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ObjectId: 201721009349301217 - Submission: 2017-04-10
TIN: 44-0546366
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
CAPITAL REGION MEDICAL CENTER
Employer identification number
44-0546366
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
Yes
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
Yes
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
Yes
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
Gaspare Calvaruso
President
(i)
(ii)
346,676
-------------
0
38,937
-------------
0
6,135
-------------
0
3,826
-------------
0
52,084
-------------
0
447,658
-------------
0
0
-------------
0
2
Tom Luebbering
Vice President
(i)
(ii)
174,953
-------------
0
20,817
-------------
0
135
-------------
0
7,177
-------------
0
43,137
-------------
0
246,219
-------------
0
0
-------------
0
3
Janet Weckenborg
Vice President
(i)
(ii)
170,699
-------------
0
30,681
-------------
0
135
-------------
0
6,986
-------------
0
39,640
-------------
0
248,141
-------------
0
0
-------------
0
4
Bob Mazur
Vice President
(i)
(ii)
103,504
-------------
0
42,773
-------------
0
2,175
-------------
0
5,500
-------------
0
36,998
-------------
0
190,950
-------------
0
0
-------------
0
5
Sarah Morrow
Vice President - partial year
(i)
(ii)
0
-------------
0
14,000
-------------
0
0
-------------
0
0
-------------
0
2,748
-------------
0
16,748
-------------
0
0
-------------
0
6
Deborah Voskamp
Vice President - partial year
(i)
(ii)
84,985
-------------
0
0
-------------
0
135
-------------
0
0
-------------
0
18,605
-------------
0
103,725
-------------
0
0
-------------
0
7
Tanya Sandifer
Vice President - partial year
(i)
(ii)
47,697
-------------
0
155,100
-------------
0
0
-------------
0
985
-------------
0
28,462
-------------
0
232,244
-------------
0
0
-------------
0
8
Jason Cecil
Vice President
(i)
(ii)
132,461
-------------
0
12,045
-------------
0
135
-------------
0
5,519
-------------
0
42,319
-------------
0
192,479
-------------
0
0
-------------
0
9
Randall Haight
Vice President/Physician
(i)
(ii)
246,431
-------------
0
31,596
-------------
0
135
-------------
0
9,053
-------------
0
50,378
-------------
0
337,593
-------------
0
0
-------------
0
10
Lisa Kolb Waggoner
Board Member/Physician
(i)
(ii)
186,509
-------------
0
2,746
-------------
0
135
-------------
0
7,709
-------------
0
45,874
-------------
0
242,973
-------------
0
0
-------------
0
11
Diane Light
Board Member/Physician
(i)
(ii)
295,769
-------------
0
13,193
-------------
0
135
-------------
0
10,600
-------------
0
40,045
-------------
0
359,742
-------------
0
0
-------------
0
12
Mitchell Godbee
Chief of Staff/Physician
(i)
(ii)
776,554
-------------
0
250,728
-------------
0
210
-------------
0
10,600
-------------
0
76,126
-------------
0
1,114,218
-------------
0
0
-------------
0
13
Dennis Luetkemeyer
Physician
(i)
(ii)
573,092
-------------
0
180,064
-------------
0
135
-------------
0
5,300
-------------
0
65,706
-------------
0
824,297
-------------
0
0
-------------
0
14
Matthew Hrastich
Physician
(i)
(ii)
614,454
-------------
0
42,485
-------------
0
135
-------------
0
9,521
-------------
0
62,198
-------------
0
728,793
-------------
0
0
-------------
0
15
Adam Patterson
Physician
(i)
(ii)
525,744
-------------
0
91,291
-------------
0
135
-------------
0
10,600
-------------
0
60,534
-------------
0
688,304
-------------
0
0
-------------
0
16
Eston Schwartz
Physician
(i)
(ii)
581,054
-------------
0
559
-------------
0
210
-------------
0
10,600
-------------
0
61,691
-------------
0
654,114
-------------
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, Line 1a
CRMC pays dues for the President to be a member of the Jefferson City Country Club. This is used for many business reasons. any personal expenses incurred are reimbursed by the President to the Medical Center. Travel for Companions - When it is determined that there is a business benefit for the spouse to attend, CRMC will pay expenses for companion travel. For Employee Star awards, the check is grossed up and the medical center pays the taxes on the employee behalf.
Schedule J, Part I, Line 3
Annually, all board members complete an evaluation of the CEO and individually present the results to the board chair who presents them to the compensation committee, consisting of 3 board members, including the Chair and Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on salary surveys from three different organizations. The comparable data are based on Missouri or the region. The compensation committee members do not have a conflect of interest with respect to the compensation arrangements. The committee documents their review and decisions.
Schedule J, Part I, Line 4
Tanya Sandifer received $147,617 in severance payments in 2015 (calender year). Contributed to a 457(b) Deferred Comp Plan: Calvaruso $2600, Luebbering $3535, Weckenborg $8139, Mazur $3528, Sandifier $4258, Cecil $2699, Haight $3337, Godbee $18000, Hrastich $15525, Patterson $17500, Schwartz $17966
Schedule J, Part I, Line 5
For all employees annual merit increases are patially based on the achievement of goals (personal and organizational). some of the organizational goals may be tied to Revenues.
Schedule J, Part I, Line 6
For all employees annual merit increases are partially based on the achievement of goals (personal and organizational). Some of the organizational goals may be tied to net earnings.
Schedule J, Part I, Line 7
Some Directors, Vice Presidents, and the President participate in the Management Incentive Compensation Program (MICP). They receive additional bonus compensation if certain stated goals are met. Most physicians receive a base salary, but also are paid an additional amount based on production.
Schedule J, Part II
Thomas Niekamp is an employee of the University of Missouri. Capital Region Medical Center makes payments to the University for the services he provides to CRMC as Vice President.
Schedule J (Form 990) 2015
Additional Data
Software ID:
15000352
Software Version:
v1.00