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Nonprofiteer
← CHAMBERSBURG HEALTH SERVICES

Form 990 for tax year 2022

Filed by CHAMBERSBURG HEALTH SERVICES.

Totals

Total revenue
$30,140,584
Total expenses
$34,063,649
Contributions and grants received
$108,443
Grants paid
$0
Program services expenses (Part IX)
$32,921,306
Management and general expenses
$1,142,343
Fundraising expenses
$0
Program service expenses (Part III)
$32,921,306

Program services were 96.6% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • ROXANNA GAPSTUR PHD RN

    PRESIDENT & CEO - WELLSPAN HEALTH

    Total calculated
    $2,391,449
    From this org
    $0
    From related orgs
    $2,303,962
    Other
    $87,487
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,523,876 related
    Bonus
    $0 + $780,000 related
    Other
    $0 + $86 related
    Deferred
    $0 + $13,477 related
    Nontaxable benefits
    $0 + $74,010 related
    Filer's total
    $0 + $2,391,449 related

  • JOHN MASSIMILLA

    VP - CHAMBERSBURG HOSPITAL

    Total calculated
    $486,638
    From this org
    $0
    From related orgs
    $410,293
    Other
    $76,345
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $331,357 related
    Bonus
    $0 + $72,226 related
    Other
    $0 + $6,710 related
    Deferred
    $0 + $27,582 related
    Nontaxable benefits
    $0 + $48,763 related
    Filer's total
    $0 + $486,638 related

  • LAURA BUCZKOWSKI

    EXECUTIVE VP & CFO - WELLSPAN HEALTH

    Total calculated
    $1,018,368
    From this org
    $0
    From related orgs
    $944,343
    Other
    $74,025
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $694,583 related
    Bonus
    $0 + $249,750 related
    Other
    $0 + $10 related
    Deferred
    $0 + $16,892 related
    Nontaxable benefits
    $0 + $57,133 related
    Filer's total
    $0 + $1,018,368 related

  • FARAAZ YOUSUF

    EXEC. VP & COO (UNTIL 11/22)

    Total calculated
    $1,032,704
    From this org
    $0
    From related orgs
    $987,746
    Other
    $44,958
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $563,091 related
    Bonus
    $0 + $401,869 related
    Other
    $0 + $22,786 related
    Deferred
    $0 + $3,087 related
    Nontaxable benefits
    $0 + $41,871 related
    Filer's total
    $0 + $1,032,704 related

  • KEITH NOLL

    CHAIR, SR VP & CHIEF ADMIN OFFICER

    Total calculated
    $786,774
    From this org
    $0
    From related orgs
    $716,629
    Other
    $70,145
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $516,511 related
    Bonus
    $0 + $189,892 related
    Other
    $0 + $10,226 related
    Deferred
    $0 + $35,192 related
    Nontaxable benefits
    $0 + $34,953 related
    Filer's total
    $0 + $786,774 related

  • ANDREW WALKER

    ASST. TREASURER, VP ACCT & FIN RPT

    Total calculated
    $333,705
    From this org
    $0
    From related orgs
    $302,426
    Other
    $31,279
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $269,240 related
    Bonus
    $0 + $33,176 related
    Other
    $0 + $10 related
    Deferred
    $0 + $5,892 related
    Nontaxable benefits
    $0 + $25,387 related
    Filer's total
    $0 + $333,705 related

  • VIPUL BHATIA

    DIRECTOR

    Total calculated
    $463,622
    From this org
    $0
    From related orgs
    $397,192
    Other
    $66,430
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $337,526 related
    Bonus
    $0 + $52,500 related
    Other
    $0 + $7,166 related
    Deferred
    $0 + $12,804 related
    Nontaxable benefits
    $0 + $53,626 related
    Filer's total
    $0 + $463,622 related

  • ERIN PICA

    DIRECTOR

    Total calculated
    $418,471
    From this org
    $0
    From related orgs
    $351,903
    Other
    $66,568
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $290,777 related
    Bonus
    $0 + $61,116 related
    Other
    $0 + $10 related
    Deferred
    $0 + $18,076 related
    Nontaxable benefits
    $0 + $48,492 related
    Filer's total
    $0 + $418,471 related

  • KEITH SMITH

    ASST. SECRETARY, VP & DEPUTY GENERAL COUNSEL

    Total calculated
    $56,586
    From this org
    $0
    From related orgs
    $41,993
    Other
    $14,593
    Hours/week
    1 + 40 related

  • KAREN PRETTY

    MANAGER - CANCER CENTER NURSING

    Total calculated
    $154,216
    From this org
    $106,268
    From related orgs
    $0
    Other
    $47,948
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $97,912
    Bonus
    $8,231
    Other
    $125
    Deferred
    $6,620
    Nontaxable benefits
    $41,328
    Filer's total
    $154,216

  • SHENDELLE CLAPPER

    DIRECTOR - CANCER CENTER

    Total calculated
    $156,550
    From this org
    $131,820
    From related orgs
    $0
    Other
    $24,730
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $122,010
    Bonus
    $7,338
    Other
    $2,472
    Deferred
    $11,879
    Nontaxable benefits
    $12,851
    Filer's total
    $156,550

  • MELISSA HELFRICK

    RADIATION THERAPIST

    Total calculated
    $139,498
    From this org
    $106,955
    From related orgs
    $0
    Other
    $32,543
    Hours/week
    40

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

  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 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 4B
THE WELLSPAN HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS ADOPTED AND MADE EFFECTIVE ON DECEMBER 19TH, 2008. THE OBJECTIVE OF THE EXECUTIVE BENEFITS PROGRAM IS TO PROVIDE AN EXECUTIVE BENEFITS PROGRAM THAT IS COMPETITIVE WITH NATIONAL NORMS IN THE HEALTHCARE INDUSTRY FOR SIMILARLY SIZED ORGANIZATIONS ENABLING WELLSPAN HEALTH TO RECRUIT AND RETAIN TOP EXECUTIVE TALENT. TIER I EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. A DESCRIPTION OF THE TARGETED BENEFIT OF THE PLAN IS AS FOLLOWS: 1) PROVIDE AN EMPLOYER SPONSORED RETIREMENT BENEFIT THAT REPLACES 60% OF AVERAGE PRE-RETIREMENT (5 YEARS) BASE COMPENSATION THROUGH A COMBINED APPROACH UTILIZING WELLSPAN'S RETIREMENT PLAN, 50% OF SOCIAL SECURITY, SPLIT-DOLLAR LIFE INSURANCE BENEFIT, AND SUPPLEMENTAL EXECUTIVE RETIREMENT BENEFIT. 2) PROVIDES A MINIMUM BENEFIT AFTER 10 YEARS OF SERVICE. 3) PROVIDES THE FULL TARGETED BENEFIT AFTER 25 YEARS OF SERVICE. 4) BENEFIT IS VESTED WHEN ELIGIBLE EXECUTIVE REACHES AGE 65. THE BENEFIT IS ALSO VESTED UPON DEATH, DISABILITY, JOB ELIMINATION AND "TERMINATION FOR GOOD REASON". 5) CREDITED SERVICE GRANTED ON A 1:2 BASIS FOR PREVIOUS SERVICE IN AN ELIGIBLE TIER II POSITION. 6) TARGETED BENEFIT IS TO BE CALCULATED USING A 15 YEAR CERTAIN PAYOUT. 7) PAYOUT WILL BE IN A LUMP SUM. 8) PAYOUT WILL BE TAXABLE WHEN VESTED. DURING THE CALENDAR YEAR 2022, THERE WERE NO DISTRIBUTIONS FROM THE SERP. THE WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN WAS ADOPTED AND MADE EFFECTIVE AS OF JULY 1, 2017. THIS PLAN WILL REPLACE THE SERP. AS PART OF THE TRANSITION, EACH PARTICIPANT IN THE SERP WAS GIVEN A ONE-TIME CHOICE TO BE GRANDFATHERED IN THE SERP OR TRANSFER TO THE NEW WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN. THE OBJECTIVE OF THE WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN IS TO ATTRACT AND RETAIN EXECUTIVE AND UPPER-LEVEL MANAGEMENT EMPLOYEES OF OUTSTANDING ABILITY. TIERS I, II, III AND A SELECT GROUP OF TIER IV EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. A DESCRIPTION OF THE TARGETED BENEFIT OF THE PLAN IS AS FOLLOWS: 1)PROVIDE AN UNFUNDED DEFERRED COMPENSATION BENEFIT TO A SELECT GROUP OF MANAGEMENT AND HIGHLY COMPENSATED EMPLOYEES. 2)PLAN ACCOUNT CONTRIBUTIONS ARE CREDITED EACH YEAR TO A SUBACCOUNT, BASED UPON VARIOUS TIER LEVELS; TIER I, 22%, TIER II, 17%, TIER III, 12%, AND TIER IV, 8%. 3)PARTICIPANT ACCOUNTS ARE CREDITED INTEREST EACH YEAR BY APPLICATION OF THE 30-YEAR U.S. TREASURY RATE ON JUNE 30 OF THE PLAN YEAR THEN ENDING, PLUS ONE PERCENT (1%). 4)PARTICIPANT VESTING OCCURS ON THE EARLIER OF: A)JUNE 30TH OF THE FOURTH PLAN YEAR: 25% PER YEAR B)PARTICIPANT REACHES AGE 65. C)UPON DEATH, DISABILITY, JOB ELIMINATION AND "TERMINATION FOR GOOD REASON". 5)NON-ELECTIVE EMPLOYER CONTRIBUTIONS ARE ALSO PERMITTED. 6)PLAN DISTRIBUTIONS TO BE ADMINISTERED PER THE PLAN DOCUMENT. ADDITIONALLY, ANY VESTED PORTION OF CONTRIBUTIONS MADE TO THE PLAN WHICH ARE NO LONGER SUBJECT TO THE RISK OF FORFEITURE, ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B(III). DURING THE CALENDAR YEAR 2022, THERE WERE NO DISTRIBUTIONS FROM THE WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN.

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
9 May 2024
IRS schema version
2022v5.0
Source object
202411309349300646

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

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