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Nonprofiteer
← GOOD SAMARITAN HOSPITAL

Form 990 for tax year 2022

Filed by GOOD SAMARITAN HOSPITAL.

Totals

Total revenue
$189,777,469
Total expenses
$176,723,845
Contributions and grants received
$5,987,216
Grants paid
$239,490
Program services expenses (Part IX)
$164,888,303
Management and general expenses
$11,835,542
Fundraising expenses
$0
Program service expenses (Part III)
$164,888,303

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

  • JOHN PETERSDORF

    BOARD MEMBER

    Total calculated
    $3,026,445
    From this org
    $0
    From related orgs
    $2,349,200
    Other
    $677,245
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $596,879 related
    Bonus
    $0 + $497,099 related
    Other
    $0 + $1,255,222 related
    Deferred
    $0 + $611,834 related
    Nontaxable benefits
    $0 + $65,411 related
    Filer's total
    $0 + $3,026,445 related

  • EVERT KUIPER

    EX-OFFICIO BM/ PRESIDENT & CEO CHI HEALTH

    Total calculated
    $1,303,984
    From this org
    $0
    From related orgs
    $1,274,593
    Other
    $29,391
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $891,215 related
    Bonus
    $0 + $275,000 related
    Other
    $0 + $108,378 related
    Deferred
    $0 + $3,276 related
    Nontaxable benefits
    $0 + $26,115 related
    Filer's total
    $0 + $1,303,984 related

  • JEANETTE WOJTALEWICZ

    CFO, CHI HEALTH (PARTIAL YEAR)

    Total calculated
    $1,223,121
    From this org
    $0
    From related orgs
    $1,168,841
    Other
    $54,280
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $649,549 related
    Bonus
    $0 + $463,014 related
    Other
    $0 + $56,278 related
    Deferred
    $0 + $17,750 related
    Nontaxable benefits
    $0 + $36,530 related
    Filer's total
    $0 + $1,223,121 related

  • CARY WARD MD

    CMO, CHI HEALTH

    Total calculated
    $726,541
    From this org
    $0
    From related orgs
    $681,233
    Other
    $45,308
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $558,482 related
    Bonus
    $0 + $117,207 related
    Other
    $0 + $5,544 related
    Deferred
    $0 + $17,750 related
    Nontaxable benefits
    $0 + $27,558 related
    Filer's total
    $0 + $726,541 related

  • EDWARD HANNON

    INTERIM PRESIDENT, GSH (TERMED 7/31/22)

    Total calculated
    $570,582
    From this org
    $0
    From related orgs
    $504,228
    Other
    $66,354
    Hours/week
    10 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $405,705 related
    Bonus
    $0 + $92,979 related
    Other
    $0 + $5,544 related
    Deferred
    $0 + $39,265 related
    Nontaxable benefits
    $0 + $27,089 related
    Filer's total
    $0 + $570,582 related

  • KIRTIBALA GUPTA MD

    BOARD MEMBER

    Total calculated
    $440,317
    From this org
    $0
    From related orgs
    $396,003
    Other
    $44,314
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $394,104 related
    Bonus
    $0
    Other
    $0 + $1,899 related
    Deferred
    $0 + $17,575 related
    Nontaxable benefits
    $0 + $26,739 related
    Filer's total
    $0 + $440,317 related

  • HEATHER MORGAN MD

    BOARD MEMBER

    Total calculated
    $329,219
    From this org
    $0
    From related orgs
    $278,612
    Other
    $50,607
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $277,757 related
    Bonus
    $0
    Other
    $0 + $855 related
    Deferred
    $0 + $16,557 related
    Nontaxable benefits
    $0 + $34,050 related
    Filer's total
    $0 + $329,219 related

  • NICK OTOOL

    INTERIM CFO, CHI HEALTH

    Total calculated
    $304,710
    From this org
    $0
    From related orgs
    $257,678
    Other
    $47,032
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $207,354 related
    Bonus
    $0 + $49,872 related
    Other
    $0 + $452 related
    Deferred
    $0 + $16,380 related
    Nontaxable benefits
    $0 + $30,652 related
    Filer's total
    $0 + $304,710 related

  • JACQUELINE LIESS

    PEDIATRIC NURSE

    Total calculated
    $290,289
    From this org
    $180
    From related orgs
    $254,630
    Other
    $35,479
    Hours/week
    1 + 44 related

    Schedule J breakdown matched by us

    Base
    $180 + $254,138 related
    Bonus
    $0
    Other
    $0 + $492 related
    Deferred
    $10,933
    Nontaxable benefits
    $15,390 + $9,156 related
    Filer's total
    $26,503 + $263,786 related

  • TIMOTHY LOEFFEL

    PERFUSIONIST

    Total calculated
    $244,784
    From this org
    $5,948
    From related orgs
    $199,521
    Other
    $39,315
    Hours/week
    1 + 44 related

    Schedule J breakdown matched by us

    Base
    $5,948 + $198,812 related
    Bonus
    $0 + $400 related
    Other
    $0 + $309 related
    Deferred
    $0 + $12,124 related
    Nontaxable benefits
    $52 + $27,139 related
    Filer's total
    $6,000 + $238,784 related

  • MICHAEL SCHNIEDERS

    FORMER PRESIDENT, GSH

    Total calculated
    $236,800
    From this org
    $0
    From related orgs
    $217,056
    Other
    $19,744
    Hours/week
    0 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $121,620 related
    Bonus
    $0 + $86,876 related
    Other
    $0 + $8,560 related
    Deferred
    $0 + $12,587 related
    Nontaxable benefits
    $0 + $7,157 related
    Filer's total
    $0 + $236,800 related

  • LISA COOPER

    TRAVELER RN

    Total calculated
    $234,564
    From this org
    $28,609
    From related orgs
    $184,367
    Other
    $21,588
    Hours/week
    5 + 40 related

    Schedule J breakdown matched by us

    Base
    $23,355 + $181,350 related
    Bonus
    $0 + $400 related
    Other
    $5,254 + $2,617 related
    Deferred
    $8,312
    Nontaxable benefits
    $8,669 + $4,607 related
    Filer's total
    $45,590 + $188,974 related

  • NICKI BOHL

    DIRECTOR PHARMACY

    Total calculated
    $230,870
    From this org
    $201,550
    From related orgs
    $0
    Other
    $29,320
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $183,973
    Bonus
    $17,190
    Other
    $387
    Deferred
    $11,657
    Nontaxable benefits
    $17,663
    Filer's total
    $230,870

  • CURT COLEMAN

    PRESIDENT, GSH

    Total calculated
    $223,090
    From this org
    $0
    From related orgs
    $215,866
    Other
    $7,224
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $0 + $142,667 related
    Bonus
    $0 + $20,000 related
    Other
    $0 + $53,199 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $7,224 related
    Filer's total
    $0 + $223,090 related

  • LISA OVERTON

    INVASIVE TECHNOLOGIST

    Total calculated
    $214,055
    From this org
    $444
    From related orgs
    $202,029
    Other
    $11,582
    Hours/week
    1 + 44 related

    Schedule J breakdown matched by us

    Base
    $444 + $200,267 related
    Bonus
    $0 + $400 related
    Other
    $0 + $1,362 related
    Deferred
    $10,965
    Nontaxable benefits
    $417 + $200 related
    Filer's total
    $11,826 + $202,229 related

  • SISTER NADINE HEIMANN OSF

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 40 related

  • SUSANNE L HRUZA MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related

  • SISTER MAURITA SOUKUP

    BOARD CHAIR

    Total calculated
    $0
    Hours/week
    1 + 11 related

  • BILL YATES

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    1 + 11 related

  • KENT BARNEY

    TREASURER

    Total calculated
    $0
    Hours/week
    1 + 11 related

  • MARDELL WILSON

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related

  • KELLY BACON

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related

  • KEVIN FITZGERALD PHD

    SECRETARY

    Total calculated
    $0
    Hours/week
    1 + 11 related

  • LG SEARCEY

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related

  • DAVE TAYLOR

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 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 — 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
DURING THE CALENDAR YEAR 2022, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4A:
CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY AN EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 52 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION AND TENURE, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY.
PART I, LINE 4B:
DURING THE 2022 CALENDAR YEAR, COMMONSPIRIT HEALTH ("COMMONSPIRIT") MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2022 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2022, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: JEANETTE WOJTALEWICZ, $50,733, MICHAEL SCHNIEDERS, $5,688. CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1, 2008. CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH ARE ELIGIBLE TO PARTICIPATE IN NON-QUALIFIED 457(F) PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES HIRED PRIOR TO JUNE 30, 2006. THE BENEFIT IS INTENDED TO BRIDGE THE DIFFERENCE, IF ANY, BETWEEN THE BENEFIT PROVIDED UNDER THE DIGNITY HEALTH EXCESS BENEFIT PLAN HAD BENEFIT SERVICE NOT BEEN FROZEN AT JANUARY 1, 2008, AND THE BENEFITS PROVIDED FROM ALL OTHER QUALIFIED AND NON-QUALIFIED PLANS. BENEFITS VEST UNDER THIS 457(F) PLAN AT THE LATER OF THE DATE THE PARTICIPANT ATTAINS AGE 62 OR IS CREDITED WITH 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES, PRIMARILY THOSE WHO ARE NOT ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN OR THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN DESCRIBED ABOVE. THIS BENEFIT PROVIDES AN ANNUAL ACCRUAL OF 10% OF TOTAL COMPENSATION AND IS PAYABLE ANNUALLY ON JULY 1 ONCE VESTED, WHICH IS AGE 62 WITH 5 YEARS OF SERVICE. THE PLAN ALSO ALLOWS FOR SPECIAL AWARDS. PAYMENTS PURSUANT TO THE PLAN ARRANGEMENTS FOR CERTAIN EMPLOYEES OCCURRED DURING 2022 AND INCLUDE J. PETERSDORF, $1,242,454. CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH PARTICIPATE IN THE DIGNITY HEALTH SUPPLEMENTAL EXECUTIVE RETENTION/RETIREMENT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN WHICH IN 2002 WAS OFFERED TO MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM BY THE DIGNITY HEALTH BOARD OF DIRECTORS AND WOULD BE PAID ONLY IF THE EXECUTIVES STAYED WITH THE ORGANIZATION FOR A SPECIFIED NUMBER OF YEARS AS THE PRIMARY PURPOSE OF THIS PLAN IS TO PROVIDE FOR THE RETENTION AND RETIREMENT OF THE PARTICIPANTS. THE EXECUTIVE MANAGEMENT TEAM IS RECRUITED FROM STABLE CAREERS IN ORGANIZATIONS FROM ACROSS THE COUNTRY AND FROM VARIOUS INDUSTRIES. DUTIES ARE BOTH EXTENSIVE AND COMPLEX AND REQUIRE SUBSTANTIAL AND DIVERSE EXPERIENCE AND SKILL SETS TO EXECUTE THEIR ROLES SUCCESSFULLY. THE CALCULATION FOR THE PAYMENTS TO EACH EXECUTIVE ARE BASED ON THE VALUE OF A FINAL AVERAGE PAY ANNUITY BENEFIT BASED ON RETIREMENT AGE AND SERVICE YEARS TO THE ORGANIZATION. DISTRIBUTION OCCURS EACH JULY 1 IF THE PLAN FORMULA WARRANTS A PAYMENT. NO PAYMENTS PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2022.
PART II:
GOOD SAMARITAN HOSPITAL FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST COMMONSPIRIT IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE COMMONSPIRIT TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES COMMONSPIRIT SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND COMMONSPIRIT'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL, AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2022.

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
10 May 2024
IRS schema version
2022v5.0
Source object
202431319349300233

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