2023-11-15T17:21:08-06:00 2022-12-31 861065772 DELOITTE TAX LLP 50 SOUTH SIXTH STREET MINNEAPOLIS MN 55402 990 2022-07-01 550689535 LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM LIAB 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 4754422 0 X N/A X 1989 WV PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATIONS OF THE RISK MANAGEMENT DIVISION 0 0 0 0 0 0 0 0 2920475 4237554 91653 58094 0 0 3012128 4295648 0 0 0 0 306253 175428 0 0 0 2637314 941811 2943567 1117239 68561 3178409 4957379 8480538 0 0 4957379 8480538 PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATION OF THE RISK MANAGEMENT DIVISION 0 0 1117239 4237554 PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATION OF THE RISK MANAGEMENT DIVISION 1117239 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 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 0 0 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 PRESIDENT/CEO 1.00 49.00 X X 0 911058 130951 HUNTINGTON BANK TRUSTEE 1.00 0.00 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 0 1812237 146170 0 0 1 0 0 REPLENISH TRUST FUND 900099 4237554 4237554 4237554 87784 87784 429084 458774 -29690 -29690 -29690 4295648 4237554 0 58094 10214 10214 165214 165214 220 220 OTHER EXPENSES 941591 941591 1117239 1117239 0 0 156550 192103 4800829 8288435 4957379 8480538 0 0 X 4957379 8480538 4957379 8480538 4957379 8480538 3178409 154131 190619 0 X 0 0 0 X X 1 MONONGALIA COUNTY HOSPITAL 237441353 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 CORPORATE BONDS 8288435 F 8288435 1 1 0 0 0 0 0 0 0 DAVID GOLDBERG PRESIDENT/CEO 0 659321 0 237960 0 13777 0 127624 0 3327 0 1042009 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 457(F) PLAN: DAVID GOLDBERG AND LISA SIMON. FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY IS PROVIDED A COPY PRIOR TO SUBMISSION FOR 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. 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