BROADDUS HOSPITAL ASSOCIATION INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- BROADDUS HOSPITAL ASSOCIATION INC (EIN 55-0379108)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-04
- IRS object ID
- 201323089349300402
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-04T06:40:54-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550486667 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Foster Toothman PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1 |
| City | Charleston | City |
| State | WV | State |
| ZIP Code | 25329 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550379108 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Broaddus Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BROA | NameControl |
| Phone | 3044571760 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 930 | AddressLine1 |
| City | Philippi | City |
| State | WV | State |
| ZIP Code | 26416 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jeff Powelson | Name |
| Title | CEO | Title |
| Phone | 3044571760 | Phone |
| Date Signed | 2013-10-25 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Harry C Harless | Name |
| PTIN | P01042847 | PTIN |
| Phone | 3043460441 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Jeff Powelson | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 930 | AddressLine1 |
| City | Philippi | City |
| State | WV | State |
| ZIP Code | 26416 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 16501577 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.davishealthsystem.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1954 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | Broaddus Hospital is the primary provider of Health Care Services in Barbour County. In 2012, the Hospital provided 482 acute inpatient days; 2,326 swing bed inpatient days; 20,556 long-term care patient days; 14,591 outpatient visits, and 8,301 emergency room visits. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 224 | TotalNbrEmployees |
| Total Nbr Volunteers | 116 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 36268 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 19229 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 15684872 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16128411 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 14943 | InvestmentIncomePriorYear |
| Investment Income Current Year | 18729 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 293816 | OtherRevenuePriorYear |
| Other Revenue Current Year | 335208 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 16029899 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16501577 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 4814 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6633429 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8248938 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9281530 | OtherExpensePriorYear |
| Other Expenses Current Year | 8203082 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15914959 | TotalExpensesPriorYear |
| Total Expenses Current Year | 16456834 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 114940 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 44743 | RevenuesLessExpensesCY |
| Total Assets BOY | 10246477 | TotalAssetsBOY |
| Total Assets EOY | 10341189 | TotalAssetsEOY |
| Total Liabilities BOY | 8270141 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8267751 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1976336 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2073438 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Broaddus Hospital Association is committed to providing patient-friendly, quality health care to its communities. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15006735 | Expense |
| Grants | 4814 | Grants |
| Revenue | 16128411 | Revenue |
| Description | Broaddus Hospital provides 24 hour emergency room services by qualifed, experienced providers. For the year 2012 there were 8,301 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 2012, there were 20,556 patient days. The Hospital provides Radiology services including General Radiology, CT Scans, Ultrasound, MRI, Dexascans, and Mammography. For the year 2012, the following procedures were done: General Radiology - 6,253; CAT Scan - 1,807; MRI - 346; Ultrasound - 823; Dexa Scans - 75; and Mammograms - 658. The Hospital provides laboratory and EKG procedures which totaled 65,379 procedures for the year; Rehab Services including PT, OT, and Speech - totaling 29,099 procedures; Acute Care Inpatient Services totaling 482 days; Swing Bed services totaling 2,326 days; and other patient services. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | 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 $493,735. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 15006735 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 6 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 224 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jeff Powelson CEO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3044571760 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HealthCare Drive | AddressLine1 |
| City | Phillipi | City |
| State | WV | State |
| ZIP Code | 26416 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (11 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| 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 | 0 | 147570 | 18307 | X | ||
| Catherine S Kalar | |||||||
| CFO | 45.00 | 0 | 69877 | 14288 | X | ||
| Deborah McCauley | |||||||
| Pharmacist | 40.00 | 104417 | 0 | 24326 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 104417 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 217447 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 56921 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Reliable Health Care LLC | |||||
| 3120 University Avenue | Morgantown | WV | 26505 | Emergency Room Providers | 1625040 |
| Diamond Healthcare Corporation | |||||
| 700 East Main Street | Richmond | VA | 23218 | Behavioral Health Consultants | 178044 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Government Grants | 8828 | GovernmentGrants |
| All Other Contributions | 10401 | AllOtherContributions |
| Total Contributions | 19229 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient services | Description |
| Business Code | 622110 | BusinessCode |
| Total Revenue Column | 16128411 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16128411 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16128411 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18729 | TotalRevenueColumn |
| Exclusion | $18,729 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 130 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 130 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 130 | TotalRevenueColumn |
| Exclusion | $130 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Cafeteria | 722212 | 247538 | $247,538 |
| Pharmacy | 446110 | 38944 | $38,944 |
| Television Income | 532210 | 7760 | $7,760 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40836 | TotalRevenueColumn |
| Exclusion | $40,836 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 335078 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16501577 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16128411 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $353,937 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4814 | Total |
| Program Services | 4814 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6314696 | Total |
| Program Services | 5690804 | ProgramServices |
| Management And General | 623892 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86751 | Total |
| Program Services | 78180 | ProgramServices |
| Management And General | 8571 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1369825 | Total |
| Program Services | 1234486 | ProgramServices |
| Management And General | 135339 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 477666 | Total |
| Program Services | 430473 | ProgramServices |
| Management And General | 47193 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133711 | Total |
| Program Services | 120500 | ProgramServices |
| Management And General | 13211 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2793 | Total |
| Management And General | 2793 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69125 | Total |
| Management And General | 69125 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2727215 | Total |
| Program Services | 2457766 | ProgramServices |
| Management And General | 269449 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21544 | Total |
| Program Services | 19415 | ProgramServices |
| Management And General | 2129 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1283000 | Total |
| Program Services | 1156675 | ProgramServices |
| Management And General | 126325 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 237662 | Total |
| Program Services | 214181 | ProgramServices |
| Management And General | 23481 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34241 | Total |
| Program Services | 30858 | ProgramServices |
| Management And General | 3383 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 348572 | Total |
| Program Services | 314133 | ProgramServices |
| Management And General | 34439 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67515 | Total |
| Program Services | 60845 | ProgramServices |
| Management And General | 6670 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 526966 | Total |
| Program Services | 474902 | ProgramServices |
| Management And General | 52064 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59017 | Total |
| Program Services | 53186 | ProgramServices |
| Management And General | 5831 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad debts | 1638746 | 1638746 | |
| State provider tax | 398002 | 398002 | |
| Medical supplies | 389758 | 389758 | |
| Repairs & maintenance | 159884 | 144087 | 15797 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105331 | Total |
| Program Services | 94924 | ProgramServices |
| Management And General | 10407 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16456834 | Total |
| Program Services | 15006735 | ProgramServices |
| Management And General | 1450099 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1913270 | BOY |
| EOY | 1455749 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 860938 | BOY |
| EOY | 911588 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1546706 | BOY |
| EOY | 2256421 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 205847 | BOY |
| EOY | 215142 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26759 | BOY |
| EOY | 74188 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 10310738 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5562585 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4572765 | BOY |
| EOY | 4748153 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 498593 | BOY |
| EOY | 561554 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 621599 | BOY |
| EOY | 118394 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10246477 | BOY |
| EOY | 10341189 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 902200 | BOY |
| EOY | 994927 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5834635 | BOY |
| EOY | 5514249 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 685157 | BOY |
| EOY | 836145 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 848149 | BOY |
| EOY | 922430 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8270141 | BOY |
| EOY | 8267751 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1688104 | BOY |
| EOY | 1782072 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 288232 | BOY |
| EOY | 291366 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1976336 | BOY |
| EOY | 2073438 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10246477 | BOY |
| EOY | 10341189 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 44743 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 52359 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 288232 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 27134 | InvestmentEarningsOrLosses |
| Other Expenditures | 24000 | OtherExpenditures |
| End Of Year Balance | 291366 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 272749 | BeginningOfYearBalance |
| Contributions | 20000 | Contributions |
| Investment Earnings Or Losses | -517 | InvestmentEarningsOrLosses |
| Other Expenditures | 4000 | OtherExpenditures |
| End Of Year Balance | 288232 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | 241937 | Contributions |
| Investment Earnings Or Losses | 30812 | InvestmentEarningsOrLosses |
| End Of Year Balance | 272749 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 350190 | OtherCostOrOtherBasis |
| Book Value | 350190 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5179133 | OtherCostOrOtherBasis |
| Depreciation | 5159466 | Depreciation |
| Book Value | 19667 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3701983 | OtherCostOrOtherBasis |
| Depreciation | 403119 | Depreciation |
| Book Value | 3298864 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1079432 | OtherCostOrOtherBasis |
| Book Value | 1079432 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4748153 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Due to affiliates | $748,844 |
| Capital leases | $584 |
| Estimated third-party settlements | $173,002 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 922430 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 14915190 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 52359 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 52359 | RevenueNotRptdF990 |
| Revenue Subtotal | 14862831 | RevenueSubtotal |
| Other Revenues Not Included | 1638746 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1638746 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 16501577 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 14818088 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 14818088 | ExpensesSubtotal |
| Other Expenses Not Included | 1638746 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1638746 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 16456834 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Intended Use of Endowment Funds: | Part V, Line 4: | These funds are restricted for scholarships related to nursing training. |
| Part XI, Line 4b - Other Adjustments: | Bad debts netted against income in the financial statements 1,638,746. | |
| Part XII, Line 4b - Other Adjustments: | Bad debts netted against income in the financial statements 1,638,746. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 120.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 349592 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 349592 | DirectOffsettingRevenue |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 339265 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 402163 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -62898 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 688857 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 751755 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -62898 | NetCommunityBenefitExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16203 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2090 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14113 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16536 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 16536 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 32739 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2090 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 30649 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 721596 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 753845 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -32249 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1675 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1675 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1675 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1675 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,057,483 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 3870397 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3870397 | CostOfCareReimbursedByMedicare |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Broaddus Hospital Association | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HealthCare Drive | AddressLine1 |
| City | Philippi | City |
| State | WV | State |
| ZIP Code | 26416 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | Dually certified long-term and intermediate care facility | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Broaddus Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 120.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Other Actions | X | OtherActions |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| 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 $ 1638746. | |
| Part II: 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 collectibility. 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 Funds. | |
| Part V, Section B, Line 12h: 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 thier total income, the bill will be reduced to 30% of their gross income in an effort to make the patient's portion more realistic and manageable. | Broaddus Hospital Association, Inc. |
| Part V, Section B, Line 16e: Accounts that are determined to be uncollectible may be referred to either Magistrate Court or Circuit Court, depending on the account balance. Accounts are referred under this policy based on the patient's and/or guarantor's employment status, assets, and other factors. | Broaddus Hospital Association, Inc. |
| Part V, Section B, Line 17e: Accounts were referred to Magistrate Court and/or Circuit Court depending on the account balance. | 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 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. | Broaddus Hospital Association, Inc. |
| Part VI, Line 2: The organization 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 gets 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 organization informs and educates patients about their elibibility for financial assistance with the following methods: 1) It posts information in public areas within 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 worklists of medically indigent patients to help secure forms of funding/assistance, and 6) The organization publishes a report in the local newspaper 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 two 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. 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 by the Board of Directors. 4) The Hospital's emergency room is available to all, regardless of ability to pay. 5) Broaddus 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, occupational therapy, outpatient behavioral health, lab, EKG, and radiology services including CT scan, ultrasound, and MRI. 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, breast cancer awareness education. | |
| Part VI, Line 6: Broaddus Hospital is an affiliated organization of Davis Health System. Davis Health System works in conjunction with many other community health agencies to promote wellness and improved lifestyle 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 and employer wellness fairs, comprehensive health fairs, local sporting event support, early childhood fairs, Walk 100 Miles in 100 Days programs, Relay for Life involvement, prostate screening, breast cancer survivor dinner, influenza vaccination clinics, smoking cessation support, and many others. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Jeff Powelson | NamePerson |
| Title | CEO | Title |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 147570 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 1133 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 18893 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 167596 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section B, line 11 | A draft of the 2012 Form 990 was reviewed by the CEO and CFO. It was then discussed with the board at its July 24, 2013 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Davis Health Systems 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 | N/A | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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