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Nonprofiteer
← TRI-STATE MEMORIAL HOSPITAL

Form 990 for tax year 2022

Filed by TRI-STATE MEMORIAL HOSPITAL.

Totals

Total revenue
$124,675,222
Total expenses
$119,409,051
Contributions and grants received
$5,127,973
Grants paid
$6,250
Program services expenses (Part IX)
$106,402,162
Management and general expenses
$13,006,889
Fundraising expenses
$0
Program service expenses (Part III)
$106,402,162

Program services were 89.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • KIMBERLY BLEWETT

    BOARD MEMBER

    Total calculated
    $284,931
    From this org
    $253,018
    From related orgs
    $0
    Other
    $31,913
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $253,018
    Bonus
    $0
    Other
    $0
    Deferred
    $11,662
    Nontaxable benefits
    $20,251
    Filer's total
    $284,931

  • JOHN RUDOLPH MD

    BOARD MEMBER

    Total calculated
    $423,617
    From this org
    $392,262
    From related orgs
    $0
    Other
    $31,355
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $382,535
    Bonus
    $9,727
    Other
    $0
    Deferred
    $12,187
    Nontaxable benefits
    $19,168
    Filer's total
    $423,617

  • DON MCQUARY

    PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • MIKE MARTIN

    VICE PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • DAN KLAVEANO

    SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    1

  • SCOTT ARNONE

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • DEBRA R AUSMAN

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • STEVE CLAASSEN

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • E WAYNE DAY MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • DICK FLERCHINGER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • K DAVID HAGEN

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • PAUL JELINEK

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • RICK WASEM

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • KYM CLIFT

    CEO

    Total calculated
    $384,867
    From this org
    $361,634
    From related orgs
    $0
    Other
    $23,233
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $315,134
    Bonus
    $40,500
    Other
    $6,000
    Deferred
    $2,170
    Nontaxable benefits
    $21,063
    Filer's total
    $384,867

  • JIM HEILSBERG

    CFO

    Total calculated
    $250,296
    From this org
    $235,693
    From related orgs
    $0
    Other
    $14,603
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $235,693
    Bonus
    $0
    Other
    $0
    Deferred
    $1,566
    Nontaxable benefits
    $13,037
    Filer's total
    $250,296

  • CRAIG FLINDERS

    PHYSICIAN

    Total calculated
    $599,469
    From this org
    $560,538
    From related orgs
    $0
    Other
    $38,931
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $560,538
    Bonus
    $0
    Other
    $0
    Deferred
    $15,250
    Nontaxable benefits
    $23,681
    Filer's total
    $599,469

  • LEROY SMITH

    PHYSICIAN

    Total calculated
    $507,453
    From this org
    $485,367
    From related orgs
    $0
    Other
    $22,086
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $485,367
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $22,086
    Filer's total
    $507,453

  • ELINA CHERNYAK

    PHYSICIAN

    Total calculated
    $627,715
    From this org
    $607,157
    From related orgs
    $0
    Other
    $20,558
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $337,006
    Bonus
    $270,151
    Other
    $0
    Deferred
    $6,899
    Nontaxable benefits
    $13,659
    Filer's total
    $627,715

  • TALMADGE CAVINESS

    PHYSICIAN

    Total calculated
    $578,313
    From this org
    $546,801
    From related orgs
    $0
    Other
    $31,512
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $546,801
    Bonus
    $0
    Other
    $0
    Deferred
    $6,100
    Nontaxable benefits
    $25,412
    Filer's total
    $578,313

  • KENNETH BERGER

    PHYSICIAN

    Total calculated
    $579,387
    From this org
    $556,878
    From related orgs
    $0
    Other
    $22,509
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $511,933
    Bonus
    $44,945
    Other
    $0
    Deferred
    $423
    Nontaxable benefits
    $22,086
    Filer's total
    $579,387

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

  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Form 990 of other organizations
  • 3 · Written employment contract
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 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

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

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
30 October 2023
IRS schema version
2022v5.0
Source object
202303109349301925

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