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Nonprofiteer
← PROVIDENCE HOSPITAL

Form 990 for tax year 2022

Filed by PROVIDENCE HOSPITAL.

Totals

Total revenue
$16,501,935
Total expenses
$51,341,113
Contributions and grants received
$10,126
Grants paid
$166,194
Program services expenses (Part IX)
$42,593,058
Management and general expenses
$8,748,055
Fundraising expenses
$0
Program service expenses (Part III)
$42,593,058

Program services were 83.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • EDWARD R LOVERN

    PRESIDENT (END 5/2023)

    Total calculated
    $825,787
    From this org
    $0
    From related orgs
    $779,035
    Other
    $46,752
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $549,622 related
    Bonus
    $0 + $165,000 related
    Other
    $0 + $64,413 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $28,452 related
    Filer's total
    $0 + $825,787 related

  • MITCHELL G LOMAX

    DIRECTOR/CFO, MINISTRY MARKET

    Total calculated
    $441,354
    From this org
    $0
    From related orgs
    $394,082
    Other
    $47,272
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $300,708 related
    Bonus
    $0 + $91,800 related
    Other
    $0 + $1,574 related
    Deferred
    $0 + $18,725 related
    Nontaxable benefits
    $0 + $28,547 related
    Filer's total
    $0 + $441,354 related

  • WILLIAM B HIGGINBOTHAM

    DIRECTOR/INTERIM PRESIDENT & CEO (START 5/2023)

    Total calculated
    $430,586
    From this org
    $0
    From related orgs
    $385,142
    Other
    $45,444
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $318,477 related
    Bonus
    $0 + $65,000 related
    Other
    $0 + $1,665 related
    Deferred
    $0 + $18,475 related
    Nontaxable benefits
    $0 + $26,969 related
    Filer's total
    $0 + $430,586 related

  • BRIDGETTE INGRID ROBERSON

    DIRECTOR (END 12/2022)

    Total calculated
    $684,687
    From this org
    $0
    From related orgs
    $674,103
    Other
    $10,584
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $323,093 related
    Bonus
    $0 + $225,040 related
    Other
    $0 + $125,970 related
    Deferred
    $0 + $2,693 related
    Nontaxable benefits
    $0 + $7,891 related
    Filer's total
    $0 + $684,687 related

  • PETER M LEIBOLD

    DIRECTOR

    Total calculated
    $2,038,328
    From this org
    $0
    From related orgs
    $1,987,673
    Other
    $50,655
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $602,973 related
    Bonus
    $0 + $1,224,000 related
    Other
    $0 + $160,700 related
    Deferred
    $0 + $16,775 related
    Nontaxable benefits
    $0 + $33,880 related
    Filer's total
    $0 + $2,038,328 related

  • ASIM HARACIC MD

    PHYSICIAN

    Total calculated
    $382,064
    From this org
    $345,110
    From related orgs
    $0
    Other
    $36,954
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $329,808
    Bonus
    $12,603
    Other
    $2,699
    Deferred
    $10,675
    Nontaxable benefits
    $26,279
    Filer's total
    $382,064

  • BINDU C JOSEPH MD

    PHYSICIAN

    Total calculated
    $446,959
    From this org
    $423,387
    From related orgs
    $0
    Other
    $23,572
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $410,711
    Bonus
    $11,103
    Other
    $1,573
    Deferred
    $19,825
    Nontaxable benefits
    $3,747
    Filer's total
    $446,959

  • MELISSA T FAGONDE MD

    PHYSICIAN

    Total calculated
    $346,503
    From this org
    $310,870
    From related orgs
    $0
    Other
    $35,633
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $269,249
    Bonus
    $40,212
    Other
    $1,409
    Deferred
    $17,653
    Nontaxable benefits
    $17,980
    Filer's total
    $346,503

  • OLUSOLA MALOMO MD

    MEDICAL DIRECTOR

    Total calculated
    $384,953
    From this org
    $337,639
    From related orgs
    $0
    Other
    $47,314
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $316,006
    Bonus
    $20,000
    Other
    $1,633
    Deferred
    $19,825
    Nontaxable benefits
    $27,489
    Filer's total
    $384,953

  • SHADI SOUFI MD

    PHYSICIAN

    Total calculated
    $508,772
    From this org
    $474,163
    From related orgs
    $0
    Other
    $34,609
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $432,222
    Bonus
    $40,475
    Other
    $1,466
    Deferred
    $19,825
    Nontaxable benefits
    $14,784
    Filer's total
    $508,772

  • SCOTT M FURNISS

    FORMER OFFICER (END 1/2020)

    Total calculated
    $465,588
    From this org
    $0
    From related orgs
    $420,701
    Other
    $44,887
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $317,301 related
    Bonus
    $0 + $97,500 related
    Other
    $0 + $5,900 related
    Deferred
    $0 + $17,747 related
    Nontaxable benefits
    $0 + $27,140 related
    Filer's total
    $0 + $465,588 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 — 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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 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)

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED.
Schedule J, Part I, Line 4a Severance or change-of-control payment
THE FOLLOWING INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM THE ORGANIZATION OR A RELATED ORGANIZATION DURING THE CALENDAR YEAR 2022: Bridgette I. Roberson - $76,923
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO INDIVIDUALS RECEIVED CURRENT YEAR DISTRIBUTIONS.

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

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
202411359349309191

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

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