2018-11-12T09:49:56-06:00 2017-12-31 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2017-01-01 550379108 Broaddus Hospital Association Inc BROA 3044571760 PO Box 930 Philippi WV 26416 Dana Gould CEO 3044571760 2018-11-07 1 Dolores Rose P01286262 3043460441 216.12.119.47 2018-11-07 12:37:22 ES P 29A4F4B1CD32CB7C611C91BEC9F33B06D5C2D658 14DF620F39F3AD6339F2027FBCC6CB851CA3639D 2017 2019-02-21 02:37:17Z Dana Gould PO Box 930 Philippi WV 26416 17901915 0 X www.davishealthsystem.org X 1954 WV Broaddus Hospital is the primary provider of Health Care Services in Barbour County. In 2017, the Hospital provided 100 acute inpatient days; 2,019 swing bed inpatient days; 18,233 long-term care patient days; 13,811 outpatient visits, 6,426 emergency room visits and 1,978 clinic visits. 8 8 264 103 20000 19000 38099 16795 16922440 17529882 40520 46454 384810 308784 17385869 17901915 4955 6409 0 0 9737299 9807500 0 0 0 7958876 7959360 17701130 17773269 -315261 128646 9879975 10336428 6990219 7228155 2889756 3108273 X Broaddus Hospital Association is committed to providing patient-friendly, quality health care to its communities. 0 0 15279153 6409 17818661 Broaddus Hospital provides 24/7 hour emergency room services by qualified, experienced providers. For the year 2017 there were 6,426 emergency room visits. The Hospital has a 60 bed dually-certified long-term and intermediate care facility where there is considerable focus on rehab services allowing patients to function at their optimal level. For the year 2017, there were 18,233 patient days. The Hospital provides Radiology services including General Radiology, CT Scans, Ultrasound, MRI, Dexa Scans, and Mammography. For the year 2017, the following procedures were done: General Radiology - 5,441; CAT Scan - 1,814; MRI - 284; Ultrasound - 805; Dexa Scans - 160; and Mammograms - 625. The Hospital provides laboratory and EKG procedures which totaled 56,171 procedures for the year; Rehab Services including PT, OT, and Speech - totaling 36,405 procedures; Respiratory and Pulmonary services totaling 4,745 procedures; Acute Care Inpatient Services totaling 100 days; Swing Bed services totaling 2,019 days; a Provider Based Clinic with 1,978 patient visits and other patient services. 687973 The Hospital provides care to patients, who meet certain criteria under its charity care policy, without charge or at amounts less than its established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as net patient service revenue. Gross charges for charity care for the year amounted to $687,973. 15967126 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 10 0 264 1 1 1 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Dana Gould CEO 3044571760 PO Box 930 Phillipi WV 26416 Forrest Kelley Chairman 3.00 2.00 X X 0 0 0 Danny Franke PhD ThM Vice-Chairman 2.00 X X 0 0 0 Jeff Rogers Secretary/Treasurer 1.00 X X 0 0 0 Mary Beth Lind Board Member 1.00 X 0 0 0 Derick Spencer Board Member 1.00 X 0 0 0 Jude McConnell Board Member 1.00 X 0 0 0 Joyce Wilson Board Member 1.00 X 0 0 0 Adam Marsh Board Member 1.00 X 0 0 0 Jeffrey Powelson CEO (retired 9/28/17) 55.00 X 0 154493 18236 Catherine S Kalar CFO 45.00 5.00 X 0 95396 17311 Dana Gould CEO as of 9/3/17 (former COO) 45.00 5.00 X 0 123661 957 Deborah McCauley Rph Pharmacist 42.00 X 114264 0 29193 114264 373550 65697 1 0 1 0 Reliable Health Care LLC 3120 University Avenue Morgantown WV 26505 Emergency Room Providers 1750884 Psychiatric Medical Care LLC PO Box 305172 Dept 141 Nashville TN 37230 Behavioral Health Consultants 166116 2 16795 16795 Patient services 622110 17529882 17529882 17529882 46454 46454 5 0 5 5 5 Cafeteria 722212 270271 270271 Timber sales 110000 20000 20000 Television 900099 8245 8245 10263 10263 308779 17901915 17818661 20000 46459 X 6409 6409 7294758 6488687 806071 84419 75091 9328 1892780 1683628 209152 535543 476365 59178 28478 25331 3147 63278 63278 3000703 2669125 331578 27873 24793 3080 1494747 1329846 164901 249043 221524 27519 27594 24545 3049 142949 127153 15796 67515 60055 7460 486061 432351 53710 53473 47564 5909 Charity Care 687973 687973 Medical supplies 527568 527568 Bad debts 361752 361752 State provider tax 351321 351321 389032 346045 42987 17773269 15967126 1806143 0 3215752 3546902 367120 460750 1221697 1427108 313531 313204 84592 79027 11138264 7718326 3775040 3419938 848699 974809 53544 114690 9879975 10336428 1046622 1113614 3592766 3231537 374583 260877 1976248 2622127 6990219 7228155 X 2512793 2686619 376963 421654 2889756 3108273 9879975 10336428 128646 89871 0 X 1 X 1 X 1 0 X 376963 46691 2000 421654 359860 17103 376963 347707 12153 359860 346645 1062 347707 291366 55279 346645 1.00000 0 0 350190 350190 5352967 3438002 1914965 134958 134958 4843719 4280324 563395 456430 456430 3419938 Due to affiliates 224990 Capital leases 5742 Estimated third-party settlements 2391395 2622127 Part V, Line 4: These funds are restricted for scholarships related to nursing training. 1 1 X 1 X 120.000000000000 1 X 1 1 0 0 847376 847376 4751175 3465324 1285851 0.07390 5598551 4312700 1285851 0.07390 47927 2345 45582 0.00260 12898 12898 0.00070 60825 2345 58480 0.00330 5659376 4315045 1344331 0.07720 11052 11052 0.00060 11052 11052 0.00060 0 361752 4057749 4057749 X 1 1 1 1 Broaddus Hospital Association 1 HealthCare Drive Philippi WV 26416 X X X X Dually certified long-term and intermediate care facility Broaddus Hospital Association Inc 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V for complete URL X X 1 16 1 See Part V for complete URL 0 1 X 120.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X https://www.davishealthsystem.org/patients-visitors/financial-counseling X https://www.davishealthsystem.org/patients-visitors/financial-counseling X https://www.davishealthsystem.org/patients-visitors/financial-counseling X X X X 1 X 0 X X X X X 1 X 0 0 Broaddus Hospital Association, Inc. Part V, Section B, Line 5: Interviews were conducted with the following: Barbour County Development Authority, Barbour County Emergency Medical Services, Barbour County Family Resource Network, Barbour County Health Department, Barbour County Senior Center, Broaddus Hospital Board of Trustees, Local Health Care Providers. and Mace's Pharmacy. Broaddus Hospital Association, Inc. Part V, Section B, Line 7d: Available on the hospital website, upon request at the hospital administration offices, and shared with the Community Wellness Collaborative and the Hospital Board of Directors. Broaddus Hospital Association, Inc. Part V, Section B, Line 11: Broaddus does not have the resources to address all needs identified, but must prioritize and develop the best possible plan to create positive change where possible and partner with other area providers to optimize the health and wellness of the community. Key areas identified by the CHNA are: 1. High Levels of Inactivity 2. Limited Access to Exercise Opportunities 3. Greater Than Average Levels of Mental Illness and Psychosis 4. Hypertension 5. Substance Abuse 6. Other Identified Concerns: Heart Disease, Diabetes, Cancer, COPD, Bone/Joint/Muscle Pain, Bariatric/Obesity; and Dental Services.High levels of inactivity and limited access to exercise opportunities-- The development of The Barbour Healthy Communities Collaborative, which includes several local businesses and health providers, works to promote walking and healthy activities in the community. Some events include the creation of a Wellness Resource Guide, an annual Health Fair, walking clubs and events, 100 Miles/100 Days walking program, and development and expansion of walking trails in the county.Greater than average levels of mental illness and psychosis-- Development of a new outpatient behavioral health program with a focus on the geriatric population, with referral options to other regional agencies.Hypertension-- Goal is to educate at risk patients through physician education, health coaches, increased walking programs and community health fairs.Substance abuse-- Although Broaddus Hospital does not have the resources for such a program, our 24/7 ER is available for emergent needs and has a referral relationship with various regional treatment centers. The Collaborative and Broaddus Hospital also provided monetary support toward the purchase and training of a drug dog.Other identified concerns: other issues such as Heart Disease, Diabetes, Cancer, COPD, Bone/Joint/Muscle Pain, Bariatric/Obesity, and Dental Services have, and will continue to be addressed. A "One Call" process has been established with Davis Medical Center that will facilitate faster transfers of ED patients. Increased access to WVU services such as cancer care, heart disease and orthopedic services have been made possible through our affiliations with Davis Medical Center and WVU. Diabetic educators, a newly developed Pulmonary Rehab Program at Broaddus Hospital; and weight reduction through Health Coaches and weight management services within the system help address the bariatric issues within the county. Broaddus Hospital Association, Inc. Part V, Section B, Line 13b: Outstanding medical debts are factored into the patient's income in determining discounts. Adjusted income provides a more accurate assessment of true ability to pay. Adjusted income is calculated by deducting monthly medical expenses from gross income. The hospital's financial assistance policy also contains a provision for catastrophic care expenses. In cases where a patient's medical charges exceed 30% of their total income, the bill will be reduced to 30% of their gross income to make the patient's portion more realistic and manageable. Broaddus Hospital Association, Inc. Part V, Section B, Line 20e: Accounts deemed uncollectible are screened for a presumptive charity adjustment before being transferred to bad debt status. This analysis is done monthly and uses the hospital's sliding scale procedures. Part V, Section B, Line 7a https://www.davishealthsystem.org/Content/Uploads/davishealthsystem.org/files/BH_2016CHNA_2017ImpStrategies_ComboReport.pdf Part V, Section B, Line 10a https://www.davishealthsystem.org/Content/Uploads/davishealthsystem.org/files/BH_2016CHNA_2017ImpStrategies_ComboReport.pdf Part I, Line 7: Cost of community health improvement services and community benefit operations was obtained from the hospital's payroll and other accounting records.Cost of charity care was estimated using a cost to charge ratio derived from worksheet 2 of the Schedule H instructions. 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 $ 361,752. Part II, Community Building Activities: The organization promotes the health of the communities it serves by participating in a neighborhood improvement and revitalization project for the community by offering expertise and resources regarding community healthcare. It also participated in disaster readiness training and public health emergency activities. Community building expenses reported in Part II were obtained from the hospital's accounting records. The 2017 activities include: Disaster Drill action, Government meetings, LEPC/SART, and Healthy Community meetings. Part III, Line 2: Bad debt expense as reported on the financial statements of the hospital. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. 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 collectability. Management also reviews troubled, aged accounts to determine collection potential. For receivables associated with self-pay patients (which includes patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. Part III, Line 8: Medicare revenue and allowable costs were obtained from the Medicare Cost Report.Depending on the timing of deductions and receipts for Medicare reimbursement, there may be an overage or shortfall in any year. Since this tends to offset itself in the subsequent year, none of the shortfall is treated as a community benefit. Part III, Line 9b: Patients who indicate that they have an inability to pay for medical care are referred to a financial counselor. Financial assistance is not offered to those patients who are merely unwilling to pay. Patients who do not meet the hospital's financial assistance guidelines but who demonstrate an inability to meet minimum payment guidelines will be given a reduced payment plan. Patients with catastrophic illnesses will be referred to the WV Catastrophic Illness Fund. Patients whose care is the result of a crime will be referred to the WV Crime Victims Fund. Part VI, Line 2: The hospital continues to work closely with the County Health Department to assure open communication in order to prevent the spread and prevention of any communicable disease present or suspected. The most recently completed community health needs assessment has led to the development of the "Barbour Healthy Communities Collaborative". This is a multi-disciplinary group of health care providers and citizens with the goal of improving the overall health and wellness of the community. Part VI, Line 3: The organization informs and educates patients about their eligibility for financial assistance with the following methods: (1) It posts information in public areas with the hospital, (2) Displays its financial policy brochure in public places, (3) Posts information on the internal network, (4) Posts information on the health system website, (5) Patient advocates contact work lists of medically indigent patients to help secure forms on funding/assistance, and (6) The organization publishes a report in local newspapers annually. Part VI, Line 4: The area the organization serves is primarily located in Barbour County, WV and is characterized by the following: 1) Rural; 2) An average household income of $37,327; 3) Two hospitals in neighboring counties also serve residents of the county, and 4) Federally-designated underserved populations reside in the county. Part VI, Line 5: The hospital promotes the health of the community by the following methods: 1) a majority of the organization's governing body is comprised of persons who reside in the organization's primary service area. 2) The organization extends medical staff privileges to all qualified physicians in its community for some or all of its departments and encourages and utilizes specialized services on site or via referral as needed to best optimize patient care. 3) The availability of surplus funds has been very limited. All available funds are utilized based on facility capital and operations to meet the needs of our patients. Expenditures and budgets are reviewed and approved by the Board of Directors. 4) The Hospital's emergency room is available to all, regardless of ability to pay. 5) Broaddus Hospital is the only hospital in Barbour County and is a critical access hospital and the primary provider of health care services in the county. It offers a 24 hour provider staffed ER, acute care beds, swing beds, a long-term care facility, rehab services including physical therapy, speech therapy, occupational therapy, outpatient behavioral health, lab, EKG, and radiology services including CT scan, ultrasound, and MRI and an Outpatient physician clinic. 6) The hospital leads some community benefit activities and functions and is a catalyst for others. It is an active supporter for Relay for Life, shop for tots, and breast cancer awareness education. Part VI, Line 6: Davis Health System (DHS) works in conjunction with many other community health agencies to promote wellness and improved lifestyles in the region. Working together and sharing resources has proven to be much more beneficial for the community, as well as the agencies in meeting their goals. Some of the ways that DHS contributes to the community health include: healthy weight classes, healthy heart screenings, colon cancer awareness and screening, regional school and employer wellness fairs, comprehensive health fairs, local sporting event support, early childhood fairs, walk 100 miles in 100 days program, Relay for Life involvement, prostrate screening, breast cancer survivor dinner, influenza vaccination clinics, smoking cessation support and many others. 0 0 0 0 0 0 0 0 0 Jeffrey Powelson CEO (retired 9/28/17) 0 154493 0 0 0 0 0 0 0 18236 0 172729 0 0 Part I, Line 3 The CEO is paid by a related organization, Davis Memorial Hospital. Davis Memorial Hospital uses a compensation committee, written employment contract, compensation survey or study, and approval by the board or compensation committee to establish the compensation of it's CEO. Form 990, Part VI, Section B, line 11b A draft of the 990 is first reviewed by the CEO and CFO and then discussed with the board. A copy of the final 990 was provided to the board before it was filed with the IRS. Form 990, Part VI, Section B, line 12c The 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. Administration monitors and questions any potential conflicts of which they become aware. Form 990, Part VI, Section B, line 15 The CEO and other officers are paid by a related organization, Davis Memorial Hospital. The Compensation Committee of the Board of Trustees of Davis Memorial Hospital is responsible for the oversight of the compensation of the CEO. 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 Any request for financial or other corporate documents are made on a case by case basis by the Administration of Davis Health System and taken to the Board as necessary. Form 990, Part IX, line 11g Purchased services: Program service expenses 2,669,125. Management and general expenses 331,578. Fundraising expenses 0. Total expenses 3,000,703. Schedule K The Health System Refunding Revenue Bonds (Davis Health System Obligated Group) Series 2016 A tax exempt bonds are reported on the Form 990, Schedule K of Davis Memorial Hospital. The liability is reported in equal portions on each hospital's balance sheet but reported in total on the consolidated financial statements. Davis Health System Inc PO Box 1697 Elkins WV 26241 550737655 Supporting Organization WV 501(C)(3) Line 12b, II N/A 0 Davis Memorial Hospital PO Box 1484 Elkins WV 26241 550375433 Hospital WV 501(C)(3) Line 3 Davis Health System Inc 0 Davis Health System Foundation PO Box 1188 Elkins WV 26241 320185772 Provides support to Davis Health System entities WV 501(c)(3) Line 10 N/A 0 Health Facilities Inc 909 Gorman Avenue Elkins WV 26241 550516937 Health Care WV N/A C 0 Central WV MedCorp Inc PO Box 2630 Elkins WV 26241 550739314 Physician Services WV N/A C 0 Elkins Regional Health Partners Physician Hospital Organization Inc PO Box 2632 Elkins WV 26241 550746206 Contract Negotiations WV N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0