2023-11-15T14:31:18-06:00 2022-12-31 390859910 BAKER TILLY US LLP 101 WASHINGTON STREET EAST CHARLESTON WV 25301 990 2022-01-01 550737655 DAVIS HEALTH SYSTEM INC DAVI 3046373155 PO BOX 1484 ELKINS WV 26241 WILLIAM KOCH CFO 3046373155 2023-11-15 1 WILLIAM KOCH 999009999 0 DOLORES ROSE P01286262 3043460441 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z VANCE JACKSON PO BOX 1484 ELKINS WV 26241 139573 0 X WWW.DAVISHEALTHSYSTEM.ORG X 1995 WV DAVIS HEALTH SYSTEM, INC. EXERCISES CONTROL OVER AFFILIATED SUBSIDIARY ORGANIZATIONS TO PROMOTE INCREASED AWARENESS AND AVAILABILITY OF HEALTHCARE TO THE COMMUNITY. 9 7 0 7 0 0 0 0 172466 139573 0 0 0 0 172466 139573 0 0 0 0 0 0 0 0 0 186968 138561 186968 138561 -14502 1012 1850572 1848742 1086504 1106649 764068 742093 DAVIS HEALTH SYSTEM IS COMMITTED TO PROVIDING QUALITY, PATIENT-FRIENDLY HEALTHCARE TO ITS COMMUNITIES. 0 0 139573 THE ORGANIZATION PROVIDED SUPPORT TO OTHER EXEMPT ORGANIZATIONS, INCLUDING DAVIS MEMORIAL HOSPITAL AND BROADDUS HOSPITAL; AND PLANNED AND PROMOTED HEALTHCARE IN THE COMMUNITY THROUGH VARIOUS OTHER ORGANIZATIONS. 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 1 CJ 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X WILLIAM KOCH 3046373196 PO BOX 1484 ELKINS WV 26241 BRIDGETTE WILSON CHAIRMAN 1.00 1.00 X X 0 0 0 ASHTON CURTIS DPM VICE CHAIRMAN 1.00 39.00 X X 0 72181 21759 HUGH HITCHCOCK TREASURER 1.00 5.00 X X 0 0 0 JOHN KABLER SECRETARY 1.00 1.00 X X 0 0 0 JAMES TRIPLETT DIRECTOR 0.50 0.50 X 0 0 0 MARY ANN CARPENTER DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM HARTMAN VICE CHAIRMAN 1.00 1.00 X X 0 0 0 JEFF POWELSON DIRECTOR 0.50 1.50 X 0 0 0 VANCE JACKSON CEO 3.00 37.00 X X 0 358038 28427 WILLIAM KOCH VP AND CFO 1.00 39.00 X 0 129285 2307 0 559504 52493 0 0 1 0 0 ADMINISTRATIVE SERVICE 561000 139573 139573 139573 139573 139573 0 0 X 38986 38986 99575 99575 138561 0 138561 0 47952 6237 5518 5518 0 0 1802620 1842505 1850572 1848742 1086504 1106649 1086504 1106649 X 764068 742093 764068 742093 1850572 1848742 X 1012 -310962 287975 X 0 1 X 1 0 X X 3 DAVIS MEMORIAL HOSPITAL 550375433 3 1 0 0 BROADDUS HOSPITAL ASSOCIATION INC 550379108 3 1 0 0 DAVIS HEALTH SYSTEM FOUNDATION 320185772 10 0 117310 0 3 117310 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART IV, SECTION A, LINE 1: DAVIS HEALTH SYSTEM (SYSTEM) IS THE PARENT CORPORATION OF DAVIS MEMORIAL HOSPITAL, BROADDUS HOSPITAL ASSOCIATION, AND DAVIS HEALTH SYSTEM FOUNDATION. THE BYLAWS OF THE SYSTEM AND THE SUPPORTED ORGANIZATIONS DESIGNATE THE SYSTEM AS THE SOLE CORPORATE MEMBER OF DAVIS MEMORIAL HOSPITAL, BROADDUS HOSPITAL ASSOCIATION AND DAVIS HEALTH SYSTEM FOUNDATION; AND GRANTING ALL RIGHTS TO MEMBERS OF NONPROFIT CORPORATIONS BY THE LAWS OF THE STATE OF WEST VIRGINIA. A MAJORITY OF THE SYSTEM'S TRUSTEES ARE ALSO TRUSTEES FOR DAVIS MEMORIAL HOSPITAL. THE FOUNDATION AND BROADDUS HOSPITAL TRUSTEES DO NOT HAVE A MAJORITY OF COMMON TRUSTEES WITH THE SYSTEM, HOWEVER, AS STATED ABOVE THE SYSTEM IS THE PARENT AND SOLE MEMBER OF EACH SUPPORTED ORGANIZATION AND ALTHOUGH THERE IS NOT A MAJORITY OF COMMON TRUSTEES FOR ALL SUPPORTED ORGANIZATIONS, THE SYSTEM IS REPRESENTED ON EACH BOARD WITH AT LEAST ONE COMMON TRUSTEE. 5518 5518 0 0 INVESTMENT IN SUBSIDIARY 1802648 DUE FROM AFFILIATES 39857 1842505 DUE TO AFFILIATE 1106649 1106649 X 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. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 1671147 0 0 0 0 0 0 1671147 0 1671147 0 0 1 0 0 0 PART III ACCOUNTING METHOD: 0 0 0 0 0 0 0 0 0 VANCE JACKSON CEO 0 357936 0 102 0 0 0 3565 0 24862 0 386465 0 0 PART I, LINE 3 THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES FOR DAVIS MEMORIAL HOSPITAL IS RESPONSIBLE FOR THE OVERSIGHT OF THE COMPENSATION FOR THE SENIOR STAFF. 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 B, LINE 11B FORM 990 WILL BE DISTRIBUTED TO ALL BOARD MEMBERS. IT WILL BE PRESENTED AND DISCUSSED AT A BOARD OF TRUSTEES MEETING OR A FINANCE COMMITTEE MEETING, WHICHEVER OCCURS FIRST AFTER THE COMPLETION OF FORM 990. IF THE FINANCE COMMITTEE MEETING IS THE FIRST TO OCCUR, ALL MEMBERS OF THE BOARD OF TRUSTEES 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 DAVIS HEALTH SYSTEM 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. BOARD MEMBERS COMPLETE THE STATEMENT IN JANUARY OF EACH YEAR. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE EXECUTIVE COMMITTEE. IN ADDITION TO BOARD MEMBERS, SENIOR STAFF IS REQUIRED TO ANNUALLY PREPARE A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES IS RESPONSIBLE FOR THE OVERSIGHT OF THE COMPENSATION FOR THE SENIOR STAFF. 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 THE INFORMATION. THE COMMITTEE MAKES THEIR DECISION USING THE GUIDANCE OF THE CONSULTANT. DURING THE TWO YEARS WHEN YAFFE DOES NOT ASSIST WITH A DETAILED REVIEW, COMPARATIVE WAGE DATA IS OBTAINED FROM A YAFFE ANNUAL SURVEY. THE COMPARATIVE DATA IS REVIEWED BY THE COMPENSATION COMMITTEE TO ESTABLISH COMPENSATION FOR EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 THE BOARD OF TRUSTEES ADOPTED A RECORD KEEPING AND DISCLOSURE POLICY IN JANUARY OF 2003. THE POLICY PROVIDES FOR DISCLOSURE OF CORPORATE AND FINANCIAL RECORDS NOT COVERED BY GOVERNMENTAL OR CONTRACTUAL AGREEMENTS. ANY REQUEST FOR FINANCIAL OR OTHER CORPORATE DOCUMENTS ARE SUBMITTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES AND DECISIONS ARE MADE ON A CASE BY CASE BASIS. THE COMPLIANCE CODE OF CONDUCT POLICY INCLUDES STANDARDS RELATING TO CONFLICTS OF INTEREST WITHIN THE ORGANIZATION. THIS INFORMATION IS SHARED WITH THE PUBLIC, BEING POSTED ON THE WEBSITE IN ADDITION TO BEING DISTRIBUTED TO ALL PATIENTS ADMITTED TO THE HOSPITAL. FORM 990, PART IX, LINE 11G CONTRACT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 38,986. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,986. FORM 990, PART XI, LINE 9: NET TRANSFERS TO AFFILIATES -87,737. EQUITY METHOD GAIN OF SUBSIDIARY 375,712. DAVIS MEMORIAL HOSPITAL PO BOX 1484 ELKINS WV 26241 550375433 HEALTH CARE WV 501(C)(3) LINE 3 DAVIS HEALTH SYSTEM INC 1 BROADDUS HOSPITAL ASSOCIATION PO BOX 930 PHILIPPI WV 26416 550379108 HEALTH CARE WV 501(C)(3) LINE 3 DAVIS HEALTH SYSTEM INC 1 DAVIS HEALTH SYSTEM FOUNDATION PO BOX 1188 ELKINS WV 26241 320185772 SUPPORTING ORGANIZATION TO HEALTH CARE ORGANIZATION WV 501(C)(3) LINE 11 DAVIS HEALTH SYSTEM INC 1 CENTRAL WV MEDCORP INC PO BOX 2630 ELKINS WV 26241 550739314 HEALTHCARE PROVIDER WV DAVIS MEMORIAL HOSPITAL C 1.00000 0 HEALTH FACILITIES INC 909 GORMAN AVENUE ELKINS WV 26241 550516937 EQUIPMENT SALES AND RENTALS WV DAVIS MEMORIAL HOSPITAL C 1.00000 0 DAVIS REGIONAL HEALTH PARTNERS INC PO BOX 2632 ELKINS WV 26241 550742606 HOSPITAL/PHYSICIAN ORGANIZATION WV DAVIS MEMORIAL HOSPITAL C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0