TY 2022 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Doug Coffman...................................................................... Director April 2022-Present	1.00 ................. 41.00	X					0	952,288	25,308
(2) Steve Altmiller...................................................................... President CEO	40.00 ................. 2.50		X				801,758	0	35,213
(3) Walter Kerschl...................................................................... Chief Medical Officer	39.00 ................. 1.00		X				469,400	0	71,112
(4) Sean Smith...................................................................... CCMC VP Operations/WCH President	20.00 ................. 21.00		X				175,575	175,575	64,166
(5) Kyle Pierson...................................................................... VP Finance - West Region	39.00 ................. 1.00		X				307,174	0	66,101
(6) Christine Daniels...................................................................... VP, Nursing	39.00 ................. 1.00		X				315,336	0	32,804
(7) Cynthia Kern...................................................................... Vice President, Quality Patient Safety	39.00 ................. 1.00		X				311,904	0	11,473
(8) MarJean Kennedy...................................................................... VP Mktg Dev Strat Init	39.00 ................. 1.00			X			227,432	0	18,773
(9) Christopher Childress...................................................................... Director of Pharmacy	40.00 .................				X		188,576	0	23,290
(10) Rhonda Boso-Suggs...................................................................... AVP Ancillary Services	40.00 .................				X		183,083	0	27,646
(11) Dorian Williams...................................................................... AVP Support Services	40.00 .................				X		174,233	0	31,995
(12) Gene Sexton...................................................................... Pharmacy Manager	40.00 .................				X		169,559	0	34,214
(13) Candace White...................................................................... Director Surgical Services	40.00 .................				X		179,163	0	17,137
(14) Carlie Lacy...................................................................... VP General Counsel, March - Present	40.00 .................		X				121,570	0	34,412
(15) Mary Jo Shahan...................................................................... Former CCMC Interim CFO 2019	................. 40.00					X	0	149,600	0
(16) Todd Kruger...................................................................... VP General Counsel, January - February	39.00 ................. 1.00		X				115,570	0	24,858
(17) Terry W Capel MD...................................................................... Chairman	1.00 ................. 1.00	X	X				0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
Medical Solutions LLC 1010 N 102nd St Ste 300 Omaha,NE681142122	Staffing Service	20,706,849
United Anesthesia Inc 601 Avery St Ste 501 Parkersburg,WV261015192	Anesthesia Services	6,146,007
Quest Diagnostics 14225 Newbrook Dr Chantilly,VA201512228	Staffing Services	1,245,802
DVA Renal Healthcare Inc PO Box 781607 Philadelphia,PA191781607	Staffing Services	894,096
Parkersburg Cardiology Assoc Inc 600 18th St Ste 512 Parkersburg,WV261013236	Staffing Services	833,553
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 20

- TIN:

SCHEDULE A
(Form 990)

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.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization

Camden-Clark Memorial Hospital Corporation

Employer identification number

31-1524546

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2022

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. 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 ....................... right arrow

33 1/3% support test—2021. 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2022. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2021. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2022

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 on 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.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. 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 ....... right arrow

33 1/3% support tests—2021. 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 ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2022

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2022

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2022

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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 0.015 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 0.035	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2022

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2022 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2022

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2022

Name of the organization

Camden-Clark Memorial Hospital Corporation

Employer identification number

31-1524546

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2022)

Schedule B (Form 990) (2022) Page 2

Name of organization Camden-Clark Memorial Hospital Corporation

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 3

Name of organization Camden-Clark Memorial Hospital Corporation		Employer identification number 31-1524546

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 4


Name of organization Camden-Clark Memorial Hospital Corporation			Employer identification number 31-1524546
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2022)

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Camden-Clark Memorial Hospital Corporation

Employer identification number

31-1524546

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

38,669

Total. Add lines 1c through 1i ....................................................................................................

38,669

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
II-B 1i	The organization paid dues to the American Hospital Association AHA as well as the West Virginia Hospital Association WVHA. A portion of these dues, specifically 38,669, was related to lobbying activities of the AHA and WVHA.

Schedule C (Form 990) 2021

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Camden-Clark Memorial Hospital Corporation

Employer identification number

31-1524546

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	3,369,099		3,369,099
b	Buildings ....	176,383,270	94,479,781	81,903,489
c	Leasehold improvements	454,037	20,951	433,086
d	Equipment ....	191,122,225	163,365,931	27,756,294
e	Other .....	14,580,043	5,287,247	9,292,796
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				122,754,764

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) Financial derivatives and other financial products
(B) Closely-held equity interests
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	23,002,180
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	402,635,785
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	3,067,500
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-13,758,640
e	Add lines 2a through 2d .....................			2e	-10,691,140
3	Subtract line 2e from line 1..................			3	413,326,925
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	-38,429
c	Add lines 4a and 4b....................			4c	-38,429
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	413,288,496

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	385,919,846
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	38,429
e	Add lines 2a through 2d....................			2e	38,429
3	Subtract line 2e from line 1...................			3	385,881,417
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	13,758,640
c	Add lines 4a and 4b.....................			4c	13,758,640
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	399,640,057

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
X 2	Most of the entities that comprise the System are tax-exempt organizations and not subject to federal or state income taxes in accordance with Section 501c3 of the Internal Revenue Code. On such basis, they will not incur any liability for income taxes, except for possible unrelated business income. AHS, WVUIS and GHC are organizations subject to federal and/or state income taxes. The System does not have any material uncertain tax positions as of December 31, 2022 and 2021.
XI 2d	This amount includes 13,758,640 provision for bad debts that was reported as an offset to revenue on the audited financial statements but are reported as an expense on the Form 990.
XI 4b	This amount includes expenses associated with rental property of 38,429 that was reported in Part VIII line 6b as an offset to rental revenue.
XII 4b	This amount includes provision for bad debts of 13,758,640 that were reported as an offset to revenue on the audited financial statements but are reported as an expense on the Form 990.
XII 2d	This amount includes rental expense of 38,429 that is an offset to revenue on Form 990 but an expense on the audited financial statements.

Schedule D (Form 990) 2021

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

Camden-Clark Memorial Hospital Corporation

Employer identification number

31-1524546

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,932,514		1,932,514	0.500 %
b	Medicaid (from Worksheet 3, column a) . . . . .	91,108,856	57,718,494	33,390,362	8.650 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	310,792	310,792
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	93,352,162	58,029,286	35,322,876	9.150 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	16,864	7,250	9,614
f	Health professions education (from Worksheet 5) . . .	220,480	9,295	211,185	0.050 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	216,377		216,377	0.060 %
j	Total. Other Benefits . .	453,721	16,545	437,176	0.110 %
k	Total. Add lines 7d and 7j .	93,805,883	58,045,831	35,760,052	9.260 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support	16,876	16,876
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	16,876	16,876

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,160,613

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

275,695

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

127,142,437

Enter Medicare allowable costs of care relating to payments on line 5.....

208,862,401

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-81,719,964

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2022

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)						Other (describe)	Facility reporting group
1	Camden-Clark Memorial Hospital 800 Garfield Avenue Parkersburg,WV26101 wvumedicine.org/camden-clark/ 102	X	X	X	X	Disproportionate Share Hospital	A

Schedule H (Form 990) 2022

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): https//wvumedicine.org/camden-clark/wp-content/uploads/sites/6/2021/12/CCMC-2021-Community-Health-Ne

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): https//wvumedicine.org/wp-content/uploads/2022/05/2022-CCMC-Community-Health-Needs-Implementation-Pl

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 0000000200.000000000000%
and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

https//wvumedicine.org/bill-pay/financial-assistance/

The FAP application form was widely available on a website (list url):

https//wvumedicine.org/wp-content/uploads/2020/03/Financial-Assistance-Application-Form-3-17-2020.pd

A plain language summary of the FAP was widely available on a website (list url):
https//wvumedicine.org/bill-pay/financial-assistance/

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

Yes

If "Yes," explain in Section C.

Schedule H (Form 990) 2022

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 5	Two primary sources of data were utilized to inform the CHNA 1 a public input survey and 2 a community meeting. The public input survey Appendix C was developed by WVU OHA with the CCMC CHNA leadership team following an iterative process. Survey topics included questions about specific health issues, thoughts on overall health of the community, quality of life, access to health care and medical needs including specialist care, risky behaviors and personal choices, some questions specific to experiences during the COVID-19 pandemic, and demographic information including geographic location and income. Data was collected anonymously from residents age 18 and older. The survey was disseminated via a web-based platform and as hard copies in the community. In addition to a MyChart email blast to patient zip codes in the service area, as well as some more targeted efforts to close demographic gaps, collection efforts included CCMC Pastoral Care Services, Parkersburg-Wood County Area Development Corporation, Social media accounts of local entities, United Way Alliance of the Mid-Ohio Valley, Wood County Development Authority, Wood County Health Department, and WTAP. A full list of Community Partners can be found in the CHNA posted online here https//wvumedicine.org/camden-clark/wp-content/uploads/sites/6/2021/12/CCMC-2021-Community-Health-Needs-AssessmentAdopted-12-7-21.pdf
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 11	The existing secondary data, new survey data, community meeting input, and lessons learned from the last CHNA cycle all factored into CCMC leaderships prioritization decisions. The group considered the degree to which the hospital can realistically affect health outcomes for each topic projects or programs already underway for each, as well as level of importance placed on each by the community relative to the reach of CCMCs impact. Leadership paid particular attention to the demographics of respondents compared to the community, feedback gathered about access to health care, how single women responded to questions about health concerns, as well as other areas and demographics they know to be of particular concern in their community. Within this discussion of where and how the hospital can realistically affect community wellbeing and health outcomes, what they could accomplish with collaboration with partners, and what topics to monitor and revist at a later time, the list of top health concerns was organized into five that will be the focus moving forward with implementation planning.
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 11	Obesity, Chronic Disease, Physical Activity, and Nutrition - During the previous CHNA cycle, obesity and chronic disease appeared among the communitys top health concerns and were prioritized by hospital leadership to address through programming. CCMC implemented strategies to address these health topics, and leadership was not surprised to see these prevalent issues rise once again to the top of the list. This cycle, building on experiences from the last and in response to community requests and ideas collected through the survey data, CCMCs team has also included physical activity and nutrition among the facets of what will be addressed via prioritizing this topic.
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 11	Substance Use and Mental Health - CCMC leadership is well-aware of ongoing issues related to drug and alcohol use in their service area, as well as a continued need for attention and resources to be directed toward mental health. In response to existing knowledge, community input, and a recent local policy decision limiting access to treatment services in CCMCs home county, the leadership team sees it necessary to prioritize these topcis.
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 11	Cancer - Cancer continues to remain in the top health concerns for this hospitals area, and CCMC has a track record of programming and partnerships that allow them to prioritize and address this issue through community benefit strategies. They will continue to do so through implementation planning this cycle.
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 11	COVID-19 - Leadership discussed the many reasons that COVID-19 remains a concern in their hospital service area. Acknowledging that a large amount of educational information exists already, CCMC still feels that there are strategies they could offer to benefit the community at this point in the COVID-19 pandemic and have chosen to prioritize it as a topic to address through upcoming implementation planning.
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 11	Poverty - Issues surrounding poverty are clearly prevalent concerns in this community cost of care, lack of employment opportunities and health insurance, or income for necessitites came up repeatedly in CCMCs survey data this cycle, as they did last cycle as well. Though the hospital cannot solve this large systemic problem, leadership is willing to look for creative ways to work to bridge the gap. Discussion included avenues to connect with people where they may already be receiving food assistance or treatment services. Leadership has chosen to prioritize this topic among the list of health and disease concerns above.
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 13b	Camden-Clark Medical Center offers discounted care only to individuals who qualify for free care. Camden Clark Medical Center offers a Prompt Pay Discount Program. Patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discount, the patient/guarantor must meet certain requirements.
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 15e	A state Medicaid representative was on site to help determine eligibility and help patients through the eligibility process.
Group Camden-Clark Memorial Hospital Line Part V, Section B, Line 24	All patients are charged an amount equal to gross charges regardless of payment method. Once FAP eligibility is confirmed, charge amounts are moved to Charity Care and no longer charged to the patient.

Schedule H (Form 990) 2022

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address		Type of Facility (describe)
1	Patriot Point Diagnostic 2838 Pike Street Parkersburg,WV26101	Radiology/Lab
2	Garfield Diagnositc 2012 Garfield Ave Bdng 2 Ste 1 Parkersburg,WV26101	Radiology/Lab
3	Sleep Lab 19th Street Campus Parkersburg,WV26101	Diagnostic
4
5
6
7
8
9
10

Schedule H (Form 990) 2022

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I Line 3c	Camden-Clark Medical Center CCMC uses 200 Federal Poverty Guideline FPG to determine free care eligibility. However, CCMC does not offer discounted care to individuals who fail the 200 FPG test.
Part I Line 6a	Camden-Clark Memorial Hospital Corporation, community benefit numbers are reported in total with other hospitals within the West Virginia United Health System. The most recent amounts can be found on WVU Medicines website here https//wvumedicine.org/about/leadership-and-more/community-benefit/
Part I Line 7	Total community benefit expense for 2022 is 93,805,883 and is 24.31 of total net expenses. To calculate net expense, provision for doubtful accounts - patient accounts of 13,758,640 was deducted from total expenses of 399,640,057 as shown in Part IX line 25 of the core Form 990, for a net expense of 385,881,417.
Part I Line 7	Worksheet 2 from the IRS Schedule H instructions was used to derive the Cost-to-Charge ratio, which was used to calculate Charity Care, Unreimbursed Medicaid and other means-tested government programs at cost.
Part II	Camden-Clark Medical Center CCMC started a leadership program in 2007. Employees who are selected to participate in this leadership program are required to volunteer in the community or at hospital activities which benefit the broader community as a whole. The activities these individuals participated in during the current year included various health fairs, church community events, Wood County Telethon, National Healthcare Decision Day, Try-Again Homes work project and various local school activities and events. These individuals also worked with and supported various community organizations such as United Way of America, The Salvation Army, Boys and Girls Club of America, and various community boards.
Part III Line 2	Bad Debt Expense at cost was calculated by multiplyingprovision for doubtful accounts - patient accounts of 13,758,640 by our cost to charge ratio of 30.24 derived from Worksheet 2 in the IRS Schedule H instructions for a toal of 4,160,613.
Part III Line 3	Estimated bad debt attributable to patients eligible for charity care was calculated by running a report within our patient revenue software of all bad debt account balances greater than 25,000. The total of that report was 911,689 which we then multipled by our cost to charge ratio of 30.24 for a total of 275,695.
Part III Line 3	We feel that, at a minimum, the estimated bad debt attributable to patients eligible for charity care of 275,695 should be considered community benefit due to the fact that a patient with an outstanding balance of 25,000 or greater usually qualifies as catastrophic if the patient completes the application process. In our Charity Care policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year.
Part III Line 4	Camden-Clark Memorial Hospitals financial statements are prepared on a consolidated basis as a member of the WV United Health System. The footnote for Accounts Receivable is as follows Patient accounts receivable are reported at net realizable value. For accounts receivable associated with services provided to patients who have third-party coverage, the System estimates net realizable value based on the estimated contractual reimbursement percentage, which in turn is based on current contract provisions and historical paid claims by payor. For self-pay accounts, including uninsured and patient responsibility accounts, the net realizable value is determined using historical collection experience, adjusted for estimated conversions of patient responsibility portions, expected recoveries and changes in trends to estimate implicit price concessions. Management continually reviews the estimated net realizable value of accounts receivable by monitoring cash collections, economic conditions and trends, changes in payor mix, changes in federal or state healthcare coverage and other matters.
Part III Line 4	The System grants credit without collateral to its patients, most of whom are local residents and are insured under third-party payor agreements, primarily with Medicare, Medicaid and various commercial insurance companies. The System records accounts receivable net of estimated price concessions and such amounts have historically been within managements expectations.
Part III Line 4	The mix of accounts receivable at December 31, 2022 and 2021, from patients and third-party payors is as follows For the year-end December 31, 2022 Medicare - 27, Medicaid - 16, Blue Cross - 19, Commercial, managed care and other - 35, Patients - 3, totaling 100. For the year-end December 31, 2021 Medicare - 31, Medicaid - 16, Blue Cross - 21, Commercial, managed care and other - 28, Patients - 4, totaling 100.
Part III Line 8	The amount reported in Part III Line 6 208,862,401 was calculated using the total Medicare allowable cost from the Medicare cost report, less Medicare reimbursement of direct GME.
Part III Line 8	CCMCs shortfall, 81,719,964 of Medicare program reimbursement should be considered a community benefit because we are relieving a government burden by providing care in excess of our costs to these patients.
Part III Line 9b	CCMC does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity, the patient will not be sent to a bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy.
Part VI Line 2	Camden Clark Medical Center considers several components in assessing how the organization determines the need of the communities it serves. The CHNA utilized a robust community based process designed to engage a wide range of community members. CCMC conducted a Community Health Needs Assessment CHNA in 2021. The CHNA can be found here https//wvumedicine.org/camden-clark/wp-content/uploads/sites/6/2021/12/CCMC-2021-Community-Health-Needs-AssessmentAdopted-12-7-21.pdf.
Part VI Line 3	CCMC provides, in writing, all options for possible financial assistance. This information is also available on CCMCs website. CCMC also has representatives that are available to discuss options with inpatients and outpatients on a daily basis. WV State Medicaid workers are onsite to help determine patient eligibility and to assist patients through the eligibility process.
Part VI Line 4	CCMCs leadership defined the community served as a 7 county area comprised of Calhoun, Pleasants, Ritchie, Roane, Tyler, Wirt, and Wood in WV. CCMC, located in Parkersburg, WV is a part of Wood County. Wood County has a population of 83,340, median household income of 50,231 and an employment rate of 54.8. 14.7 of Wood County residents are living in poverty and 7.0 of residents reported they are without health care coverage. The remaining 6 counties considered to be in CCMCs defined service area had a combined total population of 48,969 and approximately 8.15 of residents reported they are without health care coverage. Population and demographic information was obtained from the United States Census Bureau https//data.census.gov/cedsci/.
Part VI Line 5	A majority of the organizations governing body is comprised of persons who reside in the primary service area and who are neither employees nor independent contractors of the hospital, not family members thereof. The organization extends medical staff privileges to all qualified physicians in the community to many of its departments.
Part VI Line 5	Any surplus of funds is used primarily to enhance patient care. While no research is done in this facility, a residency program was started in 2009.
Part VI Line 6	CCMC is a part of the WV United Health System WVUHS. WVUHS is a not-for-profit corporation formed to serve as part of an integrated health science and healthcare delivery team. WVUHS serves as the parent corporation to an affiliated group of healthcare providing entities. The strategic plan of the System states intent to build a regional health care delivery system in its services area, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves.
Part VI Line 6	System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include West Virginia University Hospitals, Inc. in Morgantown, WV, United Hospital Center in Bridgeport, WV, City Hospital, Inc. in Martinsburg, WV, Jefferson Memorial Hospital in Ranson, WV, Potomac Valley Hospital located in Keyser, WV, St. Josephs Hospital of Buckhannon, Inc. in Buckhannon, WV, Reynolds Memorial Hospital, in Glen Dale, WV, Summersville Regional Medical Center in Summersville, WV, Braxton County Memorial Hospital in Gassaway WV, Community Health Association, doing business as, Jackson General Hospital in Ripley, WV, Wetzel County Hospital, Inc. in New Martinsville, WV, Uniontown Hospital in Uniontown, PA, Harrison Community Hospital in Cadiz, OH, Wheeling Hospital, Inc. in Wheeling, WV, Barnesville Hospital Association in Barnesville, OH and GRMC, Inc. in Oakland, MD was acquired July 1, 2022..
Part VI Line 6	In addition to the above mentioned hospitals, the System includes physician practices of United Physicians Care, Inc. and Camden-Clark Physician Corp that operate in conjunction with the System hospitals along with United Summit Center, Inc. a behavioral health center located in Clarksburg, WV. The System also includes, WVUH-East, Inc. and Camden-Clark Health Services, Inc. which operate as management companies for their respective hospitals. University Healthcare Foundation, Inc. in Martinsburg, WV, United Health Foundation, Inc. in Bridgeport, WV, Camden-Clark Foundation, Inc. in Parkersburg, WV, St. Josephs Foundation of Buckhannon, Inc. in Buckhannon, WV, Reynolds Memorial Foundation, Inc. in Glen Dale, WV, Harrison Community Hospital Foundation in Cadiz, OH, and Wheeling Foundation in Wheeling, WV, which perform various fundraising activities for their respective hospitals. In 2020, the System formed WVUHS Home Care, LLC to provide Home Health and Hospice services to our service areas, supporting System hospitals by providing continuous care to our patients. Wheeling Hospital Ambulatory Surgical Center, LLC a surgical center located in Bridgeport, OH was acquired in 2021.

Schedule H (Form 990) 2022

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization
Camden-Clark Memorial Hospital Corporation

Employer identification number
31-1524546

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Children's Museum of the MOV Inc DBA Discovery World on Market 711 Market St Parkersburg,WV26101	84-4022113	501c3	54,000	Support
(2) West Virginia University Foundation Inc 1 Waterfront Place 7th Floor Morgantown,WV26507	55-6017181	501c3	26,514	Support
(3) Galley Enterprises Inc 203 Second Street Marietta,OH45750	31-1574008		15,000	Support
(4) Wood County Junior Livestock Committee Inc 1 Court Square Suite 408 Parkersburg,WV26101	76-0730739	501c3	14,610	Support
(5) Downtown PKB Inc 400 Market St Parkersburg,WV26101	46-1593463	501c3	8,450	Support
(6) United Way Alliance of the Mid-Ohio Valley Inc 935 Market St Parkersburg,WV26101	55-0403123	501c3	7,500	Support
(7) Parkersburg Art Center Inc 725 Market St Parkersburg,WV26101	55-0526227	501c3	6,267	Support
(8) Parkersburg Area Community Foundation Inc PO Box 1762 Parkersburg,WV261021762	55-0748246	501c3	6,000	Support
(9) Barlow Agriculture & Mechanical Association PO Box 103 Barlow,OH45712	31-6060313	501c3	5,647	Support
(10) American Cancer Society Inc 3380 Chastain Meadows Pkwy Ste 200 Kennesaw,GA30144	13-1788491	501c3	5,500	Support
(11) Community Health Assocation PO Box 8207 Morgantown,WV26506	55-0462730	501c3	5,000	Support
(12) American Heart Association PO Box 841390 Dallas,TX75284	13-5613797	501c3	5,000	Support
(13) Washington County Joint Vocational School District 21740 State Route 676 Marietta,OH45750	31-0735812		5,000	Support

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2022

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
Part I Line 2	Contributions are discretionary and decisions on which organizations Camden-Clark Memorial Hospital supports are made by the President in conjunction with the Director of Marketing. Typically, local organizations are supported throughout the year and the donations are typically not specifically restricted, so there is no follow up process for monitoring the use of the funds.

Schedule I (Form 990) 2022

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

Camden-Clark Memorial Hospital Corporation

Employer identification number

31-1524546

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Yes

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2022

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Cynthia Kern Vice President, Quality Patient Safety	(i) (ii)	235,594 -------------	51,087 -------------	25,223 -------------	10,264 -------------	1,209 -------------	323,377 -------------	-------------
2Christopher Childress Director of Pharmacy	(i) (ii)	167,810 -------------	20,441 -------------	325 -------------	7,124 -------------	16,166 -------------	211,866 -------------	-------------
3Dorian Williams AVP Support Services	(i) (ii)	152,001 -------------	21,929 -------------	303 -------------	4,789 -------------	27,206 -------------	206,228 -------------	-------------
4Candace White Director Surgical Services	(i) (ii)	154,704 -------------	19,235 -------------	5,224 -------------	7,059 -------------	10,078 -------------	196,300 -------------	-------------
5Rhonda Boso-Suggs AVP Ancillary Services	(i) (ii)	156,417 -------------	25,054 -------------	1,612 -------------	7,419 -------------	20,227 -------------	210,729 -------------	-------------
6Sean Smith CCMC VP Operations/WCH President	(i) (ii)	142,625 ------------- 142,625	29,880 ------------- 29,880	3,070 ------------- 3,070	17,895 ------------- 17,895	14,188 ------------- 14,188	207,658 ------------- 207,658	-------------
7Christine Daniels VP, Nursing	(i) (ii)	129,875 -------------	52,901 -------------	132,560 -------------	18,063 -------------	14,741 -------------	348,140 -------------	-------------
8Steve Altmiller President CEO	(i) (ii)	497,031 -------------	177,816 -------------	126,911 -------------	13,725 -------------	21,488 -------------	836,971 -------------	-------------
9MarJean Kennedy VP Mktg Dev Strat Init	(i) (ii)	188,034 -------------	38,127 -------------	1,271 -------------	18,773 -------------	-------------	246,205 -------------	-------------
10Gene Sexton Pharmacy Manager	(i) (ii)	150,194 -------------	14,766 -------------	4,599 -------------	6,642 -------------	27,572 -------------	203,773 -------------	-------------
11Kyle Pierson VP Finance - West Region	(i) (ii)	251,567 -------------	54,181 -------------	1,426 -------------	37,277 -------------	28,824 -------------	373,275 -------------	-------------
12Mary Jo Shahan Former CCMC Interim CFO 2019	(i) (ii)	------------- 149,600	-------------	-------------	-------------	-------------	------------- 149,600	-------------
13Walter Kerschl Chief Medical Officer	(i) (ii)	307,006 -------------	84,892 -------------	77,502 -------------	48,624 -------------	22,488 -------------	540,512 -------------	-------------
14Doug Coffman Director April 2022-Present	(i) (ii)	------------- 659,493	------------- 193,194	------------- 99,601	------------- 13,725	------------- 11,583	------------- 977,596	-------------
15Carlie Lacy VP General Counsel, March - Present	(i) (ii)	121,305 -------------	-------------	265 -------------	18,229 -------------	16,183 -------------	155,982 -------------	-------------

Schedule J (Form 990) 2022

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Part I Line 1a	Memberships at the health and wellness center are offered to each member of the senior leadership team. These are covered in the applicable employment contracts and are included in taxable income.
Part I Line 3	Compensation for the CEO is determined by the WV United Health System compensation committee. The System engages an independent group to perform an executive compensation review and compensation survey every two years. This information is provided to the committee, which is made up of independent board members who are then responsibile for setting the compensation packages offered to each executive, ensuring that the compensation package does not exceed fair market value.
Part I Line 4b	The following individuals received deferred compensation contributions in 2022 Sean Smith in the amount of 29,125 Kyle Pierson in the amount of 25,708 Christine Daniels in the amount of 12,195 MarJean Kennedy in the amount of 18,773, Walter Kerschl in the amount of 39,140, and Carlie Lacy in the amount of 12,615. These amounts were properly recorded in deferred compensation on the Form 990 Schedule J.
Part I Line 6a	Per the WVUHS Incentive Plan incentives are contingent on meeting a net earning target.
Part II Line 12	Mary Jo Shahan was interim CFO in 2019 for Camden-Clark Memorial Hospital Corporation. However, in 2022 she was compensated for consulting work and interim CFO for related party, West Virginia University Hospitals - East.

Schedule J (Form 990) 2022

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
Camden-Clark Memorial Hospital Corporation

Employer identification number
31-1524546

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	West Virginia Hospital Finance Authority	62-1256910	956622L85	06-15-2016	19,440,924	2016 A - Refunding of 2007 A Bonds		X		X		X
B	West Virginia Hospital Finance Authority	62-1256910	956622P40	07-31-2018	56,880,000	2018C Series - Refund 2004 BC Bonds		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,438,952		10,645,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	19,440,924		56,880,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	149,889		422,708
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	19,291,033		56,457,292
12 Other unspent proceeds .............	187
13 Year of substantial completion .............	2016		2018
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X			X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........	X			X
16 Has the final allocation of proceeds been made? ..........	X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X	X
b Exception to rebate? ........		X		X
c No rebate due? .........	X			X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?	X			X
b Name of provider ..........	Cantor Fitzgerald
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........	X
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
Part I Line A	2016 A Bond - The 2016 A Bonds were issued on behalf of the West Virginia United Health System Obligated Group with an issue price of 288,869,596 per Form 8038. The 2016 A Bonds were issued to refund certain outstanding bonds. Per internal allocations based on the balance of the refunded bonds in the general ledger CCMC received 19,440,924 in proceeds to refund the 2007A bond issuance as an advanced refunding. The remaining amounts allocated from this issuance are reported on Form 990 for related parties West Virginia University Hospitals, Inc WVUH and United Hospital Center UHC.
Part I	Several bond issuances were issued in multiple series and each series is reported in this tax return separately. For each series identified in Schedule K, Part I, the taxpayer will reconcile the series amount reported in this tax return and the tax returns filed by related parties 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 manner.
Part I Line 2	Column B - The CUSIP shown on the Form 8038 956622P65 is for another bond in the 2018 issue - 2018 D E which are reported on the Schedule Ks for WVUH and UHC respectively.
Part II Line 12	The amount reported in Line 12 Column A is a result of a balance that remained in the account that is used to fund principal and interest payments on this issuance. We are provided an amount to fund prior to the payment date, once funds that are sold/redeemed to make our payment there is occasionally a residual amount. That amount is left in the account and applied to the upcoming payment.
Part IV Line 2c	Column A - Rebate calculation was prepared for the period June 15, 2016 to June 15, 2021, per the report and underlying assumptions, no IRS payment or filing is otherwise currently required. The next rebate calculation is due June 15, 2026. Column B - Rebate calculation for the 2018 Series C issuance is not due until 2023.
Part IV Line 5c	Column A - The securities for the 2016 A Bonds were purchased on June 15, 2016 and the last one matured on May 31, 2019.

Schedule K (Form 990) 2021

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

- TIN:

SCHEDULE O
(Form 990)

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

Camden-Clark Memorial Hospital Corporation

Employer identification number

31-1524546

Return Reference	Explanation
Form 990, Part III, Line 4d	Program Service Expenses 12,174,645, Grants and allocations 0, Revenue 20,348,719 Camden-Clark Memorial Hospital offers heart and vascular services for its immediate service area directly through the hospital. In addition, services are provided to underserved counties throughout the area via physicians that are employed by Camden Clark Physician Corporation, a related entity.
Form 990, Part III, Line 4d	Program Service Expenses 131,468,720, Grants and allocations 0, Revenue 148,912,737 Camden Clark offers a wide range of other medical services that include Nephrology, OBGYN services, Neurosurgery, Orthopedics, Pediatrics, General Surgery, Vascular Surgery and various other services that can be found on our website https//wvumedicine.org/camden-clark/.
Form 990, Part IV, Line 20b	The organization must attach a copy of its most recent audited financial statements. Attached are the consolidated financial statements of West Virginia United Health System, Inc. WVUHS and controlled entities. WVUHS became the sole member of Camden Clark Health Services, Inc., the parent corporation of Camden-Clark Memorial Hospital on March 1, 2011. The financial position, results of operations, and cash flows of Camden-Clark Memorial Hospital are included in the aforementioned consolidated audited financial statements.
Form 990, Part VI, Section A, Line 4	The organizations articles and bylaws were updated during 2022 to reflect that Camden Clark Health Services CCHS has sole right to vote at any meeting of the members of the Corporation and shall have all rights granted to members of nonstock, nonprofit corporations by the laws of the State of West Virginia. West Virginia United Health System, Inc., a 501c3 charitable organization WVUHS, is the sole member of the organization, is the sole member of CCHS. WVUHS has certain reserved powers with respect to both the Corporation and CCHS, and the following corporate powers of the Corporation shall be reserved to and exercisable by the board of directors of WVUHS, subject to prior approval of CCHS as reflected in the organizations articles of incorporation and bylaws, and update the organizations rules and regulations to be consistent with the governance processess followed by the other tax-exempt hospitals of which WVUHS is the sole member.
Form 990, Part VI, Section A, Line 6	Camden-Clark Health Services, Inc., a non-profit, tax-exempt corporation, is the sole member of the organization.
Form 990, Part VI, Section A, Line 7a	Camden-Clark Health Services, Inc., the organizations sole member, nominates all board members of the organization. Board members are elected by West Virginia United Health System WVUHS from the CCHS nominations. WVUHS elects all CCHS, CCMC, CCPC, and CCF board members from a slate of Director Nominees submitted to them by CCHS. CCHS will consider the underlying nominations of CCMC, CCPC, and CCF before they submit their nominations.
Form 990, Part VI, Section A, Line 7b	As the sole member of Camden Clark Health Services, Inc., WVUHS through its affiliation agreement, holds power to approve certain decisions such as annual budget, capital expenditures over 1 million, new debt over 1 million, new programs, and extraordinary filings.
Form 990, Part VI, Section B, Line 11	The Form 990 is prepared by the WVUHS Tax Team and is provided for review to the VP of Finance and Director of Accounting. It is also reviewed by the non-profit tax manager of our independent auditing firm. It is then presented to/reviewed by the Finance Committee. After being presented to the committee, it is provided to all board members for comments prior to filing with the IRS.
Form 990, Part VI, Section B, Line 12c	To identify and monitor any conflicts, a signed conflict of interest statement is required from board members of the organization and key individuals that are in a position to make or influence decisions. If an actual or possible conflict of interest is observed or disclosed, the organization invokes the procedures set out in the policy, bylaws for addressing the conflict of interest. For key individuals employees, a specific conflict of interest standard in the organizations code of ethics and business conduct also exists.
Form 990, Part VI, Section B, Line 15 a b	The compensation of the CEO is determined by the WV United Health System Compensation Committee based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. 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 2021 for 2022 compensation amounts. The compensation of all officers at the Vice President level and below is determined based upon a salary and benefit survey prepared by an independent company using data of comparable facilities. This data is then interpreted and provided to an independent compensation committee. The independent compensation committee then uses this data to determine a fair and reasonable compensation package. All relevant data as well as minutes from each meeting are retained.
Form 990, Part VI, Section C, Line 19	The organizations financial statements are made available on request and are also available on the West Virginia Healthcare Authority website. The organizations governing documents and conflict of interest policy are made available upon request.
Form 990, Part IX, Line 11g	Other service expenses consist of the following items Consulting and Professional fees of 458,170 of which 82,292 is considered program service and 375,878 is considered management and general expense. Contracted Labor fees of 13,722,864 of which 8,745,288 is considered program service and 4,977,576 is considered management and general. Contract Labor - Patient Care of 24,645,503 of which 24,508,717 is considered program service and 136,786 is considered management and general expense. Lab Fees of 13,155 of which all is considered program service expense. Resident Expenses of 3,394 of which all is considered program service expense. Lastly, Collection Agency Fees of 50,873 of which all is considered program service expense.
Form 990, Part XI, Line 9	Changes in Net Assets Transfers to related organizations of 5,592,367 and change in donated capital of 10,872.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Camden-Clark Memorial Hospital Corporation

Employer identification number

31-1524546

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Camden-Clark Health Services Inc 800 Garfield Avenue Parkersburg,WV26101 55-0769602	Healthcare Access	WV	501c3	12 Type I	West Virginia United Health System		No
(2)Camden-Clark Foundation 800 Garfield Avenue Parkersburg,WV26101 55-0667789	Hospital Support	WV	501c3	Line 7	Camden-Clark Health Services		No
(3)Auxiliary of Camden-Clark Memorial Hospital 800 Garfield Avenue Parkersburg,WV26101 55-0386283	Patient Care	WV	501c3	Line 3	N/A		No
(4)Camden-Clark Physician Corporation 604 Ann Street Parkersburg,WV26101 26-4058719	Patient Care	WV	501c3	Line 3	Camden-Clark Health Services		No
(5)West Virginia United Health System PO Box 8034 Morgantown,WV26506 55-0754713	Healthcare Access	WV	501c3	12 Type I	N/A		No
(6)West Virginia University Hospitals Inc PO Box 8034 Morgantown,WV26506 55-0643304	Patient Care	WV	501c3	Line 3	West Virginia United Health System		No
(7)West Virginia University Hospitals East 121 Administrative Drive Martinsburg,WV25401 20-2337985	Healthcare Access	WV	501c3	12 Type I	WV United Health System		No
(8)City Hospital Inc 2500 Foundation Way Martinsburg,WV25401 55-0383321	Patient Care	WV	501c3	Line 3	West Virginia University Hospitals East		No
(9)Jefferson Memorial Hospital 300 S Preston St Ranson,WV25438 55-0359755	Patient Care	WV	501c3	Line 3	West Virginia University Hospitals East		No
(10)University Healthcare Foundation 121 Administrative Drive Martinsburg,WV25401 31-1118075	Hospital Support	WV	501c3	12 Type I	West Virginia University Hospitals East		No
(11)United Hospital Center Inc 327 Medical Park Drive Bridgeport,WV26330 55-0525724	Patient Care	WV	501c3	Line 3	West Virginia United Health System		No
(12)United Physicians Care Inc 686 South Pike Street Shinnston,WV26431 55-0638563	Patient Care	WV	501c3	Line 3	United Hospital Center Inc		No
(13)United Health Foundation 327 Medical Park Drive Bridgeport,WV26330 55-0621706	Hospital Support	WV	501c3	12 Type I	United Hospital Center Inc		No
(14)West Virginia Health Care Cooperative Inc 400 Fairview Heights Rd Summersville,WV26651 55-0650441	Patient Care	WV	501c3	Line 3	WV United Health System		No
(15)United Summit Center 6 Hospital Plaza Clarksburg,WV26301 55-0752788	Behavioral Health	WV	501c3	Line 3	WV United Health System		No
(16)Potomac Valley Hospital Inc 100 Pin Oak Lane Keyser,WV26726 55-0420956	Patient Care	WV	501c3	Line 3	WV United Health System		No
(17)St Joseph's Hospital of Buckhannon Inc 1 Amalia Drive Buckhannon,WV26201 55-0356996	Patient Care	WV	501c3	Line 3	West Virginia United Health System		No
(18)Reynolds Memorial Hospital Inc 800 Wheeling Ave Glen Dale,WV26038 55-0357045	Patient Care	WV	501c3	Line 3	WV United Health System		No
(19)Reynolds Memorial Foundation 800 Wheeling Ave Glen Dale,WV26038 55-0710402	Hospital Support	WV	501c3	12 Type I	Reynolds Memorial Hospital Inc		No
(20)St Joseph's Foundation of Buckhannon Inc 1 Amalia Drive Buckhannon,WV26201 55-0727650	Hospital Support	WV	501c3	12 Type II	St Joseph's Hospital of Buckhannon		No
(21)Braxton County Memorial Hospital 100 Hoylman Drive Gassaway,WV26624 55-0611919	Patient Care	WV	501c3	Line 3	WV United Health System		No
(22)Community Health Association 122 Pinnell Street Ripley,WV25271 55-0462730	Patient Care	WV	501c3	Line 3	WV United Health System		No
(23)Wetzel County Hospital Inc 3 East Benjamin Drive New Martinsville,WV26155 84-3480493	Patient Care	WV	501c3	Line 3	WV United Health System		No
(24)WVUHS Home Care LLC PO Box 8059 Morgantown,WV26506 85-2915642	Home Health and Hospice	WV	509a2		WV United Health System		No
(25)Uniontown Hospital 500 West Berkeley Street Uniontown,PA15401 25-0965588	Patient Care	PA	501c3	Line 3	WV United Health System		No
(26)Fayette Physician Network 500 West Berkeley Street Uniontown,PA15401 45-5440305	Patient Care	PA	501c3	Line 3	WV United Health System		No
(27)Wheeling Hospital Inc 1 Medical Park Wheeling,WV26003 55-0357057	Patient Care	WV	501c3	Line 3	WV United Health System		No
(28)Harrison Community Hospital 951 E Market Street Cadiz,OH43907 34-1571750	Patient Care	OH	501c3	Line 3	WV United Health System		No
(29)Harrison Community Hospital Foundation 951 E Market Street Cadiz,OH43907 34-1571749	Hospital Support	OH	509a2	12 Type II	Harrison Community Hospital		No
(30)Barnesville Hospital Association 639 W Main Street Barnesville,OH43713 34-0719172	Patient Care	OH	501c3	Line 3	WV United Health System		No
(31)Belmont Community Hospital 4697 Harrison Street Bellaire,OH43906 34-0714643	Patient Care	OH	501c3	Line 3	Wheeling Hospital Inc		No
(32)Medical Park Foundation 1 Medical Park Wheeling,WV26003 55-0744690	Church	WV	501c3	Line 1	Wheeling Hospital Inc		No
(33)Self Insurance Trust Agreement of Wheeling Hospital Inc 1 Medical Park Wheeling,WV26003 55-0676674	Insurance	WV	501c3	12 Type I	N/A		No
(34)GRMC Inc 251 North Fourth Street Oakland,MD21550 87-1846814	Patient Care	MD	501c3	Line 3	WV United Health System		No
(35)Grant Memorial Hospital Inc PO Box 8034 Morgantown,WV26506 88-1740605	Patient Care	WV	501c3	Line 3	WV United Health System		No
(36)WVU Innovation Corporation 1085 Van Voorhis Dr Ste 500 Morgantown,WV26505 61-1764272	Support	WV	501c3	12 Type II	N/A		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) Ohio Valley Ambulatory Surgery Center 608 Washington Blvd Belpre,OH45714 20-8671724	Outpatient Surgical Services	OH	Camden-Clark Memorial Hospital Inc	Related	362,051			No		Yes		62.500 %
(2) Allied Health Sourcing Solutions PO Box 8034 Morgantown,WV26506 84-2403526	Supply Chain Management	WV	AHS LLC					No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) Allied Health Services Inc PO Box 782 Morgantown,WV26507 55-0652017	Medical Lab	WV	WV United Health System	C Corp					No
(2) West Virginia United Insurance Services 3040 University Avenue Suite 3200 Morgantown,WV26505 55-0756055	Provider Network	WV	WV United Health System	C Corp					No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

Yes

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:	22015461
Software Version:	22.0.1.0

1	Briefly describe the organization’s mission or most significant activities: To operate an acute care and emergency hospital facility.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	2,231
6	Total number of volunteers (estimate if necessary) .............	6	66
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	526,325
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	26,988

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........		9,416
9	Program service revenue (Part VIII, line 2g) .........	373,444,013	407,838,887
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,751,981	1,861,645
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,267,842	3,578,548
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	379,463,836	413,288,496
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	92,173	216,377
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	113,839,525	125,946,663
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	252,687,467	273,477,017
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	366,619,165	399,640,057
19	Revenue less expenses. Subtract line 18 from line 12.......	12,844,671	13,648,439
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	276,143,723	262,070,508
21	Total liabilities (Part X, line 26).............	315,785,650	290,599,735
22	Net assets or fund balances. Subtract line 21 from line 20.....	-39,641,927	-28,529,227

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 139,112,423 including grants of $ 216,377 ) (Revenue $ 165,701,578 )
	Camden Clark Memorial Hospital strives to supply a comprehensive range of inpatient, outpatient, outreach clinics, including prevention, guidance, diagnosis, treatment, restoration, rehabilitation and other efforts as may be required to meet the health care needs of the community and as the hospitals resources will permit. Although reimbursement for services rendered is critical to the operation and stability of the hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. Our mission is to serve the community by providing health care services and health care education. Therefore, in keeping with this commitment to service all members of the community, Camden-Clark Memorial Hospital will provide the following where the individuals need and/or an inability to pay coexist free care and/or subsidized care, and care provided to persons covered by governmental programs at or below cost.

4b	(Code: ) (Expenses $ 27,119,365 including grants of $ ) (Revenue $ 41,705,498 )
	Camden-Clark Memorial Hospital is a leader in cancer care for the mid-ohio valley, providing cancer care to patients in a 45 mile radius from the hospital. In addition to a wide range of treatment options provided, the hospital offers a number of related services to its patients. Through the hospitals collaboration with the American Cancer Society, the development of the organizations cancer resource center, a hair restoration salon, a patient navigator and an oncology social, the hospital has enhanced the education, navigation and social support of its cancer patients and families. The hospitals community and social services provide a holistic healing environment which includes support groups for patients/families.

4c	(Code: ) (Expenses $ 19,937,116 including grants of $ ) (Revenue $ 31,693,588 )
	Camden Clark Memorial Hospital offers emergency room services as part of the hospitals mission of meeting the healthcare needs of the community for a lifetime. Due to the community that it serves, the majority of patients visiting the ER are either underinsured or uninsured. For the reporting period, there were approximately 37,182 ER visits, of this total, 8,698 were ultimately admitted to the hospital. A significant portion of the hospitals inpatient volume comes directly from the ER.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 143,643,365 including grants of $ ) (Revenue $ 169,261,456 )
4e	Total program service expenses329,812,269

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Kathy G Eddy........................................................................ Vice Chairman	1.00 .......................1.00	X	X	0	0	0
(19) Randall E Snider........................................................................ Director, Secretary	1.00 .......................1.00	X	X	0	0	0
(20) Orton C Armstrong MD........................................................................ Director	1.00 .......................1.00	X		0	0	0
(21) Joe D Campbell........................................................................ Director	1.00 .......................1.00	X		0	0	0
(22) Lynford C Lovell........................................................................ Director	1.00 .......................1.00	X		0	0	0
(23) Sister Joan Kreyenbuhl........................................................................ Director	1.00 .......................1.00	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,740,333	1,277,463	518,502

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	9,416

g	Noncash contributions included in lines 1a - 1f:$		1g	8,616

h Total. Add lines 1a-1f.......		9,416

		Business Code
2a	Patient Service Revenue, Net	621110	371,267,977	370,766,995	500,982
b	Pharmacy Sales - Patients	621110	23,705,393	23,705,393
c	COVID Relief Funds - Federal	621990	7,750,203	7,750,203
d	COVID Relief Funds - Other	621990	4,177,431	4,177,431
e	Health and Wellness Center	621990	639,248	639,248
f	All other program service revenue.		298,635	298,635
g	Total. Add lines 2a–2f .....		407,838,887

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,824,251		25,343	1,798,908
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,253,352	6a
b	Less: rental expenses		38,429	6b
c	Rental income or (loss)		1,214,923	6c
d	Net rental income or (loss).......			1,214,923			1,214,923
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	37,394		7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	37,394		7c
d	Net gain or (loss).........			37,394			37,394
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Cafeteria Income		624200	1,030,445			1,030,445
b	OVASC Revenue		900099	495,826			495,826
c	Rebate Revenue		900099	314,121			314,121
d	All other revenue ....			523,233	523,233
e	Total. Add lines 11a–11d ......			2,363,625
12	Total revenue. See instructions.....			413,288,496	407,861,138	526,325	4,891,617

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	216,377	216,377
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	3,172,549	1,212,028	1,960,521
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	90,693,239	79,210,845	11,482,394
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,482,354	3,067,709	414,645
9	Other employee benefits .......	20,190,124	17,379,168	2,810,956
10	Payroll taxes ...........	8,408,397	7,204,195	1,204,202
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	434,776	550	434,226
c	Accounting ...........	29,802	1,002	28,800
d	Lobbying ...........	38,669	38,669
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	38,893,959	33,403,719	5,490,240
12	Advertising and promotion ....	901,763	2,676	899,087
13	Office expenses .......	11,613,357	7,292,811	4,320,546
14	Information technology ......	13,640	1,668	11,972
15	Royalties ..	0
16	Occupancy ...........	4,545,244	3,846,546	698,698
17	Travel ............	1,004,172	667,249	336,923
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	86,105	26,240	59,865
20	Interest ...........	9,822,780	8,312,816	1,509,964
21	Payments to affiliates .......	78,842,116	48,013,132	30,828,984
22	Depreciation, depletion, and amortization ..	16,547,327	14,036,183	2,511,144
23	Insurance ...	2,366,242	1,729,649	636,593
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies Patient Chargables	76,736,680	76,736,680
b	Taxes, Licenses Fees	14,310,248	11,934,676	2,375,572
c	Provision for Doubtful Accounts	13,803,537	13,803,537
d	Dues, Education Training Recruiting	3,240,386	1,566,326	1,674,060
e	All other expenses	246,214	107,818	138,396
25	Total functional expenses. Add lines 1 through 24e	399,640,057	329,812,269	69,827,788	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			240,426	1	7,009,696
2	Savings and temporary cash investments .........			38,411,024	2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			50,294,120	4	81,959,273
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			57,979	7	106,600
8	Inventories for sale or use ............			7,311,412	8	8,630,402
9	Prepaid expenses and deferred charges ......			4,522,310	9	3,789,987
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	385,908,674
b	Less: accumulated depreciation	10b	263,153,910	135,227,023	10c	122,754,764
11	Investments—publicly traded securities .			32,049,080	11	30,943,308
12	Investments—other securities. See Part IV, line 11 .....			6,065,551	12	5,165,612
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,964,798	15	1,710,866
16	Total assets. Add lines 1 through 15 (must equal line 33)...			276,143,723	16	262,070,508

17	Accounts payable and accrued expenses .....	50,958,958	17	61,590,964
18	Grants payable ...		18
19	Deferred revenue .........	22,632,784	19	1,713,936
20	Tax-exempt bond liabilities .........	70,694,039	20	61,351,926
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	141,604,708	23	142,940,729
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	29,895,161	25	23,002,180
26	Total liabilities. Add lines 17 through 25..	315,785,650	26	290,599,735

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-39,641,927	27	-28,529,227
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-39,641,927	32	-28,529,227
33	Total liabilities and net assets/fund balances ........	276,143,723	33	262,070,508