efile Public Visual Render
ObjectId: 201921349349305097 - Submission: 2019-05-14
TIN: 23-2729852
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.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
17
Open to Public Inspection
Name of the organization
CLINICAL CARE ASSOCIATES OF THE
UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM
Employer identification number
23-2729852
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
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
1
MICHAEL A ACKER MD
BOARD MEMBER
(i)
(ii)
0
-------------
1,090,861
0
-------------
111,301
0
-------------
504,368
0
-------------
34,521
0
-------------
25,899
0
-------------
1,766,950
0
-------------
24,418
2
RONALD B BARG MD
EXECUTIVE DIRECTOR, EX OFFICIO
(i)
(ii)
0
-------------
406,810
0
-------------
178,332
0
-------------
75,115
0
-------------
57,901
0
-------------
17,916
0
-------------
736,074
0
-------------
50,778
3
MICHAEL J DUNCAN
BOARD MEMBER
(i)
(ii)
0
-------------
663,070
0
-------------
81,153
0
-------------
117,064
0
-------------
95,850
0
-------------
18,071
0
-------------
975,208
0
-------------
96,484
4
JOSEPH P HEANEY
CFO, ASST CONTROLLER & SECRY
(i)
(ii)
0
-------------
195,894
0
-------------
57,741
0
-------------
403
0
-------------
0
0
-------------
25,506
0
-------------
279,544
0
-------------
0
5
ELIZABETH B JOHNSTON
BOARD MEMBER
(i)
(ii)
0
-------------
642,387
0
-------------
298,729
0
-------------
167,858
0
-------------
124,601
0
-------------
9,541
0
-------------
1,243,116
0
-------------
137,138
6
KEITH KASPER
CONTROLLER, BOARD MEMBER
(i)
(ii)
0
-------------
746,155
0
-------------
353,631
0
-------------
182,488
0
-------------
147,501
0
-------------
28,857
0
-------------
1,458,632
0
-------------
141,829
7
THERESA M LARIVEE
BOARD MEMBER
(i)
(ii)
0
-------------
447,031
0
-------------
209,062
0
-------------
77,643
0
-------------
65,401
0
-------------
28,851
0
-------------
827,988
0
-------------
57,718
8
KEVIN B MAHONEY
BOARD MEMBER, NETWORK EXEC.
(i)
(ii)
0
-------------
1,141,636
0
-------------
406,298
0
-------------
213,094
0
-------------
158,001
0
-------------
18,455
0
-------------
1,937,484
0
-------------
167,904
9
RALPH W MULLER
CHAIR, EX OFFICIO
(i)
(ii)
0
-------------
1,659,654
0
-------------
784,318
0
-------------
33,792
0
-------------
490,715
0
-------------
12,739
0
-------------
2,981,218
0
-------------
0
10
RICHARD A NEILL MD
BOARD MEMBER- THRU 6/4/18
(i)
(ii)
0
-------------
158,620
0
-------------
0
0
-------------
8,735
0
-------------
15,086
0
-------------
12,585
0
-------------
195,026
0
-------------
0
11
PHILIP A OKALA
BOARD MEMBER
(i)
(ii)
0
-------------
826,182
0
-------------
359,331
0
-------------
106,316
0
-------------
132,801
0
-------------
25,524
0
-------------
1,450,154
0
-------------
85,506
12
CHARLES F ORELLANA MD
SR MEDICAL DIRECTOR, BOARD MBR
(i)
(ii)
0
-------------
251,860
0
-------------
72,949
0
-------------
12,092
0
-------------
0
0
-------------
17,370
0
-------------
354,271
0
-------------
0
13
MICHAEL S PARMACEK MD
BOARD MEMBER
(i)
(ii)
0
-------------
323,195
0
-------------
293,514
0
-------------
391,602
0
-------------
34,521
0
-------------
44,776
0
-------------
1,087,608
0
-------------
0
14
PETER D QUINN MD
EX OFFICIO BOARD MEMBER
(i)
(ii)
0
-------------
934,772
0
-------------
627,179
0
-------------
9,995
0
-------------
24,300
0
-------------
18,773
0
-------------
1,615,019
0
-------------
0
15
STEVEN J RALSTON MD MPH
BOARD MEMBER
(i)
(ii)
0
-------------
334,243
0
-------------
0
0
-------------
229,974
0
-------------
24,300
0
-------------
14,453
0
-------------
602,970
0
-------------
0
16
MICHELE M VOLPE
BOARD MEMBER
(i)
(ii)
0
-------------
474,904
0
-------------
213,906
0
-------------
99,243
0
-------------
69,451
0
-------------
10,760
0
-------------
868,264
0
-------------
68,305
17
KRISTEN RAINEAR MD
CARDIOLOGIST
(i)
(ii)
735,824
-------------
0
38,820
-------------
0
20,624
-------------
0
0
-------------
0
25,149
-------------
0
820,417
-------------
0
0
-------------
0
18
JITEN RANA MD
CARDIOLOGIST
(i)
(ii)
648,870
-------------
0
57,240
-------------
0
18,764
-------------
0
0
-------------
0
28,498
-------------
0
753,372
-------------
0
0
-------------
0
19
JACK F QUINLAN MD
CARDIOLOGIST
(i)
(ii)
630,276
-------------
0
38,540
-------------
0
14,935
-------------
0
0
-------------
0
25,079
-------------
0
708,830
-------------
0
0
-------------
0
20
GARY DORSHIMER MD
INTERNIST
(i)
(ii)
538,000
-------------
92,798
-------------
0
24,816
-------------
0
0
-------------
0
17,140
-------------
0
672,754
-------------
0
0
-------------
0
21
JOSEPH D WACHSPRESS MD
CARDIOLOGIST
(i)
(ii)
514,322
-------------
0
35,080
-------------
0
15,299
-------------
0
0
-------------
0
22,084
-------------
0
586,785
-------------
0
0
-------------
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
SCHEDULE J, PART I, LINE 3
TOP MANAGEMENT COMPENSATION AS PROVIDED IN THE FORM 990, SCHEDULE J INSTRUCTIONS, SINCE THE ORGANIZATION RELIES ON A RELATED ORGANIZATION WHICH USES ONE OR MORE OF THE METHODS DESCRIBED IN LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION, THIS QUESTION HAS BEEN LEFT UNASNSWERED. REFER TO SCHEDULE O FOR A DESCRIPTION OF THE COMPENSATION REVIEW AND APPROVAL PROCESS. ------------------------------
SCHEDULE J, PART I, LINE 4B
PARTICIPATION IN A SUPP NONQUALIFIED PLAN CERTAIN TRUSTEES, OFFICERS AND/OR KEY EMPLOYEES OF THIS ORGANIZATION ARE COMPENSATED BY A RELATED ORGANIZATION, THE TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA ("UNIVERSITY"). THE UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM ("HEALTH SYSTEM") MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") DESIGNED FOR SENIOR ADMINISTRATORS OF THE HEALTH SYSTEM, AS DESIGNATED BY THE BOARD OF TRUSTEES, WHO ARE ACTIVELY EMPLOYED BY THE HEALTH SYSTEM WHEN THE CONTRIBUTIONS ARE MADE. VESTING IN THE SERP OCCURS AFTER EACH THREE YEARS OF PARTICIPATION AND UPON THE OCCURRENCE OF CERTAIN EVENTS (ATTAINMENT OF AGE 65, DEATH, DISABILITY, OR INVOLUNTARY TERMINATION WITHOUT "CAUSE"). CONTRIBUTIONS FOR THOSE WHO HAVE REACHED AGE 65 WILL BE FULLY VESTED WHEN MADE.UPON REACHING A VESTING DATE, PARTICIPANTS WILL AUTOMATICALLY RECEIVE A FULL DISTRIBUTION WHICH IS TAXABLE AS EARNED INCOME. PARTICIPANTS WHO VOLUNTARILY TERMINATE BEFORE VESTING WILL FORFEIT THE BALANCE IN THEIR ACCOUNTS. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN THE UNIVERSITY/HEALTH SYSTEM SERP PLAN DURING THE YEAR: ACKER, MICHAEL A., MD- NO DISTRIBUTION BARG, RONALD - $50,778 DUNCAN, MICHAEL J.- $96,484 JOHNSTON, ELIZABETH B.- $137,138 KASPER, KEITH - $141,829 LARIVEE, THERESA- $57,718 MAHONEY, KEVIN B.- $167,904 MULLER, RALPH W.- NO DISTRIBUTION OKALA, PHILIP A.- $85,506 QUINN, PETER D., MD- NO DISTRIBUTION VOLPE, MICHELE - $68,305 THE HEALTH SYSTEM ALSO MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN DESIGNED FOR SENIOR FACULTY OF THE SCHOOL OF MEDICINE OF THE UNIVERSITY, AS DESIGNATED BY THE BOARD OF TRUSTEES, WHO ARE ACTIVELY EMPLOYED BY THE UNIVERSITY WHEN THE CONTRIBUTIONS ARE MADE (THE "MED SERP"). VESTING IN THE MED SERP OCCURS AFTER EVERY TEN YEARS OF PARTICIPATION AND UPON THE OCCURRENCE OF CERTAIN EVENTS (ATTAINMENT OF AGE 60, DEATH, DISABILITY, OR INVOLUNTARY TERMINATION WITHOUT "CAUSE"). CONTRIBUTIONS FOR THOSE WHO HAVE REACHED AGE 60 (WITH 2 OR MORE YEARS OF PARTICIPATION) WILL BE FULLY VESTED WHEN MADE. UPON REACHING A VESTING DATE, TAXES OWED WILL BE WITHDRAWN FROM THE PLAN, AND THE REMAINING AFTER-TAX BALANCE WILL REMAIN IN THE PLAN. PARTICIPANTS WILL AUTOMATICALLY RECEIVE A FULL DISTRIBUTION THE SUMMER AFTER THE YEAR IN WHICH THEY TERMINATE EMPLOYMENT, AT WHICH TIME ANY EARNINGS NOT YET TAXED WILL BE TREATED AS TAXABLE INCOME. PARTICIPANTS WHO VOLUNTARILY TERMINATE BEFORE VESTING WILL FORFEIT THE NON-VESTED BALANCE IN THEIR ACCOUNTS. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN THE MED SERP PLAN DURING THE YEAR: ACKER, MICHAEL A.- $24,418 PARMACEK, MICHAEL S. MD- NO DISTRIBUTION QUINN, PETER D., MD- NO DISTRIBUTION ------------------------------
SCHEDULE J, PART I, LINE 7
PROVISION OF NON-FIXED PAYMENTS CLINICAL CARE ASSOCIATES PROVIDES DISCRETIONARY BONUS AND/OR INCENTIVE COMPENSATION PAYMENTS TO ELIGIBLE EMPLOYEES. PAYMENTS MADE TO ANY DISQUALIFIED PERSON IS APPROVED BY THE COMPENSATION COMMITTEE THROUGH THE PROCESS DISCRIBED IN FORM 990, PART VI, SECITON B, LINE 15.
Schedule J (Form 990) 2017
Additional Data
Software ID:
Software Version: