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 550570338 THE FOUNDATION OF MONONGALIA GENERAL HOSPITAL FOUN 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 1587700 0 X WWW.MONHEALTHSYS.ORG/FOUNDATION X 1976 WV THE FOUNDATION RAISES FUNDS FOR MONONGALIA COUNTY GENERAL HOSPITAL AND ITS AFFILIATED ENTITIES. 20 19 0 19 0 0 1776946 1385042 0 0 1610 -18384 -19384 -36384 1759172 1330274 537117 335570 0 0 11246 0 0 0 9746 401246 200121 949609 535691 809563 794583 9011007 9760051 162589 181101 8848418 9578950 THE FOUNDATION RAISES FUNDS FOR MONONGALIA COUNTY GENERAL HOSPITAL AND ITS AFFILIATED ENTITIES. 0 0 335570 335570 THE FOUNDATION RAISES FUNDS FOR MONONGALIA COUNTY GENERAL HOSPITAL AND ITS AFFILIATED ENTITIES. THESE FUNDS HELP TO IMPROVE FACILITIES, PROVIDE EQUIPMENT AND PROGRAMS AND SUPPORT OUR COMMUNITY HEALTH CAREER SCHOLARSHIPS. 335570 1 1 0 0 0 0 0 0 0 1 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 20 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WV X GENE TOWNSEND 3042853676 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 DAVID GOLDBERG PRESIDENT/CEO 1.00 49.00 X X 0 911058 131451 JOSHUA S ROGERS SECRETARY/TREASURER 1.00 X X 0 0 0 RANDY BUZZO CHAIRMAN 1.00 1.00 X X 0 0 0 STEPHANIE STOVASH VICE CHAIR 1.00 X X 0 0 0 CHAD CALLEN DIRECTOR 1.00 X 0 0 0 CHRISTIAN MILLER DIRECTOR 1.00 X 0 0 0 DAVID RAESE DIRECTOR 1.00 X 0 0 0 FREDERICK GABRIELE MD DIRECTOR 1.00 X 0 0 0 JASON MINSKER DIRECTOR 1.00 X 0 0 0 KEN JUSKOWICH DIRECTOR 1.00 X 0 0 0 MARY JO THOMAS DIRECTOR 1.00 X 0 0 0 MELISSA WATKINS DIRECTOR 1.00 X 0 0 0 NICK FANTASIA DIRECTOR 1.00 X 0 0 0 NIKKI BOWNMAN MILLS DIRECTOR 1.00 X 0 0 0 PATRICIA WATSON DIRECTOR 1.00 X 0 0 0 PATRICK ESPOSITO II DIRECTOR 1.00 1.00 X 0 0 0 ROBERT E LYNCH DIRECTOR 1.00 X 0 0 0 ROYCE KELLER DIRECTOR 1.00 X 0 0 0 RYAN ADRIAN DIRECTOR 1.00 X 0 0 0 STEPHEN LACAGNIN DIRECTOR 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 LUELLA GUNTER EXECUTIVE DIRECTOR 20.00 21.00 X 0 181444 19816 0 1993681 166486 0 0 1 0 0 115732 1269310 1385042 145158 145158 163542 -163542 -163542 -163542 57500 115732 93884 -36384 -36384 1330274 0 0 -54768 X 298070 298070 37500 37500 23836 23836 130171 130171 859 859 603 603 20 20 686 686 841 841 MISCELLANEOUS EXPENSE 29906 29906 FUNDRAISING EXPENSE 8887 8887 BAD DEBT EXPENSE 4312 4312 535691 335570 190375 9746 582608 845983 197944 282362 196105 18488 43309 0 149839 6803722 6851038 222459 549945 951529 1075727 9011007 9760051 1540 3430 45750 0 115299 177671 162589 181101 X 2517755 3248287 6330663 6330663 8848418 9578950 9011007 9760051 794583 88469 -152520 0 X 0 1 X 1 0 X 750143 1105492 1190463 1776946 1385042 6208086 750143 1105492 1190463 1776946 1385042 6208086 1082418 5125668 318043 157795 172614 205463 145158 999073 7207159 0.71120 0.83910 X PART II, SHORT YEAR EXPLANATION: THE FOUNDATION OF MONONGALIA GENERAL HOSPITAL IS CHANGING ITS TAX YEAR FROM JUNE 30 TO DECEMBER 31. THEREFORE, THE FOUNDATION OF MONONGALIA GENERAL HOSPITAL HAS FILED A SHORT PERIOD RETURN ENDING DECEMBER 31, 2022. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6258539 558478 6475 333970 118229 6371293 5312266 1467525 -78358 351581 91313 6258539 4809799 1387720 116561 891850 109964 5312266 5264510 691768 21474 1065725 102228 4809799 6870441 685499 192565 2293039 190956 5264510 0.00000 0.09280 0.90720 0 0 0 RESTRCITED INTEREST IN AUXILIAR 549945 C 549945 CASH SURRENDER VALUE OF LIFE INSURANCE 58734 OTHER LONG TERM ASSETS 6071 ASSETS HELD IN CHARITABLE REMAINDER TRUST 98568 BENFICIAL INTEREST IN REMAINDER TRUST 709211 OTHER RECEIVABLES 107448 DUE FROM AFFILIATES 94037 INTEREST RECEIVABLE 1658 1075727 DUE TO RELATED PARTIES 96129 LIABILITY UNDER UNITRUST AGREEMENTS 60424 ANNUITY OBLIGATIONS 21118 177671 X PART V, LINE 4: THE FOUNDATION RAISES FUNDS FOR MONONGALIA COUNTY GENERAL HOSPITAL AND ITS AFFILIATED ENTITIES. THESE FUNDS HLEP TO IMPROVE FACILITIES, PROVIDE EQUIPMENT AND PROGRAMS, AND SUPPORT OUR COMMUNITY HEALTH CAREER SHCOLARSHIPS. 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. JULY GOLF CLASSIC 78700 48700 30000 910 43690 AUGUST GOLF CLASSIC 94532 67032 27500 2080 47204 173232 115732 57500 2990 90894 93884 -36384 1 MONONGALIA COUNTY GENERAL HOSPITAL 1200 JD ANDERSON DR MORGANTOWN WV 26505 237441353 501(C)(3) 227021 0 TO IMPROVE FACILITIES, PROVIDE EQUIPMENT AND PROGRAMS 1 SCHOLARSHIPS 44 37500 0 PART I, LINE 2: THE FOUNDATION MONITORS THE USE OF GRANT FUNDS TO GOVERNMENT AND ORGANIZATIONS DUE TO THE CLOSE RELATIONSHIP WITH THE SINGLE RECIPIENT OF FUNDS BEING MONONGALIA COUNTY GENERAL HOSPITAL. THE FOUNDATION AWARDS HEALTH CAREER SCHOLARSHIPS FOR AREA STUDENTS WHO HAVE CHOSEN TO GO INTO SELECTED HEALTH CARE PROFESSIONS AND MEET SCHOLASTIC AND FINANCIAL NEED REQUIREMENTS. STUDENTS ARE REQUIRED TO FILL OUT A SCHOLARSHIP APPLICATION. SELECTION IS BASED ON APPLICATION, LETTER, ACADEMIC PERFORMANCE AND FINANCIAL NEED. 1 1 0 0 0 0 0 0 0 DAVID GOLDBERG 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 VP FINANCE/CFO 0 35487 0 46842 0 338850 0 14673 0 546 0 436398 0 0 LUELLA GUNTER EXECUTIVE DIRECTOR 0 169804 0 11640 0 0 0 13170 0 6646 0 201260 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 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. FORM 990, PART IX, LINE 11G MHS SHARED SERVICES FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 81,378. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,378. OTHER PROF FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 23,977. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,977. MAINTENENCE CONTRACT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 24,816. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,816. 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 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 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 AUXILIARY OF MONONGALIA GENERAL HOSPITAL C 309980 CASH MONONGALIA COUNTY GENERAL HOSPITAL COMPANY B 227701 CASH