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Object ID: 202233139349300403 - Rendered 2024-05-01
TIN: 94-1461843
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
JOHN MUIR HEALTH
Employer identification number
94-1461843
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
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) 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
CALVIN KNIGHT
CEO/DIRECTOR/PRESIDENT
(i)
(ii)
1,377,460
-------------
0
2,050,413
-------------
0
799,816
-------------
0
1,588,903
-------------
0
25,681
-------------
0
5,842,273
-------------
0
2,050,413
-------------
0
2
JANE WILLEMSEN
EXEC VP/PRESIDENT HOSPITAL OPS
(i)
(ii)
820,442
-------------
0
445,672
-------------
0
1,884,297
-------------
0
903,870
-------------
0
23,906
-------------
0
4,078,187
-------------
0
445,672
-------------
0
3
MICHAEL THOMAS
EXEC VP/CHIEF TRANSFORMATION
(i)
(ii)
715,568
-------------
0
402,302
-------------
0
19,278
-------------
0
684,519
-------------
0
23,168
-------------
0
1,844,835
-------------
0
402,302
-------------
0
4
CHRISTIAN PASS
SENIOR VP/CFO
(i)
(ii)
701,583
-------------
0
322,443
-------------
0
11,696
-------------
0
502,984
-------------
0
32,316
-------------
0
1,571,022
-------------
0
322,443
-------------
0
5
LISA FOUST
SR VP HUMAN RESOURCES
(i)
(ii)
547,408
-------------
0
196,516
-------------
0
19,758
-------------
0
288,548
-------------
0
32,316
-------------
0
1,084,546
-------------
0
196,516
-------------
0
6
MAX REYNOLDS
SR VP/GENERAL COUNSEL
(i)
(ii)
543,213
-------------
0
195,010
-------------
0
13,474
-------------
0
256,843
-------------
0
20,904
-------------
0
1,029,444
-------------
0
195,010
-------------
0
7
GEORGE SAUTER
SR VP/CHIEF STRATEGY OFFICER
(i)
(ii)
505,976
-------------
0
182,261
-------------
0
23,165
-------------
0
263,613
-------------
0
19,519
-------------
0
994,534
-------------
0
182,261
-------------
0
8
IRVING PIKE MD
SR VP/CHIEF MEDICAL OFFICER
(i)
(ii)
343,301
-------------
0
233,087
-------------
0
129,507
-------------
0
238,480
-------------
0
12,872
-------------
0
957,247
-------------
0
233,087
-------------
0
9
MICHELLE LOPES RN
CHIEF NURSING EXECUTIVE
(i)
(ii)
437,226
-------------
0
157,495
-------------
0
16,871
-------------
0
285,794
-------------
0
20,904
-------------
0
918,290
-------------
0
157,495
-------------
0
10
WILLIAM HUDSON
SR VP/CIO (THRU 9/3/21)
(i)
(ii)
321,858
-------------
0
157,490
-------------
0
149,105
-------------
0
180,246
-------------
0
16,752
-------------
0
825,451
-------------
0
157,490
-------------
0
11
MICHAEL MONALDO
VP/FACILITIES DEVELOPMENT
(i)
(ii)
380,600
-------------
0
137,098
-------------
0
10,948
-------------
0
194,572
-------------
0
18,154
-------------
0
741,372
-------------
0
137,098
-------------
0
12
JON RUSSELL
FORMER SR VP/CIO
(i)
(ii)
0
-------------
0
0
-------------
0
226,053
-------------
0
0
-------------
0
0
-------------
0
226,053
-------------
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
HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES JOHN MUIR HEALTH PAYS UP TO 50% OF HEALTH CLUB DUES FOR EXECUTIVE DIRECTORS OF OPERATIONS, VICE PRESIDENTS AND ABOVE. THESE BENEFITS ARE TREATED AS TAXABLE INCOME TO THESE INDIVIDUALS.
PART I, LINE 4A:
SEVERANCE PAYMENTS A SEVERANCE PAYMENT OF $226,052,780 WAS MADE TO JON RUSSELL IN CONNECTION WITH HIS SEPERATION OF SERVICE ON SEPTEMBER 30, 2019. A SEVERANCE PAYMENT OF $137,669 WAS MADE TO WILLIAM HUDSON IN CONNECTION WITH HIS SEPARATION OF SERVICE ON SEPTEMBER 3, 2021. THIS TAXABLE COMPENSATION WAS REPORTED IN PART II, COLUMN (B)(III).
PART I, LINE 4B:
NON-QUALIFIED RETIREMENT PLANS RETIREMENT RESTORATION PLAN EMPLOYEES ELIGIBLE FOR THE RETIREMENT RESTORATION PLAN ARE EITHER SENIOR VICE PRESIDENT OR VICE PRESIDENT LEVEL EMPLOYEES. EMPLOYER CONTRIBUTIONS ARE MADE TO THE PLAN ON BEHALF OF ELIGIBLE EMPLOYEES. THE ANNUAL INCREASE IN ACTUARIAL VALUE OF THE PLAN BENEFIT IS REPORTED IN PART II, COLUMN C. VESTING FOR THE RESTORATION PLAN IS AT THE EARLIEST OF THE FOLLOWING: REACHING AGE 65 WITH AT LEAST THREE YEARS OF SERVICE, BECOMING TOTALLY AND PERMANENTLY DISABLED, INVOLUNTARY TERMINATION FOR ANY REASON OTHER THAN CAUSE, CHANGE OF CONTROL OF JOHN MUIR HEALTH, OR DEATH. RESTORATION PLAN BENEFITS ARE PAYABLE AND TAXABLE UPON VESTING. NO PLAN BENEFIT PAYMENTS WERE MADE DURING THE YEAR. THE FOLLOWING EXECUTIVES PARTICIPATED IN THE PLAN AND EARNED THE FOLLOWING BENEFIT DURING THE YEAR: IRVING PIKE, M.D. $103,257 MAX REYNOLDS $51,554 GEORGE SAUTER $65,238 LISA FOUST $81,741 WILLIAM HUDSON $41,461 MICHELLE LOPES $119,094 MICHAEL MNALDO $48,335 SUPPLEMENTAL EXECUTIVE PLAN EMPLOYEES ELIGIBLE FOR THE SUPPLEMENTAL EXECUTIVE PLAN ARE EITHER CEO OF JOHN MUIR HEALTH, CEO OR CAO OF JOHN MUIR PHYSICIAN NETWORK, AND CURRENT EMPLOYEES THAT PREVIOUSLY HELD ONE OF THOSE POSITIONS. EMPLOYER CONTRIBUTIONS ARE MADE TO THE PLAN ON BEHALF OF ELIGIBLE EMPLOYEES. THE ANNUAL INCREASE IN ACTUARIAL VALUE OF THE PLAN BENEFIT IS REPORTED IN PART II, COLUMN C. VESTING FOR THE SUPPLEMENTAL EXECUTIVE PLAN IS AT THE EARLIEST OF THE FOLLOWING: REACHING AGE 65 WITH AT LEAST THREE YEARS OF SERVICE, BECOMING DISABLED, INVOLUNTARY TERMINATION FOR ANY REASON OTHER THAN CAUSE, TERMINATION UPON CHANGE OF CONTROL OF JOHN MUIR HEALTH, OR DEATH. BENEFITS ARE PAYABLE AND TAXABLE UPON VESTING. THE FOLLOWING PLAN BENEFIT PAYMENTS WERE MADE DURING THE YEAR - $740,386 TO CALVIN KNIGHT AND $1,845,103 TO JANE WILLEMSEN. THE FOLLOWING EXECUTIVES PARTICIPATED IN THE PLAN AND EARNED THE FOLLOWING BENEFIT DURING THE TAX YEAR: CHRISTIAN PASS $167,586 CALVIN KNIGHT $729,790 JANE WILLEMSEN $420,181 MICHAEL THOMAS $268,888
Schedule J (Form 990) 2021
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