Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
City Hospital Inc |
550383321 | 3 | Yes | 0 | 1,139,500 | |
| (B)
Jefferson Memorial Hospital |
550359755 | 3 | Yes | 0 | 179,940 | |
|
Total 2
|
1,319,440 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2018 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Part I Section A Line 12 The amount of support being reported for City Hospital, Inc. and Jefferson Memorial Hospital is the annual amount of savings realized by each company through the use of the WV United Health Systems purchasing discounts and through the combining of other necessary expenses by being a part of West Virginia University Hospitals - East WVUH-East such as the annual audit, legal fees, benchmarking, hospital reviews, and a wide range of other expenses. |
| Return Reference | Explanation |
|---|---|
| Part IV Section A Line 6 | WVUHE is a party to a Joint Operating Agreement with WVUH, WVUHS, University Healthcare Physicians, Inc. and West Virginia University and its School of Medicine. UHP is the practice plan of WVUs clinical faculty in the Eastern Pandhandle of WV i.e., the geographic area served by WVUHE. |
| Part IV Section A Line 6 | Through the agreement and in compliance with federal fraud and abuse laws, WVUHE and UHP seek to integrate their mission and purpose, clinical activities, and economic and financial activities to more efficiently and effectively provide better care to patients and better support the education, service and research missions of WVUSM. Among other things, through the terms of the JOA, WVUHE agrees to provide UHP with annual financial support. |
| Part IV Section B Line 1 | Pursuant to the corporate bylaws of City Hospital, Inc. and Jefferson Memorial Hospital, as the sole member, WVUHE has the following powers subject to the reserved powers of WVUH, which is the sole member of WVUHE - meaning that WVUHE can do these things but then must obtain approval from WVUH in some instances 1 appoint and remove BMC and JMCs board members 2 approve amendments to the AOIs and bylaws of each organization 3 approve any merger or consolidation of either organization |
| Part IV Section B Line 1 | 4 approve the sale, lease, exchange, mortgage, pledge, or other disposition of all or substantially all of the organizations property or assets 5 approve of the dissolution of either organization 6 approve capital projects above a financial threshold and other aspects of strategic planning CONs, etc. and 7 to take certain actions irrespective of whether the BMC or JMC Boards acted, including to appoint or remove the President / CEO after consultation with the Board. |
| Software ID: | 18007340 |
| Software Version: | 19.1.1.0 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part V, Line 2a 2b | The employees of West Virginia University Hospitals - East, Inc. WVUH-East are paid by City Hospital, Inc. CHI, Jefferson Memorial Hospital JMH, and WVU Hospitals, Inc. WVUH. The related payroll filings are prepared by those entities under common paymaster arrangements. |
| Form 990, Part VI, Section B, Line 11b | The Form 990 is prepared by the WVUH accounting department, it is then reviewed by the WVUH-East Vice President of Finance. Upon approval by the Vice President of Finance, it is then submitted to be reviewed by the external independent auditing firm of WVUH-East. After that review, it is provided to all board members for final review and approval before filing with the IRS. |
| Form 990, Part VI, Section B, Line 12c | Annually, all officers, members of management and board members are required to disclose any relationships which potentially give rise to a 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 C, Line 15a 15b | Salaries of all officers are subject to the approval of a board designated compensation committee. The committee uses the work of an independent salary and benefit consultant to determine the compensation packages to be made available to officers and that the compensation does not exceed fair market value of comparable positions at similar organizations. All data is retained and all decisions are appropriately documented pertaining to the compensation setting practices. This review occurs annually and was last completed in 2017 for 2018 compensation amounts. |
| Form 990, Part VI, Section C, Line 19 | All financial and governing documents including the conflict of interest policy are available upon request at the WVUH - East Administration office during normal business hours. |
| Form 990, Part VII, Section A, Line 16 | All WVUH-East employees are paid by West Virginia University Hospitals, Inc. WVUH EIN 55-0643304, City Hospital, Inc. EIN 55-0383321 or Jefferson Memorial Hospital EIN 55-0359755 under common paymaster arrangements. However, WVUH-East is responsible for the salary and benefit expense incurred for these employees and appropriately reimburses WVUH, CHI, or JMH for the salary expense incurred on its behalf. Those salary expenses are reflected in Part IX line 5 of this return. A portion of Teresa McCabes salary is the responsibility of University Healthcare Foundation EIN 31-1118075. The Foundation reimburses CHI for the apportioned amount of salary and benefits per a paymaster arrangement. |
| Form 990, Part IX, Line 11g | The detail for other fees for services is as follows Consulting and Professional Fees 11,459 all of which is considered management and general expense Contracted Labor of 518,347 consists of 126,509 program service expense and 391,838 management and general expense Contract Labor Patient Care of 682,107 all of which is considered program service expense Contracted and Professional Med Staff Dir of 196,635 all of which is considered program service expense and Collection Agency Fees of 608 all of which is considered management and general expense. |
| Form 990, Part XI, Line 9 | The 3,401,016 other change in net assets is related to the transfer of net assets for 2018, 128,000 donation to Summersville Regional Medical Center and 3,272,716 of capitalized IT expenses paid for by WVUHS and allocated to the WVUH-East. |
| Software ID: | 18007340 |
| Software Version: | 19.1.1.0 |