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Nonprofiteer
← WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC

Form 990 for tax year 2022

Filed by WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC.

Totals

Total revenue
$14,803,920
Total expenses
$15,058,939
Contributions and grants received
$228,514
Grants paid
$2,600
Program services expenses (Part IX)
$12,081,736
Management and general expenses
$2,977,203
Fundraising expenses
$0
Program service expenses (Part III)
$12,081,736

Program services were 80.2% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • Alan Levine BH PresCEO

    Director, Chair

    Total calculated
    $3,804,451
    From this org
    $0
    From related orgs
    $3,557,360
    Other
    $247,091
    Hours/week
    1 + 64 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,351,717 related
    Bonus
    $0 + $2,162,808 related
    Other
    $0 + $42,835 related
    Deferred
    $0 + $218,859 related
    Nontaxable benefits
    $0 + $28,232 related
    Filer's total
    $0 + $3,804,451 related

  • Marvin Eichorn BH EVPCAO

    Director

    Total calculated
    $3,152,666
    From this org
    $0
    From related orgs
    $3,107,146
    Other
    $45,520
    Hours/week
    1 + 64 related

    Schedule J breakdown matched by us

    Base
    $0 + $752,788 related
    Bonus
    $0 + $598,921 related
    Other
    $0 + $1,755,437 related
    Deferred
    $0 + $17,400 related
    Nontaxable benefits
    $0 + $28,120 related
    Filer's total
    $0 + $3,152,666 related

  • Tim Belisle BH EVPGen Cnsl

    Director, Secretary End July 2022

    Total calculated
    $883,358
    From this org
    $0
    From related orgs
    $827,127
    Other
    $56,231
    Hours/week
    1 + 64 related

    Schedule J breakdown matched by us

    Base
    $0 + $277,977 related
    Bonus
    $0 + $310,583 related
    Other
    $0 + $238,567 related
    Deferred
    $0 + $29,779 related
    Nontaxable benefits
    $0 + $26,452 related
    Filer's total
    $0 + $883,358 related

  • Eric Deaton BH EVPCOO

    Director

    Total calculated
    $1,375,496
    From this org
    $0
    From related orgs
    $1,268,808
    Other
    $106,688
    Hours/week
    1 + 64 related

    Schedule J breakdown matched by us

    Base
    $0 + $720,293 related
    Bonus
    $0 + $530,145 related
    Other
    $0 + $18,370 related
    Deferred
    $0 + $84,013 related
    Nontaxable benefits
    $0 + $22,675 related
    Filer's total
    $0 + $1,375,496 related

  • Julie Bennett CLOGovnc Offcr

    Director, Secretary Start April 2023

    Total calculated
    $0
    Hours/week
    1 + 64 related

  • Andrew Wampler BH Gen Cnsl

    Director, Secretary End April 2023

    Total calculated
    $248,146
    From this org
    $0
    From related orgs
    $207,386
    Other
    $40,760
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $202,835 related
    Bonus
    $0 + $1,250 related
    Other
    $0 + $3,301 related
    Deferred
    $0 + $30,762 related
    Nontaxable benefits
    $0 + $9,998 related
    Filer's total
    $0 + $248,146 related

  • Regina Day

    Administrator - HCMH/HCH

    Total calculated
    $220,065
    From this org
    $209,364
    From related orgs
    $0
    Other
    $10,701
    Hours/week
    36 + 9 related

    Schedule J breakdown matched by us

    Base
    $167,652
    Bonus
    $34,638
    Other
    $7,074
    Deferred
    $10,253
    Nontaxable benefits
    $448
    Filer's total
    $220,065

  • Lynn Krutak

    BH EVP/CFO

    Total calculated
    $1,319,206
    From this org
    $0
    From related orgs
    $1,209,478
    Other
    $109,728
    Hours/week
    1 + 64 related

    Schedule J breakdown matched by us

    Base
    $0 + $682,629 related
    Bonus
    $0 + $520,077 related
    Other
    $0 + $6,772 related
    Deferred
    $0 + $82,332 related
    Nontaxable benefits
    $0 + $27,396 related
    Filer's total
    $0 + $1,319,206 related

  • Frank Canova BH Regional CFO

    CFO, Through April 2023

    Total calculated
    $200,565
    From this org
    $0
    From related orgs
    $191,083
    Other
    $9,482
    Hours/week
    1 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $163,711 related
    Bonus
    $0 + $10,500 related
    Other
    $0 + $16,872 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $9,482 related
    Filer's total
    $0 + $200,565 related

  • Chase Wilson

    CFO, HCMH, Start April 2023

    Total calculated
    $336,497
    From this org
    $0
    From related orgs
    $296,185
    Other
    $40,312
    Hours/week
    4.5 + 40.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $229,756 related
    Bonus
    $0 + $66,225 related
    Other
    $0 + $204 related
    Deferred
    $0 + $14,416 related
    Nontaxable benefits
    $0 + $25,896 related
    Filer's total
    $0 + $336,497 related

  • Georgia Shuck

    Pharmacist, Clinical

    Total calculated
    $156,418
    From this org
    $139,601
    From related orgs
    $0
    Other
    $16,817
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $134,887
    Bonus
    $1,250
    Other
    $3,464
    Deferred
    $8,332
    Nontaxable benefits
    $8,485
    Filer's total
    $156,418

  • Hunter Hamilton

    Administrator & CNO - HCMH

    Total calculated
    $139,716
    From this org
    $113,376
    From related orgs
    $0
    Other
    $26,340
    Hours/week
    40

  • Deidre Wolfe

    Registered Nurse

    Total calculated
    $116,465
    From this org
    $101,568
    From related orgs
    $0
    Other
    $14,897
    Hours/week
    40

  • Rebecca Beck Former Officer

    CEO - HVMC

    Total calculated
    $392,286
    From this org
    $0
    From related orgs
    $352,988
    Other
    $39,298
    Hours/week
    0 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $289,360 related
    Bonus
    $0 + $62,297 related
    Other
    $0 + $1,331 related
    Deferred
    $0 + $17,728 related
    Nontaxable benefits
    $0 + $21,570 related
    Filer's total
    $0 + $392,286 related

  • David Mooney Fmr HComp

    Dir. of Rehab Svcs, HVMC

    Total calculated
    $146,771
    From this org
    $0
    From related orgs
    $117,393
    Other
    $29,378
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $115,140 related
    Bonus
    $0 + $1,250 related
    Other
    $0 + $1,003 related
    Deferred
    $0 + $7,353 related
    Nontaxable benefits
    $0 + $22,025 related
    Filer's total
    $0 + $146,771 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 — 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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

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
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Part I, Lines 4a-b
The following executives listed in Schedule J, Part II participated in a 457(f) retirement plan provided by Ballad Health (BH). The 457(f) plan is a nonqualified tax-deferred compensation plan available to a select group of key executives for the intent of supporting retention and to offer a competitive total retirement program. Account balances have a "substantial risk of forfeiture". In addition to creditor risk, substantial risk of forfeiture is created through default risk if the participant's employment with BH is terminated prior to age 65. However, the 457(f) plan contains a non-compete provision that provides the account balance to be paid in a lump sum after the executive satisfies the two-year non-compete period. This provision applies to employer contributions if the executive has provided eligible service for six or more years. The executive will receive the entire account balance if he/she becomes disabled, dies or if the executive terminates for "good reason or is involuntarily terminated without "good cause" within a 24-month period after a change-of-control occurs. Distributions from this plan are subject to federal, state, and local taxes on the entire account balance upon distribution. Alan Levine $201,459 Eric Deaton $66,613 Lynn Krutak $64,932 Tim Belisle $22,233 Andrew Wampler $18,111 The following executives received a change-of-control payment. The payment was reported as taxable income with appropriate tax withheld and remitted to the IRS. Tim Belisle $179,601

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
2022
Filed
7 May 2024
IRS schema version
2022v5.0
Source object
202431289349301313

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