MONONGALIA EMERGENCY MEDICAL SERVICES INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- MONONGALIA EMERGENCY MEDICAL SERVICES INC (EIN 55-0725494)
- Tax period
- 2024-07-01 to 2025-06-30
- Filed
- 2025-12-23
- IRS object ID
- 202533579349301473
- Schema version
- 2024v5.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-12-23T15:23:57-06:00 | ReturnTs |
| Tax Period End | 2025-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550621482 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAY GRIFFITH & MAYS AC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 707 VIRGINIA STREETEASTSUITE 400 | AddressLine1Txt |
| City | CHARLESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 253012711 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550725494 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONONGALIA EMERGENCY MEDICAL SERVICES | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MONO | BusinessNameControlTxt |
| Phone | 3042852715 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 JD ANDERSON DRIVE | AddressLine1Txt |
| City | MORGANTOWN | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26505 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FOREST WEYEN | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 3042852715 | PhoneNum |
| Signature | 2025-12-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | J RYAN LINDSAY | PreparerPersonNm |
| PTIN | P01835061 | PTIN |
| Phone | 3043459400 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONEMS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | FOREST WEYEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 JD ANDERSON DRIVE | AddressLine1Txt |
| City | MORGANTOWN | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26505 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,074,439 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://MONEMS.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | TO SET AND CARRY OUT EMERGENCY MEDICAL SERVICES PLANNING, DEVELOPMENT AND IMPLEMENTATION IN MONONGALIA COUNTY, WEST VIRGINIA, AND THE SURROUNDING SERVICE AREA; TO PROVIDE, MAINTAIN AND OPERATE EMERGENCY AMBULANCE, RESCUE AND TRANSPORTATION SYSTEM; AND TO COORDINATE ITS ACTIVITES WITH OTHER HEALTH CARE SYSTEM COMPONENTS INCLUDING REGIONAL, STATE, AND INTERSTATE EMERGENCY MEDICAL SERVICES SYSTEMS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 172 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,870,575 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,300,699 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,154,627 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,520,138 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$42,382 | PYInvestmentIncomeAmt |
| CY Investment Income | $25,470 | CYInvestmentIncomeAmt |
| PY Other Revenue | $171,047 | PYOtherRevenueAmt |
| CY Other Revenue | $179,371 | CYOtherRevenueAmt |
| PY Total Revenue | $14,153,867 | PYTotalRevenueAmt |
| CY Total Revenue | $15,025,678 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,973,512 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,902,947 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,884,081 | PYOtherExpensesAmt |
| CY Other Expenses | $4,769,427 | CYOtherExpensesAmt |
| PY Total Expenses | $12,857,593 | PYTotalExpensesAmt |
| CY Total Expenses | $13,672,374 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,296,274 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,353,304 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,368,778 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,756,827 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,799,596 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,834,341 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,569,182 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,922,486 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO SET AND CARRY OUT EMERGENCY MEDICAL SERVICES PLANNING, DEVELOPMENT AND IMPLEMENTATION IN MONONGALIA COUNTY, WEST VIRGINIA, AND THE SURROUNDING SERVICE AREA; TO PROVIDE, MAINTAIN AND OPERATE EMERGENCY AMBULANCE, RESCUE AND TRANSPORTATION SYSTEM; AND TO COORDINATE ITS ACTIVITES WITH OTHER HEALTH CARE SYSTEM COMPONENTS INCLUDING REGIONAL, STATE, AND INTERSTATE EMERGENCY MEDICAL SERVICES SYSTEMS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,450,883 | ExpenseAmt |
| Revenue | $6,683,818 | RevenueAmt |
| Desc | TO SET AND CARRY OUT EMERGENCY MEDICAL SERVICES PLANNING, DEVELOPMENT AND IMPLEMENTATION IN MONONGALIA COUNTY, WEST VIRGINIA, AND THE SURROUNDING SERVICE AREA; TO PROVIDE, MAINTAIN AND OPERATE EMERGENCY AMBULANCE, RESCUE AND TRANSPORTATION SYSTEM; AND TO COORDINATE ITS ACTIVITES WITH OTHER HEALTH CARE SYSTEM COMPONENTS INCLUDING REGIONAL, STATE, AND INTERSTATE EMERGENCY MEDICAL SERVICES SYSTEMS. | Desc |
| Total Program Service Expenses | $10,450,883 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 34 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 172 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | 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 | 0 | 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 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3042852715 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 JD ANDERSON DRIVE | AddressLine1Txt |
| City | MORGANTOWN | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26505 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| CHRIS GOODE MD | |||||||||
| CHAIR | 2.00 | 45.00 | Yes (X) | Yes (X) | $0 | $490,127 | $47,143 | ||
| CHRIS EDWARDS DO | |||||||||
| DIRECTOR | 2.00 | 45.00 | Yes (X) | Yes (X) | $0 | $695,585 | $14,169 | ||
| MICHAEL GRACE | |||||||||
| DIRECTOR | 2.00 | 45.00 | Yes (X) | $0 | $988,349 | $188,223 | |||
| KARA BROWN | |||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| JIMMY SMITH | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| RANDY WILLIAMS | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| DAVID GOLDBERG | |||||||||
| VICE CHAIR | 2.00 | 45.00 | Yes (X) | $0 | $996,584 | $51,139 | |||
| FOREST WEYEN | |||||||||
| EXECUTIVE DIRECTOR | 45.00 | Yes (X) | $162,192 | $0 | $32,033 | ||||
| JOSH SILVER | |||||||||
| FTO PARAMEDIC | 45.00 | $106,756 | $0 | $32,773 | Yes (X) | ||||
| IVAN MADOLEV | |||||||||
| DIRECTOR OF IT | 45.00 | $104,046 | $0 | $24,993 | Yes (X) | ||||
| ROBERT LISTON | |||||||||
| EMT | 45.00 | $101,565 | $0 | $45,767 | Yes (X) | ||||
| PATRICK CLARK | |||||||||
| CAPTAIN | 45.00 | $104,644 | $0 | $37,059 | Yes (X) | ||||
| JAMIE CHAMBERS | |||||||||
| DIRECTOR OF CLINICAL SERVI | 45.00 | $118,935 | $0 | $22,004 | Yes (X) | ||||
| JOHN HITCHENS | |||||||||
| DIRECTOR OF ADMINISTRATION | 45.00 | $139,364 | $0 | $36,860 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $837,502 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,170,645 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $532,163 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | 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 |
|---|---|---|---|---|---|
| ZOLL MEDICAL CORPORATION | |||||
| PO BOX 27028 | NEW YORK | NY | 10087 | EQUIPMENT VENDOR | $424,862 |
| EMS MANANGEMENT | |||||
| 2540 EMPIRE DR SUITE 300 | WINSTONSALEM | NC | 27103 | BILLING SERVICE | $332,427 |
| LIFE-ASSIST INC | |||||
| 11277 SUNRISE PARK DR | RANCHO CORDOVA | CA | 95742 | MEDICAL SUPPLIES | $163,371 |
| STRYKER SALES LLC | |||||
| 21343 NETWORK PLACE | CHICAGO | IL | 60673 | EQUIPMENT VENDOR | $144,958 |
| MON HEALTH SYSTEM INC | |||||
| 1200 JD ANDERSON DR | MORGANTOWN | WV | 26505 | MEDICAL SERVICES AND RENT | $130,377 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $2,134,197 | RelatedOrganizationsAmt |
| Government Grants | $36,000 | GovernmentGrantsAmt |
| All Other Contributions | $6,130,502 | AllOtherContributionsAmt |
| Total Contributions | $8,300,699 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621910 | $6,500,816 | $6,500,816 |
| OTHER REVENUE | 900099 | $19,322 | $19,322 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,520,138 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,161 | TotalRevenueColumnAmt |
| Exclusion | $41,161 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $33,070 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $48,761 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$15,691 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$15,691 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$15,691 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISC REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $179,371 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $179,371 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $179,371 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,025,678 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,683,818 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $41,161 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,225 | TotalAmt |
| Management And General | $194,225 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,926,048 | TotalAmt |
| Program Services | $4,949,204 | ProgramServicesAmt |
| Management And General | $976,844 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,263 | TotalAmt |
| Program Services | $139,814 | ProgramServicesAmt |
| Management And General | $33,449 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,132,772 | TotalAmt |
| Program Services | $1,721,035 | ProgramServicesAmt |
| Management And General | $411,737 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $476,639 | TotalAmt |
| Program Services | $384,623 | ProgramServicesAmt |
| Management And General | $92,016 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,480 | TotalAmt |
| Management And General | $97,480 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,544 | TotalAmt |
| Management And General | $19,544 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,811 | TotalAmt |
| Program Services | $465,811 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,250 | TotalAmt |
| Management And General | $159,250 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $873,126 | TotalAmt |
| Program Services | $749,789 | ProgramServicesAmt |
| Management And General | $123,337 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,680 | TotalAmt |
| Management And General | $165,680 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,026,833 | TotalAmt |
| Program Services | $998,776 | ProgramServicesAmt |
| Management And General | $28,057 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $516,722 | TotalAmt |
| Management And General | $516,722 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OTHER | $446,693 | $194,246 | $252,447 |
| REPAIRS AND MAINTENANCE | $413,671 | $395,525 | $18,146 |
| MEDICAL SUPPLIES | $242,125 | $242,125 | |
| FUEL | $209,935 | $209,935 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,557 | TotalAmt |
| Management And General | $132,557 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,672,374 | TotalAmt |
| Program Services | $10,450,883 | ProgramServicesAmt |
| Management And General | $3,221,491 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,299,906 | BOYAmt |
| EOY | $3,622,447 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,380 | BOYAmt |
| EOY | $34,493 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,136,458 | BOYAmt |
| EOY | $905,335 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $112,893 | BOYAmt |
| EOY | $184,555 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $227,643 | BOYAmt |
| EOY | $223,929 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,947,139 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,400,814 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,148,999 | BOYAmt |
| EOY | $4,546,325 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $412,499 | BOYAmt |
| EOY | $2,239,743 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,368,778 | BOYAmt |
| EOY | $11,756,827 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $630,172 | BOYAmt |
| EOY | $662,346 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,870,510 | BOYAmt |
| EOY | $3,041,311 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $298,914 | BOYAmt |
| EOY | $2,130,684 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,799,596 | BOYAmt |
| EOY | $5,834,341 | 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 | $4,569,182 | BOYAmt |
| EOY | $5,922,486 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,569,182 | BOYAmt |
| EOY | $5,922,486 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,368,778 | BOYAmt |
| EOY | $11,756,827 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,353,304 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,037,226 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,527,201 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,266,554 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,805,901 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,170,197 | CurrentTaxYearAmt |
| Total | $16,807,079 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,469,385 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,177,762 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,860,439 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,130,177 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,500,816 | CurrentTaxYearAmt |
| Total | $33,138,579 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $5,064,674 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,128,383 | CurrentTaxYearAmt |
| Total | $11,193,057 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,506,611 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,704,963 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,126,993 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $14,000,752 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $14,799,396 | CurrentTaxYearAmt |
| Total | $61,138,715 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $61,138,715 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $615 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $587 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,884 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $23,385 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $41,161 | CurrentTaxYearAmt |
| Total | $68,632 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $615 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $587 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,884 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $23,385 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $41,161 | CurrentTaxYearAmt |
| Total | $68,632 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,507,226 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,705,550 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,129,877 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $14,024,137 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $14,840,557 | CurrentTaxYearAmt |
| Total | $61,207,347 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99890 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99950 | PublicSupportPY509Pct |
| Investment Income CY | 0.00110 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00050 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,970 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,782 | DepreciationAmt |
| Book Value | $9,188 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $138,110 | OtherCostOrOtherBasisAmt |
| Depreciation | $89,282 | DepreciationAmt |
| Book Value | $48,828 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,033,430 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,748,406 | DepreciationAmt |
| Book Value | $1,285,024 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,743,629 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,540,344 | DepreciationAmt |
| Book Value | $3,203,285 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,546,325 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OPERATING RIGHT - OF - USE ASSET | $2,130,684 |
| LOAN PROCEEDS HELD IN ESCROW | $109,059 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,239,743 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE LIABILITY | Desc |
| Amt | $2,130,684 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,130,684 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $15,025,678 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,025,678 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,025,678 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,672,374 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,672,374 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,672,374 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION FOLLOWS THE FASB'S AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL GRACE | ||||||||||||||
| DIRECTOR | $0 | $823,168 | $0 | $164,531 | $0 | $650 | $0 | $138,068 | $0 | $50,155 | $0 | $1,176,572 | $0 | $0 |
| DAVID GOLDBERG | ||||||||||||||
| VICE CHAIR | $0 | $736,828 | $0 | $241,048 | $0 | $18,708 | $0 | $13,800 | $0 | $37,339 | $0 | $1,047,723 | $0 | $0 |
| CHRIS EDWARDS DO | ||||||||||||||
| DIRECTOR | $0 | $629,578 | $0 | $65,450 | $0 | $557 | $0 | $13,799 | $0 | $370 | $0 | $709,754 | $0 | $0 |
| CHRIS GOODE MD | ||||||||||||||
| CHAIR | $0 | $465,791 | $0 | $24,336 | $0 | $0 | $0 | $34,500 | $0 | $12,643 | $0 | $537,270 | $0 | $0 |
| FOREST WEYEN | ||||||||||||||
| EXECUTIVE DIRECTOR | $161,867 | $0 | $0 | $0 | $325 | $0 | $7,014 | $0 | $25,019 | $0 | $194,225 | $0 | $0 | $0 |
| JOHN HITCHENS | ||||||||||||||
| DIRECTOR OF ADMINISTRATION | $114,464 | $0 | $24,250 | $0 | $650 | $0 | $4,960 | $0 | $31,900 | $0 | $176,224 | $0 | $0 | $0 |
| PATRICK CLARK | ||||||||||||||
| CAPTAIN | $103,148 | $0 | $1,496 | $0 | $0 | $0 | $2,601 | $0 | $34,458 | $0 | $141,703 | $0 | $0 | $0 |
| JAMIE CHAMBERS | ||||||||||||||
| DIRECTOR OF CLINICAL SERVI | $94,935 | $0 | $24,000 | $0 | $0 | $0 | $3,693 | $0 | $18,311 | $0 | $140,939 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 MEMBERS REVIEW ALL RESPONSES FOR POSSIBLE CONFLICTS OF INTEREST. THE BOARD DETERMINES WHAT TYPES OF DECISIONS THAT MEMBER IS PROHIBITED FROM PARTICIPATING IN. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE DIRECTORS SALARY IS APPROVED BY THE BOARD OF DIRECTORS |
| 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 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS, AND RELATED COMMITTEES ARE RESPONSIBLE FOR THE OVERSIGHT AND APPROVAL OF THE ANNUAL AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| MONONGALIA HEALTH SYSTEM INC | |||||||||
| 1200 JD ANDERSON DRIVE | MORGANTOWN | WV | 26505 | HOSPITAL | WV | 501(C)(3) | LINE 3 | MONONGALIA HEALTH SYSTEM INC | 0 |
| WEST VIRGINIA UNIVERSITY HOSPITALS INC | |||||||||
| PO BOX 8034 | MORGANTOWN | WV | 26505 | HOSPITAL | WV | 501(C)(3) | LINE 3 | WEST VIRGINIA UNIVERSITY HEALTH SYSTEM | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | 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 | Yes (1) | 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MONONGALIA HEALTH SYSTEM INC | ||
| K | $130,377 | FAIR MARKET VALUE |
| WEST VIRGINIA UNIVERSITY HOSPITALS INC | ||
| M | $8,956,868 | FAIR MARKET VALUE |