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Nonprofiteer
← UTLAUT MEMORIAL FOUNDATION INC

Form 990 for tax year 2022

Filed by UTLAUT MEMORIAL FOUNDATION INC.

Totals

Total revenue
$81
Total expenses
$0
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$0
Investment income
$81
Other revenue
$0
Total assets, end of year
$0
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$0
Program services expenses (Part IX)
$0
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$0

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.

  • 2f · All other program service revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $81 · excluded $81

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 7c · Gain or loss

    securities $0 · other assets $0

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 11g · Fees: other

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 24e · All other expenses

    total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 10a · Land, buildings and equipment: cost or other basis

    $0

  • 10b · Land, buildings and equipment: accumulated depreciation

    $0

  • 10c · Land, buildings and equipment, net

    beginning of year $0 · end of year $0

  • 11 · Investments: publicly traded securities

    beginning of year $1,209,572 · end of year $0

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $0 · end of year $0

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 25 · Other liabilities

    beginning of year $0 · end of year $0

  • 28 · Net assets with donor restrictions

    beginning of year $1,209,572 · end of year $0

Mission and programs · 2022

Mission

TO CONTRIBUTE TO THE MISSION OF HSHS HOLY FAMILY HOSPITAL.

  • EDUCATION: THE UTLAUT MEMORIAL FOUNDATION EXISTS PURELY IN THE CAPACITY TO OPERATE THE VIOLA THOMPSON SCHOLARSHIP FUND. The Viola Thompson Scholarship Fund exists to fund scholarships for current and future employees of HSHS Holy Family Hospital (HFG) in Greenville. Education assistance is awarded in exchange for an employment commitment from the individual. If the colleague chooses not to fulfill his/her obligation to work at HFG for a pre-determined period of time, he/she would be liable to repay the scholarship.

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Bart Caldieraro

    CHAIR

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Crystal Grove

    Vice Chair

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Kelly M Sager

    President/HFG CEO

    Total calculated
    $439,605
    From this org
    $0
    From related orgs
    $378,418
    Other
    $61,187
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $255,474 related
    Bonus
    $0 + $63,032 related
    Other
    $0 + $59,912 related
    Deferred
    $0 + $32,607 related
    Nontaxable benefits
    $0 + $28,580 related
    Filer's total
    $0 + $439,605 related

  • Suzanne Davis

    Secretary

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Eugene Dunkley

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Jamie Baum MD

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Pam Doll

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • Randy Alderman

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Travis Thacker

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • William Walker

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • 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

  • 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 Kelly Sager -- $32,607 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.

  • KIARA CLINICAL INTEGRATION NETWORK LLC

    HEALTHCARE · IL · income -$105,950 · assets $447,864

    Directly controlled by HSSI

  • PHYSICIAN CLINICAL INTEGRATION NETWORK LLC

    HEALTHCARE · IL · income $554,315 · assets $15,980,466

    Directly controlled by KCIN

  • HSHS ACO LLC

    HEALTHCARE & SOCIAL ASSISTANCE · IL · income $1,805,698 · assets $3,189,003

    Directly controlled by KCIN

Related partnerships

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

  • SPRINGFIELD URGENT CARE REAL ESTATE LLC

    N/A · RENTAL REAL ESTATE · IL · 0% owned

    Directly controlled by LASANTE INC

  • PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC

    Related · MEDICAL · IL · 100% owned · share of income -$7,032 · share of assets $12,572 · general or managing partner

    Directly controlled by HSHS

  • SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP

    Related · REAL ESTATE · IL · 50% owned · share of income -$126,650 · share of assets $1,434,911

    Directly controlled by St John's

  • REHABILITATION HOSPITAL OF WESTERN WISCONSIN LLC

    Related · Medical · DE · 50% owned · share of income -$80,505 · share of assets $4,187,830

    Directly controlled by HSHS

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

Assets distributed on this return

Schedule N, as filed: what the organization did with its assets when it liquidated or dissolved, or disposed of more than a quarter of them, and who received them. A recipient with an EIN is usually a successor organization; filers also list expenses such as legal fees here.

1 distribution to a recipient named as a person, $1,236,580. Counted where the filer named the recipient as a person, as filed. Who received them, and what, are not published.

Provenance

Return type
form_990
Tax year
2022
Filed
10 May 2024
IRS schema version
2022v5.0
Source object
202441319349304744

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