2023-09-18T09:01:13-05:00 2022-12-31 390859910 BAKER TILLY US LLP 101 WASHINGTON STREET EAST CHARLESTON WV 25301 990 2022-01-01 320185772 DAVIS HEALTH SYSTEM FOUNDATION INC DAVI 3046373155 PO BOX 1188 ELKINS WV 26241 MIKE CVECHKO PRESIDENT 3046373155 2023-09-05 1 MIKE CVECHKO 999009999 0 DOLORES ROSE P01286262 3043460441 2023-09-05 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MIKE CVECHKO PO BOX 1188 ELKINS WV 26241 520123 0 X WWW.DHSFOUNDATION.COM X 2006 WV DAVIS HEALTH SYSTEM FOUNDATION PROVIDES OPPORTUNITIES FOR OUR COMMUNITY TO ADVANCE HEALTHCARE THROUGH GIVING. FOUNDATION INITIATIVES SUPPORT DAVIS HEALTH SYSTEM'S COMMITMENT TO BRINGING BETTER HEALTH TO LIFE. CONTRIBUTIONS PROVIDE EXPERT STAFF, STATE-OF-THE-ART TREATMENTS, AND CUTTING-EDGE TECHNOLOGIES THROUGHOUT THE POTOMAC HIGHLANDS OF NORTH CENTRAL WEST VIRGINIA SO THAT OUR NEIGHBORS, FRIENDS, AND FAMILIES CAN GO BEYOND ROUTINE CARE WITHOUT GOING FAR FROM HOME. 15 13 0 23 0 0 410026 471057 0 0 0 192 -7069 4963 402957 476212 1480 77268 0 0 0 0 0 0 0 358168 661285 359648 738553 43309 -262341 1137865 843052 32852 80312 1105013 762740 TO ADVANCE HEALTHCARE THROUGH GIVING. 0 0 523811 77268 THE DAVIS HOUSE FUND OFFERS CANCER PATIENTS AND THEIR FAMILY MEMBERS A "HOME AWAY FROM HOME" WHEN IT IS NECESSARY TO TRAVEL TO THE DMC CANCER CARE CENTER FOR TREATMENT. NOT HAVING TO WORRY ABOUT WHERE TO STAY OR HOW TO PAY FOR LODGING ALLOWS DAVIS HOUSE GUESTS TO FOCUS ON THE MOST IMPORTANT THING: GETTING WELL. THE DHS FOUNDATION PATIENT ASSISTANCE FUNDS, INCLUDING THE DMC CANCER CARE CENTER PATIENT ASSISTANCE FUND, GUARDIAN ANGEL GENERAL PATIENT ASSISTANCE FUND, AND NORONHA BENEVOLENT CARE FUND, PROVIDE FINANCIAL SUPPORT TO PATIENTS FOR MEDICALLY NECESSARY ITEMS AND SERVICES (INCLUDING A FREE MAMMOGRAM PROGRAM) THAT CONTRIBUTE DIRECTLY TO THE OVERALL HEALTH, WELLNESS, AND QUALITY OF LIFE OF THE INDIVIDUAL. 523811 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 0 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X THE ORGANIZATION 3046373155 PO BOX 1188 ELKINS WV 26241 MICHAEL CVECHKO PRESIDENT 2.00 X X 0 0 0 CINDEE CAMPBELL VICE-PRESIDENT 2.00 X X 0 0 0 CHRISTY TRIBBLE CPA TREASURER 2.00 X X 0 0 0 JEFFREY ZURBUCH SECRETARY 2.00 X X 0 0 0 CRYSTAL WARNER GIBSON DIRECTOR 2.00 X 0 0 0 STERL DEAN DIRECTOR 2.00 X 0 0 0 BOB DUNKERLEY DIRECTOR 2.00 X 0 0 0 HUGH HITCHCOCK DIRECTOR 2.00 X 0 0 0 PENNY GRAHAM DIRECTOR 2.00 X 0 0 0 PATRICIA MAYES DIRECTOR 2.00 X 0 0 0 DIANNA VANNOY DIRECTOR 2.00 X 0 0 0 MISHA PHILLIPS-LEE MD DIRECTOR/PHYSICIAN 2.00 38.00 X 0 172121 2348 WHITNEY PHILLIPS MORRIS DIRECTOR 2.00 X 0 0 0 MELANIE DEMPSEY DIRECTOR (CFO DHS TERMED 2/22) 2.00 38.00 X X 0 41992 0 JUDY SCHOONOVER RITCHIE DIRECTOR 2.00 X 0 0 0 MICHAEL BELL EXECUTIVE DIRECTOR 40.00 X 0 120716 24943 WILLIAM KOCH VP AND CFO 2.00 38.00 X 0 129285 2307 0 464114 29598 0 0 1 0 0 33210 117310 320537 471057 192 192 48874 33210 43911 4963 4963 476212 0 0 5155 X 77268 77268 89626 47655 41971 2226 2226 351650 186972 164678 2405 1279 1126 4152 2208 1944 BAD DEBT EXPENSE 200500 200500 DUES, SUBSCRIPTIONS & L 5124 2724 2400 REPAIRS & MAINTENANCE 3654 1943 1711 SALES TAX 1948 1036 912 738553 523811 214742 0 135845 126417 764280 677028 220013 3588 11572 31617 1428 1437 22133 22133 0 0 4727 2965 1137865 843052 6036 40683 26816 39629 32852 80312 X 255432 200168 849581 562572 1105013 762740 1137865 843052 -262341 -79932 0 X 0 1 X 1 0 X 272213 422671 201525 410026 391317 1697752 75733 71122 56753 203608 347946 493793 258278 410026 391317 1901360 0 0 0 1901360 23441 41152 64593 23441 41152 64593 371387 493793 299430 410026 391317 1965953 0.96710 0.96170 0.03290 0.03830 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 849581 -5957 281052 562572 1050143 47515 248077 849581 1051327 164795 165979 1050143 1350655 391939 691267 1051327 1317744 239230 23441 229760 1350655 1.00000 1 0 22133 22133 0 0 DUE TO AFFILIATES 39629 39629 X PART V, LINE 4: THE FOUNDATION'S ENDOWMENT FUNDS WILL BE USED FOR THE FOLLOWING: RENOVATE AND OPERATE DAVIS HOUSE WHICH PROVIDES FREE, TEMPORARY HOUSING TO THOSE RECEIVING TREATMENT FOR CANCER AND OTHER CRITICAL ILLNESSES AT DAVIS MEMORIAL HOSPITAL; NORONHA BENEVOLENT FUND-TO PROVIDE FINANCIAL ASSISTANCE FOR PATIENTS WITHOUT INSURANCE, HIGH DEDUCTIBLE PLANS, NOT ON STATE ASSISTANT; RENOVATE THE EMERGENCY DEPARTMENT; CANCER PATIENT ASSISTANCE; AND OTHER CHARITABLE ACTIVITIES. PART X, LINE 2: THE SYSTEM, EXCEPT FOR CENTRAL WV MEDCORP, INC. AND HEALTH FACILITIES, INC., IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SIMILAR STATE STATUTES RELATING TO NOT-FOR-PROFIT ORGANIZATIONS. CENTRAL WV MEDCORP, INC. AND HEALTH FACILITIES, INC. ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. 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. DHS GOLF TOURNAMENT 45274 14040 31234 15638 6118 26 1286 DAVIS GALA 36810 19170 17640 351 224 1160 10917 1591 6600 1 82084 33210 48874 351 224 16798 17035 1617 7886 43911 4963 1 DAVIS MEDICAL CENTER 812 GORMAN AVE ELKINS WV 26241 550375433 501(C)(3) 33941 0 TO PROVIDE SUPPORT FOR PROJECTS OR EQUIPMENT NEEDED BY DAVIS MEDICAL CENTER. WEBSTER MEMORIAL HOSPITAL 324 MILLER MOUNTAIN RD WEBSTER SPRINGS WV 26288 871759588 501(C)(3) 8438 0 TO PROVIDE SUPPORT FOR PROJECTS OR EQUIPMENT NEEDED BY WEBSTER MEMORIAL HOSPITAL. BROADDUS HOSPITAL 1 HEALTHCARE DR PHILIPPI WV 26416 550379108 501(C)(3) 19889 0 TO PROVIDE SUPPORT FOR PROJECTS OR EQUIPMENT NEEDED BY BROADDUS HOSPITAL. DAVIS HEALTH SYSTEM 812 GORMAN AVE ELKINS WV 26241 550737655 501(C)(3) 15000 0 TO PROVIDE SUPPORT FOR PROJECTS OR EQUIPMENT NEEDED BY DAVIS HEALTH SYSTEM. 4 X 0 0 0 0 0 0 0 0 0 MISHA PHILLIPS-LEE MD DIRECTOR/PHYSICIAN 0 172020 0 101 0 0 0 1928 0 420 0 174469 0 0 PART I, LINE 3 THE FOUNDATION UTILIZES DAVIS MEDICAL CENTER'S MARKET SALARY STUDY TO EVALUATE AND ADJUST THE COMPENSATION OF THE DIRECTOR, OFFICERS, AND KEY EMPLOYEES. FORM 990, PART VI, SECTION A, LINE 6 DAVIS HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THE FOUNDATION. THE FOUNDATION'S ARTICLES OF INCORPORATION AND BY-LAWS GRANT TO DAVIS HEALTH SYSTEM, INC. ALL RIGHTS GRANTED TO MEMBERS OF NONSTOCK, NONPROFIT CORPORATIONS BY THE LAWS OF THE STATE OF WEST VIRGINIA. FORM 990, PART VI, SECTION A, LINE 7A ALL DIRECTORS ARE ELECTED BY DAVIS HEALTH SYSTEM, INC., THE SOLE MEMBER OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B DAVIS HEALTH SYSTEM, INC., THE SOLE MEMBER OF THE ORGANIZATION, HAS THE SOLE AUTHORITY TO AMEND, ALTER, RESTATE, OR REPEAL THE ARTICLES OF INCORPORATION AND BY-LAWS; TO ELECT, APPOINT, OR REMOVE ANY DIRECTOR; TO ADOPT A PLAN OF MERGER OR CONSOLIDATION WITH ANOTHER ORGANIZATION; TO AUTHORIZE THE SALE, LEASE, EXCHANGE, OR MORTGAGE OF SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF THE ORGANIZATION; AND TO AUTHORIZE THE VOLUNTARY DISSOLUTION OF THE ORGANIZATION, REVOKE PROCEEDINGS THERE FOR, AND ADOPT A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE ORGANIZATION UPON DISSOLUTION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 WILL BE DISTRIBUTED TO ALL BOARD MEMBERS. IT WILL BE PRESENTED AND DISCUSSED AT A BOARD MEETING OR FINANCE COMMITTEE MEETING, WHICHEVER OCCURS FIRST AFTER COMPLETION OF THE 990. IF THE FINANCE COMMITTEE MEETING IS THE FIRST TO OCCUR, ALL BOARD MEMBERS WILL BE ENCOURAGED TO ATTEND THE FINANCE COMMITTEE MEETING WHERE THE FORM 990 WILL BE DISCUSSED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ADHERES TO THE CONFLICT OF INTEREST POLICY OF DAVIS HEALTH SYSTEM, INC. THAT POLICY REQUIRES THAT EACH DIRECTOR, OFFICER AND COMMITTEE MEMBER WITH BOARD DESIGNATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THE PERSON HAS RECEIVED A COPY OF THE POLICY AND READS AND UNDERSTANDS THE POLICY. BOARD MEMBERS COMPLETE THE STATEMENT IN AUGUST OF EACH YEAR. THE STATEMENTS ARE THEN REVIEWED BY THE EXECUTIVE COMMITTEE. ADDITIONALLY, SENIOR STAFF IS REQUIRED TO ANNUALLY PREPARE A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION UTILIZES DAVIS MEDICAL CENTER'S MARKET SALARY STUDY TO EVALUATE AND ADJUST THE COMPENSATION OF THE DIRECTOR, OFFICERS, AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 16,716. MANAGEMENT AND GENERAL EXPENSES 14,722. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,438. ADMINISTRATION FEES: PROGRAM SERVICE EXPENSES 30,939. MANAGEMENT AND GENERAL EXPENSES 27,249. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,188. BROADDUS HOSPITAL ASSOCIATION INC PO BOX 930 PHILLIPI WV 26416 550379108 HOSPITAL WV 501(C)(3) LINE 3 DAVIS HEALTH SYSTEM INC 0 DAVIS HEALTH SYSTEM INC PO BOX 1697 ELKINS WV 26241 550737655 HEALTH SYSTEM WV 501(C)(3) LINE 12C, III-FI N/A 0 DAVIS MEMORIAL HOSPITAL INC PO BOX 1484 ELKINS WV 26241 550375433 HOSPITAL WV 501(C)(3) LINE 3 DAVIS HEALTH SYSTEM INC 0 HEALTH FACILITIES INC 909 GORMAN AVENUE ELKINS WV 26241 550516937 HEALTH CARE WV DAVIS MEMORIAL HOSPITAL C 0 CENTAL WV MEDCORP INC PO BOX 2630 ELKINS WV 26241 550739314 PHYSICIAN OFFICES WV DAVIS HEALTH SYSTEM INC C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1