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Nonprofiteer
← ST MARYS GOOD SAMARITAN HOSPITAL INC

Form 990 for tax year 2022

Filed by ST MARYS GOOD SAMARITAN HOSPITAL INC.

Totals

Total revenue
$37,447,818
Total expenses
$33,107,244
Contributions and grants received
$2,252,984
Grants paid
$12,150
Program services expenses (Part IX)
$28,427,046
Management and general expenses
$4,680,198
Fundraising expenses
$0
Program service expenses (Part III)
$28,427,046

Program services were 85.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • D MONTEZ CARTER

    DIR/PRES THR9/22;PRES THONE AT 10/22

    Total calculated
    $994,869
    From this org
    $0
    From related orgs
    $773,045
    Other
    $221,824
    Hours/week
    2 + 53 related

    Schedule J breakdown matched by us

    Base
    $0 + $511,658 related
    Bonus
    $0 + $149,845 related
    Other
    $0 + $111,542 related
    Deferred
    $0 + $188,898 related
    Nontaxable benefits
    $0 + $32,926 related
    Filer's total
    $0 + $994,869 related

  • DAVID SPIVEY

    DIR & INT PRES 10/22-4/23;TH CONSULT

    Total calculated
    $951,519
    From this org
    $0
    From related orgs
    $887,462
    Other
    $64,057
    Hours/week
    2 + 53 related

    Schedule J breakdown matched by us

    Base
    $0 + $554,152 related
    Bonus
    $0 + $186,604 related
    Other
    $0 + $146,706 related
    Deferred
    $0 + $22,875 related
    Nontaxable benefits
    $0 + $41,182 related
    Filer's total
    $0 + $951,519 related

  • STONISH PIERCE

    COO HCH THR3/23;DIR/PRES/CEO AT 4/23

    Total calculated
    $481,185
    From this org
    $0
    From related orgs
    $456,331
    Other
    $24,854
    Hours/week
    2 + 53 related

    Schedule J breakdown matched by us

    Base
    $0 + $379,526 related
    Bonus
    $0 + $75,665 related
    Other
    $0 + $1,140 related
    Deferred
    $0 + $18,280 related
    Nontaxable benefits
    $0 + $6,574 related
    Filer's total
    $0 + $481,185 related

  • JOHN FOOS

    DIRECTOR; CHAIR

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • BOWEN AKERS

    DIRECTOR THROUGH 9/22

    Total calculated
    $0
    Hours/week
    1

  • JOAN ANTONE

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JACK BROWN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • WALTER CHANNELL

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • DONNIE HARRISON

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • KRISTINE HOPKINS

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JEAN MEYER

    DIRECTOR AS OF 1/23

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • ROBERT MOORE JR

    DIRECTOR AS OF 1/23

    Total calculated
    $0
    Hours/week
    1

  • ELIZABETH STRICKLAND THOMAS

    DIRECTOR AS OF 1/23

    Total calculated
    $0
    Hours/week
    1

  • JAMES PEEK

    DIRECTOR THROUGH 12/22

    Total calculated
    $0
    Hours/week
    1

  • JUNE TOMPKINS

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • KAREN WATSON

    DIRECTOR THROUGH 8/22

    Total calculated
    $0
    Hours/week
    1

  • JANICE DUNN

    TREASURER; CHIEF FINANCIAL OFFICER

    Total calculated
    $458,737
    From this org
    $0
    From related orgs
    $413,411
    Other
    $45,326
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $335,452 related
    Bonus
    $0 + $67,958 related
    Other
    $0 + $10,001 related
    Deferred
    $0 + $13,725 related
    Nontaxable benefits
    $0 + $31,601 related
    Filer's total
    $0 + $458,737 related

  • TANYA ADCOCK

    PRES, GOOD SAMARITAN HOSP THR 6/23

    Total calculated
    $363,054
    From this org
    $0
    From related orgs
    $342,080
    Other
    $20,974
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $0 + $270,851 related
    Bonus
    $0 + $70,000 related
    Other
    $0 + $1,229 related
    Deferred
    $0 + $16,736 related
    Nontaxable benefits
    $0 + $4,238 related
    Filer's total
    $0 + $363,054 related

  • ELIZABETH SCHOEN

    SEC AS OF 10/22; ASSOCIATE COUNSEL

    Total calculated
    $213,597
    From this org
    $0
    From related orgs
    $179,988
    Other
    $33,609
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $171,560 related
    Bonus
    $0 + $7,667 related
    Other
    $0 + $761 related
    Deferred
    $0 + $8,571 related
    Nontaxable benefits
    $0 + $25,038 related
    Filer's total
    $0 + $213,597 related

  • JASON SMITH MD

    CHIEF MEDICAL OFFICER THROUGH 4/23

    Total calculated
    $473,846
    From this org
    $0
    From related orgs
    $432,096
    Other
    $41,750
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $357,725 related
    Bonus
    $0 + $72,775 related
    Other
    $0 + $1,596 related
    Deferred
    $0 + $13,725 related
    Nontaxable benefits
    $0 + $28,025 related
    Filer's total
    $0 + $473,846 related

  • KIMBERLY TYLER

    ASSOCIATE CHIEF NURSING OFFICER

    Total calculated
    $204,545
    From this org
    $191,885
    From related orgs
    $0
    Other
    $12,660
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $158,598
    Bonus
    $19,678
    Other
    $13,609
    Deferred
    $7,085
    Nontaxable benefits
    $5,575
    Filer's total
    $204,545

  • JOSEPH HANCOCK

    PHARMACIST

    Total calculated
    $180,356
    From this org
    $144,512
    From related orgs
    $0
    Other
    $35,844
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $144,227
    Bonus
    $0
    Other
    $285
    Deferred
    $6,908
    Nontaxable benefits
    $28,936
    Filer's total
    $180,356

  • CASEY ALLEN-HAYES

    MANAGER, PHARMACY

    Total calculated
    $160,621
    From this org
    $153,212
    From related orgs
    $0
    Other
    $7,409
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $152,700
    Bonus
    $0
    Other
    $512
    Deferred
    $6,890
    Nontaxable benefits
    $519
    Filer's total
    $160,621

  • CYNTHIA DAVIS

    MANAGER, REHABILITATION

    Total calculated
    $156,812
    From this org
    $120,417
    From related orgs
    $0
    Other
    $36,395
    Hours/week
    45

    Schedule J breakdown matched by us

    Base
    $119,676
    Bonus
    $0
    Other
    $741
    Deferred
    $7,761
    Nontaxable benefits
    $28,634
    Filer's total
    $156,812

  • LISA BATCHELOR

    REGISTERED NURSE, SURGICAL

    Total calculated
    $135,169
    From this org
    $115,173
    From related orgs
    $0
    Other
    $19,996
    Hours/week
    45

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 — 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

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
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
GOOD SAMARITAN HOSPITAL IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. GOOD SAMARITAN HOSPITAL'S PRESIDENT IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF GOOD SAMARITAN HOSPITAL'S PRESIDENT: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
PART I, LINE 4B
THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. PARTICIPANTS' VESTED BENEFITS WERE PAID OUT IN 2022, AND THEIR NON-VESTED BENEFITS FOR 2022 WERE ACCRUED. THE FOLLOWING PAYOUTS FOR 2022 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: D. MONTEZ CARTER - $93,271 DAVID SPIVEY - $125,161 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ACCRUAL FOR 2022 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: D. MONTEZ CARTER - $170,598 THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($305,000 FOR 2022). THE FOLLOWING PAYOUTS FOR 2022 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: TANYA ADCOCK - $0 JANICE DUNN - $3,301 STONISH PIERCE - $0 JASON SMITH, MD - $0

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.

Provenance

Return type
form_990
Tax year
2022
Filed
14 May 2024
IRS schema version
2022v5.0
Source object
202441359349302014

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

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