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ObjectId: 202030719349301108 - Submission: 2020-03-11
TIN: 38-3382353
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
Spectrum Health System
Employer identification number
38-3382353
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
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
Christina Freese Decker
President / CEO
(i)
(ii)
1,003,664
-------------
0
1,274,243
-------------
0
13,908
-------------
0
557,571
-------------
0
143,850
-------------
0
2,993,236
-------------
0
807,444
-------------
0
2
Richard Breon
PRESIDENT / CEO - PART YEAR
(i)
(ii)
1,354,065
-------------
0
3,261,657
-------------
0
149,100
-------------
0
24,750
-------------
0
21,341
-------------
0
4,810,913
-------------
0
2,294,061
-------------
0
3
M Ashraf Mansour MD
Director
(i)
(ii)
0
-------------
644,283
0
-------------
178,365
0
-------------
14,116
0
-------------
27,500
0
-------------
19,219
0
-------------
883,483
0
-------------
0
4
MICHAEL P FREED
Former EVP, CFO
(i)
(ii)
0
-------------
0
3,348,651
-------------
584,434
0
-------------
0
0
-------------
0
0
-------------
0
3,348,651
-------------
584,434
3,348,651
-------------
584,434
5
Ronald Knaus
Former SVP, Chief Financial Officer
(i)
(ii)
14,118
-------------
0
3,343,407
-------------
0
3,125,040
-------------
0
0
-------------
0
75,013
-------------
0
6,557,578
-------------
0
2,928,406
-------------
0
6
Matthew Cox
SVP, Chief Financial Officer
(i)
(ii)
715,185
-------------
0
419,217
-------------
0
34,611
-------------
0
394,879
-------------
0
123,521
-------------
0
1,687,413
-------------
0
173,088
-------------
0
7
David Leonard
Secretary, SVP, Chief Legal Officer
(i)
(ii)
498,126
-------------
0
679,304
-------------
0
21,652
-------------
0
230,532
-------------
0
94,440
-------------
0
1,524,054
-------------
0
442,484
-------------
0
8
Loren Hamel MD
SVP, CHIEF STRATEGY OFFICER, President, Lakeland Regional Health System
(i)
(ii)
153,088
-------------
0
132,000
-------------
0
2,944
-------------
0
13,390
-------------
0
39,459
-------------
0
340,881
-------------
0
0
-------------
0
9
Jason Joseph
SVP, Chief Information Officer
(i)
(ii)
383,723
-------------
0
156,939
-------------
0
2,182
-------------
0
93,886
-------------
0
66,443
-------------
0
703,173
-------------
0
49,120
-------------
0
10
Celeste McIntyre
SVP, Corporate Controller
(i)
(ii)
257,570
-------------
0
90,202
-------------
0
4,292
-------------
0
76,673
-------------
0
62,914
-------------
0
491,651
-------------
0
12,219
-------------
0
11
Patrick O'Hare
SVP, Facilities & Chief Information Officer - Part Year
(i)
(ii)
422,323
-------------
0
719,141
-------------
0
21,578
-------------
0
166,081
-------------
0
80,928
-------------
0
1,410,051
-------------
0
463,482
-------------
0
12
Pamela Ries
SVP, Chief Human Resources Officer
(i)
(ii)
443,890
-------------
0
534,210
-------------
0
18,514
-------------
0
226,783
-------------
0
72,846
-------------
0
1,296,243
-------------
0
323,331
-------------
0
13
Lori Smith
SVP, Treasury
(i)
(ii)
299,819
-------------
0
120,828
-------------
0
8,377
-------------
0
75,847
-------------
0
64,862
-------------
0
569,733
-------------
0
29,222
-------------
0
14
J Michael Kramer
Former Highest Compensated
(i)
(ii)
0
-------------
0
222,529
-------------
0
428,730
-------------
0
0
-------------
0
0
-------------
0
651,259
-------------
0
222,529
-------------
0
15
Steven Heacock
SVP, Public Affairs / Research - Part Year
(i)
(ii)
321,375
-------------
0
1,412,702
-------------
0
834,841
-------------
0
101,421
-------------
0
76,136
-------------
0
2,746,475
-------------
0
1,211,883
-------------
0
16
Seth Wolk MD
SVP, Chief Medical Officer - Part Year
(i)
(ii)
471,934
-------------
0
993,976
-------------
0
132,944
-------------
0
185,048
-------------
0
123,560
-------------
0
1,907,462
-------------
0
602,765
-------------
0
17
Roger Jansen
SVP, Business Development / Chief Strategy Officer - Part Year
(i)
(ii)
630,083
-------------
0
821,595
-------------
0
21,086
-------------
0
331,402
-------------
0
100,748
-------------
0
1,904,914
-------------
0
525,201
-------------
0
18
Jill Ferris
SVP, Finance, Payer Relations and Revenue Cycle - Part Year
(i)
(ii)
239,048
-------------
0
566,632
-------------
0
431,315
-------------
0
73,880
-------------
0
56,096
-------------
0
1,366,971
-------------
0
446,515
-------------
0
19
Leonard Levy
VP, Chief Information Security Officer - Part year
(i)
(ii)
80,424
-------------
0
286,097
-------------
0
397,334
-------------
0
87,476
-------------
0
42,883
-------------
0
894,214
-------------
0
286,097
-------------
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 1a First-class or charter travel
The organization has provided first class travel and/or charter travel for certain executive employees and/or board members in limited situations. First class and/or charter travel is utilized when commercial air travel was not available for a destination, or not efficient due to schedules and/or connections, and also for bi-annual board retreat travel. In limited situations where first class travel was utilized, it was paid for as part of a corporate award airline mileage program at no additional cost to the organization. To the extent the benefit is deemed reportable, it is treated as taxable compensation in a 1099 or W-2 to the recipient.
Schedule J, Part I, Line 1a Travel for companions
The organization provided companion travel for six executive employees. The related amounts were treated as taxable compensation and included in Form W-2.
Schedule J, Part I, Line 1a Health or social club dues or initiation fees
The organization provided health club dues for nine executive employees. These amounts were treated as taxable compensation and included in Form W-2.
Schedule J, Part I, Line 4a Severance or change-of-control payment
$621,812 RONALD KNAUS $98,025 STEVEN HEACOCK $223,136 LEONARD LEVY $428,730 J. MICHAEL KRAMER
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
$2,294,061 RICHARD BREON $173,088 MATTHEW COX $446,515 JILL FERRIS $3,933,085 MICHAEL FREED $807,444 CHRISTINA FREESE DECKER $1,211,883 STEVEN HEACOCK $525,201 ROGER JANSEN $49,120 JASON JOSEPH $2,928,406 RONALD KNAUS $222,529 J. MICHAEL KRAMER $442,484 DAVID LEONARD $286,097 LEONARD LEVY $12,219 CELESTE MCINTYRE $463,482 PATRICK O'HARE $323,331 PAMELA RIES $29,222 LORI SMITH $602,765 SETH WOLK SCHEDULE J, PART I, LINE 4B IS ANSWERED "YES" BECAUSE CERTAIN INDIVIDUALS, DO "PARTICIPATE IN" SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN(S). SOME INDIVIDUALS RECEIVED DISTRIBUTIONS DURING THE YEAR (AS REPORTED ON THIS LINE) WHEREAS OTHERS PARTICIPATED IN THE PLAN(S) BUT DID NOT RECEIVE DISTRIBUTIONS. DISTRIBUTIONS REPORTED ON THIS LINE ARE ALSO INCLUDED IN SCHEDULE J, PART II, COLUMN F AS COMPENSATION REPORTED IN A PRIOR YEAR WHILE ALSO BEING REPORTED IN THE CURRENT 990 AS TOTAL COMPENSATION. THIS INCLUDES CERTAIN PAYMENTS IN 2018 OF A LONG-TERM INCENTIVE BONUS PLAN FOR CERTAIN KEY EXECUTIVES THAT HAS A THREE YEAR MEASUREMENT PERIOD ENDING JUNE 30, 2018. The nonqualified retirement plans are an industry standard and are subject to the funding requirements of nonqualified deferred compensation plans under ERISA and federal tax regulations.
Schedule J (Form 990) 2018
Additional Data
Software ID:
18007697
Software Version:
2018v3.1