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Nonprofiteer
← ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER

Form 990 for tax year 2023

Filed by ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER.

Totals

Total revenue
$14,650,222
Total expenses
$15,249,634
Contributions and grants received
$247,915
Grants paid
$0
Program service revenue
$14,239,256
Investment income
$49,174
Other revenue
$113,877
Total assets, end of year
$20,411,114
Total liabilities, end of year
$3,977,690
Net assets or fund balances, end of year
$16,433,424
Program services expenses (Part IX)
$14,530,808
Management and general expenses
$718,826
Fundraising expenses
$0
Program service expenses (Part III)
$14,530,808

Program services were 95.3% 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)

    $247,915

  • 2a · Program service revenue: NET PATIENT SERVICES

    total $13,910,158 · related or exempt $13,910,158 · unrelated business $0 · excluded $0

  • 2b · Program service revenue: PHARMACY SERVICES

    total $311,589 · related or exempt $311,589 · unrelated business $0 · excluded $0

  • 2c · Program service revenue: SERVICES SOLD

    total $17,509 · related or exempt $17,509 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $61,747 · excluded $61,747

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

    other assets $12,573

  • 7c · Gain or loss

    other assets -$12,573

  • 7d · Net gain or loss

    total -$12,573 · excluded -$12,573

  • 11a · Other revenue: INSURANCE RECOVERIES

    total $98,700 · related or exempt $0 · unrelated business $0 · excluded $98,700

  • 11b · Other revenue: CAFETERIA

    total $14,534 · related or exempt $0 · unrelated business $0 · excluded $14,534

  • 11c · Other revenue: OTHER MISCELLANEOUS RE

    total $643 · related or exempt $0 · unrelated business $0 · excluded $643

  • 11e · Other revenue, total

    $113,877

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $354,571 · program services $336,842 · management and general $17,729

  • 7 · Other salaries and wages

    total $5,768,107 · program services $5,479,702 · management and general $288,405

  • 8 · Pension plan contributions

    total $307,958 · program services $292,560 · management and general $15,398

  • 9 · Other employee benefits

    total $810,012 · program services $769,511 · management and general $40,501

  • 10 · Payroll taxes

    total $390,759 · program services $371,221 · management and general $19,538

  • 11b · Fees: legal

    total $11,724 · program services $11,138 · management and general $586

  • 11d · Fees: lobbying

    total $949 · management and general $949

  • 11f · Fees: investment management

    total $3,575 · program services $3,575

  • 11g · Fees: other

    total $4,064,612 · program services $3,862,283 · management and general $202,329

  • 12 · Advertising and promotion

    total $9,121 · program services $8,665 · management and general $456

  • 13 · Office expenses

    total $179,323 · program services $170,357 · management and general $8,966

  • 14 · Information technology

    total $525,932 · program services $499,635 · management and general $26,297

  • 16 · Occupancy

    total $291,419 · program services $276,848 · management and general $14,571

  • 17 · Travel

    total $25,112 · program services $23,856 · management and general $1,256

  • 19 · Conferences, conventions and meetings

    total $83 · program services $79 · management and general $4

  • 20 · Interest

    total $15,705 · program services $15,705

  • 21 · Payments to affiliates

    total $416,221 · program services $395,410 · management and general $20,811

  • 22 · Depreciation, depletion and amortization

    total $471,863 · program services $448,270 · management and general $23,593

  • 23 · Insurance

    total $49,687 · program services $47,203 · management and general $2,484

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $853,808 · program services $853,808 · management and general $0 · fundraising $0

  • 24b · Other expenses: INTRACOMPANY ALLOCATION

    total $582,863 · program services $553,720 · management and general $29,143 · fundraising $0

  • 24c · Other expenses: REPAIRS AND MAINTENANCE

    total $94,468 · program services $89,745 · management and general $4,723 · fundraising $0

  • 24d · Other expenses: DUES & SUBSCRIPTIONS

    total $15,281 · program services $14,517 · management and general $764 · fundraising $0

  • 24e · All other expenses

    total $6,481 · program services $6,158 · management and general $323

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $1,404 · end of year $1,399

  • 2 · Savings and temporary cash investments

    beginning of year $210,570 · end of year $257,566

  • 3 · Pledges and grants receivable

    end of year $0

  • 4 · Accounts receivable

    beginning of year $2,535,755 · end of year $1,410,184

  • 5 · Loans and receivables from officers and key people

    end of year $0

  • 6 · Loans and receivables from disqualified persons

    end of year $0

  • 7 · Other notes and loans receivable

    end of year $0

  • 8 · Inventories for sale or use

    beginning of year $137,103 · end of year $140,797

  • 9 · Prepaid expenses and deferred charges

    end of year $0

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

    $9,097,664

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

    $5,051,021

  • 10c · Land, buildings and equipment, net

    beginning of year $4,134,952 · end of year $4,046,643

  • 11 · Investments: publicly traded securities

    beginning of year $272,934 · end of year $276,595

  • 12 · Investments: other securities

    beginning of year $1,287,424 · end of year $1,421,935

  • 13 · Investments: program-related

    end of year $0

  • 14 · Intangible assets

    end of year $0

  • 15 · Other assets

    beginning of year $10,500,955 · end of year $12,855,995

  • 17 · Accounts payable and accrued expenses

    beginning of year $1,553,481 · end of year $3,520,312

  • 18 · Grants payable

    end of year $0

  • 19 · Deferred revenue

    beginning of year $288,299 · end of year $288,299

  • 20 · Tax-exempt bond liabilities

    end of year $0

  • 21 · Escrow or custodial account liability

    end of year $0

  • 22 · Loans and payables to officers and key people

    end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $222,171 · end of year $151,928

  • 24 · Unsecured notes and loans payable

    end of year $0

  • 25 · Other liabilities

    beginning of year $21,358 · end of year $17,151

  • 27 · Net assets without donor restrictions

    beginning of year $16,993,332 · end of year $16,430,968

  • 28 · Net assets with donor restrictions

    beginning of year $2,456 · end of year $2,456

Mission and programs · 2023

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)

THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH.

  • ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER PROVIDES PATIENTS WITH ACCESS TO PRIMARY CARE THROUGH FAMILY MEDICINE PRACTITIONERS THAT PROVIDE CONTINUING, COMPREHENSIVE HEALTH CARE FOR INDIVIDUAL FAMILY MEMBERS OF BOTH GENDERS AND ALL AGES. BY PLACING SPECIAL ATTENTION ON THE FAMILY AS A GROUP, THE FAMILY MEDICINE PRACTITIONER PROVIDES INTEGRATED CARE TO ALL PATIENTS WITHIN A FAMILY. FAMILY PRACTITIONERS; EMPHASIZE DISEASE PREVENTION AND WELLNESS BY RECOMMENDING PREVENTIVE TESTS, COACH PATIENTS TO CHANGE HEALTH BEHAVIORS SO THEY DO NOT DEVELOP CHRONIC CONDITIONS, MONITOR CHRONIC CONDITIONS TO PREVENT FURTHER COMPLICATIONS, COLLABORATE WITH THE SPECIALIST, COORDINATING THE PATIENT'S HEALTHCARE AND SERVING AS THE PATIENT'S ADVOCATE IN ALL CARE SETTINGS WHEN A REFERRAL TO A SPECIALIST IS NECESSARY.

    Expenses $2,692,471 · Revenue $1,612,636

  • ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER PROVIDES RESIDENTS OF COLFAX COUNTY WITH 24 HOUR EMERGENCY DEPARTMENT CARE AND MEDICAL AND SURGERY SERVICES.

    Expenses $2,412,865 · Revenue $1,489,245

  • ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER PROVIDES PATIENTS WITH ACCESS TO MEDICAL SPECIALTY SERVICES THROUGH VISITING SPECIALISTS IN THE FOLLOWING AREAS: CARDIOLOGY, EAR, NOSE AND THROAT, GASTROENTEROLOGY, GENERAL SURGERY, WOUND CARE, ONCOLOGY, OPHTHALMOLOGY, ORTHOPAEDICS AND UROLOGY. EACH ONE OF THESE SPECIALTY CLINICS ALLOWS US TO TREAT EACH PATIENT WITH ONE ON ONE SPECIALTY CARE.

    Expenses $1,506,539 · Revenue $5,114,417

  • OTHER PROGRAM SERVICES.

    Expenses $7,918,933 · Revenue $6,022,958

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • John Petersdorf

    EX-OFFICIO - SYS SVP, OPERATIONAL FINANCE

    Total calculated
    $3,082,567
    From this org
    $0
    From related orgs
    $2,089,747
    Other
    $992,820
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $645,040 related
    Bonus
    $0 + $716,812 related
    Other
    $0 + $727,895 related
    Deferred
    $0 + $923,913 related
    Nontaxable benefits
    $0 + $68,907 related
    Filer's total
    $0 + $3,082,567 related
  • Evert Kuiper

    FORMER EX-OFFICIO BM/ PRESIDENT & CEO CHI HEALTH

    Total calculated
    $2,835,767
    From this org
    $0
    From related orgs
    $2,787,233
    Other
    $48,534
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $749,566 related
    Bonus
    $0
    Other
    $0 + $2,037,667 related
    Deferred
    $0 + $20,045 related
    Nontaxable benefits
    $0 + $28,489 related
    Filer's total
    $0 + $2,835,767 related
  • Jeanette Wojtalewicz

    FORMER CFO, CHI HEALTH

    Total calculated
    $1,357,202
    From this org
    $0
    From related orgs
    $1,344,835
    Other
    $12,367
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $128,679 related
    Bonus
    $0 + $132,479 related
    Other
    $0 + $1,083,677 related
    Deferred
    $0 + $9,698 related
    Nontaxable benefits
    $0 + $2,669 related
    Filer's total
    $0 + $1,357,202 related
  • Usha Kanthety MD

    PHYSICIAN

    Total calculated
    $529,284
    From this org
    $468,764
    From related orgs
    $0
    Other
    $60,520
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $467,474
    Bonus
    $0
    Other
    $1,290
    Deferred
    $19,175
    Nontaxable benefits
    $41,345
    Filer's total
    $529,284
  • David Jones

    MARKET PRESIDENT, REGIONAL HOSPITALS

    Total calculated
    $514,309
    From this org
    $0
    From related orgs
    $460,692
    Other
    $53,617
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $303,052 related
    Bonus
    $0 + $156,175 related
    Other
    $0 + $1,465 related
    Deferred
    $0 + $19,175 related
    Nontaxable benefits
    $0 + $34,442 related
    Filer's total
    $0 + $514,309 related
  • Tim Schnack

    MARKET CFO (BEG 05/24)

    Total calculated
    $417,768
    From this org
    $0
    From related orgs
    $369,715
    Other
    $48,053
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $290,959 related
    Bonus
    $0 + $74,901 related
    Other
    $0 + $3,855 related
    Deferred
    $0 + $19,529 related
    Nontaxable benefits
    $0 + $28,524 related
    Filer's total
    $0 + $417,768 related
  • Nick Otool

    INTERIM CFO, CHI HEALTH (END 05/24)

    Total calculated
    $399,969
    From this org
    $0
    From related orgs
    $349,020
    Other
    $50,949
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $252,554 related
    Bonus
    $0 + $96,047 related
    Other
    $0 + $419 related
    Deferred
    $0 + $16,660 related
    Nontaxable benefits
    $0 + $34,289 related
    Filer's total
    $0 + $399,969 related
  • Kirtibala Gupta MD

    BOARD MEMBER

    Total calculated
    $394,026
    From this org
    $0
    From related orgs
    $346,502
    Other
    $47,524
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $342,890 related
    Bonus
    $0
    Other
    $0 + $3,612 related
    Deferred
    $0 + $18,825 related
    Nontaxable benefits
    $0 + $28,699 related
    Filer's total
    $0 + $394,026 related
  • Heather Morgan MD

    BOARD MEMBER

    Total calculated
    $378,802
    From this org
    $0
    From related orgs
    $320,425
    Other
    $58,377
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $319,514 related
    Bonus
    $0
    Other
    $0 + $911 related
    Deferred
    $0 + $18,500 related
    Nontaxable benefits
    $0 + $39,877 related
    Filer's total
    $0 + $378,802 related
  • Connie Peters

    PRESIDENT, SCHUYLER HOSPITAL

    Total calculated
    $340,135
    From this org
    $311,802
    From related orgs
    $0
    Other
    $28,333
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $197,374
    Bonus
    $102,615
    Other
    $11,813
    Deferred
    $15,936
    Nontaxable benefits
    $12,397
    Filer's total
    $340,135
  • John Jackson MD

    PHYSICIAN

    Total calculated
    $333,804
    From this org
    $296,605
    From related orgs
    $0
    Other
    $37,199
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $293,620
    Bonus
    $0
    Other
    $2,985
    Deferred
    $15,835
    Nontaxable benefits
    $21,364
    Filer's total
    $333,804
  • Nathan Stec

    FORMER HCE - PHYSICIAN ASSISTANT

    Total calculated
    $281,141
    From this org
    $0
    From related orgs
    $233,235
    Other
    $47,906
    Hours/week
    5 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $232,042 related
    Bonus
    $0 + $800 related
    Other
    $0 + $393 related
    Deferred
    $0 + $14,641 related
    Nontaxable benefits
    $0 + $33,265 related
    Filer's total
    $0 + $281,141 related
  • Lisa Montgomery

    NURSE PRACT - EMERGENCY MEDICINE

    Total calculated
    $268,875
    From this org
    $63,095
    From related orgs
    $154,458
    Other
    $51,322
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $49,999 + $154,406 related
    Bonus
    $12,230
    Other
    $866 + $52 related
    Deferred
    $13,698
    Nontaxable benefits
    $28,437 + $9,187 related
    Filer's total
    $105,230 + $163,645 related
  • Kellie Abler

    FORMER HCE - CT TECHNOLOGIST TRAVELER

    Total calculated
    $218,323
    From this org
    $0
    From related orgs
    $182,486
    Other
    $35,837
    Hours/week
    10 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $180,938 related
    Bonus
    $0 + $800 related
    Other
    $0 + $748 related
    Deferred
    $0 + $10,311 related
    Nontaxable benefits
    $0 + $25,526 related
    Filer's total
    $0 + $218,323 related
  • Jennifer Hicks

    HOUSE SUPERVISOR

    Total calculated
    $216,293
    From this org
    $3,233
    From related orgs
    $207,016
    Other
    $6,044
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $3,037 + $199,704 related
    Bonus
    $0 + $800 related
    Other
    $196 + $6,512 related
    Deferred
    $0 + $6,010 related
    Nontaxable benefits
    $0 + $34 related
    Filer's total
    $3,233 + $213,060 related
  • Steven Peterson

    PHYS ASST - FAMILY MEDICINE

    Total calculated
    $211,051
    From this org
    $637
    From related orgs
    $175,706
    Other
    $34,708
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $637 + $175,010 related
    Bonus
    $0 + $600 related
    Other
    $0 + $96 related
    Deferred
    $10,553
    Nontaxable benefits
    $14,509 + $9,646 related
    Filer's total
    $25,699 + $185,352 related
  • Tim Bricker

    EX-OFFICIO - CENTRAL REGION PRESIDENT

    Total calculated
    $0
    Hours/week
    1 + 40 related
  • Cynthia Alloway

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related
  • Kate Cutler

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related
  • Kelly Bacon

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related
  • Kent Barney

    TREASURER

    Total calculated
    $0
    Hours/week
    1 + 12 related
  • Kevin Fitzgerald PhD

    SECRETARY

    Total calculated
    $0
    Hours/week
    1 + 12 related
  • Sister Nadine Heimann Osf

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 40 related
  • Sister Maurita Soukup

    BOARD CHAIR

    Total calculated
    $0
    Hours/week
    1 + 12 related
  • Mardell Wilson EdD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related
  • Bill Yates

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    1 + 12 related
  • Lg Searcey

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 related
  • Dave Taylor

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 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)

PART I, LINE 3
DURING THE CALENDAR YEAR 2023, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH, USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3 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. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15 FOR ADDITIONAL INFORMATION.
PART I, LINES 4A-B
SCHEDULE J, PART I, LINE 4A - SEVERANCE OR CHANGE-OF-CONTROL PAYMENTS: IN ACCORDANCE WITH AN EXECUTIVE SEVERANCE POLICY, DIGNITY HEALTH'S LISTED PERSONS ARE PROVIDED WITH MARKET-STANDARD COMPENSATION RANGING FROM PAYMENTS OF 9-24 MONTHS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION. 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. CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 52 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION AND TENURE, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE 2023 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUALS' W-2 INCOME AND REPORTABLE COMPENSATION ON PART VII AND SCHEDULE J, PART II, COLUMN (B)(III): EVERT KUIPER, $ 2,025,542; JEANETTE WOJTALEWICZ, $ 1,083,464 SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DURING THE 2023 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 2023 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 2023, THE FOLLOWING PAYMENT WAS MADE PURSUANT TO THE SUPER VESTING RULES: CONNIE PETERS, $9,404.
SCH J, PART I, LINE 4B, CONTINUED
CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1, 2008. CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH ARE ELIGIBLE TO PARTICIPATE IN NON-QUALIFIED 457(F) PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES HIRED PRIOR TO JUNE 30, 2006. THE BENEFIT IS INTENDED TO BRIDGE THE DIFFERENCE, IF ANY, BETWEEN THE BENEFIT PROVIDED UNDER THE DIGNITY HEALTH EXCESS BENEFIT PLAN HAD BENEFIT SERVICE NOT BEEN FROZEN AT JANUARY 1, 2008, AND THE BENEFITS PROVIDED FROM ALL OTHER QUALIFIED AND NON-QUALIFIED PLANS. BENEFITS VEST UNDER THIS 457(F) PLAN AT THE LATER OF THE DATE THE PARTICIPANT ATTAINS AGE 62 OR IS CREDITED WITH 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES, PRIMARILY THOSE WHO ARE NOT ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN OR THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN DESCRIBED ABOVE. THIS BENEFIT PROVIDES AN ANNUAL ACCRUAL OF 10% OF TOTAL COMPENSATION AND IS PAYABLE ANNUALLY ON JULY 1 ONCE VESTED, WHICH IS AGE 62 WITH 5 YEARS OF SERVICE. THE PLAN ALSO ALLOWS FOR SPECIAL AWARDS. PAYMENTS PURSUANT TO THE PLAN ARRANGEMENTS FOR ONE BOARD MEMBERS/OFFICER, FOUR KEY EMPLOYEES, ONE HIGHEST COMPENSATED EMPLOYEE AND ONE FORMER KEY EMPLOYEE OCCURRED DURING 2023 INCLUDE J. PETERSDORF, $713,173. CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH PARTICIPATE IN THE DIGNITY HEALTH SUPPLEMENTAL EXECUTIVE RETENTION/RETIREMENT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN WHICH IN 2002 WAS OFFERED TO MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM BY THE DIGNITY HEALTH BOARD OF DIRECTORS AND WOULD BE PAID ONLY IF THE EXECUTIVES STAYED WITH THE ORGANIZATION FOR A SPECIFIED NUMBER OF YEARS AS THE PRIMARY PURPOSE OF THIS PLAN IS TO PROVIDE FOR THE RETENTION AND RETIREMENT OF THE PARTICIPANTS. THE EXECUTIVE MANAGEMENT TEAM IS RECRUITED FROM STABLE CAREERS IN ORGANIZATIONS FROM ACROSS THE COUNTRY AND FROM VARIOUS INDUSTRIES. DUTIES ARE BOTH EXTENSIVE AND COMPLEX AND REQUIRE SUBSTANTIAL AND DIVERSE EXPERIENCE AND SKILL SETS TO EXECUTE THEIR ROLES SUCCESSFULLY. THE CALCULATION FOR THE PAYMENTS TO EACH EXECUTIVE ARE BASED ON THE VALUE OF A FINAL AVERAGE PAY ANNUITY BENEFIT BASED ON RETIREMENT AGE AND SERVICE YEARS TO THE ORGANIZATION. DISTRIBUTION OCCURS EACH JULY 1 IF THE PLAN FORMULA WARRANTS A PAYMENT. NO PAYMENTS PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2023.
SCHEDULE J, PART II
ALEGENT HEALTH-MEMORIAL HOSPITAL, SCHUYLER 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 2023.

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.

  • AMERICAN MERCY HOME CARE LLC

    N/A · HOME HEALTH · OH

  • ARIZONA CARE NETWORK - NEXT LLC

    N/A · CARE NETWORK · AZ

  • ARIZONA CARE NETWORK LLC

    N/A · CARE NETWORK · AZ

  • ARIZONA DIAGNOSTIC RADIOLOGY GROUP LLC

    N/A · IMAGING CENTER · DE

  • AUDUBON LAND COMPANY LLC

    N/A · REAL ESTATE · CO

  • BAYLOR CHI ST LUKES HEALTH SERVICES LLC

    N/A · HEALTHCARE SERVICES · TX

  • BERGAN MERCY SURGERY CENTER LLC

    N/A · AMBUL SURG CTR · NE

  • BERYWOOD OFFICE PROPERTIES LLC

    N/A · HEALTHCARE SERVICES · TN

  • BIOLIFE DIGNITY HEALTH INTERNATIONAL LTD

    N/A · HEALTH SERVICES · CH

  • BLUEGRASS REGIONAL IMAGING CENTER

    N/A · DIAGNOSTIC SERVICES · KY

  • CBCC OUTSMARTING CANCER LLC

    N/A · RADIATION / ONCOLOGY · CA

  • CENTRAL NEBRASKA REHAB SVCS LLC

    N/A · PHYSICAL THERAPY · NE

  • CENTURA SUMMIT ORTHOPEDICS LLC

    N/A · DIAGNOSTIC SERVICES · CO

  • CHICAMSURG SURGERY CENTERS LLC

    N/A · SURGERY CENTER · CO

  • COLORADO SPRINGS CK LEASING LLC

    N/A · REAL ESTATE · CO

  • COMMUNITY MERCY HOME CARE OF SPRINGFLD LLC

    N/A · HOME HEALTH · OH

  • DE JV LLC

    N/A · EMERGENCY CARE · NV

  • DH GLOBAL EDUCATION LTD (AKA OPUSVI LTD)

    N/A · HEALTH SERVICES · UK

  • DHHP SURGERY CENTERS LLC

    N/A · SURGERY · DE

  • DHRT HOLDINGS LLC

    N/A · HOLDING COMPANY · DE

  • DIGNITY- GOHEALTH AND URGENT CARE MGMT LLC

    N/A · MANAGEMENT SERVICES · DE

  • DIGNITY HEALTH AT HOME LLC

    N/A · DIAGNOSTIC SERVICES · DE

  • DH PACIFICLINKAGE HEALTH INT'L LTD

    N/A · HEALTH SERVICES · CH

  • DIGNITY HEALTH SPECIALTY PHARMACY LLC

    N/A · SPECIALTY PHARMACY SERVICES · DE

  • DIGNITY HOME RECOVERY CARE LLC

    N/A · HOME RECOVERY PROGRAM · DE

  • DIGNITYUSP LAS VEGAS SURGERY CENTERS LLC

    N/A · SURGERY · TX

  • DIGNITYUSP NORCAL SURGERY CENTERS LLC

    N/A · SURGERY · TX

  • DIGNITYUSP PHOENIX SURGERY CENTERS LLC

    N/A · SURGERY · TX

  • DIGNITYUSPJOHN MUIR EAST BAY SURG CTRS LLC

    N/A · SURGERY · TX

  • DIGNITY-ABRAZO HEALTH NETWORK LLC

    N/A · MANAGEMENT SERVICES · AZ

  • DOMINICAN MAGNETIC RESONANCE IMAGING CENTER

    N/A · IMAGING CENTER · CA

  • ECCS ACQUISITION COMPANY LLC

    N/A · AMBUL SURG CTR · CO

  • ENDOSCOPY CENTER OF ARKANSAS

    N/A · DIAGNOSTIC SERVICES · AR

  • FRANCISCAN MEDICAL PAVILION BONNEY LAKE LLC

    N/A · REAL ESTATE · WA

  • FRANCISCAN SPECIALTY CARE LLC

    N/A · DIAGNOSTIC SERVICES · WA

  • GOOD SAMARITAN HOME CARE SVCS OF VINCENNE LLC

    N/A · HOME HEALTH · OH

  • HC SL VINTAGE I LLC

    N/A · PROPERTY HOLDING · WI

  • HEALTH AT HOME HOLDCO LLC

    N/A · HOME HEALTH · CO

  • HEALTHCARE SUPPORT SERVICES LLC

    N/A · LAUNDRY · NE

  • HEARTLAND ONCOLOGY LLC

    N/A · ONCOLOGY · KS

  • LAKESIDE AMBULATORY SURGICAL CENTER LLC

    N/A · AMBUL SURG CTR · NE

  • LAKESIDE ENDOSCOPY CENTER LLC

    N/A · ENDOSCOPY · NE

  • LEXINGTON MBO PARTNERS LTD

    N/A · REAL ESTATE · CO

  • LINCOLN CK LEASING LLC

    N/A · REAL ESTATE · NE

  • LONGMONT UNITED HOSPITAL ORTHOPEDIC AND SPINE

    N/A · ORTHOPEDIC SERVICES · CO

  • MEMORIAL MEDICAL PLAZA

    N/A · REAL ESTATE · CA

  • MILITARY ROAD PROPERTIES LLC

    N/A · REAL ESTATE · WA

  • MOUNTAIN MEDICAL IMAGING LLC

    N/A · MEDICAL IMAGING · TX

  • NEBRASKA SPINE HOSPITAL LLC

    N/A · SPINE HOSPITAL · NE

  • NICU OPERATING CO OF SANTA CRUZ LLC

    N/A · NEONATAL HEALTHCARE · CA

  • NORTH RIVER SURGERY CENTER LLC

    N/A · AMBUL SURG CTR · AR

  • NORTHERN PLAINS LABORATORY LLC

    N/A · DIAGNOSTIC SERVICES · ND

  • NSC CHANNEL ISLANDS LLC

    N/A · AMBULATORY SURGICAL CENTER · CA

  • ORTHOCOLORADO LLC

    N/A · ORTHO HOSPITAL · CO

  • PARK RAPIDS AREA HEALTH CARE

    N/A · HEALTHCARE SERVICES · MN

  • PEAK ONE SURGERY CENTER LLC

    N/A · SURGERY CENTER · CO

  • PENINSULA RADIATION ONCOLOGY CENTER LLC

    N/A · HEALTHCARE SERVICES · WA

  • PENRAD IMAGING LLC

    N/A · MEDICAL IMAGING · CO

  • PERFORMANCE MED EQUIP & RESPIR SVSC LLC

    N/A · HOLDING COMPANY · WA

  • PLAZA SURGERY CENTER LP

    N/A · SURGERY · CA

  • PMC HOSPITAL LLC

    N/A · HOSPITAL · TX

  • PRECISION MEDICINE ALLIANCE LLC

    N/A · DIAGNOSTIC SERVICES · CO

  • RADIATION ONCOLOGY CENTERS OF VENTURA COUNTY

    N/A · IMAGING · CA

  • RBR MANAGEMENT LLC

    N/A · AMBULANCE · NV

  • REID-ANC HOME CARE SERVICES LLC

    N/A · HOME HEALTH · IN

  • SAINT JOSEPH - SCA HOLDINGS LLC

    N/A · INACTIVE · DE

  • SAINT JOSEPH HEALTH ASC LLC

    N/A · SURGERY · KY

  • SANTA CRUZ COMPREHENSIVE IMAGING LLC

    N/A · IMAGING · CA

  • SANTA CRUZ SURGERY CENTER LLC

    N/A · SURGERY · CA

  • SEVEN OAKS SURGERY CENTER LLC

    N/A · SURGERY · CA

  • SOUTHEASTERN HOME CARE LLC

    N/A · HOME HEALTH · OH

  • ST JOSEPH'S SURGERY CENTER LP

    N/A · SURGERY · TX

  • ST ELIZABETH HOME CARE SERVICES LLC

    N/A · HOME HEALTH · KY

  • ST FRANCIS LAND COMPANY

    N/A · REAL ESTATE · CO

  • ST LUKE'S DIAGNOSTIC CATH LAB LLP

    N/A · DIAGNOSTIC SERVICES · TX

  • ST LUKE'S LAKESIDE HOSPITAL LLC

    N/A · HOSPITAL · TX

  • ST LUKE'S THE WOODLANDS SLEEP CENTER LLC

    N/A · DIAGNOSTIC SERVICES · TX

  • THE MEDICAL PAVILION AT ST JOHN'S

    N/A · REAL ESTATE · CA

  • THE VASCULAR CENTER OF COLORADO LLC

    N/A · MEDICAL SERVCS · CO

  • THREE SPRING IMAGING LLC

    N/A · HEALTHCARE SERVICES · CO

  • TIA ARIZONA LLC

    N/A · CLINIC · AZ

  • TOPTOLIFE LLC

    N/A · RETAIL · CO

  • VALLEY PHYSICIANS SURGERY CENTER AT NORTHRIDGE LLC

    N/A · SURGERY · CA

Related corporations and trusts

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

  • ALEGENT HEALTHCREIGHTON ST JOSEPH MANAGED CARE SVCS INC

    C · MANAGED CARE · NE

  • ALLIANCE HEALTH PROVIDER OF BRAZOS VALLEY INC

    C · HEALTHCARE · TX

  • ALTERNATIVE INSURANCE MANAGEMENT SERVICE INC

    C · MANAGEMENT SERVICES · CO

  • BC HOLDING COMPANY INC

    C · INACTIVE · KY

  • BRAZOSPORT HEALTH ALLIANCE

    C · HEALTHCARE · TX

  • CATHOLIC HEALTH INITIATIVES CENTER FOR TRANSLATIONAL RESEARCH

    C · LAB SERVICES · CO

  • CHI ST LUKE'S HEALTH - MEMORIAL CONDOMINIUM ASSOCIATION INC

    C · CONDO ASSOC · TX

  • COASTAL SURGICAL SPECIALISTS INC

    S · AMBULATORY SURGERY CENTER · CA

  • DIGNITY HEALTH HOLDING CORPORATION

    C · HOLDING CO · NV

  • DIGNITY HEALTH PROVIDER RESOURCES INC

    C · HEALTH PLAN · CA

  • DIVERSIFIED HEALTH RESOURCES INC

    C · HEALTHCARE · TX

  • FRANCISCAN SERVICES INC

    C · HOLDING CO · CO

  • GALLERIA PAVILION OWNERS' ASSOCIATION

    C · REAL ESTATE · NV

  • GOOD SAMARITAN OUTREACH SERVICES

    C · MEDICAL CLINIC · NE

  • HARVESTPLAINS HEALTH OF IOWA

    C · INSURANCE · WA

  • HEALTH AT HOME BLOCKER LLC

    C · HOME HEALTH · CO

  • HEALTH SERVICES OF THE PACIFIC CENTRAL COAST INC

    C · HEALTH SERVICES · CA

  • HEALTH SYSTEMS ENTERPRISES INC

    C · MANAGEMENT SERVICES · NE

  • HEALTHCARE MGMT SERVICES ORGANIZATION INC

    C · INACTIVE · WA

  • HIGHLINE MEDICAL GROUP

    C · MEDICAL SERVICES · WA

  • MEDICAL OFFICE BUILDING HORIZONTAL PROPERTY REGIME INC

    C · REAL ESTATE · AR

  • MEDQUEST

    C · SALE OF DME · ND

  • MEMORIAL CV SERVICE LINE MANAGEMENT COMPANY LLC

    C · INACTIVE · TX

  • MERCY SERVICES CORP

    C · RETAIL SALES · OR

  • MHI CLINICAL SERVICES

    C · HEALTHCARE · TX

  • MILLENNIUM SURGERY CENTER INC

    S · OUTPATIENT SURGERY SERVICES · CA

  • MOUNTAIN MANAGEMENT SERVICES INC

    C · MANAGEMENT SERVICES · TN

  • NORTH CENTRAL HEALTH CARE ALLIANCE

    C · HEALTHCARE · ND

  • QUALCHOICE HEALTH PLAN SERVICES INC

    C · ADMIN SERVICES · CO

  • QUALCHOICE HEALTH INC

    C · HOLDING CO · CO

  • QUALCHOICE HOLDINGS INC

    C · HOLDING CO · AR

  • RIVERLINK HEALTH

    C · INSURANCE · OH

  • ROSS PARK PHARMACY INC

    C · PHARMACY · OH

  • SAINT CLARE'S PRIMARY CARE INC

    C · INACTIVE · NJ

  • SJH SERVICES CORPORATION

    C · INACTIVE · CO

  • SJL PHYSICIAN MANANGEMENT SERVICES INC

    C · INACTIVE · KY

  • SOUNDPATH HEALTH INC

    C · INSURANCE · WA

  • ST MARY HEALTH VENTURES INC

    C · RETAIL PHARMACY · CA

  • ST ANTHONY DEVELOPMENT COMPANY

    C · ATHLETIC CLUB · OR

  • ST JOSEPH DEVELOPMENT COMPANY INC

    C · RENTAL · WA

  • ST LUKE'S HEALTH SYSTEM HOLDINGS INC

    C · HOLDING CO · TX

  • ST VINCENT COMMUNITY HEALTH SERVICES INC

    C · HEALTHCARE · AR

  • STE HOLDINGS

    C · HOLDING CO · NE

  • STRATEGIC AND PHYSICIANS INSURANCE LTD

    C · CAPTIVE INSURANCE · CJ

  • TOWSON MANAGEMENT INC

    C · INACTIVE · MD

  • TRINITY MANAGEMENT SERVICES ORGANIZATION

    C · MGMT SERVICES · OH

  • UNITED MEDICAL BUILDING CONDOMINIUM ASSOCIATION

    C · REAL ESTATE · CO

Provenance

Return type
form_990
Tax year
2023
Filed
14 May 2025
IRS schema version
2023v6.0
Source object
202541349349303814

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