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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 instructions and the latest information.
OMB No. 1545-0047
2021
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 08-01-2012 23,770,000 2012 C - Refund 2008 D Bond - allocated to WVUH-East entities   X   X   X
B West Virginia Hospital Finance Authority
  		62-1256910 000000000 08-19-2015 18,500,000 2015A - New construction and refinance of loans incurred at acquisition of PVH   X   X   X
C West Virginia Hospital Finance Authority
  		62-1256910 956622L85 06-15-2016 119,678,674 2016 A - Refund 2003 BD, 2008 E, and 2009 C and 2009 C issuances - 18m to WVUH-East   X   X   X
D West Virginia Hospital Finance Authority
  		62-1256910 956622N75 03-22-2017 193,415,642 2017 A - To fund building of SouthEast Tower - Heart Vascular Institute at WVUH   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 10,120,000   12,366,855  
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 23,770,000 18,500,000 119,678,674 193,416,642
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............   166,267    
7 Issuance costs from proceeds ............... 100,000   923,368 3,528,323
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............   1,325,000   189,887,319
11 Other spent proceeds ............. 23,670,000 17,008,733 118,755,296  
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2012 2016 2016 2019
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   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 X     X
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  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021
Page 2

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   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X X   X   X  
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X   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   X  
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   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 ....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   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   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   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
Schedule K (Form 990) 2021
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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   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 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   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 60,324,350. 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 A 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 were refunded with tax-exempt bonds in 2018 that is reported on the UHC Schedule K. The full Series B Bonds were allocated to Camden-Clark Medical Center and were refunded with taxable debt in 2015.
Part I Line D The CUSIPS for the two 2017 A bonds maturing on the final maturity date are 956622N75 and 956622N83.
Part I Line C WVUH and WVUH-East, 119,678,674 in total, have been reported on this return Part I, Line C. The proceeds allocated to WVUH, 101,624,324, were used to refund the 2003D, 2008E, and 2009C issuances as an advanced refundings The proceeds allocated to WVUH-East, 18,054,350, were used to refund 2008E as advanced refundings. The remaining proceeds from this issuance are reported on Form 990 for CCMC and UHC.
Part III Line 2 Column C - There is a lease agreement present that creates PBU from the use of funds from the 2003 B issuance that was refunded by the 2016 A issuance. The amount of PBU calculated for 2021 is .0089.
Part III Line 3a, b, d Column D - while there are management or service contracts as well as reserach agreements that may result in Private Business Use in bond-financed property the review of such activity for 2021 was so minor that it did not reach the reporting threshold of 2/10th of a percent. We will continue to monitor these activities in future years.
Part IV Line 2a Columns A - Rebate calculation was prepared for the issuance date through August 1, 2017. The report indicates that no rebate is due. The next compuration dates is August 1, 2022. Column B - rebate calcaution completed, no rebtae due. Column C - 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 D - issuances are not yet required to have rebate calculations, all issuances are expected to meet the exception to rebate.
Part IV Line 5c Column C - The securities for the 2016 A Bonds were purchased on June 15, 2016 and the last one matured on May 31, 2019.
Part I Line C 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 balances of the refunded bonds in the general ledger proceeds allocated to WVUH and WVUH-East, 119,678,674 in total, have been reported on this return Part I, Line C. The proceeds allocated to WVUH, 101,624,324, were used to refund the 2003D, 2008E, and 2009C issuances as an advanced refundings The proceeds allocated to WVUH-East, 18,054,350, were used to refund 2008E as an advanced refunding. The remaining proceeds from this issuance are reported on Form 990 for CCMC and UHC.
Schedule K (Form 990) 2021

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