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DAVIS MEMORIAL HOSPITAL: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
DAVIS MEMORIAL HOSPITAL (EIN 55-0375433)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-11-17
IRS object ID
201443219349303664
Schema version
2013v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2014-11-17T10:35:52-06:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN550486667PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Arnett Foster Toothman PLLCBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1P O Box 2629AddressLine1
CityCharlestonCity
StateWVState
ZIP Code25329ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN550375433EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Davis Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlDAVIBusinessNameControlTxt
Phone3046363300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1484AddressLine1
CityElkinsCity
StateWVState
ZIP Code26241ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonE Mark DoakPersonNm
Person TitlePresident/CEOPersonTitleTxt
Phone3046363300PhoneNum
Signature2014-11-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDale CarpenterPreparerPersonNm
PTINP00189642PTIN
Phone3043460441PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerE Mark DoakPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1484AddressLine1
CityElkinsCity
StateWVState
ZIP Code26241ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$95,288,336GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.davishealthsystem.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1903FormationYr
Legal Domicile StateWVLegalDomicileStateCd
Activity Or MissionTo provide quality health care to residents of Elkins, West Virginia and surrounding communities.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee797TotalEmployeeCnt
Total Volunteers87TotalVolunteersCnt
Total Gross UBI$136,689TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$61,681NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$48,410PYContributionsGrantsAmt
CY Contributions Grants$31,905CYContributionsGrantsAmt
PY Program Service Revenue$84,706,419PYProgramServiceRevenueAmt
CY Program Service Revenue$82,560,799CYProgramServiceRevenueAmt
PY Investment Income$556,200PYInvestmentIncomeAmt
CY Investment Income$554,117CYInvestmentIncomeAmt
PY Other Revenue$2,167,166PYOtherRevenueAmt
CY Other Revenue$5,469,454CYOtherRevenueAmt
PY Total Revenue$87,478,195PYTotalRevenueAmt
CY Total Revenue$88,616,275CYTotalRevenueAmt
PY Grants And Similar Paid$55,979PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$54,959CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$41,410,398PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$43,822,651CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$43,901,924PYOtherExpensesAmt
CY Other Expenses$45,582,885CYOtherExpensesAmt
PY Total Expenses$85,368,301PYTotalExpensesAmt
CY Total Expenses$89,460,495CYTotalExpensesAmt
PY Revenues Less Expenses$2,109,894PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$844,220CYRevenuesLessExpensesAmt
Total Assets BOY$73,499,011TotalAssetsBOYAmt
Total Assets EOY$77,353,945TotalAssetsEOYAmt
Total Liabilities BOY$32,318,423TotalLiabilitiesBOYAmt
Total Liabilities EOY$38,737,809TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$41,180,588NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$38,616,136NetAssetsOrFundBalancesEOYAmt
MissionTo provide patient friendly healthcare to its communities.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$74,994,101ExpenseAmt
Grant$54,959GrantAmt
Revenue$82,560,799RevenueAmt
DescThe organization operated a 90 bed acute care hospital in Elkins, West Virginia.Charges foregone for charity care amounted to $7,837,243.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$129,588ExpenseAmt
DescThe hospital provided community support by providing nutritious meals to residents of Elkins, WV.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$89,300ExpenseAmt
DescThe hospital provided community support by sponsoring various health fairs and providing food or snacks for various community events to residents of Elkins, WV.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$75,212,989TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document82IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee797EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Rebecca HammerBusinessNameLine1
FieldValueIRS element (for citing)
Phone3046373156PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1Gorman Avenue and Reed StreetAddressLine1
CityElkinsCity
StateWVState
ZIP Code26241ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Hugh Hitchcock
Board Member1.002.00Yes (X)$0$0$0
William Hartman
Vice-Chairman2.002.00Yes (X)$0$0$0
Andrew Gongola
Treasurer2.002.00Yes (X)$0$0$0
George Scott
Board Member1.001.00Yes (X)$0$0$0
Bridgette Wilson
Secretary2.002.00Yes (X)$0$0$0
Connie Tenney
Board Member1.001.00Yes (X)$0$0$0
Terry White
Board Member1.001.00Yes (X)$0$0$0
Suzi Moore
Board Member1.001.50Yes (X)$0$0$0
Ashton Curtis DPM
Board Member1.001.00Yes (X)$0$0$0
Steve Toney MD
Chairman27.004.00Yes (X)$126,789$13,000$0
Tom Felton
Board Member1.001.00Yes (X)$0$0$0
James Triplett
Board Member1.001.00Yes (X)$0$0$0
Robert Digman PHD
Board Member1.004.00Yes (X)$0$0$0
Forrest Kelley
Board Member1.003.00Yes (X)$0$0$0
Deborah Tysor
Board Member/RN38.501.00Yes (X)$47,305$0$16,957
John Kabler
Board Member1.001.00Yes (X)$0$0$0
Paul Hartel
Board Member/Physician38.002.00Yes (X)$259,529$0$19,455
E Mark Doak
President/CEO29.0011.00$294,846$0$16,957Yes (X)
Rebecca Hammer
CFO36.004.00$181,252$0$8,012Yes (X)
Mohamed M Fahim
Physician40.00$610,798$0$18,957Yes (X)
Donald R Fleming
Physician40.00$450,000$0$19,455Yes (X)
Charles K Kirkland
Physician40.00$412,425$0$19,455Yes (X)
Marshall Sklar
Physician40.00$450,000$0$7,012Yes (X)
John S Veach
Physician39.001.00$424,575$0$8,118Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,257,519TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$13,000TotReportableCompRltdOrgAmt
Total Other Compensation$134,378TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K52IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
Executive Health Resources
15 Campus BlvdNewton SquarePA19073Purchased Service$572,465
Weatherby Locums
PO Box 972633DallasTX75397Physician Locums$497,171
Comphealth
PO Box 972651DallasTX75397Physician Locums$442,108
Smith Backhoe & Dozer Service
7 Eleventh StreetElkinsWV26241Building Contractor$392,742
Dunmire Consulting
13352 Paloma DrOrlandoFL32837Consulting$369,204
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K22CntrctRcvdGreaterThan100KCnt
All Other Contributions$31,905AllOtherContributionsAmt
Total Contributions$31,905TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPatient servicesDesc
Business622110BusinessCd
Total Revenue Column$82,560,799TotalRevenueColumnAmt
Related Or Exempt Func Income$82,560,799RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$82,560,799TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$189,235TotalRevenueColumnAmt
Unrelated Business Revenue$64,485UnrelatedBusinessRevenueAmt
Exclusion$124,750ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$72,170RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$72,170RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$72,170TotalRevenueColumnAmt
Unrelated Business Revenue$4,200UnrelatedBusinessRevenueAmt
Exclusion$67,970ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$7,030,152SecuritiesAmt
Other$6,791OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$6,655,983SecuritiesAmt
Other$16,078OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$374,169SecuritiesAmt
Other-$9,287OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$364,882TotalRevenueColumnAmt
Exclusion$364,882ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
Litigation Settlement900099$2,100,000$2,100,000
EHR Incentive900099$1,918,427$1,918,427
Cafeteria722210$852,641$852,641

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$526,216TotalRevenueColumnAmt
Unrelated Business Revenue$68,004UnrelatedBusinessRevenueAmt
Exclusion$458,212ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$5,397,284OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$88,616,275TotalRevenueColumnAmt
Related Or Exempt Func Income$82,560,799RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$136,689UnrelatedBusinessRevenueAmt
Exclusion$5,886,882ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$54,959TotalAmt
Program Services$54,959ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$977,734TotalAmt
Program Services$782,676ProgramServicesAmt
Management And General$195,058ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$33,164,002TotalAmt
Program Services$26,547,784ProgramServicesAmt
Management And General$6,616,218ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$66,608TotalAmt
Program Services$53,320ProgramServicesAmt
Management And General$13,288ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$7,336,387TotalAmt
Program Services$5,872,778ProgramServicesAmt
Management And General$1,463,609ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,277,920TotalAmt
Program Services$1,823,475ProgramServicesAmt
Management And General$454,445ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$401,876TotalAmt
Management And General$401,876ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$100,205TotalAmt
Management And General$100,205ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$6,384,495TotalAmt
Program Services$5,110,788ProgramServicesAmt
Management And General$1,273,707ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$92,843TotalAmt
Management And General$92,843ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$5,571,902TotalAmt
Program Services$4,560,705ProgramServicesAmt
Management And General$1,011,197ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,894,119TotalAmt
Program Services$1,516,242ProgramServicesAmt
Management And General$377,877ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,042,202TotalAmt
Program Services$834,283ProgramServicesAmt
Management And General$207,919ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$270,358TotalAmt
Program Services$216,422ProgramServicesAmt
Management And General$53,936ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$796,259TotalAmt
Program Services$637,405ProgramServicesAmt
Management And General$158,854ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,098,480TotalAmt
Program Services$4,081,333ProgramServicesAmt
Management And General$1,017,147ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$977,153TotalAmt
Program Services$782,211ProgramServicesAmt
Management And General$194,942ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Bad debts$9,234,284$9,234,284
Medical supplies$9,009,539$9,009,539$0
Repairs and maintenance$1,984,811$1,588,841$395,970
Unrelated business inco$16,000$16,000

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,708,359TotalAmt
Program Services$2,489,944ProgramServicesAmt
Management And General$218,415ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$89,460,495TotalAmt
Program Services$75,212,989ProgramServicesAmt
Management And General$14,247,506ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,583,236BOYAmt
EOY$2,884,356EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,555,662BOYAmt
EOY$2,509,105EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$14,811,476BOYAmt
EOY$11,164,052EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$471,464BOYAmt
EOY$696,638EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,822,453BOYAmt
EOY$1,658,767EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,221,833BOYAmt
EOY$861,919EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$106,299,507LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$70,031,482LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$30,202,831BOYAmt
EOY$36,268,025EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$6,075,488BOYAmt
EOY$6,688,047EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$3,257,741BOYAmt
EOY$3,209,023EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$9,496,827BOYAmt
EOY$11,414,013EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$73,499,011BOYAmt
EOY$77,353,945EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$10,137,892BOYAmt
EOY$11,375,912EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$373,059BOYAmt
EOY$339,644EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,850,000BOYAmt
EOY$7,420,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,059,043BOYAmt
EOY$9,895,888EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$3,861,447BOYAmt
EOY$3,539,481EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,036,982BOYAmt
EOY$6,166,884EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$32,318,423BOYAmt
EOY$38,737,809EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$41,180,588BOYAmt
EOY$38,616,136EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$41,180,588BOYAmt
EOY$38,616,136EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$73,499,011BOYAmt
EOY$77,353,945EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$844,220ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$98,181NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$1,818,413OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$106,509InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$2,044,880OtherCostOrOtherBasisAmt
Book Value$2,151,389BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$231,721InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$34,221,185OtherCostOrOtherBasisAmt
Depreciation$26,984,810DepreciationAmt
Book Value$7,468,096BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$56,249,622OtherCostOrOtherBasisAmt
Depreciation$43,046,672DepreciationAmt
Book Value$13,202,950BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$13,445,590OtherCostOrOtherBasisAmt
Book Value$13,445,590BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$36,268,025TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (5 entries)

DescDescBook ValueBookValueAmt
Other receivables$100,701
Due from affiliates$3,865,640
Bond issue costs, net of amortization$126,349
Due from subsidiary$7,231,323
Estimated third-party payor settlements$90,000
FieldValueIRS element (for citing)
Total Book Value Other Assets$11,414,013TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Due to affilates$270,239
Capital leases$4,635,220
Post retirement benefit obligation$1,261,425
FieldValueIRS element (for citing)
Total Liability$6,166,884TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$79,333,273TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$48,718OtherRevenueAmt
Revenue Not Reported-$48,718RevenueNotReportedAmt
Revenue Subtotal$79,381,991RevenueSubtotalAmt
Other Revenues Not Included$9,234,284OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$9,234,284RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$88,616,275TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$80,226,211TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$80,226,211ExpensesSubtotalAmt
Other Expenses Not Included$9,234,284OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$9,234,284ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$89,460,495TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part XI, Line 2d - Other Adjustments:Decrease in retained earnings of unconsolidated subsidiary -48,718.
Part XI, Line 4b - Other Adjustments:Bad debt expense netted with revenue in financial statements 9,234,284.
Part XII, Line 4b - Other Adjustments:Bad debt expense netted with revenue in financial statements 9,234,284.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other120.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,790,515TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,790,515NetCommunityBenefitExpnsAmt
Total Expense0.03480TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$14,996,112TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,215,802DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,780,310NetCommunityBenefitExpnsAmt
Total Expense0.05960TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$17,786,627TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,215,802DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,570,825NetCommunityBenefitExpnsAmt
Total Expense0.09440TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$56,106TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$56,106NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,415TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,415NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,650,932TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,539,134DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,111,798NetCommunityBenefitExpnsAmt
Total Expense0.03880TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$218,888TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$218,888NetCommunityBenefitExpnsAmt
Total Expense0.00270TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,928,341TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,539,134DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,389,207NetCommunityBenefitExpnsAmt
Total Expense0.04220TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$22,714,968TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$11,754,936DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,960,032NetCommunityBenefitExpnsAmt
Total Expense0.13660TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,081TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,081NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,081TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,081NetCommunityBenefitExpnsAmt
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$4,586,669BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$17,346,901ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$17,977,450CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$630,549MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Davis Memorial HospitalBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1484AddressLine1
CityElkinsCity
StateWVState
ZIP Code26241ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Davis Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
All Needs Addressed0AllNeedsAddressedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (1)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care120.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (1)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Uninsured DiscountYes (X)UninsuredDiscountInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Posted In Admission OfficeYes (X)PostedInAdmissionOfficeInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Davis Memorial HospitalPart V, Section B, Line 3: Selected stakeholders from the Hospital's service area provided valuable input through a series of individual interviews. Those interviewed included representatives from Elkins Fire Department and Elkins Emergency Medical Services, Randolph-Elkins Health Department and local health providers. These individuals were chosen because they provided diversified backgrounds and a range of perspectives on health care services available to the community.
Davis Memorial HospitalPart V, Section B, Line 7: Financial constraints prevent the Hospital from addressing all of the needs identified in the Community Health Needs Assessment.
Davis Memorial HospitalPart V, Section B, Line 14g: The policy is posted on the Davis Health System Website and is published annually in local newspapers. The 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 HospitalPart V, Section B, Line 18e: 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.
Davis Memorial HospitalPart V, Section B, Line 20d: The hospital provides a straight 25% discount to uninsured individuals paying their balances. This discount is lower than any of our negotiated insurance contract rates.

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 $ 9,234,284.
Part I, Line 7gThe cost of physician clinics included in subsidized health services was $3,112,899.
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 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.The cost of bad debts was determined based on the Hospital's cost accounting system and decision support system. All costs, direct and indirect, are stepped down by department based on revenue. Bad debt expense is reduced by bad debt recoveries and discounts for payment.
Part III, Line 8:Medicare allowable costs were estimated using Worksheet B of the Schedule H instructions. None of the shortfall is considered to be community benefit since the deviation changes each year.
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 29,415 with 18% having a bachelor's degree or higher and average household income of $37,350. Upshur County has a population of 24,665 with 15.4% having a bachelor's degree or higher, average household income of $41,214. Barbour County has a population of 16,770 with 11.7% having a bachelor's degree or higher, average household income of $36,087. Pocahontas County has a population of 8,669 with 15.7% having a bachelor's degree or higher, average household income of $32,381. Tucker County has a population of 6,968 with 16% having a bachelor's degree or higher, average household income of $36,445. Additionally, 17.6% 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. A 2013 Community Benefit Report is now available via a link on the Hospital's website.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
Randolph County Hooked on Fishing Not on Drugs
PO Box 2293ElkinsWV26241501(c)(3)$13,000Support hooked on fishing, not on drugs programs
Country Roads Transit
PO Box 727ElkinsWV26241501(c)(3)$10,000Event sponsorship

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationThe 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

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Paul Hartel
Board Member/Physician$259,529$0$0$0$0$0$0$0$21,664$0$281,193$0$0$0
E Mark Doak
President/CEO$294,846$0$0$0$0$0$0$0$19,449$0$314,295$0$0$0
Rebecca Hammer
CFO$181,252$0$0$0$0$0$0$0$9,569$0$190,821$0$0$0
Mohamed M Fahim
Physician$610,798$0$0$0$0$0$0$0$23,206$0$634,004$0$0$0
Donald R Fleming
Physician$450,000$0$0$0$0$0$0$0$23,273$0$473,273$0$0$0
Charles K Kirkland
Physician$412,425$0$0$0$0$0$0$0$22,074$0$434,499$0$0$0
Marshall Sklar
Physician$450,000$0$0$0$0$0$0$0$10,830$0$460,830$0$0$0
John S Veach
Physician$424,575$0$0$0$0$0$0$0$11,588$0$436,163$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 4bFormAndLineReferenceDesc
ExplanationMark Doak participated in a 457(f) plan. However, no amount was paid in 2013.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6Davis 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 7aDavis 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 7bDavis 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 11The 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 12cThe 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 15The 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 19The 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 XI, line 9:Equity method income of subsidiary -48,718. Change in pension funded status 0. Transfers to affiliates -1,769,695.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
Broaddus Hospital Association Inc
PO Box 930PhilippiWV26416550379108HospitalWV501(c)(3)Line 3N/A0
Davis Health System Inc
PO Box 1484ElkinsWV26241550737655Health SystemWV501(c)(3)Line 11b, IIN/A0
Davis Health System Foundation
PO Box 1188ElkinsWV26241320185772Supporting organization to health care organizationWV501(c)(3)Line 9N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
Health Facilities Inc
909 Gorman AvenueElkinsWV26241550516937Health CareWVC-$48,718$11,917,0441.000000
Central WV Medcorp Inc
PO Box 2630ElkinsWV26241550739314Physician OfficesWVC0
Elkins Regional Health Partners Physician Hospital Organization Inc
PO Box 2632ElkinsWV26241550746206Hospital OrganizationWVC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Health Facilities Inc
A$59,634Cash - FMV
Central WV Medcorp Inc
B$199,598Cash - FMV
Health Facilities Inc
P$53,604Cash - FMV