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Nonprofiteer
← BON SECOURS MEDICAL GROUP GREENVILLE SPECIALTY CARE LLC

Form 990 for tax year 2022

Filed by BON SECOURS MEDICAL GROUP GREENVILLE SPECIALTY CARE LLC.

Totals

Total revenue
$84,400,469
Total expenses
$109,297,699
Contributions and grants received
$3,368
Grants paid
$0
Program services expenses (Part IX)
$99,557,251
Management and general expenses
$9,740,448
Fundraising expenses
$0
Program service expenses (Part III)
$99,557,251

Program services were 91.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • ABBY PLANT

    Board Secretary

    Total calculated
    $58,762
    From this org
    $0
    From related orgs
    $34,215
    Other
    $24,547
    Hours/week
    2 + 48 related

  • MATTHEW CALDWELL

    Chairman, Market President - BSSFHS

    Total calculated
    $1,374,984
    From this org
    $0
    From related orgs
    $1,086,217
    Other
    $288,767
    Hours/week
    10 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $535,911 related
    Bonus
    $0 + $232,063 related
    Other
    $0 + $318,243 related
    Deferred
    $0 + $257,354 related
    Nontaxable benefits
    $0 + $31,413 related
    Filer's total
    $0 + $1,374,984 related

  • Wayne Fraleigh

    Board Member, COO - BSMG

    Total calculated
    $386,970
    From this org
    $352,139
    From related orgs
    $0
    Other
    $34,831
    Hours/week
    25 + 25 related

    Schedule J breakdown matched by us

    Base
    $233,916
    Bonus
    $35,408
    Other
    $82,815
    Deferred
    $4,515
    Nontaxable benefits
    $30,316
    Filer's total
    $386,970

  • Bruce Swords

    Board Member, Chief Clinical Officer - BSSFHS

    Total calculated
    $432,178
    From this org
    $389,128
    From related orgs
    $0
    Other
    $43,050
    Hours/week
    15 + 35 related

    Schedule J breakdown matched by us

    Base
    $250,468
    Bonus
    $25,000
    Other
    $113,660
    Deferred
    $23,293
    Nontaxable benefits
    $19,757
    Filer's total
    $432,178

  • CHRISTY SINE MD

    Board Member, Physician - Pulmonary Medicine

    Total calculated
    $615,985
    From this org
    $553,273
    From related orgs
    $0
    Other
    $62,712
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $489,909
    Bonus
    $19,365
    Other
    $43,999
    Deferred
    $29,550
    Nontaxable benefits
    $33,162
    Filer's total
    $615,985

  • CORY WHITE MD

    Board Member, Physician - Endocrinology/Metabolism

    Total calculated
    $507,789
    From this org
    $452,088
    From related orgs
    $0
    Other
    $55,701
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $229,588
    Bonus
    $178,824
    Other
    $43,676
    Deferred
    $27,073
    Nontaxable benefits
    $28,628
    Filer's total
    $507,789

  • EDWARD STEWART MD

    Board Member, Physician - Cardiology

    Total calculated
    $866,852
    From this org
    $820,716
    From related orgs
    $0
    Other
    $46,136
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $576,668
    Bonus
    $220,420
    Other
    $23,628
    Deferred
    $17,050
    Nontaxable benefits
    $29,086
    Filer's total
    $866,852

  • JOANNA GRABSKA MD

    Board Member, Physician - Hematology/Oncology

    Total calculated
    $708,574
    From this org
    $678,302
    From related orgs
    $0
    Other
    $30,272
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $475,392
    Bonus
    $179,509
    Other
    $23,401
    Deferred
    $29,550
    Nontaxable benefits
    $722
    Filer's total
    $708,574

  • LESLEY PICKELL MD

    Board Member, Physician - Obstetrics and Gynecology

    Total calculated
    $456,288
    From this org
    $413,854
    From related orgs
    $0
    Other
    $42,434
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $279,728
    Bonus
    $111,244
    Other
    $22,882
    Deferred
    $25,253
    Nontaxable benefits
    $17,181
    Filer's total
    $456,288

  • PHILLIP FONTENOT MD

    Board Member, Physician - Urology

    Total calculated
    $752,884
    From this org
    $686,886
    From related orgs
    $0
    Other
    $65,998
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $347,898
    Bonus
    $295,391
    Other
    $43,597
    Deferred
    $29,550
    Nontaxable benefits
    $36,448
    Filer's total
    $752,884

  • STEPHEN RIDGEWAY MD

    Board Member, Physician - Orthopedic Surgery

    Total calculated
    $1,456,958
    From this org
    $1,397,447
    From related orgs
    $0
    Other
    $59,511
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $974,418
    Bonus
    $368,100
    Other
    $54,929
    Deferred
    $29,550
    Nontaxable benefits
    $29,961
    Filer's total
    $1,456,958

  • TOMMY MANN JR MD

    Board Member, Physician - General Surgery

    Total calculated
    $548,514
    From this org
    $512,400
    From related orgs
    $0
    Other
    $36,114
    Hours/week
    46 + 4 related

    Schedule J breakdown matched by us

    Base
    $374,171
    Bonus
    $65,971
    Other
    $72,258
    Deferred
    $4,550
    Nontaxable benefits
    $31,564
    Filer's total
    $548,514

  • Wilbur Gay

    Director of Finance BSMH Med Group

    Total calculated
    $277,433
    From this org
    $0
    From related orgs
    $242,547
    Other
    $34,886
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $206,627 related
    Bonus
    $0 + $32,544 related
    Other
    $0 + $3,376 related
    Deferred
    $0 + $4,037 related
    Nontaxable benefits
    $0 + $30,849 related
    Filer's total
    $0 + $277,433 related

  • CHRISTOPHER VAN PELT MD

    ORTHOPEDIC SURGEON

    Total calculated
    $1,926,230
    From this org
    $1,866,528
    From related orgs
    $0
    Other
    $59,702
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,110,240
    Bonus
    $709,422
    Other
    $46,866
    Deferred
    $29,550
    Nontaxable benefits
    $30,152
    Filer's total
    $1,926,230

  • Dylan Watson MD

    Orthopedic Surgeon

    Total calculated
    $1,445,759
    From this org
    $1,386,560
    From related orgs
    $0
    Other
    $59,199
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $790,246
    Bonus
    $572,530
    Other
    $23,784
    Deferred
    $29,550
    Nontaxable benefits
    $29,649
    Filer's total
    $1,445,759

  • James Jennings MD

    Orthopedic Surgeon

    Total calculated
    $1,459,568
    From this org
    $1,434,315
    From related orgs
    $0
    Other
    $25,253
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,030,861
    Bonus
    $303,514
    Other
    $99,940
    Deferred
    $4,550
    Nontaxable benefits
    $20,703
    Filer's total
    $1,459,568

  • John W Womack MD

    Orthopedic Surgeon

    Total calculated
    $1,523,011
    From this org
    $1,473,396
    From related orgs
    $0
    Other
    $49,615
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,088,559
    Bonus
    $358,646
    Other
    $26,191
    Deferred
    $29,550
    Nontaxable benefits
    $20,065
    Filer's total
    $1,523,011

  • Matthew Sellers MD

    Cardiologist

    Total calculated
    $1,542,825
    From this org
    $1,496,980
    From related orgs
    $0
    Other
    $45,845
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $927,322
    Bonus
    $545,121
    Other
    $24,537
    Deferred
    $17,050
    Nontaxable benefits
    $28,795
    Filer's total
    $1,542,825

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 — 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

  • 1a · Tax indemnification and gross-up payments
  • 1a · Housing allowance or residence for personal use
  • 1a · Health or social club dues or initiation fees
  • 1b · Written policy on the line-1a expenses
  • 2 · Substantiation required before reimbursing expenses
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

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
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Schedule J, Part I, Line 1a Tax indemnification and gross-up payments
A tax indemnification benefit to cover the income tax incurred on employee relocation was paid to one board member/officer and one board member. The entire benefit was treated as taxable compensation.
Schedule J, Part I, Line 1a Housing allowance or residence for personal use
Employer provided temporary housing related to employee relocation was provided for one board member/officer and one board member. The entire benefit was treated as taxable compensation.
Schedule J, Part I, Line 1a Health or social club dues or initiation fees
Employer paid health club fees to one board member/officer. The entire benefit was treated as taxable compensation.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
Bon Secours Mercy Health, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
The Bon Secours Mercy Health Physician SERP is a non-qualified deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. The plan provides for annual credits of a specified percentage of an eligible participants base salary paid in a plan year and interest credits. Plan participants vest in plan credits after completing a three year class vesting schedule or earlier for death or total disability or reaching age 60 while employed, or due to involuntary separation of employment other than for cause. Payments during employment are made for required tax withholding and reduce the participants account balance. Distribution of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Thomas Mann, MD,$12,500; Philip Fontenot, MD, $0; Joanna Grabska, MD, $0; James Jennings, MD, $25,000; Lesley Pickell, MD, $0; Stephen Ridgeway, MD, $0; Christopher Van Pelt, MD, $0; Dylan Watson, MD, $0; Christy Sine, MD, $0; Cory White, MD, $0; Edward Stewart, MD, $0; John Womack, MD, $0; Matthew Sellers, MD, $0.
Schedule J, Part I, Line 4b Terms and conditions of the St. Francis 457F plan
Bon Secours St. Francis Health System, Inc. established the Bon Secours St. Francis Health System Nonqualified Deferred Compensation Plan (the "St. Francis 457F plan") that allows for deposits of employee deferrals and employer contributions and is available only to eligible Bon Secours St. Francis physicians. The St. Francis 457F plan is a non-qualified plan and is subject to a minimum deferred vesting date of at least two years after the first day of the calendar year to which the deferred compensation relates, provided the participant is employed, or upon specified events, such as death or disability. For a participant who separates employment prior to reaching the deferred vesting date, the portion of the account attributable to the deferred vesting date will become vested after the participant satisfies certain conditions during the three year post-employment period. Individuals that received a distribution or participated in the plan include: Tommy Mann, Jr, MD, $4,155; Christopher Van Pelt, MD, $0; Christy Sine, MD, $0; James Jennings, MD, $4,962; Joanna Grabska, MD, $0; John Womack, $0; Lesley Pickell, MD, $0; Matthew Sellers, MD, $0; Philip Fontenot, MD, $0; Stephan Ridgeway, MD, $0.
Schedule J, Part I, Line 4b Terms and conditions of the Bon Secours Mercy Health SERP
The Bon Secours Mercy Health System SERP is a non-qualified deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. The plan provides for annual credits of a specified percentage of an eligible participants base salary paid in a plan year and interest credits. Plan participants vest in plan credits after completing a three year class vesting schedule or earlier for death or total disability or reaching age 60 while employed, or due to involuntary separation of employment other than for cause. Payments during employment are made for required tax withholding and reduce the participants account balance. Distribution of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Matthew Caldwell, $89,724; Bruce Swords, $0.
Schedule J, Part I, Line 7 Non-Fixed Payments
The organization provides annual incentive compensation for listed individuals. The organization's Board of Trustees establishes objective thresholds for quality, community benefit, and financial performance which must be achieved for incentives to be awarded. The Board also establishes threshold, target and maximum levels for incentive awards. Within these established parameters, the Board determines the CEO's incentive award and incentive awards for other listed individuals are determined by the listed individual's supervisor and disclosed to the Board. The Board may authorize modified incentive awards when appropriate in its judgment.

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.

Provenance

Return type
form_990
Tax year
2022
Filed
9 November 2023
IRS schema version
2022v5.0
Source object
202313139349304941

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