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← OHIO VALLEY GENERAL HOSPITAL PROFESSIONAL LIABILITY SELF-INS TR

Form 990 for tax year 2022

Filed by OHIO VALLEY GENERAL HOSPITAL PROFESSIONAL LIABILITY SELF-INS TR.

Totals

Total revenue
$173,190
Total expenses
$267,747
Contributions and grants received
$135,000
Grants paid
$0
Program service revenue
$0
Investment income
$38,190
Other revenue
$0
Total assets, end of year
$2,037,722
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$2,037,722
Program services expenses (Part IX)
$55,000
Management and general expenses
$212,747
Fundraising expenses
$0
Program service expenses (Part III)
$55,000

Program services were 20.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • NORMAN F MITRY

    PRESIDENT & CEO

    Total calculated
    $803,422
    From this org
    $0
    From related orgs
    $760,654
    Other
    $42,768
    Hours/week
    1 + 65.75 related

    Schedule J breakdown matched by us

    Base
    $0 + $744,104 related
    Bonus
    $0
    Other
    $0 + $16,550 related
    Deferred
    $0 + $25,980 related
    Nontaxable benefits
    $0 + $16,788 related
    Filer's total
    $0 + $803,422 related

  • SCOTT M ELSTE

    CHAIR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • SUSAN PAONE DHA

    VICE-CHAIR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • BOB TERWILLIGER

    SECRETARY

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • ELISA DITOMMASO CPA

    TREASURER

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • LYNN GEORGE PHD

    EMERITUS BOARD CHAIR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • FRED CLERICI

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • MICHAEL MALKOWSKI MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $607,334
    From this org
    $0
    From related orgs
    $571,473
    Other
    $35,861
    Hours/week
    2 + 41.25 related

    Schedule J breakdown matched by us

    Base
    $0 + $360,000 related
    Bonus
    $0 + $196,123 related
    Other
    $0 + $15,350 related
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $23,661 related
    Filer's total
    $0 + $607,334 related

  • KEVIN FLANNERY

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • THOMAS LEYDIG

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • JEFFREY HEIN MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $667,993
    From this org
    $0
    From related orgs
    $632,270
    Other
    $35,723
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $200,000 related
    Bonus
    $0 + $395,720 related
    Other
    $0 + $36,550 related
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $23,523 related
    Filer's total
    $0 + $667,993 related

  • ROGER DAVIS EDD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • CHARLES KELLY ESQ

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • RICHARD BOWERS MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • KAREN JEROME-ZAPADKA MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • MARK BRENNAN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • MICHAEL DICLEMENTE

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • DIANA KOZLINA-PERETIC DNP

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • SRIDHAR TAYUR PHD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • SHARON LOFTUS ESQ

    ASST. SECRETARY

    Total calculated
    $316,900
    From this org
    $0
    From related orgs
    $282,031
    Other
    $34,869
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $281,981 related
    Bonus
    $0
    Other
    $0 + $50 related
    Deferred
    $0 + $18,269 related
    Nontaxable benefits
    $0 + $16,600 related
    Filer's total
    $0 + $316,900 related

  • GARRETT RICHARDSON

    ASSOCIATE VP, FINANCE

    Total calculated
    $234,870
    From this org
    $0
    From related orgs
    $222,290
    Other
    $12,580
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $192,240 related
    Bonus
    $0 + $25,000 related
    Other
    $0 + $5,050 related
    Deferred
    $0 + $11,867 related
    Nontaxable benefits
    $0 + $713 related
    Filer's total
    $0 + $234,870 related

  • ROBERT ROSENBERGER

    FORMER CFO

    Total calculated
    $508,369
    From this org
    $0
    From related orgs
    $502,040
    Other
    $6,329
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $287,831 related
    Bonus
    $0
    Other
    $0 + $214,209 related
    Deferred
    $0 + $5,757 related
    Nontaxable benefits
    $0 + $572 related
    Filer's total
    $0 + $508,369 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

Answered no

  • 4b · Supplemental nonqualified retirement plan
  • 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
HERITAGE VALLEY HEALTH SYSTEM'S BOARD OF DIRECTORS HAS APPOINTED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW THE SALARIES FOR THE ORGANIZATION'S CEO AND OTHER SENIOR MANAGEMENT OFFICIALS. AS PART OF THE REVIEW, THE EXECUTIVE COMPENSATION COMMITTEE ENGAGED AN OUTSIDE CONSULTING FIRM TO REVIEW THE BASE SALARIES OF THE SENIOR MANAGEMENT TEAM INCLUDING THE CEO IN COMPARISON TO THE MARKET TO ENSURE REASONABLENESS OF COMPENSATION. MARKET ADJUSTMENTS ARE MADE ACCORDINGLY IN INSTANCES WHERE DATA SUPPORTED SUCH CHANGES FOR THIS PERIOD. BONUSES ARE PAID IN ACCORDANCE WITH AN INCENTIVE COMPENSATION PLAN WHICH WAS DEVELOPED AND APPROVED BY THE BOARD OF DIRECTORS SEVERAL YEARS AGO.
PART I, LINE 4A
ROBERT ROSENBERGER, FORMER CFO - $179,808

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.

Related corporations and trusts

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

Provenance

Return type
form_990
Tax year
2022
Filed
25 April 2024
IRS schema version
2022v5.0
Source object
202431359349306553

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