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Nonprofiteer
← ST DOMINIC HEALTH SERVICES FOUNDATION INC

Form 990 for tax year 2023

Filed by ST DOMINIC HEALTH SERVICES FOUNDATION INC.

Totals

Total revenue
$1,877,890
Total expenses
$2,314,231
Contributions and grants received
$1,540,243
Grants paid
$2,003,784
Program service revenue
$0
Investment income
$337,647
Other revenue
$0
Total assets, end of year
$24,967,349
Total liabilities, end of year
$1,347,594
Net assets or fund balances, end of year
$23,619,755
Program services expenses (Part IX)
$2,003,784
Management and general expenses
$116,298
Fundraising expenses
$194,149
Program service expenses (Part III)
$2,003,784

Program services were 86.6% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • AMY BOTELER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • BARTON LAMPTON

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • BRIAN JOHNSON

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • C RALPH DANIEL III MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • CHARLES POSTON

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • CHERYL SHERRY RULA

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • D PAUL SEAGO MD

    BOARD MEMBER/PHYSICIAN

    Total calculated
    $1,144,875
    From this org
    $0
    From related orgs
    $1,108,105
    Other
    $36,770
    Hours/week
    0.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $891,805 related
    Bonus
    $0 + $178,870 related
    Other
    $0 + $37,430 related
    Deferred
    $0 + $16,500 related
    Nontaxable benefits
    $0 + $20,270 related
    Filer's total
    $0 + $1,144,875 related

  • DICKENS Q FOURNET

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    0.5

  • DOUG RALSTON

    CHAIR

    Total calculated
    $0
    Hours/week
    0.5

  • JAMES HOUSE III MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • JEREMY TINNERELLO

    MARKET PRESIDENT (START 11/2023)

    Total calculated
    $117,519
    From this org
    $0
    From related orgs
    $117,252
    Other
    $267
    Hours/week
    0.5 + 41 related

  • JULIE HERLIHY

    IMMEDIATE PAST CHAIR

    Total calculated
    $0
    Hours/week
    0.5

  • KENNY WILLIAMSON

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • LARRY RATZLAFF

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • MATT JAMES

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • RITA MARTINSON

    SECRETARY

    Total calculated
    $0
    Hours/week
    0.5

  • SAMANTHA MOORE

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • SCOTT KASHMAN

    MARKET PRESIDENT (UNTIL 7/2023)

    Total calculated
    $311,303
    From this org
    $0
    From related orgs
    $295,199
    Other
    $16,104
    Hours/week
    0.5 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $293,628 related
    Bonus
    $0
    Other
    $0 + $1,571 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $16,104 related
    Filer's total
    $0 + $311,303 related

  • SHIRLEY TUCKER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • SISTER DOROTHEA SONDGEROTH

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5 + 40.75 related

  • TRISH DUNCAN

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • TRUDY LIPSCOMB

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • W HIBBETT NEEL

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • KRISTEN WOLKART

    INTERIM MKT PRESIDENT:7/2023-11/2023

    Total calculated
    $858,019
    From this org
    $0
    From related orgs
    $740,802
    Other
    $117,217
    Hours/week
    0.5 + 42.75 related

    Schedule J breakdown matched by us

    Base
    $0 + $493,260 related
    Bonus
    $0 + $244,790 related
    Other
    $0 + $2,752 related
    Deferred
    $0 + $96,776 related
    Nontaxable benefits
    $0 + $20,441 related
    Filer's total
    $0 + $858,019 related

  • KAY MCREE

    EXECUTIVE DIRECTOR

    Total calculated
    $240,742
    From this org
    $0
    From related orgs
    $216,752
    Other
    $23,990
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $201,355 related
    Bonus
    $0 + $15,397 related
    Other
    $0
    Deferred
    $0 + $11,162 related
    Nontaxable benefits
    $0 + $12,828 related
    Filer's total
    $0 + $240,742 related

  • SAM SCOTT

    SVP, CFO

    Total calculated
    $468,365
    From this org
    $0
    From related orgs
    $434,391
    Other
    $33,974
    Hours/week
    0.5 + 41.75 related

    Schedule J breakdown matched by us

    Base
    $0 + $334,566 related
    Bonus
    $0 + $94,413 related
    Other
    $0 + $5,412 related
    Deferred
    $0 + $15,315 related
    Nontaxable benefits
    $0 + $18,659 related
    Filer's total
    $0 + $468,365 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
  • 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:
THE FMOL HEALTH SYSTEM INC. BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE.
PART I, LINE 4A:
TWO OFFICERS AND ONE BOARD MEMBER ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 12 OR 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR.
PART I, LINE 4B:
FMOLHS MAINTAINS TWO UNFUNDED DEFERRED COMPENSATION PLANS WHICH MEET THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLANS PROVIDES FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLANS IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. NO ONE LISTED IN PART VII, SECTION A RECEIVED A PAYMENT IN THE CURRENT YEAR.

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.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

Provenance

Return type
form_990
Tax year
2023
Filed
15 May 2025
IRS schema version
2023v6.0
Source object
202531359349305983

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