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Nonprofiteer
← SAINT AGNES MEDICAL CENTER

Form 990 for tax year 2022

Filed by SAINT AGNES MEDICAL CENTER.

Totals

Total revenue
$624,845,192
Total expenses
$681,144,137
Contributions and grants received
$7,347,889
Grants paid
$1,073,219
Program services expenses (Part IX)
$631,304,013
Management and general expenses
$49,196,781
Fundraising expenses
$643,343
Program service expenses (Part III)
$631,304,013

Program services were 92.7% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • BENJAMIN CARTER

    DIRECTOR AS OF 4/23; TRINITY COO

    Total calculated
    $2,857,735
    From this org
    $0
    From related orgs
    $2,758,940
    Other
    $98,795
    Hours/week
    2 + 53 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,408,317 related
    Bonus
    $0 + $910,000 related
    Other
    $0 + $440,623 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $80,495 related
    Filer's total
    $0 + $2,857,735 related

  • ODETTE BOLANO

    DIRECTOR, CEO WEST REGION AS OF 5/23

    Total calculated
    $1,365,821
    From this org
    $0
    From related orgs
    $1,142,266
    Other
    $223,555
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $672,223 related
    Bonus
    $0 + $301,500 related
    Other
    $0 + $168,543 related
    Deferred
    $0 + $187,255 related
    Nontaxable benefits
    $0 + $36,300 related
    Filer's total
    $0 + $1,365,821 related

  • SHERI SHAPIRO

    DIRECTOR, TRINITY SVP THROUGH 3/23

    Total calculated
    $1,345,804
    From this org
    $0
    From related orgs
    $1,293,472
    Other
    $52,332
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $756,441 related
    Bonus
    $0 + $337,500 related
    Other
    $0 + $199,531 related
    Deferred
    $0 + $13,725 related
    Nontaxable benefits
    $0 + $38,607 related
    Filer's total
    $0 + $1,345,804 related

  • NANCY HOLLINGSWORTH

    DIRECTOR, PRESIDENT & CEO THR 5/23

    Total calculated
    $959,209
    From this org
    $0
    From related orgs
    $892,175
    Other
    $67,034
    Hours/week
    54 + 1 related

    Schedule J breakdown matched by us

    Base
    $0 + $546,933 related
    Bonus
    $0 + $192,500 related
    Other
    $0 + $152,742 related
    Deferred
    $0 + $22,875 related
    Nontaxable benefits
    $0 + $44,159 related
    Filer's total
    $0 + $959,209 related

  • DAVID SPIVEY

    DIR, INT PRES AS OF 6/23; TH CONS

    Total calculated
    $951,519
    From this org
    $0
    From related orgs
    $887,462
    Other
    $64,057
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $0 + $554,152 related
    Bonus
    $0 + $186,604 related
    Other
    $0 + $146,706 related
    Deferred
    $0 + $22,875 related
    Nontaxable benefits
    $0 + $41,182 related
    Filer's total
    $0 + $951,519 related

  • W EUGENE EGERTON MD

    CHIEF MEDICAL OFFICER THR 1/23

    Total calculated
    $650,071
    From this org
    $0
    From related orgs
    $604,133
    Other
    $45,938
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $471,694 related
    Bonus
    $0 + $93,852 related
    Other
    $0 + $38,587 related
    Deferred
    $0 + $13,725 related
    Nontaxable benefits
    $0 + $32,213 related
    Filer's total
    $0 + $650,071 related

  • STACY VAILLANCOURT

    CHIEF OPERATING OFFICER

    Total calculated
    $516,517
    From this org
    $0
    From related orgs
    $473,326
    Other
    $43,191
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $364,360 related
    Bonus
    $0 + $73,308 related
    Other
    $0 + $35,658 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $24,891 related
    Filer's total
    $0 + $516,517 related

  • DEANETTE SISSON

    CHIEF NURSING OFFICER

    Total calculated
    $438,409
    From this org
    $0
    From related orgs
    $398,768
    Other
    $39,641
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $311,327 related
    Bonus
    $0 + $63,013 related
    Other
    $0 + $24,428 related
    Deferred
    $0 + $13,725 related
    Nontaxable benefits
    $0 + $25,916 related
    Filer's total
    $0 + $438,409 related

  • RICK WOLF

    SECRETARY; ASSOCIATE COUNSEL

    Total calculated
    $379,630
    From this org
    $0
    From related orgs
    $335,788
    Other
    $43,842
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $289,654 related
    Bonus
    $0 + $29,543 related
    Other
    $0 + $16,591 related
    Deferred
    $0 + $13,725 related
    Nontaxable benefits
    $0 + $30,117 related
    Filer's total
    $0 + $379,630 related

  • GERALD MARGOSIAN

    COORDINATOR PHARMACY OPERATIONS

    Total calculated
    $363,675
    From this org
    $312,903
    From related orgs
    $0
    Other
    $50,772
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $282,549
    Bonus
    $1,500
    Other
    $28,854
    Deferred
    $22,875
    Nontaxable benefits
    $27,897
    Filer's total
    $363,675

  • MICHAEL FREUDIGER

    CHARGE PHARMACIST

    Total calculated
    $352,291
    From this org
    $329,076
    From related orgs
    $0
    Other
    $23,215
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $304,088
    Bonus
    $1,500
    Other
    $23,488
    Deferred
    $13,725
    Nontaxable benefits
    $9,490
    Filer's total
    $352,291

  • EDNANN NAZ

    CHIEF MEDICAL INFORMATICS OFFICER

    Total calculated
    $341,268
    From this org
    $306,020
    From related orgs
    $0
    Other
    $35,248
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $304,705
    Bonus
    $1,000
    Other
    $315
    Deferred
    $10,715
    Nontaxable benefits
    $24,533
    Filer's total
    $341,268

  • JOCELYN LLEMIT

    CLINICAL NURSE

    Total calculated
    $337,941
    From this org
    $293,247
    From related orgs
    $0
    Other
    $44,694
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $269,714
    Bonus
    $7,500
    Other
    $16,033
    Deferred
    $18,097
    Nontaxable benefits
    $26,597
    Filer's total
    $337,941

  • DOROTA FAULK

    CLINICAL NURSE

    Total calculated
    $326,610
    From this org
    $291,833
    From related orgs
    $0
    Other
    $34,777
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $284,016
    Bonus
    $7,500
    Other
    $317
    Deferred
    $13,310
    Nontaxable benefits
    $21,467
    Filer's total
    $326,610

  • JUDGE ROBERT OLIVER

    DIRECTOR; CHAIR

    Total calculated
    $0
    Hours/week
    3 + 1 related

  • LUIS SANTANA

    DIRECTOR; VICE CHAIR

    Total calculated
    $0
    Hours/week
    2

  • TERRI DONOVAN PAID BY MGMT CO

    TREASURER; INTERIM VP OF FINANCE

    Total calculated
    $0
    Hours/week
    50

  • MARY BOWLER CSC

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • PILAR DELACRUZ SAMOULIAN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • ALLEN EVANS MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • SUSAN KUSZMAR

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • JULIE MALDONADO

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • TERRENCE O'ROURKE MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • DALPINDER SANDHU MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • RON WATHEN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • DORA WESTERLUND

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • PAO YANG

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • JANET YOUNG

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

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

  • 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 3
SAINT AGNES MEDICAL CENTER IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SAINT AGNES MEDICAL CENTER'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF SAINT AGNES MEDICAL CENTER'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
PART I, LINE 4B
THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. PARTICIPANTS' VESTED BENEFITS WERE PAID OUT IN 2022, AND THEIR NON-VESTED BENEFITS FOR 2022 WERE ACCRUED. THE FOLLOWING PAYOUTS FOR 2022 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: BENJAMIN CARTER - $392,875 ODETTE BOLANO - $141,786 NANCY HOLLINGSWORTH - $128,713 SHERI SHAPIRO - $183,225 DAVID SPIVEY - $125,161 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ACCRUAL FOR 2022 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: ODETTE BOLANO - $173,530 THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($305,000 FOR 2022). THE FOLLOWING PAYOUTS FOR 2022 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: W. EUGENE EGERTON, MD - $7,781 DEANETTE SISSON - $3,148 STACY VAILLANCOURT - $3,791 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS.

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
2022
Filed
15 May 2024
IRS schema version
2022v5.0
Source object
202421369349303332

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

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