Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Roper Hospital Inc
 
Employer identification number

57-0828733
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
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) 2021
Page 2

Schedule J (Form 990) 2021
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, 1099-MISC compensation, and/or 1099-NEC (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
1Wael Haidar MD
 
Vice Chair (Beg 01/21), BSMH Chief Clinical Officer
(i)

(ii)
0
-------------
768,727
0
-------------
0
0
-------------
649,453
0
-------------
584,525
0
-------------
25,591
0
-------------
2,028,296
0
-------------
272,365
2Brian Cuddy MD
 
Chair, Neurosurgeon - RSFPP
(i)

(ii)
0
-------------
1,026,164
0
-------------
0
0
-------------
27,794
0
-------------
28,200
0
-------------
42,695
0
-------------
1,124,853
0
-------------
0
3JOSEPH GAGE JR JD
 
Board Member; BSMH Chief HR Officer
(i)

(ii)
0
-------------
536,492
0
-------------
0
0
-------------
632,095
0
-------------
299,474
0
-------------
33,176
0
-------------
1,501,237
0
-------------
223,229
4Brian YANofchick
 
Board Member; Chief Spons. Officer Prov Grp - BSMH
(i)

(ii)
0
-------------
289,976
0
-------------
0
0
-------------
149,275
0
-------------
13,100
0
-------------
12,318
0
-------------
464,669
0
-------------
0
5Susan Datta MD
 
Board Member, Internist - RSFPP
(i)

(ii)
0
-------------
289,309
0
-------------
42,078
0
-------------
12,716
0
-------------
26,299
0
-------------
41,841
0
-------------
412,243
0
-------------
0
6Henry West MD
 
Board Member, Surgeon - RSFPP
(i)

(ii)
0
-------------
517,209
0
-------------
63,674
0
-------------
941
0
-------------
28,200
0
-------------
27,913
0
-------------
637,937
0
-------------
0
7Bret D Johnson
 
Former CFO & SVP / Treasurer
(i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
306,257
0
-------------
0
0
-------------
0
0
-------------
306,257
0
-------------
0
8Anthony Jackson
 
FORMER VP & CEO Acute Care Services
(i)

(ii)
0
-------------
584,276
0
-------------
52,370
0
-------------
40,904
0
-------------
99,134
0
-------------
25,379
0
-------------
802,063
0
-------------
36,773
9Jeffrey DiLisi MD
 
President/CEO
(i)

(ii)
0
-------------
709,545
0
-------------
0
0
-------------
31,984
0
-------------
132,601
0
-------------
42,575
0
-------------
916,705
0
-------------
0
10Christopher Glenn
 
Interim CFO/Treasurer (End 06/21)
(i)

(ii)
0
-------------
223,048
0
-------------
7,750
0
-------------
5,330
0
-------------
4,100
0
-------------
25,835
0
-------------
266,063
0
-------------
0
11Adriana Day
 
CFO/Treasurer (Beg 06/21)
(i)

(ii)
0
-------------
239,831
0
-------------
33,760
0
-------------
104,236
0
-------------
42,959
0
-------------
13,273
0
-------------
434,059
0
-------------
0
12Pennie Peralta
 
Former Key EE, VP Nursing/Sr. Nurse Exec SFX
(i)

(ii)
116,252
-------------
0
0
-------------
0
2,232
-------------
0
2,054
-------------
0
13,237
-------------
0
133,775
-------------
0
0
-------------
0
13Stanley Wilson MD
 
FORMER VP, CMO Acute Care - RHI/MPH
(i)

(ii)
0
-------------
497,624
0
-------------
27,660
0
-------------
6,830
0
-------------
22,969
0
-------------
24,508
0
-------------
579,591
0
-------------
0
14Matthew Desmond
 
VP Ops Acute Care
(i)

(ii)
0
-------------
316,800
0
-------------
73,045
0
-------------
1,730
0
-------------
34,670
0
-------------
40,900
0
-------------
467,145
0
-------------
0
15Susan M Bennett
 
Chief Nursing Officer
(i)

(ii)
200,189
-------------
0
6,830
-------------
0
1,550
-------------
0
4,680
-------------
0
14,068
-------------
0
227,317
-------------
0
0
-------------
0
16Troy Powell
 
VP Post Acute Care Services
(i)

(ii)
0
-------------
290,838
0
-------------
19,540
0
-------------
2,290
0
-------------
30,787
0
-------------
40,897
0
-------------
384,352
0
-------------
0
17Mitchell Siegan MD
 
VP CMO - Acute Care
(i)

(ii)
0
-------------
556,177
0
-------------
31,200
0
-------------
3,598
0
-------------
73,541
0
-------------
39,794
0
-------------
704,310
0
-------------
0
18Mary Elizabeth Hanley DO
 
Osteopathic Medicine
(i)

(ii)
314,751
-------------
0
22,279
-------------
0
387
-------------
0
5,625
-------------
0
40,865
-------------
0
383,907
-------------
0
0
-------------
0
19Tiffany Richter
 
Medical Director RSFPP
(i)

(ii)
170,773
-------------
0
16,500
-------------
0
55
-------------
0
5,687
-------------
0
23,886
-------------
0
216,901
-------------
0
0
-------------
0
20John Fowler
 
Manager Pharmacy
(i)

(ii)
189,304
-------------
0
3,210
-------------
0
1,117
-------------
0
5,835
-------------
0
11,169
-------------
0
210,635
-------------
0
0
-------------
0
21Todd METZ
 
Supv Advanced Practitioner
(i)

(ii)
130,274
-------------
0
105,660
-------------
0
712
-------------
0
4,832
-------------
0
26,259
-------------
0
267,737
-------------
0
0
-------------
0
22Jennifer N Sterrett
 
Clinical Pharmacist
(i)

(ii)
192,874
-------------
0
0
-------------
0
1,649
-------------
0
5,673
-------------
0
5,732
-------------
0
205,928
-------------
0
0
-------------
0
Schedule J (Form 990) 2021
Page 3

Schedule J (Form 990) 2021
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 A related organization of Roper Hospital, Inc. determined the compensation of the Organization's CEO using the following methods: Compensation Committee Independent Compensation Consultant Compensation Survey or Study Approval by the Board or Compensation Committee
Schedule J, Part I, Line 4a Severance or change-of-control payment Severance Benefits consisting of continuation of base salary and insurance benefits were provided to listed individuals for specified periods. The listed individual executed releases and waivers of claims in exchange for the severance benefits. Salary continuation amounts provided during the reporting year to the listed individual was as follow: Bret D. Johnson, $306,257.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan The Roper St. Francis Healthcare 457(f) Plan's purpose is to offer eligible employees of the employer deferred compensation benefits to supplement Eligible Employees' retirement income. The Plan is intended to be a top-hat plan (i.e. an unfunded deferred compensation plan maintained for certain members of a select group of management or highly compensated employees). INDIVIDUALS THAT PARTICIPATED OR RECEIVED A DISTRIBUTION INCLUDE: Anthony Jackson, $4,375; Troy Powell, $0; Jeffrey DiLisi, MD, $0; Mitchell Siegan, MD, $0; Matthew Desmond, $0; Adriana Day, $0.
Schedule J, Part I, Line 4b Terms and conditions of the Bon Secours Mercy Health System SERP The Bon Secours Mercy Health System SERP is a non-qualified deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. The plan provides for annual credits of a specified percentage of an eligible participants base salary paid in a plan year and interest credits. Plan participants vest in plan credits after completing a three year class vesting schedule or earlier for death or total disability or reaching age 60 while employed, or due to involuntary separation of employment other than for cause. Payments during employment are made for required tax withholding and reduce the participants account balance. Distribution of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Brian Yanofchick, $34,000; Joseph Gage, Jr., JD, $177,282; and Wael Haidar, MD, $58,402.
Schedule J, Part I, Line 4b Terms and conditions of the Mercy Health SERP The Mercy Health SERP plan is a deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. It provides annual credits of a specified percentage of compensation and annual interest credits. Participants vest 50%, 75%, and 100% in their accounts after 5, 6, and 7 years of service, respectively. Vesting occurs earlier for death or total disability or reaching age 60 while employed, or involuntary termination of employment within 24 months after a change in control of the organization or due to position elimination. Payments during employment are made for required tax withholding. Payment of the vested account balance in a lump sum occurs after termination of employment. Amounts includable as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Joseph Gage, Jr., JD, $0.
Schedule J, Part I, Line 4b Terms and conditions of the Bon Secours SERP The filing organization participates in a Bon Secours sponsored executive retirement program that allows for deposits into additional retirement plans available to officers and certain key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits is made into this plan. Individuals that participated or received a distribution include: Wael Haidar, MD, $115,814.
Schedule J, Part I, Line 7 NON-FIXED PAYMENTS Goals are developed each year to support the Organization's strategic initiatives for people, quality, financial, growth and service. The Ad Hoc Compensation Committee approves the system goals annually and reports it to the full Board of Directors. Progress on each metric is reported to the Board each month on the corporate scorecard. At year-end, the Ad Hoc Compensation Committee approves the final scorecard number and reports results to the full Board. Annual incentives for the executives are based 60% on the corporate scorecard and 40% on individual performance. Executives maintain an individual scorecard on the leader evaluation manager and discuss results monthly with the President/CEO. The President/CEO approves the individual executive scorecard.
Schedule J (Form 990) 2021

Additional Data


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