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ObjectId: 201923129349301837 - Submission: 2019-11-08
TIN: 38-2776791
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
18
Open to Public Inspection
Name of the organization
BRONSON BATTLE CREEK HOSPITAL
Employer identification number
38-2776791
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
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
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) 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
1
KARAMCHANDANI MAHESH C
DIRECTOR
(i)
(ii)
0
-------------
598,141
0
-------------
51,086
0
-------------
24,856
0
-------------
13,650
0
-------------
13,937
0
-------------
701,670
0
-------------
0
2
LANE-DAVIES AARON
DIRECTOR (THRU 6-2018)
(i)
(ii)
0
-------------
300,092
0
-------------
14,741
0
-------------
2,569
0
-------------
17,700
0
-------------
19,141
0
-------------
354,243
0
-------------
0
3
LAWLOR JOHN R
DIRECTOR
(i)
(ii)
0
-------------
336,127
0
-------------
34,433
0
-------------
20,648
0
-------------
13,650
0
-------------
12,629
0
-------------
417,487
0
-------------
0
4
SARDONE FRANK J
PRESIDENT AND CEO
(i)
(ii)
0
-------------
887,624
0
-------------
376,175
0
-------------
508,273
0
-------------
368,078
0
-------------
14,102
0
-------------
2,154,252
0
-------------
635,164
5
EAST REBECCA L
SR VP CFO BHG
(i)
(ii)
0
-------------
430,410
0
-------------
133,314
0
-------------
98,847
0
-------------
154,140
0
-------------
13,382
0
-------------
830,093
0
-------------
133,314
6
FALAHEE JAMES
SR VP LEGAL & LEG. AFFAIRS
(i)
(ii)
0
-------------
415,769
0
-------------
123,037
0
-------------
168,007
0
-------------
153,072
0
-------------
19,723
0
-------------
879,608
0
-------------
211,118
7
HARRELSON KATHLEEN M
SR VP CLINICAL OPERATIONS
(i)
(ii)
0
-------------
455,422
0
-------------
140,116
0
-------------
105,298
0
-------------
144,944
0
-------------
11,449
0
-------------
857,229
0
-------------
140,116
8
HAYDEN JOHN
VP & CHIEF HR OFFICER
(i)
(ii)
0
-------------
346,826
0
-------------
114,987
0
-------------
121,006
0
-------------
119,901
0
-------------
8,897
0
-------------
711,617
0
-------------
166,237
9
JONES JR JOHN L
SR VP REG. & PHYS. SVS.
(i)
(ii)
0
-------------
407,545
0
-------------
143,082
0
-------------
96,799
0
-------------
149,976
0
-------------
19,749
0
-------------
817,151
0
-------------
143,082
10
LARSON SCOTT
SR VP MEDICAL AFFAIRS/CMO
(i)
(ii)
0
-------------
471,827
0
-------------
128,687
0
-------------
193,151
0
-------------
164,560
0
-------------
13,384
0
-------------
971,609
0
-------------
229,755
11
GOELASHUTOSH
SR VP IT AND CIO
(i)
(ii)
0
-------------
392,578
0
-------------
81,141
0
-------------
41,620
0
-------------
93,727
0
-------------
7,103
0
-------------
616,169
0
-------------
81,141
12
TRELLA REBECCA
VP POST ACUTE CARE
(i)
(ii)
0
-------------
273,913
0
-------------
44,241
0
-------------
1,164
0
-------------
57,755
0
-------------
8,400
0
-------------
385,473
0
-------------
44,241
13
WAY MICHAEL S
VP MAT. MGT. & FACILITY SV
(i)
(ii)
0
-------------
220,930
0
-------------
67,771
0
-------------
21,816
0
-------------
79,630
0
-------------
12,715
0
-------------
402,862
0
-------------
37,771
14
SANGALLI-DAVIS CHRISTINE
VP CHIEF COMPLIANCE OFFICER
(i)
(ii)
0
-------------
194,068
0
-------------
31,582
0
-------------
1,152
0
-------------
56,247
0
-------------
7,467
0
-------------
290,516
0
-------------
31,582
15
MCKERNAN JAMES E
SR VP COO BBCH
(i)
(ii)
0
-------------
307,958
0
-------------
61,852
0
-------------
21,847
0
-------------
83,923
0
-------------
19,476
0
-------------
495,056
0
-------------
61,852
16
MADALA CHANGRAMOULI
PHYSICIAN
(i)
(ii)
715,573
-------------
0
0
-------------
0
27,366
-------------
0
13,650
-------------
0
9,879
-------------
0
766,468
-------------
0
0
-------------
0
17
BURKHARDT JOSEPH
PHYSICIAN
(i)
(ii)
1,436,386
-------------
0
72,453
-------------
0
22,389
-------------
0
13,650
-------------
0
21,073
-------------
0
1,565,951
-------------
0
0
-------------
0
18
MURRAY KERRI
PHYSICIAN
(i)
(ii)
884,615
-------------
0
86,175
-------------
0
18,758
-------------
0
17,700
-------------
0
20,423
-------------
0
1,027,671
-------------
0
0
-------------
0
19
RUSSELL MARK
PHYSICIAN
(i)
(ii)
1,231,375
-------------
0
62,260
-------------
0
10,082
-------------
0
13,650
-------------
0
3,969
-------------
0
1,321,336
-------------
0
0
-------------
0
20
MUDGE RANDY
PHYSICIAN
(i)
(ii)
745,668
-------------
0
65,000
-------------
0
1,656
-------------
0
13,650
-------------
0
20,492
-------------
0
846,466
-------------
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
PART I, LINE 1A
THE BOARD OF DIRECTORS IS NOT DIRECTLY COMPENSATED. SPOUSAL TRAVEL AND HEALTH CLUB DUES ARE AVAILABLE FOR THE BOARD OF DIRECTORS. THOSE WHO PARTICIPATE RECEIVE A 1099 AND THE DUES ARE TREATED AS A TAXABLE FRINGE BENEFIT.
PART I, LINE 3
BRONSON HEALTHCARE GROUP, A RELATED ORGANIZATION, USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY AND/OR STUDY AND APPROVAL BY BOARD AND/OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR.
PART I, LINE 4B
THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENT FROM A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN FROM RELATED ENTITY BRONSON HEALTHCARE GROUP: SARDONE, FRANK J $260,526 SERP DISTRIBUTION SARDONE, FRANK J $206,295 SERP CONTRIBUTION FALAHEE JR., JAMES B $88,081 SERP DISTRIBUTION FALAHEE JR., JAMES B $74,246 SERP CONTRIBUTION HAYDEN, JOHN T $51,250 SERP DISTRIBUTION HAYDEN, JOHN T $64,075 SERP CONTRIBUTION JONES JR., JOHN $74,987 SERP CONTRIBUTION HARRELSON, KATHLEEN $83,164 SERP CONTRIBUTION EAST, REBECCA $79,612 SERP CONTRIBUTION LARSON, SCOTT D $101,068 SERP DISTRIBUTION LARSON, SCOTT D $82,174 SERP CONTRIBUTION PART II, COLUMN (B) (III) AND (F): INCLUDED IN PART II, COLUMN (B) (III) AND (F) ARE AMOUNTS THAT WERE PAID TO THE EXECUTIVE UNDER THE BRONSON HEALTHCARE GROUP, INC. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THESE AMOUNTS WERE CREDITED TO AN ACCOUNT FOR THE EXECUTIVE IN PRIOR YEARS AND WERE PREVIOUSLY REPORTED IN COLUMN C IN THE PRIOR YEAR, BUT THE EXECUTIVE WAS REQUIRED TO REMAIN EMPLOYED UNTIL THE YEAR FOR WHICH THIS FORM IS BEING FILED IN ORDER TO BECOME VESTED IN HIS OR HER ACCOUNT. AMOUNTS HAVE BEEN CREDITED TO THESE EXECUTIVES' ACCOUNTS EACH YEAR SINCE THE SERP WAS ADOPTED IN 1994, AND THE ACCOUNTS HAVE ALSO BEEN ADJUSTED FOR GAINS AND LOSSES SINCE THAT TIME. THEREFORE, THESE AMOUNTS SHOULD BE VIEWED AS HAVING BEEN EARNED OVER THE EXECUTIVE'S ENTIRE PERIOD OF EMPLOYMENT AS AN EXECUTIVE OF BRONSON. THE AMOUNT CREDITED TO EACH EXECUTIVE'S ACCOUNT IN THE SERP EACH YEAR AND EACH EXECUTIVE'S TOTAL COMPENSATION PACKAGE WAS APPROVED BY AN INDEPENDENT CONSULTANT TO ENSURE THAT THESE AMOUNTS ARE COMPARABLE TO OR LESS THAN THE AMOUNTS AWARDED TO EXECUTIVES OF COMPARABLE HEALTH CARE ORGANIZATIONS.
Schedule J (Form 990) 2018
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