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Nonprofiteer
← LUBBOCK HERITAGE HOSPITAL LLC

Form 990 for tax year 2022

Filed by LUBBOCK HERITAGE HOSPITAL LLC.

Totals

Total revenue
$88,725,116
Total expenses
$104,428,832
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$88,725,116
Investment income
$0
Other revenue
$0
Total assets, end of year
$244,263,746
Total liabilities, end of year
$185,440,343
Net assets or fund balances, end of year
$58,823,403
Program services expenses (Part IX)
$75,595,479
Management and general expenses
$28,833,353
Fundraising expenses
$0
Program service expenses (Part III)
$75,595,479

Program services were 72.4% 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: NET PATIENT REVENUE

    total $81,305,067 · related or exempt $81,305,067

  • 2b · Program service revenue: MOB RENTAL REVENUE

    total $7,420,049 · related or exempt $7,420,049

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $442,764 · program services $283,369 · management and general $159,395

  • 7 · Other salaries and wages

    total $13,843,925 · program services $8,860,112 · management and general $4,983,813

  • 10 · Payroll taxes

    total $1,197,969 · program services $766,700 · management and general $431,269

  • 11a · Fees: management

    total $1,204,661 · program services $770,983 · management and general $433,678

  • 11c · Fees: accounting

    total $4,563 · management and general $4,563

  • 11g · Fees: other

    total $6,846,304 · program services $4,381,635 · management and general $2,464,669

  • 20 · Interest

    total $7,515,186 · program services $4,809,719 · management and general $2,705,467

  • 22 · Depreciation, depletion and amortization

    total $12,512,350 · program services $8,007,904 · management and general $4,504,446

  • 24a · Other expenses: SYSTEM COST ALLOCATION

    total $31,232,769 · program services $19,988,972 · management and general $11,243,797

  • 24b · Other expenses: MEDICAL SUPPLIES

    total $24,344,297 · program services $24,344,297

  • 24c · Other expenses: RENTAL LEASE COSTS

    total $3,171,497 · program services $2,029,758 · management and general $1,141,739

  • 24e · All other expenses

    total $2,112,547 · program services $1,352,030 · management and general $760,517

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $18,901,389 · end of year $35,167,740

  • 4 · Accounts receivable

    beginning of year $7,618,848 · end of year $10,378,177

  • 8 · Inventories for sale or use

    beginning of year $2,030,098 · end of year $2,003,022

  • 9 · Prepaid expenses and deferred charges

    beginning of year $424,626 · end of year $269,547

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

    $216,395,846

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

    $38,857,292

  • 10c · Land, buildings and equipment, net

    beginning of year $188,644,727 · end of year $177,538,554

  • 15 · Other assets

    beginning of year $18,395,564 · end of year $18,906,706

  • 17 · Accounts payable and accrued expenses

    beginning of year $3,608,300 · end of year $2,793,410

  • 19 · Deferred revenue

    beginning of year -$1,294,817 · end of year -$3,232,141

  • 25 · Other liabilities

    beginning of year $190,411,649 · end of year $185,879,074

  • 27 · Net assets without donor restrictions

    beginning of year $43,290,120 · end of year $58,823,403

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.

Activities or mission (Part I)

SEE SCHEDULE O.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 O.AT PROVIDENCE, WE USE OUR VOICE TO ADVOCATE FOR VULNERABLE POPULATIONS AND NEEDED REFORMS IN HEALTH CARE. WE ARE ALSO PURSUING 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 51 HOSPITALS, 1,000 CLINICS AND A COMPREHENSIVE RANGE OF HEALTH AND SOCIAL 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.2022 PROGRAM SERVICE ACCOMPLISHMENTS: (JANUARY 1 - DECEMBER 31, 2022)COVENANT HEALTHCOVENANT HEALTH HAS A RICH HISTORY IN THE TEXAS/NEW MEXICO REGION. WHILE HEALTH CARE IN OUR REGION HAS CHANGED OVER THE YEARS, OUR COMMITMENT TO FULFILLING OUR MISSION, VISION, VALUES AND PROMISE HAVE NOT WAIVERED. DUE TO OVERLAPPING SERVICE AREAS, CLOSE GEOGRAPHIC PROXIMITY TO ONE ANOTHER, AND SHARED COMMUNITY OUTREACH PROGRAMS, THE COVENANT HEALTH HOSPITALS COLLABORATED TO DEVELOP A REGIONAL APPROACH TO THE 2021-2023 CHIP. WHILE THERE ARE SOME DIFFERENCES IN SELECT STRATEGIES AND COMMUNITY PARTNERS, COVENANT MEDICAL CENTER, COVENANT CHILDREN'S, GRACE MEDICAL CENTER, COVENANT SPECIALTY HOSPITAL, COVENANT HEALTH PLAINVIEW, AND COVENANT HEALTH LEVELLAND SHARE MANY OF THE SAME CHIP STRATEGIES, WHICH WILL ALLOW FOR MORE EFFECTIVELY LEVERAGING INVESTMENTS IN THE REGION TO MEET COMMUNITY NEEDS. BELOW WE HIGHLIGHT TWO PRIORITY AREA ACCOMPLISHMENTS ACROSS COVENANT HOSPITALS.MENTAL AND BEHAVIORAL HEALTHPRIORITY 1: MENTAL AND BEHAVIORAL HEALTH MENTAL AND BEHAVIORAL HEALTH TREATMENT, INTERVENTION AND PREVENTION SERVICES FOR THE COMMUNITY, INCLUDING RELATED ISSUES SUCH AS SUBSTANCE USENO TIME IN RECENT HISTORY TESTED MENTAL AND BEHAVIORAL HEALTH MORE THAN THE COVID-19 PANDEMIC OF 2020-2021. DURING 2020 COVENANT HEALTH OPENED A COMMUNITY RESOURCE CENTER WITHIN THE LUBBOCK YWCA BUILDING WITH EXPANDED SERVICES CONTINUING INTO 2022. THIS CENTER CONTINUES TO EXPAND ACCESS TO MENTAL HEALTH COUNSELING SERVICES FOR LOW-INCOME AND UN0INSURED. COVENANT HEALTH RUNS A COMMUNITY COUNSELING CENTER WHICH IS AN OUTREACH COUNSELING CLINIC RUN AND FUNDED BY COVENANT HEALTH. THIS IS A COUNSELING CENTER FOR THE COMMUNITY, PROVIDING ACCESS TO LOW INCOME PERSONS IN THE SERVICE AREA. ADDITIONALLY TELE-COUNSELING SERVICES ARE PROVIDED AND CONTINUED IN 2022 WHICH ALLOWED OUR OUTREACH COUNSELING CENTER TO PROVIDE COUNSELING SERVICES FOR LOW-INCOME AND UN-INSURED PERSON IN OUR REGION AND PROVIDES ACCESS TO THOSE FACING BARRIERS SUCH AS TRANSPORTATION. IN 2022 WE EXPANDED OUR COUNSELING CENTER TO INCLUDE AN INTERNSHIP PROGRAM WHICH ALLOWS US TO PROVIDE MORE SERVICES TO THE COMMUNITIES WE SERVE. IN 2022 OUR CARE COORDINATION COMMUNITY-BASED TEAMS EXPANDED A TEAM DEDICATED SOLELY TO MENTAL HEALTH OUTREACH. WE ALSO CONTINUE TO PARTNER WITH LOCAL NON-PROFITS AND IN 2022 WHO ARE ALSO FOCUSING ON A MENTAL HEALTH, WE PROVIDED SUPPORT AND EDUCATION TO THE LUBBOCK YWCA STAFF REGARDING IN 2022. COVENANT ALSO PARTICIPATES IN A REGIONAL-WIDE MENTAL HEALTH COLLABORATIVE- WEST TEXAS MENTAL HEALTH COLLABORATIVE WHICH PROVIDES SUPPORT TO THE ENTIRE TEXAS SERVICE AREA. THROUGH THIS COLLABORATIVE WE HAVE SUPPORTED THE CREATION OF A NEW DIVERSION CENTER WHICH WILL BE CONSTRUCTED IN 2023-2024 AND WE HAVE ALSO BROUGHT MENTAL HEALTH CONFERENCES TO THE REGION.SAFE, AFFORDABLE, STABLE HOUSING AND PERMANENT SUPPORTIVE HOUSING SOLUTIONSPRIORITY 2: SAFE, AFFORDABLE, STABLE HOUSING AND PERMANENT SUPPORTIVE HOUSING SOLUTIONS FOR PEOPLE EXPERIENCING CHRONIC HOMELESSNESSCOVENANT SUPPORTS OUR LOCAL NON-PROFITS WITH BOTH FUNDING AND IN-KIND SUPPORT. IN 2021 LUBBOCK, COVENANT HEALTH SUPPORTED OPEN DOOR, A LOCAL NONPROFIT ORGANIZATION WORKING TO CULTIVATE COMMUNITY AND OPPORTUNITY FOR PEOPLE ACROSS THE REGION EXPERIENCING HOMELESSNESS AND POVERTY. ALL COVENANT SERVICE AREAS ARE SUPPORTED BY OPEN DOOR. USING A COMMUNITY-BASED MODEL, THE OPEN DOOR TEAM CREATES A WELCOMING AND SUPPORTIVE ENVIRONMENT FOR PEOPLE TO ACCESS SELF-CARE, HYGIENE AND FIRST AID SERVICES. IN 2021, COVENANT HEALTH PROVIDED AN $88,000 COMMUNITY BENEFIT WELLNESS GRANT TO OPEN DOOR TO SUPPORT ITS PERMANENT SUPPORTIVE HOUSING PROGRAM AND COMMUNITY CENTER. THE PERMANENT SUPPORTIVE HOUSING PROGRAM PRIORITIZES HOUSING FIRST, IN TANDEM WITH WRAP-AROUND SERVICES THAT MEET BASIC HUMAN AND SOCIAL NEEDS. THIS PROGRAM HELPS PEOPLE GET ON THEIR FEET SO THEY ARE BETTER PREPARED TO REACH THEIR EMPLOYMENT AND EDUCATION GOALS. THE PERMANENT SUPPORTIVE HOUSING PROGRAM SERVED 85 INDIVIDUALS IN 2021. IN 2021, THE PERMANENT SUPPORTIVE HOUSING PROGRAM OPERATED BY OPEN DOOR IN LUBBOCK, TEXAS, SERVED 85 INDIVIDUALS. COVENANT HEALTH SUPPORTED THIS PARTNER WITH AN $88,000 COMMUNITY BENEFIT WELLNESS GRANT. IN 2022, WE CONTINUED TO SUPPORT AND COLLABORATE WITH OPEN DOOR AND LUBBOCK IMPACT THROUGH PROVIDING IN-KIND SERVICES TO THE HOMELESS COMMUNITY. OUR NAVIGATION TEAM ASSISTED WITH COORDINATING SERVICES FOR HOMELESS AND HOUSING UNSTABLE INDIVIDUALS. IN 2022, WE PROVIDED VOLUNTEERS TO SUPPORT HABITAT FOR HUMANITY'S BLITZ BUILD TO BUILD. WE ALSO CONTINUED TO WORK WITH BUILT FOR ZERO AND TO PARTICIPATE IN AND SUPPORT THE LUBBOCK HOMELESS CONSORTIUM. ADDITIONALLY, WE PROVIDED DENTAL SERVICES TO HOUSING UNSTABLE AND HOMELESS INDIVIDUALS IN OUR OUTREACH DENTAL CLINICS IN PLAINVIEW AND LUBBOCK AND THROUGH A COLLABORATION WITH LUBBOCK IMPACT.

    Expenses $75,595,479 · Revenue $88,725,116

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

Listed in Part VII

  • Walter Cathey

    BOARD MEMBER

    Total calculated
    $1,270,706
    From this org
    $0
    From related orgs
    $1,092,096
    Other
    $178,610
    Hours/week
    0.5 + 54.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $560,302 related
    Bonus
    $0 + $400,000 related
    Other
    $0 + $131,794 related
    Deferred
    $0 + $148,683 related
    Nontaxable benefits
    $0 + $29,927 related
    Filer's total
    $0 + $1,270,706 related

  • John Grigson

    BOARD MEMBER

    Total calculated
    $831,503
    From this org
    $0
    From related orgs
    $752,735
    Other
    $78,768
    Hours/week
    0.5 + 54.5 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

  • 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

  • Duncan Burkholder MD

    BOARD MEMBER

    Total calculated
    $465,656
    From this org
    $0
    From related orgs
    $422,284
    Other
    $43,372
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $354,146 related
    Bonus
    $0 + $23,030 related
    Other
    $0 + $45,108 related
    Deferred
    $0 + $28,772 related
    Nontaxable benefits
    $0 + $14,600 related
    Filer's total
    $0 + $465,656 related

  • Vanessa Reasoner

    CEO

    Total calculated
    $442,764
    From this org
    $414,969
    From related orgs
    $0
    Other
    $27,795
    Hours/week
    54 + 1 related

    Schedule J breakdown matched by us

    Base
    $304,098
    Bonus
    $86,587
    Other
    $24,284
    Deferred
    $8,273
    Nontaxable benefits
    $19,522
    Filer's total
    $442,764

  • Melonie Pipes

    CHIEF FINANCIAL OFFICER

    Total calculated
    $317,149
    From this org
    $0
    From related orgs
    $280,291
    Other
    $36,858
    Hours/week
    11 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $193,132 related
    Bonus
    $0 + $65,557 related
    Other
    $0 + $21,602 related
    Deferred
    $0 + $12,778 related
    Nontaxable benefits
    $0 + $24,080 related
    Filer's total
    $0 + $317,149 related

  • Randall Nichols

    EXECUTIVE DIRECTOR OPERATIONS

    Total calculated
    $278,474
    From this org
    $249,977
    From related orgs
    $0
    Other
    $28,497
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $209,060
    Bonus
    $34,574
    Other
    $6,343
    Deferred
    $10,975
    Nontaxable benefits
    $17,522
    Filer's total
    $278,474

  • 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

  • Marla Daniels

    DIR, NURSING

    Total calculated
    $197,207
    From this org
    $168,138
    From related orgs
    $0
    Other
    $29,069
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $143,885
    Bonus
    $22,295
    Other
    $1,958
    Deferred
    $8,274
    Nontaxable benefits
    $20,795
    Filer's total
    $197,207

  • Clayton Bates

    SR MGR, PERIOPERATIVE SERVICES

    Total calculated
    $177,567
    From this org
    $148,793
    From related orgs
    $0
    Other
    $28,774
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $144,315
    Bonus
    $4,478
    Other
    $0
    Deferred
    $7,674
    Nontaxable benefits
    $21,100
    Filer's total
    $177,567

  • Kathryn Bachman

    SUPV, PHARMACY

    Total calculated
    $174,305
    From this org
    $151,212
    From related orgs
    $0
    Other
    $23,093
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $151,212
    Bonus
    $0
    Other
    $0
    Deferred
    $3,772
    Nontaxable benefits
    $19,321
    Filer's total
    $174,305

  • Margarita Castro

    ACUTE CARE CHARGE RN

    Total calculated
    $171,470
    From this org
    $156,662
    From related orgs
    $0
    Other
    $14,808
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $156,662
    Bonus
    $0
    Other
    $0
    Deferred
    $8,056
    Nontaxable benefits
    $6,752
    Filer's total
    $171,470

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: WALTER CATHEY - $106,095 JOHN GRIGSON - $42,179 JAMES KELLY - $88,487 DUNCAN BURKHOLDER, M.D. - $6,809
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 HIGH PLAINS SURGERY CENTER LLC

    HEALTHCARE · PA · 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 · general or managing partner

  • 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
202303189349303420

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