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← NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND

Form 990 for tax year 2023

Filed by NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND.

Totals

Total revenue
$45,480
Total expenses
$58,351
Contributions and grants received
$0
Grants paid
$0
Program services expenses (Part IX)
$58,351
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$58,351

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

  • STEPHEN L GOESER

    PRES & CEO NEBR METHODIST

    Total calculated
    $1,532,100
    From this org
    $0
    From related orgs
    $1,250,508
    Other
    $281,592
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,032,700 related
    Bonus
    $0
    Other
    $0 + $217,808 related
    Deferred
    $0 + $256,542 related
    Nontaxable benefits
    $0 + $25,672 related
    Filer's total
    $0 + $1,532,722 related

  • LARRY V PEARSON

    CHAIRMAN

    Total calculated
    $0
    Hours/week
    1

  • ADAM YALE

    VICE CHAIRMAN

    Total calculated
    $0
    Hours/week
    1

  • DEB BASS

    TREASURER

    Total calculated
    $0
    Hours/week
    1

  • MONTY SELLON MD

    DIRECTOR

    Total calculated
    $554,672
    From this org
    $0
    From related orgs
    $509,652
    Other
    $45,020
    Hours/week
    1

    Schedule J breakdown matched by us

    Base
    $0 + $418,050 related
    Bonus
    $0 + $73,456 related
    Other
    $0 + $18,146 related
    Deferred
    $0 + $28,724 related
    Nontaxable benefits
    $0 + $17,936 related
    Filer's total
    $0 + $556,312 related

  • JODY HORNER

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • RICHARD C HAHN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • CAROLEE V JONES MD

    DIRECTOR

    Total calculated
    $862,360
    From this org
    $0
    From related orgs
    $798,625
    Other
    $63,735
    Hours/week
    1

    Schedule J breakdown matched by us

    Base
    $0 + $299,166 related
    Bonus
    $0 + $69,676 related
    Other
    $0 + $429,783 related
    Deferred
    $0 + $45,885 related
    Nontaxable benefits
    $0 + $19,490 related
    Filer's total
    $0 + $864,000 related

  • DAN KINNEY PH D

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • C L LANDEN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • SID DINSDALE

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JOHN NELSON

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • BRET C GRIESS

    SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • JEFFREY E FRANCIS

    CFO

    Total calculated
    $807,910
    From this org
    $0
    From related orgs
    $659,734
    Other
    $148,176
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $0 + $566,292 related
    Bonus
    $0 + $15,000 related
    Other
    $0 + $78,442 related
    Deferred
    $0 + $115,586 related
    Nontaxable benefits
    $0 + $33,212 related
    Filer's total
    $0 + $808,532 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

  • 1a · Health or social club dues or initiation fees
  • 1b · Written policy on the line-1a expenses
  • 2 · Substantiation required before reimbursing expenses
  • 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
NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. METHODIST HEALTH SYSTEM RETAINS AN INDEPENDENT CONSULTANT TO REVIEW ALL OFFICER COMPENSATION FOR EACH AFFILIATE. UNDER THIS PROCESS, MARKET DATA ON COMPENSATION IS GATHERED AND ANALYZED AND COMPENSATION RANGES ARE SET. THE INFORMATION IS THEN PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF NEBRASKA METHODIST HEALTH SYSTEM INC., A NEBRASKA NON-PROFIT CORPORATION. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE.
PART I, LINE 4B
THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NEBRASKA METHODIST HEALTH SYSTEM NONQUALIFIED PLAN DURING 2023 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: JEFFREY FRANCIS $90,836 ACCRUAL; PLAN DISTRIBUTION $74,249 STEPHEN GOESER $226,842 ACCRUAL; $179,348 PLAN DISTRIBUTION CAROLEE V. JONES MD $12,885 ACCRUAL; $410,595 DISTRIBUTION MONTY SELLON MD $8,145 ACCRUAL

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
13 November 2024
IRS schema version
2023v5.1
Source object
202443189349309244

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