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Nonprofiteer
← PROVIDENCE HEALTH ASSURANCE

Form 990 for tax year 2023

Filed by PROVIDENCE HEALTH ASSURANCE.

Totals

Total revenue
$4,495,526
Total expenses
$186,155
Contributions and grants received
$0
Grants paid
$2,261,024
Program services expenses (Part IX)
$0
Management and general expenses
$186,155
Fundraising expenses
$0
Program service expenses (Part III)
not reported

Program services were 0.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • DEBRA CANALES

    DIRECTOR

    Total calculated
    $5,096,572
    From this org
    $0
    From related orgs
    $5,026,633
    Other
    $69,939
    Hours/week
    0.5 + 64.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,184,847 related
    Bonus
    $0 + $3,373,872 related
    Other
    $0 + $467,914 related
    Deferred
    $0 + $25,456 related
    Nontaxable benefits
    $0 + $44,483 related
    Filer's total
    $0 + $5,096,572 related

  • RHONDA MEDOWS MD

    CHAIR

    Total calculated
    $4,470,578
    From this org
    $0
    From related orgs
    $4,437,916
    Other
    $32,662
    Hours/week
    0.5 + 64.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $586,192 related
    Bonus
    $0 + $2,482,541 related
    Other
    $0 + $1,369,183 related
    Deferred
    $0 + $17,325 related
    Nontaxable benefits
    $0 + $15,337 related
    Filer's total
    $0 + $4,470,578 related

  • DONALD ANTONUCCI

    PRESIDENT/CEO

    Total calculated
    $2,072,886
    From this org
    $0
    From related orgs
    $1,757,814
    Other
    $315,072
    Hours/week
    27 + 28 related

    Schedule J breakdown matched by us

    Base
    $0 + $828,320 related
    Bonus
    $0 + $926,873 related
    Other
    $0 + $2,621 related
    Deferred
    $0 + $272,823 related
    Nontaxable benefits
    $0 + $42,249 related
    Filer's total
    $0 + $2,072,886 related

  • ROBERT A GLUCKMAN

    CHIEF MEDICAL OFCR HEALTH PLAN

    Total calculated
    $1,217,742
    From this org
    $0
    From related orgs
    $1,146,922
    Other
    $70,820
    Hours/week
    18 + 37 related

    Schedule J breakdown matched by us

    Base
    $0 + $503,890 related
    Bonus
    $0 + $471,464 related
    Other
    $0 + $171,568 related
    Deferred
    $0 + $29,700 related
    Nontaxable benefits
    $0 + $41,120 related
    Filer's total
    $0 + $1,217,742 related

  • BRADLEY GARRIGUES

    CHIEF GROWTH OFF. PHP

    Total calculated
    $939,775
    From this org
    $0
    From related orgs
    $820,074
    Other
    $119,701
    Hours/week
    18 + 37 related

    Schedule J breakdown matched by us

    Base
    $0 + $302,723 related
    Bonus
    $0 + $482,465 related
    Other
    $0 + $34,886 related
    Deferred
    $0 + $87,343 related
    Nontaxable benefits
    $0 + $32,358 related
    Filer's total
    $0 + $939,775 related

  • CHERYL MORRISON

    COO PHP

    Total calculated
    $847,047
    From this org
    $0
    From related orgs
    $668,025
    Other
    $179,022
    Hours/week
    18 + 37 related

    Schedule J breakdown matched by us

    Base
    $0 + $451,276 related
    Bonus
    $0 + $215,707 related
    Other
    $0 + $1,042 related
    Deferred
    $0 + $83,266 related
    Nontaxable benefits
    $0 + $95,756 related
    Filer's total
    $0 + $847,047 related

  • DANIEL W RYAN

    TREASURER/VP - THRU 6/23

    Total calculated
    $746,540
    From this org
    $0
    From related orgs
    $716,116
    Other
    $30,424
    Hours/week
    17 + 33 related

    Schedule J breakdown matched by us

    Base
    $0 + $156,001 related
    Bonus
    $0 + $284,460 related
    Other
    $0 + $275,655 related
    Deferred
    $0 + $17,325 related
    Nontaxable benefits
    $0 + $13,099 related
    Filer's total
    $0 + $746,540 related

  • MICHAEL MATHIAS

    CHIEF INFORMATION OFF. PHP

    Total calculated
    $739,203
    From this org
    $0
    From related orgs
    $626,804
    Other
    $112,399
    Hours/week
    18.5 + 36.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $426,216 related
    Bonus
    $0 + $187,916 related
    Other
    $0 + $12,672 related
    Deferred
    $0 + $80,542 related
    Nontaxable benefits
    $0 + $31,857 related
    Filer's total
    $0 + $739,203 related

  • GREG ZAMUDIO

    SECRETARY

    Total calculated
    $704,073
    From this org
    $0
    From related orgs
    $605,120
    Other
    $98,953
    Hours/week
    17 + 33 related

    Schedule J breakdown matched by us

    Base
    $0 + $314,675 related
    Bonus
    $0 + $248,943 related
    Other
    $0 + $41,502 related
    Deferred
    $0 + $65,673 related
    Nontaxable benefits
    $0 + $33,280 related
    Filer's total
    $0 + $704,073 related

  • SCOTT BURTON

    MARKET PRESIDENT PHP

    Total calculated
    $518,482
    From this org
    $0
    From related orgs
    $466,540
    Other
    $51,942
    Hours/week
    16 + 34 related

    Schedule J breakdown matched by us

    Base
    $0 + $294,012 related
    Bonus
    $0 + $171,514 related
    Other
    $0 + $1,014 related
    Deferred
    $0 + $19,254 related
    Nontaxable benefits
    $0 + $32,688 related
    Filer's total
    $0 + $518,482 related

  • SALLY MARSH

    DIRECTOR SALES

    Total calculated
    $457,357
    From this org
    $0
    From related orgs
    $393,561
    Other
    $63,796
    Hours/week
    17 + 33 related

    Schedule J breakdown matched by us

    Base
    $0 + $123,316 related
    Bonus
    $0 + $269,688 related
    Other
    $0 + $557 related
    Deferred
    $0 + $42,396 related
    Nontaxable benefits
    $0 + $21,400 related
    Filer's total
    $0 + $457,357 related

  • PAUL T GIGER

    PHYSICIAN MEDICAL DIRECTOR I

    Total calculated
    $457,205
    From this org
    $0
    From related orgs
    $386,877
    Other
    $70,328
    Hours/week
    17 + 33 related

    Schedule J breakdown matched by us

    Base
    $0 + $336,143 related
    Bonus
    $0 + $27,676 related
    Other
    $0 + $23,058 related
    Deferred
    $0 + $37,168 related
    Nontaxable benefits
    $0 + $33,160 related
    Filer's total
    $0 + $457,205 related

  • STEPHANIE C DREYFUSS

    VP PHP NETWORK DEVELOPMENT

    Total calculated
    $431,673
    From this org
    $0
    From related orgs
    $378,134
    Other
    $53,539
    Hours/week
    17 + 33 related

    Schedule J breakdown matched by us

    Base
    $0 + $299,910 related
    Bonus
    $0 + $46,504 related
    Other
    $0 + $31,720 related
    Deferred
    $0 + $30,509 related
    Nontaxable benefits
    $0 + $23,030 related
    Filer's total
    $0 + $431,673 related

  • LINA SAADZOI

    TREASURER (PART YEAR)

    Total calculated
    $426,955
    From this org
    $0
    From related orgs
    $349,685
    Other
    $77,270
    Hours/week
    17 + 33 related

    Schedule J breakdown matched by us

    Base
    $0 + $257,100 related
    Bonus
    $0 + $75,000 related
    Other
    $0 + $17,585 related
    Deferred
    $0 + $55,740 related
    Nontaxable benefits
    $0 + $21,530 related
    Filer's total
    $0 + $426,955 related

  • MEGAN HEIAR

    CHIEF OF STAFF AYIN HEALTH SOLUTIONS

    Total calculated
    $384,761
    From this org
    $0
    From related orgs
    $365,675
    Other
    $19,086
    Hours/week
    16 + 34 related

    Schedule J breakdown matched by us

    Base
    $0 + $363,801 related
    Bonus
    $0
    Other
    $0 + $1,874 related
    Deferred
    $0 + $15,864 related
    Nontaxable benefits
    $0 + $3,222 related
    Filer's total
    $0 + $384,761 related

  • AARON BALS

    CHIEF COMP./RISK OFFICER

    Total calculated
    $380,865
    From this org
    $0
    From related orgs
    $339,881
    Other
    $40,984
    Hours/week
    18 + 37 related

    Schedule J breakdown matched by us

    Base
    $0 + $294,459 related
    Bonus
    $0 + $43,643 related
    Other
    $0 + $1,779 related
    Deferred
    $0 + $25,614 related
    Nontaxable benefits
    $0 + $15,370 related
    Filer's total
    $0 + $380,865 related

  • MICHAEL G WHITE

    FRMR PRESIDENT/CEO

    Total calculated
    $375,820
    From this org
    $0
    From related orgs
    $375,820
    Other
    $0
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $375,820 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $375,820 related

  • MARK JENSEN

    CHIEF SERVICE OPS OFF. - THRU 4/23

    Total calculated
    $328,342
    From this org
    $0
    From related orgs
    $306,112
    Other
    $22,230
    Hours/week
    18 + 37 related

    Schedule J breakdown matched by us

    Base
    $0 + $72,318 related
    Bonus
    $0 + $30,000 related
    Other
    $0 + $203,794 related
    Deferred
    $0 + $10,006 related
    Nontaxable benefits
    $0 + $12,224 related
    Filer's total
    $0 + $328,342 related

  • NATE PERRIZO

    FRMR CHIEF STRA & OPS OFCR PHP

    Total calculated
    $176,333
    From this org
    $0
    From related orgs
    $176,333
    Other
    $0
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $176,333 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $176,333 related

  • ISIAAH CRAWFORD PHD

    DIRECTOR

    Total calculated
    $50,000
    From this org
    $0
    From related orgs
    $50,000
    Other
    $0
    Hours/week
    0.5 + 14.5 related

  • JOSEPH BLANKENSHIP

    DIRECTOR

    Total calculated
    $35,000
    From this org
    $0
    From related orgs
    $35,000
    Other
    $0
    Hours/week
    0.5 + 1 related

  • BYRON SCOTT

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1 related

  • KERRY WEEMS

    DIRECTOR - THRU 8/23

    Total calculated
    $0
    Hours/week
    0.5 + 1 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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 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 3
SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/TOP MANAGEMENT OFFICIAL IS PAID BY A RELATED TAX-EXEMPT ORGANIZATION, PROVIDENCE HEALTH & SERVICES - WASHINGTON, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY PROVIDENCE.
PART I, LINES 4A-B
THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT DURING THE CURRENT YEAR: RHONDA MEDOWS, M.D. - $560,170 MICHAEL G. WHITE - $375,820 NATE PERRIZO - $176,333 MARK JENSEN - $171,907 DANIEL W RYAN - $142,963 NONQUALIFIED RETIREMENT PLAN 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: RHONDA MEDOWS, M.D. - $450,986 DEBRA CANALES - $411,575 ROBERT A. GLUCKMAN - $131,370 DANIEL W RYAN - $104,060 GREG ZAMUDIO - $39,855 BRADLEY GARRIGUES - $10,689 STEPHANIE C. DREYFUSS - $8,650 PAUL T. GIGER - $6,587 AARON BALS - $1,126 MARK JENSEN - $608
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

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
2023
Filed
14 November 2024
IRS schema version
2023v5.1
Source object
202423199349309282

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