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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet 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.
SchKMediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
West Virginia University Hospitals Inc
 
Employer identification number
55-0643304
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
Yes No Yes No Yes No
A West Virginia Hospital Finance Authority
  		62-1256910 000000000 06-30-2011 28,520,000 2011D - Refund 1998 Bonds   X   X   X
B West Virginia Hospital Finance Authority
  		62-1256910 000000000 06-30-2011 16,345,000 2011E - Fund construction upgrades at WVUH and City Hospital, Inc.   X   X   X
C West Virginia Hospital Finance Authority
  		62-1256910 000000000 08-01-2012 23,770,000 2012 C - Refund 2008 D Bond - allocated to WVUH-East entities   X   X   X
D West Virginia Hospital Finance Authority
  		62-1256910 000000000 10-02-2012 45,680,000 2012 D - Refund 2009 A Bonds   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 15,279,979 10,345,000 5,190,000 1,825,000
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 28,520,000 16,345,000 23,770,000 45,680,000
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 138,529 64,499 100,000 90,000
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............   5,976,323    
11 Other spent proceeds ............. 28,381,471   23,670,000 45,590,000
12 Other unspent proceeds .............   10,345,000    
13 Year of substantial completion ............. 2011 2012 2012 2012
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? ....                
15 Were the bonds issued as part of an advance refunding issue? .....                
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
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   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2017
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Schedule K (Form 990) 2017
Page 2
Part Ⅲ
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X   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   X      
c Are there any research agreements that may result in private business use of bond-financed property? ............. X     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? X       X      
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 ....SchKMediumBullet        
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 ......... SchKMediumBullet        
6 Total of lines 4 and 5 .............        
7 Does the bond issue meet the private security or payment test? ...   X   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   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   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   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X   X
b Exception to rebate? ........   X   X   X   X
c No rebate due? ......... X   X   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   X   X  
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X X  
b Name of provider ..........  
  		 
  		 
  		Raymond James Financial Products Inc
 
c Term of hedge .........       1850.0000000000 %
d Was the hedge superintegrated? ......               X
e Was the hedge terminated? ........               X
Schedule K (Form 990) 2017
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Schedule K (Form 990) 2017
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Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   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   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
Part I Schedule K - For purposes of reporting bond issuance allocations on Schedule K to the Internal Revenue Service, West Virginia University Hospitals, Inc WVUH as parent company to City Hospital, Inc. CHI, The Charles Town General Hospital dba Jefferson Medical Center JMC, University Healthcare Foundation, Inc. UHF, and Potomac Valley Hospital PVH is reporting bond issuances allocated to WVUH and its subsidiaries on a consolidated basis on Schedule K attached to this tax return. The total amount of the bonds reported on this Schedule K allocated to subsidiaries is 80,649,350. United Hospital Center, Inc. UHC EIN 55-0525724 and Camden-Clark Memorial Hospital Corporation CCMH EIN 31-1524546 are reporting bond allocations issued to them on the return filed by such taxpayer. Several bond issuances were issued in multiple series and each series is reported in this tax return separately.
Part I Line AB The 2011 D E bonds were issued as a single issue with an issue price of 44,865,000. The two series comprising this issue are broken out separately herein because the bonds refunded by the 2011D were issued prior to 2002.
Part I Line C The 2012 Series C Bonds issue price 23,770,000 were issued collectively with 2012 Series A Bonds issue price 38,145,000 and 2012 Series B Bonds issue price 50,080,000 totaling 111,995,000 total issue price for all three series reported on Form 8038 for August 1, 2012 issuance. The full Series A Bonds were allocated to United Hospital Center and will be reported on their Schedule K. The full Series B Bonds were allocated to Camden-Clark Medical Center and were refunded with taxable debt in 2015.
Part II Line 3 Column B- the difference between the amount reported in Part 1, Line B 16,345,000 for 2011E Bond and the amount reported in Part II, Line 3, Column B 16,385,822 is interest earned on the project fund since the issuance of the bonds. The interest income was used to complete the project identified in the bond documents. This issuance was allocated between WVUH and WVUH-East, the 10,345,000 allocated to WVUH was converted to a taxable loan in 2014 and the exempt portion of was refunded with those proceeds.
Part IV Line 2b Columns C D - Per rebate calculations through October 2, 2017 no rebate liability is due. The next computation date is the earlier of October 2, 2022 and the date the issues ar efully redeemed.
Part IV Line 2c Columns A B - Rebate calculations for 2011 Series D E issuance were prepared during 2016 and found that no rebate is due.
Part IV Line 3 Column A B - Interest will accrue at a fixed rate through June 30, 2021, thereafter it will accrue at a variable rate.
Schedule K (Form 990) 2017

Additional Data


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