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MONTGOMERY GENERAL HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MONTGOMERY GENERAL HOSPITAL INC (EIN 55-0372580)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201103199349302635
Schema version
2010v3.4
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

FieldValueIRS element (for citing)
Timestamp2011-11-15T10:52:17-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Arnett & Foster PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1P O Box 2629AddressLine1
CityCharlestonCity
StateWVState
ZIP Code25329ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN550372580EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Montgomery General Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMONTNameControl
Phone3044425151Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1Washington Sixth AvenueAddressLine1
CityMontgomeryCity
StateWVState
ZIP Code25136ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameVickie GayName
TitleCEOTitle
Phone3044425151Phone
Date Signed2011-11-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameHarry C HarlessName
Phone3043460441Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonVickie GayNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1Washington Sixth AvenueAddressLine1
CityMontgomeryCity
StateWVState
ZIP Code25136ZIPCode
FieldValueIRS element (for citing)
Gross Receipts22113881GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.mghwv.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1970YearFormation
State Legal DomicileWVStateLegalDomicile
Activity Or Mission DescriptionTo provide quality, cost-effective, and convenient healthcare services that meet and exceed reasonable internal and external customer expectations.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees264TotalNbrEmployees
Total Nbr Volunteers17TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year32330ContributionsGrantsPriorYear
Contributions Grants Current Year84725ContributionsGrantsCurrentYear
Program Service Revenue Prior Year22513880ProgramServiceRevenuePriorYear
Program Service Revenue CY21908840ProgramServiceRevenueCY
Investment Income Prior Year704InvestmentIncomePriorYear
Investment Income Current Year5InvestmentIncomeCurrentYear
Other Revenue Prior Year165977OtherRevenuePriorYear
Other Revenue Current Year120311OtherRevenueCurrentYear
Total Revenue Prior Year22712891TotalRevenuePriorYear
Total Revenue Current Year22113881TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12631752SalariesEtcPriorYear
Salaries Etc Current Year12204151SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10306227OtherExpensePriorYear
Other Expenses Current Year10209188OtherExpensesCurrentYear
Total Expenses Prior Year22937979TotalExpensesPriorYear
Total Expenses Current Year22413339TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-225088RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-299458RevenuesLessExpensesCY
Total Assets BOY7408001TotalAssetsBOY
Total Assets EOY7787787TotalAssetsEOY
Total Liabilities BOY6759857TotalLiabilitiesBOY
Total Liabilities EOY7243742TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY648144NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY544045NetAssetsOrFundBalancesEOY
Mission DescriptionMontgomery General Hospital is a critical access hospital. It also provides outpatient services including laboratory, radiology, surgery and therapy services; physician services; and skilled nursing services.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense16114361Expense
Revenue21908840Revenue
DescriptionThe Hospital provided health care services including 2,767 acute inpatient days; 12,576 skilled nursing days; 31,441 outpatient visits; 9,261 emergency room visits; 1,151 ambulatory surgery procedures; and 21,445 physician office visits. Charges foregone for charity care amounted to $191,655.Description
Total Program Service Expense16114361TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109653NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees264NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Sherri MurrayBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3044427437TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1Washington Sixth AvenueAddressLine1
CityMontgomeryCity
StateWVState
ZIP Code25136ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Vickie Gay
President/CEO40.00XX14109202174
Raleigh Collins
Vice-Chairman1.00X000
Robert Gilliam
Trustee1.00X000
Carl Harris
Trustee1.00X000
Robert Neal
Treasurer1.00X000
Patsy Tucker
Trustee1.00X000
Rita Bohanna
Secretary1.00X000
Donald Smith
Chairman1.00X000
Ghassan Dagher
Trustee1.00X000
Percy Mosley Jr
Trustee1.00X000
Barbara Crist
Trustee1.00X000
Naaman G Clonch
Trustee1.00X000
Sherry Murray
CFO40.00X8947901374
Mohamad Sankari
Physician40.00320013010106X
Adin Timbayan
Physician40.0032287509934X
Paul Jackson
Physician40.0041585500X
Kenneth Dwyer
Physician40.00252629021851X
Samuel R Davis
Physician40.0025232303654X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1794266TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation49093TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Advantage Rehab
5407 Morning Dove LaneCross LanesWV25313Therapy Services381634
Interim Physicians
12140 Woodcrest Executive Dr SuiteSt LouisMO63141Physician Services211106
SVI Laboratory Services
3004 Chesterfield AveCharlestonWV25304Lab144651
Alliance Healthcare Services
100 Bayview Circle Suite 400Newport BeachCA92660MRI Services131880
Arnett & Foster PLLC
101 Washington StCharlestonWV25301Accounting Fees130809
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants69725GovernmentGrants
All Other Contributions15000AllOtherContributions
Total Contributions84725TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPatient servicesDescription
Business Code900099BusinessCode
Total Revenue Column21908840TotalRevenueColumn
Related Or Exempt Function Income21908840RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue21908840TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5TotalRevenueColumn
Exclusion$5ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real63300Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real63300Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column63300TotalRevenueColumn
Exclusion$63,300ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Cafeteria72221039703$39,703
Medical records9000996000$6,000

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column11308TotalRevenueColumn
Exclusion$11,308ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue57011TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column22113881TotalRevenueColumn
Related Or Exempt Function Income21908840RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$120,316ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total234119Total
Program Services158633ProgramServices
Management And General75486ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8954987Total
Program Services6067669ProgramServices
Management And General2887318ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total223135Total
Program Services151190ProgramServices
Management And General71945ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2138519Total
Program Services1449005ProgramServices
Management And General689514ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total653391Total
Program Services442721ProgramServices
Management And General210670ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total137289Total
Management And General137289ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total86741Total
Management And General86741ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1193124Total
Program Services808430ProgramServices
Management And General384694ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total90551Total
Program Services61355ProgramServices
Management And General29196ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2779442Total
Program Services1883278ProgramServices
Management And General896164ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total149258Total
Program Services101133ProgramServices
Management And General48125ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total664634Total
Program Services450339ProgramServices
Management And General214295ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total60047Total
Program Services40686ProgramServices
Management And General19361ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total162560Total
Management And General162560ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total651354Total
Program Services441341ProgramServices
Management And General210013ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total349190Total
Program Services236602ProgramServices
Management And General112588ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad debts33430003343000
Health care provider ta357049357049
Licenses, dues & permit25383171998184
Use taxes19577132656312
Staff training1461399014712

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total125376Total
Program Services81565ProgramServices
Management And General43811ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22413339Total
Program Services16114361ProgramServices
Management And General6298978ManagementAndGeneral
Fundraising0Fundraising

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2684230BOY
EOY3392931EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY5849BOY
EOY9798EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY358432BOY
EOY341479EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY129415BOY
EOY178338EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis30336626LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec26507343LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4171472BOY
EOY3829283EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY58603BOY
EOY35958EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7408001BOY
EOY7787787EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3935329BOY
EOY4526718EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1883578BOY
EOY1971979EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
EOY160000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY940950BOY
EOY585045EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6759857BOY
EOY7243742EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY648144BOY
EOY544045EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY648144BOY
EOY544045EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7408001BOY
EOY7787787EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-299458ReconcilationRevenueExpenses
Reconcilation Other Changes195359ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis869878OtherCostOrOtherBasis
Book Value869878BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis12565681OtherCostOrOtherBasis
Depreciation11071147Depreciation
Book Value1494534BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis16519235OtherCostOrOtherBasis
Depreciation15057481Depreciation
Book Value1461754BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis381832OtherCostOrOtherBasis
Depreciation378715Depreciation
Book Value3117BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3829283TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Capital lease obligations$186,653
Due to third-party payors$398,392
FieldValueIRS element (for citing)
Total Of Amounts585045TotalOfAmounts
Total Revenue22113881TotalRevenue
Total Expenses22413339TotalExpenses
Excess Or Deficit For Year-299458ExcessOrDeficitForYear
Other$195,359OtherAmount
Total Adjustments195359TotalAdjustments
Excess Or Deficit Per FS-104099ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt22092598TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal22092598RevenueSubtotal
Other Revenues Not Included21283OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt21283RevenueNotRptdOnFinStmt
Total Revenue Per Form99022113881TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt22392056TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal22392056ExpensesSubtotal
Other Expenses Not Included21283OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt21283ExpensesNotRptdOnFinStmt
Total Expenses Per Form99022413339TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierExplanationExplanation
Part XI, Line 8 - Other Adjustments:Additional minimum pension liability recognized 182,176. Transfer from related party 13,183.
Part XII, Line 4b - Other Adjustments:Grant expenses netted against income on financial statements 21,283.
Part XIII, Line 4b - Other Adjustments:Grant expense netted against income on financial statements 21,283.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care0AmountsBudgetedForCharityCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense96460TotalCommunityBenefitExpense
Net Community Benefit Expense96460NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense790531TotalCommunityBenefitExpense
Direct Offsetting Revenue749173DirectOffsettingRevenue
Net Community Benefit Expense41358NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense886991TotalCommunityBenefitExpense
Direct Offsetting Revenue749173DirectOffsettingRevenue
Net Community Benefit Expense137818NetCommunityBenefitExpense
Percent Of Total Expense0.00730PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense886991TotalCommunityBenefitExpense
Direct Offsetting Revenue749173DirectOffsettingRevenue
Net Community Benefit Expense137818NetCommunityBenefitExpense
Percent Of Total Expense0.00730PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,682,532BadDebtExpenseAmount
Amount Reimbursed By Medicare4708921AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare4854008CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-145087MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Montgomery General Hospital IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1Washington Sixth AvenueAddressLine1
CityMontgomeryCity
StateWVState
ZIP Code25136ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Critical Access HospitalXCriticalAccessHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Not required for 2010BusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)

ExplanationExplanationReturn ReferenceReturnReference
Part I, Line 7: The cost of charity care has been calculated by obtaining gross charges from the audited financial statements for charity care write off's and multiplying these charges by the aggregate hospital cost to charge ratio. The resulting charity care cost was then increased for the estimated "charity portion" of broad-based taxes paid to the State of WV. The net amount was then reduced by the estimated "charity portion" of the revenue "disproportionate share" payment received from the state. Medicaid cost was computed by multiplying the Medicaid HMO charges for each hospital department by the respective cost-to-charge ratio that relates to each department. The ratios are obtained from this year's Medicare cost report. The Medicaid cost is then reduced by the payments received from Medicaid HMO plans. Only Medicaid HMO charges and payments were included as "tradtional" Medicaid is reimbursed by WV Medicaid at 100% of cost so the cost and related payments from non-HMO Medicaid services nets to zero.
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 $ 3343000.
Part III, Line 4: Patient Accounts Receivable: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectable 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 collectibility. 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 reduction to bad debt expense when received. Interest is not charged on patient accounts receivable.
Part III, Line 8: The shortfall is not being reported as a community benefit because the hospital will be reimbursed through a Medicare cost report settlement.The Hospital is cost reimbursed at 101% of allowable cost for Medicare and WV Medicaid traditional payer types. HMO Medicare and HMO Medicaid payers are reimbursed based on the individual contracts signed by the hospital with each HMO payer. HMO's do not have a year end settlement process.
Medicare allowable costs were estimated using Worksheet B of the Schedule H instructions.Part III, Section B, Line 8
Part VI, Line 2: Montgomery General Hospital provides acute care services, swing bed SNF serves, skilled nursing services for both skilled patients and intermediate care patients and physicians in general practice and many specialites. As the only hospital in Fayette County, Montgomery General Hospital is aware of the health needs of the community and works to provide all necessary services to all citizens of the county.
Part VI, Line 4: Montgomery General Hospital is a Critical Access Hospital located in Fayette County, West Virginia. Montgomery General Hospital is the only hospital for rural Fayette County. Fayette County is a low income area that must compete with Urban Kanawha county to attract and retain physicians, nurses and medical personnel. In addition of having to pay higher salaries to attract top medical professional, Montgomery General Hospital has a high percentage of Medicare and Medicaid patient population. Montgomery General Hospital is listed as a Health Professional Shortage Area and a Medically Underserved Area for portions of Fayette County.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Mohamad Sankari
320013000004948051580330119000
Adin Timbayan
322875000003137067970332809000
Paul Jackson
415855000000000415855000
Kenneth Dwyer
2526290000038460180050274480000
Samuel R Davis
252323000003654000255977000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonGhassan Dagher MDNamePerson
FieldValueIRS element (for citing)
RelationshipBoard memberRelationship
Amount Of Transaction17020AmountOfTransaction
Description Of TransactionRental of office space.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section B, line 11The Form 990 is reviewed by the CFO and CEO.
Annually we provide the board members with the conflict of interest policy and questionnaire. Once these are completed they are returned to administration and reviewed by our in house council.Form 990, Part VI, Section B, line 12c
The Board of Directors determines the President/CEO's salary based upon comparative industry standards. The CEO determines the CFO salary based upon comparative industry standards.Form 990, Part VI, Section B, line 15
The governing documents and conflict of interest policy are available upon request. The financial statements are published annually in the local newspaper.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Additional minimum pension liability recognized 182,176. Transfer from related party 13,183. Total to Form 990, Part XI, Line 5: 195,359.Form 990, Part XI, line 5:
Oversight of the auditNo changes have been made to the oversight of the Financial Statement audit.Form 990 Part XII Line 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
Laird Health Care Foundation Inc
Washington Sixth AvenueMontgomeryWV25136550632743Support tax-exempt health care organizationsWV501(c)(3)11N/A0
Montgomery General Elderly Care Center
Washington Sixth AvenueMontgomeryWV25136550623339Extended care facilityWV501(c)(3)9N/A0
Montgomery General Healthcare System Inc
Washington Sixth AvenueMontgomeryWV25136550632601Provide support to affiliated exempt health care providersWV501(c)(3)11N/A0
Montgomery MedCorp Inc
washington Sixth AvenuemontgomeryWV25136550767169Physicians PracticeWV501(c)(3)9N/A0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg