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Nonprofiteer
← PROVIDENCE HEALTH ALLIANCE INC

Form 990 for tax year 2022

Filed by PROVIDENCE HEALTH ALLIANCE INC.

Totals

Total revenue
$67,522,122
Total expenses
$114,032,475
Contributions and grants received
$100,000
Grants paid
$0
Program services expenses (Part IX)
$93,645,245
Management and general expenses
$20,387,230
Fundraising expenses
$0
Program service expenses (Part III)
$93,645,245

Program services were 82.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • DANIEL W HUFFINE

    ASST TREASURER/INTERIM CFO, MM (8/2022 - 10/2022)/CFO, MM (START 10/2022)

    Total calculated
    $488,948
    From this org
    $0
    From related orgs
    $461,102
    Other
    $27,846
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $361,758 related
    Bonus
    $0 + $96,369 related
    Other
    $0 + $2,975 related
    Deferred
    $0 + $15,250 related
    Nontaxable benefits
    $0 + $12,596 related
    Filer's total
    $0 + $488,948 related

  • JEFF DAVID CHANCELLOR MD

    CHAIR/PHYSICIAN

    Total calculated
    $758,384
    From this org
    $708,659
    From related orgs
    $0
    Other
    $49,725
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $592,679
    Bonus
    $112,398
    Other
    $3,582
    Deferred
    $19,825
    Nontaxable benefits
    $29,900
    Filer's total
    $758,384

  • JEROD BRADLEY PATCHIN DO

    TREASURER/PHYSICIAN

    Total calculated
    $413,562
    From this org
    $365,707
    From related orgs
    $0
    Other
    $47,855
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $348,069
    Bonus
    $15,960
    Other
    $1,678
    Deferred
    $18,300
    Nontaxable benefits
    $29,555
    Filer's total
    $413,562

  • MATT TAYLOR PATTILLO MD

    SECRETARY/PHYSICIAN

    Total calculated
    $728,140
    From this org
    $673,723
    From related orgs
    $0
    Other
    $54,417
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $600,884
    Bonus
    $70,739
    Other
    $2,100
    Deferred
    $25,275
    Nontaxable benefits
    $29,142
    Filer's total
    $728,140

  • PATRICIA A WILCOX MD

    VICE CHAIR/PHYSICIAN

    Total calculated
    $656,315
    From this org
    $602,276
    From related orgs
    $0
    Other
    $54,039
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $528,203
    Bonus
    $1,125
    Other
    $72,948
    Deferred
    $26,800
    Nontaxable benefits
    $27,239
    Filer's total
    $656,315

  • SCOTT HERNDON

    ASSISTANT TREASURER/CFO, MINISTRY MARKET (END 8/2022)

    Total calculated
    $938,250
    From this org
    $0
    From related orgs
    $887,720
    Other
    $50,530
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $521,351 related
    Bonus
    $0 + $300,000 related
    Other
    $0 + $66,369 related
    Deferred
    $0 + $16,775 related
    Nontaxable benefits
    $0 + $33,755 related
    Filer's total
    $0 + $938,250 related

  • WILLIAM R HASKETT MD

    DIRECTOR/PRESIDENT

    Total calculated
    $505,754
    From this org
    $0
    From related orgs
    $457,103
    Other
    $48,651
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $350,814 related
    Bonus
    $0 + $71,400 related
    Other
    $0 + $34,889 related
    Deferred
    $0 + $19,825 related
    Nontaxable benefits
    $0 + $28,826 related
    Filer's total
    $0 + $505,754 related

  • DAVID HOFFMAN MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $455,174
    From this org
    $418,818
    From related orgs
    $0
    Other
    $36,356
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $374,653
    Bonus
    $33,375
    Other
    $10,790
    Deferred
    $16,402
    Nontaxable benefits
    $19,954
    Filer's total
    $455,174

  • DONALD ALAN STEWART MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $636,244
    From this org
    $616,020
    From related orgs
    $0
    Other
    $20,224
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $607,496
    Bonus
    $1,000
    Other
    $7,524
    Deferred
    $6,100
    Nontaxable benefits
    $14,124
    Filer's total
    $636,244

  • ERIC L BRAUN MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $388,283
    From this org
    $344,208
    From related orgs
    $0
    Other
    $44,075
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $341,246
    Bonus
    $1,300
    Other
    $1,662
    Deferred
    $16,775
    Nontaxable benefits
    $27,300
    Filer's total
    $388,283

  • FLORENCE BOSIBORI LEE MD

    DIRECTOR/PHYSICIAN (START 9/2022)

    Total calculated
    $188,871
    From this org
    $159,421
    From related orgs
    $0
    Other
    $29,450
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $120,863
    Bonus
    $0
    Other
    $38,558
    Deferred
    $15,324
    Nontaxable benefits
    $14,126
    Filer's total
    $188,871

  • JASON ROBERT BAUERSCHLAG MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $446,893
    From this org
    $394,179
    From related orgs
    $0
    Other
    $52,714
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $345,270
    Bonus
    $6,750
    Other
    $42,159
    Deferred
    $25,275
    Nontaxable benefits
    $27,439
    Filer's total
    $446,893

  • OLUWAROTIMI ADESINA MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $316,914
    From this org
    $271,342
    From related orgs
    $0
    Other
    $45,572
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $254,856
    Bonus
    $16,000
    Other
    $486
    Deferred
    $14,343
    Nontaxable benefits
    $31,229
    Filer's total
    $316,914

  • ROBERT CHRISTOPHER MATLOCK MD

    DIRECTOR/PHYSICIAN

    Total calculated
    $582,396
    From this org
    $527,259
    From related orgs
    $0
    Other
    $55,137
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $486,126
    Bonus
    $1,000
    Other
    $40,133
    Deferred
    $25,275
    Nontaxable benefits
    $29,862
    Filer's total
    $582,396

  • CHAD CONNER MD

    PHYSICIAN

    Total calculated
    $828,541
    From this org
    $781,244
    From related orgs
    $0
    Other
    $47,297
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $754,534
    Bonus
    $25,000
    Other
    $1,710
    Deferred
    $15,250
    Nontaxable benefits
    $32,047
    Filer's total
    $828,541

  • ELIOT MARTIN WICKLIFF MD

    PHYSICIAN

    Total calculated
    $1,241,189
    From this org
    $1,187,787
    From related orgs
    $0
    Other
    $53,402
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $1,147,485
    Bonus
    $0
    Other
    $40,302
    Deferred
    $16,125
    Nontaxable benefits
    $37,277
    Filer's total
    $1,241,189

  • JOHN BRETT DIETZE MD

    PHYSICIAN

    Total calculated
    $1,130,885
    From this org
    $1,080,729
    From related orgs
    $0
    Other
    $50,156
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $866,427
    Bonus
    $209,400
    Other
    $4,902
    Deferred
    $15,250
    Nontaxable benefits
    $34,906
    Filer's total
    $1,130,885

  • MARK STUART KLEPPER MD

    PHYSICIAN

    Total calculated
    $870,314
    From this org
    $812,927
    From related orgs
    $0
    Other
    $57,387
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $536,069
    Bonus
    $98,161
    Other
    $178,697
    Deferred
    $26,800
    Nontaxable benefits
    $30,587
    Filer's total
    $870,314

  • MITCHELL GEORGE EICHHORN MD

    PHYSICIAN

    Total calculated
    $981,068
    From this org
    $939,055
    From related orgs
    $0
    Other
    $42,013
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $343,353
    Bonus
    $595,000
    Other
    $702
    Deferred
    $15,250
    Nontaxable benefits
    $26,763
    Filer's total
    $981,068

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

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)

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 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.

Provenance

Return type
form_990
Tax year
2022
Filed
9 May 2024
IRS schema version
2022v5.0
Source object
202421299349304562

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

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