STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY (EIN 55-0422958)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-11
- IRS object ID
- 202301319349301315
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-11T09:13:06-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 WASHINGTON STREET EAST | AddressLine1Txt |
| City | CHARLESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25301 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550422958 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STONEWALL JACKSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STON | BusinessNameControlTxt |
| Phone | 3042698059 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 HOSPITAL PLAZA | AddressLine1Txt |
| City | WESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF SANDENE | PersonNm |
| Person Title | EXECUTIVE VP AND CFO | PersonTitleTxt |
| Phone | 3042698059 | PhoneNum |
| Signature | 2023-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEFF | PersonFirstNm |
| Person Last | SANDENE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFFREY J PETRELL | PreparerPersonNm |
| PTIN | P00138808 | PTIN |
| Phone | 3043460441 | PhoneNum |
| Preparation | 2023-05-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID GOLDBERG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 HOSPITAL PLAZA | AddressLine1Txt |
| City | WESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $55,777,504 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STONEWALLHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 482 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $2,758 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $1,646 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,131,388 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,329,471 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $49,400,261 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $51,600,801 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,262,429 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,258,032 | CYInvestmentIncomeAmt |
| PY Other Revenue | $230,140 | PYOtherRevenueAmt |
| CY Other Revenue | $561,550 | CYOtherRevenueAmt |
| PY Total Revenue | $59,024,218 | PYTotalRevenueAmt |
| CY Total Revenue | $55,749,854 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,820 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $14,023 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,782,276 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,467,067 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,569,351 | PYOtherExpensesAmt |
| CY Other Expenses | $31,904,835 | CYOtherExpensesAmt |
| PY Total Expenses | $52,357,447 | PYTotalExpensesAmt |
| CY Total Expenses | $57,385,925 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,666,771 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,636,071 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $76,538,179 | TotalAssetsBOYAmt |
| Total Assets EOY | $65,282,027 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,241,625 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,844,619 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $59,296,554 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $52,437,408 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $48,185,587 | ExpenseAmt |
| Revenue | $52,116,663 | RevenueAmt |
| Desc | STONEWALL JACKSON MEMORIAL HOSPITAL PROVIDES ACUTE MEDICAL AND OUTPATIENT SERVICES TO RESIDENTS OF WESTON, WEST VIRGINIA AND SURROUNDING COMMUNITIES WHICH COVERS 10 DIFFERENT COUNTIES. SERVICES INCLUDED 5,515 DAYS OF INPATIENT CARE, 76,177 OUTPATIENT VISITS, 12,135 EMERGENCY ROOM VISITS, 2,033 AMBULATORY SURGERY VISITS, AND 30,494 PHYSICIAN CLINIC VISITS. THE HOSPITAL HAD 155 DELIVERIES DURING THE YEAR IN WHICH APPROXIMATELY 69% WERE MEDICAID PATIENTS. MANY OF THESE BABIES HAD SIGNIFICANT SUBSTANCE ABUSE PROBLEMS. DUE TO THE DRUG ADDICTION PROBLEMS OF THE MOTHERS, VERY FEW OF THESE WOMEN HAVE RECEIVED PRENATAL CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $14,023 | ExpenseAmt |
| Grant | $14,023 | GrantAmt |
| Desc | ANNUAL BLOOD SCREENING: STONEWALL JACKSON MEMORIAL HOSPITAL PROVIDES ALL SUPPLIES AND STAFF TO OPERATE THE PROGRAM. A PORTION OF THE EXCESS REVENUE IS FORWARDED TO THE LOCAL ROTARY CLUB TO PROMOTE CHARITABLE SERVICES. OTHER PROGRAMS INCLUDE: SCOLIOSIS SCREENING AT COUNTY ELEMENTARY AND MIDDLE SCHOOLS, HEALTH FAIRS AT THE LOCAL SENIOR CITIZENS CENTER, FREE SPORTS PHYSICALS TO MIDDLE AND HIGH SCHOOL STUDENTS, CHILDREN'S SAFETY DAY TO PROMOTE HEALTHY CHOICES TO CHILDREN UNDER 12 YEARS OF AGE, EVENTS FOR FREE OSTEOPOROSIS SCREENINGS, EVENTS FOR FREE DERMASCANS TO SCREEN FOR SKIN CANCER, WESTON WALK-RUN TO PROMOTE EXERCISE AS A WAY TO IMPROVE CARDIAC HEALTH, FREE WOMEN'S HEALTH SCREENING FOR BREAST AND CERVICAL CANCER, FREE VEIN SCREENINGS AND FREE HEARING SCREENINGS. REVENUE AND EXPENSES ARE INCLUDED IN LINE 4A ABOVE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | WILLIAM ADLER SCHOLARSHIP FUND - STONEWALL JACKSON MEMORIAL HOSPITAL SPONSORED PROGRAM TO PROVIDE SCHOLARSHIPS TO LOCAL GRADUATING HIGH SCHOOL SENIORS WHO ARE PURSUING A CAREER IN THE HEALTH CARE FIELD. IT IS HOPED THAT THIS PROGRAM WILL ENCOURAGE MORE STUDENTS TO SEEK HEALTH CARE PROFESSIONS AND LESSON THE HEALTH CARE STAFFING SHORTAGE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $48,199,610 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 181 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 482 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICK SCHERICH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3042698059 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 HOSPITAL PLAZA | AddressLine1Txt |
| City | WESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 264528558 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| ROBIN POLING | |||||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| C GREGORY CUNNINGHAM | |||||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| KIMBERLY GUM | |||||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| DAVID GOLDBERG | |||||||||
| PRESIDENT/CEO MONHEALTH | 1.00 | Yes (X) | Yes (X) | $0 | $804,616 | $112,875 | 49.00 | ||
| KEVIN STALNAKER | |||||||||
| EXECUTIVE/CAO | 50.00 | Yes (X) | Yes (X) | $0 | $243,608 | $26,156 | |||
| JOHN LAW CPA | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| DOYLE SICKLES MD | |||||||||
| DIRECTOR, PHYSICIAN | 40.00 | Yes (X) | $574,496 | $0 | $50,059 | ||||
| GREGORY ST CLAIR | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOSEPH SNEAD MD | |||||||||
| DIRECTOR | 23.00 | Yes (X) | $297 | $0 | $0 | ||||
| R GERALD WOOD RPH | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| AMY PEARSON MD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| ALISSA LAMBERT | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| GEORGE STANSBURY | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| RICK SCHERICH | |||||||||
| VP FINANCE | 25.00 | Yes (X) | $0 | $211,719 | $26,017 | 25.00 | |||
| LISA SIMON CPA | |||||||||
| CFO MONHEALTH | 1.00 | Yes (X) | $0 | $422,632 | $55,782 | 49.00 | |||
| JEFF CRUDELE | |||||||||
| INTERIM CFO | 1.00 | Yes (X) | $0 | $275,000 | $0 | 49.00 | |||
| MICHAEL GREGORY DO | |||||||||
| PHYSICIAN | 40.00 | $526,665 | $0 | $75,431 | Yes (X) | ||||
| RONALD PEARSON MD | |||||||||
| PHYSICIAN | 40.00 | $638,812 | $0 | $58,724 | Yes (X) | ||||
| ROBERT HARRIS MD | |||||||||
| PHYSICIAN OB | 40.00 | $690,694 | $0 | $66,047 | Yes (X) | ||||
| TYLER HALL MD | |||||||||
| ED PHYSICIAN | 40.00 | $431,278 | $0 | $47,657 | Yes (X) | ||||
| THOMAS WALSH | |||||||||
| PHYSICIAN | 40.00 | $337,427 | $0 | $9,125 | Yes (X) | ||||
| AVAH STALNAKER | |||||||||
| FORMER CEO, SJMH | 0.00 | $0 | $291,370 | $0 | 0.00 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,199,669 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,248,945 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $527,873 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 27 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| QUALIVIS | |||||
| 5930 CORNERSTONE COURT WEST SUITE | SAN DIEGO | CA | 92121 | CONTRACT NURSES | $1,247,880 |
| SODEXO INC & AFFILIATES | |||||
| PO BOX 536922 | ATLANTA | GA | 50353 | MAINTENANCE & DIETARY SERVICES | $498,618 |
| LEXX HEALTHCARE | |||||
| 9600 WEST SAMPLE R SUITE 300 | CORAL SPRINGS | FL | 33065 | CONTRACT PHYSICIANS | $440,819 |
| BEACH MEDICINE LLC | |||||
| 653 SAM SNEAD LANE | VIRGINIA BEACH | VA | 23462 | CONTRACT PHYSICIANS | $387,691 |
| UNIFORMED PHYSICIANS LLC | |||||
| 110 JAMES ST | HINTON | WV | 25951 | CONTRACT PHYSICIANS | $326,823 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $14,023 | FundraisingAmt |
| Government Grants | $2,239,744 | GovernmentGrantsAmt |
| All Other Contributions | $75,704 | AllOtherContributionsAmt |
| Total Contributions | $2,329,471 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICES | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $51,600,801 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $51,600,801 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $51,600,801 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $926,452 | TotalRevenueColumnAmt |
| Exclusion | $926,452 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,728 | RealAmt |
| Personal | $2,758 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $11,267 | RealAmt |
| Personal | $0 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,461 | RealAmt |
| Personal | $2,758 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,219 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $2,758 | UnrelatedBusinessRevenueAmt |
| Exclusion | $28,461 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $331,580 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $331,580 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $331,580 | TotalRevenueColumnAmt |
| Exclusion | $331,580 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $30,852 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $14,023 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $16,383 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,469 | TotalRevenueColumnAmt |
| Exclusion | $14,469 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OTHER REVENUE | 900099 | $422,690 | $422,690 |
| CAFETERIA | 722310 | $93,172 | $93,172 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $515,862 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $55,749,854 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $52,116,663 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,758 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,300,962 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,023 | TotalAmt |
| Program Services | $14,023 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,034,338 | TotalAmt |
| Program Services | $18,796,284 | ProgramServicesAmt |
| Management And General | $2,238,054 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $439,643 | TotalAmt |
| Program Services | $392,865 | ProgramServicesAmt |
| Management And General | $46,778 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,671,362 | TotalAmt |
| Program Services | $2,387,129 | ProgramServicesAmt |
| Management And General | $284,233 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,321,724 | TotalAmt |
| Program Services | $1,181,093 | ProgramServicesAmt |
| Management And General | $140,631 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,656,898 | TotalAmt |
| Management And General | $4,656,898 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,000 | TotalAmt |
| Management And General | $10,000 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,179 | TotalAmt |
| Management And General | $84,179 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,046,086 | TotalAmt |
| Program Services | $7,189,983 | ProgramServicesAmt |
| Management And General | $856,103 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,442 | TotalAmt |
| Program Services | $2,182 | ProgramServicesAmt |
| Management And General | $260 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,589,530 | TotalAmt |
| Program Services | $1,420,404 | ProgramServicesAmt |
| Management And General | $169,126 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,447,178 | TotalAmt |
| Program Services | $1,293,198 | ProgramServicesAmt |
| Management And General | $153,980 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $905,349 | TotalAmt |
| Program Services | $809,020 | ProgramServicesAmt |
| Management And General | $96,329 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,957 | TotalAmt |
| Program Services | $41,961 | ProgramServicesAmt |
| Management And General | $4,996 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,033 | TotalAmt |
| Program Services | $17,008 | ProgramServicesAmt |
| Management And General | $2,025 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,298,714 | TotalAmt |
| Program Services | $1,160,531 | ProgramServicesAmt |
| Management And General | $138,183 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $520,161 | TotalAmt |
| Program Services | $464,816 | ProgramServicesAmt |
| Management And General | $55,345 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $8,040,837 | $8,040,837 | |
| BAD DEBTS | $2,203,398 | $2,203,398 | |
| REPAIRS AND MAINTENANCE | $1,032,422 | $922,572 | $109,850 |
| MEDICAID PROVIDER TAX | $798,746 | $798,746 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,202,905 | TotalAmt |
| Program Services | $1,063,560 | ProgramServicesAmt |
| Management And General | $139,345 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,385,925 | TotalAmt |
| Program Services | $48,199,610 | ProgramServicesAmt |
| Management And General | $9,186,315 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,029,198 | BOYAmt |
| EOY | $7,198,303 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,266,160 | BOYAmt |
| EOY | $1,521,551 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,354,778 | BOYAmt |
| EOY | $4,429,380 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,113,159 | BOYAmt |
| EOY | $1,062,123 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,777 | BOYAmt |
| EOY | $62,277 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $53,994,061 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $42,975,794 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,131,365 | BOYAmt |
| EOY | $11,018,267 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,013,803 | BOYAmt |
| EOY | $35,067,261 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $658,833 | BOYAmt |
| EOY | $509,260 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,882,106 | BOYAmt |
| EOY | $4,413,605 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,538,179 | BOYAmt |
| EOY | $65,282,027 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,512,314 | BOYAmt |
| EOY | $8,769,790 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,935,306 | BOYAmt |
| EOY | $2,987,879 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,794,005 | BOYAmt |
| EOY | $1,086,950 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,241,625 | BOYAmt |
| EOY | $12,844,619 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,766,444 | BOYAmt |
| EOY | $52,006,790 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $530,110 | BOYAmt |
| EOY | $430,618 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,296,554 | BOYAmt |
| EOY | $52,437,408 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,538,179 | BOYAmt |
| EOY | $65,282,027 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,636,071 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$6,470,601 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $1,247,526 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $4,478 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $4,478 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF DUES PAID BY THE HOSPITAL TO THE AMERICAN HOSPITAL ASSOCATION AND THE WEST VIRGINIA HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,149,601 | OtherCostOrOtherBasisAmt |
| Book Value | $7,149,601 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,403,703 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,470,122 | DepreciationAmt |
| Book Value | $933,581 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,539,377 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,505,672 | DepreciationAmt |
| Book Value | $2,033,705 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $901,380 | OtherCostOrOtherBasisAmt |
| Book Value | $901,380 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,018,267 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $188,302 |
| DUE FROM STONEWALL HOME OXYGEN THERAPY | $563,786 |
| ESTIMATED THIRD PARTY SETTLEMENTS | $1,717,767 |
| INSURANCE RECOVERIES RECEIVABLES | $856,800 |
| OPERATING LEASE - RIGHT OF USE ASSET | $1,086,950 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,413,605 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE - RIGHT OF USE | Desc |
| Amt | $1,086,950 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,086,950 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HEALTH SYSTEM FOLLOWS THE FASB'S AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVIDUAL TAX POSITIONS IN THE CONSOLIDATED FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HEALTH SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST. GENERALLY, TAX RETURNS FOR YEARS ENDED JUNE 30, 2019, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | ROTARY BLOOD SCREENING | Event1Nm |
| Gross Receipts Event1 | $44,875 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $14,023 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $30,852 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $16,383 | RentFacilityCostsEvent1Amt |
| Gross Receipts Total | $44,875 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $14,023 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $30,852 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $16,383 | RentFcltyCostsTotalEventsAmt |
| Direct Expense Summary Events | $16,383 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $14,469 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $510,314 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $510,314 | DirectOffsettingRevenueAmt |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,137,566 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,019,257 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,118,309 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03840 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,647,880 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,529,571 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,118,309 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03840 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,023 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,023 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,023 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,023 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,661,903 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,529,571 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,132,332 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03870 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,203,398 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,902,428 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,514,063 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$611,635 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STONEWALL JACKSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 HOSPITAL PLAZA | AddressLine1Txt |
| City | WESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STONEWALL JACKSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.STONEWALLJACKSONHOSPITAL.COM/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.STONEWALLJACKSONHOSPITAL.COM/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| STONEWALL JACKSON MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE INFORMATION FOR THE LEWIS COUNTY AND GILMER COUNTY COMMUNITY ASSESSMENTS BEGAN IN THEWINTER OF 2022 AND ENDED IN MAY 2022, WITH THE IMPLEMENTATION OF A SURVEY MONKEY SURVEY 270 RESIDENTS PARTICIPATED. THIS WAS THE FIRST PHASE OF THE ASSESSMENT. IN MAY 2022, A STAFF MEMBER FROM MON HEALTH STONEWALL JACKSON MEMORIAL HOSPITAL COORDINATED FOCUS GROUPS IN EACH COUNTY. EACH OF THE FOCUS GROUP MEMBERS WERE PROVIDED THE SURVEY MONKEY RESULTS AND OTHER NATIONAL SURVEYS ON WEST VIRGINIA HEALTH STATISTICS. THIS ASSESSMENT IS THE FOURTH ONE CREATED BY SJMH IN COOPERATION WITH THE LEWIS COUNTY HEALTH DEPARTMENT. THIS IS THE SECOND THAT SJMH COOPERATED WITH THE GILMER COUNTY HEALTH DEPARTMENT IN CREATING AN ASSESSMENT FOR THAT COUNTY. |
| STONEWALL JACKSON MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: LEWIS COUNTY HEALTH DEPARTMENT AND GILMER COUNTY HEALTH DEPARTMENT |
| STONEWALL JACKSON MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: DRUG ABUSE WAS THE NUMBER ONE HEALTH CONCERN OF THE RESIDENTS. THE OTHER CONCERNS IN ORDER OF IMPORTANCE: OBESITY, MENTAL HEALTH ISSUES, HEART DISEASE, AND DIABETES. TO COMBAT DRUG ABUSE, A RECOVERY CENTER HAS OPENED IN GLENVILLE (GILMER COUNTY) WITH A CAPACITY FOR TWENTY RESIDENTS. IT IS A LONG-TERM (AT LEAST ONE YEAR) PROGRAM. MON HEALTH SJMH HAS OPENED A MEDICAL ASSISTANCE TREATMENT (MAT) PROGRAM FOR RESIDENTS, ALONG WITH THE MON HEALTH SYSTEM'S RECOVERY PROGRAMS AT EACH MON HOSPITAL FOR SUBSTANCE USAGE ADDICTION. THE LEWIS COUNTY HEALTH DEPARTMENT CREATED A HARM REDUCTION PROGRAM WITH SUPPORT FROM SJMH. NURSING STAFF AT SJMH IS REQUIRED TO COMPLETE CONTINUING EDUCATION ON "DRUG DIVERSION EDUCATION ON OPIATES."STRATEGIES FOR COMBATTING OBESITY AND PROMOTING PHYSICAL ACTIVITY INCLUDE A VARIETY OF PLAYGROUNDS AND WALKING TRAILS; A SCHOOL-BASED HEALTH CENTER AT THE HIGH SCHOOL AND ELEMENTARY SCHOOL; PHYSICAL ACTIVITIES AVAILABLE AT THE WACO CENTER AND VARIOUS OTHER LOCATIONS. SJMH HAS AN ADULT FITNESS PROGRAM, WHICH IS CONDUCTED TUESDAYS AND THURSDAYS IN THE MORNING IN THE STONEWALL JACKSON MEMORIAL HOSPITAL CARDIAC REHAB DEPARTMENT. THIS IS A VERY LOW-COST WAY TO MODIFY RISK FACTORS.STRATEGIES FOR COMBATTING HEART DISEASE INCLUDE THE GILMER COUNTY HEALTH DEPARTMENT SCREENING AVAILABLE ONSITE; THE SJMH CARDIAC DEPARTMENT PROVIDES COMMUNITY EDUCATION REGARDING HEART DISEASE; SJMH PROVIDES SCREENINGS THROUGHOUT THE YEAR FOR BLOOD PRESSURE, BLOOD GLUCOSE, PULSE OXIMETRY, ETC.STRATEGIES FOR COMBATING DIABETES INCLUDES 3 COMPREHENSIVE BLOOD SCREENINGS EACH YEAR IN COOPERATION WITH THE WESTON ROTARY CLUB; THE HEALTH DEPARTMENTS PROVIDE VERY LOW-COST SCREENINGS FOR THE PUBLIC DURING OFFICE HOURS; THE NURSE DIRECTOR CAN PROVIDE NUTRITIONAL EDUCATION; SJMH TRAINED A DIETITIAN AND NURSE TO CONDUCT DIABETES EDUCATION CLASSES. |
| PART V, LINE 16A | LINK FOR FINANCIAL ASSISTANCE POLICY:HTTPS://WWW.STONEWALLJACKSONHOSPITAL.COM/DOCS/2021FINANCIAL_ASSISTANCE_POLICY.PDF |
| PART V, LINE 16B | LINK FOR FINANCIAL ASSISTANCE APPLICATION:HTTPS://WWW.STONEWALLJACKSONHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_022023.PDF |
| PART V, LINE 16C | LINK TO FAP PLAIN LANGUAGE SUMMARY:HTTPS://WWW.STONEWALLJACKSONHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_022023.PDF |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE HEALTH RESOURCES AND SERVICES ADMINISTRATION ELIGIBILITY GUIDELINES ARE USED. WE ALSO EVALUATE THE PATIENT'S ASSETS AND THE AMOUNT OF MEDICAL DEBT. WE HAVE SIGNS POSTED AT REGISTRATION, AROUND AND IN THE EMERGENCY DEPARTMENT AND IN ALL PHYSICIAN CLINICS. WE SEND LETTERS TO PATIENTS WHO ARE NOT PAYING THEIR BILLS AND GIVE THE APPLICATION TO PRIVATE PAY INPATIENTS. WE ALSO TELL THE PATIENTS DURING TELEPHONE CONVERSATIONS IF THE PATIENT INDICATES HE/SHE IS NOT ABLE TO PAY THE BILL OR PAY ALL OF THE BILL. |
| PART I, LINE 7: | THE COST OF CHARITY CARE WAS ESTIMATED USING A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS.THE UNREIMBURSED COST OF MEDICAID WAS ESTIMATED USING A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. |
| 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 $ 2,203,398. |
| PART III, LINE 2: | BAD DEBT EXPENSE AS REPORTED ON AUDITED FINANCIAL STATEMENTS |
| 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. MANAGEMENT ALSO REVIEWS TROUBLED, AGED ACCOUNTS TO DETERMINE COLLECTION POTENTIAL. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO BAD DEBT EXPENSE WHEN RECEIVED. INTEREST IS NOT CHARGED ON PATIENT ACCOUNTS RECEIVABLE. |
| PART III, LINE 8: | THE MEDICARE COST REPORT WAS USED TO DETERMINE REVENUE ALLOWABLE COSTS ASSOCIATED WITH THE REVENUE. |
| PART III, LINE 9B: | OUR COLLECTIONS POLICY APPLIES TO ALL PATIENTS REGARDLESS OF FINANCIAL CLASS OR ANY OTHER CLASSIFICATION. DURING OUR COLLECTIONS PROCESS, IF THE PATIENT INDICATES THEY DO NOT HAVE THE ABILITY TO PAY THEIR BILL, THE CREDIT STAFF OFFERS EXONERATION. |
| PART VI, LINE 2: | THE ASSESSMENT WAS CONDUCTED IN THREE PHASES: THE FIRST PHASE WAS ATTAINING BACKGROUND INFORMATION ON THE HEALTHCARE PROBLEMS OF THE LOCAL AREA AND STATE. THE SECOND PHASE WAS A SURVEY CONDUCTED ONLINE AND BY PAPER. THE LAST PHASE WAS A FOCUS GROUP CONDUCTED BY AN EXPERIENCED MEDIATOR. |
| PART VI, LINE 3: | WE HAVE SIGNS POSTED AT REGISTRATION, AROUND AND IN THE EMERGENCY DEPARTMENT, AND IN ALL PHYSICIAN CLINICS. WE SEND LETTERS TO PATIENTS WHO ARE NOT PAYING THEIR BILLS. WE GIVE THE APPLICATION TO PRIVATE PAY INPATIENTS. WE TELL THE PATIENTS DURING TELEPHONE CONVERSATIONS, IF THE PATIENT INDICATES HE/SHE IS NOT ABLE TO PAY THE BILL OR PAY ALL OF THE BILL. |
| PART VI, LINE 4: | STONEWALL JACKSON MEMORIAL HOSPITAL SERVES A RELATIVELY LARGE RURAL POPULATION OF ABOUT 65,000 PEOPLE WITH AN AVERAGE HOUSEHOLD INCOME OF $32,000. 30% OF THE POPULATION IS DISABLED. APPROXIMATELY 30% ARE MEDICAID ELIGIBLE OR ARE UNINSURED. WE ARE THE LARGEST HOSPITAL IN OUR SERVICE AREA, WHICH INCLUDES TWO OTHER HOSPITALS, ONE BEING A CRITICAL ACCESS HOSPITAL. WE ARE LOCATED IN A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. |
| PART VI, LINE 5: | STONEWALL JACKSON MEMORIAL HOSPITAL (SJMH) IS A 70 BED RURAL ACUTE CARE HOSPITAL LOCATED IN LEWIS COUNTY WEST VIRGINIA. SJMH IS THE ONLY HOSPITAL LOCATED IN THE COUNTY AS SUCH IT IS SOLELY RESPONSIBLE FOR THE HEALTHCARE OF THIS RURAL COMMUNITY. SJMH PROVIDES A 24 HOUR EMERGENCY ROOM AND OBSTETRICS SERVICES AND PROVIDES CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE MAJORITY OF THE GOVERNING BODY IS COMPRISED OF COMMUNITY MEMBERS. MEDICAL PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND SJMH HAS WORKED DILIGENTLY TO PROVIDE OTHER PHYSICIAN SERVICES BY EXPANDING THE SERVICES THEY PROVIDE.SJMH CONTINUES TO MAKE CAPITAL IMPROVEMENT TO THE FACILITY AND EXPAND PATIENT CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY. |
| PART VI, LINE 6: | THE HOSPITAL IS PART OF MONONGALIA HEALTH SYSTEM, INC. WHICH INCLUDES THE FOLLOWING OTHER HEALTH CARE ENTITIES IN THE COMMUNITY: MONONGALIA COUNTY GENERAL HOSPITAL, MON HEALTH MARION NEIGHBORHOOD HOSPITAL, MON ELDER SERVICES, INC. DBA THE VILLAGE AT HERITAGE POINT, MON HEALTH CARE, INC., PRESTON MEMORIAL HOSPITAL, AND PRESTON MEMORIAL MEDICAL GROUP, 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 URGERT CARE. MONONGALIA COUNTY GENERAL HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROTARY CLUB OF WESTON | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 222 | AddressLine1Txt |
| City | WESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 550371556 | RecipientEIN |
| IRC Section | 501(C)4 | IRCSectionDesc |
| Cash Grant | $14,023 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | TO HELP THE ROTARY SUPPORT VARIOUS CHILDREN'S PROGRAMS IN LEWIS COUNTY. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 0 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID GOLDBERG | ||||||||||||||
| PRESIDENT/CEO MONHEALTH | $0 | $565,581 | $0 | $115,644 | $0 | $123,391 | $0 | $112,875 | $0 | $0 | $0 | $917,491 | $0 | $0 |
| ROBERT HARRIS MD | ||||||||||||||
| PHYSICIAN OB | $378,399 | $0 | $249,408 | $0 | $62,887 | $0 | $19,500 | $0 | $46,547 | $0 | $756,741 | $0 | $0 | $0 |
| RONALD PEARSON MD | ||||||||||||||
| PHYSICIAN | $552,582 | $0 | $27,846 | $0 | $58,384 | $0 | $26,000 | $0 | $32,724 | $0 | $697,536 | $0 | $0 | $0 |
| DOYLE SICKLES MD | ||||||||||||||
| DIRECTOR, PHYSICIAN | $367,726 | $0 | $0 | $0 | $206,770 | $0 | $26,000 | $0 | $24,059 | $0 | $624,555 | $0 | $0 | $0 |
| MICHAEL GREGORY DO | ||||||||||||||
| PHYSICIAN | $434,323 | $0 | $0 | $0 | $92,342 | $0 | $26,000 | $0 | $49,431 | $0 | $602,096 | $0 | $0 | $0 |
| TYLER HALL MD | ||||||||||||||
| ED PHYSICIAN | $355,738 | $0 | $0 | $0 | $75,540 | $0 | $19,500 | $0 | $28,157 | $0 | $478,935 | $0 | $0 | $0 |
| LISA SIMON CPA | ||||||||||||||
| CFO MONHEALTH | $0 | $367,856 | $0 | $53,534 | $0 | $1,242 | $0 | $48,897 | $0 | $6,885 | $0 | $478,414 | $0 | $0 |
| THOMAS WALSH | ||||||||||||||
| PHYSICIAN | $337,427 | $0 | $0 | $0 | $0 | $0 | $9,125 | $0 | $0 | $0 | $346,552 | $0 | $0 | $0 |
| AVAH STALNAKER | ||||||||||||||
| FORMER CEO, SJMH | $0 | $0 | $0 | $5,099 | $0 | $286,271 | $0 | $0 | $0 | $0 | $0 | $291,370 | $0 | $0 |
| JEFF CRUDELE | ||||||||||||||
| INTERIM CFO | $0 | $275,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $275,000 | $0 | $0 |
| KEVIN STALNAKER | ||||||||||||||
| EXECUTIVE/CAO | $0 | $229,807 | $0 | $12,669 | $0 | $1,132 | $0 | $6,103 | $0 | $20,053 | $0 | $269,764 | $0 | $0 |
| RICK SCHERICH | ||||||||||||||
| VP FINANCE | $0 | $191,100 | $0 | $20,020 | $0 | $599 | $0 | $5,733 | $0 | $20,284 | $0 | $237,736 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINES 4A-B | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING INDIVIDUALS DEFERRRED THE FOLLOWING AMOUNTS UNDER A 457(F) PLAN - DAVID GOLDBERG ($104,418) AND LISA SIMON ($39,945). THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT - AVAH STALNAKER ($286,271). | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | MANAGEMENT DUTIES CUSTOMARILY ARE PERFORMED UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES OR KEY EMPLOYEES, BUT THE HOSPITAL HAS CONTRACTED OUT THE MANAGEMENT DUTIES OF THE DIETARY DEPARTMENT (ALSO CONSIDERED A DEPARTMENT HEAD) AND IS EMPLOYED BY THE DIETARY COMPANY. THE CERTIFIED DIETARY MANAGER AND THE DIETITIAN ARE ALSO THE EMPLOYEES OF THE DIETARY COMPANY. ALL OTHER DIETARY STAFF ARE EMPLOYEES OF THE HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 6 | MONONGALIA HEALTH SYSTEM, INC., A WEST VIRGINIA NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | STONEWALL JACKSON MEMORIAL HOSPITAL BOARD MEMBERS ARE ELECTED OR APPOINTED BY MONONGALIA HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 7B | STONEWALL JACKSON MEMORIAL 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 OF 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 MEMBERS SHALL NOT PARTICIPATE IN. |
| FORM 990, PART VI, SECTION B, LINE 15 | 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 HOSPITAL PLACES A PUBLICATION IN THE LOCAL NEWSPAPER STATING THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 3,549,518. MANAGEMENT AND GENERAL EXPENSES 422,637. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,972,155. PHYSICIAN CONSULTING: PROGRAM SERVICE EXPENSES 2,390,782. MANAGEMENT AND GENERAL EXPENSES 284,668. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,675,450. LAB SERVICES: PROGRAM SERVICE EXPENSES 1,249,683. MANAGEMENT AND GENERAL EXPENSES 148,798. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,398,481. |
| FORM 990, PART XI, LINE 9: | CHANGE OF BENEFICIAL INTEREST HELD BY OTHERS -99,492. TRANSFERS 1,347,018. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION'S FINANCE COMMITTEE OF THE BOARD OF DIRECTORS SELECTS THE INDEPENDENT ACCOUNTANT. THIS PROCESS REMAINS UNCHANGED FROM PRIOR YEARS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MONONGALIA COUNTY GENERAL HOSPITAL COMPANY | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 237441353 | HOSPITAL | WV | 501(C)(3) | LINE 3 | MONONGALIA HEALTH SYSTEMS INC | 0 | |
| MON ELDER SERVICES INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 311520863 | CONTINUING CARE RETIREMENT VILLAGE | WV | 501(C)(3) | LINE 10 | MONONGALIA HEALTH SYSTEMS INC | 0 | |
| MONONGALIA HEALTH SYSTEM INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550621551 | PARENT/MANAGEMENT COMPANY | WV | 501(C)(3) | LINE 12C, III-FI | 0 | N/A | |
| THE FOUNDATION OF MONONGALIA GENERAL HOSPITAL | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550570338 | RAISE FUNDS FOR MONONGALIA GENERAL HOSPITAL | WV | 501(C)(3) | LINE 7 | 0 | N/A | |
| PRESTON MEMORIAL HOSPITAL | |||||||||||
| 150 MEMORIAL DRIVE | KINGWOOD | WV | 26537 | 311097818 | HOSPITAL | WV | 501(C)(3) | LINE 3 | MONONGALIA HEALTH SYSTEMS INC | 0 | |
| PRESTON MEMORIAL MEDICAL GROUP | |||||||||||
| 150 MEMORIAL DRIVE | KINGWOOD | WV | 26537 | 550717988 | PROVIDE PRIMARY AND URGENT CARE | WV | 501(C)(3) | LINE 3 | MONONGALIA HEALTH SYSTEMS INC | 0 | |
| PRESTON MEMORIAL HOSPITAL FOUNDATION | |||||||||||
| 150 MEMORIAL DRIVE | KINGWOOD | WV | 26537 | 550740121 | SUPPORT ACTIVITIES OF OTHER CHARITABLE ORGANIZATIONS | WV | 501(C)(3) | LINE 12A, I | MONONGALIA HEALTH SYSTEMS INC | 0 | |
| AUXILIARY OF MONONGALIA GENERAL HOSPITAL | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550362965 | RAISE FUNDS FOR MONONGALIA GENERAL HOSPITAL | WV | 501(C)(3) | LINE 12A, I | MONONGALIA HEALTH SYSTEMS INC | 0 | |
| LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550689535 | LIABILITY INSURANCE TRUST | WV | 501(C)(3) | LINE 12A, I | MONONGALIA HEALTH SYSTEMS INC | 0 | |
| MON HEALTH MARION NEIGHBORHOOD HOSPITAL | |||||||||||
| 140 MIDDLETOWN LOOP | WHITEHALL | WV | 26554 | 853994078 | HOSPITAL | WV | 501(C)(3) | LINE 3 | MONONGALIA HEALTH SYSTEMS INC | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MGH SURGERY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2000 MON HEALTH MEDICAL PARK DR | AddressLine1Txt |
| City | MORGANTOWN | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26505 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 472736896 | EIN |
| Primary Activities | SURGERY CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MON HEALTH CARE INC | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26508 | 550654973 | HOME MEDICAL EQUIPMENT PROVIDER | WV | N/A | C | 0 | ||
| STONEWALL HOME OXYGEN THERAPY INC | |||||||||||
| 100 MARKET PLACE MALL SUITE 8 | WESTON | WV | 26452 | 550754278 | OXYGEN THERAPY SERVICES | WV | C | 0 | STONEWALL JACKSON MEMORIAL HOSPITAL | 1.00000 | |
| FAIRMONT HOME EQUIPMENT AND SUPPLY | |||||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | 550763259 | EQUIPMENT RENT & SVC | WV | N/A | C | 0 | ||
| MORGANTOWN PHYSICAL THERAPY ASSOC INC | |||||||||||
| 943 MAPLE DRIVE | MORGANTOWN | WV | 26505 | 550614636 | REHABILITATION SERVICES | WV | N/A | C | 0 | ||
| CARE PARTNER'S INC | |||||||||||
| 511 BURROUGHS STREET SUITE 102 | MORGANTOWN | WV | 26505 | 550754326 | HOME HEALTH | WV | N/A | C | 0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STONEWALL HOME OXYGEN THERAPY INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | A | TransactionTypeTxt |
| Involved | $2,758 | InvolvedAmt |
| Method Of Amount Determination | FMV - CASH | MethodOfAmountDeterminationTxt |