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← LIABILITY INSURANCE TRUST FOR MONONGALIA HEALTH SYSTEM INC AND M

Form 990 for tax year 2022

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

Totals

Total revenue
$4,295,648
Total expenses
$1,117,239
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$4,237,554
Investment income
$58,094
Other revenue
$0
Total assets, end of year
$8,480,538
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$8,480,538
Program services expenses (Part IX)
$1,117,239
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$1,117,239

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 $4,237,554 · related or exempt $4,237,554

  • 3 · Investment income

    total $87,784 · excluded $87,784

  • 7a · Gross sales of assets other than inventory

    securities $429,084

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

    securities $458,774

  • 7c · Gain or loss

    securities -$29,690

  • 7d · Net gain or loss

    total -$29,690 · excluded -$29,690

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $10,214 · program services $10,214

  • 7 · Other salaries and wages

    total $165,214 · program services $165,214

  • 11b · Fees: legal

    total $220 · program services $220

  • 24a · Other expenses: OTHER EXPENSES

    total $941,591 · program services $941,591

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $156,550 · end of year $192,103

  • 12 · Investments: other securities

    beginning of year $4,800,829 · end of year $8,288,435

  • 27 · Net assets without donor restrictions

    beginning of year $4,957,379 · end of year $8,480,538

Mission and programs · 2022

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 $1,117,239 · Revenue $4,237,554

As filed on the 2022 return.

Listed in Part VII

  • David Goldberg

    PRESIDENT/CEO

    Total calculated
    $1,042,009
    From this org
    $0
    From related orgs
    $911,058
    Other
    $130,951
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $659,321 related
    Bonus
    $0 + $237,960 related
    Other
    $0 + $13,777 related
    Deferred
    $0 + $127,624 related
    Nontaxable benefits
    $0 + $3,327 related
    Filer's total
    $0 + $1,042,009 related

  • Huntington Bank

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Jeff Crudele

    INTERIM CFO

    Total calculated
    $480,000
    From this org
    $0
    From related orgs
    $480,000
    Other
    $0
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $480,000 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $480,000 related

  • Lisa Simon CPA

    VP FINANCE/CFO

    Total calculated
    $436,398
    From this org
    $0
    From related orgs
    $421,179
    Other
    $15,219
    Hours/week
    1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $35,487 related
    Bonus
    $0 + $46,842 related
    Other
    $0 + $338,850 related
    Deferred
    $0 + $14,673 related
    Nontaxable benefits
    $0 + $546 related
    Filer's total
    $0 + $436,398 related

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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 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, LINES 4A-B
LISA SIMON RECEIVED A SEVERANCE PAYMENT IN 2022 OF $338,707. THE FOLLOWING INDIVIDUALS PARTICIPATED IN 457(F) PLAN: DAVID GOLDBERG AND LISA SIMON.

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

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

  • CARE PARTNER'S INC

    C · HOME HEALTH · WV · controlled entity

Provenance

Return type
form_990
Tax year
2022
Filed
14 November 2023
IRS schema version
2022v5.0
Source object
202313199349326701

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