Civic Intelligence

Bifurcated System Resource Risk Retention Group Inc.

990 • Fiscal year 2022 • EIN 88-3919275

Oct 01, 2022 to Dec 31, 2022 • Filed on May 15, 2023

151 Meeting Street Suite 301Charleston, SC 29401

(609) 278-5415

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

92nd percentile

0.71x

Higher debt load relative to assets than 92% of similar nonprofits.

2022 filings • NTEE Y • $1M-$5M nonprofits • Source year 2022

Liabilities / Revenue

95th percentile

4.34x

Higher debt load relative to revenue than 95% of similar nonprofits.

2022 filings • NTEE Y • $1M-$5M nonprofits • Source year 2022

Net Margin

53rd percentile

12%

Higher net margin than 53% of similar nonprofits.

2022 filings • NTEE Y • $1M-$5M nonprofits • Source year 2022

Top Officer Pay

99th percentile

$1,240,672

Higher top officer pay than 99% of similar nonprofits.

Top officer pay equals 403.9% of source-year revenue.

2022 filings • NTEE Y • $1M-$5M nonprofits • Source year 2022

Asset Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2022

Revenue Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2022

Assets

$1,869,038

No earlier filing loaded for comparison.

Net Assets

$535,674

No earlier filing loaded for comparison.

Liabilities

$1,333,364

No earlier filing loaded for comparison.

Revenue

$307,188

No earlier filing loaded for comparison.

Expenses

$271,514

No earlier filing loaded for comparison.

Net Income

$35,674

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$4.0M$3.0M$2.0M$1.0M$0Assets 2022: $1,869,038Liabilities 2022: $1,333,364Net Assets 2022: $535,6742022Assets 2023: $2,616,204Liabilities 2023: $1,221,463Net Assets 2023: $1,394,7412023Assets 2024: $3,527,585Liabilities 2024: $2,038,568Net Assets 2024: $1,489,0172024

Highlighted filing

2022

Assets$1,869,038
Liabilities$1,333,364
Net Assets$535,674

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$1.5M$1.0M$500K$0Revenue 2022: $307,188Expenses 2022: $271,514Net Income 2022: $35,6742022Revenue 2023: $1,260,363Expenses 2023: $401,296Net Income 2023: $859,0672023Revenue 2024: $1,414,760Expenses 2024: $1,320,484Net Income 2024: $94,2762024

Highlighted filing

2022

Revenue$307,188
Expenses$271,514
Net Income$35,674
Jump To
Filing Snapshot
Filing Period
Oct 1, 2022 to Dec 31, 2022
Signed
May 15, 2023
Return Version
2022v5.0
Gross Receipts
$307,188
Mission and Program Overview

Mission

Operates as a risk retention group under the federal liability risk retention act of 1986 to the capital health system, inc. And affiliates; an irc section 501(c)(3) tax-exempt integrated healthcare delivery system.

OPERATES AS A RISK RETENTION GROUP UNDER the Federal Liability Risk Retention Act of 1986 to CAPITAL HEALTH SYSTEM & AFF; an irc 501(c)(3) tax-exempt healthcare DELIVERY SYSTEM

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$0$1,718,621▲ $1,718,621
Pd in Cap Srpls Land Bldg Eqp Fund$0$500,000▲ $500,000
Prepaid Expenses and Deferred Charges$0$150,417▲ $150,417
Rtn Earn Endowment Incm Other Fnds$0$35,674▲ $35,674
Cash and Non-Interest-Bearing Accounts$0$0→ $0
Accounts Receivable$0$0→ $0
Other Notes and Loans Receivable, Net$0$0→ $0
Pledges and Grants Receivable$0$0→ $0
Receivable From Disqualified Prsn$0$0→ $0
Receivables From Officers Etc$0$0→ $0
Investments Other Securities$0$0→ $0
Investments Program Related$0$0→ $0
Investments in Publicly Traded Securities$0$0→ $0
Land, Buildings, and Equipment, Net$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Loans From Officers Directors$0$0→ $0
Total Assets$0$1,869,038▲ $1,869,038
Other Assets Total$0$0→ $0
Liabilities
Other Liabilities$0$1,290,864▲ $1,290,864
Accounts Payable and Accrued Expenses$0$42,500▲ $42,500
Grants Payable$0$0→ $0
Mortgage Notes Payable Secured by Investment Property$0$0→ $0
Unsecured Notes Loans Payable$0$0→ $0
Deferred Revenue$0$0→ $0
Escrow Account Liability$0$0→ $0
Tax Exempt Bond Liabilities$0$0→ $0
Total Liabilities$0$1,333,364▲ $1,333,364
Net Assets / Fund Balance
Total Net Assets Fund Balance$0$535,674▲ $535,674
Total Liabilities and Net Assets / Fund Balance$0$1,869,038▲ $1,869,038
Compensation and Service Providers

Board Members and Trustees

NameTitle
Stephen a Miller JdPresident - Director
Virginia AdrihanVice President - Director
Rafael VillalobosSecretary - Director
Shane F Fleming CPATreasurer - Director
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$307,188
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$35,674

Audited Revenue Reconciliation

Revenue per Audited Statements
$307,188
Total Revenue per Audited Statements
$307,188
Total Revenue per Form 990
$307,188
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$271,514
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Management$0$79,583$0$79,583
Other Expenses$144,000$47,931-$47,931
Total Functional Expenses$144,000$127,514$0$271,514

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$271,514
Total Expenses per Audited Statements$271,514
Total Expenses per Form 990$271,514
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Fundraising Direct Expenses$0
Fundraising Gross Income$0
Gaming Direct Expenses$0
Gaming Gross Income$0
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Receivables from Disqualified Persons$0$0→ $0
Receivables from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Unearned Premium Reserve$911,546
Due to Affiliate$235,318
Loss and Loss Adj Expenses$144,000
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
Yes
Other officer compensation reviewed
Yes
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
Yes

Governance Explanations

CORE FORM, PART I, LINES 3 & 4 & PART VI, SECTION A; Q'S 1A & 1B

This organization is an affiliate within the Capital Health System, Inc. and affiliates; a tax-exempt integrated healthcare delivery system ("system"). Capital Healthcare, Inc. is the tax-exempt parent entity of the system. Although this federal form 990 shows a minority of independent members of the organization's governing body under the internal revenue code definition, this organization acts in a charitable tax-exempt manner for purposes of internal revenue code section 501(c)(3) and whose sole member is Capital Health System, Inc. ("CHS"); an internal revenue code section 501(c)(3) tax-exempt organization. Capital Healthcare, Inc.; the tax-exempt parent of the system, has a board of trustees; the majority of which are independent. The Capital Healthcare, Inc.'s Board has the overarching duty and responsibility for governing all affiliates within the system to ensure that they are operating in accordance with and supporting the system's charitable mission in providing medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin or ability to pay.

CORE FORM, PART VI, SECTION A; QUESTION 3

Virginia adrihan, vice president-director, is employed by marsh management services, inc., the firm that provides captive management services to bifurcated system resource risk retention group, inc. A portion of their compensation may be allocable to work performed for the bifurcated system resource risk retention group, inc.

CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7

Capital health system, inc. Has the controlling membership interest in the bifurcated system resource risk retention group, inc. Capital health system, inc. And capital healthcare, inc. Are members of the bifurcated system resource risk retention group, inc. Capital health system, inc. Exempt affiliates can be issued regular membership interests. Capital health system, inc., as the controlling member, has the sole right and authority to appoint the members of the board of directors. Bifurcated system resource risk retention group, inc.'s board of directors reports to capital health system, inc., the controlling member. Certain decisions of the bifurcated system resource risk retention group, inc. Are subject to the approval of capital health system, inc. Inc. Are subject to the approval of capital health system, inc.

CORE FORM, PART VI, SECTION B; QUESTION 11B

The organization is an affiliate within capital health system and affiliates ("system"); a tax-exempt integrated healthcare delivery system which includes capital health system, inc. Capital healthcare, inc. Is the tax-exempt parent entity of the system. This organization's federal form 990 was provided to each voting member of its governing body (its board of directors) prior to filing with the internal revenue service ("irs"). In addition, the capital health system, inc. Compensation committee performed a detailed review of the federal form 990 prior to providing it to each voting member of this organization's board of directors. The organization's board of directors has delegated to the capital health system, inc. Compensation committee the responsibility to oversee and coordinate the federal form 990 preparation, review and filing process for the tax-exempt affiliates of the system. As part of the organization's federal form 990 tax return preparation process the organization hired a professional certified public accounting ("cpa") firm with experience and expertise in both healthcare and not-for-profit tax return preparation to prepare the federal form 990. The cpa firm's tax professionals worked closely with the system's chief financial officer, chief compliance officer and various other individuals of the system ("internal working group") to obtain the information needed in order to prepare a complete and accurate tax return. The cpa firm prepared a draft federal form 990 and furnished it to the organization's internal working group for review. The organization's internal working group reviewed the draft federal form 990 and discussed questions and comments with the cpa firm. In addition, the organization's external independent compensation consulting firm reviewed the draft federal form 990, part vii and schedule j. Revisions were made to the draft federal form 990 where necessary and a final draft was furnished by the cpa firm to the organization's internal working group for final review and approval prior to providing it to the members of the capital health system, inc. Compensation committee and to each voting member of this organization's governing body prior to filing with the irs.

CORE FORM, PART VI, SECTION B; QUESTION 12

The organization is an affiliate within capital health system and affiliates ("system"); a tax-exempt integrated healthcare delivery system. Capital healthcare, inc. Is the tax-exempt parent entity of the system. The organization and the system regularly monitor and enforce compliance with its conflict of interest policy. Annually all members of the board of directors, officers and senior management personnel are required to review the existing conflict of interest policy and complete a questionnaire. The completed questionnaires are returned to the organization and both the system's senior vice president/chief legal officer and chief compliance officer for review. Thereafter the chief compliance officer prepares a summary of the completed questionnaires which contains information disclosed on an individual by individual basis. The system's chief compliance officer then presents this summary to the system's full board of directors for its review and discussion. This summary is updated by the chief compliance officer on a quarterly basis.

CORE FORM, PART VI, SECTION B; QUESTION 15

The organization is an affiliate within capital health system and affiliates ("system"); a tax-exempt integrated healthcare delivery system which includes capital health system, inc. ("chs"). This filing organization itself has no paid senior management personnel receiving compensation directly from this organization. Rather, key senior management personnel, including the president/chief executive officer, are employed by chs; the tax-exempt hospital within the healthcare system. However, the compensation and benefits of these individuals are shown on this tax return because they are also either officers and/or board members of this organization. Accordingly, the hospital's board of directors has an executive compensation committee ("committee"). The committee has adopted a written executive compensation philosophy which it follows when it reviews and approves of the compensation and benefits of all of the organization's senior management and others, including the chief executive officer, chief financial officer and other officers of the organization, physicians, and any other disqualified persons. It also reviews and approves employment agreements for the covered employees and disqualified persons. The committee reviews the "total compensation" of the individuals which is intended to include both current and deferred compensation and all employee benefits, both qualified and non-qualified. The committee's review is done on at least an annual basis and ensures that the "total compensation" of each such individual is reasonable. The actions taken by the committee are intended for the organization to qualify for the rebuttable presumption of reasonableness for purposes of internal revenue code section 4958 with respect to the total compensation of the senior management team. Rebuttal presumption requirements have guided the activities of the committee in all of its reviews, deliberations and approval of executive compensation actions for all of the covered employees and disqualified persons. The three factors which must be satisfied in order to receive the rebuttable presumption of reasonableness are the following: 1. The compensation arrangement is approved in advance by an "authorized body" of the applicable tax-exempt organization which is composed entirely of individuals who do not have a "conflict of interest" with respect to the compensation arrangement; 2. The authorized body obtained and relied upon "appropriate data as to comparability" prior to making its determination; and 3. The authorized body "adequately documented the basis for its determination" concurrently with making that determination. The committee is comprised of members of the board of directors each of whom is independent and are free from any conflicts of interest. The committee relied upon comparability market data provided by its independent compensation consultant from comparable healthcare and hospital peers based on tax-exempt status, revenue, location, services, and other factors to ensure the executives' compensation is representative of the executive talent market and compared to what is "ordinarily paid for like services by like enterprises under like circumstances" as referenced under irs regulations. Contemporaneous minutes are compiled and approved for all committee deliberations. These are supported by the written documentation of all peer and market compensation studies, as well as detailed performance justification used as the basis for awards under the organization's incentive programs. Recognizing the need to consider retirement planning for its senior management as a means to aid in their retention, the committee maintains a form of long-term non-qualified deferred compensation (referred to as the "performance-based capital accumulation plan", or "pbcap"), which is part of the capital health system non-qualified 457(f) deferred compensation plan. Pbcap provides the organization with an additional tool to assist in the recruitment and re

CORE FORM, PART VI, SECTION C; QUESTION 19

The organization does not make its governing documents, conflict of interest policy, and financial statements available to the public.

Core Form, Part VII and Schedule J

The organization does not compensate its board members for their services performed as a director. All directors are volunteers. Compensation and benefits, where applicable for certain members, is related to the board member's services performed as a full-time employee or independent contractor of capital health system, inc.; a related internal revenue code section 501(c)(3) tax-exempt organization.

Core Form, Part VII, Section A, Column B

This organization is an affiliate within capital health system and affiliates; a tax-exempt integrated healthcare delivery system ("system"). The system includes both for-profit and not for-profit organizations. Certain board of director members, officers and/or directors listed on core form, part vii and schedule j of this form 990 may hold similar positions with both this organization and other affiliates within the system. The hours shown on this form 990, for board members who receive no compensation for services rendered in a non-board capacity, represent the estimated hours devoted per week for this organization. To the extent these individuals serve as a member of the board of directors of other related organizations in the system, their respective hours per week per organization are approximately the same as reflected in core form, part vii of this form 990. The hours reflected on core form, part vii of this form 990, for board members who receive compensation for services rendered in a non-board capacity, paid officers and key employees, reflect total hours worked per week on behalf of capital health system and affiliates; not solely this organization.

Filing and Contact Details

Filer

Filer Name
Bifurcated System Resource Risk Retention
EIN
88-3919275
In Care Of
% SHANE F FLEMING CPA
Phone
6092785415
Address
151 MEETING STREET SUITE 301, CHARLESTON, SC 29401

Signing Officer

Name
Shane F Fleming
Title
SVP, CFO
Phone
6092785415
Signed
2023-05-15
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Stephen a Miller Jd
Formed
2022
Legal Domicile
Sc
Voting Board Members
4
Independent Board Members
1
Employees
0
Volunteers
0

Preparer

Firm
WithumSmithBrown PC
Address
200 Jefferson Park Suite 400, Whippany, NJ 07981-1070
Preparer
Scott J Mariani
Phone
9738989494
Supplemental Narrative

Additional Explanations

CORE FORM, PART V; QUESTION 15

Shane f. Fleming, cpa is listed as an officer on this form 990. This is his sole role with the organization. He provides no services to or for the organization and is not involved in the management or day to day activities of this organization. Mr. Fleming is employed by a related organization and works full time in this capacity for capital health system, inc. Accordingly his common law employer/employee relationship is with capital health system, inc. (ein: 22-3548695). Capital health system, inc. Filed a 2022 form 4720 which included a remittance of excise tax related to mr. Fleming's compensation in excess of $1m.

CORE FORM, PART XI; QUESTION 9

Other changes in net assets or fund balance includes: - capital contribution from affiliated internal revenue code section 501(c)(3) tax-exempt organizations - $500,000.

CORE FORM, PART XII; QUESTION 2

The organization is an affiliate within capital health system and affiliates; a tax-exempt integrated healthcare delivery system ("system") which includes capital health system, inc. The system's tax-exempt parent entity is capital healthcare, inc. An independent cpa firm audited the consolidated financial statements of capital health system, inc. And all affiliates for the years ended december 31, 2022 and december 31, 2021; respectively and issued a consolidated financial statement with consolidating schedules by entity. An unmodified opinion was issued each year by the independent cpa firm. Capital health system's audit committee assumes responsibility for oversight of the audit of its consolidated financial statements and the selection of an independent auditor. In addition, an independent cpa firm audited the financial statements of bifurcated system resource risk retention group, inc. For the year ended december 31, 2022. The independent cpa firm issued an unmodified opinion with respect to the audited financial statements. The bifurcated system resource risk retention group, inc.'s board of directors has assumed responsibility for the oversight of the audit of the financial statements, and the selection of an independent auditor.

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IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt0BIFURCATED SYSTEM RESOURCE RISK RETENTION GROUP, INC.'S PRIMARY PURPOSE IS TO SUPPORT THE CHARITABLE PURPOSES OF THE CAPITAL HEALTH SYSTEM, INC. AND AFFILIATES, EACH OF WHICH IS EXEMPT FROM FEDERAL INCOME TAX AND IS A CORPORATION OF THE TYPE DESCRIBED IN SECTION 501(C)(3) OF THE CODE, BY PROVIDING INSURANCE AND/OR CLAIMS DEFENSE, ADMINISTRATION, AND INDEMNITY TO, OR IN RESPECT OF, RISKS PRESENTED BY AND ACTIVITIES ENGAGED IN BY THE CAPITAL HEALTH SYSTEM, INC., AND/OR THE CAPITAL HEALTH SYSTEM EXEMPT AFFILIATES, TOGETHER WITH THEIR RESPECTIVE EMPLOYEES AND OTHERS PROVIDING SERVICES ON BEHALF OF AND WITHIN THE SCOPE OF THE EXEMPT ACTIVITIES ENGAGED IN BY CAPITAL HEALTH SYSTEM, INC., AND/OR THE CAPITAL HEALTH SYSTEM EXEMPT AFFILIATES. THE SUPPORTED ORGANIZATION IS LISTED BY NAME ON THE BIFURCATED SYSTEM RESOURCE RISK RETENTION GROUP, INC.'S INSURANCE POLICIES.
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IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0THE ORGANIZATION IS AN AFFILIATE WITHIN CAPITAL HEALTH SYSTEM AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES CAPITAL HEALTH SYSTEM, INC. ("CHS"). THIS FILING ORGANIZATION ITSELF HAS NO PAID SENIOR MANAGEMENT PERSONNEL RECEIVING COMPENSATION DIRECTLY FROM THIS ORGANIZATION. RATHER, KEY SENIOR MANAGEMENT PERSONNEL, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER, ARE EMPLOYED BY CHS; THE TAX-EXEMPT HOSPITAL WITHIN THE HEALTHCARE SYSTEM. HOWEVER, THE COMPENSATION AND BENEFITS OF THESE INDIVIDUALS ARE SHOWN ON THIS TAX RETURN BECAUSE THEY ARE ALSO EITHER OFFICERS AND/OR BOARD MEMBERS OF THIS ORGANIZATION. ACCORDINGLY, THE HOSPITAL'S BOARD OF DIRECTORS HAS AN EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES OF THE COMPENSATION AND BENEFITS OF ALL OF THE ORGANIZATION'S SENIOR MANAGEMENT AND OTHERS, INCLUDING THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND OTHER OFFICERS OF THE ORGANIZATION, PHYSICIANS, AND ANY OTHER DISQUALIFIED PERSONS. IT ALSO REVIEWS AND APPROVES EMPLOYMENT AGREEMENTS FOR THE COVERED EMPLOYEES AND DISQUALIFIED PERSONS. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF EACH SUCH INDIVIDUAL IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ARE INTENDED FOR THE ORGANIZATION TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF THE SENIOR MANAGEMENT TEAM. REBUTTAL PRESUMPTION REQUIREMENTS HAVE GUIDED THE ACTIVITIES OF THE COMMITTEE IN ALL OF ITS REVIEWS, DELIBERATIONS AND APPROVAL OF EXECUTIVE COMPENSATION ACTIONS FOR ALL OF THE COVERED EMPLOYEES AND DISQUALIFIED PERSONS. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF DIRECTORS EACH OF WHOM IS INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON COMPARABILITY MARKET DATA PROVIDED BY ITS INDEPENDENT COMPENSATION CONSULTANT FROM COMPARABLE HEALTHCARE AND HOSPITAL PEERS BASED ON TAX-EXEMPT STATUS, REVENUE, LOCATION, SERVICES, AND OTHER FACTORS TO ENSURE THE EXECUTIVES' COMPENSATION IS REPRESENTATIVE OF THE EXECUTIVE TALENT MARKET AND COMPARED TO WHAT IS "ORDINARILY PAID FOR LIKE SERVICES BY LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES" AS REFERENCED UNDER IRS REGULATIONS. CONTEMPORANEOUS MINUTES ARE COMPILED AND APPROVED FOR ALL COMMITTEE DELIBERATIONS. THESE ARE SUPPORTED BY THE WRITTEN DOCUMENTATION OF ALL PEER AND MARKET COMPENSATION STUDIES, AS WELL AS DETAILED PERFORMANCE JUSTIFICATION USED AS THE BASIS FOR AWARDS UNDER THE ORGANIZATION'S INCENTIVE PROGRAMS. RECOGNIZING THE NEED TO CONSIDER RETIREMENT PLANNING FOR ITS SENIOR MANAGEMENT AS A MEANS TO AID IN THEIR RETENTION, THE COMMITTEE MAINTAINS A FORM OF LONG-TERM NON-QUALIFIED DEFERRED COMPENSATION (REFERRED TO AS THE "PERFORMANCE-BASED CAPITAL ACCUMULATION PLAN", OR "PBCAP"), WHICH IS PART OF THE CAPITAL HEALTH SYSTEM NON-QUALIFIED 457(F) DEFERRED COMPENSATION PLAN. PBCAP PROVIDES THE ORGANIZATION WITH AN ADDITIONAL TOOL TO ASSIST IN THE RECRUITMENT AND RE
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt1THE ORGANIZATION MAINTAINS THE CAPITAL HEALTH SYSTEM NON-QUALIFIED 457(F) DEFERRED COMPENSATION PLAN (THE "457(F) PLAN"), WHICH IS A NONQUALIFIED DEFERRED COMPENSATION PLAN THAT SATISFIES THE REQUIREMENTS OF SECTION 457(F) OF THE INTERNAL REVENUE CODE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F) PLAN AND ACCRUED ADDITIONAL DEFERRED COMPENSATION IN 2022 THAT IS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE - SHANE F. FLEMING, CPA, $177,453 AND STEPHEN A. MILLER, JD, $82,000. THESE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THESE UNVESTED AMOUNTS. ACCORDINGLY, THESE UNVESTED AMOUNTS HAVE NOT BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AND WERE NOT REPORTED ON EACH INDIVIDUAL'S 2022 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES.
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt2CERTAIN INDIVIDUALS LISTED IN PART VII, SECTION A, LINE 1A RECEIVED INCENTIVE AWARDS DURING CALENDAR YEAR 2022, WHICH INCENTIVE AWARDS ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B(II) AND WERE REPORTED ON EACH SUCH INDIVIDUAL'S 2022 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. THESE INCENTIVE AWARDS WERE PAID UNDER THE CAPITAL HEALTH INCENTIVE COMPENSATION PLAN ("ICP"), APPROVED BY THE BOARD COMPENSATION COMMITTEE, AND BASED ON ACHIEVEMENT OF PRE-ESTABLISHED SYSTEM-WIDE PERFORMANCE CRITERIA AND METRICS, AS WELL AS MEETING OR EXCEEDING SPECIFIC PERFORMANCE ON "CIRCUIT BREAKERS." THE ICP PROVIDES ELIGIBLE EXECUTIVES WITH THE OPPORTUNITY TO EARN PERFORMANCE BASED COMPENSATION AND IS AN INTEGRAL COMPONENT OF THE ORGANIZATION'S EXECUTIVE COMPENSATION PACKAGE. THE BOARD COMPENSATION COMMITTEE USES THE ICP AS A MECHANISM TO REWARD PERFORMANCE AGAINST ESTABLISHED KEY PERFORMANCE REQUIREMENTS. THE GOALS COVER FINANCIAL AND OPERATIONAL METRICS AND ARE DEFINED EACH YEAR, BASED ON THE DESIRED CONCENTRATION REQUIRED BY THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE UNDERTAKES A MID-YEAR REVIEW OF PERFORMANCE TOWARDS ACHIEVEMENT OF EACH GOAL, WHICH ALLOWS THE BOARD COMPENSATION COMMITTEE TO MONITOR HOW KEY PROJECTS ARE BEING HANDLED AND TO MAKE ADJUSTMENTS, IF NECESSARY. PLEASE REFER TO SCHEDULE J, PART II, COLUMN B(II) FOR THIS INFORMATION BY PERSON AND BY AMOUNT.
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0This organization is an affiliate within the Capital Health System, Inc. and affiliates; a tax-exempt integrated healthcare delivery system ("system"). Capital Healthcare, Inc. is the tax-exempt parent entity of the system. Although this federal form 990 shows a minority of independent members of the organization's governing body under the internal revenue code definition, this organization acts in a charitable tax-exempt manner for purposes of internal revenue code section 501(c)(3) and whose sole member is Capital Health System, Inc. ("CHS"); an internal revenue code section 501(c)(3) tax-exempt organization. Capital Healthcare, Inc.; the tax-exempt parent of the system, has a board of trustees; the majority of which are independent. The Capital Healthcare, Inc.'s Board has the overarching duty and responsibility for governing all affiliates within the system to ensure that they are operating in accordance with and supporting the system's charitable mission in providing medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin or ability to pay.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1SHANE F. FLEMING, CPA IS LISTED AS AN OFFICER ON THIS FORM 990. THIS IS HIS SOLE ROLE WITH THE ORGANIZATION. HE PROVIDES NO SERVICES TO OR FOR THE ORGANIZATION AND IS NOT INVOLVED IN THE MANAGEMENT OR DAY TO DAY ACTIVITIES OF THIS ORGANIZATION. MR. FLEMING IS EMPLOYED BY A RELATED ORGANIZATION AND WORKS FULL TIME IN THIS CAPACITY FOR CAPITAL HEALTH SYSTEM, INC. ACCORDINGLY HIS COMMON LAW EMPLOYER/EMPLOYEE RELATIONSHIP IS WITH CAPITAL HEALTH SYSTEM, INC. (EIN: 22-3548695). CAPITAL HEALTH SYSTEM, INC. FILED A 2022 FORM 4720 WHICH INCLUDED A REMITTANCE OF EXCISE TAX RELATED TO MR. FLEMING'S COMPENSATION IN EXCESS OF $1M.

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