2025-11-17T18:37:25-06:00 2024-12-31 861065772 DELOITTTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 46204 990 2024-01-01 550689535 LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM LIAB 3045981242 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 JEFF SANDENE EXECUTIVE VP AND CFO 3045981242 2025-11-17 1 1 ANGELA M MOORE P00244342 3174648600 2024 2025-03-06 01:10:19Z DAVID S GOLDBERG 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 6703991 0 X N/A X 1989 WV PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATIONS OF THE RISK MANAGEMENT DIVISION. 1 0 0 0 0 0 0 0 1985321 2391233 -61297 170506 0 0 1924024 2561739 0 0 0 0 261217 281536 0 0 0 4390999 3633777 4652216 3915313 -2728192 -1353574 5752346 4626403 0 0 5752346 4626403 PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATION OF THE RISK MANAGEMENT DIVISION. 0 0 3915313 2391233 PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATION OF THE RISK MANAGEMENT DIVISION. 3915313 1 0 0 0 0 0 0 0 0 0 0 0 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 1 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 - MANAGING ACCOUNTANT 3042853676 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 DAVID GOLDBERG PRESIDENT/CEO 1.00 57.00 X X 0 996584 51139 HUNTINGTON BANK TRUSTEE 1.00 0.00 X 24080 0 0 24080 996584 51139 0 0 1 0 0 REPLENISH TRUST FUND 900099 2391233 2391233 2391233 183017 183017 4129741 4142252 -12511 -12511 -12511 2561739 2391233 0 170506 24080 24080 257456 257456 48 48 2821527 2821527 SETTLEMENTS 812202 812202 3915313 3915313 0 0 208023 100843 5544323 4525560 5752346 4626403 0 0 X 5752346 4626403 5752346 4626403 5752346 4626403 -1353574 227631 0 X 0 0 0 X X 1 MONONGALIA COUNTY GENERAL HOSPITAL CO 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 1 0 0 0 0 0 0 0 DAVID GOLDBERG PRESIDENT/CEO 0 736828 0 241048 0 18708 0 13800 0 37339 0 1047723 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 2024: PER BENEFITS- NO DISTRIBUTIONS /PAYMENTS WERE MADE FROM THE PLAN; DAVID GOLDBERG WAS THE ONLY PARTICIPANT. 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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