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.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
Santa Ynez Valley Cottage Hospital Inc
 
Employer identification number

95-2224265
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) 2018
Page 2

Schedule J (Form 990) 2018
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
1Ronald Werft
 
President & CEO
(i)

(ii)
0
-------------
1,049,563
0
-------------
331,698
0
-------------
74,769
0
-------------
13,750
0
-------------
25,130
0
-------------
1,494,910
0
-------------
0
2Steven Fellows
 
COO
(i)

(ii)
0
-------------
572,184
0
-------------
173,775
0
-------------
45,820
0
-------------
13,750
0
-------------
27,803
0
-------------
833,332
0
-------------
0
3Brett Tande
 
Senior VP and CFO
(i)

(ii)
0
-------------
541,355
0
-------------
140,737
0
-------------
145,252
0
-------------
13,750
0
-------------
27,803
0
-------------
868,897
0
-------------
0
4WENDE CAPPETTA
 
Vice President Of SYVCH
(i)

(ii)
219,697
-------------
0
41,923
-------------
0
46,291
-------------
0
13,081
-------------
0
9,704
-------------
0
330,696
-------------
0
11,400
-------------
0
5GAYLE MERCADO
 
CLINICAL MANAGER
(i)

(ii)
150,943
-------------
0
14,987
-------------
0
1,906
-------------
0
8,297
-------------
0
29,271
-------------
0
205,404
-------------
0
0
-------------
0
6RICARDO GONZALEZ MENCHACA
 
RT 3 RADIOGRAPHER 025/7630
(i)

(ii)
170,951
-------------
0
1,143
-------------
0
11,904
-------------
0
8,605
-------------
0
29,271
-------------
0
221,874
-------------
0
0
-------------
0
7NICOLE HUFF
 
CLINICAL MGR-SYVCH
(i)

(ii)
151,840
-------------
0
12,903
-------------
0
8,614
-------------
0
8,237
-------------
0
29,271
-------------
0
210,865
-------------
0
0
-------------
0
8DENISE HOLMES
 
CLINICAL MGR-SYVCH
(i)

(ii)
140,095
-------------
0
12,361
-------------
0
3,583
-------------
0
7,623
-------------
0
20,324
-------------
0
183,986
-------------
0
0
-------------
0
9NATHAN HALL
 
MANAGER RADIOLOGY
(i)

(ii)
129,605
-------------
0
8,851
-------------
0
8,595
-------------
0
6,923
-------------
0
29,271
-------------
0
183,245
-------------
0
0
-------------
0
Schedule J (Form 990) 2018
Page 3

Schedule J (Form 990) 2018
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
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation On an annual basis the Executive Compensation Committee (ECC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the ECC are independent members of the Board of Directors. The ECC engages an independent consultant to prepare comparative compensation reports for each position. The executives individual performance will also be considered when determining compensation. The ECC recommends compensation for the executives to the full Board for approval. This process takes place annually for all executives.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan COTTAGE HEALTH PROVIDES CERTAIN EXECUTIVES A SUPPLEMENTAL RETIREMENT PROGRAM. THE PROGRAM IS DEFINED AS DEFERRED COMPENSATION UNDER THE IRC SECTION 457(F). THE ANNUAL CONTRIBUTION IS 6.95% OF BASE YEARS SALARY WITH THE CONTRIBUTIONS VESTING FIVE YEARS FROM CREDITING DATE, OR AT AGE 62, OR IMMEDIATELY IN THE EVENT OF DEATH, DISABILITY, OR INVOLUNTARY TERMINATION WITHOUT CAUSE. THE UNVESTED ACCOUNT BALANCES ARE ASSETS OF THE HOSPITAL AND ARE INCLUDED IN OTHER ASSETS AND THE ACCRUED EXPENSE IS INCLUDED IN PENSION LIABILITY AND OTHER IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS. THE AMOUNTS REPORTED IN THE CURRENT YEAR'S DEFERRED COMPENSATION INCLUDES RECOGNITION OF PAST SERVICE. THE AMOUNTS ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. ANY DEFERRED CONTRIBUTIONS TO THIS PLAN WILL BE REPORTED AGAIN AS REPORTABLE COMPENSATION IN THE YEAR PAID. In 2018 Wende Cappetta received a 457(f) payout of $11,400.
Schedule J, Part I, Line 7 Non-fixed payments Each year the Board of Directors determines if a bonus can be paid based on the financial operating results of the completed year. The Board determines the total amount of the bonus pool. This pool of money is distributed to employees in the management team based on the individual's achievement of personal goals and the overall team's accomplishment of system-wide goals pertaining to quality, service excellence, employee engagement, financial or other. The payout for individuals is calculated based on percentages of their base salary and their position.
Schedule J (Form 990) 2018
Additional Data


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