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Nonprofiteer
← ST JOSEPH AMBULATORY CARE INC

Form 990 for tax year 2023

Filed by ST JOSEPH AMBULATORY CARE INC.

Totals

Total revenue
$1,586,854
Total expenses
$3,093,064
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$1,598,788
Investment income
-$11,934
Other revenue
$0
Total assets, end of year
$151,334
Total liabilities, end of year
$3,230,701
Net assets or fund balances, end of year
-$3,079,367
Program services expenses (Part IX)
$2,868,370
Management and general expenses
$224,694
Fundraising expenses
$0
Program service expenses (Part III)
$2,868,370

Program services were 92.7% 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: Occupational health

    total $987,618 · related or exempt $987,618

  • 2b · Program service revenue: Clinical care

    total $505,765 · related or exempt $505,765

  • 2c · Program service revenue: Patient service

    total $105,405 · related or exempt $105,405

  • 3 · Investment income

    total $9,931 · excluded $9,931

  • 7a · Gross sales of assets other than inventory

    securities $789,843

  • 7b · Less cost or other basis and sales expenses

    securities $811,708

  • 7c · Gain or loss

    securities -$21,865

  • 7d · Net gain or loss

    total -$21,865 · excluded -$21,865

Functional expenses

Part IX, the statement of functional expenses.

  • 7 · Other salaries and wages

    total $1,324,197 · program services $1,222,499 · management and general $101,698

  • 8 · Pension plan contributions

    total $17,034 · program services $15,734 · management and general $1,300

  • 9 · Other employee benefits

    total $125,315 · program services $115,753 · management and general $9,562

  • 10 · Payroll taxes

    total $88,447 · program services $81,698 · management and general $6,749

  • 11g · Fees: other

    total $231,725 · program services $158,662 · management and general $73,063

  • 13 · Office expenses

    total $2,150 · program services $1,472 · management and general $678

  • 16 · Occupancy

    total $91,352 · program services $62,549 · management and general $28,803

  • 17 · Travel

    total $6,989 · program services $4,785 · management and general $2,204

  • 19 · Conferences, conventions and meetings

    total $2,021 · program services $1,384 · management and general $637

  • 22 · Depreciation, depletion and amortization

    total $3,626 · program services $3,626

  • 24a · Other expenses: Drugs/medical supplies

    total $1,198,128 · program services $1,198,128

  • 24b · Other expenses: Minor equipment

    total $1,536 · program services $1,536

  • 24c · Other expenses: Food and nutrition

    total $544 · program services $544

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $18,288 · end of year $19,551

  • 4 · Accounts receivable

    beginning of year $1,098,532 · end of year $110,972

  • 8 · Inventories for sale or use

    beginning of year $123,168 · end of year $0

  • 9 · Prepaid expenses and deferred charges

    beginning of year $313,020 · end of year $449

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

    $759,288

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

    $738,926

  • 10c · Land, buildings and equipment, net

    beginning of year $23,988 · end of year $20,362

  • 12 · Investments: other securities

    beginning of year $758,047

  • 15 · Other assets

    beginning of year $2,393 · end of year $0

  • 17 · Accounts payable and accrued expenses

    beginning of year $512,938 · end of year $89,577

  • 25 · Other liabilities

    beginning of year $3,428,354 · end of year $3,141,124

  • 27 · Net assets without donor restrictions

    beginning of year -$1,603,856 · end of year -$3,079,367

Mission and programs · 2023

Mission

Employee safety and health services

  • St. Joseph's Ambulatory Care, Inc. provides employee safety and health services.

    Expenses $2,868,370 · Revenue $1,598,788

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

Listed in Part VII

  • Stephen Grubbs

    Trustee; CEO of Covenant Health

    Total calculated
    $841,706
    From this org
    $0
    From related orgs
    $803,102
    Other
    $38,604
    Hours/week
    0.1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $773,120 related
    Bonus
    $0
    Other
    $0 + $29,982 related
    Deferred
    $0 + $9,900 related
    Nontaxable benefits
    $0 + $28,704 related
    Filer's total
    $0 + $841,706 related

  • Jims Jean Jacques MD

    Physician

    Total calculated
    $624,025
    From this org
    $0
    From related orgs
    $578,245
    Other
    $45,780
    Hours/week
    0.1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $576,902 related
    Bonus
    $0
    Other
    $0 + $1,343 related
    Deferred
    $0 + $9,900 related
    Nontaxable benefits
    $0 + $35,880 related
    Filer's total
    $0 + $624,025 related

  • Heather Evans DO

    Trustee (end 7/2023)

    Total calculated
    $93,447
    From this org
    $0
    From related orgs
    $78,986
    Other
    $14,461
    Hours/week
    0.1 + 40 related

  • William Buckley

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Rosalind Prince Gilman Esq

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Anita Haskell

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Jennifer Khavari

    Trustee (end 8/2023)

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Curtis Kimball Esq

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Judith Josiah Martin

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Bradley Ryder

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Lori Varney

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • William Wood MD

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Robert Clark

    Chairman

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Rebecca Cyr Whitmore

    Vice Chairman

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Mary Prybylo ex-officio

    President

    Total calculated
    $449,316
    From this org
    $0
    From related orgs
    $408,701
    Other
    $40,615
    Hours/week
    0.1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $399,313 related
    Bonus
    $0
    Other
    $0 + $9,388 related
    Deferred
    $0 + $9,900 related
    Nontaxable benefits
    $0 + $30,715 related
    Filer's total
    $0 + $449,316 related

  • Michael Hendrix

    Treasurer/VP Finance

    Total calculated
    $340,964
    From this org
    $0
    From related orgs
    $296,216
    Other
    $44,748
    Hours/week
    0.1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $294,111 related
    Bonus
    $0
    Other
    $0 + $2,105 related
    Deferred
    $0 + $8,716 related
    Nontaxable benefits
    $0 + $36,032 related
    Filer's total
    $0 + $340,964 related

  • Donna Berry

    Secretary

    Total calculated
    $119,895
    From this org
    $0
    From related orgs
    $91,741
    Other
    $28,154
    Hours/week
    0.1 + 40 related

  • Poonam Khadka MD

    Physician

    Total calculated
    $270,682
    From this org
    $256,250
    From related orgs
    $0
    Other
    $14,432
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $255,925
    Bonus
    $0
    Other
    $325
    Deferred
    $3,540
    Nontaxable benefits
    $10,892
    Filer's total
    $270,682

  • Sanjay Pandey MD

    Physician

    Total calculated
    $271,873
    From this org
    $242,188
    From related orgs
    $0
    Other
    $29,685
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $241,624
    Bonus
    $0
    Other
    $564
    Deferred
    $4,509
    Nontaxable benefits
    $25,176
    Filer's total
    $271,873

  • Jamie Perry

    Nurse Practioner

    Total calculated
    $150,486
    From this org
    $145,714
    From related orgs
    $0
    Other
    $4,772
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $145,545
    Bonus
    $0
    Other
    $169
    Deferred
    $4,037
    Nontaxable benefits
    $735
    Filer's total
    $150,486

  • Shannon Piner

    Nurse Practioner

    Total calculated
    $126,144
    From this org
    $121,197
    From related orgs
    $0
    Other
    $4,947
    Hours/week
    40

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

None.

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Part I, Line 3
Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable.

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 corporations and trusts

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

  • Campus Holding

    C · Holding company · ME

  • Covenant Health Insurance LTD

    C · Self-insurance company · CJ

  • GNM Corporation

    C · Real estate holding company · NH

  • SJ Physicians Services

    C · Physician practice · NH

  • St Joseph Corporate Services Inc

    C · Holding company · NH

  • Strauss Incorporated

    C · Repairs and transcriptions · ME

Provenance

Return type
form_990
Tax year
2023
Filed
4 November 2024
IRS schema version
2023v5.1
Source object
202413129349300736

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