Form 990 for tax year 2022
Filed by COMMUNITY GENERAL HOSPITAL EMPLOYEE BENEFIT TRUST.
Totals
- Total revenue
- $23,869,787
- Total expenses
- $23,890,595
- Contributions and grants received
- $0
- Grants paid
- $0
- Program service revenue
- $23,864,611
- Investment income
- $5,176
- Other revenue
- $0
- Total assets, end of year
- $78,707
- Total liabilities, end of year
- $0
- Net assets or fund balances, end of year
- $78,707
- Program services expenses (Part IX)
- $23,890,595
- Management and general expenses
- $0
- Fundraising expenses
- $0
- Program service expenses (Part III)
- $23,890,595
Program services were 100.0% 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: Employer Contributions
total $20,945,705 · related or exempt $20,945,705
-
2b · Program service revenue: Employee Contributions
total $2,650,987 · related or exempt $2,650,987
-
2c · Program service revenue: Retiree Contributions
total $267,919 · related or exempt $267,919
-
3 · Investment income
total $5,176 · excluded $5,176
-
8c · Net income from fundraising events
total $0
Functional expenses
Part IX, the statement of functional expenses.
-
4 · Benefits paid to or for members
total $23,874,600 · program services $23,874,600
-
24a · Other expenses: Reinsurance Premiums
total $10,039 · program services $10,039
-
24b · Other expenses: Excise Tax
total $5,956 · program services $5,956
Balance sheet
Part X, book values.
-
1 · Cash, non-interest-bearing
beginning of year $99,515 · end of year $78,707
-
28 · Net assets with donor restrictions
beginning of year $99,515 · end of year $78,707
Mission and programs · 2022
Mission
To provide medical benefits for eligible employees of CGH Medical Center and their eligible dependents.
Activities or mission (Part I)
THE PLAN WAS ESTABLISHED TO PROVIDE MEDICAL BENEFITS FOR ELIGIBLE EMPLOYEES OF CGH MEDICAL CENTER
-
Employee health plan - Medical, Dental, Surgical, hospitalization and major medical for CGH Medical Center eligible current and retired employees and their dependents.
Expenses $23,890,595 · Revenue $23,869,787
As filed on the 2022 return.
Listed in Part VII
-
John BensonJOHN BENSON
TREASURER
- Total calculated
- $0
- Hours/week
- 1 + 3 related
Schedule J breakdown matched by us
- Base
- not reported
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported
- Nontaxable benefits
- not reported
- Filer's total
- not reported
-
Shawn HanlonSHAWN HANLON
DIRECTOR
- Total calculated
- $1,148,064
- From this org
- $0
- From related orgs
- $1,128,252
- Other
- $19,812
- Hours/week
- 1 + 44 related
Schedule J breakdown matched by us
- Base
- not reported + $1,128,252 related
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported + $19,812 related
- Nontaxable benefits
- not reported + $22,775 related
- Filer's total
- not reported + $1,170,839 related
-
Marcia JonesMARCIA JONES
CHAIR
- Total calculated
- $709,163
- From this org
- $0
- From related orgs
- $690,014
- Other
- $19,149
- Hours/week
- 1 + 44 related
Schedule J breakdown matched by us
- Base
- not reported + $690,014 related
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported + $19,149 related
- Nontaxable benefits
- not reported + $22,775 related
- Filer's total
- not reported + $731,938 related
-
Jeffrey LemayJEFFREY LEMAY
DIRECTOR
- Total calculated
- $609,377
- From this org
- $0
- From related orgs
- $593,902
- Other
- $15,475
- Hours/week
- 1 + 44 related
Schedule J breakdown matched by us
- Base
- not reported + $593,902 related
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported + $15,475 related
- Nontaxable benefits
- not reported + $22,775 related
- Filer's total
- not reported + $632,152 related
-
Mary Jean DerreberryMARY JEAN DERREBERRY
DIRECTOR
- Total calculated
- $143,081
- From this org
- $0
- From related orgs
- $118,360
- Other
- $24,721
- Hours/week
- 1 + 44 related
Schedule J breakdown matched by us
- Base
- not reported + $118,360 related
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported + $24,721 related
- Nontaxable benefits
- not reported + $22,775 related
- Filer's total
- not reported + $165,856 related
-
Andy MooreANDY MOORE
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1 + 3 related
Schedule J breakdown matched by us
- Base
- not reported
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported
- Nontaxable benefits
- not reported
- Filer's total
- not reported
-
Nancy RasmussenNANCY RASMUSSEN
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1 + 3 related
Schedule J breakdown matched by us
- Base
- not reported
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported
- Nontaxable benefits
- not reported
- Filer's total
- not reported
-
Heather SoteloHEATHER SOTELO
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1 + 3 related
Schedule J breakdown matched by us
- Base
- not reported
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported
- Nontaxable benefits
- not reported
- Filer's total
- not reported
-
Thomas KingTHOMAS KING
DIRECTOR
- Total calculated
- $702,563
- From this org
- $0
- From related orgs
- $685,211
- Other
- $17,352
- Hours/week
- 1 + 44 related
Schedule J breakdown matched by us
- Base
- not reported + $685,211 related
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported + $17,352 related
- Nontaxable benefits
- not reported + $22,775 related
- Filer's total
- not reported + $725,338 related
-
John VanosdolJOHN VANOSDOL
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1 + 3 related
Schedule J breakdown matched by us
- Base
- not reported
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported
- Nontaxable benefits
- not reported
- Filer's total
- not reported
-
Scott WolberSCOTT WOLBER
VICECHAIR
- Total calculated
- $0
- Hours/week
- 1 + 3 related
Schedule J breakdown matched by us
- Base
- not reported
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported
- Nontaxable benefits
- not reported
- Filer's total
- not reported
-
Paul G SteinkePAUL G STEINKE
ADMINISTRATOR
- Total calculated
- $661,979
- From this org
- $0
- From related orgs
- $640,784
- Other
- $21,195
- Hours/week
- 1 + 44 related
Schedule J breakdown matched by us
- Base
- not reported + $640,784 related
- Bonus
- not reported
- Other
- not reported
- Deferred
- not reported + $21,195 related
- Nontaxable benefits
- not reported + $16,781 related
- Filer's total
- not reported + $678,760 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
None.
Answered no
- 4a · Severance or change-of-control payment
- 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
- The Benefit Trust relied upon a related organization that used one or more
- Part I, Line 3
- methods described to establish top management official's compensation.
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.
-
CGH Medical Center
Govt Unit Sec 1 · Hospital · IL
Directly controlled by NA
-
NFP 501c3 · Healthcare Clinics · IL
Directly controlled by CGH Medical Center
-
NFP 501c3 · Provide medical health educationsupport · IL
Directly controlled by CGH Medical Center
Provenance
- Return type
- form_990
- Tax year
- 2022
- Filed
- 13 September 2023
- IRS schema version
- 2022v5.0
- Source object
- 202322569349301617
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