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ObjectId: 201421359349306192 - Submission: 2014-05-15
TIN: 61-1029768
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
JEWISH HOSPITAL & ST MARY'S HEALTHCARE INC
Employer identification number
61-1029768
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
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
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
Yes
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)
BRADLEY LINCKS
VICE PRESIDENT/CNO
(i)
(ii)
154,953
0
333
0
1,044
0
7,265
0
10,923
0
174,519
0
0
0
(2)
BRIAN DOHENY
VICE PRESIDENT
(i)
(ii)
180,118
0
14,262
0
1,101
0
9,288
0
10,962
0
215,732
0
0
0
(3)
CARLOTTA RINKE
VICE PRESIDENT
(i)
(ii)
172,390
0
333
0
3,288
0
5,556
0
9,953
0
191,521
0
0
0
(4)
CHERYL FUGATTE
VICE PRESIDENT/CNO
(i)
(ii)
204,110
0
18,200
0
4,918
0
14,749
0
4,273
0
246,251
0
0
0
(5)
CHRISTOPHER ROSZMAN
VICE PRESIDENT
(i)
(ii)
227,902
0
333
0
1,252
0
10,717
0
10,923
0
251,128
0
0
0
(6)
DAVID LAIRD
VICE PRESIDENT
(i)
(ii)
311,931
0
265,500
0
894,403
0
80,148
0
6,789
0
1,558,771
0
429,377
0
(7)
DEBORAH MOLNAR
VICE PRESIDENT
(i)
(ii)
359,972
0
42,717
0
2,066,964
0
92,904
0
12,263
0
2,574,820
0
1,982,086
0
(8)
EDGAR FARMER
VICE PRESIDENT
(i)
(ii)
5,394
0
0
0
146,435
0
0
0
0
0
151,829
0
0
0
(9)
GARY ERMERS
FORMER INTERIM CHIEF FINANCIAL OFFICER
(i)
(ii)
0
248,822
0
38,290
0
272,704
0
48,198
0
20,439
0
628,453
0
32,217
(10)
JAMES KETTERHAGEN
VICE PRESIDENT
(i)
(ii)
323,196
0
21,154
0
247,884
0
83,808
0
8,807
0
684,849
0
77,875
0
(11)
JAMES PAROBEK
SENIOR VICE PRESIDENT
(i)
(ii)
195,613
0
100,000
0
286,618
0
81,375
0
10,281
0
673,887
0
77,861
0
(12)
JEFFREY POLSON
VICE PRESIDENT
(i)
(ii)
164,946
0
15,494
0
26,331
0
2,989
0
3,514
0
213,274
0
0
0
(13)
JENNIFER NOLAN
VICE PRESIDENT
(i)
(ii)
221,157
0
333
0
3,426
0
10,442
0
9,778
0
245,136
0
0
0
(14)
JOHN JOHNSON
VICE PRESIDENT
(i)
(ii)
83,498
0
0
0
172,294
0
2,910
0
6,789
0
265,490
0
0
0
(15)
JULIE MCGREGOR
VICE PRESIDENT
(i)
(ii)
155,660
0
16,245
0
1,111
0
8,218
0
10,983
0
192,219
0
0
0
(16)
KATHLEEN WOOD
VICE PRESIDENT
(i)
(ii)
142,450
0
15,761
0
48,407
0
2,275
0
10,320
0
219,213
0
0
0
(17)
KENNETH JOHNSON
VICE PRESIDENT
(i)
(ii)
175,290
0
9,851
0
2,882
0
8,803
0
10,625
0
207,450
0
0
0
(18)
KIMBERLY ALUMBAUGH
VICE PRESIDENT
(i)
(ii)
308,861
0
50,000
0
20,983
0
6,345
0
642
0
386,831
0
0
0
(19)
MARK MILBURN
VICE PRESIDENT
(i)
(ii)
176,271
0
20,333
0
1,697
0
8,695
0
10,962
0
217,957
0
0
0
(20)
MARTIN BONICK
FORMER SENIOR VICE PRESIDENT
(i)
(ii)
0
0
0
0
255,769
0
0
0
0
0
255,769
0
0
0
(21)
MICHAEL COLLINS
VICE PRESIDENT
(i)
(ii)
247,069
0
22,438
0
11,283
0
11,906
0
7,699
0
300,394
0
0
0
(22)
MICHAEL ROWAN FACHE
DIRECTOR
(i)
(ii)
0
1,010,071
0
468,458
0
173,838
0
201,012
0
19,541
0
1,872,920
0
150,422
(23)
PAUL EDGETT
DIRECTOR
(i)
(ii)
0
440,982
0
214,258
0
79,137
0
64,715
0
21,785
0
820,877
0
57,444
(24)
RANDY NAPIER
VICE PRESIDENT
(i)
(ii)
210,475
0
9,230
0
3,323
0
19,067
0
7,533
0
249,628
0
0
0
(25)
ROBERT SMITH
FAMILY MEDECINE
(i)
(ii)
242,975
0
55,545
0
6,157
0
11,952
0
10,997
0
327,626
0
0
0
(26)
RON FARR
FORMER CFO
(i)
(ii)
437,424
0
5,000
0
360,090
0
108,055
0
7,699
0
918,268
0
289,263
0
(27)
RUTH WHEATLEY
VICE PRESIDENT
(i)
(ii)
259,933
0
36,982
0
3,870
0
12,245
0
642
0
313,672
0
0
0
(28)
RUTH WILLIAMS BRINKLEY
PRESIDENT/CEO KENTUCKYONE HEALTH
(i)
(ii)
0
816,304
0
90,508
0
87,605
0
126,221
0
7,975
0
1,128,613
0
0
(29)
SHARON HAGER
SECRETARY
(i)
(ii)
0
289,225
0
73,384
0
20,465
0
23,096
0
8,915
0
415,085
0
0
(30)
SHELLEY SHAUGHNESSY
VICE PRESIDENT
(i)
(ii)
273,636
0
20,503
0
7,336
0
11,387
0
10,962
0
323,823
0
0
0
(31)
SHERRI CRAIG
VICE PRESIDENT
(i)
(ii)
143,341
0
333
0
1,604
0
8,851
0
11,012
0
165,141
0
0
0
(32)
THOMAS GESSEL
FORMER SENIOR VICE PRESIDENT
(i)
(ii)
0
0
0
0
169,477
0
0
0
0
0
169,477
0
0
0
(33)
VAL SLAYTON
VICE PRESIDENT
(i)
(ii)
313,793
0
333
0
2,132
0
13,494
0
6,042
0
335,794
0
0
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
Arrangement used to establish the top management official's compensation
Schedule J, Part I, Line 3
COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
Severance or change-of-control payment
Schedule J, Part I, Line 4a
POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR JEWISH HOSPITAL AND ST. MARY'S HEALTHCARE ("JHSMH") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM CATHOLIC HEALTH INITIATIVES (A RELATED ORGANIZATION) DURING THE 2012 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE COMPENSATION ON SCHEDULE J: GARY ERMERS -$152,350 THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM JHSMH (A RELATED ORGANIZATION) DURING THE 2012 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE COMPENSATION ON SCHEDULE J: EDGAR FARMER - $140,254 RONALD FARR - $7,881 JOHN JOHNSON - $171,061 JAMES KETTERHAGEN - $92,304 DAVID LAIRD - $370,192 JAMES PAROBEK - $131,250 JEFFREY POLSON - $25,891
Supplemental nonqualified retirement plan
Schedule J, Part I, Line 4b
DURING THE 2012 CALENDAR YEAR CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: MELVIN ALEXANDER, PAUL EDGETT, GARY ERMERS, MICHAEL ROWAN AND RUTH WILLIAMS-BRINKLEY DURING 2012 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: MELVIN ALEXANDER -$3,825 PAUL EDGETT -$36,619 GARY ERMERS -$20,102 MICHAEL ROWAN -$177,916 RUTH WILLIAMS-BRINKLEY -$103,125 DURING 2012 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: PAUL EDGETT -$57,444 GARY ERMERS -$32,217 MICHAEL ROWAN -$150,422 DURING THE 2012 CALENDAR YEAR JEWISH HOSPITAL AND ST. MARY'S HEALTHCARE ("JHSMH"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: RONDAL FARR, DAVID LAIRD, JAMES KETTERHAGEN, DEBORAH MOLNAR, JAMES PAROBEK DURING 2012 THE FOLLOWING CONTRIBUTIONS WERE MADE BY JHSMH TO THE DEFERRED COMPENSATION PLAN: JAMES KETTERHAGEN - $75,000 DEBORAH MOLNAR - $75,000 JAMES PAROBEK - $75,000 RONALD FARR - $75,000 DAVID LAIRD - $75,000 DURING 2012 THE DEFERRED COMPENSATION PLANS FULLY VESTED AND WERE INCLUDED AS COMPENSATION IN THE 2012 FORM W-2 FOR THE FOLLOWING INDIVIDUALS. THE AMOUNTS REPORTED BELOW ARE THE AMOUNTS INCLUDED IN 2012 INCOME AND NOT NECESSARILY THE AMOUNT DISTRIBUTED DURING 2012 FROM THE COMPENSATION PLAN: JAMES KETTERHAGEN - $152,875 DEBORAH MOLNAR - $2,057,086 JAMES PAROBEK - $152,861 RONALD FARR - $364,263 DAVID LAIRD - $504,377
Schedule J (Form 990) 2012
Additional Data
Software ID:
12000266
Software Version:
v2012.1.0