2024-11-13T20:35:27-06:00 2023-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 46204 990 2023-01-01 550422958 STONEWALL JACKSON MEMORIAL HOSPITAL STON 3042698059 230 HOSPITAL PLAZA WESTON WV 26452 JEFF SANDENE EXECUTIVE VP AND CFO 3042698059 2024-11-13 1 0 ANGELA M MOORE P00244342 3174648600 2023 2024-10-15 13:58:12Z DAVID GOLDBERG 230 HOSPITAL PLAZA WESTON WV 26452 50163435 0 X WWW.MONHEALTH.COM/SJMH X 1959 WV ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. 14 6 440 18 0 0 44787 17261 24231319 47579940 115245 1248668 230198 1317566 24621549 50163435 14787 0 0 0 12110603 25876272 0 0 0 13672060 27870138 25797450 53746410 -1175901 -3582975 71939052 65998448 8569926 11935910 63369126 54062538 X ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, ONE PERSON AT A TIME. 0 0 44885614 48861618 STONEWALL JACKSON MEMORIAL HOSPITAL PROVIDES ACUTE MEDICAL AND OUTPATIENT SERVICES TO RESIDENTS OF WESTON, WEST VIRGINIA AND SURROUNDING COMMUNITIES WHICH COVERS 10 DIFFERENT COUNTIES. SERVICES INCLUDED 3,909 DAYS OF INPATIENT CARE, 73,658 OUTPATIENT VISITS, 12,427 EMERGENCY ROOM VISITS, 1,904 AMBULATORY SURGERY VISITS, AND 29,075 PHYSICIAN CLINIC VISITS. THE HOSPITAL HAD 117 DELIVERIES DURING THE YEAR IN WHICH APPROXIMATELY 71% WERE MEDICAID PATIENTS. MANY OF THESE BABIES HAD SIGNIFICANT SUBSTANCE ABUSE PROBLEMS. DUE TO THE DRUG ADDICTION PROBLEMS OF THE MOTHERS, VERY FEW OF THESE WOMEN HAVE RECEIVED PRENATAL CARE. ANNUAL BLOOD SCREENING: STONEWALL JACKSON MEMORIAL HOSPITAL PROVIDES ALL SUPPLIES AND STAFF TO OPERATE THE PROGRAM. A PORTION OF THE EXCESS REVENUE IS FORWARDED TO THE LOCAL ROTARY CLUB TO PROMOTE CHARITABLE SERVICES. OTHER PROGRAMS INCLUDE: SCOLIOSIS SCREENING AT COUNTY ELEMENTARY AND MIDDLE SCHOOLS, HEALTH FAIRS AT THE LOCAL SENIOR CITIZENS CENTER, FREE SPORTS PHYSICALS TO MIDDLE AND HIGH SCHOOL STUDENTS, CHILDREN'S SAFETY DAY TO PROMOTE HEALTHY CHOICES TO CHILDREN UNDER 12 YEARS OF AGE, EVENTS FOR FREE OSTEOPOROSIS SCREENINGS, EVENTS FOR FREE DERMASCANS TO SCREEN FOR SKIN CANCER, WESTON WALK-RUN TO PROMOTE EXERCISE AS A WAY TO IMPROVE CARDIAC HEALTH, FREE WOMEN'S HEALTH SCREENING FOR BREAST AND CERVICAL CANCER, FREE VEIN SCREENINGS AND FREE HEARING SCREENINGS. REVENUE AND EXPENSES ARE INCLUDED IN LINE 4A ABOVE. WILLIAM ADLER SCHOLARSHIP FUND - STONEWALL JACKSON MEMORIAL HOSPITAL SPONSORED PROGRAM TO PROVIDE SCHOLARSHIPS TO LOCAL GRADUATING HIGH SCHOOL SENIORS WHO ARE PURSUING A CAREER IN THE HEALTH CARE FIELD. IT IS HOPED THAT THIS PROGRAM WILL ENCOURAGE MORE STUDENTS TO SEEK HEALTH CARE PROFESSIONS AND LESSON THE HEALTH CARE STAFFING SHORTAGE. 44885614 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 174 0 440 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WV X RICK SCHERICH 3042698059 230 HOSPITAL PLAZA WESTON WV 264528558 DAVID GOLDBERG DIRECTOR & MHS CEO 1.00 50.00 X X 0 853663 36373 TYLER J HALL PHYSICIAN/DIRECTOR 50.00 0.00 X 484836 0 60943 AMY PEARSON MD DIRECTOR & CHIEF OF STAFF 50.00 0.00 X 417397 0 9502 KEVIN STALNAKER CAO 50.00 1.00 X X 0 279745 40833 DOYLE SICKLES DIRECTOR/PHYSICIAN 40.00 0.00 X 265144 0 46927 GREGORY CUNNINGHAM VICE CHAIR 1.00 2.00 X X 0 0 0 KIMBERLY GUM SECRETARY, TREASURER 1.00 0.00 X X 0 0 0 ROBIN POLING CHAIR 1.00 0.00 X X 0 0 0 ALISSA LAMBERT DIRECTOR 1.00 0.00 X 0 0 0 GEORGE STANSBURY DIRECTOR 1.00 0.00 X 0 0 0 GREGORY ST CLAIR DIRECTOR 1.00 0.00 X 0 0 0 JOHN LAW CPA DIRECTOR 1.00 2.00 X 0 0 0 JOSEPH SNEAD MD DIRECTOR 1.00 0.00 X 0 0 0 R GERALD WOOD DIRECTOR 1.00 0.00 X 0 0 0 RICK SCHERICH VICE PRESIDENT FINANCE 20.00 30.00 X 0 262848 36778 RONALD PEARSON SURGEON 50.00 0.00 X 967688 0 59224 ROBERT SNUFFER PHYSICIAN 50.00 0.00 X 690818 0 58224 MICHAEL GREGORY PHYSICIAN 50.00 0.00 X 646497 0 69214 ROBERT HARRIS PHYSICIAN 50.00 0.00 X 465318 0 30315 BRUCE GORBY PHYSICIAN 50.00 0.00 X 198271 0 55387 4135969 1396256 503720 40 0 1 0 QUALIVIS 5930 CORNERSTONE COURT WEST SUITE SAN DIEGO CA 92121 CONTRACT NURSES 1573044 UNIFORMED PHYSICIANS LLC 110 JAMES ST HINTON WV 25951 CONTRACT PHYSICIAN 862184 NORTHSTAR ANESTHESIA 6225 N STATE HWY 161 IRVING TX 75038 CONTRACT PHYSICIANS 583168 REPUBLIC BUSINESS CREDIT LLC PO BOX 203152 DALLAS TX 75320 CONTRACT PHYSICIANS 437382 ROGER ABRAHAMS MD 5002 WOODLAND COVE ROAD MORGANTOWN WV 26508 CONTRACT PHYSICIANS 164124 7 17261 17261 PATIENT SERVICES 622110 47579940 47579940 47579940 1248668 1248668 35888 0 35888 35888 35888 340B 900099 735891 735891 QUALITY INCENTIVE 900099 177392 177392 368395 368395 1281678 50163435 48861618 0 1284556 X 21604359 20416432 1187927 2849910 2840412 9498 1422003 1343813 78190 10000 10000 2000 2000 6406302 6406302 147131 125832 21299 38264 38264 979568 979568 78942 73517 5425 42645 42645 631287 631287 MEDICAL SUPPLIES 9183157 9175882 7275 MANAGEMENT FEES 5556898 5556898 MEDICAID PROVIDER TAX 1192230 1192230 REPAIRS AND MAINTENANCE 1068323 1026114 42209 2533391 2497742 35649 53746410 44885614 8860796 0 4891817 1219744 4638561 5370891 1130062 1307551 7825 11476 14106715 783397 22511183 13323318 32942179 37179893 78643 607804 118057 118057 5620725 6859714 71939052 65998448 2206102 6029688 1332859 11037 5030965 5895185 8569926 11935910 X 62938508 53596096 430618 466442 63369126 54062538 71939052 65998448 X -3582975 3084533 -8851755 43609 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 11307 11307 0 PART II-B, LINE 1: A PORTION OF DUES PAID BY THE HOSPITAL TO THE AMERICAN HOSPITAL ASSOCATION AND THE WEST VIRGINIA HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING. 10640000 10640000 855623 47516 808107 2270204 735881 1534323 340888 340888 13323318 OTHER RECEIVABLES 94072 DUE FROM STONEWALL HOME OXYGEN THERAPY 1348957 ESTIMATED THIRD PARTY SETTLEMENTS 3513890 OPERATING LEASE - RIGHT OF USE ASSET 1902795 6859714 OPERATING LEASE - RIGHT OF USE 1951170 ACCRUED MALPRACTICE 3944015 5895185 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, FHE, CMC, AND HFI, WHICH ARE CORPORATIONS SUBJECT TO INCOME TAX. THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2023. 1 1 X 1 X 0 1 1 1 0 0 1254886 0 1254886 0.02410 12006164 6217007 5789157 0.11130 13261050 6217007 7044043 0.13540 62562 14030 48532 0.00090 591479 0 591479 0.01140 587 0 587 0.00000 654628 14030 640598 0.01230 13915678 6231037 7684641 0.14770 0 1744398 7173653 9593207 -2419554 X 1 1 1 1 STONEWALL JACKSON MEMORIAL HOSPITAL 230 HOSPITAL PLAZA WESTON WV 26452 WWW.MONHEALTH.COM/SJMH 7 X X X STONEWALL JACKSON MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X WWW.MONHEALTH.COM/SJMH/SWJH-COMMUNITY-HEALTH-ASSESSMENT X 1 21 1 WWW.MONHEALTH.COM/UPLOADS/PUBLIC/DOCUMENTS/STONEWALL/2022_CHNA_LEWIS_COUNTY 0 1 X 200.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X WWW.MONHEALTH.COM/UPLOADS/PUBLIC/DOCUMENTS/2021FINANCIAL_ASSISTANCE_POLICY. X WWW.MONHEALTH.COM/UPLOADS/PUBLIC/DOCUMENTS/STONEWALL/FINANCIAL%20ASSISTANCE X WWW.MONHEALTH.COM/SJMH/SJMH-FINANCIAL-ASSISTANCE X X X X 1 X 0 X X X 1 X 0 0 STONEWALL JACKSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE INFORMATION FOR THE LEWIS COUNTY AND GILMER COUNTY COMMUNITY ASSESSMENTS BEGAN IN THE WINTER OF 2021 AND ENDED IN MAY 2022, WITH THE IMPLEMENTATION OF A SURVEY MONKEY SURVEY 270 RESIDENTS PARTICIPATED. THIS WAS THE FIRST PHASE OF THE ASSESSMENT. IN MAY 2022, A STAFF MEMBER FROM MON HEALTH STONEWALL JACKSON MEMORIAL HOSPITAL COORDINATED FOCUS GROUPS IN EACH COUNTY. EACH OF THE FOCUS GROUP MEMBERS WERE PROVIDED THE SURVEY MONKEY RESULTS AND OTHER NATIONAL SURVEYS ON WEST VIRGINIA HEALTH STATISTICS. THIS ASSESSMENT IS THE FOURTH ONE CREATED BY SJMH IN COOPERATION WITH THE LEWIS COUNTY HEALTH DEPARTMENT. THIS IS THE SECOND THAT SJMH COOPERATED WITH THE GILMER COUNTY HEALTH DEPARTMENT IN CREATING AN ASSESSMENT FOR THAT COUNTY. STONEWALL JACKSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: LEWIS COUNTY HEALTH DEPARTMENT AND GILMER COUNTY HEALTH DEPARTMENT STONEWALL JACKSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: DRUG ABUSE WAS THE NUMBER ONE HEALTH CONCERN OF THE RESIDENTS. THE OTHER CONCERNS IN ORDER OF IMPORTANCE: OBESITY,MENTAL HEALTH ISSUES, HEART DISEASE, AND DIABETES. TO COMBAT DRUG ABUSE, A RECOVERY CENTER HAS OPENED IN GLENVILLE (GILMER COUNTY) WITH A CAPACITY FOR TWENTY RESIDENTS. IT IS A LONG-TERM (AT LEAST ONE YEAR) PROGRAM. MON HEALTH SJMH HAS OPENED A MEDICAL ASSISTANCE TREATMENT (MAT) PROGRAM FOR RESIDENTS, ALONG WITH THE MON HEALTH SYSTEM'S RECOVERY PROGRAMS AT EACHMON HOSPITAL FOR SUBSTANCE USAGE ADDICTION. THE LEWIS COUNTY HEALTH DEPARTMENT CREATED A HARM REDUCTION PROGRAM WITH SUPPORT FROM SJMH. NURSING STAFF AT SJMH IS REQUIRED TO COMPLETE CONTINUING EDUCATION ON "DRUG DIVERSION EDUCATION ON OPIATES."STRATEGIES FOR COMBATTING OBESITY AND PROMOTING PHYSICAL ACTIVITY INCLUDE A VARIETY OF PLAYGROUNDS AND WALKING TRAILS; A SCHOOL-BASED HEALTH CENTER AT THE HIGH SCHOOL AND ELEMENTARY SCHOOL; PHYSICAL ACTIVITIES AVAILABLE AT THE WACO CENTER AND VARIOUS OTHER LOCATIONS. SJMH HAS AN ADULT FITNESS PROGRAM, WHICH IS CONDUCTED TUESDAYS AND THURSDAYS IN THE MORNING IN THE STONEWALL JACKSON MEMORIAL HOSPITAL CARDIAC REHAB DEPARTMENT. THIS IS A VERY LOW-COST WAY TO MODIFY RISK FACTORS.STRATEGIES FOR COMBATTING HEART DISEASE INCLUDE THE GILMER COUNTY HEALTH DEPARTMENT SCREENING AVAILABLE ONSITE; THE SJMH CARDIAC DEPARTMENT PROVIDES COMMUNITY EDUCATION REGARDING HEART DISEASE; SJMH PROVIDES SCREENINGS THROUGHOUT THE YEAR FOR BLOOD PRESSURE, BLOOD GLUCOSE, PULSE OXIMETRY, ETC.STRATEGIES FOR COMBATING DIABETES INCLUDES 3 COMPREHENSIVE BLOOD SCREENINGS EACH YEAR IN COOPERATION WITH THE WESTON ROTARY CLUB; THE HEALTH DEPARTMENTS PROVIDE VERY LOW-COST SCREENINGS FOR THE PUBLIC DURINGOFFICE HOURS; THE NURSE DIRECTOR CAN PROVIDE NUTRITIONAL EDUCATION; SJMH TRAINED A DIETITIAN AND NURSE TO CONDUCT DIABETES EDUCATION CLASSES. PART I, LINE 3C: THE HEALTH RESOURCES AND SERVICES ADMINISTRATION ELIGIBILITY GUIDELINES ARE USED. WE ALSO EVALUATE THE PATIENT'S ASSETS AND THE AMOUNT OF MEDICAL DEBT. WE HAVE SIGNS POSTED AT REGISTRATION, AROUND AND IN THE EMERGENCY DEPARTMENT AND IN ALL PHYSICIAN CLINICS. WE SEND LETTERS TO PATIENTS WHO ARE NOT PAYING THEIR BILLS AND GIVE THE APPLICATION TO PRIVATE PAY INPATIENTS. WE ALSO TELL THE PATIENTS DURING TELEPHONE CONVERSATIONS IF THE PATIENT INDICATES HE/SHE IS NOT ABLE TO PAY THE BILL OR PAY ALL OF THE BILL. 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 $ 1,744,398. PART III, LINE 2: BAD DEBT EXPENSE AS REPORTED ON AUDITED FINANCIAL STATEMENTS PART III, LINE 4: THE FOOTNOTE IS ON PAGE 14 OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE REVENUE ALLOWABLE COSTS ASSOCIATED WITH THE REVENUE. PART III, LINE 9B: OUR COLLECTIONS POLICY APPLIES TO ALL PATIENTS REGARDLESS OF FINANCIAL CLASS OR ANY OTHER CLASSIFICATION. DURING OUR COLLECTIONS PROCESS, IF THE PATIENT INDICATES THEY DO NOT HAVE THE ABILITY TO PAY THEIR BILL, THE CREDIT STAFF OFFERS EXONERATION. PART VI, LINE 2: THE ASSESSMENT WAS CONDUCTED IN THREE PHASES: THE FIRST PHASE WAS ATTAINING BACKGROUND INFORMATION ON THE HEALTHCARE PROBLEMS OF THE LOCAL AREA AND STATE. THE SECOND PHASE WAS A SURVEY CONDUCTED ONLINE AND BY PAPER. THE LAST PHASE WAS A FOCUS GROUP CONDUCTED BY AN EXPERIENCED MEDIATOR. PART VI, LINE 3: WE HAVE SIGNS POSTED AT REGISTRATION, AROUND AND IN THE EMERGENCY DEPARTMENT, AND IN ALL PHYSICIAN CLINICS. WE SEND LETTERS TO PATIENTS WHO ARE NOT PAYING THEIR BILLS. WE GIVE THE APPLICATION TO PRIVATE PAY INPATIENTS. WE TELL THE PATIENTS DURING TELEPHONE CONVERSATIONS, IF THE PATIENT INDICATES HE/SHE IS NOT ABLE TO PAY THE BILL OR PAY ALL OF THE BILL. PART VI, LINE 4: STONEWALL JACKSON MEMORIAL HOSPITAL SERVES A RELATIVELY LARGE RURAL POPULATION OF ABOUT 65,000 PEOPLE WITH AN AVERAGE HOUSEHOLD INCOME OF $32,000. 30% OF THE POPULATION IS DISABLED. APPROXIMATELY 30% ARE MEDICAID ELIGIBLE OR ARE UNINSURED. WE ARE THE LARGEST HOSPITAL IN OUR SERVICE AREA, WHICH INCLUDES TWO OTHER HOSPITALS, ONE BEING A CRITICAL ACCESS HOSPITAL. WE ARE LOCATED IN A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. LOCATED IN NORTH CENTRAL WEST VIRGINIA, LEWIS COUNTY HAS A TOTAL AREA OF 390 SQUARE MILES, OF WHICH 382 IS LAND AND 8 SQUARE MILES IS WATER. THE COUNTY WAS CREATED FROM PART OF HARRISON COUNTY BY AN ACT OF THE VIRGINIA GENERAL ASSEMBLY ON DECEMBER 18, 1816. (WIKIPEDIA, 2012) MON HEALTH STONEWALL JACKSON MEMORIAL HOSPITAL AND THE LEWIS COUNTY HEALTH DEPARTMENT ARE BOTH LOCATED WITHIN THE CITY LIMITS OF WESTON, WV. THE COMMUNITY HEALTH NEEDS ASSESSMENT REPRESENTS RESIDENTS FROM THIS COMMUNITY. PART VI, LINE 5: STONEWALL JACKSON MEMORIAL HOSPITAL (SJMH) IS A 70 BED RURAL ACUTE CARE HOSPITAL LOCATED IN LEWIS COUNTY WEST VIRGINIA. SJMH IS THE ONLY HOSPITAL LOCATED IN THE COUNTY AS SUCH IT IS SOLELY RESPONSIBLE FOR THE HEALTHCARE OF THIS RURAL COMMUNITY. SJMH PROVIDES A 24 HOUR EMERGENCY ROOM AND OBSTETRICS SERVICES AND PROVIDES CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE MAJORITY OF THE GOVERNING BODY IS COMPRISED OF COMMUNITY MEMBERS. MEDICAL PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND SJMH HAS WORKED DILIGENTLY TO PROVIDE OTHER PHYSICIAN SERVICES BY EXPANDING THE SERVICES THEY PROVIDE. SJMH CONTINUES TO MAKE CAPITAL IMPROVEMENT TO THE FACILITY AND EXPAND PATIENT CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY. PART VI, LINE 6: THE HOSPITAL IS PART OF MONONGALIA HEALTH SYSTEM, INC. WHICH INCLUDES THE FOLLOWING OTHER HEALTH CARE ENTITIES IN THE COMMUNITY: MONONGALIA COUNTY GENERAL HOSPITAL, MON HEALTH MARION NEIGHBORHOOD HOSPITAL, MON ELDER SERVICES, INC. DBA THE VILLAGE AT HERITAGE POINT, MON HEALTH CARE, INC., PRESTON MEMORIAL HOSPITAL, AND PRESTON MEMORIAL MEDICAL GROUP, 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. MONONGALIA COUNTY GENERAL HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL. ON 9/1/22 MON HEALTH SYSTEM AND CAMC HEALTH SYSTEM COMBINED TO CREATE A SINGLE HEALTHCARE SYSTEM CALLED VANDALIA HEALTH. 0 1 0 0 0 0 0 0 0 RONALD PEARSON SURGEON 786843 0 180845 0 0 0 27000 0 32224 0 1026912 0 0 0 DAVID GOLDBERG DIRECTOR & MHS CEO 0 714488 0 139175 0 0 0 30000 0 6373 0 890036 0 0 ROBERT SNUFFER PHYSICIAN 578851 0 111967 0 0 0 26000 0 32224 0 749042 0 0 0 MICHAEL GREGORY PHYSICIAN 608497 0 38000 0 0 0 20500 0 48714 0 715711 0 0 0 TYLER J HALL PHYSICIAN/DIRECTOR 476836 0 8000 0 0 0 29000 0 31943 0 545779 0 0 0 ROBERT HARRIS PHYSICIAN 275304 0 91551 0 98463 0 8956 0 21359 0 495633 0 0 0 AMY PEARSON MD DIRECTOR & CHIEF OF STAFF 315939 0 101458 0 0 0 0 0 9502 0 426899 0 0 0 KEVIN STALNAKER CAO 0 248249 0 31496 0 0 0 30000 0 10833 0 320578 0 0 DOYLE SICKLES DIRECTOR/PHYSICIAN 232311 0 32833 0 0 0 26000 0 20927 0 312071 0 0 0 RICK SCHERICH VICE PRESIDENT FINANCE 0 239656 0 23192 0 0 0 30000 0 6778 0 299626 0 0 BRUCE GORBY PHYSICIAN 195075 0 3196 0 0 0 27000 0 28387 0 253658 0 0 0 PART I, LINE 4B 457(F) INELIGIBLE DEFERRED COMPENSATION PLAN - A 457 F PLAN IS OFFERED TO CERTAIN MANAGEMENT AND/OR HIGHLY COMPENSATED EMPLOYEES TO OFFER THOSE EMPLOYEES A DEFERRED COMPENSATION OPPORTUNITY. THE PLAN IS INTENDED TO BE A "TOP-HAT PLAN", OR UNFUNDED DEFERRED COMPENSATION PLAN MAINTAINED FOR A SELECT GROUP OF EMPLOYEES. PARTICIPANTS MAY BECOME VESTED IN AMOUNTS CREDITED ON JANUARY 1 ELECTED BY THE PARTICIPANT AT THE TIME THE INITIAL DEFERRAL WAS ELECTED. A PARTICIPANT SHALL BECOME FULLY VESTED UPON DEATH, DISABILITY, ATTAINMENT OF AGE 60, OR SEPARATION OF SERVICE, AS DEFINED BY THE PLAN. ANY UNVESTED CONTRIBUTIONS SHALL BE FORFEITED TO THE PLAN OR EMPLOYER. FOR 2023: PER BENEFITS - NO DISTRIBUTIONS / PAYMENTS WERE MADE FROM THE PLAN; DAVID GOLDBERG WAS THE ONLY PARTICIPANT RALPH G WOOD JR FAMILY MEMBER 24999 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES CUSTOMARILY ARE PERFORMED UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES OR KEY EMPLOYEES, BUT THE HOSPITAL HAS CONTRACTED OUT THE MANAGEMENT DUTIES OF THE DIETARY DEPARTMENT (ALSO CONSIDERED A DEPARTMENT HEAD) AND IS EMPLOYED BY THE DIETARY COMPANY. THE CERTIFIED DIETARY MANAGER AND THE DIETITIAN ARE ALSO THE EMPLOYEES OF THE DIETARY COMPANY. ALL OTHER DIETARY STAFF ARE EMPLOYEES OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 MONONGALIA HEALTH SYSTEM, INC., A WEST VIRGINIA NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A STONEWALL JACKSON MEMORIAL HOSPITAL BOARD MEMBERS ARE ELECTED OR APPOINTED BY MONONGALIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B STONEWALL JACKSON MEMORIAL HOSPITAL'S BOARD SHALL GIVE NOTICE TO MONONGALIA HEALTH SYSTEM AND RECEIVE ITS APPROVAL BEFORE ACTING ON ANY OF THE FOLLOWING MATTERS: (A) AMENDMENT OF THE ARTICLES OF INCORPORATION OF THE HOSPITAL OR THE BYLAWS; (B) SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF THE HOSPITAL AND ANY EXPENDITURE IN EXCESS OF $750,000; (C) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (D) ELECTION TO DISSOLVE THE HOSPITAL ENTITY; (E) APPROVAL OF THE BUDGET OF THE HOSPITAL; (F) APPROVAL IN ADVANCE OF THE HIRING OF THE PRESIDENT OF THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY IS PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW PRIOR TO SUBMISSION. THE 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 MEMBERS SHALL NOT PARTICIPATE IN. FORM 990, PART VI, SECTION B, LINE 15 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 HOSPITAL PLACES A PUBLICATION IN THE LOCAL NEWSPAPER STATING THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,414,754. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,414,754. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 2,652,660. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,652,660. NURSE SERVICES: PROGRAM SERVICE EXPENSES 2,338,888. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,338,888. FORM 990, PART XI, LINE 9: CHANGE OF BENEFICIAL INTEREST HELD BY OTHERS 43,609. 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