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← HUMC MEDICAL OBSERVATION PA

Form 990 for tax year 2022

Filed by HUMC MEDICAL OBSERVATION PA.

Totals

Total revenue
$0
Total expenses
$2,000
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$0
Investment income
$0
Other revenue
$0
Total assets, end of year
$168,831
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$168,831
Program services expenses (Part IX)
$0
Management and general expenses
$2,000
Fundraising expenses
$0
Program service expenses (Part III)
$0

Program services were 0.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • JAMES CLARKE MD

    PRESIDENT - TRUSTEE

    Total calculated
    $1,138,204
    From this org
    $0
    From related orgs
    $1,095,555
    Other
    $42,649
    Hours/week
    2.5

    Schedule J breakdown matched by us

    Base
    $0 + $681,002 related
    Bonus
    $0 + $238,031 related
    Other
    $0 + $176,522 related
    Deferred
    $0 + $15,250 related
    Nontaxable benefits
    $0 + $27,399 related
    Filer's total
    $0 + $1,138,204 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

  • 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)

Pt I Line 3
PLEASE REFER TO OUR RESPONSE TO CORE FORM, PART VI, QUESTION 15A INCLUDED IN SCHEDULE O.
Pt I Line 4b
THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUAL(S) INCLUDES PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") AS THE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2022 FORM W-2 AS TAXABLE WAGES: JAMES CLARKE, MD, $107,141.

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.

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
2022
Filed
13 November 2023
IRS schema version
2022v5.0
Source object
202323179349302382

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