Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic Attach to Form 990.
medium right arrow graphic Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
NORTHSIDE HEALTH SERVICES INC
 
Employer identification number

58-1917328
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2022
Page 2

Schedule J (Form 990) 2022
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1ROBERT T QUATTROCCHI
PRESIDENT & CEO NSH, INC.
(i)

(ii)
0
-------------
1,487,319
0
-------------
3,450,000
0
-------------
29,224
0
-------------
0
0
-------------
33,658
0
-------------
5,000,201
0
-------------
0
2JORGE J HERNANDEZ
VP/ASST. SECRETARY
(i)

(ii)
0
-------------
595,133
0
-------------
331,873
0
-------------
33,213
0
-------------
0
0
-------------
22,992
0
-------------
983,211
0
-------------
0
3SHANNON BANNA
VP/CFO NSH, INC./ASST. TREASURER
(i)

(ii)
0
-------------
647,234
0
-------------
258,060
0
-------------
35,315
0
-------------
0
0
-------------
9,967
0
-------------
950,576
0
-------------
0
Schedule J (Form 990) 2022
Page 3

Schedule J (Form 990) 2022
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
PART I, LINE 4B MR. QUATTROCCHI HAS LED THE ORGANIZATION FOR MORE THAN TWENTY YEARS AS CEO AND FOR SEVENTEEN YEARS AS A SENIOR EXECUTIVE PRIOR TO BECOMING CEO. IN RECOGNITION OF HIS SUCCESSFUL LEADERSHIP AND EXTENDED TENURE, AND TO ENCOURAGE CONTINUATION OF THIS RELATIONSHIP, THE BOARD OF DIRECTORS HAS PROVIDED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") DESIGNED TO PROVIDE THE CEO WITH A SOURCE OF RETIREMENT INCOME. NORTHSIDE DOES NOT CONSIDER SERP PAYMENTS TO BE DEFERRED COMPENSATION FOR TAX REPORTING PURPOSES. THE SERP PAYMENTS ARE BASED ON A MATHEMATICAL FORMULA, PURSUANT TO A SIGNED CONTRACT, AND ARE REVIEWED AND ASSESSED PERIODICALLY FOR REASONABLENESS BY AN OUTSIDE CONSULTANT. THE COMPENSATION COMMITTEE AND FULL BOARD OF DIRECTORS APPROVE EACH PAYMENT BEFORE PAYMENT IS MADE. HOWEVER, NO FURTHER FUNDING OF THE SERP IS EXPECTED BASED ON ACTUARIAL PROJECTIONS. AS A RESULT, IN ORDER TO ASSIST FURTHER IN THE CEO'S RETENTION, THE COMPANY HAS ESTABLISHED AN ANNUAL RETENTION PROGRAM FOR THE CEO, PROVIDING FOR AN ANNUAL RETENTION INCENTIVE, BUT ONLY IF HE CONTINUES TO BE EMPLOYED ON THE LAST DAY OF EACH FISCAL YEAR, BEGINNING WITH THE FISCAL YEAR ENDING SEPTEMBER 30, 2021. NORTHSIDE DOES NOT CONSIDER THE RETENTION PAYMENTS TO BE DEFERRED COMPENSATION FOR TAX REPORTING PURPOSES. AS AN ADDITIONAL RETENTION INCENTIVE, THE BOARD OF DIRECTORS MAY DEFER A PORTION OF ANY ANNUAL BONUS PAYABLE TO THE CEO CONDITIONING PAYMENT OF THE DEFERRED PORTION ON THE CEO'S CONTINUED EMPLOYMENT AND SATISFACTION OF CERTAIN SPECIFIED ORGANIZATION METRICS.
PART II CERTAIN AMOUNTS REPORTED ON SCHEDULE J, PART II, COLUMN (B) MAY INCLUDE AMOUNTS FOR SERVICES PERFORMED IN A PRIOR CALENDAR YEAR BUT NOT DUE AND PAYABLE UNTIL THE ORGANIZATION'S CURRENT TAX YEAR.
Schedule J (Form 990) 2022

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