2025-11-17T18:08:12-06:00 2024-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 46204 990 2024-01-01 550379108 BROADDUS HOSPITAL ASSOCIATION INC BROA 3044571760 PO BOX 930 PHILIPPI WV 26416 JEFF SANDENE CHIEF FINANCIAL OFFICER 3044571760 2025-11-17 1 0 ANGELA M MOORE P00244342 3174648600 2025-11-15 2024 2025-03-06 01:10:19Z DANA GOULD PO BOX 930 PHILIPPI WV 26416 27023776 0 X WWW.DAVISHEALTHSYSTEM.ORG X 1954 WV BROADDUS HOSPITAL IS THE PRIMARY PROVIDER OF HEALTH CARE SERVICES IN BARBOUR COUNTY. 15 7 268 8 0 0 0 0 21694724 26686603 141487 -4653 322328 330985 22158539 27012935 0 19449 0 0 13982257 13616799 0 0 0 8817387 9969032 22799644 23605280 -641105 3407655 14541312 16712195 5250496 5408986 9290816 11303209 BROADDUS HOSPITAL ASSOCIATION IS COMMITTED TO PROVIDING PATIENT-FRIENDLY, QUALITY HEALTH CARE TO ITS COMMUNITIES. 0 0 19327855 19449 26686832 BROADDUS HOSPITAL PROVIDES 24/7 HOUR EMERGENCY ROOM SERVICES BY QUALIFIED, EXPERIENCED PROVIDERS. 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. THE HOSPITAL PROVIDES RADIOLOGY SERVICES INCLUDING GENERAL RADIOLOGY, CT SCANS, ULTRASOUND, MRI, DEXA SCANS, AND MAMMOGRAPHY. 19327855 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 19 0 1 268 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WV X DANA GOULD CEO 3044571760 PO BOX 930 PHILLIPI WV 26416 VANCE JACKSON DHS CEO (END 06/24) 1.00 39.00 X X 0 393822 226509 GARRETT BUTLER DIRECTOR 1.00 40.00 X 0 508227 37836 DANA GOULD CEO 40.00 0.00 X X 0 172776 11984 WILLIAM KOCH VP FINANCE AND CFO 5.00 35.00 X X 0 155808 24191 RONALD ANDRO DHS SVP CHIEF ADMINISTRATIVE OFFICER 1.00 41.00 X 0 37284 87 DANNY FRANKE VICE CHAIR 2.00 14.00 X X 0 23642 175 AARON NORRIS CHAIRMAN 2.00 0.00 X X 0 0 0 CRYSTAL GRAY SECRETARY 1.00 0.00 X X 0 0 0 MARY BETH LIND END NOV 2024 CHAIRMAN 1.00 0.00 X X 0 0 0 AMANDA WAGNER DIRECTOR 1.00 0.00 X 0 0 0 DONNA PHILLIPS DIRECTOR (ENDS 01/24) 1.00 0.00 X 0 0 0 JEFF POWELSON DIRECTOR 1.00 1.00 X 0 0 0 KEVIN SHAFFER DIRECTOR 1.00 0.00 X 0 0 0 NGOZI STEPHEN IWUNOR DIRECTOR 1.00 0.00 X 0 0 0 ZACHARY CUNNINGHAM DIRECTOR 1.00 0.00 X 0 0 0 MARK DOAK INTERIM CEO 1.00 40.00 X X 0 56250 0 DAVID GOLDBERG DIRECTOR 1.00 57.00 X 0 996584 51139 MARIA SCHUBERT DIRECTOR (ENDS 08/24) 1.00 0.00 X 0 36594 90 TRACI FURBY ED NURSE 40.00 0.00 X 165049 0 0 EMILY STARKS NURSE PRACITIONER 40.00 0.00 X 128118 0 27292 LESA CORLEY DIRECTOR OF NURSING 40.00 0.00 X 118754 0 29158 LINDSAY ARBOGAST NURSE PRACITIONER 40.00 0.00 X 111948 0 22571 LINDA MAYLE CLINICAL SUPERVISOR 40.00 0.00 X 112349 0 14251 636218 2380987 445283 8 0 1 0 QUALIVIS LLC PO BOX 674913 DALLAS TX 752674913 AGENCY SERVICES 676347 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 753734606 MEDICAL SERVICES 403024 UNIVERSAL ENGINEERING & CONTRACTING LLC 400 AIRPORT ROAD SUITE 6C ELKINS WV 26241 CONTRACTOR SERVICES 150000 SUNBELT STAFFING LOCKBOX DEPT CH 14430 PALATINE IL 60055 AGENCY SERVICES 121436 4 NET PATIENT SERVICE RE 622110 26656740 26656740 340B INCOME 622110 29863 29863 26686603 6188 6188 10841 -10841 -10841 -10841 CAFETERIA 722514 330756 330756 MEDICAL RECORDS 900099 229 229 330985 27012935 26686832 0 326103 X 19449 19449 10766443 8698042 2068401 164309 136376 27933 1923680 1554111 369569 762367 609894 152473 134297 134297 585 585 37407 37407 2587 2587 4277191 3425673 851518 37701 37701 1036814 829643 207171 4620 3696 924 621203 481286 139917 39441 32516 6925 1170 936 234 5174 5174 405100 324080 81020 48197 48197 MEDICAL SUPPLIES 1698712 1698712 STATE PROVIDER TAX 845081 845081 REPAIRS & MAINTENANCE 359465 287572 71893 DUES/BOOKS 184196 147357 36839 230091 144946 85145 23605280 19327855 4277425 0 264533 67658 557280 4060658 4474957 3301466 316381 179373 233905 68147 5005236 618833 5755184 4386403 2939072 1164611 0 3483879 14541312 16712195 1661017 2652716 540000 0 0 140279 3049479 2615991 5250496 5408986 X 9290816 11303209 9290816 11303209 14541312 16712195 3407655 276273 -1671535 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2587 2587 0 PART II-B, LINE 1, LOBBYING ACTIVITIES: THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE WEST VIRGNIA HOSPITAL ASSOCIATION, OF WHICH A PERCENTAGE OF THE DUES IS ALLOCATED TO LOBBYING ACTIVITIES. 120000 120000 4138044 302317 3835727 422243 281786 140457 324949 34730 290219 4386403 DUE FROM AFFILIATES 3483879 3483879 DUE TO AFFILIATES 1791335 ESTIMATED THIRD-PARTY SETTLEMENTS 824656 2615991 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, 2024 AND 2023. TAX RETURNS FOR THE YEAR ENDED JUNE 30, 2020, ARE OPEN FOR THE MHS ENTITIES AND TAX RETURNS FOR THE YEAR ENDED DECEMBER 31, 2021, ARE OPEN FOR CAMC ENTITIES. 1 1 X 1 X 120.000000000000 1 X 1 1 1 0 0 1139723 1139723 0.04830 7071342 7071342 947035 947035 9158100 8018377 1139723 0.04830 9158100 8018377 1139723 0.04830 0 1088504 4519313 4519313 X 1 1 1 1 BROADDUS HOSPITAL ASSOCIATION 1 HEALTHCARE DRIVE PHILIPPI WV 26416 96 X X X X X DUALLY CERTIFIED LONG-TERM AND INTERMEDIATE CARE FACILITY BROADDUS HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X 22 1 0 0 1 X SEE SCHEDULE H, PART V, PAGE 8 X X 1 22 1 SEE SCHEDULE H, PART V, PAGE 8 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/FI X HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING/FI X HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING/FI X X X X 1 X 0 X X X X X 1 X 0 0 BROADDUS HOSPITAL ASSOCIATION 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 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 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 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 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 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. 0 TUCKER COMMUNITY FOUNDATION PO BOX 491 PARSONS WV 26287 550687098 501(C)(3) 17929 0 FMV GENERAL SUPPORT 1 0 1 1 0 0 0 0 0 0 0 DAVID GOLDBERG DIRECTOR 0 736828 0 241048 0 18708 0 13800 0 37339 0 1047723 0 0 VANCE JACKSON DHS CEO (END 06/24) 0 166596 0 150 0 227076 0 190581 0 35928 0 620331 0 0 GARRETT BUTLER DIRECTOR 0 496446 0 11285 0 496 0 10001 0 27835 0 546063 0 0 DANA GOULD CEO 0 172050 0 108 0 618 0 10338 0 1646 0 184760 0 0 WILLIAM KOCH VP FINANCE AND CFO 0 155658 0 150 0 0 0 6331 0 17860 0 179999 0 0 TRACI FURBY ED NURSE 165049 0 0 0 0 0 0 0 0 0 165049 0 0 0 EMILY STARKS NURSE PRACITIONER 128032 0 0 0 86 0 2617 0 24675 0 155410 0 0 0 PART I, LINES 4A-B VANCE JACKSON RECEIVED $227,026 OF SEVERANCE PAYMENTS DURING TY24. 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 2024 NO DISTRIBUTIONS / PAYMENTS WERE MADE FROM THE PLAN; DAVID GOLDBERG WAS THE ONLY PARTICIPANT. PART I, LINE 3: 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 A, LINE 6 THE SOLE MEMBER OF BROADDUS HOSPITAL ASSOCIATION, INC. IS DAVIS HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A BROADDUS HOSPITAL ASSOCIATION, INC.'S BOARD MEMBERS ARE ELECTED OR APPOINTED BY DAVIS HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7B DAVIS HEALTH SYSTEM, INC. IS BROADDUS HOSPITAL ASSOCIATION, INC.'S SOLE MEMBER AND HAS RESERVED POWERS UNDER BROADDUS HOSPITAL ASSOCIATION, INC.'S GOVERNING DOCUMENTS, WHICH PROVIDE THAT DECISIONS OF BROADDUS HOSPITAL ASSOCIATION, INC.'S GOVERNING BODY, SUCH AS ELECTION OF OFFICERS, APPROVAL OF ANNUAL BUDGETS AND BORROWINGS, ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER. THE SOLE MEMBER ALSO HAS ALL APPROVAL POWERS PROVIDED TO MEMBERS OF WEST VIRGINIA NONPROFIT CORPORATIONS UNDER STATE LAW. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE 990 IS FIRST REVIEWED BY EXECUTIVE LEADERSHIP 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 OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,425,673. MANAGEMENT AND GENERAL EXPENSES 851,518. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,277,191. 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