Allied for Health Surveys Executive Compensation Survey 2018 Questions
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1 Executive - About This Location Executive2018Questions.docx page 1 Allied for Health Surveys Executive Compensation Survey 2018 Questions About This Location Please see the Glossary of Terms (on the Resources tab of this site) for definitions. *1a. *1b. As of May 1, 2018, how many total employees (full- and part-time headcount) were on payroll at this location? # employees How many Full-Time Equivalent employees (FTEs)? One FTE corresponds to one person working 40 hours per week for a total of 2080 hours per year (40 hours x 52 weeks). # FTEs *2. As of May 1, 2018, how many occupied beds were there at this location? Includes the number of beds (at a particular moment in time) for which the organization had occupied, including beds in suspension and nursery bassinets. If not applicable, fill in 0. # *3. Approximately what were total operating expenses at this location for your most recent fiscal year? Total operating expenses as defined by OSHPD is total costs incurred by revenue-producing and nonrevenue producing cost centers for providing patient care at the hospital. Exclude non-operating expenses, provisions for income taxes, and provisions for bad debts. $
2 Executive - Compensation Executive2018Questions.docx page 2 Compensation: 0000 Position Title show description Record #: You can create multiple records for the same position. Each record can report on a single incumbent, or averages for a group of incumbents. Please answer these questions as of May 1, a. Internal job title - assists with identifying a specific record in the listing (will display on previous page): 1b. Internal job code *2. At this location, is there a salary structure for this position? (Please report even if the position has no current incumbents) a. If yes, what are the minimum and maximum of the salary structure? (Please include a structure even if the position has no current incumbents) $ annual salary minimum $ annual salary maximum *3. How many employees at this location are you reporting with this record, and what was their average annual salary? Report headcount, not FTEs. # employees being reported $ average annual salary *4. At this location, is there an incentive compensation program for this position? a. If yes, what was the actual incentive paid out (if any) for the most recent fiscal year? Enter the average if more than one incumbent; if none, enter 0. $ incentive paid out *5. At this location, is there a target bonus for this position? a. If yes, what is that target, either as a $ amount OR a % of salary? $ bonus amount OR % of salary 6. Comments?
3 Executive - Compensation Policy Executive2018Questions.docx page 3 Compensation Budgets This survey section asks about your organization as a whole, including all locations. The following questions ask about your organization's Compensation Budgets, Short-Term and Long-Term Incentive Plans and Design, Benefits, Perquisites, Qualified and Non-Qualified Retirement Plans. *1. As part of its annual planning process, does your organization budget for salary increases for Executives each year? a. If yes, what was your organization's salary increase budget for its last fiscal year? Express as a percentage change from the prior year, to the nearest decimal: if no change, enter 0; if an increase, enter a positive number (e.g., up 3.2%, enter 3.2); if a decrease, enter a negative number (e.g., down 2.2%, enter -2.2). % *2. What was your organization's actual salary increase ("spend") for Executives for its last fiscal year? Express as a percentage change from the prior year, to the nearest decimal: if no change, enter 0; if an increase, enter a positive number (e.g., up 3.2%, enter 3.2); if a decrease, enter a negative number (e.g., down 2.2%, enter -2.2). % *3. Does your organization have a formal salary structure for any of its executive positions? a. If yes, was the salary structure adjusted during the last fiscal year? If multiple salary structures, please respond for the one that encompasses the most executive employees and is most representative of your executive salary policy. b. If yes (salary structure was adjusted), what was the adjustment to the structure? Express as a percentage change from the prior structure, to the nearest decimal: e.g., up 3.2%, enter 3.2; down 2.2%, enter Do not enter 0. % *4. Are any of your organization's executive positions eligible for deferred compensation? a. If yes, what was the average deferred compensation amount granted to eligible executives in each of these categories during the last fiscal year? Express as a percentage of salary; if none, enter 0. CEO (top executive) executives reporting to the CEO all other executives % OR not eligible % OR not eligible % OR not eligible
4 Executive - Compensation Policy Executive2018Questions.docx page 4 Short-Term Incentive Plans *5. Does your organization currently have a short-term (annual) incentive plan for any of its executives?, but planning to develop or implement one in the next year, and not planning to develop or implement one in the next year
5 Executive - Compensation Policy Executive2018Questions.docx page 5 Short-Term Incentive Design *6. For its short-term incentive plan for executives, does your organization have a formal annual incentive pool? a. If yes, is it budgeted? b. If yes (pool is budgeted), how is the total available pool determined? Select all that apply. percent of revenue percent of revenue above threshold percent of eligible participants' salaries percent of eligible participants' salary range midpoint fixed dollar amount other: *7. What criteria does your organization consider when determining short-term incentive awards for each of these categories of executives? Select all that apply in each column. CEO (top executive) executives reporting to the CEO all other executives revenue or net operating income occupancy rate profitability or operating margin expense control quality of care (clinical) productivity customer service or satisfaction organizational initiative individual objectives or MBOs discretionary other not eligible *8. Is there a financial target or threshold your organization must meet before any short-term incentive awards are paid to executives? *9. What factors determine whether an executive is eligible for the short-term incentive plan? Select all that apply. organization level salary grade actual annual salary reporting relationship discretionary other:
6 Executive - Compensation Policy Executive2018Questions.docx page 6 *10a. How many executives were eligible to participate in the short-term incentive plan during the last fiscal year? If none, enter 0. # *10b. How many eligible executives received awards during the last fiscal year? If none, enter 0. #
7 Executive - Compensation Policy Executive2018Questions.docx page 7 Long-Term Incentive Plans *11. Does your organization currently have a long-term incentive plan for any of its executives?, but planning to develop or implement one in the next year, and not planning to develop or implement one in the next year
8 Executive - Compensation Policy Executive2018Questions.docx page 8 Long-Term Incentive Design *12. What items are part of your organization's long-term incentive plan for executives? Select all that apply. incentive stock options stock appreciation rights restricted stock plans non-qualified stock options performance units or shares (cash) phantom stock other: *13a. How many executives were eligible to participate in the long-term incentive plan during the last fiscal year? If none, enter 0. # *13b. How many eligible executives actually received awards during the last fiscal year? If none, enter 0. # *14. What levels are eligible to participate in the long-term incentive plan? Select all that apply. CEO (top executive) executives reporting to the CEO all other executives *15. How often are grants made? 1 year 2 years 3 years 4 years other: *16. Over what period of time is performance measured before payout is determined? 2 years 3 years 4 years 5 years or more
9 Executive - Compensation Policy Executive2018Questions.docx page 9 Benefits *17. What special benefits (above and beyond those offered to non-executive employees) are offered to your organization's CEO (top executive) (if any)? Select all that apply. (Note that Automobile Allowance will be addressed in a subsequent question.) supplemental vacation supplemental medical supplemental life insurance employment contracts severance plan supplemental LTD long term care equity ownership other special benefits: none *18. What special benefits (above and beyond those offered to non-executive employees) are offered to executives reporting to the CEO (top executive) (if any)? Select all that apply. (Note that Automobile Allowance will be addressed in a subsequent question.) supplemental vacation supplemental medical supplemental life insurance employment contracts severance plan supplemental LTD long term care equity ownership other special benefits: none *19. What special benefits (above and beyond those offered to non-executive employees) are offered to executives NOT reporting to the CEO (if any)? Select all that apply. (Note that Automobile Allowance will be addressed in a subsequent question.) supplemental vacation supplemental medical supplemental life insurance employment contracts severance plan supplemental LTD long term care equity ownership other special benefits: none
10 Executive - Compensation Policy Executive2018Questions.docx page 10 Severance Plan for the CEO (Top Executive) In question 17, you indicated a severance plan is offered to your organization's CEO (top executive). *20. Is salary continuation a part of this plan? a. If yes, how many months of salary continuation? # months *21. Does the plan offer additional salary continuation in the event of change of control? That is, the incumbent loses their position or experiences a material diminution in job duties and responsibilities due to the sale, liquidation, demerger, acquisition, restructuring or merger with another facility. a. If yes, how many additional months of salary continuation? # additional months *22. In this plan, is severance offset for other income earned by the incumbent? a. If yes, after how many months? # months *23. Which of these components (if any) are a part of this plan? Select all that apply. short-term incentive payment for current year long-term incentive payment for current year short-term incentive continuation long-term incentive continuation continuation of some (but not all) benefits continuation of all benefits outplacement assistance none of these
11 Executive - Compensation Policy Executive2018Questions.docx page 11 Severance Plan(s) for Executives Reporting to the CEO (Top Executive) In question 18, you indicated a severance plan is offered to your organization's executives reporting to the CEO (top executive). If more than one such plan is offered, and details vary, please answer for the typical plan. *24. Is salary continuation a part of this plan? a. If yes, how many months of salary continuation? # months *25. Does the plan offer additional salary continuation in the event of change of control? That is, the incumbent loses their position or experiences a material diminution in job duties and responsibilities due to the sale, liquidation, demerger, acquisition, restructuring or merger with another facility. a. If yes, how many additional months of salary continuation? # additional months *26. In this plan, is severance offset for other income earned by the incumbent? a. If yes, after how many months? # months *27. Which of these components (if any) are a part of this plan? Select all that apply. short-term incentive payment for current year long-term incentive payment for current year short-term incentive continuation long-term incentive continuation continuation of some (but not all) benefits continuation of all benefits outplacement assistance none of these
12 Executive - Compensation Policy Executive2018Questions.docx page 12 Severance Plan(s) for Executives Not Reporting to the CEO In question 19, you indicated a severance plan is offered to your organization's executives NOT reporting to the CEO (top executive). If more than one such plan is offered, and details vary, please answer for the typical plan. *28. Is salary continuation a part of this plan? a. If yes, how many months of salary continuation? # months *29. Does the plan offer additional salary continuation in the event of change of control? That is, the incumbent loses their position or experiences a material diminution in job duties and responsibilities due to the sale, liquidation, demerger, acquisition, restructuring or merger with another facility. a. If yes, how many additional months of salary continuation? # additional months *30. In this plan, is severance offset for other income earned by the incumbent? a. If yes, after how many months? # months *31. Which of these components (if any) are a part of this plan? Select all that apply. short-term incentive payment for current year long-term incentive payment for current year short-term incentive continuation long-term incentive continuation continuation of some (but not all) benefits continuation of all benefits outplacement assistance none of these
13 Executive - Compensation Policy Executive2018Questions.docx page 13 Perquisites For CEO *32. For each item listed, is this benefit offered to the CEO (top executive)? If yes, what is the estimated annual value? offered? yes no annual value automobile allowance $ cell phone and/or allowance $ country club $ education expenses $ financial counseling $ health club $ leased automobile $ legal services $ long-term care $ low interest loans $ luncheon club $ paid physical exam $ pre-retirement counseling $ profit sharing $ sign-on bonus $ special spending account $ spouse travel $ tax preparation $
14 Executive - Compensation Policy Executive2018Questions.docx page 14 Perquisites For Executives Reporting to the CEO *33. In your organization, how many executives report directly to the CEO? If none, fill in 0. # *34. For each item listed, is this benefit offered to executives reporting to the CEO? If yes, to how many executives is it offered, and what is the estimated average annual value per person? offered? yes no # offered to average annual value automobile allowance # $ cell phone and/or allowance # $ country club # $ education expenses # $ financial counseling # $ health club # $ leased automobile # $ legal services # $ long-term care # $ low interest loans # $ luncheon club # $ paid physical exam # $ pre-retirement counseling # $ profit sharing # $ sign-on bonus # $ special spending account # $ spouse travel # $ tax preparation # $
15 Executive - Compensation Policy Executive2018Questions.docx page 15 Perquisites For Executives Not Reporting to the CEO *35. In your organization, how many executives are there who do NOT report directly to the CEO? If none, fill in 0. # *36. For each item listed, is this benefit offered to executives NOT reporting to the CEO? If yes, to how many executives is it offered, and what is the estimated average annual value per person? offered? yes no # offered to average annual value automobile allowance # $ cell phone and/or allowance # $ country club # $ education expenses # $ financial counseling # $ health club # $ leased automobile # $ legal services # $ long-term care # $ low interest loans # $ luncheon club # $ paid physical exam # $ pre-retirement counseling # $ profit sharing # $ sign-on bonus # $ special spending account # $ spouse travel # $ tax preparation # $
16 Executive - Compensation Policy Executive2018Questions.docx page 16 Retirement Qualified Plan Participation *37. Are any of your organization's executives eligible for AND participating in a qualified retirement plan that is, one offered to all employees? Qualified retirement plans are those that do meet the IRS guidelines for special tax benefits of the rules of the Employee Retirement Income Security Act. Qualified retirement plans include: defined-contribution plans (401(k), 403(b)), profit-sharing plans, cash balance pension plan, defined contribution money purchase pension plans, or defined benefit plans).
17 Executive - Compensation Policy Executive2018Questions.docx page 17 Retirement Qualified Plan Details *38. What type(s) of qualified retirement plans does your organization offer? Select all that apply. defined benefit plan cash balance pension plan defined contribution money purchase pension plan defined contribution plan (e.g., 401(k) or 403(b)) 39. If you selected either "defined benefit plan" or "cash balance pension plan" in Q38 above... a. What is the typical percentage of annual salary accrued in the qualified plan for each of these positions? Please enter a percentage for each. You may need to ask your actuary. CEO COO CFO other direct reports to CEO % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist 40. If you selected either "defined contribution money purchase pension plan" or "defined contribution plan" in Q38 above... a. Does the plan allow for employee deferrals? b. Does your organization provide an employer match on the employee deferral? c. Does your organization provide a floor (guaranteed) contribution each year into the plan? d. Assuming that the executive participates to the maximum allowed, what is the percentage of annual salary paid into the qualified plan by the employer from a floor, discretionary, and/or matching contribution? For example, if the executive receives a floor contribution = 3%, discretionary = 2% and matching contribution = 2% you would enter 7 (3+2+2). Please enter a percentage for each position. CEO COO CFO other direct reports to CEO % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist e. Assuming that the executive participates to the maximum allowed, what is the typical percentage of annual salary paid into the qualified plan by the executive? Please enter a percentage for each position. CEO COO CFO other direct reports to CEO % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist
18 Executive - Compensation Policy Executive2018Questions.docx page 18 Retirement Non-Qualified Plan Participation *41. Are any of your organization's executives eligible for AND participating in a non-qualified retirement plan that is, one offered only to a limited number of executives, not all employees? Non-qualified retirement plans are those that do not meet the IRS guidelines for special tax benefits of the rules of the Employee Retirement Income Security Act. Non-qualified retirement plans include: defined benefit plans (i.e. SERP or QSERP) and defined contribution plans (i.e. 457(b), 457(f)).
19 Executive - Compensation Policy Executive2018Questions.docx page 19 Retirement Non-Qualified Plan Details *42. What type(s) of non-qualified plans does your organization offer? Select all that apply. defined benefit plan (e.g., SERP or QSERP) defined contribution plan (e.g., 457(b) or 457(f)) 43. If you selected "defined benefit plan" in Q42 above... a. What is the percentage of annual salary accrued in the non-qualified plan for each of these positions? Please enter a percentage for each. You may need to ask your actuary. CEO COO CFO other direct reports to CEO % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist 44. If you selected "defined contribution plan" in Q42 above... a. Does the plan allow for employee deferrals? b. Does your organization provide an employer match on the employee deferral? c. Does your organization provide a floor (guaranteed) contribution each year into the plan? d. Assuming that the executive participates to the maximum allowed, what is the percentage of annual salary paid into the nonqualified plan by the employer from a floor, discretionary, and/or matching contribution? For example, if the executive receives a floor contribution = 3%, discretionary = 2% and matching contribution = 2% you would enter 7 (3+2+2). Please enter a percentage for each position. CEO COO CFO other direct reports to CEO % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist e. Assuming that the executive participates to the maximum allowed, what is the typical percentage of annual salary paid into the non-qualified plan by the executive? Please enter a percentage for each position. CEO COO CFO other direct reports to CEO % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist % OR not eligible OR does not exist
20 Executive - Compensation Policy Executive2018Questions.docx page 20 Conclusion 45. Any comments?
21 Executive - Future Request Executive2018Questions.docx page 21 Future Request *1. Are there any additional positions you would like included in next year's survey? a. If yes, please supply the position title and the job description for each position you would like added. (Must provide clear job descriptions in order for job additions to be considered.) Position Title #1: Job Description #1: It seems this Future Request should not be repeated for each location. If so, we can make it a separate questionnaire that applies to all locations, and is only completed once. Position Title #2: Job Description #2: Position Title #3: Job Description #3: 2. Please provide any additional feedback or future requests.
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