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ObjectId: 201410459349302626 - Submission: 2014-02-14
TIN: 38-3382353
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
Attach to Form 990.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public Inspection
Name of the organization
SPECTRUM HEALTH SYSTEM
Employer identification number
38-3382353
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
First-class or charter travel
Housing allowance or residence for personal use
Travel for companions
Payments for business use of personal residence
Tax idemnification and gross-up payments
Health or social club dues or initiation fees
Discretionary spending account
Personal services (e.g., maid, chauffeur, chef)
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain
....
1b
Yes
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a?
.......
2
Yes
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
Compensation committee
Written employment contract
Independent compensation consultant
Compensation survey or study
Form 990 of other organizations
Approval by the board or compensation committee
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment?
................
4a
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
.........
4b
Yes
c
Participate in, or receive payment from, an equity-based compensation arrangement?
.........
4c
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization?
...........................
5a
No
b
Any related organization?
.........................
5b
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
...........................
6a
No
b
Any related organization?
.........................
6b
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III
............
7
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III
.............................
8
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?
.........................
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012
Page 2
Schedule J (Form 990) 2012
Page
2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note.
The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A)
Name and Title
(B)
Breakdown of W-2 and/or 1099-MISC compensation
(C)
Retirement and other deferred compensation
(D)
Nontaxable
benefits
(E)
Total of columns
(B)(i)-(D)
(F)
Compensation
reported as deferred
in prior Form 990
(i)
Base compensation
(ii)
Bonus & incentive compensation
(iii)
Other reportable compensation
(1)
A ROBERT VAN TUINEN MD
DIRECTOR - PART YEAR
(i)
(ii)
25,000
294,686
0
0
0
7,469
0
21,460
0
13,214
25,000
336,828
0
0
(2)
DAVID LEONARD
SECRETARY / CHIEF LEGAL OFFICER
(i)
(ii)
390,229
0
274,956
0
46,238
0
121,963
0
69,408
0
902,794
0
172,344
0
(3)
J MICHAEL KRAMER
SVP & CHIEF QUALITY OFFICER
(i)
(ii)
303,768
0
119,606
0
6,010
0
118,494
0
49,800
0
597,678
0
30,202
0
(4)
JILL FERRIS
CORPORATE CONTROLLER
(i)
(ii)
163,538
0
32,816
0
364
0
30,489
0
26,541
0
253,748
0
0
0
(5)
JOHN BYRNES MD
EXEC VICE PRESIDENT / CHIEF STRATEGY OFFICER
(i)
(ii)
281,689
0
275,957
0
32,359
0
78,122
0
58,576
0
726,703
0
174,386
0
(6)
JOHN MACKEIGAN MD
EXEC VICE PRESIDENT / CMO
(i)
(ii)
497,521
0
432,738
0
43,668
0
96,809
0
15,430
0
1,086,167
0
300,915
0
(7)
JOHN MOSLEY
EVP & CHIEF STRATEGY OFFICER
(i)
(ii)
400,319
0
406,796
0
51,771
0
77,954
0
14,712
0
951,551
0
300,918
0
(8)
LORI SMITH
CORPORATE TREASURY OFFICER
(i)
(ii)
147,478
0
24,612
0
1,430
0
8,462
0
17,928
0
199,910
0
0
0
(9)
M ASHRAF MANSOUR
DIRECTOR
(i)
(ii)
0
570,816
0
79,998
0
5,152
0
17,500
0
8,703
0
682,169
0
0
(10)
MATTHEW VAN VRANKEN
EVP, SH DELIVERY SYSTEM
(i)
(ii)
845,611
0
542,443
0
58,858
0
270,019
0
109,719
0
1,826,651
0
322,225
0
(11)
MICHAEL P FREED
EXEC VICE PRESIDENT/CFO
(i)
(ii)
648,141
0
404,990
0
18,217
0
204,362
0
81,762
0
1,357,472
0
247,656
0
(12)
MICHAEL ROSENCRANCE
VP, IS SH DELIVERY SYSTEM
(i)
(ii)
291,946
0
186,160
0
4,140
0
84,800
0
62,794
0
629,839
0
121,634
0
(13)
PATRICK O'HARE
SVP, CIO
(i)
(ii)
382,997
0
258,198
0
37,989
0
124,847
0
60,499
0
864,530
0
157,289
0
(14)
RICHARD BREON
PRESIDENT / CEO
(i)
(ii)
1,091,257
0
1,236,719
0
85,408
0
421,886
0
193,879
0
3,029,149
0
835,988
0
(15)
ROGER JANSEN
SVP, HUMAN RESOURCES
(i)
(ii)
376,979
0
145,239
0
17,174
0
160,362
0
61,964
0
761,717
0
44,925
0
(16)
RONALD KNAUS
VICE PRESIDENT FINANCE - SHH
(i)
(ii)
0
321,833
0
197,525
0
4,434
0
104,223
0
57,395
0
685,408
0
119,763
(17)
STEVEN HEACOCK
SVP, PUBLIC AFFAIRS
(i)
(ii)
329,881
0
135,607
0
15,428
0
113,609
0
60,509
0
655,034
0
48,669
0
Schedule J (Form 990) 2012
Page 3
Schedule J (Form 990) 2012
Page
3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier
Return Reference
Explanation
First-class or charter travel
Schedule J, Part I, Line 1a
THE ORGANIZATION PROVIDED FIRST-CLASS TRAVEL FOR SIX EXECUTIVE EMPLOYEES AND SEVEN BOARD MEMBERS. IN CERTAIN LIMITED SITUATIONS WHEN COMMERCIAL AIR TRAVEL WAS NOT AVAILABLE FOR A DESTINATION OR NOT EFFICIENT DUE TO SCHEDULES AND/OR CONNECTIONS, CHARTER AIR TRAVEL WAS UTILIZED BY CERTAIN EXECUTIVE EMPLOYEES.
Travel for companions
Schedule J, Part I, Line 1a
THE ORGANIZATION PROVIDED COMPANION TRAVEL FOR THREE EXECUTIVE EMPLOYEES AND TWO BOARD MEMBERS. THESE AMOUNTS WERE EITHER TREATED AS TAXABLE COMPENSATION AND INCLUDED IN FORM W-2 OR FORM 1099 ACCORDINGLY OR THE ORGANIZATION WAS REIMBURSED BY THE EXECUTIVE OR BOARD MEMBER.
Health or social club dues or initiation fees
Schedule J, Part I, Line 1a
THE ORGANIZATION PROVIDED HEALTH CLUB DUES FOR SEVEN EXECUTIVE EMPLOYEES. THESE AMOUNTS WERE TREATED AS TAXABLE COMPENSATION AND INCLUDED IN FORM W-2.
Supplemental nonqualified retirement plan
Schedule J, Part I, Line 4b
$835,988 RICHARD BREON $174,386 JOHN BYRNES $247,656 MICHAEL FREED $ 48,669 STEVEN HEACOCK $ 44,925 ROGER JANSEN $119,763 RONALD KNAUS $ 30,202 J. MICHAEL KRAMER $172,344 DAVID LEONARD $300,915 JOHN MACKEIGAN $300,918 JOHN MOSLEY $157,289 PATRICK O'HARE $121,634 MICHAEL ROSENCRANCE SCHEDULE J, PART I, LINE 4B IS ANSWERED "YES" BECAUSE CERTAIN INDIVIDUALS, WHOSE SALARY AND BENEFITS ARE PAID BY THE REPORTING ORGANIZATION OR A RELATED ORGANIZATION, DO "PARTICIPATE IN" SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN(S). SOME INDIVIDUALS RECEIVED DISTRIBUTIONS DURING THE YEAR (AS REPORTED ON THIS LINE) WHEREAS OTHERS PARTICIPATED IN THE PLAN(S) BUT DID NOT RECEIVE DISTRIBUTIONS. DURING THE YEAR THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE PLAN(S) BUT DID NOT RECEIVE A DISTRIBUTION: JILL FERRIS. DISTRIBUTIONS REPORTED ON THIS LINE ARE ALSO INCLUDED IN SCHEDULE J, PART II, COLUMN F AS COMPENSATION REPORTED IN A PRIOR YEAR.
Schedule J (Form 990) 2012
Additional Data
Software ID:
12000266
Software Version:
v2012.1.0