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Nonprofiteer
← Helen Ellis Memorial Hospital Auxiliary Inc

Form 990 for tax year 2023

Filed by Helen Ellis Memorial Hospital Auxiliary Inc.

Totals

Total revenue
$24,298
Total expenses
$11,460
Contributions and grants received
$1,139
Grants paid
$1,500
Program service revenue
$8,513
Investment income
$0
Other revenue
$14,646
Total assets, end of year
$26,435
Total liabilities, end of year
$277
Net assets or fund balances, end of year
$26,158
Program services expenses (Part IX)
$1,500
Management and general expenses
$9,960
Fundraising expenses
$0
Program service expenses (Part III)
$1,500

Program services were 13.1% 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.

  • 1b · Membership dues

    $1,139

  • 2a · Program service revenue: Commission Revenue

    total $8,513 · excluded $8,513

  • 10a · Gross sales of inventory

    $24,584

  • 10b · Cost of goods sold

    $9,938

  • 10c · Net income from sales of inventory

    total $14,646 · related or exempt $14,646

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $1,500 · program services $1,500

  • 13 · Office expenses

    total $3,672 · management and general $3,672

  • 19 · Conferences, conventions and meetings

    total $5,006 · management and general $5,006

  • 24a · Other expenses: Sales Tax

    total $1,282 · management and general $1,282

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $275 · end of year $275

  • 2 · Savings and temporary cash investments

    beginning of year $10,638 · end of year $23,477

  • 4 · Accounts receivable

    beginning of year $2,582 · end of year $2,683

  • 25 · Other liabilities

    beginning of year $175 · end of year $277

  • 27 · Net assets without donor restrictions

    beginning of year $13,320 · end of year $26,158

Mission and programs · 2023

Mission

Volunteer Activity for supported tax-exempt Hospital.

  • The Gift Shop operates at the organization's supported Hospital facility and is for the convenience of the Hospital's patients, employees, and visitors.

    Expenses $1,500 · Grants $1,500 · Revenue $14,646

As filed on the 2023 return.

Listed in Part VII

  • Quattlebaum Ryan

    Director

    Total calculated
    $516,036
    From this org
    $0
    From related orgs
    $417,278
    Other
    $98,758
    Hours/week
    0.5 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $327,812 related
    Bonus
    $0 + $67,969 related
    Other
    $0 + $21,497 related
    Deferred
    $0 + $68,501 related
    Nontaxable benefits
    $0 + $30,257 related
    Filer's total
    $0 + $516,036 related

  • Dameron-Bare Pamela

    Dir/Volunteer Coordinator

    Total calculated
    $48,813
    From this org
    $0
    From related orgs
    $46,703
    Other
    $2,110
    Hours/week
    0.5 + 40 related

  • Bare William

    President / Dir

    Total calculated
    $0
    Hours/week
    0.5

  • Campana Anita

    Director/2nd VP

    Total calculated
    $0
    Hours/week
    0.5

  • Cassella Linda

    Dir/Asst Treasurer

    Total calculated
    $0
    Hours/week
    0.5

  • Chendorain Marie

    Dir/1st VP

    Total calculated
    $0
    Hours/week
    0.5

  • Chimento Bruce

    Dir/Treasurer

    Total calculated
    $0
    Hours/week
    0.5

  • Chimento Marlene

    Director (beg 9/23)

    Total calculated
    $0
    Hours/week
    0.5

  • Kendall Shirley

    Dir/Recording Sec

    Total calculated
    $0
    Hours/week
    0.5

  • Lester Joyce

    Director

    Total calculated
    $0
    Hours/week
    0.5

  • Mulroe Michael

    Director

    Total calculated
    $0
    Hours/week
    0.5

  • Norcott Carol

    Dir (beg 1/19-end 6/12/23)

    Total calculated
    $0
    Hours/week
    0.5

  • Parker Jane

    Corresponding Sec

    Total calculated
    $0
    Hours/week
    0.5

  • Rodriquez Ruben

    Parliamentarian

    Total calculated
    $0
    Hours/week
    0.5

  • Sullivan Joseph

    Director

    Total calculated
    $0
    Hours/week
    0.5

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 4b
One of the Directors on the filing organization's Board of Directors, Ryan Quattlebaum, is compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth and top-tier parent of the supported hospital organization. In recognition of the contribution that each executive makes to the success of AdventHealth, AdventHealth provides supplemental executive retirement benefit plans to eligible executives. As the supplemental executive retirement benefit plans were updated in 2020 and certain individuals still participate as grand-fathered participants in certain plans, the narrative below discusses all plans in which there were any participants in 2023. The SERP III plan effectively replaces the prior SERP II plan, the Executive Flex Benefit Program Plan, and the Senior Executive Death Benefit Plan for qualified executives except for certain grandfathered executive employees. The SERP III plan provides eligible executives a percentage of their base pay, which is credited to a deferred compensation account. The plan also provides for compensation deferral and selection of life insurance coverage and long-term care insurance. To be eligible to participate in the SERP III plan, executives must be on the AHSSHC corporate payroll and be either a CEO of an AdventHealth entity, an AHSSHC Vice President (VP) or VP of an AdventHealth entity with a base salary of at least $330,000 in 2023 (adjusted annually by the same percentage as IRC Section 401(a)(17) limit increases), or other leader specifically approved by the AdventHealth President. Eligible executives do not include grandfathered executives, meaning those executives who would satisfy all the eligibility requirements of the SERP II plan prior to Dec 31, 2027, had the plan not been amended and restated as of Jan. 1, 2020. Contribution credits will be established and maintained by class year accounts for each participant using tiered contribution credit percentages of annual base compensation. Contribution credit percentages range between 15% and 19% of base compensation. Contribution credits will be made each quarter in 25% increments with reductions in contributions if the executive is also a grandfathered FLEX participant (see below). SERP III provides for a class year vesting and payment schedule (7 years for each class year) with respect to amounts accumulated in the executive's deferred compensation account. Upon attainment of a normal retirement age (age 62), or upon certain other circumstances as defined in the SERP III plan document, all deferred amounts are paid immediately to the participant. For any executives working beyond the normal retirement age, future employer contributions will be made quarterly from SERP III directly to the participant as a taxable cash bonus. The SERP II plan is a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AdventHealth and/or to other Seventh-day Adventist Church hospitals or health care institutions. Under the provisions of the SERP II plan, benefits are provided to qualifying executive participants on a pro-rata schedule beginning with 20 years of service as an employee of AdventHealth and/or another hospital or health care institution controlled by the Seventh-day Adventist Church and who satisfy certain other qualifying criteria. Eligible employees are restricted to those executives who, as of January 1, 2020, satisfied, or if employment continues, will satisfy the eligibility requirements of SERP II prior to December 31, 2027. This supplemental executive retirement plan (SERP II) was designed to provide eligible executives with the economic equivalent of an annual income beginning at normal retirement age equal to 60% of the average of the participant's three, five or seven highest years of base salary from AdventHealth active employment inclusive of income from all other Seventh-day Adventist Church healthcare employer-financed retirement income sources and investment income earned on those contributions through social security normal retirement age as defined in the plan. The number of years included in highest average compensation is determined by the individual's year of entry to SERP II and by the individual's year of entry to the AdventHealth Executive FLEX Benefit Program. The Flex Plan was originally designed to provide eligible executives an opportunity to select from among a variety of supplemental benefits, including a split dollar life insurance policy and long-term care insurance, to individually tailor a benefits program appropriate to each executive's needs. In 2020, the Flex Plan was amended to exclude employed executives who are hired or promoted after a certain date from being eligible to participate in the Flex Plan except for certain insurance coverage features of the plan. The Flex Plan provides eligible participants a pre-determined benefits allowance credit that is equal to a percentage of the executive's base pay from which the cost of mandatory and elective employee benefits is deducted. The benefits allowance credit percentage for any plan year shall not be greater than the maximum dollar amount or the percentage of compensation as determined by the AdventHealth Benefits Administration Committee. For grandfathered eligible employees, the annual pre-determined Flex allowance is contributed and any funds that remain after the cost of mandatory and elective benefits are subtracted are, at the employee's option, contributed to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. Upon attainment of age 65, all previous 457(f) deferred amounts are paid immediately to the participant and any future employer contributions are made quarterly from the Plan directly to the participant. The Plan provides for a class year vesting schedule (2 years for each class year) with respect to amounts accumulated in the executive's 457(f) deferred compensation account. Distributions could also be made from the executive's 457(f) deferred compensation account upon attainment of age 65 or upon an involuntary separation. The account will be forfeited by the executive upon a voluntary separation. With respect to grandfathered participants, the Flex Plan documents define eligible employees to include the Chief Executive Officers of AdventHealth entities and Vice Presidents of all AdventHealth entities whose base salary was at least equal to the Internal Revenue Code Section 401(a)(17) compensation limit each year. FLEX Plan FLEX Plan SERP II SERP III Contr. Distr.* Contr./Distr. Contr. Quattlebaum, Ryan $ 0 $ 0 $ 0 $ 50,774 * Including Investment Earnings

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.

  • AdventHealth Surgery Center Daytona Beach LLC

    Surgery Center · FL

  • AdventHealth Surgery Center Innovation Tower LLC

    Surgery Center · FL

  • Fletcher Hospital Surgical Ventures LLC

    Indirect Interest in Surgery Center · NC

  • Florida Hospital DMERT LLC

    Medical Equipment · FL · general or managing partner

  • Florida Hospital Home Infusion LLP

    Home Infusion Services · FL · general or managing partner

  • Functional Neurosurgical Ambulatory Surgery Ctr LLC

    Surgery Center · CO

  • M&O Orlando MOB I LLC

    Operation of Medical Office Building · DE

  • OnPoint OBGYN LLC

    Healthcare Services · CO

  • Orange City Surgical LLC

    Surgery Center · FL

  • PAHS OnPoint Imaging LLC

    Imaging Center · CO

  • PAHS OnPoint Urgent Care LLC

    Urgent Care Center · CO

  • Surgery Center of Rome LP

    Surgery Center · GA

  • SCA - Alliance LLC

    Indirect Interest in Surgery Center · DE

  • SCA-Central Florida LLC

    Indirect Interest in Surgery Center · DE

  • The Bariatric Center of Kansas City LLC

    Surgery Center · KS

  • Urgent Care Centers of Brevard County LLC

    Urgent Care Centers · FL · general or managing partner

Related corporations and trusts

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

  • AdventHealth at Overland Park-College MOB Condominium Assoc

    C · Condo Association · KS

  • AdventHealth City Center North Owners' Assoc Inc (65-123123)

    C · Maintenance Association · KS

  • AdventHealth Primary Care Inc fka AH North Polk Inc

    C · Inactive · FL

  • AdventHealth Value Based Bundle Management LLC

    C · Medical Contracting and Billing · FL

  • Altamonte Medical Plaza Condominium Association Inc

    C · Condo Association · FL

  • Apopka Medical Plaza Condominium Assoc Inc (11-123123)

    C · Condo Association · FL

  • Battle Creek Adventist Hospital

    C · Inactive · MI

  • Florida Hospital Flagler Medical Offices Association Inc

    C · Condo Association · FL

  • Florida Hosp Hlth Village Property Owner's Assoc Inc

    C · Condo Association · FL

  • Florida Hospital Healthcare System Inc

    C · PHSO / CIN · FL

  • Florida Medical Plaza Condominium Association Inc

    C · Condo Association · FL

  • Kissimmee Multispecialty Clinic Condominium Association Inc

    C · Condo Association · FL

  • Midwest Management Services Inc

    C · Inactive · KS

  • North American Health Services Inc & Sub

    C · Holding Co. · TN

  • Ormond Prof Associates Condo Assoc Inc (430 year end)

    C · Condo Association · FL

  • Park Ridge Property Owner's Association Inc

    C · Condo Association · NC

  • Park Ridge Condominium #1 Unit Owners Association Inc

    C · Condo Association · NC

  • Redmond Park Health Services Inc

    C · Holding Company · GA

  • Surgicare of Rome Inc

    C · Holding Company · GA

  • The Garden Retirement Community Inc

    C · Real Estate Rental · FL

  • Winter Park Medical Office Building I Condo Assoc Inc

    C · Condo Association · FL

Provenance

Return type
form_990
Tax year
2023
Filed
9 September 2024
IRS schema version
2023v5.1
Source object
202422539349301402

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