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Nonprofiteer
← PROVIDENCE HEALTH ALLIANCE INC

Form 990 for tax year 2023

Filed by PROVIDENCE HEALTH ALLIANCE INC.

Totals

Total revenue
$72,452,049
Total expenses
$97,225,592
Contributions and grants received
$759,651
Grants paid
$0
Program service revenue
not reported
Investment income
not reported
Other revenue
not reported
Total assets, end of year
not reported
Total liabilities, end of year
not reported
Net assets or fund balances, end of year
not reported
Program services expenses (Part IX)
$82,505,756
Management and general expenses
$14,719,836
Fundraising expenses
$0
Program service expenses (Part III)
$82,505,756

Program services were 84.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • BRIAN K BECKER MD

    EX-OFFICIO/PRESIDENT EXECUTIVE DIRECTOR

    Total calculated
    $516,157
    From this org
    $0
    From related orgs
    $464,737
    Other
    $51,420
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $358,234 related
    Bonus
    $0 + $73,500 related
    Other
    $0 + $33,003 related
    Deferred
    $0 + $20,299 related
    Nontaxable benefits
    $0 + $31,121 related
    Filer's total
    $0 + $516,157 related

  • DANIEL W HUFFINE

    CFO, MINISTRY MARKET

    Total calculated
    $736,270
    From this org
    $0
    From related orgs
    $699,488
    Other
    $36,782
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $492,557 related
    Bonus
    $0 + $136,488 related
    Other
    $0 + $70,443 related
    Deferred
    $0 + $16,500 related
    Nontaxable benefits
    $0 + $20,282 related
    Filer's total
    $0 + $736,270 related

  • JEFF DAVID CHANCELLOR MD

    CHAIR/PHYSICIAN

    Total calculated
    $671,290
    From this org
    $618,188
    From related orgs
    $0
    Other
    $53,102
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $604,334
    Bonus
    $7,462
    Other
    $6,392
    Deferred
    $21,053
    Nontaxable benefits
    $32,049
    Filer's total
    $671,290

  • JEROD BRADLEY PATCHIN DO

    TREASURER/PHYSICIAN

    Total calculated
    $420,274
    From this org
    $368,027
    From related orgs
    $0
    Other
    $52,247
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $344,774
    Bonus
    $19,440
    Other
    $3,813
    Deferred
    $19,800
    Nontaxable benefits
    $32,447
    Filer's total
    $420,274

  • OLUWAROTIMI ADESINA MD

    SECRETARY/PHYSICIAN

    Total calculated
    $312,632
    From this org
    $260,582
    From related orgs
    $0
    Other
    $52,050
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $246,096
    Bonus
    $12,500
    Other
    $1,986
    Deferred
    $15,216
    Nontaxable benefits
    $36,834
    Filer's total
    $312,632

  • PATRICIA A WILCOX MD

    VICE CHAIR/PHYSICIAN

    Total calculated
    $632,629
    From this org
    $581,998
    From related orgs
    $0
    Other
    $50,631
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $526,681
    Bonus
    $0
    Other
    $55,317
    Deferred
    $28,300
    Nontaxable benefits
    $22,331
    Filer's total
    $632,629

  • DONALD ALAN STEWART MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $647,537
    From this org
    $624,947
    From related orgs
    $0
    Other
    $22,590
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $610,686
    Bonus
    $3,927
    Other
    $10,334
    Deferred
    $7,958
    Nontaxable benefits
    $14,632
    Filer's total
    $647,537

  • ERIC L BRAUN MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $398,686
    From this org
    $347,195
    From related orgs
    $0
    Other
    $51,491
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $343,515
    Bonus
    $0
    Other
    $3,680
    Deferred
    $18,150
    Nontaxable benefits
    $33,341
    Filer's total
    $398,686

  • FLORENCE BOSIBORI LEE MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $159,159
    From this org
    $128,967
    From related orgs
    $0
    Other
    $30,192
    Hours/week
    24

    Schedule J breakdown matched by us

    Base
    $119,018
    Bonus
    $0
    Other
    $9,949
    Deferred
    $15,890
    Nontaxable benefits
    $14,302
    Filer's total
    $159,159

  • JASON ROBERT BAUERSCHLAG MD

    DIRECTOR/PHYSICIAN (END 12/2023)

    Total calculated
    $466,026
    From this org
    $406,325
    From related orgs
    $0
    Other
    $59,701
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $370,055
    Bonus
    $6,000
    Other
    $30,270
    Deferred
    $26,650
    Nontaxable benefits
    $33,051
    Filer's total
    $466,026

  • MATT TAYLOR PATTILLO MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $833,445
    From this org
    $783,100
    From related orgs
    $0
    Other
    $50,345
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $750,576
    Bonus
    $27,614
    Other
    $4,910
    Deferred
    $18,150
    Nontaxable benefits
    $32,195
    Filer's total
    $833,445

  • PAUL CLAIBORNE MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $585,993
    From this org
    $536,466
    From related orgs
    $0
    Other
    $49,527
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $460,971
    Bonus
    $46,665
    Other
    $28,830
    Deferred
    $18,150
    Nontaxable benefits
    $31,377
    Filer's total
    $585,993

  • ROBERT CHRISTOPHER MATLOCK MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $564,400
    From this org
    $506,920
    From related orgs
    $0
    Other
    $57,480
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $498,248
    Bonus
    $0
    Other
    $8,672
    Deferred
    $19,800
    Nontaxable benefits
    $37,680
    Filer's total
    $564,400

  • BORIS A MURILLO MD

    PHYSICIAN

    Total calculated
    $874,043
    From this org
    $817,460
    From related orgs
    $0
    Other
    $56,583
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $733,447
    Bonus
    $75,341
    Other
    $8,672
    Deferred
    $19,800
    Nontaxable benefits
    $36,783
    Filer's total
    $874,043

  • DONALD JEFFREY YOUNG MD

    PHYSICIAN

    Total calculated
    $915,723
    From this org
    $868,634
    From related orgs
    $0
    Other
    $47,089
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $854,722
    Bonus
    $2,618
    Other
    $11,294
    Deferred
    $9,900
    Nontaxable benefits
    $37,189
    Filer's total
    $915,723

  • ELIOT MARTIN WICKLIFF MD

    PHYSICIAN

    Total calculated
    $1,295,604
    From this org
    $1,238,453
    From related orgs
    $0
    Other
    $57,151
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,233,543
    Bonus
    $0
    Other
    $4,910
    Deferred
    $18,150
    Nontaxable benefits
    $39,001
    Filer's total
    $1,295,604

  • JOHN BRETT DIETZE MD

    PHYSICIAN

    Total calculated
    $1,370,132
    From this org
    $1,316,181
    From related orgs
    $0
    Other
    $53,951
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $858,869
    Bonus
    $449,600
    Other
    $7,712
    Deferred
    $16,500
    Nontaxable benefits
    $37,451
    Filer's total
    $1,370,132

  • MITCHELL GEORGE EICHHORN MD

    PHYSICIAN

    Total calculated
    $1,601,864
    From this org
    $1,552,508
    From related orgs
    $0
    Other
    $49,356
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $767,345
    Bonus
    $782,000
    Other
    $3,163
    Deferred
    $16,500
    Nontaxable benefits
    $32,856
    Filer's total
    $1,601,864

  • SCOTT HERNDON

    FORMER OFFICER (END 8/2022)

    Total calculated
    $1,624,101
    From this org
    $0
    From related orgs
    $1,564,886
    Other
    $59,215
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $582,193 related
    Bonus
    $0 + $878,940 related
    Other
    $0 + $103,753 related
    Deferred
    $0 + $18,150 related
    Nontaxable benefits
    $0 + $41,065 related
    Filer's total
    $0 + $1,624,101 related

  • WILLIAM R HASKETT MD

    FORMER OFFICER (END 6/2023)

    Total calculated
    $489,499
    From this org
    $430
    From related orgs
    $457,256
    Other
    $31,813
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $179,627 related
    Bonus
    $0 + $71,400 related
    Other
    $430 + $206,229 related
    Deferred
    $0 + $14,342 related
    Nontaxable benefits
    $898 + $16,573 related
    Filer's total
    $1,328 + $488,171 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, 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

  • 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 CALENDAR YEAR 2023: WILLIAM R HASKETT, MD - $171,635
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

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.

Related corporations and trusts

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

Provenance

Return type
form_990
Tax year
2023
Filed
10 May 2025
IRS schema version
2023v6.0
Source object
202501309349300915

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