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ObjectId: 201941359349306839 - Submission: 2019-05-15
TIN: 71-0830696
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
ST VINCENT MEDICAL GROUP
Employer identification number
71-0830696
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
Yes
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
CHAD ADUDDELL
Market CEO
(i)
(ii)
0
-------------
517,479
0
-------------
107,937
0
-------------
60,400
0
-------------
62,976
0
-------------
22,409
0
-------------
771,201
0
-------------
40,151
2
LARRY SCHUMACHER
SENIOR VICE PRESIDENT/BOARD MEMBER
(i)
(ii)
0
-------------
735,553
0
-------------
641,436
0
-------------
25,258
0
-------------
128,458
0
-------------
24,683
0
-------------
1,555,388
0
-------------
0
3
JOHN JONES MD
BOARD MEMBER / SURGEON
(i)
(ii)
260,966
-------------
138,158
0
-------------
0
5,253
-------------
2,781
0
-------------
9,450
2,276
-------------
11,069
268,495
-------------
161,458
0
-------------
0
4
ANDREW KUMPURIS MD
BOARD MEMBER/CARDIOLOGIST
(i)
(ii)
0
-------------
650,625
0
-------------
333,003
0
-------------
10,668
0
-------------
16,075
0
-------------
15,153
0
-------------
1,025,524
0
-------------
0
5
Sayyadul Siddiqui
Board Member / Vice Chief of Staff
(i)
(ii)
0
-------------
549,493
0
-------------
177,677
0
-------------
1,932
0
-------------
16,075
0
-------------
21,683
0
-------------
766,860
0
-------------
0
6
MARK MCGINNIS
Former TREASURER/CHIEF FINANCIAL OFFICER - SVIMC
(i)
(ii)
0
-------------
424,016
0
-------------
104,627
0
-------------
62,976
0
-------------
16,075
0
-------------
26,032
0
-------------
633,726
0
-------------
0
7
SHAWN BARNETT
MKT SVP CFO
(i)
(ii)
0
-------------
298,845
0
-------------
2,500
0
-------------
414
0
-------------
3,074
0
-------------
25,110
0
-------------
329,943
0
-------------
0
8
Tadd Richert
MARKET CFO/TREASURER (PARTIAL YEAR THROUGH 2/23/18)
(i)
(ii)
0
-------------
315,651
0
-------------
0
0
-------------
14,716
0
-------------
0
0
-------------
24,676
0
-------------
355,043
0
-------------
0
9
OTIS GORDON
GASTROENTEROLOGIST
(i)
(ii)
607,087
-------------
0
137,104
-------------
0
1,880
-------------
0
130
-------------
0
21,245
-------------
0
767,446
-------------
0
0
-------------
0
10
ALI KRISHT
NEUROSURGEON
(i)
(ii)
1,834,539
-------------
0
188,652
-------------
0
4,652
-------------
0
16,075
-------------
0
21,901
-------------
0
2,065,819
-------------
0
0
-------------
0
11
ALI RAJA
NEUROSURGEON
(i)
(ii)
637,495
-------------
0
89,816
-------------
0
1,960
-------------
0
16,764
-------------
0
21,311
-------------
0
767,346
-------------
0
0
-------------
0
12
STYLIANOS RAMMOS
NEUROSURGEON
(i)
(ii)
632,778
-------------
0
704,814
-------------
0
1,960
-------------
0
16,075
-------------
0
21,683
-------------
0
1,377,310
-------------
0
0
-------------
0
13
RAGHU REDDY
PULMONOLOGIST-GENERAL
(i)
(ii)
462,053
-------------
0
326,187
-------------
0
1,185
-------------
0
16,587
-------------
0
2,004
-------------
0
808,016
-------------
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 4a SEVERANCE OR CHANGE-OF-CONTROL PAYMENT
POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
DURING THE 2017 CALENDAR YEAR CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS/PRESIDENTS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: Mark J. McGinnis Chad Aduddell Lawrence P. Schumacher DURING 2017 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: Chad Aduddell - $47,278 Lawrence P. Schumacher - 112,320 DURING 2017 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: Chad Aduddell - $40,157
Schedule J, Part I, Line 5a Compensation contingent on revenues of the organization
ST. VINCENT MEDICAL GROUP PROVIDED INCENTIVE COMPENSATION FOR CERTAIN PHYSICIANS BASED UPON "NET COLLECTED REVENUE." THESE AMOUNTS WERE NOT DETERMINED WITH REFERENCE TO ORGANIZATIONAL NET COLLECTED REVENUE OR ORGANIZATIONAL NET INCOME. RATHER, THESE AMOUNTS WERE DETERMINED BASED UPON THE PHYSICIAN'S CONTRIBUTION TO NET COLLECTED REVENUE BASED ON SERVICES PERFORMED BY THAT INDIVIDUAL PHYSICIAN IN EXCESS OF A THRESHOLD. PHYSICIAN TOTAL COMPENSATION IS APPROVED IN ADVANCE BY A COMMITTEE OF THE BOARD OF DIRECTORS OF SVIMC FOLLOWING IRC SEC. 4958 REBUTTABLE PRESUMPTION OF REASONABLENESS PROCEDURES. TOTAL COMPENSATION IS SUBJECT TO A CAP THAT ENSURES COMPENSATION IS AT FAIR MARKET VALUE.
Schedule J (Form 990) 2017
Additional Data
Software ID:
17005876
Software Version:
2017v2.2