2011-11-14T13:42:05-06:00 2010-12-31 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-01-01 550379108 Broaddus Hospital Association Inc BROA 3044571760 PO Box 930 Philippi WV 26416 Jeff Powelson 3044571760 2011-11-08 1 Harry C Harless 3043460441 2010 2016-03-07 17:11:31Z Jeff Powelson PO Box 930 Phillipi WV 26416 15570499 0 X www.davishealthsystem.org X 1954 WV Broaddus Hospital is the primary provider of Health Care Services in Barbour County. In 2010, the Hospital provided 720 acute inpatient days; 2,105 swing bed inpatient days; 20,061 long-term care patient days; 14,518 outpatient visits, and 7,791 emergency room visits. In addition, the hospital provided charity care amounting to $512,563 to patients without financial resources to pay for their care. 9 9 229 112 0 0 51497 276930 13992040 14977513 35034 30513 316655 285543 14395226 15570499 0 0 0 0 5777054 6620929 0 0 0 8492566 8712058 14269620 15332987 125606 237512 9811244 10062089 8251223 8207412 1560021 1854677 X Broaddus Hospital Association is committed to providing patient-friendly, quality health care to its communities. 0 0 13619110 14751883 Broaddus Hospital provides 24/7 hour emergency room services by qualifed, experienced providers. For the year 2010 there were 7,791 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 2010, there were 20,061 patient days. The Hospital provides Radiology services including General Radiology, CT Scans, Ultrasound, MRI, Dexascans, and Mammography. For the year 2010, the following procedures were done: General Radiology - 6,037; CAT Scan - 2,190; MRI - 252; Ultrasound - 921; Dexa Scans - 97; and Mammograms - 596. The Hospital provides laboratory and EKG procedures which totaled 58,274 procedures for the year; Rehab Services including PT, OT, and Speech - totaling 30,291 procedures; Acute Care Inpatient Services totaling 720 days; Swing Bed services totaling 2,105 days; and other patient services. 335252 225630 The Hospital provides care to patients, who meet certain criteria under its charity care policy, without charge or at amounts less that 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 $512,563. 13954362 1 1 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 2 0 1 229 1 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X Jeff Powelson CEO 3044571760 1 HealthCare Drive Phillipi WV 26416 Robert Digman 3.00 X 0 0 0 Jeff Kelley 2.00 X 0 0 0 Dorothy Hayhurst 2.00 X 0 0 0 Kathy Beverly 1.00 X 0 0 0 Karen Bialek 1.00 X 0 0 0 Marsha Denniston 1.00 X 0 0 0 Forrest Kelley 1.00 X 0 0 0 Jude McConnell 1.00 X 0 0 0 James Taylor 1.00 X 0 0 0 Jeff Powelson 55.00 X 0 141189 18121 Catherine S Kalar 42.00 X 0 62591 13997 0 203780 32118 0 0 1 0 Reliable Health Care LLC 3120 University Avenue Morgantown WV 26505 Emergency Room Providers 1576800 Diamond Healthcare Corporation 700 East Main Street Richmond VA 23218 Behavior Health Consulting 194217 2 29100 247830 276930 Patient services 622110 14977513 14977513 14977513 30513 30513 70 70 70 70 Cafeteria 722212 211824 211824 Pharmacy 446110 50355 50355 Television Income 532210 7660 7660 15634 15634 285473 15570499 14977513 0 316056 4709717 4262765 446952 78483 71035 7448 1473930 1334054 139876 358799 324749 34050 92905 84088 8817 90930 90930 3386056 3064719 321337 30467 30467 1589289 1437947 151342 219145 198348 20797 34247 30997 3250 354242 320624 33618 72253 65396 6857 480014 434461 45553 65105 58927 6178 Bad debts 1658344 1658344 0 State provider tax 307595 307595 0 Repairs and Maintenance 230975 209055 21920 Consumer sales tax 57961 52461 5500 Dues and subscriptions 38387 34744 3643 4143 4053 90 15332987 13954362 1378625 0 1627702 1433153 191869 198687 1566832 1657441 178505 196258 42707 21159 8934905 4647034 4561236 4287871 218207 482080 832714 849631 591472 935809 9811244 10062089 812759 922155 6429718 6139786 145076 109570 863670 1035901 8251223 8207412 X 1560021 1581928 272749 1560021 1854677 9811244 10062089 X 237512 57144 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 350190 350190 5179132 4243916 935216 2949153 403118 2546035 456430 456430 4287871 Bond Repayment Fund 849631 F 849631 Estimated third-party payor settlements 795725 Covenant not to compete 73598 Bond issue cost, net 37708 Other receivables 23250 Due from affiliates 5528 935809 Due to affiliates 1022856 Capital leases 13045 1035901 15570499 15332987 237512 57144 57144 294656 15328563 0 15328563 241936 241936 15570499 15332987 0 15332987 0 15332987 Part XII, Line 4b - Other Adjustments: Income related to temporarily restricted assets 241,936. 1 1 X 1 X 120.000000000000 1 X 1 1 1 0 1 1 335252 225630 109622 0.00800 734621 681607 53014 0.00390 1069873 907237 162636 0.01190 23062 2485 20577 0.00150 13640 13640 0.00100 36702 2485 34217 0.00250 1106575 909722 196853 0.01440 10377 10377 0.00080 10377 10377 0.00080 1 1091025 3074495 3498337 -423842 X 1 1 1 1 Broaddus Hospital Association

1 HealthCare Drive Philippi WV 26416

X X X X Long-Term Care Skilled Nursing Facility Broaddus Hospital Association Inc 1 1 1 120.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 X X 1 X X X X X X 1 X 0 1 Part I, Line 6a: Davis Health System, Gorman Avenue, Elkins WV 26241 Part I, Line 7: Community benefits reports are filled out by staff and managers involved to determine the cost of labor and supplies.The 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 $ 1658344. 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. Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectibility. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. 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 cost report Part III, Line 9b: Patients who indicate that they have an inability to pay for medical care are referred to a financial counselor and/or Medicaid Eligibility Specialist. 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. Broaddus Hospital Association, Inc. Part V, Section B, Line 11h: 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 15e: 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 16e: Accounts were referred to Magistrate Court and/or Corcuit Court, depending on the account balance. Broaddus Hospital Association, Inc. Part V, Section B, Line 17e: 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 chargemaster prices. We then apply our financial assistance policy and federal poverty guidelines and if the patient qualifes, they receive discounted services. Broaddus Hospital Association, Inc. Part V, Section B, Line 21: 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 qualifes, they receive discounted services. Part I,line 6aThe organization makes its community benefit report available to the public by publishing it into regional newspapers, mailing it to certain regional zip codes and making it available in common areas in the hospital's facilities. 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 gleans information and statistics from health screenings that are held for the public, as well as our employees. This information helps in planning future educational events and screenings.The facility also communicates regularly with the county health department as well as with all of the area medical providers (i.e. physicians, PAs, etc.). Part VI, Line 3: The organization informs and educates patients about assistance with the following methods: 1) It posts info in public areas within the hospital, 2) Displays its financial policy brochure to the public, 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 characterized by the following: 1) Rural, 2) An average household income of $31,173 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 6: 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 organizaiton 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 meed 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 hospital in Barbour County and is a critical access hospital and the primary provider of heath 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, occupationsl 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 or Relay for Life, shop for tots, breast cacer awareness education, cardiac projects, various exercise and health screenings, etc. Many hospital employees volunteer to support these and other community functions. 7) It provides an internet link for its Community Benefit Report. Part VI, Line 7: 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. X X X X 0 0 0 0 0 0 0 0 0 Jeff Powelson 0 141189 0 0 0 0 0 1422 0 17923 0 160534 0 0 Form 990, Part VI, Section B, line 11 The 2010 Form 990 will be reviewed by the CEO and CFO. The 990 will be discussed and reviewed with the entire board at the October board meeting. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 57,144. CLARIFICATION OF ITEM MARKED YES FORM 990, PART XII, LINE 2C The organization has not changed its oversight process in the past year. Explanation of Volunteers Form 990, Part I, Line 6 For 2009, there were a total of 112 volunteers for the long-term care unit. From this number 10 were chaplins, 60 were musicians, singers, and entertainers, and 42 were volunteers that helped with the activities and outings of the long-term care residents. 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 Health Facilities Inc 909 Gorman Avenue Elkins WV 26241 550516937 Health Care WV N/A C Central WV MedCorp Inc PO Box 2630 Elkins WV 26241 550739314 Physician Services WV N/A C 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 1 0 0 0 0 0 0 1 0 0 0 0 0 0