CITY HOSPITAL INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CITY HOSPITAL INC (EIN 55-0383321)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-13
IRS object ID
201313179349300636
Schema version
2012v2.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-13T08:58:53-00:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN550383321EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1City Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCITYNameControl
Phone3042641000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 Foundation Way Room 2310AddressLine1
CityMartinsburgCity
StateWVState
ZIP Code25401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameChristopher KnightName
TitleVP of FinanceTitle
Phone3042641358Phone
Date Signed2013-10-23DateSigned
Authorize Third PartyfalseAuthorizeThirdParty
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonChristopher KnightNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12000 Foundation Way Suite 2310AddressLine1
CityMartinsburgCity
StateWVState
ZIP Code25401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts157899244GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.wvuh-east.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1940YearFormation
State Legal DomicileWVStateLegalDomicile
Activity Or Mission DescriptionCity Hospital is a non profit acute care hospital providing high-quality health wellness services to the residents of the Eastern Panhandle of WV, expanding access to care and participating in the education of healthcare professionals.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees1461TotalNbrEmployees
Total Nbr Volunteers89TotalNbrVolunteers
Total Gross UBI338850TotalGrossUBI
Net Unrelated Business Txbl Income-4624NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year159278ContributionsGrantsPriorYear
Contributions Grants Current Year263337ContributionsGrantsCurrentYear
Program Service Revenue Prior Year140692833ProgramServiceRevenuePriorYear
Program Service Revenue CY154650250ProgramServiceRevenueCY
Investment Income Prior Year681952InvestmentIncomePriorYear
Investment Income Current Year115821InvestmentIncomeCurrentYear
Other Revenue Prior Year1805675OtherRevenuePriorYear
Other Revenue Current Year1950995OtherRevenueCurrentYear
Total Revenue Prior Year143339738TotalRevenuePriorYear
Total Revenue Current Year156980403TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year314403GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY27430GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year61573352SalariesEtcPriorYear
Salaries Etc Current Year66385514SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year76084231OtherExpensePriorYear
Other Expenses Current Year84949061OtherExpensesCurrentYear
Total Expenses Prior Year137971986TotalExpensesPriorYear
Total Expenses Current Year151362005TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5367752RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5618398RevenuesLessExpensesCY
Total Assets BOY107836793TotalAssetsBOY
Total Assets EOY109049527TotalAssetsEOY
Total Liabilities BOY80196400TotalLiabilitiesBOY
Total Liabilities EOY80982615TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY27640393NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY28066912NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCity Hospital is a non-profit acute care hospital located in the Eastern Panhandle of WV. The mission of City Hospital is to provide high quality, cost effective health and wellness services to the community. CHI provides these to patients in need without consideration of their ability to pay.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense42813604Expense
Revenue93410142Revenue
DescriptionCity Hospital provides general medical services to the residents in the Eastern Panhandle region of WV. Such services include family medicine, internal medicine, observation, a fully accredited cancer center, and outpatient ancillary testing. During 2012, City Hospital documented 136,533 ancillary tests, and 2,688 observation visits.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense4999705Expense
Revenue10908289Revenue
DescriptionThe General Surgery department at City Hospital is staffed by specialists and general surgeons offering the latest in surgical techniques including laproscopic procedures, lithotripsy, and same day/ambulatory surgery. Same day surgery visits for 2012 totaled 6,176.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense2839038Expense
Revenue6194175Revenue
DescriptionIn September 2009 City Hospital Inc opened a new 18-bed Orthopedic Unit. The unit is tailored toward personal care, patient comfort and privacy. The unit features a dedicated orthopedic nursing staff supported by staff from rehabilitation, care management, nutrition, and respiratory therapy. The team specializes in the care of patients following orthopedic surgery including total joints, fractures and knee and hip replacements. Orthopedic patient days in 2012 totaled 3,536, and 350 observation days.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp63246290TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt27430TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev45834803TotalOfOtherProgramServiceRev
Total Program Service Expense113898637TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096149NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees1461NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonChristopher KnightNamePerson
Telephone Number3042641358TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12000 Foundation Way Suite 2310AddressLine1
CityMartinsburgCity
StateWVState
ZIP Code25401ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Richard Pill
Chairman000.02000.73XX000
Walter Washington
Vice-Chairman000.02000.73XX000
Robert Baronner Jr
Treasurer000.02000.73XX000
Betty Gunnoe
Secretary000.02000.73XX000
Keith Berkeley DVM
Director000.02000.73X000
Fred Butcher PhD
Director000.02000.73X000
Jackee Long
Director000.02000.73X000
Suzanne Shipley
Director000.02000.73X000
David Baltierra MD
JMH Med Staff President000.02000.73X000
D Scott Roach
Director000.02000.73X000
Rhonda Monroe
Director000.02000.73X000
John A Draper Jr MD
CHI Med Staff President000.02000.73X000
Konrad C Nau MD
Director000.02000.73X000
Nicholas Trietsch
Director000.02000.73X000
Dr Richard Knapp
Director000.02000.73X000
Anthony Zelenka
Cheif Administrative Officer050.00X302245032238
Robert Strauch
VP Med Affairs040.00X13460301072
Donna Clews
VP of Nursing040.00X17962308062
Linda Campbell Jones
Chief CRNA040.00224684018007X
Jason T White
Assistant Chief CRNA040.00212443032238X
Robert C Johnson Jr
CRNA040.00209590033738X
Robert Brucker
CRNA040.0020773308932X
Donna Hupp Baker
CRNA040.00210736011382X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1681657TotalReportableCompFromOrg
Total Other Compensation145669TotalOtherCompensation
Number Individuals GT100 K35NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Quest Diagnostics
14225 Newbrook DrChantillyVA20151Lab Services647607
Focusone Solutions LLC
13609 California St 500OmahaNE681545233Contract Labor603852
C&A Industries Inc
13609 California StOmahaNE68154Contract Labor690251
Salutus Emer Specialists
PO Box 1150MartinsburgWV25402Contract Labor690170
Hospitalist Medicine Physicians of Berkeley County PLLC
PO Box 645037CincinnatoOH45264Contracted Hospitalists854275
FieldValueIRS element (for citing)
Number Of Contractors GT100 K24NumberOfContractorsGT100K
Related Organizations260837RelatedOrganizations
Government Grants2500GovernmentGrants
Total Contributions263337TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Services153095444153095444
Wellness Center730697730697
Patient Pharmacy824109824109
FieldValueIRS element (for citing)
Total Program Service Revenue154650250TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1034662TotalRevenueColumn
Exclusion$1,034,662ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real49873Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real49873Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column49873TotalRevenueColumn
Exclusion$49,873ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other918841Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-918841Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-918841TotalRevenueColumn
Exclusion-$918,841ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Partnership Passthrough Income338850338850
Cafeteria Income398261$398,261
Cash Discounts501514$501,514

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column662497TotalRevenueColumn
Related Or Exempt Function Income662497RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1901122TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column156980403TotalRevenueColumn
Related Or Exempt Function Income155312747RelatedOrExemptFunctionIncome
Unrelated Business Revenue338850UnrelatedBusinessRevenue
Exclusion$1,065,469ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total27430Total
Program Services27430ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total657843Total
Management And General657843ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total52338113Total
Program Services42901518ProgramServices
Management And General9436595ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1643786Total
Program Services1347410ProgramServices
Management And General296376ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7039864Total
Program Services5804485ProgramServices
Management And General1235379ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4705908Total
Program Services3857430ProgramServices
Management And General848478ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total183895Total
Program Services22942ProgramServices
Management And General160953ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total55688Total
Management And General55688ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total14888Total
Management And General14888ManagementAndGeneral
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total17633039Total
Program Services11776428ProgramServices
Management And General5856611ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total563168Total
Program Services4569ProgramServices
Management And General558599ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total28063426Total
Program Services25264328ProgramServices
Management And General2799098ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total139402Total
Program Services19453ProgramServices
Management And General119949ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2184367Total
Program Services479956ProgramServices
Management And General1704411ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total360516Total
Program Services201752ProgramServices
Management And General158764ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total2798234Total
Management And General2798234ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7759217Total
Management And General7759217ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1373334Total
Management And General1373334ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Provision for Doubtful Accounts1745013617450136
Association Dues1468036226484539
Recruitment Expense36415827665387505
Taxes, Licenses, Fees569518343135451381638

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total163607Total
Program Services88338ProgramServices
Management And General75269ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total151362005Total
Program Services113898637ProgramServices
Management And General37463368ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY284197BOY
EOY399725EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY29696025BOY
EOY23778310EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY14632710BOY
EOY20198112EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY655276BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1954541BOY
EOY1687063EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY354034BOY
EOY844859EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis116904983LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec61941106LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY51254607BOY
EOY54963877EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY76010BOY
EOY41391EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2663680BOY
EOY2350331EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY6265713BOY
EOY4785859EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY107836793BOY
EOY109049527EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY12206103BOY
EOY12156564EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY53299806BOY
EOY52295376EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY14690491BOY
EOY16530675EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY80196400BOY
EOY80982615EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY27326335BOY
EOY27591975EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY312058BOY
EOY472937EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2000BOY
EOY2000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY27640393BOY
EOY28066912EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY107836793BOY
EOY109049527EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses5618398ReconcilationRevenueExpenses
Reconciliation Unrealized Invest512641ReconciliationUnrealizedInvest
Reconcilation Other Changes-5704520ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Pertcentage1700.00000PublicSupportPertcentage170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

Total Direct Lobbying TotalDirectLobbying

FieldValueIRS element (for citing)
Filing Organizations Totals14888FilingOrganizationsTotals

Total Lobbying Expenditures TotalLobbyingExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals14888FilingOrganizationsTotals

Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals113898637FilingOrganizationsTotals

Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals113913525FilingOrganizationsTotals

Lobbying Nontaxable LobbyingNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals1000000FilingOrganizationsTotals

Grassroots Nontaxable GrassrootsNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals250000FilingOrganizationsTotals

Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus31000000CurrentYearMinus3
Current Year Minus21000000CurrentYearMinus2
Current Year Minus11000000CurrentYearMinus1
Current Year1000000CurrentYear
Total4000000Total
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmount

Total Lobbying Expenditures2 TotalLobbyingExpenditures2

FieldValueIRS element (for citing)
Current Year Minus312507CurrentYearMinus3
Current Year Minus212820CurrentYearMinus2
Current Year Minus113274CurrentYearMinus1
Current Year14888CurrentYear
Total53489Total

Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus3250000CurrentYearMinus3
Current Year Minus2250000CurrentYearMinus2
Current Year Minus1250000CurrentYearMinus1
Current Year250000CurrentYear
Total1000000Total
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmount

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierII-AIdentifier
Return Reference1bReturnReference
ExplanationThe amount listed is made up of the amount of West Virginia Hospital Association and American Hospital Association dues that the associations determined as attributable to lobbying expense.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis106462OtherCostOrOtherBasis
Book Value106462BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis50000910OtherCostOrOtherBasis
Depreciation16944864Depreciation
Book Value33056046BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis61234083OtherCostOrOtherBasis
Depreciation40297645Depreciation
Book Value20936438BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5563528OtherCostOrOtherBasis
Depreciation4698597Depreciation
Book Value864931BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings54963877TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescription
Financial derivatives and other financial products
Closely-held equity interests

Other Liabilities OtherLiabilities (8 entries)

DescriptionDescriptionAmountAmount
Federal income taxes
Accrued wages, benefits and payroll taxes$6,109,124
Malpractice Liability$585,160
Accrued pension benefits$1,531,529
Accrued bond interest$74,209
Due to third Party Payors$1,819,000
Interest Rate Swaps$2,890,813
Self Insurance Liability$3,520,840
FieldValueIRS element (for citing)
Total Of Amounts16530675TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt139731699TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments457333NetUnrealizedGainsInvestments
Other Revenues-17450136OtherRevenues
Revenue Not Rptd F990-16992803RevenueNotRptdF990
Revenue Subtotal156724502RevenueSubtotal
Other Revenues Not Included255901OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt255901RevenueNotRptdOnFinStmt
Total Revenue Per Form990156980403TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt133864339TotExpensesEtcAuditedFinclStmt
Other Expenses Included-47530OtherExpensesIncluded
Expenses Not Rptd F990-47530ExpensesNotRptdF990
Expenses Subtotal133911869ExpensesSubtotal
Other Expenses Not Included17450136OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt17450136ExpensesNotRptdOnFinStmt
Total Expenses Per Form990151362005TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
X2The annual audit and financial statements of City Hospital are prepared on a consolidated basis as a member of the WV United Health System. 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. There were no tax uncertainties that met the recognition threshold in 2012.
XI2dAllowance for Doubtful Accounts presented as an offset to revenue on the audited financial statements. For 990 purposes Allowances for Doubtful Accounts totaling 17,450,136 are presented as expense.
XI4bCapital Campaign contributions of 255,900 from City Hospital Foundation were posted to the balance sheet of City Hospital financial statements, the amount was reported as contribution revenue for 990 reporting, round of 1 is also included.
XII2dUnrealized Losses on Debt Instruments of 47,530 are included on the Financial Statements as expense are not included as expense on the 990.
XII4bAllowance for Doubtful Accounts presented as an offset to revenue on the audited financial statements, for 990 purposes Allowances for Doubtful Accounts totaling 17,450,136 are presented as expense.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3623251TotalCommunityBenefitExpense
Net Community Benefit Expense3623251NetCommunityBenefitExpense
Percent Of Total Expense0.02710PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense28800054TotalCommunityBenefitExpense
Direct Offsetting Revenue20784726DirectOffsettingRevenue
Net Community Benefit Expense8015328NetCommunityBenefitExpense
Percent Of Total Expense0.05990PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense513885TotalCommunityBenefitExpense
Direct Offsetting Revenue472557DirectOffsettingRevenue
Net Community Benefit Expense41328NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense32937190TotalCommunityBenefitExpense
Direct Offsetting Revenue21257283DirectOffsettingRevenue
Net Community Benefit Expense11679907NetCommunityBenefitExpense
Percent Of Total Expense0.08730PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense71626TotalCommunityBenefitExpense
Direct Offsetting Revenue21940DirectOffsettingRevenue
Net Community Benefit Expense49686NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense487608TotalCommunityBenefitExpense
Direct Offsetting Revenue77406DirectOffsettingRevenue
Net Community Benefit Expense410202NetCommunityBenefitExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense6610TotalCommunityBenefitExpense
Net Community Benefit Expense6610NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense565844TotalCommunityBenefitExpense
Direct Offsetting Revenue99346DirectOffsettingRevenue
Net Community Benefit Expense466498NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense33503034TotalCommunityBenefitExpense
Direct Offsetting Revenue21356629DirectOffsettingRevenue
Net Community Benefit Expense12146405NetCommunityBenefitExpense
Percent Of Total Expense0.09080PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Total Community Building Expense8815TotalCommunityBuildingExpense
Net Community Building Expense8815NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense2546TotalCommunityBuildingExpense
Net Community Building Expense2546NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense20104TotalCommunityBuildingExpense
Net Community Building Expense20104NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense761TotalCommunityBuildingExpense
Net Community Building Expense761NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense2368TotalCommunityBuildingExpense
Net Community Building Expense2368NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense34594TotalCommunityBuildingExpense
Net Community Building Expense34594NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$7,744,370BadDebtExpenseAmount
Amount Attributable To370716AmountAttributableTo
Amount Reimbursed By Medicare48800869AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare56205793CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-7404924MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1City Hospital IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12000 Foundation Way Suite 2310AddressLine1
CityMartinsburgCity
StateWVState
ZIP Code25401ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.universityhealthcare.comWebsiteAddress
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours
Facility Reporting GroupAFacilityReportingGroup

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent0000000002.000000000000FPGFreePercent
Uses FPG DiscountedfalseUsesFPGDiscounted
Explains BasistrueExplainsBasis
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection ActivitiestrueCollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (33 entries)

IdentifierIdentifierExplanationExplanation
Part I Line 3cCity Hospital Inc. CHI uses 200 Federal Poverty Guideline to determine free care eligibility. CHI offers a Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discounted the patient/guarantor must meet certain requirements.
Part I Line 6aCommunity benefit amounts for City Hospital, Inc are reported on WV United Health Systems website www.wvunitedhealthsystem.org under community responsibility report.
Part I Line 7Column f - Total community benefit expense for 2012 is 33,503,034 and is 25.02 of total net expenses. To calculate net expense, bad debt of 17,450,136 was deducted from total expenses of 151,362,005 as shown in Part IX line 25 of the core Form 990.
Part I Line 7Worksheet 2 from the IRS Schedule H instructions was used to derive the Cost-to-charge ratio, which was used to calculate Charity Care at cost, Unreimbursed Medicaid and other means-tested government programs at cost. To calculate the Medicare allowable cost shown on Part III question 8 we used the allowable cost from the Medicare Cost Report.
Part IIPhysical improvements and housing - City Hospital employees spent a weekday volunteering at two local social service agencies on behalf of the United Way of the Eastern Panhandle. City Hospital also provided the kick-off breakfast for all 500 volunteers throughout the Eastern Panhandle.
Part IIEconomic Development - In 2012,hospital representatives participated as members of the Berkeley County Development Authority and Board Members of the Martinsburg Berkeley County Chamber of Commerce.
Part IICommunity Support - City Hospital supports and participates in many health related community activities by providing judges for science fairs at the local schools. We have teams that participate in the annual March of Dimes Walk, American Cancer Society Relay for Life in Berkeley County and various other fundraising events for local, health related, non-profit organizations. Many employees serve as volunteer board of directors for community non-profit organizations such as Hospice of the Panhandle, Boys Girls Club of the Eastern Panhandle, Eastern Panhandle Free Clinic and the United Way of the Eastern Panhandle.
Part IILeadership Development and Training - At least one management representative from City Hospital participates in the Chamber of Commerces Leadership Berkeley class each year.
Part IICoalition building - CHI staff participate in the Health Human Services Council as well as Healthier Berkeley County. All of these entities focus on improving community access to health care, human services in general, and determine ways to encourage healthy lifestyles.
Part IICommunity Health Improvement Advocacy - CHI is a partner in the MAPP project which is a collaborative initiative to assess community social service needs and develop a plan to tackle these issues. In 2012, City Hospital completed its community health needs assessment and is in the process of developing implementation plans to address four key issues chronic disease, breast and lung cancers, behavioral health and prenatal and perinatal care.
Part IIWorkforce Development - CHI participates in activities sponsored by the Martinsburg Berkeley County Chambers Workforce Development Committee. CHI is a major sponsor of the Womens Network, an organization, established by the Berkeley County Chamber, which sponsors womens professional activities, social networking and professional development seminars. A representative from CHI also serves on the Blue Ridge Community Technical College Board of Governors.
Part IICHI also has agreements with area community colleges and universities to allow students to complete clinical rotations at the hospital.
Part III Line 4City Hospitals footnote for Accounts Receivable - patients states accounts receivable are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon managements assessment of individual accounts. The allowance for doubtful accounts is estimated based upon a periodic review of the accounts receivable aging, payor classifications, and application of historical write-off percentages. City Hospital grants credit without collateral to its patients, most of whom are local residents and are insured under third-party payor agreements, primarily with Medicare, Medicaid, and various commercial insurance companies. CHI maintains allowances for potential credit losses and such losses have historically been within managements expectations.
Part III Line 8Part III Line 6 was calculated using total cost from the Medicare Cost Report less Medicare reimbursement of direct GME. City Hospitals shortfall of 7,404,924 on Medicare program should be considered a community benefit because we are relieving a government burden by providing care in excess of our cost to these patients.
Part III Line 9bCHI does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity, the patient will not be sent to bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy.
Part VLine 11 - City Hospital offers discounted care only to individuals who qualify for free care. CHI offers a Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discounted the patient/guarantor must meet certain requirements.
Part VLine 22 - City Hospital charges all patients an amount equal to gross charges regardless of payment method.
Part VI Line 2City Hospital Inc is a part of WVUH-East, Inc. a healthcare system serving the Eastern Panhandle of WV. The West Virginia University Hospitals, East WVUH-East Marketing Department considers several components in assessing how the organization determines the need of the communities it serves. Through outside consultants to collaborating with various departments, a needs assessment takes into account several factors including physician to population ratios, physician availability in the entire service area, and general health risks for our community.
Part VI Line 2The Primary Service Area PSA for CHI includes Berkeley and Jefferson Counties in WV with Morgan County, WV being a secondary service area. This data is then analyzed to provide general estimates to guide CHI and WVUH-East to where they could better care for residents of West Virginias Eastern Panhandle.
Part VI Line 2Sources utilized to help gather this information come from a variety of areas. Physician distribution and population data come from the American Medical Association and the U.S. Census Bureau and the general health risk for our community comes from clinical diagnosis information gathered by the West Virginia Health Care Authority and Thomson Reuters Market Planner Plus.
Part VI Line 2We also conduct market research to ask consumers how they perceive the health system and where they go for health care services. Once all the data is gathered to determine where residents of West Virginia are going for care and what types of services they are receiving, a needs assessment can then begin based on physician distribution and population estimates.
Part VI Line 2WVUH-East is working with other local organizations in a project known as MAPP Mobilizing for Action through Planning and Partnerships to create and implement a community health improvement plan. Recommendations and an Implementation Plan were presented in July 2013, outlining the process and priorities to be addressed related to community health needs.
Part VI Line 3City Hospital employs 4 financial analysts to meet with patients to discuss financial eligibility for our charity care program. City Hospital has the qualification requirements, as well as, applications for charity care available at all registration areas. Patients that do not qualify for state or federally funded programs can apply for the charity care program at City Hospital. The Financial Policy and Charity Care Policy for City Hospital can be found online at www.wvuniversityhealthcare.com under the Patient Visitors section.
Part VI Line 4City Hospital is a non-profit acute care hospital located in Berkeley County, WV population 107,098 in the city of Martinsburg, WV. Martinsburg is the largest city in the Eastern Panhandle, and the 8th largest municipality in the state of West Virginia, with a total population of 17,513 residents. The Primary Service Area for City Hospital consists of Berkeley County, WV and Jefferson County, WV, with an extended service area including Morgan County, WV. The 2011 market share for City Hospitals Primary Service Area is 43.5 with 17.6 of those patients covered by Medicaid and 6.6 uninsured. Jefferson Memorial Hospital, a non-profit critical access hospital under common management, is located within the Primary Service Area and War Memorial Hospital, a non-profit critical access hospital, operated by Valley Health System, is located in the extended service area of Morgan County, WV.
Part VI Line 4Berkeley County has a population of 107,098, with an average household income of 52,504 and an unemployment rate of 5.6. Currently, 11.9 of the people residing in Berkeley County live below the Federal Poverty Guideline according to the U.S. Census Bureau 2007-2011 census. Jefferson Countys population is 54,504, with an average household income of 65,285 and an unemployment rate of 4.1. Currently, 9.1 of Jefferson County residents live below the poverty line. In WVUH-Easts extended service area, Morgan County has a population of 17,471, with an average household income of 36,703 and unemployment rate 7.3. Currently, 12.7 of Morgan County residents live below the poverty line.
Part VI Line 5The CHI board of directors is a community board, with fourteen of the fifteen members living in or around Martinsburg, WV. The remaining board member lives in Morgantown, WV and has connections with CHI through the WV United Health System. Having members living outside our PSA allows us to be more aware of the healthcare needs in other areas of West Virginia. None of the board members are employees nor contractors of the organization, nor family members thereof.
Part VI Line 5CHI extends privileges to all qualified medical staff in Berkeley County and surrounding communities to meet its healthcare needs.
Part VI Line 5CHI allocates available funding to capital purchases and expanding services to improve patient care, support medical education in Berkeley County and surrounding counties in West Virginia and bordering states.
Part VI Line 5In 2009, CHI began offering discounted screening in response to a struggling economy. Recognizing that individuals were putting off scheduling routine, preventive testing such as mammograms and blood work, CHI offered Discounted Mammogram Clinics in April and October 2012 cash, no insurance. The clinics were successful in serving over 100 patients at City Hospital. The Rotary Health Fair, held in April, provided a full blood work-up at cost. Nearly 500 individuals took advantage of these screenings.
Part VI Line 5Our Mini-Medical School Program, which is held 6 times per year in Berkeley County, is a community health education program featuring local physicians and topics that address health needs in our communities. The program is jointly sponsored by WVUH-East and the WVU Robert C. Byrd Health Sciences Center Eastern Division. It is offered free to the community with an average attendance of 75 - 100 in Berkeley County.
Part VI Line 6CHI is a part of the WV United Health System. CHI plays a significant role in improving the general health care of the community. The strategic plan of the System states intent to build a regional health care delivery system in its services area, defined above, 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.
Part VI Line 6System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include United Health Center, which is more centrally located in the state, Jefferson Memorial Hospital which is located in the Eastern Panhandle of WV, Camden-Clark Medical Center located in Parkersburg, WV and West Virginia University Hospitals located in Morgantown, WV.
Part VI Line 6The 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. City Hospital Foundation and Jefferson Healthcare Foundation operate in the Eastern Panhandle, United Health Foundation operates in Clarksburg, and Camden-Clark Foundation operates in Parkersburg, WV.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierIIdentifier
Return Reference2ReturnReference
ExplanationCity Hospital did not provide more than 5,000 to any one recipient during 2012.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Anthony Zelenka
Cheif Administrative Officer2663623510977432238334483
Donna Clews
VP of Nursing157773211507008062187685
Linda Campbell Jones
Chief CRNA22391077418007242691
Jason T White
Assistant Chief CRNA21228116232238244681
Robert C Johnson Jr
CRNA2095424833738243328
Robert Brucker
CRNA2073533808932216665
Donna Hupp Baker
CRNA21047825811382222118

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierIIdentifier
Return Reference3ReturnReference
ExplanationSalaries of all officers are subject to the approval of a compensation committee designated by the WVUH-East Board of Directors. This committee uses the work of an independent salary and benefit consultant to determine the compensation packages to be made available to officers and that the compensation does not exceed fair market value of comparable positions at similar organizations. All data is retained and all decisions are appropriately documented pertaining to the compensation setting practices. This review occurs annually and was last completed in 2011 for 2012 compensation amounts.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

ExplanationExplanation
Form 990, Part III, Line 4d Program Service Expenses 63,246,290, Grants and allocations 27,430, Revenue 45,834,803 City Hospital, Inc. CHI is a not-for-profit facility that operates twenty-four hours a day, seven days a week. The hospital provides acute care services, as well as emergency and specialty patient care. CHI serves as part of a regional health system, WVUH-East which serves Berkeley, Jefferson and Morgan Counties. City Hospital serves as a clinical education site for WVU, the WV School of Osteopathic Medicine and other universities and community colleges in the area. The Erma Byrd Health Professions Education Center, which houses WVUs Robert C Byrd Health Sciences Center-Eastern Division, is also located on the City Hospital campus.
Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 City Hospital has a Level III Trauma Center and a fully accredited Cancer Program which offers cancer drug trials through its affiliation with the Mary Babb Randolph Cancer Center in Morgantown, WV. CHIs state of the art imaging services include but are not limited to 64 slice CT, PET CT, SPECT CT, MRI, Open Bore MRI, ultrasound, and digital mammography.
Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 A 28 million expansion project launched at City Hospital in 2009 brought a new cardiac catheterization lab to City Hospital in October 2010. Although the lab performed diagnostic catheterizations through December 2010, the lab expanded services in January 2011 to include elective primary coronary intervention PCI and emergent therapeutic cardiac catheterization STEMI. A new 20-bed ICU/CCU opened at the same time which included four cardiac beds to support the cath lab. The third component, a new Emergency Department that can accommodate up to 65,000 patients, opened in 2011 as well.
Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 Other services provided by City Hospital, in addition to patient care, include a teaching program and a variety of community outreach involvement programs. In 2006, City Hospital changed surveying vendors to Press Ganey. With over 900 hospitals in their database, allowing for comparison to a much larger base of hospitals than with the prior vendor and creating more opportunities for future improvements. City Hospital also contracted with Custom Learning Systems to create an organizational culture that focuses on customer service.
Form 990 Part IV Line 24a Bond issuances allocated to City Hospital, Inc are being reported on Schedule K of West Virginia University Hospitals, Inc EIN 55-0643304. West Virginia University Hospitals, Inc is a 501c3 and is the parent hospital of City Hospital, Inc.
Form 990 Part VI Section B Line 11a The Form 990 is prepared by the WVUH tax accountant and then reviewed by the WVUH-East Controller. Upon approval, it is then reviewed by the non-profit tax manager of our independent auditing firm. Once all review notes are cleared, it is presented to the WVUH-Easts Vice President of Finance for review. After gaining approval from the VP of Finance, it is then presented to all of the Board Members for a final review. Upon review by the Board of Directors, it is signed and submitted to the IRS.
Form 990 Part VI Section B Line 12c All Board Members are required to disclose, annually, any relationship which may lead to a potential conflict of interest. These responses are processed and maintained by the WVUH-East Compliance Committee. All board members are to be willing to identify conflicts of interest and abstain from voting when appropriate.
Form 990 Part VI Section B Line 15b The compensation of all executives is determined through the use of an independent salary consulting firm compiling the compensation data of comparable organizations in comparable geographic locations. This data is then used by an independent compensation committee to set the compensation for each executive. The data and supporting documentation are retained and documented.
Form 990 Part VI Section C Line 19 All financial and governing documents including conflict of interest policy are retained onsite and are made available to the public upon request.
Form 990 Part IX Line 11g Other Services Expense includes Consulting and Professional Fees 744,491, Contract Labor 6,298,957, Lab Fees 807,882, Contract Labor - Patient Care 3,439,103, Physician Practice Support 816,564, CP Med Staff and Med Staff Director 4,209,356, and Collection Agency Fees 1,316,686.
Form 990 Part XI Line 9 Other changes in net assets or fund balance includes 88,926 Change in restricted net assets, Hospitalists Net AR of 1,782, 5,615,809 of related organization capitalization, and 2,000 capital stock transfered from WVUH-Enterprises that was merged into City Hospital January 31, 2011, and 3 rounding.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (15 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
West Virginia United Health System Inc
1000 Technology DriveFairmontWV26554550754713Healthcare AccessWV501C311 aN/Afalse
West Virginia University Hospitals
PO Box 8034MorgantownWV26506550643304Patient CareWV501C33N/Afalse
West Virginia University Hospitals - East Inc
2000 Foundation WayMartinsburgWV25401202337985Patient AccessWV501C311aN/Afalse
Jefferson Memorial Hospital Inc
2000 Foundation WayMartinsburgWV25401550359755Patient CareWV501C33N/Afalse
City Hospital Foundation
2000 Foundation WayMartinsburgWV25401311118075Hospital SupportWV501C311aN/Afalse
Jefferson Healthcare Foundation Inc
2000 Foundation WayMartinsburgWV25401550768901Hospital SupportWV501C311aN/Afalse
United Health Foundation
327 Medical Park DriveBridgeportWV26330550621706Hospital SupportWV501C311aN/Afalse
United Hospital Center Inc
327 Medical Park DriveBridgeportWV26330550525724Patient CareWV501C33N/Afalse
United Physicians Care Inc
686 South Pike StreetShinnstonWV26431550638563Patient CareWV501C33N/Afalse
United Summit Center Inc
6 Hospital PlazaClarksburgWV26301550752788Behavioral HealthWV501C33N/Afalse
West Virginia Health Care Co-Op
PO Box 8059MorgantownWV26506550650441SupportWV501C311aN/Afalse
Camden-Clark Memorial Hospital
800 Garfield AveParkersburgWV26102311524546Patient CareWV501C33N/Afalse
Camden-Clark Health Services
800 Garfield AveParkersburgWV26102550769602Healthcare AccessWV501C311a, IN/Afalse
Camden-Clark Foundation
800 Garfield AveParkersburgWV26102550667789SupportWV501C311aN/Afalse
Camden-Clark Physician Corp
604 Ann StreetParkersburgWV26102264058719Patient CareWV501C311a, IN/Afalse

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrg
Allied Health Services Inc
PO Box 782MorgantownWV26507550652017Medical LabWVN/AC Corpfalse
West Virginia United Insurance Services Inc
1000 Technology Drive Suite 2320FairmontWV26554550756055Provider NetworkWVN/AC Corpfalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.