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← LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM INC AND M

Form 990 for tax year 2023

Filed by LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM INC AND M.

Totals

Total revenue
$1,924,024
Total expenses
$4,652,216
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$1,985,321
Investment income
-$61,297
Other revenue
$0
Total assets, end of year
$5,752,346
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$5,752,346
Program services expenses (Part IX)
$4,652,216
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$4,652,216

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: REPLENISH TRUST FUND

    total $1,985,321 · related or exempt $1,985,321

  • 3 · Investment income

    total $171,573 · excluded $171,573

  • 7a · Gross sales of assets other than inventory

    securities $9,979,753

  • 7b · Less cost or other basis and sales expenses

    securities $10,212,623

  • 7c · Gain or loss

    securities -$232,870

  • 7d · Net gain or loss

    total -$232,870 · excluded -$232,870

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $24,545 · program services $24,545

  • 7 · Other salaries and wages

    total $236,672 · program services $236,672

  • 13 · Office expenses

    total $188 · program services $188

  • 23 · Insurance

    total $2,806,996 · program services $2,806,996

  • 24a · Other expenses: SETTLEMENTS

    total $1,583,815 · program services $1,583,815

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $192,103 · end of year $208,023

  • 11 · Investments: publicly traded securities

    end of year $5,544,323

  • 12 · Investments: other securities

    beginning of year $8,288,435

  • 27 · Net assets without donor restrictions

    beginning of year $8,480,538 · end of year $5,752,346

Mission and programs · 2023

Mission

PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATION OF THE RISK MANAGEMENT DIVISION.

Activities or mission (Part I)

PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATIONS OF THE RISK MANAGEMENT DIVISION.

  • PAYMENT OF LIABILITY CLAIMS AND COSTS ASSOCIATED WITH THE OPERATION OF THE RISK MANAGEMENT DIVISION.

    Expenses $4,652,216 · Revenue $1,985,321

As filed on the 2023 return.

Listed in Part VII

  • David Goldberg

    PRESIDENT/CEO

    Total calculated
    $890,036
    From this org
    $0
    From related orgs
    $853,663
    Other
    $36,373
    Hours/week
    1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $714,488 related
    Bonus
    $0 + $139,175 related
    Other
    $0
    Deferred
    $0 + $30,000 related
    Nontaxable benefits
    $0 + $6,373 related
    Filer's total
    $0 + $890,036 related

  • Huntington Bank

    TRUSTEE

    Total calculated
    $24,545
    From this org
    $24,545
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

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, 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

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • WOMEN AND CHILDREN'S MEDICAL OFFICE BUILDING LLC

    MEDICAL OFFICE BUILDING · WV

  • GENERAL DIVISION MEDICAL OFFICE BUILDING LLC

    MEDICAL OFFICE BUILDING · WV

  • DASCO-CAMC HOME MEDICAL EQUIPMENT LLC

    HOME MEDICAL EQUIPMENT · WV

  • MGH SURGERY LLC

    SURGERY CENTER · WV

  • MON HEALTH-DASCO HOME MEDICAL EQUIPMENT LLC

    HOME MEDICAL EQUIPMENT · OH

  • CHARLESTON SURGICAL HOSPITAL LLC

    SURGERY CENTER · WV

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • VANDALIA INSURANCE COMPANY

    C · INSURANCE · VT · controlled entity

  • MON HEALTH CARE INC

    C · MEDICAL EQUIPMENT · WV · controlled entity

  • STONEWALL HOME OXYGEN THERAPY INC

    C · OXYGEN THERAPY SERVICES · WV · controlled entity

  • FAIRMONT HOME EQUIPMENT AND SUPPLY

    C · EQUIPMENT RENT & SVC · WV · controlled entity

  • MORGANTOWN PHYSICAL THERAPY ASSOC INC

    C · REHABILITATION SERVICES · WV · controlled entity

  • HEALTH FACILITIES INC

    C · HEALTH CARE · WV · controlled entity

  • CENTRAL WV MEDCORP INC

    C · PHYSICIAN SERVICES · WV · controlled entity

  • DAVIS REGIONAL HEALTH PARTNERS INC

    C · CONTRACT NEGOTIATIONS · WV · controlled entity

Provenance

Return type
form_990
Tax year
2023
Filed
13 November 2024
IRS schema version
2023v5.1
Source object
202423189349308977

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