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Nonprofiteer
← ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER

Form 990 for tax year 2022

Filed by ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER.

Totals

Total revenue
$16,178,375
Total expenses
$14,597,326
Contributions and grants received
$1,047,561
Grants paid
$0
Program service revenue
$14,959,234
Investment income
$34,504
Other revenue
$137,076
Total assets, end of year
$19,081,097
Total liabilities, end of year
$2,085,309
Net assets or fund balances, end of year
$16,995,788
Program services expenses (Part IX)
$13,907,662
Management and general expenses
$689,664
Fundraising expenses
$0
Program service expenses (Part III)
$13,907,662

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)

    $1,045,561

  • 1f · All other contributions, gifts and grants

    $2,000

  • 2a · Program service revenue: NET PATIENT SERVICES

    total $14,764,788 · related or exempt $14,764,788 · unrelated business $0 · excluded $0

  • 2b · Program service revenue: PHARMACY SERVICES

    total $184,186 · related or exempt $184,186 · unrelated business $0 · excluded $0

  • 2c · Program service revenue: SERVICES SOLD

    total $10,260 · related or exempt $10,260 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $34,504 · excluded $34,504

  • 10a · Gross sales of inventory

    $492

  • 10b · Cost of goods sold

    $951

  • 10c · Net income from sales of inventory

    total -$459 · excluded -$459

  • 11a · Other revenue: EMPLOYEE RETENTION CRE

    total $122,322 · related or exempt $0 · unrelated business $0 · excluded $122,322

  • 11b · Other revenue: CAFETERIA

    total $14,954 · related or exempt $0 · unrelated business $0 · excluded $14,954

  • 11c · Other revenue: OTHER MISCELLANEOUS RE

    total $259 · related or exempt $0 · unrelated business $0 · excluded $259

  • 11e · Other revenue, total

    $137,535

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $268,264 · program services $254,851 · management and general $13,413

  • 7 · Other salaries and wages

    total $5,765,067 · program services $5,476,813 · management and general $288,254

  • 8 · Pension plan contributions

    total $310,816 · program services $295,275 · management and general $15,541

  • 9 · Other employee benefits

    total $790,929 · program services $751,383 · management and general $39,546

  • 10 · Payroll taxes

    total $396,168 · program services $376,360 · management and general $19,808

  • 11d · Fees: lobbying

    total $954 · management and general $954

  • 11f · Fees: investment management

    total $2,481 · program services $2,481

  • 11g · Fees: other

    total $3,215,600 · program services $3,055,726 · management and general $159,874

  • 12 · Advertising and promotion

    total $7,384 · program services $7,015 · management and general $369

  • 13 · Office expenses

    total $297,342 · program services $282,475 · management and general $14,867

  • 14 · Information technology

    total $397,409 · program services $377,539 · management and general $19,870

  • 16 · Occupancy

    total $324,566 · program services $308,338 · management and general $16,228

  • 17 · Travel

    total $18,289 · program services $17,375 · management and general $914

  • 20 · Interest

    total $11,294 · program services $11,294

  • 21 · Payments to affiliates

    total $257,214 · program services $244,353 · management and general $12,861

  • 22 · Depreciation, depletion and amortization

    total $481,881 · program services $457,787 · management and general $24,094

  • 23 · Insurance

    total $56,557 · program services $53,729 · management and general $2,828

  • 24a · Other expenses: INTRACOMPANY ALLOCATION

    total $940,357 · program services $893,339 · management and general $47,018 · fundraising $0

  • 24b · Other expenses: MEDICAL SUPPLIES

    total $800,200 · program services $800,200 · management and general $0 · fundraising $0

  • 24c · Other expenses: REPAIRS AND MAINTENANCE

    total $227,169 · program services $215,811 · management and general $11,358 · fundraising $0

  • 24d · Other expenses: DUES & SUBSCRIPTIONS

    total $17,787 · program services $16,398 · management and general $1,389 · fundraising $0

  • 24e · All other expenses

    total $9,598 · program services $9,120 · management and general $478

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $500 · end of year $1,404

  • 2 · Savings and temporary cash investments

    beginning of year $223,667 · end of year $210,570

  • 3 · Pledges and grants receivable

    end of year $0

  • 4 · Accounts receivable

    beginning of year $1,672,834 · end of year $2,535,755

  • 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 $128,722 · end of year $137,103

  • 9 · Prepaid expenses and deferred charges

    end of year $0

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

    $8,894,338

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

    $4,759,386

  • 10c · Land, buildings and equipment, net

    beginning of year $4,112,474 · end of year $4,134,952

  • 11 · Investments: publicly traded securities

    beginning of year $271,045 · end of year $272,934

  • 12 · Investments: other securities

    beginning of year $1,242,658 · end of year $1,287,424

  • 13 · Investments: program-related

    end of year $0

  • 14 · Intangible assets

    end of year $0

  • 15 · Other assets

    beginning of year $11,774,332 · end of year $10,500,955

  • 17 · Accounts payable and accrued expenses

    beginning of year $2,587,141 · end of year $1,553,481

  • 18 · Grants payable

    end of year $0

  • 19 · Deferred revenue

    beginning of year $1,100,309 · 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 $291,975 · end of year $222,171

  • 24 · Unsecured notes and loans payable

    end of year $0

  • 25 · Other liabilities

    beginning of year $47,785 · end of year $21,358

  • 27 · Net assets without donor restrictions

    beginning of year $15,396,566 · end of year $16,993,332

  • 28 · Net assets with donor restrictions

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

Mission and programs · 2022

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 $3,021,361 · Revenue $2,107,566

  • 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 $1,307,172 · Revenue $5,567,779

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

    Expenses $1,748,904 · Revenue $1,589,273

  • OTHER PROGRAM SERVICES:

    Expenses $7,830,225 · Revenue $5,694,616

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • John Petersdorf

    EX-OFFICIO BOARD MEMBER

    Total calculated
    $3,026,445
    From this org
    $0
    From related orgs
    $2,349,200
    Other
    $677,245
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $596,879 related
    Bonus
    $0 + $497,099 related
    Other
    $0 + $1,255,222 related
    Deferred
    $0 + $611,834 related
    Nontaxable benefits
    $0 + $65,411 related
    Filer's total
    $0 + $3,026,445 related
  • Evert Kuiper

    EX-OFFICIO BM/ PRESIDENT & CEO CHI HEALTH

    Total calculated
    $1,303,984
    From this org
    $0
    From related orgs
    $1,274,593
    Other
    $29,391
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $891,215 related
    Bonus
    $0 + $275,000 related
    Other
    $0 + $108,378 related
    Deferred
    $0 + $3,276 related
    Nontaxable benefits
    $0 + $26,115 related
    Filer's total
    $0 + $1,303,984 related
  • Jeanette Wojtalewicz

    CFO, CHI HEALTH (TERMED 1/6/23)

    Total calculated
    $1,223,121
    From this org
    $0
    From related orgs
    $1,168,841
    Other
    $54,280
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $649,549 related
    Bonus
    $0 + $463,014 related
    Other
    $0 + $56,278 related
    Deferred
    $0 + $17,750 related
    Nontaxable benefits
    $0 + $36,530 related
    Filer's total
    $0 + $1,223,121 related
  • Usha Kanthety MD

    PHYSICIAN

    Total calculated
    $529,893
    From this org
    $469,305
    From related orgs
    $0
    Other
    $60,588
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $468,465
    Bonus
    $0
    Other
    $840
    Deferred
    $24,652
    Nontaxable benefits
    $35,936
    Filer's total
    $529,893
  • John Jackson MD

    PHYSICIAN

    Total calculated
    $478,918
    From this org
    $427,488
    From related orgs
    $0
    Other
    $51,430
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $421,944
    Bonus
    $0
    Other
    $5,544
    Deferred
    $17,750
    Nontaxable benefits
    $33,680
    Filer's total
    $478,918
  • Kirtibala Gupta MD

    BOARD MEMBER

    Total calculated
    $440,317
    From this org
    $0
    From related orgs
    $396,003
    Other
    $44,314
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $394,104 related
    Bonus
    $0
    Other
    $0 + $1,899 related
    Deferred
    $0 + $17,575 related
    Nontaxable benefits
    $0 + $26,739 related
    Filer's total
    $0 + $440,317 related
  • David Jones

    MARKET PRESIDENT, REGIONAL HOSPITALS

    Total calculated
    $338,527
    From this org
    $0
    From related orgs
    $307,588
    Other
    $30,939
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $256,033 related
    Bonus
    $0 + $50,308 related
    Other
    $0 + $1,247 related
    Deferred
    $0 + $11,983 related
    Nontaxable benefits
    $0 + $18,956 related
    Filer's total
    $0 + $338,527 related
  • Heather Morgan MD

    BOARD MEMBER

    Total calculated
    $329,219
    From this org
    $0
    From related orgs
    $278,612
    Other
    $50,607
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $277,757 related
    Bonus
    $0
    Other
    $0 + $855 related
    Deferred
    $0 + $16,557 related
    Nontaxable benefits
    $0 + $34,050 related
    Filer's total
    $0 + $329,219 related
  • Nick Otool

    INTERIM CFO, CHI HEALTH

    Total calculated
    $304,710
    From this org
    $0
    From related orgs
    $257,678
    Other
    $47,032
    Hours/week
    5 + 45 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
  • Nathan Stec

    PHYSICIAN ASSISTANT

    Total calculated
    $268,370
    From this org
    $12,934
    From related orgs
    $211,478
    Other
    $43,958
    Hours/week
    5 + 55 related

    Schedule J breakdown matched by us

    Base
    $12,934 + $211,315 related
    Bonus
    $0
    Other
    $0 + $163 related
    Deferred
    $14,340
    Nontaxable benefits
    $21,775 + $7,843 related
    Filer's total
    $49,049 + $219,321 related
  • Connie Peters

    PRESIDENT, SCHUYLER HOSPITAL

    Total calculated
    $265,158
    From this org
    $239,165
    From related orgs
    $0
    Other
    $25,993
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $175,797
    Bonus
    $44,179
    Other
    $19,189
    Deferred
    $14,463
    Nontaxable benefits
    $11,530
    Filer's total
    $265,158
  • Renee Sayer

    NURSE PRACTITIONER

    Total calculated
    $201,708
    From this org
    $190,447
    From related orgs
    $0
    Other
    $11,261
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $190,261
    Bonus
    $0
    Other
    $186
    Deferred
    $11,227
    Nontaxable benefits
    $34
    Filer's total
    $201,708
  • Kellie Abler

    CT TECHNOLOGIST TRAVELER

    Total calculated
    $186,004
    From this org
    $15,521
    From related orgs
    $157,043
    Other
    $13,440
    Hours/week
    10 + 50 related

    Schedule J breakdown matched by us

    Base
    $15,521 + $139,460 related
    Bonus
    $0 + $15,300 related
    Other
    $0 + $2,283 related
    Deferred
    $0 + $3,137 related
    Nontaxable benefits
    $0 + $10,303 related
    Filer's total
    $15,521 + $170,483 related
  • Kelly Bacon

    BOARD MEMBER

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

    TREASURER

    Total calculated
    $0
    Hours/week
    1 + 11 related
  • Kevin Fitzgerald PhD

    SECRETARY

    Total calculated
    $0
    Hours/week
    1 + 11 related
  • Sister Nadine Heimann Osf

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 40 related
  • Susanne L Hruza MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 11 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 + 11 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

  • 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
DURING THE CALENDAR YEAR 2022, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY COMMONSPIRIT HEALTH [OR SUBSTITUTE OTHER RELATED ORG NAME], A RELATED ORGANIZATION. COMMONSPIRIT HEALTH [OR SUBSTITUTE OTHER RELATED ORG NAME], USED THE FOLLOWING 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.
PART I, LINE 4B
SCHEDULE J, PART I, LINE 4A - SEVERANCE OR CHANGE-OF-CONTROL PAYMENTS: 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. SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: 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. DURING 2022 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: CONNIE PETERS, $7,847. 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 PAYMENT WAS MADE PURSUANT TO THE SUPER VESTING RULES: JEANETTE WOJTALEWICZ, $50,733 AND CONNIE PETERS, $8,901.
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 CERTAIN EMPLOYEES OCCURRED DURING 2022: JOHN PETERSDORF, $1,242,454. 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 2022.
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 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.

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 (ACN LLC)

    N/A · CARE NETWORK · AZ

  • ARIZONA DIAGNOSTIC RADIOLOGY GROUP LLC

    N/A · DIAGNOSTIC SERVICES · CA

  • ARIZONA DIAGNOSTIC RADIOLOGY GROUP LLC

    N/A · DIAGNOSTIC SERVICES · CA

  • AUDUBON LAND COMPANY LLC

    N/A · REAL ESTATE · CO

  • BAYLOR CHI ST LUKES HEALTH SERVICES LLC

    N/A · HEALTHCARE SRVC · TX

  • BERGAN MERCY SURGERY CENTER LLC

    N/A · AMBUL SURG CTR · NE

  • BERYWOOD OFFICE PROPERTIES LLC

    N/A · PHYS OFFICE · TN

  • BIOLIFE DIGNITY HEALTH INTERNATIONAL LTD

    N/A · HEALTH SERVICES · CH

  • BLUEGRASS REGIONAL IMAGING CENTER

    N/A · DIAGNOSTIC IMAGING · KY

  • CBCC OUTSMARTING CANCER LLC

    N/A · RADIATION / ONCOLOGY · CA

  • CENTRAL NEBRASKA REHABILITATION SVCS LLC

    N/A · PHYSICAL THERAPY · NE

  • CENTURA SUMMIT ORTHOPEDICS LLC

    N/A · HEALTHCARE SRVC · 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

  • DHHP SURGERY CENTERS LLC

    N/A · SURGERY · DE

  • DHRT HOLDINGS LLC

    N/A · HOLDING COMPANY · DE

  • DIGNITY- GOHEALTHURGENT CARE MANAGEMENT LLC

    N/A · MANAGEMENT SERVICES · DE

  • DIGNITY HEALTH AT HOME LLC

    N/A · HEALTHCARE SRVC · DE

  • 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

  • FOLSOM SIERRA ENDOSCOPY CENTER LP

    N/A · ENDOSCOPY · CA

  • FRANCISCAN MEDICAL PAVILION BONNEY LAKE LLC

    N/A · REAL ESTATE · WA

  • FRANCISCAN SPECIALTY CARE LLC

    N/A · HEALTHCARE SRVC · 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 SRVC · NE

  • LEXINGTON MBO PARTNERS LTD

    N/A · REAL ESTATE · CO

  • LINCOLN CK LEASING LLC

    N/A · REAL ESTATE · NE

  • MEMORIAL MEDICAL PLAZA

    N/A · REAL ESTATE · CA

  • MERCY DAVIS CANCER CENTER MANAGEMENT CO LLC

    N/A · MANAGEMENT OF CANCER CENTER · CA

  • MERCY REHABILITATION HOSPITAL LLC

    N/A · HEALTHCARE SRVC · TX

  • 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 SRVC · MN

  • PENINSULA RADIATION ONCOLOGY CENTER LLC

    N/A · HEALTHCARE SRVC · 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

  • 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

  • SAINT JOSEPH-ANC HOME CARE SERVICES

    N/A · HOME HEALTH · KY

  • SANTA CRUZ COMPREHENSIVE IMAGING LLC

    N/A · IMAGING · CA

  • SANTA CRUZ LAND & BUILDING LP

    N/A · REAL ESTATE · 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

  • TEMPLETON SURGERY CENTER LLC

    N/A · SURGERY · CA

  • 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 SRVC · 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

  • WEST LAKES SURGERY CENTER LLC

    N/A · HEALTHCARE SRVC · IA

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 PROVIDERS OF BRAZOS VALLEY INC

    C · HEALTHCARE · TX

  • ALTERNATIVE INSURANCE MANAGEMENT SERVICE INC

    C · MANAGEMENT SERVICES · CO

  • AMERICAN NURSING CARE INC

    C · HOME HEALTH · OH

  • AMERIMED INC

    C · HOME HEALTH · OH

  • 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

  • CONSOLIDATED HEALTH SERVICES

    C · HOME HEALTH · OH

  • DES MOINES MEDICAL CENTER INC

    C · REAL ESTATE · IA

  • DIGNITY HEALTH HOLDING CORPORATION

    C · HOLDING CO · NV

  • DIGNITY HEALTH INSURANCE LTD

    C · CAPTIVE INSURANCE · CJ

  • 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 · MGMT · NE

  • HEALTHCARE MGMT SERVICES ORGANIZATION INC

    C · INACTIVE · WA

  • HEARTLANDPLAINS HEALTH

    C · INSURANCE · NE

  • HIGHLINE MEDICAL GROUP

    C · MEDICAL SERVICES · WA

  • INTEGRATED MEDICAL SERVICES

    C · MULTI-SPECIALTY PHYSICIANS GROUP · AZ

  • 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 · MGMT SVC ORG · 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 MANAGEMENT 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

  • 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
2022
Filed
10 May 2024
IRS schema version
2022v5.0
Source object
202421319349304837

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