efile Public Visual Render
ObjectId: 202112289349301936 - Submission: 2021-08-16
TIN: 55-0675666
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
19
Open to Public Inspection
Name of the organization
CABELL HUNTINGTON HOSPITAL INC
Employer identification number
55-0675666
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 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
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 on 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) 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
1
KEVIN FOWLER
PRESIDENT & CEO
(i)
(ii)
571,544
-------------
272,745
-------------
24,630
-------------
-------------
28,978
-------------
897,897
-------------
-------------
2
DAVID M WARD
SR VP, CFO, & CAO
(i)
(ii)
466,666
-------------
200,265
-------------
20,206
-------------
-------------
22,662
-------------
709,799
-------------
-------------
3
HOYT BURDICK
SR VP & CMO
(i)
(ii)
407,453
-------------
145,408
-------------
4,344
-------------
-------------
28,978
-------------
586,183
-------------
-------------
4
GLEN WASHINGTON
FORMER VP CEO AT PVH
(i)
(ii)
257,581
-------------
-------------
8,753
-------------
-------------
19,319
-------------
285,653
-------------
-------------
5
PAUL SMITH
VP & GENERAL COUNSEL
(i)
(ii)
312,191
-------------
50,284
-------------
4,343
-------------
-------------
28,978
-------------
395,796
-------------
-------------
6
BRADLEY BURCK
VP CHH FOUNDATION
(i)
(ii)
237,315
-------------
26,100
-------------
1,442
-------------
-------------
28,978
-------------
293,835
-------------
-------------
7
DENNIS LEE
VP & CIO
(i)
(ii)
283,059
-------------
38,099
-------------
1,956
-------------
-------------
28,978
-------------
352,092
-------------
-------------
8
LISA CHAMBERLIN STUMP
VP STRATEGIC MARKETING & PLAN
(i)
(ii)
276,480
-------------
42,332
-------------
1,533
-------------
-------------
28,978
-------------
349,323
-------------
-------------
9
TIM MARTIN
VP HOSPITAL OPERATIONS & EC
(i)
(ii)
355,378
-------------
50,346
-------------
1,590
-------------
-------------
28,978
-------------
436,292
-------------
-------------
10
JOY PELFREY
FORMER VP & CNO
(i)
(ii)
333,693
-------------
-------------
992
-------------
-------------
14,489
-------------
349,174
-------------
-------------
11
HAROLD E PRESTON
FORMER VP PHYSICIANS SERVICES
(i)
(ii)
209,859
-------------
-------------
-------------
-------------
-------------
209,859
-------------
-------------
12
AHMET OZTURK MD
ANESTHESIOLOGIST
(i)
(ii)
577,212
-------------
12,000
-------------
6,429
-------------
-------------
28,978
-------------
624,619
-------------
-------------
13
GHASSAN MOUFARREGE
ANESTHESIOLOGIST
(i)
(ii)
441,058
-------------
12,000
-------------
1,112
-------------
-------------
13,734
-------------
467,904
-------------
-------------
14
TIMOTHY DAMRON MD
CARDIOLOGIST
(i)
(ii)
448,110
-------------
9,148
-------------
2,874
-------------
-------------
28,978
-------------
489,110
-------------
-------------
15
BETH TOPPINS MD
EMERGENCY ROOM PHYSICIAN
(i)
(ii)
346,754
-------------
36,666
-------------
119
-------------
-------------
28,978
-------------
412,517
-------------
-------------
16
DAVID GRALEY
FORMER VP CHH FOUNDATION
(i)
(ii)
119,791
-------------
-------------
-------------
-------------
26,564
-------------
146,355
-------------
-------------
17
BRIAN BOWER MD
OBSTETRICIAN/GYNECOLOGIST
(i)
(ii)
365,000
-------------
16,758
-------------
552
-------------
-------------
28,978
-------------
411,288
-------------
-------------
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 1, LINE 1A
KEVIN FOWLER, PRESIDENT AND CEO, WAS PROVIDED WITH PERSONAL COUNTRY CLUB BENEFITS. THESE BENEFITS WERE ADDED TO HIS W-2 AS TAXABLE COMPENSATION.
PART 1, LINE 4A
PAYMENTS OF $209,859 WERE MADE TO HAROLD PRESTON UNDER A SALARY CONTINUATION AGREEMENT. PAYMENTS OF $349,174 WERE MADE TO JOY PELFREY UNDER A SALARY CONTINUATION AGREEMENT.
PART 1, LINE 4B
THE FOLLOWING PAYMENTS WERE CONTRIBUTED TO A 457(F) PLAN: KEVIN FOWLER, PRESIDENT/CEO $914,883 DAVID M. WARD, SR VP, CFO, & CAO 47,997 PAUL SMITH, VP & GENERAL COUNSEL 27,259 DENNIS LEE, VP & CIO 24,526 LISA CHAMBERLIN STUMP, VP STRATEGIC MARKETING & PLAN 24,223
PART 1, LINE 4C
BONUSES WERE PAID TO VPS/OFFICERS BUT NOT EQUITY BASED. KEVIN FOWLER, PRESIDENT/CEO; DAVID M. WARD, SR VP, CFO, & CAO; PAUL SMITH, VP & GENERAL COUNSEL; DENNIS LEE, VP & CIO; AND LISA CHAMBERLIN STUMP, VP STRATEGIC MARKETING & PLAN PARTICIPATED IN A 457(F) PLAN.
PART 1, LINE 6
A BONUS PLAN EXISTS FOR EXECUTIVES OF THE ORGANIZATION. DETAIL OF PAYMENTS MADE ARE DISCLOSED IN SCHEDULE J, PART II, COLUMN II. BONUSES ARE BASED ON MEETING MULTIPLE GOALS SET FORTH FOR EACH EXECUTIVE. BONUSES ARE ONLY ACCRUED AND PAID WHEN THE ORGANIZATION HAS NET INCOME.
Schedule J (Form 990) 2019
Additional Data
Software ID:
Software Version: