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Nonprofiteer
← FORSYTH MEMORIAL HOSPITAL INC

Form 990 for tax year 2022

Filed by FORSYTH MEMORIAL HOSPITAL INC.

Totals

Total revenue
$1,377,864,424
Total expenses
$1,409,445,707
Contributions and grants received
$22,273,285
Grants paid
$2,104,271
Program service revenue
$1,347,574,893
Investment income
$945,729
Other revenue
$7,070,517
Total assets, end of year
$2,102,000,445
Total liabilities, end of year
$196,380,928
Net assets or fund balances, end of year
$1,905,619,517
Program services expenses (Part IX)
$1,129,907,265
Management and general expenses
$279,538,442
Fundraising expenses
$0
Program service expenses (Part III)
$1,129,907,265

Program services were 80.2% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • ASHLEY PERROTT MD

    TRUSTEE/SENIOR PHYSICIAN EXECUTIVE

    Total calculated
    $566,582
    From this org
    $526,679
    From related orgs
    $0
    Other
    $39,903
    Hours/week
    45.2

    Schedule J breakdown matched by us

    Base
    $406,759
    Bonus
    $98,400
    Other
    $21,520
    Deferred
    $18,300
    Nontaxable benefits
    $21,603
    Filer's total
    $566,582

  • FRANKLIN CHEN MD

    TRUSTEE/CLINICAL PHYSICIAN EXECUTIVE

    Total calculated
    $706,125
    From this org
    $652,755
    From related orgs
    $0
    Other
    $53,370
    Hours/week
    45.2

    Schedule J breakdown matched by us

    Base
    $574,281
    Bonus
    $29,867
    Other
    $48,607
    Deferred
    $18,300
    Nontaxable benefits
    $35,070
    Filer's total
    $706,125

  • SAMUEL BAREFOOT

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • LARI HARDING

    CHAIR

    Total calculated
    $0
    Hours/week
    0.2 + 0.2 related

  • CHARLES HAUSER

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • MIKE HORN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • ROBERT LANDRY

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • LINDA LATHAM

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    0.2

  • CHRISTOPHER LEON

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • TRACEY MARTIN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • MARK OWENS

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • CHARLES WELTON

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • IMEN CLARK

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • AVERY HALL

    SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    0.2

  • WILLIAM HALL

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • FRED HARGETT

    EVP & CFO

    Total calculated
    $2,417,516
    From this org
    $0
    From related orgs
    $2,355,664
    Other
    $61,852
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,092,939 related
    Bonus
    $0 + $843,828 related
    Other
    $0 + $418,897 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $43,552 related
    Filer's total
    $0 + $2,417,516 related

  • MICHAEL SETLIFF

    PRESIDENT NHFMC & GWM

    Total calculated
    $1,177,550
    From this org
    $1,024,957
    From related orgs
    $0
    Other
    $152,593
    Hours/week
    50 + 0.2 related

    Schedule J breakdown matched by us

    Base
    $608,168
    Bonus
    $345,135
    Other
    $71,654
    Deferred
    $113,628
    Nontaxable benefits
    $38,965
    Filer's total
    $1,177,550

  • ALISHA HUTCHENS

    COO

    Total calculated
    $500,170
    From this org
    $448,808
    From related orgs
    $0
    Other
    $51,362
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $371,642
    Bonus
    $63,228
    Other
    $13,938
    Deferred
    $18,300
    Nontaxable benefits
    $33,062
    Filer's total
    $500,170

  • JOHN MANN

    PRES & COO

    Total calculated
    $1,140,029
    From this org
    $979,412
    From related orgs
    $0
    Other
    $160,617
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $596,981
    Bonus
    $322,622
    Other
    $59,809
    Deferred
    $112,545
    Nontaxable benefits
    $37,733 + $10,339 related
    Filer's total
    $1,129,690 + $10,339 related

  • ROLAND FRIEDMAN

    UROLOGIST

    Total calculated
    $1,029,299
    From this org
    $973,165
    From related orgs
    $0
    Other
    $56,134
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $323,031
    Bonus
    $555,893
    Other
    $94,241
    Deferred
    $18,300
    Nontaxable benefits
    $37,834
    Filer's total
    $1,029,299

  • KATHLEEN ELLIOTT

    ONCOLOGIST

    Total calculated
    $889,897
    From this org
    $833,763
    From related orgs
    $0
    Other
    $56,134
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $490,471
    Bonus
    $318,565
    Other
    $24,727
    Deferred
    $18,300
    Nontaxable benefits
    $37,834
    Filer's total
    $889,897

  • STANLEY FULLER

    SVP CHIEF CLINICAL OFFICER

    Total calculated
    $932,687
    From this org
    $790,038
    From related orgs
    $0
    Other
    $142,649
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $523,375
    Bonus
    $210,136
    Other
    $56,527
    Deferred
    $100,958
    Nontaxable benefits
    $41,691
    Filer's total
    $932,687

  • BRANDON CRAVEN

    UROLOGIST

    Total calculated
    $1,012,422
    From this org
    $734,434
    From related orgs
    $222,051
    Other
    $55,937
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $389,513
    Bonus
    $283,475
    Other
    $61,446 + $222,051 related
    Deferred
    $18,300
    Nontaxable benefits
    $37,637
    Filer's total
    $790,371 + $222,051 related

  • KIRSTEN ROYSTER

    FMR PRES & COO KMC (SEE SCHEDULE O)

    Total calculated
    $783,348
    From this org
    $689,224
    From related orgs
    $0
    Other
    $94,124
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $401,451
    Bonus
    $235,329
    Other
    $52,444
    Deferred
    $79,096
    Nontaxable benefits
    $15,028
    Filer's total
    $783,348

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

  • 1a · First-class or charter travel
  • 1a · Travel for companions
  • 1a · Discretionary spending account
  • 1a · Housing allowance or residence for personal use
  • 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 1A
FRINGE OR EXPENSE EXPLANATION FIRST-CLASS OR CHARTER TRAVEL: FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES FOR COMMERCIAL FLIGHTS. HOWEVER, CHARTER TRAVEL IS AVAILABLE TO CERTAIN EXECUTIVES, BOARD MEMBERS, AND APPROVED BUSINESS PERSONNEL MEETING APPLICABLE POLICY CRITERIA. TRAVEL FOR COMPANIONS: COMPANIONS ARE ALLOWED ON CERTAIN CHARTER FLIGHTS PAID FOR BY THE ORGANIZATION. IN THAT CASE, THE VALUE OF THE COMPANION'S FLIGHT IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. DISCRETIONARY SPENDING ACCOUNT: CERTAIN EXECUTIVES RECEIVE A DISCRETIONARY SPENDING ACCOUNT. THE DOLLAR AMOUNT IN THE ACCOUNT IS PRE-APPROVED BY THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD OF TRUSTEES. THE EXECUTIVE MAY DEFER THE AMOUNT TO A RETIREMENT ACCOUNT OR THE AMOUNT IS TREATED AS COMPENSATION AND IS SPREAD OUT OVER THE COURSE OF THE YEAR IN THE EXECUTIVE'S PAYCHECKS AS TAXABLE INCOME. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: WE PROVIDE TEMPORARY HOUSING ALLOWANCES IN CERTAIN EXECUTIVE RECRUITMENT AND RELOCATION PACKAGES. THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS.
PART I, LINE 3
THE FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH, AN INTEGRATED HEALTHCARE SYSTEM AND RELIES UPON NOVANT HEALTH, INC., THE PARENT ORGANIZATION, TO USE THE PROCESS DESCRIBED IN PART VI, LINE 15A/15B OF THIS RETURN TO ESTABLISH COMPENSATION FOR CERTAIN EXECUTIVES. THIS PROCESS ADHERES TO THE REQUIREMENTS SET FORTH TO SECURE THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, THE UTILIZATION OF THIRD-PARTY COMPARABILITY DATA SUCH AS PUBLISHED COMPENSATION SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION.
PART I, LINE 4B
PART I, LINES 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONE NONQUALIFIED FRANKLIN CHEN $11,800 BRANDON CRAVEN $11,522 KATHLEEN ELLIOT $10,793 ROLAND FRIEDMAN $11,015 STANLEY FULLER $11,326 FRED HARGETT $11,892 JOHN MANN $11,846 KIRSTEN ROYSTER $11,892 MICHAEL SETLIFF $31,278 EQUITY-BASED NONE
PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS:
THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. GENERALLY, ANNUAL CONTRIBUTIONS TO THE PLAN OR PAYMENTS TO PARTICIPANTS WILL BE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J. PRIOR TO MAKING THE CONTRIBUTIONS OR PAYMENTS, THE NOVANT HEALTH COMPENSATION AND LEADERSHIP COMMITTEE ("COMMITTEE") WILL APPROVE THE AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WILL APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. OTHERWISE, VESTING WILL OCCUR ON JANUARY 1ST OF EACH YEAR FOR THE APPROPRIATE CLASS-YEAR VESTING PERIOD. THE COMMITTEE REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS.

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

The 10 largest by cash amount. The API serves every itemized grant.

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.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

Related corporations and trusts

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

Provenance

Return type
form_990
Tax year
2022
Filed
14 November 2023
IRS schema version
2022v5.0
Source object
202333189349311278

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

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