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Object ID: 202213189349302121 - Rendered 2024-05-19
TIN: 45-3791176
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
21
Open to Public Inspection
Name of the organization
SANFORD GROUP RETURN
Employer identification number
45-3791176
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
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
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) 2021
Schedule J (Form 990) 2021
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
BILL MARLETTE
EVP, CFO & TREASURER-END 12/21
(i)
(ii)
0
-------------
1,504,270
0
-------------
431,002
0
-------------
245,068
0
-------------
0
0
-------------
13,341
0
-------------
2,193,681
0
-------------
0
2
BILL MARLETTE
SEE SCH J, PART III, LINES 4A-4B
(i)
(ii)
0
-------------
0
0
-------------
436,802
0
-------------
4,380,230
0
-------------
0
0
-------------
0
0
-------------
4,817,032
0
-------------
0
3
MICAH ABERSON
EVP, CHIEF INNOV OFFICER
(i)
(ii)
0
-------------
1,065,078
0
-------------
332,002
0
-------------
171,269
0
-------------
13,846
0
-------------
22,466
0
-------------
1,604,661
0
-------------
0
4
MICAH ABERSON
SEE SCH J, PART III, LINES 4A-4B
(i)
(ii)
0
-------------
0
0
-------------
1,622,419
0
-------------
3,248,404
0
-------------
0
0
-------------
0
0
-------------
4,870,823
0
-------------
258,008
5
BILL GASSEN III
TRUSTEE, PRESIDENT & CEO
(i)
(ii)
0
-------------
1,703,249
0
-------------
1,182,759
0
-------------
261,043
0
-------------
205,720
0
-------------
1,883
0
-------------
3,354,654
0
-------------
0
6
ADAM STYS MD
PHYSICIAN
(i)
(ii)
3,237,602
-------------
0
0
-------------
0
18,464
-------------
0
14,500
-------------
0
26,240
-------------
0
3,296,806
-------------
0
0
-------------
0
7
WILLIAM BRUNNER MD
PHYSICIAN
(i)
(ii)
3,120,391
-------------
0
0
-------------
0
3,597
-------------
0
14,097
-------------
0
22,972
-------------
0
3,161,057
-------------
0
0
-------------
0
8
ERIC BELANGER MD
PHYSICIAN
(i)
(ii)
2,931,861
-------------
0
0
-------------
0
16,854
-------------
0
13,566
-------------
0
26,672
-------------
0
2,988,953
-------------
0
0
-------------
0
9
TOMASZ STYS MD
PHYSICIAN
(i)
(ii)
2,806,729
-------------
0
0
-------------
0
140,308
-------------
0
14,500
-------------
0
23,293
-------------
0
2,984,830
-------------
0
0
-------------
0
10
DARREN WALKER
SVP, CHIEF PEOPLE OFFICER
(i)
(ii)
0
-------------
708,024
0
-------------
253,000
0
-------------
88,457
0
-------------
14,500
0
-------------
24,975
0
-------------
1,088,956
0
-------------
0
11
DARREN WALKER
SEE SCH J, PART III, LINES 4A-4B
(i)
(ii)
0
-------------
0
0
-------------
0
0
-------------
1,832,714
0
-------------
0
0
-------------
0
0
-------------
1,832,714
0
-------------
0
12
MATT HOCKS
EVP, CHIEF OPERATING OFFICER
(i)
(ii)
0
-------------
1,360,816
0
-------------
330,002
0
-------------
216,577
0
-------------
154,897
0
-------------
27,725
0
-------------
2,090,017
0
-------------
0
13
BRYAN NERMOE
PRESIDENT & CEO, FARGO
(i)
(ii)
0
-------------
826,264
0
-------------
402,504
0
-------------
137,342
0
-------------
503,120
0
-------------
24,543
0
-------------
1,893,773
0
-------------
0
14
PAUL HANSON
PRESIDENT & CEO, SIOUX FALLS
(i)
(ii)
0
-------------
828,765
0
-------------
202,504
0
-------------
138,899
0
-------------
503,120
0
-------------
19,168
0
-------------
1,692,456
0
-------------
0
15
MICHAEL LEBEAU MD
SVP, HEALTH SVC OPERATIONS-BEG 10/21
(i)
(ii)
0
-------------
835,513
0
-------------
452,002
0
-------------
138,585
0
-------------
104,900
0
-------------
26,672
0
-------------
1,557,672
0
-------------
0
16
RANDY BURY
FORMER CHIEF ADMIN OFF-END 12/21
(i)
(ii)
0
-------------
984,890
0
-------------
273,000
0
-------------
177,196
0
-------------
27,139
0
-------------
26,297
0
-------------
1,488,522
0
-------------
0
17
JENNIFER GRENNAN
EVP, CHIEF ADMIN OFFICER
(i)
(ii)
0
-------------
807,782
0
-------------
216,500
0
-------------
127,466
0
-------------
91,600
0
-------------
25,297
0
-------------
1,268,645
0
-------------
0
18
MICHELLE BRUHN
EVP, CFO & TREASURER-BEG 12/21
(i)
(ii)
0
-------------
847,016
0
-------------
179,504
0
-------------
124,238
0
-------------
92,080
0
-------------
25,297
0
-------------
1,268,135
0
-------------
0
19
MARIA BELL MD
TRUSTEE, PHYSICIAN
(i)
(ii)
966,197
-------------
0
54,000
-------------
0
54,206
-------------
0
14,500
-------------
0
27,672
-------------
0
1,116,575
-------------
0
0
-------------
0
20
MICHELLE MICKA
SVP, FINANCE, HEALTH SERVICES
(i)
(ii)
0
-------------
568,879
0
-------------
153,277
0
-------------
74,862
0
-------------
70,120
0
-------------
24,975
0
-------------
892,113
0
-------------
0
21
SUSAN JARVIS
PRESIDENT & CEO, BEMIDJI
(i)
(ii)
0
-------------
531,089
0
-------------
133,253
0
-------------
98,930
0
-------------
68,920
0
-------------
25,865
0
-------------
858,057
0
-------------
0
22
TODD SCHAFFER
PRESIDENT & CEO, BISMARCK-BEG 10/21
(i)
(ii)
0
-------------
502,124
0
-------------
65,000
0
-------------
90,633
0
-------------
25,444
0
-------------
2,315
0
-------------
685,516
0
-------------
0
23
MARK LUNDEEN MD
TRUSTEE, PHYSICIAN
(i)
(ii)
420,939
-------------
0
0
-------------
0
825
-------------
0
14,500
-------------
0
3,375
-------------
0
439,639
-------------
0
0
-------------
0
24
JOANN KUNKEL
FORMER CFO-SCH J, PART III, 4A-4B
(i)
(ii)
0
-------------
0
0
-------------
339,000
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
339,000
0
-------------
0
25
ANDY NORTH
TRUSTEE, SECRETARY
(i)
(ii)
303,056
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
303,056
-------------
0
0
-------------
0
26
MARK PAULSON MD
TRUSTEE, PAST CHAIR, PHYSICIAN
(i)
(ii)
261,607
-------------
0
0
-------------
0
1,108
-------------
0
11,913
-------------
0
27,053
-------------
0
301,681
-------------
0
0
-------------
0
Schedule J (Form 990) 2021
Schedule J (Form 990) 2021
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
ON PART I, QUESTIONS REGARDING COMPENSATION, SANFORD CHECKED SEVERAL OF THE ITEMS AS PROVIDED TO LISTED PERSONS: FIRST CLASS OR CHARTER TRAVEL - CHARTER TRAVEL FOR BUSINESS PURPOSES IS PROVIDED FOR INDIVIDUALS AS NEEDED AND AS COST APPROPRIATE, IN ACCORDANCE WITH WRITTEN POLICIES. THESE COSTS ARE NOT INCLUDED IN THE W-2'S OF THE INDIVIDUALS AS THEY ARE INCURRED FOR BUSINESS PURPOSES OF SANFORD. TRAVEL FOR COMPANIONS - LIMITED TRAVEL FOR COMPANIONS IS OFFERED FOR CERTAIN MEETINGS AND EVENTS. THESE COSTS ARE INCLUDED IN THE 1099'S OF THE INDIVIDUALS. SANFORD USED THE SIFL (STANDARD INDUSTRY FARE LEVEL) RATE METHOD TO IMPUTE THE FRINGE BENEFIT TO THE LISTED PERSON. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - CERTAIN COMPENSATION MAY BE GROSSED UP TO INCLUDE APPROPRIATE TAX AMOUNTS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - ALL SANFORD EMPLOYEES ARE ELIGIBLE FOR DISCOUNTED WELLNESS MEMBERSHIPS, A PORTION OF THESE DISCOUNTS AND OTHER CLUB DUES ARE INCLUDED AS FRINGE BENEFITS AND TAXED AS SUCH. PART I, LINE 3: THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2021.
PART I, LINES 4A-B
LINE 4A-SEVERANCE OR CHANGE OF CONTROL PAYMENT UPON HIRE OR PROMOTION, SELECT OFFICERS AND KEY EMPLOYEES SIGN AN EXECUTIVE SEVERANCE AGREEMENT (THE "AGREEMENT"). THE AGREEMENT PROVIDES THAT THE EXECUTIVE WILL RECEIVE A MULTIPLE OF HIS OR HER SALARY (BASED ON YEARS OF SERVICE OR POSITION) AS A PAYMENT IN THE EVENT OF A DEFINED SEPARATION EVENT, WHICH CAN INCLUDE AN INVOLUNTARY SEPARATION OR AN EMPLOYEE VOLUNTARILY LEAVING FOR A DEFINED CONTRACTUAL REASON. FINAL SEPARATION PAYMENTS MIGHT VARY FROM THE AMOUNT PROVIDED IN THE AGREEMENT AS A RESULT OF NEGOTIATIONS SURROUNDING POST-SEPARATION OBLIGATIONS AND INCENTIVES (THE "SEPARATION" PAYMENT). LINE 4B-SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS SANFORD SPONSORS NONQUALIFIED RETIREMENT PLANS FOR SELECT OFFICERS OR KEY EMPLOYEES. CERTAIN OF THE BELOW OFFICERS OR KEY EMPLOYEES WERE PAID AS A RESULT OF A VESTING EVENT. LINE 4A AND 4B-PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS AND/OR SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: BILL MARLETTE: 2021 BONUS AND INCENTIVE COMPENSATION $436,802 SEPARATION $2,924,223 NONQUALIFIED RETIREMENT PLAN $1,456,007 TOTAL $4,817,032 MICAH ABERSON: 2021 BONUS AND INCENTIVE COMPENSATION $374,404 RETENTION PLAN AGREEMENT $1,248,015 SEPARATION $2,768,875 NONQUALIFIED RETIREMENT PLAN $479,529 TOTAL $4,870,823 DARREN WALKER: SEPARATION $1,635,127 NONQUALIFIED RETIREMENT PLAN $197,587 TOTAL $1,832,714 . JOANN KUNKEL: 2020 BONUS AND INCENTIVE COMPENSATION $339,000
PART I, LINE 6
SANFORD PHYSICIANS ARE COMPENSATED BASED ON THE PROFESSIONAL SERVICES THEY PERFORM WITHIN THE CLINIC IN WHICH THEY PROVIDE CARE. GENERALLY, THE MODEL IS BASED ON PRODUCTION.
PART I, LINE 7
CERTAIN EMPLOYEES ARE ELIGIBLE FOR A DISCRETIONARY INCENTIVE BONUS. BONUSES ARE PAID BASED ON THE ACHIEVEMENT OF FINANCIAL AND OTHER GOALS.
Schedule J (Form 990) 2021
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