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Nonprofiteer
← ST MARYS HOSPITAL FOUNDATION

Form 990 for tax year 2023

Filed by ST MARYS HOSPITAL FOUNDATION.

Totals

Total revenue
$393,048
Total expenses
$165,504
Contributions and grants received
$250,039
Grants paid
$47,489
Program service revenue
$127,575
Investment income
$15,456
Other revenue
-$22
Total assets, end of year
$1,113,515
Total liabilities, end of year
$5,240
Net assets or fund balances, end of year
$1,108,275
Program services expenses (Part IX)
$48,863
Management and general expenses
$93,573
Fundraising expenses
$23,068
Program service expenses (Part III)
$48,863

Program services were 29.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • DAMON HARBISON

    TRUSTEE & HOSPITAL PRESIDENT

    Total calculated
    $707,044
    From this org
    $0
    From related orgs
    $478,548
    Other
    $228,496
    Hours/week
    1 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $366,317 related
    Bonus
    $0 + $85,494 related
    Other
    $0 + $26,737 related
    Deferred
    $0 + $178,768 related
    Nontaxable benefits
    $0 + $49,728 related
    Filer's total
    $0 + $707,044 related

  • DR MARYANN LANGENFELD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • DR RAJENDRA SHROFF

    TRUSTEE & PHYSICIAN

    Total calculated
    $177,818
    From this org
    $0
    From related orgs
    $140,496
    Other
    $37,322
    Hours/week
    1

    Schedule J breakdown matched by us

    Base
    $0 + $140,496 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0 + $8,661 related
    Nontaxable benefits
    $0 + $28,661 related
    Filer's total
    $0 + $177,818 related

  • GARY UNVERFEHRT

    TRUSTEE & VICE CHAIRPERSON

    Total calculated
    $0
    Hours/week
    1

  • GREG DODSON

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • GREGG WINN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • JACK GRAHAM

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • KEITH KESSLER

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • KIM MCMILLAN

    TRUSTEE & CHAIRPERSON

    Total calculated
    $0
    Hours/week
    1

  • LAVERNE BRINK

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • MICHAEL BAUMGARTNER

    TRUSTEE & REGIONAL PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • PATTY WILLIAMS

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • REV RON JOHNSON

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • SUSAN ROBBINS

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • WES MONKEN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • DOUGLAS LONG

    ASST SECRETARY, GENERAL COUNSEL AT SSM HEALTH

    Total calculated
    $2,202,252
    From this org
    $0
    From related orgs
    $1,425,239
    Other
    $777,013
    Hours/week
    1 + 72.2 related

    Schedule J breakdown matched by us

    Base
    $0 + $759,270 related
    Bonus
    $0 + $495,539 related
    Other
    $0 + $170,430 related
    Deferred
    $0 + $753,634 related
    Nontaxable benefits
    $0 + $23,379 related
    Filer's total
    $0 + $2,202,252 related

  • JOHN SNODSMITH

    REGIONAL VP FINANCE

    Total calculated
    $391,637
    From this org
    $0
    From related orgs
    $292,287
    Other
    $99,350
    Hours/week
    1 + 43 related

    Schedule J breakdown matched by us

    Base
    $0 + $257,255 related
    Bonus
    $0 + $34,175 related
    Other
    $0 + $857 related
    Deferred
    $0 + $69,162 related
    Nontaxable benefits
    $0 + $30,188 related
    Filer's total
    $0 + $391,637 related

  • KAY ZIBBY-DAMRON

    EXECUTIVE DIRECTOR

    Total calculated
    $199,624
    From this org
    $0
    From related orgs
    $162,164
    Other
    $37,460
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $0 + $152,528 related
    Bonus
    $0 + $8,943 related
    Other
    $0 + $693 related
    Deferred
    $0 + $21,367 related
    Nontaxable benefits
    $0 + $16,093 related
    Filer's total
    $0 + $199,624 related

  • KAREN REWERTS

    FORMER OFFICER, VP-FINANCIAL OPERATIONS

    Total calculated
    $1,088,845
    From this org
    $0
    From related orgs
    $801,331
    Other
    $287,514
    Hours/week
    0 + 43 related

    Schedule J breakdown matched by us

    Base
    $0 + $589,021 related
    Bonus
    $0 + $154,022 related
    Other
    $0 + $58,288 related
    Deferred
    $0 + $253,200 related
    Nontaxable benefits
    $0 + $34,314 related
    Filer's total
    $0 + $1,088,845 related

  • MATT KINSELLA

    FORMER OFFICER

    Total calculated
    $733,947
    From this org
    $0
    From related orgs
    $532,042
    Other
    $201,905
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $405,421 related
    Bonus
    $0 + $105,716 related
    Other
    $0 + $20,905 related
    Deferred
    $0 + $160,100 related
    Nontaxable benefits
    $0 + $41,805 related
    Filer's total
    $0 + $733,947 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

  • 3 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 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 FOUNDATION'S TOP MANAGEMENT OFFICIAL (EXECUTIVE DIRECTOR) IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
SCHEDULE J PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN
SSM HEAL TH (SSMH) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMH QUALIFIED DEFINED BENEFIT PLAN WHO EARNS OVER THE INTERNAL REVENUE SERVICE COMPENSATION LIMIT. THE PLAN "RESTORES" THE BENEFITS TO THESE EMPLOYEES THAT WOULD HAVE BEEN PROVIDED UNDER THE SSMH QUALIFIED PLAN IF THE REGULATIONS DID NOT IMPOSE COMPENSATION LIMITS. AN INDIVIDUAL CAN TAKE A DISTRIBUTION FROM THE PLAN AT (1) AGE 65 OR OLDER IF THE INDIVIDUAL IS STILL EMPLOYED BY SSMH OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMH. NO INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2023. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2023: DAMON HARBISON $37,247 JOHN SNODSMITH $11,873 MATTHEW KINSELLA $39,596 KAREN REWERTS $56,755 DOUGLAS LONG $161,286 THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2023. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. DAMON HARBISON $25,899 MATT KINSELLA $19,814 KAREN REWERTS $53,386

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

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
2023
Filed
15 November 2024
IRS schema version
2023v5.1
Source object
202443209349318264

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