Compensation of Hospital Employees

Compensation of Hospital Employees

Calendar Year: Entity Name:

2020 MULTICARE HEALTH SYSTEM (includes 8 hospitals & numerous clinics and medical offices, etc.)

(A)Employee Name (who does not have direct patient care responsibilities)

Indicate if Lead Administrator

1 WILLIAM ROBERTSON PRESIDENT & CEO

2 JAMES MCMANUS 3 FLORENCE CHANG 4 JEFF POLTAWSKY 5 CHRISTI McCARREN

SENIOR VICE PRESIDENT & CFO EXECUTIVE VICE PRESIDENT & COO & CHIEF EXEC - SOUTH SOUND REGION PRESIDENT, MARY BRIDGE & PEDS NETWORK SENIOR VICE PRESIDENT - RETAIL HEALTH & COMMUNITY BASE

6 TIM BRICKER (part year)SENIOR VICE PRESIDENT/CHIEF EXEC - SOUTH SOUND REGION, (Pt Year)

7 DAVID CARLSON

SENIOR VICE PRESIDENT - PROVIDER ENTERPRISE & CPO

8 DAVID O'BRIEN

SENIOR VICE PRESIDENT/CHIEF EXEC - INLAND NW REGION

Hospital if applicable

MARY BRIDGE CHILDRENS HOSPITAL AND PEDIATRIC NETWORK

MULTICARE TACOMA GENERAL, ALLENMORE, MULTICARE GOOD SAMARITAN, AUBURN MEDICAL CENTER, COVINGTON,

MULTICARE DEACONESS, MULTICARE VALLEY & ROCKWOOD CLINICS

(B) Breakdown of W-2 and/or 1099 MISC Compensation

(i) Base Compensation

(ii) Bonus & Incentive

Compensation

(iii) Other Reportable Compensation

1,373,459

465,731

627,396

123,580

1,073,907

306,718

399,804 415,817

118,499 166,912

478,695

1,508,566

653,685

275,491

579,449

225,098

DOH 422-092/CHS 257 (REV` 08/01/2012)

(C) Retirement and Deferred Compensation

(D)NonTaxable Benefits

635,988

24,519

96,375

18,383

508,451

27,044

65,979 28,341

24,529 17,507

54,060

15,826

16,462

31,407

16,299

18,215

(E) Total 2,499,697

865,734 1,916,120

608,811 628,577 2,057,147 977,045 839,061

Add Additional lines as needed

Notes:

Please refer to IRS Form 990 and Schedule J for definitions of types of compensation

Form 990 Schedule J



If the five highest paid employees do not include the lead administrator, please report compensation information for the lead administrator on line 1, and for the five highest paid employees without patient care responsibilities on lines 2 through 6. Please submit compensation information to DOH either by mail, fax or email to the following address: Washington State Department of Health Center for Health Statistics/Hospital and Patient Data Section MS: 47814 Olympia, WA 98504-7814 Fax: (360) 753-4135 email: hos@doh.

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