2023-11-15T14:32:21-06:00 2022-12-31 390859910 BAKER TILLY US LLP 101 WASHINGTON STREET EAST CHARLESTON WV 25301 990 2022-01-01 550379108 BROADDUS HOSPITAL ASSOCIATION INC BROA 3044571760 PO BOX 930 PHILIPPI WV 26416 DANA GOULD CEO 3044571760 2023-11-15 1 DANA GOULD 999009999 0 DOLORES ROSE P01286262 3043460441 2023-11-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DANA GOULD PO BOX 930 PHILIPPI WV 26416 24382008 0 X WWW.DAVISHEALTHSYSTEM.ORG X 1954 WV BROADDUS HOSPITAL IS THE PRIMARY PROVIDER OF HEALTH CARE SERVICES IN BARBOUR COUNTY. IN 2022, THE HOSPITAL PROVIDED 124 ACUTE INPATIENT DAYS; 1,904 SWING BED INPATIENT DAYS; 16,315 LONG-TERM CARE PATIENT DAYS AND 6,227 EMERGENCY ROOM VISITS. 8 8 268 8 0 0 2835129 200 20985876 23760895 165717 -112993 310988 620913 24297710 24269015 4992 4374 0 0 11848956 12238960 0 0 0 9806811 9624880 21660759 21868214 2636951 2400801 15616403 12404769 7973642 3838758 7642761 8566011 X BROADDUS HOSPITAL ASSOCIATION IS COMMITTED TO PROVIDING PATIENT-FRIENDLY, QUALITY HEALTH CARE TO ITS COMMUNITIES. 0 0 16629224 24381808 BROADDUS HOSPITAL PROVIDES 24/7 HOUR EMERGENCY ROOM SERVICES BY QUALIFIED, EXPERIENCED PROVIDERS. FOR THE YEAR 2022 THERE WERE 6,227 EMERGENCY ROOM VISITS. THE HOSPITAL HAS A 60 BED DUALLY-CERTIFIED LONG-TERM AND INTERMEDIATE CARE FACILITY WHERE THERE IS CONSIDERABLE FOCUS ON REHAB SERVICES ALLOWING PATIENTS TO FUNCTION AT THEIR OPTIMAL LEVEL. FOR THE YEAR 2022, THERE WERE 16,315 LTC PATIENT DAYS. THE HOSPITAL PROVIDES RADIOLOGY SERVICES INCLUDING GENERAL RADIOLOGY, CT SCANS, ULTRASOUND, MRI, DEXA SCANS, AND MAMMOGRAPHY. FOR THE YEAR 2022, THE FOLLOWING PROCEDURES WERE DONE: GENERAL RADIOLOGY - 5,001; CAT SCAN - 2,387; MRI - 270; ULTRASOUND - 1,025; DEXA SCANS - 242; AND MAMMOGRAMS - 670. THE HOSPITAL PROVIDES LABORATORY AND EKG PROCEDURES WHICH TOTALED 60,978 PROCEDURES FOR THE YEAR; REHAB SERVICES INCLUDING PT, OT, AND SPEECH - TOTALING 33,905 PROCEDURES; RESPIRATORY AND PULMONARY SERVICES TOTALING 7,967 PROCEDURES; ACUTE CARE INPATIENT SERVICES TOTALING 124 DAYS; SWING BED SERVICES TOTALING 1,904 DAYS; A PROVIDER BASED CLINIC WITH 4,411 PATIENT VISITS AND OTHER PATIENT SERVICES.CHARGES FOREGONE FOR CHARITY CARE AMOUNTED TO $458,214. 4374 4374 THE HOSPITAL PROVIDED COMMUNITY SUPPORT BY SPONSORING VARIOUS HEALTH FAIRS AND LOCAL NONPROFIT ORGANIZATIONS. ADDITIONAL COMMUNITY SUPPORT ACTIVITIES AND HEALTH EDUCATION INCLUDED: FLU SHOT CLINIC, KIDS SAFETY FAIR, SENIOR DAY, SOCIAL SERVICE COUNSELING AND MENTAL HEALTH MONTH. CASH DONATIONS TO THE COMMUNITY WERE $4,374. 16633598 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 10 0 268 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DANA GOULD CEO 3044571760 PO BOX 930 PHILLIPI WV 26416 MARY BETH LIND CHAIRMAN 3.00 X X 0 0 0 DANNY FRANKE PHD THM VICE-CHAIRMAN 2.00 X X 0 0 0 JOYCE WAGNER SECRETARY 1.00 X X 0 0 0 CRYSTAL GRAY BOARD MEMBER 1.00 X 0 0 0 DONNA PHILLIPS BOARD MEMBER 1.00 X 0 0 0 JEFFREY POWELSON BOARD MEMBER 1.00 X 0 0 0 THOMAS HOXIE BOARD MEMBER 1.00 X 0 0 0 AARON NORRIS MD BOARD MEMBER 1.00 X 0 0 0 DANA GOULD CEO 55.00 X 0 162883 2963 EMILY STARKS NURSE PRACTITIONER 40.00 X 117191 0 21802 LESA CORLEY DIRECTOR OF NURSING 40.00 X 111575 0 33797 SHANE RITCHIE NURSE PRACTITIONER 40.00 X 103091 0 1708 HAROLD NORMAN II RN SUPERVISOR 40.00 X 109840 0 32409 441697 162883 92679 4 0 1 0 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 75373 BEHAVIORAL HEALTH CLINIC 415103 1 200 200 PATIENT SERVICES 900099 23760895 23760895 23760895 112993 -112993 -112993 -112993 CAFETERIA 900099 291239 291239 TELEVISION 900099 9140 9140 320534 320534 620913 24269015 24381808 0 -112993 X 4374 4374 9095944 6680061 2415883 121653 89342 32311 2333592 1713790 619802 687771 505099 182672 20238 14863 5375 1803 1803 54435 54435 4530657 3327315 1203342 28693 21072 7621 563077 412566 150511 236450 173649 62801 45407 33347 12060 58700 43109 15591 67515 49583 17932 409482 300724 108758 126744 93081 33663 MEDICAL SUPPLIES 1353662 1353662 BAD DEBTS 511151 511151 STATE PROVIDER TAX 449488 449488 NUTRITION SERVICES - FO 420077 308505 111572 747301 548817 198484 21868214 16633598 5234616 0 3108095 1186374 469450 466771 2340163 1943931 221333 338576 165079 180324 13649262 9526373 3821459 4122889 5305101 3893740 185723 272164 15616403 12404769 1756450 1470501 1089032 1487704 1008568 3640456 1359689 7973642 3838758 X 7642761 8566011 7642761 8566011 15616403 12404769 X 2400801 -477551 -1000000 X 1 X 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2697 2697 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE WEST VIRGNIA HOSPITAL ASSOCIATION, OF WHICH A PERCENTAGE OF THE DUES IS ALLOCATED TO LOBBYING ACTIVITIES. 195787 -195787 195787 195787 271557 -75770 195787 359705 -88148 271557 421654 -61949 359705 0 0 350190 350190 6195296 4127844 2067452 134958 134958 6279061 5398529 880532 689757 689757 4122889 DUE TO AFFILIATES 292439 ESTIMATED THIRD-PARTY SETTLEMENTS 816870 CAPITAL LEASES 250380 1359689 X PART V, LINE 4: THESE FUNDS ARE RESTRICTED FOR SCHOLARSHIPS RELATED TO NURSING TRAINING. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE SYSTEM TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY OR ASSET IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICES (IRS). THE SYSTEM HAS CONCLUDED THAT AS OF DECEMBER 31, 2022 AND 2021, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS OR ANY TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED DECEMBER 31, 2019. 1 1 X 1 X 120.000000000000 1 X 1 1 0 0 829714 829714 7988198 7988198 8817912 8817912 0 0.00000 5669 5669 0.00030 5669 5669 0.00030 8823581 8817912 5669 0.00030 0 276642 4013885 4013885 X 1 1 1 1 BROADDUS HOSPITAL ASSOCIATION 1 HEALTHCARE DRIVE PHILIPPI WV 26416 X X X X DUALLY CERTIFIED LONG-TERM AND INTERMEDIATE CARE FACILITY BROADDUS HOSPITAL ASSOCIATION INC 1 0 0 1 X X X X X X X X 22 1 0 0 1 X SEE PART V FOR COMPLETE URL X X 1 22 1 SEE PART V FOR COMPLETE URL 0 1 X 120.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING X HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING X HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING X X X X 1 X 0 X X X X X 1 X 0 0 BROADDUS HOSPITAL ASSOCIATION, INC. PART V, SECTION B, LINE 5: INTERVIEWS WERE CONDUCTED WITH THE FOLLOWING: BARBOUR COUNTY DEVELOPMENT AUTHORITY, BARBOUR COUNTY EMERGENCY MEDICAL SERVICES, BARBOUR COUNTY FAMILY RESOURCE NETWORK, BARBOUR COUNTY HEALTH DEPARTMENT, BARBOUR COUNTY SENIOR CENTER, BROADDUS HOSPITAL BOARD OF TRUSTEES, LOCAL HEALTH CARE PROVIDERS, AND MACE'S PHARMACY. BROADDUS HOSPITAL ASSOCIATION, INC. PART V, SECTION B, LINE 7D: AVAILABLE ON THE HOSPITAL WEBSITE, UPON REQUEST AT THE HOSPITAL ADMINISTRATION OFFICES, AND SHARED WITH THE COMMUNITY WELLNESS COLLABORATIVE AND THE HOSPITAL BOARD OF DIRECTORS. BROADDUS HOSPITAL ASSOCIATION, INC. PART V, SECTION B, LINE 11: BROADDUS DOES NOT HAVE THE RESOURCES TO ADDRESS ALL NEEDS IDENTIFIED, BUT MUST PRIORITIZE AND DEVELOP THE BEST POSSIBLE PLAN TO CREATE POSITIVE CHANGE WHERE POSSIBLE AND PARTNER WITH OTHER AREA PROVIDERS TO OPTIMIZE THE HEALTH AND WELLNESS OF THE COMMUNITY. KEY AREAS IDENTIFIED BY THE CHNA ARE: 1. HIGH LEVELS OF INACTIVITY 2. LIMITED ACCESS TO EXERCISE OPPORTUNITIES 3. GREATER THAN AVERAGE LEVELS OF MENTAL ILLNESS AND PSYCHOSIS 4. HYPERTENSION 5. SUBSTANCE ABUSE 6. OTHER IDENTIFIED CONCERNS: HEART DISEASE, DIABETES, CANCER, COPD, BONE/JOINT/MUSCLE PAIN, BARIATRIC/OBESITY; AND DENTAL SERVICES.HIGH LEVELS OF INACTIVITY AND LIMITED ACCESS TO EXERCISE OPPORTUNITIES THE DEVELOPMENT OF THE BARBOUR HEALTHY COMMUNITIES COLLABORATIVE, WHICH INCLUDES SEVERAL LOCAL BUSINESSES AND HEALTH PROVIDERS, WORKS TO PROMOTE WALKING AND HEALTHY ACTIVITIES IN THE COMMUNITY. SOME EVENTS INCLUDE THE CREATION OF A WELLNESS RESOURCE GUIDE, AN ANNUAL HEALTH FAIR, WALKING CLUBS AND EVENTS, 100 MILES/100 DAYS WALKING PROGRAM, AND DEVELOPMENT AND EXPANSION OF WALKING TRAILS IN THE COUNTY.GREATER THAN AVERAGE LEVELS OF MENTAL ILLNESS AND PSYCHOSIS DEVELOPMENT OF A NEW OUTPATIENT BEHAVIORAL HEALTH PROGRAM WITH A FOCUS ON THE GERIATRIC POPULATION, WITH REFERRAL OPTIONS TO OTHER REGIONAL AGENCIES.HYPERTENSION GOAL IS TO EDUCATE AT RISK PATIENTS THROUGH PHYSICIAN EDUCATION, HEALTH COACHES, INCREASED WALKING PROGRAMS AND COMMUNITY HEALTH FAIRS.SUBSTANCE ABUSE ALTHOUGH BROADDUS HOSPITAL DOES NOT HAVE THE RESOURCES FOR SUCH A PROGRAM, OUR 24/7 ER IS AVAILABLE FOR EMERGENT NEEDS AND HAS A REFERRAL RELATIONSHIP WITH VARIOUS REGIONAL TREATMENT CENTERS. THE COLLABORATIVE AND BROADDUS HOSPITAL ALSO PROVIDED MONETARY SUPPORT TOWARD THE PURCHASE AND TRAINING OF A DRUG DOG. BROADDUS HOSPITAL ASSOCIATION, INC. PART V, SECTION B, LINE 13B: OUTSTANDING MEDICAL DEBTS ARE FACTORED INTO THE PATIENT'S INCOME IN DETERMINING DISCOUNTS. ADJUSTED INCOME PROVIDES A MORE ACCURATE ASSESSMENT OF TRUE ABILITY TO PAY. ADJUSTED INCOME IS CALCULATED BY DEDUCTING MONTHLY MEDICAL EXPENSES FROM GROSS INCOME. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY ALSO CONTAINS A PROVISION FOR CATASTROPHIC CARE EXPENSES. IN CASES WHERE A PATIENT'S MEDICAL CHARGES EXCEED 30% OF THEIR TOTAL INCOME, THE BILL WILL BE REDUCED TO 30% OF THEIR GROSS INCOME TO MAKE THE PATIENT'S PORTION MORE REALISTIC AND MANAGEABLE. BROADDUS HOSPITAL ASSOCIATION, INC. PART V, SECTION B, LINE 20E: ACCOUNTS DEEMED UNCOLLECTIBLE ARE SCREENED FOR A PRESUMPTIVE CHARITY ADJUSTMENT BEFORE BEING TRANSFERRED TO BAD DEBT STATUS. THIS ANALYSIS IS DONE MONTHLY AND USES THE HOSPITAL'S SLIDING SCALE PROCEDURES. PART V, SECTION B, LINE 7A HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/CONTENT/UPLOADS/DAVISHEALTHSYSTEM.ORG/FILES/2022_BH_CHNA.PDF PART V, SECTION B, LINE 10A HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/CONTENT/UPLOADS/DAVISHEALTHSYSTEM.ORG/FILES/2022_BH_CHNA.PDF PART V, SECTION B, LINE 22C INDIVIDUALS NOT MEETING THE CRITERIA FOR FREE CARE UNDER THE FAP POLICY, BUT WHO HAVE NO THIRD PARTY COVERAGE (GOVERNMENTAL OR COMMERCIAL) WILL BE ELIGIBLE FOR DISCOUNTED CARE. THE DISCOUNT IS AN ESTIMATE OF AMOUNTS GENERALLY BILLED (AGB) TO COMMERCIAL AND MEDICARE PATIENTS. A DISCOUNT OF 30% WILL BE APPLIED TO ALL HOSPITAL CHARGES BILLED. PART I, LINE 7: COST OF COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS WAS OBTAINED FROM THE HOSPITAL'S PAYROLL AND OTHER ACCOUNTING RECORDS.COST OF CHARITY CARE WAS ESTIMATED USING A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 276,642. PART III, LINE 2: BAD DEBT EXPENSE AS REPORTED ON THE FINANCIAL STATEMENTS OF THE HOSPITAL. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE CARRIED AT THE ORIGINAL CHARGE LESS AN ESTIMATE MADE FOR DOUBTFUL OR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. THE ALLOWANCE IS BASED UPON A REVIEW OF THE OUTSTANDING BALANCES AGED BY FINANCIAL CLASS. MANAGEMENT USES COLLECTION PERCENTAGES BASED UPON HISTORICAL COLLECTION EXPERIENCE TO DETERMINE COLLECTABILITY. MANAGEMENT ALSO REVIEWS TROUBLED, AGED ACCOUNTS TO DETERMINE COLLECTION POTENTIAL. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO BAD DEBT EXPENSE WHEN RECEIVED. INTEREST IS NOT CHARGED ON PATIENT ACCOUNTS RECEIVABLE. PART III, LINE 8: MEDICARE REVENUE AND ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORT.DEPENDING ON THE TIMING OF DEDUCTIONS AND RECEIPTS FOR MEDICARE REIMBURSEMENT, THERE MAY BE AN OVERAGE OR SHORTFALL IN ANY YEAR. SINCE THIS TENDS TO OFFSET ITSELF IN THE SUBSEQUENT YEAR, NONE OF THE SHORTFALL IS TREATED AS A COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS WHO INDICATE THAT THEY HAVE AN INABILITY TO PAY FOR MEDICAL CARE ARE REFERRED TO A FINANCIAL COUNSELOR. FINANCIAL ASSISTANCE IS NOT OFFERED TO THOSE PATIENTS WHO ARE MERELY UNWILLING TO PAY. PATIENTS WHO DO NOT MEET THE HOSPITAL'S FINANCIAL ASSISTANCE GUIDELINES BUT WHO DEMONSTRATE AN INABILITY TO MEET MINIMUM PAYMENT GUIDELINES WILL BE GIVEN A REDUCED PAYMENT PLAN. PATIENTS WITH CATASTROPHIC ILLNESSES WILL BE REFERRED TO THE WV CATASTROPHIC ILLNESS FUND. PATIENTS WHOSE CARE IS THE RESULT OF A CRIME WILL BE REFERRED TO THE WV CRIME VICTIMS FUND. PART VI, LINE 2: THE HOSPITAL CONTINUES TO WORK CLOSELY WITH THE COUNTY HEALTH DEPARTMENT TO ASSURE OPEN COMMUNICATION IN ORDER TO PREVENT THE SPREAD AND PREVENTION OF ANY COMMUNICABLE DISEASE PRESENT OR SUSPECTED. THE DEVELOPMENT OF THE "BARBOUR HEALTHY COMMUNITIES COLLABORATIVE" IS A MULTI-DISCIPLINARY GROUP OF HEALTH CARE PROVIDERS AND CITIZENS WITH THE GOAL OF IMPROVING THE OVERALL HEALTH AND WELLNESS OF THE COMMUNITY. PART VI, LINE 3: THE ORGANIZATION INFORMS AND EDUCATES PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE WITH THE FOLLOWING METHODS: (1) IT POSTS INFORMATION IN PUBLIC AREAS WITH THE HOSPITAL, (2) DISPLAYS ITS FINANCIAL POLICY BROCHURE IN PUBLIC PLACES, (3) POSTS INFORMATION ON THE INTERNAL NETWORK, (4) POSTS INFORMATION ON THE HEALTH SYSTEM WEBSITE, (5) PATIENT ADVOCATES CONTACT WORK LISTS OF MEDICALLY INDIGENT PATIENTS TO HELP SECURE FORMS ON FUNDING/ASSISTANCE, AND (6) THE ORGANIZATION PUBLISHES A REPORT IN LOCAL NEWSPAPERS ANNUALLY. PART VI, LINE 4: THE AREA THE ORGANIZATION SERVES IS PRIMARILY LOCATED IN BARBOUR COUNTY, WV AND IS CHARACTERIZED BY THE FOLLOWING: 1) RURAL; 2) AN AVERAGE HOUSEHOLD INCOME OF $37,516; 3) TWO HOSPITALS IN NEIGHBORING COUNTIES ALSO SERVE RESIDENTS OF THE COUNTY, AND 4) FEDERALLY-DESIGNATED UNDERSERVED POPULATIONS RESIDE IN THE COUNTY. PART VI, LINE 5: THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY THE FOLLOWING METHODS: 1) A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. 2) THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS AND ENCOURAGES AND UTILIZES SPECIALIZED SERVICES ON SITE OR VIA REFERRAL AS NEEDED TO BEST OPTIMIZE PATIENT CARE. 3) THE AVAILABILITY OF SURPLUS FUNDS HAS BEEN VERY LIMITED. ALL AVAILABLE FUNDS ARE UTILIZED BASED ON FACILITY CAPITAL AND OPERATIONS TO MEET THE NEEDS OF OUR PATIENTS. EXPENDITURES AND BUDGETS ARE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. 4) THE HOSPITAL'S EMERGENCY ROOM IS AVAILABLE TO ALL, REGARDLESS OF ABILITY TO PAY. 5) BROADDUS HOSPITAL IS THE ONLY HOSPITAL IN BARBOUR COUNTY AND IS A CRITICAL ACCESS HOSPITAL AND THE PRIMARY PROVIDER OF HEALTH CARE SERVICES IN THE COUNTY. IT OFFERS A 24 HOUR PROVIDER STAFFED ER, ACUTE CARE BEDS, SWING BEDS, A LONG-TERM CARE FACILITY, REHAB SERVICES INCLUDING PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, OUTPATIENT BEHAVIORAL HEALTH, LAB, EKG, AND RADIOLOGY SERVICES INCLUDING CT SCAN, ULTRASOUND, AND MRI AND AN OUTPATIENT PHYSICIAN CLINIC. 6) THE HOSPITAL LEADS SOME COMMUNITY BENEFIT ACTIVITIES AND FUNCTIONS AND IS A CATALYST FOR OTHERS. IT IS AN ACTIVE SUPPORTER FOR RELAY FOR LIFE, SHOP FOR TOTS, AND BREAST CANCER AWARENESS EDUCATION. PART VI, LINE 6: DAVIS HEALTH SYSTEM (DHS) WORKS IN CONJUNCTION WITH MANY OTHER COMMUNITY HEALTH AGENCIES TO PROMOTE WELLNESS AND IMPROVED LIFESTYLES IN THE REGION. WORKING TOGETHER AND SHARING RESOURCES HAS PROVEN TO BE MUCH MORE BENEFICIAL FOR THE COMMUNITY, AS WELL AS THE AGENCIES IN MEETING THEIR GOALS. SOME OF THE WAYS THAT DHS CONTRIBUTES TO THE COMMUNITY HEALTH INCLUDE: HEALTHY WEIGHT CLASSES, HEALTHY HEART SCREENINGS, COLON CANCER AWARENESS AND SCREENING, REGIONAL SCHOOL AND EMPLOYER WELLNESS FAIRS, COMPREHENSIVE HEALTH FAIRS, LOCAL SPORTING EVENT SUPPORT, EARLY CHILDHOOD FAIRS, WALK 100 MILES IN 100 DAYS PROGRAM, RELAY FOR LIFE INVOLVEMENT, PROSTRATE SCREENING, BREAST CANCER SURVIVOR DINNER, INFLUENZA VACCINATION CLINICS, SMOKING CESSATION SUPPORT AND MANY OTHERS. X X X X X 0 0 0 0 0 0 0 0 0 DANA GOULD CEO 0 161441 0 101 0 1341 0 1622 0 1341 0 165846 0 0 PART I, LINE 3 THE CEO IS PAID BY A RELATED ORGANIZATION, DAVIS MEMORIAL HOSPITAL. DAVIS MEMORIAL HOSPITAL USES A COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACTS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE CEO. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE 990 IS FIRST REVIEWED BY THE CEO AND CFO AND THEN DISCUSSED WITH THE BOARD. A COPY OF THE FINAL 990 WAS PROVIDED TO THE BOARD BEFORE IT WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY REQUIRES THAT EACH DIRECTOR, OFFICER AND COMMITTEE MEMBER WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THE PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY AND READS AND UNDERSTANDS THE POLICY. ADMINISTRATION MONITORS AND QUESTIONS ANY POTENTIAL CONFLICTS OF WHICH THEY BECOME AWARE. FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND OTHER OFFICERS ARE PAID BY A RELATED ORGANIZATION, DAVIS MEMORIAL HOSPITAL. THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF DAVIS MEMORIAL HOSPITAL IS RESPONSIBLE FOR THE OVERSIGHT OF THE COMPENSATION OF THE CEO. A CONSULTANT (YAFFE & COMPANY) IS ENGAGED WHO FACILITATES THE ANNUAL EVALUATION PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVES. THE CONSULTANT COORDINATES A SERIES OF MEETINGS, LEADS DISCUSSIONS ON THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE EVALUATION, PRESENTS MARKET ANALYSIS INFORMATION FOR KEY POSITIONS AND PROVIDES RECOMMENDATIONS FOR SALARY LEVELS BASED ON THAT INFORMATION. THE COMMITTEE MAKES THEIR DECISION USING THE GUIDANCE OF THE CONSULTANT. FORM 990, PART VI, SECTION C, LINE 19 ANY REQUEST FOR FINANCIAL OR OTHER CORPORATE DOCUMENTS ARE MADE ON A CASE BY CASE BASIS BY THE ADMINISTRATION OF DAVIS HEALTH SYSTEM AND TAKEN TO THE BOARD AS NECESSARY. FORM 990, PART IX, LINE 11G ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 367,706. MANAGEMENT AND GENERAL EXPENSES 132,983. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 500,689. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 1,315,282. MANAGEMENT AND GENERAL EXPENSES 475,679. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,790,961. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 90,436. MANAGEMENT AND GENERAL EXPENSES 32,707. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 123,143. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,273,478. MANAGEMENT AND GENERAL EXPENSES 460,560. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,734,038. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 93,907. MANAGEMENT AND GENERAL EXPENSES 33,962. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,869. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 186,506. MANAGEMENT AND GENERAL EXPENSES 67,451. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 253,957. FORM 990, PART XI, LINE 9: TRANSFERS TO AFFILIATES -1,000,000. SCHEDULE K THE HEALTH SYSTEM REFUNDING REVENUE BONDS (DAVIS HEALTH SYSTEM OBLIGATED GROUP) SERIES 2016 A TAX EXEMPT BONDS ARE REPORTED ON THE FORM 990, SCHEDULE K OF DAVIS MEMORIAL HOSPITAL. THE LIABILITY IS REPORTED IN EQUAL PORTIONS ON EACH HOSPITAL'S BALANCE SHEET BUT REPORTED IN TOTAL ON THE CONSOLIDATED FINANCIAL STATEMENTS. DAVIS HEALTH SYSTEM INC PO BOX 1697 ELKINS WV 26241 550737655 SUPPORTING ORGANIZATION WV 501(C)(3) LINE 12B, II N/A 0 DAVIS MEMORIAL HOSPITAL PO BOX 1484 ELKINS WV 26241 550375433 HOSPITAL WV 501(C)(3) LINE 3 DAVIS HEALTH SYSTEM INC 0 DAVIS HEALTH SYSTEM FOUNDATION PO BOX 1188 ELKINS WV 26241 320185772 PROVIDES SUPPORT TO DAVIS HEALTH SYSTEM ENTITIES WV 501(C)(3) LINE 10 N/A 0 HEALTH FACILITIES INC 909 GORMAN AVENUE ELKINS WV 26241 550516937 HEALTH CARE WV N/A C 0 CENTRAL WV MEDCORP INC PO BOX 2630 ELKINS WV 26241 550739314 PHYSICIAN SERVICES WV N/A C 0 DAVIS REGIONAL HEALTH PARTNERS INC PO BOX 2632 ELKINS WV 26241 550746206 CONTRACT NEGOTIATIONS WV N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0