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Nonprofiteer
← COVENANT PHYSICIAN PARTNERS INC

Form 990 for tax year 2022

Filed by COVENANT PHYSICIAN PARTNERS INC.

Totals

Total revenue
$18,191,962
Total expenses
$18,120,743
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$18,120,745
Investment income
$71,217
Other revenue
$0
Total assets, end of year
$20,493,473
Total liabilities, end of year
$9,861,818
Net assets or fund balances, end of year
$10,631,655
Program services expenses (Part IX)
$12,351,869
Management and general expenses
$5,768,874
Fundraising expenses
$0
Program service expenses (Part III)
$12,351,869

Program services were 68.2% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: PAYMENTS FROM EO AFFIL

    total $18,120,745 · related or exempt $18,120,745

  • 3 · Investment income

    total $71,217 · excluded $71,217

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $571,915 · program services $389,521 · management and general $182,394

  • 7 · Other salaries and wages

    total $9,897,265 · program services $6,740,848 · management and general $3,156,417

  • 8 · Pension plan contributions

    total $199,099 · program services $135,603 · management and general $63,496

  • 9 · Other employee benefits

    total $90,920 · program services $61,924 · management and general $28,996

  • 10 · Payroll taxes

    total $706,837 · program services $481,414 · management and general $225,423

  • 11g · Fees: other

    total $5,083,400 · program services $3,462,212 · management and general $1,621,188

  • 12 · Advertising and promotion

    total $2,486 · program services $1,693 · management and general $793

  • 13 · Office expenses

    total $123,716 · program services $84,261 · management and general $39,455

  • 14 · Information technology

    total $655 · program services $446 · management and general $209

  • 16 · Occupancy

    total $28,480 · program services $19,397 · management and general $9,083

  • 17 · Travel

    total $163,670 · program services $111,473 · management and general $52,197

  • 19 · Conferences, conventions and meetings

    total $5,719 · program services $3,895 · management and general $1,824

  • 22 · Depreciation, depletion and amortization

    total $5,186 · program services $3,532 · management and general $1,654

  • 24a · Other expenses: SYSTEM COST ALLOCATION

    total $1,095,581 · program services $746,180 · management and general $349,401

  • 24b · Other expenses: OTHER DIRECT EXPENSES

    total $92,816 · program services $63,215 · management and general $29,601

  • 24c · Other expenses: MEDICAL SUPPLIES

    total $31,853 · program services $31,853

  • 24d · Other expenses: RECRUITING & RELOCATION

    total $9,040 · program services $6,157 · management and general $2,883

  • 24e · All other expenses

    total $12,105 · program services $8,245 · management and general $3,860

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $14,429,217 · end of year $20,256,826

  • 9 · Prepaid expenses and deferred charges

    beginning of year $180,778 · end of year $206,760

  • 10a · Land, buildings and equipment: cost or other basis

    $131,678

  • 10b · Land, buildings and equipment: accumulated depreciation

    $101,791

  • 10c · Land, buildings and equipment, net

    beginning of year $35,072 · end of year $29,887

  • 15 · Other assets

    beginning of year $5,906,533 · end of year $0

  • 17 · Accounts payable and accrued expenses

    beginning of year $5,305,017 · end of year $5,739,742

  • 19 · Deferred revenue

    beginning of year $5,781,727 · end of year $3,592,773

  • 25 · Other liabilities

    beginning of year $0 · end of year $529,303

  • 27 · Net assets without donor restrictions

    beginning of year $9,464,856 · end of year $10,631,655

Mission and programs · 2022

Mission

AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.

  • SEE SCHEDULE OPROVIDENCEAT PROVIDENCE, WE USE OUR VOICE TO ADVOCATE FOR VULNERABLE POPULATIONS AND NEEDED REFORMS IN HEALTH CARE. WE PURSUE INNOVATIVE WAYS TO TRANSFORM HEALTH CARE BY KEEPING PEOPLE HEALTHY, AND MAKING OUR SERVICES MORE CONVENIENT, ACCESSIBLE AND AFFORDABLE FOR ALL. IN AN INCREASINGLY UNCERTAIN WORLD, WE ARE COMMITTED TO HIGH-QUALITY, COMPASSIONATE CARE FOR EVERYONE-REGARDLESS OF COVERAGE OR ABILITY TO PAY. WE HELP PEOPLE AND COMMUNITIES BENEFIT FROM THE BEST HEALTH CARE MODEL FOR THE FUTURE-TODAY.TOGETHER, OUR 117,000 CAREGIVERS (ALL EMPLOYEES) SERVE IN 52 HOSPITALS, 1,085 CLINICS AND A COMPREHENSIVE RANGE OF SERVICES ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. THE PROVIDENCE FAMILY INCLUDES:-PROVIDENCE ACROSS SEVEN WESTERN STATES-COVENANT HEALTH IN WEST TEXAS-PROVIDENCE FACEY MEDICAL FOUNDATION IN LOS ANGELES, CA-KADLEC IN SOUTHEAST WASHINGTON-PACIFIC MEDICAL CENTERS IN SEATTLE, WA-SWEDISH HEALTH SERVICES IN SEATTLE, WAAS A COMPREHENSIVE HEALTH CARE ORGANIZATION, WE ARE SERVING MORE PEOPLE, ADVANCING BEST PRACTICES AND CONTINUING OUR MORE THAN 100-YEAR TRADITION OF SERVING THE POOR AND VULNERABLE. DELIVERING SERVICES ACROSS SEVEN STATES, PROVIDENCE IS COMMITTED TO TOUCHING MILLIONS OF MORE LIVES AND ENHANCING THE HEALTH OF THE AMERICAN WEST TO TRANSFORM CARE FOR THE NEXT GENERATION AND BEYOND.THROUGH COMMUNITY BENEFIT PROGRAMS AND OTHER HIGH-IMPACT INVESTMENTS, WE WORK TO ENSURE BASIC HEALTH NEEDS ARE MET AND SERVE TO REMOVE BARRIERS TO CARE, BUILD COMMUNITY RESILIENCE AND INNOVATE FOR THE FUTURE. MINISTRIES AND AFFILIATES SUPPORT ORGANIZATIONS, PROGRAMS AND INITIATIVES THAT IMPROVE HEALTH AND WELL-BEING AND INCREASE EQUITABLE ACCESS TO QUALITY CARE AT THE COMMUNITY LEVEL AND AT SCALE ACROSS SEVEN STATES.WE ARE PROUD OF OUR HISTORY AND CONTINUED COMMITMENT TO HELPING BUILD A MORE EQUITABLE, SUSTAINABLE FUTURE. OUR STEADFAST COMMITMENT TO RESPONDING TO COMMUNITY NEED IS ONE OF THE MANY WAYS MINISTRIES, AFFILIATES AND CAREGIVERS LIVE OUT OUR SHARED MISSION AND CONTINUE TO SERVE AS A VITAL SAFETY NET FOR THOSE WHO ARE VULNERABLE.FOR MORE INFORMATION GO TO: HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT ENVIRONMENTAL, SOCIAL, AND GOVERNANCE STANDARDSPROVIDENCE CONTINUES TO ADVANCE A SOCIAL RESPONSIBILITY FRAMEWORK THAT INCLUDES A STRONGER COMMITMENT TO DIVERSITY, EQUITY, INCLUSION ("DEI"), AND ENVIRONMENTAL STEWARDSHIP. IN 2022, WE ELEVATED THE WORK OF DEI, BY RESTRUCTURING RESOURCES WITH PLANS TO ALIGN AND SCALE DEI STRATEGIES ACROSS THE PROVIDENCE FAMILY OF ORGANIZATIONS. WE CONTINUE TO EXECUTE ON OUR INTEGRATED STRATEGIC & FINANCIAL PLAN WHICH CLEARLY EXPRESSES OUR COMMITMENT AND ACCELERATION OF THIS IMPORTANT WORK TO ADDRESS SOCIAL, RACIAL, AND ECONOMIC DISPARITIES IN THE COMMUNITIES WE SERVE. PROVIDENCE'S SOCIAL RESPONSIBILITY FRAMEWORK AIMS TO DEPLOY THE ASSETS OF OUR SYSTEM TO SUPPORT COMMUNITY HEALTH IMPROVEMENT, STRENGTHEN LOCAL ECONOMIES AND REDUCE OUR CARBON FOOTPRINT. WE HAVE IMPLEMENTED AN ENVIRONMENTAL STEWARDSHIP SYSTEM STRATEGY THAT ENCOURAGES WASTE REDUCTIONS, EFFICIENT ENERGY AND WATER USAGE, LOCAL AGRICULTURE PARTNERSHIPS, LESS TOXIC AND FEWER CHEMICAL USE, AND A REDUCTION IN CARBON FROM TRAVEL. WE HAVE ALSO HELD ENVIRONMENTAL STEWARDSHIP AS ONE OF THE TOP PRIORITIES FOR OUR LEADERSHIP INCENTIVE PROGRAM TO ENSURE ALIGNMENT AND MOMENTUM CONTINUES. IN APRIL 2022, PROVIDENCE PUBLISHED ITS FIRST ENVIRONMENTAL STEWARDSHIP REPORT, IN WHICH WE REPORTED 12 PERCENT REDUCTION IN CARBON EMISSIONS IN SEVEN KEY CATEGORIES IN OUR ACUTE CARE FACILITIES SINCE OUR 2019 BASELINE. AS OF SEPTEMBER 30, 2022, (THE MOST RECENT DATA AVAILABLE), WE HAVE INCREASED THAT REDUCTION TO 13 PERCENT.REALIZING OUR MISSION OUR MISSION IS REALIZED THROUGH THE DELIVERY OF QUALITY IN-PATIENT AND OUT-PATIENT SERVICES, AND FOCUSED COMMUNITY INITIATIVES AND PROGRAMS THAT ARE DEDICATED TO IMPROVING THE LIVES OF ALL WE SERVE. PROGRAM SERVICE ACCOMPLISHMENTS COVENANT HEALTH PARTNERS IS A JOINT VENTURE BETWEEN MORE THAN 300 PHYSICIANS AND THE FOUR HOSPITALS IN THE COVENANT HEALTH SYSTEM IN A UNIQUE COLLABORATION KNOWN AS CLINICAL INTEGRATION. THE PROGRAM IS DESIGNED TO IMPROVE HEALTH OUTCOMES AND INCREASE THE VALUE RECEIVED FOR THE DOLLARS SPENT BY AREA EMPLOYERS ON EMPLOYEE HEALTH BENEFITS. THE COVENANT HEALTH PARTNERS CLINICAL INTEGRATION PROGRAM JOINS TOGETHER WHAT WOULD OTHERWISE BE A FRAGMENTED GROUP OF INDEPENDENTLY PRACTICING PHYSICIANS INTO A COMPREHENSIVE CARE MANAGEMENT PROGRAM, COMPRISED OF A COMMON SET OF QUALITY GOALS AND MEASURES ACROSS ALL INSURANCE CARRIERS, WITH A FOCUS ON IMPROVED HEALTH CARE OUTCOMES AND REDUCING THE LONG TERM COST OF CARE. UNLIKE OTHER DISEASE MANAGEMENT OR PREVENTIVE HEALTH PROGRAMS, THE CLINICAL INTEGRATION PROGRAM PROVIDES EXTENSIVE INFRASTRUCTURE AND SUPPORT TO PHYSICIANS PARTICIPATING IN THE PROGRAM, AS WELL AS A PAY-FOR-PERFORMANCE INCENTIVE SYSTEM, TO DRIVE AN OUTSTANDING LEVEL OF PERFORMANCE.COVENANT HEALTH PARTNERS (CHP) BEGAN IN 2013 WHEN A NUMBER OF PHYSICIANS SUPPORTED BY COVENANT HEALTH SYSTEM, HAD THE VISION TO IMPROVE THE CURRENT MEDICAL DELIVERY SYSTEM IN THE COMMUNITY THROUGH A MODEL NOT WIDELY USED, KNOWN AS CLINICAL INTEGRATION. THE VISION RESULTED IN THE FORMING OF COVENANT HEALTH PARTNERS; A COLLABORATION BETWEEN COVENANT HEALTH SYSTEM, COVENANT MEDICAL GROUP (WHICH EMPLOYS ABOUT 150 PHYSICIANS), AND 160 INDEPENDENT PHYSICIANS.FOR MORE INFORMATION ON COVENANT HEALTH PARTNERS, PLEASE VISITHTTPS://WWW.COVENANTHEALTHPARTNERS.ORG/ FOR MORE INFORMATION ABOUT PROVIDENCE ST. JOSEPH HEALTH, PLEASE VISITHTTPS://WWW.PROVIDENCE.ORG/

    Expenses $12,351,869 · Revenue $18,120,745

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Nilesh Patel MD

    BOARD MEMBER

    Total calculated
    $890,922
    From this org
    $0
    From related orgs
    $801,743
    Other
    $89,179
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $680,102 related
    Bonus
    $0 + $22,435 related
    Other
    $0 + $99,206 related
    Deferred
    $0 + $58,045 related
    Nontaxable benefits
    $0 + $31,134 related
    Filer's total
    $0 + $890,922 related

  • John Grigson

    FRMR OFF. - TX/NM REG. CFO

    Total calculated
    $831,503
    From this org
    $0
    From related orgs
    $752,735
    Other
    $78,768
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $507,578 related
    Bonus
    $0 + $168,000 related
    Other
    $0 + $77,157 related
    Deferred
    $0 + $67,544 related
    Nontaxable benefits
    $0 + $11,224 related
    Filer's total
    $0 + $831,503 related

  • Jason Strefling MD

    BOARD MEMBER

    Total calculated
    $705,087
    From this org
    $0
    From related orgs
    $677,675
    Other
    $27,412
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $646,040 related
    Bonus
    $0 + $12,798 related
    Other
    $0 + $18,837 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $27,412 related
    Filer's total
    $0 + $705,087 related

  • James Kelly

    FRMR OFF. - VP SENIOR CORP COUNSEL

    Total calculated
    $687,399
    From this org
    $0
    From related orgs
    $604,046
    Other
    $83,353
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $342,441 related
    Bonus
    $0 + $172,339 related
    Other
    $0 + $89,266 related
    Deferred
    $0 + $68,063 related
    Nontaxable benefits
    $0 + $15,290 related
    Filer's total
    $0 + $687,399 related

  • Richard Henderson MD

    BOARD MEMBER

    Total calculated
    $606,084
    From this org
    $0
    From related orgs
    $566,571
    Other
    $39,513
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $508,633 related
    Bonus
    $0 + $9,025 related
    Other
    $0 + $48,913 related
    Deferred
    $0 + $9,150 related
    Nontaxable benefits
    $0 + $30,363 related
    Filer's total
    $0 + $606,084 related

  • Michael Robertson MD

    CHP CEO

    Total calculated
    $571,915
    From this org
    $520,422
    From related orgs
    $0
    Other
    $51,493
    Hours/week
    27.5 + 27.5 related

    Schedule J breakdown matched by us

    Base
    $399,394
    Bonus
    $100,984
    Other
    $20,044
    Deferred
    $27,732
    Nontaxable benefits
    $23,761
    Filer's total
    $571,915

  • Jeremy Dalton MD

    BOARD MEMBER (PART YEAR)

    Total calculated
    $570,621
    From this org
    $0
    From related orgs
    $523,005
    Other
    $47,616
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $464,216 related
    Bonus
    $0 + $15,050 related
    Other
    $0 + $43,739 related
    Deferred
    $0 + $35,089 related
    Nontaxable benefits
    $0 + $12,527 related
    Filer's total
    $0 + $570,621 related

  • Chetlen Crossnoe MD

    BOARD MEMBER

    Total calculated
    $540,118
    From this org
    $0
    From related orgs
    $501,486
    Other
    $38,632
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $444,848 related
    Bonus
    $0 + $22,874 related
    Other
    $0 + $33,764 related
    Deferred
    $0 + $19,728 related
    Nontaxable benefits
    $0 + $18,904 related
    Filer's total
    $0 + $540,118 related

  • Jeremy L Brown MD

    BOARD MEMBER

    Total calculated
    $468,328
    From this org
    $0
    From related orgs
    $433,734
    Other
    $34,594
    Hours/week
    0.5 + 54.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $377,336 related
    Bonus
    $0 + $33,203 related
    Other
    $0 + $23,195 related
    Deferred
    $0 + $7,213 related
    Nontaxable benefits
    $0 + $27,381 related
    Filer's total
    $0 + $468,328 related

  • Christopher Collins MD

    BOARD MEMBER

    Total calculated
    $423,551
    From this org
    $0
    From related orgs
    $386,924
    Other
    $36,627
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $325,442 related
    Bonus
    $0 + $8,713 related
    Other
    $0 + $52,769 related
    Deferred
    $0 + $13,807 related
    Nontaxable benefits
    $0 + $22,820 related
    Filer's total
    $0 + $423,551 related

  • Karen Talusan-Soriano MD

    BOARD MEMBER

    Total calculated
    $350,776
    From this org
    $0
    From related orgs
    $287,815
    Other
    $62,961
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $265,835 related
    Bonus
    $0 + $6,855 related
    Other
    $0 + $15,125 related
    Deferred
    $0 + $26,123 related
    Nontaxable benefits
    $0 + $36,838 related
    Filer's total
    $0 + $350,776 related

  • William B Snodgrass MD

    BOARD MEMBER/CHAIR

    Total calculated
    $341,993
    From this org
    $0
    From related orgs
    $298,723
    Other
    $43,270
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $281,714 related
    Bonus
    $0 + $5,540 related
    Other
    $0 + $11,469 related
    Deferred
    $0 + $14,130 related
    Nontaxable benefits
    $0 + $29,140 related
    Filer's total
    $0 + $341,993 related

  • David Stowers

    EXECUTIVE DIRECTOR CARE MANAGEMENT

    Total calculated
    $337,543
    From this org
    $293,546
    From related orgs
    $0
    Other
    $43,997
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $228,781
    Bonus
    $62,060
    Other
    $2,705
    Deferred
    $19,839
    Nontaxable benefits
    $24,158
    Filer's total
    $337,543

  • Adam Spivey

    CFO

    Total calculated
    $304,231
    From this org
    $0
    From related orgs
    $266,060
    Other
    $38,171
    Hours/week
    14 + 41 related

    Schedule J breakdown matched by us

    Base
    $0 + $188,992 related
    Bonus
    $0 + $56,112 related
    Other
    $0 + $20,956 related
    Deferred
    $0 + $10,708 related
    Nontaxable benefits
    $0 + $27,463 related
    Filer's total
    $0 + $304,231 related

  • Marissa Yates MD

    BOARD MEMBER

    Total calculated
    $289,702
    From this org
    $0
    From related orgs
    $239,702
    Other
    $50,000
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $230,410 related
    Bonus
    $0 + $3,140 related
    Other
    $0 + $6,152 related
    Deferred
    $0 + $7,530 related
    Nontaxable benefits
    $0 + $42,470 related
    Filer's total
    $0 + $289,702 related

  • Joshua Hill MD

    BOARD MEMBER

    Total calculated
    $283,465
    From this org
    $0
    From related orgs
    $256,813
    Other
    $26,652
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $245,459 related
    Bonus
    $0 + $2,660 related
    Other
    $0 + $8,694 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $26,652 related
    Filer's total
    $0 + $283,465 related

  • Joel Landry

    BOARD MEMBER

    Total calculated
    $276,801
    From this org
    $0
    From related orgs
    $237,067
    Other
    $39,734
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $209,988 related
    Bonus
    $0 + $5,473 related
    Other
    $0 + $21,606 related
    Deferred
    $0 + $21,767 related
    Nontaxable benefits
    $0 + $17,967 related
    Filer's total
    $0 + $276,801 related

  • Rachael Stehling

    EXEC DIR, BUSINESS DEVELOPMENT

    Total calculated
    $275,362
    From this org
    $224,374
    From related orgs
    $0
    Other
    $50,988
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $172,836
    Bonus
    $39,995
    Other
    $11,543
    Deferred
    $24,835
    Nontaxable benefits
    $26,153
    Filer's total
    $275,362

  • Angela Ferguson MD

    BOARD MEMBER

    Total calculated
    $261,884
    From this org
    $0
    From related orgs
    $238,735
    Other
    $23,149
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $221,686 related
    Bonus
    $0 + $6,350 related
    Other
    $0 + $10,699 related
    Deferred
    $0 + $12,334 related
    Nontaxable benefits
    $0 + $10,815 related
    Filer's total
    $0 + $261,884 related

  • Lindzi Timberlake

    SECRETARY

    Total calculated
    $247,668
    From this org
    $0
    From related orgs
    $225,368
    Other
    $22,300
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $178,359 related
    Bonus
    $0 + $46,635 related
    Other
    $0 + $374 related
    Deferred
    $0 + $8,744 related
    Nontaxable benefits
    $0 + $13,556 related
    Filer's total
    $0 + $247,668 related

  • Lisa Barrington

    DIR, QUALITY IMPROVEMENT

    Total calculated
    $190,643
    From this org
    $156,138
    From related orgs
    $0
    Other
    $34,505
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $130,671
    Bonus
    $23,962
    Other
    $1,505
    Deferred
    $9,006
    Nontaxable benefits
    $25,499
    Filer's total
    $190,643

  • Terri Pierce

    DIR, CARE MANAGEMENT

    Total calculated
    $171,757
    From this org
    $142,983
    From related orgs
    $0
    Other
    $28,774
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $122,134
    Bonus
    $19,428
    Other
    $1,421
    Deferred
    $14,170
    Nontaxable benefits
    $14,604
    Filer's total
    $171,757

  • Allison Horton

    CLINICAL PHARMACIST

    Total calculated
    $168,045
    From this org
    $145,426
    From related orgs
    $0
    Other
    $22,619
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $145,426
    Bonus
    $0
    Other
    $0
    Deferred
    $8,104
    Nontaxable benefits
    $14,515
    Filer's total
    $168,045

  • Brent Nall MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5 + 0.5 related

  • Lakhu Rohra MD

    BOARD MEMBER - THRU 5/22

    Total calculated
    $0
    Hours/week
    0.5 + 0.5 related

  • Randy Rozean MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5 + 0.5 related

  • Swetha Gadwala MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5 + 0.5 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
  • 7 · Other non-fixed payments

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
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 1A
PROVIDENCE EXPENSE REIMBURSEMENT PROCEDURES INCLUDE THE FOLLOWING POLICIES: FIRST CLASS TRAVEL OR CHARTER TRAVEL AIR TRAVEL IS GENERALLY REIMBURSABLE AT THE LEAST EXPENSIVE AIRFARE WHICH PERMITS DEPARTURES AND ARRIVALS AT REASONABLE TIMES AND REASONABLE DISTANCE TRAVELED. EMPLOYEES ARE ENCOURAGED TO PLAN IN ADVANCE TO GET AVAILABLE DISCOUNTS. AIRLINE FREQUENT FLYER UPGRADES WILL NEVER BE REIMBURSED. IN LIMITED SITUATIONS, FIRST CLASS TICKETS AND CHARTER MAY BE REIMBURSED WHEN APPROVED BY A SENIOR LEVEL SUPERVISOR. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS TAX INDEMNIFICATIONS OR GROSS-UP PAYMENTS - RELOCATION PROVIDENCE FOLLOWS THE FEDERAL AND STATE TAXATION LAWS RELATED TO RELOCATION EXPENSES PAID TO THE EMPLOYEE OR TO A THIRD PARTY ON THE EMPLOYEE'S BEHALF. THEY ARE CONSIDERED TAXABLE WAGES AND ARE REPORTED AS SUCH. BASED ON THE WAY PROVIDENCE HAS CHOSEN TO PAY THE RELOCATION EXPENSES, PROVIDENCE REPORTS REIMBURSEMENTS AND PAYMENTS TO VENDORS AS INCOME AND THESE EXPENSE PAYMENTS ARE REFLECTED ON THE EXECUTIVE'S FORM W-2. PROVIDENCE PROVIDES A GROSS-UP FOR THE RELOCATION BENEFITS, SO THAT A PORTION OF THE REIMBURSEMENT DOES NOT HAVE TO BE USED TO PAY TAXES, AND THIS TAX GROSS-UP IS ALSO REPORTED AS TAXABLE INCOME. THE AMOUNTS REPORTED FOR THESE GROSS-UP PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990. TAX INDEMNIFICATIONS OR GROSS-UP PAYMENTS - FINANCIAL/RETIREMENT PLANNING PROVIDENCE FOLLOWS THE FEDERAL AND STATE TAXATION LAWS RELATED TO FINANCIAL AND RETIREMENT PLANNING EXPENSES PAID TO THE EMPLOYEE OR TO A THIRD PARTY ON THE EMPLOYEE'S BEHALF. THEY ARE CONSIDERED TAXABLE WAGES AND ARE REPORTED AS SUCH. BASED ON THE WAY PROVIDENCE HAS CHOSEN TO PAY THESE OTHER EXPENSES, PROVIDENCE REPORTS REIMBURSEMENTS AND PAYMENTS TO VENDORS AS INCOME AND THESE EXPENSE PAYMENTS ARE REFLECTED ON THE EXECUTIVE'S FORM W-2. PROVIDENCE PROVIDES A GROSS-UP FOR THIS BENEFIT, SO THAT A PORTION OF THE PAYMENT DOES NOT HAVE TO BE USED TO PAY TAXES, AND THIS TAX GROSS-UP IS ALSO REPORTED AS TAXABLE INCOME. THE AMOUNTS REPORTED FOR THESE GROSS-UP PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990. PERSONAL SERVICES PROVIDENCE OFFERS FINANCIAL PLANNING SERVICES AS AN OPTIONAL BENEFIT TO EMPLOYEES AT VICE PRESIDENT LEVEL AND ABOVE. THE AMOUNTS REPORTED FOR THE FINANCIAL PLANNING SERVICES ARE INCLUDED AS TAXABLE INCOME ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990 FOR THE EMPLOYEES WHO PARTICIPATE.
PART I, LINE 4B
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: JOHN GRIGSON - $42,179 JAMES KELLY - $88,487 MICHAEL ROBERTSON, M.D. - $5,515 WILLIAM B. SNODGRASS, M.D - $167
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

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.

  • 20TH STREET SURGERY LLC

    AMBULATORY SURGERY CENTER · CA

  • BRIDGEPORT MEDICAL IMAGING LLC (BMI)

    IMAGING - DIAGNOSTICS · OR · general or managing partner

  • BROADWAY IMAGING LLC

    MEDICAL IMAGING · MT · general or managing partner

  • CANBY MEDICAL CENTER I LLC

    REAL ESTATE - MOB · OR · general or managing partner

  • CENTER FOR MEDICAL IMAGING LLC (CMI)

    IMAGING - DIAGNOSTICS · OR · general or managing partner

  • CLACKAMAS RADIATION ONCOLOGY CENTER LLC

    RADIATION ONCOLOGY · OR · general or managing partner

  • COASTAL ASC HOLDINGS LLC

    HEALTHCARE · CA · general or managing partner

  • COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY

    HEALTHCARE · CA · general or managing partner

  • COVENANT PARK PHASE I VENTURE LLC

    REAL ESTATE · TX

  • CSS JV LLC

    AMBULATORY SURGERY CENTER · OR

  • FIRST HILL SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · WA · general or managing partner

  • FULLERTON SURGICAL CENTER LP

    AMBULATORY SURGERY CENTER · CA · general or managing partner

  • GREATER VALLEY MEDICAL BUILDING LP

    REAL ESTATE - MOB · CA · general or managing partner

  • HCSA PROPERTIES LLC

    REAL ESTATE RENTAL · WA

  • HERITAGE INVESTMENT GROUP I LLC

    INVESTMENTS · CA

  • HOAG ORTHOPEDIC INSTITUTE

    HEALTHCARE · CA

  • HOI ASC HOLDINGS LLC

    INVESTMENTS · CA

  • IMAGING ASSOCIATES LLC

    MEDICAL IMAGING · AK · general or managing partner

  • LSC REAL PROPERTY LLC

    REAL ESTATE · TX

  • METHODIST DIAGNOSTIC IMAGING

    HEALTHCARE · TX · general or managing partner

  • MISSION VIEJO PARTNERS II LLC

    REAL ESTATE - MOB · CA · general or managing partner

  • NEWPORT IMAGING CENTER

    HEALTHCARE · CA · general or managing partner

  • NORTH OC IMAGING JV HOLDINGS LLC

    HEALTHCARE · CA

  • OREGON ADVANCED IMAGING LLC

    MEDICAL IMAGING · OR · general or managing partner

  • PAVILION SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · CA

  • PETCT IMAGING AT SWEDISH CANCER INSTITUTE LLC

    MEDICAL IMAGING · WA · general or managing partner

  • PERFORMANCE MEDICAL EQUIPMENT & RESPIRATORY SERVICES LLC

    MEDICAL EQUIPMENT · WA · general or managing partner

  • PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCE ALASKA HOUSE I OWNER LP

    SUPPORTIVE HOUSING · AK

  • PROVIDENCE & SCA OFF-CAMPUS HOLDINGS LLC

    MEDICAL · AL

  • PROVIDENCE & SCA ON-CAMPUS HOLDINGS LLC

    MEDICAL · AL · general or managing partner

  • PROVIDENCE HOUSE OAKLAND LP

    SUPPORTIVE HOUSING · CA · general or managing partner

  • PROVIDENCE IMAGING CENTER JOINT VENTURE

    MEDICAL IMAGING · AK

  • PROVIDENCE ST JOSEPH HEALTH LONG TERM PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCE SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · MT

  • PROVIDENCEUSP SPOKANE SURGERY CENTERS LLC

    AMBULATORY SURGERY CENTER · WA

  • PROVIDENCEUSP SURGERY CTRS LLC

    AMBULATORY SURGERY CENTER · CA

  • RADIATION THERAPY INNOVATIONS LLC

    HEALTHCARE · WA · general or managing partner

  • RIVERSIDE HEALTHCARE

    HEALTHCARE · MN · general or managing partner

  • SJO ASC HOLDINGS LLC

    HEALTHCARE · CA

  • ST JOSEPH PHYSICIAN VENTURES I LLC

    REAL ESTATE · CA · general or managing partner

  • ST JOSEPHSATELLITE DIALYSIS CENTERS LLC

    HEALTHCARE · CA

  • ST JUDE SURGICAL CENTERS LLC

    AMBULATORY SURGERY CENTER · CA · general or managing partner

  • ST MARY MEDICAL CENTER LLC

    HEALTHCARE · CA

  • ST PETER-SOUTH SOUND REGIONAL MRI CENTER

    MEDICAL IMAGING · WA · general or managing partner

  • SURGERY CENTER AT TANASBOURNE LLC

    AMBULATORY SURGERY CENTER · KS · general or managing partner

  • THE MADISON SPOKANE INN LLC

    HOTEL SERVICES · WA · general or managing partner

  • WON-ONC LLC

    REAL ESTATE - MOB · WA · general or managing partner

Related corporations and trusts

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

  • 1221 MADISON STREET OWNERS ASSOC

    C · OWNERS' ASSOCIATION · WA

  • ACCLARA SOLUTIONS GROUP LLC

    C · HOLDING COMPANY · TX

  • ACCLARA SOLUTIONS INTERMEDIATE LLC

    C · HEALTHCARE FINANCIAL SERVICES · TX

  • ADVATA INC (FKA KENSCI INC)

    C · HEALTHCARE · WA

  • AMERICAN UNITY GROUP LTD

    C · CAPTIVE INSURANCE · BD

  • AYIN HEALTH SOLUTIONS INC

    C · HEALTHCARE · DE

  • BOURGET HEALTH SERVICES INC

    C · CLINICAL/MEDICAL LAB · WA

  • CARON CORPORATION

    C · MEDICAL PHYSICIAN SERVICE · MT

  • CLOUD 21 LIMITED

    C · HEALTHCARE · UK

  • COLBURN HILL GROUP INC

    C · HEALTHCARE · DE

  • ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA

    S · HEALTHCARE · CA

  • HMR WEIGHT MANAGEMENT SERVICES CORP

    C · HEALTHCARE · WA

  • HOAG MANAGEMENT SERVICES INC

    C · HEALTHCARE · CA

  • HOAG PHYSICIAN PARTNERS

    C · HEALTHCARE · CA

  • KENSCI TECH INDIA PRIVATE LIMITED

    C · HEALTHCARE · IN

  • KENSCI ASIA PACIFIC PTE LTD

    C · HEALTHCARE · SN

  • LUBBOCK METHODIST HOSP PRACTICE MGMT

    C · INACTIVE · TX

  • LUBBOCK METHODIST HOSPITAL SVCS

    C · HEALTHCARE · TX

  • LUMEDIC INC (FKA LUMEDIC ACQ CO INC)

    C · HEALTHCARE · WA

  • MEDICAL SPECIALTIES MANAGERS INC

    C · HEALTHCARE · WA

  • MISSION VIEJO MEDICAL VENTURES INC

    C · HEALTHCARE · CA

  • PERFORMANCE HEALTH TECHNOLOGY LTD

    C · HEALTHCARE · OR

  • PHN HOLDINGS

    C · STRATEGIC PLANNING SERVICES · CA

  • PROVIDENCE ASSURANCE INC

    C · CAPTIVE INSURANCE · AZ

  • PROVIDENCE GLOBAL CENTER LLP

    C · IT SVCS · IN

  • PROVIDENCE HEALTH CARE VENTURES INC

    C · CLINICAL/MEDICAL LAB · WA

  • PROVIDENCE HEALTH NETWORK

    C · PREPAID HEALTHCARE · CA

  • PROVIDENCE PARTNERS HOLDINGS INC

    C · INVESTMENT · DE

  • PROVIDENCE PHYSICIAN SERVICES CO

    C · HEALTHCARE · WA

  • PROVIDENCE RE

    C · INVESTMENT · CJ

  • PROVIDENCE ST JOSEPH HEALTH NETWORK

    C · HEALTHCARE · CA

  • QUIVIQ INC

    C · HEALTHCARE ANALYTICS · WA

  • ST JOSEPH HEALTH

    C · HOLDING COMPANY · CA

  • ST JOSEPH HEALTH SOURCE INC

    C · HEALTHCARE · CA

  • ST JOSEPH MEDICAL PLAZA ASSOCIATION

    C · CONDO ASSOCIATION · CA

  • ST JOSEPH PROF SVCS ENTERPRSES INC

    C · HEALTHCARE · CA

  • TEGRIA HOLDINGS LLC (FKA GRADY BLOCKER LLC)

    C · HOLDING COMPANY · DE

  • TEGRIA INSIGHTS GROUP HOLDINGS INC

    C · HOLDING COMPANY · WA

  • TEGRIA INSIGHTS GROUP INC

    C · HEALTHCARE · WA

  • TEGRIA PRODUCTS GROUP INC

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP INC (FKA PROV RCM GROUP INC)

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP US INC

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP-CAN INC

    C · HEALTHCARE · CA

  • TEGRIA SERVICES GROUP INC (FKA PROVIDENCE SERVICES GROUP)

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP-US INC (FKA BLUETREE NETWORK INC)

    C · HEALTHCARE · WI

  • TRUSANA INC

    C · HEALTHCARE · DE

  • VINSERRA INC

    C · INVESTMENT · CA

Provenance

Return type
form_990
Tax year
2022
Filed
7 November 2023
IRS schema version
2022v5.0
Source object
202333179349308643

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