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.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
Mercy Medical Center - Newton
 
Employer identification number

42-1470935
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
 
No
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) 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
1CHRIS CHRISTENSEN
 
Former Vice Chair/VP Professional Services
(i)

(ii)
0
-------------
250,493
0
-------------
12,162
0
-------------
15,275
0
-------------
12,480
0
-------------
15,241
0
-------------
305,651
0
-------------
0
2STEVE KUKLA
 
FORMER DIRECTOR/SVP, CFO MMC, Secretary/Treasurer
(i)

(ii)
0
-------------
54,202
0
-------------
0
0
-------------
2,196
0
-------------
8,705
0
-------------
2,280
0
-------------
67,383
0
-------------
0
3LAURIE ALBERT-CONNER
 
President
(i)

(ii)
240,747
-------------
0
11,782
-------------
0
16,277
-------------
0
13,340
-------------
0
2,304
-------------
0
284,450
-------------
0
0
-------------
0
4KARL KEELER
 
PRESIDENT CHI Iowa Corp
(i)

(ii)
0
-------------
458,728
0
-------------
102,420
0
-------------
116,135
0
-------------
0
0
-------------
22,114
0
-------------
699,397
0
-------------
0
5MICHAEL WEGNER
 
Former Director / Market SVP COO
(i)

(ii)
0
-------------
571,535
0
-------------
92,336
0
-------------
20,932
0
-------------
16,375
0
-------------
15,434
0
-------------
716,612
0
-------------
0
6SONJA RANCK
 
Chief Nursing Officer (Part Year)
(i)

(ii)
154,683
-------------
0
2,000
-------------
0
779
-------------
0
9,921
-------------
0
22,241
-------------
0
189,624
-------------
0
0
-------------
0
7RANDALL RUBIN
 
SVP, CFO CHI IOWA CORP
(i)

(ii)
0
-------------
425,383
0
-------------
21,214
0
-------------
20,932
0
-------------
16,375
0
-------------
23,711
0
-------------
507,615
0
-------------
0
8JOHN GACHIANI
 
PHYSICIAN
(i)

(ii)
0
-------------
915,162
0
-------------
0
0
-------------
756
0
-------------
15,653
0
-------------
21,038
0
-------------
952,609
0
-------------
0
9Megan DePoorter
 
CRNA
(i)

(ii)
159,141
-------------
0
0
-------------
0
14,914
-------------
0
11,381
-------------
0
21,753
-------------
0
207,189
-------------
0
0
-------------
0
10Susan Pair
 
CRNA
(i)

(ii)
208,813
-------------
0
0
-------------
0
25,632
-------------
0
13,033
-------------
0
21,753
-------------
0
269,231
-------------
0
0
-------------
0
11Susan Springer
 
CRNA
(i)

(ii)
169,863
-------------
0
0
-------------
0
1,515
-------------
0
10,038
-------------
0
5,700
-------------
0
187,116
-------------
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
Schedule J, Part I, Line 4a Post-Termination Payments During the calendar year 2018, post-termination payments were addressed in executive employment agreements for Catholic Health Initiatives 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 7 Non-fixed payments MERCY MEDICAL CENTER-NEWTON MAINTAINS A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE BOARD OF DIRECTORS. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON HITTING MINIMUM LEVELS OF OPERATING MARGIN, UNLESS THE BOARD OF DIRECTORS USE THEIR DISCRETION TO APPROVE AN EXCEPTION.
Schedule J (Form 990) 2018
Additional Data


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