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.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
SCRIPPS HEALTH PLAN SERVICES INC
 
Employer identification number

33-0782099
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
 
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
1CHRISTOPHER VAN GORDER
TRUSTEE/PRESIDENT AND CEO
(i)

(ii)
0
-------------
1,318,797
0
-------------
906,126
0
-------------
6,471,415
0
-------------
1,121,931
0
-------------
22,687
0
-------------
9,840,956
0
-------------
6,413,502
2STEVE BELL
TREASURER
(i)

(ii)
139,959
-------------
0
18,651
-------------
0
246
-------------
0
11,211
-------------
0
9,022
-------------
0
179,089
-------------
0
0
-------------
0
3BRADLEY ELLIS
SECRETARY
(i)

(ii)
0
-------------
323,448
0
-------------
106,568
0
-------------
50,504
0
-------------
60,710
0
-------------
33,037
0
-------------
574,267
0
-------------
26,555
4MARC A REYNOLDS
PRESIDENT
(i)

(ii)
0
-------------
397,880
0
-------------
167,452
0
-------------
157,916
0
-------------
39,862
0
-------------
22,735
0
-------------
785,845
0
-------------
141,216
5ANIL KESWANI
CORP VP, CMO
(i)

(ii)
432,209
-------------
0
144,351
-------------
0
97,675
-------------
0
87,043
-------------
0
33,118
-------------
0
794,396
-------------
0
60,377
-------------
0
6Karri Rodgers
Interim President
(i)

(ii)
305,920
-------------
0
69,863
-------------
0
22,512
-------------
0
10,800
-------------
0
35,420
-------------
0
444,515
-------------
0
0
-------------
0
7JANE FLANAGAN-BROWN
DIRECTOR PROVIDER NETWORK MGMT
(i)

(ii)
139,170
-------------
0
19,080
-------------
0
254
-------------
0
3,281
-------------
0
21,178
-------------
0
182,963
-------------
0
0
-------------
0
8BRENDA J MADANAT
Care Manager
(i)

(ii)
147,113
-------------
0
0
-------------
0
516
-------------
0
5,990
-------------
0
16,526
-------------
0
170,145
-------------
0
0
-------------
0
9VICTOR RODRIGUEZ
DIRECTOR, EDI SYSTEMS & OPS
(i)

(ii)
152,897
-------------
0
20,661
-------------
0
823
-------------
0
7,093
-------------
0
21,529
-------------
0
203,003
-------------
0
0
-------------
0
10APRIL SEGAL
Advance Practice Pharmacist
(i)

(ii)
144,709
-------------
5,309
0
-------------
0
46
-------------
2
5,813
-------------
213
8,070
-------------
309
158,638
-------------
5,833
0
-------------
0
11MAUREEN WADE
ASST VP, MEDICAL MGMT
(i)

(ii)
193,491
-------------
0
36,002
-------------
0
10,780
-------------
0
4,720
-------------
0
24,633
-------------
0
269,626
-------------
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 1B CERTAIN EXECUTIVES REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE AN AUTOMOBILE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR W-2S.
Schedule J, Part I, Line 4b SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN (SERP) PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN KEY EMPLOYEES. IT HAS BEEN CLOSED TO NEW PARTICIPANTS SINCE 2001. THE PLAN PROVIDES A BENEFIT DETERMINED BY A FORMULA DRIVEN BY THE EXECUTIVE'S AVERAGE OF THE FIVE HIGHEST YEARS OF PAY AND TAKES INTO CONSIDERATION TENURE AT SCRIPPS HEALTH, AGE, AND LIFE EXPECTANCY AND ASSUMES MAXIMUM PARTICIPATION IN OTHER RETIREMENT PROGRAMS. EFFECTIVE JANUARY 1, 2014, SCRIPPS HEALTH FROZE ALL BENEFITS UNDER THE EXISTING SERP PLAN FOR THE PARTICIPANTS. EFFECTIVE DECEMBER 31, 2017, SCRIPPS HEALTH TERMINATED THIS 409(A) PLAN AND DISTRIBUTED TO EACH PARTICIPANT AN AMOUNT EQUAL TO THE INCOME TAX WITHHOLDING AND FICA TAXES DUE ON THE VESTED BENEFITS. THE REMAINING AMOUNTS WERE DISTRIBUTED APPROXIMATELY 1 YEAR LATER. THE FOLLOWING INDIVIDUAL RECEIVED PAYMENTS FROM THE SERP PLAN IN CALENDAR YEAR 2017: CHRISTOPHER VAN GORDER $ 3,350,352 EFFECTIVE APRIL 1, 2014, SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME. SCRIPPS HEALTH EXECUTIVE BENEFITS PROGRAM PROVIDES A 457F PLAN WITH A FLEXIBLE BENEFIT ALLOWANCE THAT CAN BE USED TO PURCHASE ADDITIONAL INSURANCE COVERAGE FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES. ANY REMAINING BENEFIT ALLOWANCE CAN BE DEPOSITED INTO THE SUPPLEMENTAL ACCUMULATION RETIREMENT ACCOUNT (SARA) WITH A FUTURE VESTING DATE. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SARA PLAN IN CALENDAR YEAR 2017: CHRISTOPHER VAN GORDER $ 237,738 BRADLEY ELLIS $ 26,555 MARC A. REYNOLDS $ 141,216 ANIL KESWANI $ 60,377
Schedule J (Form 990) 2017
Additional Data


Software ID:  
Software Version: