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Nonprofiteer
← MEMORIALCARE SELECT HEALTH PLAN

Form 990 for tax year 2022

Filed by MEMORIALCARE SELECT HEALTH PLAN.

Totals

Total revenue
$51,349,756
Total expenses
$62,969,317
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$51,329,614
Investment income
$20,142
Other revenue
$0
Total assets, end of year
$27,780,950
Total liabilities, end of year
$16,060,456
Net assets or fund balances, end of year
$11,720,494
Program services expenses (Part IX)
$56,472,933
Management and general expenses
$6,496,384
Fundraising expenses
$0
Program service expenses (Part III)
$56,472,933

Program services were 89.7% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • BARRY S ARBUCKLE

    BOARD CHAIR, MHS PRESIDENT/CEO

    Total calculated
    $6,316,169
    From this org
    $0
    From related orgs
    $4,388,545
    Other
    $1,927,624
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,716,120 related
    Bonus
    $0 + $2,163,320 related
    Other
    $0 + $509,105 related
    Deferred
    $0 + $1,902,383 related
    Nontaxable benefits
    $0 + $25,241 related
    Filer's total
    $0 + $6,316,169 related

  • JOHN BISHOP THRU 010623

    CEO/EVP, LBMMC

    Total calculated
    $1,788,944
    From this org
    $0
    From related orgs
    $1,427,034
    Other
    $361,910
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $713,893 related
    Bonus
    $0 + $389,013 related
    Other
    $0 + $324,128 related
    Deferred
    $0 + $343,190 related
    Nontaxable benefits
    $0 + $18,720 related
    Filer's total
    $0 + $1,788,944 related

  • MARIBEL FERRER

    CEO, SHP

    Total calculated
    $466,489
    From this org
    $0
    From related orgs
    $456,447
    Other
    $10,042
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $345,686 related
    Bonus
    $0 + $93,190 related
    Other
    $0 + $17,571 related
    Deferred
    $0 + $1,783 related
    Nontaxable benefits
    $0 + $8,259 related
    Filer's total
    $0 + $466,489 related

  • MARIA CHANDLER MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • STEPHEN MCNAMARA

    VP PFS AND CFO SHP

    Total calculated
    $508,608
    From this org
    $0
    From related orgs
    $464,402
    Other
    $44,206
    Hours/week
    4 + 56 related

    Schedule J breakdown matched by us

    Base
    $0 + $334,828 related
    Bonus
    $0 + $95,046 related
    Other
    $0 + $34,528 related
    Deferred
    $0 + $24,400 related
    Nontaxable benefits
    $0 + $19,806 related
    Filer's total
    $0 + $508,608 related

  • SCOTT FERER

    CHIEF MEDICAL OFFICER

    Total calculated
    $460,700
    From this org
    $0
    From related orgs
    $427,555
    Other
    $33,145
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $0 + $327,596 related
    Bonus
    $0 + $86,592 related
    Other
    $0 + $13,367 related
    Deferred
    $0 + $15,250 related
    Nontaxable benefits
    $0 + $17,895 related
    Filer's total
    $0 + $460,700 related

  • SANDRA K JENSEN

    RN, CASE MANAGER, LEAD

    Total calculated
    $187,105
    From this org
    $166,811
    From related orgs
    $0
    Other
    $20,294
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $166,200
    Bonus
    $395
    Other
    $216
    Deferred
    $8,779
    Nontaxable benefits
    $11,515
    Filer's total
    $187,105

  • MARK GUNTER

    DIRECTOR, FINANCE

    Total calculated
    $209,448
    From this org
    $183,648
    From related orgs
    $0
    Other
    $25,800
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $165,928
    Bonus
    $16,726
    Other
    $994
    Deferred
    $9,590
    Nontaxable benefits
    $16,210
    Filer's total
    $209,448

  • DEBORAH R SCHUTZ

    DIRECTOR, MEDICAL MANAGEMENT

    Total calculated
    $186,196
    From this org
    $165,436
    From related orgs
    $0
    Other
    $20,760
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $163,691
    Bonus
    $0
    Other
    $1,745
    Deferred
    $8,205
    Nontaxable benefits
    $12,555
    Filer's total
    $186,196

  • HIEU HAN

    MANAGER, ENROLLMENT

    Total calculated
    $136,350
    From this org
    $111,954
    From related orgs
    $0
    Other
    $24,396
    Hours/week
    60

  • REBECCA RODRIGUEZ

    MANAGER, QUALITY

    Total calculated
    $155,576
    From this org
    $150,041
    From related orgs
    $0
    Other
    $5,535
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $136,509
    Bonus
    $13,374
    Other
    $158
    Deferred
    $4,522
    Nontaxable benefits
    $1,013
    Filer's total
    $155,576

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
  • 7 · Other non-fixed payments

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
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
THE COMPENSATION OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS DETERMINED BY MEMORIAL HEALTH SERVICES (MHS), THE TAX-EXEMPT PARENT OF MEMORIALCARE SELECT HEALTH PLAN. SEE SCHEDULE O FORM 990, PART VI, LINES 15A AND 15B FOR THE PROCESS USED BY MHS TO DETERMINE COMPENSATION.
PART I, LINE 4B
LINE 4B - SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: THE ORGANIZATION MAINTAINS A DEFINED CONTRIBUTION PLAN WHERE EACH YEAR'S CONTRIBUTION VESTS AFTER THREE YEARS. DURING THE 2022 CALENDAR YEAR, THE ORGANIZATION MADE THE FOLLOWING CONTRIBUTIONS TO THE PLAN ON BEHALF OF THE FOLLOWING INDIVIDUALS, WHICH IS REPORTED AS "RETIREMENT AND DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C). CONTRIBUTIONS THAT ARE IMMEDIATELY VESTED UNDER THE CIRCUMSTANCES REFERENCED BELOW ARE REPORTED AS "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). BARRY S. ARBUCKLE - $486,581 JOHN BISHOP - $318,790
PART I, LINE 7
CERTAIN EXECUTIVES RECEIVE PART OF THEIR OVERALL COMPENSATION IN THE FORM OF AN ANNUAL INCENTIVE PAYMENT. SEVERAL FINANCIAL AND NON-FINANCIAL METRICS ARE UTILIZED IN THE FORMULA FOR THE INCENTIVE COMPENSATION, AND THESE METRICS AND THE FORMULA ARE REVIEWED AND APPROVED EACH YEAR IN ADVANCE BY THE COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. PAYMENT OF ANY INCENTIVE COMPENSATION MUST BE APPROVED BY THE COMPENSATION COMMITTEE AFTER IT HAS REVIEWED THE METRICS TO DETERMINE WHETHER THEY HAVE BEEN MET AND THE AMOUNT OF THE PAYMENTS (IF ANY) BASED ON THE APPROVED FORMULA.

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.

Provenance

Return type
form_990
Tax year
2022
Filed
24 April 2024
IRS schema version
2022v5.0
Source object
202421249349302912

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