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ObjectId: 201511339349305446 - Submission: 2015-05-13
TIN: 91-1858433
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, line 23.
Attach to Form 990.
See separate instructions.
Information about Schedule J (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
13
Open to Public Inspection
Name of the organization
The Nebraska Medical Center
Employer identification number
91-1858433
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
directors, trustees, officers, including 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
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
Yes
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
Yes
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) 2013
Page 2
Schedule J (Form 990) 2013
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
Dr Marlin G Stahl
MEMBER & BMC CMO
(i)
(ii)
213,404
0
0
0
856
0
236
0
305
0
214,801
0
0
0
2
Glenn Fosdick
CEO thru 12/13/2013
(i)
(ii)
668,135
0
300,000
0
789,119
0
158,593
0
21,615
0
1,937,462
0
749,383
0
3
Stephen B Smith
CMO thru 3/31/2014
(i)
(ii)
341,099
0
340,026
0
161,090
0
124,066
0
15,164
0
981,445
0
130,021
0
4
William S Dinsmoor
CFO thru 1/5/2014 & CEO
(i)
(ii)
423,619
0
210,000
0
144,480
0
138,057
0
8,560
0
924,716
0
139,271
0
5
Joe B Graham
COO
(i)
(ii)
396,482
0
170,000
0
336,139
0
124,415
0
24,943
0
1,051,979
0
329,652
0
6
Rosanna D Morris
CNO & COO effective 1/6/2014
(i)
(ii)
220,333
0
241,050
0
107,194
0
97,230
0
912
0
666,719
0
101,050
0
7
Tadd M Pullin
VP Marketing and Planning
(i)
(ii)
332,987
0
120,000
0
6,213
0
11,776
0
14,874
0
485,850
0
0
0
8
Ruta P Davidson
COO BMC
(i)
(ii)
142,552
0
97,112
0
1,695
0
17,486
0
26,186
0
285,031
0
0
0
9
Louis W Burgher MD
Clarkson College President
(i)
(ii)
320,829
0
0
0
0
0
0
0
13,635
0
334,464
0
0
0
10
Theresa Franco
Exec Dir Oncology
(i)
(ii)
251,395
0
27,484
0
20,327
0
24,022
0
22,137
0
345,365
0
0
0
11
Jorge A Parodi
Exec Dir CP thru 3/31/2014
(i)
(ii)
243,581
0
0
0
21,802
0
20,649
0
14,035
0
300,067
0
0
0
12
Stephanie Daubert
CFO effective 1/6/2014
(i)
(ii)
182,868
0
0
0
8,438
0
22,381
0
22,118
0
235,805
0
0
0
13
Thomas C Macy
Nebraska Orthopaedic Hosp CEO
(i)
(ii)
244,340
0
0
0
1,059
0
22,783
0
25,626
0
293,808
0
0
0
14
Deborah K Istas
Exec Dir Neuro
(i)
(ii)
233,096
0
17,559
0
1,588
0
25,201
0
2,121
0
279,565
0
0
0
15
David S Fuller
Interim, Chief Process Officer
(i)
(ii)
194,277
0
20,000
0
27,082
0
23,448
0
26,186
0
290,993
0
0
0
16
Levi Scheppers
CAO effective 1/6/2014
(i)
(ii)
185,076
0
0
0
649
0
12,280
0
14,334
0
212,339
0
0
0
17
Charles D Lakso
Exec Dir Diagnostic Services
(i)
(ii)
229,131
0
0
0
1,572
0
17,292
0
7,465
0
255,460
0
0
0
18
Randall J Hallett
Exec Dir Devel thru 12/31/13
(i)
(ii)
236,613
0
61,115
0
13,568
0
17,952
0
19,359
0
348,607
0
0
0
19
Michael F Powell
Exec Dir Pharmacy Services
(i)
(ii)
194,614
0
3,000
0
6,448
0
23,207
0
23,950
0
251,219
0
0
0
20
Lisa J McClane
Exec Dir Women & Children
(i)
(ii)
196,923
0
0
0
1,367
0
12,711
0
4,403
0
215,404
0
0
0
21
Carissa SchweitzerMasek
Exec Dir Enterprise Apps
(i)
(ii)
180,416
0
0
0
17,442
0
17,924
0
8,494
0
224,276
0
0
0
22
Donald Futrell
Exec Dir Fac & Clin Spc plng
(i)
(ii)
198,203
0
0
0
1,391
0
18,452
0
19,174
0
237,220
0
0
0
23
Mark W Weiss
Exec Dir Enterprise Tech Serv
(i)
(ii)
191,984
0
0
0
832
0
846
0
23,806
0
217,468
0
0
0
24
Jana Danielson
Exec Dir Revenue Cycle
(i)
(ii)
177,587
0
0
0
17,380
0
15,426
0
1,323
0
211,716
0
0
0
25
Connie S Ogden
Exec Dir Acute Adult Services
(i)
(ii)
186,051
0
0
0
1,260
0
16,930
0
2,252
0
206,493
0
0
0
26
Julie Lazure
Exec Dir Acute Care Program
(i)
(ii)
173,664
0
0
0
1,230
0
19,592
0
17,380
0
211,866
0
0
0
27
Mandy Constantine
Exec Dir Telehealth
(i)
(ii)
186,130
0
0
0
1,064
0
0
0
7,005
0
194,199
0
0
0
28
Crista Madsen
Exec Dir Mktg & Communications
(i)
(ii)
153,457
0
0
0
1,084
0
12,004
0
14,888
0
181,433
0
0
0
29
Marcel Devetten MD
Associate CMO thru 12/31/2014
(i)
(ii)
276,818
0
0
0
1,925
0
17,871
0
14,676
0
311,290
0
0
0
30
Cynthia D Owen
Quality & Compliance Advisor
(i)
(ii)
118,896
0
0
0
225,999
0
41,353
0
5
0
386,253
0
0
0
31
Steven J Wees MD
Physician
(i)
(ii)
197,600
0
46,198
0
1,342
0
15,317
0
19,626
0
280,083
0
0
0
32
Chad Whyte
Physician
(i)
(ii)
218,461
0
2,000
0
1,525
0
15,933
0
22,864
0
260,783
0
0
0
33
Richard Hurd
Physician
(i)
(ii)
161,366
0
6,000
0
55,991
0
17,363
0
5,762
0
246,482
0
0
0
Schedule J (Form 990) 2013
Page 3
Schedule J (Form 990) 2013
Page
3
Part III
Supplemental Information
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.
Return Reference
Explanation
NONQUALIFIED RETIREMENT PLANS
SchEDULE J, Part I, Line 4b CERTAIN EXECUTIVES DO PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. A PAYOUT OCCURRED DURING THE YEAR FROM A SUPPLEMENTAL NONQUALIFIED PLAN TO THE FOLLOWING INDIVIDUALS: GLENN FOSDICK $749,383 WILLIAM DINSMOOR $139,271 STEPHEN SMITH $130,021 JOE GRAHAM $329,652 ROSANNA MORRIS $101,050
CONTINGENT COMPENSATION
SchEDULE J, Part I, Line 5a & 6a THE ORGANIZATION'S REVENUES AND NET EARNINGS ARE TAKEN INTO CONSIDERATION WHEN CALCULATING EXECUTIVE INCENTIVE COMPENSATION IN ADDITION TO OTHER NON-FINANCIAL FACTORS. EXECUTIVE INCENTIVE COMPENSATION IS DETERMINED BY SEVERAL KEY METRICS THAT ARE ESTABLISHED BY THE NEBRASKA MEDICAL CENTER BOARD OF DIRECTORS. THESE METRICS ARE INCLUSIVE OF STRATEGIC, FINANCIAL, OPERATIONAL AND QUALITY OUTCOMES. ON AN ANNUAL BASIS, THE NEBRASKA MEDICAL CENTER BOARD OF DIRECTORS REVIEWS ACHIEVEMENT OF PRESET TARGETS AND APPROVES INCENTIVES WHEN WARRANTED. THESE PERFORMANCE PAYMENTS ARE IN LIEU OF A TYPICAL EXECUTIVE'S BASE PAY. THE BOARD OF DIRECTORS AND EXECUTIVES DETERMINED IT IS IN THE BEST INTEREST OF THE ORGANIZATION TO HAVE A PORTION OF THEIR BASE PAY SUBJECT TO FORFEITURE UNLESS THE PRE-DETERMINED FINANCIAL AND NON-FINANCIAL FACTORS DISCUSSED ABOVE ARE ACHIEVED. INCENTIVE COMPENSATION RELATED TO FY13 PERFORMANCE WERE PAID TO THE FOLLOWING INDIVIDUALS: GLENN FOSDICK $300,000 STEPHEN SMITH, MD $340,026 JOE GRAHAM $170,000 WILLIAM DINSMOOR $210,000 ROSANNA MORRIS $241,050 TADD PULLIN $120,000 RANDALL HALLET $61,115 THERESA FRANCO $27,484 DEB ISTAS $17,559 RUTA DAVIDSON $97,112 DAVID FULLER $20,000
SEVERANCE PAYMENTS
SCHEDULE J, PART I, LINE 4A THE FOLLOWING EMPLOYEES WERE TERMINATED DURING FISCAL YEAR 2014 AND RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2013: CINDY D. OWEN $225,913
Schedule J (Form 990) 2013
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