BROADDUS HOSPITAL ASSOCIATION INC: Form 990, tax year 2023
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- Organization
- BROADDUS HOSPITAL ASSOCIATION INC (EIN 55-0379108)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-13
- IRS object ID
- 202423189349311872
- Schema version
- 2023v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-13T20:32:25-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 4200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550379108 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROADDUS HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BROA | BusinessNameControlTxt |
| Phone | 3044571760 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 930 | AddressLine1Txt |
| City | PHILIPPI | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26416 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANA GOULD | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 3044571760 | PhoneNum |
| Signature | 2024-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANGELA M MOORE | PreparerPersonNm |
| PTIN | P00244342 | PTIN |
| Phone | 3174648600 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DANA GOULD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 930 | AddressLine1Txt |
| City | PHILIPPI | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26416 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,158,539 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DAVISHEALTHSYSTEM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | BROADDUS HOSPITAL IS THE PRIMARY PROVIDER OF HEALTH CARE SERVICES IN BARBOUR COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 269 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $200 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,760,895 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,694,724 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$112,993 | PYInvestmentIncomeAmt |
| CY Investment Income | $141,487 | CYInvestmentIncomeAmt |
| PY Other Revenue | $620,913 | PYOtherRevenueAmt |
| CY Other Revenue | $322,328 | CYOtherRevenueAmt |
| PY Total Revenue | $24,269,015 | PYTotalRevenueAmt |
| CY Total Revenue | $22,158,539 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,374 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,238,960 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,982,257 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,624,880 | PYOtherExpensesAmt |
| CY Other Expenses | $8,817,387 | CYOtherExpensesAmt |
| PY Total Expenses | $21,868,214 | PYTotalExpensesAmt |
| CY Total Expenses | $22,799,644 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,400,801 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$641,105 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,404,769 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,541,312 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,838,758 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,250,496 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,566,011 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,290,816 | NetAssetsOrFundBalancesEOYAmt |
| Mission | BROADDUS HOSPITAL ASSOCIATION IS COMMITTED TO PROVIDING PATIENT-FRIENDLY, QUALITY HEALTH CARE TO ITS COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,067,571 | ExpenseAmt |
| Revenue | $21,703,547 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $18,067,571 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 269 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WV | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANA GOULD CEO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3044571760 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 930 | AddressLine1Txt |
| City | PHILLIPI | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26416 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| VANCE JACKSON | ||||||||
| DHS CEO | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $315,542 | $16,877 | |
| WILLIAM KOCH | ||||||||
| VP OF FINANCE AND CFO | 5.00 | 35.00 | Yes (X) | Yes (X) | $0 | $165,014 | $1,587 | |
| DANNY FRANKE | ||||||||
| VICE-CHAIRMAN | 2.00 | 14.00 | Yes (X) | Yes (X) | $0 | $2,633 | $0 | |
| JOYCE WILSON | ||||||||
| SECRETARY (END 08/23) | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARY BETH LIND | ||||||||
| CHAIRMAN | 3.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| AARON NORRIS MD | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CRYSTAL GRAY | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DONNA PHILLIPS | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFF POWELSON | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KEVIN SHAFFER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS HOXIE | ||||||||
| BOARD MEMBER (END 08/23) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DANA GOULD | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $0 | $169,931 | $2,884 | ||
| GWENDOLYN DEMARCO | ||||||||
| CLINICAL SUPERVISOR | 40.00 | 0.00 | $122,904 | $0 | $20,717 | Yes (X) | ||
| LINDA MAYLE | ||||||||
| CHARGE RN | 40.00 | 0.00 | $115,784 | $0 | $20,723 | Yes (X) | ||
| EMILY STARKS | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $128,359 | $0 | $7,086 | Yes (X) | ||
| LESA CORLEY | ||||||||
| DIRECTOR OF NURSING | 40.00 | 0.00 | $113,553 | $0 | $20,955 | Yes (X) | ||
| TRACI FURBY | ||||||||
| RN ED NURSE | 40.00 | 0.00 | $125,087 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $605,687 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $653,120 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $90,829 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PSYCHIATRIC MEDICAL CARE LLC | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 734606 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75373 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | BEHAVIORAL HEALTH CLINIC | ServicesDesc |
| Compensation | $444,030 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE RE | 622110 | $21,418,959 | $21,418,959 |
| 340B INCOME | 622110 | $275,765 | $275,765 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,694,724 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $141,487 | TotalRevenueColumnAmt |
| Exclusion | $141,487 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA | 722514 | $313,505 | $313,505 | |
| TELEVISION | 900099 | $7,826 | $7,826 | |
| MEDICAL RECORDS | 900099 | $953 | $953 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $322,328 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,158,539 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,703,547 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $454,992 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,718,546 | TotalAmt |
| Program Services | $7,871,700 | ProgramServicesAmt |
| Management And General | $2,846,846 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,316 | TotalAmt |
| Program Services | $105,986 | ProgramServicesAmt |
| Management And General | $38,330 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,348,564 | TotalAmt |
| Program Services | $1,724,785 | ProgramServicesAmt |
| Management And General | $623,779 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $770,831 | TotalAmt |
| Program Services | $566,098 | ProgramServicesAmt |
| Management And General | $204,733 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,313 | TotalAmt |
| Management And General | $90,313 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $608 | TotalAmt |
| Management And General | $608 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,058 | TotalAmt |
| Management And General | $85,058 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,242,717 | TotalAmt |
| Program Services | $3,861,915 | ProgramServicesAmt |
| Management And General | $380,802 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,736 | TotalAmt |
| Management And General | $1,736 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,767 | TotalAmt |
| Program Services | $35,080 | ProgramServicesAmt |
| Management And General | $12,687 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $550,323 | TotalAmt |
| Program Services | $404,157 | ProgramServicesAmt |
| Management And General | $146,166 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,482 | TotalAmt |
| Program Services | $37,074 | ProgramServicesAmt |
| Management And General | $13,408 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $361,744 | TotalAmt |
| Program Services | $265,665 | ProgramServicesAmt |
| Management And General | $96,079 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,969 | TotalAmt |
| Program Services | $110,872 | ProgramServicesAmt |
| Management And General | $40,097 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $1,657,864 | $1,657,864 |
| STATE PROVIDER TAX | $512,137 | $512,137 |
| NUTRITION SERVICES | $495,522 | $495,522 |
| REPAIRS & MAINTENANCE | $320,597 | $320,597 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $249,550 | TotalAmt |
| Program Services | $98,119 | ProgramServicesAmt |
| Management And General | $151,431 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,799,644 | TotalAmt |
| Program Services | $18,067,571 | ProgramServicesAmt |
| Management And General | $4,732,073 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,186,374 | BOYAmt |
| EOY | $264,533 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $466,771 | BOYAmt |
| EOY | $557,280 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,943,931 | BOYAmt |
| EOY | $4,474,957 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $338,576 | BOYAmt |
| EOY | $316,381 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $180,324 | BOYAmt |
| EOY | $233,905 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,809,376 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $54,192 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,122,889 | BOYAmt |
| EOY | $5,755,184 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,893,740 | BOYAmt |
| EOY | $2,939,072 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $272,164 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,404,769 | BOYAmt |
| EOY | $14,541,312 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,470,501 | BOYAmt |
| EOY | $1,661,017 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,008,568 | BOYAmt |
| EOY | $540,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,359,689 | BOYAmt |
| EOY | $3,049,479 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,838,758 | BOYAmt |
| EOY | $5,250,496 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,566,011 | BOYAmt |
| EOY | $9,290,816 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,566,011 | BOYAmt |
| EOY | $9,290,816 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,404,769 | BOYAmt |
| EOY | $14,541,312 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$641,105 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $296,579 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $1,069,331 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,530 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,530 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1, LOBBYING ACTIVITIES: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE WEST VIRGNIA HOSPITAL ASSOCIATION, OF WHICH A PERCENTAGE OF THE DUES IS ALLOCATED TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $195,787 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$195,787 | InvestmentEarningsOrLossesAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $195,787 | BeginningYearBalanceAmt |
| End Year Balance | $195,787 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $271,557 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$75,770 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $195,787 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $359,705 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$88,148 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $271,557 | EndYearBalanceAmt |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $440,588 | OtherCostOrOtherBasisAmt |
| Book Value | $440,588 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,055,392 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,632 | DepreciationAmt |
| Book Value | $4,043,760 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,313,396 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,560 | DepreciationAmt |
| Book Value | $1,270,836 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,755,184 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $1,688,496 |
| ESTIMATED THIRD-PARTY SETTLEMENTS | $1,175,011 |
| CAPITAL LEASES | $185,972 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,049,479 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 120.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $663,925 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $663,925 | DirectOffsettingRevenueAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,304,293 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,304,293 | DirectOffsettingRevenueAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,968,218 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,968,218 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,968,218 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,968,218 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $136,286 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,732,732 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,732,732 | CostOfCareReimbursedByMedcrAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROADDUS HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HEALTHCARE DRIVE | AddressLine1Txt |
| City | PHILIPPI | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26416 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | DUALLY CERTIFIED LONG-TERM AND INTERMEDIATE CARE FACILITY | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROADDUS HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, PAGE 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 120.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING/FI | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING/FI | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING/FI | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VANCE JACKSON | ||||||||||||||
| DHS CEO | $0 | $314,560 | $0 | $0 | $0 | $982 | $0 | $2,024 | $0 | $14,853 | $0 | $332,419 | $0 | $0 |
| DANA GOULD | ||||||||||||||
| CEO | $0 | $169,931 | $0 | $0 | $0 | $0 | $0 | $1,308 | $0 | $1,576 | $0 | $172,815 | $0 | $0 |
| WILLIAM KOCH | ||||||||||||||
| VP OF FINANCE AND CFO | $0 | $164,424 | $0 | $0 | $0 | $590 | $0 | $872 | $0 | $715 | $0 | $166,601 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 | EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 1,915,154. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,915,154. LAB SERVICES: PROGRAM SERVICE EXPENSES 33,173. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,173. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 1,146. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,146. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 643,721. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 643,721. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 215,781. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 215,781. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,052,940. MANAGEMENT AND GENERAL EXPENSES 380,802. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,433,742. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (1) | CHARLESTON AREA MEDICAL CENTER INC | |
| CHARLESTON AREA MEDICAL CENTER INC | |||||||||||
| PO BOX 1547 | CHARLESTON | WV | 253261547 | 550526150 | HOSPITAL | WV | 501(C)(3) | 3 | 0 | VANDALIA HEALTH INC | |
| MONONGALIA HEALTH SYSTEM INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550621551 | PARENT COMPANY | WV | 501(C)(3) | 12C, III-FI | 0 | VANDALIA HEALTH INC | |
| MONONGALIA COUNTY GENERAL HOSPITAL COMPANY | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 237441353 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| MON ELDER SERVICES INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 311520863 | CONTINUING CARE RETIREMENT CENTER | WV | 501(C)(3) | 10 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| 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 | Yes (1) | MONONGALIA COUNTY GENERAL HOSPITAL CO | |
| PRESTON MEMORIAL HOSPITAL | |||||||||||
| 150 MEMORIAL DRIVE | KINGWOOD | WV | 26537 | 311097818 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| PRESTON MEMORIAL MEDICAL GROUP | |||||||||||
| 300 SOUTH PRICE STREET | KINGWOOD | WV | 26537 | 550717988 | PRIMARY AND URGENT CARE | WV | 501(C)(3) | 3 | Yes (1) | PRESTON MEMORIAL HOSPITAL | |
| PRESTON MEMORIAL HOSPITAL FOUNDATION | |||||||||||
| 300 SOUTH PRICE STREET | KINGWOOD | WV | 26537 | 550740121 | RAISE FUNDS FOR PRESTON HOSPITAL | WV | 501(C)(3) | 12B, II | Yes (1) | PRESTON MEMORIAL HOSPITAL | |
| AUXILIARY OF MONONGALIA GENERAL HOSPITAL INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550362965 | RAISE FUNDS FOR MONONGALIA GENERAL HOSPITAL | WV | 501(C)(3) | 12A, I | Yes (1) | MONONGALIA COUNTY GENERAL HOSPITAL CO | |
| LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550689535 | LIABILITY INSURANCE TRUST | WV | 501(C)(3) | 12A, I | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| STONEWALL JACKSON MEMORIAL HOSPITAL | |||||||||||
| 230 HOSPITAL PLAZA | WESTON | WV | 26452 | 550422958 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| MON HEALTH MARION NEIGHBORHOOD HOSPITAL INC | |||||||||||
| 140 MIDDLETOWN LOOP | WHITEHALL | WV | 26554 | 853994078 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| CAMC GREENBRIER VALLEY MEDICAL CENTER INC | |||||||||||
| 1320 MAPLEWOOD AVENUE | RONCEVERTE | WV | 24970 | 884128022 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | CHARLESTON AREA MEDICAL CENTER INC | |
| CAMC PLATEAU MEDICAL CENTER INC | |||||||||||
| 430 MAIN STREET | OAK HILL | WV | 25901 | 921715117 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | CHARLESTON AREA MEDICAL CENTER INC | |
| CAMC HEALTH EDUCATION AND RESEARCH INSTITUTE INC | |||||||||||
| PO BOX 1547 | CHARLESTON | WV | 253261547 | 550753754 | MEDICAL EDUCATIONAL RESEARCH | WV | 501(C)(3) | 12A, I | Yes (1) | CHARLESTON AREA MEDICAL CENTER INC | |
| DAVIS HEALTH SYSTEM INC | |||||||||||
| PO BOX 1484 | ELKINS | WV | 26241 | 550737655 | HEALTH SYSTEM | WV | 501(C)(3) | 12B, II | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| DAVIS MEMORIAL HOSPITAL INC | |||||||||||
| PO BOX 1484 | ELKINS | WV | 26241 | 550375433 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | DAVIS HEALTH SYSTEM INC | |
| DAVIS HEALTH SYSTEM FOUNDATION INC | |||||||||||
| PO BOX 1188 | ELKINS | WV | 26241 | 320185772 | PROVIDES SUPPORT TO DAVIS HEALTH SYSTEM ENTITIES | WV | 501(C)(3) | 10 | Yes (1) | DAVIS HEALTH SYSTEM INC | |
| WEBSTER MEMORIAL HOSPITAL | |||||||||||
| 812 GORMAN AVENUE | ELKINS | WV | 26241 | 871759588 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | DAVIS HEALTH SYSTEM INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| WOMEN AND CHILDREN'S MEDICAL OFFICE BUILDING LLC | |||||||||
| PO BOX 1547 | CHARLESTON | WV | 253261547 | 550669065 | MEDICAL OFFICE BUILDING | WV | N/A | 0 | 0 |
| GENERAL DIVISION MEDICAL OFFICE BUILDING LLC | |||||||||
| PO BOX 1547 | CHARLESTON | WV | 253261547 | 550623949 | MEDICAL OFFICE BUILDING | WV | N/A | 0 | 0 |
| DASCO-CAMC HOME MEDICAL EQUIPMENT LLC | |||||||||
| 501 MORRIS STREET | CHARLESTON | WV | 25301 | 844487189 | HOME MEDICAL EQUIPMENT | WV | N/A | 0 | 0 |
| MGH SURGERY LLC | |||||||||
| 2000 MON HEALTH MEDICAL PARK DRIVE | MORGANTOWN | WV | 26505 | 472736896 | SURGERY CENTER | WV | N/A | 0 | 0 |
| MON HEALTH-DASCO HOME MEDICAL EQUIPMENT LLC | |||||||||
| 375 N WEST ST | WESTERVILLE | OH | 43082 | 871577276 | HOME MEDICAL EQUIPMENT | OH | N/A | 0 | 0 |
| CHARLESTON SURGICAL HOSPITAL LLC | |||||||||
| 1306 KANAWHA BLVD E | CHARLESTON | WV | 25301 | 550526191 | SURGERY CENTER | WV | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VANDALIA INSURANCE COMPANY | |||||||||||||||
| 76 ST PAUL STREET STE 500 | BURLINGTON | VT | 05401 | 030308754 | INSURANCE | VT | N/A | C | Yes (1) | ||||||
| MON HEALTH CARE INC | |||||||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550654973 | MEDICAL EQUIPMENT | WV | N/A | C | Yes (1) | ||||||
| STONEWALL HOME OXYGEN THERAPY INC | |||||||||||||||
| 100 MARKET PLACE MALL SUITE 8 | WESTON | WV | 26452 | 550754278 | OXYGEN THERAPY SERVICES | WV | N/A | C | Yes (1) | ||||||
| FAIRMONT HOME EQUIPMENT AND SUPPLY | |||||||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550763259 | EQUIPMENT RENT & SVC | WV | N/A | C | Yes (1) | ||||||
| MORGANTOWN PHYSICAL THERAPY ASSOC INC | |||||||||||||||
| 943 MAPLE DRIVE | MORGANTOWN | WV | 26505 | 550614636 | REHABILITATION SERVICES | WV | N/A | C | Yes (1) | ||||||
| HEALTH FACILITIES INC | |||||||||||||||
| 909 GORMAN AVENUE | ELKINS | WV | 26241 | 550516937 | HEALTH CARE | WV | N/A | C | Yes (1) | ||||||
| CENTRAL WV MEDCORP INC | |||||||||||||||
| PO BOX 2630 | ELKINS | WV | 26241 | 550739314 | PHYSICIAN SERVICES | WV | N/A | C | Yes (1) | ||||||
| DAVIS REGIONAL HEALTH PARTNERS INC | |||||||||||||||
| PO BOX 2632 | ELKINS | WV | 26241 | 550746206 | CONTRACT NEGOTIATIONS | WV | N/A | C | Yes (1) | ||||||
| ZERCOR RE SEGREGATED PORTFOLIO #2 DAVIS | |||||||||||||||
| CAPTIVE INSURANCE | N/A | C | Yes (1) | 18 FORUM LANE 2ND FLOOR | GRAND CAYMAN | CAYMAN ISLANDS | CJ | KY1-1102 | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |