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
THE EVANGELICAL LUTHERAN GOOD SAMARITAN
SOCIETY
Employer identification number

45-0228055
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
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.
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) 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
1BILL MARLETTE
TREASURER-END 12/21
(i)

(ii)
0
-------------
1,504,270
0
-------------
431,002
0
-------------
245,068
0
-------------
0
0
-------------
13,341
0
-------------
2,193,681
0
-------------
0
2BILL MARLETTE
SEE SCH J, PART III, LINES 4A-4B
(i)

(ii)
0
-------------
0
0
-------------
436,802
0
-------------
4,380,230
0
-------------
0
0
-------------
0
0
-------------
4,817,032
0
-------------
0
3MATT HOCKS
DIRECTOR-BEG 1/21
(i)

(ii)
0
-------------
1,360,816
0
-------------
330,002
0
-------------
216,577
0
-------------
154,897
0
-------------
27,725
0
-------------
2,090,017
0
-------------
0
4RANDY BURY
PRESIDENT & CEO-END 12/21
(i)

(ii)
0
-------------
984,890
0
-------------
273,000
0
-------------
177,196
0
-------------
27,139
0
-------------
26,297
0
-------------
1,488,522
0
-------------
0
5GREGORY JOHNSON
VP, MEDICAL OFFICER, GSS
(i)

(ii)
0
-------------
405,923
0
-------------
15,000
0
-------------
57,126
0
-------------
14,500
0
-------------
23,472
0
-------------
516,021
0
-------------
0
6ERIC VANDEN HULL
VP, FINANCE
(i)

(ii)
0
-------------
391,470
0
-------------
15,000
0
-------------
53,450
0
-------------
14,500
0
-------------
18,709
0
-------------
493,129
0
-------------
0
7THOMAS SYVERSON
FORMER OFFICER - EVP
(i)

(ii)
0
-------------
385,471
0
-------------
600
0
-------------
0
0
-------------
13,992
0
-------------
26,297
0
-------------
426,360
0
-------------
0
8NATHAN SCHEMA
PRESIDENT & CEO-BEG 12/21
(i)

(ii)
0
-------------
308,970
0
-------------
15,000
0
-------------
44,890
0
-------------
19,030
0
-------------
24,907
0
-------------
412,797
0
-------------
0
9CLINT GRAYBILL
EXEC DIRECTOR, OPERATIONS, GSS
(i)

(ii)
0
-------------
269,668
0
-------------
11,541
0
-------------
36,531
0
-------------
12,119
0
-------------
11,510
0
-------------
341,369
0
-------------
0
10JULIE RIEKEN
STAFF NURSE - RN
(i)

(ii)
184,933
-------------
0
0
-------------
0
98,208
-------------
0
12,835
-------------
0
8,391
-------------
0
304,367
-------------
0
0
-------------
0
11ROCHELLE RINDELS
VP, NURSING & CLINICAL SVC, GSS
(i)

(ii)
0
-------------
194,077
0
-------------
15,000
0
-------------
26,863
0
-------------
9,874
0
-------------
20,192
0
-------------
266,006
0
-------------
0
12AIMEE MIDDLETON
VP, OPERATIONS-BEG 12/21
(i)

(ii)
0
-------------
161,445
0
-------------
10,600
0
-------------
43,719
0
-------------
10,087
0
-------------
24,354
0
-------------
250,205
0
-------------
0
13DUSTIN SCHOLZ
FORMER KEY EMPLOYEE - REGIONAL VP
(i)

(ii)
0
-------------
160,850
0
-------------
900
0
-------------
23,946
0
-------------
8,430
0
-------------
23,497
0
-------------
217,623
0
-------------
0
14MELISSA JORDAN
RN, RAPID RESPONSE
(i)

(ii)
119,194
-------------
0
750
-------------
0
89,136
-------------
0
0
-------------
0
7,359
-------------
0
216,439
-------------
0
0
-------------
0
15PATRICIA CAMERO
DIRECTOR-END 6/21
(i)

(ii)
166,099
-------------
0
600
-------------
0
0
-------------
0
3,827
-------------
0
8,916
-------------
0
179,442
-------------
0
0
-------------
0
16LISA MELBY
DIRECTOR
(i)

(ii)
143,075
-------------
0
600
-------------
0
0
-------------
0
7,624
-------------
0
24,370
-------------
0
175,669
-------------
0
0
-------------
0
17DAN HAMES
FORMER KEY EMPLOYEE - REGIONAL VP
(i)

(ii)
0
-------------
61,650
0
-------------
0
0
-------------
95,765
0
-------------
3,111
0
-------------
9,387
0
-------------
169,913
0
-------------
0
18LINDA STUDER
FORMER KEY EMPLOYEE - VP, OPER
(i)

(ii)
131,722
-------------
0
2,600
-------------
0
10
-------------
0
6,984
-------------
0
12,715
-------------
0
154,031
-------------
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
PART I, LINE 1A FIRST CLASS OR CHARTER TRAVEL - FIRST CLASS TRAVEL OR CHARTER TRAVEL IS PROVIDED FOR INDIVIDUALS AS NEEDED AND AS COST APPROPRIATE, IN ACCORDANCE WITH WRITTEN POLICIES. THESE COSTS ARE NOT INCLUDED IN THE W-2'S OF THE INDIVIDUALS AS THEY ARE INCURRED FOR BUSINESS PURPOSES OF THE SOCIETY.
PART I, LINES 4A-B LINE 4A - SEVERANCE OR CHANGE OF CONTROL UPON HIRE OR PROMOTION, SELECT OFFICERS AND KEY EMPLOYEES SIGN AN EXECUTIVE SEVERANCE AGREEMENT (THE "AGREEMENT"). THE AGREEMENT PROVIDES THAT THE EXECUTIVE WILL RECEIVE A MULTIPLE OF HIS OR HER SALARY (BASED ON YEARS OF SERVICE OR POSITION) AS A PAYMENT IN THE EVENT OF A DEFINED SEPARATION EVENT, WHICH CAN INCLUDE AN INVOLUNTARY SEPARATION OR AN EMPLOYEE VOLUNTARILY LEAVING FOR A DEFINED CONTRACTUAL REASON. FINAL SEPARATION PAYMENTS MIGHT VARY FROM THE AMOUNT PROVIDED IN THE AGREEMENT AS A RESULT OF NEGOTIATIONS SURROUNDING POST-SEPARATION OBLIGATIONS AND INCENTIVES (THE "SEPARATION" PAYMENT). LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS SANFORD SPONSORS NONQUALIFIED RETIREMENT PLANS FOR SELECT OFFICERS OR KEY EMPLOYEES. CERTAIN OF THE BELOW OFFICERS OR KEY EMPLOYEES WERE PAID AS A RESULT OF A VESTING EVENT. LINES 4A AND 4B - PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS AND/OR SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: BILL MARLETTE: 2021 BONUS AND INCENTIVE COMPENSATION $436,802 SEPARATION $2,924,223 NONQUALIFIED RETIREMENT PLAN $1,456,007 TOTAL $4,817,032
Schedule J (Form 990) 2021

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