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ObjectId: 201941969349301259 - Submission: 2019-07-15
TIN: 94-6174066
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
STANFORD HEALTH CARE
Employer identification number
94-6174066
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
Yes
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
ED DAMROSE MD
DIRECTOR
(i)
(ii)
0
-------------
254,752
0
-------------
367,947
0
-------------
3,989
0
-------------
25,566
0
-------------
10,331
0
-------------
662,585
0
-------------
0
2
CHRISTOPHER DAWES
DIRECTOR (SEE SCHEDULE O)
(i)
(ii)
0
-------------
979,769
0
-------------
151,000
0
-------------
2,576,566
0
-------------
1,242,300
0
-------------
42,057
0
-------------
4,991,692
0
-------------
1,800,000
3
DAVID ENTWISTLE
DIRECTOR/CEO
(i)
(ii)
1,605,703
-------------
0
768,009
-------------
0
49,532
-------------
0
305,599
-------------
0
51,964
-------------
0
2,780,807
-------------
0
0
-------------
0
4
SAM GAMBHIR MD
DIRECTOR
(i)
(ii)
0
-------------
591,294
0
-------------
221,027
0
-------------
0
0
-------------
27,000
0
-------------
28,705
0
-------------
868,026
0
-------------
0
5
ROBERT HARRINGTON
DIRECTOR
(i)
(ii)
0
-------------
559,554
0
-------------
354,556
0
-------------
19,183
0
-------------
23,538
0
-------------
31,724
0
-------------
988,555
0
-------------
0
6
LLOYD B MINOR MD
DIRECTOR
(i)
(ii)
0
-------------
1,467,861
0
-------------
250,000
0
-------------
1,925,159
0
-------------
124,300
0
-------------
39,518
0
-------------
3,806,838
0
-------------
1,306,452
7
NORMAN RIZK MD
DIRECTOR
(i)
(ii)
0
-------------
418,296
0
-------------
597,357
0
-------------
0
0
-------------
27,000
0
-------------
13,762
0
-------------
1,056,415
0
-------------
0
8
QUINN MCKENNA
COO
(i)
(ii)
950,442
-------------
0
928,847
-------------
0
52,887
-------------
0
118,505
-------------
0
45,638
-------------
0
2,096,319
-------------
0
0
-------------
0
9
LINDA HOFF
CFO
(i)
(ii)
347,949
-------------
0
500,000
-------------
0
53,472
-------------
0
42,670
-------------
0
14,087
-------------
0
958,178
-------------
0
0
-------------
0
10
DALE BEATTY
CNO & VP PATIENT CARE SERVICES
(i)
(ii)
246,798
-------------
0
231,015
-------------
0
91,616
-------------
0
27,025
-------------
0
11,250
-------------
0
607,704
-------------
0
0
-------------
0
11
CATHERINE D KRNA
VP - AMBULATORY CARE & GI
(i)
(ii)
458,241
-------------
0
110,374
-------------
0
53,983
-------------
0
63,375
-------------
0
38,067
-------------
0
724,040
-------------
0
0
-------------
0
12
SHIRLEY WEBER
VP - CLINICAL OPERATIONS
(i)
(ii)
312,183
-------------
0
69,015
-------------
0
76,273
-------------
0
26,759
-------------
0
28,678
-------------
0
512,908
-------------
0
24,839
-------------
0
13
ERIC YABLONKA
CHIEF INFORMATION OFFICER
(i)
(ii)
160,767
-------------
0
300,000
-------------
0
36,310
-------------
0
16,154
-------------
0
5,276
-------------
0
518,507
-------------
0
0
-------------
0
14
DAVID J CONNOR
VP FINANCE
(i)
(ii)
575,468
-------------
0
179,100
-------------
0
90,576
-------------
0
26,775
-------------
0
21,595
-------------
0
893,514
-------------
0
0
-------------
0
15
WENDY H FOAD
ASSOCIATE CNO
(i)
(ii)
407,829
-------------
0
98,084
-------------
0
426,429
-------------
0
29,594
-------------
0
2,749
-------------
0
964,685
-------------
0
0
-------------
0
16
DAVID D JONES
VP & CHIEF HR OFFICER
(i)
(ii)
464,156
-------------
0
409,618
-------------
0
26,804
-------------
0
59,254
-------------
0
23,834
-------------
0
983,666
-------------
0
0
-------------
0
17
PRAVENE NATH
CHIEF MED INFO OFFICER
(i)
(ii)
107,699
-------------
0
0
-------------
0
639,987
-------------
0
20,438
-------------
0
590
-------------
0
768,714
-------------
0
0
-------------
0
18
JENNIFER VARGAS
VP BUS DEVELOPMENT
(i)
(ii)
0
-------------
0
50,000
-------------
0
608,421
-------------
0
0
-------------
0
0
-------------
0
658,421
-------------
0
2,808
-------------
0
19
MARK TORTORICH
VP DESIGN, PLAN, CONSTRUCTION
(i)
(ii)
41,399
-------------
0
0
-------------
0
428,915
-------------
0
15,067
-------------
0
2,881
-------------
0
488,262
-------------
0
0
-------------
0
20
DENNIS LUND
DIRECTOR (SEE SCHEDULE O)
(i)
(ii)
0
-------------
389,149
0
-------------
485,163
0
-------------
29,696
0
-------------
16,902
0
-------------
37,742
0
-------------
958,652
0
-------------
0
21
RANDALL LIVINGSTON
DIRECTOR (SEE SCHEDULE O)
(i)
(ii)
0
-------------
687,644
0
-------------
0
0
-------------
200
0
-------------
249,222
0
-------------
31,993
0
-------------
969,059
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 1A
HOUSING ALLOWANCE 3 OFFICERS, 3 KEY EMPLOYEES, AND 1 HIGHEST COMPENSATED EMPLOYEE RECEIVED HOUSING AS A TAXABLE BENEFIT AND THE AMOUNT HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B (III).
SCHEDULE J, PART I, LINE 4A
IN 2017 IN CONNECTION WITH THEIR DEPARTURE, THREE HIGHEST COMPENSATED EMPLOYEES & ONE KEY EMPLOYEE RECEIVED TOTAL SEVERANCE PAYMENTS OF $342,077, $375,211, 535,787 & $605,613 WHICH ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(III).
SCHEDULE J, PART I, LINE 4B
STANFORD HEALTH CARE ("SHC") PROVIDES ALL SENIOR EXECUTIVES WITH A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO SUPPLEMENT THEIR RETIREMENT BENEFITS. FOR EACH CALENDAR YEAR, A HYPOTHETICAL ACCOUNT IS ESTABLISHED FOR EACH PARTICIPANT AND CREDITED WITH AN AMOUNT EQUAL TO A PERCENTAGE OF BASE SALARY (DEPENDING ON THE INDIVIDUAL'S POSITION) AS OF THE LAST DAY OF EACH QUARTER. THE COMPENSATION COMMITTEE MAY DETERMINE THAT CREDITS SHALL BE MADE IN ADDITION TO THOSE ABOVE IN ITS SOLE DISCRETION. A PARTICIPANT BECOMES VESTED IN EACH CALENDAR YEAR ACCOUNT ON THE FIRST BUSINESS DAY OF JANUARY FOLLOWING THE SECOND CALENDAR YEAR IN WHICH THE ACCOUNT WAS ESTABLISHED (OR, IF LATER, THE DATE ON WHICH THE PARTICIPANT COMPLETES TWO FULL YEARS OF PARTICIPATION). THE PARTICIPANT BECOMES FULLY VESTED IN HIS OR HER ACCOUNTS UNDER THE SERP UPON THE EARLIEST OF (A) DISCHARGE FROM EMPLOYMENT WITHOUT CAUSE; (B) ENTITLEMENT TO LONG-TERM DISABILITY INCOME BENEFITS; (C) ATTAINMENT OF AGE OF 60 WHILE EMPLOYED OR IF LATER, THE PARTICIPANT'S COMPLETION OF TWO FULL YEARS OF PARTICIPATION; (D) COMPLETION OF SEVEN YEARS AS AN ELIGIBLE EMPLOYEE; OR (E) DEATH. THE FOLLOWING AMOUNTS BECAME VESTED AND WERE PAID TO THE FOLLOWING INDIVIDUALS IN CALENDAR YEAR 2017: CHRISTOPHER DAWES $ 170,729 DAVID CONNOR $ 50,816 JENNIFER VARGAS $ 2,808 CATHERINE KRNA $ 14,451 SHIRLEY WEBER $ 66,630 FOR CERTAIN INDIVIDUALS LISTED ON SCHEDULE J, PART II, AMOUNTS CREDITED UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). AMOUNTS CREDITED AND DISCLOSED ON THE FORM 990 IN PRIOR YEARS THAT VESTED AND WERE PAID IN CALENDAR 2017 ARE REPORTED IN COLUMN (F). CHRISTOPHER DAWES, PRESIDENT OF LPCH HAD TWO NONQUALIFIED DEFERRED COMPENSATION ARRANGEMENTS. UNDER THE FIRST ARRANGEMENT, MR. DAWES RECEIVED CREDITS TO HIS ACCOUNT THROUGH 2016 PROVIDED HE REMAINED EMPLOYED IN HIS CURRENT POSITION. THIS BALANCE OF $2,375,967 WAS PAID IN MARCH OF 2017. UNDER THE SECOND ARRANGEMENT, MR. DAWES RECEIVED AN ADDITIONAL CREDIT TO HIS ACCOUNT WITH PAYMENT CONTINGENT ON CONTINUED SERVICE THRORUGH APRIL 1, 2018. RANDALL LIVINGSTON AND LLOYD B. MINOR PARTICIPATE IN A DEFERRED COMPENSATION PLAN AT STANFORD UNIVERSITY, A RELATED ORGANIZATION. AMOUNTS ARE CREDITED TO THE PLAN BASED ON PERFORMANCE AND CERTAIN OTHER FACTORS. PLAN BALANCES ARE SUBJECT TO FORFEITURE AND/OR PAYMENT IF CERTAIN CONDITIONS ARE MET. CERTAIN BONUS AMOUNTS MAY BE DEFERRED AND PAID IN A LATER YEAR SUBJECT TO IRC SECTION 457(F).
SCHEDULE J, PART I, LINE 7 & PART II, DESCRIPTION FOR COLUMN B(II)
OFFICERS AND OTHERS WITH AMOUNTS IN THIS COLUMN RECEIVE BONUS AWARDS AND INCENTIVE COMPENSATION. THE ANNUAL INCENTIVE PLAN (AIP) IS BASED ON ACHIEVING CERTAIN GOALS ESTABLISHED PRIOR TO THE NEW FISCAL YEAR. THE GOALS ARE BASED ON THE FOCUSED AREAS, SUCH AS PATIENT CARE, QUALITY/SAFETY SERVICE, FINANCIAL RESULT, AND DEPARTMENT/PERSONAL PERFORMANCE.
SCHEDULE J, PART II, DESCRIPTION FOR COLUMN B(III)
OTHER REPORTABLE COMPENSATION IN SCHEDULE J, PART II, COLUMN B(III) INCLUDES HOUSING ASSISTANCE, SERP CASH DISTRIBUTION, GRANT MONIES, ACCRUED VACATION PAY OUT, GROUP TERM LIFE, AND TAXABLE MOVING ASSISTANCE. IN ADDITION, SHC HAS PROVIDED VARIOUS ITEMS OF "LISTED PROPERTY" (E.G. COMPUTERS AND PERIPHERALS) TO THE ABOVE LISTED EMPLOYEES PRINCIPALLY FOR THEIR BUSINESS USE.
SCHEDULE J, PART II
DIRECTORS ARE NOT COMPENSATED IN THEIR CAPACITY AS DIRECTORS OF SHC. HOWEVER, IF THE INDIVIDUALS LISTED WERE ALSO EMPLOYEES OF RELATED ORGANIZATIONS, POSITIONS FOR WHICH THEY RECEIVED COMPENSATION AS REPORTED IN PART II.
Schedule J (Form 990) 2017
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