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Object ID: 201801349349306090 - Rendered 2024-04-28
TIN: 23-1913910
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.
Information about Schedule J (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
16
Open to Public Inspection
Name of the organization
ST MARY MEDICAL CENTER
Employer identification number
23-1913910
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 in 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 in 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
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) 2016
Schedule J (Form 990) 2016
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 and/or 1099-MISC compensation
(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
JIM WOODWARD
PRESIDENT & CEO AS OF 7/16
(i)
(ii)
0
-------------
229,071
0
-------------
30,000
0
-------------
32,327
0
-------------
42,710
0
-------------
12,490
0
-------------
346,598
0
-------------
0
2
PAUL CONLON
DIRECTOR; TH SVP CLIN QUAL/PAT SFTY
(i)
(ii)
0
-------------
450,388
0
-------------
115,896
0
-------------
131,904
0
-------------
19,875
0
-------------
28,542
0
-------------
746,605
0
-------------
0
3
CATHERINE MIKUS
SECRETARY; GENERAL COUNSEL
(i)
(ii)
0
-------------
209,674
0
-------------
49,650
0
-------------
21,099
0
-------------
16,352
0
-------------
21,448
0
-------------
318,223
0
-------------
0
4
SHARON PROFERA
INT CFO/TREAS THROUGH 3/17
(i)
(ii)
187,270
-------------
0
18,030
-------------
0
1,335
-------------
0
13,226
-------------
0
23,464
-------------
0
243,325
-------------
0
0
-------------
0
5
DEIRDRE DONAGHY MD
VP, CMO THROUGH 1/17
(i)
(ii)
238,961
-------------
0
0
-------------
0
65,971
-------------
0
11,079
-------------
0
15,970
-------------
0
331,981
-------------
0
51,035
-------------
0
6
RAJANI WALSH MD
PHYSICIAN
(i)
(ii)
361,589
-------------
0
0
-------------
0
2,517
-------------
0
11,925
-------------
0
7,846
-------------
0
383,877
-------------
0
0
-------------
0
7
RONALD FELIPE MD
PHYSICIAN
(i)
(ii)
284,505
-------------
0
0
-------------
0
288
-------------
0
9,747
-------------
0
7
-------------
0
294,547
-------------
0
0
-------------
0
8
TERRI RIVERA
VP MISSION & COMMUNITY HEALTH
(i)
(ii)
174,029
-------------
0
14,587
-------------
0
93,077
-------------
0
11,870
-------------
0
18,009
-------------
0
311,572
-------------
0
77,869
-------------
0
9
SHARON HOPKINS
ADMINISTRATOR, HIM & QUALITY
(i)
(ii)
240,449
-------------
0
16,309
-------------
0
5,149
-------------
0
36,124
-------------
0
7,847
-------------
0
305,878
-------------
0
0
-------------
0
10
SHARON BROWN
VP, PATIENT CARE & CNO
(i)
(ii)
228,167
-------------
0
20,865
-------------
0
6,520
-------------
0
34,740
-------------
0
12,552
-------------
0
302,844
-------------
0
0
-------------
0
11
DAN MOEN
FORMER OFFICER; TRINITY EXECUTIVE
(i)
(ii)
0
-------------
611,995
0
-------------
160,861
0
-------------
149,819
0
-------------
11,925
0
-------------
33,097
0
-------------
967,697
0
-------------
0
12
GREG WOZNIAK
FORMER OFFICER
(i)
(ii)
0
-------------
0
0
-------------
30,963
0
-------------
699,645
0
-------------
0
0
-------------
35,010
0
-------------
765,618
0
-------------
485,322
13
JEFFREY YARMEL
FORMER KE; MERCY SEPA
(i)
(ii)
237,266
-------------
18,841
64,760
-------------
0
2,889
-------------
0
11,232
-------------
0
10,295
-------------
0
326,442
-------------
18,841
0
-------------
0
14
BRIAN BURGESS
FORMER KE; MERCY SEPA SVP
(i)
(ii)
0
-------------
305,888
0
-------------
99,587
0
-------------
6,476
0
-------------
11,662
0
-------------
25,027
0
-------------
448,640
0
-------------
0
15
MARY SWEENEY
FORMER KE; TH CHRO MID-ATLANTIC REG
(i)
(ii)
16,932
-------------
297,089
10,072
-------------
41,776
1,007
-------------
7,176
1,279
-------------
14,696
820
-------------
24,754
30,110
-------------
385,491
0
-------------
0
Schedule J (Form 990) 2016
Schedule J (Form 990) 2016
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
ST. MARY MEDICAL CENTER (SMMC) IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SMMC'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 SMMC'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, LINES 4A-B
THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2016. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: GREG WOZNIAK - $485,322 COLUMN (F) OF SCHEDULE J, PART II, INCLUDES THE PORTION OF THIS AMOUNT THAT WAS REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2016. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. BENEFITS FOR PARTICIPANTS VESTED IN A PLAN WERE PAID OUT IN 2016, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2016. THE FOLLOWING PAYOUTS FOR 2016 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: PAUL CONLIN - $109,481 DAN MOEN - $129,453 GREG WOZNIAK - $101,458 THE FOLLOWING ACCRUALS FOR 2016 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: JIM WOODWARD - $40,104 THE FOLLOWING ARE PARTICIPANTS IN A ST. MARY MEDICAL CENTER NONQUALIFIED DEFERRED COMPENSATION PLAN IN 2016. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN ST. MARY MEDICAL CENTER EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. BENEFITS FOR PARTICIPANTS VESTED IN A PLAN WERE PAID OUT IN 2016, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2016. THE FOLLOWING PAYOUTS FOR 2016 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHECULE J, PART II: DEIRDRE DONAGHY - $65,407 TERRI RIVERA - $91,710 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 2016 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: SHARON BROWN - $22,947 SHARON HOPKINS - $19,670
Schedule J (Form 990) 2016
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