2025-11-17T17:55:14-06:00 2024-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 46204 990 2024-01-01 550375433 DAVIS MEMORIAL HOSPITAL DAVI 3046363300 PO BOX 1484 ELKINS WV 26241 JEFF SANDENE EVP AND CFO 3046373196 2025-11-17 1 0 ANGELA M MOORE P00244342 3174648600 2025-11-14 2024 2025-03-06 01:10:19Z RON ANDRO PO BOX 1484 ELKINS WV 26241 115132247 0 X WWW.DAVISHEALTHSYSTEM.ORG X 1903 WV TO PROVIDE QUALITY HEALTH CARE TO RESIDENTS OF ELKINS, WEST VIRGINIA AND SURROUNDING COMMUNITIES. 14 3 1051 65 88949 25199 39490 244397 104381650 113420026 369577 57288 2673491 1409164 107464208 115130875 32619 0 0 0 66961917 70310683 0 0 0 69101645 67407981 136096181 137718664 -28631973 -22587789 50342111 74271161 84306469 123554069 -33964358 -49282908 WE CARE FOR LIFE. 0 0 114564621 113569578 THE ORGANIZATION OPERATED AN 80 BED ACUTE CARE HOSPITAL IN ELKINS, WEST VIRGINIA. 114564621 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 91 0 1 1051 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X RICK SCHERICH 3046373196 812 GORMAN AVE ELKINS WV 26241 DAVID GOLDBERG DIRECTOR 1.00 57.00 X X 0 996584 51139 VANCE JACKSON DHS CEO (END 6/24) 35.00 5.00 X X 0 393822 226509 AMANDA PENNINGTON MD DIRECTOR 40.00 0.00 X 402022 0 43206 MISHA PHILLIPS-LEE DIRECTOR 40.00 2.00 X 242415 0 30075 WILLIAM KOCH VP FINANCE AND CFO 25.00 15.00 X X 0 155808 24191 DREW PINGLEY VICE CHAIR 40.00 0.00 X X 112771 0 29611 MARK DOAK DIRECTOR/INTERIM CEO 35.00 6.00 X X 56250 0 0 RONALD ANDRO DHS SVP ADMINISTRATIVE OFFICER 35.00 7.00 X X 0 37284 87 DANNY FRANKE DIRECTOR 14.00 2.00 X 23642 0 175 JAMES TRIPLETT CHAIRMAN 1.00 1.00 X X 0 0 0 CHAD SHOEMAKER DIRECTOR 1.00 0.00 X 0 0 0 CONNIE TENNEY DIRECTOR 1.00 0.00 X 0 0 0 DENISE CAMPBELL DIRECTOR 1.00 0.00 X 0 0 0 TOM FELTON DIRECTOR 1.00 0.00 X 0 0 0 MOHAMED FAHIM ANESTHESIOLOGIST 40.00 0.00 X 643464 0 65062 MICHAEL GALLOWAY PHYSICIAN 40.00 0.00 X 603259 0 40486 ARTHUR FINE PHYSICIAN 40.00 0.00 X 588364 0 39049 GARRETT BUTLER PHYSICIAN 40.00 1.00 X 508227 0 37836 EMAD KOWATLI PHYSICIAN 40.00 0.00 X 481471 0 36991 3661885 1583498 624417 92 0 1 0 QUALIVIS LLC PO BOX 674913 DALLAS TX 753974913 AGENCY SERVICES 2958508 RIVERSIDE ANESTHESIA PSC 425 LEWIS HARGETT CIRCLE LEXINGTON KY 40503 ANESTHESIA SERVICES 2404594 COMMONWEALTH ANESTHESIA PSC 425 LEWIS HARGETT CIRCLE LEXINGTON KY 40503 ANESTHESIA SERVICES 1306441 CPS SOLUTIONS LLC PO BOX 7410634 CHICAGO IL 606740634 IT CONSULTING 1130192 LUCAS J PAVLOVICH 1502 HARRISON AVENUE ELKINS WV 26241 ORTHOPEDIC SERVICES 1122572 23 244397 244397 PATIENT SERVICES 622110 112110748 112110748 PHARMACY REVENUE 456110 1309278 1309278 113420026 58660 34787 23873 82644 0 82644 82644 12492 70152 1372 -1372 -1372 -1372 CAFETERIA 722514 1135298 1135298 MANAGEMENT FEES 561000 41670 41670 149552 149552 1326520 115130875 113569578 88949 1227951 X 883917 883917 111715 111715 49977899 42950077 7027822 1360871 1170349 190522 14681247 12402531 2278716 3295034 2636027 659007 657085 657085 198207 198207 323039 323039 66678 66678 21097179 19023512 2073667 241501 241501 4820124 3871006 949118 819425 655540 163885 4656606 3612452 1044154 174007 139810 34197 16066 12853 3213 4493148 4493148 42000 42000 3782705 3026164 756541 433573 433573 MEDICAL SUPPLIES 17867879 17867879 PROVIDER TAX 3455941 3455941 REPAIRS AND MAINTENANCE 2116003 1692802 423201 LICENSE/FEES 1028906 822001 206905 1117909 396888 721021 137718664 114564621 23154043 0 5639442 5443515 26831 1998246 17177198 25538764 1436856 1733259 1413856 791198 364343 24347951 3271387 2831503 21076564 1188349 295536 -1381207 20898682 18140337 50342111 74271161 23126209 34255688 56303320 56721419 4876940 32576962 84306469 123554069 X -33964358 -49282908 -33964358 -49282908 50342111 74271161 -22587789 130158 7139081 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5308 5308 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE AMERICAN HOSPITAL ASSOCIATION, WHICH PARTICIPATES IN LOBBYING ACTIVITIES. 805609 805609 14058635 610415 13448220 5520273 1893698 3626575 3963434 767274 3196160 21076564 RIGHT OF USE ASSETS 9802 DUE FROM SUBSIDIARIES 18130535 18140337 DUE TO AFFILATES 32238498 POST RETIREMENT BENEFIT OBLIGATION 338464 32576962 X PART X, LINE 2: THE IRS HAS DETERMINED THAT THE SYSTEM ENTITIES ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE CODE AND APPLICABLE STATE STATUTES, EXCEPT FOR MHC, FHE, CMC, AND HFI, WHICH ARE CORPORATIONS SUBJECT TO INCOME TAX. THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2024 AND 2023. TAX RETURNS FOR THE YEAR ENDED JUNE 30, 2020, ARE OPEN FOR THE MHS ENTITIES AND TAX RETURNS FOR THE YEAR ENDED DECEMBER 31, 2021, ARE OPEN FOR CAMC ENTITIES. 1 1 X 1 X 120.000000000000 1 X 1 1 1 0 1 1 3384221 3384221 0.02490 31061704 21936592 9125112 0.06710 34445925 21936592 12509333 0.09200 34445925 21936592 12509333 0.09200 1 -1731406 0 13848736 18601157 -4752421 X 1 1 1 1 DAVIS MEMORIAL HOSPITAL PO BOX 1484 ELKINS WV 26241 HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/LOCA 141 X X X DAVIS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, PAGE 8 X 1 22 1 SEE PART V, PAGE 8 0 1 X 120.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X 1 X 0 X X X X X 1 X 0 0 DAVIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: INPUT WAS SOLICITED FROM THOSE REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY IN AUGUST 2022. 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. KEY STAKEHOLDERS APPROACHED FOR INPUT INCLUDED COMMUNITY HEALTH CENTERS, COLLEGES, NON-PROFIT ORGANIZATIONS, EMERGENCY MEDICAL SERVICES, HEALTH DEPARTMENTS, DEVELOPMENT AUTHORITIES, CHAMBER OF COMMERCE, STATE AND LOCAL GOVERNMENT AGENCIES, ETC., AS WELL AS PUBLIC OFFICIALS AND CHURCH LEADERS. 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:1. SUBSTANCE ABUSE2. MENTAL HEALTH3. CHRONIC DISEASE MANAGEMENT (COPD)4. FOOD INSECURITY5. TRANSPORTATION INSECURITYTHE HOSPITAL 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. THE HOSPITAL WILL CONTINUE TO COLLABORATE WITH EXTERNAL PARTNERS ON STRATEGIES AND POLICIES THAT WILL POSITIVELY IMPACT THE LOCAL DRUG EPIDEMIC.THE HOSPITAL WILL CONTINUE TO BUILD ON THE DAVIS MEDICAL CENTER NUTRITION/POPULATION HEALTH COLLABORATION FOR DIABETES PREVENTION PROGRAM AND INCREASE THE NUMBER OF PARTICIPANTS YEAR OVER YEAR. 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/FILES/2023_DMC_CHNA.PDF PART V, SECTION B, LINE 10A HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/CONTENT/UPLOADS/DAVISHEALTHSYSTEM.ORG/FILES/2023_DMC_CHNA.PDF PART V, SECTION B, LINE 16A HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING PART V, SECTION B, LINE 16B HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING PART V, SECTION B, LINE 16C HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING 2 1 - DIRECT CARE OF ELKINS 720 BEVERLY PIKE ELKINS WV 26241 MEDICAL CLINIC 2 - BUCKHANNON MEDICAL CENTER 11 NORTH LOCUST STREET BUCKHANNON WV 26201 MEDICAL CLINIC 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 $ 1,731,406. 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: WHEN WE HAVE AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT RECEIVABLES, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH WE HAVE THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF OUR RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE. FOR CHANGES IN CREDIT ISSUES NOT ASSESSED AT THE DATE OF SERVICE, THE SYSTEM WILL PROSPECTIVELY RECOGNIZE THOSE AMOUNTS IN NET PATIENT SERVICE REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. THE PROVISION FOR DOUBTFUL ACCOUNTS WAS IMMATERIAL AS OF DECEMBER 31, 2024 AND 2023. 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. RANDOLPH COUNTY HAS A POPULATION OF 27,932 WITH 15.7% HAVING A BACHELOR'S DEGREE OR HIGHER AND AVERAGE HOUSEHOLD INCOME OF $45,206. UPSHUR COUNTY HAS A POPULATION OF 23,816 WITH 16.2% HAVING A BACHELOR'S DEGREE OR HIGHER, AVERAGE HOUSEHOLD INCOME OF $40,802. BARBOUR COUNTY HAS A POPULATION OF 15,465 WITH 13.9% HAVING A BACHELOR'S DEGREE OR HIGHER, AVERAGE HOUSEHOLD INCOME OF $38,906. POCAHONTAS COUNTY HAS A POPULATION OF 7,869 WITH 13.6% HAVING A BACHELOR'S DEGREE OR HIGHER, AVERAGE HOUSEHOLD INCOME OF $37,642. TUCKER COUNTY HAS A POPULATION OF 6,762 WITH 19.5% HAVING A BACHELOR'S DEGREE OR HIGHER, AVERAGE HOUSEHOLD INCOME OF $47,527. ADDITIONALLY, 16.8% OF ALL WEST VIRGINIANS LIVE BELOW THE 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. X 1 1 X X X 1 1 0 0 0 0 0 0 0 DAVID GOLDBERG DIRECTOR 0 736828 0 241048 0 18708 0 13800 0 37339 0 1047723 0 0 MOHAMED FAHIM ANESTHESIOLOGIST 639144 0 0 0 4320 0 38365 0 26697 0 708526 0 0 0 MICHAEL GALLOWAY PHYSICIAN 582426 0 0 0 20833 0 11721 0 28765 0 643745 0 0 0 ARTHUR FINE PHYSICIAN 567851 0 0 0 20513 0 11430 0 27619 0 627413 0 0 0 VANCE JACKSON DHS CEO (END 6/24) 0 166596 0 150 0 227076 0 190581 0 35928 0 620331 0 0 GARRETT BUTLER PHYSICIAN 496446 0 11285 0 496 0 10001 0 27835 0 546063 0 0 0 EMAD KOWATLI PHYSICIAN 461462 0 0 0 20009 0 9275 0 27716 0 518462 0 0 0 AMANDA PENNINGTON MD DIRECTOR 401648 0 0 0 374 0 16211 0 26995 0 445228 0 0 0 MISHA PHILLIPS-LEE DIRECTOR 242415 0 0 0 0 0 7484 0 22591 0 272490 0 0 0 WILLIAM KOCH VP FINANCE AND CFO 0 155658 0 150 0 0 0 6331 0 17860 0 179999 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. PART I, LINES 4A-B VANCE JACKSON RECEIVED $227,026 OF SEVERANCE PAYMENTS DURING TY24. 457(F) INELIGIBLE DEFERRED COMPENSATION PLAN - A 457 F PLAN IS OFFERED TO CERTAIN MANAGEMENT AND/OR HIGHLY COMPENSATED EMPLOYEES TO OFFER THOSE EMPLOYEES A DEFERRED COMPENSATION OPPORTUNITY. THE PLAN IS INTENDED TO BE A "TOP-HAT PLAN", OR UNFUNDED DEFERRED COMPENSATION PLAN MAINTAINED FOR A SELECT GROUP OF EMPLOYEES. PARTICIPANTS MAY BECOME VESTED IN AMOUNTS CREDITED ON JANUARY 1 ELECTED BY THE PARTICIPANT AT THE TIME THE INITIAL DEFERRAL WAS ELECTED. A PARTICIPANT SHALL BECOME FULLY VESTED UPON DEATH, DISABILITY, ATTAINMENT OF AGE 60, OR SEPARATION OF SERVICE, AS DEFINED BY THE PLAN. ANY UNVESTED CONTRIBUTIONS SHALL BE FORFEITED TO THE PLAN OR EMPLOYER. FOR 2024 NO DISTRIBUTIONS / PAYMENTS WERE MADE FROM THE PLAN; DAVID GOLDBERG WAS THE ONLY PARTICIPANT. PART I, LINE 3: THE 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. RICHARD CAMPBELL FAMILY MEMBER OF DENISE CAMPBELL 30892 EMPLOYMENT 0 CHRISTIE SHOEMAKER FAMILY MEMBER OF CHAD SHOEMAKER 80823 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 DAVIS MEMORIAL HOSPITAL'S SOLE MEMBER IS DAVIS HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A DAVIS MEMORIAL HOSPITAL'S BOARD MEMBERS ARE ELECTED OR APPOINTED BY DAVIS HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7B DAVIS HEALTH SYSTEM, INC. IS DAVIS MEMORIAL HOSPITAL'S SOLE MEMBER AND HAS RESERVED POWERS UNDER DAVIS MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, WHICH PROVIDE THAT DECISIONS OF DAVIS MEMORIAL HOSPITAL'S GOVERNING BODY, SUCH AS ELECTION OF OFFICERS, APPROVAL OF ANNUAL BUDGETS AND BORROWINGS, ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER. THE SOLE MEMBER ALSO HAS ALL APPROVAL POWERS PROVIDED TO MEMBERS OF WEST VIRGINIA NONPROFIT CORPORATIONS UNDER STATE LAW. FORM 990, PART VI, SECTION B, LINE 11B 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 PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 19,023,512. MANAGEMENT AND GENERAL EXPENSES 2,073,667. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,097,179. 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