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.
-
CHMC Anesthesia Foundation Inc
501(c)(3) · To promote anesthesiology services and research · MA
-
CHMC Anesthesia Foundation Inc Charitable Trust
501(c)(3) · To promote anesthesiology services and research · MA
Directly controlled by CHMC Anesthesia Foundation Inc
Provenance
- Return type
- form_990
- Tax year
- 2022
- Filed
- 19 March 2024
- IRS schema version
- 2022v5.0
- Source object
- 202410829349300556
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