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← CHMC ANESTHESIA FOUNDATION INC RETIREE MEDICAL BENEFIT TRUST

Form 990 for tax year 2022

Filed by CHMC ANESTHESIA FOUNDATION INC RETIREE MEDICAL BENEFIT TRUST.

Totals

Total revenue
$5,363,095
Total expenses
$120,954
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$0
Investment income
$5,363,095
Other revenue
$0
Total assets, end of year
$26,820,004
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$26,820,004
Program services expenses (Part IX)
not reported
Management and general expenses
not reported
Fundraising expenses
not reported
Program service expenses (Part III)
not reported

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.

  • 3 · Investment income

    total $668,811 · excluded $668,811

  • 7a · Gross sales of assets other than inventory

    securities $25,224,625

  • 7b · Less cost or other basis and sales expenses

    securities $20,530,341

  • 7c · Gain or loss

    securities $4,694,284

  • 7d · Net gain or loss

    total $4,694,284 · excluded $4,694,284

Functional expenses

Part IX, the statement of functional expenses.

  • 4 · Benefits paid to or for members

    total $118,631

  • 11f · Fees: investment management

    total $2,323

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $1,422,226 · end of year $945,851

  • 11 · Investments: publicly traded securities

    beginning of year $22,624,538 · end of year $25,874,153

  • 29 · Capital stock, trust principal or current funds

    beginning of year $0 · end of year $0

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $0 · end of year $0

  • 31 · Retained earnings, endowment or other funds

    beginning of year $24,046,764 · end of year $26,820,004

Mission and programs · 2022

Mission

The retiree medical plan is a welfare plan as defined by ERISA. The plan is funded entirely by CHMC Anesthesia Foundation, Inc. (the employer). Benefits reimburse qualifying medical expenses defined in IRC Sections 213(d), incurred by participants, spouses, and dependent children not reimbursed from other sources.

Activities or mission (Part I)

Tax-exempt employee benefit trust

  • Benefits to participants, spouses, and dependent children; the employer (CHMC Anesthesia Foundation, Inc.) does not charge for donated services.

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

Listed in Part VII

  • Joseph P Cravero MD

    President

    Total calculated
    $1,137,070
    From this org
    $0
    From related orgs
    $1,000,893
    Other
    $136,177
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $755,750 related
    Bonus
    $0 + $115,660 related
    Other
    $0 + $129,483 related
    Deferred
    $0 + $86,160 related
    Nontaxable benefits
    $0 + $50,017 related
    Filer's total
    $0 + $1,137,070 related
  • James Dinardo MD

    Director

    Total calculated
    $1,316,910
    From this org
    $0
    From related orgs
    $1,211,099
    Other
    $105,811
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $585,402 related
    Bonus
    $0 + $59,750 related
    Other
    $0 + $565,947 related
    Deferred
    $0 + $59,160 related
    Nontaxable benefits
    $0 + $46,651 related
    Filer's total
    $0 + $1,316,910 related
  • Jeffrey Burns MD

    Director

    Total calculated
    $952,851
    From this org
    $0
    From related orgs
    $840,087
    Other
    $112,764
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $720,200 related
    Bonus
    $0 + $20,000 related
    Other
    $0 + $99,887 related
    Deferred
    $0 + $59,160 related
    Nontaxable benefits
    $0 + $53,604 related
    Filer's total
    $0 + $952,851 related
  • Lynne Ferrari MD

    Director

    Total calculated
    $740,328
    From this org
    $0
    From related orgs
    $634,517
    Other
    $105,811
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $562,149 related
    Bonus
    $0 + $24,400 related
    Other
    $0 + $47,968 related
    Deferred
    $0 + $59,160 related
    Nontaxable benefits
    $0 + $46,651 related
    Filer's total
    $0 + $740,328 related
  • Paul R Hickey MD

    Former President

    Total calculated
    $1,009,889
    From this org
    $0
    From related orgs
    $909,249
    Other
    $100,640
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $295,864 related
    Bonus
    $0 + $12,000 related
    Other
    $0 + $601,385 related
    Deferred
    $0 + $59,160 related
    Nontaxable benefits
    $0 + $41,480 related
    Filer's total
    $0 + $1,009,889 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

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement

The filer's explanations (Part III)

Part I, Line 3
All individuals listed in Schedule J, Part II, are compensated by a related organization, CHMC Anesthesia Foundation, Inc., which relied on a compensation committee, Forms 990 of other organizations, compensation surveys/studies, and approval by the board or compensation committee to establish compensation of the CEO/Executive Director in fiscal year ending June 30, 2023.
Part I, Line 4b
CHMC Anesthesia Foundation, Inc. (the Foundation), a related organization established the CHMC Anesthesia Foundation, Inc. 2016 After-Tax Retirement Plan (the Plan) to reward long-term licensed physician employees by providing a fixed annual contribution by the Foundation, and allowing the Foundation to make additional discretionary contributions. All contributions to the Plan are made by the Foundation. Employee contributions are not permitted. The Foundation's annual contribution for each participant employed at the end of the plan year (June 30) is 6% of base salary. In addition to the regular annual contribution, the Foundation makes a one-time contribution on behalf of participants first employed by the Foundation after December 21, 2008 after completing seven years of service. The amount of the contribution is $20,000 for each of the seven years in which the participant was a full-time employee (at least 32 hours per week), and $20,000 prorated, based on the participant's full-time equivalent percentage (FTE), for each year in which the participant worked part-time. Any pre-2016 account contributions are fully vested for each participant. 50% of post-2016 earnings account amounts vest after ten years of service, 75% vest after fifteen years of service, and amounts are fully vested after twenty years of service. The following amounts have been included in Schedule J, Part II, Column B(iii) related to the After-Tax Plan: Dr. Hickey $17,310; Dr. Burns $43,992; Dr. Cravero $45,000; Dr. Dinardo $34,104; and Dr. Ferrari $32,731. During 2022, Dr. Paul Hickey had a distribution from his After-Tax Plan account in the amount of $567,301. This amount has been reported in Schedule J, Part II, Column B(iii). Furthermore, as this amount was reported on previous Form 990s as part of deferred compensation, it is being disclosed in Schedule J, Part II, Column F.

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
19 March 2024
IRS schema version
2022v5.0
Source object
202410829349300556

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