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← ST MARYS GOOD SAMARITAN FOUNDATION INC

Form 990 for tax year 2022

Filed by ST MARYS GOOD SAMARITAN FOUNDATION INC.

Totals

Total revenue
$1,105,658
Total expenses
$1,368,450
Contributions and grants received
$704,707
Grants paid
$1,362,110
Program service revenue
$0
Investment income
$294,931
Other revenue
$106,020
Total assets, end of year
$1,418,854
Total liabilities, end of year
$129,557
Net assets or fund balances, end of year
$1,289,297
Program services expenses (Part IX)
$1,362,110
Management and general expenses
$6,340
Fundraising expenses
$0
Program service expenses (Part III)
$1,362,110

Program services were 99.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • D MONTEZ CARTER

    DIR/SEC/PRES-9/22;PRES THONE AT10/22

    Total calculated
    $994,869
    From this org
    $0
    From related orgs
    $773,045
    Other
    $221,824
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $511,658 related
    Bonus
    $0 + $149,845 related
    Other
    $0 + $111,542 related
    Deferred
    $0 + $188,898 related
    Nontaxable benefits
    $0 + $32,926 related
    Filer's total
    $0 + $994,869 related

  • STONISH PIERCE

    COO HCH THR3/23;DIR/PRES/CEO AT 4/23

    Total calculated
    $481,185
    From this org
    $0
    From related orgs
    $456,331
    Other
    $24,854
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $379,526 related
    Bonus
    $0 + $75,665 related
    Other
    $0 + $1,140 related
    Deferred
    $0 + $18,280 related
    Nontaxable benefits
    $0 + $6,574 related
    Filer's total
    $0 + $481,185 related

  • REBECCA SMITH

    DIRECTOR; CHAIR

    Total calculated
    $0
    Hours/week
    1

  • PRICE WOODWARD

    DIRECTOR; VICE CHAIR

    Total calculated
    $0
    Hours/week
    1

  • NEENA AMIN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • RIEZL BAKER

    DIRECTOR THROUGH 12/22

    Total calculated
    $0
    Hours/week
    1

  • DEBORAH CORNELIA

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • AVIS DICKEY

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • TINA FISCHLIN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • VICKIE HANEY

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • PERRY LEE OD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JENNIFER MERCER

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JEAN MEYER

    DIRECTOR THROUGH 12/22

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • JAMES PARKS MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JEP POUND

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • LOUIS SEABOLT

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • ARTHUR TORSIGLIERI MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • LINDA WELTY

    DIRECTOR THROUGH 12/22

    Total calculated
    $0
    Hours/week
    1

  • DAVID SPIVEY

    INT PRES & CEO 10/2-4/23;TH CONSULT

    Total calculated
    $951,519
    From this org
    $0
    From related orgs
    $887,462
    Other
    $64,057
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $554,152 related
    Bonus
    $0 + $186,604 related
    Other
    $0 + $146,706 related
    Deferred
    $0 + $22,875 related
    Nontaxable benefits
    $0 + $41,182 related
    Filer's total
    $0 + $951,519 related

  • JANICE DUNN

    TREASURER; CHIEF FINANCIAL OFFICER

    Total calculated
    $458,737
    From this org
    $0
    From related orgs
    $413,411
    Other
    $45,326
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $335,452 related
    Bonus
    $0 + $67,958 related
    Other
    $0 + $10,001 related
    Deferred
    $0 + $13,725 related
    Nontaxable benefits
    $0 + $31,601 related
    Filer's total
    $0 + $458,737 related

  • ELIZABETH SCHOEN

    SECRETARY AT 11/22; ASSOCIATE CNSL

    Total calculated
    $213,597
    From this org
    $0
    From related orgs
    $179,988
    Other
    $33,609
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $171,560 related
    Bonus
    $0 + $7,667 related
    Other
    $0 + $761 related
    Deferred
    $0 + $8,571 related
    Nontaxable benefits
    $0 + $25,038 related
    Filer's total
    $0 + $213,597 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
ST. MARY'S GOOD SAMARITAN FOUNDATION IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. ST. MARY'S GOOD SAMARITAN FOUNDATION'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF ST. MARY'S GOOD SAMARITAN FOUNDATION'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
PART I, LINE 4B
THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. PARTICIPANTS' VESTED BENEFITS WERE PAID OUT IN 2022, AND THEIR NON-VESTED BENEFITS FOR 2022 WERE ACCRUED. THE FOLLOWING PAYOUTS FOR 2022 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: D. MONTEZ CARTER - $93,271 DAVID SPIVEY - $125,161 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THIS AMOUNT THAT WAS REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ACCRUAL FOR 2022 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: D. MONTEZ CARTER - $170,598 THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($305,000 FOR 2022). THE FOLLOWING PAYOUTS FOR 2022 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: JANICE DUNN - $3,301 STONISH PIERCE - $0

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.

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
202441349349301929

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