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Nonprofiteer
← COVENANT MEDICAL GROUP

Form 990 for tax year 2022

Filed by COVENANT MEDICAL GROUP.

Totals

Total revenue
$174,081,657
Total expenses
$173,978,380
Contributions and grants received
$0
Grants paid
$0
Program services expenses (Part IX)
$163,138,976
Management and general expenses
$10,839,404
Fundraising expenses
$0
Program service expenses (Part III)
$163,138,976

Program services were 93.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • MOHAMMAD OTAHBACHI MD

    PHYSICIAN

    Total calculated
    $1,379,618
    From this org
    $1,338,601
    From related orgs
    $0
    Other
    $41,017
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,233,989
    Bonus
    $33,167
    Other
    $71,445
    Deferred
    $8,639
    Nontaxable benefits
    $32,378
    Filer's total
    $1,379,618

  • ROBERT GAINES MD

    PHYSICIAN

    Total calculated
    $1,247,653
    From this org
    $1,210,520
    From related orgs
    $0
    Other
    $37,133
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,194,595
    Bonus
    $500
    Other
    $15,425
    Deferred
    $4,890
    Nontaxable benefits
    $32,243
    Filer's total
    $1,247,653

  • ANDREW ROBINSON MD

    PHYSICIAN

    Total calculated
    $1,210,498
    From this org
    $1,097,678
    From related orgs
    $0
    Other
    $112,820
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $939,171
    Bonus
    $21,816
    Other
    $136,691
    Deferred
    $75,874
    Nontaxable benefits
    $36,946
    Filer's total
    $1,210,498

  • STEPHEN GRUPKE

    PHYSICIAN

    Total calculated
    $1,165,068
    From this org
    $1,149,980
    From related orgs
    $0
    Other
    $15,088
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,136,304
    Bonus
    $9,311
    Other
    $4,365
    Deferred
    $4,575
    Nontaxable benefits
    $10,513
    Filer's total
    $1,165,068

  • JONATHAN MANNAS

    PHYSICIAN

    Total calculated
    $1,136,261
    From this org
    $1,098,859
    From related orgs
    $0
    Other
    $37,402
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,058,134
    Bonus
    $16,688
    Other
    $24,037
    Deferred
    $1,133
    Nontaxable benefits
    $36,269
    Filer's total
    $1,136,261

  • IBRAHIM SHALABY MD

    BOARD MEMBER

    Total calculated
    $941,902
    From this org
    $904,364
    From related orgs
    $0
    Other
    $37,538
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $836,570
    Bonus
    $20,500
    Other
    $47,294
    Deferred
    $9,150
    Nontaxable benefits
    $28,388
    Filer's total
    $941,902

  • DAVID BLANN MD

    BOARD MEMBER

    Total calculated
    $908,095
    From this org
    $877,390
    From related orgs
    $0
    Other
    $30,705
    Hours/week
    49.5 + 0.5 related

    Schedule J breakdown matched by us

    Base
    $798,899
    Bonus
    $18,792
    Other
    $59,699
    Deferred
    $9,150
    Nontaxable benefits
    $21,555
    Filer's total
    $908,095

  • KEVIN JONES DO

    BOARD MEMBER

    Total calculated
    $877,344
    From this org
    $837,688
    From related orgs
    $0
    Other
    $39,656
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $816,620
    Bonus
    $500
    Other
    $20,568
    Deferred
    $6,862
    Nontaxable benefits
    $32,794
    Filer's total
    $877,344

  • PAUL WALTER MD

    BOARD MEMBER/CMO

    Total calculated
    $733,237
    From this org
    $693,188
    From related orgs
    $0
    Other
    $40,049
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $577,791
    Bonus
    $19,834
    Other
    $95,563
    Deferred
    $9,150
    Nontaxable benefits
    $30,899
    Filer's total
    $733,237

  • BRIAN WILLIAMS MD

    BOARD MEMBER/CHAIR

    Total calculated
    $721,617
    From this org
    $681,815
    From related orgs
    $0
    Other
    $39,802
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $653,394
    Bonus
    $15,015
    Other
    $13,406
    Deferred
    $6,863
    Nontaxable benefits
    $32,939
    Filer's total
    $721,617

  • RYAN OWEN MD

    BOARD MEMBER

    Total calculated
    $712,193
    From this org
    $673,918
    From related orgs
    $0
    Other
    $38,275
    Hours/week
    49 + 1 related

    Schedule J breakdown matched by us

    Base
    $635,252
    Bonus
    $14,620
    Other
    $24,046
    Deferred
    $5,965
    Nontaxable benefits
    $32,310
    Filer's total
    $712,193

  • AMY HENNING DO

    BOARD MEMBER

    Total calculated
    $686,387
    From this org
    $659,877
    From related orgs
    $0
    Other
    $26,510
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $611,775
    Bonus
    $16,726
    Other
    $31,376
    Deferred
    $4,575
    Nontaxable benefits
    $21,935
    Filer's total
    $686,387

  • JOHN HANNA MD

    BOARD MEMBER

    Total calculated
    $620,750
    From this org
    $584,057
    From related orgs
    $0
    Other
    $36,693
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $498,853
    Bonus
    $500
    Other
    $84,704
    Deferred
    $6,863
    Nontaxable benefits
    $29,830
    Filer's total
    $620,750

  • SCOTT LETBETTER MD

    BOARD MEMBER

    Total calculated
    $603,000
    From this org
    $565,626
    From related orgs
    $0
    Other
    $37,374
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $531,713
    Bonus
    $8,095
    Other
    $25,818
    Deferred
    $6,504
    Nontaxable benefits
    $30,870
    Filer's total
    $603,000

  • KRISTEN KOTHMANN

    CMG CEO

    Total calculated
    $580,713
    From this org
    $504,330
    From related orgs
    $0
    Other
    $76,383
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $342,813
    Bonus
    $117,233
    Other
    $44,284
    Deferred
    $55,755
    Nontaxable benefits
    $20,628
    Filer's total
    $580,713

  • JEREMY DALTON MD

    BOARD MEMBER/VICE CHAIR

    Total calculated
    $570,621
    From this org
    $523,005
    From related orgs
    $0
    Other
    $47,616
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $464,216
    Bonus
    $15,050
    Other
    $43,739
    Deferred
    $35,089
    Nontaxable benefits
    $12,527
    Filer's total
    $570,621

  • KATIE HENDLEY MD

    BOARD MEMBER

    Total calculated
    $445,260
    From this org
    $419,097
    From related orgs
    $0
    Other
    $26,163
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $403,804
    Bonus
    $8,375
    Other
    $6,918
    Deferred
    $8,647
    Nontaxable benefits
    $17,516
    Filer's total
    $445,260

  • KAREN TALUSAN-SORIANO MD

    BOARD MEMBER

    Total calculated
    $350,776
    From this org
    $287,815
    From related orgs
    $0
    Other
    $62,961
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $265,835
    Bonus
    $6,855
    Other
    $15,125
    Deferred
    $26,123
    Nontaxable benefits
    $36,838
    Filer's total
    $350,776

  • ADAM SPIVEY

    CFO

    Total calculated
    $304,231
    From this org
    $0
    From related orgs
    $266,060
    Other
    $38,171
    Hours/week
    14 + 41 related

    Schedule J breakdown matched by us

    Base
    $0 + $188,992 related
    Bonus
    $0 + $56,112 related
    Other
    $0 + $20,956 related
    Deferred
    $0 + $10,708 related
    Nontaxable benefits
    $0 + $27,463 related
    Filer's total
    $0 + $304,231 related

  • CHRISTOPHER COTTON MD

    BOARD MEMBER

    Total calculated
    $301,453
    From this org
    $261,417
    From related orgs
    $0
    Other
    $40,036
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $234,212
    Bonus
    $500
    Other
    $26,705
    Deferred
    $24,353
    Nontaxable benefits
    $15,683
    Filer's total
    $301,453

  • JOSHUA HILL MD

    BOARD MEMBER

    Total calculated
    $283,465
    From this org
    $256,813
    From related orgs
    $0
    Other
    $26,652
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $245,459
    Bonus
    $2,660
    Other
    $8,694
    Deferred
    $0
    Nontaxable benefits
    $26,652
    Filer's total
    $283,465

  • CINDY ECHOLS

    SECRETARY

    Total calculated
    $70,924
    From this org
    $52,516
    From related orgs
    $0
    Other
    $18,408
    Hours/week
    1

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

  • 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: IBRAHIM SHALABY, M.D. - $28,639 PAUL WALTER, M.D. - $ 26,878 KRISTEN KOTHMANN - $ 40,233
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.

Provenance

Return type
form_990
Tax year
2022
Filed
2 November 2023
IRS schema version
2022v5.0
Source object
202333189349303673

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

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