2023-11-15T09:44:44-06:00 2022-12-31 390859910 BAKER TILLY US LLP 101 WASHINGTON STREET EAST CHARLESTON WV 25301 990 2022-01-01 550372580 MONTGOMERY GENERAL HOSPITAL INC MONT 3044425151 401 SIXTH AVENUE MONTGOMERY WV 25136 SHERRI MURRAY CFO 3044421246 2023-11-13 1 SHERRI MURRAY 999009999 0 DOLORES ROSE P01286262 3043460441 2023-11-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DEBORAH HILL 401 SIXTH AVENUE MONTGOMERY WV 25136 32749617 0 X WWW.MGHWV.COM X 1970 WV TO PROVIDE QUALITY, COST-EFFECTIVE, AND CONVENIENT HEALTHCARE SERVICES THAT MEET AND EXCEED REASONABLE INTERNAL AND EXTERNAL CUSTOMER EXPECTATIONS. 10 9 370 10 0 0 2793360 305005 28253237 31477401 31940 24919 1230604 942292 32309141 32749617 4000 2500 0 0 13654735 17184796 0 0 0 15083111 15433153 28741846 32620449 3567295 129168 13407051 11084086 8740462 6114720 4666589 4969366 MONTGOMERY 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. 0 0 25412804 2500 32414490 THE HOSPITAL PROVIDED HEALTH CARE SERVICES INCLUDING 1,060 ACUTE INPATIENT DAYS; 2,175 SWING BED DAYS; 12,037 SKILLED NURSING DAYS; 22,573 OUTPATIENT VISITS; 7,538 EMERGENCY ROOM VISITS; 845 AMBULATORY SURGERY PROCEDURES; AND 22,624 PHYSICIAN OFFICE VISITS. CHARGES FOREGONE FOR CHARITY CARE AMOUNTED TO $25,353. 25412804 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 51 0 370 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X SHERRI MURRAY 3044421246 401 SIXTH AVENUE MONTGOMERY WV 25136 RALEIGH COLLINS TRUSTEE 0.50 1.50 X 1800 0 0 GHASSAN Y DAGHER MD CHAIR 0.50 1.50 X X 2600 0 0 JOYCE BROWN SECRETARY 0.50 1.50 X X 2100 0 0 BARBARA CRIST VICE-CHAIR 0.50 0.50 X X 2400 0 0 DEBORAH HILL PRESIDENT & CEO 39.50 0.50 X X 30778 0 305 RITA BOHANNA TRUSTEE 0.50 1.50 X 900 0 0 DONALD SMITH TRUSTEE 0.50 1.50 X 2600 0 0 PATRICIA TUCKER TRUSTEE 0.50 1.50 X 2100 0 0 LOU ANN BOWEN TRUSTEE 0.50 1.50 X 2000 0 0 DEANNE VALENTINE TRUSTEE 0.50 1.50 X 2400 0 0 DUSTIN SMITH TRUSTEE 0.50 1.50 X 1200 0 0 SHERRI MURRAY CFO 39.50 0.50 X 138267 0 317 ROBERT EGGLESTON MD PHYSICIAN 40.00 X 316684 0 8373 MYRA PRIDDY MD PHYSICIAN 40.00 X 373564 0 0 MARK TARAKJI MD PHYSICIAN 40.00 X 399164 0 115625 DILIP GHODASARA MD PHYSICIAN 40.00 X 586024 0 0 WILLIAM CASTO MD PHYSICIAN 40.00 X 484393 0 12212 2348974 0 136832 17 0 1 0 ADVANTAGE REHAB 150 HIDDEN VALLEY ROAD SCOTT DEPOT WV 25560 THERAPY SERVICES 1264434 MEDICAL INFORMATION TECHNOLOGY INC MEDITECH CIRCLE WESTWOOD MA 02090 EMR SERVICES 617561 KANAWHA VALLEY RADIOLOGISTS PO BOX 3428 CHARLESTON WV 25334 RADIOLOGIST SERVICES 468000 SHARP ANESTHESIA PO BOX 88 FAYETTEVILLE WV 25840 ANESTHESIA SERVICES 308000 AMN HEALTHCARE PO BOX 281939 ATLANTA GA 30384 NURSING SERVICES 257474 9 278376 26629 305005 PATIENT SERVICES 622110 31477401 31477401 31477401 21919 21919 5203 0 5203 5203 5203 3000 0 3000 3000 3000 340B PROGRAM 900099 863017 863017 CAFETERIA 722210 69537 69537 4535 4535 937089 32749617 32414490 0 30122 X 2500 2500 189767 139568 50199 14043220 10328388 3714832 437987 322127 115860 1585956 1166425 419531 927866 682419 245447 122086 122086 259360 259360 3875117 2850038 1025079 59233 43564 15669 471609 346855 124754 636148 467869 168279 1321999 972293 349706 57306 42147 15159 42726 42726 570216 419378 150838 677995 498646 179349 BAD DEBTS 3235000 3235000 MEDICAL SUPPLIES 2786631 2786631 HEALTH CARE PROVIDER TA 528493 528493 DUES AND SUBSCRIPTIONS 310671 228490 82181 478563 351973 126590 32620449 25412804 7207645 0 4806583 3335681 4955865 3058860 646415 600162 27536 37916 34135164 30554305 2690535 3580859 280117 470608 13407051 11084086 2997552 2632044 269960 158426 5472950 3324250 8740462 6114720 X 4666589 4969366 4666589 4969366 13407051 11084086 X 129168 173609 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 869878 869878 12175288 12052350 122938 20704490 18123240 2581250 385508 378715 6793 3580859 ACCRUED PENSION OBLIGATION 1584901 DUE TO THIRD PARTY PAYERS 1335680 OPERATING LEASE LIABILITY 403669 3324250 X PART X, LINE 2: THE ORGANIZATION ARE NONPROFIT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAVE BEEN RECOGNIZED AS TAX EXEMPT UNDER SECTION 501(A) OF THE CODE AND SIMILAR STATE STATUTES RELATING TO NOT-FOR-PROFIT ORGANIZATIONS. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE ORGANIZATION TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY OR ASSET IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE-LIKELY-THAN-NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICES (IRS). THE ORGANIZATION HAS CONCLUDED THAT AS OF DECEMBER 31, 2022 AND 2021, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. GENERALLY, TAX RETURNS FOR YEARS ENDED DECEMBER 31, 2019, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. 1 1 X 1 X 120.000000000000 1 X 120.000000000000 1 0 0 539088 539088 0.01830 7365185 7030346 334839 0.01140 7904273 7030346 873927 0.02970 2500 2500 0.00010 2500 2500 0.00010 7906773 7030346 876427 0.02980 1 3235000 4761582 4761582 X 1 1 1 1 MONTGOMERY GENERAL HOSPITAL INC 401 SIXTH AVENUE MONTGOMERY WV 25136 X X X X MONTGOMERY GENERAL HOSPITAL INC 1 0 0 1 X X X X X X X X 22 1 0 0 1 X HTTPS://MGHWV.COM/COMMUNITY-HEALTH X 1 22 1 HTTPS://MGHWV.COM/COMMUNITY-HEALTH 0 1 X 100.000000000000 120.000000000000 X X X 1 1 X X X X 1 X HTTPS://MGHWV.COM/FINANCIAL-RESOURCES X HTTPS://MGHWV.COM/FINANCIAL-RESOURCES X HTTPS://MGHWV.COM/FINANCIAL-RESOURCES X X X 1 X 0 X X X 1 X 0 0 MONTGOMERY GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 5: MONTGOMERY GENERAL HOSPITAL (MGH) ENLISTED THE ASSISTANCE OF KINGERY AND COMPANY, LLC, TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT THAT DETERMINES THE PRIORITY HEALTH ISSUES FACING THEIR PATIENTS AND THE SURROUNDING COMMUNITIES. THE PROJECT INCLUDED SURVEYING RESIDENTS AND SERVICE PROVIDERS, HOSTING FOCUS GROUPS, INTERVIEWING BOARD MEMBERS, COMMUNITY MEMBERS, AND KEY STAKEHOLDERS, CONDUCTING SECONDARY DATA RESEARCH, AND PROVIDING A SUMMARY REPORT WITH KEY FINDINGS AND RECOMMENDATIONS. MONTGOMERY GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE RESULTS OF THE CHNA WILL ENABLE THE HOSPITAL, AS WELL AS OTHER COMMUNITY PROVIDERS, TO COLLABORATE THEIR EFFORTS TO PROVIDE THE NECESSARY RESOURCES FOR THE COMMUNITY. AFTER REVIEWING DATA SOURCES PROVIDING DEMOGRAPHIC, POPULATION, SOCIOECONOMIC, AND HEALTH STATUS INFORMATION, IN ADDITION TO COMMUNITY FEEDBACK, HEALTH NEEDS OF THE COMMUNITY WERE PRIORITIZED. THE FOLLOWING HAVE BEEN SELECTED AS THE PRIORITY HEALTH ISSUES TO BE ADDRESSED:1. OBESITY IN ADULTSTHE FITNESS CENTER AT MGH WILL CONTINUE TO BE AVAILABLE TO ITS COMMUNITY MEMBERS FREE OF CHARGE DURING WEEKLY STAFFED HOURS. THIS STATE-OF-THE-ART FACILITY PROVIDES A WIDE VARIETY OF EQUIPMENT INCLUDING: TREADMILLS, ELLIPTICALS, STAIR-MASTERS, A SITH GYM, FREE WEIGHTS, AND RECUMBENT BIKES.2. SUBSTANCE ABUSETHE HOSPITAL WILL MAINTAIN ITS COLLABORATION AND REFERRAL NETWORK TO ADDRESS PATIENTS' NEEDS WITH REGARDS TO ADDICTION AND ABUSE. MGH WILL CONTINUE TO PROVIDE OUTREACH AND EDUCATION TO THE RESIDENTS OF MONTGOMERY AND THE SURROUNDING COMMUNITIES.3. DIABETESTHE HOSPITAL WILL CONTINUE TO TREAT EMERGENT ISSUES RELATED TO DIABETES. IN ADDITION, MGH WILL PROVIDE COUNSELING AND EDUCATION TO THE RESIDENTS TO ENCOURAGE PREVENTION AND TREATMENT. 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 OFFS AND MULTIPLYING THESE CHARGES BY THE AGGREGATE HOSPITAL COST TO CHARGE RATIO. MEDICAID COMMUNITY BENEFIT COST WAS ESTIMATED BASED ON THE COSTS IN EXCESS OF REIMBURSEMENTS FOR THE HOSPITAL'S SKILLED NURSING UNIT. OTHER HOSPITAL SERVICES ARE REIMBURSED BY WV MEDICAID AT 100% OF COST. SINCE THOSE COSTS AND REIMBURSEMENTS WOULD NET TO ZERO COMMUNITY BENEFIT EXPENSE, THOSE AMOUNTS ARE NOT INCLUDED IN THE MEDICAID COSTS AND OFF-SETTING REVENUE TOTALS REPORTED. 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 $ 3,235,000. PART III, LINE 2: BAD DEBTS AS REPORTED ON FINANCIAL STATEMENTS. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE CARRIED AT NET REALIZABLE VALUE TAKING INTO ACCOUNT IMPLICIT AND EXPLICIT PRICE CONCESSIONS. THE ESTIMATED IMPLICIT PRICE CONCESSIONS ARE BASED UPON MANAGEMENT'S JUDGMENTAL ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR EXPLICIT PRICE CONCESSIONS, IF NECESSARY. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ESTIMATED PRICE CONCESSIONS BASED UPON ITS REVIEW OF ACCOUNTS RECEIVABLE PAYOR COMPOSITION AND AGING, TAKING INTO CONSIDERATION RECENT EXPERIENCE BY PAYOR CATEGORY, PAYOR AGREEMENT RATE CHANGES, AND OTHER FACTORS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO MAKE MODIFICATIONS TO PATIENT SERVICE REVENUE AND TO ESTABLISH AN APPROPRIATE ESTIMATE FOR PRICE CONCESSIONS. THE ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH EXTERNAL COLLECTION AGENCIES. PART III, LINE 8: THE MEDICARE COSTS AND REIMBURSEMENTS WERE DERIVED FROM THE HOSPITAL'S MEDICARE COST REPORT. PART III, LINE 9B: CHARITY APPLICATION IS AVAILABLE TO ANY PERSON INTERESTED. COLLECTION STAFF WILL MEET WITH INTERESTED PATIENTS TO HELP COMPLETE AND ASSESS ALL REQUIRED INFORMATION. PART VI, LINE 2: MONTGOMERY GENERAL HOSPITAL PROVIDES ACUTE CARE SERVICES, SWING BED SNF SERVICES, SKILLED NURSING SERVICES FOR BOTH SKILLED PATIENTS AND INTERMEDIATE CARE PATIENTS AND PHYSICIANS IN GENERAL PRACTICE AND MANY SPECIALTIES. 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 3: MGH WILL MAKE REASONABLE EFFORTS TO EXPLAIN THE BENEFITS OF MEDICAID AND OTHER AVAILABLE PUBLIC AND PRIVATE PROGRAMS TO PATIENTS AND PROVIDE INFORMATION ON THOSE PROGRAMS THAT MAY PROVIDE COVERAGE FOR SERVICES. INFORMATION ON PUBLIC OR PRIVATE COVERAGE AND MGH'S FINANCIAL ASSISTANCE POLICY WILL BE COMMUNICATED TO PATIENTS IN EASY-TO-UNDERSTAND, CULTURALLY APPROPRIATE LANGUAGE, AND IN THE MOST PREVALENT LANGUAGES SPOKEN IN APPLICABLE HOSPITAL SERVICE AREA COMMUNITIES. MGH WILL MAKE RESOURCES AVAILABLE TO ASSIST PATIENTS IN ENROLLING IN AND/OR APPLYING FOR FEDERAL AND GOVERNMENT PROGRAMS. REQUESTS FOR FINANCIAL ASSISTANCE WILL BE PROCESSED PROMPTLY AND MGH WILL NOTIFY THE PATIENT OR APPLICANT IN WRITING WITHIN 60 DAYS OF RECEIPT OF A COMPLETED APPLICATION. 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 PROFESSIONALS, 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. PART VI, LINE 5: THE MAJORITY OF MONTGOMERY GENERAL HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE ORGANIZATION USES SURPLUS FUNDS FOR IMPROVEMENTS IN PATIENT CARE. CURRENTLY, THE ORGANIZATION IS IN THE PROCESS OF UPDATING ALL PATIENT ROOMS AND IMPLEMENTING AN EMR. THE ORGANIZATION OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL, REGARDLESS OF ABILITY TO PAY. THE ORGANIZATION OFFERS OPEN MRI SERVICES AND IS IN THE PROCESS OF IMPLEMENTING DIGITAL RADIOLOGY. THE ORGANIZATION INVOLVES ITSELF IN THE COMMUNITY BY SPONSORING HEALTH FAIRS AS WELL AS LUNCH AND LEARN OPPORTUNITIES TO ADDRESS THE DIABETIC POPULATION. X X 0 0 0 0 0 0 0 0 0 DILIP GHODASARA MD PHYSICIAN 586024 0 0 0 0 0 0 0 0 0 586024 0 0 0 MARK TARAKJI MD PHYSICIAN 399164 0 0 0 0 0 0 0 115625 0 514789 0 0 0 WILLIAM CASTO MD PHYSICIAN 482393 0 2000 0 0 0 0 0 12212 0 496605 0 0 0 MYRA PRIDDY MD PHYSICIAN 373564 0 0 0 0 0 0 0 0 0 373564 0 0 0 ROBERT EGGLESTON MD PHYSICIAN 316684 0 0 0 0 0 0 0 8373 0 325057 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CFO AND CEO. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY BOARD MEMBERS ARE PROVIDED THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE. ONCE THESE ARE COMPLETED THEY ARE RETURNED TO ADMINISTRATION AND REVIEWED BY OUR IN-HOUSE COUNSEL. FORM 990, PART VI, SECTION B, LINE 15 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 C, LINE 19 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 IX, LINE 11G LAB SERVICE FEES: PROGRAM SERVICE EXPENSES 648,517. MANAGEMENT AND GENERAL EXPENSES 233,253. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 881,770. ER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,089. MANAGEMENT AND GENERAL EXPENSES 1,111. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,200. LTC PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 287,469. MANAGEMENT AND GENERAL EXPENSES 103,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 390,863. THERAPY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 677,029. MANAGEMENT AND GENERAL EXPENSES 243,509. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 920,538. ADMIN PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 233,794. MANAGEMENT AND GENERAL EXPENSES 84,089. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 317,883. MEDICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 861,028. MANAGEMENT AND GENERAL EXPENSES 309,688. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,170,716. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 139,112. MANAGEMENT AND GENERAL EXPENSES 50,035. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 189,147. FORM 990, PART XI, LINE 9: TRANSFERS FROM RELATED PARTIES -494,175. CHANGE IN PENSION FUNDED PLAN STATUS 667,784. LAIRD HEALTH CARE FOUNDATION INC WASHINGTON SIXTH AVENUE MONTGOMERY WV 25136 550632743 SUPPORT TAX-EXEMPT HEALTH CARE ORGANIZATIONS WV 501(C)(3) LINE 7 MONTGOMERY GENERAL HEALTH CARE SYSTEM 0 MONTGOMERY GENERAL ELDERLY CARE CENTER WASHINGTON SIXTH AVENUE MONTGOMERY WV 25136 550623339 EXTENDED CARE FACILITY WV 501(C)(3) LINE 11 MONTGOMERY GENERAL HEALTH CARE SYSTEM 0 MONTGOMERY GENERAL HEALTH CARE SYSTEM INC WASHINGTON SIXTH AVENUE MONTGOMERY WV 25136 550632601 PROVIDE SUPPORT TO AFFILIATED EXEMPT HEALTH CARE PROVIDERS WV 501(C)(3) LINE 12C, III-FI N/A 0 MONTGOMERY MEDCORP INC WASHINGTON SIXTH AVENUE MONTGOMERY WV 25136 550767169 PHYSICIANS PRACTICE WV 501(C)(3) LINE 11 MONTGOMERY GENERAL HEALTH CARE SYSTEM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0