BROADDUS HOSPITAL ASSOCIATION INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- BROADDUS HOSPITAL ASSOCIATION INC (EIN 55-0379108)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202213199349313271
- Schema version
- 2021v4.2
- 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 | 2022-11-15T12:56:45-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 WASHINGTON STREET EAST | AddressLine1Txt |
| City | CHARLESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25329 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | 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 | CEO | PersonTitleTxt |
| Phone | 3044571760 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DANA | PersonFirstNm |
| Person Last | GOULD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DOLORES ROSE | PreparerPersonNm |
| PTIN | P01286262 | PTIN |
| Phone | 3043460441 | PhoneNum |
| Preparation | 2022-11-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | 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 | $24,297,710 | 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. IN 2020, THE HOSPITAL PROVIDED 49 ACUTE INPATIENT DAYS; 1,721 SWING BED INPATIENT DAYS; 16,275 LONG-TERM CARE PATIENT DAYS; 12,912 OUTPATIENT VISITS, 4,922 EMERGENCY ROOM VISITS AND 3,127 CLINIC VISITS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 244 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $13,361 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,835,129 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,360,857 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,985,876 | CYProgramServiceRevenueAmt |
| PY Investment Income | $58,292 | PYInvestmentIncomeAmt |
| CY Investment Income | $165,717 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,630,670 | PYOtherRevenueAmt |
| CY Other Revenue | $310,988 | CYOtherRevenueAmt |
| PY Total Revenue | $20,063,180 | PYTotalRevenueAmt |
| CY Total Revenue | $24,297,710 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,484 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $4,992 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,075,440 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,848,956 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,643,178 | PYOtherExpensesAmt |
| CY Other Expenses | $9,806,811 | CYOtherExpensesAmt |
| PY Total Expenses | $19,721,102 | PYTotalExpensesAmt |
| CY Total Expenses | $21,660,759 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $342,078 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,636,951 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,498,556 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,616,403 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,803,621 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,973,642 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,694,935 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,642,761 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| 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 | $16,436,923 | ExpenseAmt |
| Revenue | $21,296,864 | RevenueAmt |
| Desc | BROADDUS HOSPITAL PROVIDES 24/7 HOUR EMERGENCY ROOM SERVICES BY QUALIFIED, EXPERIENCED PROVIDERS. FOR THE YEAR 2021 THERE WERE 5,712 EMERGENCY ROOM VISITS. 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. FOR THE YEAR 2021, THERE WERE 14,663 LTC PATIENT DAYS. THE HOSPITAL PROVIDES RADIOLOGY SERVICES INCLUDING GENERAL RADIOLOGY, CT SCANS, ULTRASOUND, MRI, DEXA SCANS, AND MAMMOGRAPHY. FOR THE YEAR 2021, THE FOLLOWING PROCEDURES WERE DONE: GENERAL RADIOLOGY - 4,800; CAT SCAN - 2,283; MRI - 231; ULTRASOUND - 1,094; DEXA SCANS - 275; AND MAMMOGRAMS - 714. THE HOSPITAL PROVIDES LABORATORY AND EKG PROCEDURES WHICH TOTALED 55,784 PROCEDURES FOR THE YEAR; REHAB SERVICES INCLUDING PT, OT, AND SPEECH - TOTALING 26,699 PROCEDURES; RESPIRATORY AND PULMONARY SERVICES TOTALING 7,867 PROCEDURES; ACUTE CARE INPATIENT SERVICES TOTALING 178 DAYS; SWING BED SERVICES TOTALING 1,917 DAYS; A PROVIDER BASED CLINIC WITH 6,436 PATIENT VISITS AND OTHER PATIENT SERVICES.CHARGES FOREGONE FOR CHARITY CARE AMOUNTED TO $471,054. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,992 | ExpenseAmt |
| Grant | $4,992 | GrantAmt |
| Desc | THE HOSPITAL PROVIDED COMMUNITY SUPPORT BY SPONSORING VARIOUS HEALTH FAIRS AND LOCAL NONPROFIT ORGANIZATIONS. ADDITIONAL COMMUNITY SUPPORT ACTIVITIES AND HEALTH EDUCATION INCLUDED: FLU SHOT CLINIC, KIDS SAFETY FAIR, SENIOR DAY, SOCIAL SERVICE COUNSELING AND MENTAL HEALTH MONTH. CASH DONATIONS TO THE COMMUNITY WERE $4,992. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $16,441,915 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | Yes (1) | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 244 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| 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 (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| MARY BETH LIND | |||||||
| CHAIRMAN | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANNY FRANKE PHD THM | |||||||
| VICE-CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DERICK SPENCER | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOYCE WILSON FN-P | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CRYSTAL GRAY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DONNA PHILLIPS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFFREY POWELSON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JUNE MCCONNELL | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH MCCOMAS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS HOXIE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PETE PALKO DO | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DANA GOULD | |||||||
| CEO | 55.00 | Yes (X) | $0 | $170,861 | $2,919 | ||
| STACY WELLMAN | |||||||
| NURSING HOME ADMIN | 40.00 | $111,223 | $0 | $1,880 | Yes (X) | ||
| EMILY STARKS | |||||||
| NURSE PRACTITIONER | 40.00 | $111,579 | $0 | $33,498 | Yes (X) | ||
| LESA CORLEY | |||||||
| DIRECTOR OF NURSING | 40.00 | $107,164 | $0 | $33,535 | Yes (X) | ||
| SHANE RITCHIE | |||||||
| FNP | 40.00 | $102,102 | $0 | $1,452 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $432,068 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $170,861 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $73,284 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PSYCHIATRIC MEDICAL CARE LLC | BusinessNameLine1Txt |
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 | $555,958 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,835,129 | GovernmentGrantsAmt |
| Total Contributions | $2,835,129 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICES | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $20,985,876 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,985,876 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,985,876 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $165,717 | TotalRevenueColumnAmt |
| Exclusion | $165,717 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CAFETERIA | 722212 | $257,094 | $257,094 |
| TELEVISION | 900099 | $8,525 | $8,525 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,369 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,369 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $310,988 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,297,710 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,296,864 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $165,717 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,992 | TotalAmt |
| Program Services | $4,992 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,484,459 | TotalAmt |
| Program Services | $6,191,110 | ProgramServicesAmt |
| Management And General | $2,293,349 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,595 | TotalAmt |
| Program Services | $78,512 | ProgramServicesAmt |
| Management And General | $29,083 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,625,739 | TotalAmt |
| Program Services | $1,916,002 | ProgramServicesAmt |
| Management And General | $709,737 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $631,163 | TotalAmt |
| Program Services | $460,560 | ProgramServicesAmt |
| Management And General | $170,603 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,006 | TotalAmt |
| Program Services | $18,247 | ProgramServicesAmt |
| Management And General | $6,759 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,898 | TotalAmt |
| Management And General | $2,898 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,512 | TotalAmt |
| Management And General | $66,512 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,666,308 | TotalAmt |
| Program Services | $3,405,006 | ProgramServicesAmt |
| Management And General | $1,261,302 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,342 | TotalAmt |
| Program Services | $36,005 | ProgramServicesAmt |
| Management And General | $13,337 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $590,977 | TotalAmt |
| Program Services | $430,402 | ProgramServicesAmt |
| Management And General | $160,575 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217,999 | TotalAmt |
| Program Services | $159,074 | ProgramServicesAmt |
| Management And General | $58,925 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,987 | TotalAmt |
| Program Services | $26,989 | ProgramServicesAmt |
| Management And General | $9,998 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,950 | TotalAmt |
| Program Services | $56,880 | ProgramServicesAmt |
| Management And General | $21,070 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,515 | TotalAmt |
| Program Services | $49,266 | ProgramServicesAmt |
| Management And General | $18,249 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $320,731 | TotalAmt |
| Program Services | $234,037 | ProgramServicesAmt |
| Management And General | $86,694 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,543 | TotalAmt |
| Program Services | $95,257 | ProgramServicesAmt |
| Management And General | $35,286 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,315,365 | $1,315,365 | |
| BAD DEBTS | $802,071 | $802,071 | |
| STATE PROVIDER TAX | $421,192 | $421,192 | |
| NUTRITION SERVICES - FO | $383,180 | $279,606 | $103,574 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $632,235 | TotalAmt |
| Program Services | $461,342 | ProgramServicesAmt |
| Management And General | $170,893 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,660,759 | TotalAmt |
| Program Services | $16,441,915 | ProgramServicesAmt |
| Management And General | $5,218,844 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,868,702 | BOYAmt |
| EOY | $3,108,095 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $474,708 | BOYAmt |
| EOY | $469,450 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,571,586 | BOYAmt |
| EOY | $2,340,163 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $334,909 | BOYAmt |
| EOY | $221,333 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,051 | BOYAmt |
| EOY | $165,079 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,956,924 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,135,465 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,114,695 | BOYAmt |
| EOY | $3,821,459 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,844,929 | BOYAmt |
| EOY | $5,305,101 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,976 | BOYAmt |
| EOY | $185,723 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,498,556 | BOYAmt |
| EOY | $15,616,403 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,155,859 | BOYAmt |
| EOY | $1,756,450 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,972,692 | BOYAmt |
| EOY | $1,089,032 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,949,552 | BOYAmt |
| EOY | $1,487,704 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,959 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,698,559 | BOYAmt |
| EOY | $3,640,456 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,803,621 | BOYAmt |
| EOY | $7,973,642 | 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 | $4,694,935 | BOYAmt |
| EOY | $7,642,761 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,694,935 | BOYAmt |
| EOY | $7,642,761 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,498,556 | BOYAmt |
| EOY | $15,616,403 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,636,951 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $310,875 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $195,787 | BeginningYearBalanceAmt |
| End Year Balance | $195,787 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $421,654 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$61,949 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $359,705 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $376,963 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $46,691 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $2,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $421,654 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $350,190 | OtherCostOrOtherBasisAmt |
| Book Value | $350,190 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,822,366 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,956,545 | DepreciationAmt |
| Book Value | $1,865,821 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $134,958 | OtherCostOrOtherBasisAmt |
| Book Value | $134,958 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,712,517 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,178,920 | DepreciationAmt |
| Book Value | $533,597 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $936,893 | OtherCostOrOtherBasisAmt |
| Book Value | $936,893 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,821,459 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $228,121 |
| ESTIMATED THIRD-PARTY SETTLEMENTS | $3,412,335 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,640,456 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THESE FUNDS ARE RESTRICTED FOR SCHOLARSHIPS RELATED TO NURSING TRAINING. |
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE SYSTEM TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY OR ASSET IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICES (IRS). THE SYSTEM HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS OR ANY TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED DECEMBER 31, 2018. |
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 | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $807,792 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $409,887 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $397,905 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01890 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,743,392 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,374,838 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $368,554 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01750 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,551,184 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,784,725 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $766,459 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03640 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $813 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $813 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,551,997 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,784,725 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $767,272 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03640 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $639,287 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,428,695 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,428,695 | 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 |
| 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 INC | 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 | 19 | 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 FOR COMPLETE URL | 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 | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V FOR COMPLETE URL | 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 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING | 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 |
| 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 Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BROADDUS HOSPITAL ASSOCIATION, INC. | PART V, SECTION B, LINE 5: INPUT WAS SOLICITED FROM THOSE REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY IN AUGUST AND SEPTEMBER 2019. DISCUSSIONS INCLUDED THE HEALTH NEEDS OF THE COMMUNITY, BARRIERS TO HEALTH CARE ACCESS, OPPORTUNITIES FOR IMPROVEMENT, PERCEPTION OF BROADDUS HOSPITAL AND FEEDBACK ON THE HOSPITAL'S INITIATIVES. THE FOLLOWING WERE SELECTED TO PROVIDE FEEDBACK: *BARBOUR COUNTY DEVELOPMENT AUTHORITY*BARBOUR COUNTY SENIOR CENTER*BARBOUR COUNTY EMERGENCY MEDICAL SERVICES*BARBOUR COUNTY FAMILY RESOURCE NETWORK*BARBOUR COUNTY HEALTH DEPARTMENT*CVECHKO INSURANCE |
| BROADDUS HOSPITAL ASSOCIATION, INC. | 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, INC. | 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. SUBSTANCE ABUSE 2. DIABETES3. TOBACCO USE 3. LACK OF AVAILABLE HEALTH CARE OR CLINICS4. OTHER HEALTH CONCERNS: ALCOHOL ABUSE, MENTAL HEALTH ISSUES, OBESITY, ARTHRITIS, COPD AND HEART ISSUES. THE HOSPITAL PLAYS A KEY ROLE IN PROMOTING THE HEALTH OF THE COMMUNITY. PROGRAMS INCLUDE: 100 MILES IN 100 DAYS; HEALTH FAIRS; COMMUNITY HEALTH COLLABORATIVE; HEALTH SCREENINGS; AND HEALTH EDUCATIONAL PROGRAMS. ALTHOUGH POOR ATTITUDES, LACK OF MOTIVATION AND LACK OF LOW-COST NUTRITIONAL FOODS KEEP MANY INDIVIDUALS AND FAMILIES FROM BEING HEALTHY.RECOMMENDATIONS TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED INCLUDE EXPANSION OF THE DRUG ABUSE PREVENTION PROGRAMS AND ADDITIONAL PROGRAMS TO HELP FAMILIES AND CHILDREN LIVE A HEALTHIER LIFESTYLE. |
| BROADDUS HOSPITAL ASSOCIATION, INC. | 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, INC. | 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/IMAGES/BH_2019COMMUNITYHEALTHNEEDSREPORT.PDF |
| PART V, SECTION B, LINE 10A | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/CONTENT/UPLOADS/DAVISHEALTHSYSTEM.ORG/FILES/BH_2016CHNA_2017IMPSTRATEGIES_COMBOREPORT.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 (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | COST OF COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS WAS OBTAINED FROM THE HOSPITAL'S PAYROLL AND OTHER ACCOUNTING RECORDS.COST OF CHARITY CARE WAS ESTIMATED USING A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 639,287. |
| 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) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANA GOULD | PersonNm |
| Title | CEO | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $160,049 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $10,812 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $1,598 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $1,321 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $173,780 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE CEO ARE PAID BY A RELATED ORGANIZATION, DAVIS MEMORIAL HOSPITAL. DAVIS MEMORIAL HOSPITAL USES A COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACTS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE CEO. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A DRAFT OF THE 990 IS FIRST REVIEWED BY THE CEO AND CFO 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 | ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 333,592. MANAGEMENT AND GENERAL EXPENSES 123,571. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 457,163. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 1,320,611. MANAGEMENT AND GENERAL EXPENSES 489,189. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,809,800. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 93,134. MANAGEMENT AND GENERAL EXPENSES 34,499. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,633. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,382,202. MANAGEMENT AND GENERAL EXPENSES 512,004. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,894,206. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 99,711. MANAGEMENT AND GENERAL EXPENSES 36,935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,646. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 175,756. MANAGEMENT AND GENERAL EXPENSES 65,104. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 240,860. |
| SCHEDULE K | THE HEALTH SYSTEM REFUNDING REVENUE BONDS (DAVIS HEALTH SYSTEM OBLIGATED GROUP) SERIES 2016 A TAX EXEMPT BONDS ARE REPORTED ON THE FORM 990, SCHEDULE K OF DAVIS MEMORIAL HOSPITAL. THE LIABILITY IS REPORTED IN EQUAL PORTIONS ON EACH HOSPITAL'S BALANCE SHEET BUT REPORTED IN TOTAL ON THE CONSOLIDATED FINANCIAL STATEMENTS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVIS HEALTH SYSTEM INC | |||||||||||
| PO BOX 1697 | ELKINS | WV | 26241 | 550737655 | SUPPORTING ORGANIZATION | WV | 501(C)(3) | LINE 12B, II | N/A | 0 | |
| DAVIS MEMORIAL HOSPITAL | |||||||||||
| PO BOX 1484 | ELKINS | WV | 26241 | 550375433 | HOSPITAL | WV | 501(C)(3) | LINE 3 | 0 | DAVIS HEALTH SYSTEM INC | |
| DAVIS HEALTH SYSTEM FOUNDATION | |||||||||||
| PO BOX 1188 | ELKINS | WV | 26241 | 320185772 | PROVIDES SUPPORT TO DAVIS HEALTH SYSTEM ENTITIES | WV | 501(C)(3) | LINE 10 | N/A | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| HEALTH FACILITIES INC | |||||||||
| 909 GORMAN AVENUE | ELKINS | WV | 26241 | 550516937 | HEALTH CARE | WV | N/A | C | 0 |
| CENTRAL WV MEDCORP INC | |||||||||
| PO BOX 2630 | ELKINS | WV | 26241 | 550739314 | PHYSICIAN SERVICES | WV | N/A | C | 0 |
| DAVIS REGIONAL HEALTH PARTNERS INC | |||||||||
| PO BOX 2632 | ELKINS | WV | 26241 | 550746206 | CONTRACT NEGOTIATIONS | WV | N/A | C | 0 |
| 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 |