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 311520863 MON ELDER SERVICES INC MONE 3045981242 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 JEFF SANDENE EXECUTIVE VP AND CFO 3045981242 2023-11-14 1 JEFF SANDENE XXX-XX-XXXX 0 ANNE FULTON P00941863 6123974000 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAVID S GOLDBERG 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 3307341 0 X N/A X 1997 WV TO BE THE SENIOR LIVING COMMUNITY OF CHOICE IN MONONGALIA COUNTY. THE RESPECT, TRUST AND FRIENDSHIP OF OUR RESIDENTS WILL BE EARNED EVERY DAY. 13 12 80 12 0 0 0 0 5838091 3091698 577063 67807 0 0 6415154 3159505 0 0 0 0 3595454 1896667 0 0 0 2927796 1308691 6523250 3205358 -108096 -45853 32374549 38940579 24024288 23136484 8350261 15804095 TO BE THE SENIOR LIVING COMMUNITY OF CHOICE IN MONONGALIA COUNTY. THE RESPECT, TRUST, AND FRIENDSHIP OF OUR RESIDENTS WILL BE EARNED EVERY DAY. 0 0 2601823 3091698 CONTINUING CARE RETIREMENT VILLAGE CONSISTING OF 90 INDEPENDENT LIVING APARTMENTS, 40 ASSISTED LIVING UNITS, AND COMMON SUPPORT AREAS ON 11 ACRES. 2601823 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 19 0 1 80 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WV X GENE TOWNSEND - CONTROLLER 3042853676 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 DAVID GOLDBERG DIRECTOR & MHS CEO 1.00 49.00 X X 0 911058 131451 ED BOYLE 9122 START CHAIR 1.00 6.50 X X 0 0 0 JOHN LAW CPA SECRETARY/TREASURER 1.00 2.00 X X 0 0 0 KATHY MCNEILL VICE CHAIR 1.00 4.50 X X 0 0 0 BOBBIE CONKLIN DIRECTOR 1.00 1.00 X 0 0 0 GREGORY CUNNINGHAM DIRECTOR 1.00 2.00 X 0 0 0 MARK JOHNSON MD DIRECTOR 1.00 1.00 X 0 0 0 MIKE MORRIS DIRECTOR 1.00 1.00 X 0 0 0 NATALIE STONE DIRECTOR 1.00 2.00 X 0 0 0 RAY THOMPSON DIRECTOR 1.00 3.00 X 0 0 0 RODNEY BEAN DIRECTOR 1.00 1.00 X 0 0 0 RONALD G STOVASH DIRECTOR 1.00 6.00 X 0 0 0 TERRY SHAFFER DIRECTOR 1.00 1.00 X 0 0 0 JEFF CRUDELE INTERIM CFO 1.00 49.00 X 0 480000 0 LISA SIMON CPA VP FINANCE/CFO 1.00 50.00 X 0 421179 15219 JEANETTE LANCASTER DIRECTOR OF SALES & MARKETING 40.00 0.00 X 130901 0 13990 WILMA STERNTHAL EXECUTIVE DIRECTOR 50.00 0.00 X 128545 0 9226 259446 1812237 169886 2 0 1 0 VERITAS CONTRACTING INC 246 BUSINESS PARK DRIVE FAIRMOUNT WV 26554 CONSTRUCTION SERVICES 306665 CDW GOVERNMENT INC 75 REMITTANCE DRIVESTE 1515 CHICAGO IL 60675 IT PRODUCT/SERVICES 144244 MONONGAHELA POWER COMPANY 5001 NASA BLVD FAIRMONT WV 26554 ELECTRIC SERVICES 105433 DEVAULT HEATING AND COOLING 200 7TH STREET FAIRMOUNT WV 26554 HVAC SERVICES 104399 4 ROOM AND BOARD 623000 3032069 3032069 RESIDENT SERVICES 623000 59629 59629 3091698 215643 215643 147836 -147836 -147836 -147836 3159505 3091698 0 67807 1403938 1159131 244807 52771 43516 9255 338397 279046 59351 101561 83748 17813 129252 129252 110 110 15637 15637 85250 72303 12947 4355 4355 12062 1399 10663 158898 157782 1116 3958 3933 25 81157 81157 522734 522734 5064 5064 DIETARY RELATED EXPENSE 192728 192728 REPAIRS AND MAINTENANCE 37070 35002 2068 RECREATIONAL EVENTS 16699 11765 4934 SALES TAX 13318 12805 513 30399 20867 9532 3205358 2601823 603535 0 342546 171801 854816 340710 69721 78061 25782 92555 20141028 340951 12687633 19800077 18280872 18473624 20624 76306 32374549 38940579 713122 472814 1007983 1312448 8721350 8301864 13581833 13049358 24024288 23136484 X 8350261 15804095 8350261 15804095 32374549 38940579 -45853 151740 7347947 0 X 0 1 X 1 0 X 561916 561916 5994987 6089165 6187830 5838091 3091698 27201771 5994987 6089165 6749746 5838091 3091698 27763687 0 0 0 27763687 20731 314329 385073 435218 215643 1370994 20731 314329 385073 435218 215643 1370994 6015718 6403494 7134819 6273309 3307341 29134681 0.95290 0.96280 0.04710 0.03720 X SCHEDULE A, PART III: MON ELDER SERVICES, INC. CHANGED THE TAX YEAR FROM JUNE 30 TO DECEMBER 31. AS A RESULT, THE ORGANIZATION IS FILING A SHORT PERIOD RETURN FOR THE PERIOD 7/1/22 - 12/31/22. 343671 343671 17695002 158643 17536359 2033351 65582 1967769 69004 116726 -47722 19800077 REFUNDABLE FEES 12766746 SECURITY DEPOSITS 150246 ESTIMATED LIABILITY OBLIGATIONS 108669 DUE TO AFFILIATES 23697 13049358 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 DIRECTOR & MHS 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 VP FINANCE/CFO 0 35487 0 46842 0 338850 0 14673 0 546 0 436398 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 THE 457(F) PLAN: DAVID GOLDBERG AND LISA SIMON. A MONONGALIA COUNTY BUILDING COMMISSION 311520863 610208CK4 2011-04-20 12454808 TO REFINANCE ORIGINAL CONSTRUCTION ISSUANCE 0 0 0 A 4153731 12454808 12205712 249096 2011 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: MONONGALIA COUNTY BUILDING COMMISSION (F) DESCRIPTION OF PURPOSE: TO REFINANCE ORIGINAL CONSTRUCTION ISSUANCE FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY IS PROVIDED A COPY, PRIOR TO SUBMISSION, FOR THEIR REVIEW AND TO ANSWER QUESTIONS OR REVISE. IF CHANGES ARE MADE, BASED ON MEMBER'S REVISIONS, MANAGEMENT REDISTRIBUTES A FINAL VERSION. 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. THE BOARD THEN DETERMINES WHAT TYPES OF DECISIONS THAT MEMBER IS PROHIBITED FROM PARTICIPATING. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS PAID BY MONONGALIA HEALTH SYSTEM. ANNUALLY, A CONSULTANT COMPILES A MARKET DATA REPORT ON CEO COMPENSATION, THIS REPORT IS THEN REVIEWED BY THE EXECUTIVE COMMITTEE TO DETERMINE COMPENSATION FOR THE INDIVIDUAL. ANNUALLY, A CONSULTANT COMPILES A MARKET DATA REPORT ON CFO AND COO COMPENSATION, THIS REPORT IS THEN REVIEWED BY THE EXECUTIVE COMMITTEE TO DETERMINE COMPENSATION FOR THE INDIVIDUAL. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH PUBLIC DISCLOSURE WITH THE WV HEALTH CARE AUTHORITY. 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 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 PRESTON MEMORIAL HOSPITAL FOUNDATION 300 SOUTH PRICE STREET KINGWOOD WV 26537 550740121 RAISE FUNDS FOR PRESTON HOSPITAL WV 501(C)(3) 12B, II 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 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0