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Nonprofiteer
← HSHS HOLY FAMILY HOSPITAL INC

Form 990 for tax year 2022

Filed by HSHS HOLY FAMILY HOSPITAL INC.

Totals

Total revenue
$25,072,673
Total expenses
$28,009,557
Contributions and grants received
$355,043
Grants paid
$0
Program services expenses (Part IX)
$25,496,507
Management and general expenses
$2,513,050
Fundraising expenses
$0
Program service expenses (Part III)
$25,496,507

Program services were 91.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • BART CALDIERARO

    CHAIR

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Crystal Grove

    Vice Chair

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • KELLY M SAGER

    President & CEO

    Total calculated
    $439,605
    From this org
    $378,418
    From related orgs
    $0
    Other
    $61,187
    Hours/week
    59 + 1 related

    Schedule J breakdown matched by us

    Base
    $255,474
    Bonus
    $63,032
    Other
    $59,912
    Deferred
    $32,607
    Nontaxable benefits
    $28,580
    Filer's total
    $439,605

  • Suzanne Davis

    Secretary

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • EUGENE DUNKLEY

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • JAMIE BAUM MD

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • RANDY ALDERMAN

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • TRAVIS THACKER

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • WILLIAM WALKER

    Board Member

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • PATRICIA ALLEN

    Interim CFO - Illinois

    Total calculated
    $695,496
    From this org
    $0
    From related orgs
    $541,100
    Other
    $154,396
    Hours/week
    3 + 57 related

    Schedule J breakdown matched by us

    Base
    $0 + $414,598 related
    Bonus
    $0 + $44,684 related
    Other
    $0 + $81,818 related
    Deferred
    $0 + $126,563 related
    Nontaxable benefits
    $0 + $27,833 related
    Filer's total
    $0 + $695,496 related

  • TODD Smart

    Treasurer

    Total calculated
    $410,831
    From this org
    $0
    From related orgs
    $329,569
    Other
    $81,262
    Hours/week
    0.3 + 59.8 related

    Schedule J breakdown matched by us

    Base
    $0 + $267,686 related
    Bonus
    $0 + $38,335 related
    Other
    $0 + $23,548 related
    Deferred
    $0 + $45,254 related
    Nontaxable benefits
    $0 + $36,008 related
    Filer's total
    $0 + $410,831 related

  • CYNTHIA CROUCH

    Facilitator - Clinical RN

    Total calculated
    $149,748
    From this org
    $116,562
    From related orgs
    $0
    Other
    $33,186
    Hours/week
    40

  • ERICA BONE

    Registered Nurse - Critical Care

    Total calculated
    $174,941
    From this org
    $124,833
    From related orgs
    $0
    Other
    $50,108
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $123,093
    Bonus
    $0
    Other
    $1,740
    Deferred
    $18,752
    Nontaxable benefits
    $31,356
    Filer's total
    $174,941

  • KATLYN OBERMARK

    Pharmacist

    Total calculated
    $173,373
    From this org
    $136,598
    From related orgs
    $0
    Other
    $36,775
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $132,581
    Bonus
    $0
    Other
    $4,017
    Deferred
    $0
    Nontaxable benefits
    $36,775
    Filer's total
    $173,373

  • KAYLA TOMPKINS

    Pharmacist

    Total calculated
    $163,008
    From this org
    $109,868
    From related orgs
    $0
    Other
    $53,140
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $104,378
    Bonus
    $5,000
    Other
    $490
    Deferred
    $18,746
    Nontaxable benefits
    $34,394
    Filer's total
    $163,008

  • KELLI CLUTTS

    Director - Nursing

    Total calculated
    $138,518
    From this org
    $133,216
    From related orgs
    $0
    Other
    $5,302
    Hours/week
    40

  • EVERT J KUIPER

    Former Division CEO - Illinois (until Jan 2022)

    Total calculated
    $532,473
    From this org
    $0
    From related orgs
    $526,246
    Other
    $6,227
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $51,437 related
    Bonus
    $0
    Other
    $0 + $474,809 related
    Deferred
    $0 + $3,413 related
    Nontaxable benefits
    $0 + $2,814 related
    Filer's total
    $0 + $532,473 related

  • MARK ENNEN

    Former DIRECTOR OF FINANCE

    Total calculated
    $213,836
    From this org
    $0
    From related orgs
    $169,539
    Other
    $44,297
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $141,967 related
    Bonus
    $0
    Other
    $0 + $27,572 related
    Deferred
    $0 + $31,472 related
    Nontaxable benefits
    $0 + $12,825 related
    Filer's total
    $0 + $213,836 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 — 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 · Form 990 of other organizations
  • 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)

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Patricia Allen -- $37,240 Kelly Sager -- $32,607 Todd Smart -- $25,135 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Evert Kuiper -- $19,540

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
10 May 2024
IRS schema version
2022v5.0
Source object
202401319349304745

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