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Nonprofiteer
← BON SECOURS ST FRANCIS HEALTH SYSTEM INC

Form 990 for tax year 2022

Filed by BON SECOURS ST FRANCIS HEALTH SYSTEM INC.

Totals

Total revenue
$12,019,297
Total expenses
$14,362,308
Contributions and grants received
$1,621,854
Grants paid
$0
Program service revenue
$10,375,645
Investment income
$0
Other revenue
$21,798
Total assets, end of year
$7,657,187
Total liabilities, end of year
$2,816,218
Net assets or fund balances, end of year
$4,840,969
Program services expenses (Part IX)
$13,181,698
Management and general expenses
$1,180,610
Fundraising expenses
$0
Program service expenses (Part III)
$13,181,698

Program services were 91.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • HENRY GALLIVAN

    BOARD CHAIR

    Total calculated
    $0
    Hours/week
    3 + 3.5 related

  • John Pazdan

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    3 + 3.5 related

  • MATTHEW CALDWELL

    Market President BSSFHS

    Total calculated
    $1,374,984
    From this org
    $0
    From related orgs
    $1,086,217
    Other
    $288,767
    Hours/week
    15 + 35 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

  • Carlos Quintero

    Board Member

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • DONALD KLINE

    Board Member (End 04/22), BSMH COO

    Total calculated
    $1,836,880
    From this org
    $0
    From related orgs
    $1,790,988
    Other
    $45,892
    Hours/week
    3 + 47 related

    Schedule J breakdown matched by us

    Base
    $0 + $858,576 related
    Bonus
    $0 + $320,000 related
    Other
    $0 + $612,412 related
    Deferred
    $0 + $3,742 related
    Nontaxable benefits
    $0 + $42,150 related
    Filer's total
    $0 + $1,836,880 related

  • GARY DANIELS Jr

    Board Member

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • Kenneth Baca

    Board Member

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • Matthew COOney

    Board Member

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • Paul Smith

    Board Member (05/22-06/22); Group President (End 06/22)

    Total calculated
    $2,267,913
    From this org
    $0
    From related orgs
    $1,760,664
    Other
    $507,249
    Hours/week
    3 + 47 related

    Schedule J breakdown matched by us

    Base
    $0 + $806,642 related
    Bonus
    $0 + $339,394 related
    Other
    $0 + $614,628 related
    Deferred
    $0 + $465,114 related
    Nontaxable benefits
    $0 + $42,135 related
    Filer's total
    $0 + $2,267,913 related

  • Raymond LATtimore

    Board Member

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • SR KATHRYN CLAUSS

    Board Member

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • TOMMY MANN JR MD

    Board Member; General Surgeon

    Total calculated
    $548,514
    From this org
    $0
    From related orgs
    $512,400
    Other
    $36,114
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $374,171 related
    Bonus
    $0 + $65,971 related
    Other
    $0 + $72,258 related
    Deferred
    $0 + $4,550 related
    Nontaxable benefits
    $0 + $31,564 related
    Filer's total
    $0 + $548,514 related

  • Wendy WALDEN

    Board Member

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • Robert Stiekes

    CFO - BSSFHS

    Total calculated
    $493,413
    From this org
    $0
    From related orgs
    $432,622
    Other
    $60,791
    Hours/week
    25 + 25 related

    Schedule J breakdown matched by us

    Base
    $0 + $321,979 related
    Bonus
    $0 + $100,500 related
    Other
    $0 + $10,143 related
    Deferred
    $0 + $30,312 related
    Nontaxable benefits
    $0 + $30,479 related
    Filer's total
    $0 + $493,413 related

  • DAT TA MD

    URGENT CARE PHYSICIAN

    Total calculated
    $314,246
    From this org
    $275,101
    From related orgs
    $0
    Other
    $39,145
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $231,476
    Bonus
    $0
    Other
    $43,625
    Deferred
    $4,067
    Nontaxable benefits
    $35,078
    Filer's total
    $314,246

  • IVET HUDSON MD

    Urgent Care Physician

    Total calculated
    $276,995
    From this org
    $243,238
    From related orgs
    $0
    Other
    $33,757
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $210,968
    Bonus
    $0
    Other
    $32,270
    Deferred
    $4,028
    Nontaxable benefits
    $29,729
    Filer's total
    $276,995

  • JASON CRUMPLER MD

    URGENT CARE PHYSICIAN

    Total calculated
    $308,913
    From this org
    $275,889
    From related orgs
    $0
    Other
    $33,024
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $237,013
    Bonus
    $0
    Other
    $38,876
    Deferred
    $4,122
    Nontaxable benefits
    $28,902
    Filer's total
    $308,913

  • Lane Phillips MD

    Urgent Care Physician

    Total calculated
    $278,556
    From this org
    $263,374
    From related orgs
    $0
    Other
    $15,182
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $243,424
    Bonus
    $5,216
    Other
    $14,734
    Deferred
    $4,167
    Nontaxable benefits
    $11,015
    Filer's total
    $278,556

  • LYNN STORCH OWENS MD

    Urgent Care Physician

    Total calculated
    $245,810
    From this org
    $241,629
    From related orgs
    $0
    Other
    $4,181
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $239,186
    Bonus
    $0
    Other
    $2,443
    Deferred
    $3,900
    Nontaxable benefits
    $281
    Filer's total
    $245,810

  • LISA LANDRETH

    Former Interim CFO - BSSFHS

    Total calculated
    $193,631
    From this org
    $0
    From related orgs
    $180,734
    Other
    $12,897
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $143,123 related
    Bonus
    $0 + $24,616 related
    Other
    $0 + $12,995 related
    Deferred
    $0 + $3,324 related
    Nontaxable benefits
    $0 + $9,573 related
    Filer's total
    $0 + $193,631 related

  • Thomas Morris PHD

    Former Board President; BSMH Chief Sponsorship Officer

    Total calculated
    $559,865
    From this org
    $0
    From related orgs
    $530,903
    Other
    $28,962
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $225,804 related
    Bonus
    $0 + $67,202 related
    Other
    $0 + $237,897 related
    Deferred
    $0 + $4,031 related
    Nontaxable benefits
    $0 + $24,931 related
    Filer's total
    $0 + $559,865 related

  • WILLIAM KUSNIERZ

    FORMER CFO - BSSFHS

    Total calculated
    $613,120
    From this org
    $0
    From related orgs
    $565,581
    Other
    $47,539
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $364,405 related
    Bonus
    $0 + $121,270 related
    Other
    $0 + $79,906 related
    Deferred
    $0 + $35,696 related
    Nontaxable benefits
    $0 + $11,843 related
    Filer's total
    $0 + $613,120 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

  • 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 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 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; William Kusnierz $27,913; Thomas Morris, PH.D, $56,298; Donald Kline, $184,492; Robert Stiekes, $0; Paul Smith, $309,220.
Schedule J, Part I, Line 4b Terms and conditions of the Youngstown Market SERP
The Youngstown Market SERP Plan is a deferred compensation plan which provides supplemental retirement benefits to persons selected by the Mercy Health Youngstown LLC Board of trustees or its delegate. The Plan provides annual credits of a specified percentage of compensation and annual interest credits. Participants vest 100% in their accounts after three years of service, except for participants who had attained at least ten years of service at plan inception, who had immediate vesting. Vesting occurs earlier upon death or total disability. Payments are made during employment for required tax withholding. The vested account balance is paid as a lump sum after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year are as follows: Donald Kline $0.
Schedule J, Part I, Line 4b Terms and conditions of the Bon Secours Mercy Health Physicians SERP
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: Tommy Mann, Jr, MD, $12,500.
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.
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.

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.

  • BON SECOURS AMBULATORY SERVICES - ST FRANCIS LLC

    ALL OTHER OUTPATIENT CARE CENTERS · SC · income $12,023,344 · assets $7,583,134

    Directly controlled by BON SECOURS ST FRANCIS HEALTH SYSTEM

  • Upstate Good Help ACO LLC

    Accountable Care Organization · SC · income $0 · assets $0

    Directly controlled by Bon Secours St Francis Health System

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.

Provenance

Return type
form_990
Tax year
2022
Filed
13 November 2023
IRS schema version
2022v5.0
Source object
202323179349307992

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