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ObjectId: 201843169349303144 - Submission: 2018-11-12
TIN: 54-0620889
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
INOVA HEALTH CARE SERVICES
Employer identification number
54-0620889
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
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
JKNOX SINGLETON
PRESIDENT
(i)
(ii)
0
-------------
1,320,845
0
-------------
3,278,873
0
-------------
9,055,564
0
-------------
1,944,850
0
-------------
645
0
-------------
15,600,777
0
-------------
1,424,025
2
RICHARD MAGENHEIMER
TREASURER-CFO
(i)
(ii)
0
-------------
706,313
0
-------------
364,400
0
-------------
534,553
0
-------------
666,913
0
-------------
21,787
0
-------------
2,293,966
0
-------------
429,700
3
JOHN GAUL
ASST SECRETARY
(i)
(ii)
480,329
-------------
0
141,828
-------------
0
21,710
-------------
0
203,033
-------------
0
27,343
-------------
0
874,243
-------------
0
47,276
-------------
0
4
MARK STAUDER
COO
(i)
(ii)
0
-------------
1,024,801
0
-------------
657,176
0
-------------
757,233
0
-------------
1,356,934
0
-------------
23,547
0
-------------
3,819,691
0
-------------
712,120
5
PATRICK CHRISTIANSEN
EVP CEO IFMC
(i)
(ii)
0
-------------
671,108
0
-------------
398,008
0
-------------
136,911
0
-------------
585,796
0
-------------
17,740
0
-------------
1,809,563
0
-------------
241,448
6
JOHN NIEDERHUBER
CEO ITMI & EVP IHS
(i)
(ii)
0
-------------
985,683
0
-------------
198,473
0
-------------
436,466
0
-------------
37,500
0
-------------
9,920
0
-------------
1,668,042
0
-------------
0
7
LORING FLINT
EVP CHIEF MEDICAL OFFICER
(i)
(ii)
0
-------------
652,575
0
-------------
418,228
0
-------------
44,478
0
-------------
567,126
0
-------------
21,053
0
-------------
1,703,460
0
-------------
209,114
8
ROBERT GRASTY
EVP CHRO COO
(i)
(ii)
0
-------------
129,653
0
-------------
370,889
0
-------------
357,237
0
-------------
12,423
0
-------------
18,228
0
-------------
888,430
0
-------------
0
9
SUSAN CARROLL
REGIONAL EXEC OFFICER
(i)
(ii)
436,862
-------------
0
117,961
-------------
0
115,334
-------------
0
216,644
-------------
0
27,775
-------------
0
914,576
-------------
0
80,151
-------------
0
10
JOHN FITZGERALD
CEO IFOH
(i)
(ii)
431,400
-------------
0
131,380
-------------
0
175,848
-------------
0
112,212
-------------
0
20,359
-------------
0
871,199
-------------
0
107,192
-------------
0
11
HARVEY MCDUFFIE
SVP PRESIDENT INOVA REALTY
(i)
(ii)
28,845
-------------
0
175,000
-------------
0
1,154
-------------
0
0
-------------
0
0
-------------
0
204,999
-------------
0
0
-------------
0
12
CONSUELO PILOT
EVP CIO
(i)
(ii)
0
-------------
428,203
0
-------------
323,468
0
-------------
32,622
0
-------------
342,432
0
-------------
26,101
0
-------------
1,152,826
0
-------------
157,784
13
DEBORAH ADDO
CEO IMVH
(i)
(ii)
420,074
-------------
0
140,998
-------------
0
122,087
-------------
0
166,580
-------------
0
3,070
-------------
0
852,809
-------------
0
88,759
-------------
0
14
JOHN HAMILTON
PHYSICIAN
(i)
(ii)
1,287,284
-------------
0
85,629
-------------
0
1,242
-------------
0
55,500
-------------
0
22,350
-------------
0
1,452,005
-------------
0
0
-------------
0
15
TODD STOTTLEMYER
CEO ICPH
(i)
(ii)
735,969
-------------
0
572,150
-------------
0
34,410
-------------
0
595,932
-------------
0
25,413
-------------
0
1,963,874
-------------
0
272,875
-------------
0
16
CHRISTOPHER O'CONNOR
CEO IHVI
(i)
(ii)
856,083
-------------
0
228,353
-------------
0
37,523
-------------
0
147,715
-------------
0
15,314
-------------
0
1,284,988
-------------
0
0
-------------
0
17
HOMAYOUN HASHEMI
PHYSICIAN
(i)
(ii)
1,116,489
-------------
0
0
-------------
0
2,322
-------------
0
61,760
-------------
0
21,331
-------------
0
1,201,902
-------------
0
0
-------------
0
18
JAMES ECKLUND
DEPT CHAIR NEUROSCIENCE
(i)
(ii)
1,103,204
-------------
0
174,861
-------------
0
22,402
-------------
0
177,059
-------------
0
26,643
-------------
0
1,504,169
-------------
0
0
-------------
0
19
MARSHALL RUFFIN
FORMER EVP CTO
(i)
(ii)
597,445
-------------
0
0
-------------
0
431,375
-------------
0
55,500
-------------
0
15,792
-------------
0
1,100,112
-------------
0
371,202
-------------
0
20
HPATRICK WALTERS
FORMER SVP STRAT PLANNER
(i)
(ii)
0
-------------
430,708
0
-------------
172,544
0
-------------
105,653
0
-------------
271,943
0
-------------
18,797
0
-------------
999,645
0
-------------
55,046
21
JAMES SANTRY
FORMER EVP CEO DTC AND AMB SVCS
(i)
(ii)
0
-------------
471,602
0
-------------
339,869
0
-------------
237,399
0
-------------
316,401
0
-------------
26,941
0
-------------
1,392,212
0
-------------
278,529
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 3
Question 3 - The following methods were used by Imanco, Inc., a realted organization, to establish the compensation of IHCS's CEO for the tax year: Compensation committee Independent compensation consultant Written employment contract Compensation survey or study Form 990 of other organizations Approval by the board or compensation committee
Part I, Lines 4a-b
Severence: J. Knox Singleton $5,007,436 Marshall Ruffin $26,591 Robert Grasty $343,468 SERP Plan Payments: J. Knox Singleton - $258,502 Richard Magenheimer - $105,241 Patrick Walters - $64,721 Mark Stauder - $154,396 Deborah Addo - $87,185 Marshall Ruffin - $389,143 James Santry - $202,989 John Fitzgerald - $136,704 Susan Carroll - $84,194 Patrick Christiansen - $99,388 The Supplemental Executive Retirement plan (SERP Plan) is a nonqualified retirement plan. Employees eligible to participate are Executive Directors, Assistant Vice Presidents, Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, CFO, COO, and CEO. Each year, a certain percentage of each participant's base salary is contributed to the SERP Plan. This amount ranges from 5% to 20%, depending on position. After three years of continuous participation, participants vest in 50% of their balance at that time and are paid out the vested balance as a taxable event. After a total of six years participation and after attaining age 45, participants are 100% vested and are paid out their remaining balance as a taxable event. Vesting then reverts to a 3 year rolling schedule until year 12. Thereafter, the annual contribution is paid out to the participant each year as a taxable event.
Schedule J (Form 990) 2017
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