2014-08-13T09:38:31-05:00 2013-12-31 550486667 Arnett Foster Toothman PLLC P O Box 2629 Charleston WV 25329 990 2013-01-01 550379108 Broaddus Hospital Association Inc BROA 3044571760 PO Box 930 Philippi WV 26416 Jeff Powelson CEO 3044571760 2014-08-07 1 Harry C Harless P01042847 3043460441 2013 2015-11-30 17:44:51Z Jeff Powelson PO Box 930 Philippi WV 26416 17116964 0 X www.davishealthsystem.org X 1954 WV Broaddus Hospital is the primary provider of Health Care Services in Barbour County. In 2013, the Hospital provided 401 acute inpatient days; 2,074 swing bed inpatient days; 20,423 long-term care patient days; 13,847 outpatient visits, 7,922 emergency room visits and 582 clinic visits. 8 8 243 109 0 0 19229 18045 16128411 16440431 18729 17505 335208 640983 16501577 17116964 4814 3842 0 0 8248938 8654135 0 0 0 8203082 8349306 16456834 17007283 44743 109681 10341189 9961333 8267751 7663023 2073438 2298310 X Broaddus Hospital Association is committed to providing patient-friendly, quality health care to its communities. 0 0 14283875 3842 16440431 Broaddus Hospital provides 24/7 hour emergency room services by qualified, experienced providers. For the year 2013 there were 7922 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 2013, there were 20423 patient days. The Hospital provides Radiology services including General Radiology, CT Scans, Ultrasound, MRI, Dexascans, and Mammography. For the year 2013, the following procedures were done: General Radiology - 5886; CAT Scan - 1965 ; MRI - 379; Ultrasound - 811; Dexa Scans - 113; and Mammograms - 659. The Hospital provides laboratory and EKG procedures which totaled 66468 procedures for the year; Rehab Services including PT, OT, and Speech - totaling 29269 procedures; Acute Care Inpatient Services totaling 401 days; Swing Bed services totaling 2074 days; a Provider Based Clinic that started in August and had 582 visits and other patient services. 465738 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 $465,738. 14749613 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 8 0 1 243 1 0 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 1 1 0 X Jeff Powelson CEO 3044571760 PO Box 930 Phillipi WV 26416 Robert Digman Chairman 3.00 X 0 0 0 Forest Kelley Vice-Chairman 2.00 X 0 0 0 Dorothy Hayhurst Secretary/Treasurer 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 James Taylor Board Member 1.00 X 0 0 0 Jeff Rogers Board Member 1.00 X 0 0 0 Danny Franke Board Member 1.00 X 0 0 0 Jeff Powelson CEO 55.00 X 0 156452 16957 Catherine S Kalar CFO 45.00 X 0 76546 13565 Deborah McCauley Pharmacist 40.00 X 101020 0 23216 101020 232998 53738 1 0 1 0 Reliable Health Care LLC 3120 University Avenue Morgantown WV 26505 Emergency Room Providers 1643700 Diamond Healthcare Corporation 700 East Main Street Richmond VA 23218 Behavioral Health Consultants 188053 2 8550 9495 18045 Patient services 622110 16440431 16440431 16440431 17505 17505 10 0 10 10 10 Cafeteria 722212 241216 241216 Pharmacy 446110 20302 20302 Television Income 532210 7390 7390 372065 372065 640973 17116964 16440431 0 658488 X 3842 3842 6507560 5539235 968325 38228 32540 5688 1626792 1384725 242067 481555 409900 71655 121366 103307 18059 14866 14866 86795 86795 2894181 2463527 430654 18521 15765 2756 1199094 1021055 178039 234502 199608 34894 21562 18354 3208 338032 287733 50299 67515 57469 10046 526546 448196 78350 61748 52560 9188 Bad debts 1522581 1522581 Medical supplies 488391 488391 State provider tax 400816 400816 Repairs & maintenance 238554 203057 35497 114236 96952 17284 17007283 14749613 2257670 0 1455749 1550125 911588 900084 2256421 1919684 215142 276076 74188 69837 10443681 6056142 4748153 4387539 561554 739789 118394 118199 10341189 9961333 994927 811818 5514249 5178613 836145 581615 922430 1090977 8267751 7663023 X 1782072 1951665 291366 346645 2073438 2298310 10341189 9961333 109681 115191 0 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 291366 55279 346645 288232 27134 24000 291366 272749 20000 -517 4000 288232 241937 30812 272749 0 0 350190 350190 5182191 3109223 2072968 3838292 2303151 1535141 1073008 643768 429240 4387539 Due to affiliates 748036 Capital leases 65067 Estimated third-party settlements 277874 1090977 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 1 1 708343 999948 -291605 0.00000 3988311 3060698 927613 0.05990 4696654 4060646 636008 0.05990 58749 1807 56942 0.00370 16390 16390 0.00110 75139 1807 73332 0.00480 4771793 4062453 709340 0.06470 1571 1571 0.00010 1571 1571 0.00010 0 1005360 3876118 3876118 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 1 X X X X X X X X X 13 1 0 1 X X X X X X X X X X 1 0 1 1 120.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X 1 0 X X X X X 1 X 0 0 Broaddus Hospital Association, Inc. Part V, Section B, Line 3: 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 5d: 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 12i: 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 18e: 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 19d: All patients are charged based on the hospital charge master prices. The financial assistance policy and federal poverty guidelines are then applied and if the patient qualifies, they receive discounted services. Broaddus Hospital Association, Inc. Part V, Section B, Line 20d: All patients are charged based on the hospital chargemaster prices. We then apply our financial assistance policy and federal poverty guidelines and if the patient qualifies, they receive discounted services. 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 and Medicaid 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 $ 1,522,581. 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. 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.The cost of bad debts was estimated using a cost to charge ratio derived from worksheet 2 of the Schedule H instructions. Part III, Line 8: Medicare allowable costs were estimated using Worksheet B of the Schedule H instructions.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 $33,158, 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 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: health 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 X X X X X 0 0 0 0 0 0 0 0 0 Jeff Powelson CEO 0 156452 0 0 0 0 0 0 0 18767 0 175219 0 0 Form 990, Part VI, Section B, line 11 A draft of the 2013 Form 990 was reviewed by the CEO and CFO. It was then discussed with the board at its July 23, 2014 meeting. 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 2,463,527. Management and general expenses 430,654. Fundraising expenses 0. Total expenses 2,894,181. 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 55-0746206 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