DAVIS MEMORIAL HOSPITAL: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- DAVIS MEMORIAL HOSPITAL (EIN 55-0375433)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-13
- IRS object ID
- 202013189349301551
- Schema version
- 2019v5.1
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-13T07:30:55-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550486667 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Carbis Toothman LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1Txt |
| City | Charleston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25329 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550375433 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Davis Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DAVI | BusinessNameControlTxt |
| Phone | 3046363300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1484 | AddressLine1Txt |
| City | Elkins | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26241 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Melanie Dempsey | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3046363300 | PhoneNum |
| Signature | 2020-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Dolores Rose | PreparerPersonNm |
| PTIN | P01286262 | PTIN |
| Phone | 3043460441 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.12.119.47 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-11-12 | IPDt |
| IP Tm | 10:58:51 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 89762B9AA0C8C1D590E5D40209EB2976C0D4AEE2 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 6DED3FDB4E3D1D97B2E3EA971B8E25D5FADB4D20 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Vance Jackson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1484 | AddressLine1Txt |
| City | Elkins | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26241 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $141,615,914 | 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 | 1903 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | To provide quality health care to residents of Elkins, West Virginia and surrounding communities. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 924 | TotalEmployeeCnt |
| Total Volunteers | 90 | TotalVolunteersCnt |
| Total Gross UBI | $144,147 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $88,112 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $20,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $110,222,063 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $113,007,877 | CYProgramServiceRevenueAmt |
| PY Investment Income | $361,306 | PYInvestmentIncomeAmt |
| CY Investment Income | $197,049 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,284,259 | PYOtherRevenueAmt |
| CY Other Revenue | $1,780,759 | CYOtherRevenueAmt |
| PY Total Revenue | $112,887,628 | PYTotalRevenueAmt |
| CY Total Revenue | $114,985,685 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $37,312 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $36,263 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $49,239,035 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $51,147,541 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $64,668,248 | PYOtherExpensesAmt |
| CY Other Expenses | $66,270,363 | CYOtherExpensesAmt |
| PY Total Expenses | $113,944,595 | PYTotalExpensesAmt |
| CY Total Expenses | $117,454,167 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,056,967 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,468,482 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $87,088,971 | TotalAssetsBOYAmt |
| Total Assets EOY | $86,716,738 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $35,183,311 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $39,422,395 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $51,905,660 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $47,294,343 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide patient friendly healthcare to its communities. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $85,565,951 | ExpenseAmt |
| Grant | $36,263 | GrantAmt |
| Revenue | $114,507,006 | RevenueAmt |
| Desc | The organization operated an 80 bed acute care hospital in Elkins, West Virginia.Charges foregone for charity care amounted to $2,712,536. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $223,268 | ExpenseAmt |
| Desc | The hospital provided community support by sponsoring various health fairs and local nonprofit organizations and providing food or snacks for various community events to residents of Elkins, WV. Additional community support and health education included: Childbirth classes, flu shot clinics, breastfeeding classes, healthy hearts forums, diabetic foot exams, Maintain Don't Gain community program and organization of community wellness program. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $85,789,219 | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 65 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 924 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | 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 | Melanie Dempsey | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3046373156 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Gorman Avenue and Reed Street | AddressLine1Txt |
| City | Elkins | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26241 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 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 |
|---|---|---|---|---|---|---|---|---|
| Bridgette Wilson | ||||||||
| Chairman | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Ashton Curtis DPM | ||||||||
| Vice Chairman | 39.00 | 1.00 | Yes (X) | Yes (X) | $81,855 | $0 | $22,541 | |
| Hugh Hitchcock | ||||||||
| Treasurer | 3.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Terry White | ||||||||
| Secretary | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| James Triplett | ||||||||
| Board Member | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| George Scott | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Tom Felton | ||||||||
| Board Member | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Danny Franke | ||||||||
| Board Member | 2.00 | 2.50 | Yes (X) | $0 | $0 | $0 | ||
| Andrew Gongola | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| John Kabler | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Connie Tenney | ||||||||
| Board Member | 0.25 | 0.25 | Yes (X) | $0 | $0 | $0 | ||
| William Hartman | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Drew PingleyMSN RN | ||||||||
| Board Member | 39.00 | 1.00 | Yes (X) | $78,384 | $0 | $23,226 | ||
| Johanna Biola MD | ||||||||
| Board Member | 39.00 | 1.00 | Yes (X) | $245,603 | $0 | $26,143 | ||
| Jeff Powelson | ||||||||
| Board Member | 1.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Amanda Pennington MD | ||||||||
| Board Member | 39.00 | 1.00 | Yes (X) | $449,431 | $0 | $28,791 | ||
| Vance Jackson | ||||||||
| CEO | 40.00 | Yes (X) | $310,859 | $0 | $27,279 | |||
| Melanie Dempsey | ||||||||
| VP of Finance | 36.00 | 4.00 | Yes (X) | $164,373 | $0 | $2,717 | ||
| Mohamed M Fahim MD | ||||||||
| Physician | 40.00 | 1.50 | $605,574 | $0 | $34,317 | Yes (X) | ||
| Walter Boardwine DO | ||||||||
| Physician | 40.00 | 1.00 | $590,584 | $0 | $11,128 | Yes (X) | ||
| Donald R Fleming MD | ||||||||
| physician | 40.00 | 11.00 | $483,270 | $0 | $32,135 | Yes (X) | ||
| Deborah Chadwick MD | ||||||||
| physician | 40.00 | 4.00 | $446,609 | $0 | $29,343 | Yes (X) | ||
| Nirva Dube MD | ||||||||
| Physician | 40.00 | $367,018 | $0 | $16,258 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,823,560 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $253,878 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 54 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WV Gastroenterology & Endoscopy | |||||
| PO Box 2831 | Elkins | WV | 26241 | Physicians | $2,523,905 |
| Medstream Anesthesia | |||||
| 82 Patton Ave Suite 510 | Asheville | NC | 28801 | Physicians | $969,050 |
| Channels Construction | |||||
| 239 Bruce Street | Elkins | WV | 26241 | Construction | $801,070 |
| Psychiatric Medical Care LLC | |||||
| PO Box 734606 | Dallas | TX | 75373 | Physicians | $643,137 |
| University Health Associate | |||||
| PO Box 740 | Morgantown | WV | 26507 | Physicians | $613,885 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient services | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $113,007,877 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $113,007,877 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $113,007,877 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $134,033 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $73,887 | UnrelatedBusinessRevenueAmt |
| Exclusion | $60,146 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $231,626 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $231,626 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $231,626 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $20,256 | UnrelatedBusinessRevenueAmt |
| Exclusion | $211,370 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,667,245 | SecuritiesAmt |
| Other | $26,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,630,229 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $37,016 | SecuritiesAmt |
| Other | $26,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,016 | TotalRevenueColumnAmt |
| Exclusion | $63,016 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Cafeteria | 722210 | $950,950 | $950,950 | |
| Management fees | 900099 | $50,004 | $50,004 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $548,179 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $548,179 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,549,133 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $114,985,685 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $114,507,006 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $144,147 | UnrelatedBusinessRevenueAmt |
| Exclusion | $334,532 | 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 | $36,263 | TotalAmt |
| Program Services | $36,263 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $479,483 | TotalAmt |
| Program Services | $269,565 | ProgramServicesAmt |
| Management And General | $209,918 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,229,511 | TotalAmt |
| Program Services | $20,930,431 | ProgramServicesAmt |
| Management And General | $16,299,080 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $870,596 | TotalAmt |
| Program Services | $489,449 | ProgramServicesAmt |
| Management And General | $381,147 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,918,941 | TotalAmt |
| Program Services | $5,576,429 | ProgramServicesAmt |
| Management And General | $4,342,512 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,649,010 | TotalAmt |
| Program Services | $1,489,273 | ProgramServicesAmt |
| Management And General | $1,159,737 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,226 | TotalAmt |
| Management And General | $210,226 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,473 | TotalAmt |
| Management And General | $68,473 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,304,434 | TotalAmt |
| Program Services | $17,646,585 | ProgramServicesAmt |
| Management And General | $657,849 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,604 | TotalAmt |
| Management And General | $124,604 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,458,700 | TotalAmt |
| Program Services | $3,068,881 | ProgramServicesAmt |
| Management And General | $2,389,819 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,925,339 | TotalAmt |
| Program Services | $1,082,426 | ProgramServicesAmt |
| Management And General | $842,913 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,102,169 | TotalAmt |
| Program Services | $619,639 | ProgramServicesAmt |
| Management And General | $482,530 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,534 | TotalAmt |
| Program Services | $158,278 | ProgramServicesAmt |
| Management And General | $123,256 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $694,530 | TotalAmt |
| Program Services | $390,465 | ProgramServicesAmt |
| Management And General | $304,065 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,888,466 | TotalAmt |
| Program Services | $2,186,096 | ProgramServicesAmt |
| Management And General | $1,702,370 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,185,983 | TotalAmt |
| Program Services | $1,228,960 | ProgramServicesAmt |
| Management And General | $957,023 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Bad debts | $13,550,313 | $13,550,313 |
| Medical supplies | $13,097,238 | $13,097,238 |
| Medicaid provider tax | $1,833,584 | $1,833,584 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,544,770 | TotalAmt |
| Program Services | $2,135,344 | ProgramServicesAmt |
| Management And General | $1,409,426 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,454,167 | TotalAmt |
| Program Services | $85,789,219 | ProgramServicesAmt |
| Management And General | $31,664,948 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,502,309 | BOYAmt |
| EOY | $2,902,350 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,274 | BOYAmt |
| EOY | $117,899 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,087,415 | BOYAmt |
| EOY | $10,779,838 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $740,707 | BOYAmt |
| EOY | $619,499 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,782,346 | BOYAmt |
| EOY | $1,943,113 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $598,617 | BOYAmt |
| EOY | $760,069 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $122,534,537 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $86,600,744 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,018,025 | BOYAmt |
| EOY | $35,933,793 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,447,881 | BOYAmt |
| EOY | $15,380,016 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,981,259 | BOYAmt |
| EOY | $3,732,778 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,908,138 | BOYAmt |
| EOY | $14,547,383 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,088,971 | BOYAmt |
| EOY | $86,716,738 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,040,019 | BOYAmt |
| EOY | $21,405,702 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,184,983 | BOYAmt |
| EOY | $1,245,339 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,146,767 | BOYAmt |
| EOY | $7,934,142 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,667,204 | BOYAmt |
| EOY | $2,309,672 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,144,338 | BOYAmt |
| EOY | $6,527,540 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,183,311 | BOYAmt |
| EOY | $39,422,395 | 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 | $51,905,660 | BOYAmt |
| EOY | $47,294,343 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,905,660 | BOYAmt |
| EOY | $47,294,343 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,088,971 | BOYAmt |
| EOY | $86,716,738 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,468,482 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $437,405 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $337,675 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$2,917,915 | 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 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 | $16,189 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $16,189 | 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: | FormAndLineReferenceDesc |
| Explanation | The organization pays membership fees to the American Hospital Association, which participates in lobbying activities. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $106,509 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $2,044,880 | OtherCostOrOtherBasisAmt |
| Book Value | $2,151,389 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $699,757 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $56,268,603 | OtherCostOrOtherBasisAmt |
| Depreciation | $32,479,329 | DepreciationAmt |
| Book Value | $24,489,031 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $60,909,743 | OtherCostOrOtherBasisAmt |
| Depreciation | $54,121,415 | DepreciationAmt |
| Book Value | $6,788,328 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,505,045 | OtherCostOrOtherBasisAmt |
| Book Value | $2,505,045 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $35,933,793 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Estimated third-party payor settlements | $3,222,931 |
| Due from affiliates | $1,592,487 |
| Other receivables | $342,913 |
| Due from subsidiary | $8,684,698 |
| Right of Use Assets (net) | $704,354 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $14,547,383 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to affilates | $4,586,428 |
| Capital leases | $1,437,231 |
| Post retirement benefit obligation | $503,881 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,527,540 | 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 | 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, 2019 and 2018, 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, 2016. | 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 | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,971,764 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,971,764 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02860 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,544,768 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,736,764 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,808,004 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10400 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,516,532 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,736,764 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,779,768 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13260 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,530 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $58,530 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,298 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $806,703 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $349,352 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $457,351 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $163,440 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $163,440 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,029,971 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $349,352 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $680,619 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00660 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,546,503 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,086,116 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,460,387 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13920 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $13,550,313 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $22,652,804 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $22,986,888 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$334,084 | MedicareSurplusOrShortfallAmt |
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 |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 WVUH Davis MOB LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Medical office rentals | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.26670 | OrgProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Davis Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1484 | AddressLine1Txt |
| City | Elkins | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26241 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Davis Memorial Hospital | 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 |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| 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, Page 8 for URL | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Page 8 for 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 |
| 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 | See Part V, Page 8 for URL | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Page 8 for URL | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Part V, Page 8 for URL | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| 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 Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Davis Memorial Hospital | Part V, Section B, Line 5: nput was solicited from those representing the broad interests of the community in May and June 2019. Discussions included the health needs of the community, barriers to health care access, opportunities for improvement, perception of Davis Medical Center and feedback on the Hospital's initiatives. The following were selected to provide feedback.* Appalachian Community Health* Davis & Elkins College* Randolph County Substance Abuse Coalition* Randolph County Emergency Medical Services* Randolph County Family Resource Network* Randolph County Health Department* United Methodist Church |
| Davis Memorial Hospital | Part V, Section B, Line 11: The primary health concern is substance abuse followed by mental health issues. Other health concerns include:* Lack of infants receiving vaccinations* Obesity* arthritis* diabetes* dialysis* COPD* heart issuesThe Hosptial has many communtiy outreach programs such as: 100 miles in 100 days; multiphasic blood tests, bike rodeo, health fairs, etc. Laurel Place provides geriatric inpatient psychiatry.Financial constraints prevent the Hospital from addressing all of the needs identified in the Community Health Needs Assessment. |
| Davis Memorial Hospital | Part V, Section B, Line 16j: The Financial Assistance Policy is posted in all patient registration areas including ER, Admissions and OP testing. The procedure is also explained in financial counseling brochures available throughout the Health System and in physician offices. All employees are also notified via the internal website where it is posted. We also employ two financial counselors who work with and screen the uninsured and underinsured populations. We also have a financial advocate from health and human services. |
| Davis Memorial Hospital | Part V, Section B, Line 20e: The Hospital also screens patients through a third party database through the advisory board prior to placement with a collection agency. This scrub provides us with the likelihood the patient will qualify for Medicaid as well as screens the patients for our internal assistance policy. The presumptive charity adjustments are done as budgetary constraints allow to better identify the medically indigent and patients who have a need for assistance to prevent derogatory collection activity. |
| Part V, Section B, Line 7a | https://www.davishealthsystem.org/Content/Uploads/davishealthsystem.org/images/DMC_2019CommunityHealthNeedsReport.pdf |
| Part V, Section B, Line 11a | https://www.davishealthsystem.org/Content/Uploads/davishealthsystem.org/images/DMC_2019CommunityHealthNeedsReport.pdf |
| Part V, Section B, Line 16a | https://www.davishealthsystem.org/Content/Uploads/davishealthsystem.org/files/DHSFinancialAssistancePolicy2015.pdf |
| Part V, Section B, Line 16b | https://www.davishealthsystem.org/Content/Uploads/davishealthsystem.org/files/CharityApplication.pdf |
| Part V, Section B, Line 16c | https://www.davishealthsystem.org/patients-visitors/financial-counseling |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - DirectCare of Elkins | ||||
| 720 Beverly Pike | Elkins | WV | 26241 | Medical Clinic |
| 3 - Women's HealthCare | ||||
| 812 Gorman Avenue | Elkins | WV | 26241 | OB/GYN Clinic |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | The cost of charity care was determined based on the hospital's cost accounting system. The total account cost and total account revenue for those receiving charity care are reported to come to a true cost associated with the accounts. The determined cost to charge ratio for the total account is then applied to the portion on charity care received.The cost of Medicaid was determined using the Hospital's cost accounting system. Accounts showing Medicaid as the primary payer along with total account cost was pulled, the cost to charge ratio was determined and applied to the total Medicaid revenue.The cost of subsidized health services was determined using the hospital's cost accounting system.Community benefit costs were determined from reports filled out by staff/managers involved to determine contributions. Participants supply labor cost as well as any labor costs involved in the community activity. Managers are supplied with community benefit forms. When they perform community service, they supply cost information and any offsetting revenue associated with the event. We have one staff member that compiles these forms on a monthly basis. Health professions education costs are compiled through the year and reported by the manager involved in the education opportunity or approving party. |
| Part I, Line 7g: | Subsidized health care services include clinics as well as OB/GYN/Labor/Delivery & Nursery services. |
| 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 $ 13,550,313. |
| Part II, Community Building Activities: | Davis Health System's mission includes the delivery of healthcare services and programs that promote improved health for individuals and families. The quality of life of entire communities is impacted through these vital programs generally offered at little or no cost. Some of the health issues targeted by Davis Health System to the communities served by our organization include diabetes, obesity and weight management, tobacco use and heart disease, women's health, influenza, and cancer and cancer prevention. Our outreach serves five primary West Virginia counties (Randolph, Tucker, Upshur, Barbour, and Pocahontas), with some overflow to neighboring counties as well. Several examples of projects that represent our commitment to advancing the emotional and physical health benefits to the people of these communities include: community health fairs, diabetes education programs and support groups, diabetes foot screenings, speaking engagements and presentations to schools, civic groups and other organizations, colon cancer screenings and education, community walking program, participation with the American Cancer Society's Relay for Life and March of Dimes, partnership with boards of education, influenza vaccination clinics, partnership with county health departments, drug take-back, smoking cessation classes and support and pap smear and breast examinations. |
| Part III, Line 2: | Bad debt expense as reported on audited financial statements. |
| Part III, Line 4: | Audited financial statement footnote relating to bad debt expense: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. 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 collectibility. Management also reviews troubled, aged accounts to determine collection potential. Delinquency status is based on date of service. Patient accounts receivables are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. |
| Part III, Line 8: | Medicare allowable costs and revenues are from the Medicare Cost Report. |
| Part III, Line 9b: | Patients who indicate they have an inability to pay for their medical care are referred to the financial counselor and/or a Medicaid Eligibility Specialist. Patients who do meet financial assistance guidelines but demonstrate an inability to meet our minimum payment guidelines are given a reduced payment plan. Collection procedures regarding reduced payment plans follow the hospital's normal procedures. Patients with catastrophic illnesses are referred to the WV Catastrophic Illness Fund. Patients whose care is a result of a crime will be referred to the WV Crime Victims Fund. |
| Part VI, Line 2: | Davis Health System relies heavily on data provided by the Bureau for Public Health; namely, the county Health Profiles that outline risk factors for chronic diseases. In addition, the Community Health Promotion Director gleans information and statistics from health screenings that are held for the public, as well as our employees. This information helps in planning future educational events and screenings. |
| Part VI, Line 3: | The information is posted in public areas within the hospital. The financial policy brochure is publicly displayed and posted on the internal network and the health system website. A patient advocate contacts work lists of medically indigent patients to help secure and provide education to affiliate and non-affiliate physician offices referring to Davis Memorial Hospital. |
| Part VI, Line 4: | The Hospital serves several rural counties in eastern West Virginia. The population forecasted is expected to fall, but due tot he large senior population in the service area, there will be a steady demand on needed healthcare services. Randolph County has a population of 28,695 with 18% having a bachelor's degree or higher and a median household income of $40,094. Upshur County has a population of 24,176 with 18% having a bachelor's degree or higher, median household income of $39,438. Barbour County has a population of 16,441 with 16% having a bachelor's degree or higher, median household income of $37,516. Pocahontas County has a population of 8,247 with 18% having a bachelor's degree or higher, median household income of $37,111. Tucker County has a population of 6,839 with 15% having a bachelor's degree or higher, median household income of $43,294.Additionally, 19% of all West Virginians live below the poverty level and the counties in the service average 21.2% below poverty level. Davis Memorial is the only hospital in Randolph County. There is one critical access hospital in Barbour County, one critical access hospital in Pocahontas County and one general service hospital in Upshur County. |
| Part VI, Line 5: | The organization's health care facilities further its exempt purpose in the following ways. The organization's governing body is comprised of persons who reside in the organization's primary service area. The corporate by laws provide for Board representation from the counties surrounding Davis Memorial Hospital. The organization extends medical staff privileges to all qualified physicians in its community for some or all of its departments. The organization operates an emergency room available to all, regardless of ability to pay. Specialized services offered by the organization that are not available elsewhere include neurology, pain management, otolaryngology, pulmonology, lithotripsy, sleep studies, PET, digital mammography, critical care medicine, general surgery, internal medicine, obstetrics and gynecology, radiation oncology, medical oncology and hematology. An advanced telemedicine initiative at Davis Health System provides additional specialized services in partnership with other health care providers, nursing homes and larger medical institutions - providing greater medical access to patients in more rural areas of the state. The organization serves as a vehicle for attracting charitable support, as well as a source of community volunteer activities. Student volunteers, youth volunteers and an active adult volunteer program support the mission of the health system by enhancing patient care and programs. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|
| Mountain State Forest Festival | ||||||
| PO Box 388 | Elkins | WV | 26241 | 501(c)(3) | $14,200 | Assist in production of county fair, parades, and events. |
| Country Roads Transit | ||||||
| PO Box 727 | Elkins | WV | 26241 | 501(c)(3) | $5,000 | Maintain and update local assisted living and senior transportation. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The organization grants money to other 501(c)(3) organizations and relies on the IRS's oversight of the grantees as they have an exemption from the IRS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Johanna Biola MD | ||||||||||||||
| Board Member | $245,495 | $0 | $108 | $0 | $0 | $0 | $2,471 | $0 | $23,672 | $0 | $271,746 | $0 | $0 | $0 |
| Amanda Pennington MD | ||||||||||||||
| Board Member | $448,462 | $0 | $969 | $0 | $0 | $0 | $4,508 | $0 | $24,283 | $0 | $478,222 | $0 | $0 | $0 |
| Vance Jackson | ||||||||||||||
| CEO | $310,757 | $0 | $102 | $0 | $0 | $0 | $3,118 | $0 | $24,161 | $0 | $338,138 | $0 | $0 | $0 |
| Melanie Dempsey | ||||||||||||||
| VP of Finance | $152,272 | $0 | $12,101 | $0 | $0 | $0 | $1,522 | $0 | $1,195 | $0 | $167,090 | $0 | $0 | $0 |
| Mohamed M Fahim MD | ||||||||||||||
| Physician | $605,472 | $0 | $102 | $0 | $0 | $0 | $6,031 | $0 | $28,286 | $0 | $639,891 | $0 | $0 | $0 |
| Walter Boardwine DO | ||||||||||||||
| Physician | $590,482 | $0 | $102 | $0 | $0 | $0 | $5,776 | $0 | $5,352 | $0 | $601,712 | $0 | $0 | $0 |
| Donald R Fleming MD | ||||||||||||||
| physician | $453,168 | $0 | $30,102 | $0 | $0 | $0 | $4,500 | $0 | $27,635 | $0 | $515,405 | $0 | $0 | $0 |
| Deborah Chadwick MD | ||||||||||||||
| physician | $446,507 | $0 | $102 | $0 | $0 | $0 | $4,316 | $0 | $25,027 | $0 | $475,952 | $0 | $0 | $0 |
| Nirva Dube MD | ||||||||||||||
| Physician | $366,916 | $0 | $102 | $0 | $0 | $0 | $3,479 | $0 | $12,779 | $0 | $383,276 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1a | FormAndLineReferenceDesc |
| Explanation | The Hospital will reimburse for all of the reasonable travel, lodging and meal expenses incurred by the CEO's spouse for two business-related meetings or conferences per year. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | County Commissioner of Randolph County WV | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| CUSIP | 75260PXXX | CUSIPNum |
| Bond Issued | 2016-12-29 | BondIssuedDt |
| Issue Price | $7,165,000 | IssuePriceAmt |
| Purpose | Series 2016 A Bonds - refund 1998 & 1999 Bond issue | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $3,371,864 | RetiredAmt |
| Total Proceeds | $7,058,906 | TotalProceedsAmt |
| In Reserve Fund | $706,000 | InReserveFundAmt |
| Refunding Escrow | $5,934,518 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $240,388 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $178,000 | OtherSpentProceedsAmt |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Davis Health System is the parent corporation of Davis Memorial Hospital. The bylaws of the corporation designate Davis Health System as the sole corporate member of Davis Memorial Hospital, and granting all rights to members of nonprofit corporations by the laws of the state of West Virginia. |
| Form 990, Part VI, Section A, line 7a | Davis Health System is the parent corporation of Davis Memorial Hospital. The bylaws of the corporation designate Davis Health System as the sole corporate member of Davis Memorial Hospital, and granting all rights to members of nonprofit corporations by the laws of the state of West Virginia. |
| Form 990, Part VI, Section A, line 7b | Davis Health System is the parent corporation of Davis Memorial Hospital. The bylaws of the corporation designate Davis Health System as the sole corporate member of Davis Memorial Hospital, and granting all rights to members of nonprofit corporations by the laws of the state of West Virginia. |
| Form 990, Part VI, Section B, line 11b | The 990 will be distributed to all board members. It will be presented and discussed at a Board of Trustees meeting or a Finance Committee meeting, whichever occurs first after the completion of Form 990. If the Finance Committee meeting is the first to occur, all members of the Board of Trustees will be encouraged to attend the Finance Committee where the Form is to be discussed. |
| Form 990, Part VI, Section B, line 12c | The Davis Health System Conflict of Interest Policy requires that each director, officer, and committee member with board delegated powers shall annually sign a statement which affirms the person has received a copy of the conflict of interest policy and reads and understands the policy. Board members complete the statement in January of each year. The conflict of interest statements are reviewed by the Executive Committee. In addition to board members, senior staff are required to annually prepare a conflict of interest statement. |
| Form 990, Part VI, Section B, line 15 | The Compensation Committee of the Board of Trustees is responsible for the oversight of the compensation for the senior staff. A consultant (Yaffe & Company) is engaged who facilitates the annual evaluation process for determining compensation for executives. The consultant coordinates a series of meetings, leads discussions on the chief executive officer's performance evaluation, presents market analysis information for key positions and provides recommendations for salary levels based on that information. The committee makes their decision using the guidance of the consultant. |
| Form 990, Part VI, Section C, line 19 | The Board of Trustees adopted a Record Keeping and Disclosure Policy in January of 2003. The policy provides for disclosure of corporate and financial records not covered by governmental or contractual agreements. Any request for financial or other corporate documents are submitted to the Executive Committee of the Board of Trustees and decisions are made on a case by case basis. The Compliance Code of Conduct Policy includes standards relating to conflicts of interest within the organization. This information is shared with the public, being posted on the website in addition to being distributed to all patients admitted to the hospital. |
| Form 990, Part IX, line 11g | Administrative Services: Program service expenses 736,022. Management and general expenses 573,159. Fundraising expenses 0. Total expenses 1,309,181. Anesthesia Services: Program service expenses 1,118,793. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,118,793. Emergency Services: Program service expenses 4,696,882. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,696,882. Lab Services: Program service expenses 3,720,283. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,720,283. Hospitalists: Program service expenses 1,724,911. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,724,911. Surgical Services: Program service expenses 1,149,366. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,149,366. Radiology Services: Program service expenses 234,208. Management and general expenses 0. Fundraising expenses 0. Total expenses 234,208. Radiation Services: Program service expenses 1,632,313. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,632,313. Medical Services: Program service expenses 2,208,519. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,208,519. Pharmacy Services: Program service expenses 316,533. Management and general expenses 0. Fundraising expenses 0. Total expenses 316,533. Other Purchased Services: Program service expenses 108,755. Management and general expenses 84,690. Fundraising expenses 0. Total expenses 193,445. |
| Form 990, Part XI, line 9: | Equity method income of subsidiary -1,262,326. Change in pension funded plan status 17,055. Transfers to affiliates -1,672,644. |
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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Broaddus Hospital Association Inc | |||||||||||
| PO Box 930 | Philippi | WV | 26416 | 550379108 | Hospital | WV | 501(c)(3) | Line 3 | Davis Health System Inc | 0 | |
| Davis Health System Inc | |||||||||||
| PO Box 1484 | Elkins | WV | 26241 | 550737655 | Health System | WV | 501(c)(3) | Line 12c, III-FI | 0 | N/A | |
| Davis Health System Foundation | |||||||||||
| PO Box 1188 | Elkins | WV | 26241 | 320185772 | Supporting organization to health care organization | WV | 501(c)(3) | Line 11 | Davis Health System Inc | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WVUH-Davis MOB LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 Harrison Avenue | AddressLine1Txt |
| City | Elkins | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26241 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 821104026 | EIN |
| Primary Activities | Rental of medical facilities and equipment | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Facilities Inc | |||||||||||
| 909 Gorman Avenue | Elkins | WV | 26241 | 550516937 | Health Care | WV | Davis Memorial Hospital | C | $12,452,455 | 1.00000 | Yes (1) |
| Central WV Medcorp Inc | |||||||||||
| PO Box 2630 | Elkins | WV | 26241 | 550739314 | Physician Offices | WV | Davis Memorial Hospital | C | $40,454 | 1.00000 | Yes (1) |
| Elkins Regional Health Partners Physician Hospital Organization Inc | |||||||||||
| PO Box 2632 | Elkins | WV | 26241 | 550746206 | Hospital Organization | WV | Davis Memorial Hospital | C | $57,000 | 0.50000 | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Health Facilities Inc | ||
| A | $93,735 | Cash - FMV |
| Health Facilities Inc | ||
| Q | $50,004 | Cash - FMV |