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Nonprofiteer
← PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC

Form 990 for tax year 2022

Filed by PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC.

Totals

Total revenue
$58,793
Total expenses
$15,122
Contributions and grants received
$43,341
Grants paid
$8,755
Program services expenses (Part IX)
$8,755
Management and general expenses
$5,863
Fundraising expenses
$504
Program service expenses (Part III)
$8,755

Program services were 57.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • DENA JACQUAY

    DIRECTOR/PH CHIEF ADMIN OFFICER

    Total calculated
    $1,193,028
    From this org
    $0
    From related orgs
    $908,033
    Other
    $284,995
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $648,964 related
    Bonus
    $0 + $217,050 related
    Other
    $0 + $42,019 related
    Deferred
    $0 + $239,919 related
    Nontaxable benefits
    $0 + $45,076 related
    Filer's total
    $0 + $1,193,028 related

  • RHONDA SHARP

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $398,851
    From this org
    $0
    From related orgs
    $360,618
    Other
    $38,233
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $322,156 related
    Bonus
    $0 + $32,124 related
    Other
    $0 + $6,338 related
    Deferred
    $0 + $33,550 related
    Nontaxable benefits
    $0 + $4,683 related
    Filer's total
    $0 + $398,851 related

  • JORDI DISLER

    DIRECTOR/LGHOS PRESIDENT

    Total calculated
    $406,241
    From this org
    $0
    From related orgs
    $308,629
    Other
    $97,612
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $207,367 related
    Bonus
    $0 + $78,305 related
    Other
    $0 + $22,957 related
    Deferred
    $0 + $70,059 related
    Nontaxable benefits
    $0 + $27,553 related
    Filer's total
    $0 + $406,241 related

  • SHELBY COOPER

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $274,959
    From this org
    $0
    From related orgs
    $233,151
    Other
    $41,808
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $184,474 related
    Bonus
    $0 + $20,358 related
    Other
    $0 + $28,319 related
    Deferred
    $0 + $15,712 related
    Nontaxable benefits
    $0 + $26,096 related
    Filer's total
    $0 + $274,959 related

  • JAIME CUNNINGHAM

    DIRECTOR/SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    1

  • JENNIFER MCBRIDE

    DIRECTOR-PARTIAL YR

    Total calculated
    $0
    Hours/week
    1

  • JERRY MILLER

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • KERRY SPRUNGER

    DIRECTOR/CHAIR

    Total calculated
    $0
    Hours/week
    1

  • VICKIE STANSKI

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • SANDY STURTZ-RINGLER

    DIRECTOR/VICE CHAIR

    Total calculated
    $0
    Hours/week
    1

  • MICHAEL PACKNETT

    PH PRESIDENT & CEO

    Total calculated
    $2,941,140
    From this org
    $0
    From related orgs
    $2,602,841
    Other
    $338,299
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,330,197 related
    Bonus
    $0 + $664,677 related
    Other
    $0 + $607,967 related
    Deferred
    $0 + $302,282 related
    Nontaxable benefits
    $0 + $36,017 related
    Filer's total
    $0 + $2,941,140 related

  • JEANNE' WICKENS

    PH CHIEF FINANCIAL OFFICER

    Total calculated
    $1,622,167
    From this org
    $0
    From related orgs
    $1,264,400
    Other
    $357,767
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $804,432 related
    Bonus
    $0 + $363,922 related
    Other
    $0 + $96,046 related
    Deferred
    $0 + $325,215 related
    Nontaxable benefits
    $0 + $32,552 related
    Filer's total
    $0 + $1,622,167 related

  • BENJAMIN MILES

    FORMER OFFICER/CURRENT HPS PRESIDENT

    Total calculated
    $588,857
    From this org
    $0
    From related orgs
    $582,664
    Other
    $6,193
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $64,367 related
    Bonus
    $0
    Other
    $0 + $518,297 related
    Deferred
    $0 + $1,948 related
    Nontaxable benefits
    $0 + $4,245 related
    Filer's total
    $0 + $588,857 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

  • 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
RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF PARKVIEW LAGRANGE HOSPITAL FOUNDATION, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC.
PART I, LINES 4A-B
SEVERANCE PAYMENT BENJAMIN MILES $275,656 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS THE FOLLOWING INDIVIDUALS PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION AND THE AMOUNT OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. THE FOLLOWING INDIVIDUALS VESTED IN A PORTION OF THEIR DEFERRED COMPENSATION PLANS, WHICH IS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS AT THE TIME OF VESTING. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III): JORDI DISLER $21,333; DENA JACQUAY $39,944; BENJAMIN MILES $242,356; MICHAEL PACKNETT $577,374; JEANNE' WICKENS $70,644 AMOUNTS LISTED ABOVE THAT HAVE BEEN REPORTED AS DEFERRED COMPENSATION ON PRIOR FORM 990 WILL ALSO BE REFLECTED IN SCHEDULE J, PART II, COLUMN (F). FOR EXAMPLE, THE AMOUNT OF $577,374 REPORTED AS REQUIRED FOR MR. PACKNETT WAS A RESULT OF THE VESTING OF SUCH AMOUNT UNDER THE TERMS OF THE RESPECTIVE PLANS. HOWEVER, THESE AMOUNTS WERE PREVIOUSLY REPORTED IN MR. PACKNETT'S DEFERRED COMPENSATION OVER MORE THAN 10 YEARS AS THE AMOUNTS WERE DEFERRED UNDER THE PLANS. AS SUCH, THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN (F) IS AN INDICATION OF AMOUNTS THAT HAVE BEEN REPORTED TWICE, ONCE AS A DEFERRAL AND ONCE AS VESTED. THE FOLLOWING INDIVIDUALS HAVE AN AMOUNT INCLUDED IN SCHEDULE J, PART II, COLUMN (C) FOR AN AMOUNT EARNED BUT NOT YET VESTED UNDER ONE OF PARKVIEW'S DEFERRED COMPENSATION PLANS. THE AMOUNTS ARE AT RISK AND WILL NOT BE PAID UNLESS AND UNTIL EACH EMPLOYEE HAS PROVIDED SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. BENEFITS UNDER THE PLANS VEST AT THE TIME SET FORTH IN THE PLAN DOCUMENTS AND ARE FORFEITED IF THE EMPLOYEES TERMINATE EMPLOYMENT BEFORE SATISFYING THOSE PLAN CONDITIONS. DEFERRALS REPORTED IN SCHEDULE J, PART II, COLUMN (C) INCLUDE: JORDI DISLER $35,158; DENA JACQUAY $203,319; MICHAEL PACKNETT $268,732; JEANNE' WICKENS $303,865

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
8 November 2023
IRS schema version
2022v5.0
Source object
202343129349304809

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