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Nonprofiteer
← CENTRASTATE MEDICAL CENTER INC

Form 990 for tax year 2023

Filed by CENTRASTATE MEDICAL CENTER INC.

Totals

Total revenue
$384,276,165
Total expenses
$387,147,617
Contributions and grants received
$24,791,227
Grants paid
$3,508
Program services expenses (Part IX)
$348,433,206
Management and general expenses
$38,714,411
Fundraising expenses
$0
Program service expenses (Part III)
$348,433,206

Program services were 90.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • THOMAS W SCOTT FACHE

    TRUSTEE-PRESIDENT/CEO

    Total calculated
    $926,522
    From this org
    $870,269
    From related orgs
    $0
    Other
    $56,253
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $719,135
    Bonus
    $148,512
    Other
    $2,622
    Deferred
    $30,000
    Nontaxable benefits
    $26,253
    Filer's total
    $926,522

  • JAMES J MATERA MD

    SVP/MEDICAL DIRECTOR

    Total calculated
    $814,409
    From this org
    $775,843
    From related orgs
    $0
    Other
    $38,566
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $491,649
    Bonus
    $68,796
    Other
    $215,398
    Deferred
    $22,500
    Nontaxable benefits
    $16,066
    Filer's total
    $814,409

  • DEBORAH ROMMEL-CONNORS MBA

    VP REVENUE CYCLE

    Total calculated
    $686,373
    From this org
    $640,112
    From related orgs
    $0
    Other
    $46,261
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $257,136
    Bonus
    $29,812
    Other
    $353,164
    Deferred
    $30,000
    Nontaxable benefits
    $16,261
    Filer's total
    $686,373

  • JOHN A DELLOCONO

    SVP/CFO

    Total calculated
    $662,673
    From this org
    $602,968
    From related orgs
    $0
    Other
    $59,705
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $516,480
    Bonus
    $72,277
    Other
    $14,211
    Deferred
    $22,500
    Nontaxable benefits
    $37,205
    Filer's total
    $662,673

  • AMIT S KHAROD MD

    TRUSTEE

    Total calculated
    $564,394
    From this org
    $40,750
    From related orgs
    $492,614
    Other
    $31,030
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $455,878 related
    Bonus
    $0
    Other
    $40,750 + $36,736 related
    Deferred
    $0 + $7,391 related
    Nontaxable benefits
    $0 + $23,639 related
    Filer's total
    $40,750 + $523,644 related

  • MOUSTAFA SHAFEY MD

    MEDICAL DIR. - MENTAL HLTH

    Total calculated
    $393,163
    From this org
    $356,673
    From related orgs
    $0
    Other
    $36,490
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $334,562
    Bonus
    $20,221
    Other
    $1,890
    Deferred
    $30,000
    Nontaxable benefits
    $6,490
    Filer's total
    $393,163

  • CATHLEEN G JANZEKOVICH

    VP, PATIENT SERVICES

    Total calculated
    $390,228
    From this org
    $361,805
    From related orgs
    $0
    Other
    $28,423
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $324,884
    Bonus
    $33,405
    Other
    $3,516
    Deferred
    $26,281
    Nontaxable benefits
    $2,142
    Filer's total
    $390,228

  • KAREN B FREEMAN MSA

    VP QUALITY & PATIENT SAFETY

    Total calculated
    $385,187
    From this org
    $348,303
    From related orgs
    $0
    Other
    $36,884
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $283,781
    Bonus
    $30,958
    Other
    $33,564
    Deferred
    $30,000
    Nontaxable benefits
    $6,884
    Filer's total
    $385,187

  • HOWARD A STEIN MD

    PHYSICIAN

    Total calculated
    $368,538
    From this org
    $332,487
    From related orgs
    $0
    Other
    $36,051
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $303,837
    Bonus
    $27,066
    Other
    $1,584
    Deferred
    $22,500
    Nontaxable benefits
    $13,551
    Filer's total
    $368,538

  • JAMES RICHVALSKY

    VP, PHYS PRACT MGMT(TERM 8/23)

    Total calculated
    $367,097
    From this org
    $333,604
    From related orgs
    $0
    Other
    $33,493
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $191,185
    Bonus
    $0
    Other
    $142,419
    Deferred
    $17,646
    Nontaxable benefits
    $15,847
    Filer's total
    $367,097

  • NANCY BARONE

    CSHCF VP OF DEVELOPMENT

    Total calculated
    $334,920
    From this org
    $292,541
    From related orgs
    $0
    Other
    $42,379
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $261,888
    Bonus
    $26,435
    Other
    $4,218
    Deferred
    $30,000
    Nontaxable benefits
    $12,379
    Filer's total
    $334,920

  • DANIELLE VANWERT

    VP CLINICAL SERVICES

    Total calculated
    $332,784
    From this org
    $286,551
    From related orgs
    $0
    Other
    $46,233
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $258,767
    Bonus
    $27,300
    Other
    $484
    Deferred
    $22,500
    Nontaxable benefits
    $23,733
    Filer's total
    $332,784

  • VINCENT L D'ELIA

    VP MRKTING PUBLIC/GOVT REL.

    Total calculated
    $321,335
    From this org
    $285,284
    From related orgs
    $0
    Other
    $36,051
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $254,057
    Bonus
    $26,241
    Other
    $4,986
    Deferred
    $22,500
    Nontaxable benefits
    $13,551
    Filer's total
    $321,335

  • KIMBERLY H SIMERS

    AVP INTEGRATIVE HEALTH

    Total calculated
    $301,445
    From this org
    $261,575
    From related orgs
    $0
    Other
    $39,870
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $239,462
    Bonus
    $20,644
    Other
    $1,469
    Deferred
    $30,000
    Nontaxable benefits
    $9,870
    Filer's total
    $301,445

  • LAURA L SCHILARE

    VP FINANCE

    Total calculated
    $297,204
    From this org
    $262,217
    From related orgs
    $0
    Other
    $34,987
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $235,441
    Bonus
    $24,652
    Other
    $2,124
    Deferred
    $19,473
    Nontaxable benefits
    $15,514
    Filer's total
    $297,204

  • DAVID A DE SIMONE ESQ

    FORMER KEY EMPLOYEE

    Total calculated
    $263,333
    From this org
    $263,333
    From related orgs
    $0
    Other
    $0
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $263,333
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $263,333

  • KENNNETH ENG DO

    TRUSTEE

    Total calculated
    $260,442
    From this org
    $0
    From related orgs
    $244,774
    Other
    $15,668
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $226,038 related
    Bonus
    $0
    Other
    $0 + $18,736 related
    Deferred
    $0 + $3,133 related
    Nontaxable benefits
    $0 + $12,535 related
    Filer's total
    $0 + $260,442 related

  • JOHN P DETULLIO MD

    TRUSTEE

    Total calculated
    $212,104
    From this org
    $0
    From related orgs
    $205,145
    Other
    $6,959
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $180,953 related
    Bonus
    $0
    Other
    $0 + $24,192 related
    Deferred
    $0 + $5,805 related
    Nontaxable benefits
    $0 + $1,154 related
    Filer's total
    $0 + $212,104 related

  • ASHISH AWASTHI MD FACC

    TRUSTEE

    Total calculated
    $60,750
    From this org
    $60,750
    From related orgs
    $0
    Other
    $0
    Hours/week
    25

  • RAMANASRI KUDIPUDI MD

    TRUSTEE

    Total calculated
    $11,250
    From this org
    $11,250
    From related orgs
    $0
    Other
    $0
    Hours/week
    5

  • JOHN M CANTALUPO ESQ

    CHAIR - TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • KENNETH J REILLY CWS

    VICE CHAIR - TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • NADIA K BATCHELOR

    SECRETARY/TREASURER-TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • JOHN F EGGERT

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • ROBERT GORDON DDS

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • BRIAN GRAGNOLATI

    TRUSTEE

    Total calculated
    $0
    Hours/week
    55

  • MAUREEN M LAWRENCE

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • PETER G LICATA ESQ

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • BARABRA J MCMORROW

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • GERALD K NORKUS

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • MAUREEN A SCHNEIDER PHD MBA RN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    55

  • WILLIAM A SCHORIES

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • STEVEN SHERIS MD FACC FACP

    TRUSTEE

    Total calculated
    $0
    Hours/week
    55

  • BRETT TAFT

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

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 · Travel for companions
  • 1a · Health or social club dues or initiation fees
  • 1b · Written policy on the line-1a expenses
  • 2 · Substantiation required before reimbursing expenses
  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

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
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

SCHEDULE J, PART I; QUESTIONS 1A AND 1B
The organization provided travel for companions of officers and trustees for the annual board retreat and certain educational seminars. The organization paid social club dues for Thomas W. Scott, President/CEO of the organization, which are part of his employment agreement contract. Utilization of this membership was primarily for the benefit of CentraState Medical Center, Inc.
SCHEDULE J, PART I; QUESTION 4A
THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE DURING CALENDAR YEAR 2023 WHICH WAS INCLUDED IN EACH INDIVIDUAL'S 2023 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: JAMES RICHVALSKY, $103,631 AND DAVID A. DE SIMONE, ESQ. $263,333.
SCHEDULE J, PART I; QUESTION 4B
THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") AS THE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2023 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: JAMES J. MATERA, M.D., $207,874 AND DEBORAH ROMMEL-CONNORS, MBA, $320,357.
SCHEDULE J, PART I; QUESTION 7
CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2023 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2023 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.
SCHEDULE J, PART II; COLUMN F
THE AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN (F) INCLUDE AMOUNTS REPORTED ON PRIOR YEARS' FORMS 990 IN SCHEDULE J, PART II, IN COLUMN (C) AS NON-TAXABLE UNVESTED DEFERRED COMPENSATION THAT IS NOW BEING REPORTED AGAIN ON THIS YEAR'S FORM 990. ACCORDINGLY, IN PRIOR YEARS THE INDIVIDUAL'S NEVER ACTUALLY RECEIVED ANY OF THESE UNVESTED BENEFIT AMOUNTS.

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
2023
Filed
15 May 2024
IRS schema version
2023v5.1
Source object
202413199349312886

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