2012-05-14T15:17:30-05:00 2011-06-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-07-01 550779739 West Virginia University Medical Corporation Charleston Division WEST 3043471297 PO Box 7000 Morgantown WV 265077000 Jane Weise Haley 3042935033 2012-05-10 1 Greg Gibbs 3043460441 2010 2016-02-24 21:20:13Z West Virginia University Physicians J Gregory Rosencrance M PO Box 7000 Morgantown WV 265077000 43226947 0 X wvupc.org X 2002 WV The organization's mission is to support the West Virginia University School of Medicine - Charleston Division. 9 0 268 0 0 0 26341 0 46089451 43194930 46399 32017 0 0 46162191 43226947 1539492 2006192 0 0 29820642 30241217 0 0 0 8274452 7490585 39634586 39737994 6527605 3488953 14127540 17598077 4003599 3985183 10123941 13612894 X The mission of West Virginia University Medical Corporation - Charleston Division, doing business as West Virginia University Physicians of Charleston, is to support the West Virginia University School of Medicine and to improve the lives of our patients, physicians, students, and employees by maintaining an efficient,effective and friendly academic and clinical practice environment. 0 0 29792137 9967 43194930 The Corporation supported the faculty physicians of the West Virginia School of Medicine in their provision of medical services with approximately 239,500 procedures performed and 107,000 patient visits during the year ended June 30, 2011. The Corporation incurred expenditures for salaries, wages and employee benefits on behalf of the School of Medicine for faculty physicians, residents, and staff. 2631757 1996225 The Corporation continuously meets its exempt purpose by providing funds to the state-supported West Virginia University School of Medicine. By providing these funds, the Corporation has both lessened the burdens of government and advanced graduate medical education in West Virginia. As part of its mission to support the School of Medicine, the Corporation incurred expenditures for professional liability premiums on behalf of the faculty physicians of the School of Medicine of approximately $635,532 for the year ended June 30, 2011. 1705324 The Corporation has also lessened the burdens of government by relieving poverty in West Virginia by supporting the faculty physicians in their provision of charity care.In addition, the Corporation has promoted health for the benefit of the community, West Virginia (both rural and metropolitan areas) and surrounding states. For example, the Corporation has supported the faculty physicians in their non-revenue producing endeavors such as practicing in free care clinics, providing health-related information via telemedicine and printed materials, and providing phone access to the faculty physicians for the state's rural physicians. 34129218 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 74 0 1 268 1 0 0 0 0 0 0 0 0 X 9 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 X Kelly Henderson 3042857122 255 Scott Avenue Morgantown WV 265070897 James G Rosencrance MD 40.00 X X 233850 0 21814 Roberto Kusminsky MD 40.00 X 224740 0 27615 Elizabeth Kurczinski MD 40.00 X 124572 0 17952 Raheel Khan MD 40.00 X 107541 0 10672 Martin Kommer MD 40.00 X 118538 0 12088 Jeffrey Ashley MD 40.00 X 252216 0 23242 Stephen Bush MD 40.00 X 556481 0 54368 L Clark Hansburger 40.00 X 128826 0 11810 R Todd Depond 40.00 X 264360 0 40556 Jane Weise Haley 40.00 X 95291 0 32584 Frank C Lucente MD 40.00 X 420062 0 48877 Brett A Faulknier MD 40.00 X 418263 0 32377 Patrick A Stone MD 40.00 X 401538 0 48798 Luis A Bracero MD 40.00 X 364923 0 54377 Samuel C Rossi MD 40.00 X 354829 0 32377 4066030 0 469507 80 0 1 0 0 Direct patient care 621111 27075738 27075738 Education & research 611710 8815742 8815742 Expense reimbursements 900099 5906119 5906119 Other health care 900099 1397331 1397331 43194930 32017 32017 43226947 43194930 0 32017 2006192 2006192 2337081 2215543 121538 23689437 19906997 3782440 1981877 1783689 198188 1140301 969256 171045 1092521 928643 163878 57684 57684 66461 66461 1947546 1655415 292131 90987 13633 77354 1070778 877528 193250 25269 21479 3790 450717 428181 22536 242954 206511 36443 135262 114973 20289 149491 134542 14949 881307 635532 245775 Bad debts 1969679 1969679 0 Dues, memberships, lice 215600 100460 115140 Repairs and maintenance 67354 63265 4089 Recruitment 24408 14960 9448 WV provider tax 19624 18446 1178 75464 64294 11170 39737994 34129218 5608776 0 1424 1422 10343578 13346265 2451056 2871266 231156 143381 96230 187364 1109240 566516 561439 542724 442657 505655 14127540 17598077 3817251 3952239 186348 32944 4003599 3985183 X 10123941 13612894 10123941 13612894 14127540 17598077 3488953 0 X X 0 1 1 X 0 X 204836 102668 102168 872202 463848 408354 32202 32202 542724 Due to related party 32944 32944 43226947 39737994 3488953 0 3488953 37320828 0 37320828 5906119 5906119 43226947 33831875 0 33831875 5906119 5906119 39737994 Part XII, Line 4b - Other Adjustments: Expense reimbursements 5,906,119. Part XIII, Line 4b - Other Adjustments: Expense reimbursements 5,906,119. 0 WVU School of Medicine 3110 MacCorkle Ave SE Charleston WV 25304 556000842 3 1996225 To support the School of Medicine. 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Not considered necessary since given to related entity. X X X X 0 0 0 0 0 0 0 0 0 James G Rosencrance MD 233850 0 0 0 0 0 21814 0 2661 0 258325 0 0 0 Roberto Kusminsky MD 224740 0 0 0 0 0 27615 0 2988 0 255343 0 0 0 Jeffrey Ashley MD 252216 0 0 0 0 0 23242 0 2765 0 278223 0 0 0 Stephen Bush MD 509067 0 47414 0 0 0 54368 0 4981 0 615830 0 0 0 R Todd Depond 264360 0 0 0 0 0 40556 0 2808 0 307724 0 0 0 Frank C Lucente MD 420062 0 0 0 0 0 48877 0 3867 0 472806 0 0 0 Brett A Faulknier MD 416005 0 2258 0 0 0 32377 0 5254 0 455894 0 0 0 Patrick A Stone MD 401538 0 0 0 0 0 48798 0 3829 0 454165 0 0 0 Luis A Bracero MD 364923 0 0 0 0 0 54377 0 4067 0 423367 0 0 0 Samuel C Rossi MD 354829 0 0 0 0 0 32377 0 4027 0 391233 0 0 0 Form 990, Part VI, Section A, line 6 The membership of the Corporation consists of physicians who are faculty members of the West Virginia University School of Medicine, Charleston Division (the School of Medicine). Revenues of the Corporation are used for the public purpose of furthering the goals and objectives of the School of Medicine and are derived principally from billings for medical services furnished by the Corporation's membership within the scope of their duties as faculty of the School of Medicine. Form 990, Part VI, Section A, line 7a There are nine voting members of the Corporation's board of directors. The members consist of the Associate Vice President and six (6) departmental chairs. The eighth is elected for a 2 year term from and by the full-time faculty members of the West Virginia University Medical Corporation - Charleston Division. The ninth is the Dean of the West Virginia University School of Medicine, who is an ex-officio voting member. Form 990, Part VI, Section A, line 7b Any substantive changes in the bylaws proposed by the board of directors must be consistent with West Virginia University Board of Governors policies and shall not be adopted by the Board or implemented until the same have been approved by the President of the University or his designee. Form 990, Part VI, Section B, line 11 Form 990 is prepared by the Corporation's independent accountants, with assistance from the Controller of the Master Service Organization. Before the 990 is filed with the IRS, the CFO reviews the 990 with the Finance Committee and Board members to ensure they have an understanding of the information provided on the form. Form 990, Part VI, Section B, line 12c All new employees must complete an electronic disclosure module at the outset of employment that addresses whether they have any relationships that could constitute a conflict of interest as described in the corporation's by-laws and related conflict of interest policy. The electronic disclosure forms must also be updated annually, and any disclosures of potential conflicts on either the initial or recurring annual disclosures will be reviewed and analyzed to determine whether a conflict exists and, if so, the employment ramifications of the same. Additionally, the corporation has adopted a policy that requires employed faculty to disclose annually, in writing, any outside relationships which could potentially constitute a conflict of interest on forms prescribed by the corporation's Conflict of Interest policy. Again, documented disclosures of potential conflicts will be reviewed and analyzed to determine whether actual conflicts exist. Form 990, Part VI, Section B, line 15 The corporation reviews compensation of the CEO, officers and faculty against reported benchmarks. The corporation also obtains Fair Market Value studies from its affiliated hospital. These are reviewed at least annually. Form 990, Part VI, Section C, line 19 The corporation provides financial statements to the public upon written request. The corporation has a website where its Code of Conduct which contains information regarding conflict avoidance is posted, along with the corporation's Conflict of Interest policy and related resources and disclosure forms. www.wvupc.org/compliance Oversight of Audit Form 990, Part XII, Line 2c The oversight process of the audit has not changed since last year. West Virginia University School of Medicine Charleston Division 3110 MacCorkle Avenue Charleston WV 25304 556000842 Education WV 501(c)(3) 2 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0