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← USC CAPTIVE INSURANCE COMPANY

Form 990 for tax year 2023

Filed by USC CAPTIVE INSURANCE COMPANY.

Totals

Total revenue
$16,566
Total expenses
$16,566
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$16,566
Investment income
$0
Other revenue
$0
Total assets, end of year
$251,035
Total liabilities, end of year
$1,035
Net assets or fund balances, end of year
$250,000
Program services expenses (Part IX)
$16,566
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$16,566

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: PROGRAM FEE REVENUE

    total $16,566 · related or exempt $16,566

  • 3 · Investment income

    total $0

  • 4 · Income from investment of tax-exempt bond proceeds

    total $0

  • 5 · Royalties

    total $0

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 6d · Net rental income or loss

    total $0

  • 7d · Net gain or loss

    total $0

  • 8a · Fundraising events: gross income

    $0

  • 8b · Fundraising events: direct expenses

    $0

  • 8c · Net income from fundraising events

    total $0

  • 9a · Gaming: gross income

    $0

  • 9b · Gaming: direct expenses

    $0

  • 9c · Net income from gaming

    total $0

  • 10a · Gross sales of inventory

    $0

  • 10b · Cost of goods sold

    $0

  • 10c · Net income from sales of inventory

    total $0

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $0

  • 2 · Grants to domestic individuals

    total $0

  • 3 · Grants to foreign organizations and individuals

    total $0

  • 4 · Benefits paid to or for members

    total $0

  • 5 · Compensation of officers, directors and key employees

    total $0

  • 6 · Compensation of disqualified persons

    total $0

  • 7 · Other salaries and wages

    total $0

  • 8 · Pension plan contributions

    total $0

  • 9 · Other employee benefits

    total $0

  • 10 · Payroll taxes

    total $0

  • 11a · Fees: management

    total $15,000 · program services $15,000

  • 11b · Fees: legal

    total $0

  • 11c · Fees: accounting

    total $0

  • 11d · Fees: lobbying

    total $0

  • 11e · Fees: professional fundraising services

    total $0

  • 11f · Fees: investment management

    total $0

  • 11g · Fees: other

    total $0

  • 12 · Advertising and promotion

    total $0

  • 13 · Office expenses

    total $0

  • 14 · Information technology

    total $0

  • 15 · Royalties

    total $0

  • 16 · Occupancy

    total $0

  • 17 · Travel

    total $0

  • 18 · Travel or entertainment for public officials

    total $0

  • 19 · Conferences, conventions and meetings

    total $0

  • 20 · Interest

    total $0

  • 21 · Payments to affiliates

    total $0

  • 22 · Depreciation, depletion and amortization

    total $0

  • 23 · Insurance

    total $0

  • 24a · Other expenses: MEMBERSHIP FEES

    total $1,035 · program services $1,035

  • 24b · Other expenses: LICENSE FEES

    total $500 · program services $500

  • 24c · Other expenses: BANK FEES

    total $31 · program services $31

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $0 · end of year $0

  • 2 · Savings and temporary cash investments

    beginning of year $93,529 · end of year $205,264

  • 3 · Pledges and grants receivable

    beginning of year $0 · end of year $0

  • 4 · Accounts receivable

    beginning of year $0 · end of year $0

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 7 · Other notes and loans receivable

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $0 · end of year $0

  • 9 · Prepaid expenses and deferred charges

    beginning of year $0 · end of year $0

  • 10c · Land, buildings and equipment, net

    beginning of year $0 · end of year $0

  • 11 · Investments: publicly traded securities

    beginning of year $0 · end of year $0

  • 12 · Investments: other securities

    beginning of year $0 · end of year $0

  • 13 · Investments: program-related

    beginning of year $0 · end of year $0

  • 14 · Intangible assets

    beginning of year $0 · end of year $0

  • 15 · Other assets

    beginning of year $156,471 · end of year $45,771

  • 17 · Accounts payable and accrued expenses

    beginning of year $0 · end of year $1,035

  • 18 · Grants payable

    beginning of year $0 · end of year $0

  • 19 · Deferred revenue

    beginning of year $0 · end of year $0

  • 20 · Tax-exempt bond liabilities

    beginning of year $0 · end of year $0

  • 21 · Escrow or custodial account liability

    beginning of year $0 · end of year $0

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $0 · end of year $0

  • 24 · Unsecured notes and loans payable

    beginning of year $0 · end of year $0

  • 25 · Other liabilities

    beginning of year $0 · end of year $0

  • 29 · Capital stock, trust principal or current funds

    beginning of year $0 · end of year $0

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $0 · end of year $0

  • 31 · Retained earnings, endowment or other funds

    beginning of year $250,000 · end of year $250,000

Mission and programs · 2023

Mission

SEE SCHEDULE O

  • See Schedule O

    Expenses $16,566 · Revenue $16,566

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • STEVEN D SHAPIRO MD

    DIRECTOR

    Total calculated
    $3,317,744
    From this org
    $0
    From related orgs
    $3,022,882
    Other
    $294,862
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,615,877 related
    Bonus
    $0 + $1,000,000 related
    Other
    $0 + $407,005 related
    Deferred
    $0 + $233,000 related
    Nontaxable benefits
    $0 + $61,862 related
    Filer's total
    $0 + $3,317,744 related

  • ROD HANNERS

    DIRECTOR (AS OF 6/28/24)

    Total calculated
    $2,347,640
    From this org
    $0
    From related orgs
    $2,288,159
    Other
    $59,481
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,287,277 related
    Bonus
    $0 + $771,374 related
    Other
    $0 + $229,508 related
    Deferred
    $0 + $33,000 related
    Nontaxable benefits
    $0 + $26,481 related
    Filer's total
    $0 + $2,347,640 related

  • DAVID PENG MD MPH

    DIRECTOR (UNTIL 6/28/24)

    Total calculated
    $1,568,130
    From this org
    $0
    From related orgs
    $1,482,989
    Other
    $85,141
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,037,304 related
    Bonus
    $0 + $310,000 related
    Other
    $0 + $135,685 related
    Deferred
    $0 + $33,000 related
    Nontaxable benefits
    $0 + $52,141 related
    Filer's total
    $0 + $1,568,130 related

  • BEONG-SOO KIM

    DIRECTOR

    Total calculated
    $1,510,140
    From this org
    $0
    From related orgs
    $1,270,799
    Other
    $239,341
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $821,257 related
    Bonus
    $0 + $300,000 related
    Other
    $0 + $149,542 related
    Deferred
    $0 + $233,000 related
    Nontaxable benefits
    $0 + $6,341 related
    Filer's total
    $0 + $1,510,140 related

  • ERIK BRINK

    TREASURER(UNTIL 4/22/24)/DIR.

    Total calculated
    $1,448,929
    From this org
    $0
    From related orgs
    $1,302,529
    Other
    $146,400
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,029,324 related
    Bonus
    $0 + $150,000 related
    Other
    $0 + $123,205 related
    Deferred
    $0 + $69,458 related
    Nontaxable benefits
    $0 + $76,942 related
    Filer's total
    $0 + $1,448,929 related

  • CAROLYN DOMEN-BROSHEARS

    SECRETARY

    Total calculated
    $534,484
    From this org
    $0
    From related orgs
    $460,242
    Other
    $74,242
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $375,071 related
    Bonus
    $0 + $50,000 related
    Other
    $0 + $35,171 related
    Deferred
    $0 + $33,000 related
    Nontaxable benefits
    $0 + $41,242 related
    Filer's total
    $0 + $534,484 related

  • JASON BENNETT

    DIRECTOR/PRESIDENT

    Total calculated
    $494,500
    From this org
    $0
    From related orgs
    $430,949
    Other
    $63,551
    Hours/week
    10 + 30 related

    Schedule J breakdown matched by us

    Base
    $0 + $384,609 related
    Bonus
    $0 + $36,000 related
    Other
    $0 + $10,340 related
    Deferred
    $0 + $33,000 related
    Nontaxable benefits
    $0 + $30,551 related
    Filer's total
    $0 + $494,500 related

  • CASANDRA PORTER

    DIRECTOR (AS OF 6/28/24)

    Total calculated
    $477,547
    From this org
    $0
    From related orgs
    $332,243
    Other
    $145,304
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $296,071 related
    Bonus
    $0 + $34,124 related
    Other
    $0 + $2,048 related
    Deferred
    $0 + $33,000 related
    Nontaxable benefits
    $0 + $112,304 related
    Filer's total
    $0 + $477,547 related

  • CAROLINE WILHELM

    TREASURER (AS OF 4/22/24)

    Total calculated
    $436,709
    From this org
    $0
    From related orgs
    $374,582
    Other
    $62,127
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $339,287 related
    Bonus
    $0 + $30,000 related
    Other
    $0 + $5,295 related
    Deferred
    $0 + $33,000 related
    Nontaxable benefits
    $0 + $29,127 related
    Filer's total
    $0 + $436,709 related

  • WAJEEHA SHAKEEL

    FIN/DATA ANALYTICS MANAGER

    Total calculated
    $179,764
    From this org
    $0
    From related orgs
    $137,031
    Other
    $42,733
    Hours/week
    2 + 38 related

    Schedule J breakdown matched by us

    Base
    $0 + $121,147 related
    Bonus
    $0 + $3,500 related
    Other
    $0 + $12,384 related
    Deferred
    $0 + $14,514 related
    Nontaxable benefits
    $0 + $28,219 related
    Filer's total
    $0 + $179,764 related

  • DIANE HANSON

    DIRECTOR

    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, 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)

SCHEDULE J, PART I, LINE 3
THE ORGANIZATION RELIES ON THE UNIVERSITY OF SOUTHERN CALIFORNIA (USC), A RELATED ORGANIZATION, TO ESTABLISH THE COMPENSATION OF THE PRESIDENT.
SCHEDULE J, PART I, LINE 4B
ERIK BRINK: UNDER HIS EMPLOYMENT AGREEMENT EFFECTIVE SEPTEMBER 13, 2023, THE CFO WAS ENTITLED TO A SIGNING BONUS OF $250,000 (ACCRUING AT $125,000 PER YEAR) SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE, WHICH IS SCHEDULED TO VEST AND BE PAYABLE IN 2025. FOR CALENDAR YEAR 2023 A RATABLE ACCRUAL OF $36,458 HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN (C). BEONG-SOO KIM: DURING CALENDAR YEAR 2023, SENIOR VICE PRESIDENT & GENERAL COUNSEL AT THE UNIVERSITY OF SOUTHERN CALIFORNIA, PARTICIPATED IN A RETENTION PROGRAM. A PAYMENT OF $1,000,000 (ACCRUING AT $200,000 PER YEAR) IS SCHEDULED TO VEST AND BE PAYABLE IN 2026 SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. AN ACCRUAL OF $200,000 HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN (C). STEVEN D. SHAPIRO, MD: UNDER HIS EMPLOYMENT AGREEMENT, THE SENIOR VICE PRESIDENT OF HEALTH AFFAIRS WAS ELIGIBLE FOR A DEFERRED BONUS. DURING CALENDAR YEAR 2023 HE WAS ELIGIBLE TO RECEIVE A PAYMENT IN THE GREATER AMOUNT OF $750,000 OR BASED ON PERFORMANCE METRICS. A PAYMENT OF $1,000,000 WAS PAID OUT IN CALENDAR YEAR 2023 AND HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B(II). HE ALSO PARTICIPATED IN A RETENTION BONUS PLAN IN WHICH A PAYMENT OF $1,000,000 (ACCRUING AT $200,000 PER YEAR) IS SCHEDULED TO VEST AND BE PAYABLE IN 2026 SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. AN ACCRUAL OF $200,000 HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN (C). ROD HANNERS: DURING CALENDAR YEAR 2023, CEO OF KECK MEDICINE OF USC AT THE UNIVERSITY OF SOUTHERN CALIFORNIA, PARTICIPATED IN A RETENTION PROGRAM. THE RETENTION AWARD WAS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. A PAYMENT OF $250,000 VESTED ON DECEMBER 31, 2022 AND WAS PAID IN JANUARY 2023. THE PAYMENT AMOUNT HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(II). OTHER: IN 1994 USC CREATED A 457(F) SUPPLEMENTAL RETIREMENT PLAN TO PROVIDE MAKE-UP BENEFITS TO EMPLOYEES WHOSE COMPENSATION EXCEEDED THE EARNINGS LIMITATION FOR CONTRIBUTIONS TO THE USC DEFINED CONTRIBUTION RETIREMENT PLAN. AS OF JANUARY 1, 2005, THE PLAN WAS FROZEN AND PARTICIPANTS, WITH RESPECT TO FUTURE MAKE-UP BENEFITS, WERE NO LONGER PERMITTED TO DEFER THESE BENEFITS.
SCHEDULE J, PART II
NONE OF THE OFFICERS AND DIRECTORS OF THIS ORGANIZATION RECEIVED ANY COMPENSATION FROM THE FILING ORGANIZATION DURING 2023. DURING 2023, THE INDIVIDUALS REPORTED ON SCHEDULE J, PART II WERE EMPLOYEES OF THE ORGANIZATION'S SUPPORTED ORGANIZATION, THE UNIVERSITY OF SOUTHERN CALIFORNIA ("USC").

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.

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.

  • MAY ROBERTS DEWRIGHT TRUST

    T · USC SUPPORT · CA · controlled entity

    Directly controlled by NA

  • INTEGRATED DIGITAL ASSET CORPORATION

    C · 3RD PARTY CON · CA · controlled entity

    Directly controlled by NA

  • CHARITABLE REMAINDER TRUSTS (346)

    T · FUNDRAISING · CA · controlled entity

    Directly controlled by NA

  • POOLED INCOME FUND (1)

    T · FUNDRAISING · CA · controlled entity

    Directly controlled by NA

  • CHARITABLE REMAINDER TRUST (1)

    T · INVESTMENT · CA · controlled entity

    Directly controlled by USCAHF

Provenance

Return type
form_990
Tax year
2023
Filed
14 May 2025
IRS schema version
2023v6.0
Source object
202511359349305006

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