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ObjectId: 201641349349301874 - Submission: 2016-05-13
TIN: 74-1653640
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.
Information about Schedule J (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
Memorial Hermann Foundation
Employer identification number
74-1653640
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), 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
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) 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
1
Wolterman Daniel J
Director; President & CEO
(i)
(ii)
0
.................
1,275,023
0
.................
1,463,325
0
.................
407,895
0
.................
2,449,324
0
.................
14,651
0
.................
5,610,218
0
.................
272,575
2
Laraway Dennis L
CFO & Treasurer
(i)
(ii)
0
.................
747,405
0
.................
609,321
0
.................
4,859
0
.................
199,356
0
.................
10,853
0
.................
1,571,794
0
.................
0
3
Gordon Deborah
Chief Legal Officer & Secr
(i)
(ii)
0
.................
246,487
0
.................
0
0
.................
164,604
0
.................
18,049
0
.................
8,424
0
.................
437,564
0
.................
0
4
Shea W Christopher
Deputy General Counsel & Asst
(i)
(ii)
0
.................
282,960
0
.................
61,923
0
.................
1,415
0
.................
16,068
0
.................
9,045
0
.................
371,411
0
.................
0
5
Trevino Illeana V
CEO Foundation
(i)
(ii)
320,222
.................
0
210,623
.................
0
57,591
.................
0
68,552
.................
0
14,014
.................
0
671,002
.................
0
41,929
.................
0
6
Voss Julie
VP, FOUNDATION MAJOR GIFT
(i)
(ii)
150,102
.................
0
59,853
.................
0
8,293
.................
0
37,166
.................
0
13,037
.................
0
268,451
.................
0
4,583
.................
0
7
BAYLESSELIZABETH G
Dir Foundation I
(i)
(ii)
126,698
.................
0
27,155
.................
0
807
.................
0
9,354
.................
0
5,076
.................
0
169,090
.................
0
0
.................
0
8
Lackey Deborah B
Dir Foundation III
(i)
(ii)
136,212
.................
0
29,629
.................
0
942
.................
0
11,605
.................
0
9,864
.................
0
188,252
.................
0
0
.................
0
9
SUSMANROBIN A
Dir Foundation II
(i)
(ii)
133,469
.................
0
29,183
.................
0
5,109
.................
0
10,287
.................
0
5,142
.................
0
183,190
.................
0
0
.................
0
10
Duco Bernard A Jr
Former CLO & Serc
(i)
(ii)
0
.................
271,923
0
.................
353,040
0
.................
649,656
0
.................
43,001
0
.................
2,308
0
.................
1,319,928
0
.................
93,822
11
MCVEIGHDENNIS P
Former CAO & Asst Treas
(i)
(ii)
0
.................
11,547
0
.................
42,851
0
.................
462,089
0
.................
792,527
0
.................
0
0
.................
1,309,014
0
.................
31,948
12
Reimer P Renee
Frmr Chief Risk Off &Asst Secr
(i)
(ii)
0
.................
325,823
0
.................
210,694
0
.................
54,045
0
.................
111,614
0
.................
7,203
0
.................
709,379
0
.................
44,750
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
Nonqualified Retirement Plans
Memorial Hermann Health System (of which this filer is a part) sponsors two nonqualified retirement plans for certain executives who are part of a select group of highly compensated or management employees. The first plan is called the Memorial Hermann Supplemental Executive Retirement Plan (SERP). It is a make-up plan and provides for an annual payment (upon achieving full vesting in the qualified retirement plan) equivalent to the amount of the accrual from the employer that is lost to the employee due to the limits on compensation and benefits in the Internal Revenue Code. The second plan is called the Memorial Hermann Health System Select Group 457(b) Deferred Compensation Plan (457). It allows for deferral of base salary for those executives who work for a tax exempt entity of Memorial Hermann and whose base salary is above the qualified plan limit. Contributions to this plan are subject to the IRS federal limit. No matching contributions are made on any deferrals under this plan. Applicable SERP amounts accrued per person: Wolterman 100,490.59 Trevino 9,931.32 Duco 12,385.41 Reimer 7,599.67 Applicable 457 amounts distributed per person: Duco 20,833.68 Mcveigh 29,106.36
Schedule J (Form 990) 2014
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