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Nonprofiteer
← SIBLEY MEDICAL CENTER

Form 990 for tax year 2022

Filed by SIBLEY MEDICAL CENTER.

Totals

Total revenue
$20,547,566
Total expenses
$15,460,876
Contributions and grants received
$661,276
Grants paid
$2,970
Program services expenses (Part IX)
$11,436,009
Management and general expenses
$4,024,867
Fundraising expenses
$0
Program service expenses (Part III)
$11,436,009

Program services were 74.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • MICHAEL PHELPS

    PRESIDENT/CEO

    Total calculated
    $1,338,223
    From this org
    $0
    From related orgs
    $1,274,183
    Other
    $64,040
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,270,809 related
    Bonus
    $0
    Other
    $0 + $3,374 related
    Deferred
    $0 + $26,074 related
    Nontaxable benefits
    $0 + $37,966 related
    Filer's total
    $0 + $1,338,223 related

  • GORDON GABLENZ

    CIO

    Total calculated
    $883,584
    From this org
    $0
    From related orgs
    $794,145
    Other
    $89,439
    Hours/week
    4 + 46 related

    Schedule J breakdown matched by us

    Base
    $0 + $789,842 related
    Bonus
    $0
    Other
    $0 + $4,303 related
    Deferred
    $0 + $28,440 related
    Nontaxable benefits
    $0 + $60,999 related
    Filer's total
    $0 + $883,584 related

  • AARON BLOOMQUIST

    CFO

    Total calculated
    $552,467
    From this org
    $0
    From related orgs
    $490,798
    Other
    $61,669
    Hours/week
    4 + 46 related

    Schedule J breakdown matched by us

    Base
    $0 + $488,856 related
    Bonus
    $0
    Other
    $0 + $1,942 related
    Deferred
    $0 + $14,169 related
    Nontaxable benefits
    $0 + $47,500 related
    Filer's total
    $0 + $552,467 related

  • BENJAMIN NIELSEN

    COO

    Total calculated
    $381,798
    From this org
    $0
    From related orgs
    $363,774
    Other
    $18,024
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $338,638 related
    Bonus
    $0
    Other
    $0 + $25,136 related
    Deferred
    $0 + $17,240 related
    Nontaxable benefits
    $0 + $784 related
    Filer's total
    $0 + $381,798 related

  • JEFF NELSON

    BOARD MEMBER

    Total calculated
    $7,400
    From this org
    $1,200
    From related orgs
    $6,200
    Other
    $0
    Hours/week
    0.4 + 2.4 related

  • LISA PFARR

    CHAIR

    Total calculated
    $1,800
    From this org
    $1,800
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.4

  • DEE THOMAS

    TREASURER

    Total calculated
    $1,200
    From this org
    $1,200
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.4

  • DIANE BIAS-MOSEL

    SECRETARY

    Total calculated
    $1,200
    From this org
    $1,200
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.4

  • TIMOTHY DOLAN

    BOARD MEMBER

    Total calculated
    $1,200
    From this org
    $1,200
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.4

  • JAMES KREFT

    BOARD MEMBER

    Total calculated
    $1,200
    From this org
    $1,200
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.4

  • NANCY MATHWIG

    BOARD MEMBER

    Total calculated
    $1,200
    From this org
    $1,200
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.4

  • LYLE RUD

    BOARD MEMBER

    Total calculated
    $1,200
    From this org
    $1,200
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.4

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
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings

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
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
THE PRESIDENT/CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICAL CENTER TO DETERMINE THE PRESIDENT/CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYMENT CONTRACT 5) COMPENSATION SURVEY OR STUDY 6) APROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE)
PART I, LINE 4B
MICHAEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $397,642 WAS CONTRIBUTED TO THE PLAN, $68,254 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $395,053 WAS CONTRIBUTED TO THE PLAN, $50,590 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. AARON BLOOMQUIST PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $125,556 WAS CONTRIBUTED TO THE PLAN, $0 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED.
PART I, LINE 6
THE OFFICERS OF RIDGEVIEW MEDICAL CENTER AND AFFILIATES RECEIVE BONUSES CONTINGENT ON THE NET EARNINGS OF THE CONSOLIDATED ENTITY AND GOALS ACHIEVED. BONUSES WERE EARNED IN 2022 AND PAID IN 2023.

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
13 November 2023
IRS schema version
2022v5.0
Source object
202323179349305977

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