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Nonprofiteer
← FORSYTH MEDICAL CENTER FOUNDATION

Form 990 for tax year 2023

Filed by FORSYTH MEDICAL CENTER FOUNDATION.

Totals

Total revenue
$5,595,810
Total expenses
$4,708,949
Contributions and grants received
$3,967,017
Grants paid
$3,974,213
Program services expenses (Part IX)
$4,114,699
Management and general expenses
$375,863
Fundraising expenses
$218,387
Program service expenses (Part III)
$4,114,699

Program services were 87.4% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • ANDREA GENDRACHI

    TRUSTEE (FR 1/1/23)

    Total calculated
    $0
    Hours/week
    0.2

  • ANDREW SCHNEIDER MD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • BONNIE DONAHUE

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • CHARLES BLIXT

    TRUSTEE (FR 1/1/23)

    Total calculated
    $0
    Hours/week
    0.2

  • DAMON PRATT

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • DAVID BAILEY

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • ELIZABETH MADDEN

    TRUSTEE, CHAIR (TO 12/6/23)

    Total calculated
    $0
    Hours/week
    0.2

  • ELMS ALLEN MD

    TRUSTEE (TO 12/31/23)

    Total calculated
    $0
    Hours/week
    0.2

  • EVA WU

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • GARY ORTIZ

    TRUSTEE (FR 1/1/23)

    Total calculated
    $0
    Hours/week
    0.2

  • GWENDOLYN CLEMENTS

    TRUSTEE (FR 1/1/23)

    Total calculated
    $0
    Hours/week
    0.2

  • JALEEMA SPEAKS MD

    TRUSTEE/OBSTETRICIAN/GYNECOLOGIST

    Total calculated
    $473,367
    From this org
    $0
    From related orgs
    $418,675
    Other
    $54,692
    Hours/week
    0.2 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $281,876 related
    Bonus
    $0 + $127,896 related
    Other
    $0 + $8,903 related
    Deferred
    $0 + $17,504 related
    Nontaxable benefits
    $0 + $37,188 related
    Filer's total
    $0 + $473,367 related

  • JOHN CARD MD

    TRUSTEE,CHAIR (FR 12/6/23)/INTERNIST

    Total calculated
    $505,107
    From this org
    $0
    From related orgs
    $459,157
    Other
    $45,950
    Hours/week
    0.2 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $349,484 related
    Bonus
    $0 + $26,936 related
    Other
    $0 + $82,737 related
    Deferred
    $0 + $19,800 related
    Nontaxable benefits
    $0 + $26,150 related
    Filer's total
    $0 + $505,107 related

  • JOHN WOLFE

    TRUSTEE (FR 1/1/23)

    Total calculated
    $0
    Hours/week
    0.2

  • JOHN-MARK MITCHELL

    TRUSTEE (FR 1/1/23)

    Total calculated
    $0
    Hours/week
    0.2

  • JOSEPH ELY

    TRUSTEE, VICE CHAIR (TO 12/6/23)

    Total calculated
    $0
    Hours/week
    0.2 + 0.2 related

  • JOSEPH LOGAN

    TRUSTEE, VICE CHAIR (FR 12/6/23)

    Total calculated
    $0
    Hours/week
    0.2

  • LARRY PULLIAM

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • MARY FOWLER

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • ROLLAND BARRETT MD

    TRUSTEE/CLIN ETHICS MED ED CONSULT

    Total calculated
    $2,016
    From this org
    $0
    From related orgs
    $2,016
    Other
    $0
    Hours/week
    0.2 + 0.2 related

  • RONNIE WILLARD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • SHERRY POLONSKY

    TREAS

    Total calculated
    $0
    Hours/week
    0.2

  • STEPHANIE FLORES DE VALGAZ

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.2

  • TADELRO BROWN

    SECR

    Total calculated
    $0
    Hours/week
    0.2

  • THOMAS GROTE MD

    TRUSTEE/ONCOLOGIST

    Total calculated
    $777,667
    From this org
    $0
    From related orgs
    $732,259
    Other
    $45,408
    Hours/week
    0.2 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $591,521 related
    Bonus
    $0 + $103,783 related
    Other
    $0 + $36,955 related
    Deferred
    $0 + $19,800 related
    Nontaxable benefits
    $0 + $25,608 related
    Filer's total
    $0 + $777,667 related

  • DOROTHY ANN CAULKINS

    SVP FDN

    Total calculated
    $836,987
    From this org
    $0
    From related orgs
    $725,233
    Other
    $111,754
    Hours/week
    8 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $362,587 related
    Bonus
    $0 + $272,742 related
    Other
    $0 + $89,904 related
    Deferred
    $0 + $78,889 related
    Nontaxable benefits
    $0 + $32,865 related
    Filer's total
    $0 + $836,987 related

  • FRED HARGETT

    EVP/CFO (TO 9/6/23)

    Total calculated
    $2,451,375
    From this org
    $0
    From related orgs
    $2,400,670
    Other
    $50,705
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $886,648 related
    Bonus
    $0 + $1,074,292 related
    Other
    $0 + $439,730 related
    Deferred
    $0 + $19,800 related
    Nontaxable benefits
    $0 + $30,905 related
    Filer's total
    $0 + $2,451,375 related

  • GEOFFREY GARDNER

    CFO (FR 9/6/23)

    Total calculated
    $1,037,855
    From this org
    $0
    From related orgs
    $909,106
    Other
    $128,749
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $496,309 related
    Bonus
    $0 + $343,441 related
    Other
    $0 + $69,356 related
    Deferred
    $0 + $98,858 related
    Nontaxable benefits
    $0 + $29,891 related
    Filer's total
    $0 + $1,037,855 related

  • HEATHER EGAN

    EXEC DIRECTOR

    Total calculated
    $213,028
    From this org
    $167,236
    From related orgs
    $0
    Other
    $45,792
    Hours/week
    25 + 25 related

    Schedule J breakdown matched by us

    Base
    $152,953
    Bonus
    $13,290
    Other
    $993
    Deferred
    $9,699
    Nontaxable benefits
    $36,093
    Filer's total
    $213,028

  • KIMBERLY HENDERSON

    FMR OFFICER (12/31/19)

    Total calculated
    $1,241,092
    From this org
    $0
    From related orgs
    $1,085,117
    Other
    $155,975
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $620,747 related
    Bonus
    $0 + $346,188 related
    Other
    $0 + $118,182 related
    Deferred
    $0 + $125,670 related
    Nontaxable benefits
    $0 + $30,305 related
    Filer's total
    $0 + $1,241,092 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

  • 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
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 DOROTHY CAULKINS $43,170 GEOFFREY GARDNER $25,993 KIMBERLY HENDERSON $66,932 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, INCLUDING THE AMOUNTS AWARDED UNDER THIS SERP.

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.

Provenance

Return type
form_990
Tax year
2023
Filed
14 November 2024
IRS schema version
2023v5.1
Source object
202433199349310553

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

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