Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
The Cheshire Medical Center
 
Employer identification number

02-0354549
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.
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
 
No
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.
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), 501(c)(4), and 501(c)(29) organizations 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
Yes
 
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) 2014
Page 2

Schedule J (Form 990) 2014
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 in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1John Birkmeyer MDTrustee (i)
(ii)		 0
.................
211,596 		0
.................
0 		0
.................
50,103 		0
.................
30,458 		0
.................
4,400 		0
.................
296,557 		0
.................
0
2Judith A Boule MDMedical Staff President (i)
(ii)		 0
.................
284,901 		0
.................
0 		0
.................
39,717 		0
.................
258,941 		0
.................
17,599 		0
.................
601,158 		0
.................
0
3Wendy Fielding CPATrustee (i)
(ii)		 0
.................
220,289 		0
.................
0 		0
.................
270 		0
.................
37,462 		0
.................
20,362 		0
.................
278,383 		0
.................
0
4Timothy J Fisher MDTrustee (i)
(ii)		 0
.................
276,988 		0
.................
0 		0
.................
0 		0
.................
54,503 		0
.................
20,059 		0
.................
351,550 		0
.................
0
5Lawrence J Jaeger MDTrustee (i)
(ii)		 0
.................
317,165 		0
.................
0 		0
.................
744 		0
.................
238,600 		0
.................
13,682 		0
.................
570,191 		0
.................
0
6Steven Paris MDTrustee (i)
(ii)		 0
.................
329,589 		0
.................
0 		0
.................
27,982 		0
.................
100,968 		0
.................
16,361 		0
.................
474,900 		0
.................
0
7Leslie T Pitts MDTrustee (i)
(ii)		 0
.................
264,504 		0
.................
0 		0
.................
260 		0
.................
191,801 		0
.................
17,729 		0
.................
474,294 		0
.................
0
8Arthur W NicholsPresident (i)
(ii)		 466,891
.................
0 		57,978
.................
0 		47,380
.................
0 		77,642
.................
0 		21,661
.................
0 		671,552
.................
0 		0
.................
0
9Don Caruso MDCEO/CMO (i)
(ii)		 0
.................
342,742 		0
.................
0 		0
.................
2,014 		0
.................
236,579 		0
.................
17,839 		0
.................
599,174 		0
.................
0
10Robert CochraneCFO (i)
(ii)		 207,760
.................
0 		0
.................
0 		0
.................
0 		0
.................
0 		18,168
.................
0 		225,928
.................
0 		0
.................
0
11Cindi CoughlinCNO (i)
(ii)		 163,449
.................
0 		0
.................
0 		33,000
.................
0 		86,924
.................
0 		19,145
.................
0 		302,518
.................
0 		0
.................
0
12Paul PezoneVP Facilities & Support Se (i)
(ii)		 144,237
.................
0 		0
.................
0 		41,400
.................
0 		20,656
.................
0 		18,606
.................
0 		224,899
.................
0 		0
.................
0
13Erli ChenPhysicist (i)
(ii)		 188,138
.................
0 		0
.................
0 		44,905
.................
0 		29,339
.................
0 		14,891
.................
0 		277,273
.................
0 		0
.................
0
14Larry MillerChief CRNA (i)
(ii)		 178,618
.................
0 		0
.................
0 		22,490
.................
0 		63,600
.................
0 		9,099
.................
0 		273,807
.................
0 		0
.................
0
15Julie GreenVP, Human Resources (i)
(ii)		 134,968
.................
0 		0
.................
0 		46,900
.................
0 		25,637
.................
0 		19,206
.................
0 		226,711
.................
0 		0
.................
0
16Yvonne GoldsberrySr. Director of Community Health (i)
(ii)		 130,191
.................
0 		0
.................
0 		38,500
.................
0 		18,675
.................
0 		15,070
.................
0 		202,436
.................
0 		0
.................
0
17Letasha HeapeCRNA (i)
(ii)		 155,877
.................
0 		0
.................
0 		0
.................
0 		6,231
.................
0 		22,933
.................
0 		185,041
.................
0 		0
.................
0
Schedule J (Form 990) 2014
Page 3

Schedule J (Form 990) 2014
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 1a The Cheshire Medical Center does not reimburse expenses for first class travel, housing allowance, health or social club dues, personal services, business use of personal residence, discretionary spending accounts, or provide tax indemnification or gross up payments. The Medical Center does reimburse Board members for companion travel to business related meetings under specific circumstances. All reimbursements are reported on a Form 1099 issued to the Board member. During the calendar year 2014, which is the basis for Form 990, Part VII and Schedule J reporting for the fiscal year ending June 30, 2015, no Board members were reimbursed under this arrangement.
Part I, Line 3 The President of The Cheshire Medical Center is paid by the filing organization and methods use to determine compensation are as noted on Schedule, J, Part I, Line 3. The CEO is paid by Dartmouth-Hithcock Health, a related organization, which uses a compensation committee, an independent consultant, Form 990 of other organizatinos, written employment contract, a compensation survey or study, and approval by the Board or compensation committee to establish the CEO's compensation.
Part I, Line 4b Dartmouth-Hitchcock, a related organization at the end of the filing period, paid compensation through a SERP to the following individuals listed in Part VII: Stephen A. Paris-$19,669; Judith A. Boule-$38,211. Dartmouth-Hitchcock supplemental retirement plan terms and conditions: An eligible employee is a participant in the Dartmouth-Hitchcock retirement plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (including a qualified defined benefit plan) who would be entitled to additional contributions or benefit accruals under the terms of the plans for the plan year, but are limited by IRC section 401(a)(17) and/or 415. For eligible employees, the employer will pay the eligible employee an amount determined by the employer each year to offset the amount of the reduction in the benefit accrual or contributions as a result of limitations imposed by IRC sections 401(a)(17) and/or 415.
Part I, Line 7 Senior Management is eligible for incentive compensation at the discretion of the Board based on, but not directly related to, overall organizational financial performance and other discretionary measures.
Form 990, Part VII-A and Schedule J, Part II: The annual change in the actuarial value of the pension plan for the employees listed below has been reported as part of deferred compensation. The pension plan is held and administered by a related organization, The Cheshire Medical Center. The amounts reported for 2014 are: Arthur Nichols-$43,649 Cynthia Coughlin-$65,909 Paul Pezone-$1,101 Erli Chen-$8,595 Larry Miller-$38,424 Julienne Green-$2,806 Yvonne Goldsberry-$7,332 The present value of the accrued benefit at the beginning of the reporting period, representing accrual over multiple years of service for each participant, was: Arthur Nichols-$829,347 Cynthia Coughlin-$544,606 Paul Pezone-$32,348 Erli Chen-$120,724 Larry Miller-$982,529 Julienne Green-$79,794 Yvonne Goldsberry-$33,435
Schedule J (Form 990) 2014

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