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ObjectId: 202443209349310319 - Submission: 2024-11-15
TIN: 31-4379443
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
23
Open to Public Inspection
Name of the organization
ADENA HEALTH SYSTEM
Employer identification number
31-4379443
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) 2023
Page 2
Schedule J (Form 990) 2023
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
ATIQ REHMAN
PHYSICIAN
(i)
(ii)
993,491
-------------
1,644,119
554,523
-------------
0
23,871
-------------
0
19,939
-------------
0
52,295
-------------
0
1,644,119
-------------
1,644,119
0
-------------
0
2
ROGER WILTFONG
PHYSICIAN
(i)
(ii)
383,685
-------------
1,462,744
998,341
-------------
0
17,375
-------------
0
16,500
-------------
0
46,843
-------------
0
1,462,744
-------------
1,462,744
0
-------------
0
3
JAMES FLEMING
PHYSICIAN
(i)
(ii)
487,079
-------------
1,190,583
532,901
-------------
0
100,405
-------------
0
20,160
-------------
0
50,038
-------------
0
1,190,583
-------------
1,190,583
0
-------------
0
4
WAHEED GUL
PHYSICIAN
(i)
(ii)
637,987
-------------
1,051,988
275,273
-------------
0
53,751
-------------
0
23,000
-------------
0
61,977
-------------
0
1,051,988
-------------
1,051,988
0
-------------
0
5
KELLY GALLINA
PHYSICIAN
(i)
(ii)
308,615
-------------
1,011,737
603,156
-------------
0
22,642
-------------
0
16,500
-------------
0
60,824
-------------
0
1,011,737
-------------
1,011,737
0
-------------
0
6
JEFF GRAHAM
CEO
(i)
(ii)
956,818
-------------
0
39,688
-------------
0
13,860
-------------
0
23,080
-------------
0
35,120
-------------
0
1,068,566
-------------
0
0
-------------
0
7
REGGINA YANDILA
FORMER TRUSTEE/PHYSICIAN
(i)
(ii)
154,372
-------------
380,470
132,880
-------------
0
47,545
-------------
0
10,605
-------------
0
35,068
-------------
0
380,470
-------------
380,470
0
-------------
0
8
DR SHAHEED KOURY
CHIEF CLINICAL OFFICER
(i)
(ii)
547,451
-------------
0
52,677
-------------
0
25,072
-------------
0
76,153
-------------
0
50,759
-------------
0
752,112
-------------
0
0
-------------
0
9
JAMES MCMANUS
AHS CHIEF FINANCIAL OFFICER
(i)
(ii)
547,954
-------------
0
35,472
-------------
0
38,085
-------------
0
74,012
-------------
0
51,932
-------------
0
747,455
-------------
0
29,615
-------------
0
10
ANTHONY FREEMAN
FORMER CHIEF MEDICAL OFFICER
(i)
(ii)
469,949
-------------
0
0
-------------
0
144,147
-------------
0
21,276
-------------
0
56,803
-------------
0
692,175
-------------
0
0
-------------
0
11
KATHERINE EDRINGTON
COO
(i)
(ii)
605,161
-------------
0
13,933
-------------
0
2,100
-------------
0
17,691
-------------
0
15,083
-------------
0
653,968
-------------
0
0
-------------
0
12
CRAIG BABBITT
CHIEF LEGAL OFFICER
(i)
(ii)
441,135
-------------
0
7,813
-------------
0
45,873
-------------
0
65,500
-------------
0
36,819
-------------
0
597,140
-------------
0
43,544
-------------
0
13
RICHARD D MIZER
PRESIDENT OF AMG
(i)
(ii)
388,472
-------------
0
3,629
-------------
0
48,102
-------------
0
58,868
-------------
0
22,448
-------------
0
521,519
-------------
0
38,895
-------------
0
14
HEATHER SPRAGUE
CHIEF HUMAN RESOURCE OFFICER
(i)
(ii)
387,878
-------------
0
8,314
-------------
0
40,610
-------------
0
17,244
-------------
0
59,690
-------------
0
513,736
-------------
0
0
-------------
0
15
KRISTIN BOGGS
CHIEF COMPLIANCE OFFICER
(i)
(ii)
340,102
-------------
0
6,991
-------------
0
74,117
-------------
0
56,792
-------------
0
4,454
-------------
0
482,456
-------------
0
38,875
-------------
0
16
JAMIE SMITH
CHIEF INFORMATION OFFICER
(i)
(ii)
305,428
-------------
0
4,328
-------------
0
35,235
-------------
0
48,138
-------------
0
35,514
-------------
0
428,643
-------------
0
34,610
-------------
0
17
JOHN GABIS
PRESIDENT OF AMG
(i)
(ii)
365,780
-------------
0
2,677
-------------
0
5,291
-------------
0
14,646
-------------
0
25,000
-------------
0
413,394
-------------
0
0
-------------
0
18
MOLLY M GROOMS
CHIEF NURSING OFFICER
(i)
(ii)
308,991
-------------
0
2,747
-------------
0
34,538
-------------
0
48,879
-------------
0
2,896
-------------
0
398,051
-------------
0
33,855
-------------
0
19
DONALD DIENER
PRESIDENT OF ARMC
(i)
(ii)
286,217
-------------
0
0
-------------
0
4,205
-------------
0
67,727
-------------
0
31,462
-------------
0
389,611
-------------
0
0
-------------
0
20
LISA CARLSON
FORMER CFO
(i)
(ii)
28,082
-------------
0
291
-------------
0
241,683
-------------
0
931
-------------
0
89
-------------
0
271,076
-------------
0
241,505
-------------
0
21
TY MCBEE
VP OF STRATEGIC OPERATIONS
(i)
(ii)
223,347
-------------
0
4,514
-------------
0
1,111
-------------
0
11,580
-------------
0
13,204
-------------
0
253,756
-------------
0
0
-------------
0
Schedule J (Form 990) 2023
Page 3
Schedule J (Form 990) 2023
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
ADENA HEALTH SYSTEM PROVIDES FOR A MEMBERSHIP TO THE LOCAL COUNTRY CLUB FOR ALL OFFICERS AND KEY EMPLOYEES. THIS BENEFIT IS GROSSED UP AND TAXED AND RECEIVED BY SEVEN OF THE OFFICERS AND KEY EMPLOYEES.
PART I, LINE 4B
THE ORGANIZATION HAS A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENT FROM THE SERP IN 2023: LISA CARLSON $241,505 SERP EARNINGS JAMES MCMANUS $29,615 SERP EARNINGS CRAIG BABBITT $43,544 SERP EARNINGS RICHARD MIZER $38,895 SERP EARNINGS KRISTIN BOGGS $38,875 SERP EARNINGS JAMIE SMITH $34,610 SERP EARNINGS MOLLY GROOMS $33,855 SERP EARNINGS THE SERP ACCRUALS, INCLUDED IN PART II, COLUMN (C), ARE AMOUNTS CREDITED TO THE EXECUTIVE UNDER THE SECTION 457(F) DEFERRED COMPENSATION PLAN. JAMES MCMANUS $60,232 SERP ACCURAL DR. SHAHEED KOURY $59,652 SERP ACCRUAL CRAIG BABBITT $48,080 SERP ACCRUAL RICHARD MIZER $42,368 SERP ACCRUAL KRISTIN BOGGS $40,292 SERP ACCRUAL JAMIE SMITH $33,790 SERP ACCRUAL MOLLY GROOMS $33,263 SERP ACCRUAL
PART I, LINE 7
MANAGEMENT OF ADENA HEALTH SYSTEM HAVE A PORTION OF THEIR ANNUAL SALARY AT RISK UNDER AN INDUSTRY STANDARD VARIABLE COMPENSATION PLAN. IF THE OPERATING RESULTS OF AHS MEET A MARGIN TARGET IN ANY FISCAL YEAR, ADDITIONAL COMPENSATION IS PAID THAT IS CALCULATED USING THE OPERATING MARGIN ALONG WITH RESULTS IN EMPLOYEE ENGAGEMENT, PATIENT QUALITY, AND SATISFACTION USING A BALANCED SCORECARD FORMULA.
Schedule J (Form 990) 2023
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