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← GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE TRUS

Form 990 for tax year 2023

Filed by GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE TRUS.

Totals

Total revenue
$484,655
Total expenses
$0
Contributions and grants received
$0
Grants paid
$0
Program services expenses (Part IX)
$0
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$0

Listed in Part VII

  • PATRICK O'SHAUGHNESSY

    PRESIDENT & CEO

    Total calculated
    $4,648,566
    From this org
    $0
    From related orgs
    $3,177,674
    Other
    $1,470,892
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $1,748,018 related
    Bonus
    $0 + $1,400,000 related
    Other
    $0 + $29,656 related
    Deferred
    $0 + $1,414,803 related
    Nontaxable benefits
    $0 + $56,089 related
    Filer's total
    $0 + $4,648,566 related

  • PATRICK MINICUS

    EVP & CFO

    Total calculated
    $1,928,665
    From this org
    $0
    From related orgs
    $1,220,160
    Other
    $708,505
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $921,345 related
    Bonus
    $0 + $270,000 related
    Other
    $0 + $28,815 related
    Deferred
    $0 + $655,803 related
    Nontaxable benefits
    $0 + $52,702 related
    Filer's total
    $0 + $1,928,665 related

  • RUTH HENNESSEY

    PRESIDENT

    Total calculated
    $1,387,512
    From this org
    $0
    From related orgs
    $1,094,062
    Other
    $293,450
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $695,448 related
    Bonus
    $0 + $150,000 related
    Other
    $0 + $248,614 related
    Deferred
    $0 + $273,450 related
    Nontaxable benefits
    $0 + $20,000 related
    Filer's total
    $0 + $1,387,512 related

  • SALVATORE SODANO

    CHAIRMAN

    Total calculated
    $0
    Hours/week
    2

  • BRIAN MCGUIRE

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    2

  • THOMAS CHRISTMAN

    SECRETARY

    Total calculated
    $0
    Hours/week
    2

  • ROBERT ZUCCARO

    TREASURER

    Total calculated
    $0
    Hours/week
    2

  • JERRY BALENTINE DO

    TRUSTEE AS OF 01/2023

    Total calculated
    $0
    Hours/week
    2

  • PETER DAGHER

    TRUSTEE AS OF 09/2023

    Total calculated
    $0
    Hours/week
    2

  • REV LEE DESCOTEAUX

    TRUSTEE AS OF 01/2023

    Total calculated
    $0
    Hours/week
    2

  • HON VITO DESTEFANO

    TRUSTEE AS OF 06/2023

    Total calculated
    $0
    Hours/week
    2

  • RE JASON GRISAFI

    TRUSTEE AS OF 01/2023

    Total calculated
    $0
    Hours/week
    2

  • JOSEPH MATTONE ESQ

    TRUSTEE AS OF 03/2023

    Total calculated
    $0
    Hours/week
    2

  • SUSAN O'HARA RN

    TRUSTEE AS OF 03/2023

    Total calculated
    $0
    Hours/week
    2

  • RONALD SHINDEL

    TRUSTEE AS OF 03/2023

    Total calculated
    $0
    Hours/week
    2

  • WILLIAM WARD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    2

  • PETER QUICK

    TRUSTEE

    Total calculated
    $0
    Hours/week
    2

  • DEBRA DEL VECCHIO

    TRUSTEE

    Total calculated
    $0
    Hours/week
    2

  • REGINA PISCAZZI

    TRUSTEE

    Total calculated
    $0
    Hours/week
    2

  • JOHN ROMANELLI MD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    2

  • ANDREW ZUCARO

    TRUSTEE

    Total calculated
    $0
    Hours/week
    2

  • REV JOHN MCCARTNEY

    TRUSTEE

    Total calculated
    $0
    Hours/week
    2

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 - METHODS TO ESTABLISH COMPENSATION BY RELATED ORGANIZATION
THE FOLLOWING METHODS ARE USED BY A RELATED ORGANIZATION TO ESTABLISH COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, FORM 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN
THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C. RUTH HENNESSY $252,000 PARTICIPATION IN THE PLAN PATRICK O'SHAUGHNESSY $1,392,000 PARTICIPATION IN THE PLAN PATRICK MINICUS $633,000 PARTICIPATION IN THE PLAN THE DEFERRED COMPENSATION IN COLUMN C FOR THESE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. THE FOLLOWING INDIVIDUALS VESTED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III). THESE AMOUNTS INCLUDE A TAX GROSS UP. RUTH HENNESSY $224,144 VESTED IN PLAN. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2023 FORM W-2, BOX 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT.
PART II - FORMER OFFICERS & DIRECTORS
EFFECTIVE 12/19/18, RUTH HENNESSEY WAS TRANSFERRED TO GOOD SAMARITAN HOSPITAL MEDICAL CENTER, A RELATED ENTITY, TO SERVE AS THE PRESIDENT/CAO.

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
2023
Filed
12 November 2024
IRS schema version
2023v5.1
Source object
202433209349317583

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