2024-11-13T22:41:49-06:00 2023-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 46204 990 2023-01-01 237441353 MONONGALIA COUNTY GENERAL HOSPITAL CO MONO 3045981242 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 JEFF SANDENE EXECUTIVE VP AND CFO 3045981242 2024-11-13 1 0 ANGELA M MOORE P00244342 3174648600 2023 2024-10-15 13:58:12Z DAVID S GOLDBERG 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 384247930 0 X WWW.MONHEALTHSYS.ORG X 1972 WV TO DELIVER THE BEST HEALTHCARE AND REMAIN THE PROVIDER OF CHOICE IN OUR REGIONAL SERVICE AREA BECAUSE OF OUR QUALITY, RESPECT, INTEGRITY, AND CREATIVITY, AS WELL AS OUR DEDICATION TO PATIENT SAFETY. 12 8 2053 8 875863 0 73961 197257 159044865 377781148 -2336 1869872 2176314 4399653 161292804 384247930 0 0 0 0 74644636 143556931 0 0 0 95430871 205974939 170075507 349531870 -8782703 34716060 266380201 326526981 142056131 134205758 124324070 192321223 TO ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. 0 0 292148557 380851824 MONONGALIA GENERAL HOSPITAL (MGH) IS A 154-BED GENERAL, ACUTE CARE HOSPITAL IN MORGANTOWN, WV.MGH PROVIDES A WIDE ARRAY OF OUTPATIENT SERVICES INCLUDING OUTPATIENT SURGERY (11,760 SURGERIES), PHYSICIAN OFFICES (177,910 VISITS), AND MANY OTHER SERVICES. SOME OTHER SERVICES INCLUDE CARDIAC CATHETERIZATION, CT SCAN, MRI, NUCLEAR MEDICINE, AND ULTRASOUND. 292148557 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 73 0 2053 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 WV X GENE TOWNSEND - MANAGING ACCOUNTANT 3042853676 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 WILLIAM MCBEE JR MD DIRECTOR, CHIEF OF STAFF 50.00 0.00 X 2115889 0 50841 DAVID GOLDBERG DIRECTOR & MHS CEO 1.00 50.00 X X 0 853663 36373 JOSEPH BLATT MD DIRECTOR/CHIEF OF STAFF 50.00 0.00 X 396955 0 22333 KRYSTAL ATKINSON DIRECTOR & MHMC CAO 1.00 50.00 X X 0 376237 30376 KIMBERLY MOYERS CHAIR 1.00 0.00 X X 0 0 0 NATALIE STONE VICE CHAIR 1.00 2.00 X X 0 0 0 SAM CHICO III SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 DONALD ROBINSON DIRECTOR 1.00 0.00 X 0 0 0 PASTOR JUNIUS LEWIS DIRECTOR 1.00 0.00 X 0 0 0 PATRICK ESPOSITO II DIRECTOR 1.00 1.00 X 0 0 0 RANDY BUZZO DIRECTOR 1.00 1.00 X 0 0 0 ROBERT HULL MD DIRECTOR 1.00 0.00 X 0 0 0 KEVIN GESSLER VP OF FINANCE 10.00 40.00 X 0 248249 1153 IHTISHAAM QAZI PHYSICIAN 50.00 0.00 X 1085972 0 29115 JASCHAR SHAKURI-RAD PHYSICIAN 50.00 0.00 X 1073023 0 30233 ALEXANDER NAGY PHYSICIAN 50.00 0.00 X 1008711 0 59404 KRISHNA BINGI PHYSICIAN 50.00 0.00 X 868068 0 49525 SALAM SBAITY PHYSICIAN 50.00 0.00 X 828729 0 25003 7377347 1478149 334356 73 0 1 0 QUALIVIS INC PO BOX 123847 DEPT 3847 DALLAS TX 75312 AGENCY SERVICES 7659794 NORTHSTAR ANESTHESIA OF WV PLLC 6225 N STATE HWY 161 STE 200 IRVING TX 75038 ANESTHESIA SERVICES 5656146 MONONGAHELA POWER COMPANY PO BOX 3615 AKRON OH 44309 UTILITIES 1509604 MORRISON MANAGEMENT INC PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE MANAGEMENT 1472539 MOUNTAIN EMERGENCY PHYSICIANS PO BOX 677979 DALLAS TX 75267 ER PHYSICIAN ADMIN/SERVICES 1409338 157 25000 172257 172257 197257 PATIENT SERVICE REV 621990 377781148 376905285 875863 377781148 1519321 1519321 453114 0 453114 453114 453114 350551 0 350551 350551 350551 EQUITY IN ASC 900099 2400575 2400575 CHILD CARE REV-TUITION 900099 491507 491507 DERM RETAIL SALES 900099 116585 116585 937872 937872 3946539 384247930 380851824 875863 2322986 116870702 109080117 7790585 2045905 1909525 136380 24640324 22997803 1642521 92071 92071 34060053 33883082 176971 220 220 2571537 2567272 4265 9245 9245 5994508 4795606 1198902 167325 150735 16590 4049867 3239894 809973 13583022 6791511 6791511 3618101 3618101 MEDICAL SUPPLIES 75942106 75942106 MANAGEMENT FEES 38723544 38723544 MEDICAID TAX 10507769 10507769 BAD DEBT 7077883 7077883 9577688 9577688 349531870 292148557 57383313 0 -943727 3618804 68381443 80558715 6781015 6233198 1333141 1006360 156976263 18005309 109017183 138970954 41942949 42451787 15248464 4216608 0 35142751 38947537 266380201 326526981 24052568 25668903 91848458 88803221 26155105 19733634 142056131 134205758 X 124324070 192321223 124324070 192321223 266380201 326526981 34716060 3419101 29861992 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6030000 6030000 99158442 5072639 94085803 621688 194938 426750 51166133 12737732 38428401 138970954 OTHER RECEIVABLES 3091925 DUE FROM THIRD-PARTY PAYORS 5142460 UNDER BOND INDENTURE AGREEMENTS HELD BY TRUST 2088162 TAX INCREMENT FINANCING BONDS HELD BY TRUSTEES 2208604 SELF INSURANCE FUNDING AGREEMENT 5752346 DUE FROM AFFILIATES 20450830 OTHER ASSETS 213210 38947537 INTEREST RATE SWAP AGREEMENT 5355609 RABBI TRUST LIABILITY 1276215 OTHER LIABILITIES 367331 DEFERRED REVENUE 12129 PENSION LIABILITY 6813065 SELF INSURANCE PROVISION 5909285 19733634 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, FHE, CMC, AND HFI, WHICH ARE CORPORATIONS SUBJECT TO INCOME TAX. THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2023. 1 1 1 X 0 1 1 0 0 1716403 0 1716403 0.00500 14067730 0 14067730 0.04110 15784133 15784133 0.04610 18109 2500 15609 0.00000 1441298 0 1441298 0.00420 1459407 2500 1456907 0.00420 17243540 2500 17241040 0.05030 0 7077883 53689777 58900478 -5210701 X 1 1 1 1 MONONGALIA GENERAL HOSPITAL 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 MONHEALTHSYS.COM 35 X X X MONONGALIA GENERAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X WWW.MONGENERAL.COM/MAIN/COMMUNITYHEALTH X 1 22 1 WWW.MONGENERAL.COM/MAIN/COMMUNITYHEALTH 0 1 X 200.000000000000 200.000000000000 X X X 1 1 X X X 1 X HTTPS://WWW.MONHEALTH.COM/MAIN/FINANCIAL-ASSISTANCE X HTTPS://WWW.MONHEALTH.COM/MAIN/FINANCIAL-ASSISTANCE X HTTPS://WWW.MONHEALTH.COM/MAIN/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X 1 X 0 0 MONONGALIA GENERAL HOSPITAL PART V, SECTION B, LINE 5: MON HEALTH PARTNERED WITH WEST VIRGINIA UNIVERSITY'S OFFICE OF HEALTH AFFAIRS (WVU OHA) TO COMPLETE THE CHNA USING A ROBUST COMMUNITYBASED PROCESS DESIGNED TO ENGAGE A BROAD REPRESENTATION OF COMMUNITY MEMBERS. A CHNA LEADERSIHP TEAM INCLUDING HOSPITAL AND COMMUNITY REPRESENTATION WAS CONVENED BY MHMC TO INFORM AND GUIDE THE PROCESS. FOR THE 2022 PROCESS, THREE ENTITIES WITHIN MONONGALIA COUNTY CAME TOGETHER TO COMPLETE THE COMMUNITY HEALTH NEEDS ASSSESSMENT PROCESS TOGETHER FOR THE FIRST TIME. MON HEALTH MEDICAL CENTER, IN PARTNERSHIP WITH WVU MEDICINE RUBY MEMORIAL HOSPITAL AND THE MONONGALIA COUNTY HEALTH DEPARTMENT, COLLABORATED TO DEVELOP A COOPERATIVE DATA COLLECTION EFFORT THAT WOULD HELP COLLECTIVELY MEET REPORTING REQUIREMENTS FOR EACH. DUE TO CLINIC AND CAMPUS LOCATIONS IN MONONGALIA COUNTY, THIS TEAM DEFINED THE COMMUNITY SERVED AS MONONGALIA AND MARIONCOUNTIES IN WEST VIRGINIA. TWO PRIMARY SOURCES OF DATA WERE UTILIZED TO INFORM THE CHNA: 1) A PUBLIC INPUT SURVEY AND 2) A DATA PRESENTATION SESSION WHERE INFORMATION WAS GATHERED FROM ATTENDEES. MONONGALIA GENERAL HOSPITAL PART V, SECTION B, LINE 6B: WEST VIRGINIA UNIVERSITY'S OFFICE OF HEALTH AFFAIRS (WVU OHA) MONONGALIA GENERAL HOSPITAL PART V, SECTION B, LINE 11: THOUGH COMMUNITY HEALTH NEEDS WERE IDENTIFIED, MANY NEEDS ARE OUTSIDE OF THE SCOPE OF SERVICES OFFERED BY MONONGALIA GENERAL HOSPITAL. FOR NEEDS WITHIN THE SCOPE OF MONONGALIA GENERAL HOSPITAL, THE BOARD AND ADMINISTRATION HAVE DEVELOPED AN IMPLEMENTATION STRATEGY. PART I, LINE 7: THE HOSPITAL USED A COST-TO-CHARGE RATIO DERIVED FROM MEDICARE COST REPORT FOR TOTAL PROGRAM COSTS AND TOTAL PROGRAM CHARGES TO ESTIMATE THE OVERALL COST-TO-CHARGE RATIO (CCR). THIS CCR WAS USED IN COMPUTATIONS FOR UNREIMBURSED MEDICAID AND CHARITY CARE. 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 $ 7,077,883. 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 COLLECTABILITY. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS MGH RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO THE PROVISION FOR BAD DEBT EXPENSE WHEN RECEIVED. INTEREST IS NOT CHARGED ON PATIENT ACCOUNTS RECEIVABLE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. THE COSTS ARE ALLOCATED TO THE VARIOUS DEPARTMENTS USING A STEP DOWN APPROACH AND REMOVING ANY COSTS THAT ARE NOT ALLOWABLE UNDER MEDICARE RULES. THE ORGANIZATION IS A TAX EXEMPT, NOT-FOR-PROFIT ENTITY THAT SERVES MONONGALIA AND SURROUNDING COUNTIES PATIENT POPULATION REGARDLESS OF THEIR MEANS TO PAY OR HEALTH INSURANCE STATUS. MEDICARE PATIENTS IN OUR SERVICE AREA DEPEND ON THE ORGANIZATION TO DELIVER THEIR HEALTH CARE AND MEET THEIR MEDICAL NEEDS REGARDLESS OF MEDICARE COVERAGE OF COST FOR PROVIDING THE NEEDED SERVICE. SINCE THE ORGANIZATION CONSTANTLY WORK TO OPERATE AS COST EFFICIENT AS POSSIBLE, WE FEEL STRONGLY THAT MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. PART III, LINE 9B: THERE ARE PROVISIONS IN THE DEBT COLLECTION POLICY TO BE FOLLOWED FOR PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. THE POLICY STATES THAT FINANCIAL ASSISTANCE SHALL BE OFFERED TO THE HOSPITAL'S UNINSURED AND UNDERINSURED PATIENTS ON A NONDISCRIMINATORY BASIS TO MEET THE NEED OF THE COMMUNITY. CHARITY CARE REQUESTS WILL BE REVIEWED AND EVALUATED BY THE CFO AND DIRECTOR OF PATIENT ACCOUNTING FOR APPROVAL. PATIENTS THAT QUALIFY FOR 100% CHARITY CARE ARE NOT PURSUED FOR COLLECTION. PART VI, LINE 2: THE CHNA PROCESS BEGAN WITH A THOROUGH REVIEW OF THE PREVIOUS CYCLE'S NEEDS ASSESSMENT REPORT, AND INCLUDED A REVIEW OF PUBLICLY AVAILABLE SECONDARY DATA RELATED TO COUNTIES WITHIN MON GENERAL'S SERVICE AREA. THESE DATA INCLUDED THE ABOVE U.S. CENSUS DATA AND COUNTY HEALTH RANKINGS DATA. USING THESE REPORTS AS A SPRINGBOARD, THE LEADERSHIP TEAM STARTED THE INITIAL DISCUSSION AROUND CRITICAL HEALTH NEEDS, CHANGES IN THE COMMUNITY DEMOGRAPHICS OVER THE PREVIOUS FEW YEARS, AND LESSONS LEARNED FROM THE LAST CHNA CYCLE'S HEALTH TOPIC PRIORITIZATION AND DEVELOPMENT OF IMPLEMENTATION ACTIVITIES. PRIMARY DATA COLLECTION WAS COMPRISED OF SURVEYING COMMUNITY MEMBERS TO GATHER PERCEPTIONS OF HEALTH ISSUES, QUALITY OF LIFE, AND OTHER RELATED TOPICS. SURVEY DATA WAS ANALYZED AND PRESENTED BACK TO THE MHMC LEADERSHIP TEAM AS WELL AS THE MONONGALIA COUNTY COLLABORATIVE TEAM AT A DATA PRESENTATION HOSTED VIRTUALLY. THIS EVENT WAS FOCUSED ON REVIEWING THE SURVEY DATA, DISCUSSING COMMUNITY ASSETS THAT IMPACT POPULATION HEALTH IN MHMC'S SERVICE AREA, AS WELL AS DISCUSSING THE NEEDS OF THOSE NOT WELL REPRESENTED IN THE SURVEY DATA. AT THIS MEETING, THE GROUP WORKED TO DISCUSS POSSIBLE STRATEGIES FOR EACH AREA OF CONCERN, AS WELL AS EXISTING RESOURCES TO ADDRESS THESE NEEDS. EACH ENTITY OF THE COLLABORATIVE TEAM FOCUSED ON RESOURCES SPECIFIC TO THEIR ORGANIZATION, BUT MANY OF THE PROGRAMS SERVE THE SAME COMMUNITY. THE COLLABORATIVE TEAM INTENDS TO MOVE FORWARD WITH AT LEAST ONE JOINT IMPLEMENTATION STRATEGY TO SERVE THEIR COMMUNITY AS A WHOLE. PART VI, LINE 3: THE PLAIN LANGUAGE SUMMARY OF THE FAP AND FAP APPLICATION ARE AVAILABLE ON THE HOSPITAL'S WEBSITE. PAPER COPIES OF THE FAP, PLAIN LANGUAGE SUMMARY OF THE FAP, AND FAP APPLICATION ARE AVAILABLE UPON REQUEST AND COPIES ARE IN THE EMERGENCY ROOM AND ADMISSIONS AREA. THE HOSPITAL HAS SIGNS THAT NOTIFY THE PATIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IN THE EMERGENCY ROOM AND ADMISSIONS AREA. UNINSURED PATIENTS ARE PROVIDED A PLAIN LANGUAGE SUMMARY AND FAP APPLICATION FORM. BILLING STATEMENTS INCLUDE A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN INFORMATION. THE HOSPITAL HAS FINANCIAL COUNSELORS AVAILABLE TO EDUCATE PATIENTS ON THE ELIGIBILITY OF ASSISTANCE. PART VI, LINE 4: FOR THE 2022 PROCESS, THREE ENTITIES WITHIN MONONGALIA COUNTY CAME TOGETHER TO COMPLETE THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS TOGETHER FOR THE FIRST TIME. MON HEALTH MEDICAL CENTER, IN PARTNERSHIP WITH WVU MEDICINE RUBY MEMORIAL HOSPITAL AND THE MONONGALIA COUNTY HEALTH DEPARTMENT, COLLABORATED TO DEVELOP A COOPERATIVE DATA COLLECTION EFFORT THAT WOULD HELP COLLECTIVELY MEET REPORTING REQUIREMENTS FOR EACH. DUE TO CLINIC AND CAMPUS LOCATIONS BEYOND MONONGALIA COUNTY, THIS TEAM DEFINED THE COMMUNITY SERVED AS MONONGALIA AND MARION COUNTIES IN WEST VIRGINIA. PART VI, LINE 5: THE HOSPITAL HAS AN OPEN MEDICAL STAFF SERVING A MULTITUDE OF SPECIALTIES. THE BOARD OF DIRECTORS IS COMPRISED OF VARIOUS MEMBERS OF THE COMMUNITY AS REQUIRED UNDER ITS BYLAWS. THE ORGANIZATION SPONSORS AN ANNUAL HEALTH FAIR AT THE LOCAL MALL, IN WHICH THOUSANDS OF CITIZENS FROM THE LOCAL COMMUNITY COME TO LEARN ABOUT SERVICES OFFERED AND ARE PROVIDED THE OPPORTUNITY TO RECEIVE MULTIPHASIC BLOODWORK FOR A NOMINAL FEE. PART VI, LINE 6: THE HOSPITAL IS PART OF MONONGALIA HEALTH SYSTEM, INC. WHICH INCLUDES THE FOLLOWING OTHER HEALTH CARE ENTITIES IN THE COMMUNITY: MON HEALTH MARION NEIGHBORHOOD HOSPITAL, MON ELDER SERVICES, INC. DBA THE VILLAGE AT HERITAGE POINT, MON HEALTH CARE, INC., PRESTON MEMORIAL HOSPITAL, PRESTON MEMORIAL MEDICAL GROUP, AND STONEWALL JACKSON MEMORIAL HOSPITAL. MON HEALTH MARION NEIGHBORHOOD HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL. MON ELDER SERVICES, INC. IS A NOT-FOR-PROFIT RESIDENTIAL AND ASSISTED LIVING PROVIDER. MON HEALTH CARE, INC. IS A FOR-PROFIT DURABLE MEDICAL EQUIPMENT RETAILER. PRESTON MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL. PRESTON MEMORIAL MEDICAL CENTER GROUP IS A NOT-FOR-PROFIT ENTITY WHICH PROVIDES PRIMARY AND URGENT CARE. STONEWALL JACKSON MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL. IN 2022 THE MON HEALTH SYSTEM AND CHARLESTON AREA MEDICAL CENTER HEALTH SYSTEM MERGED TO FORM A NEW SYSTEM NAMED VANDALIA HEALTH. PART VI, LINE 7, REPORTS FILED WITH STATES WV 0 1 0 0 0 0 0 0 0 WILLIAM MCBEE JR MD DIRECTOR, CHIEF OF STAFF 1250000 0 865889 0 0 0 45000 0 5841 0 2166730 0 0 0 IHTISHAAM QAZI PHYSICIAN 605651 0 280321 0 200000 0 22500 0 6615 0 1115087 0 0 0 JASCHAR SHAKURI-RAD PHYSICIAN 868431 0 104592 0 100000 0 22500 0 7733 0 1103256 0 0 0 ALEXANDER NAGY PHYSICIAN 1000002 0 8709 0 0 0 52500 0 6904 0 1068115 0 0 0 KRISHNA BINGI PHYSICIAN 764648 0 103420 0 0 0 41600 0 7925 0 917593 0 0 0 DAVID GOLDBERG DIRECTOR & MHS CEO 0 714488 0 139175 0 0 0 30000 0 6373 0 890036 0 0 SALAM SBAITY PHYSICIAN 747117 0 81612 0 0 0 22500 0 2503 0 853732 0 0 0 JOSEPH BLATT MD DIRECTOR/CHIEF OF STAFF 362077 0 34878 0 0 0 18704 0 3629 0 419288 0 0 0 KRYSTAL ATKINSON DIRECTOR & MHMC CAO 0 342455 0 33782 0 0 0 23972 0 6404 0 406613 0 0 KEVIN GESSLER VP OF FINANCE 0 227811 0 20438 0 0 0 0 0 1153 0 249402 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, LINE 4B 457(F) INELIGIBLE DEFERRED COMPENSATION PLAN - A 457 F PLAN IS OFFERED TO CERTAIN MANAGEMENT AND/OR HIGHLY COMPENSATED EMPLOYEES TO OFFER THOSE EMPLOYEES A DEFERRED COMPENSATION OPPORTUNITY. THE PLAN IS INTENDED TO BE A "TOP-HAT PLAN", OR UNFUNDED DEFERRED COMPENSATION PLAN MAINTAINED FOR A SELECT GROUP OF EMPLOYEES. PARTICIPANTS MAY BECOME VESTED IN AMOUNTS CREDITED ON JANUARY 1 ELECTED BY THE PARTICIPANT AT THE TIME THE INITIAL DEFERRAL WAS ELECTED. A PARTICIPANT SHALL BECOME FULLY VESTED UPON DEATH, DISABILITY, ATTAINMENT OF AGE 60, OR SEPARATION OF SERVICE, AS DEFINED BY THE PLAN. ANY UNVESTED CONTRIBUTIONS SHALL BE FORFEITED TO THE PLAN OR EMPLOYER. FOR 2023: PER BENEFITS - NO DISTRIBUTIONS / PAYMENTS WERE MADE FROM THE PLAN; DAVID GOLDBERG WAS THE ONLY PARTICIPANT A MONONGALIA COUNTY BUILDING COMMISSION 550714648 000000000 2021-06-30 6649397 REFUND BONDS ISSUED 4/20/2011 0 0 0 B MONONGALIA COUNTY BUILDING COMMISSION 550714648 000000000 2019-07-01 34250000 REFUND BONDS ISSUED 3/28/12 0 0 0 C MONONGALIA COUNTY BUILDING COMMISSION 550714648 610218BN8 2015-04-28 55725495 REFUND BONDS ISSUED 6/15/2005 AND TO FINANCE CERTAIN CAPITAL PROJECTS 0 0 0 A 637495 6649397 66991 6582406 1 0 1 1 B 395000 34250000 34250000 1 0 1 1 C 12740000 51450000 776600 5198733 49750162 2016 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 0 C 0 0 0 1 0 0 0 0 0 A 1 B 1 C 1 EARNINGS FOR 2015 PROJECT FUND COLUMN C: DIFFERENCES BETWEEN THE ISSUE PRICE (PART 1) AND THE TOTAL PROCEEDS (PART II, LINE 3) ARE DUE TO INVESTMENT EARNINGS REBATE CALCULATION DATE OF REBATE CALCULATION FOR 2015 BONDS IS X DISH MACHINE 1 137695 FMV X MISC. EQUIPMENT 1 32592 FMV X MISC. DONATION 1 1970 FMV 0 0 0 0 PART I, COLUMN (B): THE NUMBERS ABOVE REPRESENT THE NUMBER OF CONTRIBUTORS THAT CONTRIBUTED THE ITEMS TO MON COUNTY GENERAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MONONGALIA COUNTY GENERAL HOSPITAL IS MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A MONONGALIA COUNTY GENERAL HOSPITAL'S BOARD MEMBERS ARE ELECTED OR APPOINTED BY MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B MONONGALIA COUNTY GENERAL HOSPITAL'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 HOSPITAL OR THE BYLAWS; (B) SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF THE HOSPITAL AND ANY EXPENDITURE IN EXCESS OF $750,000; (C) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (D) ELECTION TO DISSOLVE THE HOSPITAL ENTITY; (E) APPROVAL OF THE BUDGET OF THE HOSPITAL' (F) APPROVAL IN ADVANCE OF THE HIRING OF THE PRESIDENT TO THE HOSPITAL. 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 ASKED 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 MEMBER SHALL NOT PARTICIPATE IN. 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 EXECUTIVE CEO COMPENSATION. THIS REPORT IS THEN REVIEWED BY THE EXECUTIVE COMMITTEE TO DETERMINE COMPENSATION FOR THE INDIVIDUAL. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE KEPT ONSITE AT MONONGALIA GENERAL HOSPITAL 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 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 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