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ObjectId: 202201319349303765 - Submission: 2022-05-11
TIN: 58-1503902
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
20
Open to Public Inspection
Name of the organization
Piedmont Healthcare Inc
Employer identification number
58-1503902
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
No
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) 2020
Page 2
Schedule J (Form 990) 2020
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
Mr Kevin Brown
Board Member & CEO, PHC
(i)
(ii)
1,339,779
-------------
0
1,174,927
-------------
0
517,218
-------------
0
364,429
-------------
0
21,494
-------------
0
3,417,847
-------------
0
347,329
-------------
0
2
Mr Michael McAnder
CFO & Treasurer (End 7/20)
(i)
(ii)
357,162
-------------
0
0
-------------
0
927,767
-------------
0
66,931
-------------
0
5,196
-------------
0
1,357,056
-------------
0
498,228
-------------
0
3
Mr Thomas Arnold
CFO & Treasurer (Eff 7/20)
(i)
(ii)
424,857
-------------
0
245,916
-------------
0
156,777
-------------
0
79,670
-------------
0
13,247
-------------
0
920,467
-------------
0
62,570
-------------
0
4
Ms Elizabeth Leddy
CHIEF LEGAL OFF & Sec.
(i)
(ii)
459,494
-------------
0
335,067
-------------
0
49,241
-------------
0
109,035
-------------
0
17,590
-------------
0
970,427
-------------
0
0
-------------
0
5
Dr Leigh Hamby MD
PHC CMO
(i)
(ii)
594,907
-------------
0
418,830
-------------
0
163,285
-------------
0
112,971
-------------
0
19,776
-------------
0
1,309,769
-------------
0
95,871
-------------
0
6
Ms Michelle Fisher
Pres. Prim Care & Ret Svcs
(i)
(ii)
409,260
-------------
0
238,736
-------------
0
98,361
-------------
0
79,197
-------------
0
19,776
-------------
0
845,330
-------------
0
62,097
-------------
0
7
Mr Michael Mandl
Exec. Vice President
(i)
(ii)
778,484
-------------
0
564,842
-------------
0
86,725
-------------
0
156,690
-------------
0
12,477
-------------
0
1,599,218
-------------
0
0
-------------
0
8
Mr Christopher Lloyd
President Piedmont Clinic
(i)
(ii)
546,109
-------------
0
315,452
-------------
0
63,719
-------------
0
115,514
-------------
0
8,266
-------------
0
1,049,060
-------------
0
0
-------------
0
9
Mr Sidney Kirschner
Chief Philanthropy Officer
(i)
(ii)
547,985
-------------
0
400,774
-------------
0
473,530
-------------
0
105,630
-------------
0
12,447
-------------
0
1,540,366
-------------
0
88,530
-------------
0
10
Mr Douwe Bergsma
Chief Marketing Officer
(i)
(ii)
327,334
-------------
0
118,740
-------------
0
146,103
-------------
0
51,333
-------------
0
9,118
-------------
0
652,628
-------------
0
0
-------------
0
11
Mr Robert Cross
VP - Gov Reimbursement
(i)
(ii)
304,570
-------------
0
111,586
-------------
0
103,725
-------------
0
17,100
-------------
0
12,445
-------------
0
549,426
-------------
0
0
-------------
0
12
Mr Geoffrey Brown
Chief Information Officer
(i)
(ii)
421,768
-------------
0
246,696
-------------
0
128,891
-------------
0
79,305
-------------
0
12,474
-------------
0
889,134
-------------
0
63,460
-------------
0
13
Ms Vicki Cansler
Chief HR Officer
(i)
(ii)
398,542
-------------
0
226,964
-------------
0
109,751
-------------
0
76,466
-------------
0
8,672
-------------
0
820,395
-------------
0
59,366
-------------
0
14
Mr Shannon Glover
VP - Managed Care
(i)
(ii)
346,564
-------------
0
128,033
-------------
0
14,239
-------------
0
17,100
-------------
0
17,254
-------------
0
523,190
-------------
0
0
-------------
0
Schedule J (Form 990) 2020
Page 3
Schedule J (Form 990) 2020
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: OTHER COMPENSATION ITEMS
FIRST-CLASS TRAVEL: THE FOLLOWING INDIVIDUAL WAS PERMITTED (PURSUANT TO THEIR CONTRACTS) TO FLY FIRST-CLASS DURING CALENDAR YEAR 2020. FIRST-CLASS TRAVEL IS NOT REPORTED ON THE EMPLOYEE'S FORM W-2, HOWEVER, THE COMPANY IS REIMBURSED FOR ANY PERSONAL EXPENSES INCURRED BY THE EMPLOYEE. KEVIN BROWN TRAVEL FOR COMPANIONS: CERTAIN EXECUTIVES ARE PERMITTED TO TRAVEL WITH COMPANIONS WHEN IT IS APPROPRIATE FOR THE BUSINESS EVENT AND PURPOSE. TRAVEL FOR COMPANIONS IS REVIEWED ON A CASE BY CASE BASIS AND IS REIMBURSED BY THE EMPLOYEE, PAID ON BEHALF OF THE EMPLOYEE, OR TREATED AS TAXABLE INCOME, AS APPROPRIATE AND IN COMPLIANCE WITH COMPANY POLICY. DISCRETIONARY SPENDING ACCOUNTS: THE FOLLOWING EMPLOYEES RECEIVED DISCRETIONARY SPENDING ACCOUNTS IN FIXED AMOUNTS DETERMINED BY JOB LEVEL. THESE SPENDING ACCOUNTS WERE INCLUDED IN EACH EMPLOYEE'S TAXABLE WAGES: KEVIN BROWN $37,700 MICHAEL MANDL $12,000 SIDNEY KIRSCHNER $12,000 MICHAEL MCANDER $7,385 DR. LEIGH HAMBY $12,000 CHRISTOPHER LLOYD $12,000 ELIZABETH LEDDY $12,000 THOMAS ARNOLD $12,000 GEOFFREY BROWN $12,000 MICHELLE FISHER $12,000 VICKI CANSLER $12,000 DOUWE BERGSMA $10,615
SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS
KEVIN BROWN RECEIVED A PAYMENT OF $347,329 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. GEOFFREY BROWN RECEIVED A PAYMENT OF $63,460 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. MICHAEL MCANDER RECEIVED A PAYMENT OF $498,228 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THOMAS ARNOLD RECEIVED A PAYMENT OF $62,570 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. VICKI CANSLER RECEIVED A PAYMENT OF $59,366 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. MICHELLE FISHER RECEIVED A PAYMENT OF $62,097 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. DR. LEIGH HAMBY RECEIVED A PAYMENT OF $95,871 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. SIDNEY KIRSCHNER RECEIVED A PAYMENT OF $88,530 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: ELIZABETH LEDDY DOUWE BERGSMA CHRISTOPHER LLOYD MICHAEL MANDL
SCHEDULE J, PART I, LINE 7: NON-FIXED PAYMENTS
CERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED BONUS PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS.
Schedule J (Form 990) 2020
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