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ObjectId: 201603209349308525 - Submission: 2016-11-15
TIN: 22-1487576
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" on Form 990, Part IV, line 23.
Attach to Form 990.
Information about Schedule J (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
15
Open to Public Inspection
Name of the organization
HACKENSACK UNIVERSITY MEDICAL CENTER
Employer identification number
22-1487576
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 on 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 on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on 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," on line 5a or 5b, describe in Part III.
6
For persons listed on 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," on line 6a or 6b, describe in Part III.
7
For persons listed on 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
Yes
8
Were any amounts reported on 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" on 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) 2015
Page 2
Schedule J (Form 990) 2015
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 on 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 in column(B) reported as deferred on prior Form 990
(i)
Base compensation
(ii)
Bonus & incentive compensation
(iii)
Other reportable compensation
1
ROBERT C GARRETT
GOVERNOR - PRESIDENT/CEO
(i)
(ii)
1,490,912
-------------
0
676,300
-------------
0
1,786,406
-------------
0
880,049
-------------
0
56,023
-------------
0
4,889,690
-------------
0
853,929
-------------
0
2
PRANAYCHANDRA J VAIDYA MD
GOVERNOR
(i)
(ii)
93,462
-------------
453,790
0
-------------
12,391
0
-------------
22,791
1,011
-------------
53,209
0
-------------
34,924
94,473
-------------
577,105
0
-------------
0
3
ROBERT L GLENNING
EVP/CHIEF FINANCIAL OFFICER
(i)
(ii)
995,563
-------------
0
229,900
-------------
0
999,393
-------------
0
443,869
-------------
0
35,551
-------------
0
2,704,276
-------------
0
492,472
-------------
0
4
IHOR S SAWCZUK MD
EVP/CHIEF MEDICAL OFFICER
(i)
(ii)
1,440,663
-------------
0
149,700
-------------
0
268,920
-------------
0
474,340
-------------
0
44,134
-------------
0
2,377,757
-------------
0
83,850
-------------
0
5
AUDREY C MURPHY RN ESQ
EVP/CHIEF LEGAL OFFICER
(i)
(ii)
532,617
-------------
0
125,700
-------------
0
272,525
-------------
0
315,267
-------------
0
32,701
-------------
0
1,278,810
-------------
0
70,243
-------------
0
6
NANCY R CORCORAN-DAVIDOFF
EVP/CHIEF HUMAN RESOURCES OFF
(i)
(ii)
483,096
-------------
0
114,300
-------------
0
295,888
-------------
0
334,278
-------------
0
39,634
-------------
0
1,267,196
-------------
0
81,689
-------------
0
7
DIANNE A AROH
EVP PATIENT CARE/CNO
(i)
(ii)
567,354
-------------
0
125,500
-------------
0
182,061
-------------
0
166,232
-------------
0
3,458
-------------
0
1,044,605
-------------
0
34,545
-------------
0
8
JON M FITZGERALD
EVP/COO - HUMC FOUNDATION
(i)
(ii)
482,190
-------------
0
117,100
-------------
0
28,094
-------------
0
128,025
-------------
0
30,140
-------------
0
785,549
-------------
0
0
-------------
0
9
KETUL J PATEL TERM 13115
EVP/CHIEF OPERATING OFFICER
(i)
(ii)
96,487
-------------
0
199,260
-------------
0
4,384
-------------
0
1,485
-------------
0
10,398
-------------
0
312,014
-------------
0
0
-------------
0
10
MARK D SPARTA
ACTING CEO AT PASCACK VALLEY
(i)
(ii)
466,823
-------------
0
89,200
-------------
0
141,488
-------------
0
183,402
-------------
0
43,055
-------------
0
923,968
-------------
0
0
-------------
0
11
JOSEPH E PARRILLO MD
CHAIRMAN HVH
(i)
(ii)
1,245,517
-------------
0
110,000
-------------
0
121,568
-------------
0
9,275
-------------
0
35,177
-------------
0
1,521,537
-------------
0
0
-------------
0
12
ANDREW L PECORA MD
VP/CHIEF INNOVATION OFFICER
(i)
(ii)
855,835
-------------
0
493,200
-------------
0
52,736
-------------
0
195,726
-------------
0
1,800
-------------
0
1,599,297
-------------
0
16,939
-------------
0
13
ERIC D SOMBERG MD
CHIEF, CARDIOTHORACIC SURGERY
(i)
(ii)
836,041
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
1,800
-------------
0
837,841
-------------
0
0
-------------
0
14
MANUEL ALVAREZ
CHAIR, OB/GYN
(i)
(ii)
438,483
-------------
342,240
28,946
-------------
0
11,578
-------------
0
142,437
-------------
1,323
33,252
-------------
0
654,696
-------------
343,563
0
-------------
0
15
JEFFREY R BOSCAMP MD
VP/CAO & CHAIR, PEDIATRICS
(i)
(ii)
646,545
-------------
0
76,000
-------------
0
71,851
-------------
0
265,290
-------------
0
16,664
-------------
0
1,076,350
-------------
0
0
-------------
0
Schedule J (Form 990) 2015
Page 3
Schedule J (Form 990) 2015
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
SCHEDULE J, PART I; QUESTION 1
THE ORGANIZATION'S CURRENT EXECUTIVE VICE PRESIDENT AND CHIEF DEVELOPMENT OFFICER OF HACKENSACK UNIVERSITY MEDICAL CENTER FOUNDATION, INC., JON M. FITZGERALD, RELOCATED TO THE STATE OF NEW JERSEY FOR HACKENSACK UNIVERSITY MEDICAL CENTER WORK PURPOSES. IN ORDER TO FACILITATE THE RELOCATION OF HIS PRIMARY RESIDENCE, THE ORGANIZATION PROVIDED HIM WITH A HOUSING ALLOWANCE IN THE AMOUNT OF $12,000 WHICH WAS INCLUDED IN HIS 2015 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES.
SCHEDULE J, PART I; QUESTION 3
PLEASE REFER TO OUR RESPONSE TO CORE FORM, PART VI, QUESTION 15 INCLUDED IN SCHEDULE O.
SCHEDULE J, PART I; QUESTION 4
THE ORGANIZATION PROVIDED A SUPPLEMENTAL RETIREMENT PLAN FOR EXECUTIVE EMPLOYEES THAT CONTINUED THE QUALIFIED PENSION PLAN FORMULA AS TO COMPENSATION THAT EXCEEDED THE AMOUNT OF COMPENSATION THAT COULD BE CONSIDERED UNDER THE QUALIFIED PENSION PLAN. ALL PARTICIPATING EXECUTIVE EMPLOYEES RECEIVED A BENEFIT UNDER THE SUPPLEMENTAL PLAN THAT RELATED TO THE EXECUTIVE'S ENTIRE PERIOD OF SERVICE FOR THE ORGANIZATION, WHILE THE VALUE IN ANY ONE YEAR WOULD VARY GREATLY BASED ON FACTORS SUCH AS INTEREST RATES AND THE EMPLOYEE'S AGE. Please note that this plan was frozen as of december 31, 2010.
SCHEDULE J, PART I; QUESTION 4B
THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES VESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH ARE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2015 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: ROBERT C. GARRETT, $168,840; ROBERT L. GLENNING, $106,740; AUDREY C. MURPHY, RN ESQ, $55,524; NANCY R. CORCORAN DAVIDOFF, $49,392 AND DIANNE A. AROH, $58,788 (NEW FLEX PLAN). THE AMOUNTS REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") WHICH ARE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2015 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: ROBERT C. GARRETT, $1,536,397; ROBERT L. GLENNING, $854,231; IHOR S. SAWCZUK, M.D., $221,897; AUDREY C. MURPHY, RN ESQ., $181,744; NANCY R. CORCORAN-DAVIDOFF, $211,463; DIANNE A. AROH, $95,861; JOSEPH E. PARRILLO, M.D., $95,811; ANDREW L. PECORA, M.D., $45,344; MARK D. SPARTA, $62,192; MANUEL ALVAREZ, $10,561 AND JEFFREY R. BOSCAMP, M.D., $25,816 (NEW SERP PLAN). THE ORGANIZATION, ON JANUARY 1, 2011, INSTITUTED A DEFERRED COMPENSATION PROGRAM UNDER INTERNAL REVENUE CODE SECTION 401(A) WHEREIN THE ORGANIZATION MATCHES 2% OF AN INDIVIDUAL'S SALARY UP TO A MAXIMUM OF $5,300. THE MATCH IS SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE AMOUNTS WERE NOT INCLUDED IN EACH INDIVIDUAL'S 2015 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDES UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THE UNVESTED BENEFITS. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN THESE INDIVIDUAL'S 2015 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: ROBERT C. GARRETT, $287,897; ROBERT L. GLENNING, $29,283; IHOR S. SAWCZUK, M.D., $172,597; AUDREY C. MURPHY, R.N., ESQ., $136,896; NANCY R. CORCORAN-DAVIDOFF, $169,642; DIANNE A. AROH, $59,813; MARK D. SPARTA, $31,951; JON M. FITZGERALD, $47,500; JUNE ARCHER, $6,923; ANDREW L. PECORA, M.D., $64,417; MANUEL ALVAREZ, $52,393 AND JEFFREY R. BOSCAMP, M.D., $143,051 (OLD AND NEW SERP PLANS).
SCHEDULE J, PART I; QUESTION 7
Certain listed individuals received, as part of their compensation, payments under a long-term incentive compensation plan. These performance awards were based on the achievement of challenging long-term goals relating to Hackensack University Medical Centers mission of delivering excellent patient care to the community it serves. The incentive compensation awards were reviewed and approved by a committee of the Hackensack University Health Network, Inc. Board of Trustees consisting entirely of independent Board members. This committee reviewed and approved the incentive compensation awards, together with all compensation amounts, in a manner that qualifies for the "rebuttable presumption of reasonableness" under Internal Revenue Service rules. This means that the compensation is presumed to be reasonable under federal tax law.
SCHEDULE J, PART II; COLUMN F
THE AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN F FOR THE FOLLOWING INDIVIDUALS INCLUDES VESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) AS THE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE REPORTED IN SCHEDULE J, PART II, COLUMN (C) AS RETIREMENT AND OTHER DEFERRED COMPENSATION ON PRIOR YEAR'S FORM 990. THESE AMOUNTS WERE TREATED AS TAXABLE INCOME AND REPORTED IN THE INDIVIDUAL'S 2015 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: ROBERT C. GARRETT, $853,929; ROBERT L. GLENNING, $492,472; IHOR S. SAWCZUK, M.D., $83,850; AUDREY C. MURPHY, R.N., ESQ., $70,243; NANCY R. CORCORAN-DAVIDOFF, $81,689; DIANNE A. AROH, $34,545 AND ANDREW L. PECORA, M.D., $16,939.
Schedule J (Form 990) 2015
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