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ObjectId: 201821349349302107 - Submission: 2018-05-14
TIN: 51-0190238
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
16
Open to Public Inspection
Name of the organization
Wake Forest University Baptist Medical
Center
Employer identification number
51-0190238
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 nonfixed
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) 2016
Page 2
Schedule J (Form 990) 2016
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
Nathan O Hatch PhD
Director
(i)
(ii)
0
-------------
862,932
0
-------------
90,000
0
-------------
70,680
0
-------------
598,507
0
-------------
63,968
0
-------------
1,686,087
0
-------------
0
2
John H McConnell MD
Director (ex-off) & CEO (to 4-26-17)
(i)
(ii)
0
-------------
1,026,651
0
-------------
434,548
0
-------------
569,856
0
-------------
247,313
0
-------------
19,113
0
-------------
2,297,481
0
-------------
0
3
Kevin P High MD
EVP, Health System Affairs
(i)
(ii)
0
-------------
585,172
0
-------------
211,063
0
-------------
21,612
0
-------------
165,135
0
-------------
21,696
0
-------------
1,004,678
0
-------------
0
4
Edward Abraham MD
Dean, School of Med
(i)
(ii)
0
-------------
581,304
0
-------------
205,821
0
-------------
147,544
0
-------------
161,945
0
-------------
17,224
0
-------------
1,113,838
0
-------------
124,000
5
Eric Tomlinson DCs PhD
President, WFIQ
(i)
(ii)
0
-------------
404,785
0
-------------
130,952
0
-------------
263,690
0
-------------
99,845
0
-------------
12,149
0
-------------
911,421
0
-------------
235,022
6
Chad A Eckes
EVP Crp Svc, CFO, Asst Trs (to 6-11-
(i)
(ii)
698,706
-------------
0
284,502
-------------
0
840
-------------
0
209,328
-------------
0
22,006
-------------
0
1,215,382
-------------
0
0
-------------
0
7
Terry G Williams
EVP, Chief Strategy Officer
(i)
(ii)
530,336
-------------
0
194,191
-------------
0
1,260
-------------
0
147,243
-------------
0
23,126
-------------
0
896,156
-------------
0
0
-------------
0
8
ROBERT GFELLER
VP, External Relations & Chief Mktg
(i)
(ii)
458,293
-------------
0
120,364
-------------
0
3,612
-------------
0
123,294
-------------
0
20,842
-------------
0
726,405
-------------
0
0
-------------
0
9
Lilicia Bailey
VP, Chief Human Resources (eff 8-23-
(i)
(ii)
138,204
-------------
0
0
-------------
0
31,304
-------------
0
18,520
-------------
0
5,617
-------------
0
193,645
-------------
0
0
-------------
0
10
Deette M Emon
VP, CIO
(i)
(ii)
401,349
-------------
0
113,392
-------------
0
765
-------------
0
98,679
-------------
0
9,336
-------------
0
623,521
-------------
0
0
-------------
0
11
Norman B Potter Jr to 2-28-17
VP, Development
(i)
(ii)
0
-------------
313,307
0
-------------
94,021
0
-------------
19,157
0
-------------
78,567
0
-------------
22,663
0
-------------
527,715
0
-------------
0
12
Karen H Huey
VP, Facilities
(i)
(ii)
287,382
-------------
0
80,814
-------------
0
975
-------------
0
67,859
-------------
0
20,200
-------------
0
457,230
-------------
0
0
-------------
0
13
J Mclain wallace Jr
VP, Gen Counsel & Sec
(i)
(ii)
439,903
-------------
0
123,909
-------------
0
19,932
-------------
0
132,622
-------------
0
18,398
-------------
0
734,764
-------------
0
0
-------------
0
14
J Reid Morgan
Assistant Secretary
(i)
(ii)
0
-------------
459,486
0
-------------
40,000
0
-------------
61,098
0
-------------
64,000
0
-------------
78,553
0
-------------
703,137
0
-------------
0
15
Bradley A Clark
Treasurer
(i)
(ii)
272,946
-------------
0
81,871
-------------
0
552
-------------
0
58,504
-------------
0
18,784
-------------
0
432,657
-------------
0
0
-------------
0
16
Michael T Waid
Sr. VP Hlth sys ops
(i)
(ii)
358,207
-------------
0
112,812
-------------
0
19,173
-------------
0
100,141
-------------
0
21,699
-------------
0
612,032
-------------
0
0
-------------
0
17
Cathleen Wheatley
VP clinical op, chief nurs
(i)
(ii)
411,669
-------------
0
107,741
-------------
0
3,612
-------------
0
100,708
-------------
0
9,749
-------------
0
633,479
-------------
0
0
-------------
0
18
Dan Squires
Dir Fin Affilates - Op Finance
(i)
(ii)
169,964
-------------
0
14,384
-------------
0
301,843
-------------
0
15,070
-------------
0
15,821
-------------
0
517,082
-------------
0
0
-------------
0
19
Conrad Emmerich
Sr. VP Business Svc, Exec VP Hlth Sy
(i)
(ii)
326,955
-------------
0
98,810
-------------
0
668
-------------
0
82,046
-------------
0
18,905
-------------
0
527,384
-------------
0
0
-------------
0
20
Victoria Russell
VP Clinical op, Ex Adm Dir
(i)
(ii)
304,189
-------------
0
83,819
-------------
0
146,370
-------------
0
29,149
-------------
0
8,027
-------------
0
571,554
-------------
0
0
-------------
0
21
Cheryl E H Locke
Former Officer
(i)
(ii)
354,716
-------------
0
96,131
-------------
0
84,301
-------------
0
84,065
-------------
0
17,908
-------------
0
637,121
-------------
0
61,120
-------------
0
22
Lisa M Wyatt
Former Officer
(i)
(ii)
0
-------------
0
0
-------------
0
0
-------------
104,500
0
-------------
0
0
-------------
122
0
-------------
104,622
0
-------------
0
23
Joanne C Ruhland
Former Officer
(i)
(ii)
266,981
-------------
0
0
-------------
0
53,843
-------------
0
67,295
-------------
0
17,769
-------------
0
405,888
-------------
0
31,600
-------------
0
24
K Barbara Carbone MD
Former Officer
(i)
(ii)
0
-------------
0
0
-------------
0
0
-------------
395,567
0
-------------
0
0
-------------
122
0
-------------
395,689
0
-------------
0
25
Russell M Howerton MD
Former Officer
(i)
(ii)
0
-------------
520,490
0
-------------
156,287
0
-------------
21,612
0
-------------
154,739
0
-------------
22,566
0
-------------
875,694
0
-------------
0
Schedule J (Form 990) 2016
Page 3
Schedule J (Form 990) 2016
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 3
The Governance and Compensation committee of the WFUBMC Board of Directors is responsible for reviewing and approving all medical center officers' compensation (including the compensation of most of the officers of the filing organization). The committee utilizes an independent, external compensation consultant firm experienced in health care and higher education compensation that based recommendations on compensation surveys and studies to determine the appropriateness of each officer's compensation. These compensation consultants present total compensation comparability data for the positions for which compensation is being determined. The data is reviewed by the Governance and Compensation Committee of WFUBMC's governing board at its meeting; none of the members of that committee are employees of the filing organization. Minutes of the deliberations of the committee are contemporaneously recorded. In the event that any member of the Governance and Compensation committee has a conflict of interest, that committee member does not participate in the deliberation or approval process, and their abstention from the process is reflected in the minutes.
Part I, Lines 4a-b
CERTAIN EXECUTIVES PARTICIPATE IN OR RECEIVE SEVERANCE PAYMENTS AND PAYMENTS FROM SUPPLEMENTAL NON QUALIFIED RETIREMENT PLANS. THE DETERMINATION OF THE AMOUNT OF THE NON QUALIFIED RETIREMENT PLANS FOLLOWED THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE Form 990. THE FOLLOWING current/FORMER Directors, OFFICERS, and highly compensated employees RECEIVED SEVERANCE AND SERP PAYMENTS IN their calendar year 2016 compensation: Name Severance SERP John D. McConnell, MD -0- 546,312 Barbara Carbone 395,567 -0- Joanne Ruhland -0- 31,600 Lisa Wyatt 104,500 -0- Cheryl Locke -0- 61,120 Edward Abraham -0- 124,000 Name Severance SERP Eric Tomlinson -0- 235,022 Victoria Russell 146,548 145,000 Dan Squires -0- 301,188 The compensation of Dr. Nathan O. Hatch includes a deferred benefit of $300,000.
Part I, Line 7
CERTAIN OFFICERS, KEY EMPLOYEES AND FACULTY MEMBERS HAVE INCENTIVE COMPENSATION COMPONENTS CONTAINED IN THEIR EMPLOYMENT AGREEMENTS and through medical center policies. THESE ARE OFTEN GOAL-BASED AND ARE DETERMINED IN THE COURSE OF EVALUATION OF THE INDIVIDUAL'S PERFORMANCE BY HIS/HER DEPARTMENT CHAIR, SUPERVISOR OR THE COMPENSATION COMMITTEE OF THE BOARD, AS APPLICABLE.
Schedule J (Form 990) 2016
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