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Nonprofiteer
← ST MARYS COMMUNITY HOSPITAL

Form 990 for tax year 2022

Filed by ST MARYS COMMUNITY HOSPITAL.

Totals

Total revenue
$42,500,144
Total expenses
$38,155,965
Contributions and grants received
$1,069,483
Grants paid
$3,230
Program service revenue
$40,959,270
Investment income
$70,051
Other revenue
$401,340
Total assets, end of year
$59,866,550
Total liabilities, end of year
$809,914
Net assets or fund balances, end of year
$59,056,636
Program services expenses (Part IX)
$30,587,438
Management and general expenses
$7,568,527
Fundraising expenses
$0
Program service expenses (Part III)
$30,587,438

Program services were 80.2% 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 (TERMED 1/6/23)

    Total calculated
    $1,223,121
    From this org
    $0
    From related orgs
    $1,168,841
    Other
    $54,280
    Hours/week
    5 + 45 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

  • JEFFREY STEARNES MD

    PHYSICIAN

    Total calculated
    $795,757
    From this org
    $0
    From related orgs
    $741,464
    Other
    $54,293
    Hours/week
    0 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $740,204 related
    Bonus
    $0
    Other
    $0 + $1,260 related
    Deferred
    $0 + $18,357 related
    Nontaxable benefits
    $0 + $35,936 related
    Filer's total
    $0 + $795,757 related

  • STACY BLUM MD

    PHYSICIAN-FAMILY MEDICINE

    Total calculated
    $611,786
    From this org
    $465,369
    From related orgs
    $91,923
    Other
    $54,494
    Hours/week
    40 + 5 related

    Schedule J breakdown matched by us

    Base
    $425,730 + $91,923 related
    Bonus
    $0
    Other
    $39,639
    Deferred
    $17,925
    Nontaxable benefits
    $34,912 + $1,657 related
    Filer's total
    $518,206 + $93,580 related

  • BRETT MEYER MD

    PHYSICIAN-FAMILY MEDICINE

    Total calculated
    $593,944
    From this org
    $477,642
    From related orgs
    $96,820
    Other
    $19,482
    Hours/week
    40 + 5 related

    Schedule J breakdown matched by us

    Base
    $476,802 + $96,820 related
    Bonus
    $0
    Other
    $840
    Deferred
    $17,750
    Nontaxable benefits
    $1,732
    Filer's total
    $497,124 + $96,820 related

  • BRADLEY VASA MD

    MEDICAL DIRECTOR

    Total calculated
    $521,028
    From this org
    $467,442
    From related orgs
    $0
    Other
    $53,586
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $465,310
    Bonus
    $0
    Other
    $2,132
    Deferred
    $17,750
    Nontaxable benefits
    $35,836
    Filer's total
    $521,028

  • KIRTIBALA GUPTA MD

    BOARD MEMBER/PHYSICIAN

    Total calculated
    $440,317
    From this org
    $0
    From related orgs
    $396,003
    Other
    $44,314
    Hours/week
    1 + 59 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

  • SAMANTHA BOYER MD

    PHYSICIAN-FAMILY MEDICINE

    Total calculated
    $421,396
    From this org
    $306,553
    From related orgs
    $109,980
    Other
    $4,863
    Hours/week
    35 + 10 related

    Schedule J breakdown matched by us

    Base
    $295,331 + $109,980 related
    Bonus
    $0
    Other
    $11,222
    Deferred
    $3,188
    Nontaxable benefits
    $1,675
    Filer's total
    $311,416 + $109,980 related

  • TRAVIS TIERNEY MD

    NEUROSURGEON

    Total calculated
    $419,675
    From this org
    $389,758
    From related orgs
    $0
    Other
    $29,917
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $388,215
    Bonus
    $0
    Other
    $1,543
    Deferred
    $17,925
    Nontaxable benefits
    $11,992
    Filer's total
    $419,675

  • DANIEL DEFREECE MD

    PRESIDENT

    Total calculated
    $383,688
    From this org
    $322,791
    From related orgs
    $0
    Other
    $60,897
    Hours/week
    49 + 1 related

    Schedule J breakdown matched by us

    Base
    $246,288
    Bonus
    $59,905
    Other
    $16,598
    Deferred
    $29,996
    Nontaxable benefits
    $30,901
    Filer's total
    $383,688

  • DAVID JONES

    MARKET PRESIDENT, REGIONAL HOSPITALS

    Total calculated
    $338,527
    From this org
    $0
    From related orgs
    $307,588
    Other
    $30,939
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $256,033 related
    Bonus
    $0 + $50,308 related
    Other
    $0 + $1,247 related
    Deferred
    $0 + $11,983 related
    Nontaxable benefits
    $0 + $18,956 related
    Filer's total
    $0 + $338,527 related

  • HEATHER MORGAN MD

    BOARD MEMBER/PHYSICIAN

    Total calculated
    $329,219
    From this org
    $0
    From related orgs
    $278,612
    Other
    $50,607
    Hours/week
    1 + 59 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 O'TOOL

    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

  • 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 + 12 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

    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, 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)

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 COMPENSATION SURVEY OR STUDY METHOD TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION.
PART 1, 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 1, 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. DURING 2022 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: DANIEL DEFREECE, $14,181. 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 M WOJTALEWICZ, $50,733. 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: JOHN 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
ST. MARY'S COMMUNITY 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

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
2022
Filed
10 May 2024
IRS schema version
2022v5.0
Source object
202431319349302183

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