2024-11-13T22:27:14-06:00 2023-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 46204 990 2023-01-01 550737655 DAVIS HEALTH SYSTEM INC DAVI 3046373155 PO BOX 1484 ELKINS WV 26241 WILLIAM KOCH EXECUTIVE VP AND CFO 3046373155 2024-11-13 1 0 ANGELA M MOORE P00244342 3174648600 2023 2024-10-15 13:58:12Z MARK DOAK PO BOX 1484 ELKINS WV 26241 144709 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. 10 8 0 8 0 0 0 0 139573 144709 0 -291637 0 0 139573 -146928 0 0 0 0 0 0 0 0 0 138561 149709 138561 149709 1012 -296637 1848742 2020119 1106649 1805920 742093 214199 WE CARE FOR LIFE. 0 0 144709 THE ORGANIZATION PROVIDED SUPPORT TO OTHER EXEMPT ORGANIZATIONS, INCLUDING DAVIS MEMORIAL HOSPITAL, BROADDUS HOSPITAL, AND WEBSTER MEMORIAL 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 3 0 0 0 1 CJ 0 0 0 0 0 0 0 0 0 0 X 10 8 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 DAVID GOLDBERG DIRECTOR (START 12/23) 1.00 50.00 X 0 853663 36373 VANCE JACKSON CEO 3.00 37.00 X X 0 315542 16877 BRIDGETTE WILSON CHAIRMAN 1.00 0.00 X X 0 0 0 HUGH HITCHCOCK TREASURER 1.00 2.00 X X 0 0 0 JOHN KABLER SECRETARY 1.00 0.00 X X 0 0 0 WILLIAM HARTMAN VICE CHAIRMAN 1.00 0.00 X X 0 0 0 ASHTON CURTIS DPM DIRECTOR 1.00 0.00 X 0 0 0 JAMES TRIPLETT DIRECTOR 1.00 1.00 X 0 0 0 JEFF POWELSON DIRECTOR 1.00 1.00 X 0 0 0 MARY ANNE CARPENTER DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM KOCH VP OF FINANCE AND CFO 5.00 35.00 X 0 165014 1587 0 1334219 54837 0 0 1 0 0 ADMINISTRATIVE SERVICE 561000 144709 144709 144709 291637 -291637 -291637 -291637 -146928 144709 0 -291637 X 5010 5010 48699 48699 96000 96000 149709 0 149709 0 6237 2877 5518 5518 0 0 1842505 2017242 1848742 2020119 1106649 1805920 1106649 1805920 X 742093 214199 742093 214199 1848742 2020119 -296637 -231257 0 X 0 1 X 1 0 X X 4 DAVIS MEMORIAL HOSPITAL 550375433 3 1 0 0 BROADDUS HOSPITAL ASSOCIATION INC 550379108 3 1 0 0 DAVIS HEALTH SYSTEM FOUNDATION 320185772 10 0 0 0 WEBSTER MEMORIAL HOSPITAL 871759588 3 1 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 SCHEDULE A, PART IV, SECTION A, LINE 1: DAVIS HEALTH SYSTEM (SYSTEM) IS THE PARENT CORPORATION OF DAVIS MEMORIAL HOSPITAL, BROADDUS HOSPITAL ASSOCIATION, DAVIS HEALTH SYSTEM FOUNDATION, AND WEBSTER MEMORIAL HOSPITAL. THE BYLAWS OF THE SYSTEM AND THE SUPPORTED ORGANIZATIONS DESIGNATE THE SYSTEM AS THE SOLE CORPORATE MEMBER OF DAVIS MEMORIAL HOSPITAL, BROADDUS HOSPITAL ASSOCIATION, DAVIS HEALTH SYSTEM FOUNDATION, AND WEBSTER MEMORIAL HOSPITAL; 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. DAVIS HEALTH SYSTEM FOUNDATION, BROADDUS HOSPITAL, AND WEBSTER MEMORIAL 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 1958665 DUE FROM AFFILIATES 58577 2017242 DUE TO AFFILIATE 1127019 ACCRUED MALPRACTICE 678901 1805920 X PART X, LINE 2: THE IRS HAS DETERMINED THAT THE SYSTEM ENTITIES ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE CODE AND APPLICABLE STATE STATUTES, EXCEPT FOR MHC, FHE, CMC, AND HFI, WHICH ARE CORPORATIONS SUBJECT TO INCOME TAX. THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2023. TAX RETURNS FOR THE YEAR ENDED JUNE 30, 2019, ARE OPEN FOR THE MHS ENTITIES AND TAX RETURNS FOR THE YEAR ENDED DECEMBER 31, 2020, ARE OPEN FOR CAMC ENTITIES. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 2726729 0 0 0 0 0 0 2726729 0 2726729 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 DAVID GOLDBERG DIRECTOR (START 12/23) 0 714488 0 139175 0 0 0 30000 0 6373 0 890036 0 0 VANCE JACKSON CEO 0 314560 0 0 0 982 0 2024 0 14853 0 332419 0 0 WILLIAM KOCH VP OF FINANCE AND CFO 0 164424 0 0 0 590 0 872 0 715 0 166601 0 0 PART I, LINE 3: 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. PART I, LINE 4B: 457(F) INELIGIBLE DEFERRED COMPENSATION PLAN - A 457 F PLAN IS OFFERED TO CERTAIN MANAGEMENT AND/OR HIGHLY COMPENSATED EMPLOYEES TO OFFER THOSE EMPLOYEES A DEFERRED COMPENSATION OPPORTUNITY. THE PLAN IS INTENDED TO BE A "TOP-HAT PLAN", OR UNFUNDED DEFERRED COMPENSATION PLAN MAINTAINED FOR A SELECT GROUP OF EMPLOYEES. PARTICIPANTS MAY BECOME VESTED IN AMOUNTS CREDITED ON JANUARY 1 ELECTED BY THE PARTICIPANT AT THE TIME THE INITIAL DEFERRAL WAS ELECTED. A PARTICIPANT SHALL BECOME FULLY VESTED UPON DEATH, DISABILITY, ATTAINMENT OF AGE 60, OR SEPARATION OF SERVICE, AS DEFINED BY THE PLAN. ANY UNVESTED CONTRIBUTIONS SHALL BE FORFEITED TO THE PLAN OR EMPLOYER. FOR 2023: PER BENEFITS - NO DISTRIBUTIONS / PAYMENTS WERE MADE FROM THE PLAN; DAVID GOLDBERG WAS THE ONLY PARTICIPANT. 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 48,699. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 48,699. VANDALIA HEALTH INC PO BOX 1547 CHARLESTON WV 253261547 550664138 PARENT COMPANY WV 501(C)(3) 12C, III-FI N/A 0 CAMC FOUNDATION INC PO BOX 1547 CHARLESTON WV 253261547 310887133 FUNDRAISING WV 501(C)(3) 12A, I CHARLESTON AREA MEDICAL CENTER INC 1 CHARLESTON AREA MEDICAL CENTER INC PO BOX 1547 CHARLESTON WV 253261547 550526150 HOSPITAL WV 501(C)(3) 3 VANDALIA HEALTH INC 0 MONONGALIA HEALTH SYSTEM INC 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550621551 PARENT COMPANY WV 501(C)(3) 12C, III-FI VANDALIA HEALTH INC 0 MONONGALIA COUNTY GENERAL HOSPITAL COMPANY 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 237441353 HOSPITAL WV 501(C)(3) 3 MONONGALIA HEALTH SYSTEM INC 1 MON ELDER SERVICES INC 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 311520863 CONTINUING CARE RETIREMENT CENTER WV 501(C)(3) 10 MONONGALIA HEALTH SYSTEM INC 1 THE FOUNDATION OF MONONGALIA GENERAL HOSPITAL 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550570338 RAISE FUNDS FOR MONONGALIA GENERAL HOSPITAL WV 501(C)(3) 7 MONONGALIA 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