2023-11-15T15:08:57-06:00 2022-12-31 861065772 DELOITTE TAX LLP 50 SOUTH SIXTH STREET MINNEAPOLIS MN 55402 990 2022-07-01 237441353 MONONGALIA COUNTY GENERAL HOSPITAL CO MONO 3045981242 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 JEFF SANDENE EXECUTIVE VP AND CFO 3045981242 2023-11-14 1 JEFF SANDENE XXX-XX-XXXX 0 ANNE FULTON P00941863 6123974000 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAVID S GOLDBERG 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 161970930 0 X WWW.MONHEALTHSYS.ORG X 1972 WV TO DELIVER THE BEST HEALTHCARE AND REMAIN THE PROVIDER OF CHOICE IN OUR REGIONAL SERVICE AREA BECAUSE OF OUR QUALITY, RESPECT, INTEGRITY, AND CREATIVITY, AS WELL AS OUR DEDICATION TO PATIENT SAFETY. 13 10 2072 10 488623 0 10267876 73961 299995590 159044865 4244545 -2336 1501385 2176314 316009396 161292804 0 0 0 0 149651960 74644636 0 0 0 185233316 95430871 334885276 170075507 -18875880 -8782703 268456681 266380201 158749442 142056131 109707239 124324070 X TO ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. 0 0 137395151 160542749 MONONGALIA GENERAL HOSPITAL (MGH) IS A 154-BED GENERAL, ACUTE CARE HOSPITAL IN MORGANTOWN, WV.MGH PROVIDES A WIDE ARRAY OF OUTPATIENT SERVICES INCLUDING OUTPATIENT SURGERY (10,866 SURGERIES), PHYSICIAN OFFICES (180,234 VISITS), AND MANY OTHER SERVICES. SOME OTHER SERVICES INCLUDE CARDIAC CATHETERIZATION, CT SCAN, MRI, NUCLEAR MEDICINE, AND ULTRASOUND.MGH IS LICENSED FOR 154 INPATIENT BEDS WHICH ARE ALL PRIVATE ROOMS. MGH HAD 3,516 DISCHARGES FOR THE YEAR WITH A TOTAL OF 15,779 PATIENT DAYS. MGH HAD 471 DELIVERIES FOR THE YEAR. INPATIENT GENERAL SURGERY 1,190 AND OPEN HEART SURGERY ARE ALSO OFFERED.MGH HAS AN EMERGENCY DEPARTMENT SERVING MONONGALIA AND SURROUNDING COUNTIES WITH A TOTAL OF 12,966 VISITS DURING THE YEAR. 137395151 1 1 0 0 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 99 0 1 2072 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 WV X GENE TOWNSEND - CONTROLLER 3042853676 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 WILLIAM MCBEE DIRECTOR, CHIEF OF STAFF 50.00 X 2024024 0 46432 DAVID GOLDBERG DIRECTOR & MHS CEO 1.00 49.00 X X 0 911058 131451 KRYSTAL ATKINSON DIRECTOR & MHMC CAO 1.00 50.00 X X 0 297414 22372 KIMBERLY MOYERS CHAIR 1.00 X X 0 0 0 NATALIE STONE VICE CHAIR 1.00 2.00 X X 0 0 0 SAM CHICO III SECRETARY/TREASURER 1.00 X X 0 0 0 DONALD ROBINSON DIRECTOR 1.00 X 0 0 0 ED BOYLE 9122 START DIRECTOR 1.00 6.50 X 0 0 0 JOSEPH BLATT MD DIRECTOR 1.00 X 0 0 0 PASTOR JUNIUS LEWIS DIRECTOR 1.00 X 0 0 0 PATRICK ESPOSITO II DIRECTOR 1.00 1.00 X 0 0 0 RANDY BUZZO DIRECTOR 1.00 1.00 X 0 0 0 ROBERT HULL MD DIRECTOR 40.00 X 0 0 0 JEFF CRUDELE INTERIM CFO 1.00 49.00 X 0 480000 0 LISA SIMON CPA VP FINANCE/CFO 1.00 50.00 X 0 421179 15219 GHARIB WISSAM PHYSICIAN 50.00 X 1262853 0 131775 ALEXANDER A NAGY PHYSICIAN 50.00 X 1301675 0 54160 JASCHAR SHAKURI-RAD PHYSICIAN 50.00 X 1049641 0 73661 KRISHNA BINGI PHYSICIAN 50.00 X 880768 0 46160 IHTISHAAM QAZI PHYSICIAN 50.00 X 794476 0 122547 7313437 2109651 643777 147 0 1 0 QUALIVIS INC PO BOX 123847 DEPT 3847 DALLAS TX 75312 AGENCY SERVICES 11000876 NORTHSTAR ANESTHESIA OF WV PLLC 6225 N STATE HWY 161 STE 200 IRVING TX 75038 ANESTHESIA SERVICES 4462707 MORRISON MANAGEMENT INC PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE MANAGEMENT 1520755 PHILIPS HEALTHCARE INC PO BOX 100355 ATLANTA GA 30384 BIOMED/DI SERVICES 1440560 MOUNTAIN EMERGENCY PHYSICIANS PO BOX 677979 DALLAS TX 75267 ER PHYSICIAN ADMIN/SERVICES 1282988 126 37729 36232 73961 PATIENT SERVICE REVENU 621990 159044865 159044865 159044865 675790 675790 189807 0 189807 189807 189807 678126 -678126 -678126 -678126 MISCELLANEOUS REVENUE 900099 1497884 1497884 LAB INCOME 621500 488623 488623 1986507 161292804 160542749 488623 187471 59161701 53943408 5218293 1848703 1708552 140151 10452950 9660511 792439 3181282 2940109 241173 19251570 19251570 49218 49218 11163750 11038047 125703 46 23 23 1517670 1510400 7270 599 599 4274494 3419595 854899 69914 62943 6971 1945940 1556752 389188 9548336 4774168 4774168 -3815 -3815 MEDICAL SUPPLIES 34960017 34960017 MEDICAID TAX 4831776 4831776 BAD DEBT 3105078 2557320 547758 EQUIPMENT AND SUPPLIES 2035013 2035013 2681265 2399733 281532 170075507 137395151 32680356 0 1787018 -943727 47814473 68381443 8378727 6781015 912161 1333141 333635794 224618611 114845053 109017183 51891824 42451787 4480140 4216608 38347285 35142751 268456681 266380201 27658418 24052568 6318271 94657111 91848458 30115642 26155105 158749442 142056131 X 109707239 124324070 109707239 124324070 268456681 266380201 X -8782703 652075 19605962 3141497 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8039622 8039622 175675845 116796316 58879529 149483060 107397613 42085447 437267 424682 12585 109017183 INVESTMENTS 42451787 F 42451787 OTHER RECEIVABLES 3862416 DUE FROM THIRD-PARTY PAYORS 4069278 UNDER BOND INDENTURE AGREEMENTS HELD BY TRUST 2174932 TAX INCREMENT FINANCING BONDS HELD BY TRUSTEES 2647090 SELF INSURANCE FUNDING AGREEMENT 8480537 DUE FROM AFFILIATES 13694238 OTHER ASSETS 214260 35142751 ACCRUAL FOR ESTIMATED PROFESSIONAL AND GENERAL 7761859 DUE TO AFFILIATES 76306 INTEREST RATE SWAP AGREEMENT 4976562 ACCRUED PENSION COSTS 9386391 RABBI TRUST LIABILITY 1123988 CAPITAL LEASE 2829999 26155105 X PART X, LINE 2: THE IRS HAS DETERMINED THAT THE SYSTEM ENTITIES ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE CODE AND APPLICABLE STATE STATUTES, EXCEPT FOR MHC WHICH IS A CORPORATION SUBJECT TO INCOME TAX. THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022 AND 2021. 1 1 1 X 0 1 1 0 1 1 6430882 6430882 0.03860 21949721 5795871 16153850 0.09690 28380603 5795871 22584732 0.13550 296302 21495 274807 0.00160 783632 783632 0.00470 100112 100112 0.00060 1180046 21495 1158551 0.00690 29560649 5817366 23743283 0.14240 6160 6160 0.00000 6160 6160 0.00000 0 931554 24718863 34518414 -9799551 X 1 1 1 1 MONONGALIA GENERAL HOSPITAL 1200 JD ANDERSON DRIVE MORGANTOWN WV 26505 MONHEALTHSYS.COM X X X MONONGALIA GENERAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X WWW.MONGENERAL.COM/MAIN/COMMUNITY-HEALTH X 1 22 1 WWW.MONGENERAL.COM/MAIN/COMMUNITY-HEALTH-NEEDS-ASSES 0 1 X 200.000000000000 200.000000000000 X X X 1 1 X X X 1 X MONHEALTH.COM/MAIN/FINANCIAL-ASSISTANCE X MONHEALTH.COM/MAIN/FINANCIAL-ASSISTANCE X MONHEALTH.COM/MAIN/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X 1 X 0 0 MONONGALIA GENERAL HOSPITAL PART V, SECTION B, LINE 5: PART V, SECTION B, LINE 5: MON HEALTH PARTNERED WITH WEST VIRGINIA UNIVERSITY'S OFFICE OF HEALTH AFFAIRS (WVU OHA) TO COMPLETE THE CHNA USING A ROBUST COMMUNITY-BASED PROCESS DESIGNED TO ENGAGE A BROAD REPRESENTATION OF COMMUNITY MEMBERS. A CHNA LEADERSIHP TEAM INCLUDING HOSPITAL AND COMMUNITY REPRESENTATION WAS CONVENED BY MHMC TO INFORM AND GUIDE THE PROCESS. FOR THE 2022 PROCESS, THREE ENTITIES WITHIN MONONGALIA COUNTY CAME TOGETHER TO COMPLETE THE COMMUNITY HEALTH NEEDS ASSSESSMENT PROCESS TOGETHER FOR THE FIRST TIME. MON HEALTH MEDICAL CENTER, IN PARTNERSHIP WITH WVU MEDICINE RUBY MEMORIAL HOSPITAL AND THE MONONGALIA COUNTY HEALTH DEPARTMENT, COLLABORATED TO DEVELOP A COOPERATIVE DATA COLLECTION EFFORT THAT WOULD HELP COLLECTIVELY MEET REPORTING REQUIREMENTS FOR EACH. DUE TO CLINIC AND CAMPUS LOCATIONS IN MONONGALIA COUNTY, THIS TEAM DEFINED THE COMMUNITY SERVED AS MONONGALIA AND MARION COUNTIES IN WEST VIRGINIA. TWO PRIMARY SOURCES OF DATA WERE UTILIZED TO INFORM THE CHNA: 1) A PUBLIC INPUT SURVEY AND 2) A DATA PRESENTATION SESSION WHERE INFORMATION WAS GATHERED FROM ATTENDEES. MONONGALIA GENERAL HOSPITAL PART V, SECTION B, LINE 6B: WEST VIRGINIA UNIVERSITY'S OFFICE OF HEALTH AFFAIRS (WVU OHA) MONONGALIA GENERAL HOSPITAL PART V, SECTION B, LINE 11: PART V, SECTION B, LINE 11: THOUGH COMMUNITY HEALTH NEEDS WERE IDENTIFIED, MANY NEEDS ARE OUTSIDE OF THE SCOPE OF SERVICES OFFERED BY MONONGALIA GENERAL HOSPITAL. FOR NEEDS WITHIN THE SCOPE OF MONONGALIA GENERAL HOSPITAL, THE BOARD AND ADMINISTRATION HAVE DEVELOPED AN IMPLEMENTATION STRATEGY. PART I, LINE 7: THE HOSPITAL USED A COST-TO-CHARGE RATIO DERIVED FROM MEDICARE COST REPORT FOR TOTAL PROGRAM COSTS AND TOTAL PROGRAM CHARGES TO ESTIMATE THE OVERALL COST-TO-CHARGE RATIO (CCR). THIS CCR WAS USED IN COMPUTATIONS FOR UNREIMBURSED MEDICAID AND CHARITY CARE. 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 $ 3,399,664. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE CARRIED AT THE ORIGINAL CHARGE LESS AN ESTIMATE MADE FOR DOUBTFUL OR UNCOLLECTIBLE ACCOUNTS. THE ALLOWANCE IS BASED UPON A REVIEW OF THE OUTSTANDING BALANCES AGED BY FINANCIAL CLASS. MANAGEMENT USES COLLECTION PERCENTAGES BASED UPON HISTORICAL COLLECTION EXPERIENCE TO DETERMINE COLLECTABILITY. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS MGH RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO THE PROVISION FOR BAD DEBT EXPENSE WHEN RECEIVED. INTEREST IS NOT CHARGED ON PATIENT ACCOUNTS RECEIVABLE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. THE COSTS ARE ALLOCATED TO THE VARIOUS DEPARTMENTS USING A STEP DOWN APPROACH AND REMOVING ANY COSTS THAT ARE NOT ALLOWABLE UNDER MEDICARE RULES. THE ORGANIZATION IS A TAX EXEMPT, NOT-FOR-PROFIT ENTITY THAT SERVES MONONGALIA AND SURROUNDING COUNTIES PATIENT POPULATION REGARDLESS OF THEIR MEANS TO PAY OR HEALTH INSURANCE STATUS. MEDICARE PATIENTS IN OUR SERVICE AREA DEPEND ON THE ORGANIZATION TO DELIVER THEIR HEALTH CARE AND MEET THEIR MEDICAL NEEDS REGARDLESS OF MEDICARE COVERAGE OF COST FOR PROVIDING THE NEEDED SERVICE. SINCE THE ORGANIZATION CONSTANTLY WORK TO OPERATE AS COST EFFICIENT AS POSSIBLE, WE FEEL STRONGLY THAT MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. PART III, LINE 9B: THERE ARE PROVISIONS IN THE DEBT COLLECTION POLICY TO BE FOLLOWED FOR PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. THE POLICY STATES THAT FINANCIAL ASSISTANCE SHALL BE OFFERED TO THE HOSPITAL'S UNINSURED AND UNDERINSURED PATIENTS ON A NONDISCRIMINATORY BASIS TO MEET THE NEED OF THE COMMUNITY. CHARITY CARE REQUESTS WILL BE REVIEWED AND EVALUATED BY THE CFO AND DIRECTOR OF PATIENT ACCOUNTING FOR APPROVAL. PATIENTS THAT QUALIFY FOR 100% CHARITY CARE ARE NOT PURSUED FOR COLLECTION. PART VI, LINE 2: THE CHNA PROCESS BEGAN WITH A THOROUGH REVIEW OF THE PREVIOUS CYCLE'S NEEDS ASSESSMENT REPORT, AND INCLUDED A REVIEW OF PUBLICLY AVAILABLE SECONDARY DATA RELATED TO COUNTIES WITHIN MON GENERAL'S SERVICE AREA. THESE DATA INCLUDED THE ABOVE U.S. CENSUS DATA AND COUNTY HEALTH RANKINGS DATA. USING THESE REPORTS AS A SPRINGBOARD, THE LEADERSHIP TEAM STARTED THE INITIAL DISCUSSION AROUND CRITICAL HEALTH NEEDS, CHANGES IN THE COMMUNITY DEMOGRAPHICS OVER THE PREVIOUS FEW YEARS, AND LESSONS LEARNED FROM THE LAST CHNA CYCLE'S HEALTH TOPIC PRIORITIZATION AND DEVELOPMENT OF IMPLEMENTATION ACTIVITIES. PRIMARY DATA COLLECTION WAS COMPRISED OF SURVEYING COMMUNITY MEMBERS TO GATHER PERCEPTIONS OF HEALTH ISSUES, QUALITY OF LIFE, AND OTHER RELATED TOPICS. SURVEY DATA WAS ANALYZED AND PRESENTED BACK TO THE MHMC LEADERSHIP TEAM AS WELL AS THE MONONGALIA COUNTY COLLABORATIVE TEAM AT A DATA PRESENTATION HOSTED VIRTUALLY. THIS EVENT WAS FOCUSED ON REVIEWING THE SURVEY DATA, DISCUSSING COMMUNITY ASSETS THAT IMPACT POPULATION HEALTH IN MHMC'S SERVICE AREA, AS WELL AS DISCUSSING THE NEEDS OF THOSE NOT WELL REPRESENTED IN THE SURVEY DATA. AT THIS MEETING, THE GROUP WORKED TO DISCUSS POSSIBLE STRATEGIES FOR EACH AREA OF CONCERN, AS WELL AS EXISTING RESOURCES TO ADDRESS THESE NEEDS. EACH ENTITY OF THE COLLABORATIVE TEAM FOCUSED ON RESOURCES SPECIFIC TO THEIR ORGANIZATION, BUT MANY OF THE PROGRAMS SERVE THE SAME COMMUNITY. THE COLLABORATIVE TEAM INTENDS TO MOVE FORWARD WITH AT LEAST ONE JOINT IMPLEMENTATION STRATEGY TO SERVE THEIR COMMUNITY AS A WHOLE. PART VI, LINE 3: THE PLAIN LANGUAGE SUMMARY OF THE FAP AND FAP APPLICATION ARE AVAILABLE ON THE HOSPITAL'S WEBSITE. PAPER COPIES OF THE FAP, PLAIN LANGUAGE SUMMARY OF THE FAP, AND FAP APPLICATION ARE AVAILABLE UPON REQUEST AND COPIES ARE IN THE EMERGENCY ROOM AND ADMISSIONS AREA. THE HOSPITAL HAS SIGNS THAT NOTIFY THE PATIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IN THE EMERGENCY ROOM AND ADMISSIONS AREA. UNINSURED PATIENTS ARE PROVIDED A PLAIN LANGUAGE SUMMARY AND FAP APPLICATION FORM. BILLING STATEMENTS INCLUDE A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN INFORMATION. THE HOSPITAL HAS FINANCIAL COUNSELORS AVAILABLE TO EDUCATE PATIENTS ON THE ELIGIBILITY OF ASSISTANCE. PART VI, LINE 4: FOR THE 2022 PROCESS, THREE ENTITIES WITHIN MONONGALIA COUNTY CAME TOGETHER TO COMPLETE THECOMMUNITY HEALTH NEEDS ASSESSMENT PROCESS TOGETHER FOR THE FIRST TIME. MON HEALTH MEDICAL CENTER, IN PARTNERSHIP WITH WVU MEDICINE RUBY MEMORIAL HOSPITAL AND THE MONONGALIA COUNTY HEALTH DEPARTMENT, COLLABORATED TO DEVELOP A COOPERATIVE DATA COLLECTION EFFORT THAT WOULD HELP COLLECTIVELY MEET REPORTING REQUIREMENTS FOR EACH. DUE TO CLINIC AND CAMPUS LOCATIONS BEYOND MONONGALIA COUNTY, THIS TEAM DEFINED THE COMMUNITY SERVED AS MONONGALIA AND MARION COUNTIES IN WEST VIRGINIA. PART VI, LINE 5: THE HOSPITAL HAS AN OPEN MEDICAL STAFF SERVING A MULTITUDE OF SPECIALTIES. THE BOARD OF DIRECTORS IS COMPRISED OF VARIOUS MEMBERS OF THE COMMUNITY AS REQUIRED UNDER ITS BYLAWS. THE ORGANIZATION SPONSORS AN ANNUAL HEALTH FAIR AT THE LOCAL MALL, IN WHICH THOUSANDS OF CITIZENS FROM THE LOCAL COMMUNITY COME TO LEARN ABOUT SERVICES OFFERED AND ARE PROVIDED THE OPPORTUNITY TO RECEIVE MULTIPHASIC BLOODWORK FOR A NOMINAL FEE. PART VI, LINE 6: THE HOSPITAL IS PART OF MONONGALIA HEALTH SYSTEM, INC. WHICH INCLUDES THE FOLLOWING OTHER HEALTH CARE ENTITIES IN THE COMMUNITY: MON HEALTH MARION NEIGHBORHOOD HOSPITAL, MON ELDER SERVICES, INC. DBA THE VILLAGE AT HERITAGE POINT, MON HEALTH CARE, INC., PRESTON MEMORIAL HOSPITAL, PRESTON MEMORIAL MEDICAL GROUP, AND STONEWALL JACKSON MEMORIAL HOSPITAL. MON HEALTH MARION NEIGHBORHOOD HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL. MON ELDER SERVICES, INC. IS A NOT-FOR-PROFIT RESIDENTIAL AND ASSISTED LIVING PROVIDER. MON HEALTH CARE, INC. IS A FOR-PROFIT DURABLE MEDICAL EQUIPMENT RETAILER. PRESTON MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL. PRESTON MEMORIAL MEDICAL CENTER GROUP IS A NOT-FOR-PROFIT ENTITY WHICH PROVIDES PRIMARY AND URGENT CARE. STONEWALL JACKSON MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL. IN 2022 THE MON HEALTH SYSTEM AND CHARLESTON AREA MEDICAL CENTER HEALTH SYSTEM MERGED TO FORM A NEW SYSTEM NAMED VANDALIA HEALTH. PART VI, LINE 7, REPORTS FILED WITH STATES WV 1 1 0 0 0 0 0 0 0 WILLIAM MCBEE DIRECTOR, CHIEF OF STAFF 1244567 0 778827 0 630 0 41000 0 5432 0 2070456 0 0 0 GHARIB WISSAM PHYSICIAN 859223 0 403000 0 630 0 125615 0 6160 0 1394628 0 0 0 ALEXANDER A NAGY PHYSICIAN 993341 0 303000 0 5334 0 47500 0 6660 0 1355835 0 0 0 JASCHAR SHAKURI-RAD PHYSICIAN 787255 0 244967 0 17419 0 62808 0 10853 0 1123302 0 0 0 DAVID GOLDBERG DIRECTOR & MHS CEO 0 576356 0 237960 0 96742 0 128124 0 3327 0 1042509 0 0 KRISHNA BINGI PHYSICIAN 712748 0 167600 0 420 0 40000 0 6160 0 926928 0 0 0 IHTISHAAM QAZI PHYSICIAN 513667 0 280179 0 630 0 115385 0 7162 0 917023 0 0 0 JEFF CRUDELE INTERIM CFO 0 480000 0 0 0 0 0 0 0 0 0 480000 0 0 LISA SIMON CPA VP FINANCE/CFO 0 35487 0 46842 0 338850 0 14673 0 546 0 436398 0 0 KRYSTAL ATKINSON DIRECTOR & MHMC CAO 0 265591 0 30250 0 1573 0 16212 0 6160 0 319786 0 0 PART I, LINE 3 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, LINES 4A-B LISA SIMON RECEIVED A SEVERANCE PAYMENT IN 2022 OF $338,707. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F) PLAN: DAVID GOLDBERG, LISA SIMON, GHARIB WISSAM, AND JASCHAR SHAKURI-RAD. A MONONGALIA COUNTY BUILDING COMMISSION 550714648 610208CK4 2011-04-20 9515218 REFUND A PORTION OF VARIABLE RATE BONDS TAX 0 0 0 B MONONGALIA COUNTY BUILDING COMMISSION 550714648 610208BRC 2008-02-13 48145000 CONSTRUCTION AND EXPANSION OF FACILITIES 0 0 0 C MONONGALIA COUNTY BUILDING COMMISSION 550714648 610218BN8 2015-04-28 51450000 REFUNDING AND IMPROVEMENT REVENUE BOND 0 0 0 A 2851568 9515218 9324914 190305 2011 0 1 0 1 B 3559002 48145000 13151213 705242 34288545 2009 0 1 0 1 C 18546633 61954096 55978763 776865 5198468 0 1 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 1 RAYMOND JAMES 32.400000000000 0 0 0 0 0 C 0 0 0 1 0 0 0 0 0 A 1 B 1 C 1 SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: MONONGALIA COUNTY BUILDING COMMISSION (F) DESCRIPTION OF PURPOSE: REFUND A PORTION OF VARIABLE RATE BONDS TAX (A) ISSUER NAME: MONONGALIA COUNTY BUILDING COMMISSION (F) DESCRIPTION OF PURPOSE: CONSTRUCTION AND EXPANSION OF FACILITIES (A) ISSUER NAME: MONONGALIA COUNTY BUILDING COMMISSION (F) DESCRIPTION OF PURPOSE: REFUNDING AND IMPROVEMENT REVENUE BOND FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MONONGALIA COUNTY GENERAL HOSPITAL IS MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A MONONGALIA COUNTY GENERAL HOSPITAL'S BOARD MEMBERS ARE ELECTED OR APPOINTED BY MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B MONONGALIA COUNTY GENERAL 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 TO THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY IS PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW PRIOR TO SUBMISSION. THE BOARD MEMBERS ARE ASKED TO INFORM MANAGEMENT OF ANY QUESTIONS OR REVISIONS THEY MAY HAVE. IF CHANGES ARE MADE, BASED ON BOARD MEMBER'S REVISIONS, MANAGEMENT REDISTRIBUTES A FINAL VERSION TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY A CONFLICT OF INTEREST QUESTIONNAIRE IS SENT OUT TO ALL BOARD MEMBERS. THE BOARD THEN REVIEWS ALL RESPONSES FOR POSSIBLE CONFLICTS OF INTEREST. IF A CONFLICT IS NOTED, THE BOARD MEMBERS DETERMINE WHICH DECISIONS THE CONFLICTED MEMBER SHALL NOT PARTICIPATE IN. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS PAID BY MONONGALIA HEALTH SYSTEM. ANNUALLY, A CONSULTANT COMPILES A MARKET DATA REPORT ON EXECUTIVE CEO COMPENSATION. THIS REPORT IS THEN REVIEWED BY THE EXECUTIVE COMMITTEE TO DETERMINE COMPENSATION FOR THE INDIVIDUAL. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE KEPT ONSITE AT MONONGALIA GENERAL HOSPITAL AND ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION LIABILITY 154,498. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS 2,986,999. TRANSFERS 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. 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