2011-05-13T13:42:31-05:00 2010-06-30 DIXON HUGHES GOODMAN LLP PO BOX 1747 CHARLESTON WV 25326 990 2009-07-01 264058719 CAMDEN-CLARK PHYSICIAN CORPORATION CAMD 3044242202 800 GARFIELD AVENUE PARKERSBURG WV 26102 ALLEN BUTCHER 3044242202 2011-05-09 1 RICK SLATER 3043430168 2009 2016-02-24 21:20:13Z X ALLEN BUTCHER 800 GARFIELD AVENUE PARKERSBURG WV 26102 5241904 0 X WWW.CCMH.ORG X 2008 WV TO SUPPORT, MANAGE, AND FURNISH FACILITIES, PERSONNEL, AND MEDICAL SERVICES TO INDIVIDUALS IN NEED. 5 3 47 0 0 0 0 5161852 0 80052 5241904 0 0 6731222 0 0 1622398 8353620 -3111716 1325297 1263237 62060 THE GENERAL PURPOSES OF THE CORPORATION ARE AS FOLLOWS: TO ESTABLISH, SUPPORT, MANAGE, AND FURNISH FACILITIES, PERSONNEL, AND SERVICES TO PROVIDE DIAGNOSTIC, THERAPEUTIC, WELLNESS, HEALTH PROMOTION, SURGICAL, AND OTHER PROFESSIONAL MEDICAL SERVICES TO SICK, INJURED, OR DISABLED PERSONS WITHOUT REGARD TO RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, OR FINANCIAL STATUS, AND TO OTHERWISE PROMOTE THE QUALITY, ACCESSIBILITY, AND AFFORDABILITY OF SUCH PROFESSIONAL MEDICAL SERVICES. 0 0 8039021 5553045 CAMDEN-CLARK PHYSICIAN CORPORATION CARRIED ON ACTIVITIES RELATED TO RENDERING PROFESSIONAL MEDICAL SERVICES TO THE SICK, INJURED, AND DISABLED AS JUSTIFIED BY THE FACILITIES, PERSONNEL, FUNDS AND OTHER RESOURCES THAT WERE MADE AVAILABLE TO THE CORPORATION. THEY MANAGED, OPERATED, AND PARTICIPATED, SO FAR AS CORPORATION POLICIES, CIRCUMSTANCES, AND AVAILABLE RESOURCES WARRANTED, IN ACTIVITIES DESIGNED AND CARRIED ON TO PROMOTE THE GENERAL HEALTH OF PERSONS WITHIN CORPORATION'S SERVICE AREA. THEY HAVE MANY LOCATIONS WHERE SUCH SERVICES WERE PERFORMED: 1) WITHIN CAMDEN-CLARK MEMORIAL HOSPITAL, 2)WITHIN MEDICAL OFFICE BUILDING A, B, AND C OF CAMDEN-CLARK MEMORIAL HOSPITAL, AND 3) WITHIN SERVICE CLINICS OUTSIDE OF CAMDEN-CLARK MEMORIAL HOSPITAL BUT WITHIN THE CORPORATION'S SERVICE AREA. 8039021 1 0 0 0 0 0 0 0 0 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 0 0 0 1 9 0 1 47 0 0 0 0 0 0 0 0 0 0 5 3 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WV X X BRIAN STANDLEY 3044242202 800 GARFIELD AVENUE PARKERSBURG WV 26102 KATHY G EDDY 1.00 X X 0 0 0 TERRY CAPEL 1.00 X X 0 0 0 DANIEL MCGRAW 40.00 X 361344 573578 13227 JOE CAMPBELL 1.00 X 0 0 0 MICHAEL KING 5.00 X 0 617776 64855 ALLEN BUTCHER 5.00 X 0 365947 29383 JASON LANDERS 40.00 X 43766 53472 6132 SHANE PARMER 40.00 X 191837 169845 15233 LISA CASALENUOVO 40.00 X 180599 263092 11688 JOSEPH DARROW JR 40.00 X 234367 260584 4295 GABOR ALTDORFER 40.00 X 234290 260968 4289 CHRISTOPHER BAILEY 40.00 X 140375 0 2425 TUAN NGUYEN 40.00 X 139297 156769 3908 JOSPEH BOGGS 40.00 X 108937 0 2159 1634812 2722031 157594 8 0 1 0 ALLSCRIPTS LLC 24630 NETWORK PLACE CHICAGO IL 60673 ELECTRONIC RECORD SOFTWARE 178466 THE CHARLES SCHWAB TRUST COMPANY 12401 RESEARCH BLVD BLDG 2 AUSTIN TX 78759 PENSION TRUSTEE 122693 2 NET PATIENT REVENUE 621110 5161852 5161852 5161852 OTHER REVENUE 621110 80052 80052 80052 5241904 5241904 0 0 1709518 1656164 53354 4134317 3980955 153362 259900 246905 12995 418891 397946 20945 208596 198166 10430 321268 305205 16063 146 139 7 190169 180661 9508 274355 260637 13718 8603 8173 430 75713 71927 3786 348499 331074 17425 PROVISION FOR BAD DEBTS 352125 352125 TAXES AND LICENSES 20807 19767 1040 30713 29177 1536 8353620 8039021 314599 0 146038 648378 732597 234847 0 497750 33131 0 1325297 1263237 0 1263237 X 62060 0 62060 0 1325297 X 0 1 1 X 0 X 732597 234847 497750 497750 5241904 8353620 -3111716 3173776 3173776 62060 8415680 3173776 3173776 5241904 0 5241904 8353620 0 8353620 0 8353620 Part XI, Line 8 - Other Adjustments: TRANSFERS FROM CAMDEN-CLARK MEMORIAL HOSPITAL: 3173776. Part XII, Line 2d - Other Adjustments: TRANSFERS FROM CAMDEN-CLARK MEMORIAL HOSPITAL PART X, LINE 2: EFFECTIVE JULY 1, 2009, THE ORGANIZATION ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ("FASB") AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVIDUAL TAX POSITIONS IN THE FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST AS OF JUNE 30, 2010, AND THE ADOPTION OF THE GUIDANCE DID NOT HAVE A MATERIAL EFFECT ON THE FINANCIAL POSITION OR RESULTS OF OPERATIONS. X 0 0 0 1 0 0 0 0 0 DANIEL MCGRAW 354234 565659 0 0 7110 7919 0 11122 1058 1047 362402 585747 0 0 MICHAEL KING 0 579276 0 0 0 38500 0 62761 0 2094 0 682631 0 0 ALLEN BUTCHER 0 332947 0 0 0 33000 0 27298 0 2085 0 395330 0 0 SHANE PARMER 189012 166420 0 0 2825 3425 0 13141 1047 1045 192884 184031 0 0 LISA CASALENUOVO 171374 255898 0 0 9225 7194 0 9605 1042 1041 181641 273738 0 0 JOSEPH DARROW JR 222906 250046 0 0 11461 10538 0 2200 1051 1044 235418 263828 0 0 GABOR ALTDORFER 228329 250429 0 0 5961 10539 0 2200 1051 1038 235341 264206 0 0 TUAN NGUYEN 126613 152953 0 0 12684 3816 0 1835 1042 1031 140339 159635 0 0 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 AND COLLECTIONS FOR EACH PHYSICIAN. THE AMOUNT OF THE BONUS IS INCLUDED IN THE INDIVIDUALS' BASE COMPENSATIONS ON SCHEDULE J, PART II, COLUMN (B)(I). Form 990, Part VI, Section A, line 6 CAMDEN-CLARK HEALTH SERVICES, INC., 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 REVIEWED THE COMPLETED FORM PRIOR TO FILING. AFTER THE RETURN WAS FILED, A COPY WAS 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 BOARD OF DIRECTORS. A COMPENSATION COMMITTEE CONSISTING OF ALL NON-PHYSICIAN MEMBERS OF THE BOARD REVIEW AND APPROVE 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 XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. FORM 990, PART VII DANIEL MCGRAW IS COMPENSATED FOR HIS POSITION AS A PHYSICIAN WITH THE ORGANIZATION, NOT FOR SERVING ON THE BOARD OF DIRECTORS. CAMDEN-CLARK HEALTH SERVICES INC 800 GARFIELD AVENUE PARKERSBURG WV 26102 550769602 AIDS, STRENGTHENS, AND SUPPORTS CAMDEN-CLARK MEMORIAL HOSPITAL. WV 501(c)(3) Line 11a, I N/A 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 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 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 7 N/A 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 1 1