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Nonprofiteer
← COVENANT MEDICAL GROUP

Form 990 for tax year 2023

Filed by COVENANT MEDICAL GROUP.

Totals

Total revenue
$187,130,359
Total expenses
$187,118,348
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$187,118,348
Investment income
$12,011
Other revenue
$0
Total assets, end of year
$66,261,334
Total liabilities, end of year
$109,974,187
Net assets or fund balances, end of year
-$43,712,853
Program services expenses (Part IX)
$176,282,391
Management and general expenses
$10,835,957
Fundraising expenses
$0
Program service expenses (Part III)
$176,282,391

Program services were 94.2% 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: NET PATIENT REVENUE

    total $100,884,516 · related or exempt $100,884,516

  • 2b · Program service revenue: SVCS-EXEMPT AFFILIATES

    total $55,564,729 · related or exempt $55,564,729

  • 2c · Program service revenue: INTER-AFFILIATE REV.

    total $30,669,103 · related or exempt $30,669,103

  • 3 · Investment income

    total $12,011 · excluded $12,011

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $10,670,462 · program services $10,005,658 · management and general $664,804

  • 7 · Other salaries and wages

    total $124,660,711 · program services $116,893,954 · management and general $7,766,757

  • 9 · Other employee benefits

    total $9,949,865 · program services $9,329,957 · management and general $619,908

  • 11g · Fees: other

    total $14,919,043 · program services $13,989,539 · management and general $929,504

  • 16 · Occupancy

    total $9,551,816 · program services $8,956,708 · management and general $595,108

  • 20 · Interest

    total $863 · management and general $863

  • 22 · Depreciation, depletion and amortization

    total $330,806 · program services $310,196 · management and general $20,610

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $13,208,290 · program services $13,208,290 · management and general $0

  • 24b · Other expenses: OTHER DIRECT EXPENSES

    total $3,826,492 · program services $3,588,089 · management and general $238,403

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $71,693,220 · end of year $3,480,241

  • 4 · Accounts receivable

    beginning of year $13,374,740 · end of year $11,084,811

  • 9 · Prepaid expenses and deferred charges

    beginning of year $16,872 · end of year $679,181

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

    $19,518,175

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

    $17,336,092

  • 10c · Land, buildings and equipment, net

    beginning of year $2,188,600 · end of year $2,182,083

  • 15 · Other assets

    beginning of year $41,243,895 · end of year $48,835,018

  • 17 · Accounts payable and accrued expenses

    beginning of year $7,637,819 · end of year $10,548,317

  • 25 · Other liabilities

    beginning of year $133,935,269 · end of year $99,425,870

  • 27 · Net assets without donor restrictions

    beginning of year -$13,055,761 · end of year -$43,712,853

Mission and programs · 2023

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 O AT 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, WA AS 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 EXECUTE ON OUR INTEGRATED STRATEGIC AND FINANCIAL PLAN, WHICH CLEARLY EXPRESSES OUR COMMITMENT AND ACCELERATION OF THE IMPORTANT WORK TO ADDRESS SOCIAL, RACIAL, AND ECONOMIC DISPARITIES AND REDUCE OUR CARBON FOOTPRINT IN THE COMMUNITIES WE SERVE. PROVIDENCE ADVANCES PROGRESS ON OUR CARBON NEGATIVE GOAL AND IN 2023 WE ESTIMATED THAT WE DECREASED EMISSIONS BY OVER 12 PERCENT COMPARED TO OUR 2019 BASELINE. IN ADDITION, OUR EFFORTS LED TO THE INTRODUCTION OF THE GREEN HOSPITALS ACT, LEGISLATION MODELED AFTER PROVIDENCE THAT WOULD PROVIDE CRITICAL FEDERAL FUNDING TO WEATHERIZE AND MODERNIZE HEALTH CARE FACILITIES. PROVIDENCE COMPLETED A COMPREHENSIVE CLIMATE RESILIENCE PLAN IN ALIGNMENT WITH OUR COMMITMENT TO THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES CLIMATE PLEDGE. WE CONTINUE TO REDUCE GREENHOUSE GAS EMISSIONS WITH A FOCUS ON LED LIGHTING UPGRADES, WATER CONSERVATION, MORE EFFICIENT DELIVERY OF NITROUS OXIDE GAS DURING ANESTHESIA, AND ADVANCING OUR WASTE OPTIMIZATION WORK ACROSS ALL HOSPITALS AND CLINICS.PROGRAM SERVICE ACCOMPLISHMENTSCOVENANT MEDICAL GROUP IS A NON-PROFIT, TAX-EXEMPT MEDICAL FOUNDATION THAT IS CERTIFIED UNDER TEXAS LAW TO EMPLOY PHYSICIANS AND PRACTICE MEDICINE. IT IS OWNED BY COVENANT HEALTH SYSTEM, BUT IS SELF-GOVERNING IN MOST ASPECTS, OTHER THAN FISCAL MATTERS. THERE IS A BOARD OF 13 PHYSICIANS WHO PROVIDE THE OVERSIGHT OF THE GROUP'S STRATEGIC PLANNING, POLICY DEVELOPMENT, RECRUITMENT AND CREDENTIALING, QUALITY IMPROVEMENT TASKS, RESEARCH, AND MEDICAL EDUCATION ACTIVITIES. ALL OF THE BOARD MEMBERS ARE ACTIVELY PRACTICING WITHIN CMG. THIS SELF-GOVERNING ASPECT OF CMG TENDS TO MAKE IT QUITE PHYSICIAN-FRIENDLY IN ITS POLICY DEVELOPMENT AND PLANNING IN THAT THE BOARD MEMBERS ARE IMMEDIATELY PERSONALLY IMPACTED IN THEIR OWN PRACTICE BY THEIR BOARD DECISIONS.WHO WE ARE AND WHAT WE DO "CARING FOR THE PEOPLE OF OUR REGION" OUR REGION: COVENANT MEDICAL GROUP IS HEADQUARTERED IN LUBBOCK, TEXAS, THE SITE OF THE SOUTHWEST'S PREEMINENT MEDICAL CENTER BETWEEN THE DALLAS / FORT WORTH METROPLEX AND PHOENIX. WITH A COUNTY POPULATION OF 250,000 AND SERVING AN AREA OF 1.2 MILLION PEOPLE IN THE REGION, LUBBOCK HASMANY OF THE AMENITIES OF A LARGER METROPOLITAN AREA, INTERNATIONAL AIRPORT, GREAT SHOPPING AND RESTAURANTS, AND EXCELLENT PUBLIC AND PRIVATE SCHOOLS, YET RETAINING A WONDERFUL "SMALL-TOWN" ATMOSPHERE. OUR HEALTH SYSTEM'S REGIONAL CLINICS ARE LOCATED THROUGHOUT WEST TEXAS AND EASTERN NEW MEXICO. OUR REGIONAL CLINIC NETWORK CONTAINS SEVERAL OPERATIONALLY DIFFERENT MODELS. SOME ARE DIRECTLY OWNED AND OPERATED BY CMG; SOME ARE RURAL HEALTH CLINICS IN WHICH CMG SUPPLIES ITS EMPLOYED PHYSICIANS TO WORK FOR A RURAL HOSPITAL-OWNED FACILITY; SOME ARE RURAL HEALTH CLINICS IN WHICH THE PHYSICIANS ARE INDEPENDENT CONTRACTORS; AND SOME ARE SATELLITE CLINIC SITES TO WHICH CMG SUBSPECIALISTS TRAVEL A FEW TIMES PER MONTH. THESE REGIONAL CLINICS ARE INTEGRAL TO THE PROVISION OF PRIMARY CARE SERVICES TO THEIR LOCAL COMMUNITIES, AND ALSO SEND SUBSTANTIAL NUMBERS OF PATIENTS TO LUBBOCK FOR TERTIARY CARE THAT IS NOT AVAILABLE LOCALLY.FOR MORE INFORMATION ON COVENANT MEDICAL GROUP GO TO: WWW.COVMEDGROUP.ORGFOR MORE INFORMATION ON COVENANT HEALTH SYSTEM GO TO: WWW.COVENANTHEALTH.ORGFOR MORE INFORMATION ABOUT PROVIDENCE, PLEASE VISIT WWW.PROVIDENCE.ORG

    Expenses $176,282,391 · Revenue $187,118,348

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

Listed in Part VII

  • Ibrahim Shalaby MD

    BOARD MEMBER

    Total calculated
    $1,101,338
    From this org
    $997,755
    From related orgs
    $0
    Other
    $103,583
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $939,898
    Bonus
    $2,867
    Other
    $54,990
    Deferred
    $67,895
    Nontaxable benefits
    $35,688
    Filer's total
    $1,101,338

  • Kyler Barkley MD

    BOARD MEMBER

    Total calculated
    $1,044,777
    From this org
    $968,010
    From related orgs
    $0
    Other
    $76,767
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $944,309
    Bonus
    $11,000
    Other
    $12,701
    Deferred
    $36,525
    Nontaxable benefits
    $40,242
    Filer's total
    $1,044,777

  • David Blann MD

    BOARD MEMBER

    Total calculated
    $1,019,882
    From this org
    $939,219
    From related orgs
    $0
    Other
    $80,663
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $859,345
    Bonus
    $12,361
    Other
    $67,513
    Deferred
    $64,638
    Nontaxable benefits
    $16,025
    Filer's total
    $1,019,882

  • Brian Williams MD

    BOARD MEMBER/CHAIR - THRU 12/31/23

    Total calculated
    $906,035
    From this org
    $815,107
    From related orgs
    $0
    Other
    $90,928
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $784,047
    Bonus
    $9,032
    Other
    $22,028
    Deferred
    $49,302
    Nontaxable benefits
    $41,626
    Filer's total
    $906,035

  • John Hanna MD

    BOARD MEMBER

    Total calculated
    $860,652
    From this org
    $785,138
    From related orgs
    $0
    Other
    $75,514
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $655,346
    Bonus
    $0
    Other
    $129,792
    Deferred
    $46,465
    Nontaxable benefits
    $29,049
    Filer's total
    $860,652

  • Sergio Lara MD

    BOARD MEMBER

    Total calculated
    $853,322
    From this org
    $793,162
    From related orgs
    $0
    Other
    $60,160
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $755,171
    Bonus
    $0
    Other
    $37,991
    Deferred
    $48,331
    Nontaxable benefits
    $11,829
    Filer's total
    $853,322

  • Ryan Owen MD

    BOARD MEMBER

    Total calculated
    $815,456
    From this org
    $750,749
    From related orgs
    $0
    Other
    $64,707
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $704,790
    Bonus
    $4,770
    Other
    $41,189
    Deferred
    $29,850
    Nontaxable benefits
    $34,857
    Filer's total
    $815,456

  • Paul Walter MD

    BOARD MEMBER/CMO

    Total calculated
    $768,070
    From this org
    $674,242
    From related orgs
    $0
    Other
    $93,828
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $639,875
    Bonus
    $2,000
    Other
    $32,367
    Deferred
    $50,815
    Nontaxable benefits
    $43,013
    Filer's total
    $768,070

  • Scott Letbetter MD

    BOARD MEMBER

    Total calculated
    $657,086
    From this org
    $583,461
    From related orgs
    $0
    Other
    $73,625
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $542,510
    Bonus
    $9,490
    Other
    $31,461
    Deferred
    $38,242
    Nontaxable benefits
    $35,383
    Filer's total
    $657,086

  • Jeremy Dalton MD

    BOARD MEMBER/VICE CHAIR

    Total calculated
    $655,838
    From this org
    $606,212
    From related orgs
    $0
    Other
    $49,626
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $550,298
    Bonus
    $6,000
    Other
    $49,914
    Deferred
    $45,842
    Nontaxable benefits
    $3,784
    Filer's total
    $655,838

  • Amy Henning Do

    BOARD MEMBER

    Total calculated
    $622,766
    From this org
    $595,651
    From related orgs
    $0
    Other
    $27,115
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $544,863
    Bonus
    $9,667
    Other
    $41,121
    Deferred
    $24,756
    Nontaxable benefits
    $2,359
    Filer's total
    $622,766

  • Karen Talusan-Soriano MD

    BOARD MEMBER

    Total calculated
    $370,247
    From this org
    $306,694
    From related orgs
    $0
    Other
    $63,553
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $287,830
    Bonus
    $4,100
    Other
    $14,764
    Deferred
    $28,428
    Nontaxable benefits
    $35,125
    Filer's total
    $370,247

  • Christopher Cotton MD

    BOARD MEMBER - THRU 12/31/23

    Total calculated
    $319,578
    From this org
    $260,143
    From related orgs
    $0
    Other
    $59,435
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $249,746
    Bonus
    $0
    Other
    $10,397
    Deferred
    $24,391
    Nontaxable benefits
    $35,044
    Filer's total
    $319,578

  • Kristen Kothmann

    CMG CEO

    Total calculated
    $675,416
    From this org
    $584,424
    From related orgs
    $0
    Other
    $90,992
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $354,332
    Bonus
    $201,708
    Other
    $28,384
    Deferred
    $58,950
    Nontaxable benefits
    $32,042
    Filer's total
    $675,416

  • Adam Spivey

    CFO - THRU 11/23

    Total calculated
    $260,906
    From this org
    $0
    From related orgs
    $229,966
    Other
    $30,940
    Hours/week
    14 + 41 related

    Schedule J breakdown matched by us

    Base
    $0 + $172,623 related
    Bonus
    $0 + $34,407 related
    Other
    $0 + $22,936 related
    Deferred
    $0 + $3,518 related
    Nontaxable benefits
    $0 + $27,422 related
    Filer's total
    $0 + $260,906 related

  • Mohammad Otahbachi MD

    PHYSICIAN

    Total calculated
    $1,912,105
    From this org
    $1,780,396
    From related orgs
    $0
    Other
    $131,709
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,694,884
    Bonus
    $8,000
    Other
    $77,512
    Deferred
    $96,816
    Nontaxable benefits
    $34,893
    Filer's total
    $1,912,105

  • Andrew Robinson MD

    PHYSICIAN

    Total calculated
    $1,556,675
    From this org
    $1,430,565
    From related orgs
    $0
    Other
    $126,110
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,351,960
    Bonus
    $9,268
    Other
    $69,337
    Deferred
    $93,646
    Nontaxable benefits
    $32,464
    Filer's total
    $1,556,675

  • Ramakrishnan Ranganath MD

    PHYSICIAN

    Total calculated
    $1,493,581
    From this org
    $1,404,516
    From related orgs
    $0
    Other
    $89,065
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,387,961
    Bonus
    $3,250
    Other
    $13,305
    Deferred
    $48,267
    Nontaxable benefits
    $40,798
    Filer's total
    $1,493,581

  • Robert Scranton

    PHYSICIAN

    Total calculated
    $1,365,379
    From this org
    $1,284,811
    From related orgs
    $0
    Other
    $80,568
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,271,965
    Bonus
    $3,188
    Other
    $9,658
    Deferred
    $43,725
    Nontaxable benefits
    $36,843
    Filer's total
    $1,365,379

  • Jefferson Murphree

    PHYSICIAN

    Total calculated
    $1,352,821
    From this org
    $1,290,398
    From related orgs
    $0
    Other
    $62,423
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,264,815
    Bonus
    $0
    Other
    $25,583
    Deferred
    $43,834
    Nontaxable benefits
    $18,589
    Filer's total
    $1,352,821

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 PLANNING 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 ALTHOUGH THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY COVENANT MEDICAL GROUP, THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION.
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: MOHAMMAD OTAHBACHI, M.D. - $51,005 ANDREW ROBINSON, M.D. - $39,784 RAMAKRISHNAN RANGANATH, M.D. - $9,825 ROBERT SCRANTON - $6,582 IBRAHIM SHALABY, M.D. - $34,665 KYLER BARKLEY, M.D. - $7,720 DAVID BLANN, M.D. - $26,625 BRIAN WILLIAMS, M.D. - $10,749 JOHN HANNA, M.D. - $23,973 SERGIO LARA, M.D. - $16,964 RYAN OWEN, M.D. - $9,649 PAUL WALTER, M.D. - $16 KRISTEN KOTHMANN - $24,193 SCOTT LETBETTER, M.D. - $5,945 JEREMY DALTON, M.D. - $5,312 AMY HENNING D.O. - $8,504
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.

  • 20TH STREET SURGERY LLC

    AMBULATORY SURGERY CENTER · CA

  • BRIDGEPORT MEDICAL IMAGING LLC (BMI)

    IMAGING - DIAGNOSTICS · OR · general or managing partner

  • BROADWAY IMAGING LLC

    MEDICAL IMAGING · MT · general or managing partner

  • CANBY MEDICAL CENTER I LLC

    REAL ESTATE - MOB · OR · general or managing partner

  • CENTER FOR MEDICAL IMAGING LLC (CMI)

    IMAGING - DIAGNOSTICS · OR · general or managing partner

  • CLACKAMAS RADIATION ONCOLOGY CENTER LLC

    RADIATION ONCOLOGY · OR · general or managing partner

  • COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY

    HEALTHCARE · CA · general or managing partner

  • COVENANT HIGH PLAINS SURGERY CENTER LLC

    HEALTHCARE · PA · general or managing partner

  • COVENANT PARK PHASE I VENTURE LLC

    REAL ESTATE · TX

  • CSS JV LLC

    AMBULATORY SURGERY CENTER · OR

  • FIRST HILL SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · WA · general or managing partner

  • FULLERTON SURGICAL CENTER LP

    AMBULATORY SURGERY CENTER · CA · general or managing partner

  • GREATER VALLEY MEDICAL BUILDING LP

    REAL ESTATE - MOB · CA · general or managing partner

  • HERITAGE INVESTMENT GROUP I LLC

    INVESTMENTS · CA

  • IMAGING ASSOCIATES LLC

    MEDICAL IMAGING · AK · general or managing partner

  • LSC REAL PROPERTY LLC

    REAL ESTATE · TX · general or managing partner

  • METHODIST DIAGNOSTIC IMAGING

    HEALTHCARE · TX · general or managing partner

  • MISSION VIEJO PARTNERS II LLC

    REAL ESTATE - MOB · CA · general or managing partner

  • NORTH OC IMAGING JV HOLDINGS LLC

    HEALTHCARE · CA

  • OREGON ADVANCED IMAGING LLC

    MEDICAL IMAGING · OR · general or managing partner

  • PAVILION SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · CA

  • PERFORMANCE MEDICAL EQUIPMENT & RESPIRATORY SERVICES LLC

    MEDICAL EQUIPMENT · WA · general or managing partner

  • PETCT IMAGING AT SWEDISH CANCER INSTITUTE LLC

    MEDICAL IMAGING · WA · general or managing partner

  • PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCE & SCA OFF-CAMPUS HOLDINGS LLC

    MEDICAL · AL

  • PROVIDENCE & SCA ON-CAMPUS HOLDINGS LLC

    MEDICAL · AL · general or managing partner

  • PROVIDENCE ALASKA HOUSE I OWNER LP

    SUPPORTIVE HOUSING · AK

  • PROVIDENCE HOUSE OAKLAND LP

    SUPPORTIVE HOUSING · CA · general or managing partner

  • PROVIDENCE IMAGING CENTER JOINT VENTURE

    MEDICAL IMAGING · AK

  • PROVIDENCE ST JOSEPH HEALTH LONG TERM PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCE SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · MT

  • PROVIDENCEUSP SPOKANE SURGERY CENTERS LLC

    AMBULATORY SURGERY CENTER · WA

  • PROVIDENCEUSP SURGERY CTRS LLC

    AMBULATORY SURGERY CENTER · CA

  • RADIATION THERAPY INNOVATIONS LLC

    HEALTHCARE · WA · general or managing partner

  • RIVERSIDE HEALTHCARE

    HEALTHCARE · MN · general or managing partner

  • ST JOSEPH PHYSICIAN VENTURES I LLC

    REAL ESTATE · CA · general or managing partner

  • ST JOSEPHSATELLITE DIALYSIS CENTERS LLC

    HEALTHCARE · CA

  • ST JUDE SURGICAL CENTERS LLC

    AMBULATORY SURGERY CENTER · CA · general or managing partner

  • ST PETER-SOUTH SOUND REGIONAL MRI CENTER

    MEDICAL IMAGING · WA · general or managing partner

  • SURGERY CENTER AT TANASBOURNE LLC

    AMBULATORY SURGERY CENTER · KS · general or managing partner

  • THE MADISON SPOKANE INN LLC

    HOTEL SERVICES · WA · general or managing partner

  • WON-ONC LLC

    REAL ESTATE - MOB · WA · general or managing partner

Related corporations and trusts

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

  • 1221 MADISON STREET OWNERS ASSOC

    C · OWNERS' ASSOCIATION · WA

  • ADVATA INC (FKA KENSCI INC)

    C · HEALTHCARE · WA

  • AMERICAN UNITY GROUP LTD

    C · CAPTIVE INSURANCE · BD

  • AYIN HEALTH HOLDINGS INC

    C · HEALTHCARE · DE

  • AYIN HEALTH SOLUTIONS INC

    C · HEALTHCARE · OR

  • BOURGET HEALTH SERVICES INC

    C · CLINICAL/MEDICAL LAB · WA

  • CARON CORPORATION

    C · MEDICAL PHYSICIAN SERVICE · MT

  • CLOUD 21 LIMITED

    C · HEALTHCARE · UK

  • ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA

    S · HEALTHCARE · CA

  • HCSA PROPERTIES LLC

    C · REAL ESTATE RENTAL · WA

  • KENSCI ASIA PACIFIC PTE LTD

    C · HEALTHCARE · SN

  • KENSCI TECH INDIA PRIVATE LIMITED

    C · HEALTHCARE · IN

  • LUBBOCK METHODIST HOSP PRACTICE MGMT

    C · INACTIVE · TX

  • LUBBOCK METHODIST HOSPITAL SVCS

    C · HEALTHCARE · TX

  • MEDICAL SPECIALTIES MANAGERS INC

    C · HEALTHCARE · WA

  • MISSION VIEJO MEDICAL VENTURES INC

    C · HEALTHCARE · CA

  • PHN HOLDINGS

    C · STRATEGIC PLANNING SERVICES · CA

  • PRAIA HEALTH INC

    C · HEALTHCARE · DE

  • PROVIDENCE GLOBAL CENTER LLP

    C · IT SVCS · IN

  • PROVIDENCE HEALTH CARE VENTURES INC

    C · CLINICAL/MEDICAL LAB · WA

  • PROVIDENCE HEALTH NETWORK

    C · PREPAID HEALTHCARE · CA

  • PROVIDENCE PARTNERS HOLDINGS INC

    C · INVESTMENT · DE

  • PROVIDENCE PHYSICIAN SERVICES CO

    C · HEALTHCARE · WA

  • PROVIDENCE ST JOSEPH HEALTH NETWORK

    C · HEALTHCARE · CA

  • PROVSOURCE

    C · HEALTHCARE · DE

  • ST JOSEPH HEALTH

    C · HOLDING COMPANY · CA

  • ST JOSEPH HEALTH SOURCE INC

    C · HEALTHCARE · CA

  • ST JOSEPH MEDICAL PLAZA ASSOCIATION

    C · CONDO ASSOCIATION · CA

  • ST JOSEPH PROF SVCS ENTERPRSES INC

    C · HEALTHCARE · CA

  • TEGRIA HOLDINGS LLC (FKA GRADY BLOCKER LLC)

    C · HOLDING COMPANY · DE

  • TEGRIA INSIGHTS GROUP HOLDINGS INC

    C · HOLDING COMPANY · WA

  • TEGRIA INSIGHTS GROUP INC

    C · HEALTHCARE · WA

  • TEGRIA PRODUCTS GROUP INC

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP US INC

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP INC (FKA PROV RCM GROUP INC)

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP INC (FKA PROVIDENCE SERVICES GROUP)

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP-CAN INC

    C · HEALTHCARE · CA

  • TEGRIA SERVICES GROUP-US INC (FKA BLUETREE NETWORK INC)

    C · HEALTHCARE · WI

  • TRUSANA INC

    C · HEALTHCARE · DE

  • VINSERRA INC

    C · INVESTMENT · CA

  • WEIGHT LOSS INC (FKA HMR WEIGHT MANAGEMENT SERVICES CORP)

    C · HEALTHCARE · WA

Provenance

Return type
form_990
Tax year
2023
Filed
30 October 2024
IRS schema version
2023v5.1
Source object
202423179349302072

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