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← COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICES FOUNDATION

Form 990 for tax year 2022

Filed by COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICES FOUNDATION.

Totals

Total revenue
$49,222
Total expenses
$28,468
Contributions and grants received
$14,847
Grants paid
$25,922
Program service revenue
$0
Investment income
$20,484
Other revenue
$13,891
Total assets, end of year
$1,482,766
Total liabilities, end of year
$14,378
Net assets or fund balances, end of year
$1,468,388
Program services expenses (Part IX)
$28,219
Management and general expenses
$249
Fundraising expenses
$0
Program service expenses (Part III)
$28,219

Program services were 99.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

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.

  • 1c · Fundraising events

    $9,380

  • 1f · All other contributions, gifts and grants

    $5,467

  • 3 · Investment income

    total $20,484 · excluded $20,484

  • 8a · Fundraising events: gross income

    $2,498

  • 8a · Fundraising events: contributions included on line 1c

    $9,380

  • 8b · Fundraising events: direct expenses

    $2,352

  • 8c · Net income from fundraising events

    total $146 · excluded $146

  • 9a · Gaming: gross income

    $900

  • 9b · Gaming: direct expenses

    $67

  • 9c · Net income from gaming

    total $833 · excluded $833

  • 11a · Other revenue: INTERCOMPANY TRANSACTI

    total $12,912 · excluded $12,912

  • 11e · Other revenue, total

    $12,912

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $25,922 · program services $25,922

  • 11f · Fees: investment management

    total $1,612 · program services $1,531 · management and general $81

  • 11g · Fees: other

    total $934 · program services $766 · management and general $168

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $165,086 · end of year $192,786

  • 11 · Investments: publicly traded securities

    beginning of year $467,292 · end of year $453,538

  • 12 · Investments: other securities

    beginning of year $807,357 · end of year $836,442

  • 15 · Other assets

    beginning of year $871 · end of year $0

  • 25 · Other liabilities

    beginning of year $0 · end of year $14,378

  • 27 · Net assets without donor restrictions

    beginning of year $685,732 · end of year $697,464

  • 28 · Net assets with donor restrictions

    beginning of year $754,874 · end of year $770,924

Mission and programs · 2022

Mission

AS AN AFFILIATE OF COMMONSPIRIT HEALTH, WE MAKE THE HEALING PRESENCE OF GOD KNOWN IN OUR WORLD BY IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL.

Activities or mission (Part I)

THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH.

  • THE FOUNDATION AIDS ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL, MISSOURI VALLEY, IA BY SOLICITING CONTRIBUTIONS FOR THE USE AND BENEFIT OF THE HOSPITAL'S PROGRAMS AND SERVICES. THE HOSPITAL PROVIDES ACUTE, PREVENTIVE AND CLINICAL HEALTHCARE SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE BASED ON RACE, SEX, NATIONAL ORIGIN OR RELIGION.

    Expenses $28,219 · Grants $25,922

As filed on the 2022 return.

Listed in Part VII

  • EVERT KUIPER

    PRESIDENT & CEO CHI HEALTH

    Total calculated
    $1,303,984
    From this org
    $0
    From related orgs
    $1,274,593
    Other
    $29,391
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $891,215 related
    Bonus
    $0 + $275,000 related
    Other
    $0 + $108,378 related
    Deferred
    $0 + $3,276 related
    Nontaxable benefits
    $0 + $26,115 related
    Filer's total
    $0 + $1,303,984 related

  • JEANETTE WOJTALEWICZ

    CFO, CHI HEALTH (TERMED 1/6/23)

    Total calculated
    $1,223,121
    From this org
    $0
    From related orgs
    $1,168,841
    Other
    $54,280
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $649,549 related
    Bonus
    $0 + $463,014 related
    Other
    $0 + $56,278 related
    Deferred
    $0 + $17,750 related
    Nontaxable benefits
    $0 + $36,530 related
    Filer's total
    $0 + $1,223,121 related

  • DANIEL RICHTER MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $352,389
    From this org
    $0
    From related orgs
    $297,803
    Other
    $54,586
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $293,202 related
    Bonus
    $0
    Other
    $0 + $4,601 related
    Deferred
    $0 + $17,750 related
    Nontaxable benefits
    $0 + $36,836 related
    Filer's total
    $0 + $352,389 related

  • KATHY BERTOLINI

    VP PHILANTHROPY

    Total calculated
    $344,388
    From this org
    $0
    From related orgs
    $300,958
    Other
    $43,430
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $257,632 related
    Bonus
    $0 + $39,475 related
    Other
    $0 + $3,851 related
    Deferred
    $0 + $16,772 related
    Nontaxable benefits
    $0 + $26,658 related
    Filer's total
    $0 + $344,388 related

  • DAVID JONES

    MARKET PRESIDENT REGIONAL HOSPITALS

    Total calculated
    $338,527
    From this org
    $0
    From related orgs
    $307,588
    Other
    $30,939
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $256,033 related
    Bonus
    $0 + $50,308 related
    Other
    $0 + $1,247 related
    Deferred
    $0 + $11,983 related
    Nontaxable benefits
    $0 + $18,956 related
    Filer's total
    $0 + $338,527 related

  • NICK OTOOL

    INTERIM CFO, CHI HEALTH

    Total calculated
    $304,710
    From this org
    $0
    From related orgs
    $257,678
    Other
    $47,032
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $207,354 related
    Bonus
    $0 + $49,872 related
    Other
    $0 + $452 related
    Deferred
    $0 + $16,380 related
    Nontaxable benefits
    $0 + $30,652 related
    Filer's total
    $0 + $304,710 related

  • JENNIFER HALL

    VICE CHAIR/NURSE PRACTITIONER

    Total calculated
    $139,854
    From this org
    $0
    From related orgs
    $111,367
    Other
    $28,487
    Hours/week
    1 + 40 related

  • REBECCA FLINT

    CHAIR

    Total calculated
    $0
    Hours/week
    1

  • JASON SHERER

    SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • TIMOTHY SPROUL

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • BILL WADSWORTH

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • BETH FOUTS

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • RAGENE DARLING

    DIRECTOR

    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, 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

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)

PART I, LINE 3
COMPENSATION FOR THE EXECUTIVE DIRECTOR OF COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICES FOUNDATION, THE VP OF PHILANTHROPY, WAS ESTABLISHED BY THE CHI HEALTH CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE.
PART I, LINE 4B
SCHEDULE J, PART I, LINE 4A - SEVERANCE OR CHANGE-OF-CONTROL PAYMENTS: CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY AN EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 52 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION AND TENURE, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DURING THE 2022 CALENDAR YEAR, COMMONSPIRIT HEALTH ("COMMONSPIRIT") MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2022 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2022, THE FOLLOWING PAYMENT WAS MADE PURSUANT TO THE SUPER VESTING RULES: JEANETTE WOJTALEWICZ, $50,733.
SCHEDULE J, PART II
COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICES FOUNDATION FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST COMMONSPIRIT IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE COMMONSPIRIT TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES COMMONSPIRIT SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND COMMONSPIRIT'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL, AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2022.

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

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.

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
10 May 2024
IRS schema version
2022v5.0
Source object
202421319349304642

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