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Nonprofiteer
← CHILD HEALTH PATIENT SAFETY ORGANIZATION INC

Form 990 for tax year 2022

Filed by CHILD HEALTH PATIENT SAFETY ORGANIZATION INC.

Totals

Total revenue
$1,022,819
Total expenses
$1,037,771
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$1,022,775
Investment income
$39
Other revenue
$5
Total assets, end of year
$247,401
Total liabilities, end of year
$166,249
Net assets or fund balances, end of year
$81,152
Program services expenses (Part IX)
$882,105
Management and general expenses
$155,666
Fundraising expenses
$0
Program service expenses (Part III)
$882,105

Program services were 85.0% 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.

  • 2a · Program service revenue: PARTICIPATION FEES

    total $1,022,775 · related or exempt $1,022,775

  • 3 · Investment income

    total $39 · excluded $39

  • 11a · Other revenue: MISCELLANEOUS

    total $5 · excluded $5

  • 11e · Other revenue, total

    $5

Functional expenses

Part IX, the statement of functional expenses.

  • 11a · Fees: management

    total $395,447 · program services $336,130 · management and general $59,317

  • 11b · Fees: legal

    total $4,465 · program services $3,795 · management and general $670

  • 11c · Fees: accounting

    total $2,435 · program services $2,070 · management and general $365

  • 11g · Fees: other

    total $105,280 · program services $89,488 · management and general $15,792

  • 13 · Office expenses

    total $812 · program services $690 · management and general $122

  • 16 · Occupancy

    total $26,014 · program services $22,112 · management and general $3,902

  • 17 · Travel

    total $153 · program services $130 · management and general $23

  • 19 · Conferences, conventions and meetings

    total $12,234 · program services $10,399 · management and general $1,835

  • 22 · Depreciation, depletion and amortization

    total $36,639 · program services $31,143 · management and general $5,496

  • 23 · Insurance

    total $1,520 · program services $1,292 · management and general $228

  • 24a · Other expenses: CONTRACTED STAFF

    total $452,772 · program services $384,856 · management and general $67,916

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $325,211 · end of year $130,056

  • 9 · Prepaid expenses and deferred charges

    beginning of year $0 · end of year $6,421

  • 11 · Investments: publicly traded securities

    beginning of year $0 · end of year $75,174

  • 15 · Other assets

    beginning of year $0 · end of year $35,750

  • 19 · Deferred revenue

    beginning of year $188,100 · end of year $106,551

  • 25 · Other liabilities

    beginning of year $41,142 · end of year $59,698

  • 27 · Net assets without donor restrictions

    beginning of year $95,969 · end of year $81,152

Mission and programs · 2022

Mission

TO IMPROVE THE SAFETY AND QUALITY OF CHILD HEALTH CARE DELIVERY BY CREATING A SECURE ENVIRONMENT WHERE CLINICIANS AND HEALTH CARE ORGANIZATIONS CAN COLLECT, AGGREGATE, AND ANALYZE DATA THAT WILL ENABLE THE IDENTIFICATION AND REDUCTION OF RISKS AND HAZARDS ASSOCIATED WITH PATIENT CARE.

  • THE CHILD HEALTH PATIENT SAFETY ORGANIZATION, INC. (PSO) WAS ORGANIZED TO IMPROVE THE SAFETY OF CHILDREN'S HOSPITALS BY SHARING DATA AND EXPERIENCES. MANDATED BY THE PATIENT SAFETY AND QUALITY IMPROVEMENT ACT (PSQIA), THE PSO PROVIDES FEDERAL PROTECTIONS FOR CHILDREN'S HOSPITALS TO LEAD IN PATIENT SAFETY AND ELIMINATE HARM, UTILIZING COLLABORATIVE INITIATIVES AND NATIONAL EXPERTS.

    Expenses $882,105 · Revenue $1,022,775

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • THOMAS SHUFFLEBARGER

    CHAIR

    Total calculated
    $0
    Hours/week
    1

  • CAROL KEMPER

    VICE-CHAIR, SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    1

  • PATRICIA DEPOMPEI

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • JAMES FORTENBERRY

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • BARBARA JOERS

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • JOHN NICKENS

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • MARK WIETECHA

    CEO

    Total calculated
    $1,570,772
    From this org
    $30,893
    From related orgs
    $1,204,844
    Other
    $335,035
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $22,097 + $861,782 related
    Bonus
    $8,625 + $336,375 related
    Other
    $171 + $6,687 related
    Deferred
    $7,880 + $307,320 related
    Nontaxable benefits
    $496 + $19,339 related
    Filer's total
    $39,269 + $1,531,503 related

  • AMY KNIGHT

    PRESIDENT

    Total calculated
    $1,026,872
    From this org
    $99,276
    From related orgs
    $694,929
    Other
    $232,667
    Hours/week
    5 + 35 related

    Schedule J breakdown matched by us

    Base
    $73,683 + $515,779 related
    Bonus
    $25,438 + $178,064 related
    Other
    $155 + $1,086 related
    Deferred
    $25,888 + $181,217 related
    Nontaxable benefits
    $3,195 + $22,367 related
    Filer's total
    $128,359 + $898,513 related

  • MICHELLE HOGERTY

    CFAO

    Total calculated
    $333,623
    From this org
    $7,820
    From related orgs
    $304,937
    Other
    $20,866
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $7,309 + $285,038 related
    Bonus
    $478 + $18,623 related
    Other
    $33 + $1,276 related
    Deferred
    $171 + $6,665 related
    Nontaxable benefits
    $351 + $13,679 related
    Filer's total
    $8,342 + $325,281 related

  • TOREY MACK

    CHIEF QUALITY & SOLUTIONS OFFICER

    Total calculated
    $357,607
    From this org
    $35,358
    From related orgs
    $318,219
    Other
    $4,030
    Hours/week
    4 + 36 related

    Schedule J breakdown matched by us

    Base
    $33,673 + $303,056 related
    Bonus
    $1,650 + $14,851 related
    Other
    $35 + $312 related
    Deferred
    $226 + $2,029 related
    Nontaxable benefits
    $178 + $1,597 related
    Filer's total
    $35,762 + $321,845 related

  • LORI HOTZEL

    CTO

    Total calculated
    $309,693
    From this org
    $33,869
    From related orgs
    $237,088
    Other
    $38,736
    Hours/week
    5 + 35 related

    Schedule J breakdown matched by us

    Base
    $28,507 + $199,552 related
    Bonus
    $5,250 + $36,750 related
    Other
    $112 + $786 related
    Deferred
    $2,732 + $19,123 related
    Nontaxable benefits
    $2,110 + $14,771 related
    Filer's total
    $38,711 + $270,982 related

  • KASSANDRA K JENSEN

    VP, EDUCATION & EXECUTIVE LEARNING

    Total calculated
    $320,310
    From this org
    $6,958
    From related orgs
    $271,362
    Other
    $41,990
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $5,805 + $226,399 related
    Bonus
    $1,140 + $44,460 related
    Other
    $13 + $503 related
    Deferred
    $628 + $24,481 related
    Nontaxable benefits
    $422 + $16,459 related
    Filer's total
    $8,008 + $312,302 related

  • DAVID BERTOCH

    VP, INFO & COMP DATA (THRU 2/11/22)

    Total calculated
    $247,991
    From this org
    $6,031
    From related orgs
    $235,182
    Other
    $6,778
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $1,154 + $44,997 related
    Bonus
    $745 + $29,055 related
    Other
    $4,132 + $161,130 related
    Deferred
    $95 + $3,714 related
    Nontaxable benefits
    $74 + $2,895 related
    Filer's total
    $6,200 + $241,791 related

  • AIMEE OSSMAN

    VP, POLICY

    Total calculated
    $272,010
    From this org
    $5,917
    From related orgs
    $230,757
    Other
    $35,336
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $5,066 + $197,583 related
    Bonus
    $840 + $32,760 related
    Other
    $11 + $414 related
    Deferred
    $489 + $19,078 related
    Nontaxable benefits
    $394 + $15,375 related
    Filer's total
    $6,800 + $265,210 related

  • KORY K KITTLE

    VP, ANALYTICS

    Total calculated
    $260,205
    From this org
    $5,567
    From related orgs
    $217,082
    Other
    $37,556
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $4,623 + $180,278 related
    Bonus
    $925 + $36,075 related
    Other
    $19 + $729 related
    Deferred
    $517 + $20,158 related
    Nontaxable benefits
    $422 + $16,459 related
    Filer's total
    $6,506 + $253,699 related

  • MATTHEW HALL

    PRINCIPAL, BIOSTATISTICIAN

    Total calculated
    $258,563
    From this org
    $5,412
    From related orgs
    $211,033
    Other
    $42,118
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $4,602 + $179,458 related
    Bonus
    $800 + $31,200 related
    Other
    $10 + $375 related
    Deferred
    $459 + $17,911 related
    Nontaxable benefits
    $594 + $23,154 related
    Filer's total
    $6,465 + $252,098 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 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS, INC. (NACHRI) ACTS AS THE "COMMON PAYMASTER" FOR CHILD HEALTH PATIENT SAFETY ORGANIZATION (CHPSO). NACHRI ISSUES ALL W-2S FOR ALL EMPLOYEES OF THIS GROUP. THE W-2S ARE REPORTED ONLY ON THE NACHRI RETURN, WHILE COMPENSATION ALLOCATED BY TIME-SPENT IS REPORTED ON THE NACHRI AND CHPSO RETURNS. THE PROCESS FOR DETERMINING COMPENSATION FOR OFFICERS AND STAFF IS DONE THROUGH THE NACHRI BOARD. THEREFORE, ALL QUESTIONS REGARDING COMPENSATION POLICY ARE ANSWERED ON THE NACHRI RETURN. METHODS USED BY NACHRI INCLUDE COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE.
PART I, LINES 4A-B
DAVID BERTOCH RECEIVED SEVERANCE PAYMENTS TOTALING $165,133 DURING THE CALENDAR YEAR. THE PAYMENT IS INCLUDED IN PART VII, COLUMN D AND SCHEDULE J, PART II, COLUMN BIII. THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. THE FOLLOWING LISTED EMPLOYEES PARTICIPATED IN A 457(F) PLAN DURING THE YEAR: - MARK WIETECHA (NO DISTRIBUTION IN 2022, $269,100 WAS CONTRIBUTED TO THE PLAN) - AMY KNIGHT (NO DISTRIBUTION IN 2022, $181,410 WAS CONTRIBUTED TO THE PLAN)

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
2022
Filed
25 August 2023
IRS schema version
2022v5.0
Source object
202342409349301574

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

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