2023-05-11T09:13:06-05:00 2022-06-30 390859910 BAKER TILLY US LLP 101 WASHINGTON STREET EAST CHARLESTON WV 25301 990 2021-07-01 550422958 STONEWALL JACKSON MEMORIAL HOSPITAL STON 3042698059 230 HOSPITAL PLAZA WESTON WV 26452 JEFF SANDENE EXECUTIVE VP AND CFO 3042698059 2023-05-09 1 JEFF SANDENE 999009999 JEFFREY J PETRELL P00138808 3043460441 2023-05-09 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z DAVID GOLDBERG 230 HOSPITAL PLAZA WESTON WV 26452 55777504 0 X WWW.STONEWALLHOSPITAL.COM X 1959 WV ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. 13 10 482 15 2758 1646 8131388 2329471 49400261 51600801 1262429 1258032 230140 561550 59024218 55749854 5820 14023 0 0 24782276 25467067 0 0 0 27569351 31904835 52357447 57385925 6666771 -1636071 76538179 65282027 17241625 12844619 59296554 52437408 X ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. 0 0 48185587 52116663 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. 14023 14023 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. 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. 48199610 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 181 0 482 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X RICK SCHERICH 3042698059 230 HOSPITAL PLAZA WESTON WV 264528558 ROBIN POLING CHAIRMAN 1.00 X X 0 0 0 C GREGORY CUNNINGHAM VICE CHAIRMAN 1.00 X X 0 0 0 KIMBERLY GUM SECRETARY/TREASURER 1.00 X X 0 0 0 DAVID GOLDBERG PRESIDENT/CEO MONHEALTH 1.00 49.00 X X 0 804616 112875 KEVIN STALNAKER EXECUTIVE/CAO 50.00 X X 0 243608 26156 JOHN LAW CPA DIRECTOR 1.00 X 0 0 0 DOYLE SICKLES MD DIRECTOR, PHYSICIAN 40.00 X 574496 0 50059 GREGORY ST CLAIR DIRECTOR 1.00 X 0 0 0 JOSEPH SNEAD MD DIRECTOR 23.00 X 297 0 0 R GERALD WOOD RPH DIRECTOR 1.00 X 0 0 0 AMY PEARSON MD DIRECTOR 1.00 X 0 0 0 ALISSA LAMBERT DIRECTOR 1.00 X 0 0 0 GEORGE STANSBURY DIRECTOR 1.00 X 0 0 0 RICK SCHERICH VP FINANCE 25.00 25.00 X 0 211719 26017 LISA SIMON CPA CFO MONHEALTH 1.00 49.00 X 0 422632 55782 JEFF CRUDELE INTERIM CFO 1.00 49.00 X 0 275000 0 MICHAEL GREGORY DO PHYSICIAN 40.00 X 526665 0 75431 RONALD PEARSON MD PHYSICIAN 40.00 X 638812 0 58724 ROBERT HARRIS MD PHYSICIAN OB 40.00 X 690694 0 66047 TYLER HALL MD ED PHYSICIAN 40.00 X 431278 0 47657 THOMAS WALSH PHYSICIAN 40.00 X 337427 0 9125 AVAH STALNAKER FORMER CEO, SJMH 0.00 0.00 X 0 291370 0 3199669 2248945 527873 27 1 1 0 QUALIVIS 5930 CORNERSTONE COURT WEST SUITE SAN DIEGO CA 92121 CONTRACT NURSES 1247880 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 50353 MAINTENANCE & DIETARY SERVICES 498618 LEXX HEALTHCARE 9600 WEST SAMPLE R SUITE 300 CORAL SPRINGS FL 33065 CONTRACT PHYSICIANS 440819 BEACH MEDICINE LLC 653 SAM SNEAD LANE VIRGINIA BEACH VA 23462 CONTRACT PHYSICIANS 387691 UNIFORMED PHYSICIANS LLC 110 JAMES ST HINTON WV 25951 CONTRACT PHYSICIANS 326823 12 14023 2239744 75704 2329471 PATIENT SERVICES 622110 51600801 51600801 51600801 926452 926452 39728 2758 11267 0 28461 2758 31219 2758 28461 331580 0 331580 331580 331580 30852 14023 16383 14469 14469 OTHER REVENUE 900099 422690 422690 CAFETERIA 722310 93172 93172 515862 55749854 52116663 2758 1300962 X 14023 14023 21034338 18796284 2238054 439643 392865 46778 2671362 2387129 284233 1321724 1181093 140631 4656898 4656898 10000 10000 84179 84179 8046086 7189983 856103 2442 2182 260 1589530 1420404 169126 1447178 1293198 153980 905349 809020 96329 46957 41961 4996 19033 17008 2025 1298714 1160531 138183 520161 464816 55345 MEDICAL SUPPLIES 8040837 8040837 BAD DEBTS 2203398 2203398 REPAIRS AND MAINTENANCE 1032422 922572 109850 MEDICAID PROVIDER TAX 798746 798746 1202905 1063560 139345 57385925 48199610 9186315 0 11029198 7198303 1266160 1521551 4354778 4429380 1113159 1062123 88777 62277 53994061 42975794 11131365 11018267 41013803 35067261 658833 509260 5882106 4413605 76538179 65282027 10512314 8769790 4935306 2987879 1794005 1086950 17241625 12844619 X 58766444 52006790 530110 430618 59296554 52437408 76538179 65282027 X -1636071 -6470601 1247526 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4478 0 0 0 4478 0 PART II-B, LINE 1: A PORTION OF DUES PAID BY THE HOSPITAL TO THE AMERICAN HOSPITAL ASSOCATION AND THE WEST VIRGINIA HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING. 7149601 7149601 13403703 12470122 933581 32539377 30505672 2033705 901380 901380 11018267 OTHER RECEIVABLES 188302 DUE FROM STONEWALL HOME OXYGEN THERAPY 563786 ESTIMATED THIRD PARTY SETTLEMENTS 1717767 INSURANCE RECOVERIES RECEIVABLES 856800 OPERATING LEASE - RIGHT OF USE ASSET 1086950 4413605 OPERATING LEASE - RIGHT OF USE 1086950 1086950 X PART X, LINE 2: 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. ROTARY BLOOD SCREENING 44875 14023 30852 16383 44875 14023 30852 16383 16383 14469 1 1 X 1 X 0 1 1 1 0 0 510314 510314 14137566 12019257 2118309 0.03840 14647880 12529571 2118309 0.03840 14023 14023 0.00030 14023 14023 0.00030 14661903 12529571 2132332 0.03870 1 2203398 7902428 8514063 -611635 X 1 1 1 1 STONEWALL JACKSON MEMORIAL HOSPITAL 230 HOSPITAL PLAZA WESTON WV 26452 X X X STONEWALL JACKSON MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 21 1 0 1 1 X HTTPS://WWW.STONEWALLJACKSONHOSPITAL.COM/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_ X 1 21 1 HTTPS://WWW.STONEWALLJACKSONHOSPITAL.COM/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_ 0 1 X 200.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X 1 X 0 X X X 1 X 0 0 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 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. 1 ROTARY CLUB OF WESTON PO BOX 222 WESTON WV 26452 550371556 501(C)4 14023 0 TO HELP THE ROTARY SUPPORT VARIOUS CHILDREN'S PROGRAMS IN LEWIS COUNTY. 0 1 X X 1 1 0 0 0 0 0 0 0 DAVID GOLDBERG PRESIDENT/CEO MONHEALTH 0 565581 0 115644 0 123391 0 112875 0 0 0 917491 0 0 ROBERT HARRIS MD PHYSICIAN OB 378399 0 249408 0 62887 0 19500 0 46547 0 756741 0 0 0 RONALD PEARSON MD PHYSICIAN 552582 0 27846 0 58384 0 26000 0 32724 0 697536 0 0 0 DOYLE SICKLES MD DIRECTOR, PHYSICIAN 367726 0 0 0 206770 0 26000 0 24059 0 624555 0 0 0 MICHAEL GREGORY DO PHYSICIAN 434323 0 0 0 92342 0 26000 0 49431 0 602096 0 0 0 TYLER HALL MD ED PHYSICIAN 355738 0 0 0 75540 0 19500 0 28157 0 478935 0 0 0 LISA SIMON CPA CFO MONHEALTH 0 367856 0 53534 0 1242 0 48897 0 6885 0 478414 0 0 THOMAS WALSH PHYSICIAN 337427 0 0 0 0 0 9125 0 0 0 346552 0 0 0 AVAH STALNAKER FORMER CEO, SJMH 0 0 0 5099 0 286271 0 0 0 0 0 291370 0 0 JEFF CRUDELE INTERIM CFO 0 275000 0 0 0 0 0 0 0 0 0 275000 0 0 KEVIN STALNAKER EXECUTIVE/CAO 0 229807 0 12669 0 1132 0 6103 0 20053 0 269764 0 0 RICK SCHERICH VP FINANCE 0 191100 0 20020 0 599 0 5733 0 20284 0 237736 0 0 PART I, LINES 4A-B 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). 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. 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 N/A 0 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 N/A 0 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 MGH SURGERY LLC 2000 MON HEALTH MEDICAL PARK DR MORGANTOWN WV 26505 472736896 SURGERY CENTER WV N/A 0 0 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 STONEWALL JACKSON MEMORIAL HOSPITAL C 1.00000 0 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 STONEWALL HOME OXYGEN THERAPY INC A 2758 FMV - CASH