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← AUXILIARY OF FORSYTH MEMORIAL HOSPITAL

Form 990 for tax year 2023

Filed by AUXILIARY OF FORSYTH MEMORIAL HOSPITAL.

Totals

Total revenue
$625,460
Total expenses
$277,511
Contributions and grants received
$423
Grants paid
$49,487
Program services expenses (Part IX)
$247,149
Management and general expenses
$30,123
Fundraising expenses
$239
Program service expenses (Part III)
$247,149

Program services were 89.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • BILL BLACKARD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • CAROLYN CROSBY

    PRES

    Total calculated
    $0
    Hours/week
    0.2

  • ELAINE BUTLER

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • LAURA MONSEN

    TREAS

    Total calculated
    $0
    Hours/week
    0.2

  • LISA BERNTHAL

    TRUSTEE (FR 1/1/23)

    Total calculated
    $0
    Hours/week
    0.2

  • MARY BINKLEY

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • NATALIE FULCHER

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • PAT BLACKARD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • PEGGY PARKS

    SECR

    Total calculated
    $0
    Hours/week
    0.2

  • SHARON DUNNAGAN

    VICE PRES

    Total calculated
    $0
    Hours/week
    0.2

  • 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

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

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
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, LINE 4B
PART I, LINES 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONE NONQUALIFIED GEOFFREY GARDNER $25,993 EQUITY-BASED NONE
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.

Provenance

Return type
form_990
Tax year
2023
Filed
14 November 2024
IRS schema version
2023v5.1
Source object
202423269349300832

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