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Nonprofiteer
← COVENANT ACO INC

Form 990 for tax year 2022

Filed by COVENANT ACO INC.

Totals

Total revenue
$511,909
Total expenses
$492,011
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$492,011
Investment income
$19,898
Other revenue
$0
Total assets, end of year
$2,847,235
Total liabilities, end of year
$3,204,195
Net assets or fund balances, end of year
-$356,960
Program services expenses (Part IX)
$334,453
Management and general expenses
$157,558
Fundraising expenses
$0
Program service expenses (Part III)
$334,453

Program services were 68.0% 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: INTERAFFILIATE REVENUE

    total $492,011 · related or exempt $492,011

  • 3 · Investment income

    total $19,898 · excluded $19,898

Functional expenses

Part IX, the statement of functional expenses.

  • 11g · Fees: other

    total $492,011 · program services $334,453 · management and general $157,558

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $5,133,201 · end of year $2,490,523

  • 9 · Prepaid expenses and deferred charges

    beginning of year $105

  • 15 · Other assets

    beginning of year $0 · end of year $356,712

  • 17 · Accounts payable and accrued expenses

    end of year $608

  • 19 · Deferred revenue

    beginning of year $3,551,266 · end of year $3,203,587

  • 25 · Other liabilities

    beginning of year $1,466,887 · end of year $0

  • 27 · Net assets without donor restrictions

    beginning of year $115,153 · end of year -$356,960

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 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.PROGRAM SERVICE ACCOMPLISHMENTSCOVENANT ACO, INC., A TEXAS NONPROFIT CORPORATION ("COVENANT ACO"), IS A PHYSICIAN-GOVERNED ENTITY ORGANIZED TO PARTICIPATE AS AN ACCOUNTABLE CARE ORGANIZATION ("ACO") IN THE MEDICARE SHARED SAVINGS PROGRAM ("MSSP"), WHERE GROUPS OF DOCTORS AND OTHER HEALTH CARE PROVIDERS VOLUNTARILY WORK TOGETHER WITH MEDICARE TO GIVE HIGH QUALITY SERVICE TO MEDICARE FEE-FOR-SERVICE BENEFICIARIES. COVENANT ACO AIMS TO IMPROVE PATIENT OUTCOMES AND ENRICH THE HEALTHCARE EXPERIENCE BY PROVIDING BETTER CARE FOR INDIVIDUALS AND LOWERING HEALTHCARE EXPENSES.FOR MORE INFORMATION ABOUT COVENANT ACO, INC., PLEASE VISIT WWW.COVENANTHEALTHPARTNERS.ORGFOR MORE INFORMATION ABOUT PROVIDENCE ST. JOSEPH HEALTH, PLEASE VISIT WWW.PROVIDENCE.ORG

    Expenses $334,453 · Revenue $492,011

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

    REGIONAL CHIEF FINANCIAL OFFICER

    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

  • RYAN OWEN MD

    BOARD MEMBER

    Total calculated
    $712,193
    From this org
    $0
    From related orgs
    $673,918
    Other
    $38,275
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $635,252 related
    Bonus
    $0 + $14,620 related
    Other
    $0 + $24,046 related
    Deferred
    $0 + $5,965 related
    Nontaxable benefits
    $0 + $32,310 related
    Filer's total
    $0 + $712,193 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

    CEO

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

    Schedule J breakdown matched by us

    Base
    $0 + $399,394 related
    Bonus
    $0 + $100,984 related
    Other
    $0 + $20,044 related
    Deferred
    $0 + $27,732 related
    Nontaxable benefits
    $0 + $23,761 related
    Filer's total
    $0 + $571,915 related

  • 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/VICE CHAIR

    Total calculated
    $540,118
    From this org
    $0
    From related orgs
    $501,486
    Other
    $38,632
    Hours/week
    1 + 0.5 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

  • JEFFREY HANNEL MD

    BOARD MEMBER

    Total calculated
    $444,959
    From this org
    $0
    From related orgs
    $390,388
    Other
    $54,571
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $244,348 related
    Bonus
    $0 + $32,558 related
    Other
    $0 + $113,482 related
    Deferred
    $0 + $29,316 related
    Nontaxable benefits
    $0 + $25,255 related
    Filer's total
    $0 + $444,959 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

  • 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

  • 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

  • CARI SORRELL MD

    BOARD MEMBER

    Total calculated
    $3,681
    From this org
    $0
    From related orgs
    $3,681
    Other
    $0
    Hours/week
    0.5

  • 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 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 TAX-EXEMPT RELATED ORGANIZATION, COVENANT HEALTH PARTNERS, 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: 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.

Related corporations and trusts

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

Provenance

Return type
form_990
Tax year
2022
Filed
7 November 2023
IRS schema version
2022v5.0
Source object
202323179349308437

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