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Nonprofiteer
← ST MARYS GOOD SAMARITAN HOSPITAL INC

Form 990 for tax year 2023

Filed by ST MARYS GOOD SAMARITAN HOSPITAL INC.

Totals

Total revenue
$41,963,849
Total expenses
$33,293,233
Contributions and grants received
$69,715
Grants paid
$8,050
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)
$28,817,262
Management and general expenses
$4,475,971
Fundraising expenses
$0
Program service expenses (Part III)
$28,817,262

Program services were 86.6% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • STONISH PIERCE

    DIRECTOR, PRESIDENT & CEO

    Total calculated
    $916,778
    From this org
    $0
    From related orgs
    $778,059
    Other
    $138,719
    Hours/week
    2 + 53 related

    Schedule J breakdown matched by us

    Base
    $0 + $473,856 related
    Bonus
    $0 + $223,750 related
    Other
    $0 + $80,453 related
    Deferred
    $0 + $109,787 related
    Nontaxable benefits
    $0 + $28,932 related
    Filer's total
    $0 + $916,778 related

  • JOHN FOOS

    DIRECTOR; CHAIR

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • JOAN ANTONE

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JACK BROWN

    DIRECTOR THROUGH 12/23

    Total calculated
    $0
    Hours/week
    1

  • WALTER CHANNELL

    DIRECTOR THROUGH 12/23

    Total calculated
    $0
    Hours/week
    1

  • DONNIE HARRISON JR

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • KRISTINE HOPKINS

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JEAN MEYER

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • ROBERT MOORE JR

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JAMES PARKS

    DIRECTOR AS OF 1/24

    Total calculated
    $0
    Hours/week
    1 + 2 related

  • ELIZABETH STRICKLAND THOMAS

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JUNE TOMPKINS

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • GARY USRY

    DIRECTOR AS OF 1/24

    Total calculated
    $0
    Hours/week
    1

  • JANICE DUNN

    TREASURER & CFO THROUGH 2/24

    Total calculated
    $394,670
    From this org
    $0
    From related orgs
    $350,886
    Other
    $43,784
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $340,370 related
    Bonus
    $0
    Other
    $0 + $10,516 related
    Deferred
    $0 + $14,850 related
    Nontaxable benefits
    $0 + $28,934 related
    Filer's total
    $0 + $394,670 related

  • MICHAEL GUSHO

    TREAS AT 2/24; CFO SVC AREA SOUTH

    Total calculated
    $1,002,197
    From this org
    $0
    From related orgs
    $936,965
    Other
    $65,232
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $650,389 related
    Bonus
    $0 + $166,250 related
    Other
    $0 + $120,326 related
    Deferred
    $0 + $24,750 related
    Nontaxable benefits
    $0 + $40,482 related
    Filer's total
    $0 + $1,002,197 related

  • ELIZABETH SCHOEN

    SECRETARY; ASSOCIATE COUNSEL

    Total calculated
    $293,002
    From this org
    $0
    From related orgs
    $250,579
    Other
    $42,423
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $225,447 related
    Bonus
    $0 + $23,633 related
    Other
    $0 + $1,499 related
    Deferred
    $0 + $11,785 related
    Nontaxable benefits
    $0 + $30,638 related
    Filer's total
    $0 + $293,002 related

  • JEFFREY BROWN

    SENIOR VICE PRESIDENT, OPERATIONS

    Total calculated
    $337,284
    From this org
    $0
    From related orgs
    $304,425
    Other
    $32,859
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $247,460 related
    Bonus
    $0 + $54,000 related
    Other
    $0 + $2,965 related
    Deferred
    $0 + $18,274 related
    Nontaxable benefits
    $0 + $14,585 related
    Filer's total
    $0 + $337,284 related

  • KIMBERLY TYLER

    ASSOCIATE CHIEF NURSE OFFICER

    Total calculated
    $217,356
    From this org
    $186,096
    From related orgs
    $0
    Other
    $31,260
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $162,479
    Bonus
    $20,073
    Other
    $3,544
    Deferred
    $8,273
    Nontaxable benefits
    $22,987
    Filer's total
    $217,356

  • JOSEPH HANCOCK

    PHARMACIST

    Total calculated
    $178,091
    From this org
    $140,783
    From related orgs
    $0
    Other
    $37,308
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $140,489
    Bonus
    $0
    Other
    $294
    Deferred
    $6,743
    Nontaxable benefits
    $30,565
    Filer's total
    $178,091

  • DONALD SOUTHARD

    NURSING SUPERVISOR

    Total calculated
    $153,843
    From this org
    $135,825
    From related orgs
    $0
    Other
    $18,018
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $133,595
    Bonus
    $0
    Other
    $2,230
    Deferred
    $6,243
    Nontaxable benefits
    $11,775
    Filer's total
    $153,843

  • CASEY ALLEN-HAYES

    MANAGER, PHARMACY

    Total calculated
    $125,403
    From this org
    $123,307
    From related orgs
    $0
    Other
    $2,096
    Hours/week
    45

  • CYNTHIA DAVIS

    MANAGER, REHABILITATION

    Total calculated
    $160,904
    From this org
    $122,757
    From related orgs
    $0
    Other
    $38,147
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $122,611
    Bonus
    $0
    Other
    $146
    Deferred
    $7,824
    Nontaxable benefits
    $30,323
    Filer's total
    $160,904

  • D MONTEZ CARTER

    FORMER OFFICER; TH OF NE PRES & CEO

    Total calculated
    $1,638,045
    From this org
    $0
    From related orgs
    $1,367,293
    Other
    $270,752
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $820,976 related
    Bonus
    $0 + $371,250 related
    Other
    $0 + $175,067 related
    Deferred
    $0 + $233,475 related
    Nontaxable benefits
    $0 + $37,277 related
    Filer's total
    $0 + $1,638,045 related

  • DAVID SPIVEY

    FORMER OFF;PRES SAINT AGNES THR 1/24

    Total calculated
    $965,098
    From this org
    $0
    From related orgs
    $916,565
    Other
    $48,533
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $699,276 related
    Bonus
    $0 + $75,000 related
    Other
    $0 + $142,289 related
    Deferred
    $0 + $24,750 related
    Nontaxable benefits
    $0 + $23,783 related
    Filer's total
    $0 + $965,098 related

  • JASON SMITH MD

    FORMER KEY EMPLOYEE

    Total calculated
    $345,542
    From this org
    $0
    From related orgs
    $322,529
    Other
    $23,013
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $117,999 related
    Bonus
    $0
    Other
    $0 + $204,530 related
    Deferred
    $0 + $1,863 related
    Nontaxable benefits
    $0 + $21,150 related
    Filer's total
    $0 + $345,542 related

  • TANYA ADCOCK

    FORMER OFFICER

    Total calculated
    $416,717
    From this org
    $0
    From related orgs
    $287,104
    Other
    $129,613
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $126,155 related
    Bonus
    $0
    Other
    $0 + $160,949 related
    Deferred
    $0 + $127,973 related
    Nontaxable benefits
    $0 + $1,640 related
    Filer's total
    $0 + $416,717 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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

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
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
GOOD SAMARITAN HOSPITAL IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. GOOD SAMARITAN HOSPITAL'S PRESIDENT IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF GOOD SAMARITAN HOSPITAL'S PRESIDENT: - 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, LINES 4A-B
THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2023. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: TANYA ADCOCK - $159,280 JASON SMITH, MD - $188,433 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERANCE AMOUNT, WHICH WAS UNPAID AS OF 12/31/23: TANYA ADCOCK - $126,325 (PAID IN 2024) THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2023. 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 2023, AND THEIR NON-VESTED BENEFITS FOR 2023 WERE ACCRUED. THE FOLLOWING PAYOUTS FOR 2023 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: D. MONTEZ CARTER - $73,923 MICHAEL GUSHO - $99,937 DAVID SPIVEY - $137,761 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ACCRUALS FOR 2023 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: D. MONTEZ CARTER - $213,675 STONISH PIERCE - $94,937 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 ($330,000 FOR 2023). THE FOLLOWING PAYOUTS FOR 2023 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: TANYA ADCOCK - $1,080 JANICE DUNN - $3,129 STONISH PIERCE - $0 JASON SMITH, MD - $7,580 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

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.

Related corporations and trusts

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

Provenance

Return type
form_990
Tax year
2023
Filed
13 May 2025
IRS schema version
2023v6.0
Source object
202521339349303052

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