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ObjectId: 201532579349301178 - Submission: 2015-09-14
TIN: 91-0567263
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
YAKIMA VALLEY MEMORIAL HOSPITAL
Employer identification number
91-0567263
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
directors, trustees, officers, including 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
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) 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
RUSSELL M MYERS
PRESIDENT/CEO STARTING 1/2014
(i)
(ii)
315,077
0
0
0
0
0
-49,727
0
18,966
0
284,316
0
0
0
2
RICHARD W LINNEWEH JR
PRESIDENT/CEO UNTIL 1/2014
(i)
(ii)
543,618
0
0
0
0
0
20,400
0
19,491
0
583,509
0
0
0
3
DALE S OLANDER
VICE PRESIDENT/CFO UNTIL 4/2014
(i)
(ii)
230,997
0
0
0
0
0
14,851
0
22,319
0
268,167
0
139,700
0
4
TIM REED
VP/CFO STARTING 4/2014, MP COO UNTIL
(i)
(ii)
0
180,445
0
0
0
0
0
8,785
0
23,949
0
213,179
0
0
5
THOMAS I BOYD
PHYSICIAN
(i)
(ii)
280,450
0
306,764
0
0
0
17,799
0
18,370
0
623,383
0
0
0
6
TONY HA
PHYSICIAN
(i)
(ii)
280,465
0
266,447
0
0
0
17,799
0
18,379
0
583,090
0
0
0
7
GILBERT K ONG
PHYSICIAN
(i)
(ii)
0
428,268
0
63,392
0
0
0
17,799
0
28,496
0
537,955
0
0
8
ROBERT J CONROY
PHYSICIAN
(i)
(ii)
0
493,650
0
0
0
0
0
20,400
0
17,083
0
531,133
0
0
9
PALMER WRIGHT
PHYSICIAN
(i)
(ii)
0
307,379
0
163,149
0
0
0
15,198
0
16,860
0
502,586
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
PART I, LINE 4B
IN JULY 2002, THE HOSPITAL'S BOARD OF TRUSTEES ADOPTED A SALARY CONTINUATION PLAN (THE "PLAN"), IN THE FORM OF A NON-QUALIFIED RETIREMENT BENEFIT FOR SENIOR EXECUTIVES. THE RETIREMENT BENEFIT PROVIDED BY THE PLAN IS SUPPLEMENTARY TO THE HOSPITAL'S EMPLOYEE PENSION PLAN, TAX-DEFERRED ANNUITY RETIREMENT PLAN, 401(K) PLAN AND SOCIAL SECURITY RETIREMENT EARNINGS. BENEFITS ARE CALCULATED AS THE DIFFERENCE BETWEEN THE PROJECTED AGE-65 VALUE OF THE AFOREMENTIONED BENEFITS AND 75% OF THE LUMP SUM AT AGE 65. NO BENEFITS UNDER THE PLAN ARE GENERALLY AVAILABLE FOR A SENIOR EXECUTIVE WHO RETIRES PRIOR TO HIS/HER 65TH BIRTHDAY. FUNDING FOR THE PLAN BEGAN IN 2002, AND THE HOSPITAL FIRST BEGAN ACCRUING A LIABILITY FOR THE PLAN DURING THE FISCAL YEAR ENDING OCTOBER 31, 2005. THE HOSPITAL'S LIABILITY ACCRUAL IS BASED ON THE ASSUMPTION THAT ALL NINE EXECUTIVES WILL BE WORKING UNTIL AGE 65. MR. RUSSELL M MYERS IS THE CEO OF YAKIMA VALLEY MEMORIAL HOSPITAL. AS OF 10/31/2014 MR. MYERS IS 60 YEARS OLD AND HAS BEEN IN HIS CURRENT AND OTHER CAPACITIES AT THE HOSPITAL SINCE 1989. MR. MYERS' ACCRUED BENEFITS UNDER THE PLAN DECREASED IN THE AMOUNT OF $70,127 DURING THE 2014 CALENDAR YEAR. MR. DALE S OLANDER IS THE CFO OF YAKIMA VALLEY MEMORIAL HOSPITAL. AS OF 10/31/14 MR. OLANDER IS 58 YEARS OLD AND HAS BEEN IN CURRENT AND OTHE CAPACITIES AT THE HOSPITAL SINCE 2000. MR. OLANDER ACCRUED BENEFITS UNDER THE PLAN DECREASED IN THE AMOUNT OF $3,552 DURING THE 2014 CALENDAR YEAR.
Schedule J (Form 990) 2013
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