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
2019
Open to Public Inspection
Name of the organization
UPPER VALLEY MEDICAL CENTER
 
Employer identification number

31-0537095
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 on 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 on 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
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) 2019
Page 2

Schedule J (Form 990) 2019
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
1MICHAEL J MAIBERGER
FORMER KEY EMPLOYEE
(i)

(ii)
0
-------------
564,689
0
-------------
520,375
0
-------------
1,207,754
0
-------------
1,031,331
0
-------------
30,730
0
-------------
3,354,879
0
-------------
831,140
2MARY H BOOSALIS
PREMIER PRESIDENT & CEO
(i)

(ii)
0
-------------
1,152,156
0
-------------
616,657
0
-------------
52,172
0
-------------
22,778
0
-------------
20,512
0
-------------
1,864,275
0
-------------
0
3SCOTT A SHELTON
FORMER KEY EMPLOYEE
(i)

(ii)
0
-------------
505,156
0
-------------
269,139
0
-------------
152,574
0
-------------
13,302
0
-------------
17,824
0
-------------
957,995
0
-------------
0
4JENNIFER J HAULER DO
FORMER KEY EMPLOYEE
(i)

(ii)
0
-------------
519,043
0
-------------
372,959
0
-------------
1,783
0
-------------
52,997
0
-------------
2,779
0
-------------
949,561
0
-------------
0
5FAYEZ D ABBOUD MD
PRES MEDICAL STAFF (FROM SEP)
(i)

(ii)
0
-------------
618,585
0
-------------
36,800
0
-------------
26,340
0
-------------
9,558
0
-------------
28,234
0
-------------
719,517
0
-------------
0
6BARBARA A JOHNSON
EXEC VP & PREMIER COO
(i)

(ii)
0
-------------
476,627
0
-------------
149,539
0
-------------
39,802
0
-------------
27,000
0
-------------
11,127
0
-------------
704,095
0
-------------
0
7GEOFFREY P WALKER
FORMER OFFICER
(i)

(ii)
0
-------------
411,905
0
-------------
140,011
0
-------------
96,988
0
-------------
23,811
0
-------------
26,531
0
-------------
699,246
0
-------------
0
8THOMAS R PARKER
PRESIDENT & CEO
(i)

(ii)
399,599
-------------
0
168,998
-------------
0
50,576
-------------
0
66,901
-------------
0
12,860
-------------
0
698,934
-------------
0
0
-------------
0
9DIANE L PLEIMAN
FORMER OFFICER
(i)

(ii)
0
-------------
415,889
0
-------------
178,508
0
-------------
52,684
0
-------------
21,465
0
-------------
7,653
0
-------------
676,199
0
-------------
0
10GARY G GINTER
VP &PREMIER CHIEF INFO OFFICER
(i)

(ii)
0
-------------
408,643
0
-------------
140,815
0
-------------
4,063
0
-------------
69,684
0
-------------
28,333
0
-------------
651,538
0
-------------
0
11CRAIG SELF
FORMER KEY EMPLOYEE
(i)

(ii)
0
-------------
0
0
-------------
148,256
0
-------------
375,613
0
-------------
74,192
0
-------------
20,655
0
-------------
618,716
0
-------------
300,262
12RENEE P GEORGE
FORMER KEY EMPLOYEE
(i)

(ii)
0
-------------
387,083
0
-------------
151,484
0
-------------
1,323
0
-------------
50,260
0
-------------
13,183
0
-------------
603,333
0
-------------
0
13MARGARET W MARK
VP NURSING SERVICE/PREMIER CNO
(i)

(ii)
0
-------------
376,334
0
-------------
137,400
0
-------------
13,986
0
-------------
23,441
0
-------------
27,942
0
-------------
579,103
0
-------------
0
14DALE E CREECH JR
FORMER OFFICER
(i)

(ii)
0
-------------
0
0
-------------
82,482
0
-------------
427,995
0
-------------
17,945
0
-------------
11,552
0
-------------
539,974
0
-------------
151,924
15RAFAY ATIQ MD
TRUSTEE
(i)

(ii)
0
-------------
398,631
0
-------------
81,430
0
-------------
3,166
0
-------------
10,166
0
-------------
31,798
0
-------------
525,191
0
-------------
0
16SCOTT B KANAGY DO
TRUSTEE & CMO
(i)

(ii)
334,777
-------------
0
138,312
-------------
0
1,142
-------------
0
16,373
-------------
0
26,150
-------------
0
516,754
-------------
0
0
-------------
0
17J MICHAEL SIMS
SYS VP-TREAS & CORP CONTROLLER
(i)

(ii)
0
-------------
303,223
0
-------------
68,302
0
-------------
89,634
0
-------------
24,054
0
-------------
29,351
0
-------------
514,564
0
-------------
0
18THOMAS R CURTIN
VP - REVENUE CYCLE
(i)

(ii)
0
-------------
318,812
0
-------------
80,976
0
-------------
7,671
0
-------------
26,866
0
-------------
33,348
0
-------------
467,673
0
-------------
0
19MARK W SHAW
FORMER KEY EMPLOYEE
(i)

(ii)
0
-------------
0
0
-------------
30,246
0
-------------
387,960
0
-------------
16,713
0
-------------
5,855
0
-------------
440,774
0
-------------
38,000
20TIMOTHY D SNIDER
BOARD TREASURER & COO
(i)

(ii)
255,385
-------------
0
98,141
-------------
0
2,465
-------------
0
25,016
-------------
0
26,148
-------------
0
407,155
-------------
0
0
-------------
0
21KIM K STRAHL
SYS VP & CPO
(i)

(ii)
0
-------------
233,940
0
-------------
100,231
0
-------------
3,377
0
-------------
21,635
0
-------------
12,150
0
-------------
371,333
0
-------------
0
22BILLIE L LUCENTE-BAKER
SYS VP - HR OPS (FROM AUG)
(i)

(ii)
0
-------------
215,099
0
-------------
35,605
0
-------------
1,495
0
-------------
20,083
0
-------------
14,063
0
-------------
286,345
0
-------------
0
23JENNA M DOWNEY ESQ
FORMER OFFICER
(i)

(ii)
0
-------------
190,262
0
-------------
32,305
0
-------------
792
0
-------------
8,381
0
-------------
13,557
0
-------------
245,297
0
-------------
0
24MELISSA M TALLMADGE
DIR NURSING - SURGERY/ED
(i)

(ii)
157,116
-------------
0
24,448
-------------
0
1,086
-------------
0
17,378
-------------
0
18,346
-------------
0
218,374
-------------
0
0
-------------
0
25KATHRYN M BOERGER
DIRECTOR HR
(i)

(ii)
139,037
-------------
0
27,195
-------------
0
19,363
-------------
0
14,659
-------------
0
731
-------------
0
200,985
-------------
0
0
-------------
0
26TERESA A GULKER
DIR NRS-MEDSURG/WMS SRVCS
(i)

(ii)
149,514
-------------
0
24,273
-------------
0
1,306
-------------
0
13,272
-------------
0
9,111
-------------
0
197,476
-------------
0
0
-------------
0
27REBECCA A RICE
FORMER TRUSTEE & OFFICER
(i)

(ii)
0
-------------
0
36,605
-------------
0
141,576
-------------
0
17,678
-------------
0
128
-------------
0
195,987
-------------
0
40,307
-------------
0
28RYAN E MCELDOWNEY
STAFF PHARMACIST
(i)

(ii)
150,216
-------------
0
777
-------------
0
879
-------------
0
11,651
-------------
0
26,388
-------------
0
189,911
-------------
0
0
-------------
0
29ELAINE M DEAN
SYSTEM VP-BUSINESS DEVELOPMENT
(i)

(ii)
0
-------------
178,094
0
-------------
 
0
-------------
724
0
-------------
2,692
0
-------------
5,452
0
-------------
186,962
0
-------------
0
30BENJAMIN A WATSON ESQ
BOARD SECRETARY
(i)

(ii)
0
-------------
144,706
0
-------------
21,428
0
-------------
582
0
-------------
6,180
0
-------------
10,065
0
-------------
182,961
0
-------------
0
31CHRISTOPHER J PATSIAVOS
STAFF PHARMACIST
(i)

(ii)
165,330
-------------
 
778
-------------
 
247
-------------
 
1,252
-------------
 
1,208
-------------
 
168,815
-------------
 
0
-------------
 
Schedule J (Form 990) 2019
Page 3

Schedule J (Form 990) 2019
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
PART I, LINE 4A: THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT IN 2019: CRAIG SELF $381,414. THE FOLLOWING INDIVIDUALS WERE SELECTED TO PARTICIPATE IN A VOLUNTARY RETIREMENT PROGRAM AND RECEIVED THE FOLLOWING PAYMENTS IN 2019: DALE CREECH JR $234,232; MICHAEL MAIBERGER $221,850; REBECCA RICE $111,075; MARK SHAW $103,000. PART I, LINE 4B: DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, UPPER VALLEY AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. UPPER VALLEY SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN AND A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE BENEFITS UNDER THESE SUPPLEMENTAL NONQUALIFIED PLANS ARE SUBJECT TO MULTI-YEAR VESTING AND A PARTICIPANT CAN FORFEIT BENEFITS EARNED IF VESTING REQUIREMENTS ARE NOT SATISFIED. UNDER THE TERMS OF THE SUPPLEMENTAL PLANS, AND BECAUSE OF TAX RULES PERTAINING TO TAXATION OF THE EARNED BENEFITS UPON VESTING, CERTAIN INDIVIDUALS RECEIVED A PAYOUT OF THE CUMULATIVE VESTED BENEFITS UNDER THEIR SUPPLEMENTAL PLAN DURING 2019. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2019: DALE CREECH JR $196,960; BARBARA JOHNSON $25,958; MICHAEL MAIBERGER $18,567; MARGARET MARK $5,206; THOMAS PARKER $22,946; DIANE PLEIMAN $49,329; REBECCA RICE $30,579; MARK SHAW $286,638; SCOTT A SHELTON $144,980; J. MICHAEL SIMS $65,725; GEOFFREY P. WALKER $90,728. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PLAN PAYMENT 2019: MICHAEL MAIBERER $111,125. IN ADDITION, THE FOLLOWING SERP AMOUNTS WERE DEFERRED ON THE PARTICIPANTS' BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNTS ARE VESTED AND PAID TO THE SERP PARTICIPANTS: THOMAS CURTIN $7,888; RENEE GEORGE $38,933; GARY GINTER $47,436; JENNIFER HAULER, D.O. $43,676; BARBARA JOHNSON $11,541; SCOTT KANAGY $8,069; MICHAEL MAIBERGER $83,348; MARGARET MARK $13,181; THOMAS PARKER $43,947; CRAIG SELF $65,158; TIMOTHY SNIDER $3,843. BASED ON THE GUIDANCE PROVIDED IN THE INSTRUCTIONS TO THE FORM 990, ANY PAYMENTS TO THE PARTICIPANTS RELATED TO THESE PLANS THAT WERE MADE WITHIN 2-1/2 MONTHS AFTER THE END OF THE ORGANIZATION'S TAX YEAR ARE NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. ANY PAYMENTS MADE AFTER THE 2-1/2 MONTHS WERE PROPERLY REPORTED ON PRIOR YEARS' FILED IRS FORM 990 RETURNS, DISCLOSING COMPENSATION EARNED BY THESE INDIVIDUALS UNDER THE PLANS FOR EACH SUCH YEAR.
Schedule J (Form 990) 2019

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