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ObjectId: 201741319349304784 - Submission: 2017-05-11
TIN: 24-0795623
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
POCONO MEDICAL CENTER
Employer identification number
24-0795623
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
No
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.
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
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
JEFF SNYDER
PRESIDENT/CHIEF EXECUTIVE
(i)
(ii)
420,130
-------------
0
183,469
-------------
0
58,877
-------------
0
187,443
-------------
0
18,897
-------------
0
868,816
-------------
0
58,877
-------------
0
2
VINCENT FRANCESCANGELI MD
CHIEF OF PMC MEDICAL STAFF
(i)
(ii)
267,349
-------------
0
76,728
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
344,077
-------------
0
0
-------------
0
3
MICHAEL A WILK
SVP FINANCE/CFO (TERM 6/30/16)
(i)
(ii)
307,833
-------------
0
69,161
-------------
0
49,064
-------------
0
58,047
-------------
0
18,897
-------------
0
503,002
-------------
0
49,064
-------------
0
4
STEPHEN CUNNINGHAM
SVP & CHIEF DEVELOPMENT OF
(i)
(ii)
291,233
-------------
0
0
-------------
0
140,444
-------------
0
35,030
-------------
0
240
-------------
0
466,947
-------------
0
140,444
-------------
0
5
LYNN LANSDOWNE
VP OF HUMAN RESOURCES
(i)
(ii)
204,972
-------------
0
46,971
-------------
0
0
-------------
0
39,423
-------------
0
18,897
-------------
0
310,263
-------------
0
0
-------------
0
6
WILLIAM CORS
VP OF MEDICAL AFFAIRS
(i)
(ii)
354,763
-------------
0
74,611
-------------
0
96,285
-------------
0
0
-------------
0
18,897
-------------
0
544,556
-------------
0
42,742
-------------
0
7
LAMONT LOUIS
VP PHYSICIAN NETWORK
(i)
(ii)
205,921
-------------
0
39,301
-------------
0
0
-------------
0
26,000
-------------
0
17,468
-------------
0
288,690
-------------
0
0
-------------
0
8
ELIZABETH WISE
VP OF OPERATIONS
(i)
(ii)
383,128
-------------
0
0
-------------
0
0
-------------
0
32,000
-------------
0
7,545
-------------
0
422,673
-------------
0
0
-------------
0
9
FERDINAND FEOLA
VP & CHIEF INFORMATION OFFICER
(i)
(ii)
205,463
-------------
0
36,213
-------------
0
0
-------------
0
25,161
-------------
0
18,897
-------------
0
285,734
-------------
0
0
-------------
0
10
VIRGINIA GORTYCH-BARNES
PHYSICIAN ADVISOR
(i)
(ii)
246,204
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
18,897
-------------
0
265,101
-------------
0
0
-------------
0
11
JOHN CROCKETT
PHYSICIAN LIASON/RECRUITER
(i)
(ii)
231,975
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
18,897
-------------
0
250,872
-------------
0
0
-------------
0
12
LOUIS NARDELLA
CLINICAL PSYCHIATRIST
(i)
(ii)
212,169
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
18,897
-------------
0
231,066
-------------
0
0
-------------
0
13
WILLIAM THOMA
CONTROLLER
(i)
(ii)
197,978
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
18,897
-------------
0
216,875
-------------
0
0
-------------
0
14
STACY GOETZ
CANCER CENTER ADMINISTRATOR
(i)
(ii)
183,523
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
18,897
-------------
0
202,420
-------------
0
0
-------------
0
15
KATHLEEN KUCK
FORMER PRESIDENT/CEO
(i)
(ii)
0
-------------
0
0
-------------
0
586,791
-------------
0
139,663
-------------
0
7,545
-------------
0
733,999
-------------
0
0
-------------
0
16
PAULETTE NISH
FORMER VP & CNO
(i)
(ii)
0
-------------
0
0
-------------
0
106,500
-------------
0
13,845
-------------
0
0
-------------
0
120,345
-------------
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
PART I, LINE 1A
SOME TOP EXECUTIVES TOOK ADVANTAGE OF THIS BENEFIT. LTD IS A TAXABLE BENEFIT AND A TAX GROSS UP WAS PROVIDED TO ASSIST THE EMPLOYEE WITH THEIR PERSONAL INCOME TAX LIABILITY.
PART I, LINES 4A-B
THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM THE ORGANIZATION IN CALENDAR YEAR 2015: KATHLEEN KUCK, FORMER PRESIDENT/CEO - $581,929 PAULETTE NISH, FORMER VP & CNO - $106,500 THE FOLLOWING INDIVIDUAL PARTICIPATED IN THE 457(F)SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OF POCONO MEDICAL CENTER, BUT DID NOT RECEIVE A DISTRIBUTION IN CALENDAR YEAR 2015: LYNNE LANSDOWNE, VP OF HUMAN RESOURCES THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F)SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OF POCONO MEDICAL CENTER AND RECEIVED A DISTRIBUTION IN CALENDAR YEAR 2015: JEFF SNYDER - PRESIDENT/CEO - $58,877 MICHAEL WILK, SVP FINANCE/CFO - $49,064 WILLIAM CORS, VP OF MEDICAL AFFAIRS - $42,742 STEPHEN CUNNINGHAM, SVP & CHIEF DEVELOPMENT OFFICER - $140,444
PART I, LINE 7
INCENTIVE COMPENSATION IS PAID BASED ON THE FOLLOWING FOUR PERFORMANCE CRITERIA: 1) INCREASE IN THE SERVICES AVAILABLE TO THE COMMUNITY, 2) IMPROVEMENT IN CUSTOMER SATISFACTION AND QUALITY OF SERVICE PROVIDED, 3) STABLE FINANCIAL RATIOS, AND 4) IMPROVING EMPLOYEE SATISFACTION. PHYSICIANS RECEIVE NON-FIXED BONUS AND INCENTIVE COMPENSATION BASED ON THEIR RESPECTIVE CONTRACT. INCENTIVES ARE EITHER BASED ON A PERCENTAGE OF PAYMENTS RECEIVED ABOVE REQUIRED EXPENSE COVERAGE THRESHOLD OR RELATIVE VALUE UNIT (RVU) THRESHOLD.
Schedule J (Form 990) 2015
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