Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
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| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | IN MAY 2018, CABELL HUNTINGTON HOSPITAL, INC. BECAME THE SOLE MEMBER OF ST. MARY'S MEDICAL CENTER, A FULL SERVICE ACUTE CARE HOSPITAL LOCATED IN HUNTINGTON, WEST VIRGINIA. AT THAT TIME, MOUNTAIN HEALTH NETWORK, INC. (MHN) BEGAN PROVIDING MANAGEMENT SERVICES TO CABELL HUNTINGTON HOSPITAL, INC. AS WELL AS ST. MARY'S MEDICAL CENTER. MHN IS COMPRISED OF EXPERIENCED HEALTH CARE PROFESSIONALS, PERSONS WITH EXTENSIVE FINANCIAL AND BUSINESS EXPERTISE, CLINICIANS WITH EXTENSIVE MEDICAL EXPERIENCE AND EXPERIENCED HOSPITAL BOARD MEMBERS. MHN WILL BE RETAINED TO FORMULATE AND IMPLEMENT APPROPRIATE MEASURES FOR THE INTEGRATION OF CERTAIN PROGRAMS AND SERVICES AT BOTH HOSPITALS AS WELL AS PROVIDED CONTINUED MANAGEMENT, STRATEGIC PLANNING AND OPERATIONAL SUPERVISION. |
| FORM 990, PART VI, SECTION A, LINE 6 | The organization is a membership (not a stock) corporation under West Virginia state law. Effective May 1, 2018, under agreement, the organization's sole corporate member was transferred to Cabell Huntington Hospital, Inc., a related not-for-profit organization from the previous sole corporate member, Pallottine Health Services. |
| FORM 990, PART VI, SECTION A, LINE 7A | Effective May 1, 2018, in accordance with the terms and requirements of its governing documents (i.e. bylaws), on an annual basis, the organization's current board members recommend the list of candidates for membership to the governing body for the subsequent term to the Cabell Huntington Hospital, Inc. board of directors. |
| FORM 990, PART VI, SECTION A, LINE 7B | As a result of the ownership change effective May 1, 2018 Cabell Huntington Hospital, Inc., as the sole corporate member, also has the right to approve or ratify significant decisions of the organization's governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization. |
| FORM 990, PART VI, SECTION B, LINE 11B: | The Form 990 is reviewed by the organization's management in consultation with an independent accounting firm. The financial review is based on the organization's audited financial statements for the relevant time period. The CFO will review the 990 with the finance/audit committee and the board of directors at the next scheduled board meeting in August. |
| FORM 990, PART VI, SECTION B, LINE 12C: | Upon employment and annually thereafter each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about his/her personal interests and relationships so the organization can (1) determine whether any potential or actual conflicts of interest may exist, and (2) monitor work or service assignments to avoid placing the key employee, officer or director in a position where there may be an appearance, potential or actual, of a conflict of interest or a question of objectivity. The completed conflicts of interest and disclosure forms for directors are returned to the organization. In the event that any board member is deemed to lack independence or a conflict of interest exists, he/she is required to leave the room and cannot be part of the discussion or vote. |
| FORM 990, PART VI, SECTION B, LINE 15: | On an annual basis, the organization provides documentation to the executive compensation committee of the St. Mary's Medical Center, Inc. board of directors for evaluation of compensation of the organization's officers and key employees for review and approval. Such information includes comparable data from similar size tax-exempt organizations in the Huntington, West Virginia community as well as compensation for these positions (as disclosed on form 990) with other organizations in the health care industry that are of similar size, demographics, and geography. Review and approval of the compensation arrangement by the officers/executive committee is documented. |
| FORM 990, PART VI, SECTION C, LINE 19: | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 2900 First Avenue, Huntington, WV 25702. A nominal fee is charged if copies are requested. |
| FORM 990, PART VI, LINE 16B | The organization has adopted a formal written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements. However, the normal due diligence process for analyzing any such arrangements undertaken in conjunction with the organization's external legal counsel, accountants and other business advisers does include a review to determine the following: 1) the impact of the arrangement under applicable federal and state law 2) whether the arrangement will jeopardize the organization's exempt status as a Section 501(c)(3) charitable organization-hospital. 3) whether the arrangement will result in any unrelated business taxable income 4) the impact of the arrangement on any existing contractual agreements or other business relationships and 5) whether the arrangement will result in any conflicts of interest. If there are any concerns with respect to any of the above matters, the organization will take appropriate steps to ensure that, if the joint venture is pursued, the arrangement will be in compliance with applicable federal and state law and to safeguard the organization's tax-exempt status. A formal written policy and procedure has been approved. |
| FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS | Transfers to/from Affiliates, net $ 1,474,806 Changes in pension fund status 13,044,946 Total $14,519,752 |
| FORM 990, PART XII, LINE 2C | THE FINANCE/AUDIT COMMITTEE SHALL REVIEW THE RESULTS OF THE ANNUAL AUDIT AND ALL OTHER REPORTS FROM INDEPENDENT EXTERNAL AUDITORS AND SHALL ARRANGE FOR THOSE REPORTS, TOGETHER WITH ANY RECOMMENDATIONS FROM THE FINANCE/AUDIT COMMITTEE, TO BE PRESENTED TO THE BOARD OF DIRECTORS AT SUCH A TIME AS THE BOARD OF DIRECTORS MAY SCHEDULE FOR THAT PURPOSE. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION SERVICES TOTAL FEES:1285588 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MEDICAL SERVICES TOTAL FEES:3681007 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER CONTRACT SERVICES TOTAL FEES:1937719 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:20937487 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:17539202 |
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| Software Version: |