2023-11-15T15:08:57-06:00 2022-12-31 861065772 DELOITTE TAX LLP 50 SOUTH SIXTH STREET MINNEAPOLIS MN 55402 990 2022-07-01 550740121 PRESTON MEMORIAL HOSPITAL FOUNDATION INC PRES 3043291400 150 MEMORIAL DRIVE KINGWOOD WV 26537 JEFF SANDENE EXECUTIVE VP AND CFO 3043291400 2023-11-14 1 JEFF SANDENE XXX-XX-XXXX 0 ANNE FULTON P00941863 6123974000 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z KEVIN GESSLER 150 MEMORIAL DRIVE KINGWOOD WV 26537 24405 0 X PRESTONMEMORIAL.ORG X 1997 WV RAISE, RECEIVE,AND APPLY FUNDS FOR FACILITY IMPROVEMENTS, EQUIPMENT, TECHNOLOGY, AND EXPANSION OF SERVICES FOR PRESTON MEMORIAL HOSPITAL. 11 10 0 8 0 0 19689 4946 0 0 58986 14909 606 334 79281 20189 0 0 0 0 0 0 0 0 4021 12710 4804 12710 4804 66571 15385 1427939 1363972 4062 3172 1423877 1360800 RAISE, RECEIVE,AND APPLY FUNDS FOR FACILITY IMPROVEMENTS, EQUIPMENT, TECHNOLOGY, AND EXPANSION OF SERVICES. 0 0 THE FOUNDATION SUPPORTS ACTIVITIES OF PRESTON MEMORIAL HOSPITAL AND ITS AFFILIATED NON-PROFIT ORGANIZATIONS BY PROVIDING A COORDINATED PROGRAM OF FUND DEVELOPMENT AND CONTINUED PHILANTHROPIC SUPPORT FOR THE HOSPITAL, ASSISTING THE HOSPITAL IN OBTAINING GRANTS FROM OTHER FOUNDATIONS, PROMOTING COMMUNITY AWARENESS OF AND SUPPORT FOR THE HOSPITAL AND ASSISTING THE HOSPITAL IN IDENTIFYING COMMUNITY EXPECTATIONS AND NEEDS FOR HEALTHCARE SERVICES IN THE SERVICE AREA. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WV X KEVIN GESSLER VP OF FINANCE 3043291400 150 MEMORIAL DRIVE KINGWOOD WV 265371442 MELISSA LOCKWOOD DIRECTOR/PMH CAO 1.00 50.00 X X 0 269786 48363 CORRENA SMITHBURGER DIRECTOR/SECRETARY 1.00 X X 0 0 0 KERRY GNIK VICE CHAIR 1.00 X X 0 0 0 TARRELL RIES DIRECTOR/CHAIR 1.00 1.00 X X 0 0 0 CLINT MCCABE DIRECTOR 1.00 X 0 0 0 LAURIE THOMPSON DIRECTOR 1.00 X 0 0 0 MIKE SHAFFER DIRECTOR 1.00 X 0 0 0 RITA MCCROBIE DIRECTOR 1.00 2.00 X 0 0 0 SARAH WARCHOLA DIRECTOR 1.00 X 0 0 0 TRELLA GREASER DIRECTOR 1.00 X 0 0 0 WILLIAM SHOCKEY DIRECTOR 1.00 X 0 0 0 DAVID GOLDBERG MHS PRESIDENT & CEO 1.00 49.00 X 0 911058 131451 JEFF CRUDELE INTERIM CFO 1.00 49.00 X 0 480000 0 LISA SIMON CPA MHS VP FINANCE/CFO 1.00 50.00 X 0 421179 15219 KEVIN GESSLER TREASURER/PMH VP OF FINANCE 1.00 40.00 X 0 224307 21425 0 2306330 216458 0 0 1 0 0 4946 4946 19125 19125 4216 -4216 -4216 -4216 OTHER REVENUE 900099 334 334 334 20189 334 0 14909 2761 2761 386 386 INDIRECT FUNDRAISING EX 1260 1260 MISC. 397 397 4804 0 783 4021 22819 18183 16917 0 1388203 1345789 1427939 1363972 4062 3172 4062 3172 X 1423877 1360800 1423877 1360800 1427939 1363972 15385 -53094 -25368 0 X 0 1 X 1 0 X X 1 PRESTON MEMORIAL HOSPITAL 311097818 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A, PART IV, SECTION C, LINE 1: MONONGALIA HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THE FOUNDATION AND THE FOUNDATION'S SUPPORTED ORGANIZATION, PRESTON MEMORIAL HOSPITAL. MONONGALIA HEALTH SYSTEM, INC. APPOINTS OR ELECTS ALL MEMBERS OF THE BOARD OF DIRECTORS FOR BOTH ENTITITES AND MUST APPROVE ANY GOVERNANCE CHANGES OR OTHER MAJOR MATTERS OF BOTH ORGANIZATIONS. 0 DUE TO RELATED PARTY 2946 VOLUNTEER PROGRAM 226 3172 X PART X, LINE 2: THE IRS HAS DETERMINED THAT THE SYSTEM ENTITIES ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE CODE AND APPLICABLE STATE STATUTES, EXCEPT FOR MHC WHICH IS A CORPORATION SUBJECT TO INCOME TAX. THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022 AND 2021. 1 1 0 0 0 0 0 0 0 DAVID GOLDBERG MHS PRESIDENT & CEO 0 576356 0 237960 0 96742 0 128124 0 3327 0 1042509 0 0 JEFF CRUDELE INTERIM CFO 0 480000 0 0 0 0 0 0 0 0 0 480000 0 0 LISA SIMON CPA MHS VP FINANCE/CFO 0 35487 0 46842 0 338850 0 14673 0 546 0 436398 0 0 MELISSA LOCKWOOD DIRECTOR/PMH CAO 0 239831 0 29955 0 0 0 45183 0 3180 0 318149 0 0 KEVIN GESSLER TREASURER/PMH VP OF FINANCE 0 202501 0 21806 0 0 0 20462 0 963 0 245732 0 0 PART I, LINE 3 THE CEO'S COMPENSATION IS PAID BY MONONGALIA HEALTH SYSTEM. MONONGALIA HEALTH SYSTEM USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: COMPENSATION COMMITTEE; INDEPENDENT COMPENSATION CONSULTANT; COMPENSATION SURVEY OR STUDY; -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B LISA SIMON RECEIVED A SEVERANCE PAYMENT IN 2022 OF $338,707. THE FOLLOWING INDIVIDUALS PARTICIPATED IN 457(F) PLAN: DAVID GOLDBERG AND LISA SIMON. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PRESTON MEMORIAL HOSPITAL FOUNDATION IS MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A PRESTON MEMORIAL HOSPITAL FOUNDATION'S BOARD MEMBERS ARE ELECTED OR APPOINTED BY MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B PRESTON MEMORIAL HOSPITAL FOUNDATION'S BOARD SHALL GIVE NOTICE TO MONONGALIA HEALTH SYSTEM AND RECEIVE ITS APPROVAL BEFORE ACTING ON ANY OF THE FOLLOWING MATTERS: (A) AMENDMENT OF THE ARTICLES OF INCORPORATION OF THE FOUUNDATION OR THE BYLAWS; (B) SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF THE FOUNDATION AND ANY EXPENDITURE IN EXCESS OF $750,000; (C) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (D) ELECTION TO DISSOLVE THE FOUNDATION ENTITY; (E) APPROVAL OF THE BUDGET OF THE FOUNDATION FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY IS PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW PRIOR TO SUBMISSION. THE BOARD MEMBERS ARE ASKSED TO INFORM MANAGEMENT OF ANY QUESTIONS OR REVISIONS THEY MAY HAVE. IF CHANGES ARE MADE, BASED ON BOARD MEMBER'S REVISIONS, MANAGEMENT REDISTRIBUTES A FINAL VERSION TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, A CONFLICT OF INTEREST QUESTIONNAIRE IS SENT OUT TO ALL BOARD MEMBERS. THE BOARD THEN REVIEWS ALL RESPONSES FOR POSSIBLE CONFLICTS OF INTEREST. IF A CONFLICT IS NOTED, THE BOARD MEMBERS DETERMINE WHICH DECISIONS THE CONFLICTED MEMBERS SHALL NOT PARTICIPATE IN. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE KEPT ONSITE AT PRESTON MEMORIAL HOSPITAL FOUNDATION AND ARE MADE AVAILABLE UPON REQUEST. VANDALIA HEALTH INC PO BOX 1547 CHARLESTON WV 253261547 550664138 PARENT COMPANY WV 501(C)(3) 12C, III-FI N/A 0 CAMC FOUNDATION INC PO BOX 1547 CHARLESTON WV 253261547 310887133 FUNDRAISING WV 501(C)(3) 12A, I CHARLESTON AREA MEDICAL CENTER INC 1 CHARLESTON AREA MEDICAL CENTER INC PO BOX 1547 CHARLESTON WV 253261547 550526150 HOSPITAL WV 501(C)(3) 3 VANDALIA HEALTH INC 0 MONONGALIA HEALTH SYSTEM INC 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550621551 PARENT COMPANY WV 501(C)(3) 12C, III-FI VANDALIA HEALTH INC 0 MONONGALIA COUNTY GENERAL HOSPITAL COMPANY 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 237441353 HOSPITAL WV 501(C)(3) 3 MONONGALIA HEALTH SYSTEM INC 1 MON ELDER SERVICES INC 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 311520863 CONTINUING CARE RETIREMENT CENTER WV 501(C)(3) 10 MONONGALIA HEALTH SYSTEM INC 1 THE FOUNDATION OF MONONGALIA GENERAL HOSPITAL 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550570338 RAISE FUNDS FOR MONONGALIA GENERAL HOSPITAL WV 501(C)(3) 7 MONONGALIA COUNTY GENERAL HOSPITAL CO 1 PRESTON MEMORIAL HOSPITAL 150 MEMORIAL DRIVE KINGWOOD WV 26537 311097818 HOSPITAL WV 501(C)(3) 3 MONONGALIA HEALTH SYSTEM INC 1 PRESTON MEMORIAL MEDICAL GROUP 300 SOUTH PRICE STREET KINGWOOD WV 26537 550717988 PRIMARY AND URGENT CARE WV 501(C)(3) 3 PRESTON MEMORIAL HOSPITAL 1 AUXILIARY OF MONONGALIA GENERAL HOSPITAL 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550362965 RAISE FUNDS FOR MONONGALIA GENERAL HOSPITAL WV 501(C)(3) 12A, I MONONGALIA COUNTY GENERAL HOSPITAL CO 1 LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550689535 LIABILITY INSURANCE TRUST WV 501(C)(3) 12A, I MONONGALIA HEALTH SYSTEM INC 1 STONEWALL JACKSON MEMORIAL HOSPITAL 230 HOSPITAL PLAZA WESTON WV 26452 550422958 HOSPITAL WV 501(C)(3) 3 MONONGALIA HEALTH SYSTEM INC 1 MON HEALTH MARION NEIGHBORHOOD HOSPITAL 140 MIDDLETOWN LOOP WHITEHALL WV 26554 853994078 HOSPITAL WV 501(C)(3) 3 MONONGALIA HEALTH SYSTEM INC 1 CAMC GREENBRIER VALLEY MEDICAL CENTER INC 1320 MAPLEWOOD AVENUE RONCEVERTE WV 24970 884128022 HOSPITAL WV 501(C)(3) 3 CHARLESTON AREA MEDICAL CENTER INC 1 CAMC PLATEAU MEDICAL CENTER INC 430 MAIN STREET OAK HILL WV 25901 921715117 HOSPITAL WV 501(C)(3) 3 CHARLESTON AREA MEDICAL CENTER INC 1 CAMC HEALTH EDUCATION AND RESEARCH INSTITUTE INC PO BOX 1547 CHARLESTON WV 253261547 550753754 MEDICAL EDUCATIONAL RESEARCH WV 501(C)(3) 12A, I CHARLESTON AREA MEDICAL CENTER INC 1 WOMEN AND CHILDREN'S MEDICAL OFFICE BUILDING LLC PO BOX 1547 CHARLESTON WV 253261547 550669065 MEDICAL OFFICE BUILDING WV N/A 0 0 GENERAL DIVISION MEDICAL OFFICE BUILDING LLC PO BOX 1547 CHARLESTON WV 253261547 550623949 MEDICAL OFFICE BUILDING WV N/A 0 0 DASCO-CAMC HOME MEDICAL EQUIPMENT LLC 501 MORRIS STREET CHARLESTON WV 25301 844487189 HOME MEDICAL EQUIPMENT WV N/A 0 0 MGH SURGERY LLC 2000 MON HEALTH MEDICAL PARK DRIVE MORGANTOWN WV 26505 472736896 SURGERY CENTER WV N/A 0 0 MON HEALTH-DASCO HOME MEDICAL EQUIPMENT LLC 375 N WEST ST WESTERVILLE OH 43082 871577276 HOME MEDICAL EQUIPMENT OH N/A 0 0 VANDALIA INSURANCE COMPANY 76 ST PAUL STREET STE 500 BURLINGTON VT 05401 030308754 INSURANCE VT N/A C 1 MON HEALTH CARE INC 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550654973 MEDICAL EQUIPMENT WV N/A C 1 STONEWALL HOME OXYGEN THERAPY INC 100 MARKET PLACE MALL SUITE 8 WESTON WV 26452 550754278 OXYGEN THERAPY SERVICES WV N/A C 1 FAIRMONT HOME EQUIPMENT AND SUPPLY 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550763259 EQUIPMENT RENT & SVC WV N/A C 1 MORGANTOWN PHYSICAL THERAPY ASSOC INC 943 MAPLE DRIVE MORGANTOWN WV 26505 550614636 REHABILITATION SERVICES WV N/A C 1 CARE PARTNER'S INC 511 BURROUGHS STREET SUITE 102 MORGANTOWN WV 26505 550754326 HOME HEALTH WV N/A C 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1