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TIN: 91-1858433
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
The Nebraska Medical Center
Employer identification number
91-1858433
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
Yes
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
Louis W Burgher
Director
(i)
(ii)
313,144
-------------
0
0
-------------
0
0
-------------
0
16,823
-------------
0
0
-------------
0
329,967
-------------
0
0
-------------
0
2
James T Canedy
DIRECTOR
(i)
(ii)
503,959
-------------
0
0
-------------
0
13,944
-------------
0
0
-------------
0
0
-------------
0
517,903
-------------
0
0
-------------
0
3
Bradley Britigan
FORMER PRESIDENT
(i)
(ii)
0
-------------
43,747
0
-------------
532,046
0
-------------
8,400
0
-------------
0
-------------
3,150
0
-------------
587,343
0
-------------
0
4
Debra J Romberger
Director
(i)
(ii)
0
-------------
207,697
0
-------------
317,083
0
-------------
0
0
-------------
4,405
0
-------------
3,150
0
-------------
532,335
0
-------------
0
5
Carl V Smith
Director
(i)
(ii)
0
-------------
405,223
0
-------------
113,833
0
-------------
0
0
-------------
0
0
-------------
3,442
0
-------------
522,498
0
-------------
0
6
Suzanne Nuss
Officer - CNO
(i)
(ii)
240,083
-------------
0
121,278
-------------
0
28,968
-------------
0
12,728
-------------
0
13,295
-------------
0
416,352
-------------
0
0
-------------
0
7
Stephanie R Daubert
Officer - NM CFO
(i)
(ii)
403,399
-------------
0
192,850
-------------
0
30,589
-------------
0
23,525
-------------
0
27,812
-------------
0
678,175
-------------
0
0
-------------
0
8
Daniel DeBehnke
CEO (BEGINNING 8/1/16)
(i)
(ii)
303,752
-------------
0
168,010
-------------
0
22,908
-------------
0
0
-------------
0
3,706
-------------
0
498,376
-------------
0
0
-------------
0
9
Rosanna D Morris
CEO (THRU 8/1/16)
(i)
(ii)
510,635
-------------
0
367,000
-------------
0
227,298
-------------
0
9,075
-------------
0
22,099
-------------
0
1,136,107
-------------
0
218,767
-------------
0
10
Dennis D Bierle
System Clinical Operations COO
(i)
(ii)
341,418
-------------
0
160,568
-------------
0
9,802
-------------
0
16,825
-------------
0
21,330
-------------
0
549,943
-------------
0
0
-------------
0
11
Theresa Franco
Cancer Ctr/Rad/Imag Svcs VP
(i)
(ii)
282,589
-------------
0
54,144
-------------
0
6,719
-------------
0
22,604
-------------
0
5,058
-------------
0
371,114
-------------
0
0
-------------
0
12
Julie Lazure
Acute Care/Path Svcs VP
(i)
(ii)
244,640
-------------
0
46,437
-------------
0
6,719
-------------
0
17,767
-------------
0
7,803
-------------
0
323,366
-------------
0
0
-------------
0
13
Thomas C Macy
Amb Clinics/Clinical Prog VP
(i)
(ii)
273,066
-------------
0
54,584
-------------
0
11,088
-------------
0
17,062
-------------
0
8,944
-------------
0
364,744
-------------
0
0
-------------
0
14
Matthew E Pospisil
Periop Svs/Bellevue VP
(i)
(ii)
203,251
-------------
0
37,800
-------------
0
736
-------------
0
18,090
-------------
0
17,760
-------------
0
277,637
-------------
0
0
-------------
0
15
Frank V Venuto
Chief Human Capital Officer
(i)
(ii)
322,772
-------------
0
164,350
-------------
0
27,840
-------------
0
0
-------------
0
31,291
-------------
0
546,253
-------------
0
0
-------------
0
16
Jeffrey D Akerson
Staff Physician-Primary
(i)
(ii)
290,428
-------------
0
59,682
-------------
0
12,385
-------------
0
7,258
-------------
0
7,878
-------------
0
377,631
-------------
0
0
-------------
0
17
Brian J Lancaster
Information Technology VP
(i)
(ii)
231,454
-------------
0
21,468
-------------
0
20,202
-------------
0
5,200
-------------
0
10,025
-------------
0
288,349
-------------
0
0
-------------
0
18
Chad L Moes
Staff Physician-Primary
(i)
(ii)
189,953
-------------
0
133,222
-------------
0
802
-------------
0
0
-------------
0
9,674
-------------
0
333,651
-------------
0
0
-------------
0
19
Mark J Ptacek
Faculty Physician
(i)
(ii)
298,304
-------------
0
11,734
-------------
0
806
-------------
0
10,661
-------------
0
15,537
-------------
0
337,042
-------------
0
0
-------------
0
20
Cory D Shaw
Chief Strategy Officer
(i)
(ii)
409,289
-------------
0
203,163
-------------
0
28,179
-------------
0
19,422
-------------
0
32,627
-------------
0
692,680
-------------
0
0
-------------
0
21
Ruta P Davidson
Former Chief Experience Office
(i)
(ii)
0
-------------
0
0
-------------
0
125,076
-------------
0
0
-------------
0
0
-------------
0
125,076
-------------
0
0
-------------
0
22
William S Dinsmoor
Former Nebraska Medicine CEO
(i)
(ii)
0
-------------
0
0
-------------
0
1,802,910
-------------
0
11,380
-------------
0
0
-------------
0
1,814,290
-------------
0
6,150
-------------
0
23
Deborah K Istas
Former Bellevue VP
(i)
(ii)
73,444
-------------
0
0
-------------
0
232,319
-------------
0
13,140
-------------
0
396
-------------
0
319,299
-------------
0
0
-------------
0
24
Tadd M Pullin
Former SVP, Marketing/Planning
(i)
(ii)
0
-------------
0
0
-------------
0
141,339
-------------
0
0
-------------
0
0
-------------
0
141,339
-------------
0
78,568
-------------
0
25
HARRIS A FRANKEL
CHEIF MEDICAL OFFICER
(i)
(ii)
0
-------------
416,768
0
-------------
212,198
0
-------------
8,956
0
-------------
0
0
-------------
5,303
0
-------------
643,225
0
-------------
0
26
CHADWICK BROUGH
CHIEF EXPERIENCE OFFICER
(i)
(ii)
197,355
-------------
0
60,000
-------------
0
6,464
-------------
0
0
-------------
0
14,145
-------------
0
277,964
-------------
0
0
-------------
0
27
MICHAEL A ASH
CHIEF TRANSFORMATION OFFICER
(i)
(ii)
0
-------------
364,233
0
-------------
187,609
0
-------------
8,400
0
-------------
21,061
0
-------------
3,375
0
-------------
584,678
0
-------------
0
28
TIMOTHY P GLIDDEN
NURSE ANESTHETIST LEAD
(i)
(ii)
239,364
-------------
0
7,325
-------------
0
8,557
-------------
0
22,096
-------------
0
5,167
-------------
0
282,509
-------------
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 4A
SEVERANCE PAYMENTS THE FOLLOWING EMPLOYEES WERE TERMED PRIOR TO FISCAL YEAR 2017 AND RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2016: WILLIAM DINSMOOR: $534,997 DEBORAH K. ISTAS: $232,300
SCHEDULE J, Part I, Line 4b
NONQUALIFIED RETIREMENT PLANS CERTAIN EXECUTIVES DO PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. A PAYOUT OCCURRED DURING THE YEAR FROM A SUPPLEMENTAL NONQUALIFIED PLAN TO CURRENT AND FORMER* INDIVIDUALS: ROSANNA D. MORRIS: $218,767 *WILLIAM S. DINSMOOR: $6,150 *TADD M. PULLIN: $78,568 IN ADDITION, TNMC HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (AMENDED AND RESTATED JANUARY 1, 2008) WHICH CONSTITUTES AN UNFUNDED, UNSECURED PLAN TO PROVIDE SUPPLEMENTAL RETIREMENT BENEFITS TO A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES UPON SEPARATION OF SERVICE, SUBJECT TO THE TERMS AND CONDITIONS OF THE PLAN. THE BENEFIT IS PAID IN FULL ONE YEAR AFTER EMPLOYMENT SEPARATION, AND THE AMOUNT IS BASED ON THE PARTICIPANT'S ANNUAL COMPENSATION, VALUE OF THE PARTICIPANT'S TNMC QUALIFIED RETIREMENT PLAN BENEFIT, SOCIAL SECURITY BENEFIT, AND NUMBER OF YEARS OF SERVICE. A PAYOUT OCCURRED DURING THE YEAR FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO CURRENT AND FORMER* INDIVIDUALS: *RUTA P. DAVIDSON: $125,076 *WILLIAM S. DINSMOOR: $1,261,763 *TADD M. PULLIN: $62,474
SCHEDULE J, Part I, Line 6A
CONTINGENT COMPENSATION THE ORGANIZATION'S FINANCIAL RESULTS ARE TAKEN INTO CONSIDERATION WHEN CALCULATING COMPENSATION IN ADDITION TO OTHER NON-FINANCIAL FACTORS. EXECUTIVE INCENTIVE COMPENSATION IS DETERMINED BY SEVERAL KEY METRICS THAT ARE ESTABLISHED BY THE NEBRASKA MEDICAL CENTER GOVERNING BODY. THESE METRICS ARE INCLUSIVE OF STRATEGIC, FINANCIAL, OPERATIONAL AND QUALITY OUTCOMES. ON AN ANNUAL BASIS, THE NEBRASKA MEDICAL CENTER GOVERNING BODY REVIEWS ACHIEVEMENT OF PRESET TARGETS AND APPROVES INCENTIVES WHEN WARRANTED. THESE PERFORMANCE PAYMENTS ARE SET IN CONSIDERATION OF TOTAL COMPENSATION VS. COMPARED TO MARKET FOR SIMILIAR POSITIONS. AS IT WAS DETERMINED THAT IT IS IN THE BEST INTEREST OF THE ORGANIZATION TO HAVE A PORTION OF THEIR BASE PAY SUBJECT TO FORFEITURE UNLESS THE PRE-DETERMINED FINANCIAL AND NON-FINANCIAL FACTORS DISCUSSED ABOVE ARE ACHIEVED. INCENTIVE COMPENSATION RELATED TO FY17 PERFORMANCE WERE PAID TO THE FOLLOWING INDIVIDUALS: BRADLEY E. BRITIGAN: $532,046 SUZANNE NUSS: $121,278 DEBRA ROMBERGER: $317,083 STEPHANIE R. DAUBERT: $192,850 DANIEL DEBEHNKE: $168,010 ROSANNA D. MORRIS: $367,000 DENNIS D. BIERLE: $160,568 JEFFREY D. AKERSON: $59,682 BRIAN J. LANCASTER: $21,468 CHAD L. MOES: $133,222 MARK J. PTACEK: $11,734 CORY D. SHAW: $203,163 CHADWICK BROUGH: $60,000 CARL V. SMITH: $113,833 HARRIS A. FRANKEL: $212,198 THERESA FRANCO: $54,144 JULIE LAZURE: $46,437 THOMAS C. MACY: $54,584 MATTHEW E. POSPISIL: $37,800 FRANK V. VENUTO: $164,350 MICHAEL A. ASH: $187,609 TIMOTHY P. GLIDDEN: $7,325
Schedule J (Form 990) 2016
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