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
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
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
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
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
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
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
13000170
Software Version:
2013v3.1
-
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
United Hospital Center Inc
Employer identification number
55-0525724
Return Reference
Explanation
Form 990, Part III, Line 4d: Other Program Services Description
OTHER PROGRAM SERVICES 4: United Hospital Center conducted, through the Education Department, a diabetes support group for participants from various counties. There were approximately 315 participants with an expense of $22,500. In addition, staff assisted the indigent patients in the Lilly Cares program for starter insulin and also received viscometers from Bayer Co. to distribute and properly educate patients in the daily monitoring of their blood glucose. OTHER PROGRAM SERVICES 5: OTHER PROGRAM SERVICES 6: United Hospital Center is one of the largest providers of obstetrical services in terms of deliveries and serves as a regional resources for obstetric services. In fulfilling that role, Family Medicine Faculty and residents conduct weekly planning clinics and pediatric clinics for the /Harrison County Health Department, A total expense of $3,640 with 728 persons seen at these clinics. OTHER PROGRAM SERVICES 7: To address other health manpower shortages through the region, UHC's School of Radiological Technology graduated twelve radiology technologist this year. The cost of this program was $262,950 with a tuition revenue of $75,355. In addition, UHC serves as a clinical training site for nursing students from West Virginia Wesleyan College, Fairmont State University, Alderson Broaddus College, United Technical Center, Mongalia Technical center, West Virginia University, Wheeling Jesuit University, Edinboro University and Fred Eberle School of Practical Nursing. OTHER PROGRAM SERVICES 8: UHC's employees volunteer with the Health Occupations Student Association for the United Technical Center and Fairmont State University. UHC's School of Radiologic Technology conducted radiology demonstrations at area schools and participated in high school career days. Total expense was $500 with approximately 900 students. OTHER PROGRAM SERVICES 9: United Hospital Center has representatives serving on several community boards including, but not limited to Family Services of Harrison and Marion Counties, Harrison County Drop-in Advisory Board, WV Network Ethic Advisory Committee, Coalition for the Homeless and Goodwill Advisory Board. In addition, UHC representative were guest speakers at area organizations/events about various health care concerns or issues. OTHER PROGRAM SERVICES 10: UHC provides administrative facilities for the American Cancer Society. In addition, UHC allows some organizations the use of classrooms with no charge. The organizations include but not limited to WV Autism Support Group, Addiction Support Group, Breast Cancer Support Group, Kids Talk Support Group, and Narcotics Anonymous. United Hospital Center also provides a space for the American Red Cross to conduct Blood Drives. In 2013, expenses incurred for the space was $4,500 serving 371 persons. OTHER PROGRAM SERVICES 11: United Hospital Center donates expired or opened unused products for distribution to Third World countries such as Africa and South America. A portion of this year's contribution was sent to Doc to Doc which collects and ships supplies to teaching hospitals, smaller public hospitals, and rural medical clinics in developing countries. OTHER PROGRAM SERVICES 12: UHC also offers rotations for students in the following programs: Emergency Medical Personnel, Medical Record Technology, Pharmacy, Safety Engineering,and Clinical Education for Rehab Students. Rotations for one of the three practicums and internships for counseling students in a masters degree program are provided as needed in cooperation with West Virginia University. OTHER PROGRAM SERVICES 13: The obstetric department also conducts childbirth classes for expecting parents. These classes are for expectant mothers and teaches to practice techniques for the best possible experience in childbirth. Total expenses for these classes were $7,992 with revenue of $2,025. A total of 453 persons participated in the classes. The obstetric department also conducts sibling tours for older siblings to alleviate anxiety for when the new baby arrives.
Form 990, Part VI, Line 11b: Form 990 Review Process
The annual Form 990 is presented to the Hospital's Finance Committee of the Board of Directors for review, prior to filing.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
On an annual basis education is provided to all officers of the Board of Directors with respect to their fiduciary responsibility 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. The statements are maintained by the hospital's in house general counsel and specifically reviewed as necessary based on business presented to the board.
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management
It is the compensation philosophy of UHC to pay fair and competitive wages to all employees. Annual wage comparisons are performed by the Human Resource department of the hospital. The hospital uses the following resources: Databay Resources, Towers Watson, Data Blue Survey, Mercer, and CompData. The organizations CEO and other officers and key employees also have an additional review 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. Also, the minutes of such approval must be ratified by members of the board.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
All governing documents, conflicts of interest policy, and financial statements are available to the public upon request.
Other Changes In Net Assets Or Fund Balances - Other Decreases
Net Asset Transfers = -$1555129
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.