2012-11-12T10:55:23-06:00 2011-12-31 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 60606 990 2011-01-01 550753754 CAMC Health Education and Research Institute Inc CAMC 3043889900 PO Box 1547 Charleston WV 253261547 Sharon A Hall 3043889900 2012-11-12 1 Laura Gillespie P00855604 3124861000 2011 2016-02-24 21:20:13Z CAMC Institute Sharon A Hall 3200 MacCorkle Ave Charleston WV 25304 11092657 0 X www.camcinstitute.org X 1996 WV CAMC Health Education and Research Institute, Inc. ("CHERI")'s primary exempt purpose is to provide education opportunities and perform research which benefits both the community and Charleston Area Medical Center ("CAMC"), a not-for-profit corporation organized under the laws of the State of West Virginia. The organization administers a graduate medical education program. Its education focus and research opportunities center around anesthesia, and trauma, as well as other health related programs. 11 2 132 0 0 0 1261454 2854862 4423059 4065928 0 0 5390085 4171867 11074598 11092657 0 0 0 0 6738776 6607312 0 0 0 4691969 5143090 11430745 11750402 -356147 -657745 6217506 5832233 3164298 2807207 3053208 3025026 See response, Schedule O. 0 0 4313032 2826802 The organization serves as administrator of Charleston Area Medical Center, Inc. ("CAMC") graduate medical education and nurse anesthesia programs, and conducts a variety of professional education and training programs for CAMC healthcare professionals as well as healthcare professionals throughout the state of West Virginia. 2611953 Provision of services pertaining to various research activities including centers for clinical trials and cancer research, health services and outcomes research, trauma research and other health related research centers of excellence. 3177795 241325 Provision of various health programs designed to improve health education and awareness in the state and local communities. 10102780 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 128 0 1 132 1 0 0 0 0 0 0 0 0 0 0 0 X 11 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X Larry C Hudson 3043887603 501 Morris Street Charleston WV 25301 William H Carter MD 1.00 X 0 0 0 Glenn Crotty Jr MD 1.00 X 0 577560 79215 Clark Hansbarger MD 1.00 X 0 0 0 Steven Jubelirer MD 1.00 X 0 420020 34695 Ronald E Moore 1.00 X 0 238713 150964 E Gail Pitchford 1.00 X 0 204360 51389 David L Ramsey 1.00 X 0 934890 178365 Beth A Samples 1.00 X 0 1094566 48333 Edwin Welch PhD 1.00 X 0 0 0 Robert D Whitler 40.00 X X 0 212628 33520 Sharon A Hall 40.00 X X 255447 0 55010 Gregory E Souther 40.00 X 95042 0 12662 Nancy L Tierney 40.00 X 178792 0 35112 Priscilla P Walkup 40.00 X 155179 0 29613 William A White Jr 40.00 X 155566 5629 35774 Cassandra L Taylor 40.00 X 151605 0 19685 Kathryn F Newcome 40.00 X 139795 7294 35650 1131426 3695660 799987 6 0 1 0 Marshall University One John Marshall Drive Huntington WV 25755 School of Anesthesia Faculty 561417 WVU Physicians of Charleston 3110 MacCorkle Ave Charleston WV 25304 Professional Fees 251134 Siemens Medical Solutions Dept AT 40065 Atlanta GA 311920065 Information Technology Services 114320 3 432059 2422803 2854862 Education Services 611710 2826802 2826802 Research Revenue 621990 997801 997801 Non Clinical Services 621990 241325 241325 4065928 Affiliate Transfer 900099 4171867 4171867 4171867 11092657 7239994 0 997801 424728 424728 4945079 4865151 79928 165987 158825 7162 721949 133841 588108 349569 320549 29020 341384 341384 5075 5075 6717 6717 31406 27593 3813 1739574 1739309 265 77285 77285 142946 141106 1840 78389 78389 469298 363546 105752 183313 180875 2438 1379773 1372149 7624 442882 417815 25067 16649 16649 Medical Supplies 61560 61560 Dietary 58587 57277 1310 Repairs and Maintenance 56255 55642 613 Miscellaneous 51997 51868 129 11750402 10102780 1647622 0 238412 497556 5561 6654 0 5877283 4521212 1034817 1356071 4938716 3971952 6217506 5832233 2230851 1647909 933447 1159298 3164298 2807207 X -1299562 -1242302 2646819 2559050 1705951 1708278 3053208 3025026 6217506 5832233 X -657745 629563 X 0 1 1 X 1 1 X X X X 0 0 0 Charleston Area Medical CenterInc 550526150 3 1 1 1 3671867 1 3671867 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3350983 9827 9003 257356 3112457 3192263 11882 340282 191625 1819 3350983 2863709 10174 479445 154052 7013 3192263 2863709 2863709 0.55000 0.45000 0 1 1 182388 160196 22192 5694895 4361016 1333879 1356071 Interest in Net Asset : CAMC Foundation 3112466 Affiliate Receivables 859486 3971952 Affiliate Payable 497126 Accrued Payroll and Related Payroll Expenses 662172 1159298 Description of Intended Use of Endowment Funds: Part V, Line 4: To provide education opportunities and perform medical research, which benefits both the community and CAMC. Description of Uncertain Tax Positions Under FIN 48: Part X: CAMC Health Education and Research Institute, Inc. is part of the consolidated audit for CAMC Health System, Inc. and Subsidiaries (collectively, the "System"). Language regarding FIN 48 included in the consolidated footnotes is as follows: "CAMC, the Foundation, the Institute and CAMC Teays, are exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code (the "Code") and applicable state statutes, but are subject to unrelated business income tax. The System does not have any material uncertain tax positions at December 31, 2011." 0 1 0 0 0 0 0 0 0 Glenn Crotty Jr MD 0 387963 0 129183 0 60414 0 54033 0 25182 0 656775 0 37564 Steven Jubelirer MD 0 420020 0 0 0 0 0 14700 0 19995 0 454715 0 0 Ronald E Moore 0 183492 0 41480 0 13741 0 141029 0 9935 0 389677 0 0 E Gail Pitchford 0 152767 0 36205 0 15388 0 40534 0 10855 0 255749 0 0 David L Ramsey 0 592117 0 235000 0 107773 0 155318 0 23047 0 1113255 0 57392 Beth A Samples 0 184907 0 41792 0 867867 0 30170 0 18163 0 1142899 0 598275 Robert D Whitler 0 153835 0 32694 0 26099 0 8055 0 25465 0 246148 0 0 Sharon A Hall 157939 0 43012 0 54496 0 36547 0 18463 0 310457 0 24742 0 Nancy L Tierney 161426 0 9871 0 7495 0 10582 0 24530 0 213904 0 0 0 Priscilla P Walkup 148767 0 250 0 6162 0 9390 0 20223 0 184792 0 0 0 William A White Jr 149154 1603 250 4026 6162 0 9744 0 26030 0 191340 5629 0 0 Cassandra L Taylor 151355 0 250 0 0 0 9390 0 10295 0 171290 0 0 0 Kathryn F Newcome 139545 2563 250 4731 0 0 9876 0 25774 0 175445 7294 0 0 Part I, Line 3 The CAMCHSI Board of Directors Compensation Committee selects and supervises an independent consultant who advises the Committee on compensation arrangements and transactions between CAMCHSI companies and executives. The Committee uses the data to determine the total compensation of CHERI's President and the other executives. The data is reviewed every two years or when a new person comes into an executive role. Part I, Line 4b Supplemental Executive Retirement Plan ("SERP"). Participants are members of the Executive group. Participant Beth Samples in 2011 was paid in the amount of $846,435 in SERP benefits. Terms & Conditions of SERP Plan: Defined Benefit. Vest at age 60, or later,if one time postponement is made prior to age 59. Deferred vesting date cannot be earlier than age 65 or later than age 68. Benefit at age 60 with 30 years of service is computed as the difference between 55% of Final Average Total compensation and sum of retirement benefits paid from: CAMC Health System, Inc. Qualified Retirement Plan, Non-Qualified Retirement Benefit Restoration Plan and 50% of projected age 62 Primary Social Security Benefit. Eligible to receive SERP benefits upon earliest of: normal retirement or date elected, if extended; death; disability; involuntary termination without cause. Early retirement at age 55 with at least 5 years of service reduced 1.83% for each year of service less than 30 and .5% reduction for each month prior to Normal Retirement Date (age 60). Taxes due upon distribution. Subject to the Substantial Risk of Forfeiture. CEO Supplemental Executive Retirement Plan ("SERP"): Participant-CEO Terms and Conditions of CEO SERP Plan: Defined Contribution. Vest at age 65. Benefit at age 65 projected as the difference between 60% of Final 5 Year Average Total compensation and sum of retirement benefits paid from: CAMC Health System, Inc. Qualified Retirement Plan and 50% of projected age 65 Primary Social Security Benefit. Actual benefits will depend upon simulated investment results based on investment options selected by participant. Eligible to receive SERP benefits upon earliest of: deferred vesting date; death; disability; involuntary termination without cause. Taxes due upon vesting. Subject to the Substantial Risk of Forfeiture. Form 990, Part VI, Section A, line 6 CAMC Health System, Inc. ("CAMCHSI") is CHERI's sole voting member. Form 990, Part VI, Section A, line 7a CAMC Health System, Inc. ("CAMCHSI") is CHERI's sole voting member and has authority to elect all voting trustees of CHERI other than ex- officio trustees named in CHERI's governing documents. The sole voting member has the sole authority to amend CHERI's governing documents. Form 990, Part VI, Section A, line 7b CAMCHSI is CHERI's sole voting member and has reserved powers under CHERI's governing documents, which provide that decisions of CHERI's governing body such as election of officers, approval of annual budgets and borrownings are subject to approval by the sole voting member. The sole voting member also has all approval powers provided to members of West Virginia nonprofit corporations under state law. Form 990, Part VI, Section B, line 11 CHERI compiles necessary information for Form 990 through efforts of various officers and trustees of the organization. The return is then prepared and reviewed by an external consultant firm. This firm then reviews the completed Form 990 with the CAMC Health System, Inc. Board of Trustees and its Audit Committee. CAMC's CFO reviews the return with CHERI's Board of Directors. Form 990, Part VI, Section B, line 12c Corporate officers including the President and Secretary develop the agendas for board meetings and identify potential conflict of interest issues relative to action items and assist the President with resolution of same. Annual disclosure precedures are implemented and the President and CAMC Health System, Inc. Board of Directors Nominating Committee periodically review conflict situations. Form 990, Part VI, Section B, line 15 The CAMCHSI Board of Directors Compensation Committee selects and supervises an independent consultant who advises the Committee on compensation arrangements and transactions between CAMC Health System, Inc. subsidiaries (including CHERI) and executives (including CHERI's President). The Committee uses the data to determine the total compensation of CHERI's President and other executive officers. This data is reviewed every two years or when a new person comes into an executive role. Form 990, Part VI, Section C, line 19 The organization is part of a consolidated financial audit for CAMC Health System, Inc. and Subsidiaries. Consolidated Audited Financial Statements are available on-line at CAMC.org. They are also filed with the WV Health Care Authority where they are available on-line and in person. There is no formal method of making the Bylaws and Conflict of Interest Policy publicly available, but they are available upon request. The Articles of Incorporation are publicly available at the WV Secretary of State's Office. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Change in Temp Restricted -87,770. Change in Perm Restricted 2,328. Capital Contribution to Fixed Assets 715,005. Total to Form 990, Part XI, Line 5: 629,563. Explanation of Compensation paid to Directors: Form 990, Part VII: The compensation paid to individuals who are Directors reflects payment for their services in different roles at related organizations, not remuneration for their participation on the Board of Directors of CAMC Health Education and Research Institute, Inc. Form 990, Part VII, Column E: Description of reasonable effort made to obtain compensation from related organization: Some members of the board were compensated by related organizations for other duties as follows: CAMC - David L. Ramsey 48 hours, Glenn Crotty Jr. 45 hours, Ronald E. Moore 45 hours, Beth A. Samples 45 hours, Robert D. Whitler 45 hours, Steven Jubilerir 45 hours, E. Gail Pitchford 45 hours. These are on a weekly basis. William A. White Jr. was paid for 71 hours at CAMC for the year, and Kathryn F. Newcome was paid for 90 hours at CAMC for the year. CAMC Health System Inc PO Box 1547 Charleston WV 253261547 550664138 Parent Company WV 501(c)(3) Line 11, Type III-FI N/A 0 Charleston Area Medical Center Inc PO Box 1547 Charleston WV 253261547 550526150 Hospital WV 501(c)(3) Line 3 CAMC Health System Inc 1 CAMC Teays Valley Hospital Inc PO Box 1547 Charleston WV 253261547 550752636 Hospital WV 501(c)(3) Line 3 CAMC Health System Inc 1 Charleston Area Medical Center FoundationInc PO Box 1547 Charleston WV 253261547 310887133 Foundation WV 501(c)(3) Line 11, Type II CAMC Health System Inc 1 Women and Children's Medical Office Building Partnership PO Box 1547 Charleston WV 253261547 550669065 Medical Office Building WV N/A General Division Medical Office Building Partnership PO Box 1547 Charleston WV 253261547 550623949 Medical Office Building WV N/A Integrated Health Care Providers Inc PO Box 1547 Charleston WV 253261547 550751010 Specialty Physician Practices WV N/A C 0 0 1 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 Charleston Area Medical Center Inc J 252446 FMV Charleston Area Medical Center Inc L 341384 FMV Charleston Area Medical Center Inc O 4243990 FMV Charleston Area Medical Center Inc P 1810735 FMV Charleston Area Medical Center Inc R 4717867 FMV CAMC Foundation Inc C 432059 FMV CAMC Teays Valley Hospital Inc P 61172 FMV