efile Public Visual Render
ObjectId: 201701359349313510 - Submission: 2017-05-15
TIN: 84-0405257
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
Catholic Health Initiatives Colorado
Employer identification number
84-0405257
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
MICHAEL ROWAN FACHE
CHAIR
(i)
(ii)
0
-------------
1,273,340
0
-------------
1,763,164
0
-------------
859,409
0
-------------
15,775
0
-------------
41,802
0
-------------
3,953,490
0
-------------
242,516
2
DEAN SWINDLE CPA
VICE CHAIR
(i)
(ii)
0
-------------
1,160,179
0
-------------
1,519,534
0
-------------
232,777
0
-------------
303,959
0
-------------
17,848
0
-------------
3,234,297
0
-------------
145,738
3
MARGARET SABIN
GROUP CEO & CEO - PENROSE ST FRANCIS HEALTH SERVICES
(i)
(ii)
631,113
-------------
0
319,946
-------------
0
243,076
-------------
0
153,003
-------------
0
92,050
-------------
0
1,439,188
-------------
0
133,860
-------------
0
4
DANIEL REEVES
Group CFO & CFO - Penrose St Francis Health Services
(i)
(ii)
283,673
-------------
0
89,378
-------------
0
9,387
-------------
0
24,000
-------------
0
13,693
-------------
0
420,131
-------------
0
0
-------------
0
5
DAVID THOMPSON
Group CFO & CFO - St. Anthony's Hospital
(i)
(ii)
330,678
-------------
0
98,946
-------------
0
16,827
-------------
0
24,000
-------------
0
19,096
-------------
0
489,547
-------------
0
0
-------------
0
6
Jeffrey Brickman
Group CEO & CEO - St. Anthony's Hospital
(i)
(ii)
631,114
-------------
0
305,772
-------------
0
183,494
-------------
0
134,160
-------------
0
2,571
-------------
0
1,257,111
-------------
0
149,218
-------------
0
7
Janiece MCNichols
FORMER KE - CFO - St. Anthony North
(i)
(ii)
180,960
-------------
0
52,545
-------------
0
21,198
-------------
0
4,192
-------------
0
7,154
-------------
0
266,049
-------------
0
0
-------------
0
8
Thomas Gessel
CEO Mercy Regional Medical Center
(i)
(ii)
338,701
-------------
0
168,098
-------------
0
105,508
-------------
0
24,000
-------------
0
22,644
-------------
0
658,951
-------------
0
0
-------------
0
9
Jane Strobel
CFO Mercy Regional Medical Center
(i)
(ii)
170,032
-------------
0
52,849
-------------
0
19,753
-------------
0
24,000
-------------
0
1,568
-------------
0
268,202
-------------
0
0
-------------
0
10
Brian Moore
CEO St. Mary-Corwin Medical Center
(i)
(ii)
298,662
-------------
0
105,232
-------------
0
35,826
-------------
0
18,000
-------------
0
25,977
-------------
0
483,697
-------------
0
0
-------------
0
11
Vanessa Kochevar
CFO St. Mary-Corwin Medical Center
(i)
(ii)
224,107
-------------
0
65,801
-------------
0
505
-------------
0
18,000
-------------
0
22,644
-------------
0
331,057
-------------
0
0
-------------
0
12
A STEWART LEVY
PHYSICIAN
(i)
(ii)
830,392
-------------
0
1,866
-------------
0
2,208
-------------
0
24,000
-------------
0
29,613
-------------
0
888,079
-------------
0
0
-------------
0
13
Mark ROBINSON
Physician
(i)
(ii)
843,399
-------------
0
104,336
-------------
0
1,233
-------------
0
18,000
-------------
0
13,526
-------------
0
980,494
-------------
0
0
-------------
0
14
Camille Azar
Physician
(i)
(ii)
674,787
-------------
0
157,108
-------------
0
3,968
-------------
0
24,000
-------------
0
13,682
-------------
0
873,545
-------------
0
0
-------------
0
15
Shawn Nakamura
Physician
(i)
(ii)
644,113
-------------
0
181,114
-------------
0
3,440
-------------
0
36,000
-------------
0
6,806
-------------
0
871,473
-------------
0
0
-------------
0
16
Brandon Green
Physician
(i)
(ii)
575,511
-------------
0
177,467
-------------
0
913
-------------
0
18,000
-------------
0
16,161
-------------
0
788,052
-------------
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 II REPORTABLE INDIVIDUALS COMPENSATED BY UNRELATED ORGANIZATIONS
ALL KEY EMPLOYEES AND HOSPITAL CEOS ARE COMPENSATED BY CENTURA HEALTH CORPORATION, WHO MANAGES THE DAILY ACTIVITIES OF THE CATHOLIC HEALTH INITIATIVES-COLORADO (CHIC) HOSPITALS UNDER A JOINT OPERATING AGREEMENT DATED DECEMBER 8, 1995 BETWEEN THE ADVENTIST HEALTHCARE SYSTEM AND CATHOLIC HEALTH INITIATIVES. AS SUCH, THEIR SALARIES ARE PAID TO THEM BY CENTURA, AN UNRELATED ORGANIZATION, FOR SERVICES RENDERED IN THEIR CAPACITY AS KEY EMPLOYEES OR OFFICERS OF CHIC. ALL OF THEIR REPORTABLE COMPENSATION IS DISCLOSED ON FORM 990, SCHEDULE J, PART II, ROW (I) AND 990, PART VII, COLUMN (D) AS REPORTING ORGANIZATION COMPENSATION. IN ADDITION, THE CEO AND CFO OF CHIC WERE APPOINTED AS SUCH BY THE CHIC BOARD OF DIRECTORS. WHILE THEY ARE OFFICERS OF THESE ENTITIES, A VERY SMALL PORTION OF THEIR TIME IS DIRECTLY RELATED TO THE OPERATIONS OF CHIC. THEY ARE COMPENSATED BY CENTURA, WHICH IS CHARGED WITH MANAGING THE FACILITIES. THEIR RESPECTIVE COMPENSATION IS NOT REPORTED ON THE FILING ORGANIZATION'S 990 BUT IN FACT IS REPORTED IN FULL ON PART VII AND SCHEDULE J OF CENTURA HEALTH CORPORATION'S FORM 990.
Schedule J, Part I, Line 3 METHODS USED TO ESTABLISH CEO COMPENSATION
CATHOLIC HEALTH INITIATIVES-COLORADO'S CEO IS PAID BY CENTURA HEALTH CORPORATION (CENTURA). OUTSIDE CONSULTANTS ARE ENGAGED TO PROVIDE RECOMMENDATIONS TO CENTURA'S COMPENSATION COMMITTEE REGARDING THE COMPENSATION OF FACILITY CEOS. THE CONSULTANT'S RECOMMENDATIONS ARE THEN PRESENTED TO AND APPROVED BY THE COMPENSATION COMMITTEE.
Schedule J, Part I, Line 1a Travel for companions
SENIOR VICE PRESIDENTS AND HOSPITAL CEOS ARE PAID THROUGH CENTURA HEALTH CORPORATION AND ARE ELIGIBLE FOR THE FOLLOWING BENEFITS: TRAVEL FOR COMPANIONS, HEALTH OR SOCIAL CLUB DUES, AND REIMBURSEMENT UP TO $10,000 FOR PERSONAL SERVICES SUCH AS TAX, FINANCIAL, AND ESTATE PLANNING SERVICES, ALONG WITH TAX GROSS-UP PAYMENTS FOR ANY REIMBURSEMENTS INCLUDED IN TAXABLE COMPENSATION. ALL BENEFITS ARE PROVIDED PURSUANT TO A WRITTEN POLICY GOVERNING PAYMENT AND REIMBURSEMENT, SUBSTANTIATION IS REQUIRED FOR ALL EXPENSES SUBMITTED FOR REIMBURSEMENT, AND REIMBURSEMENTS ARE INCLUDED IN TAXABLE COMPENSATION WHERE APPROPRIATE.
Schedule J, Part I, Line 1a Tax indemnification and gross-up payments
See Schedule J, Part I, Line 1a - Travel for Companions Disclosure
Schedule J, Part I, Line 1a Personal services
See Schedule J, Part I, Line 1a - Travel for Companions Disclosure
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
DURING THE 2015 CALENDAR YEAR CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: MICHAEL ROWAN, JAMES SWINDLE, AND JOHN DICOLA. DURING 2015, THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: JAMES SWINDLE $288,009 John Dicola $144,319 DURING 2015, THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: MICHAEL ROWAN $242,516 JAMES SWINDLE $145,738 JOHN DICOLA $411,817 DUE TO THE "SUPER" VESTING RULES UNDER THE CHI DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS TERMINATION, AGE, OR YEARS OF SERVICE ARE ELIGIBLE TO RECEIVE THEIR 2015 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2015, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: MICHAEL ROWAN $313,628 IN ADDITION, CENTURA OFFERS A NON-QUALIFIED RETIREMENT PLAN IN WHICH SENIOR EXECUTIVES (SENIOR VP'S AND ABOVE) ARE PROVIDED A 10% OF SALARY ALLOWANCE TO PURCHASE INSURANCE PRODUCTS OR CONTRIBUTE INTO THE DEFERRED COMPENSATION PLAN. IN ADDITION, A PENSION RESTORATION BENEFIT IS PROVIDED WHICH CREDITS PARTICIPANTS WITH A BENEFIT WHICH IS CALCULATED BASED ON THE EXCESS OF THE PARTICIPANT'S COMPENSATION OVER THE MAXIMUM ALLOWED FOR PENSION CONTRIBUTIONS. AMOUNTS DEFERRED ARE NOT REPORTED AS TAXABLE INCOME UNTIL/UNLESS A TRIGGERING EVENT OCCURS. THIS DEFERRED COMPENSATION PLAN HAS A SUBSTANTIAL RISK OF FORFEITURE PROVISION AND AN ELECTED VESTING SCHEDULE. THE FOLLOWING INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN AND RECEIVED CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN DURING THE CALENDAR YEAR 2015: MARGARET SABIN $154,314 JEFFREY BRICKMAN $167,792 DURING THE CALENDAR YEAR 2015 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CENTURA FROM THE DEFERRED COMPENSATION PLAN: JEFFREY BRICKMAN $110,160 MARGARET SABIN $129,003
Schedule J, Part I, Line 7 Non-fixed payments
PARTICIPANTS IN CENTURA'S INCENTIVE COMPENSATION PLANS INCLUDE DIRECTORS AND ABOVE. PAYOUTS ARE BASED ON METRICS ESTABLISHED AND APPROVED BY CENTURA'S COMPENSATION COMMITTEE. THE METRICS INCLUDE QUANTIFIABLE MEASURES PERTAINING TO FINANCIAL PERFORMANCE, SAFETY AND QUALITY AND ASSOCIATE SATISFACTION WITH EACH METRIC WEIGHTED IN DETERMINING THE OVERALL SCORE. THE INCENTIVE COMPENSATION PAYOUT IS CALCULATED BASED ON THE CUMULATIVE SCORE FOR ALL METRICS AND THE PAYOUT IS BASED ON A COMBINATION OF THE SCORE, THE INDIVIDUAL'S BASE COMPENSATION AMOUNT AND POSITION (E.G. DIRECTOR, VICE PRESIDENT).
Schedule J, Part II COMPENSATION FROM AN UNRELATED ORGANIZATION OR INDIVIDUAL
NAME - MARGARET SABIN, COMPENSATION FROM UNRELATED ORGANIZATION - 1439188.000000, NAME OF UNRELATED ORGANIZATION - CENTURA HEALTH CORPORATION, TYPE OF COMPENSATION - WAGES AND BENEFITS
Schedule J, Part II COMPENSATION FROM AN UNRELATED ORGANIZATION OR INDIVIDUAL
NAME - DANIEL REEVES, COMPENSATION FROM UNRELATED ORGANIZATION - 420131.000000, NAME OF UNRELATED ORGANIZATION - CENTURA HEALTH CORPORATION, TYPE OF COMPENSATION - WAGES AND BENEFITS
Schedule J, Part II COMPENSATION FROM AN UNRELATED ORGANIZATION OR INDIVIDUAL
NAME - DAVID THOMPSON, COMPENSATION FROM UNRELATED ORGANIZATION - 489547.000000, NAME OF UNRELATED ORGANIZATION - CENTURA HEALTH CORPORATION, TYPE OF COMPENSATION - SALARIES AND WAGES
Schedule J (Form 990) 2015
Additional Data
Software ID:
15000238
Software Version:
2015v3.0