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Nonprofiteer
← SELF INSURANCE FUND - NOVANT HEALTH INC

Form 990 for tax year 2023

Filed by SELF INSURANCE FUND - NOVANT HEALTH INC.

Totals

Total revenue
-$29,428
Total expenses
$18,100
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$0
Investment income
-$29,428
Other revenue
$0
Total assets, end of year
$14,884,287
Total liabilities, end of year
$6,420,448
Net assets or fund balances, end of year
$8,463,839
Program services expenses (Part IX)
$18,100
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$18,100

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.

  • 3 · Investment income

    total $153,802 · excluded $153,802

  • 7a · Gross sales of assets other than inventory

    securities $15,920,134

  • 7b · Less cost or other basis and sales expenses

    securities $16,103,364

  • 7c · Gain or loss

    securities -$183,230

  • 7d · Net gain or loss

    total -$183,230 · excluded -$183,230

Functional expenses

Part IX, the statement of functional expenses.

  • 11a · Fees: management

    total $18,100 · program services $18,100

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $20,417 · end of year $5,761,092

  • 11 · Investments: publicly traded securities

    beginning of year $6,742,340

  • 15 · Other assets

    beginning of year $53,389 · end of year $9,123,195

  • 25 · Other liabilities

    beginning of year $7,694,355 · end of year $6,420,448

  • 27 · Net assets without donor restrictions

    beginning of year -$878,209 · end of year $8,463,839

Mission and programs · 2023

Mission

SEE SCHEDULE O

  • THE ORGANIZATION HAS HISTORICALLY FUNDED GENERAL AND PROFESSIONAL LIABILITY CLAIMS LEVIED AGAINST THE NON-PROFIT ORGANIZATIONS OF NOVANT HEALTH'S INTEGRATED HEALTHCARE SYSTEM. ASSETS, LIABILITIES, AND INVESTMENT EARNINGS OF THE ORGANIZATION ARE RECORDED ON THE BOOKS OF THE SYSTEM'S PARENT ORGANIZATION, NOVANT HEALTH, INC. HOWEVER, THE FINANCIAL ACTIVITY OF THE ORGANIZATION IS REPORTED SEPARATELY ON THIS FORM 990. THE ORGANIZATION IS IN THE PROCESS OF WIND-DOWN IN ANTICIPATION OF DISSOLUTION IN 2024.

    Expenses $18,100

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

Listed in Part VII

  • DENISE MIHAL

    CHAIR/EVP

    Total calculated
    $1,963,192
    From this org
    $0
    From related orgs
    $1,921,892
    Other
    $41,300
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $856,282 related
    Bonus
    $0 + $842,945 related
    Other
    $0 + $222,665 related
    Deferred
    $0 + $19,800 related
    Nontaxable benefits
    $0 + $21,500 related
    Filer's total
    $0 + $1,963,192 related

  • FRANK EMORY JR

    TRUSTEE (FR 1/1/23)/EVP

    Total calculated
    $1,852,933
    From this org
    $0
    From related orgs
    $1,800,483
    Other
    $52,450
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $803,363 related
    Bonus
    $0 + $775,564 related
    Other
    $0 + $221,556 related
    Deferred
    $0 + $19,800 related
    Nontaxable benefits
    $0 + $32,650 related
    Filer's total
    $0 + $1,852,933 related

  • JULIA HYETT

    TRUSTEE/VP CORP INSURANCE

    Total calculated
    $352,232
    From this org
    $0
    From related orgs
    $311,364
    Other
    $40,868
    Hours/week
    0.2 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $222,495 related
    Bonus
    $0 + $57,696 related
    Other
    $0 + $31,173 related
    Deferred
    $0 + $14,912 related
    Nontaxable benefits
    $0 + $25,956 related
    Filer's total
    $0 + $352,232 related

  • NAN HOLLAND

    TRUSTEE/VP RISK MGMT

    Total calculated
    $389,980
    From this org
    $0
    From related orgs
    $358,408
    Other
    $31,572
    Hours/week
    0.2 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $252,846 related
    Bonus
    $0 + $64,912 related
    Other
    $0 + $40,650 related
    Deferred
    $0 + $15,535 related
    Nontaxable benefits
    $0 + $16,037 related
    Filer's total
    $0 + $389,980 related

  • SCOTT MYERS

    TRUSTEE/SVP CORP FINANCE

    Total calculated
    $1,062,074
    From this org
    $0
    From related orgs
    $946,449
    Other
    $115,625
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $474,683 related
    Bonus
    $0 + $349,472 related
    Other
    $0 + $122,294 related
    Deferred
    $0 + $95,228 related
    Nontaxable benefits
    $0 + $20,397 related
    Filer's total
    $0 + $1,062,074 related

  • STANLEY FULLER MD

    TRUSTEE (FR 1/1/23)/SVP CCO

    Total calculated
    $1,100,808
    From this org
    $0
    From related orgs
    $947,480
    Other
    $153,328
    Hours/week
    0.2 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $535,885 related
    Bonus
    $0 + $363,476 related
    Other
    $0 + $48,119 related
    Deferred
    $0 + $105,764 related
    Nontaxable benefits
    $0 + $47,564 related
    Filer's total
    $0 + $1,100,808 related

  • FRED HARGETT

    EVP/CFO (TO 9/6/23)

    Total calculated
    $2,451,375
    From this org
    $0
    From related orgs
    $2,400,670
    Other
    $50,705
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $886,648 related
    Bonus
    $0 + $1,074,292 related
    Other
    $0 + $439,730 related
    Deferred
    $0 + $19,800 related
    Nontaxable benefits
    $0 + $30,905 related
    Filer's total
    $0 + $2,451,375 related

  • GEOFFREY GARDNER

    CFO (FR 9/6/23)

    Total calculated
    $1,037,855
    From this org
    $0
    From related orgs
    $909,106
    Other
    $128,749
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $496,309 related
    Bonus
    $0 + $343,441 related
    Other
    $0 + $69,356 related
    Deferred
    $0 + $98,858 related
    Nontaxable benefits
    $0 + $29,891 related
    Filer's total
    $0 + $1,037,855 related

  • ERIC ESKIOGLU MD

    FMR TRUSTEE (TO 12/1/22)/FMR KE

    Total calculated
    $1,635,415
    From this org
    $0
    From related orgs
    $1,599,799
    Other
    $35,616
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0 + $626,977 related
    Other
    $0 + $972,822 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $35,616 related
    Filer's total
    $0 + $1,635,415 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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 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 FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH, AN INTEGRATED HEALTHCARE SYSTEM AND RELIES UPON NOVANT HEALTH, INC., THE PARENT ORGANIZATION, TO USE THE PROCESS DESCRIBED IN PART VI, LINE 15A/15B OF THIS RETURN TO ESTABLISH COMPENSATION FOR CERTAIN EXECUTIVES. THIS PROCESS ADHERES TO THE REQUIREMENTS SET FORTH TO SECURE THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, THE UTILIZATION OF THIRD-PARTY COMPARABILITY DATA SUCH AS PUBLISHED COMPENSATION SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION.
PART I, LINES 4A-B
PART I, LINES 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE ERIC ESKIOGLU MD $948,234 NONQUALIFIED GEOFFREY GARDNER $25,993 SCOTT MYERS $75,251 EQUITY-BASED NONE
PART I, LINE 4A - SEVERANCE PLAN:
ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS BASED ON ANNUAL COMPENSATION FOR A SPECIFIED PERIOD OF TIME. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN.
PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS:
THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. GENERALLY, ANNUAL CONTRIBUTIONS TO THE PLAN OR PAYMENTS TO PARTICIPANTS WILL BE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J. PRIOR TO MAKING THE CONTRIBUTIONS OR PAYMENTS, THE NOVANT HEALTH COMPENSATION AND LEADERSHIP COMMITTEE ("COMMITTEE") WILL APPROVE THE AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WILL APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. OTHERWISE, VESTING WILL OCCUR ON JANUARY 1ST OF EACH YEAR FOR THE APPROPRIATE CLASS-YEAR VESTING PERIOD. THE COMMITTEE REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SERP.

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 corporations and trusts

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

Provenance

Return type
form_990
Tax year
2023
Filed
14 November 2024
IRS schema version
2023v5.1
Source object
202433269349301108

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