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ObjectId: 202321319349301607 - Submission: 2023-05-11
TIN: 38-3316559
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
21
Open to Public Inspection
Name of the organization
IHA HEALTH SERVICES CORPORATION
Employer identification number
38-3316559
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
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.
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
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
1
DANIEL ROTH MD
TRUSTEE THR 4/22;TH CHF CLINCL OFFCR
(i)
(ii)
0
-------------
861,506
0
-------------
502,944
0
-------------
231,371
0
-------------
267,315
0
-------------
39,773
0
-------------
1,902,909
0
-------------
212,729
2
ROBERT CASALOU
TRUSTEE; PRES/CEO-MICHIGAN REGION
(i)
(ii)
0
-------------
1,053,686
0
-------------
472,500
0
-------------
219,121
0
-------------
17,400
0
-------------
55,001
0
-------------
1,817,708
0
-------------
0
3
JAMES MORAVEK JR MD
ORTHOPAEDIC SURGEON
(i)
(ii)
707,075
-------------
0
567,867
-------------
0
1,187
-------------
0
13,050
-------------
0
27,126
-------------
0
1,316,305
-------------
0
0
-------------
0
4
RYAN MLYNAREK MD
ORTHOPAEDIC SURGEON
(i)
(ii)
619,883
-------------
0
494,907
-------------
0
576
-------------
0
13,050
-------------
0
46,429
-------------
0
1,174,845
-------------
0
0
-------------
0
5
MONTGOMERY GILLARD MD
DERMATOLOGIC SURGEON
(i)
(ii)
745,490
-------------
0
270,021
-------------
0
2,597
-------------
0
17,400
-------------
0
44,284
-------------
0
1,079,792
-------------
0
0
-------------
0
6
GEORGE GIBSON DO
ORTHOPAEDIC SURGEON
(i)
(ii)
565,642
-------------
0
449,958
-------------
0
1,345
-------------
0
17,400
-------------
0
33,577
-------------
0
1,067,922
-------------
0
0
-------------
0
7
KRISTOPHER AALDERINK MD
ORTHOPAEDIC SURGEON
(i)
(ii)
913,410
-------------
0
500
-------------
0
1,374
-------------
0
17,400
-------------
0
41,879
-------------
0
974,563
-------------
0
0
-------------
0
8
MARK LEPAGE MD
FMR OFFICER; TH SVP MED GRP STRATEGY
(i)
(ii)
0
-------------
551,456
0
-------------
121,946
0
-------------
245,670
0
-------------
13,050
0
-------------
34,405
0
-------------
966,527
0
-------------
166,370
9
SHANNON STRIEBICH
TRSTEE 5/22; PRES TH OAK&MI SVP OPS
(i)
(ii)
0
-------------
561,957
0
-------------
193,262
0
-------------
71,655
0
-------------
17,400
0
-------------
38,878
0
-------------
883,152
0
-------------
0
10
MANAK SOOD MD
TRUSTEE; SURGERY DIVISION HEAD
(i)
(ii)
661,352
-------------
0
69,843
-------------
0
3,870
-------------
0
21,750
-------------
0
34,275
-------------
0
791,090
-------------
0
0
-------------
0
11
KATHLEEN BEEKMAN MD
TRUSTEE; PHYSICIAN
(i)
(ii)
334,729
-------------
0
346,108
-------------
0
779
-------------
0
17,400
-------------
0
31,213
-------------
0
730,229
-------------
0
0
-------------
0
12
CYNTHIA ELLIOTT
TRUSTEE AS OF 11/21; PRESIDENT
(i)
(ii)
364,816
-------------
52,398
150,747
-------------
50,000
13,624
-------------
1,149
18,412
-------------
12,921
20,362
-------------
3,114
567,961
-------------
119,582
0
-------------
0
13
MOHAMMAD SALAMEH MD
EVP, CHIEF MEDICAL OFFICER
(i)
(ii)
403,992
-------------
0
148,399
-------------
0
15,698
-------------
0
21,750
-------------
0
16,303
-------------
0
606,142
-------------
0
0
-------------
0
14
THERESA POPPE MD
TRUSTEE; V CHR; PRIMARY CRE DIV HEAD
(i)
(ii)
301,939
-------------
0
220,866
-------------
0
1,127
-------------
0
17,400
-------------
0
35,992
-------------
0
577,324
-------------
0
0
-------------
0
15
RAJIV DEENADAYALU MD
TRUSTEE; TREAS; OB GYN DIV HEAD
(i)
(ii)
363,547
-------------
0
146,988
-------------
0
1,659
-------------
0
21,750
-------------
0
34,472
-------------
0
568,416
-------------
0
0
-------------
0
16
BRUNO DI GIOVINE MD
TRUSTEE; MED SPECIALTIES DIV HEAD
(i)
(ii)
440,540
-------------
0
500
-------------
0
1,958
-------------
0
13,050
-------------
0
37,216
-------------
0
493,264
-------------
0
0
-------------
0
17
MATTHEW AJLUNI DO
TRUSTEE; URGENT CARE DIV HEAD
(i)
(ii)
354,958
-------------
0
32,303
-------------
0
451
-------------
0
13,050
-------------
0
34,724
-------------
0
435,486
-------------
0
0
-------------
0
18
DEBORAH WEENER MD
TRUSTEE; PHYSICIAN
(i)
(ii)
141,702
-------------
0
232,053
-------------
0
929
-------------
0
13,050
-------------
0
31,856
-------------
0
419,590
-------------
0
0
-------------
0
19
ROBERT BREAKEY MD
TRUSTEE; CHAIR; PHYSICIAN
(i)
(ii)
189,763
-------------
0
149,008
-------------
0
5,157
-------------
0
21,750
-------------
0
31,204
-------------
0
396,882
-------------
0
0
-------------
0
20
MICHAEL BRUDERLY MD
TRUSTEE; PHYSICIAN
(i)
(ii)
195,063
-------------
0
146,772
-------------
0
338
-------------
0
17,400
-------------
0
33,005
-------------
0
392,578
-------------
0
0
-------------
0
21
JASON HARRIS
CHIEF OPERATING OFFICER AS OF 3/22
(i)
(ii)
249,197
-------------
0
63,385
-------------
0
13,716
-------------
0
17,400
-------------
0
25,501
-------------
0
369,199
-------------
0
0
-------------
0
22
MARIA BOWLES
VP FINANCE, CFO
(i)
(ii)
271,264
-------------
0
70,500
-------------
0
401
-------------
0
13,050
-------------
0
8,114
-------------
0
363,329
-------------
0
0
-------------
0
23
TENDAI THOMAS MD
TRUSTEE; PHYSICIAN
(i)
(ii)
163,227
-------------
0
132,685
-------------
0
1,047
-------------
0
17,400
-------------
0
34,349
-------------
0
348,708
-------------
0
0
-------------
0
24
MELISSA HEINEN DO
TRUSTEE; SEC; PEDS DIVISION HEAD
(i)
(ii)
247,942
-------------
0
79,214
-------------
0
1,069
-------------
0
13,050
-------------
0
6,726
-------------
0
348,001
-------------
0
0
-------------
0
25
LOWELL SPRAGUE
FORMER OFFICER;DIR REAL ESTATE & FAC
(i)
(ii)
163,521
-------------
0
95,700
-------------
0
983
-------------
0
16,036
-------------
0
28,350
-------------
0
304,590
-------------
0
0
-------------
0
26
CARMEN GREEN-LEE MD
TRUSTEE; PHYSICIAN
(i)
(ii)
96,235
-------------
0
135,178
-------------
0
1,482
-------------
0
17,747
-------------
0
22,698
-------------
0
273,340
-------------
0
0
-------------
0
27
CORY RYAN PA-C
TRUSTEE; PHYSICIAN ASSISTANT CERT
(i)
(ii)
170,174
-------------
0
7,403
-------------
0
95
-------------
0
11,146
-------------
0
21,641
-------------
0
210,459
-------------
0
0
-------------
0
28
KELLY STRICKLER CPNP
FORMER OFFICER
(i)
(ii)
125,463
-------------
0
1,220
-------------
0
68
-------------
0
3,821
-------------
0
4,386
-------------
0
134,958
-------------
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 3
IHA IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. IHA'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF IHA'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
PART I, LINE 4B
THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2021. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. PARTICIPANTS' VESTED BENEFITS WERE PAID OUT IN 2021, AND THEIR NON-VESTED BENEFITS FOR 2021 WERE ACCRUED. THE FOLLOWING PAYOUTS FOR 2021 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: ROBERT CASALOU - $183,750 MARK LEPAGE, MD - $233,027 DANIEL ROTH, MD - $212,729 SHANNON STRIEBICH - $58,262 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ACCRUALS FOR 2021 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: CYNTHIA ELLIOTT - $9,583 DANIEL ROTH, MD - $254,265
Schedule J (Form 990) 2021
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