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Nonprofiteer
← GOOD SAMARITAN HOSPITAL FOUNDATION KEARNEY NEBRASKA

Form 990 for tax year 2022

Filed by GOOD SAMARITAN HOSPITAL FOUNDATION KEARNEY NEBRASKA.

Totals

Total revenue
$1,452,103
Total expenses
$4,045,544
Contributions and grants received
$491,441
Grants paid
$3,780,653
Program services expenses (Part IX)
$3,950,717
Management and general expenses
$93,109
Fundraising expenses
$1,718
Program service expenses (Part III)
$3,950,717

Program services were 97.7% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • EVERT KUIPER

    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

    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

  • EDWARD HANNON

    INTERIM PRESIDENT GSH (TERMED 7/31/22_)

    Total calculated
    $570,582
    From this org
    $0
    From related orgs
    $504,228
    Other
    $66,354
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $405,705 related
    Bonus
    $0 + $92,979 related
    Other
    $0 + $5,544 related
    Deferred
    $0 + $39,265 related
    Nontaxable benefits
    $0 + $27,089 related
    Filer's total
    $0 + $570,582 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

  • LISA THAVENET-WEBB

    TREASURER/VP FINANCE

    Total calculated
    $325,231
    From this org
    $0
    From related orgs
    $270,106
    Other
    $55,125
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $237,708 related
    Bonus
    $0 + $29,869 related
    Other
    $0 + $2,529 related
    Deferred
    $0 + $16,471 related
    Nontaxable benefits
    $0 + $38,654 related
    Filer's total
    $0 + $325,231 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

  • CURT COLEMAN

    PRESIDENT GSH

    Total calculated
    $223,090
    From this org
    $0
    From related orgs
    $215,866
    Other
    $7,224
    Hours/week
    5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $142,667 related
    Bonus
    $0 + $20,000 related
    Other
    $0 + $53,199 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $7,224 related
    Filer's total
    $0 + $223,090 related

  • CINDI RICHTER

    EXECUTIVE DIRECTOR

    Total calculated
    $122,404
    From this org
    $0
    From related orgs
    $87,732
    Other
    $34,672
    Hours/week
    45

  • DICK BEECHNER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • ELLEN GITT

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • STEPHEN LOWE

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • TIM MANNLEIN

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • CAROLYN MENKE

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • PJ O'NEILL

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    1

  • ROBERT RYCEK

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • MELISSA SCOTT-PANDORF

    SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • LOIS THALKEN

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • JON WATTS

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • RITA WEBER

    CHAIR

    Total calculated
    $0
    Hours/week
    1

  • MARSHA WILKERSON

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • ANGELA NICKEL

    BOARD MEMBER

    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 — 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 GOOD SAMARITAN HOSPITAL FOUNDATION, THE VP OF PHILANTHROPY AND THE EXECUTIVE DIRECTOR, 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 1, LINE 4A:
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.
PART 1, LINE 4B:
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 PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: JEANETTE WOJTALEWICZ, $50,733.
PART II:
GOOD SAMARITAN HOSPITAL 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.

Provenance

Return type
form_990
Tax year
2022
Filed
10 May 2024
IRS schema version
2022v5.0
Source object
202441319349303209

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

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