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Nonprofiteer
← TRI-COUNTY MEMORIAL HOSPITAL INC

Form 990 for tax year 2022

Filed by TRI-COUNTY MEMORIAL HOSPITAL INC.

Totals

Total revenue
$29,553,088
Total expenses
$26,987,290
Contributions and grants received
$1,676,030
Grants paid
$0
Program services expenses (Part IX)
$20,753,330
Management and general expenses
$6,233,960
Fundraising expenses
$0
Program service expenses (Part III)
$20,753,330

Program services were 76.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • KIMBERLY BREIDENBACH MD

    TRUSTEE/CHIEF OF STAFF

    Total calculated
    $335,495
    From this org
    $0
    From related orgs
    $274,283
    Other
    $61,212
    Hours/week
    0.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $245,740 related
    Bonus
    $0 + $2,250 related
    Other
    $0 + $26,293 related
    Deferred
    $0 + $39,718 related
    Nontaxable benefits
    $0 + $21,494 related
    Filer's total
    $0 + $335,495 related

  • DENNIS STEPHENSON

    CHAIRPERSON

    Total calculated
    $0
    Hours/week
    0.5

  • BETH LISOWSKI

    VICE-CHAIRPERSON

    Total calculated
    $0
    Hours/week
    0.5

  • RON GUZA

    TREASURER

    Total calculated
    $0
    Hours/week
    0.5

  • KATHY KLOCK

    SECRETARY

    Total calculated
    $0
    Hours/week
    0.5

  • MARILU BINTZ MD

    TRUSTEE

    Total calculated
    $673,396
    From this org
    $0
    From related orgs
    $620,762
    Other
    $52,634
    Hours/week
    0.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $615,301 related
    Bonus
    $0
    Other
    $0 + $5,461 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $8,409 related
    Filer's total
    $0 + $673,396 related

  • RANDY LUBAHN

    TRUSTEE

    Total calculated
    $184,917
    From this org
    $0
    From related orgs
    $141,251
    Other
    $43,666
    Hours/week
    0.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $136,742 related
    Bonus
    $0
    Other
    $0 + $4,509 related
    Deferred
    $0 + $20,972 related
    Nontaxable benefits
    $0 + $22,694 related
    Filer's total
    $0 + $184,917 related

  • VICKIE BAKALARS

    TRUSTEE

    Total calculated
    $186,676
    From this org
    $0
    From related orgs
    $141,983
    Other
    $44,693
    Hours/week
    0.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $138,203 related
    Bonus
    $0
    Other
    $0 + $3,780 related
    Deferred
    $0 + $21,199 related
    Nontaxable benefits
    $0 + $23,494 related
    Filer's total
    $0 + $186,676 related

  • MARLYS KOLSTAD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.5

  • JONI OLSON

    ADMINISTRATOR

    Total calculated
    $261,186
    From this org
    $0
    From related orgs
    $206,921
    Other
    $54,265
    Hours/week
    0.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $181,884 related
    Bonus
    $0 + $200 related
    Other
    $0 + $24,837 related
    Deferred
    $0 + $30,388 related
    Nontaxable benefits
    $0 + $23,877 related
    Filer's total
    $0 + $261,186 related

  • DAN KLIDZEJS

    FINANCE ADMINISTRATOR (TERMED MAY)

    Total calculated
    $60,530
    From this org
    $0
    From related orgs
    $52,175
    Other
    $8,355
    Hours/week
    0.5 + 40 related

  • MARK ZELLMER

    PHYSICIAN ASSISTANT

    Total calculated
    $191,528
    From this org
    $159,816
    From related orgs
    $0
    Other
    $31,712
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $158,612
    Bonus
    $0
    Other
    $1,204
    Deferred
    $8,235
    Nontaxable benefits
    $23,477
    Filer's total
    $191,528

  • KATE CAIN

    PHARMACY DIRECTOR

    Total calculated
    $185,712
    From this org
    $162,614
    From related orgs
    $0
    Other
    $23,098
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $162,526
    Bonus
    $0
    Other
    $88
    Deferred
    $8,177
    Nontaxable benefits
    $14,921
    Filer's total
    $185,712

  • CARLA SENDELBACH

    REGISTERED NURSE

    Total calculated
    $143,127
    From this org
    $115,978
    From related orgs
    $0
    Other
    $27,149
    Hours/week
    40

  • GANESH RAM

    PHYSICIAN ASSISTANT

    Total calculated
    $170,358
    From this org
    $162,200
    From related orgs
    $0
    Other
    $8,158
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $152,032
    Bonus
    $10,125
    Other
    $43
    Deferred
    $8,108
    Nontaxable benefits
    $50
    Filer's total
    $170,358

  • KATHY BOE

    NURSE PRACTITIONER

    Total calculated
    $151,294
    From this org
    $122,895
    From related orgs
    $0
    Other
    $28,399
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $114,834
    Bonus
    $0
    Other
    $8,061
    Deferred
    $6,057
    Nontaxable benefits
    $22,342
    Filer's total
    $151,294

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

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
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.

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 November 2023
IRS schema version
2022v5.0
Source object
202333199349301493

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

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