CAMDEN-CLARK PHYSICIAN CORPORATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CAMDEN-CLARK PHYSICIAN CORPORATION (EIN 26-4058719)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201313199349306386
- Schema version
- 2012v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T13:11:36-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1747 | AddressLine1 |
| City | CHARLESTON | City |
| State | WV | State |
| ZIP Code | 25326 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264058719 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMDEN-CLARK PHYSICIAN CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CAMD | NameControl |
| Phone | 3044242202 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 GARFIELD AVENUE | AddressLine1 |
| City | PARKERSBURG | City |
| State | WV | State |
| ZIP Code | 26102 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ALLEN R BUTCHER | Name |
| Title | CFO | Title |
| Phone | 3044242202 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SUSAN S DULL | Name |
| PTIN | P00233523 | PTIN |
| Phone | 3043430168 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ALLEN R BUTCHER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 GARFIELD AVENUE | AddressLine1 |
| City | PARKERSBURG | City |
| State | WV | State |
| ZIP Code | 26102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 16290473 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CCMH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2008 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | TO SUPPORT, MANAGE, AND FURNISH FACILITIES, PERSONNEL, AND MEDICAL SERVICES TO INDIVIDUALS IN NEED. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 129 | TotalNbrEmployees |
| Total Nbr Volunteers | 5 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8452616 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16024609 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 42059 | OtherRevenuePriorYear |
| Other Revenue Current Year | 265864 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 8494675 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16290473 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6593119 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12390589 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4655012 | OtherExpensePriorYear |
| Other Expenses Current Year | 9583019 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 11248131 | TotalExpensesPriorYear |
| Total Expenses Current Year | 21973608 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2753456 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -5683135 | RevenuesLessExpensesCY |
| Total Assets BOY | 3630642 | TotalAssetsBOY |
| Total Assets EOY | 2684615 | TotalAssetsEOY |
| Total Liabilities BOY | 1193242 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1616535 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2437400 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1068080 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 10315556 | Expense |
| Revenue | 7985279 | Revenue |
| Description | 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. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5096630 | Expense |
| Revenue | 4466507 | Revenue |
| Description | CAMDEN CLARK PHYSICIAN CORPORATION OFFERS SURGICAL SERVICES IN CONJUNCTION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION. THE ORGANIAZATION EMPLOYS 6 SURGEONS WHO PROVIDE SURGICAL SERVICES IN A VARIETY OF DISCIPLINES, INCLUDING OPEN HEART, CARDIO-THORACIC, VASCULAR AND GENERAL SURGERY. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2813755 | Expense |
| Revenue | 1853794 | Revenue |
| Description | CAMDEN CLARK PHYSICIAN CORPORATION OFFERS OB/GYN SERVICES THROUGH A TEAM OF EMPLOYED PHYSICIANS AND IN COLLABORATION WITH CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3415286 | Expense |
| Revenue | 1984893 | Revenue |
| Description | 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 3415286 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 1984893 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 21641227 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 79 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 129 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WV | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIAN STANDLEY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3044242202 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 GARFIELD AVENUE | AddressLine1 |
| City | PARKERSBURG | City |
| State | WV | State |
| ZIP Code | 26102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| 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 | 846490 | 0 | 26024 | |||
| JOE CAMPBELL | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| MICHAEL KING | ||||||||
| EX OFFICIO | 5.00 | X | 0 | 539228 | 101033 | |||
| ALLEN BUTCHER | ||||||||
| TREASURER | 5.00 | X | 0 | 336732 | 16825 | |||
| JASON LANDERS | ||||||||
| EXEC DIRECTOR/SECRETARY | 40.00 | X | 41443 | 0 | 5032 | |||
| DR LISA CASALENUOVO | ||||||||
| PHYSICIAN | 40.00 | 447112 | 0 | 24025 | X | |||
| DR MICHAEL GALLOWAY | ||||||||
| PHYSICIAN | 40.00 | 546242 | 0 | 20286 | X | |||
| DR GABOR ALTDORFER | ||||||||
| PHYSICIAN | 40.00 | 743952 | 0 | 19531 | X | |||
| DR JOSE CRUZZAVALA | ||||||||
| PHYSICIAN | 40.00 | 785439 | 0 | 9961 | X | |||
| DR NIK SHAH | ||||||||
| PHYSICIAN | 40.00 | 1000326 | 0 | 11451 | X | |||
| DR SIVAMURTHY KYATHARI | ||||||||
| PHYSICIAN | 40.00 | 532049 | 0 | 20761 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 4943053 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 875960 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 254929 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ALLSCRIPTS LLC | |||||
| 24630 NETWORK PLACE | CHICAGO | IL | 606731246 | SOFTWARE SERVICES | 167540 |
| LOCUMTENENSCOM LLC | |||||
| PO BOX 405547 | ATLANTA | GA | 303845547 | PHYSICIAN FEES | 122127 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 16024609 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16024609 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16024609 | TotalProgramServiceRevenue |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 265864 | TotalRevenueColumn |
| Related Or Exempt Function Income | 265864 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 265864 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16290473 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16290473 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5080125 | Total |
| Program Services | 5056887 | ProgramServices |
| Management And General | 23238 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5812310 | Total |
| Program Services | 5632129 | ProgramServices |
| Management And General | 180181 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 292821 | Total |
| Program Services | 283743 | ProgramServices |
| Management And General | 9078 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 744311 | Total |
| Program Services | 721237 | ProgramServices |
| Management And General | 23074 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 461022 | Total |
| Program Services | 446730 | ProgramServices |
| Management And General | 14292 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1100 | Total |
| Management And General | 1100 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 813089 | Total |
| Program Services | 787883 | ProgramServices |
| Management And General | 25206 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187 | Total |
| Program Services | 187 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 300844 | Total |
| Program Services | 291518 | ProgramServices |
| Management And General | 9326 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1703 | Total |
| Program Services | 1650 | ProgramServices |
| Management And General | 53 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 446576 | Total |
| Program Services | 432732 | ProgramServices |
| Management And General | 13844 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7460 | Total |
| Program Services | 7229 | ProgramServices |
| Management And General | 231 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190360 | Total |
| Program Services | 184459 | ProgramServices |
| Management And General | 5901 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 587205 | Total |
| Program Services | 569002 | ProgramServices |
| Management And General | 18203 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 6058010 | 6058010 | |
| PROVISION FOR BAD DEBTS | 897281 | 897281 | |
| REPAIRS AND MAINTENANCE | 193397 | 187402 | 5995 |
| PROFESSIONAL DEVELOPMEN | 66257 | 64204 | 2053 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19550 | Total |
| Program Services | 18944 | ProgramServices |
| Management And General | 606 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21973608 | Total |
| Program Services | 21641227 | ProgramServices |
| Management And General | 332381 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 1 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 364469 | BOY |
| EOY | 188413 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1811771 | BOY |
| EOY | 1535682 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 344450 | BOY |
| EOY | 13317 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 273950 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1257762 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 596073 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 476365 | BOY |
| EOY | 661689 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 359637 | BOY |
| EOY | 285513 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3630642 | BOY |
| EOY | 2684615 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1193242 | BOY |
| EOY | 1616535 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1193242 | BOY |
| EOY | 1616535 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2437400 | BOY |
| EOY | 1068080 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2437400 | BOY |
| EOY | 1068080 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3630642 | BOY |
| EOY | 2684615 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -5683135 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 4313815 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: 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. | GeneralExplanation |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1257762 | OtherCostOrOtherBasis |
| Depreciation | 596073 | Depreciation |
| Book Value | 661689 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 661689 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| INSURANCE | 280953 |
| WORKERS COMPENSATION FUND | 854 |
| PREPAID EXPENSES | 3706 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 285513 | TotalBookValueOtherAssets |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 0 | SubstantiationRequired |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR DANIEL MCGRAW | ||||||||||||||
| BOARD MEMBER - SEE SCH. O | 824490 | 0 | 0 | 0 | 22000 | 0 | 17050 | 0 | 8974 | 0 | 872514 | 0 | 0 | 0 |
| MICHAEL KING | ||||||||||||||
| EX OFFICIO | 0 | 499728 | 0 | 0 | 0 | 39500 | 0 | 96711 | 0 | 4322 | 0 | 640261 | 0 | 0 |
| ALLEN BUTCHER | ||||||||||||||
| TREASURER | 0 | 302732 | 0 | 0 | 0 | 34000 | 0 | 13243 | 0 | 3582 | 0 | 353557 | 0 | 0 |
| DR LISA CASALENUOVO | ||||||||||||||
| PHYSICIAN | 430112 | 0 | 0 | 0 | 17000 | 0 | 12813 | 0 | 11212 | 0 | 471137 | 0 | 0 | 0 |
| DR MICHAEL GALLOWAY | ||||||||||||||
| PHYSICIAN | 523742 | 0 | 0 | 0 | 22500 | 0 | 15148 | 0 | 5138 | 0 | 566528 | 0 | 0 | 0 |
| DR GABOR ALTDORFER | ||||||||||||||
| PHYSICIAN | 721452 | 0 | 0 | 0 | 22500 | 0 | 12699 | 0 | 6832 | 0 | 763483 | 0 | 0 | 0 |
| DR JOSE CRUZZAVALA | ||||||||||||||
| PHYSICIAN | 762939 | 0 | 0 | 0 | 22500 | 0 | 6296 | 0 | 3665 | 0 | 795400 | 0 | 0 | 0 |
| DR NIK SHAH | ||||||||||||||
| PHYSICIAN | 977826 | 0 | 0 | 0 | 22500 | 0 | 6250 | 0 | 5201 | 0 | 1011777 | 0 | 0 | 0 |
| DR SIVAMURTHY KYATHARI | ||||||||||||||
| PHYSICIAN | 515049 | 0 | 0 | 0 | 17000 | 0 | 13406 | 0 | 7355 | 0 | 552810 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | DURING 2012, THE ORGANIZATION BEGAN TO BUILD A PRIMARY CARE PRESENCE AS IT IS BELIEVED THAT THERE IS A LACK OF ADEQUATE PRIMARY CARE SERVICES IN THIS COMMUNITY. THIS WAS DONE THROUGH THE ACQUISITION OF TWO EXISTING PRACTICES AS WELL AS THROUGH THE HIRING OF ADDITIONAL PRIMARY CARE PHYSICIANS. |
| 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, SECTION A | DR. DANIEL MCGRAW IS COMPENSATED FOR HIS POSITION AS A PHYSICIAN WITH THE ORGANIZATION, NOT FOR SERVING ON THE BOARD OF DIRECTORS. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 9: | TRANSFERS FROM CAMDEN-CLARK MEMORIAL HOSPITAL 4,313,815. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (16 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | N/A | 0 |
| 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 | N/A | 0 |
| WEST VIRGINIA UNIVERSITY HOSPITALS EAST | ||||||||||
| 2000 FOUNDATION WAY | MARTINSBURG | WV | 25401 | 202337985 | HEALTHCARE ACCESS | WV | 501(C)(3) | LINE 11A, I | N/A | 0 |
| 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 | N/A | 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 |
| WVU HEALTHCARE CO-OP | ||||||||||
| PO BOX 8059 | MORGANTOWN | WV | 26506 | 550650441 | SUPPORT | WV | 501(C)(3) | LINE 11A, I | N/A | 0 |
| UNITED SUMMIT CENTER | ||||||||||
| 6 HOSPITAL PLAZA | CLARKSBURG | WV | 26301 | 550752788 | BEHAVIORAL HEALTH | WV | 501(C)(3) | LINE 3 | N/A | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 1 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
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