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ObjectId: 201722159349301102 - Submission: 2017-08-03
TIN: 04-3358566
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
UMass Memorial Health Care Inc (Parent)
Employer identification number
04-3358566
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
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 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
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
No
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
Gary N Lapidas
Former President/Director until 1/18/13, UMM Health Ventures, Inc.
(i)
(ii)
0
-------------
0
0
-------------
0
578,684
-------------
0
0
-------------
0
109
-------------
0
578,794
-------------
0
578,684
-------------
0
2
Eric W Dickson MD
President & CEO/Director, UMM Health Care, Inc.
(i)
(ii)
929,390
-------------
0
446,327
-------------
0
59,404
-------------
0
345,769
-------------
0
53,241
-------------
0
1,834,131
-------------
0
57,487
-------------
0
3
Cheryl M Lapriore
President/Director, UMM Health Ventures, Inc.
(i)
(ii)
254,023
-------------
0
58,020
-------------
0
79,214
-------------
0
95,921
-------------
0
23,357
-------------
0
510,536
-------------
0
79,214
-------------
0
4
Dana E Swenson
President/Director, UMM Realty, Inc.
(i)
(ii)
245,140
-------------
0
55,755
-------------
0
0
-------------
0
92,725
-------------
0
22,462
-------------
0
416,082
-------------
0
0
-------------
0
5
Robert W Finberg MD
Director, UMM Health Care, Inc.
(i)
(ii)
0
-------------
262,809
0
-------------
28,470
0
-------------
640,000
0
-------------
107,867
0
-------------
29,448
0
-------------
1,068,594
0
-------------
640,000
6
Carlos Iitsuka
Director until 7/16, UMM Health Ventures, Inc.
(i)
(ii)
298,073
-------------
0
83,850
-------------
0
0
-------------
0
37,197
-------------
0
29,470
-------------
0
448,589
-------------
0
0
-------------
0
7
O Nsidinanya Okike MD
Director, UMM Health Care, Inc.
(i)
(ii)
0
-------------
126,955
0
-------------
0
0
-------------
206,903
0
-------------
1,587
0
-------------
2,328
0
-------------
337,773
0
-------------
19,000
8
Chris Philbin
Director, Clinton Hospital Association
(i)
(ii)
197,596
-------------
0
36,720
-------------
0
6,189
-------------
0
28,801
-------------
0
25,965
-------------
0
295,272
-------------
0
6,189
-------------
0
9
Catherine Rossi
Director, Clinton Hospital Association
(i)
(ii)
179,541
-------------
0
33,048
-------------
0
12,218
-------------
0
54,986
-------------
0
24,690
-------------
0
304,483
-------------
0
12,218
-------------
0
10
Douglas S Brown
Secretary, UMM Health Care, Inc.
(i)
(ii)
541,141
-------------
0
145,260
-------------
0
51,623
-------------
0
230,248
-------------
0
24,551
-------------
0
992,823
-------------
0
51,623
-------------
0
11
Katharine Bolland Eshghi
Assistant Secretary, UMM Health Care, Inc.
(i)
(ii)
334,982
-------------
0
75,735
-------------
0
35,381
-------------
0
74,940
-------------
0
24,357
-------------
0
545,396
-------------
0
35,381
-------------
0
12
John Glassburn
Secretary, UMM Community Hospitals, Inc.
(i)
(ii)
174,318
-------------
0
9,551
-------------
0
0
-------------
0
4,854
-------------
0
22,462
-------------
0
211,185
-------------
0
0
-------------
0
13
Sergio Melgar
Treasurer, UMM Health Care, Inc.
(i)
(ii)
650,172
-------------
0
175,500
-------------
0
0
-------------
0
79,034
-------------
0
39,149
-------------
0
943,854
-------------
0
0
-------------
0
14
William O'Brien
Secretary, UMBHS, Inc.
(i)
(ii)
121,856
-------------
0
7,015
-------------
0
0
-------------
0
31,003
-------------
0
25,965
-------------
0
185,841
-------------
0
0
-------------
0
15
Jeanne Shirshac
Treasurer, UMM Accountable Care Organization, Inc.
(i)
(ii)
199,214
-------------
0
36,755
-------------
0
6,977
-------------
0
26,980
-------------
0
24,545
-------------
0
294,471
-------------
0
6,977
-------------
0
16
Francis W Smith
Secretary, UMM Medical Group, Inc.
(i)
(ii)
196,526
-------------
0
14,584
-------------
0
0
-------------
0
18,175
-------------
0
26,476
-------------
0
255,762
-------------
0
0
-------------
0
17
Milton Anderson
Former Sr. VP, Chief HR Officer until 9/14
(i)
(ii)
0
-------------
0
0
-------------
0
197,672
-------------
0
12,246
-------------
0
2,243
-------------
0
212,161
-------------
0
197,672
-------------
0
18
George Brenckle PhD
Former Sr. VP, Chief Information Officer until 4/14
(i)
(ii)
0
-------------
0
0
-------------
0
283,922
-------------
0
50,093
-------------
0
109
-------------
0
334,123
-------------
0
283,922
-------------
0
19
James P Cyr
Sr. VP, Operations (UMMMC)
(i)
(ii)
0
-------------
251,134
0
-------------
57,500
0
-------------
39,833
0
-------------
144,362
0
-------------
23,357
0
-------------
516,186
0
-------------
39,833
20
Therese Day
VP, Finance / CFO of Med Center
(i)
(ii)
0
-------------
284,949
0
-------------
64,837
0
-------------
21,081
0
-------------
114,112
0
-------------
23,357
0
-------------
508,336
0
-------------
21,081
21
Robert Feldmann
VP, Corporate Controller
(i)
(ii)
265,340
-------------
0
89,936
-------------
0
0
-------------
0
83,498
-------------
0
25,664
-------------
0
464,438
-------------
0
0
-------------
0
22
Barbara Fisher
Sr VP, Operations (UMMMC)
(i)
(ii)
0
-------------
259,412
0
-------------
59,592
0
-------------
34,021
0
-------------
145,401
0
-------------
24,962
0
-------------
523,387
0
-------------
34,021
23
Patricia George
VP & Deputy CIO, until 11/15
(i)
(ii)
301,124
-------------
0
60,469
-------------
0
25,000
-------------
0
35,957
-------------
0
15,390
-------------
0
437,939
-------------
0
25,000
-------------
0
24
Margaret Hudlin MD
CMO/VP Perioperative Svcs, until 9/1/16
(i)
(ii)
0
-------------
352,077
0
-------------
80,325
0
-------------
114,257
0
-------------
35,700
0
-------------
25,964
0
-------------
608,323
0
-------------
114,257
25
Cathy Jewell
Sr VP, Chief Nursing Officer
(i)
(ii)
0
-------------
271,469
0
-------------
16,200
0
-------------
64,923
0
-------------
110,865
0
-------------
26,723
0
-------------
490,179
0
-------------
0
26
Bart Metzger
Sr VP, Chief HR Officer
(i)
(ii)
275,796
-------------
0
73,918
-------------
0
9,600
-------------
0
32,921
-------------
0
18,590
-------------
0
410,826
-------------
0
0
-------------
0
27
John T Randolph
VP, Chief Corporate Compliance
(i)
(ii)
222,205
-------------
0
51,190
-------------
0
0
-------------
0
100,688
-------------
0
25,357
-------------
0
399,440
-------------
0
0
-------------
0
28
Alice Shakman
Sr. VP, Operations (UMMMC)
(i)
(ii)
0
-------------
263,479
0
-------------
58,826
0
-------------
30,620
0
-------------
113,035
0
-------------
12,157
0
-------------
478,117
0
-------------
30,620
29
Jeffrey A Smith MD
Executive VP, COO
(i)
(ii)
0
-------------
255,953
0
-------------
129,250
0
-------------
0
0
-------------
26,095
0
-------------
13,295
0
-------------
424,593
0
-------------
0
30
Timothy Tarnowski
Sr VP, Chief Info Officer
(i)
(ii)
447,018
-------------
0
101,250
-------------
0
10,449
-------------
0
54,780
-------------
0
37,335
-------------
0
650,832
-------------
0
0
-------------
0
31
Diane Thompson
Sr. VP, Chief Nursing Officer until 4/9/15
(i)
(ii)
0
-------------
99,292
0
-------------
45,487
0
-------------
404,752
0
-------------
17,153
0
-------------
7,803
0
-------------
574,487
0
-------------
385,039
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
1) THE ABOVE DIRECTORS RECEIVE NO COMPENSATION FOR THEIR ROLE AS DIRECTORS. ALL COMPENSATION RECEIVED RELATES TO THEIR POSITION AS A PHYSICIAN/ADMINISTRATOR
Schedule J, Part I, Line 4a Severance or change-of-control payment
The following individuals received or had deferred severance in the reporting period: Included in Sch J Col Biii: Anderson, Milton $ 183,169 Brenckle, George, Ph.D. $ 261,927 George, Patricia $ 25,000 Thompson, Diane $ 245,761
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
The following individuals participated in, or received payment from, a supplemental nonqualified retirement plan in the reporting period: Officers, Directors, Trustees: Bolland Eshghi, Katharine $35,381 Brown, Douglas S. $51,623 Dickson, Eric W., MD $57,487 Finberg, Robert W., MD $640,000 Iitsuka, Carlos $- Lapriore, Cheryl M. $79,214 Melgar, Sergio $- Okike, O. Nsidinanya, MD $19,000 Philbin, Chris $6,189 Rossi, Catherine $12,218 Shirshac, Jeanne $6,977 Swenson, Dana E. $- Subtotal Off, Dir, Trustees $908,089 Key Employees: Cyr, James P. $39,833 Day, Therese $21,081 Feldmann, Robert $- Fisher, Barbara $34,021 Hudlin, Margaret, MD $114,257 Jewell, Cathy $- Metzger, Bart $- Randolph, John T. $- Shakman, Alice $30,620 Smith, Jeffrey A., MD $- Tarnowski, Timothy $- Thompson, Diane $92,217 Subtotal Key Employees $332,029 Former: Anderson, Milton $14,504 Brenckle, George, Ph.D. $21,995 Lapidas, Gary N. $578,684 Subtotal Former $615,183 Total $1,855,301
Schedule J (Form 990) 2015
Additional Data
Software ID:
15000238
Software Version:
2015v3.0