2016-08-15T13:52:05-05:00 2015-12-31 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2015-01-01 550379108 Broaddus Hospital Association Inc BROA 3044571760 PO Box 930 Philippi WV 26416 Jeff Powelson CEO 3044571760 2016-08-12 1 Tessa W Carr P01291277 3043460441 2015 2016-09-27 15:27:22Z Jeff Powelson PO Box 930 Philippi WV 26416 18830373 0 X www.davishealthsystem.org X 1954 WV Broaddus Hospital is the primary provider of Health Care Services in Barbour County. In 2015, the Hospital provided 227 acute inpatient days; 2,084 swing bed inpatient days; 20,304 long-term care patient days; 13,615 outpatient visits, 7,241 emergency room visits and 2,735 clinic visits. 10 10 242 98 0 0 12253 18475 16688928 16885971 51633 45849 298993 1880078 17051807 18830373 3269 9093 0 0 8879763 9174039 0 0 0 7820671 8087428 16703703 17270560 348104 1559813 9684783 10202885 7039277 7039080 2645506 3163805 X Broaddus Hospital Association is committed to providing patient-friendly, quality health care to its communities. 0 0 15439773 9093 18766049 Broaddus Hospital provides 24/7 hour emergency room services by qualified, experienced providers. For the year 2015 there were 7,241 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 2015, there were 20,304 patient days. The Hospital provides Radiology services including General Radiology, CT Scans, Ultrasound, MRI, Dexa Scans, and Mammography. For the year 2015, the following procedures were done: General Radiology - 5,618; CAT Scan - 1,700 ; MRI - 290; Ultrasound - 800; Dexa Scans - 119; and Mammograms - 636. The Hospital provides laboratory and EKG procedures which totaled 61,524 procedures for the year; Rehab Services including PT, OT, and Speech - totaling 32,364 procedures; Acute Care Inpatient Services totaling 227 days; Swing Bed services totaling 2,084 days; a Provider Based Clinic with 2,735 patient visits and other patient services. 244169 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 $244,169. 15683942 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 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 6 0 242 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Jeff Powelson CEO 3044571760 PO Box 930 Phillipi WV 26416 Forrest Kelley Chairman 3.00 X X 0 0 0 Danny Franke Vice-Chairman 1.00 X X 0 0 0 Jeff Rogers Secretary/Treasurer 1.00 X X 0 0 0 Robert Digman Board Member 2.00 X 0 0 0 Dorothy Hayhurst Board Member 1.00 X 0 0 0 Kathy Beverly Board Member 1.00 X 0 0 0 Jude McConnell Board Member 1.00 X 0 0 0 Mary Beth Lind Board Member 1.00 X 0 0 0 Richard Mace 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 Derrick Spencer Board Member 1.00 X 0 0 0 Jeff Powelson CEO 55.00 X 0 171946 18421 Catherine S Kalar CFO 45.00 5.00 X 0 90262 16579 Deborah McCauley Pharmacist 42.00 X 107093 0 26035 Jill Taylor-Phillips MD Clinical Physician 40.00 X 180361 0 1803 287454 262208 62838 2 0 1 0 Reliable Health Care LLC 3120 University Avenue Morgantown WV 26505 Emergency Room Providers 1651260 Diamond Healthcare Corporation 700 East Main Street Richmond VA 23218 Behavioral Health Consultants 205056 2 9360 9115 18475 Patient services 622110 16885971 16885971 16885971 45849 45849 EHR incentive income 900099 1498996 1498996 Cafeteria 722212 263303 263303 Sales tax refunds 900099 91379 91379 26400 26400 1880078 18830373 18766049 0 45849 X 9093 9093 6843688 6165479 678209 84203 75858 8345 1744802 1571892 172910 501346 451663 49683 56694 51076 5618 20664 20664 63875 63875 2855668 2572671 282997 19702 17750 1952 1271756 1146466 125290 235294 211976 23318 22313 20102 2211 279951 252208 27743 67515 60824 6691 755167 680330 74837 64510 58117 6393 Bad debts 1179097 1179097 Medical supplies 585673 585673 State provider tax 247459 247459 Repairs & maintenance 247411 222893 24518 114679 103315 11364 17270560 15683942 1586618 0 1777692 2907225 912554 912733 1599363 1491191 309959 301337 84013 66862 10691217 7028070 4144463 3663147 783692 778698 73047 81692 9684783 10202885 692443 921422 4822710 4446520 384399 178332 1139725 1492806 7039277 7039080 X 2297799 2803945 347707 359860 2645506 3163805 9684783 10202885 X 1559813 -41514 -1000000 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 347707 12153 359860 346645 1062 347707 291366 55279 346645 288232 27134 24000 291366 272749 20000 -517 4000 288232 1.00000 0 0 350190 350190 5191534 3139829 2051705 134958 134958 4211470 3888241 323229 803065 803065 3663147 Due to affiliates 196412 Capital leases 39732 Estimated third-party settlements 1256662 1492806 X Part V, Line 4: These funds are restricted for scholarships related to nursing training. Part X, Line 2: The System, except for Central West Virginia Medcorp, Inc., and Health Facilities, Inc., is exempt from Federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code and similar state statutes relating to not-for-profit organizations. Central West Virginia Medcorp, Inc. and Health Facilities, Inc. are subject to Federal and state income taxes. The System is subject to routine audits by taxing jurisdictions; however, there are currently no audits or any tax examinations for years prior to the fiscal year ended December 31, 2012. 1 1 X 1 X 120.000000000000 1 X 1 1 0 0 413014 413014 4492831 3684946 807885 0.05020 4905845 4097960 807885 0.05020 38674 2145 36529 0.00230 20359 20359 0.00130 59033 2145 56888 0.00360 4964878 4100105 864773 0.05380 12774 12774 0.00080 12774 12774 0.00080 0 799466 3427120 3427120 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 13 1 0 0 1 X www.davishealthsystem.org X X 1 13 1 http://davishealthsystem.com/MasterImages/files/CHNA%20Implementation%20Pla 0 0 1 X 120.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 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: Online surveys were incorporated into the plan (page 28) as well as personal interviews conducted of: Rochelle Sutton, RN - Barbour Co Health Dept., Mike Cvechko, Chamber of Commerce; Bob Digman, PhD, Board Member; Joan Propst, RN - Provost AB University; Cecil Holbert, MD - Myers Clinic; Susie Cvechko, RN - Broaddus Director of IP Services; Dr. Joe Super - Barbour County Board of Education; Rich Mace, RPH - Mace's Pharmacy; Sharon Moats, RN - Broaddus ER Nurse Manager; Brenda Wilmoth - Senior Center; Reg Trefethan - Heart and Hand; Rob Jones - Director of Barbour Co EMS; Eric Ruf - Administrator - Belington Clinic. 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 Hospital 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. Access to care; 2. Behavioral Health; 3. Drug & alcohol abuse; 4. Physical activity and nutrition; 5. Public Health Education; and 6. Tobacco use.Access to care--hired a new hospital-based provider that offers a wide variety of family care services including inpatient, outpatient and nursing home care.Developed Community Awareness and Education Program that will be held through sessions at eight satellite Senior Centers throughout Barbour County.Behavioral Health-currently offered primarily to geriatric population but is evaluating resources to expand the services to all ages.Drug & Alcohol Abuse: Broaddus Hospital does not have the clinical expertise or the financial resources to provide a comprehensive long term solution for this crisis in the region. However, Braoddus does provide immediate emergency needs of these patients through ER department which maintains a referral relationship with various regional treatment centers on an as needed basis.Physical Activity and Nutrition: Risk factors that ranked very high in Barbour County were obesity and lack of leisure exercise, hypertension and high cholesterol. With collaboration with other community providers and organizations, a committee, "Barbour Healthy Commnities Collaborative," has been formed. Goals of the group inlcude increasing community education and awareness with regards to physical activity, nutrition and other risk factors.Public Health Education: All members of the Healthy Communities Collaborative have committed to assist with increasing awareness and education.Tobacco Use: Smoking cessation classes are available within the community through the Barbour County Health Department and Family Resource Network. 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. Broaddus Hospital Association, Inc. Part V, Section B, Line 22d: To determine the maximum amounts charged to FAP-eligible individuals, the Hospital uses a sliding scale up to 300% of FPL and determination is made based on household income and number of family members living in the home. Consideration is also given to the percentage of disposable income after necessities. Part I, Line 6a: The hospital did not prepare a community benefit report, but our website provides a comprehensive overview of the services and programs offered throughout the Davis Health System. The website is a convenient channel of communication to our public and patients and is kept current to bring our visitors current and accurate information. 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.Amount of cash and in-kind contributions was obtained from the hospital's 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, Ln 7 Col(f): The cost of bad debts was estimated using a cost to charge ratio derived from worksheet 2 of the Schedule H instructions. 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 2014 activities include: Region 6/7 Homeland Security, Preparedness Ebola, WV Task Force and disaster drill action. 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 recently completed community 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. Please refer to the "Implementation Plan and the "Resource Packet" for additional information (both are attached). 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 Healthy 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. 1 Part I, Line 2: Maintains documentation received from the organization that confirms the receipt of the donation/grant. 0 0 0 0 0 0 0 0 0 Jeff Powelson CEO 0 171946 0 0 0 0 0 0 0 19793 0 191739 0 0 Jill Taylor-Phillips MD Clinical Physician 180361 0 0 0 0 0 1803 0 1144 0 183308 0 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 11 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 Compensation Committee of the Board of Trustees 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 2,572,671. Management and general expenses 282,997. Fundraising expenses 0. Total expenses 2,855,668. Form 990, Part XI, line 9: Capital transfers to affiliates -1,000,000. Davis Health System Inc PO Box 1697 Elkins WV 26241 550737655 Supporting Organization WV 501(C)(3) 3 N/A 0 Davis Memorial Hospital PO Box 1484 Elkins WV 26241 550375433 Hospital WV 501(C)(3) 3 Davis Health System Inc 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 1 0 0 0 0 0 1 1 0 0