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Nonprofiteer
← GRACE CLINIC OF LUBBOCK

Form 990 for tax year 2023

Filed by GRACE CLINIC OF LUBBOCK.

Totals

Total revenue
$42,244,571
Total expenses
$42,243,911
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$42,243,910
Investment income
$661
Other revenue
$0
Total assets, end of year
$36,312,722
Total liabilities, end of year
$77,070,627
Net assets or fund balances, end of year
-$40,757,905
Program services expenses (Part IX)
$28,672,783
Management and general expenses
$13,571,128
Fundraising expenses
$0
Program service expenses (Part III)
$28,672,783

Program services were 67.9% 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 $28,830,019 · related or exempt $28,830,019

  • 2b · Program service revenue: INTER-AFFILIATE REV.

    total $6,893,860 · related or exempt $6,893,860

  • 2c · Program service revenue: OTHER OPERATING REV.

    total $6,520,031 · related or exempt $6,520,031

  • 3 · Investment income

    total $661 · excluded $661

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $4,380,723 · program services $2,803,663 · management and general $1,577,060

  • 7 · Other salaries and wages

    total $21,948,348 · program services $14,046,943 · management and general $7,901,405

  • 8 · Pension plan contributions

    total $303,775 · program services $194,416 · management and general $109,359

  • 10 · Payroll taxes

    total $1,360,301 · program services $870,593 · management and general $489,708

  • 11a · Fees: management

    total $4,384,661 · program services $2,806,183 · management and general $1,578,478

  • 11b · Fees: legal

    total $13,520 · management and general $13,520

  • 11c · Fees: accounting

    total $9,112 · program services $5,832 · management and general $3,280

  • 11g · Fees: other

    total $1,173,104 · program services $750,787 · management and general $422,317

  • 16 · Occupancy

    total $3,169,441 · program services $2,028,442 · management and general $1,140,999

  • 22 · Depreciation, depletion and amortization

    total $16,608 · program services $10,629 · management and general $5,979

  • 24a · Other expenses: MEDICAL SUPPLES

    total $4,570,365 · program services $4,570,365

  • 24b · Other expenses: LICENSES & TAXES

    total $323,462 · program services $207,016 · management and general $116,446

  • 24c · Other expenses: DUES & SUBSCRIPTIONS

    total $49,320 · program services $31,565 · management and general $17,755

  • 24d · Other expenses: POSTAGE & SHIPPING

    total $37,299 · program services $23,871 · management and general $13,428

  • 24e · All other expenses

    total $503,872 · program services $322,478 · management and general $181,394

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $10,819,180 · end of year $27,410,609

  • 4 · Accounts receivable

    beginning of year $6,090,693 · end of year $8,413,643

  • 8 · Inventories for sale or use

    beginning of year $278,160 · end of year $300,811

  • 9 · Prepaid expenses and deferred charges

    beginning of year $63,588 · end of year $113,590

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

    $123,401

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

    $63,221

  • 10c · Land, buildings and equipment, net

    beginning of year $76,788 · end of year $60,180

  • 15 · Other assets

    beginning of year $13,889 · end of year $13,889

  • 17 · Accounts payable and accrued expenses

    beginning of year $350,029 · end of year $427,561

  • 19 · Deferred revenue

    beginning of year $6,717 · end of year $6,717

  • 25 · Other liabilities

    beginning of year $50,850,259 · end of year $76,636,349

  • 27 · Net assets without donor restrictions

    beginning of year -$33,864,707 · end of year -$40,757,905

Mission and programs · 2023

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 OAS 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.PROVIDENCEAT 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, WA AS 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 STANDARDS PROVIDENCE CONTINUES TO EXECUTE ON OUR INTEGRATED STRATEGIC AND FINANCIAL PLAN, WHICH CLEARLY EXPRESSES OUR COMMITMENT AND ACCELERATION OF THE IMPORTANT WORK TO ADDRESS SOCIAL, RACIAL, AND ECONOMIC DISPARITIES AND REDUCE OUR CARBON FOOTPRINT IN THE COMMUNITIES WE SERVE. PROVIDENCE ADVANCES PROGRESS ON OUR CARBON NEGATIVE GOAL AND IN 2023 WE ESTIMATED THAT WE DECREASED EMISSIONS BY OVER 12 PERCENT COMPARED TO OUR 2019 BASELINE. IN ADDITION, OUR EFFORTS LED TO THE INTRODUCTION OF THE GREEN HOSPITALS ACT, LEGISLATION MODELED AFTER PROVIDENCE THAT WOULD PROVIDE CRITICAL FEDERAL FUNDING TO WEATHERIZE AND MODERNIZE HEALTH CARE FACILITIES. PROVIDENCE COMPLETED A COMPREHENSIVE CLIMATE RESILIENCE PLAN IN ALIGNMENT WITH OUR COMMITMENT TO THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES CLIMATE PLEDGE. WE CONTINUE TO REDUCE GREENHOUSE GAS EMISSIONS WITH A FOCUS ON LED LIGHTING UPGRADES, WATER CONSERVATION, MORE EFFICIENT DELIVERY OF NITROUS OXIDE GAS DURING ANESTHESIA, AND ADVANCING OUR WASTE OPTIMIZATION WORK ACROSS ALL HOSPITALS AND CLINICS. GRACE CLINIC OF LUBBOCK PROVIDES SERVICES INCLUDING WALK-IN CLINIC,PRIMARY CARE, OBSTETRICS, PAIN MANAGEMENT, PODIATRY AND ORTHOPEDICS, ASWELL AS OUTPATIENT SURGICAL CENTER PHARMACY, IMAGING AND LABORATORYSERVICES.

    Expenses $28,672,783 · Revenue $42,243,910

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Alejandro Verdugo

    PHYSICIAN

    Total calculated
    $1,366,704
    From this org
    $1,328,210
    From related orgs
    $0
    Other
    $38,494
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $861,078
    Bonus
    $0
    Other
    $467,132
    Deferred
    $4,950
    Nontaxable benefits
    $33,544
    Filer's total
    $1,366,704

  • Hemmo Bosscher

    PHYSICIAN

    Total calculated
    $825,944
    From this org
    $792,172
    From related orgs
    $0
    Other
    $33,772
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $739,103
    Bonus
    $0
    Other
    $53,069
    Deferred
    $5,072
    Nontaxable benefits
    $28,700
    Filer's total
    $825,944

  • Bhupesh Dihenia MD

    DIRECTOR

    Total calculated
    $815,091
    From this org
    $794,868
    From related orgs
    $0
    Other
    $20,223
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $752,039
    Bonus
    $0
    Other
    $42,829
    Deferred
    $4,950
    Nontaxable benefits
    $15,273
    Filer's total
    $815,091

  • James Kelly

    FRMR OFF. - VP SENIOR CORP COUNSEL

    Total calculated
    $808,682
    From this org
    $0
    From related orgs
    $704,260
    Other
    $104,422
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $354,037 related
    Bonus
    $0 + $304,115 related
    Other
    $0 + $46,108 related
    Deferred
    $0 + $71,532 related
    Nontaxable benefits
    $0 + $32,890 related
    Filer's total
    $0 + $808,682 related

  • Robin Minielly MD

    PHYSICIAN

    Total calculated
    $734,577
    From this org
    $694,959
    From related orgs
    $0
    Other
    $39,618
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $545,845
    Bonus
    $0
    Other
    $149,114
    Deferred
    $4,950
    Nontaxable benefits
    $34,668
    Filer's total
    $734,577

  • Elias Ghandour

    PHYSICIAN

    Total calculated
    $670,092
    From this org
    $640,504
    From related orgs
    $0
    Other
    $29,588
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $630,210
    Bonus
    $0
    Other
    $10,294
    Deferred
    $4,950
    Nontaxable benefits
    $24,638
    Filer's total
    $670,092

  • Matthew Soape MD

    DIRECTOR

    Total calculated
    $664,596
    From this org
    $627,313
    From related orgs
    $0
    Other
    $37,283
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $624,764
    Bonus
    $0
    Other
    $2,549
    Deferred
    $4,739
    Nontaxable benefits
    $32,544
    Filer's total
    $664,596

  • Stephen Hallier

    PHYSICIAN

    Total calculated
    $646,406
    From this org
    $639,107
    From related orgs
    $0
    Other
    $7,299
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $452,440
    Bonus
    $0
    Other
    $186,667
    Deferred
    $4,950
    Nontaxable benefits
    $2,349
    Filer's total
    $646,406

  • Shelly Hook MD

    DIRECTOR

    Total calculated
    $551,630
    From this org
    $512,039
    From related orgs
    $0
    Other
    $39,591
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $290,408
    Bonus
    $0
    Other
    $221,631
    Deferred
    $4,950
    Nontaxable benefits
    $34,641
    Filer's total
    $551,630

  • Duncan Burkholder MD

    DIRECTOR/CHAIR

    Total calculated
    $518,844
    From this org
    $495,227
    From related orgs
    $0
    Other
    $23,617
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $407,471
    Bonus
    $22,913
    Other
    $64,843
    Deferred
    $9,900
    Nontaxable benefits
    $13,717
    Filer's total
    $518,844

  • Vanessa Bayouth

    CEO

    Total calculated
    $428,075
    From this org
    $0
    From related orgs
    $400,911
    Other
    $27,164
    Hours/week
    27.5 + 27.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $305,524 related
    Bonus
    $0 + $65,363 related
    Other
    $0 + $30,024 related
    Deferred
    $0 + $4,886 related
    Nontaxable benefits
    $0 + $22,278 related
    Filer's total
    $0 + $428,075 related

  • Rebecca Raedeke MD

    DIRECTOR

    Total calculated
    $405,012
    From this org
    $373,349
    From related orgs
    $0
    Other
    $31,663
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $268,144
    Bonus
    $41,879
    Other
    $63,326
    Deferred
    $4,697
    Nontaxable benefits
    $26,966
    Filer's total
    $405,012

  • Christopher Collins MD

    DIRECTOR

    Total calculated
    $388,859
    From this org
    $370,047
    From related orgs
    $0
    Other
    $18,812
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $307,965
    Bonus
    $3,404
    Other
    $58,678
    Deferred
    $4,950
    Nontaxable benefits
    $13,862
    Filer's total
    $388,859

  • Wael Qubti MD

    DIRECTOR

    Total calculated
    $369,838
    From this org
    $333,681
    From related orgs
    $0
    Other
    $36,157
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $231,573
    Bonus
    $27,662
    Other
    $74,446
    Deferred
    $4,453
    Nontaxable benefits
    $31,704
    Filer's total
    $369,838

  • Jared Brinker MD

    DIRECTOR/SECRETARY

    Total calculated
    $341,637
    From this org
    $306,998
    From related orgs
    $0
    Other
    $34,639
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $198,751
    Bonus
    $25,677
    Other
    $82,570
    Deferred
    $4,701
    Nontaxable benefits
    $29,938
    Filer's total
    $341,637

  • Patti May MD

    DIRECTOR

    Total calculated
    $325,215
    From this org
    $313,654
    From related orgs
    $0
    Other
    $11,561
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $305,997
    Bonus
    $0
    Other
    $7,657
    Deferred
    $8,321
    Nontaxable benefits
    $3,240
    Filer's total
    $325,215

  • Adam Spivey

    CFO - THRU 11/23

    Total calculated
    $260,906
    From this org
    $0
    From related orgs
    $229,966
    Other
    $30,940
    Hours/week
    13 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $172,623 related
    Bonus
    $0 + $34,407 related
    Other
    $0 + $22,936 related
    Deferred
    $0 + $3,518 related
    Nontaxable benefits
    $0 + $27,422 related
    Filer's total
    $0 + $260,906 related

  • Melonie Pipes

    FRMR OFF. - COV CFO

    Total calculated
    $256,989
    From this org
    $0
    From related orgs
    $224,492
    Other
    $32,497
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $165,747 related
    Bonus
    $0 + $35,225 related
    Other
    $0 + $23,520 related
    Deferred
    $0 + $4,139 related
    Nontaxable benefits
    $0 + $28,358 related
    Filer's total
    $0 + $256,989 related

  • Craig Renfroe

    FRMR DIRECTOR OF FINANCE

    Total calculated
    $245,119
    From this org
    $0
    From related orgs
    $209,153
    Other
    $35,966
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $184,984 related
    Bonus
    $0 + $23,276 related
    Other
    $0 + $893 related
    Deferred
    $0 + $10,215 related
    Nontaxable benefits
    $0 + $25,751 related
    Filer's total
    $0 + $245,119 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 3
DESCRIPTION OF PROCESS TO REVIEW COMPENSATION PAID TO TOP MANAGEMENT OFFICIAL THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/TOP MANAGEMENT OFFICIAL IS PAID BY A RELATED TAX EXEMPT ORGANIZATION, LUBBOCK HERITAGE HOSPITAL, LLC, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY PROVIDENCE.
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: ALEJANDRO VERDUGO - $22,680. HEMMO BOSSCHER - $24,044. BHUPESH DIHENIA, M.D. - $38,113. JAMES KELLY - $45,298. ROBIN MINIELLY, M.D. - $9,141. STEPHEN HALLIER - $6,422. SHELLY HOOK, M.D. - $8,434. DUNCAN BURKHOLDER, M.D. - $17,045. VANESSA BAYOUTH - $2,204. REBECCA RAEDEKE, M.D. - $4,775. WAEL QUBTI, M.D. - $1,950. JARED BRINKER, M.D. - $1,956. PATTI MAY, M.D. - $2,480.
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

  • 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

  • HERITAGE INVESTMENT GROUP I 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

  • 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

  • PERFORMANCE MEDICAL EQUIPMENT & RESPIRATORY SERVICES LLC

    MEDICAL EQUIPMENT · WA · general or managing partner

  • PETCT IMAGING AT SWEDISH CANCER INSTITUTE LLC

    MEDICAL IMAGING · WA · general or managing partner

  • PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCE & SCA OFF-CAMPUS HOLDINGS LLC

    MEDICAL · AL

  • PROVIDENCE & SCA ON-CAMPUS HOLDINGS LLC

    MEDICAL · AL · general or managing partner

  • PROVIDENCE ALASKA HOUSE I OWNER LP

    SUPPORTIVE HOUSING · AK

  • 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

  • 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 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

  • ADVATA INC (FKA KENSCI INC)

    C · HEALTHCARE · WA

  • AMERICAN UNITY GROUP LTD

    C · CAPTIVE INSURANCE · BD

  • AYIN HEALTH HOLDINGS INC

    C · HEALTHCARE · DE

  • AYIN HEALTH SOLUTIONS INC

    C · HEALTHCARE · OR

  • BOURGET HEALTH SERVICES INC

    C · CLINICAL/MEDICAL LAB · WA

  • CARON CORPORATION

    C · MEDICAL PHYSICIAN SERVICE · MT

  • CLOUD 21 LIMITED

    C · HEALTHCARE · UK

  • ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA

    S · HEALTHCARE · CA

  • HCSA PROPERTIES LLC

    C · REAL ESTATE RENTAL · WA

  • KENSCI ASIA PACIFIC PTE LTD

    C · HEALTHCARE · SN

  • KENSCI TECH INDIA PRIVATE LIMITED

    C · HEALTHCARE · IN

  • LUBBOCK METHODIST HOSP PRACTICE MGMT

    C · INACTIVE · TX

  • LUBBOCK METHODIST HOSPITAL SVCS

    C · HEALTHCARE · TX

  • MEDICAL SPECIALTIES MANAGERS INC

    C · HEALTHCARE · WA

  • MISSION VIEJO MEDICAL VENTURES INC

    C · HEALTHCARE · CA

  • PHN HOLDINGS

    C · STRATEGIC PLANNING SERVICES · CA

  • PRAIA HEALTH INC

    C · HEALTHCARE · DE

  • 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 ST JOSEPH HEALTH NETWORK

    C · HEALTHCARE · CA

  • PROVSOURCE

    C · HEALTHCARE · DE

  • 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 US INC

    C · HOLDING COMPANY · DE

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

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP INC (FKA PROVIDENCE SERVICES GROUP)

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP-CAN INC

    C · HEALTHCARE · CA

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

    C · HEALTHCARE · WI

  • TRUSANA INC

    C · HEALTHCARE · DE

  • VINSERRA INC

    C · INVESTMENT · CA

  • WEIGHT LOSS INC (FKA HMR WEIGHT MANAGEMENT SERVICES CORP)

    C · HEALTHCARE · WA

Provenance

Return type
form_990
Tax year
2023
Filed
30 October 2024
IRS schema version
2023v5.1
Source object
202443169349304204

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