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
UNITED HOSPITAL CENTER INC
Employer identification number
55-0525724
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)
(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)
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
Total
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.
0
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..
0
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.)
0
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
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000175
Software Version:
-
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
UNITED HOSPITAL CENTER INC
Employer identification number
55-0525724
Identifier
Return Reference
Explanation
Pt VI, Line 2
It is the goal of UHC to maintain the highest of competence of its board of directors.
Therefore on occassion certain members of the Board of Directors
may also have a business relationship with the hospital. An example would be a Lawyer whose
law firm represents UHC or a bank officer in which UHC has business
accounts. All business relationships are disclosed in annual conflict
of interest statements and the Board members are encouraged to obstain from
any votes that would appear to be a conflict of interest.
Pt VI, Line 11a
The annual Form 990 is presented to the Hospital's Finance Committee of the Board of Directors for review.
Pt VI, Line 12c
On an annual basis education is provided to all Officers and Board of Directors with respect to their fiduciary
responsibilities and what may or may not be considered a conflict of interest. This education is
provided by the hospital's in house general counsel. All officers and
board of directors are required to complete an annual conflict of interest
and disclosure statement. These statements are maintained by the hospital's in house general counsel
and specifically reviewed as necessary based on business presented to the Board of Directors.
Pt VI, Line 15
It is the compensation philosophy of UHC to pay fair and competitive wages to
all employees. Annual wage comparisons are performed by the hospital's
human resources department. In addition the organizations CEO and other officers and key employees an
additional review is performed every two years by an independent consultant. Any recommended changes in compensation
for the CEO and other officers or key employees must be approved
by the Compensation Committee of the Board of Directors. In addition the minutes
of such approval must be ratified by members of the board.
Pt VI, Line 19
All governing documents conflict of interest policy and financial statements are available to the public upon request.
Form 990, Part IV, Line 12A
The consolidated financial statements are audited at the system level.
Even though the audit is performed at the system level each hospital's
Audit Finance Committee members participates in the annual
planning with the independent auditors. In addition the individual
Form 990, Part III, Line 4d
THE UNITED HOSPITAL CENTER'S RESPITORY CARE, PHARMACY, NURSING DEPARTMENTS AND 27903. 0. 0. IN AN EFFORT TO INFORM THE COMMUNITY ABOUT THE AVAILABILITY OF HEALTH SERVICES, 62342. 0. 0. UNITED HOSPITAL ASSOCIATES PARTICIPATED IN HEALTH FAIRS/SCREENINGS FOR THE 3362. 0. 0. UNITED HOSPITAL CENTER CONDUCTED, THROUGH THE EDUCATION DEPARTMENT, A DIABETES 19650. 0. 0. UHC SPONSORS AN ANNUAL PATHOLOGY SEMINAR THAT IS ORGANIZED BY ONE OF ITS STAFF 12770. 0. 0. UNITED HSOPITAL CENTER IS ONE OF THE LARGEST
hospital's audit finance members have special meetings to review
the audit report SAS 114 and SAS 115 and the Constructive Service Letter
with the auditors. The SAS 115 and CSL are detailed by hospital where
deficiencies are identified. The audit work itself is actually done at the individual facility level.
Form 990, Part VIII, Line 2a - 2e
Income from patient services other than medicare and medicaid enables the hospital
to serve the remaining population. Medicare and Medicaid payments
received enable the hospital to better serve the Medicare/Medicaid
population of the surrounding communities.In order to keep
patient costs to minimum discounts are utilized when offered by the hospital vendors.
Form 990, Part XII, Line 2c
The consolidated financial statements are audited at the system level.
Even though the audit is performed at the system level each hospital's
Audit Finance Committee members participates in the annual
planning with the independent auditors. In addition the individual
hospital's audit finance members have special meetings to review
the audit report SAS 114 and SAS 115 and the Constructive Service Letter
with the auditors. The SAS 115 and CSL are detailed by hospital where
deficiencies are identified. The audit work itself is actually done at the individual facility level.
Schedule K Footnotes
West Virginia University Hospitals, Inc., EIN 55-0643304 ("WVUH"), City
Hospital, Inc., EIN 55-0383321 ("City Hospital"), The Charles Town General Hospital d/b/a
Jefferson Memorial Hospital, EIN 55-0359755 ("Jefferson Memorial General Hospital"), City
Hospital Foundation, Inc., EIN 55-XXX-XX-XXXX ("City Hospital Foundation"), and United Hospital
Center, Inc, EIN 55-0525724 ("United Hospital Center")and Camden Clark Health Services, EIN
55-0769602 ("Camden Clark") are members of the West Virginia United
Health System Obligated Group and have issued tax-exempt bonds under West Virginia United
Health System. However, these bond issuances were in turn reallocated by West Virginia United
Health System to its system obligated group members. For purposes of reporting bond issuance
allocations on Schedule K to the Internal Revenue Service, United Hospital Center is reporting bond allocations
issued to it on the Schedule K attached to this tax return.
For each series identified in Schedule K, Part I, the taxpayer will reconcile the series
amount reported in this tax return and the tax return filed by WVUH (the obilgated group agent)
to the applicable 8038 filed with the IRS for each bond issuance. Each bond series is
reported on the appropriate Form 990,Schedule K, only once in this matter.
Schedule K, Part I, Line A, Column (f)
The 2006 Series A Bonds (issue price - $80,036,762, CUSIP 956622XA7) were issued collectively with 2006 Series B Bonds (issue price
- $46,150,000, CUSIP 956622WK6), 2006 Series C Bonds (issue price - $46,500,000, CUSIP
956622WL4) and 2006 Series D Bonds (issue price - $60,375,000, CUSIP 956622WM2) totaling
$233,061,762 (total issue price for all four series reported on Form 8038 for June 8, 2006
issuance). 2006 Series B Bonds were refunded by 2008 Series A Bonds and are reported on
Schedule K, Part I, Line B of this tax return. 2006 Series C Bonds were refunded by 2008 Series B
Bonds and are reported on Schedule K, Part I, Line C of this tax return. 2006 Series D Bonds were
refunded by 2008 Series C Bonds, which were refunded by 2009 Series C Bonds and are reported on Schedule K, Part I, Line D of this tax return.
The purpose of the 2006 Series A Bonds, together with the 2006 Series B Bonds, the 2006 Series C
Bonds and the 2006 Series D Bonds, was to fund construction of new hospital facilities owned by United Hospital Center.
Schedule K, Part I, Line B, Column (f)
The 2008 Series A Bonds (issue price - $46,420,000, CUSIP number 956622YE8) were issued collectively with 2008 Series B Bonds
(issue price - $46,765,000, CUSIP number 956622YD0), 2008 Series C Bonds (issue price -
$60,725,000, CUSIP number 956622YF5) and 2008 Series D Bonds (issue price -
$27,115,000, CUSIP number 956622YG3) totaling $181,025,000 (total issue price for all four
reported on Form 8038 for August 29, 2008 issuance). 2008 Series B Bonds are reported on
Schedule K, Part I, Line C of this tax return. 2008 Series C Bonds, which were refunded by 2009
Series C Bonds and are reported on Schedule K, Part I, Line D of this tax return and the 2008
Series D Bonds were allocated to WVUH and are reported on the tax return filed by such taxpayer.
The purpose of the 2006 Series A Bonds, together with the 2008 Series A bonds (originally issued
as 2006 Series B Bonds), the 2008 Series B Bonds (originally issued as 2006 Series C Bonds) and
the 2009 Series C Bonds (originally issued as 2006 Series D Bonds), was to fund construction of new hospital facilities owned by United Hospital Center.
Schedule K, Part I, Line C, Column (f)
The 2008 Series B Bonds (issue price - $46,765,000, CUSIP number 956622YD0) were issued collectively with 2008 Series A
Bonds (issue price - $46,420,000, CUSIP number 956622YE8), 2008 Series C Bonds (issue
price - $60,725,000, CUSIP number 956622YF5) and 2008 Series D Bonds (issue price -
$27,115,000, CUSIP number 956622YG3) totaling $181,025,000 (total issue price for all four
reported on Form 8038 for August 29, 2008 issuance). 2008 Series A Bonds are reported on
Schedule K, Part I, Line B of this tax return. 2008 Series C Bonds, which were refunded by 2009
Series C Bonds and are reported on Schedule K, Part I, Line D of this tax return and the 2008
Series D Bonds were allocated to WVUH and are reported on the tax return filed by such taxpayer.
The purpose of the 2006 Series A Bonds, together with the 2008 Series A bonds (originally issued
as 2006 Series B Bonds), the 2008 Series B Bonds (originally issued as 2006 Series C Bonds) and
the 2009 Series C Bonds (originally issued as 2006 Series D Bonds), was to fund construction of new hospital facilities owned by United Hospital Center.
Schedule K, Part I, Line D, Column (f)
The 2009 C Series Bonds were issued as one series but were allocated within the Obligated Group to WVUH and City Hospital (issue price -
$31,894,128.04) and United Hospital Center (issue price - $69,402,501.06). The total issue price
for the 2009 Series C Bonds was $101,296,629.10 (consistent with total issue price reported on
Form 8038 for December 17, 2009 issuance, CUSIP 956622D27). The portion of the 2009
Series C Bonds allocated to WVUH and its subsidiary is reported on the tax return filed by such taxpayer.
The purpose of the 2006 Series A Bonds, together with the 2008 Series A bonds (originally issued
as 2006 Series B Bonds), the 2008 Series B Bonds (originally issued as 2006 Series C Bonds) and
the 2009 Series C Bonds (originally issued as 2006 Series D Bonds), was to fund construction of
new hospital facilities owned by United Hospital Center.
Part VIII, Line 11f
Contributions reported on line 11f differs from the amount reported on
Schedule B due to pledge receivable being recorded as revenue primarily in 2007 and 2008.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.