efile Public Visual Render
ObjectId: 202041359349303984 - Submission: 2020-05-14
TIN: 32-0007056
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
OhioHealth Corporation Group Return
Employer identification number
32-0007056
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
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) 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
Blom David P
President/CEO/Board - OhioHealth
(i)
(ii)
0
-------------
1,324,352
0
-------------
1,634,418
0
-------------
32,780
0
-------------
1,706,294
0
-------------
21,811
0
-------------
4,719,655
0
-------------
0
2
Caulin-Glaser Teresa L MD
Chair Board
(i)
(ii)
0
-------------
610,315
0
-------------
546,980
0
-------------
35,603
0
-------------
12,733
0
-------------
19,868
0
-------------
1,225,499
0
-------------
0
3
Herbert-Sinden Cheryl L
Chair Board
(i)
(ii)
0
-------------
453,901
0
-------------
376,557
0
-------------
28,566
0
-------------
177,701
0
-------------
19,614
0
-------------
1,056,339
0
-------------
0
4
Johnson Katherine E MD
Chair Board
(i)
(ii)
205,255
-------------
0
0
-------------
0
78
-------------
0
12,498
-------------
0
9,528
-------------
0
227,359
-------------
0
0
-------------
0
5
Knutson Douglas MD
Vice-Chair Board
(i)
(ii)
0
-------------
419,183
0
-------------
139,855
0
-------------
26,065
0
-------------
14,375
0
-------------
11,893
0
-------------
611,371
0
-------------
0
6
Louge Michael W
Executive VP & COO/CFO (Start 8/18; End 6/19)
(i)
(ii)
0
-------------
945,879
0
-------------
942,782
0
-------------
17,881
0
-------------
659,219
0
-------------
26,750
0
-------------
2,592,511
0
-------------
0
7
Meldrum Terri W Esq
Secretary Board
(i)
(ii)
0
-------------
379,479
0
-------------
243,500
0
-------------
23,907
0
-------------
70,598
0
-------------
26,750
0
-------------
744,234
0
-------------
0
8
Morrison Karen J
President Board
(i)
(ii)
0
-------------
472,759
0
-------------
387,048
0
-------------
9,401
0
-------------
129,307
0
-------------
26,466
0
-------------
1,024,981
0
-------------
0
9
Snyder Ronald P
President Board
(i)
(ii)
0
-------------
189,351
0
-------------
52,863
0
-------------
6,876
0
-------------
17,497
0
-------------
19,868
0
-------------
286,455
0
-------------
0
10
Thornhill Hugh A
President Board
(i)
(ii)
0
-------------
424,117
0
-------------
363,430
0
-------------
29,056
0
-------------
126,192
0
-------------
26,750
0
-------------
969,545
0
-------------
0
11
Abel Michael Joseph
Board
(i)
(ii)
0
-------------
180,227
0
-------------
51,409
0
-------------
5,293
0
-------------
19,048
0
-------------
24,890
0
-------------
280,867
0
-------------
0
12
Arshi Arash MD
Board
(i)
(ii)
634,860
-------------
0
1,560
-------------
0
73,743
-------------
0
7,163
-------------
0
27,210
-------------
0
744,536
-------------
0
0
-------------
0
13
Brandon Heather
Board
(i)
(ii)
0
-------------
245,933
0
-------------
89,523
0
-------------
21,569
0
-------------
15,170
0
-------------
19,868
0
-------------
392,063
0
-------------
0
14
Bunyard Stephen P
Board
(i)
(ii)
0
-------------
364,572
0
-------------
258,397
0
-------------
8,520
0
-------------
67,675
0
-------------
19,868
0
-------------
719,032
0
-------------
0
15
Collazo Antonio E MD
Board
(i)
(ii)
433,510
-------------
0
69,557
-------------
0
2,308
-------------
0
16,500
-------------
0
20,450
-------------
0
542,325
-------------
0
0
-------------
0
16
DeVillers Rebecca E DO
Board
(i)
(ii)
154,984
-------------
0
6,204
-------------
0
12,230
-------------
0
12,364
-------------
0
226
-------------
0
186,008
-------------
0
0
-------------
0
17
Ferris Frank MD
Board
(i)
(ii)
0
-------------
289,177
0
-------------
83,959
0
-------------
46,885
0
-------------
11,608
0
-------------
10,826
0
-------------
442,455
0
-------------
0
18
Gallaher Connie L
Board
(i)
(ii)
0
-------------
305,651
0
-------------
146,858
0
-------------
23,518
0
-------------
30,484
0
-------------
10,826
0
-------------
517,337
0
-------------
0
19
Geskey Joseph DO
Board
(i)
(ii)
0
-------------
302,171
0
-------------
41,913
0
-------------
16,777
0
-------------
3,625
0
-------------
28,373
0
-------------
392,859
0
-------------
0
20
Gingrich Curtis MD
Board
(i)
(ii)
0
-------------
378,004
0
-------------
123,928
0
-------------
4,906
0
-------------
30,275
0
-------------
10,705
0
-------------
547,818
0
-------------
0
21
Hagen Bruce P
Board
(i)
(ii)
0
-------------
503,367
0
-------------
363,433
0
-------------
32,479
0
-------------
76,794
0
-------------
19,614
0
-------------
995,687
0
-------------
0
22
Imm Amy MD
Board
(i)
(ii)
0
-------------
482,308
0
-------------
164,121
0
-------------
26,524
0
-------------
34,471
0
-------------
26,078
0
-------------
733,502
0
-------------
0
23
Jepson Brian D
Board
(i)
(ii)
0
-------------
492,139
0
-------------
358,638
0
-------------
24,148
0
-------------
54,370
0
-------------
24,890
0
-------------
954,185
0
-------------
0
24
Lawson Michael S
Board
(i)
(ii)
0
-------------
467,027
0
-------------
319,058
0
-------------
5,116
0
-------------
69,782
0
-------------
10,405
0
-------------
871,388
0
-------------
0
25
Grewal Karanvir S MD
Board
(i)
(ii)
870,508
-------------
0
1,560
-------------
0
68,517
-------------
0
13,613
-------------
0
27,535
-------------
0
981,733
-------------
0
0
-------------
0
26
Markovich Stephen E MD
Board
(i)
(ii)
0
-------------
794,812
0
-------------
709,750
0
-------------
29,146
0
-------------
452,427
0
-------------
26,150
0
-------------
2,012,285
0
-------------
0
27
Moorman Matthew MD
Board
(i)
(ii)
337,951
-------------
0
75,600
-------------
0
15,320
-------------
0
8,583
-------------
0
47,263
-------------
0
484,717
-------------
0
0
-------------
0
28
Niles John P
Board (End 11/18)
(i)
(ii)
0
-------------
222,534
0
-------------
50,946
0
-------------
74,161
0
-------------
0
0
-------------
17,976
0
-------------
365,617
0
-------------
0
29
Reichfield Michael L
Board
(i)
(ii)
0
-------------
394,186
0
-------------
293,309
0
-------------
27,896
0
-------------
113,699
0
-------------
19,868
0
-------------
848,958
0
-------------
0
30
Rudy John
Board
(i)
(ii)
0
-------------
157,369
0
-------------
19,537
0
-------------
1,076
0
-------------
14,874
0
-------------
22,690
0
-------------
215,546
0
-------------
0
31
Urse Geraldine L DO
Board
(i)
(ii)
251,490
-------------
0
30,862
-------------
0
8,766
-------------
0
30,111
-------------
0
18,838
-------------
0
340,067
-------------
0
0
-------------
0
32
von Gunten Charles MD
Board
(i)
(ii)
0
-------------
293,745
0
-------------
70,000
0
-------------
34,992
0
-------------
11,608
0
-------------
10,826
0
-------------
421,171
0
-------------
0
33
Vora Sanjay K MD
Board
(i)
(ii)
267,727
-------------
0
60,040
-------------
0
21,608
-------------
0
12,120
-------------
0
27,774
-------------
0
389,269
-------------
0
0
-------------
0
34
Wasielewski Ray MD
Board
(i)
(ii)
654,706
-------------
0
32,966
-------------
0
21,588
-------------
0
10,052
-------------
0
28,390
-------------
0
747,702
-------------
0
0
-------------
0
35
Romanelli Vincent MD
OhioHlth Board
(i)
(ii)
496,170
-------------
0
57,807
-------------
0
19,398
-------------
0
15,349
-------------
0
26,968
-------------
0
615,692
-------------
0
0
-------------
0
36
Crowell Robert MD
Board
(i)
(ii)
0
-------------
664,275
0
-------------
124,469
0
-------------
27,731
0
-------------
11,092
0
-------------
24,700
0
-------------
852,267
0
-------------
0
37
Gossman Charles
Board
(i)
(ii)
0
-------------
188,182
0
-------------
39,213
0
-------------
49,256
0
-------------
21,355
0
-------------
22,690
0
-------------
320,696
0
-------------
0
38
Smith Jeffrey
Board
(i)
(ii)
0
-------------
247,124
0
-------------
88,960
0
-------------
23,195
0
-------------
19,175
0
-------------
25,951
0
-------------
404,405
0
-------------
0
39
Smith Brien J MD
Board
(i)
(ii)
0
-------------
527,780
0
-------------
46,849
0
-------------
21,336
0
-------------
4,902
0
-------------
18,242
0
-------------
619,109
0
-------------
0
40
O'Brien Jr James M MD
Board
(i)
(ii)
0
-------------
394,571
0
-------------
137,326
0
-------------
23,772
0
-------------
7,063
0
-------------
26,078
0
-------------
588,810
0
-------------
0
41
Silver Mitchell MD
Board
(i)
(ii)
964,238
-------------
0
1,560
-------------
0
77,090
-------------
0
13,490
-------------
0
25,690
-------------
0
1,082,068
-------------
0
0
-------------
0
42
Kadar Melissa
Board (Start 11/18)
(i)
(ii)
0
-------------
168,017
0
-------------
29,892
0
-------------
4,997
0
-------------
8,422
0
-------------
23,489
0
-------------
234,817
0
-------------
0
43
Vanderhoff Bruce MD
Sr. VP and Chief Medical Officer OhioHealth
(i)
(ii)
0
-------------
704,187
0
-------------
576,397
0
-------------
25,197
0
-------------
213,144
0
-------------
26,450
0
-------------
1,545,375
0
-------------
0
44
Yates Vinson M
Sr. Vice President & CFO (End 8/18)
(i)
(ii)
0
-------------
616,231
0
-------------
503,928
0
-------------
27,036
0
-------------
191,277
0
-------------
19,868
0
-------------
1,358,340
0
-------------
0
45
Sperling Ronald
Interim Sr. Vice President & CFO (Start 10/18 through 6/19)
(i)
(ii)
0
-------------
180,000
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
180,000
0
-------------
0
46
Yakubov Steven MD
Physician Core - OPG
(i)
(ii)
1,062,201
-------------
174,642
44,241
-------------
0
91,228
-------------
78
8,025
-------------
0
28,360
-------------
30
1,234,055
-------------
174,750
0
-------------
0
47
BalturshotGregory W MD
Physician Core OPG
(i)
(ii)
1,402,265
-------------
0
1,613,309
-------------
0
20,162
-------------
0
10,403
-------------
0
28,331
-------------
0
3,074,470
-------------
0
0
-------------
0
48
BonassoChristian L MD
Physician Core OPG
(i)
(ii)
1,390,106
-------------
0
1,391,988
-------------
0
18,968
-------------
0
13,823
-------------
0
27,990
-------------
0
2,842,875
-------------
0
0
-------------
0
49
Dorbish Ronald
Physician Core OPG
(i)
(ii)
1,030,420
-------------
0
547,000
-------------
0
55,060
-------------
0
13,146
-------------
0
27,690
-------------
0
1,673,316
-------------
0
0
-------------
0
50
SeamanBrian F DO
Physician Ortho Surgery (General)
(i)
(ii)
1,004,408
-------------
0
1,601,547
-------------
0
18,968
-------------
0
13,886
-------------
0
22,489
-------------
0
2,661,298
-------------
0
0
-------------
0
51
Cassandra James MD
Physician Cardio Interventional
(i)
(ii)
934,504
-------------
0
496,364
-------------
0
19,400
-------------
0
4,823
-------------
0
22,112
-------------
0
1,477,203
-------------
0
0
-------------
0
52
Seckinger Mark R
FRM Secretary Board
(i)
(ii)
0
-------------
265,163
0
-------------
154,494
0
-------------
25,875
0
-------------
49,291
0
-------------
11,132
0
-------------
505,955
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 3 Arrangement used to establish the top management official's compensation
The Parent Corporation (a related organization) used the following methods to establish the compensation of the CEO for each of the filing organizations included in the OhioHealth Group 990 return. - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Compensation survey or study - Approval by the board or compensation committee
Schedule J, Part I, Line 4a Severance or change-of-control payment
UNDER A VOLUNTARY TERMINATION AGREEMENT ENTERED INTO BY THE EMPLOYEE AND THE ORGANIZATION OR UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM OHIOHEALTH. SEVERANCE PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSON IN PART VII: JOHN P. NILES - $31,223
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
Eligible executives listed in the Form 990, Part VII participate in a supplemental non-qualified plan. These arrangements are an industry standard and are unfunded. Due to the substantial risk of forfeiture provision, there is no guarantee that these officers will ever receive these benefits. Amounts for these arrangements are included in the deferred compensation amount. No supplemental non-qualified retirement plan payments were made during the year to any listed persons in Part VII.
Schedule J, Part I, Line 7 Non-fixed payments
Incentive bonuses are calculated using an objective formula that includes clinical quality, patient, physician and employee satisfaction, and financial items. Minor modifications to increase or decrease incentive payments, within the maximum amount established for each position, may be made based on individual performance and accountabilities. In addition, one-time bonuses may be awarded to recognize exemplary performance. All payments are examined for reasonableness and are reviewed and approved by either the Executive Compensation Committee (for disqualified persons) or through management and the company's human resources function (for non-disqualified persons).
Schedule J (Form 990) 2018
Additional Data
Software ID:
18007697
Software Version:
2018v3.1