Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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)
West Virginia University Hospitals Inc |
550643304 | 3 | Yes | 0 | 9,491,652 | |
| (B)
United Hospital Center |
550525724 | 3 | Yes | 0 | 2,824,764 | |
| (C)
Camden-Clark Memorial Hospital |
311524546 | 3 | Yes | 0 | 2,590,810 | |
|
Total 3
|
14,907,226 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, 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 2019. 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 2020. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Part I Section A Line 9 The amounts of support being reported for West Virginia University Hospitals, Inc., United Hospital 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. |
| Return Reference | Explanation |
|---|---|
| Part IV Section B Line 6 | WVUHS supports West Virginia University Hospitals, Inc., United Hospital Center, and Camden Clark Memorial Hospital as well as their supported hospitals. West Virginia United Health System, Inc. dba West Virginia University Health System WVUHS was formed to serve as a part of an integrated health science and healthcare delivery system. WVUHS functions to provide strategic leadership, oversight, and centralized support services for member hospitals and affiliated organizations which allow those |
| Part IV Section B Line 1 | Per Article 3 of the WVUHS Bylaws. The Corporation shall possess all of the powers granted to a corporation pursuant to the West Virginia Nonprofit Corporation Act W. Va. Code sub-section 31E-1-101 et seq. In addition, the Corporation shall have, unless set forth otherwise in a Subsidiarys governing document, the following powers with respect to each Hospital and each Subsidiary of a Hospital. |
| Part IV Section B Line 1 | For the purposes of these Bylaws, Hospital shall mean West Virginia University Hospitals, Inc., United Hospital Center, Inc. Elect and remove any member or members of each Hospitals and Subsidiarys governing board consistent with, if applicable, the requirements for consumer representatives on the boards of licensed hospitals as stated in the West Virginia hospital licensing regulations at 64 CSR 12 sub-section 64-12-7. |
| Software ID: | 19009610 |
| Software Version: | 19.2.1.0 |
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 WVUHS are leased from a related entity, WVU Hospitals, Inc. EIN 55-0643304. Under these terms, WVU Hospitals, Inc. completes and files all payroll tax filings. |
| Form 990, Part VI, Section B, Line 11b | The Form 990 is prepared by the WVUHS Tax Team 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 the 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 general counsel and the Chief Compliance Officer. 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 15a 15b | The System engages an independent group to perform an executive compensation review and compensation survey annually. 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. Full compensation surveys were completed for 2017, 2018, and 2019 compensation amounts, with data provided by the independent consultant to the compensation committee. |
| 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 WVUHS are leased from a related entity, WVU Hospitals, Inc. EIN 55-0643304. WVUHS reimburses WVUH and other related parties for salary, benefits, and applicable taxes for WVUHS employees and for a portion of compensation paid to Melissa McCoy, Darin Rogers, Karen Bowling, Frank Briggs and Anthony Condia as their time is split between WVUHS, WVUH and other related parties. The appropriate 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 | The 47,270,574 change in net assets is 47,70,573 transfers from affiliates and 1 rounding. |
| Form 990, Part IV, Line 14b | Form 926 - STATEMENT PURSUANT TO Section 1.351-3a BY West Virginia United Health System, Inc., A SIGNIFICANT TRANSFEROR 1 Name and employer identification number of transferee corporation Name Augusta Insurance Company, Ltd. EIN 98-1399333 2 Date of transfers of assets 12/01/2019 3 Aggregate Fair Market Value and Basis of Property Transferred Fair Market Value 7,041,482 Cash, Basis 7,041,482 4 Date and control number of private letter rulings issued by the IRS in connection with the exchange N/A |
| Form 990, Part IV, Line 14b | The following is additional information as required by Treasury Regulation Section 1.6038B-1c and Temporary Regulation Sections 1-6038B-1Tc5 and 1.6038-1Td. Transferor - West Virginia United Health System d/b/a West Virginia University Health System FEIN - 55-0754713 Address PO Box 8034, Morgantown, WV 26505. Transferee Augusta Insurance Company, Ltd. FEIN - 98-1399333 Address PO Box 69 Grand Cayman, Cayman Islands KY1-1102 Incorporated in the Cayman Islands. Property Transferred The Transferor transferred cash i.e., Active Business Property of 7,041,482 that represented non-taxable deposits or constructive capital contributions to the Transferee in 2019. Consideration Received no shares were issued under the Meaningless Gesture Doctrine Transfer of Property of a Foreign Branch with Previously Deducted Losses Under Treasury Regulation Sections 1.367A-6 and -6T, not applicable Transfer of Property Under Internal Revenue Code Section 367A5, not applicable |
| Software ID: | 19009610 |
| Software Version: | 19.2.1.0 |