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Nonprofiteer
← PROVIDENCE HEALTH FOUNDATION

Form 990 for tax year 2022

Filed by PROVIDENCE HEALTH FOUNDATION.

Totals

Total revenue
$2,173,861
Total expenses
$1,128,922
Contributions and grants received
$2,168,734
Grants paid
$1,014,665
Program service revenue
$0
Investment income
$5,127
Other revenue
$0
Total assets, end of year
$5,290,268
Total liabilities, end of year
$2,109
Net assets or fund balances, end of year
$5,288,159
Program services expenses (Part IX)
$1,023,944
Management and general expenses
$4,641
Fundraising expenses
$100,337
Program service expenses (Part III)
$1,023,944

Program services were 90.7% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • ANTHONY M CANCELOSI

    SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • THOMAS J MUDLAFF

    CHAIR

    Total calculated
    $0
    Hours/week
    1

  • ERICKA TRICE

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JUSTIN E SILVERS

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • KEVIN ARCHER

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • KRYSTAL BRUMFIELD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • KYMBER MENKITI

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • MARK L HAYES JD RPH

    DIRECTOR

    Total calculated
    $833,290
    From this org
    $0
    From related orgs
    $794,948
    Other
    $38,342
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $324,988 related
    Bonus
    $0 + $396,000 related
    Other
    $0 + $73,960 related
    Deferred
    $0 + $16,775 related
    Nontaxable benefits
    $0 + $21,567 related
    Filer's total
    $0 + $833,290 related

  • MONTEZ ANDERSON

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • EDWARD R LOVERN

    PRESIDENT, MINISTRY MARKET (END 5/2023)

    Total calculated
    $825,787
    From this org
    $0
    From related orgs
    $779,035
    Other
    $46,752
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $549,622 related
    Bonus
    $0 + $165,000 related
    Other
    $0 + $64,413 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $28,452 related
    Filer's total
    $0 + $825,787 related

  • MITCHELL G LOMAX

    CFO, MINISTRY MARKET

    Total calculated
    $441,354
    From this org
    $0
    From related orgs
    $394,082
    Other
    $47,272
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $300,708 related
    Bonus
    $0 + $91,800 related
    Other
    $0 + $1,574 related
    Deferred
    $0 + $18,725 related
    Nontaxable benefits
    $0 + $28,547 related
    Filer's total
    $0 + $441,354 related

  • WILLIAM B HIGGINBOTHAM

    INTERIM PRESIDENT, MINISTRY MARKET (START 5/2023)

    Total calculated
    $430,586
    From this org
    $0
    From related orgs
    $385,142
    Other
    $45,444
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $318,477 related
    Bonus
    $0 + $65,000 related
    Other
    $0 + $1,665 related
    Deferred
    $0 + $18,475 related
    Nontaxable benefits
    $0 + $26,969 related
    Filer's total
    $0 + $430,586 related

  • SCOTT M FURNISS

    FORMER OFFICER (END 1/2020)

    Total calculated
    $465,588
    From this org
    $0
    From related orgs
    $420,701
    Other
    $44,887
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $317,301 related
    Bonus
    $0 + $97,500 related
    Other
    $0 + $5,900 related
    Deferred
    $0 + $17,747 related
    Nontaxable benefits
    $0 + $27,140 related
    Filer's total
    $0 + $465,588 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

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)

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO INDIVIDUALS RECEIVED CURRENT YEAR DISTRIBUTIONS.

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.

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
2022
Filed
8 May 2024
IRS schema version
2022v5.0
Source object
202441299349303914

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