2023-05-11T09:09:40-05:00 2022-06-30 390859910 BAKER TILLY US LLP 20 STANWIX STREET PITTSBURGH PA 15222 990 2021-07-01 311520863 MON ELDER SERVICES INC MONE 3045981242 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 JEFF SANDENE EXECUTIVE VP AND CFO 3045981242 2023-05-09 1 JEFF SANDENE 999009999 JEFFREY J PETRELL P00138808 4126976400 2023-04-27 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z DAVID S GOLDBERG 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 6415154 0 X N/A X 1997 WV TO BE THE SENIOR LIVING COMMUNITY OF CHOICE IN MONONGALIA COUNTY. THE RESPECT, TRUST AND FRIENDSHIP OF OUR RESIDENTS WILL BE EARNED EVERY DAY. 14 13 79 13 0 0 561916 0 6187830 5838091 613062 577063 0 0 7362808 6415154 0 0 0 0 3317146 3595454 0 0 0 2877221 2927796 6194367 6523250 1168441 -108096 35632091 32374549 23775657 24024288 11856434 8350261 TO BE THE SENIOR LIVING COMMUNITY OF CHOICE IN MONONGALIA COUNTY. THE RESPECT, TRUST, AND FRIENDSHIP OF OUR RESIDENTS WILL BE EARNED EVERY DAY. 0 0 4910671 5838091 CONTINUING CARE RETIREMENT VILLAGE CONSISTING OF 90 INDEPENDENT LIVING APARTMENTS, 40 ASSISTED LIVING UNITS, AND COMMON SUPPORT AREAS ON 11 ACRES. 4910671 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 79 1 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WV X GENE TOWNSEND - CONTROLLER 3042853676 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 DAVID GOLDBERG PRESIDENT/CEO 1.00 49.00 X X 0 804616 112875 LISA SIMON CPA VP FINANCE/CFO 1.00 49.00 X 0 422632 55782 JEFF CRUDELE INTERIM CFO 1.00 49.00 X 0 275000 0 EDWARD P BOYLE II CHAIR 1.00 1.00 X X 0 0 0 KATHY MCNEIL VICE CHAIR 1.00 1.00 X X 0 0 0 JOHN LAW SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 BOBBIE CONKLIN DIRECTOR 1.00 1.00 X 0 0 0 DAVID RAMSEY DIRECTOR 1.00 1.00 X 0 0 0 GREGORY CUNNINGHAM DIRECTOR 1.00 1.00 X 0 0 0 MARK JOHNSON MD DIRECTOR 1.00 1.00 X 0 0 0 MIKE MORRIS DIRECTOR 1.00 1.00 X 0 0 0 NATALIE STONE DIRECTOR 1.00 1.00 X 0 0 0 RAY THOMPSON DIRECTOR 1.00 1.00 X 0 0 0 RODNEY BEAN DIRECTOR 1.00 1.00 X 0 0 0 RON STOVASH DIRECTOR 1.00 1.00 X 0 0 0 TERRY SHAFFER DIRECTOR 1.00 1.00 X 0 0 0 0 1502248 168657 0 0 1 0 VERITAS CONTRACTING LLC 246 BUSINESS PARK DR FAIRMONT WV 26554 CONSTRUCTION 468788 MICHAEL J CALLEN CONSTRUCTION 182 GREENVILLE SCHOOL ROAD BRUCETON MILLS WV 26525 CONSTRUCTION 267611 US FOOD SERVICE PO BOX 643190 PITTSBURGH PA 15264 FOOD SERVICE 228816 CDW 75 REMITTANCE DRIVE STE 1515 CHICAGO IL 60675 IT SERVICES 224190 4 ROOM AND BOARD 623000 5726386 5726386 RESIDENT SERVICES 623000 111705 111705 5838091 435218 435218 141345 500 0 0 141345 500 141845 141845 6415154 5838091 0 577063 2676736 2207265 469471 62332 51400 10932 661758 545693 116065 194628 160492 34136 278618 278618 37487 37487 172466 158420 14046 51231 62 51169 30255 3577 26678 306268 303285 2983 10657 9498 1159 557229 557229 983878 983878 29349 29349 DIETARY RELATED EXPENSE 360308 360308 MISCELLANEOUS EXPENSE 51426 49444 1982 REPAIRS AND MAINTENANCE 29010 27392 1618 RECREATIONAL EVENTS 15449 10884 4565 14165 9724 4441 6523250 4910671 1612579 0 206946 342546 1446054 854816 22999 69721 18302 25782 19032 92555 25670864 12983231 12750934 12687633 21055159 18280872 112665 20624 35632091 32374549 732303 713122 795173 1007983 8524786 8721350 13723395 13581833 23775657 24024288 X 11856434 8350261 11856434 8350261 35632091 32374549 -108096 -3398077 0 X 0 1 X 1 0 X 136 561916 562052 5859124 5994987 6089165 6187830 5838091 29969197 5859260 5994987 6089165 6749746 5838091 30531249 0 0 0 30531249 24786 20731 314329 385073 435218 1180137 24786 20731 314329 385073 435218 1180137 5884046 6015718 6403494 7134819 6273309 31711386 0.96280 0.97570 0.03720 0.02430 X 0 3993736 3993736 14806135 9534888 5271247 1898094 1244437 653657 4972899 2203906 2768993 12687633 REFUNDABLE FEES 13217609 SECURITY DEPOSITS 128088 ESTIMATED LIABILITY OBLIGATIONS 103605 DUE TO AFFILIATES 132531 13581833 X PART X, LINE 2: THE HEALTH SYSTEM IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC), WITH THE EXCEPTION OF MHC WHICH IS A CORPORATION SUBJECT TO INCOME TAX. ADDITIONALLY, THE HEALTH SYSTEM QUALIFIES FOR CHARITABLE CONTRIBUTIONS DEDUCTIONS UNDER SECTION 170(B)(1)(A)(VI) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(1). INCOME WHICH IS NOT RELATED TO EXEMPT PURPOSES, LESS APPLICABLE DEDUCTIONS, IS SUBJECT TO FEDERAL AND STATE CORPORATE INCOME TAXES. THE HEALTH SYSTEM HAD NO SIGNIFICANT UNRELATED BUSINESS INCOME FOR THE YEARS ENDED JUNE 30, 2022 OR 2021. INTEREST AND PENALTIES RELATED TO INCOME TAX ASSESSMENTS, IF ANY, ARE REFLECTED IN INCOME TAX EXPENSE ON THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. 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, 2018, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. 0 1 0 0 0 0 0 0 0 DAVID GOLDBERG PRESIDENT/CEO 0 565581 0 115644 0 123391 0 112875 0 0 0 917491 0 0 LISA SIMON CPA VP FINANCE/CFO 0 367856 0 53534 0 1242 0 48897 0 6885 0 478414 0 0 JEFF CRUDELE INTERIM CFO 0 275000 0 0 0 0 0 0 0 0 0 275000 0 0 PART I, LINE 3 THE CEO'S COMPENSATION IS PAID BY MONONGALIA HEALTH SYSTEM. MONONGALIA HEALTH SYSTEM USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE FOLLOWING INDIVIDUALS DEFERRED THE FOLLOWING AMOUNTS UNDER A 457(F) PLAN - DAVID GOLDBERG ($104,418) AND LISA SIMON ($39,945). A MONONGALIA COUNTY BUILDING COMMISSION 311520863 610208CK4 2011-04-20 12454808 TO REFINANCE ORIGINAL CONSTRUCTION ISSUANCE 0 0 1 A 4153731 12454808 12205712 249096 2011 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY IS PROVIDED A COPY, PRIOR TO SUBMISSION, FOR THEIR REVIEW AND TO ANSWER QUESTIONS OR REVISE. IF CHANGES ARE MADE, BASED ON MEMBER'S REVISIONS, MANAGEMENT REDISTRIBUTES A FINAL VERSION. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, A CONFLICT OF INTEREST QUESTIONNAIRE IS SENT OUT TO ALL BOARD MEMBERS. THE BOARD THEN REVIEWS ALL RESPONSES FOR POSSIBLE CONFLICTS OF INTEREST. THE BOARD THEN DETERMINES WHAT TYPES OF DECISIONS THAT MEMBER IS PROHIBITED FROM PARTICIPATING. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS PAID BY MONONGALIA HEALTH SYSTEM. ANNUALLY, A CONSULTANT COMPILES A MARKET DATA REPORT ON CEO COMPENSATION, THIS REPORT IS THEN REVIEWED BY THE EXECUTIVE COMMITTEE TO DETERMINE COMPENSATION FOR THE INDIVIDUAL. ANNUALLY, A CONSULTANT COMPILES A MARKET DATA REPORT ON CFO AND COO COMPENSATION, THIS REPORT IS THEN REVIEWED BY THE EXECUTIVE COMMITTEE TO DETERMINE COMPENSATION FOR THE INDIVIDUAL. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES IT FORM 990 AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH PUBLIC DISCLOSURE WITH THE WV HEALTH CARE AUTHORITY. MONONGALIA HEALTH SYSTEM 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 550621551 PARENT/MANAGEMENT COMPANY WV 501(C)(3) LINE 12C, III-FI 0 MONONGALIA COUNTY GENERAL HOSPITAL CO 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 237441353 HOSPITAL WV 501(C)(3) LINE 3 MONONGALIA HEALTH SYSTEM INC 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 MONONGALIA COUNTY GENERAL HOSPITAL CO 0 PRESTON MEMORIAL HOSPITAL 300 SOUTH PRICE STREET KINGWOOD WV 26537 311097818 HOSPITAL WV 501(C)(3) LINE 3 MONONGALIA HEALTH SYSTEM INC 0 PRESTON MEMORIAL MEDICAL GROUP 300 SOUTH PRICE STREET KINGWOOD WV 26537 550717988 PRIMARY AND URGENT CARE WV 501(C)(3) LINE 3 PRESTON MEMORIAL HOSPITAL 0 PRESTON MEMORIAL HEALTH FOUNDATION 300 SOUTH PRICE STREET KINGWOOD WV 26537 550740121 RAISE FUNDS FOR PRESTON HOSPITAL WV 501(C)(3) LINE 12B, II PRESTON MEMORIAL HOSPITAL 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 COUNTY GENERAL HOSPITAL CO 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 SYSTEM INC 0 STONEWALL JACKSON MEMORIAL HOSPITAL 230 HOSPITAL PLAZA WESTON WV 26452 550422958 HOSPITAL WV 501(C)(3) LINE 3 MONONGALIA HEALTH SYSTEM INC 0 MON HEALTH MARION NEIGHBORHOOD HOSPITAL 140 MIDDLETOWN LOOP WHITEHALL WV 26554 853994078 HOSPITAL WV 501(C)(3) LINE 3 MONONGALIA HEALTH SYSTEM 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 N/A C 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0