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Nonprofiteer
← HSHS GOOD SHEPHERD HOSPITAL INC

Form 990 for tax year 2022

Filed by HSHS GOOD SHEPHERD HOSPITAL INC.

Totals

Total revenue
$17,501,132
Total expenses
$19,007,323
Contributions and grants received
$365,450
Grants paid
$0
Program service revenue
$16,797,149
Investment income
$82,747
Other revenue
$255,786
Total assets, end of year
$21,168,629
Total liabilities, end of year
$7,340,631
Net assets or fund balances, end of year
$13,827,998
Program services expenses (Part IX)
$16,666,972
Management and general expenses
$2,340,351
Fundraising expenses
$0
Program service expenses (Part III)
$16,666,972

Program services were 87.7% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • Aaron Puchbauer

    President & CEO (UNTIL 8/6/22)

    Total calculated
    $402,755
    From this org
    $166,241
    From related orgs
    $166,240
    Other
    $70,274
    Hours/week
    30 + 30 related

    Schedule J breakdown matched by us

    Base
    $105,997 + $105,996 related
    Bonus
    $15,875 + $15,875 related
    Other
    $44,369 + $44,369 related
    Deferred
    $14,779 + $14,779 related
    Nontaxable benefits
    $20,358 + $20,358 related
    Filer's total
    $201,378 + $201,377 related

  • Chad Markham

    President & CEO

    Total calculated
    $458,223
    From this org
    $187,957
    From related orgs
    $187,956
    Other
    $82,310
    Hours/week
    30 + 30 related

    Schedule J breakdown matched by us

    Base
    $149,996 + $149,996 related
    Bonus
    $33,767 + $33,766 related
    Other
    $4,194 + $4,194 related
    Deferred
    $21,895 + $21,895 related
    Nontaxable benefits
    $19,260 + $19,260 related
    Filer's total
    $229,112 + $229,111 related

  • DENISE BENCE

    CHAIR

    Total calculated
    $0
    Hours/week
    1

  • JOSH SHALLENBERGER

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    1

  • ERIC FORLINES

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • KIM TURNER

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • PAUL KAY MD

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • Sr Marybeth Culnan OSF

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • TRAVIS BANFIELD

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • PATRICIA ALLEN

    Interim CFO - Illinois

    Total calculated
    $695,496
    From this org
    $0
    From related orgs
    $541,100
    Other
    $154,396
    Hours/week
    3 + 57 related

    Schedule J breakdown matched by us

    Base
    $0 + $414,598 related
    Bonus
    $0 + $44,684 related
    Other
    $0 + $81,818 related
    Deferred
    $0 + $126,563 related
    Nontaxable benefits
    $0 + $27,833 related
    Filer's total
    $0 + $695,496 related

  • TODD Smart

    Treasurer

    Total calculated
    $410,831
    From this org
    $0
    From related orgs
    $329,569
    Other
    $81,262
    Hours/week
    0.3 + 59.8 related

    Schedule J breakdown matched by us

    Base
    $0 + $267,686 related
    Bonus
    $0 + $38,335 related
    Other
    $0 + $23,548 related
    Deferred
    $0 + $45,254 related
    Nontaxable benefits
    $0 + $36,008 related
    Filer's total
    $0 + $410,831 related

  • ALLISON HAGEN

    Registered Nurse

    Total calculated
    $146,318
    From this org
    $134,263
    From related orgs
    $0
    Other
    $12,055
    Hours/week
    40

  • ANDREW CORZINE

    Pharmacist

    Total calculated
    $234,420
    From this org
    $154,139
    From related orgs
    $0
    Other
    $80,281
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $150,384
    Bonus
    $0
    Other
    $3,755
    Deferred
    $46,147
    Nontaxable benefits
    $34,134
    Filer's total
    $234,420

  • KARLA DIXON

    Director - Nursing

    Total calculated
    $180,511
    From this org
    $142,998
    From related orgs
    $0
    Other
    $37,513
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $116,214
    Bonus
    $8,050
    Other
    $18,734
    Deferred
    $1,916
    Nontaxable benefits
    $35,597
    Filer's total
    $180,511

  • Mary Theresa Thull

    ED House Supervisor

    Total calculated
    $132,371
    From this org
    $129,117
    From related orgs
    $0
    Other
    $3,254
    Hours/week
    40

  • Shelle Sloan

    Nurse Practitioner

    Total calculated
    $223,231
    From this org
    $166,991
    From related orgs
    $0
    Other
    $56,240
    Hours/week
    10

    Schedule J breakdown matched by us

    Base
    $145,552
    Bonus
    $21,049
    Other
    $390
    Deferred
    $20,639
    Nontaxable benefits
    $35,601
    Filer's total
    $223,231

  • EVERT J KUIPER

    Former Division CEO - Illinois (until Jan 2022)

    Total calculated
    $532,473
    From this org
    $0
    From related orgs
    $526,246
    Other
    $6,227
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $51,437 related
    Bonus
    $0
    Other
    $0 + $474,809 related
    Deferred
    $0 + $3,413 related
    Nontaxable benefits
    $0 + $2,814 related
    Filer's total
    $0 + $532,473 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

  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Form 990 of other organizations
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 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)

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Patricia Allen -- $37,240 Chad Markham -- $37,690 Aaron Puchbauer -- $25,396 Todd Smart -- $25,135 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Evert Kuiper -- $196,540

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.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

Related partnerships

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

Related corporations and trusts

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

  • KIARA INC

    C Corporation · HEALTHCARE · IL · 100% owned · share of income $601,904 · share of assets $18,670,450 · controlled entity

    Directly controlled by HSHS

  • LASANTE WISCONSIN INC

    C Corporation · HEALTHCARE · IL · controlled entity

    Directly controlled by KIARA INC

  • LASANTE INC

    C Corporation · HEALTHCARE · IL · controlled entity

    Directly controlled by KIARA INC

  • PREVEA HEALTH SERVICES INC

    C Corporation · HEALTHCARE · WI · 50% owned · share of income -$1,641,640 · share of assets $24,425,128 · controlled entity

    Directly controlled by HSSI

  • PREVEA CLINIC INC

    C Corporation · HEALTHCARE · WI · controlled entity

    Directly controlled by PHSI

  • RENAISSANCE QUALITY INSURANCE LTD

    C Corporation · INSURANCE · CJ · 100% owned · share of income $0 · share of assets $156,895,227 · controlled entity

    Directly controlled by HSSI

  • OJV INC

    C Corporation · HEALTHCARE · IL · controlled entity

    Directly controlled by LASANTE INC

Provenance

Return type
form_990
Tax year
2022
Filed
10 May 2024
IRS schema version
2022v5.0
Source object
202441319349304394

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