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Nonprofiteer
← SELF INSURANCE FUND - NOVANT HEALTH INC

Form 990 for tax year 2022

Filed by SELF INSURANCE FUND - NOVANT HEALTH INC.

Totals

Total revenue
-$115,444
Total expenses
$32,919
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$0
Investment income
-$115,444
Other revenue
$0
Total assets, end of year
$6,816,146
Total liabilities, end of year
$7,694,355
Net assets or fund balances, end of year
-$878,209
Program services expenses (Part IX)
$32,919
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$32,919

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

Listed in Part VII

  • DENISE MIHAL

    CHAIR

    Total calculated
    $1,795,117
    From this org
    $0
    From related orgs
    $1,755,765
    Other
    $39,352
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $834,650 related
    Bonus
    $0 + $692,010 related
    Other
    $0 + $229,105 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $21,052 related
    Filer's total
    $0 + $1,795,117 related

  • SCOTT MYERS

    TRUSTEE

    Total calculated
    $1,009,232
    From this org
    $0
    From related orgs
    $898,590
    Other
    $110,642
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $460,420 related
    Bonus
    $0 + $292,519 related
    Other
    $0 + $145,651 related
    Deferred
    $0 + $90,827 related
    Nontaxable benefits
    $0 + $19,815 related
    Filer's total
    $0 + $1,009,232 related

  • ERIC ESKIOGLU MD

    TRUSTEE (UNTIL 12/1/2022)

    Total calculated
    $1,804,753
    From this org
    $0
    From related orgs
    $1,748,678
    Other
    $56,075
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $822,425 related
    Bonus
    $0 + $721,758 related
    Other
    $0 + $204,495 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $37,775 related
    Filer's total
    $0 + $1,804,753 related

  • NAN HOLLAND

    TRUSTEE

    Total calculated
    $371,020
    From this org
    $0
    From related orgs
    $341,508
    Other
    $29,512
    Hours/week
    0.2 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $244,740 related
    Bonus
    $0 + $59,011 related
    Other
    $0 + $37,757 related
    Deferred
    $0 + $14,321 related
    Nontaxable benefits
    $0 + $15,191 related
    Filer's total
    $0 + $371,020 related

  • JULIA HYETT

    TRUSTEE

    Total calculated
    $332,656
    From this org
    $0
    From related orgs
    $299,710
    Other
    $32,946
    Hours/week
    0.2 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $214,697 related
    Bonus
    $0 + $54,648 related
    Other
    $0 + $30,365 related
    Deferred
    $0 + $8,322 related
    Nontaxable benefits
    $0 + $24,624 related
    Filer's total
    $0 + $332,656 related

  • FRED HARGETT

    EVP & CFO

    Total calculated
    $2,417,516
    From this org
    $0
    From related orgs
    $2,355,664
    Other
    $61,852
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,092,939 related
    Bonus
    $0 + $843,828 related
    Other
    $0 + $418,897 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $43,552 related
    Filer's total
    $0 + $2,417,516 related

  • FRANK EMORY

    FMR TRUSTEE

    Total calculated
    $1,643,957
    From this org
    $0
    From related orgs
    $1,593,978
    Other
    $49,979
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $790,498 related
    Bonus
    $0 + $599,395 related
    Other
    $0 + $204,085 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $31,679 related
    Filer's total
    $0 + $1,643,957 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

  • 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
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 ERIC ESKIOGLU $126,073 FRED HARGETT $11,892 DENISE MIHAL $11,428 SCOTT MYERS $100,803 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.

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
2022
Filed
14 November 2023
IRS schema version
2022v5.0
Source object
202303189349307620

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