Form 990 for tax year 2022
Filed by COTTAGE GROVE COMMUNITY HOSPITAL FOUNDATION.
Totals
- Total revenue
- $67,782
- Total expenses
- $95,137
- Contributions and grants received
- $65,972
- Grants paid
- $88,764
- Program service revenue
- not reported
- Investment income
- not reported
- Other revenue
- not reported
- Total assets, end of year
- not reported
- Total liabilities, end of year
- not reported
- Net assets or fund balances, end of year
- not reported
- Program services expenses (Part IX)
- $88,764
- Management and general expenses
- $3,303
- Fundraising expenses
- $3,070
- Program service expenses (Part III)
- $88,764
Program services were 93.3% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.
Listed in Part VII
-
SEAN KELLY
SECRETARY
- Total calculated
- $0
- Hours/week
- 1
-
MATT PARSONS
TREASURER
- Total calculated
- $0
- Hours/week
- 1
-
JAMES GILROY
PRESIDENT
- Total calculated
- $0
- Hours/week
- 1
-
ZUZANNA M WIECKOWSKA
DIRECTOR
- Total calculated
- $324,648
- From this org
- $0
- From related orgs
- $274,514
- Other
- $50,134
- Hours/week
- 1 + 40 related
Schedule J breakdown matched by us
- Base
- $0 + $269,094 related
- Bonus
- $0 + $5,420 related
- Other
- $0
- Deferred
- $0 + $28,011 related
- Nontaxable benefits
- $0 + $22,123 related
- Filer's total
- $0 + $324,648 related
-
SHERRY DUERST-HIGGINS
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
MICHAEL JOHNSON
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
JUDY CUNNINGHAM
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
JOY SERKOWNEY
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
JENNIFER SVIHUS
DIRECTOR, CDO OREGON NETWORK
- Total calculated
- $61,458
- From this org
- $0
- From related orgs
- $61,458
- Other
- $0
- Hours/week
- 1 + 40 related
-
BRIAN MCCASLINE
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
ALICIA M BEYMER
DIRECTOR, CAO SACRED HEART MED. CENTER
- Total calculated
- $384,094
- From this org
- $0
- From related orgs
- $334,079
- Other
- $50,015
- Hours/week
- 1 + 40 related
Schedule J breakdown matched by us
- Base
- $0 + $283,380 related
- Bonus
- $0 + $50,699 related
- Other
- $0
- Deferred
- $0 + $30,720 related
- Nontaxable benefits
- $0 + $19,295 related
- Filer's total
- $0 + $384,094 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
- 1a · First-class or charter travel
- 1a · Travel for companions
- 1a · Tax indemnification and gross-up payments
- 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
- PEACEHEALTH (A RELATED ORGANIZATION) HAS POLICES REGARDING THE ELIGIBILITY OF EXECUTIVES FOR THESE ITEMS. FOR EXAMPLE TRAVEL FOR COMPANIONS AND HOUSING ALLOWANCES ARE RELATED TO RELOCATION BENEFITS OR FIRST CLASS TRAVEL FOR FLIGHTS EXCEEDING SIX HOURS IN DURATION. THESE BENEFITS WERE REPORTED AND TREATED AS TAXABLE.
- PART I, LINE 3
- THE ORGANIZATION DOES NOT HAVE ANY PAID EMPLOYEES. EMPLOYEES ARE COMPENSATED BY PEACEHEALTH (A RELATED ORGANIZATION) WHICH USES A MARKET BASED COMPENSATION PROGRAM UTILIZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. PEACEHEALTH ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/SKILLS/COMPETENCE TO DO THE JOB. THE RANGES OF PAY RATES ARE REVIEWED ON AN ANNUAL BASIS.
- PART I, LINE 4B
- PEACEHEALTH (A RELATED ORGANIZATION) HAS POLICES REGARDING THE ELIGIBILITY OF EXECUTIVES FOR THESE ITEMS. BOARD MEMBERS LISTED ON SCHEDULE J ARE EMPLOYEES OF PEACEHEALTH A RELATED ENTITY AND PEACEHEALTH'S CEO, EXECUTIVE VICE PRESIDENT, SENIOR VICE PRESIDENT, CERTAIN PHYSICIANS AND OTHER HIGHLY COMPENSATED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN VARIOUS NONQUALIFIED RETIREMENT PLANS. CONTRIBUTIONS TO THESE PLANS AND RELATED INVESTMENT RETURNS ARE DISCLOSED ON SCHEDULE J AS DEFERRED COMPENSATION AND AS BONUS COMPENSATION WHEN PAID TO THE INDIVIDUAL.
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
-
$0
SUPPORT FOR PEACEHEALTH COTTAGE GROVE COMMUNITY MEDICAL CENTER.
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.
-
501(C)(3) · HOSPITAL · WA
Provenance
- Return type
- form_990
- Tax year
- 2022
- Filed
- 29 March 2024
- IRS schema version
- 2022v5.0
- Source object
- 202431099349301318
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