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Nonprofiteer
← MERCY HOSPITAL OF DEVILS LAKE

Form 990 for tax year 2022

Filed by MERCY HOSPITAL OF DEVILS LAKE.

Totals

Total revenue
$29,838,173
Total expenses
$28,188,280
Contributions and grants received
$908,163
Grants paid
$0
Program services expenses (Part IX)
$25,415,541
Management and general expenses
$2,647,897
Fundraising expenses
$124,842
Program service expenses (Part III)
$25,415,541

Program services were 90.2% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • KEVIN DAHMEN MD

    FORMER SECRETARY / TREASURER

    Total calculated
    $648,477
    From this org
    $0
    From related orgs
    $589,888
    Other
    $58,589
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $313,376 related
    Bonus
    $0 + $274,580 related
    Other
    $0 + $1,932 related
    Deferred
    $0 + $26,275 related
    Nontaxable benefits
    $0 + $32,314 related
    Filer's total
    $0 + $648,477 related

  • RANADA ENGELBERT

    HOSPITALIST

    Total calculated
    $531,464
    From this org
    $531,464
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $531,464
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $531,464

  • GEORGE DUEBER

    PHYSICIAN - EMERGENCY MEDICINE

    Total calculated
    $441,464
    From this org
    $394,971
    From related orgs
    $0
    Other
    $46,493
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $378,039
    Bonus
    $15,000
    Other
    $1,932
    Deferred
    $17,944
    Nontaxable benefits
    $28,549
    Filer's total
    $441,464

  • JULIE GOEBEL

    DIRECTOR/DIVISION SVP COO

    Total calculated
    $386,593
    From this org
    $0
    From related orgs
    $365,482
    Other
    $21,111
    Hours/week
    1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $290,611 related
    Bonus
    $0 + $45,000 related
    Other
    $0 + $29,871 related
    Deferred
    $0 + $810 related
    Nontaxable benefits
    $0 + $20,301 related
    Filer's total
    $0 + $386,593 related

  • TESSA MARBURGER MD

    DIRECTOR/NEUROLOGIST

    Total calculated
    $380,828
    From this org
    $0
    From related orgs
    $351,802
    Other
    $29,026
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $351,051 related
    Bonus
    $0
    Other
    $0 + $751 related
    Deferred
    $0 + $17,331 related
    Nontaxable benefits
    $0 + $11,695 related
    Filer's total
    $0 + $380,828 related

  • MARIANN DOELING

    PRESIDENT

    Total calculated
    $360,648
    From this org
    $0
    From related orgs
    $325,606
    Other
    $35,042
    Hours/week
    1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $231,914 related
    Bonus
    $0 + $59,393 related
    Other
    $0 + $34,299 related
    Deferred
    $0 + $17,669 related
    Nontaxable benefits
    $0 + $17,373 related
    Filer's total
    $0 + $360,648 related

  • NICK O'TOOL

    DIVISION VP FINANCE

    Total calculated
    $304,710
    From this org
    $0
    From related orgs
    $257,678
    Other
    $47,032
    Hours/week
    1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $207,354 related
    Bonus
    $0 + $49,872 related
    Other
    $0 + $452 related
    Deferred
    $0 + $16,380 related
    Nontaxable benefits
    $0 + $30,652 related
    Filer's total
    $0 + $304,710 related

  • AMBER STOWMAN

    VP OPERATIONAL FINANCE (THRU 12/2022)

    Total calculated
    $262,100
    From this org
    $0
    From related orgs
    $219,871
    Other
    $42,229
    Hours/week
    1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $180,807 related
    Bonus
    $0 + $38,497 related
    Other
    $0 + $567 related
    Deferred
    $0 + $13,507 related
    Nontaxable benefits
    $0 + $28,722 related
    Filer's total
    $0 + $262,100 related

  • AARON JOHNSON

    VP PATIENT CARE SERVICES (THRU 5/22)

    Total calculated
    $255,818
    From this org
    $237,825
    From related orgs
    $0
    Other
    $17,993
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $75,978
    Bonus
    $0
    Other
    $161,847
    Deferred
    $6,227
    Nontaxable benefits
    $11,766
    Filer's total
    $255,818

  • KURT SARGENT

    FORMER VP OPERATIONAL FINANCE

    Total calculated
    $224,577
    From this org
    $0
    From related orgs
    $215,142
    Other
    $9,435
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $49,734 related
    Bonus
    $0
    Other
    $0 + $165,408 related
    Deferred
    $0 + $7,514 related
    Nontaxable benefits
    $0 + $1,921 related
    Filer's total
    $0 + $224,577 related

  • TOBIAS STEEN

    PHYSICIAN ASSISTANT

    Total calculated
    $175,782
    From this org
    $145,008
    From related orgs
    $0
    Other
    $30,774
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $142,635
    Bonus
    $0
    Other
    $2,373
    Deferred
    $3,084
    Nontaxable benefits
    $27,690
    Filer's total
    $175,782

  • STACEY KONZAK

    PHYSICIAN ASSISTANT

    Total calculated
    $174,288
    From this org
    $154,219
    From related orgs
    $0
    Other
    $20,069
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $142,678
    Bonus
    $3,733
    Other
    $7,808
    Deferred
    $9,064
    Nontaxable benefits
    $11,005
    Filer's total
    $174,288

  • TAYLOR GRUNDSTAD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • SR MARY RUTH HUHN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • CORRY KENNER

    VICE CHAIR/CHAIR

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • LISA KOSTELECKY

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • MICHAEL LEFOR

    DIRECTOR (THROUGH 7/27/22)

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • MIKE MURPHY

    CHAIR (THROUGH 10/10/22)

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • KIRK SCHOEPP

    DIRECTOR (THROUGH 7/26/22)

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • JULIE TRAYNOR

    SECRETARY / TREASURER

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • CURTIS WIESZ

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 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 — 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 2022, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH USED COMPENSATION SURVEY OR STUDY TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION.
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. 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 2022 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): KURT SARGENT $165,294 AND AARON JOHNSON $161,680.
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: MARIANN DOELING $10,192.
PART II
MERCY HOSPITAL OF DEVILS LAKE 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.

Provenance

Return type
form_990
Tax year
2022
Filed
9 May 2024
IRS schema version
2022v5.0
Source object
202411309349305356

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