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Nonprofiteer
← COVENANT MEDICAL GROUP

Form 990 for tax year 2024

Filed by COVENANT MEDICAL GROUP.

Totals

Total revenue
$223,188,639
Total expenses
$222,830,243
Contributions and grants received
$0
Grants paid
$17
Program service revenue
$222,830,240
Investment income
$358,399
Other revenue
$0
Total assets, end of year
$138,288,545
Total liabilities, end of year
$228,299,660
Net assets or fund balances, end of year
-$90,011,115
Program services expenses (Part IX)
$210,707,359
Management and general expenses
$12,122,884
Fundraising expenses
$0
Program service expenses (Part III)
$210,707,359

Program services were 94.6% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: NET PATIENT REVENUE

    total $114,164,357 · related or exempt $114,164,357

  • 2b · Program service revenue: SVCS-EXEMPT AFFILIATES

    total $62,009,223 · related or exempt $62,009,223

  • 2c · Program service revenue: INTER-AFFILIATE REV.

    total $46,656,660 · related or exempt $46,656,660

  • 3 · Investment income

    total $355,711 · excluded $355,711

  • 7a · Gross sales of assets other than inventory

    securities $2,688

  • 7b · Less cost or other basis and sales expenses

    securities $0

  • 7c · Gain or loss

    securities $2,688

  • 7d · Net gain or loss

    total $2,688 · excluded $2,688

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $17 · program services $17

  • 5 · Compensation of officers, directors and key employees

    total $11,127,168 · program services $10,482,798 · management and general $644,370

  • 7 · Other salaries and wages

    total $134,870,335 · program services $127,060,042 · management and general $7,810,293

  • 8 · Pension plan contributions

    total $7,805,172 · program services $7,353,177 · management and general $451,995

  • 9 · Other employee benefits

    total $16,199,063 · program services $15,260,981 · management and general $938,082

  • 10 · Payroll taxes

    total $7,145,158 · program services $6,731,384 · management and general $413,774

  • 11b · Fees: legal

    total $28,007 · program services $26,385 · management and general $1,622

  • 11g · Fees: other

    total $13,338,673 · program services $12,566,236 · management and general $772,437

  • 12 · Advertising and promotion

    total $16,918 · program services $15,938 · management and general $980

  • 13 · Office expenses

    total $1,367,931 · program services $1,288,715 · management and general $79,216

  • 14 · Information technology

    total $246,331 · program services $232,066 · management and general $14,265

  • 16 · Occupancy

    total $10,027,824 · program services $9,447,115 · management and general $580,709

  • 17 · Travel

    total $426,374 · program services $401,683 · management and general $24,691

  • 20 · Interest

    total $1,619 · program services $1,525 · management and general $94

  • 22 · Depreciation, depletion and amortization

    total $487,251 · program services $459,034 · management and general $28,217

  • 23 · Insurance

    total $2,507,232 · program services $2,362,039 · management and general $145,193

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $13,488,888 · program services $13,488,888 · management and general $0

  • 24b · Other expenses: OTHER DIRECT EXPENSES

    total $3,746,282 · program services $3,529,336 · management and general $216,946

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $3,480,241 · end of year $63,791,639

  • 4 · Accounts receivable

    beginning of year $11,084,811 · end of year $28,013,747

  • 9 · Prepaid expenses and deferred charges

    beginning of year $679,181 · end of year $1,128,404

  • 10a · Land, buildings and equipment: cost or other basis

    $18,661,476

  • 10b · Land, buildings and equipment: accumulated depreciation

    $16,448,364

  • 10c · Land, buildings and equipment, net

    beginning of year $2,182,083 · end of year $2,213,112

  • 15 · Other assets

    beginning of year $48,835,018 · end of year $43,141,643

  • 17 · Accounts payable and accrued expenses

    beginning of year $10,548,317 · end of year $11,154,514

  • 19 · Deferred revenue

    beginning of year $0 · end of year $2,546,741

  • 25 · Other liabilities

    beginning of year $99,425,870 · end of year $214,598,405

  • 27 · Net assets without donor restrictions

    beginning of year -$43,712,853 · end of year -$90,011,115

Mission and programs · 2024

Mission

AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.

  • SEE SCHEDULE O AT PROVIDENCE, WE USE OUR VOICE TO ADVOCATE FOR VULNERABLE POPULATIONS AND NEEDED REFORMS IN HEALTH CARE. WE ARE ALSO PURSUING INNOVATIVE WAYS TO TRANSFORM HEALTH CARE BY KEEPING PEOPLE HEALTHY, AND MAKING OUR SERVICES MORE CONVENIENT, ACCESSIBLE AND AFFORDABLE FOR ALL. IN AN INCREASINGLY UNCERTAIN WORLD, WE ARE COMMITTED TO HIGH-QUALITY, COMPASSIONATE HEALTH CARE FOR EVERYONE - REGARDLESS OF COVERAGE OR ABILITY TO PAY. WE HELP PEOPLE AND COMMUNITIES BENEFIT FROM THE BEST HEALTH CARE MODEL FOR THE FUTURE - TODAY.TOGETHER, OUR 125,000 CAREGIVERS (ALL EMPLOYEES) SERVE IN 51 HOSPITALS, 1,014 CLINICS AND A COMPREHENSIVE RANGE OF HEALTH AND SOCIAL SERVICES ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. THE PROVIDENCE AFFILIATE FAMILY INCLUDES:-PROVIDENCE ACROSS FIVE WESTERN STATES-COVENANT HEALTH IN WEST TEXAS AND NEW MEXICO-FACEY MEDICAL GROUP IN LOS ANGELES, CA-KADLEC IN SOUTHEAST WASHINGTON-PACIFIC MEDICAL CENTERS IN SEATTLE, WA-SWEDISH HEALTH SERVICES IN SEATTLE, WA IN 2024, PROVIDENCE MINISTRIES AND AFFILIATES PROVIDED $1.9 BILLION IN COMMUNITY BENEFIT PROGRAMS. THIS INCLUDES FREE AND DISCOUNTED CARE, UNCOMPENSATED AND SUBSIDIZED CARE, AND OTHER COMMUNITY HEALTH ACTIVITIES.ONE OF THESE VITAL PROGRAMS, MEDICAID, IS A LIFELINE FOR MILLIONS OF INDIVIDUALS, INCLUDING SENIORS, CHILDREN, PREGNANT PATIENTS, THOSE WITH DISABILITIES AND VETERANS. WE ARE GRATEFUL TO EVERYONE IN OUR COMMUNITIES WHO HAS JOINED US IN ADVOCATING FOR CONTINUED FUNDING AND EXPANSION OF THIS PROGRAM. TOGETHER, WE ARE HELPING TO ENSURE MORE PEOPLE HAVE ACCESS TO NEEDED CARE.FOR MORE INFORMATION GO TO: HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORTTHROUGH OUR COMMUNITY BENEFIT PROGRAMS, WE FOCUS ON MEETING THE DIVERSE NEEDS OF THE PEOPLE WE SERVE BY WORKING TO ENSURE BASIC HEALTH NEEDS ARE MET, REMOVING BARRIERS TO CARE, BUILDING COMMUNITY RESILIENCE AND INNOVATING FOR THE FUTURE. PROVIDENCE CONTINUES TO WORK TOWARDS CARBON NEGATIVE AND IN 2024 DECREASED EMISSIONS BY 19 PERCENT COMPARED TO OUR 2019 BASELINE. OUR EFFORTS EARNED US A SYSTEM RECORD 55 ENVIRONMENTAL EXCELLENCE AWARDS FROM PRACTICE GREENHEALTH AND MADE US THE FIRST LARGE SYSTEM TO RECEIVE THE JOINT COMMISSION'S SUSTAINABLE HEALTHCARE CERTIFICATION IN 2024 FOR EACH OF OUR HOSPITALS.PROGRAM SERVICE ACCOMPLISHMENTSCOVENANT MEDICAL GROUP IS A NON-PROFIT, TAX-EXEMPT MEDICAL FOUNDATION THAT IS CERTIFIED UNDER TEXAS LAW TO EMPLOY PHYSICIANS AND PRACTICE MEDICINE. IT IS OWNED BY COVENANT HEALTH SYSTEM, BUT IS SELF-GOVERNING IN MOST ASPECTS, OTHER THAN FISCAL MATTERS. THERE IS A BOARD OF 14 PHYSICIANS WHO PROVIDE THE OVERSIGHT OF THE GROUP'S STRATEGIC PLANNING, POLICY DEVELOPMENT, RECRUITMENT AND CREDENTIALING, QUALITY IMPROVEMENT TASKS, RESEARCH, AND MEDICAL EDUCATION ACTIVITIES. ALL OF THE BOARD MEMBERS ARE ACTIVELY PRACTICING WITHIN CMG. THIS SELF-GOVERNING ASPECT OF CMG TENDS TO MAKE IT QUITE PHYSICIAN-FRIENDLY IN ITS POLICY DEVELOPMENT AND PLANNING IN THAT THE BOARD MEMBERS ARE IMMEDIATELY PERSONALLY IMPACTED IN THEIR OWN PRACTICE BY THEIR BOARD DECISIONS.WHO WE ARE AND WHAT WE DO "CARING FOR THE PEOPLE OF OUR REGION" OUR REGION: COVENANT MEDICAL GROUP IS HEADQUARTERED IN LUBBOCK, TEXAS, THE SITE OF THE SOUTHWEST'S PREEMINENT MEDICAL CENTER BETWEEN THE DALLAS / FORT WORTH METROPLEX AND PHOENIX. WITH A COUNTY POPULATION OF 250,000 AND SERVING AN AREA OF 1.2 MILLION PEOPLE IN THE REGION, LUBBOCK HASMANY OF THE AMENITIES OF A LARGER METROPOLITAN AREA, INTERNATIONAL AIRPORT, GREAT SHOPPING AND RESTAURANTS, AND EXCELLENT PUBLIC AND PRIVATE SCHOOLS, YET RETAINING A WONDERFUL "SMALL-TOWN" ATMOSPHERE. OUR HEALTH SYSTEM'S REGIONAL CLINICS ARE LOCATED THROUGHOUT WEST TEXAS AND EASTERN NEW MEXICO. OUR REGIONAL CLINIC NETWORK CONTAINS SEVERAL OPERATIONALLY DIFFERENT MODELS. SOME ARE DIRECTLY OWNED AND OPERATED BY CMG; SOME ARE RURAL HEALTH CLINICS IN WHICH CMG SUPPLIES ITS EMPLOYED PHYSICIANS TO WORK FOR A RURAL HOSPITAL-OWNED FACILITY; SOME ARE RURAL HEALTH CLINICS IN WHICH THE PHYSICIANS ARE INDEPENDENT CONTRACTORS; AND SOME ARE SATELLITE CLINIC SITES TO WHICH CMG SUBSPECIALISTS TRAVEL A FEW TIMES PER MONTH. THESE REGIONAL CLINICS ARE INTEGRAL TO THE PROVISION OF PRIMARY CARE SERVICES TO THEIR LOCAL COMMUNITIES, AND ALSO SEND SUBSTANTIAL NUMBERS OF PATIENTS TO LUBBOCK FOR TERTIARY CARE THAT IS NOT AVAILABLE LOCALLY.FOR MORE INFORMATION ON COVENANT MEDICAL GROUP GO TO: WWW.COVMEDGROUP.ORGFOR MORE INFORMATION ON COVENANT HEALTH SYSTEM GO TO: WWW.COVENANTHEALTH.ORGFOR MORE INFORMATION ABOUT PROVIDENCE, PLEASE VISIT WWW.PROVIDENCE.ORG

    Expenses $210,707,359 · Grants $17 · Revenue $222,830,243

As filed on the 2024 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Mohammad Otahbachi

    PHYSICIAN

    Total calculated
    $1,709,220
    From this org
    $1,604,254
    From related orgs
    $0
    Other
    $104,966
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,509,227
    Bonus
    $12,000
    Other
    $83,027
    Deferred
    $88,146
    Nontaxable benefits
    $16,820
    Filer's total
    $1,709,220

  • Senthilraj Ganeshan

    PHYSICIAN

    Total calculated
    $1,619,364
    From this org
    $1,556,788
    From related orgs
    $0
    Other
    $62,576
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,522,264
    Bonus
    $9,500
    Other
    $25,024
    Deferred
    $51,551
    Nontaxable benefits
    $11,025
    Filer's total
    $1,619,364

  • Andrew Robinson

    PHYSICIAN

    Total calculated
    $1,565,708
    From this org
    $1,455,276
    From related orgs
    $0
    Other
    $110,432
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,364,729
    Bonus
    $4,634
    Other
    $85,913
    Deferred
    $94,548
    Nontaxable benefits
    $15,884
    Filer's total
    $1,565,708

  • Stephen Grupke

    PHYSICIAN

    Total calculated
    $1,512,910
    From this org
    $1,455,451
    From related orgs
    $0
    Other
    $57,459
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,425,986
    Bonus
    $1,798
    Other
    $27,667
    Deferred
    $46,905
    Nontaxable benefits
    $10,554
    Filer's total
    $1,512,910

  • Kiran Yalamanchili

    PHYSICIAN

    Total calculated
    $1,398,879
    From this org
    $1,318,770
    From related orgs
    $0
    Other
    $80,109
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,275,330
    Bonus
    $0
    Other
    $43,440
    Deferred
    $75,288
    Nontaxable benefits
    $4,821
    Filer's total
    $1,398,879

  • Ibrahim Shalaby MD

    BOARD MEMBER/VICE CHAIR

    Total calculated
    $1,189,795
    From this org
    $1,097,976
    From related orgs
    $0
    Other
    $91,819
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,036,715
    Bonus
    $4,300
    Other
    $56,961
    Deferred
    $74,199
    Nontaxable benefits
    $17,620
    Filer's total
    $1,189,795

  • David Blann MD

    BOARD MEMBER

    Total calculated
    $1,065,002
    From this org
    $990,803
    From related orgs
    $0
    Other
    $74,199
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $905,396
    Bonus
    $2,568
    Other
    $82,839
    Deferred
    $67,702
    Nontaxable benefits
    $6,497
    Filer's total
    $1,065,002

  • Kyler Barkley MD

    BOARD MEMBER

    Total calculated
    $1,059,398
    From this org
    $1,005,023
    From related orgs
    $0
    Other
    $54,375
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $984,432
    Bonus
    $5,500
    Other
    $15,091
    Deferred
    $37,857
    Nontaxable benefits
    $16,518
    Filer's total
    $1,059,398

  • Ryan Owen MD

    BOARD MEMBER

    Total calculated
    $931,646
    From this org
    $883,269
    From related orgs
    $0
    Other
    $48,377
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $837,212
    Bonus
    $4,770
    Other
    $41,287
    Deferred
    $31,557
    Nontaxable benefits
    $16,820
    Filer's total
    $931,646

  • Sergio Lara MD

    BOARD MEMBER

    Total calculated
    $910,685
    From this org
    $850,388
    From related orgs
    $0
    Other
    $60,297
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $801,107
    Bonus
    $0
    Other
    $49,281
    Deferred
    $59,038
    Nontaxable benefits
    $1,259
    Filer's total
    $910,685

  • Paul Walter MD

    BOARD MEMBER/CMO

    Total calculated
    $870,353
    From this org
    $794,291
    From related orgs
    $0
    Other
    $76,062
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $732,425
    Bonus
    $4,000
    Other
    $57,866
    Deferred
    $56,482
    Nontaxable benefits
    $19,580
    Filer's total
    $870,353

  • Kompal Parmar

    BOARD MEMBER

    Total calculated
    $764,167
    From this org
    $703,545
    From related orgs
    $0
    Other
    $60,622
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $637,296
    Bonus
    $1,425
    Other
    $64,824
    Deferred
    $46,544
    Nontaxable benefits
    $14,078
    Filer's total
    $764,167

  • John Hanna MD

    BOARD MEMBER

    Total calculated
    $743,840
    From this org
    $683,523
    From related orgs
    $0
    Other
    $60,317
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $550,070
    Bonus
    $0
    Other
    $133,453
    Deferred
    $48,297
    Nontaxable benefits
    $12,020
    Filer's total
    $743,840

  • Scott Letbetter MD

    BOARD MEMBER

    Total calculated
    $699,700
    From this org
    $638,507
    From related orgs
    $0
    Other
    $61,193
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $577,801
    Bonus
    $17,908
    Other
    $42,798
    Deferred
    $43,538
    Nontaxable benefits
    $17,655
    Filer's total
    $699,700

  • Jack Shannon

    BOARD MEMBER

    Total calculated
    $698,786
    From this org
    $635,290
    From related orgs
    $0
    Other
    $63,496
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $597,977
    Bonus
    $0
    Other
    $37,313
    Deferred
    $47,264
    Nontaxable benefits
    $16,232
    Filer's total
    $698,786

  • Jeremy Dalton MD

    BOARD MEMBER/CHAIR

    Total calculated
    $675,931
    From this org
    $630,559
    From related orgs
    $0
    Other
    $45,372
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $566,270
    Bonus
    $5,250
    Other
    $59,039
    Deferred
    $45,062
    Nontaxable benefits
    $310
    Filer's total
    $675,931

  • Kristen Kothmann

    CMG CEO

    Total calculated
    $636,416
    From this org
    $561,869
    From related orgs
    $0
    Other
    $74,547
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $364,723
    Bonus
    $166,206
    Other
    $30,940
    Deferred
    $61,178
    Nontaxable benefits
    $13,369
    Filer's total
    $636,416

  • Amy Henning Do

    BOARD MEMBER

    Total calculated
    $526,176
    From this org
    $503,090
    From related orgs
    $0
    Other
    $23,086
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $462,505
    Bonus
    $2,816
    Other
    $37,769
    Deferred
    $22,304
    Nontaxable benefits
    $782
    Filer's total
    $526,176

  • Karen Talusan-Soriano MD

    BOARD MEMBER

    Total calculated
    $355,273
    From this org
    $309,414
    From related orgs
    $0
    Other
    $45,859
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $290,836
    Bonus
    $3,331
    Other
    $15,247
    Deferred
    $28,265
    Nontaxable benefits
    $17,594
    Filer's total
    $355,273

  • Kathleen Burrell

    SECRETARY (PART YEAR)

    Total calculated
    $180,050
    From this org
    $0
    From related orgs
    $164,613
    Other
    $15,437
    Hours/week
    0.5 + 54.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $154,769 related
    Bonus
    $0 + $9,353 related
    Other
    $0 + $491 related
    Deferred
    $0 + $7,665 related
    Nontaxable benefits
    $0 + $7,772 related
    Filer's total
    $0 + $180,050 related

  • Sean Hill

    BOARD MEMBER/CFO (PART YEAR)

    Total calculated
    $166,022
    From this org
    $0
    From related orgs
    $155,226
    Other
    $10,796
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $141,248 related
    Bonus
    $0 + $12,480 related
    Other
    $0 + $1,498 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $10,796 related
    Filer's total
    $0 + $166,022 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
  • 7 · Other non-fixed payments

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
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 1A
PROVIDENCE EXPENSE REIMBURSEMENT PROCEDURES INCLUDE THE FOLLOWING POLICIES: FIRST CLASS TRAVEL OR CHARTER TRAVEL AIR TRAVEL IS GENERALLY REIMBURSABLE AT THE LEAST EXPENSIVE AIRFARE WHICH PERMITS DEPARTURES AND ARRIVALS AT REASONABLE TIMES AND REASONABLE DISTANCE TRAVELED. EMPLOYEES ARE ENCOURAGED TO PLAN IN ADVANCE TO GET AVAILABLE DISCOUNTS. AIRLINE FREQUENT FLYER UPGRADES WILL NEVER BE REIMBURSED. IN LIMITED SITUATIONS, FIRST CLASS TICKETS AND CHARTER MAY BE REIMBURSED WHEN APPROVED BY A SENIOR LEVEL SUPERVISOR. THESE REIMBURSEMENTS ARE NOT REPORTED AS TAXABLE COMPENSATION. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS TAX INDEMNIFICATIONS OR GROSS-UP PAYMENTS - RELOCATION PROVIDENCE FOLLOWS THE FEDERAL AND STATE TAXATION LAWS RELATED TO RELOCATION EXPENSES PAID TO THE EMPLOYEE OR TO A THIRD PARTY ON THE EMPLOYEE'S BEHALF. THEY ARE CONSIDERED TAXABLE WAGES AND ARE REPORTED AS SUCH. BASED ON THE WAY PROVIDENCE HAS CHOSEN TO PAY THE RELOCATION EXPENSES, PROVIDENCE REPORTS REIMBURSEMENTS AND PAYMENTS TO VENDORS AS INCOME AND THESE EXPENSE PAYMENTS ARE REFLECTED ON THE EXECUTIVE'S FORM W-2. PROVIDENCE PROVIDES A GROSS-UP FOR THE RELOCATION BENEFITS, SO THAT A PORTION OF THE REIMBURSEMENT DOES NOT HAVE TO BE USED TO PAY TAXES, AND THIS TAX GROSS-UP IS ALSO REPORTED AS TAXABLE INCOME. THE AMOUNTS REPORTED FOR THESE GROSS-UP PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990. TAX INDEMNIFICATIONS OR GROSS-UP PAYMENTS - FINANCIAL/RETIREMENT PLANNING PROVIDENCE FOLLOWS THE FEDERAL AND STATE TAXATION LAWS RELATED TO FINANCIAL AND RETIREMENT PLANNING EXPENSES PAID TO THE EMPLOYEE OR TO A THIRD PARTY ON THE EMPLOYEE'S BEHALF. THEY ARE CONSIDERED TAXABLE WAGES AND ARE REPORTED AS SUCH. BASED ON THE WAY PROVIDENCE HAS CHOSEN TO PAY THESE OTHER EXPENSES, PROVIDENCE REPORTS REIMBURSEMENTS AND PAYMENTS TO VENDORS AS INCOME AND THESE EXPENSE PAYMENTS ARE REFLECTED ON THE EXECUTIVE'S FORM W-2. PROVIDENCE PROVIDES A GROSS-UP FOR THIS BENEFIT, SO THAT A PORTION OF THE PAYMENT DOES NOT HAVE TO BE USED TO PAY TAXES, AND THIS TAX GROSS-UP IS ALSO REPORTED AS TAXABLE INCOME. THE AMOUNTS REPORTED FOR THESE GROSS-UP PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990. PERSONAL SERVICES PROVIDENCE OFFERS FINANCIAL PLANNING SERVICES AS AN OPTIONAL BENEFIT TO EMPLOYEES AT VICE PRESIDENT LEVEL AND ABOVE. THIS BENEFIT IS CONSIDERED A TAXABLE BENEFIT AND IS INCLUDED ON THE EMPLOYEE'S FORM W-2. THE AMOUNTS REPORTED FOR THE FINANCIAL PLANNING SERVICES ARE INCLUDED AS TAXABLE INCOME ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990 FOR THE EMPLOYEES WHO PARTICIPATE.
PART I, LINE 3
DESCRIPTION OF PROCESS TO REVIEW COMPENSATION PAID TO TOP MANAGEMENT OFFICIAL ALTHOUGH THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY COVENANT MEDICAL GROUP, THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION.
PART I, LINE 4B
ENTITIES WITHIN THE PROVIDENCE SYSTEM SPONSOR NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS FOR CERTAIN EXECUTIVES. THE PLANS PROVIDE FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND, DEPENDING ON THE PLAN, ARE SUBJECT TO EITHER A THREE YEAR, AGE 59 1/2 OR A FIVE YEAR, AGE 65 VESTING SCHEDULE. UNTIL THE EXECUTIVE PROVIDES THESE SUBSTANTIAL FUTURE SERVICES, THESE SUPPLEMENTAL RETIREMENT CONTRIBUTIONS ARE AT RISK, AND WILL BE FORFEITED IF THE EXECUTIVE LEAVES THE ORGANIZATION BEFORE REACHING HER OR HIS VESTING DATE. THE SUPPLEMENTAL RETIREMENT CONTRIBUTIONS ARE INCLUDED IN COLUMN (C) AS A NONTAXABLE BENEFIT IN THE YEAR THE CONTRIBUTION IS CREDITED TO THE EXECUTIVE'S ACCOUNT, AND ARE INCLUDED AGAIN ON THE FORM 990 IN COLUMN (B)(III) IF AND WHEN THE AMOUNT BECOMES VESTED IN A FUTURE YEAR, AS THE FORM 990 REQUIRES. THE FOLLOWING INDIVIDUALS RECEIVED A PAYOUT DURING THE CURRENT YEAR: MOHAMMAD OTAHBACHI - $53,414 SENTHILRAJ GANESHAN - $398 ANDREW ROBINSON - $54,219 STEPHEN GRUPKE - $25,491 KIRAN YALAMANCHILI - $13,196 IBRAHIM SHALABY, M.D. - $38,195 DAVID BLANN, M.D. - $31,537 KYLER BARKLEY, M.D. - $12,539 RYAN OWEN, M.D. - $15,174 SERGIO LARA, M.D. - $21,270 PAUL WALTER, M.D. - $21,130 KOMPAL PARMAR - $7,544 JOHN HANNA, M.D. - $21,524 SCOTT LETBETTER, M.D. - $8,513 JACK SHANNON - $22,193 JEREMY DALTON, M.D. - $9,053 KRISTEN KOTHMANN - $28,994 AMY HENNING D.O. - $9,778
PART I, LINE 7
NON-FIXED PAYMENTS THE PROVIDENCE EXECUTIVE COMPENSATION COMMITTEE (OF THE BOARD) HAS APPROVED AN EXECUTIVE COMPENSATION PHILOSOPHY THAT CLOSELY TIES AN EXECUTIVE'S COMPENSATION TO PERFORMANCE - BOTH THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE EXECUTIVE. THERE IS NO GUARANTEE THAT THIS PART OF A LEADER'S COMPENSATION WILL BE PAID - IF THE PERFORMANCE OF THE ORGANIZATION OR OF THE INDIVIDUAL DOES NOT MEET THE PERFORMANCE STANDARDS FOR PAYMENT, NO PERFORMANCE-BASED PAYMENT IS MADE. THIS APPROACH IS REFLECTED IN PROVIDENCE'S LEADERSHIP ANNUAL INCENTIVE PLAN AND LONG-TERM INCENTIVE PLAN, WHICH ARE PERFORMANCE-BASED ANNUAL INCENTIVE PLANS THAT AFFORD PARTICIPATING EXECUTIVES THE OPPORTUNITY TO EARN "AT RISK" COMPENSATION THROUGH PERFORMANCE AGAINST VERY CHALLENGING GOALS. PAYOUTS WILL BE AWARDED BASED ON GOALS RELATED TO STRATEGIC OBJECTIVES, FISCAL STEWARDSHIP AND QUALITY OF CARE - THESE GOALS ARE SET BEFORE THE YEAR BEGINS AND ARE VERY CHALLENGING. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWS AND APPROVES EACH YEAR'S PERFORMANCE GOALS TO MAKE SURE THEY ARE SUFFICIENTLY CHALLENGING, AND TO MAKE SURE THE GOALS ARE DESIGNED TO HELP PROVIDENCE MEET ITS MISSION AND STRATEGIC PURPOSES. EACH YEAR THE PSJH BOARD EXECUTIVE COMPENSATION COMMITTEE REVIEWS THE INCENTIVE PERFORMANCE AND MUST CERTIFY THE ACHIEVEMENT OF PERFORMANCE GOALS BEFORE ANY AWARDS ARE PAID OUT. WHEN REVIEWING AND APPROVING TOTAL COMPENSATION FOR EXECUTIVES, THE EXECUTIVE COMPENSATION COMMITTEE INCLUDES INCENTIVE AWARDS, TO MAKE SURE THAT COMPENSATION IS REASONABLE AND WELL-SUPPORTED BY MARKET DATA. THE COMMITTEE CONSISTS ONLY OF DIRECTORS WHO ARE FREE OF CONFLICTS OF INTEREST, AND THE COMMITTEE RELIES ON MARKET SURVEY DATA GATHERED BY AN INDEPENDENT CONSULTANT. THE COMMITTEE CONDUCTS THIS REVIEW AND APPROVAL PROCESS IN A MANNER THAT IS IN ACCORDANCE WITH IRS REQUIREMENTS FOR COMPENSATION OF TAX-EXEMPT ORGANIZATION LEADERS, AND IN ACCORDANCE WITH THE BEST GOVERNANCE PRACTICES IN THE INDUSTRY.

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.

  • 20TH STREET SURGERY LLC

    AMBULATORY SURGERY CENTER · CA

  • BRIDGEPORT MEDICAL IMAGING LLC (BMI)

    IMAGING - DIAGNOSTICS · OR · general or managing partner

  • BROADWAY IMAGING LLC

    MEDICAL IMAGING · MT · general or managing partner

  • CANBY MEDICAL CENTER I LLC

    REAL ESTATE - MOB · OR · general or managing partner

  • CENTER FOR MEDICAL IMAGING LLC (CMI)

    IMAGING - DIAGNOSTICS · OR · general or managing partner

  • CLACKAMAS RADIATION ONCOLOGY CENTER LLC

    RADIATION ONCOLOGY · OR · general or managing partner

  • COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY

    HEALTHCARE · CA · general or managing partner

  • COVENANT HIGH PLAINS SURGERY CENTER LLC

    HEALTHCARE · TX · general or managing partner

  • COVENANT PARK PHASE I VENTURE LLC

    REAL ESTATE · TX

  • CSS JV LLC

    AMBULATORY SURGERY CENTER · OR

  • FIRST HILL SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · WA · general or managing partner

  • FULLERTON SURGICAL CENTER LP

    AMBULATORY SURGERY CENTER · CA · general or managing partner

  • GREATER VALLEY MEDICAL BUILDING LP

    REAL ESTATE - MOB · CA · general or managing partner

  • HERITAGE INVESTMENT GROUP I LLC

    INVESTMENTS · CA

  • IMAGING ASSOCIATES LLC

    MEDICAL IMAGING · AK · general or managing partner

  • LSC REAL PROPERTY LLC

    REAL ESTATE · TX · general or managing partner

  • METHODIST DIAGNOSTIC IMAGING

    HEALTHCARE · TX · general or managing partner

  • MISSION VIEJO PARTNERS II LLC

    REAL ESTATE - MOB · CA · general or managing partner

  • NORTH OC IMAGING JV HOLDINGS LLC

    HEALTHCARE · CA

  • OREGON ADVANCED IMAGING LLC

    MEDICAL IMAGING · OR · general or managing partner

  • PAVILION SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · CA

  • PERFORMANCE MEDICAL EQUIPMENT & RESPIRATORY SERVICES LLC

    MEDICAL EQUIPMENT · WA · general or managing partner

  • PETCT IMAGING AT SWEDISH CANCER INSTITUTE LLC

    MEDICAL IMAGING · WA · general or managing partner

  • PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCE & SCA OFF-CAMPUS HOLDINGS LLC

    MEDICAL · AL

  • PROVIDENCE & SCA ON-CAMPUS HOLDINGS LLC

    MEDICAL · AL · general or managing partner

  • PROVIDENCE HOUSE OAKLAND LP

    SUPPORTIVE HOUSING · CA · general or managing partner

  • PROVIDENCE IMAGING CENTER JOINT VENTURE

    MEDICAL IMAGING · AK

  • PROVIDENCE ST JOSEPH HEALTH LONG TERM PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCEUSP SPOKANE SURGERY CENTERS LLC

    AMBULATORY SURGERY CENTER · WA

  • PROVIDENCEUSP SURGERY CTRS LLC

    AMBULATORY SURGERY CENTER · CA

  • RADIATION THERAPY INNOVATIONS LLC

    HEALTHCARE · WA · general or managing partner

  • RIVERSIDE HEALTHCARE

    HEALTHCARE · MN · general or managing partner

  • ST JOSEPH PHYSICIAN VENTURES I LLC

    REAL ESTATE · CA · general or managing partner

  • ST JOSEPHSATELLITE DIALYSIS CENTERS LLC

    HEALTHCARE · CA

  • ST JUDE SURGICAL CENTERS LLC

    AMBULATORY SURGERY CENTER · CA · general or managing partner

  • ST PETER-SOUTH SOUND REGIONAL MRI CENTER

    MEDICAL IMAGING · WA · general or managing partner

  • WON-ONC LLC

    REAL ESTATE - MOB · WA · general or managing partner

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • 1221 MADISON STREET OWNERS ASSOC

    C · OWNERS' ASSOCIATION · WA

  • ADVATA INC (FKA KENSCI INC)

    C · HEALTHCARE · WA

  • AYIN HEALTH HOLDINGS INC

    C · HEALTHCARE · DE

  • AYIN HEALTH SOLUTIONS INC

    C · HEALTHCARE · OR

  • BOURGET HEALTH SERVICES INC

    C · CLINICAL/MEDICAL LAB · WA

  • CARON CORPORATION

    C · MEDICAL PHYSICIAN SERVICE · MT

  • CLOUD 21 LIMITED

    C · HEALTHCARE · UK

  • ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA

    S · HEALTHCARE · CA

  • HOSPITAL CENTRAL SERVICES ASSOCIATION

    C · LAUNDRY SERVICES · WA

  • INTEGRIS SOLUTIONS LIMITED

    C · HEALTHCARE · UK

  • KENSCI ASIA PACIFIC PTE LTD

    C · HEALTHCARE · SN

  • KENSCI TECH INDIA PRIVATE LIMITED

    C · HEALTHCARE · IN

  • LINDY TRANSFER HOLDINGS INC

    C · HEALTHCARE · WA

  • LUBBOCK METHODIST HOSP PRACTICE MGMT

    C · INACTIVE · TX

  • LUBBOCK METHODIST HOSPITAL SVCS

    C · HEALTHCARE · TX

  • MEDICAL SPECIALTIES MANAGERS INC

    C · HEALTHCARE · WA

  • MISSION VIEJO MEDICAL VENTURES INC

    C · HEALTHCARE · CA

  • PHN HOLDINGS

    C · STRATEGIC PLANNING SERVICES · CA

  • PROVIDENCE GLOBAL CENTER LLP

    C · IT SVCS · IN

  • PROVIDENCE HEALTH CARE VENTURES INC

    C · CLINICAL/MEDICAL LAB · WA

  • PROVIDENCE HEALTH NETWORK

    C · PREPAID HEALTHCARE · CA

  • PROVIDENCE PARTNERS HOLDINGS INC

    C · INVESTMENT · DE

  • PROVIDENCE PHYSICIAN SERVICES CO

    C · HEALTHCARE · WA

  • PROVIDENCE ST JOSEPH HEALTH NETWORK

    C · HEALTHCARE · CA

  • PROVSOURCE

    C · HEALTHCARE · DE

  • ST JOSEPH HEALTH

    C · HOLDING COMPANY · CA

  • ST JOSEPH HEALTH SOURCE INC

    C · HEALTHCARE · CA

  • ST JOSEPH MEDICAL PLAZA ASSOCIATION

    C · CONDO ASSOCIATION · CA

  • ST JOSEPH PROF SVCS ENTERPRISES INC

    C · HEALTHCARE · CA

  • TEGRIA HOLDINGS LLC (FKA GRADY BLOCKER LLC)

    C · HOLDING COMPANY · DE

  • TEGRIA INSIGHTS GROUP HOLDINGS INC

    C · HOLDING COMPANY · WA

  • TEGRIA INSIGHTS GROUP INC

    C · HEALTHCARE · WA

  • TEGRIA PRODUCTS GROUP INC

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP US INC

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP INC (FKA PROV RCM GROUP INC)

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP INC (FKA PROVIDENCE SERVICES GROUP)

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP-CAN INC

    C · HEALTHCARE · CA

  • TEGRIA SERVICES GROUP-US INC (FKA BLUETREE NETWORK INC)

    C · HEALTHCARE · WI

  • TRUSANA INC

    C · HEALTHCARE · DE

  • VINSERRA INC

    C · INVESTMENT · CA

  • WEIGHT LOSS INC (FKA HMR WEIGHT MANAGEMENT SERVICES CORP)

    C · HEALTHCARE · WA

Provenance

Return type
form_990
Tax year
2024
Filed
30 October 2025
IRS schema version
2024v5.2
Source object
202523099349301592

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