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Nonprofiteer
← TRI-STATE HEALTH SERVICES INC

Form 990 for tax year 2022

Filed by TRI-STATE HEALTH SERVICES INC.

Totals

Total revenue
$3,537,083
Total expenses
$4,056,242
Contributions and grants received
$2,171,614
Grants paid
$0
Program service revenue
$1,426,200
Investment income
-$60,836
Other revenue
$105
Total assets, end of year
$10,211,506
Total liabilities, end of year
$1,350,835
Net assets or fund balances, end of year
$8,860,671
Program services expenses (Part IX)
$3,884,081
Management and general expenses
$172,161
Fundraising expenses
$0
Program service expenses (Part III)
$3,884,081

Program services were 95.8% 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.

  • 1e · Government grants (contributions)

    $1,944,988

  • 1f · All other contributions, gifts and grants

    $226,626

  • 2a · Program service revenue: RENTAL INCOME

    total $845,408 · related or exempt $845,408

  • 2b · Program service revenue: MEALS ON WHEELS

    total $553,048 · related or exempt $553,048

  • 2c · Program service revenue: SERVICES SOLD

    total $27,744 · related or exempt $27,744

  • 3 · Investment income

    total $21,618 · excluded $21,618

  • 7a · Gross sales of assets other than inventory

    other assets $910,000

  • 7b · Less cost or other basis and sales expenses

    other assets $992,454

  • 7c · Gain or loss

    other assets -$82,454

  • 7d · Net gain or loss

    total -$82,454 · excluded -$82,454

  • 11a · Other revenue: GIFT SHOP

    total $105 · excluded $105

  • 11e · Other revenue, total

    $105

Functional expenses

Part IX, the statement of functional expenses.

  • 11b · Fees: legal

    total $12,971 · program services $10,506 · management and general $2,465

  • 11c · Fees: accounting

    total $112,675 · program services $96,900 · management and general $15,775

  • 11g · Fees: other

    total $2,717,328 · program services $2,694,107 · management and general $23,221

  • 12 · Advertising and promotion

    total $148 · program services $148

  • 13 · Office expenses

    total $149,783 · program services $145,290 · management and general $4,493

  • 16 · Occupancy

    total $307,790 · program services $307,790

  • 17 · Travel

    total $86,993 · program services $86,993

  • 21 · Payments to affiliates

    total $100,820 · program services $95,779 · management and general $5,041

  • 22 · Depreciation, depletion and amortization

    total $351,968 · program services $235,009 · management and general $116,959

  • 23 · Insurance

    total $131,493 · program services $131,493

  • 24a · Other expenses: REPAIRS AND MAINTENANCE

    total $80,342 · program services $76,325 · management and general $4,017

  • 24b · Other expenses: MISCELLANEOUS EXPENSES

    total $3,804 · program services $3,614 · management and general $190

  • 24c · Other expenses: MEDICAL SUPPLIES

    total $127 · program services $127

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $250 · end of year $250

  • 2 · Savings and temporary cash investments

    beginning of year $9,313,031 · end of year $6,728,782

  • 4 · Accounts receivable

    beginning of year $709,398 · end of year $786,820

  • 9 · Prepaid expenses and deferred charges

    beginning of year $397,532 · end of year $483,504

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

    $5,470,344

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

    $3,504,613

  • 10c · Land, buildings and equipment, net

    beginning of year $2,400,152 · end of year $1,965,731

  • 15 · Other assets

    beginning of year $221,948 · end of year $246,419

  • 17 · Accounts payable and accrued expenses

    beginning of year $84,844 · end of year $100,693

  • 19 · Deferred revenue

    beginning of year $482,366 · end of year $482,366

  • 25 · Other liabilities

    beginning of year $3,095,271 · end of year $767,776

  • 27 · Net assets without donor restrictions

    beginning of year $9,290,619 · end of year $8,771,460

  • 28 · Net assets with donor restrictions

    beginning of year $89,211 · end of year $89,211

Mission and programs · 2022

Mission

AS AN AFFILIATE OF COMMONSPIRIT HEALTH, WE MAKE THE HEALING PRESENCE OF GOD KNOWN IN OUR WORLD BY IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL.

Activities or mission (Part I)

PROVIDES SERVICES TO PERSONS AGED 60+ AND THE HANDICAPPED OF ANY AGE WITH FUNDING FROM AREA AGENCY ON AGING AS WELL AS A LOCAL LEVY. ALSO PROVIDES RENTAL SPACE FOR EXEMPT AND NON-EXEMPT HEALTH CARE PROVIDERS.

  • PROVIDE SERVICES TO PERSONS AGED 60+ AND THE HANDICAPPED OF ANY AGE.

    Expenses $3,359,661 · Revenue $580,792

  • PROVIDE RENTAL SPACE FOR EXEMPT AND NON-EXEMPT HEALTH CARE PROVIDERS.

    Expenses $524,420 · Revenue $845,408

As filed on the 2022 return.

Listed in Part VII

  • JONATHAN TIMMIS

    CHAIR/SYS SVP-STRAT-TRANSFORMATION

    Total calculated
    $1,105,470
    From this org
    $0
    From related orgs
    $1,060,677
    Other
    $44,793
    Hours/week
    2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $576,151 related
    Bonus
    $0 + $483,266 related
    Other
    $0 + $1,260 related
    Deferred
    $0 + $17,925 related
    Nontaxable benefits
    $0 + $26,868 related
    Filer's total
    $0 + $1,105,470 related

  • MATT GRIMSHAW

    PRESIDENT/CEO

    Total calculated
    $790,966
    From this org
    $0
    From related orgs
    $746,327
    Other
    $44,639
    Hours/week
    2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $456,489 related
    Bonus
    $0 + $267,194 related
    Other
    $0 + $22,644 related
    Deferred
    $0 + $17,929 related
    Nontaxable benefits
    $0 + $26,710 related
    Filer's total
    $0 + $790,966 related

  • DAVE WERKIN

    SEC'Y/TREAS/CFO TRINITY HEALTH SYS

    Total calculated
    $325,435
    From this org
    $0
    From related orgs
    $303,182
    Other
    $22,253
    Hours/week
    2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $257,682 related
    Bonus
    $0 + $45,500 related
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0 + $22,253 related
    Filer's total
    $0 + $325,435 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

  • 4b · Supplemental nonqualified retirement plan

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
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
DURING THE CALENDAR YEAR 2022, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY TRINITY HEALTH SYSTEM GROUP, A RELATED ORGANIZATION. TRINITY HEALTH SYSTEM GROUP USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4A:
CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY AN EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY.
PART I, LINE 4B:
DURING THE 2022 CALENDAR YEAR, COMMONSPIRIT HEALTH ("COMMONSPIRIT") MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2022 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2022, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: MATTHEW GRIMSHAW, $22,644.
PART II:
TRI STATE HEALTH SERVICES INC. FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST COMMONSPIRIT IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE COMMONSPIRIT TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES COMMONSPIRIT SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND COMMONSPIRIT'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL, AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2022.

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
2022
Filed
13 May 2024
IRS schema version
2022v5.0
Source object
202401349349304975

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