2020-11-13T07:30:55-06:00 2019-12-31 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2019-01-01 550375433 Davis Memorial Hospital DAVI 3046363300 PO Box 1484 Elkins WV 26241 Melanie Dempsey CFO 3046363300 2020-11-12 1 Dolores Rose P01286262 3043460441 216.12.119.47 2020-11-12 10:58:51 ES P 89762B9AA0C8C1D590E5D40209EB2976C0D4AEE2 6DED3FDB4E3D1D97B2E3EA971B8E25D5FADB4D20 2019 2021-01-29 14:40:06Z Vance Jackson PO Box 1484 Elkins WV 26241 141615914 0 X www.davishealthsystem.org X 1903 WV To provide quality health care to residents of Elkins, West Virginia and surrounding communities. 16 12 924 90 144147 88112 20000 0 110222063 113007877 361306 197049 2284259 1780759 112887628 114985685 37312 36263 0 0 49239035 51147541 0 0 0 64668248 66270363 113944595 117454167 -1056967 -2468482 87088971 86716738 35183311 39422395 51905660 47294343 To provide patient friendly healthcare to its communities. 0 0 85565951 36263 114507006 The organization operated an 80 bed acute care hospital in Elkins, West Virginia.Charges foregone for charity care amounted to $2,712,536. 223268 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. 85789219 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 65 0 924 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Melanie Dempsey 3046373156 Gorman Avenue and Reed Street Elkins WV 26241 Bridgette Wilson Chairman 1.00 1.00 X X 0 0 0 Ashton Curtis DPM Vice Chairman 39.00 1.00 X X 81855 0 22541 Hugh Hitchcock Treasurer 3.00 3.00 X X 0 0 0 Terry White Secretary 1.00 1.00 X X 0 0 0 James Triplett Board Member 0.50 0.50 X 0 0 0 George Scott Board Member 1.00 1.00 X 0 0 0 Tom Felton Board Member 0.50 0.50 X 0 0 0 Danny Franke Board Member 2.00 2.50 X 0 0 0 Andrew Gongola Board Member 1.00 1.00 X 0 0 0 John Kabler Board Member 1.00 1.00 X 0 0 0 Connie Tenney Board Member 0.25 0.25 X 0 0 0 William Hartman Board Member 1.00 1.00 X 0 0 0 Drew PingleyMSN RN Board Member 39.00 1.00 X 78384 0 23226 Johanna Biola MD Board Member 39.00 1.00 X 245603 0 26143 Jeff Powelson Board Member 1.50 0.50 X 0 0 0 Amanda Pennington MD Board Member 39.00 1.00 X 449431 0 28791 Vance Jackson CEO 40.00 X 310859 0 27279 Melanie Dempsey VP of Finance 36.00 4.00 X 164373 0 2717 Mohamed M Fahim MD Physician 40.00 1.50 X 605574 0 34317 Walter Boardwine DO Physician 40.00 1.00 X 590584 0 11128 Donald R Fleming MD physician 40.00 11.00 X 483270 0 32135 Deborah Chadwick MD physician 40.00 4.00 X 446609 0 29343 Nirva Dube MD Physician 40.00 X 367018 0 16258 3823560 0 253878 54 0 1 0 WV Gastroenterology & Endoscopy PO Box 2831 Elkins WV 26241 Physicians 2523905 Medstream Anesthesia 82 Patton Ave Suite 510 Asheville NC 28801 Physicians 969050 Channels Construction 239 Bruce Street Elkins WV 26241 Construction 801070 Psychiatric Medical Care LLC PO Box 734606 Dallas TX 75373 Physicians 643137 University Health Associate PO Box 740 Morgantown WV 26507 Physicians 613885 13 Patient services 622110 113007877 113007877 113007877 134033 73887 60146 231626 0 231626 231626 20256 211370 26667245 26000 26630229 0 37016 26000 63016 63016 Cafeteria 722210 950950 950950 Management fees 900099 50004 50004 548179 548179 1549133 114985685 114507006 144147 334532 X 36263 36263 479483 269565 209918 37229511 20930431 16299080 870596 489449 381147 9918941 5576429 4342512 2649010 1489273 1159737 210226 210226 68473 68473 18304434 17646585 657849 124604 124604 5458700 3068881 2389819 1925339 1082426 842913 1102169 619639 482530 281534 158278 123256 694530 390465 304065 3888466 2186096 1702370 2185983 1228960 957023 Bad debts 13550313 13550313 Medical supplies 13097238 13097238 Medicaid provider tax 1833584 1833584 3544770 2135344 1409426 117454167 85789219 31664948 0 2502309 2902350 22274 117899 10087415 10779838 740707 619499 1782346 1943113 598617 760069 122534537 86600744 36018025 35933793 14447881 15380016 4981259 3732778 15908138 14547383 87088971 86716738 16040019 21405702 2184983 1245339 8146767 7934142 2667204 2309672 6144338 6527540 35183311 39422395 X 51905660 47294343 51905660 47294343 87088971 86716738 X -2468482 437405 337675 -2917915 X 1 X 1 X 1 0 X 0 0 0 0 0 0 0 0 1 16189 16189 0 Part II-B, Line 1: The organization pays membership fees to the American Hospital Association, which participates in lobbying activities. 106509 2044880 2151389 699757 56268603 32479329 24489031 60909743 54121415 6788328 2505045 2505045 35933793 Estimated third-party payor settlements 3222931 Due from affiliates 1592487 Other receivables 342913 Due from subsidiary 8684698 Right of Use Assets (net) 704354 14547383 Due to affilates 4586428 Capital leases 1437231 Post retirement benefit obligation 503881 6527540 X 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, 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. 1 1 X 1 X 120.000000000000 1 X 1 1 1 0 1 1 2971764 2971764 0.02860 20544768 9736764 10808004 0.10400 23516532 9736764 13779768 0.13260 58530 58530 0.00060 1298 1298 0.00000 806703 349352 457351 0.00440 163440 163440 0.00160 1029971 349352 680619 0.00660 24546503 10086116 14460387 0.13920 1 13550313 22652804 22986888 -334084 X 1 1 1 WVUH Davis MOB LLC Medical office rentals 0.26670 1 1 Davis Memorial Hospital PO Box 1484 Elkins WV 26241 X X X Davis Memorial Hospital 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X See Part V, Page 8 for URL X 1 19 1 See Part V, Page 8 for URL 0 1 X 120.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X See Part V, Page 8 for URL X See Part V, Page 8 for URL X See Part V, Page 8 for URL X X X X X 1 X 0 X X X X 1 X 0 0 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 2 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 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. 1 Mountain State Forest Festival PO Box 388 Elkins WV 26241 501(c)(3) 14200 Assist in production of county fair, parades, and events. Country Roads Transit PO Box 727 Elkins WV 26241 501(c)(3) 5000 Maintain and update local assisted living and senior transportation. 2 Part I, Line 2: 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. X 1 1 X X X 0 0 0 0 0 0 0 0 0 Johanna Biola MD Board Member 245495 0 108 0 0 0 2471 0 23672 0 271746 0 0 0 Amanda Pennington MD Board Member 448462 0 969 0 0 0 4508 0 24283 0 478222 0 0 0 Vance Jackson CEO 310757 0 102 0 0 0 3118 0 24161 0 338138 0 0 0 Melanie Dempsey VP of Finance 152272 0 12101 0 0 0 1522 0 1195 0 167090 0 0 0 Mohamed M Fahim MD Physician 605472 0 102 0 0 0 6031 0 28286 0 639891 0 0 0 Walter Boardwine DO Physician 590482 0 102 0 0 0 5776 0 5352 0 601712 0 0 0 Donald R Fleming MD physician 453168 0 30102 0 0 0 4500 0 27635 0 515405 0 0 0 Deborah Chadwick MD physician 446507 0 102 0 0 0 4316 0 25027 0 475952 0 0 0 Nirva Dube MD Physician 366916 0 102 0 0 0 3479 0 12779 0 383276 0 0 0 Part I, Line 1a 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. A County Commissioner of Randolph County WV 75260PXXX 2016-12-29 7165000 Series 2016 A Bonds - refund 1998 & 1999 Bond issue 0 0 0 A 3371864 7058906 706000 5934518 240388 178000 1 0 1 1 A 0 0 0 0 0 0 0 0 1 A 1 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. 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 N/A 0 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 WVUH-Davis MOB LLC 801 Harrison Avenue Elkins WV 26241 821104026 Rental of medical facilities and equipment WV N/A Health Facilities Inc 909 Gorman Avenue Elkins WV 26241 550516937 Health Care WV Davis Memorial Hospital C 12452455 1.00000 1 Central WV Medcorp Inc PO Box 2630 Elkins WV 26241 550739314 Physician Offices WV Davis Memorial Hospital C 40454 1.00000 1 Elkins Regional Health Partners Physician Hospital Organization Inc PO Box 2632 Elkins WV 26241 550746206 Hospital Organization WV Davis Memorial Hospital C 57000 0.50000 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 Health Facilities Inc A 93735 Cash - FMV Health Facilities Inc Q 50004 Cash - FMV