efile Public Visual Render
ObjectId: 201823189349308682 - Submission: 2018-11-14
TIN: 55-0643304
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
17
Open to Public Inspection
Name of the organization
West Virginia University Hospitals Inc
Employer identification number
55-0643304
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
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
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) 2017
Page 2
Schedule J (Form 990) 2017
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
Stephen Tancin
VP Ancillary Services
(i)
(ii)
269,820
-------------
59,008
-------------
27,784
-------------
-------------
20,679
-------------
377,291
-------------
-------------
2
Dorothy Oakes
VP Nursing Services
(i)
(ii)
-------------
-------------
178,840
-------------
-------------
-------------
178,840
-------------
-------------
3
David Hubbard MD
Director / Physician
(i)
(ii)
434,460
-------------
64,694
-------------
762
-------------
27,000
-------------
252
-------------
527,168
-------------
-------------
4
Mark Smith
Director - Employee Representative
(i)
(ii)
212,653
-------------
131,259
-------------
-47
-------------
252
-------------
-------------
344,117
-------------
-------------
5
Taylor Troischt
Physician
(i)
(ii)
203,284
-------------
27,647
-------------
-------------
-------------
23,825
-------------
254,756
-------------
-------------
6
Douglas Mitchell
VP Chief Nursing Officer
(i)
(ii)
239,682
-------------
48,878
-------------
690
-------------
24,150
-------------
15,370
-------------
328,770
-------------
-------------
7
Justin Gibson
Executive Director of Finance
(i)
(ii)
214,332
-------------
42,678
-------------
270
-------------
21,700
-------------
23,947
-------------
302,927
-------------
-------------
8
David Flynn
Pharmacy Director
(i)
(ii)
186,990
-------------
31,881
-------------
120
-------------
-------------
23,725
-------------
242,716
-------------
-------------
9
Albert Wright
President/CEO WVUHS
(i)
(ii)
-------------
883,141
-------------
279,450
-------------
137,459
-------------
175,000
-------------
24,583
-------------
1,499,633
-------------
119,998
10
Melissa McCoy
VP Finance/CFO
(i)
(ii)
168,712
-------------
168,712
36,964
-------------
36,964
9,604
-------------
9,604
25,103
-------------
25,102
11,929
-------------
11,930
252,312
-------------
252,312
9,518
-------------
9,517
11
Amy Bush
VP of Operations
(i)
(ii)
260,057
-------------
55,497
-------------
15,793
-------------
25,840
-------------
8,635
-------------
365,822
-------------
15,493
-------------
12
Anthony Condia
VP Marketing and Communications
(i)
(ii)
234,143
-------------
47,750
-------------
25,562
-------------
23,762
-------------
8,068
-------------
339,285
-------------
25,512
-------------
13
Douglass Harrison
VP Healthcare Integration
(i)
(ii)
236,934
-------------
101,543
45,362
-------------
19,441
315
-------------
135
36,033
-------------
15,442
5,966
-------------
2,557
324,610
-------------
139,118
-------------
14
Leeann Cerimele
Chief Human Resources Officer
(i)
(ii)
259,351
-------------
111,150
40,807
-------------
17,489
210
-------------
90
39,503
-------------
16,930
16,698
-------------
7,157
356,569
-------------
152,816
-------------
15
Robert Ortiz
VP Clinical Operations
(i)
(ii)
182,726
-------------
30,365
-------------
62,312
-------------
-------------
396
-------------
275,799
-------------
-------------
16
Neisha Griffith
VP Cancer Services
(i)
(ii)
168,859
-------------
23,327
-------------
110,187
-------------
25,500
-------------
9,936
-------------
337,809
-------------
19,078
-------------
17
Melissa Martin
VP Privacy Health Information
(i)
(ii)
212,480
-------------
37,971
-------------
-------------
-------------
8,566
-------------
259,017
-------------
-------------
18
John Bihun
Director of Human Resources
(i)
(ii)
45,528
-------------
21,407
-------------
231,848
-------------
-------------
5,402
-------------
304,185
-------------
-------------
Schedule J (Form 990) 2017
Page 3
Schedule J (Form 990) 2017
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 1b
The CEO receives allowances for both housing and automobile expenses. This benefit is reported in both Part VII and Schedule J of the Form 990. It is also part of the overall compensation package as approved by the compensation committee and the Board of Directors. This was included as taxable compensation on the Form W-2 of the CEO for 2017.
Part I Line 3
Compensation for WVU Hospitals, Inc. CEO is determined by the WV United Health System compensation committee. The System engages an independent group to perform an executive compensation review and compensation survey every two years. This information is provided to the committee, which is made up of independent board members who are then responsible for setting the compensation packages offered to each executive, ensuring that the compensation package offered does not exceed fair market value.
Part I Line 4b
During 2017, certain individuals reported in Part VII participated in a nonqualified retirement plan. The following is a list of those individuals, plan types and amounts.
Part II Line 1a
Douglass Harrison - CAA deferred contributions of 51,475 Douglas Mitchell - CAA deferred contributions of 24,150 Anthony Condia - CAA deferred contributions of 23,762 and received vesting distributions of 25,512 Amy Bush - CAA deferred contributions of 25,840 and received vesting distributions of 15,493 Melissa McCoy - CAA deferred contributions of 50,205 and received vesting distributions of 19,035 Leeann Cerimele - CAA deferred contributions of 56,433 Neisha Griffith - CAA deferred contributions of 25,500 and received vesting distributions of 19,078 Justin Gibson CAA deferred contributions of 21,700. All of the above amounts are properly reported on the Form W-2 for 2017.
Part I Line 4a
Dorothy Oaks received 178,840.35 in severance pay and taxable fringes in 2017. This amount is reported as Other Compensation in column iii and was included in her W-2 for 2017.
Schedule J (Form 990) 2017
Additional Data
Software ID:
17005317
Software Version:
18.2.0.0