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. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
West Virginia United Health System Inc
Employer identification number
55-0754713
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
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).
f
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
..................................................
g
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
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(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?
Yes
No
Yes
No
Yes
No
(1)
West Virginia University Hospitals Inc
550643304
3
Yes
Yes
Yes
10,391,606
(2)
United Hospital Center
550525724
3
Yes
Yes
Yes
4,279,316
(3)
Camden-Clark Memorial Hospital
311524546
3
Yes
Yes
Yes
1,376,460
Total
16,047,382
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
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).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
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..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
0 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
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
......................
b
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
.....................
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
..................................................
b
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
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
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.).
14
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.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
0 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
0 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
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
..........
b
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
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
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
Part I Line H The amount of support being reported for West Virginia University Hospitals, Inc., United Hosptial Center, and Camden Clark Memorial Hospital is the annual amount of savings realized by each company through the use of the Systems purchasing discounts and through the combining of other necessary expenses such as the annual audit, legal fees, benchmarking, hospital reviews, and a wide range of other expenses.
Explanation
Schedule A (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.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
West Virginia United Health System Inc
Employer identification number
55-0754713
Identifier
Return Reference
Explanation
Form 990 Part IV
12a
For 2011, WVUHS chose to prepare Schedule D Parts XII - XIII to reconcile the revenue and expenses shown on the consolidated audited financial statements to revenue and expenses for WVUHS shown on the Form 990. This is consistent with the prior year reporting. By reconciling to the audited consolidated statements we allow for greater transparency in reporting.
Form 990 Part V
2ab
The employees of the West Virginia United Health System are paid by a related entity, WVU Hospitals, Inc. EIN 55-0643304 through a common paymaster relationship. Under these terms, the paymaster files all payroll tax filings.
Form 990 Part VI
1ab
Board members considered not independent are considered so because of wages received from the organization or due to a system entity contracting business with a company owned 5 or more by the board member.
Form 990 Part VI
4
The Bylaws of WVUHS were updated in January 2011 to reflect WVUHS becoming the sole member of Camden-Clark Health Services CCHS. The composition of the WVUHS Board of Directors was changed to allow for 5 of the 10 Community representatives on the board to be nominated by CCHS.
Form 990 Part VI
11b
The Form 990 is prepared by the WVU Hospitals accounting department and is then submitted to be reviewed by the external independent audit firm of the System. After the external review is completed the Form 990 is presented to the WVUHS CFO, upon approval from the CFO it is then presented to the audit committee and Board of Directors. Once approved the Form 990 is submitted to the IRS.
Form 990 Part VI
12c
All Board Members are required to annually disclose any relationships which may give rise to a potential conflict of interest. These responses are then tracked by the audit committee, when a conflict arises disclosure of the financial interest and all material facts is provided to the board, and after any discussion with the interested person, he/she shall leave the board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. If the remaining board or committee members decide a conflict exists, procedures outlined in the WVUHS Conflict of Interest Policy may be utilized.
Form 990 Part VI
15ab
The System engages an independent group to perform an executive compensation review and compensation survey. This information is then provided to the compensation committee which is made up of independent board members. The compensation committee is then responsible for setting the compensation packages offered to each executive. The minutes of the compensation committee are contemporaneously documented and retained. This survey was completed in 2011 for 2012 compensation amounts.
Form 990 Part VI
19
All financial and governing documents are made available during regular business hours at the business office.
Form 990 Part VII
All System employees are paid by West Virginia University Hospitals, Inc WVUH EIN 55-0643304 under a common paymaster agreement. WVUHS reimburses WVUH for salary, benefits, and applicable taxes for WVUHS employees and for a portion of Robert Brandfass and Richard Kings salary as their time is split between WVUHS and WVUH. Those salary expenses are reflected in Part IX of this return. Average hours for WVUHS and all related organizations was 50 hours per week for both Robert Brandfass and Richard King.
Form 990 Part XI
1
WVUHS receives and pays invoices for Legal and Accounting Services that have been provided to all system entities. Based on an allocation agreed upon by all entities, the System then bills each entity for their respective portion of that service and the expense is offset by the reimbursements. The amounts reported in Part IX - Statement of Functional Expenses Line 11b and 11c reflect the portion of legal and accounting expense attributable to WVUHS.
Form 990 Part XI
5
Other changes in net assets reported on line 5 consists of Net Unrealized Gains on Investments of 7,945 and 2,257,640 of allocations to member hospitals.
Form 990 Part XII
2c
No changes from prior year.
Form 990 Part III Program Service Accomplishments
Line 4d Other Activities
Program Service Expenses 1,651,283, Grants and allocations 77,690, Revenue 0 Other areas of focus by WVUHS include using the same community benefit data collection and reporting system to ensure accurate documentation of monies spent to improve the health and social status of our communities. In addition, WVUHS hospitals are sharing experiences and plans related to their community health needs assessments, which will direct future use of community benefit funds to achieve targeted health status improvement and community development goals. WVUHS facilities share information in clinical areas to streamline development of plans and implementation efforts. WVU Hospitals, a JCAHO-accredited Stroke Treatment Center, shared its stroke protocols with United Hospital Center in 2009 to improve delivery of services and reduction of treatment times in the region.
Form 990 Part III Program Service Accomplishments
Line 4d Other Activities
Program Service Expenses 0, Grants and allocations 0, Revenue 0 A modified version of those protocols is under development at WVUH-East facilities to improve stroke treatment in the Eastern Panhandle. United Hospital Center, which provides interventional cardiology services angioplasties without on-site surgical back-up, shared its processes and protocols with City Hospital Inc., which allowed it to provide similar services in Martinsburg, WV.
Form 990 Part III Program Service Accomplishments
Line 4d Other Activities
Program Service Expenses 0, Grants and allocations 0, Revenue 0 WVUHS facilities continue to use a common patient satisfaction vendor, Press-Ganey, to allow for comparative review of results and to share best practices within the organization as well as those recommended by Press-Ganey. On January 1, 2012 Camden Clark Medical Center CCMC was added to the WVUHS contract with Press-Ganey at discounted per survey rates available through the System that are attractive to CCMC. WVUHS facilities were the first hospitals in West Virginia to participate in Highmark Blue Cross Blue Shield Quality Blue program, which rewards hospitals for improving key clinical processes, as well as patient outcomes.
Form 990 Part III Program Service Accomplishments
Line 4d Other Activities
Program Service Expenses 0, Grants and allocations 0, Revenue 0 The Quality Blue program brought cohesion and sharing of best practices between hospital Quality Improvement staff. Consequently there is a focus on both quality care and satisfaction at the system level the WVUHS Board of Trustees continuously looks at Clinical Quality and Patient Satisfaction dashboards which track results from each facility. In 2004, WVUHS hospitals purchased Patient Business Folder software, which is an optical imaging software, this allows physicians and other hospital staff to access patient records immediately and more cost effectively than with the existing paper records.
Form 990, Part III, Line 4d Program Service Expenses 1,651,283, Grants and allocations 77,690, Revenue 0 Other areas of focus by WVUHS include using the same community benefit data collection and reporting system to ensure accurate documentation of monies spent to improve the health and social status of our communities. In addition, WVUHS hospitals are sharing experiences and plans related to their community health needs assessments, which will direct future use of community benefit funds to achieve targeted health status improvement and community development goals. WVUHS facilities share information in clinical areas to streamline development of plans and implementation efforts. WVU Hospitals, a JCAHO-accredited Stroke Treatment Center, shared its stroke protocols with United Hospital Center in 2009 to improve delivery of services and reduction of treatment times in the region. Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 A modified version of those protocols is under development at WVUH-East facilities to improve stroke treatment in the Eastern Panhandle. United Hospital Center, which provides interventional cardiology services angioplasties without on-site surgical back-up, shared its processes and protocols with City Hospital Inc., which allowed it to provide similar services in Martinsburg, WV. Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 WVUHS facilities continue to use a common patient satisfaction vendor, Press-Ganey, to allow for comparative review of results and to share best practices within the organization as well as those recommended by Press-Ganey. On January 1, 2012 Camden Clark Medical Center CCMC was added to the WVUHS contract with Press-Ganey at discounted per survey rates available through the System that are attractive to CCMC. WVUHS facilities were the first hospitals in West Virginia to participate in Highmark Blue Cross Blue Shield Quality Blue program, which rewards hospitals for improving key clinical processes, as well as patient outcomes. Form 990, Part III, Line 4d Program Service Expenses 0, Grants and allocations 0, Revenue 0 The Quality Blue program brought cohesion and sharing of best practices between hospital Quality Improvement staff. Consequently there is a focus on both quality care and satisfaction at the system level the WVUHS Board of Trustees continuously looks at Clinical Quality and Patient Satisfaction dashboards which track results from each facility. In 2004, WVUHS hospitals purchased Patient Business Folder software, which is an optical imaging software, this allows physicians and other hospital staff to access patient records immediately and more cost effectively than with the existing paper records. Form 990 Part IV Line 12a For 2011, WVUHS chose to prepare Schedule D Parts XII - XIII to reconcile the revenue and expenses shown on the consolidated audited financial statements to revenue and expenses for WVUHS shown on the Form 990. This is consistent with the prior year reporting. By reconciling to the audited consolidated statements we allow for greater transparency in reporting. Form 990 Part V Line 2ab The employees of the West Virginia United Health System are paid by a related entity, WVU Hospitals, Inc. EIN 55-0643304 through a common paymaster relationship. Under these terms, the paymaster files all payroll tax filings. Form 990 Part VI Section A Line 1ab Board members considered not independent are considered so because of wages received from the organization or due to a system entity contracting business with a company owned 5 or more by the board member. Form 990 Part VI Section A Line 4 The Bylaws of WVUHS were updated in January 2011 to reflect WVUHS becoming the sole member of Camden-Clark Health Services CCHS. The composition of the WVUHS Board of Directors was changed to allow for 5 of the 10 Community representatives on the board to be nominated by CCHS. Form 990 Part VI Section B Line 11b The Form 990 is prepared by the WVU Hospitals accounting department and is then submitted to be reviewed by the external independent audit firm of the System. After the external review is completed the Form 990 is presented to the WVUHS CFO, upon approval from the CFO it is then presented to the audit committee and Board of Directors. Once approved the Form 990 is submitted to the IRS. Form 990 Part VI Section B Line 12c All Board Members are required to annually disclose any relationships which may give rise to a potential conflict of interest. These responses are then tracked by the audit committee, when a conflict arises disclosure of the financial interest and all material facts is provided to the board, and after any discussion with the interested person, he/she shall leave the board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. If the remaining board or committee members decide a conflict exists, procedures outlined in the WVUHS Conflict of Interest Policy may be utilized. Form 990 Part VI Section B Line 15ab The System engages an independent group to perform an executive compensation review and compensation survey. This information is then provided to the compensation committee which is made up of independent board members. The compensation committee is then responsible for setting the compensation packages offered to each executive. The minutes of the compensation committee are contemporaneously documented and retained. This survey was completed in 2011 for 2012 compensation amounts. Form 990 Part VI Section A Line 19 All financial and governing documents are made available during regular business hours at the business office. Form 990 Part VII Section A All System employees are paid by West Virginia University Hospitals, Inc WVUH EIN 55-0643304 under a common paymaster agreement. WVUHS reimburses WVUH for salary, benefits, and applicable taxes for WVUHS employees and for a portion of Robert Brandfass and Richard Kings salary as their time is split between WVUHS and WVUH. Those salary expenses are reflected in Part IX of this return. Average hours for WVUHS and all related organizations was 50 hours per week for both Robert Brandfass and Richard King. Form 990 Part XI Section B Line 1 WVUHS receives and pays invoices for Legal and Accounting Services that have been provided to all system entities. Based on an allocation agreed upon by all entities, the System then bills each entity for their respective portion of that service and the expense is offset by the reimbursements. The amounts reported in Part IX - Statement of Functional Expenses Line 11b and 11c reflect the portion of legal and accounting expense attributable to WVUHS. Form 990 Part XI Line 5 Other changes in net assets reported on line 5 consists of Net Unrealized Gains on Investments of 7,945 and 2,257,640 of allocations to member hospitals. Form 990 Part XII Line 2c No changes from prior year.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.