFICIO 5.00 40.00 X 0 648718 -19528 ALLEN BUTCHER TREASURER 5.00 40.00 X 0 393082 13889 HECTOR HAMILTON EXEC DIRECTOR/SECRETARY 40.00 X 121042 0 3600 DR LISA CASALENUOVO PHYSICIAN 40.00 X 498141 0 21461 DR MICHAEL GALLOWAY PHYSICIAN 40.00 X 583296 0 5860 DR GABOR ALTDORFER PHYSICIAN 40.00 X 631122 0 16271 DR JOSE CRUZZAVALA PHYSICIAN 40.00 X 653372 0 11614 DR NIK SHAH PHYSICIAN 40.00 X 999890 0 13294 DR SIVAMURTHY KYATHARI PHYSICIAN 40.00 X 496310 0 13521 4827246 1041800 115291 35 0 1 0 MFC CORPORATION PO BOX 779 PARKERSBURG WV 26101 BILLING & COLLECTIONS 581166 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 STAFFING SERVICES 399083 MEDPOWER STAFFING 22422 DOLOMITE HILLS DRIVE ASHBURN VA 20148 STAFFING SERVICES 152056 COMPHEALTH ASSOCIATES INC PO BOX 972651 DALLAS TX 75397 STAFFING SERVICES 141903 JACKSON & COKER LOCUM TENENS PO BOX 277638 ATLANTA GA 30384 STAFFING SERVICES 123691 5 NET PATIENT REVENUE 621110 14463792 14463792 14463792 OTHER REVENUE 621110 3795 3795 3795 14467587 14467587 0 0 4948175 4885854 62321 8366950 8107575 259375 179532 173967 5565 874984 847860 27124 619773 600560 19213 38983 38983 1414174 1370335 43839 12651 12651 115821 112231 3590 9160 8876 284 52003 50391 1612 76818 74437 2381 214644 207990 6654 706069 684181 21888 MEDICAL SUPPLIES 2490763 2490763 PROVISION FOR BAD DEBTS 1126827 1126827 RENT/LEASE EQUIPMENT 518639 502560 16079 RECRUITMENT AND RETENTI 67246 65161 2085 102149 98982 3167 21935361 21421201 514160 0 1 -1 188413 483716 1535682 1973540 13317 0 7574 256341 1375741 810717 661689 565024 285513 0 2684615 3286194 1616535 2401532 0 7284355 1616535 9685887 X 1068080 -6399693 1068080 -6399693 2684615 3286194 -7467774 0 X 0 1 X 1 0 X SCHEDULE A, PART I, LINE 3 ALTHOUGH THE ORGANIZATION QUALIFIES AS A HOSPITAL UNDER IRC SECTION 170(B)(1)(A)(III) AS SHOWN ON SCHEDULE A, PART I, LINE III, THE ORGANIZATION IS NOT A LICENSED HOSPITAL IN THE STATE OF WEST VIRGINIA, AND THEREFORE, IT IS NOT REQUIRED TO COMPLETE FORM 990, SCHEDULE H. 1375741 810717 565024 565024 DUE TO RELATED ORGANIZATIONS 7284355 7284355 X PART X, LINE 2: WEST VIRGINIA UNITED HEALTH 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 2012 AND 2011. X 0 0 X 0 0 0 1 0 0 0 0 0 DR DANIEL MCGRAW BOARD MEMBER - SEE SCH. O 804573 0 0 0 39500 0 27165 0 8144 0 879382 0 0 0 MICHAEL KING EX OFFICIO 0 515964 0 92734 0 40020 0 -24414 0 4886 0 629190 0 0 ALLEN BUTCHER TREASURER 0 300224 0 57991 0 34867 0 9395 0 4494 0 406971 0 0 DR LISA CASALENUOVO PHYSICIAN 480641 0 0 0 17500 0 8506 0 12955 0 519602 0 0 0 DR MICHAEL GALLOWAY PHYSICIAN 560315 0 0 0 22981 0 216 0 5644 0 589156 0 0 0 DR GABOR ALTDORFER PHYSICIAN 608122 0 0 0 23000 0 8316 0 7955 0 647393 0 0 0 DR JOSE CRUZZAVALA PHYSICIAN 630372 0 0 0 23000 0 7650 0 3964 0 664986 0 0 0 DR NIK SHAH PHYSICIAN 976890 0 0 0 23000 0 7650 0 5644 0 1013184 0 0 0 DR SIVAMURTHY KYATHARI PHYSICIAN 479160 0 0 0 17150 0 7877 0 5644 0 509831 0 0 0 PART I, LINE 1A MEMBERSHIPS AT THE FAMILY FITNESS CENTER ARE OFFERED TO EACH MEMBER OF THE SENIOR LEADERSHIP TEAM. THESE DUES ARE COVERED IN THE APPLICABLE EMPLOYMENT CONTRACTS. PART I, LINE 5 EACH PHYSICIAN HAS A PRODUCTIVITY BONUS IN THEIR CONTRACT. THIS BONUS IS BASED ON PRODUCING OVER A SET RELATIVE VALUE UNIT (RVU) DURING THE YEAR. THERE IS ALSO A COMPONENT FOR EACH PHYSICIAN BASED ON COLLECTIONS. AS AN EXAMPLE, IF THE PHYSICIAN PRODUCES IN EXCESS OF THEIR ESTABLISHED RVU NUMBER AT THE 90TH PRECENTILE, BUT COLLECTS AT THE 75TH PERCENTILE, THE BONUS IS THEN BASED ON THE 75TH PERCENTILE. FORM 990, PART VI, SECTION A, LINE 1 DR. MCGRAW AND MICHAEL KING ARE NOT INDEPENDENT. DR. MCGRAW WAS COMPENSATED BY CCPC AND MICHAEL KING WAS COMPENSATED AS CEO BY THE RELATED ORGANIZATION CAMDEN CLARK MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 CAMDEN-CLARK HEALTH SERVICES, INC. (AS OF MARCH 1, 2011, AFFILIATED WITH WEST VIRGINIA UNITED HEALTH SYSTEM), 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, ELECTS NO LESS THAN FIVE BUT NO MORE THAN NINE INDIVIDUALS OF THE BOARD AT THE ANNUAL MEETING. THE TERM FOR EACH DIRECTOR IS THREE YEARS. FORM 990, PART VI, SECTION A, LINE 7B CAMDEN-CLARK HEALTH SERVICES, INC., THE ORGANIZATION'S SOLE MEMBER, SHALL APPROVE ALL MATTERS REGARDING CAMDEN-CLARK PHYSICIAN CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE CHIEF FINANCIAL OFFICER AND DIRECTOR OF FINANCE REVIEW THE COMPLETED FORM PRIOR TO FILING. AFTER THE RETURN IS FILED, A COPY IS SENT TO THE BOARD OF DIRECTORS FOR THEIR REVIEW. 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 EXECUTIVE DIRECTOR'S PAY IS REVIEWED AND APPROVED BY THE CAMDEN-CLARK MEMORIAL HOSPITAL (CCMH) BOARD OF DIRECTORS. A COMPENSATION COMMITTEE CONSISTING OF ALL NON-PHYSICIAN MEMBERS OF THE CCMH BOARD REVIEWS AND APPROVES PAY FOR THE PHYSICIANS. THEIR CONTRACTS ARE BASED ON MEDICAL GROUP MANAGEMENT ASSOCIATION STANDARDS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON THE WV HEALTHCARE AUTHORITY'S WEBSITE. FORM 990, PART VII, COLUMN F BOARD MEMBER 5) MICHAEL A. KING REPORTS A NEGATIVE AMOUNT FOR RELATED ORGANIZATION DEFERRED COMPENSATION. THIS AMOUNT REPRESENTS A DECREASE IN ACTUARIAL VALUE OF A DEFINED BENEFIT PLAN AND IS NETTED WITH THE AMOUNT OF COMPENSATION REPORTED FOR 403(B) PLANS. THE INDIVIDUAL AMOUNTS ARE AS FOLLOWS: 6) MICHAEL A. KING: 403(B) PLAN COMPENSATION: $7,650 DECREASE IN ACTUARIAL VALUE OF DEFINED BENEFIT PLAN: $-32,064 FORM 990, PART VII, SECTION A DR. DANIEL MCGRAW IS COMPENSATED FOR HIS POSITION AS A PHYSICIAN WITH THE ORGANIZATION, NOT FOR SERVING ON THE BOARD OF DIRECTORS. 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 1 CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION 800 GARFIELD AVENUE PARKERSBURG WV 26102 311524546 OPERATES AN ACUTE CARE AND EMERGENCY HOSPITAL FACILITY. WV 501(C)(3) LINE 3 N/A 0 AUXILIARY OF CAMDEN-CLARK MEMORIAL HOSPITAL OF PARKERSBURG 800 GARFIELD AVENUE PARKERSBURG WV 26102 550386283 PROMOTES ADVANCEMENT AND WELFARE OF CAMDEN-CLARK MEMORIAL HOSPITAL. WV 501(C)(3) LINE 11A, I N/A 0 CAMDEN-CLARK FOUNDATION INC 800 GARFIELD AVENUE PARKERSBURG WV 26102 550667789 RAISE AND MANAGE FUNDS FOR CAMDEN-CLARK MEMORIAL HOSPITAL. WV 501(C)(3) LINE 11A, I N/A 0 WV UNITED HEALTH SYSTEM 1000 TECHNOLOGY DRIVE FAIRMONT WV 26554 550175471 HEALTHCARE ACCESS WV 501(C)(3) LINE 11A, I N/A 0 WEST VIRGINIA UNIVERSITY HOSPITALS INC PO BOX 8034 MORGANTOWN WV 26506 550643304 PATIENT CARE WV 501(C)(3) LINE 3 WEST VIRGINIA UNITED HEALTH SYSTEM 1 WEST VIRGINIA UNIVERSITY HOSPITALS EAST 2000 FOUNDATION WAY MARTINSBURG WV 25401 202337985 HEALTHCARE ACCESS WV 501(C)(3) LINE 11A, I WEST VIRGINIA UNITED HEALTH SYSTEM 1 CITY HOSPITAL INC 2000 FOUNDATION WAY MARTINSBURG WV 25401 550383321 PATIENT CARE WV 501(C)(3) LINE 3 N/A 0 JEFFERSON MEMORIAL HOSPITAL 2000 FOUNDATION WAY MARTINSBURG WV 25401 550359755 PATIENT CARE WV 501(C)(3) LINE 3 N/A 0 CITY HOSPITAL FOUNDATION 2000 FOUNDATION WAY MARTINSBURG WV 25401 311118075 HOSPITAL SUPPORT WV 501(C)(3) LINE 11A, I N/A 0 JEFFERSON HEALTHCARE FOUNDATION 2000 FOUNDATION WAY MARTINSBURG WV 25401 550768901 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 1 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 WVU HEALTHCARE CO-OP PO BOX 8059 MORGANTOWN WV 26506 550650441 SUPPORT WV 501(C)(3) LINE 11A, I WEST VIRGINIA UNITED HEALTH SYSTEM 1 UNITED SUMMIT CENTER 6 HOSPITAL PLAZA CLARKSBURG WV 26301 550752788 BEHAVIORAL HEALTH WV 501(C)(3) LINE 3 N/A 0 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 1000 TECHNOLOGY DRIVE SUITE 2320 FAIRMONT WV 26554 550756055 PROVIDER NETWORK WV WV UNITED HEALTH SYSTEM C 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 1 SCHEDULE R LINE 1R CAMDEN CLARK MEMORIAL HOSPITAL (CCMH) PAYS CERTAIN BENEFITS/EXPENSES ON BEHALF OF CCPC. AN INTERCOMPANY CHARGE IS MADE TO RECORD THESE EXPENSES ON CCPC'S BOOKS, BUT NOT REIMBURSEMENT IS MADE TO CCMH. CCMH ALSO TRANSFERS CRASH ON A MONTHLY BASIS, AS NEEDED, TO ASSIST CCPC IN ITS CASH FLOW NEEDS. SCHEDULE R LINE 1J CCPC IS THE CONTROLLED ORGANIZATION. IT RENTS SPACE FROM CAMDEN CLARK MEMORIAL HOSPITAL, UTILIZES HOSPITAL EQUIPMENT, AND IS SUPPORTED BY THE HOSPITAL FROM A CASH FLOW STANDPOINT, AS NEEDED, TO MEET MONTHLY OBLIGATIONS SUCH AS PAYROLL AND ACCOUNTS PAYABLE.