Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
LRGHealthcare
 
Employer identification number

02-0222150
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.
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.
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
 
No
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) 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
1Samual Aldridge
Vice President, Medical Staff
(i)

(ii)
421,348
-------------
0
5,000
-------------
0
0
-------------
0
9,121
-------------
0
31,254
-------------
0
466,723
-------------
0
0
-------------
0
2Vercin Ephrem MD
President, Medical Staff
(i)

(ii)
287,972
-------------
0
5,000
-------------
0
18,000
-------------
0
4,282
-------------
0
32,010
-------------
0
347,264
-------------
0
0
-------------
0
3Glenn Fusonie MD
Trustee (end 2/18)
(i)

(ii)
393,374
-------------
0
5,000
-------------
0
17,333
-------------
0
7,614
-------------
0
31,119
-------------
0
454,440
-------------
0
0
-------------
0
4Paul Racicot MD
Past President, Medical Staff
(i)

(ii)
290,217
-------------
0
5,000
-------------
0
0
-------------
0
8,529
-------------
0
29,405
-------------
0
333,151
-------------
0
0
-------------
0
5Kevin Donovan
President & CEO
(i)

(ii)
421,288
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
31,119
-------------
0
452,407
-------------
0
0
-------------
0
6Wayne Bennett
CFO
(i)

(ii)
256,222
-------------
0
20,000
-------------
0
0
-------------
0
0
-------------
0
25,120
-------------
0
301,342
-------------
0
0
-------------
0
7Frederick Jones MD
Chief Medical Officer
(i)

(ii)
363,215
-------------
0
5,000
-------------
0
18,000
-------------
0
5,856
-------------
0
33,804
-------------
0
425,875
-------------
0
0
-------------
0
8David Mattice MD
Physician
(i)

(ii)
403,117
-------------
0
5,000
-------------
0
18,000
-------------
0
6,829
-------------
0
33,669
-------------
0
466,615
-------------
0
0
-------------
0
9John Vignati MD
Physician
(i)

(ii)
412,748
-------------
0
0
-------------
0
0
-------------
0
8,450
-------------
0
32,254
-------------
0
453,452
-------------
0
0
-------------
0
10Tristan Wihbey MD
Physician
(i)

(ii)
373,564
-------------
0
5,000
-------------
0
0
-------------
0
0
-------------
0
4,222
-------------
0
382,786
-------------
0
0
-------------
0
11Samuel Brown MD
Physician
(i)

(ii)
372,250
-------------
0
5,000
-------------
0
0
-------------
0
4,173
-------------
0
33,119
-------------
0
414,542
-------------
0
0
-------------
0
12Veronica Tucker MD
Physician
(i)

(ii)
356,664
-------------
0
5,000
-------------
0
12,500
-------------
0
0
-------------
0
30,715
-------------
0
404,879
-------------
0
0
-------------
0
13Henry Lipman FACHE
Former CFO
(i)

(ii)
69,855
-------------
0
0
-------------
0
135,002
-------------
0
0
-------------
0
538
-------------
0
205,395
-------------
0
135,002
-------------
0
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 4b Part I, Line 4b: LRGH sponsors a split-dollar life insurance employee benefit program for certain officers and key employees. Split-dollar life insurance is an arrangement in which the employee is the owner of the life insurance policy and the premiums are paid by both the employer and employee. Pursuant to LRGH's split-dollar agreement, the collateral assignment therein, the employer's share of the policy premiums paid is recovered either upon termination of the policy or at the death of the participant. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance coverage. Total cumulative premiums paid for Henry Lipman through January 2017 were $138,792. Mr. Lipman retired at that time, so the policy was cashed out. Income from the policy was reported as part of Mr. Lipman's calendar year 2017 compensation on Schedule J, Part II, Column C for the fiscal year ending September 30, 2018.
Part I, Line 7 Certain individuals listed in Form 990, Part VII received a portion of their reportable compensation in the form of an incentive bonus. The primary purpose of the incentive pay is to recognize the quality of the performance of eligible physicians and executives of the Hospital. The amount of the incentive pay bonus is based on performance relative to strategic goals and measurable objectives and is discretionary in nature.
Schedule J (Form 990) 2017
Additional Data


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