DAVIS MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- DAVIS MEMORIAL HOSPITAL (EIN 55-0375433)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201203209349306585
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T14:35:22-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550486667 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Foster Toothman PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1 |
| City | Charleston | City |
| State | WV | State |
| ZIP Code | 25329 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550375433 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Davis Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DAVI | NameControl |
| Phone | 3046363300 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1484 | AddressLine1 |
| City | Elkins | City |
| State | WV | State |
| ZIP Code | 26241 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | E Mark Doak | Name |
| Title | President/CEO | Title |
| Phone | 3046363300 | Phone |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Dale Carpenter | Name |
| PTIN | P00189642 | PTIN |
| Phone | 3043460441 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | E Mark Doak | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1484 | AddressLine1 |
| City | Elkins | City |
| State | WV | State |
| ZIP Code | 26241 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 83239306 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.davishealthsystem.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1903 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | To provide quality health care to residents of Elkins, West Virginia and surrounding communities. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 778 | TotalNbrEmployees |
| Total Nbr Volunteers | 90 | TotalNbrVolunteers |
| Total Gross UBI | 132139 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 68530 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 3441 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 52389 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 80376879 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 80470242 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 452923 | InvestmentIncomePriorYear |
| Investment Income Current Year | 646751 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1089769 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2066597 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 81923012 | TotalRevenuePriorYear |
| Total Revenue Current Year | 83235979 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 68159 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 78869 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 38390810 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 40134233 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 38169500 | OtherExpensePriorYear |
| Other Expenses Current Year | 39922652 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 76628469 | TotalExpensesPriorYear |
| Total Expenses Current Year | 80135754 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 5294543 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3100225 | RevenuesLessExpensesCY |
| Total Assets BOY | 67787349 | TotalAssetsBOY |
| Total Assets EOY | 72031083 | TotalAssetsEOY |
| Total Liabilities BOY | 24024317 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 29753809 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 43763032 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 42277274 | NetAssetsOrFundBalancesEOY |
| Mission Description | To provide patient friendly healthcare to its communities. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 69351439 | Expense |
| Grants | 78869 | Grants |
| Revenue | 80469722 | Revenue |
| Description | The organization operated a 90 bed acute care hospital in Elkins, West Virginia.Charges foregone for charity care amounted to $7,976,035. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | The hospital provided community support by providing nutritious meals to residents of Elkins, WV. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 310132 | Expense |
| Revenue | 520 | Revenue |
| Description | The hospital provided community support by sponsoring various health fairs and providing food or snacks for various community events to residents of Elkins, WV. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 69661571 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 73 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 778 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Rebecca Hammer | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3046373156 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Gorman Avenue and Reed Street | AddressLine1 |
| City | Elkins | City |
| State | WV | State |
| ZIP Code | 26241 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|
| Hugh Hitchcock | |||||||
| Board Member | 2.00 | X | 0 | 0 | 0 | ||
| William Hartman | |||||||
| Board Member | 2.00 | X | 0 | 0 | 0 | ||
| Andrew Gongola | |||||||
| Board Member | 2.00 | X | 0 | 0 | 0 | ||
| George Scott | |||||||
| Board Member | 2.00 | X | 0 | 0 | 0 | ||
| Bridgette Wilson | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Connie Tenney | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Terry White | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Suzi Moore | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Ashton Curtis DPM | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Steve Toney MD | |||||||
| Board Member | 1.00 | X | 1925 | 114823 | 0 | ||
| Tom Felton | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| James Triplett | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Nitesh Ratnakar MD | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Robert Digman PHD | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Forrest Kelley | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Deborah Tysor | |||||||
| Board Member | 1.00 | X | 48834 | 0 | 17431 | ||
| E Mark Doak | |||||||
| President/CEO | 40.00 | 308039 | 0 | 20030 | X | ||
| Rebecca Hammer | |||||||
| CFO | 40.00 | 178891 | 0 | 17100 | X | ||
| Mohamed M Fahim | |||||||
| Physician | 40.00 | 606475 | 0 | 3695 | X | ||
| Donald R Fleming | |||||||
| Physician | 40.00 | 491224 | 0 | 22622 | X | ||
| Charles K Kirkland | |||||||
| Physician | 40.00 | 404955 | 0 | 22474 | X | ||
| Mary A Scott | |||||||
| Physician | 40.00 | 397182 | 0 | 11191 | X | ||
| Anne L Banfield | |||||||
| Physician | 40.00 | 355134 | 0 | 11163 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2792659 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 114823 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 125706 | TotalOtherCompensation |
| Number Individuals GT100 K | 41 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Dunmire Consulting | |||||
| 13352 Paloma Dr | Orlando | FL | 32837 | Consulting | 429723 |
| Executive Health Resources | |||||
| 15 Campus Blvd | Newton Square | PA | 19073 | Purchased Service | 309107 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 75397 | Locums | 249488 |
| Alliance Healthcare | |||||
| PO Box 96485 | Chicago | IL | 60693 | PET/CT Scans | 247420 |
| Comphealth | |||||
| PO Box 972651 | Dallas | TX | 75397 | Contract Fees | 227835 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 12 | NumberOfContractorsGT100K |
| All Other Contributions | 52389 | AllOtherContributions |
| Total Contributions | 52389 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient services | Description |
| Business Code | 622110 | BusinessCode |
| Total Revenue Column | 80470242 | TotalRevenueColumn |
| Related Or Exempt Function Income | 80470242 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 80470242 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 646178 | TotalRevenueColumn |
| Unrelated Business Revenue | 59935 | UnrelatedBusinessRevenue |
| Exclusion | $586,243 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 70570 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 70570 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 70570 | TotalRevenueColumn |
| Unrelated Business Revenue | 4200 | UnrelatedBusinessRevenue |
| Exclusion | $66,370 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3900 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3327 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 573 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 573 | TotalRevenueColumn |
| Exclusion | $573 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Pharmacy | 446110 | 1096764 | $1,096,764 | |
| Cafeteria | 722210 | 785685 | $785,685 | |
| Management fees | 900099 | 68004 | 68004 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 45574 | TotalRevenueColumn |
| Exclusion | $45,574 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1996027 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 83235979 | TotalRevenueColumn |
| Related Or Exempt Function Income | 80470242 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 132139 | UnrelatedBusinessRevenue |
| Exclusion | $2,581,209 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78869 | Total |
| Program Services | 78869 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 529556 | Total |
| Program Services | 442338 | ProgramServices |
| Management And General | 87218 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30433214 | Total |
| Program Services | 25420864 | ProgramServices |
| Management And General | 5012350 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1399806 | Total |
| Program Services | 1169258 | ProgramServices |
| Management And General | 230548 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5714302 | Total |
| Program Services | 4773156 | ProgramServices |
| Management And General | 941146 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2057355 | Total |
| Program Services | 1718509 | ProgramServices |
| Management And General | 338846 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 735436 | Total |
| Program Services | 614310 | ProgramServices |
| Management And General | 121126 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 206110 | Total |
| Management And General | 206110 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60030 | Total |
| Management And General | 60030 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4091475 | Total |
| Program Services | 3417609 | ProgramServices |
| Management And General | 673866 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 144103 | Total |
| Management And General | 144103 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5947825 | Total |
| Program Services | 5081252 | ProgramServices |
| Management And General | 866573 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1358292 | Total |
| Program Services | 1134581 | ProgramServices |
| Management And General | 223711 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1094295 | Total |
| Program Services | 914065 | ProgramServices |
| Management And General | 180230 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 263070 | Total |
| Program Services | 219742 | ProgramServices |
| Management And General | 43328 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 705280 | Total |
| Program Services | 589120 | ProgramServices |
| Management And General | 116160 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4134470 | Total |
| Program Services | 3453523 | ProgramServices |
| Management And General | 680947 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 646606 | Total |
| Program Services | 540110 | ProgramServices |
| Management And General | 106496 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical supplies | 9475818 | 9475818 | 0 |
| Bad debts | 6775879 | 6775879 | 0 |
| Repairs and maintenance | 1787569 | 1493156 | 294413 |
| State provider tax | 1176611 | 1176611 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1319783 | Total |
| Program Services | 1172801 | ProgramServices |
| Management And General | 146982 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80135754 | Total |
| Program Services | 69661571 | ProgramServices |
| Management And General | 10474183 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1274469 | BOY |
| EOY | 1236594 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 110573 | BOY |
| EOY | 5450640 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10857253 | BOY |
| EOY | 11197748 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 586684 | BOY |
| EOY | 633770 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1260271 | BOY |
| EOY | 1268315 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 513202 | BOY |
| EOY | 441972 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 88915390 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 61033709 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23313928 | BOY |
| EOY | 27881681 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9869164 | BOY |
| EOY | 11186704 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11284143 | BOY |
| EOY | 3766827 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8717662 | BOY |
| EOY | 8966832 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67787349 | BOY |
| EOY | 72031083 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8234225 | BOY |
| EOY | 12069445 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9515000 | BOY |
| EOY | 8850000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1528246 | BOY |
| EOY | 626600 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1308608 | BOY |
| EOY | 266510 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3438238 | BOY |
| EOY | 7941254 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24024317 | BOY |
| EOY | 29753809 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43763032 | BOY |
| EOY | 42277274 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43763032 | BOY |
| EOY | 42277274 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67787349 | BOY |
| EOY | 72031083 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3100225 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -4585983 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 106509 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 2044880 | OtherCostOrOtherBasis |
| Book Value | 2151389 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 231721 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 32698149 | OtherCostOrOtherBasis |
| Depreciation | 25167682 | Depreciation |
| Book Value | 7762188 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 50080726 | OtherCostOrOtherBasis |
| Depreciation | 35866027 | Depreciation |
| Book Value | 14214699 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3753405 | OtherCostOrOtherBasis |
| Book Value | 3753405 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 27881681 | TotalOfBookValueLandBuildings |
Closely Held Equity Interests CloselyHeldEquityInterests
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 3766827 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 3766827 | TotalOfBookValueSecurities |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Other receivables | 207305 |
| Due from affiliates | 2567147 |
| Bond issue costs, net of amortization | 184472 |
| Due from subsidiary | 5501466 |
| Estimated third party payor settlements | 506442 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 8966832 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Deferred investment income | $405,101 |
| Deferred compensation payable | $237,658 |
| Due to affilates | $36,811 |
| Capital leases | $5,753,723 |
| Post retirement benefit obligation | $1,507,961 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 7941254 | TotalOfAmounts |
| Total Revenue | 83235979 | TotalRevenue |
| Total Expenses | 80135754 | TotalExpenses |
| Excess Or Deficit For Year | 3100225 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -398165 | NetUnrealizedGLOnInvestments |
| Other | -$4,187,818 | OtherAmount |
| Total Adjustments | -4585983 | TotalAdjustments |
| Excess Or Deficit Per FS | -1485758 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 76446372 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 138816 | OtherRevenues |
| Revenue Not Rptd F990 | 138816 | RevenueNotRptdF990 |
| Revenue Subtotal | 76307556 | RevenueSubtotal |
| Other Revenues Not Included | 6928423 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 6928423 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 83235979 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 73359875 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 73359875 | ExpensesSubtotal |
| Other Expenses Not Included | 6775879 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 6775879 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 80135754 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 8 - Other Adjustments: | Equity method income of subsidiary -503,914. Change in pension funded status -1,814,837. Transfers to affiliates -1,855,339. Income per books: Premier Purchasing Partners 138,816. Income per K-1: Premier Purchasing Partners -152,544. Total to Schedule D, Part XI, Line 8: -4,187,818. |
| Part XII, Line 2d - Other Adjustments: | Income per books: Premier Purchasing Partners LP 138,816. |
| Part XII, Line 4b - Other Adjustments: | From K-1: Premier Purchasing Partners LP 152,544. Bad debt expense netted with revenue in financial statements 6,775,879. |
| Part XIII, Line 4b - Other Adjustments: | Bad debt expense netted with revenue in financial statements 6,775,879. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 120.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3540912 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 51765 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3489147 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04760 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12691675 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8699312 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3992363 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05440 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16232587 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8751077 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7481510 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10200 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 311281 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 520 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 310761 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00420 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1100 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1100 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3216513 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1319634 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1896879 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02590 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 262395 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 262395 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00360 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3791289 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1320154 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2471135 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03370 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20023876 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10071231 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9952645 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13570 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3817 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3817 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3817 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3817 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $3,102,675 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 19973106 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 20561025 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -587919 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Davis Memorial Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1484 | AddressLine1 |
| City | Elkins | City |
| State | WV | State |
| ZIP Code | 26241 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Davis Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 120.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Lien On Residence | X | LienOnResidence |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 payor 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 1 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 $ 6775879. | ||
| Community benefit reports are inserted into regional newspapers, mailed to certain regional zip codes, and made available in common areas in Davis Health System facilities. | How the community benefit report is made available to the public | Part I, Line 6b: |
| The cost of physician clinics included in subsidized health services was $2,880,799. | Physician clinic costs included in subsidized services | Part I, Line 7g |
| 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 onrevenue. 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 quidelines 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 refult of a crime will be referred to the WV Crime Victims Fund. | ||
| Medicare revenues and costs not included on lines 5 and 6 include professional fees and HMO inpatient and outpatient care totaling $7,617,536. | Additional Medicare revenues and costs | Part III, Section B, lines 5 and 6 |
| Part V, Section B, Line 13g: 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 2 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 15e: We are also screening patients through a third party database through the advisory board prior to placement with a collections agency. This scrub provides us with likelihood to qualify for medicaid as well as screens the patients for our internal assistance policy. The presumptive charity adjustments that are done as budgetary constraints allow to better identify medically indigent and patients who have a need for assistance to prevent derogatory collection activity. | Davis Memorial Hospital | |
| Part V, Section B, Line 19d: 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. | Davis Memorial Hospital | |
| Part V, Section B, Line 21: All patients, including insurance companies, are billed at gross charges. Discounts are provided at the time of payment in full. Charity discounts are applied at the point of approval. | Davis Memorial Hospital | |
| 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 worklists 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 29,405 with 16.9% having a bachelor's degree or higher and average household income of $32,027. Upshur county has a population of 24,254 with 15.5% having a bachelor's degree or higher, average household income of $35,255. Barbour county has a population of 16,589 with 12.1% having a bachelor's degree or higher, average household income of $34,547. Pocahontas county has a population of 8,719 with 12.5% having a bachelor's degree or higher, average household income of $30,757. Tucker county has a population of 7,141 with 13.2% having a bachelor's degree or higher, average household income of $33,630. Additionally, 17.8% 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 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, critical care medicine, general surgery, internal medicine, obstetrics and gynecology, radiation oncology, medical oncology and hematology. The organization serves as a vehicle for attracting charitable support, as well as a source of community volunteer activities. The organization provides an internet link to its Community Benefit Report. | ||
| Part VI, Line 6: 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, womens 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant | EIN Of RecipientEINOfRecipient |
|---|---|---|---|---|---|---|---|
| Randolph County Hooked on Fishing Not on Drugs | |||||||
| PO Box 2293 | Elkins | WV | 26241 | 501(c)(3) | 13000 | Support hooked on fishing, not on drugs programs | |
| Mountain State Forest Festival | |||||||
| PO Box 388 | Elkins | WV | 26241 | 501(c)(4) | 5900 | Event sponsorship | 550488261 |
| United Hospital Center | |||||||
| PO Box 1680 | Clarksburg | WV | 26301 | 501(c)(3) | 14650 | Support program for sane exams and fees | 550525724 |
| Randolph County Senior Center | |||||||
| PO Box 727 | Elkins | WV | 26241 | 501(c)(3) | 5000 | Country roads transit | 550487683 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| E Mark Doak | |||||||||||||
| 307887 | 0 | 152 | 0 | 0 | 0 | 3220 | 0 | 19038 | 0 | 330297 | 0 | 0 | 0 |
| Rebecca Hammer | |||||||||||||
| 178739 | 0 | 152 | 0 | 0 | 0 | 0 | 0 | 18444 | 0 | 197335 | 0 | 0 | 0 |
| Mohamed M Fahim | |||||||||||||
| 606323 | 0 | 152 | 0 | 0 | 0 | 3695 | 0 | 3791 | 0 | 613961 | 0 | 0 | 0 |
| Donald R Fleming | |||||||||||||
| 461072 | 0 | 30152 | 0 | 0 | 0 | 3488 | 0 | 22572 | 0 | 517284 | 0 | 0 | 0 |
| Charles K Kirkland | |||||||||||||
| 404803 | 0 | 152 | 0 | 0 | 0 | 3340 | 0 | 21702 | 0 | 429997 | 0 | 0 | 0 |
| Mary A Scott | |||||||||||||
| 333121 | 0 | 64061 | 0 | 0 | 0 | 3205 | 0 | 9900 | 0 | 410287 | 0 | 0 | 0 |
| Anne L Banfield | |||||||||||||
| 285193 | 0 | 69941 | 0 | 0 | 0 | 3177 | 0 | 9900 | 0 | 368211 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 4b | ReturnReference |
| Explanation | Mark Doak participated in a 457 (f) plan. However, no amount was paid out in 2011. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 11 | 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 XI, line 5: | Net unrealized losses on investments: -398,165. Equity method income of subsidiary -503,914. Change in pension funded status -1,814,837. Transfers to affiliates -1,855,339. Income per books: Premier Purchasing Partners 138,816. Income per K-1: Premier Purchasing Partners -152,544. Total to Form 990, Part XI, Line 5: -4,585,983. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, Line 2C | The organization has not changed its selection or oversight process in the past year. | Clarification of 'yes' response |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Broaddus Hospital Association Inc | ||||||||||
| PO Box 930 | Philippi | WV | 26416 | 550379108 | Hospital | WV | 501(c)(3) | Line 3 | N/A | 0 |
| Davis Health System Inc | ||||||||||
| PO Box 1484 | Elkins | WV | 26241 | 550737655 | Health System | WV | 501(c)(3) | Line 11b, II | 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 9 | N/A | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|
| Health Facilities Inc | ||||||||||
| 909 Gorman Avenue | Elkins | WV | 26241 | 550516937 | Health Care | WV | C | -503914 | 10133023 | 1.00000 |
| Central WV Medcorp Inc | ||||||||||
| PO Box 2630 | Elkins | WV | 26241 | 550739314 | Physician Offices | WV | C | |||
| Elkins Regional Health Partners Physician Hospital Organization Inc | ||||||||||
| PO Box 2632 | Elkins | WV | 26241 | 550746206 | Hospital Organization | WV | C | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Health Facilities Inc | ||
| A | 201444 | Cash - FMV |
| Central WV Medcorp Inc | ||
| B | 1649417 | Cash - FMV |
| Health Facilities Inc | ||
| K | 50004 | Cash - FMV |