Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public Inspection
Name of the organization
Spectrum Health System Group Return
 
Employer identification number

61-1740292
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 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
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 in 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
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) 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
1Christina Freese-Decker
 
See Schedule O 		(i)

(ii)		 0
-------------
734,498 		0
-------------
390,398 		0
-------------
44,647 		0
-------------
400,371 		0
-------------
121,694 		0
-------------
1,691,608 		0
-------------
48,693
2Gwen Sandefur
 
President, SHH 		(i)

(ii)		 434,865
-------------
0 		143,000
-------------
0 		3,481
-------------
0 		126,674
-------------
0 		68,218
-------------
0 		776,238
-------------
0 		0
-------------
0
3Randall Stasik
 
President, SHGM 		(i)

(ii)		 284,112
-------------
0 		399,101
-------------
0 		7,472
-------------
0 		98,800
-------------
0 		52,226
-------------
0 		841,711
-------------
0 		275,436
-------------
0
4Mary Kay Vandriel
 
President, SHBR & SHRC 		(i)

(ii)		 257,418
-------------
0 		105,305
-------------
0 		14,221
-------------
0 		108,176
-------------
0 		49,996
-------------
0 		535,116
-------------
0 		13,791
-------------
0
5Sheryl Lewis-Blake
 
President, SHP 		(i)

(ii)		 267,938
-------------
0 		95,240
-------------
0 		4,021
-------------
0 		61,569
-------------
0 		56,020
-------------
0 		484,788
-------------
0 		0
-------------
0
6Andrea Leslie
 
President, SHU & SHK 		(i)

(ii)		 154,081
-------------
0 		41,569
-------------
0 		794
-------------
0 		8,808
-------------
0 		26,340
-------------
0 		231,592
-------------
0 		0
-------------
0
7Brian Brasser
 
President, SHU & SHK - Part Year 		(i)

(ii)		 0
-------------
274,824 		0
-------------
126,377 		0
-------------
2,076 		0
-------------
87,721 		0
-------------
59,442 		0
-------------
550,440 		0
-------------
29,300
8Ron Lewis
 
President, SHZ 		(i)

(ii)		 246,638
-------------
0 		59,957
-------------
0 		1,596
-------------
0 		58,086
-------------
0 		53,077
-------------
0 		419,354
-------------
0 		0
-------------
0
9Marc Chircop
 
See Schedule O 		(i)

(ii)		 429,812
-------------
0 		192,091
-------------
0 		27,022
-------------
0 		154,981
-------------
0 		75,392
-------------
0 		879,298
-------------
0 		45,741
-------------
0
10Douglas Welday
 
See Schedule O 		(i)

(ii)		 424,327
-------------
0 		164,240
-------------
0 		4,317
-------------
0 		103,041
-------------
0 		72,247
-------------
0 		768,172
-------------
0 		22,408
-------------
0
11Chad Tuttle
 
See Schedule O 		(i)

(ii)		 239,294
-------------
0 		77,077
-------------
0 		2,028
-------------
0 		69,189
-------------
0 		48,778
-------------
0 		436,366
-------------
0 		0
-------------
0
12Kevin Smith
 
See Schedule O 		(i)

(ii)		 182,097
-------------
0 		47,690
-------------
0 		1,732
-------------
0 		10,303
-------------
0 		18,615
-------------
0 		260,437
-------------
0 		0
-------------
0
13Karen Pakkala
 
See Schedule O 		(i)

(ii)		 177,232
-------------
0 		46,237
-------------
0 		4,713
-------------
0 		12,875
-------------
0 		6,292
-------------
0 		247,349
-------------
0 		0
-------------
0
14Jason Slaikeu MD
 
See Schedule O 		(i)

(ii)		 486,642
-------------
0 		66,203
-------------
0 		9,087
-------------
0 		15,900
-------------
0 		27,464
-------------
0 		605,296
-------------
0 		0
-------------
0
15Gregory Gadbois MD
 
Chair, SHMG - Part Year 		(i)

(ii)		 179,860
-------------
96,942 		0
-------------
66,566 		5,887
-------------
468 		18,120
-------------
5,730 		15,174
-------------
7,735 		219,041
-------------
177,441 		0
-------------
0
16John Schuen MD
 
Vice Chair, SHMG 		(i)

(ii)		 286,463
-------------
0 		40,479
-------------
0 		14,173
-------------
0 		30,230
-------------
0 		31,580
-------------
0 		402,925
-------------
0 		0
-------------
0
17Brian Phillips
 
Treasurer, SHMG 		(i)

(ii)		 361,752
-------------
0 		500
-------------
0 		8,868
-------------
0 		26,500
-------------
0 		22,484
-------------
0 		420,104
-------------
0 		0
-------------
0
18Darryl Elmouchi MD
 
President, SHMG 		(i)

(ii)		 674,105
-------------
0 		95,485
-------------
0 		32,037
-------------
0 		19,875
-------------
0 		47,388
-------------
0 		868,890
-------------
0 		0
-------------
0
19Seth Wolk MD
 
See Schedule O 		(i)

(ii)		 0
-------------
724,703 		0
-------------
336,751 		0
-------------
45,468 		0
-------------
333,414 		0
-------------
116,449 		0
-------------
1,556,785 		0
-------------
0
20Douglas Apple MD
 
Interim President, SHMG - Part Year 		(i)

(ii)		 444,442
-------------
0 		178,729
-------------
0 		2,927
-------------
0 		144,308
-------------
0 		72,273
-------------
0 		842,679
-------------
0 		30,435
-------------
0
21Vicki Weaver
 
President, SHF 		(i)

(ii)		 278,866
-------------
0 		93,705
-------------
0 		5,088
-------------
0 		23,850
-------------
0 		10,934
-------------
0 		412,443
-------------
0 		0
-------------
0
22Richard Breon
 
See Schedule O 		(i)

(ii)		 0
-------------
1,292,901 		0
-------------
6,604,791 		0
-------------
47,682 		0
-------------
1,311,971 		0
-------------
210,655 		0
-------------
9,468,000 		0
-------------
5,573,130
23Joan A BUDDEN
 
See Schedule O 		(i)

(ii)		 0
-------------
719,086 		0
-------------
367,769 		0
-------------
19,776 		0
-------------
340,216 		0
-------------
119,548 		0
-------------
1,566,395 		0
-------------
74,685
24David Krhovsky MD
 
Director, SHGM 		(i)

(ii)		 356,722
-------------
0 		70,610
-------------
0 		5,792
-------------
0 		5,300
-------------
0 		62,962
-------------
0 		501,386
-------------
0 		0
-------------
0
25Allan Nelson MD
 
Director, SHL 		(i)

(ii)		 242,947
-------------
0 		500
-------------
0 		21,987
-------------
0 		30,813
-------------
0 		26,962
-------------
0 		323,209
-------------
0 		0
-------------
0
26Patrick O'Hare
 
Director, SHL 		(i)

(ii)		 0
-------------
499,504 		0
-------------
281,543 		0
-------------
22,598 		0
-------------
268,314 		0
-------------
76,317 		0
-------------
1,148,276 		0
-------------
48,785
27Christopher Skinner MD
 
Director, SHBR 		(i)

(ii)		 379,390
-------------
0 		500
-------------
0 		6,612
-------------
0 		15,900
-------------
0 		17,178
-------------
0 		419,580
-------------
0 		0
-------------
0
28Donald Bradley
 
Director, SHRC - Part Year 		(i)

(ii)		 204,062
-------------
0 		250
-------------
0 		5,968
-------------
0 		16,805
-------------
0 		17,977
-------------
0 		245,062
-------------
0 		0
-------------
0
29Scott Grindel
 
Director, SHRC - Part Year 		(i)

(ii)		 179,182
-------------
0 		500
-------------
0 		7,482
-------------
0 		15,784
-------------
0 		22,347
-------------
0 		225,295
-------------
0 		0
-------------
0
30Patricia Hoepner
 
Director, SHRC 		(i)

(ii)		 233,606
-------------
0 		500
-------------
0 		7,479
-------------
0 		18,026
-------------
0 		16,713
-------------
0 		276,324
-------------
0 		0
-------------
0
31David Ottenbaker MD
 
See Schedule O 		(i)

(ii)		 360,223
-------------
0 		121,221
-------------
0 		15,631
-------------
0 		23,850
-------------
0 		19,139
-------------
0 		540,064
-------------
0 		0
-------------
0
32Mary Anne Jones
 
Director, SHU & SHK 		(i)

(ii)		 0
-------------
409,902 		0
-------------
182,403 		0
-------------
5,849 		0
-------------
121,658 		0
-------------
73,844 		0
-------------
793,656 		0
-------------
47,329
33Judy Smith MD
 
Director, SHU & SHK 		(i)

(ii)		 465,348
-------------
0 		158,205
-------------
0 		10,202
-------------
0 		19,875
-------------
0 		21,822
-------------
0 		675,452
-------------
0 		0
-------------
0
34Thomas Visser MD
 
Director, SHZ 		(i)

(ii)		 537,968
-------------
0 		500
-------------
0 		7,922
-------------
0 		23,850
-------------
0 		23,161
-------------
0 		593,401
-------------
0 		0
-------------
0
35JAY LABINE
 
Director, SHCC 		(i)

(ii)		 0
-------------
399,160 		0
-------------
178,183 		0
-------------
2,739 		0
-------------
108,153 		0
-------------
63,485 		0
-------------
751,720 		0
-------------
41,581
36Simin Beg
 
Director, SHMG 		(i)

(ii)		 235,344
-------------
0 		16,196
-------------
0 		8,759
-------------
0 		18,009
-------------
0 		29,577
-------------
0 		307,885
-------------
0 		0
-------------
0
37Lee Begrow DO
 
Director, SHMG - Part Year 		(i)

(ii)		 346,192
-------------
0 		2,000
-------------
0 		8,882
-------------
0 		26,500
-------------
0 		23,196
-------------
0 		406,770
-------------
0 		0
-------------
0
38Michael Harrison MD
 
Director, SHMG 		(i)

(ii)		 472,348
-------------
0 		160,618
-------------
0 		10,914
-------------
0 		26,500
-------------
0 		34,032
-------------
0 		704,412
-------------
0 		0
-------------
0
39Melinda Johnson
 
Director, SHMG 		(i)

(ii)		 293,866
-------------
0 		53,651
-------------
0 		6,397
-------------
0 		19,875
-------------
0 		22,836
-------------
0 		396,625
-------------
0 		0
-------------
0
40Leslie Jurecko MD
 
Director, SHMG 		(i)

(ii)		 246,677
-------------
0 		58,289
-------------
0 		6,730
-------------
0 		15,209
-------------
0 		23,923
-------------
0 		350,828
-------------
0 		0
-------------
0
41Edward Murphy MD
 
Director, SHMG - Part Year 		(i)

(ii)		 752,561
-------------
0 		500
-------------
0 		8,022
-------------
0 		26,500
-------------
0 		23,993
-------------
0 		811,576
-------------
0 		0
-------------
0
42Mary O'Callaghan
 
Director, SHMG 		(i)

(ii)		 239,203
-------------
0 		32,209
-------------
0 		9,114
-------------
0 		26,661
-------------
0 		1,047
-------------
0 		308,234
-------------
0 		0
-------------
0
43Thomas Rupp MD
 
Director, SHMG - Part Year 		(i)

(ii)		 270,249
-------------
0 		500
-------------
0 		452,006
-------------
0 		23,850
-------------
0 		8,028
-------------
0 		754,633
-------------
0 		0
-------------
0
44Matthew Steensma MD
 
Director, SHMG 		(i)

(ii)		 532,277
-------------
0 		500
-------------
0 		7,081
-------------
0 		15,900
-------------
0 		23,503
-------------
0 		579,261
-------------
0 		0
-------------
0
45Brett Zimmerman DO
 
Director, SHMG 		(i)

(ii)		 350,183
-------------
0 		47,705
-------------
0 		7,349
-------------
0 		19,875
-------------
0 		17,394
-------------
0 		442,506
-------------
0 		0
-------------
0
46William Jewell
 
Secretary, SHH 		(i)

(ii)		 331,445
-------------
0 		138,270
-------------
0 		3,613
-------------
0 		100,405
-------------
0 		55,023
-------------
0 		628,756
-------------
0 		28,764
-------------
0
47Shelly Johnson
 
Chief Operating Officer, SHGM 		(i)

(ii)		 141,551
-------------
0 		42,539
-------------
0 		1,176
-------------
0 		5,981
-------------
0 		23,906
-------------
0 		215,153
-------------
0 		0
-------------
0
48Kerri Nelson
 
Controller, SHL 		(i)

(ii)		 165,930
-------------
0 		43,346
-------------
0 		1,069
-------------
0 		9,390
-------------
0 		20,765
-------------
0 		240,500
-------------
0 		0
-------------
0
49Thomas Knoerl
 
Controller, SHBR & SHRC 		(i)

(ii)		 183,881
-------------
0 		53,981
-------------
0 		827
-------------
0 		15,235
-------------
0 		22,544
-------------
0 		276,468
-------------
0 		0
-------------
0
50Catherine Rybicki
 
Chief Operating Officer, SHBR & SHRC 		(i)

(ii)		 161,024
-------------
0 		47,720
-------------
0 		1,661
-------------
0 		15,124
-------------
0 		19,665
-------------
0 		245,194
-------------
0 		0
-------------
0
51Carla Neil
 
Chief Operating Officer, SHP 		(i)

(ii)		 180,993
-------------
0 		45,376
-------------
0 		2,546
-------------
0 		14,077
-------------
0 		2,738
-------------
0 		245,730
-------------
0 		0
-------------
0
52Kevin Nichols
 
Controller, SHGM/SHP - Part Year 		(i)

(ii)		 150,456
-------------
0 		43,838
-------------
0 		487
-------------
0 		5,027
-------------
0 		20,924
-------------
0 		220,732
-------------
0 		0
-------------
0
53Deidre Weller
 
See Schedule O 		(i)

(ii)		 161,934
-------------
0 		44,885
-------------
0 		872
-------------
0 		9,075
-------------
0 		9,025
-------------
0 		225,791
-------------
0 		0
-------------
0
54Ryan Johnson
 
Controller, SHU & SHK 		(i)

(ii)		 151,761
-------------
0 		44,861
-------------
0 		331
-------------
0 		6,349
-------------
0 		22,864
-------------
0 		226,166
-------------
0 		0
-------------
0
55Priscilla Mahar
 
Chief Operating Officer, SHU & SHK 		(i)

(ii)		 158,605
-------------
0 		52,018
-------------
0 		4,042
-------------
0 		15,421
-------------
0 		20,485
-------------
0 		250,571
-------------
0 		0
-------------
0
56Joseph Klesney
 
Chief Operating Officer, SHZ 		(i)

(ii)		 138,592
-------------
0 		40,480
-------------
0 		1,002
-------------
0 		7,816
-------------
0 		21,131
-------------
0 		209,021
-------------
0 		0
-------------
0
57Ryan Powers
 
Controller, SHZ 		(i)

(ii)		 144,509
-------------
0 		42,305
-------------
0 		1,055
-------------
0 		8,212
-------------
0 		20,690
-------------
0 		216,771
-------------
0 		0
-------------
0
58Pauline Krywanski
 
SVP, Finance, SHMG - Part Year 		(i)

(ii)		 321,678
-------------
0 		142,889
-------------
0 		4,087
-------------
0 		84,358
-------------
0 		37,964
-------------
0 		590,976
-------------
0 		35,971
-------------
0
59Julie Lepzinski
 
SVP, Chief Operating Officer, SHMG 		(i)

(ii)		 350,300
-------------
0 		133,707
-------------
0 		2,873
-------------
0 		14,575
-------------
0 		55,513
-------------
0 		556,968
-------------
0 		17,193
-------------
0
60Thomas Mcgraw
 
Secretary, SHMG 		(i)

(ii)		 312,521
-------------
0 		138,559
-------------
0 		3,733
-------------
0 		82,041
-------------
0 		57,531
-------------
0 		594,385
-------------
0 		32,507
-------------
0
61Joseph Scallen
 
See Schedule O 		(i)

(ii)		 303,480
-------------
0 		109,069
-------------
0 		86,179
-------------
0 		17,635
-------------
0 		322
-------------
0 		516,685
-------------
0 		0
-------------
0
62Robert Connors
 
President, HDVCH, SHH 		(i)

(ii)		 505,706
-------------
0 		323,492
-------------
0 		9,488
-------------
0 		21,200
-------------
0 		73,575
-------------
0 		933,461
-------------
0 		156,104
-------------
0
63Konstantin Elisevich
 
Academic Chair, Neurosciences, SHMG 		(i)

(ii)		 961,446
-------------
0 		325,138
-------------
0 		12,924
-------------
0 		23,850
-------------
0 		21,843
-------------
0 		1,345,201
-------------
0 		0
-------------
0
64Martin Strueber
 
Surgical Director, Cardiothoracic Surgeon, SHH - Part Year 		(i)

(ii)		 528,795
-------------
0 		0
-------------
0 		633,897
-------------
0 		14,575
-------------
0 		15,284
-------------
0 		1,192,551
-------------
0 		0
-------------
0
65Marcus Haw
 
Dept Chief, HDVCH Cardiothorac, SHH 		(i)

(ii)		 991,171
-------------
0 		100,000
-------------
0 		15,462
-------------
0 		23,850
-------------
0 		26,477
-------------
0 		1,156,960
-------------
0 		0
-------------
0
66Todd Vitaz MD
 
Physician, SHMG 		(i)

(ii)		 1,041,571
-------------
0 		500
-------------
0 		8,810
-------------
0 		15,900
-------------
0 		28,692
-------------
0 		1,095,473
-------------
0 		0
-------------
0
67James Lebolt
 
Physician, SHMG 		(i)

(ii)		 919,866
-------------
0 		500
-------------
0 		7,640
-------------
0 		15,900
-------------
0 		30,591
-------------
0 		974,497
-------------
0 		0
-------------
0
68Ronald Knaus
 
See Schedule O 		(i)

(ii)		 0
-------------
616,494 		0
-------------
360,724 		0
-------------
29,444 		0
-------------
481,370 		0
-------------
107,541 		0
-------------
1,595,573 		0
-------------
69,284
69Lisa Shannon
 
Former Chief Operating Officer, SHH 		(i)

(ii)		 0
-------------
0 		626,610
-------------
0 		663
-------------
0 		0
-------------
0 		0
-------------
0 		627,273
-------------
0 		626,610
-------------
0
70Kevin Splaine
 
Former President, SHH 		(i)

(ii)		 0
-------------
0 		16
-------------
0 		304,542
-------------
0 		0
-------------
0 		0
-------------
0 		304,558
-------------
0 		16
-------------
0
71John Sella
 
Former CFO, SHGM 		(i)

(ii)		 190,152
-------------
0 		51,543
-------------
0 		1,584
-------------
0 		13,683
-------------
0 		23,014
-------------
0 		279,976
-------------
0 		0
-------------
0
72Mark Vipperman
 
Former President, SHL 		(i)

(ii)		 78,805
-------------
0 		438,208
-------------
0 		247,438
-------------
0 		60,894
-------------
0 		39,932
-------------
0 		865,277
-------------
0 		438,208
-------------
0
73Connie Downs
 
Former Controller, SHP 		(i)

(ii)		 24,164
-------------
0 		0
-------------
0 		155,619
-------------
0 		0
-------------
0 		3,899
-------------
0 		183,682
-------------
0 		0
-------------
0
74James Davidson
 
See Schedule O 		(i)

(ii)		 240,707
-------------
0 		65,565
-------------
0 		3,757
-------------
0 		17,237
-------------
0 		18,537
-------------
0 		345,803
-------------
0 		0
-------------
0
75Mark Guzicki
 
See Schedule O 		(i)

(ii)		 0
-------------
251,647 		0
-------------
111,587 		0
-------------
10,871 		0
-------------
18,550 		0
-------------
61,020 		0
-------------
453,675 		0
-------------
25,302
76Kenneth Fawcett Jr MD
 
See Schedule O 		(i)

(ii)		 255,693
-------------
0 		137,397
-------------
0 		9,824
-------------
0 		45,346
-------------
0 		59,605
-------------
0 		507,865
-------------
0 		50,643
-------------
0
77M Ashraf Mansour MD
 
Former Vice Chair, SHMG 		(i)

(ii)		 615,152
-------------
0 		209,751
-------------
0 		12,924
-------------
0 		26,500
-------------
0 		15,262
-------------
0 		879,589
-------------
0 		0
-------------
0
78James Tucci MD
 
Former President, SHMG 		(i)

(ii)		 223,492
-------------
0 		542
-------------
0 		379,122
-------------
0 		18,495
-------------
0 		25,198
-------------
0 		646,849
-------------
0 		42
-------------
0
79Larry Jongekrijg
 
Former Sr. Dir. Foundation Finance / Operations, SHF 		(i)

(ii)		 47,748
-------------
0 		0
-------------
0 		113,590
-------------
0 		2,735
-------------
0 		5,268
-------------
0 		169,341
-------------
0 		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
Schedule J, Part I, Line 1a First-class or charter travel The organization has provided first class travel and/or charter travel for certain executive employees and/or board members in limited situations. First class and/or charter travel is utilized when commercial air travel was not available for a destination, or not efficient due to schedules and/or connections, and also for bi-annual board retreat travel. In the limited situations where first class and/or charter travel was utilized, it was paid for as part of a corporate award airline mileage program at no additional cost to the organization. To the extent the benefit is deemed reportable, it is treated as taxable compensation in a 1099 or W-2 to the recipient.
Schedule J, Part I, Line 1a Tax indemnification and gross-up payments Participants in the EMBA Program, upon graduation, take into income the forgiven loan amounts (upon meeting specific particiption requirements). The payments are grossed up to cover any additional tax due as a result.
Schedule J, Part I, Line 1a Health or social club dues or initiation fees The organization provided health club dues for eleven executive employees. These amounts were treated as taxable compensation and included in Form W-2.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation See disclosure on Schedule O for Form 990, Part VI, Sec B, Line 15A
Schedule J, Part I, Line 4a Severance or change-of-control payment $94,613 Connie Downs $84,594 Larry Jongekrijg $443,984 Thomas Rupp $303,762 Kevin Splaine $600,000 Martin Strueber $345,958 James Tucci $208,034 Mark Vipperman
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan $ 30,435 Douglas Apple $ 29,300 Brian Brasser $ 5,573,130 Richard Breon $ 74,685 Joan Budden $ 45,741 Marc Chircop $ 156,104 Robert Connors $ 50,643 Kenneth Fawcett, JR $ 48,693 Christina Freese-Decker $ 25,302 Mark Guzicki $ 28,764 William Jewell $ 47,329 Mary Anne Jones $ 69,284 Ronald Knaus $ 35,971 Pauline Krywanski $ 41,581 Jay Labine $ 17,193 Julie Lepzinski $ 32,507 Thomas McGraw $ 48,785 Patrick O'Hare $ 626,610 Lisa Shannon $ 16 Kevin Splaine $ 275,436 Randall Stasik $ 42 James Tucci $ 13,791 Mary Kay Vandriel $ 438,208 Mark Vipperman $ 22,408 Douglas Welday SCHEDULE J, PART I, LINE 4B IS ANSWERED "YES" BECAUSE CERTAIN INDIVIDUALS, DO "PARTICIPATE IN" SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN(S). SOME INDIVIDUALS RECEIVED DISTRIBUTIONS DURING THE YEAR (AS REPORTED ON THIS LINE) WHEREAS OTHERS PARTICIPATED IN THE PLAN(S) BUT DID NOT RECEIVE DISTRIBUTIONS. Due to certain age restrictions of the plan, Richard Breon received a distribution from the supplemental executive retirement plan this year pursuant to the plan requirements. This distribution was from Mr. Breon's employer, Spectrum Health System and is reported on this form due to the corporate relationship as the parent of the Group Return. DISTRIBUTIONS REPORTED ON THIS LINE ARE ALSO INCLUDED IN SCHEDULE J, PART II, COLUMN F AS COMPENSATION REPORTED IN A PRIOR YEAR. The nonqualified retirement plans are an industry standard and are subject to the funding requirements of nonqualified deferred compensation plans under ERISA and federal tax regulations.
Schedule J, Part I, Line 7 Non-fixed payments SCHEDULE J, PART I, LINE 7, IS ANSWERED "YES" BECAUSE CERTAIN INDIVIDUALS, WHOSE SALARY AND BENEFITS ARE PAID BY THE REPORTING ORGANIZATION OR A RELATED ORGANIZATION, RECEIVED A NON-FIXED PAYMENT DURING THE YEAR. THE NON-FIXED PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN C.
Schedule J (Form 990) 2016
Additional Data


Software ID: 16000421
Software Version: 2016v3.0