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Nonprofiteer
← ST JOSEPH AMBULATORY CARE INC

Form 990 for tax year 2022

Filed by ST JOSEPH AMBULATORY CARE INC.

Totals

Total revenue
$4,376,647
Total expenses
$5,018,744
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$4,403,026
Investment income
-$26,379
Other revenue
$0
Total assets, end of year
$2,337,436
Total liabilities, end of year
$3,941,292
Net assets or fund balances, end of year
-$1,603,856
Program services expenses (Part IX)
$4,816,447
Management and general expenses
$202,297
Fundraising expenses
$0
Program service expenses (Part III)
$4,816,447

Program services were 96.0% 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: Patient service

    total $2,832,679 · related or exempt $2,832,679

  • 2b · Program service revenue: Occupational health

    total $1,087,172 · related or exempt $1,087,172

  • 2c · Program service revenue: Clinical care

    total $483,175 · related or exempt $483,175

  • 3 · Investment income

    total $15,728 · excluded $15,728

  • 7a · Gross sales of assets other than inventory

    securities $55,701

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

    securities $97,808

  • 7c · Gain or loss

    securities -$42,107

  • 7d · Net gain or loss

    total -$42,107 · excluded -$42,107

Functional expenses

Part IX, the statement of functional expenses.

  • 7 · Other salaries and wages

    total $1,448,624 · program services $1,289,275 · management and general $159,349

  • 8 · Pension plan contributions

    total $13,338 · program services $11,871 · management and general $1,467

  • 9 · Other employee benefits

    total $187,213 · program services $166,620 · management and general $20,593

  • 10 · Payroll taxes

    total $94,218 · program services $83,854 · management and general $10,364

  • 11g · Fees: other

    total $223,047 · program services $223,047

  • 13 · Office expenses

    total $21,177 · program services $19,481 · management and general $1,696

  • 16 · Occupancy

    total $92,892 · program services $85,461 · management and general $7,431

  • 17 · Travel

    total $5,406 · program services $4,974 · management and general $432

  • 19 · Conferences, conventions and meetings

    total $7,816 · program services $7,191 · management and general $625

  • 22 · Depreciation, depletion and amortization

    total $4,254 · program services $3,914 · management and general $340

  • 24a · Other expenses: Drugs/medical supplies

    total $2,918,613 · program services $2,918,613

  • 24b · Other expenses: Food and nutrition

    total $1,481 · program services $1,481

  • 24c · Other expenses: Minor equipment

    total $665 · program services $665

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $20,029 · end of year $18,288

  • 4 · Accounts receivable

    beginning of year $645,688 · end of year $1,098,532

  • 8 · Inventories for sale or use

    beginning of year $208,930 · end of year $123,168

  • 9 · Prepaid expenses and deferred charges

    end of year $313,020

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

    $759,288

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

    $735,300

  • 10c · Land, buildings and equipment, net

    beginning of year $28,242 · end of year $23,988

  • 12 · Investments: other securities

    beginning of year $830,334 · end of year $758,047

  • 15 · Other assets

    beginning of year $691 · end of year $2,393

  • 17 · Accounts payable and accrued expenses

    beginning of year $658,509 · end of year $512,938

  • 25 · Other liabilities

    beginning of year $2,012,402 · end of year $3,428,354

  • 27 · Net assets without donor restrictions

    beginning of year -$936,997 · end of year -$1,603,856

Mission and programs · 2022

Mission

Employee safety and health services

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

    Expenses $4,816,447 · Revenue $4,403,026

As filed on the 2022 return.

Listed in Part VII

  • Stephen Grubbs

    Trustee

    Total calculated
    $890,263
    From this org
    $0
    From related orgs
    $853,102
    Other
    $37,161
    Hours/week
    0.1 + 45.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $775,120 related
    Bonus
    $0 + $50,000 related
    Other
    $0 + $27,982 related
    Deferred
    $0 + $9,150 related
    Nontaxable benefits
    $0 + $28,011 related
    Filer's total
    $0 + $890,263 related

  • Ganesha Santhyadka MD

    Trustee

    Total calculated
    $847,596
    From this org
    $0
    From related orgs
    $803,935
    Other
    $43,661
    Hours/week
    0.1 + 40.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $779,230 related
    Bonus
    $0
    Other
    $0 + $24,705 related
    Deferred
    $0 + $9,150 related
    Nontaxable benefits
    $0 + $34,511 related
    Filer's total
    $0 + $847,596 related

  • Heather Evans DO

    Trustee

    Total calculated
    $207,120
    From this org
    $0
    From related orgs
    $182,003
    Other
    $25,117
    Hours/week
    0.1 + 0.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $181,790 related
    Bonus
    $0
    Other
    $0 + $213 related
    Deferred
    $0 + $5,238 related
    Nontaxable benefits
    $0 + $19,879 related
    Filer's total
    $0 + $207,120 related

  • William Buckley

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Robert Clark

    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

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Curtis Kimball Esq

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Bernard LaBree

    Trustee (end 1/2022)

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Adrien Roy Jr

    Trustee (end 1/2022)

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Bradley Ryder

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Rebecca Whitmore

    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

  • William Lucy

    Chair

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • L William Demaso

    Vice Chair

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Mary Prybylo RN MSN

    President & CEO, Ex-Officio

    Total calculated
    $482,201
    From this org
    $0
    From related orgs
    $436,469
    Other
    $45,732
    Hours/week
    0.1 + 40.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $397,526 related
    Bonus
    $0 + $27,282 related
    Other
    $0 + $11,661 related
    Deferred
    $0 + $9,150 related
    Nontaxable benefits
    $0 + $36,582 related
    Filer's total
    $0 + $482,201 related

  • Michael Hendrix

    Treasurer, VP Finance

    Total calculated
    $603,649
    From this org
    $0
    From related orgs
    $561,056
    Other
    $42,593
    Hours/week
    0.1 + 40.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $308,976 related
    Bonus
    $0 + $250,000 related
    Other
    $0 + $2,080 related
    Deferred
    $0 + $7,519 related
    Nontaxable benefits
    $0 + $35,074 related
    Filer's total
    $0 + $603,649 related

  • Donna Berry

    Secretary

    Total calculated
    $115,789
    From this org
    $0
    From related orgs
    $88,925
    Other
    $26,864
    Hours/week
    0.1 + 40.4 related

  • Sanjay Pandey MD

    Physician

    Total calculated
    $290,490
    From this org
    $261,725
    From related orgs
    $0
    Other
    $28,765
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $240,698
    Bonus
    $0
    Other
    $21,027
    Deferred
    $4,196
    Nontaxable benefits
    $24,569
    Filer's total
    $290,490

  • Poonam Khadka MD

    Physician

    Total calculated
    $226,426
    From this org
    $212,620
    From related orgs
    $0
    Other
    $13,806
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $191,804
    Bonus
    $0
    Other
    $20,816
    Deferred
    $3,206
    Nontaxable benefits
    $10,600
    Filer's total
    $226,426

  • Lisa Gordon PA

    Physician Assistance

    Total calculated
    $166,266
    From this org
    $130,395
    From related orgs
    $0
    Other
    $35,871
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $119,720
    Bonus
    $5,000
    Other
    $5,675
    Deferred
    $2,275
    Nontaxable benefits
    $33,596
    Filer's total
    $166,266

  • Jamie Perry

    Nurse Practitioner

    Total calculated
    $126,702
    From this org
    $124,289
    From related orgs
    $0
    Other
    $2,413
    Hours/week
    40

  • Shannon Piner

    Nurse Practitioner

    Total calculated
    $111,243
    From this org
    $107,821
    From related orgs
    $0
    Other
    $3,422
    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
2022
Filed
9 November 2023
IRS schema version
2022v5.0
Source object
202343189349305559

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