DAVIS MEMORIAL HOSPITAL: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- DAVIS MEMORIAL HOSPITAL (EIN 55-0375433)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-14
- IRS object ID
- 202433199349317438
- Schema version
- 2023v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-14T18:36:57-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 4200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550375433 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DAVI | BusinessNameControlTxt |
| Phone | 3046363300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1484 | AddressLine1Txt |
| City | ELKINS | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26241 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF SANDENE | PersonNm |
| Person Title | EVP AND CFO | PersonTitleTxt |
| Phone | 3046373196 | PhoneNum |
| Signature | 2024-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANGELA M MOORE | PreparerPersonNm |
| PTIN | P00244342 | PTIN |
| Phone | 3174648600 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK DOAK | PrincipalOfficerNm |
| Gross Receipts | $107,464,208 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DAVISHEALTHSYSTEM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1903 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTH CARE TO RESIDENTS OF ELKINS, WEST VIRGINIA AND SURROUNDING COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 1050 | TotalEmployeeCnt |
| Total Volunteers | 65 | TotalVolunteersCnt |
| Total Gross UBI | $126,294 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $70,461 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $956,495 | PYContributionsGrantsAmt |
| CY Contributions Grants | $39,490 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $116,357,826 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $104,381,650 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$1,560,117 | PYInvestmentIncomeAmt |
| CY Investment Income | $369,577 | CYInvestmentIncomeAmt |
| PY Other Revenue | $402,621 | PYOtherRevenueAmt |
| CY Other Revenue | $2,673,491 | CYOtherRevenueAmt |
| PY Total Revenue | $116,156,825 | PYTotalRevenueAmt |
| CY Total Revenue | $107,464,208 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $64,305 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $32,619 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $56,361,884 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $66,961,917 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $81,765,266 | PYOtherExpensesAmt |
| CY Other Expenses | $69,223,645 | CYOtherExpensesAmt |
| PY Total Expenses | $138,191,455 | PYTotalExpensesAmt |
| CY Total Expenses | $136,218,181 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$22,034,630 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$28,753,973 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $85,218,888 | TotalAssetsBOYAmt |
| Total Assets EOY | $50,342,111 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $50,299,505 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $84,306,469 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $34,919,383 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$33,964,358 | NetAssetsOrFundBalancesEOYAmt |
| Mission | WE CARE FOR LIFE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $99,919,742 | ExpenseAmt |
| Grant | $32,619 | GrantAmt |
| Revenue | $105,631,906 | RevenueAmt |
| Desc | THE ORGANIZATION OPERATED AN 80 BED ACUTE CARE HOSPITAL IN ELKINS, WEST VIRGINIA. | Desc |
| Total Program Service Expenses | $99,919,742 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 69 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1050 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM KOCH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3046373196 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 812 GORMAN AVE | AddressLine1Txt |
| City | ELKINS | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26241 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| AMANDA PENNINGTON MD | ||||||||
| BOARD MEMBER | 40.00 | 0.00 | Yes (X) | $488,533 | $0 | $27,396 | ||
| VANCE JACKSON | ||||||||
| DHS CEO (END 06/24) | 35.00 | 5.00 | Yes (X) | $315,542 | $0 | $16,877 | Yes (X) | |
| MISHA PHILLIPS-LEE | ||||||||
| BOARD MEMBER | 1.00 | 2.00 | Yes (X) | $194,879 | $0 | $20,525 | ||
| WILLIAM KOCH | ||||||||
| VP OF FINANCE AND CFO | 25.00 | 15.00 | Yes (X) | $165,014 | $0 | $1,587 | Yes (X) | |
| DREW PINGLEY MSN RN | ||||||||
| VICE CHAIRMAN | 40.00 | 0.00 | Yes (X) | $107,926 | $0 | $22,941 | Yes (X) | |
| DANNY FRANKE | ||||||||
| BOARD MEMBER (START 10/23) | 14.00 | 2.00 | Yes (X) | $2,633 | $0 | $0 | ||
| JAMES TRIPLETT | ||||||||
| CHAIRMAN | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| CHAD SHOEMAKER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CONNIE TENNEY | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DENISE CAMPBELL | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHANNA BIOLA MD | ||||||||
| BOARD MEMBER (END 03/23) | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM FELTON | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS BENZ | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $803,581 | $0 | $28,309 | Yes (X) | ||
| MOHAMED FAHIM | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $646,063 | $0 | $30,019 | Yes (X) | ||
| GARRETT BUTLER | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $514,699 | $0 | $28,287 | Yes (X) | ||
| ARTHUR FINE | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $495,095 | $0 | $23,195 | Yes (X) | ||
| MICHAEL GALLOWAY | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $464,847 | $0 | $25,804 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,198,812 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $224,940 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 106 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WV GASTROENTEROLOGY & ENDOSCOPY | |||||
| PO BOX 2831 | ELKINS | WV | 26241 | GASTRO SURGICAL SERVICES | $2,354,100 |
| COMMONWEALTH ANESTHESIA PSC | |||||
| 425 LEWIS HARGETT CIRCLE | LEXINGTON | KY | 40503 | ANESTHESIA SERVICES | $1,490,289 |
| RICHARD TOPPING MD | |||||
| 1 FOREST BROOK DRIVE | ELKINS | WV | 26241 | ORTHOPEDIC SERVICES | $1,064,388 |
| LUCAS PAVLOVICH JR MD | |||||
| 1114 PINEVIEW DRIVE | ELKINS | WV | 26241 | ORTHOPEDIC SERVICES | $1,061,244 |
| MEDSTREAM ANESTHESIA | |||||
| PO BOX 63467 | CHARLOTTE | NC | 282633467 | ANESTHESIA SERVICES | $950,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 24 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $39,490 | RelatedOrganizationsAmt |
| Total Contributions | $39,490 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICES | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $104,381,650 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $104,381,650 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $104,381,650 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $369,577 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $309,943 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $59,634 | UnrelatedBusinessRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $203,257 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $203,257 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $203,257 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $16,656 | UnrelatedBusinessRevenueAmt |
| Exclusion | $186,601 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|---|
| CAFETERIA | 722514 | $1,479,917 | $1,479,917 | ||
| TAX REFUND | 900099 | $603,249 | $603,249 | ||
| MANAGEMENT FEES | 900099 | $50,004 | $50,004 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $337,064 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $337,064 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,470,234 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $107,464,208 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $105,631,906 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $126,294 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,666,518 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,619 | TotalAmt |
| Program Services | $32,619 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,363,853 | TotalAmt |
| Program Services | $864,819 | ProgramServicesAmt |
| Management And General | $499,034 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,010,374 | TotalAmt |
| Program Services | $31,075,140 | ProgramServicesAmt |
| Management And General | $17,935,234 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,387,406 | TotalAmt |
| Program Services | $879,690 | ProgramServicesAmt |
| Management And General | $507,716 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,944,873 | TotalAmt |
| Program Services | $6,305,582 | ProgramServicesAmt |
| Management And General | $3,639,291 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,255,411 | TotalAmt |
| Program Services | $3,332,212 | ProgramServicesAmt |
| Management And General | $1,923,199 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,452 | TotalAmt |
| Management And General | $113,452 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $249,344 | TotalAmt |
| Management And General | $249,344 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,639 | TotalAmt |
| Management And General | $343,639 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,305,561 | TotalAmt |
| Program Services | $18,887,769 | ProgramServicesAmt |
| Management And General | $1,417,792 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,542 | TotalAmt |
| Management And General | $192,542 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,722 | TotalAmt |
| Program Services | $141,877 | ProgramServicesAmt |
| Management And General | $81,845 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,900,000 | TotalAmt |
| Program Services | $5,009,022 | ProgramServicesAmt |
| Management And General | $2,890,978 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,216,631 | TotalAmt |
| Program Services | $1,405,463 | ProgramServicesAmt |
| Management And General | $811,168 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $243,572 | TotalAmt |
| Program Services | $154,438 | ProgramServicesAmt |
| Management And General | $89,134 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,501,330 | TotalAmt |
| Program Services | $1,585,980 | ProgramServicesAmt |
| Management And General | $915,350 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,142,443 | TotalAmt |
| Program Services | $2,626,531 | ProgramServicesAmt |
| Management And General | $1,515,912 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,174,805 | TotalAmt |
| Program Services | $177,673 | ProgramServicesAmt |
| Management And General | $997,132 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $16,297,419 | $16,297,419 | |
| BAD DEBTS | $7,406,459 | $7,406,459 | |
| REPAIRS AND MAINTENANCE | $2,321,604 | $1,472,021 | $849,583 |
| FOOD & NUTRITION | $1,458,757 | $1,458,757 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,132,365 | TotalAmt |
| Program Services | $806,271 | ProgramServicesAmt |
| Management And General | $1,326,094 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,218,181 | TotalAmt |
| Program Services | $99,919,742 | ProgramServicesAmt |
| Management And General | $36,298,439 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,862,841 | BOYAmt |
| EOY | $5,639,442 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,058 | BOYAmt |
| EOY | $26,831 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,831,713 | BOYAmt |
| EOY | $17,177,198 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,156,082 | BOYAmt |
| EOY | $1,436,856 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,689,242 | BOYAmt |
| EOY | $1,733,259 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $855,584 | BOYAmt |
| EOY | $791,198 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,194,714 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $363,211 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,653,104 | BOYAmt |
| EOY | $2,831,503 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,832,086 | BOYAmt |
| EOY | $1,188,349 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,381,207 | BOYAmt |
| EOY | -$1,381,207 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,580,385 | BOYAmt |
| EOY | $20,898,682 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,218,888 | BOYAmt |
| EOY | $50,342,111 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,973,951 | BOYAmt |
| EOY | $23,126,209 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$65,659 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,413,561 | BOYAmt |
| EOY | $56,303,320 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,977,652 | BOYAmt |
| EOY | $4,876,940 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,299,505 | BOYAmt |
| EOY | $84,306,469 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,919,383 | BOYAmt |
| EOY | -$33,964,358 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,919,383 | BOYAmt |
| EOY | -$33,964,358 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,218,888 | BOYAmt |
| EOY | $50,342,111 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$28,753,973 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$40,129,768 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $8,163 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $8,163 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE AMERICAN HOSPITAL ASSOCIATION, WHICH PARTICIPATES IN LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $906,906 | OtherCostOrOtherBasisAmt |
| Book Value | $906,906 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,730,105 | OtherCostOrOtherBasisAmt |
| Depreciation | $160,200 | DepreciationAmt |
| Book Value | $1,569,905 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $557,703 | OtherCostOrOtherBasisAmt |
| Depreciation | $203,011 | DepreciationAmt |
| Book Value | $354,692 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,831,503 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $4,708,729 |
| OTHER RECEIVABLES | $1,439,485 |
| DUE FROM SUBSIDIARY | $14,750,468 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $20,898,682 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILATES | $4,755,635 |
| OPERATING LEASES | $121,305 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,876,940 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE IRS HAS DETERMINED THAT THE SYSTEM ENTITIES ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE CODE AND APPLICABLE STATE STATUTES, EXCEPT FOR MHC, FHE, CMC, AND HFI, WHICH ARE CORPORATIONS SUBJECT TO INCOME TAX. THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2023. TAX RETURNS FOR THE YEAR ENDED JUNE 30, 2019, ARE OPEN FOR THE MHS ENTITIES AND TAX RETURNS FOR THE YEAR ENDED DECEMBER 31, 2020, ARE OPEN FOR CAMC ENTITIES. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 120.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,495,340 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $75,365 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,419,975 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01880 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,832,901 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,632,082 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,200,819 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08700 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,328,241 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,707,447 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,620,794 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10580 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,638 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,628 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $93,343 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $93,343 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,176,551 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,017,263 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,159,288 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01680 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,969 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $62,969 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,338,501 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,017,273 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,321,228 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01800 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,666,742 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,724,720 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,942,022 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12380 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $19,033,410 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $18,116,632 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $18,116,632 | CostOfCareReimbursedByMedcrAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1484 | AddressLine1Txt |
| City | ELKINS | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26241 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, PAGE 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 120.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DAVIS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: INPUT WAS SOLICITED FROM THOSE REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY IN AUGUST 2022. DISCUSSIONS INCLUDED THE HEALTH NEEDS OF THE COMMUNITY, BARRIERS TO HEALTH CARE ACCESS, OPPORTUNITIES FOR IMPROVEMENT, PERCEPTION OF DAVIS MEDICAL CENTER AND FEEDBACK ON THE HOSPITAL'S INITIATIVES. KEY STAKEHOLDERS APPROACHED FOR INPUT INCLUDED COMMUNITY HEALTH CENTERS, COLLEGES, NON-PROFIT ORGANIZATIONS, EMERGENCY MEDICAL SERVICES, HEALTH DEPARTMENTS, DEVELOPMENT AUTHORITIES, CHAMBER OF COMMERCE, STATE AND LOCAL GOVERNMENT AGENCIES, ETC., AS WELL AS PUBLIC OFFICIALS AND CHURCH LEADERS. |
| DAVIS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: THE PRIMARY HEALTH CONCERN IS SUBSTANCE ABUSE FOLLOWED BY MENTAL HEALTH ISSUES. OTHER HEALTH CONCERNS INCLUDE:1. SUBSTANCE ABUSE2. MENTAL HEALTH3. CHRONIC DISEASE MANAGEMENT (COPD)4. FOOD INSECURITY5. TRANSPORTATION INSECURITYTHE HOSPTIAL HAS MANY COMMUNTIY OUTREACH PROGRAMS SUCH AS: 100 MILES IN 100 DAYS; MULTIPHASIC BLOOD TESTS, BIKE RODEO, HEALTH FAIRS, ETC. LAUREL PLACE PROVIDES GERIATRIC INPATIENT PSYCHIATRY. THE HOSPITAL WILL CONTINUE TO COLLABORATE WITH EXTERNAL PARTNERS ON STRATEGIES AND POLICIES THAT WILL POSITIVELY IMPACT THE LOCAL DRUG EPIDEMIC.THE HOSPITAL WILL CONTINUE TO BUILD ON THE DAVIS MEDICAL CENTER NUTRITION/POPULATION HEALTH COLLABORATION FOR DIABETES PREVENTION PROGRAM AND INCREASE THE NUMBER OF PARTICIPANTS YEAR OVER YEAR. |
| DAVIS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS POSTED IN ALL PATIENT REGISTRATION AREAS INCLUDING ER, ADMISSIONS AND OP TESTING. THE PROCEDURE IS ALSO EXPLAINED IN FINANCIAL COUNSELING BROCHURES AVAILABLE THROUGHOUT THE HEALTH SYSTEM AND IN PHYSICIAN OFFICES. ALL EMPLOYEES ARE ALSO NOTIFIED VIA THE INTERNAL WEBSITE WHERE IT IS POSTED. WE ALSO EMPLOY TWO FINANCIAL COUNSELORS WHO WORK WITH AND SCREEN THE UNINSURED AND UNDERINSURED POPULATIONS. WE ALSO HAVE A FINANCIAL ADVOCATE FROM HEALTH AND HUMAN SERVICES. |
| DAVIS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 20E: THE HOSPITAL ALSO SCREENS PATIENTS THROUGH A THIRD PARTY DATABASE THROUGH THE ADVISORY BOARD PRIOR TO PLACEMENT WITH A COLLECTION AGENCY. THIS SCRUB PROVIDES US WITH THE LIKELIHOOD THE PATIENT WILL QUALIFY FOR MEDICAID AS WELL AS SCREENS THE PATIENTS FOR OUR INTERNAL ASSISTANCE POLICY. THE PRESUMPTIVE CHARITY ADJUSTMENTS ARE DONE AS BUDGETARY CONSTRAINTS ALLOW TO BETTER IDENTIFY THE MEDICALLY INDIGENT AND PATIENTS WHO HAVE A NEED FOR ASSISTANCE TO PREVENT DEROGATORY COLLECTION ACTIVITY. |
| PART V, SECTION B, LINE 7A | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/CONTENT/UPLOADS/DAVISHEALTHSYSTEM.ORG/FILES/2023_DMC_CHNA.PDF |
| PART V, SECTION B, LINE 10A | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/CONTENT/UPLOADS/DAVISHEALTHSYSTEM.ORG/FILES/2023_DMC_CHNA.PDF |
| PART V, SECTION B, LINE 16A | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING |
| PART V, SECTION B, LINE 16B | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING |
| PART V, SECTION B, LINE 16C | HTTPS://WWW.DAVISHEALTHSYSTEM.ORG/PATIENTS-VISITORS/FINANCIAL-COUNSELING |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - DIRECT CARE OF ELKINS | ||||
| 720 BEVERLY PIKE | ELKINS | WV | 26241 | MEDICAL CLINIC |
| 2 - BUCKHANNON MEDICAL CENTER | ||||
| 11 NORTH LOCUST STREET | BUCKHANNON | WV | 26201 | MEDICAL CLINIC |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $ 7,406,459. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | DAVIS HEALTH SYSTEM'S MISSION INCLUDES THE DELIVERY OF HEALTHCARE SERVICES AND PROGRAMS THAT PROMOTE IMPROVED HEALTH FOR INDIVIDUALS AND FAMILIES. THE QUALITY OF LIFE OF ENTIRE COMMUNITIES IS IMPACTED THROUGH THESE VITAL PROGRAMS GENERALLY OFFERED AT LITTLE OR NO COST. SOME OF THE HEALTH ISSUES TARGETED BY DAVIS HEALTH SYSTEM TO THE COMMUNITIES SERVED BY OUR ORGANIZATION INCLUDE DIABETES, OBESITY AND WEIGHT MANAGEMENT, TOBACCO USE AND HEART DISEASE, WOMEN'S HEALTH, INFLUENZA, AND CANCER AND CANCER PREVENTION. OUR OUTREACH SERVES FIVE PRIMARY WEST VIRGINIA COUNTIES (RANDOLPH, TUCKER, UPSHUR, BARBOUR, AND POCAHONTAS), WITH SOME OVERFLOW TO NEIGHBORING COUNTIES AS WELL. SEVERAL EXAMPLES OF PROJECTS THAT REPRESENT OUR COMMITMENT TO ADVANCING THE EMOTIONAL AND PHYSICAL HEALTH BENEFITS TO THE PEOPLE OF THESE COMMUNITIES INCLUDE: COMMUNITY HEALTH FAIRS, DIABETES EDUCATION PROGRAMS AND SUPPORT GROUPS, DIABETES FOOT SCREENINGS, SPEAKING ENGAGEMENTS AND PRESENTATIONS TO SCHOOLS, CIVIC GROUPS AND OTHER ORGANIZATIONS, COLON CANCER SCREENINGS AND EDUCATION, COMMUNITY WALKING PROGRAM, PARTICIPATION WITH THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE AND MARCH OF DIMES, PARTNERSHIP WITH BOARDS OF EDUCATION, INFLUENZA VACCINATION CLINICS, PARTNERSHIP WITH COUNTY HEALTH DEPARTMENTS, DRUG TAKE-BACK, SMOKING CESSATION CLASSES AND SUPPORT AND PAP SMEAR AND BREAST EXAMINATIONS. |
| PART III, LINE 2: | BAD DEBT EXPENSE AS REPORTED ON AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 4: | AUDITED FINANCIAL STATEMENT FOOTNOTE RELATING TO BAD DEBT EXPENSE: PATIENT ACCOUNTS RECEIVABLE ARE CARRIED AT THE ORIGINAL CHARGE LESS AN ESTIMATE MADE FOR DOUBTFUL OR UNCOLLECTIBLE ACCOUNTS. THE ALLOWANCE IS BASED UPON A REVIEW OF THE OUTSTANDING BALANCES AGED BY FINANCIAL CLASS. MANAGEMENT USES COLLECTION PERCENTAGES BASED UPON HISTORICAL COLLECTION EXPERIENCE TO DETERMINE COLLECTIBILITY. MANAGEMENT ALSO REVIEWS TROUBLED, AGED ACCOUNTS TO DETERMINE COLLECTION POTENTIAL. DELINQUENCY STATUS IS BASED ON DATE OF SERVICE. PATIENT ACCOUNTS RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO BAD DEBT EXPENSE WHEN RECEIVED. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COSTS AND REVENUES ARE FROM THE MEDICARE COST REPORT. |
| PART III, LINE 9B: | PATIENTS WHO INDICATE THEY HAVE AN INABILITY TO PAY FOR THEIR MEDICAL CARE ARE REFERRED TO THE FINANCIAL COUNSELOR AND/OR A MEDICAID ELIGIBILITY SPECIALIST. PATIENTS WHO DO MEET FINANCIAL ASSISTANCE GUIDELINES BUT DEMONSTRATE AN INABILITY TO MEET OUR MINIMUM PAYMENT GUIDELINES ARE GIVEN A REDUCED PAYMENT PLAN. COLLECTION PROCEDURES REGARDING REDUCED PAYMENT PLANS FOLLOW THE HOSPITAL'S NORMAL PROCEDURES. PATIENTS WITH CATASTROPHIC ILLNESSES ARE REFERRED TO THE WV CATASTROPHIC ILLNESS FUND. PATIENTS WHOSE CARE IS A RESULT OF A CRIME WILL BE REFERRED TO THE WV CRIME VICTIMS FUND. |
| PART VI, LINE 2: | DAVIS HEALTH SYSTEM RELIES HEAVILY ON DATA PROVIDED BY THE BUREAU FOR PUBLIC HEALTH; NAMELY, THE COUNTY HEALTH PROFILES THAT OUTLINE RISK FACTORS FOR CHRONIC DISEASES. IN ADDITION, THE COMMUNITY HEALTH PROMOTION DIRECTOR GLEANS INFORMATION AND STATISTICS FROM HEALTH SCREENINGS THAT ARE HELD FOR THE PUBLIC, AS WELL AS OUR EMPLOYEES. THIS INFORMATION HELPS IN PLANNING FUTURE EDUCATIONAL EVENTS AND SCREENINGS. |
| PART VI, LINE 3: | THE INFORMATION IS POSTED IN PUBLIC AREAS WITHIN THE HOSPITAL. THE FINANCIAL POLICY BROCHURE IS PUBLICLY DISPLAYED AND POSTED ON THE INTERNAL NETWORK AND THE HEALTH SYSTEM WEBSITE. A PATIENT ADVOCATE CONTACTS WORK LISTS OF MEDICALLY INDIGENT PATIENTS TO HELP SECURE AND PROVIDE EDUCATION TO AFFILIATE AND NON-AFFILIATE PHYSICIAN OFFICES REFERRING TO DAVIS MEMORIAL HOSPITAL. |
| PART VI, LINE 4: | THE HOSPITAL SERVES SEVERAL RURAL COUNTIES IN EASTERN WEST VIRGINIA. RANDOLPH COUNTY HAS A POPULATION OF 27,932 WITH 15.7% HAVING A BACHELOR'S DEGREE OR HIGHER AND AVERAGE HOUSEHOLD INCOME OF $45,206. UPSHUR COUNTY HAS A POPULATION OF 23,816 WITH 16.2% HAVING A BACHELOR'S DEGREE OR HIGHER, AVERAGE HOUSEHOLD INCOME OF $40,802. BARBOUR COUNTY HAS A POPULATION OF 15,465 WITH 13.9% HAVING A BACHELOR'S DEGREE OR HIGHER, AVERAGE HOUSEHOLD INCOME OF $38,906. POCAHONTAS COUNTY HAS A POPULATION OF 7,869 WITH 13.6% HAVING A BACHELOR'S DEGREE OR HIGHER, AVERAGE HOUSEHOLD INCOME OF $37,642. TUCKER COUNTY HAS A POPULATION OF 6,762 WITH 19.5% HAVING A BACHELOR'S DEGREE OR HIGHER, AVERAGE HOUSEHOLD INCOME OF $47,527. ADDITIONALLY, 16.8% OF ALL WEST VIRGINIANS LIVE BELOW THE POVERTY LEVEL. DAVIS MEMORIAL IS THE ONLY HOSPITAL IN RANDOLPH COUNTY. THERE IS ONE CRITICAL ACCESS HOSPITAL IN BARBOUR COUNTY, ONE CRITICAL ACCESS HOSPITAL IN POCAHONTAS COUNTY AND ONE GENERAL SERVICE HOSPITAL IN UPSHUR COUNTY. |
| PART VI, LINE 5: | THE ORGANIZATION'S HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE IN THE FOLLOWING WAYS. THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. THE CORPORATE BY LAWS PROVIDE FOR BOARD REPRESENTATION FROM THE COUNTIES SURROUNDING DAVIS MEMORIAL HOSPITAL. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. THE ORGANIZATION OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL, REGARDLESS OF ABILITY TO PAY. SPECIALIZED SERVICES OFFERED BY THE ORGANIZATION THAT ARE NOT AVAILABLE ELSEWHERE INCLUDE NEUROLOGY, PAIN MANAGEMENT, OTOLARYNGOLOGY, PULMONOLOGY, LITHOTRIPSY, SLEEP STUDIES, PET, DIGITAL MAMMOGRAPHY, CRITICAL CARE MEDICINE, GENERAL SURGERY, INTERNAL MEDICINE, OBSTETRICS AND GYNECOLOGY, RADIATION ONCOLOGY, MEDICAL ONCOLOGY AND HEMATOLOGY. AN ADVANCED TELEMEDICINE INITIATIVE AT DAVIS HEALTH SYSTEM PROVIDES ADDITIONAL SPECIALIZED SERVICES IN PARTNERSHIP WITH OTHER HEALTH CARE PROVIDERS, NURSING HOMES AND LARGER MEDICAL INSTITUTIONS - PROVIDING GREATER MEDICAL ACCESS TO PATIENTS IN MORE RURAL AREAS OF THE STATE. THE ORGANIZATION SERVES AS A VEHICLE FOR ATTRACTING CHARITABLE SUPPORT, AS WELL AS A SOURCE OF COMMUNITY VOLUNTEER ACTIVITIES. STUDENT VOLUNTEERS, YOUTH VOLUNTEERS AND AN ACTIVE ADULT VOLUNTEER PROGRAM SUPPORT THE MISSION OF THE HEALTH SYSTEM BY ENHANCING PATIENT CARE AND PROGRAMS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| MOUNTAIN STATE FOREST FESTIVAL | ||||||||
| PO BOX 388 | ELKINS | WV | 26241 | 550488261 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| ELKINS YMCA | ||||||||
| 400 DAVIS AVENUE | ELKINS | WV | 26241 | 550376877 | 501(C)(3) | $5,500 | $0 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION GRANTS MONEY TO OTHER 501(C)(3) ORGANIZATIONS AND RELIES ON THE IRS'S OVERSIGHT OF THE GRANTEES AS THEY HAVE AN EXEMPTION FROM THE IRS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS BENZ | ||||||||||||||
| PHYSICIAN | $799,591 | $0 | $0 | $0 | $3,990 | $0 | $3,300 | $0 | $25,009 | $0 | $831,890 | $0 | $0 | $0 |
| MOHAMED FAHIM | ||||||||||||||
| PHYSICIAN | $642,567 | $0 | $0 | $0 | $3,496 | $0 | $3,300 | $0 | $26,719 | $0 | $676,082 | $0 | $0 | $0 |
| GARRETT BUTLER | ||||||||||||||
| PHYSICIAN | $511,546 | $0 | $0 | $0 | $3,153 | $0 | $3,300 | $0 | $24,987 | $0 | $542,986 | $0 | $0 | $0 |
| ARTHUR FINE | ||||||||||||||
| PHYSICIAN | $475,743 | $0 | $16,667 | $0 | $2,685 | $0 | $2,586 | $0 | $20,609 | $0 | $518,290 | $0 | $0 | $0 |
| AMANDA PENNINGTON MD | ||||||||||||||
| BOARD MEMBER | $488,533 | $0 | $0 | $0 | $0 | $0 | $3,300 | $0 | $24,096 | $0 | $515,929 | $0 | $0 | $0 |
| MICHAEL GALLOWAY | ||||||||||||||
| PHYSICIAN | $461,416 | $0 | $0 | $0 | $3,431 | $0 | $2,875 | $0 | $22,929 | $0 | $490,651 | $0 | $0 | $0 |
| VANCE JACKSON | ||||||||||||||
| DHS CEO (END 06/24) | $314,560 | $0 | $0 | $0 | $982 | $0 | $2,024 | $0 | $14,853 | $0 | $332,419 | $0 | $0 | $0 |
| MISHA PHILLIPS-LEE | ||||||||||||||
| BOARD MEMBER | $194,879 | $0 | $0 | $0 | $0 | $0 | $1,782 | $0 | $18,743 | $0 | $215,404 | $0 | $0 | $0 |
| WILLIAM KOCH | ||||||||||||||
| VP OF FINANCE AND CFO | $164,424 | $0 | $0 | $0 | $590 | $0 | $872 | $0 | $715 | $0 | $166,601 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE HOSPITAL WILL REIMBURSE FOR ALL OF THE REASONABLE TRAVEL, LODGING AND MEAL EXPENSES INCURRED BY THE CEO'S SPOUSE FOR TWO BUSINESS-RELATED MEETINGS OR CONFERENCES PER YEAR. |
| PART I, LINE 3: | THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES IS RESPONSIBLE FOR THE OVERSIGHT OF THE COMPENSATION FOR THE SENIOR STAFF. A CONSULTANT (YAFFE & COMPANY) IS ENGAGED WHO FACILITATES THE ANNUAL EVALUATION PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVES. THE CONSULTANT COORDINATES A SERIES OF MEETINGS, LEADS DISCUSSIONS ON THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE EVALUATION, PRESENTS MARKET ANALYSIS INFORMATION FOR KEY POSITIONS AND PROVIDES RECOMMENDATIONS FOR SALARY LEVELS BASED ON THAT INFORMATION. THE COMMITTEE MAKES THEIR DECISION USING THE GUIDANCE OF THE CONSULTANT. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| RICHARD CAMPBELL | |||
| FAMILY MEMBER OF DENISE CAMPBELL | $11,974 | EMPLOYMENT | 0 |
| MATT LEE | |||
| FAMILY MEMBER OF MISHA PHILLIPS-LEE | $246,507 | EMPLOYMENT | 0 |
| CHRISTIE SHOEMAKER | |||
| FAMILY MEMBER OF CHAD SHOEMAKER | $109,135 | EMPLOYMENT | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | DAVIS MEMORIAL HOSPITAL'S BOARD MEMBERS ARE ELECTED OR APPOINTED BY DAVIS HEALTH SYSTEM, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | DAVIS MEMORIAL HOSPITAL'S BOARD MEMBERS ARE ELECTED OR APPOINTED BY DAVIS HEALTH SYSTEM, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | DAVIS HEALTH SYSTEM, INC. IS DAVIS MEMORIAL HOSPITAL'S SOLE MEMBER AND HAS RESERVED POWERS UNDER DAVIS MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, WHICH PROVIDE THAT DECISIONS OF DAVIS MEMORIAL HOSPITAL'S GOVERNING BODY, SUCH AS ELECTION OF OFFICERS, APPROVAL OF ANNUAL BUDGETS AND BORROWINGS, ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER. THE SOLE MEMBER ALSO HAS ALL APPROVAL POWERS PROVIDED TO MEMBERS OF WEST VIRGINIA NONPROFIT CORPORATIONS UNDER STATE LAW. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 WILL BE DISTRIBUTED TO ALL BOARD MEMBERS. IT WILL BE PRESENTED AND DISCUSSED AT A BOARD OF TRUSTEES MEETING OR A FINANCE COMMITTEE MEETING, WHICHEVER OCCURS FIRST AFTER THE COMPLETION OF FORM 990. IF THE FINANCE COMMITTEE MEETING IS THE FIRST TO OCCUR, ALL MEMBERS OF THE BOARD OF TRUSTEES WILL BE ENCOURAGED TO ATTEND THE FINANCE COMMITTEE WHERE THE FORM IS TO BE DISCUSSED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE DAVIS HEALTH SYSTEM CONFLICT OF INTEREST POLICY REQUIRES THAT EACH DIRECTOR, OFFICER, AND COMMITTEE MEMBER WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THE PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY AND READS AND UNDERSTANDS THE POLICY. BOARD MEMBERS COMPLETE THE STATEMENT IN JANUARY OF EACH YEAR. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE EXECUTIVE COMMITTEE. IN ADDITION TO BOARD MEMBERS, SENIOR STAFF ARE REQUIRED TO ANNUALLY PREPARE A CONFLICT OF INTEREST STATEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES IS RESPONSIBLE FOR THE OVERSIGHT OF THE COMPENSATION FOR THE SENIOR STAFF. A CONSULTANT (YAFFE & COMPANY) IS ENGAGED WHO FACILITATES THE ANNUAL EVALUATION PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVES. THE CONSULTANT COORDINATES A SERIES OF MEETINGS, LEADS DISCUSSIONS ON THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE EVALUATION, PRESENTS MARKET ANALYSIS INFORMATION FOR KEY POSITIONS AND PROVIDES RECOMMENDATIONS FOR SALARY LEVELS BASED ON THAT INFORMATION. THE COMMITTEE MAKES THEIR DECISION USING THE GUIDANCE OF THE CONSULTANT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE BOARD OF TRUSTEES ADOPTED A RECORD KEEPING AND DISCLOSURE POLICY IN JANUARY OF 2003. THE POLICY PROVIDES FOR DISCLOSURE OF CORPORATE AND FINANCIAL RECORDS NOT COVERED BY GOVERNMENTAL OR CONTRACTUAL AGREEMENTS. ANY REQUEST FOR FINANCIAL OR OTHER CORPORATE DOCUMENTS ARE SUBMITTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES AND DECISIONS ARE MADE ON A CASE BY CASE BASIS. THE COMPLIANCE CODE OF CONDUCT POLICY INCLUDES STANDARDS RELATING TO CONFLICTS OF INTEREST WITHIN THE ORGANIZATION. THIS INFORMATION IS SHARED WITH THE PUBLIC, BEING POSTED ON THE WEBSITE IN ADDITION TO BEING DISTRIBUTED TO ALL PATIENTS ADMITTED TO THE HOSPITAL. |
| FORM 990, PART IX, LINE 11G | ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 1,096,016. MANAGEMENT AND GENERAL EXPENSES 1,417,792. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,513,808. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 2,258,689. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,258,689. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 5,829,480. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,829,480. LAB SERVICES: PROGRAM SERVICE EXPENSES 2,345,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,345,000. SURGICAL SERVICES: PROGRAM SERVICE EXPENSES 3,177,027. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,177,027. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 267,269. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 267,269. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 3,914,288. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,914,288. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| VANDALIA HEALTH INC | |||||||||||
| PO BOX 1547 | CHARLESTON | WV | 253261547 | 550664138 | PARENT COMPANY | WV | 501(C)(3) | 12C, III-FI | N/A | 0 | |
| CAMC FOUNDATION INC | |||||||||||
| PO BOX 1547 | CHARLESTON | WV | 253261547 | 310887133 | FUNDRAISING | WV | 501(C)(3) | 12A, I | Yes (1) | CHARLESTON AREA MEDICAL CENTER INC | |
| CHARLESTON AREA MEDICAL CENTER INC | |||||||||||
| PO BOX 1547 | CHARLESTON | WV | 253261547 | 550526150 | HOSPITAL | WV | 501(C)(3) | 3 | 0 | VANDALIA HEALTH INC | |
| MONONGALIA HEALTH SYSTEM INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550621551 | PARENT COMPANY | WV | 501(C)(3) | 12C, III-FI | 0 | VANDALIA HEALTH INC | |
| MONONGALIA COUNTY GENERAL HOSPITAL COMPANY | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 237441353 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| MON ELDER SERVICES INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 311520863 | CONTINUING CARE RETIREMENT CENTER | WV | 501(C)(3) | 10 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| THE FOUNDATION OF MONONGALIA GENERAL HOSPITAL | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550570338 | RAISE FUNDS FOR MONONGALIA GENERAL HOSPITAL | WV | 501(C)(3) | 7 | Yes (1) | MONONGALIA COUNTY GENERAL HOSPITAL CO | |
| PRESTON MEMORIAL HOSPITAL | |||||||||||
| 150 MEMORIAL DRIVE | KINGWOOD | WV | 26537 | 311097818 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| PRESTON MEMORIAL MEDICAL GROUP | |||||||||||
| 300 SOUTH PRICE STREET | KINGWOOD | WV | 26537 | 550717988 | PRIMARY AND URGENT CARE | WV | 501(C)(3) | 3 | Yes (1) | PRESTON MEMORIAL HOSPITAL | |
| PRESTON MEMORIAL HOSPITAL FOUNDATION | |||||||||||
| 300 SOUTH PRICE STREET | KINGWOOD | WV | 26537 | 550740121 | RAISE FUNDS FOR PRESTON HOSPITAL | WV | 501(C)(3) | 12B, II | Yes (1) | PRESTON MEMORIAL HOSPITAL | |
| AUXILIARY OF MONONGALIA GENERAL HOSPITAL INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550362965 | RAISE FUNDS FOR MONONGALIA GENERAL HOSPITAL | WV | 501(C)(3) | 12A, I | Yes (1) | MONONGALIA COUNTY GENERAL HOSPITAL CO | |
| LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550689535 | LIABILITY INSURANCE TRUST | WV | 501(C)(3) | 12A, I | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| STONEWALL JACKSON MEMORIAL HOSPITAL | |||||||||||
| 230 HOSPITAL PLAZA | WESTON | WV | 26452 | 550422958 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| MON HEALTH MARION NEIGHBORHOOD HOSPITAL INC | |||||||||||
| 140 MIDDLETOWN LOOP | WHITEHALL | WV | 26554 | 853994078 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | MONONGALIA HEALTH SYSTEM INC | |
| CAMC GREENBRIER VALLEY MEDICAL CENTER INC | |||||||||||
| 1320 MAPLEWOOD AVENUE | RONCEVERTE | WV | 24970 | 884128022 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | CHARLESTON AREA MEDICAL CENTER INC | |
| CAMC PLATEAU MEDICAL CENTER INC | |||||||||||
| 430 MAIN STREET | OAK HILL | WV | 25901 | 921715117 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | CHARLESTON AREA MEDICAL CENTER INC | |
| CAMC HEALTH EDUCATION AND RESEARCH INSTITUTE INC | |||||||||||
| PO BOX 1547 | CHARLESTON | WV | 253261547 | 550753754 | MEDICAL EDUCATIONAL RESEARCH | WV | 501(C)(3) | 12A, I | Yes (1) | CHARLESTON AREA MEDICAL CENTER INC | |
| BROADDUS HOSPITAL ASSOCIATION INC | |||||||||||
| PO BOX 930 | PHILLIPI | WV | 26416 | 550379108 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | DAVIS HEALTH SYSTEM INC | |
| DAVIS HEALTH SYSTEM INC | |||||||||||
| PO BOX 1484 | ELKINS | WV | 26241 | 550737655 | HEALTH SYSTEM | WV | 501(C)(3) | 12B, II | 0 | MONONGALIA HEALTH SYSTEM INC | |
| DAVIS HEALTH SYSTEM FOUNDATION INC | |||||||||||
| PO BOX 1188 | ELKINS | WV | 26241 | 320185772 | PROVIDES SUPPORT TO DAVIS HEALTH SYSTEM ENTITIES | WV | 501(C)(3) | 10 | Yes (1) | DAVIS HEALTH SYSTEM INC | |
| WEBSTER MEMORIAL HOSPITAL | |||||||||||
| 812 GORMAN AVENUE | ELKINS | WV | 26241 | 871759588 | HOSPITAL | WV | 501(C)(3) | 3 | Yes (1) | DAVIS HEALTH SYSTEM INC | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VANDALIA INSURANCE COMPANY | |||||||||||||||
| 76 ST PAUL STREET STE 500 | BURLINGTON | VT | 05401 | 030308754 | INSURANCE | VT | N/A | C | Yes (1) | ||||||
| MON HEALTH CARE INC | |||||||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550654973 | MEDICAL EQUIPMENT | WV | N/A | C | Yes (1) | ||||||
| STONEWALL HOME OXYGEN THERAPY INC | |||||||||||||||
| 100 MARKET PLACE MALL SUITE 8 | WESTON | WV | 26452 | 550754278 | OXYGEN THERAPY SERVICES | WV | N/A | C | Yes (1) | ||||||
| FAIRMONT HOME EQUIPMENT AND SUPPLY | |||||||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550763259 | EQUIPMENT RENT & SVC | WV | N/A | C | Yes (1) | ||||||
| MORGANTOWN PHYSICAL THERAPY ASSOC INC | |||||||||||||||
| 943 MAPLE DRIVE | MORGANTOWN | WV | 26505 | 550614636 | REHABILITATION SERVICES | WV | N/A | C | Yes (1) | ||||||
| HEALTH FACILITIES INC | |||||||||||||||
| 909 GORMAN AVENUE | ELKINS | WV | 26241 | 550516937 | HEALTH CARE | WV | N/A | C | Yes (1) | ||||||
| CENTRAL WV MEDCORP INC | |||||||||||||||
| PO BOX 2630 | ELKINS | WV | 26241 | 550739314 | PHYSICIAN SERVICES | WV | N/A | C | Yes (1) | ||||||
| DAVIS REGIONAL HEALTH PARTNERS INC | |||||||||||||||
| PO BOX 2632 | ELKINS | WV | 26241 | 550746206 | CONTRACT NEGOTIATIONS | WV | N/A | C | Yes (1) | ||||||
| ZERCOR RE SEGREGATED PORTFOLIO #2 DAVIS | |||||||||||||||
| CAPTIVE INSURANCE | N/A | C | Yes (1) | 18 FORUM LANE 2ND FLOOR | GRAND CAYMAN | CAYMAN ISLANDS | CJ | KY1-1102 | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| DAVIS HEALTH SYSTEM FOUNDATION INC | ||
| C | $33,941 | BOOK VALUE |
| HEALTH FACILITIES INC | ||
| A | $76,290 | CASH, FMV |
| HEALTH FACILITIES INC | ||
| Q | $50,004 | CASH, FMV |