efile Public Visual Render
ObjectId: 202323069349301642 - Submission: 2023-11-02
TIN: 87-0409820
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
22
Open to Public Inspection
Name of the organization
SELECTHEALTH INC
Employer identification number
87-0409820
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) 2022
Page 2
Schedule J (Form 990) 2022
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
A MARC HARRISON MD
TRUSTEE (PARTIAL)
(i)
(ii)
0
-------------
2,137,760
0
-------------
2,604,254
0
-------------
13,451
0
-------------
1,857,710
0
-------------
9,576
0
-------------
6,622,751
0
-------------
1,862,265
2
ALBERT R ZIMMERLI
TRUSTEE
(i)
(ii)
0
-------------
1,206,132
0
-------------
888,226
0
-------------
2,204,533
0
-------------
1,380,079
0
-------------
10,459
0
-------------
5,689,429
0
-------------
759,188
3
ROBERT W ALLEN
TRUSTEE (PARTIAL)
(i)
(ii)
0
-------------
1,190,385
0
-------------
806,124
0
-------------
557,411
0
-------------
2,267,020
0
-------------
16,364
0
-------------
4,837,304
0
-------------
693,309
4
LYDIA W JUMONVILLE
TRUSTEE (PARTIAL)
(i)
(ii)
0
-------------
1,457,019
0
-------------
1,300,392
0
-------------
435,796
0
-------------
675,533
0
-------------
19,797
0
-------------
3,888,537
0
-------------
382,586
5
MARK R BRIESACHER MD
TRUSTEE (PARTIAL)
(i)
(ii)
0
-------------
152,262
0
-------------
617,848
0
-------------
2,902,282
0
-------------
26,281
0
-------------
2,929
0
-------------
3,701,602
0
-------------
1,229,981
6
JAMES P VALIN
TRUSTEE (PARTIAL)
(i)
(ii)
0
-------------
1,018,982
0
-------------
675,622
0
-------------
104,638
0
-------------
137,560
0
-------------
30,233
0
-------------
1,967,035
0
-------------
98,880
7
GREGORY M JOHNSON
FORMER OFFICER
(i)
(ii)
0
-------------
546,031
0
-------------
305,661
0
-------------
755,765
0
-------------
260,012
0
-------------
21,267
0
-------------
1,888,736
0
-------------
655,717
8
MARTI LOLLI
TRUSTEE/PRES/CEO (PARTIAL)
(i)
(ii)
783,713
-------------
0
444,627
-------------
0
51,465
-------------
0
572,601
-------------
0
10,156
-------------
0
1,862,562
-------------
0
408,507
-------------
0
9
DAVID A LEMPERLE
VP SALES (PARTIAL)
(i)
(ii)
141,430
-------------
0
268,826
-------------
0
565,021
-------------
0
42,618
-------------
0
3,402
-------------
0
1,021,297
-------------
0
234,441
-------------
0
10
ROBERT L WHITE
FORMER OFFICER
(i)
(ii)
59,716
-------------
0
221,001
-------------
0
630,043
-------------
0
89,196
-------------
0
7,695
-------------
0
1,007,651
-------------
0
148,453
-------------
0
11
TODD TRETTIN
VP (PARTIAL) / TREASURER / CFO
(i)
(ii)
475,502
-------------
0
139,506
-------------
0
1,534
-------------
0
281,337
-------------
0
9,151
-------------
0
907,030
-------------
0
138,906
-------------
0
12
RUSSEL J KUZEL MD
CMO (PARTIAL) / VP (PARTIAL)
(i)
(ii)
47,198
-------------
0
263,972
-------------
0
541,994
-------------
0
31,222
-------------
0
512
-------------
0
884,898
-------------
0
230,029
-------------
0
13
KRISTIN R MCCULLAGH
SEC/VP/CHIEF ADMIN OFFICER (PARTIAL)
(i)
(ii)
421,599
-------------
0
116,798
-------------
0
1,916
-------------
0
241,663
-------------
0
9,734
-------------
0
791,710
-------------
0
109,144
-------------
0
14
KRISTA SCHONROCK MD
SENIOR MEDICAL DIRECTOR
(i)
(ii)
433,658
-------------
0
109,689
-------------
0
1,884
-------------
0
210,107
-------------
0
9,789
-------------
0
765,127
-------------
0
0
-------------
0
15
STEPHEN BARLOW MD
MEDICAL DIRECTOR
(i)
(ii)
396,784
-------------
0
120,494
-------------
0
1,634
-------------
0
194,684
-------------
0
11,767
-------------
0
725,363
-------------
0
0
-------------
0
16
JON R GRIFFITH
CHIEF EXP OFFICER/VP (PARTIAL)
(i)
(ii)
326,658
-------------
0
93,996
-------------
0
1,881
-------------
0
189,668
-------------
0
11,845
-------------
0
624,048
-------------
0
93,996
-------------
0
17
H ERIC CANNON
PHARMACY SERVICES
(i)
(ii)
311,161
-------------
0
84,854
-------------
0
3,076
-------------
0
186,015
-------------
0
12,330
-------------
0
597,436
-------------
0
84,854
-------------
0
18
SEAN DUNROE
CHIEF STRAT OFFICER/VP (PARTIAL)
(i)
(ii)
305,477
-------------
0
78,219
-------------
0
1,945
-------------
0
187,786
-------------
0
12,969
-------------
0
586,396
-------------
0
77,984
-------------
0
19
ED CASTLEDINE
MARKET PRESIDENT
(i)
(ii)
289,649
-------------
0
72,452
-------------
0
51,268
-------------
0
117,688
-------------
0
7,607
-------------
0
538,664
-------------
0
0
-------------
0
20
HEATHER O'TOOLE
CMO (PARTIAL) / VP (PARTIAL)
(i)
(ii)
303,949
-------------
0
0
-------------
0
30,217
-------------
0
134,923
-------------
0
8,979
-------------
0
478,068
-------------
0
0
-------------
0
21
ROB HITCHCOCK
TRUSTEE/PRESIDENT (PARTIAL)
(i)
(ii)
239,463
-------------
0
133,100
-------------
0
1,269
-------------
0
81,318
-------------
0
2,041
-------------
0
457,191
-------------
0
0
-------------
0
22
SCOTT WHITTLE MD
MEDICAL DIRECTOR
(i)
(ii)
90,078
-------------
0
66,304
-------------
0
206,650
-------------
0
2,458
-------------
0
4,072
-------------
0
369,562
-------------
0
0
-------------
0
23
JERRY R EDGINGTON
VICE PRESIDENT (PARTIAL)
(i)
(ii)
115,175
-------------
0
196,539
-------------
0
1,372
-------------
0
34,389
-------------
0
4,814
-------------
0
352,289
-------------
0
171,334
-------------
0
24
PATRICIA R RICHARDS
FORMER OFFICER
(i)
(ii)
0
-------------
0
137,717
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
137,717
-------------
0
118,893
-------------
0
Schedule J (Form 990) 2022
Page 3
Schedule J (Form 990) 2022
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 - IN ACCORDANCE WITH COMPANY POLICY, FIRST CLASS AND CHARTER TRAVEL WAS AVAILABLE ON A VERY LIMITED BASIS TO INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A FOR LONG INTERNATIONAL FLIGHTS AND/OR FOR SAFETY OR HEALTH REASONS. THE ADDITIONAL COST OF FIRST CLASS AND CHARTER TRAVEL WAS NOT REPORTED AS TAXABLE COMPENSATION. THE COSTS ASSOCIATED WITH THE LIMITED CIRCUMSTANCES OF FIRST CLASS AND CHARTER TRAVEL WERE A NECESSARY BUSINESS EXPENSE. TRAVEL FOR COMPANIONS - PURSUANT TO COMPANY POLICY, COMPANION TRAVEL EXPENSES ARE AVAILABLE TO ANYONE IF APPROVED IN ADVANCE BY SENIOR MANAGEMENT OF THE FILING ORGANIZATION. IF APPROVED, THE REIMBURSED EXPENSES ARE REPORTED AS TAXABLE TO THE EMPLOYEE ON A FORM W-2 OR 1099. TAX GROSS-UP PAYMENTS - PURSUANT TO COMPANY POLICY, A LIMITED NUMBER OF BENEFITS AND PERQUISITES TO THE GOVERNING BODY AND CERTAIN OFFICERS ARE GROSSED UP FOR TAX PURPOSES. A TOTAL OF TWO INDIVIDUALS RECEIVED THIS BENEFIT. THE PAYMENTS ARE INCLUDED ON EITHER A FORM W-2 OR 1099.
PART I, LINE 3
INTERMOUNTAIN HEALTH CARE, INC., THE SOLE MEMBER OF THE FILING ORGANIZATION, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE SELECTHEALTH CEO: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -COMPENSATION SURVEY/STUDY -APPROVAL BY THE COMPENSATION COMMITTEE
PART I, LINES 4A-B
THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN 2022: - MARK R. BRIESACHER, MD $2,141,477 - RUSSEL J. KUZEL, MD $541,600 - DAVID A. LEMPERLE $563,599 - ROBERT L. WHITE $471,729 - SCOTT WHITTLE $146,495 IHC HEALTH SERVICES, INC., A RELATED TAX-EXEMPT ORGANIZATION, OFFERS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. PARTICIPATION IN THE PLAN IS LIMITED TO EMPLOYEES DESIGNATED BY THE BOARD. THE AMOUNTS IN THE PLAN ARE NOT VESTED, ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE, AND MAY OR MAY NOT BE PAID IN THE FUTURE. AMOUNTS DEFERRED DURING 2022 FOR THE INDIVIDUALS REPORTED ON PART VII OF THE FORM 990 HAVE BEEN INCLUDED IN THE SCHEDULE J, PART II, COLUMN (C) TOTAL. THE FOLLOWING INDIVIDUALS RECEIVED A SUPPLEMENTAL EMPLOYER RETIREMENT PAYMENT IN 2022: - MARK R. BRIESACHER, MD $750,631 - GREGORY M. JOHNSON $655,717 - ROBERT L. WHITE $148,453 - ALBERT R. ZIMMERLI $360,375 THE 2022 SUPPLEMENTAL EMPLOYER RETIREMENT PAYMENT REPORTED ABOVE IS INCLUDED IN THE PART II, COLUMN (B)(III) TOTALS.
PART II, COLUMN (C):
DURING 2022, BENEFITS FOR SEVERAL INDIVIDUALS WERE INCLUDED IN PART II, COLUMN (C) AS PART OF A RETENTION AGREEMENT PACKAGE.
Schedule J (Form 990) 2022
Additional Data
Software ID:
Software Version: