2023-05-11T09:15:33-05:00 2022-06-30 390859910 BAKER TILLY US LLP 101 WASHINGTON STREET EAST CHARLESTON WV 25301 990 2021-07-01 311097818 PRESTON MEMORIAL HOSPITAL PRES 3043291400 150 MEMORIAL DRIVE KINGWOOD WV 265371442 JEFF SANDENE EXECUTIVE VP AND CFO 3043291400 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 150 MEMORIAL DRIVE KINGWOOD WV 265371442 55192277 0 X WWW.PRESTONMEMORIAL.ORG X 1955 WV TO ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. 12 9 439 20 0 0 4710177 1736391 45349746 52924928 193272 231658 302488 278860 50555683 55171837 0 0 0 0 24984115 27792897 0 0 0 21551498 27678293 46535613 55471190 4020070 -299353 60807644 55257695 48677780 45158303 12129864 10099392 X TO ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. 0 0 39091949 53193458 THE HOSPITAL HAD 2,697 INPATIENT DAYS, CARED FOR 9,231 EMERGENCY PATIENTS AND TREATED 74,857 PATIENTS IN ITS OUTPATIENT CLINICS. THE HOSPITAL PROVIDES CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. CHARGES FOREGONE FOR CHARITY CARE AMOUNTED TO $251,306.THE HOSPITAL PROMOTES AND PROVIDES ACTIVITIES SUCH AS HEALTH FAIRS, BLOOD DRIVES, AND A FITNESS CENTER TO IMPROVE THE HEALTH AND WELFARE OF ITS PATIENTS. THE HOSPITAL ALSO CONDUCTS COMMUNITY-WIDE SPEAKER BUREAUS TO HELP EDUCATE THE COMMUNITY ON SPECIFIC HEALTH AND WELLNESS MATTERS.THE HOSPITAL STRIVES TO PROVIDE AND PROMOTE NEEDED SERVICES IN THE COMMUNITY BY PARTNERING WITH LOCAL AGENCIES SUCH AS THE PRESTON COUNTY HEALTH DEPARTMENT, FAMILY RESOURCE NETWORK, PRESTON PREVENTION PARTNERSHIP, AND THE PRESTON COUNTY CHAMBER OF COMMERCE. 153918 10330 THE ORGANIZATION SPONSORED HEALTH FAIRS, BLOOD DRIVES, CANCER SCREENINGS, CPR/FIRST AID CLASSES, CRISIS INTERVENTION, DIABETES INTERVENTION, FAMILY/PARENTING/SIBLING EDUCATION, FITNESS EDUCATION, FLU SHOTS, NUTRITION/WEIGHT MAINTENANCE, SCHOOL BASED PROGRAMS, SENIOR EDUCATION AND OUTREACH PROGRAMS, SPORTS INJURY PREVENTION, SUBSTANCE ABUSE AND TOBACCO/SMOKING CESSATION. 39245867 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 61 0 439 0 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X KEVIN GESSLER VP FINANCIAL SERVICE 3043291400 150 MEMORIAL DRIVE KINGWOOD WV 265371442 MELISSA LOCKWOOD PMH CAO 48.00 2.00 X X 0 261084 18680 NICK TAYLOR CHAIR 1.00 1.00 X X 0 0 0 RAY THOMPSON VICE CHAIR 1.00 1.00 X X 0 0 0 TIM CALVERT SEC/TREAS, FINANCE CHAIR 1.00 1.00 X X 0 0 0 BONNIE FORMAN MD CHIEF OF STAFF 20.00 X 159566 0 13953 RON CRITES PMH BOARD MEMBER 1.00 1.00 X 0 0 0 RITA MCCROBIE PMH BOARD MEMBER 1.00 1.00 X 0 0 0 KATHY MCNEILL PMH BOARD MEMBER 1.00 1.00 X 0 0 0 TARRELL RIES PMH BOARD MEMBER 1.00 1.00 X 0 0 0 LARRY WILLIAMS PMH BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID GOLDBERG MHS PRESIDENT/CEO 1.00 49.00 X X 0 804616 112875 RON STOVASH PMH BOARD MEMBER 1.00 X 0 0 0 KEVIN GESSLER JR CPA CFE CHFP VP OF FINANCIAL SERVICES 40.00 10.00 X 0 199407 12321 LISA SIMON CPA MHS VP FINANCE/CFO 1.00 49.00 X 0 422632 55782 JEFF CRUDELE INTERIM CFO 1.00 49.00 X 0 275000 0 JAMES HOLEHOUSE MD PHYSICIAN 40.00 X 279397 0 32072 MARISA DOWNEY DO PHYSICIAN 40.00 X 415132 0 44284 LORN A WOLFE MD PHYSICIAN 40.00 X 423858 0 47401 DAVID M FOURQUREAN MD PHYSICIAN 40.00 X 434062 0 40575 FRANK M ABRAHAM MD PHYSICIAN 40.00 X 602791 0 66328 2314806 1962739 444271 34 0 1 0 SYNERGY SURGICALISTS WV INC 280 W KAGY BOULEVARD SUITE D 320 BOZEMAN MT 59715 ORTHOPEDIC DOCTORS 1508994 RURAL PHYSICIANS GROUP 10624 S EASTERN AVENUE SUITE A-26 HENDERSON NV 89052 HOSPITALISTS 802455 QUALIVIS LLC PO BOX 123847 DALLAS TX 75312 RN STAFFING 614273 ALLIANCE HEALTHCARE SERVICES PO BOX 735714 DALLAS TX 75373 MRI SERVICES 226170 AKKARY CENTER 1100 FORT PIERPOINT DRIVE MORGANTOWN WV 26508 BARIATRIC SURGERY SERVICES 213970 9 1734891 1500 1736391 PATIENT SERVICES 622110 52620499 52620499 340B DRUG PROGRAM 900099 304429 304429 52924928 9243 9243 242855 0 20440 242855 -20440 222415 222415 CAFETERIA SALES 722212 149572 149572 129288 129288 278860 55171837 53203788 0 231658 X 178946 128251 50695 19903787 14265044 5638743 595947 427115 168832 5723150 4101782 1621368 1391067 996978 394089 4024372 4024372 85811 85811 16032 16032 7528603 6227814 1300789 13436 9630 3806 1558781 1117591 441190 270741 194040 76701 508933 364752 144181 71390 51165 20225 1028798 1028798 2706617 1939832 766785 260880 186973 73907 MEDICAL SUPPLIES 4025715 4025715 BAD DEBT 3318711 3318711 HEALTHCARE PROVIDER TAX 956970 956970 REPAIRS & MAINTENANCE 715684 512931 202753 586819 420573 166246 55471190 39245867 16225323 0 14027590 7586600 5738379 8044838 950904 1106111 152468 136055 56550983 32871627 25198060 23679356 12617192 11150907 109739 227688 2013312 3326140 60807644 55257695 4068517 2861279 33197652 32302121 11411611 9994903 48677780 45158303 X 12129864 10099392 12129864 10099392 60807644 55257695 X -299353 -1694074 -37045 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 18302 0 0 0 18302 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE WEST VIRGINIA HOSPITAL ASSOCIATION WHICH PARTICIPATES IN LOBBYING ACTIVITIES. 1085000 36195 1121195 28172091 17679425 10492666 130748 41403 89345 24267446 14754969 9512477 2859503 395830 2463673 23679356 FUNDED DEPRECIATION-CMB 1010633 F FUNDED DEPRECIATION-PNC 10140274 F 11150907 LAND HELD FOR DEVELOPMENT 1085000 DUE FROM 3RD PARTY PAYORS 1252631 OTHER RECEIVABLES 649849 OPERATING LEASE ROU ASSET 226592 DUE FROM RELATED PARTIES 112068 3326140 DUE TO 3RD PARTY PAYORS 2850000 DUE TO RELATED PARTY 753584 HHS STIMULUS AND OTHER COVID FUNDING 4281412 OPERATING LEASE LIABILITY 226592 ESTIMATED PROFESSIONAL LIABILITY OBLIGATION 1700454 ACCRUED PENSION OBLIGATION 182861 9994903 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. 1 1 X 1 X 1 X 1 1 0 1 1 1118234 1118234 956970 956970 2075204 2075204 0 0.00000 153918 10330 143588 0.00280 485290 485290 0.00930 38574 38574 0.00070 677782 10330 667452 0.01280 2752986 2085534 667452 0.01280 0 3318711 7860865 7860865 X 1 1 1 1 PRESTON MEMORIAL HOSPITAL 150 MEMORIAL DRIVE KINGWOOD WV 26537 HTTP://WWW.PRESTONMEMORIAL.ORG/ X X X X 24X7 LAB AND RADIOLOGY. CENTER OF EXCELLENCE IN BARIATRIC SURGERY. PRESTON MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X HTTPS://WWW.MONHEALTH.COM/PRESTON-MEMORIAL/WELLNESS-INITIATIVES X 1 21 1 HTTPS://WWW.MONHEALTH.COM/PRESTON-MEMORIAL/WELLNESS-INITIATIVES 0 1 X 200.000000000000 200.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.MONHEALTH.COM/PRESTON-MEMORIAL/PATIENT-PAYMENTS X HTTPS://WWW.MONHEALTH.COM/PRESTON-MEMORIAL/PATIENT-PAYMENTS X HTTPS://WWW.MONHEALTH.COM/PRESTON-MEMORIAL/PATIENT-PAYMENTS X X X X X 1 X 0 X X X 1 X 0 0 PRESTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE 2022 CHNA INCLUDED QUANTITATIVE RESEARCH METHODS AND COMMUNITY CONVERSATIONS TO DETERMINE HEALTH TRENDS AND DISPARITIES AFFECTING PRESTON COUNTY RESIDENTS. THROUGH A COMPREHENSIVE VIEW OF STATISTICAL HEALTH INDICATORS AND COMMMUNITY STAKEHOLDER FEEDBACK, A PROFILE OF PRIORITY AREAS WAS DETERMINED. THE FINDINGS WILL GUIDE HEALTHCARE SERVICES AND HEALTH IMPROVEMENT EFFORTS, AS WELL AS SERVE AS A COMMUNITY RESOURCE FOR GRANT MAKING, ADVOCACY, AND TO SUPPORT THE MANY PROGRAMS PROVIDED BY HEALTH AND SOCIAL SERVICE PARTNERS.IN ASSESSING COMMUNITY HEALTH NEEDS, INPUT WAS SOLICITED AND RECEIVED FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, AS WELL AS UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THESE INDIVIDUALS PROVIDED WIDE PERSPECTIVES ON HEALTH TRENDS, EXPERTISE ABOUT EXISTING COMMUNITY RESOURCES AVAILABLE TO MEET THOSE NEEDS, AND INSIGHTS INTO SERVICE DELIVERY GAPS THAT CONTRIBUTE TO HEALTH DISPARITIES AND INEQUITIES. PRESTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: GRAFTON CITY HOSPITAL PRESTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PRESTON MEMORIAL HOSPITAL DEVELOPED AN IMPLEMENTATION PLAN THAT ADDRESSED ALL OF THE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA. THE SIGNIFICANT NEEDS IDENTIFIED AND HOW PRESTON HAS RESPONDED:1. OBESITY: DIETICIAN ASSISTANCE FOR HEALTHY EATING AND PHYSICIAN GUIDED WEIGHT-LOSS PROGRAM; SPONSORED FITNESS CENTER; COMMUNITY EDUCATION2. CHRONIC LUNG DISEASE: TOBACCO PREVENTION AND CESSATION; SCHOOL- BASED YOUTH AND PARENT E-CIGARETTE AND VAPING PREVENTION EDUCATION; COMMUNITY-BASED EDUCATIONAL PRESENTATIONS; FREE TOBACCO CESSATION CLASSES; PULMONARY REHABILITATION CENTER SERVICES; PROVISION OF LOW-DOSE CT SCAN CARE PATHWAY FOR PATIENTS WITH QUALIFYING CRITERIA3. DIABETES AND CORONARY HEART DISEASE: FREE OR REDUCED COST COMMUNITY-BASED SCREENINGS, PARTICIPATION IN HEALTH FAIRS; EDUCATIONAL PRESENTATIONS; FIRST AID AND CPR COURSES FOR COMMUNITY MEMBERS AND HEALTHCARE PROVIDERS4. OPIOID USE DISORDER: SPEAKERS BUREAUS ON OPIOID PREVENTION AND ALTERNATIVES TO PAIN MANAGEMENT; PARTNERSHIP WITH MEDICATION-ASSISTED TREATMENT PROGRAM; PROVIDED SCHOOL-BASED YOUTH EDUCATION ON DRUG PREVENTION; IMPLEMENTATION OF THE RECOVERY CARE PROGRAM; IMPLEMENTATION OF PEER RECOVERY PROGRAM- REVERSE THE CYCLE; 5. COVID 19 RESPONSE: SCREENINGS, COMMUNITY VACCINE CLINICS; STATE SPONSORED TESTING LOCATION UNTIL JUNE 2022; EXPANSION OF TELEHEALTH SERVICES; DEVELOPMENT OF VIRTUAL HEALTH EDUCATION MATERIALS. PART I, LINE 3C: THE VP OF FINANCIAL SERVICES AND FINANCIAL COUNSELOR REVIEW ALL CHARITY APPLICATIONS. THE VP OF FINANCIAL SERVICES AND COUNSELOR THEN DETERMINE, BASED ON FINANCIAL INFORMATION GIVEN BY THE PATIENT (TAX RETURNS, PAY STUBS, HOUSEHOLD EXPENSES, AND OTHER FAMILY CONSIDERATIONS), IF DEEP DISCOUNTS CAN BE PROVIDED TO THE PATIENT, OR IF A COMPLETE WRITE-OFF TO FREE-CARE IS DEEMED APPROPRIATE. PART I, LINE 7: ACTUAL REVENUE AND COSTS WERE TAKEN FROM THE GENERAL LEDGER. REASONABLE ESTIMATES WERE USED WHERE APPROPRIATE. FINANCIAL ASSISTANCE AT COST WAS CALCULATED BASED ON THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. UNREIMBURSED MEDICAID AND UNREIMBURSED COST - OTHER MEANS-TESTED GOVERNMENT PROGRAMS WERE CALCULATED USING THE CALCULATED COST-TO-CHARGE RATIO. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS AND HEALTH PROFESSIONS EDUCATION WERE CALCULATED USING INTERNAL COST ACCOUNTING SYSTEMS THAT USE DIRECT AND INDIRECT COST REPORTING. 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 $ 3,318,711. PART II, COMMUNITY BUILDING ACTIVITIES: PRESTON OFFERS ITS CONFERENCE ROOM SPACE FOR MULTIPLE COMMUNITY MEETINGS, INCLUDING BIRTHING CLASSES, CPR, EMS & FIRST RESPONDER CLASSES, PARENTING CLASSES, ETC. PART III, LINE 2: BAD DEBT EXPENSE AS REPORTED ON THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 4: PATIENTS SEEKING FINANCIAL ASSISTANCE COMPLETE FINANCIAL ASSISTANCE APPLICATIONS AND WORK WITH THE HOSPITAL'S FINANCIAL COUNSELOR TO DETERMINE APPROPRIATE LEVELS OF DISCOUNTS (OR COMPLETE FREE CARE) BASED ON INFORMATION SUPPLIED BY THE PATIENT. ALL SELF-PAY PATIENTS ARE OFFERED BASELINE DISCOUNTS OF 10% FROM CHARGES, AND AN ADDITIONAL 30% PROMPT PAYMENT DISCOUNT IF PAYMENT IS MADE WITHIN A CERTAIN TIME PERIOD AFTER RECEIVING A BILL. PATIENTS WHO REFUSE ASSISTANCE AND REFUSE PAYMENT OPTIONS ARE TURNED OVER TO A COLLECTION AGENCY AFTER 3 BILLS HAVE BEEN SUBMITTED, AND BAD DEBT IS RECOGNIZED AT THAT TIME. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE HOSPITAL'S MEDICARE COST REPORT. PART III, LINE 9B: THE HOSPITAL FINANCIAL COUNSELING STAFF HELPS PATIENTS SEEK FINANCIAL ASSISTANCE THROUGH GOVERNMENT PROGRAMS OR OTHER PAYMENT SERVICES BEFORE APPLYING FOR CHARITY CARE. IF GOVERNMENT PROGRAMS OR OTHER SERVICES ARE DENIED, A FINANCIAL COUNSELOR WORKS WITH PATIENT TO OBTAIN FINANCIAL INFORMATION LIKE TAX RETURNS, HOUSEHOLD BILLS, BANK ACCOUNT INFORMATION, ETC. THE FINANCIAL COUNSELOR WORKS WITH THE VP OF FINANCIAL SERVICES TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FULL OR PARTIAL CHARITY CARE. ONCE THIS DETERMINATION IS MADE, THE FINANCIAL COUNSELOR COMMUNICATES RESULTS WITH THE PATIENT. IF PARTIAL PAYMENT IS DUE AFTER A DISCOUNT HAS BEEN RECOMMENDED, THE FINANCIAL COUNSELOR WORKS WITH THE PATIENT ON A PAYMENT ARRANGEMENT. IF A PATIENT, WHO HAS BEEN DEEMED ELIGIBLE FOR PARTIAL CHARITY CARE, AGREES TO A PAYMENT PLAN AND THEN FAILS TO PAY THE REMAINING BALANCE AGREED TO, THE REMAINING BALANCE WILL BE ADJUSTED OFF AS BAD DEBT. THE REMAINING BALANCE WILL BE TURNED OVER TO A COLLECTION AGENCY. PART VI, LINE 2: THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE YEAR ENDED JUNE 30, 2019 TO IDENTIFY LOCAL HEALTH AND MEDICAL NEEDS OF THE RESIDENTS SERVED BY THE HOSPITAL. TO COMPLETE THE ASSESSMENT THE HOSPITAL PERFORMED SEVERAL INDEPENDENT DATA ANALYSES BASED ON SECONDARY SOURCE DATA AND COMBINED THE RESULTS WITH LOCAL SURVEY DATA AND OPINIONS FROM LOCAL EXPERTS. PART VI, LINE 3: THE HOSPITAL PERSONNEL INSTRUCT PATIENTS DURING THE REGISTRATION PROCESS WHO DO NOT HAVE INSURANCE OR THE INABILITY TO PAY, TO COMPLETE AN APPLICATION FOR CHARITY CARE AFTER ALL OTHER SOURCES OF FINANCIAL ASSISTANCE HAVE BEEN DENIED. HOSPITAL PERSONNEL ASSIST PATIENTS WITH OBTAINING OTHER FINANCIAL ASSISTANCE BEFORE APPLYING FOR CHARITY CARE. THE FINANCIAL COUNSELING POLICY IS POSTED IN THE WAITING ROOMS AND AT THE FRONT-DESK. THE HOSPITAL ALSO HAS A FORMAL RESOLUTION IN PLACE WITH THE PRESTON COUNTY COMMMISSION (LOCAL GOVERNMENT) INFORMING ALL LOCAL CITIZENS OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: PRESTON MEMORIAL HOSPITAL LOCATED IN KINGWOOD, WV, IS SITUATED IN A RURAL GEOGRAPHIC LOCATION. PRESTON COUNTY HAS A POPULATION OF 33,679 (2018), WITH MORE THAN 19% OF THE SERVICE AREA POPULATION OVER THE AGE OF 65. THE MEDIAN HOUSEHOLD INCOME WAS $46,673 WHICH IS HIGHER THAN THE STATE MEDIAN INCOME OF $44,061, BUT LOWER THAN THE NATIONAL MEDIAN INCOME OF $57,652. THE HOSPITAL'S MEDICAID UTILIZATION IS 17%, MEDICARE UTILIZATION IS 40%, AND AN ESTIMATED 10% OF THE HOSPITAL'S PATIENTS SERVED ARE UNINSURED (OR UNDERINSURED). PRESTON MEMORIAL HOSPITAL IS THE ONLY HOSPITAL IN THE COUNTY. THERE ARE 2 MAJOR COMPETITORS OUTSIDE OF THE COUNTY - WEST VIRGINIA UNIVERSITY HOSPITALS AND MONONGALIA GENERAL HOSPITAL. BOTH HOSPITALS ARE LOCATED APPROXIMATELY 50 MINUTES AWAY FROM THE HOSPITAL AND ARE SITUATED IN URBANIZED LOCATIONS IN MONONGALIA COUNTY, WV. OTHER HOSPITALS ARE ALSO APPROXIMATELY 45 MINUTES TO ONE HOUR DRIVING DISTANCE FROM PRESTON MEMORIAL HOSPTIAL. THERE IS A FQHC LOCATED IN THE COUNTY (PRESTON-TAYLOR COMMUNITY HEALTH CENTER). THERE ARE NO OTHER DESIGNATED MEDICALLY UNDERSERVED AREAS IN THE COUNTY. PART VI, LINE 5: PRESTON MEMORIAL HOSPITAL HAS A GOVERNING BODY COMPRISED OF CITIZENS OF PRESTON COUNTY. THEY ARE NOT EMPLOYEES, CONTRACTORS OR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY AND BEYOND TO HELP TAKE CARE OF THE NEEDS OF ITS PATIENTS. THE ORGANIZATION ROUTINELY DOES NOT HAVE SURPLUS FUNDS AVAILABLE FROM OPERATIONS. HOWEVER, THE HOSPITAL HAS IDENTIFIED RESOURCES THROUGH BORROWING OR FUNDRAISING TO INVEST IN NEW TECHNOLOGIES FOR IMAGING SERVICES, ELECTRONIC HEALTH RECORDS, FACILITY IMPROVEMENTS, PATIENT CARE ROOM UPGRADES AND OTHER CLINICAL CAPITAL IMPROVEMENTS (E.G., MONITORS, VENTS, SURGICAL EQUIPMENT, ETC.). THE HOSPITAL ALSO PROVIDES 24 X 7 EMERGENCY SERVICES AND A LEVEL 4 TRAUMA CENTER. THE HOSPITAL'S EMERGENCY DEPARTMENT AND ALL OTHER CLINICAL SERVICES WHERE MEDICAL NEED IS DEMONSTRATED IS AVAILABLE TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL'S SPECIALIZED SERVICES INCLUDE: ENT, OB/GYN CARE, GENERAL SURGERY, ORTHOPEDICS, PSYCHIATRY, PHYSICAL THERAPY, CARDIOLOGY, LABORATORY, RADIOLOGY, AND NEUROLOGY. IF THESE SERVICES WERE NOT AVAILABLE, PATIENTS IN THE PRIMARY SERVICE AREA WOULD HAVE TO TRAVEL MORE THAN 45 MINUTES TO OBTAIN THESE SERVICES ELSEWHERE. THE HOSPITAL WORKS DILIGENTLY TO ATTRACT CHARITABLE SUPPORT THROUGH ITS FOUNDATION, AND ENGAGES OVER 30 VOLUNTEERS TO SUPPORT MULTIPLE ACTIVITIES AT THE HOSPITAL. PART VI, LINE 6: AS OF 2/28/2014, PRESTON MEMORIAL HOSPITAL, COLLECTIVELY WITH PRESTON MEMORIAL FOUNDATION AND PRESTON MEMORIAL MEDICAL GROUP, IS PART OF THE MON HEALTH SYSTEM, INC. THE MON HEALTH SYSTEM INCLUDES MONONGALIA COUNTY GENERAL HOSPITAL COMPANY, MON ELDER SERVICES, INC., MON HEALTH CARE AND STONEWALL JACKSON MEMORIAL HOSPITAL. ALL ENTITIES ARE UNDER COMMON GOVERNANCE AND CONTROL, AND COLLECTIVELY OPERATE TO SERVE THE HEALTHCARE NEEDS AND CHARITABLE NEEDS OF THE COMMUNITY. THE MEDICAL GROUP PROVIDES OFFICE RENTAL SPACE TO OTHER HEALTH CARE PROVIDERS IN THE COMMUNITY. THE FOUNDATION SERVES AS A FUNDRAISING ARM OF THE HOSPITAL TO HELP PROVIDE SUPPORT FOR CAPITAL IMPROVEMENTS, MAINTENANCE COSTS FOR THE RADIOLOGY DEPARTMENT, AND TO SUPPORT COMMUNITY ACTIVITIES THROUGH CHARITABLE GIVING. 0 1 0 0 0 0 0 0 0 DAVID GOLDBERG MHS PRESIDENT/CEO 0 565581 0 115644 0 123391 0 112875 0 0 0 917491 0 0 FRANK M ABRAHAM MD PHYSICIAN 602740 0 0 0 51 0 24362 0 41966 0 669119 0 0 0 LISA SIMON CPA MHS VP FINANCE/CFO 0 367856 0 53534 0 1242 0 48897 0 6885 0 478414 0 0 DAVID M FOURQUREAN MD PHYSICIAN 353838 0 0 0 80224 0 17579 0 22996 0 474637 0 0 0 LORN A WOLFE MD PHYSICIAN 407740 0 0 0 16118 0 17116 0 30285 0 471259 0 0 0 MARISA DOWNEY DO PHYSICIAN 343691 0 0 0 71441 0 16759 0 27525 0 459416 0 0 0 JAMES HOLEHOUSE MD PHYSICIAN 279397 0 0 0 0 0 11395 0 20677 0 311469 0 0 0 MELISSA LOCKWOOD PMH CAO 0 228224 0 32860 0 0 0 6908 0 11772 0 279764 0 0 JEFF CRUDELE INTERIM CFO 0 275000 0 0 0 0 0 0 0 0 0 275000 0 0 KEVIN GESSLER JR CPA CFE CHFP VP OF FINANCIAL SERVICES 0 179960 0 18700 0 747 0 5436 0 6885 0 211728 0 0 BONNIE FORMAN MD CHIEF OF STAFF 156174 0 0 0 3392 0 6412 0 7541 0 173519 0 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). FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PRESTON MEMORIAL HOSPITAL IS MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A PRESTON MEMORIAL HOSPITAL'S BOARD MEMBERS ARE ELECTED OR APPOINTED BY MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B PRESTON 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 MEMBERS ARE ASKSED TO INFORM MANAGEMENT OF ANY QUESTIONS OR REVISIONS THEY MAY HAVE. IF CHANGES ARE MADE, BASED ON 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 REVIEWS ALL RESPONSES FOR POSSIBLE CONFLICTS OF INTEREST AND DETERMINES WHAT TYPES OF DECISIONS THAT A MEMBER IS PROHIBITED FROM PARTICIPATING. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, A CONSULTANT COMPILES A MARKET DATA REPORT ON CEO COMPENSATION. THIS REPORT IS THEN REVIEWED BY THE EXCUTIVE COMMITTEE TO DETERMINE COMPENSATION FOR THE INDIVIDUAL. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS 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. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH PUBLIC DISCLOSURE WITH THE WV HEALTH CARE AUTHORITY. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,752,891. MANAGEMENT AND GENERAL EXPENSES 1,088,174. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,841,065. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 3,413,478. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,413,478. BILLING & CODING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 212,615. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 212,615. ACUTE CARE SERVICES: PROGRAM SERVICE EXPENSES 61,445. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 61,445. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION OBLIGATION 16,801. EQUITY TRANSFERS DECREASE IN VALUE OF ASSETS HELD BY OTHERS -53,846. 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 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 MON ELDER SERVICES INC 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 311520863 RETIREMENT COMMUNITY WV 501(C)(3) LINE 12C, III-FI 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 MEDICAL GROUP 300 SOUTH PRICE STREET KINGWOOD WV 26537 550717988 PRIMARY AND URGENT CARE WV 501(C)(3) LINE 3 PRESTON MEMORIAL HOSPITAL 1 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 1 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 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1