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ObjectId: 202023209349300647 - Submission: 2020-11-15
TIN: 55-0525724
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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
.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
19
Open to Public
Inspection
Name of the organization
United Hospital Center Inc
Employer identification number
55-0525724
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
10-01-2015
7,500,000
2015 Series A - Acquisition of St. Josephs Hospital of Buckhannon
X
X
X
B
West Virginia Hospital Finance Authority
62-1256910
956622L85
06-15-2016
149,749,999
2016 Series A - Refund 2006A and 2009 C issuances
X
X
X
C
West Virginia Hospital Finance Authority
62-1256910
956622P65
07-31-2018
23,680,000
2018 Series D - Redeem 2012A issuance
X
X
X
Part
Ⅱ
Proceeds
A
B
C
D
1
Amount of bonds retired
..................
8,996,832
2,555,000
2
Amount of bonds legally defeased
..............
3
Total proceeds of issue
..................
7,500,000
149,749,999
23,680,000
4
Gross proceeds in reserve funds
.............
5
Capitalized interest from proceeds
.............
6
Proceeds in refunding escrows
...............
7
Issuance costs from proceeds
...............
1,155,297
176,862
8
Credit enhancement from proceeds
.............
9
Working capital expenditures from proceeds
.............
10
Capital expenditures from proceeds
.............
7,500,000
11
Other spent proceeds
.............
148,571,155
23,503,138
12
Other unspent proceeds
.............
942
13
Year of substantial completion
.............
2015
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 2018, a current refunding issue)?
........
X
X
X
15
Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2018, an advance refunding issue)?
........
X
X
X
16
Has the final allocation of proceeds been made?
..........
X
X
X
17
Does the organization maintain adequate books and records to support the final allocation of proceeds?
..................
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) 2019
Page 2
Schedule K (Form 990) 2019
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?
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?
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
....
2.630 %
2.630 %
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
.........
0.310 %
0.310 %
6
Total of lines 4 and 5
.............
2.940 %
2.940 %
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
2
If "No" to line 1, did the following apply?
....
a
Rebate not due yet?
.......
X
X
X
b
Exception to rebate?
........
X
X
X
c
No rebate due?
.........
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
4a
Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?
X
X
X
b
Name of provider
..........
Deutsche Bank AG
c
Term of hedge
.........
2242.0000000000 %
d
Was the hedge superintegrated?
......
X
e
Was the hedge terminated?
........
X
Schedule K (Form 990) 2019
Page 3
Schedule K (Form 990) 2019
Page
3
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
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
X
7
Has the organization established written procedures to monitor the requirements of section 148?
...
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
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, and University Healthcare Foundation, Inc. UHF, is reporting bond issuances allocated to WVUH and its subsidiaries on a consolidated basis on Schedule K attached to this tax return. 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. For each series identified in Schedule K, Part I, the taxpayer will reconcile the series amount reported in this tax return and the tax return filed by UHC and CCMC 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 B
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 UHC received 149,749,999 in proceeds to refund the 2006A issuance as a current refunding and 2009C bond issuance as an advanced refunding. The remaining amounts allocated from this issuance are reported on Form 990 for WVUH and CCMC.
Part II Line 12
The amount reported in Line 12 Column B 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 occisaionally a residual amount. That amount is left in the account to apply to future payments.
Part IV Line 2
Column A and B - 2015A, 2016A, and 2018D issuances are not yet required to have rebate calculations the issuances are expected to meet the exception to rebate.
Part IV Line 5c
Column B - 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) 2019
Additional Data
Software ID:
19009610
Software Version:
19.2.1.0