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Nonprofiteer
← MANOR CARE OF LACEY WA ASSOCIATION

Form 990 for tax year 2022

Filed by MANOR CARE OF LACEY WA ASSOCIATION.

Totals

Total revenue
$12,484,367
Total expenses
$14,375,856
Contributions and grants received
$355,382
Grants paid
$0
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)
$13,950,273
Management and general expenses
$425,583
Fundraising expenses
$0
Program service expenses (Part III)
$13,950,273

Program services were 97.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • ANDREA SYPE

    TRUSTEE/AVP TAX-PART YEAR

    Total calculated
    $121,018
    From this org
    $0
    From related orgs
    $121,018
    Other
    $0
    Hours/week
    1 + 39 related

  • DELAINE RICE-WHITE

    TRUSTEE/VP REHAB SERVICES

    Total calculated
    $397,601
    From this org
    $0
    From related orgs
    $386,736
    Other
    $10,865
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $265,444 related
    Bonus
    $0 + $119,462 related
    Other
    $0 + $1,830 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $10,865 related
    Filer's total
    $0 + $397,601 related

  • JOHN HUBER

    TRUSTEE/VP OPERATIONS SUPPORT

    Total calculated
    $282,364
    From this org
    $0
    From related orgs
    $270,023
    Other
    $12,341
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $24,457 related
    Bonus
    $0 + $41,202 related
    Other
    $0 + $204,364 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $12,341 related
    Filer's total
    $0 + $282,364 related

  • KATHRYN SUE HOOPS

    TRUSTEE

    Total calculated
    $14,594
    From this org
    $0
    From related orgs
    $14,594
    Other
    $0
    Hours/week
    1 + 40 related

  • MARTIN ALLEN

    TRUSTEE/VP BUSINESS OFFICE SUPPORT

    Total calculated
    $328,591
    From this org
    $0
    From related orgs
    $312,085
    Other
    $16,506
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $273,975 related
    Bonus
    $0 + $35,094 related
    Other
    $0 + $3,016 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $16,506 related
    Filer's total
    $0 + $328,591 related

  • RAMI UBAYDI

    TRUSTEE/VP OPERATIONS

    Total calculated
    $427,223
    From this org
    $0
    From related orgs
    $416,235
    Other
    $10,988
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $47,946 related
    Bonus
    $0 + $61,658 related
    Other
    $0 + $306,631 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $10,988 related
    Filer's total
    $0 + $427,223 related

  • ROBERT SHARON

    TRUSTEE/VP OF FINANCE-PART YEAR

    Total calculated
    $295,244
    From this org
    $0
    From related orgs
    $283,127
    Other
    $12,117
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $181,483 related
    Bonus
    $0 + $29,621 related
    Other
    $0 + $72,023 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $12,117 related
    Filer's total
    $0 + $295,244 related

  • TIM ROBERTS

    TRUSTEE/VP OF TREASURY

    Total calculated
    $354,722
    From this org
    $0
    From related orgs
    $349,564
    Other
    $5,158
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $280,616 related
    Bonus
    $0 + $64,537 related
    Other
    $0 + $4,411 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $5,158 related
    Filer's total
    $0 + $354,722 related

  • JUSTIN SKIVER

    TRUSTEE

    Total calculated
    $585,171
    From this org
    $0
    From related orgs
    $579,491
    Other
    $5,680
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $453,418 related
    Bonus
    $0 + $125,000 related
    Other
    $0 + $1,073 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $5,680 related
    Filer's total
    $0 + $585,171 related

  • LUKE PILE

    TRUSTEE

    Total calculated
    $648,690
    From this org
    $0
    From related orgs
    $635,225
    Other
    $13,465
    Hours/week
    1 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $376,316 related
    Bonus
    $0 + $258,027 related
    Other
    $0 + $882 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $13,465 related
    Filer's total
    $0 + $648,690 related

  • ANGELA BRANDT

    PRESIDENT

    Total calculated
    $868,270
    From this org
    $0
    From related orgs
    $858,024
    Other
    $10,246
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $634,364 related
    Bonus
    $0 + $220,060 related
    Other
    $0 + $3,600 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $10,246 related
    Filer's total
    $0 + $868,270 related

  • JEFFREY C KUHN

    SECRETARY, CHIEF LEGAL OFFICER - PART YEAR

    Total calculated
    $971,690
    From this org
    $0
    From related orgs
    $927,467
    Other
    $44,223
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $390,988 related
    Bonus
    $0 + $196,494 related
    Other
    $0 + $339,985 related
    Deferred
    $0 + $23,904 related
    Nontaxable benefits
    $0 + $20,319 related
    Filer's total
    $0 + $971,690 related

  • RANDALL OOSTRA

    PHS PRES. & CEO - PART YEAR

    Total calculated
    $5,479,619
    From this org
    $0
    From related orgs
    $5,476,040
    Other
    $3,579
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,664,907 related
    Bonus
    $0 + $2,628,840 related
    Other
    $0 + $1,182,293 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $3,579 related
    Filer's total
    $0 + $5,479,619 related

  • STEVEN M CAVANAUGH

    TREASURER, CFO - PART YEAR

    Total calculated
    $2,477,340
    From this org
    $0
    From related orgs
    $2,435,815
    Other
    $41,525
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $604,206 related
    Bonus
    $0 + $1,107,251 related
    Other
    $0 + $724,358 related
    Deferred
    $0 + $28,986 related
    Nontaxable benefits
    $0 + $12,539 related
    Filer's total
    $0 + $2,477,340 related

  • STEPHEN SADOWSKI

    CHIEF LEGAL OFFICER

    Total calculated
    $689,717
    From this org
    $0
    From related orgs
    $683,615
    Other
    $6,102
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $596,289 related
    Bonus
    $0 + $86,275 related
    Other
    $0 + $1,051 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $6,102 related
    Filer's total
    $0 + $689,717 related

  • ARTURO POLIZZI

    PRESIDENT AND CEO

    Total calculated
    $1,618,580
    From this org
    $0
    From related orgs
    $1,605,830
    Other
    $12,750
    Hours/week
    1 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,003,178 related
    Bonus
    $0 + $597,348 related
    Other
    $0 + $5,304 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $12,750 related
    Filer's total
    $0 + $1,618,580 related

  • LOUIS ROBICHAUX

    TREASURER

    Total calculated
    $0
    Hours/week
    1 + 54 related

  • SUSAN MOREY

    SVP, SKILLED NURSING

    Total calculated
    $589,983
    From this org
    $0
    From related orgs
    $565,119
    Other
    $24,864
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $241,944 related
    Bonus
    $0 + $106,402 related
    Other
    $0 + $216,773 related
    Deferred
    $0 + $22,858 related
    Nontaxable benefits
    $0 + $2,006 related
    Filer's total
    $0 + $589,983 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
A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, INC., USES AN INDEPENDENT CONSULTANT, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S EXECUTIVES.
PART I, LINES 4A-B
UNDER A VOLUNTARY TERMINATION AGREEMENT ENTERED INTO BY THE EMPLOYEE AND THE ORGANIZATION OR UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM PROMEDICA. SEVERANCE PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSONS IN PART VII: STEVEN CAVANAUGH RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $688,132 DURING 2022. JEFFERY KUHN RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $333,184 DURING 2022. JOHN HUBER RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $203,385 DURING 2022. RAMI UBAYDI RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $306,392 DURING 2022. ROBERT SHARON RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $51,000 DURING 2022. ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII.
SCHEDULE J, SUPPLEMENTAL INFORMATION:
IN ADDITION, HCR MANORCARE, INC. A RELATED ORGANIZATION PROVIDES A SPLIT-DOLLAR LIFE INSURANCE PLAN TO ITS CHIEF EXECUTIVE OFFICER FROM WHICH NO CASH PAYMENTS WERE MADE DURING THE YEAR.

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 November 2023
IRS schema version
2022v5.0
Source object
202333189349313548

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

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