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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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 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 monetary support
Yes
No
Yes
No
Yes
No
(A)
West Virginia University Hospitals Inc
550643304
3
Yes
Yes
Yes
8,863,383
(B)
United Hospital Center
550525724
3
Yes
Yes
Yes
4,024,961
(C)
Camden-Clark Memorial Hospital
311524546
3
Yes
Yes
Yes
4,523,784
Total
17,412,128
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
0 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
If the organization did not check a 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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
0 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Part I Line H The amounts of support being reported for West Virginia University Hospitals, Inc., United Hosptial Center, and Camden Clark Memorial Hospital are 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) 2013
Additional Data
Software ID:
13000230
Software Version:
13.6.0.0
-
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
West Virginia United Health System Inc
Employer identification number
55-0754713
Return Reference
Explanation
Form 990, Part III, Line 4d
Program Service Expenses 0, Grants and allocations 0, Revenue 0 2 WVUHS facilities share information in clinical areas to streamline development of healthcare plans and implementation efforts. Shared protocols include stroke care, developed at WVU Hospitals, a JCAHO-accredited Stroke Treatment Center, and shared with United Hospital Center and in modified form with West Virginia University Hospitals - East, Inc d/b/a University Healthcare facilities in the Eastern Panhandle interventional cardiology services angioplasties without on-site surgical back-up, developed at United Hospital Center, and shared with West Virginia University Hospitals - East, Inc. d/b/a University Healthcare.
Form 990, Part III, Line 4d
Program Service Expenses 0, Grants and allocations 0, Revenue 0 3 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.
Form 990, Part III, Line 4d
Program Service Expenses 0, Grants and allocations 0, Revenue 0 4 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. The Quality Blue program brought cohesion and sharing of best practices between hospital Quality Improvement staff.
Form 990, Part III, Line 4d
Program Service Expenses 0, Grants and allocations 0, Revenue 0 5 There is a focus on both quality care and satisfaction at the system level the WVUHS Board of Directors continuously looks at Clinical Quality and Patient Satisfaction dashboards which track results from each facility.
Form 990, Part III, Line 2
In 2013, Legal Services became a program of WVUHS. In 2013, Legal Services consisted of the Vice President and General Counsel of WVUHS, the Associate Collections Counsel of WVUHS, and the Associate Collection Counsels staff. The Vice President and Legal Counsel oversees the general legal affairs of WVUHS and its subsidiaries. The Vice President and general Counsel also served on a day-to-day basis as the Vice President and General Counsel of WVUHS subsidiary, West Virginia University Hospitals, Inc. WVUH, and each of WVUHs subsidiaries. The purpose of the WVUHS Legal Services Department is to ensure that WVUHS and its subsidiaries operate in compliance with all applicable laws, to reduce the legal costs incurred by WVUHS and its subsidiaries, to maximize collections, and to minimize collection costs.
Form 990, Part IV, Line 12b
WVUHS chose to prepare Schedule D Parts XI - XII 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 WVUHS are leased from a related entity, WVU Hospitals, Inc. EIN 55-0643304. Under these terms, WVU Hospitals, Inc. files all payroll tax filings.
Form 990, Part VI, Section A, Line 1ab
Board members considered not independent are considered so because of compensation received from the organization.
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 Officers, Directors and 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 every two years. This information is provided to the compensation committee which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compensation package does not exceed fair market value based on the data from the consultant group. The minutes of the compensation committee are contemporaneously documented and retained. A full compensation survey was completed in 2012 for 2013 compensation amounts, with data provided by the independent consultant to the compensation committee in 2012. Interim data is provided to the committee on a case by case basis.
Form 990, Part VI, Section C, Line 19
All financial and governing documents along with Board of Director Conflict of Interest statements are made available during regular business hours at the business office. In accordance with West Virginia Legislative code every member of the board shall file a written statement, which shall be fully available for public disclosure, with the appropriate chairman of the board.
Form 990, Part VII, Section A, Line 1-29
The employees of the WVUHS are leased from a related entity, WVU Hospitals, Inc. EIN 55-0643304. WVUHS reimburses WVUH for salary, benefits, and applicable taxes for WVUHS employees and for a portion of Richard Kings salary as his time is split between WVUHS and WVUH. Those salary expenses are reflected in Part IX Line 5 of this return.
Form 990, Part VII, 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 9
Other changes in net assets reported on line 9 consists of reimbursements to member hospitals for capital items in the amount of 16,865.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.