TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Richard Pill Chairman	1.00	X	X	0	0
(2) Walter Washington Vice-Chairman	1.00	X	X	0	0
(3) Robert Baronner Jr Treasurer	1.00	X	X	0	0
(4) Shelia Hamilton Secretary	1.00	X	X	0	0
(5) Keith Berkeley DVM Director	1.00	X		0	0
(6) Fred Butcher PhD Director	1.00	X		0	0
(7) Betty Gunnoe Director	1.00	X		0	0
(8) Mitch Jacques MD Director	1.00	X		0	0
(9) David Baltierra MD Director	1.00	X		0	0
(10) D Scott Roach JMH Med Staff President	1.00	X		0	0
(11) Rhonda Monroe Director	1.00	X		0	0
(12) Dawn Jones MD CHI Med Staff President	1.00	X		0	0
(13) Jeffrey B DeBord DO Director	1.00	X		0	0
(14) Nicholas Trietsch Director	1.00	X		0	0
(15) Dr Richard Knapp Director	1.00	X		0	0
(16) Anthony Zelenka Cheif Administrative Officer	50.00		X	256,570	32,238
(17) Robert Strauch VP Med Affairs	40.00		X	97,185	825

(A) Name and business address	(B) Description of services	(C) Compensation
Quest Diagnostics 14225 Newbrook Dr Chantilly,VA20151	Lab Services	636,750
Handcraft Cleaners and Laundry 1501 Roseneath Rd Richmond,VA23230	Laundry Services	565,105
C&A Industries Inc 13609 California St Omaha,NE68154	Contract labor	634,332
Insight Health Services 26250 Enterprise Ct Lake Forest,CA92630	Mobile MRI and PET services	628,457
Hospitalist Medicine Physicians of Berkeley County PLLC PO Box 645037 Cincinnato,OH45264	Contracted Hospitalists	552,120
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 28

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	314,403	314,403
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	543,411		543,411
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	47,989,739	39,809,109	8,180,630
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,455,764	1,207,605	248,159
9	Other employee benefits .......	7,353,313	6,133,679	1,219,634
10	Payroll taxes ...........	4,231,125	3,509,861	721,264
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	125,148	293	124,855
c	Accounting ...........	57,266		57,266
d	Lobbying ...........	13,274		13,274
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......	0
g	Other ..........	16,142,870	11,950,711	4,192,159
12	Advertising and promotion ....	355,458	7,608	347,850
13	Office expenses .......	26,179,498	23,850,068	2,329,430
14	Information technology ......	288,383	78,979	209,404
15	Royalties ..	0
16	Occupancy ...........	2,221,311	403,234	1,818,077
17	Travel ............	340,065	168,790	171,275
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	2,225,477	589	2,224,888
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	6,775,945		6,775,945
23	Insurance ..............	1,022,153		1,022,153
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	Provision for Doubtful Accounts	14,563,488	14,563,488
b	Association Dues	138,865	47,716	91,149
c	Educational Training	137,194	7,711	129,483
d	Taxes, Licenses, Fees	4,377,957	3,032,554	1,345,403
e
f	All other expenses	1,119,879	270,323	849,556
25	Total functional expenses. Add lines 1 through 24f	137,971,986	105,356,721	32,615,265	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	43,010	1	284,197
2	Savings and temporary cash investments .......	18,960,480	2	29,696,025
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	12,841,702	4	14,632,710
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............	1,336,500	7	655,276
8	Inventories for sale or use ..............	1,777,782	8	1,954,541
9	Prepaid expenses and deferred charges ............	359,773	9	354,034
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	112,412,372
b	Less: accumulated depreciation. .....	10b	61,157,765	41,817,952	10c	51,254,607
11	Investments—publicly traded securities ..........	13,004,060	11	76,010
12	Investments—other securities. See Part IV, line 11 ......		12	2,663,680
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	4,523,141	15	6,265,713
16	Total assets. Add lines 1 through 15 (must equal line 34)...	94,664,400	16	107,836,793
	17	Accounts payable and accrued expenses .	9,198,849	17	12,206,103
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........	48,383,698	20	53,299,806
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	11,564,203	25	14,690,491
26	Total liabilities. Add lines 17 through 25.....	69,146,750	26	80,196,400
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	25,205,594	27	27,326,335
28	Temporarily restricted net assets .....	312,056	28	312,058
29	Permanently restricted net assets .....		29	2,000
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	25,517,650	33	27,640,393
34	Total liabilities and net assets/fund balances .....	94,664,400	34	107,836,793

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

City Hospital Inc

Employer identification number

55-0383321

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

0 %

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

0 %

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

0 %

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

City Hospital Inc

Employer identification number

55-0383321

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization City Hospital Inc
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization City Hospital Inc
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
City Hospital Inc

Employer identification number

55-0383321

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

City Hospital Inc

Employer identification number

55-0383321

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(a) Filing organization's totals	(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......	13,274
c	Total lobbying expenditures (add lines 1a and 1b) ...................	13,274
d	Other exempt purpose expenditures ........................	105,356,721
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............	105,369,995
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.	1,000,000
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................	250,000
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................		Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount	1,000,000	1,000,000	1,000,000	1,000,000	4,000,000

b	Lobbying ceiling amount (150% of line 2a, column(e))					6,000,000

c	Total lobbying expenditures	12,860	12,507	12,820	13,274	51,461

d	Grassroots nontaxable amount	250,000	250,000	250,000	250,000	1,000,000

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,500,000

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
II-A	1b	The 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.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

City Hospital Inc

Employer identification number

55-0383321

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	106,462		106,462
b	Buildings ................	44,197,120	14,787,723	29,409,397
c	Leasehold improvements ............
d	Equipment ................	59,815,587	41,647,080	18,168,507
e	Other .................	8,293,203	4,722,962	3,570,241
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				51,254,607

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Unamortized Borrowing Costs				420,286
(2) Due from Affiliates				4,446,235
(3) Estimated Third Party Payor Settlements				51,329
(4) Other Non-current Assets				1,347,863





Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				6,265,713

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes
Accrued wages, benefits and payroll taxes		5,283,299
Malpractice Liability		670,135
Accrued pension benefits		1,469,225
Accrued bond interest		42,066
Due to third Party Payors		1,658,780
Interest Rate Swaps		2,946,121
Self Insurance Liability		2,620,865


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		14,690,491
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	143,339,738
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	137,971,986
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	5,367,752
4	Net unrealized gains (losses) on investments ..........................	4	-1,802,928
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8	-1,442,081
9	Total adjustments (net). Add lines 4 through 8 .........................	9	-3,245,009
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	2,122,743

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	142,838,878
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	-348,175
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................			2e	-348,175
3	Subtract line 2e from line 1.....................			3	143,187,053
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b	152,685
c	Add lines 4a and 4b.......................			4c	152,685
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	143,339,738

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	139,134,516
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c	1,462,530
d	Other (Describe in Part XIV.) ............	2d	-300,000
e	Add lines 2a through 2d......................			2e	1,162,530
3	Subtract line 2e from line 1.....................			3	137,971,986
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	137,971,986

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
X	2	The 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 2011.
XI	8	The amount on line 8 includes 249,806 Change in restricted net assets, 2,177 of comfort items contributed by City Foundation posted to balance sheet, Hospitalists Net AR of 63,736, 1,627,974 of related organization capitalization, and 2,000 capital stock transfered from WVUH-Enterprises that was merged into City Hospital January 31, 2011.
XII	4b	The amount shown consists of 152,685 contributions from City Foundation posted to balance sheet accounts.
XIII	2c	The amount shown on line 2c 1,462,530 unrealized losses on debt instruments included in expense on audited financial statments but not taken as an expense on the Form 990.
XIII	2d	The amount shown on line 2d consists of 300,000 contributions to City Foundation posted to balance sheet accounts.

Schedule D (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

City Hospital Inc

Employer identification number

55-0383321

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

If "Yes," did the organization make it available to the public? ...............

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	3,633,885		3,633,885	2.940 %
b Medicaid (from Worksheet 3, column a) .....	22,889,483	14,352,014	8,537,469	6.920 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .	437,640	420,228	17,412	0.010 %
dTotal Financial Assistance and Means-Tested Government Programs .....	26,961,008	14,772,242	12,188,766	9.870 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	248,862	16,790	232,072	0.190 %
f Health professions education (from Worksheet 5) ..	345,536	137,887	207,649	0.170 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	22,725		22,725	0.020 %
jTotal Other Benefits ...	617,123	154,677	462,446	0.380 %
kTotal. Add lines 7d and 7j. ..	27,578,131	14,926,919	12,651,212	10.250 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	11,386	11,386	0.010 %
2	Economic development	4,261	4,261
3	Community support	15,589	15,589	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	831	831
7	Community health improvement advocacy	4,561	4,561
8	Workforce development	4,722	4,722
9	Other
10	Total	41,350	41,350	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

6,729,788

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

179,739

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

46,584,639

Enter Medicare allowable costs of care relating to payments on line 5.....

49,660,257

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-3,075,618

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	City Hospital Inc 2000 Foundation Way Suite 2310 Martinsburg,WV25401	X	X	X	X

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?.......		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: % If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14
15	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	DDid the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
Part I line 3c		City Hospital Inc. CHI uses 200 Federal Poverty Guideline to determine free care eligibility. However, City Hospital does not offer discounted care to individuals who do not qualify for free care.
Part I line 6a		Community benefit amounts for City Hospital, Inc are reported on WV United Health Systems website www.wvunitedhealthsystem.org under community responsibility report.
Part I line 7		Worksheet 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 I line 7		Column f - Total community benefit expense for 2011 is 27,578,131 and is 22.35 of total net expenses. To calculate net expense, bad debt of 14,563,488 was deducted from total expenses of 137,971,986 as shown in Part IX line 25 of the core Form 990.
Part II		Physical 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 II		Economic Development - In 2011,hospital representatives participated as members of the Berkeley County Development Authority and Board Members of the Martinsburg Berkeley County Chamber of Commerce.
Part II		Community 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 II		Coalition 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 II		Community 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 2011, CHI also began data collection through a survey, focus groups and face-to-face interviews as part of a community health needs assessment to develop a plan to address health needs in the community. CHI also has a representative on the Berkeley County Board of Health.
Part II		Workforce 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 II		CHI also has agreements with area community colleges and universities to allow students to complete clinical rotations at the hospital.
Part III line 4		City 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 4		Part III, Line 2 - Bad Debt Expense at cost was calculated by multiplying bad debt expense of 14,563,488 by our cost-to-charge ratio of 46.21 derived from Worksheet 2 in the IRS Schedule H instructions for a total of 6,729,788. Line 3 - Estimated bad debt attributable to patients eligible for charity care was calculated by running a report within our patient revenue software of all bad debt account balances greater than 25,000. The total of that report was 444,407, which was then multiplied by the cost-to-charge ratio of 46.21 for a total of 179,739.
Part III line 4		We feel that, at a minimum, the estimated bad debt attributable to patients eligible for charity care of 179,739 should be considered community benefit due to the fact that a patient with an outstanding balance of 25,000 or greater usually qualifies as catastrophic if the patient completes the application process. In our Charity Care policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year.
Part III line 8		Part III Line 6 was calculated using total cost from the Medicare Cost Report less Medicare reimbursement of direct GME. City Hospitals shortfall of 3,075,618 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 9b		CHI does have a debt collection policy. The policy does not yet address collection practices to be followed for patients who are known to qualify for charity care or financial assistance.
Part V		Line 10 - City Hospital offers discounted care only to individuals who qualify for free care. CHI does offer a prompt pay discount to Self-Pay patients with no third-party coverage that meet certain criteria.
Part V		Line 21 - City Hospital charges all patients an amount equal to gross charges regardless of payment method.
Part VI Line 2		City 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 2		The 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 reseidents of West Virginias Eastern Panhandle.
Part VI Line 2		Sources 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 2		We 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 2		WVUH-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.
Part VI Line 3		City 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.
Part VI Line 4		City Hospital is a non-profit acute care hospital located in Berkeley County, WV population 104,169 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 17,227 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 2010 market share for City Hospitals Primary Service Area is 41.61 with 16.8 of those patients covered by Medicaid and 8.6 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 4		Berkeley County has a population of 104,169, with an average household income of 38,763 and an unemployment rate of 8.1. Currently, 11.5 of the people in Berkeley County live below the 2010 Federal Poverty Guideline according to the U.S. Census Bureau 2010 census. Jefferson Countys population is 53,498, with an average household income of 44,347 and an unemployment rate of 5.9. 10.3 of Jefferson County residents live below the 2010 Federal Poverty Guideline.
Part VI Line 4		In WVUH-Easts extended service area, Morgan County has a population of 17,541, with an average household income of 35,016 and an unemployment rate of 9.0. 10.4 of Morgan County residents currently live below 2010 Federal Poverty Guidelines.
Part VI Line 5		The 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 neither employees nor contractors of the organization, nor family members thereof.
Part VI Line 5		CHI extends privileges to all qualified medical staff in Berkeley County and surrounding communities to meet its healthcare needs.
Part VI Line 5		CHI 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 5		In 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 2011 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 5		Our 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 6		CHI 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 6		System 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.

Schedule H (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
City Hospital Inc

Employer identification number
55-0383321

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) City Hospital Foundation2000 Foundation Way Suite 2310 Martinsburg,WV25401	31-1118075	501c3	300,000	Support
(2) WVUH-East Inc2000 Foundation Way Suite 2310 Martinsburg,WV25401	20-2337985	501c3	12,003	Support

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
I	2	City Hospital provides physician support to UPC-East Services to help UPC-East Services meet the mission of both City Hopsital and WVUH-East Services. City Hospital also contributed suppport this year to City Hospital Foundation as part of a capital campaign drive that the Foundation is running. During 2011 City Hospital provided support to related parties to help further the exempt purpose of the organization.

Schedule I (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

City Hospital Inc

Employer identification number

55-0383321

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) Anthony Zelenka	(i) (ii)	243,890	11,770	910		32,238	288,808
(2) Donna Clews	(i) (ii)	148,133		707		7,752	156,592
(3) Linda Campbell Jones	(i) (ii)	214,330		298		17,507	232,135
(4) Jason T White	(i) (ii)	202,751		62		32,238	235,051
(5) Robert C Johnson Jr	(i) (ii)	199,225		48		28,436	227,709
(6) Mark D Kovacs	(i) (ii)	198,181		45		33,238	231,464
(7) Donna Hupp Baker	(i) (ii)	192,270		258		10,901	203,429

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation

Schedule J (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

City Hospital Inc

Employer identification number

55-0383321

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Panhandle Medical Associates	Jeffrey B DeBord, DO	130,400	Payment for medical services		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
IV	1	Jeffrey B DeBord, DO owns greater than 5 of Panhandle Medical Associates. Panhandle Medical Associates provides contracted medical services to City Hospital Inc.

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

City Hospital Inc

Employer identification number

55-0383321

Identifier	Return Reference	Explanation
Form 990 Part IV	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	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	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	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	19	All financial and governing documents are retained onsite and are made available to the public upon request.
Form 990 Part XI	5	The amount on line 5 Other changes in net assets or fund balance includes 1,802,928 of unrealized gains, 249,806 Change in restricted net assets, 2,177 contribution from City Foundation of comfort items for the oncology department posted to net assets on the financial statements and reported as contribution revenue on the Form 990, Hospitalists Net AR of 63,737, 1,627,973 of related organization capitalization, and 2,000 capital stock transfered from WVUH-Enterprises that was merged into City Hospital January 31, 2011.
Form 990 Part III Program Service Accomplishments	Line 4d Other Activities	Program Service Expenses 51,597,389, Grants and allocations 314,403, Revenue 25,714,441 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 Program Service Accomplishments	Line 4d Other Activities	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 Program Service Accomplishments	Line 4d Other Activities	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 Program Service Accomplishments	Line 4d Other Activities	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 III, Line 4d Program Service Expenses 51,597,389, Grants and allocations 314,403, Revenue 25,714,441 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 are retained onsite and are made available to the public upon request. Form 990 Part XI Line 5 The amount on line 5 Other changes in net assets or fund balance includes 1,802,928 of unrealized gains, 249,806 Change in restricted net assets, 2,177 contribution from City Foundation of comfort items for the oncology department posted to net assets on the financial statements and reported as contribution revenue on the Form 990, Hospitalists Net AR of 63,737, 1,627,973 of related organization capitalization, and 2,000 capital stock transfered from WVUH-Enterprises that was merged into City Hospital January 31, 2011.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

City Hospital Inc

Employer identification number

55-0383321

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) West Virginia United Health System Inc 1000 Technology Drive Fairmont,WV26554 55-0754713	Healthcare Access	WV	501C3	11 a	N/A		No
(2) West Virginia University Hospitals PO Box 8034 Morgantown,WV26506 55-0643304	Patient Care	WV	501C3	3	WV United Health System	Yes
(3) West Virginia University Hospitals - East Inc 2000 Foundation Way Martinsburg,WV25401 20-2337985	Patient Access	WV	501C3	11a	WVU Hospitals Inc	Yes
(4) Jefferson Memorial Hospital Inc 2000 Foundation Way Martinsburg,WV25401 55-0359755	Patient Care	WV	501C3	3	WVUH-East Inc	Yes
(5) City Hospital Foundation 2000 Foundation Way Martinsburg,WV25401 31-1118075	Hospital Support	WV	501C3	11a	N/A		No
(6) Jefferson Healthcare Foundation Inc 2000 Foundation Way Martinsburg,WV25401 55-0768901	Hospital Support	WV	501C3	11a	N/A		No
(7) WVUH-East Services Inc 2000 Foundation Way Martinsburg,WV25401 31-1118076	Patient Care	WV	501C3	3	WVUH-East Inc	Yes
(8) United Health Foundation 327 Medical Park Drive Bridgeport,WV26330 55-0621706	Hospital Support	WV	501C3	11a	N/A		No
(9) United Hospital Center Inc 327 Medical Park Drive Bridgeport,WV26330 55-0525724	Patient Care	WV	501C3	3	WV United Health System	Yes
(10) United Physicians Care Inc 686 South Pike Street Shinnston,WV26431 55-0638563	Patient Care	WV	501C3	3	N/A		No
(11) United Summit Center Inc 6 Hospital Plaza Clarksburg,WV26301 55-0752788	Behavioral Health	WV	501C3	3	N/A		No
(12) West Virginia Health Care Co-Op PO Box 8059 Morgantown,WV26506 55-0650441	Support	WV	501C3	11a	WV United Health System	Yes
(13) Camden-Clark Memorial Hospital 800 Garfield Ave Parkersburg,WV26102 31-1524546	Patient Care	WV	501C3	3	WV United Health System	Yes
(14) Camden-Clark Health Services 800 Garfield Ave Parkersburg,WV26102 55-0769602	Healthcare Access	WV	501C3	11a, I	N/A		No
(15) Camden-Clark Foundation 800 Garfield Ave Parkersburg,WV26102 55-0667789	Support	WV	501C3	11a	N/A		No
(16) Camden-Clark Physician Corp 604 Ann Street Parkersburg,WV26102 26-4058719	Patient Care	WV	501C3	11a, I	N/A		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(h) Percentage ownership
(1) Allied Health Services Inc PO Box 782 Morgantown,WV26507 55-0652017	Medical Lab	WV	WV United Health System	C Corp	-301,353	100.000 %
(2) West Virginia United Insurance Services Inc 1000 Technology Drive Suite 2320 Fairmont,WV26554 55-0756055	Provider Network	WV	WV United Health System	C Corp	-5,878	100.000 %
(3) WVUH-East Enterprises 2000 Foundation Way Martinsburg,WV25401 55-0653982	Medical Equip	WV	WVUH-East Inc	C Corp	70,009	100.000 %

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) West Virginia University Hospitals-East Inc	o	9,547,435	Cost
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

1	Briefly describe the organization’s mission or most significant activities: City 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.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	14
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	1,376
6	Total number of volunteers (estimate if necessary) ....	6	91
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	752,164
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-8,507

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	18,390	159,278
9	Program service revenue (Part VIII, line 2g) .........	122,008,270	140,692,833
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	878,976	681,952
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,779,750	1,805,675
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	124,685,386	143,339,738
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	4,335,415	314,403
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	59,670,788	61,573,352
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	60,058,968	76,084,231
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	124,065,171	137,971,986
19	Revenue less expenses. Subtract line 18 from line 12.......	620,215	5,367,752
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	94,664,400	107,836,793
21	Total liabilities (Part X, line 26).............	69,146,750	80,196,400
22	Net assets or fund balances. Subtract line 21 from line 20.....	25,517,650	27,640,393

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 45,432,543 including grants of $ ) (Revenue $ 98,445,380 )
	City 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 2011, City Hospital documented 136,292 ancillary tests, and 2,347 observation visits.

4b	(Code: ) (Expenses $ 4,476,349 including grants of $ ) (Revenue $ 9,699,563 )
	The 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 2011 totaled 7,945.

4c	(Code: ) (Expenses $ 3,850,440 including grants of $ ) (Revenue $ 8,343,315 )
	In 2011 at City Hospital, we performed approximately 3,202 GI Endoscopy procedures with associated pre-surgical testing making it one of the top revenue generating services for that fiscal year. We also replaced one equipment tower with all High Definition technology in 2011 and replaced the 3 remaining towers and all GI scopes with High Definition in 2012. High Definition is the latest technology in endoscopy equipment. High resolution and color results in improved visualization.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 51,597,389 including grants of $ 314,403 ) (Revenue $ 25,714,441 )
4e	Total program service expenses$ 105,356,721

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,510,063	163,135

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Donna Clews VP of Nursing	40.00	X		148,840	0	7,752
(19) Linda Campbell Jones Chief CRNA	40.00		X	214,628	0	17,507
(20) Jason T White Assistant Chief CRNA	40.00		X	202,813	0	32,238
(21) Robert C Johnson Jr CRNA	40.00		X	199,273	0	28,436
(22) Mark D Kovacs CRNA	40.00		X	198,226	0	33,238
(23) Donna Hupp Baker CRNA	40.00		X	192,528	0	10,901

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		152,685
e	Government grants (contributions)1e		6,593

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$ 2,177
h	Total. Add lines 1a-1f.......			159,278
			Business Code
2a	Patient Services			139,174,941	139,174,941
b	Wellness Center			742,226	742,226
c	Patient Pharmacy			775,666	775,666
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			140,692,833
3	Investment income (including dividends, interest
	and other similar amounts).....			1,193,640	1,193,640
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross rents	60,938
b	Less: rental expenses
c	Rental income or (loss)	60,938
d	Net rental income or (loss).......			60,938			60,938
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses		511,688
c	Gain or (loss)		-511,688
d	Net gain or (loss)..........			-511,688			-511,688
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	Partnership Passthrough Income			752,164		752,164
b	Cafeteria Income			348,926			348,926
c	Cash Discounts			327,421			327,421
d	All other revenue ....			316,226	316,226
e	Total. Add lines 11a–11d ......			1,744,737
12	Total revenue. See Instructions....			143,339,738	142,202,699	752,164	225,597


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			43,010	1	284,197
2	Savings and temporary cash investments .......			18,960,480	2	29,696,025
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			12,841,702	4	14,632,710
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............			1,336,500	7	655,276
8	Inventories for sale or use ..............			1,777,782	8	1,954,541
9	Prepaid expenses and deferred charges ............			359,773	9	354,034
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	112,412,372
b	Less: accumulated depreciation. .....	10b	61,157,765	41,817,952	10c	51,254,607
11	Investments—publicly traded securities ..........			13,004,060	11	76,010
12	Investments—other securities. See Part IV, line 11 ......				12	2,663,680
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			4,523,141	15	6,265,713
16	Total assets. Add lines 1 through 15 (must equal line 34)...			94,664,400	16	107,836,793
17	Accounts payable and accrued expenses .			9,198,849	17	12,206,103
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........			48,383,698	20	53,299,806
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			11,564,203	25	14,690,491
26	Total liabilities. Add lines 17 through 25.....			69,146,750	26	80,196,400
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			25,205,594	27	27,326,335
28	Temporarily restricted net assets .....			312,056	28	312,058
29	Permanently restricted net assets .....				29	2,000
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			25,517,650	33	27,640,393
34	Total liabilities and net assets/fund balances .....			94,664,400	34	107,836,793