Instrumentl eFile Render
Object ID: 202111959349301901 - Rendered 2024-12-14
TIN: 36-2170833
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
19
Open to Public Inspection
Name of the organization
Ann & Robert H Lurie Children's Hospital of
Chicago
Employer identification number
36-2170833
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
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
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
No
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
Yes
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
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) 2019
Schedule J (Form 990) 2019
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
Matthew Davis MD
Ex-Off Dir/Chr of Pediatrics
(i)
(ii)
0
-------------
455,939
0
-------------
40,670
0
-------------
276
0
-------------
28,000
0
-------------
30,156
0
-------------
555,041
0
-------------
0
2
Michael D Kelleher MD
Ex-Off Dir/CMO until 12/19
(i)
(ii)
0
-------------
561,810
0
-------------
193,792
0
-------------
267,065
0
-------------
134,912
0
-------------
29,959
0
-------------
1,187,538
0
-------------
0
3
Erik C King MD
Ex-OFF Dir/Pres LCSF/Physician
(i)
(ii)
0
-------------
700,796
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
700,796
0
-------------
0
4
Patrick M Magoon
Ex-Off/LCH Pres/CEO untl 12/19
(i)
(ii)
1,489,362
-------------
0
1,000,000
-------------
0
8,382
-------------
0
35,223
-------------
0
24,002
-------------
0
2,556,969
-------------
0
505,259
-------------
0
5
Elizabeth J Perlman MD
Ex-Off Dir/Chr Dept Path/Lab
(i)
(ii)
0
-------------
560,793
0
-------------
100,374
0
-------------
4,150
0
-------------
300,687
0
-------------
31,692
0
-------------
997,696
0
-------------
0
6
Marleta Reynolds MD
Ex-Off Dir/Chf of Surgery,DH
(i)
(ii)
0
-------------
977,810
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
977,810
0
-------------
0
7
Thomas P Shanley MD
Ex-Offc Dir/Pres & CEO LCH
(i)
(ii)
0
-------------
640,986
0
-------------
265,970
0
-------------
516
0
-------------
166,674
0
-------------
30,156
0
-------------
1,104,302
0
-------------
0
8
Nancy M Borders
Gen Counsl/Corp Sec untl 12/19
(i)
(ii)
378,113
-------------
0
215,312
-------------
0
209,096
-------------
0
98,964
-------------
0
25,584
-------------
0
927,069
-------------
0
0
-------------
0
9
Ron Blaustein
Sr. VP/Chief Financial Officer
(i)
(ii)
470,753
-------------
0
204,245
-------------
0
776
-------------
0
135,503
-------------
0
29,456
-------------
0
840,733
-------------
0
0
-------------
0
10
Joni M Duncan
Chief HR Officer
(i)
(ii)
352,321
-------------
0
122,352
-------------
0
1,600
-------------
0
93,614
-------------
0
29,362
-------------
0
599,249
-------------
0
0
-------------
0
11
Lisa M Dykstra
Ex-Off Dir/Sr. VP/CIO
(i)
(ii)
385,930
-------------
0
133,542
-------------
0
618
-------------
0
99,091
-------------
0
5,914
-------------
0
625,095
-------------
0
0
-------------
0
12
Michelle M Stephenson
Ex-Off Director/Exec VP-COO
(i)
(ii)
557,502
-------------
0
249,483
-------------
0
4,096
-------------
0
537,748
-------------
0
27,043
-------------
0
1,375,872
-------------
0
0
-------------
0
13
Grant Stirling
Ex-Off Dir/Pres/Chf Dvl Offcr
(i)
(ii)
531,803
-------------
0
267,082
-------------
0
1,339
-------------
0
148,760
-------------
0
27,570
-------------
0
976,554
-------------
0
0
-------------
0
14
Scott T Wilkerson
Executive Director LCHPCIN
(i)
(ii)
363,932
-------------
0
262,133
-------------
0
2,322
-------------
0
14,000
-------------
0
28,974
-------------
0
671,361
-------------
0
0
-------------
0
15
Monica Heenan
Ex-Off Dir/Cf Strategy Officer
(i)
(ii)
414,283
-------------
0
143,482
-------------
0
2,946
-------------
0
110,522
-------------
0
39,668
-------------
0
710,901
-------------
0
0
-------------
0
16
Susan H Gordon
Ex-Off Dir/Sr. VP/Chf,External
(i)
(ii)
354,037
-------------
0
120,867
-------------
0
2,424
-------------
0
210,554
-------------
0
7,909
-------------
0
695,791
-------------
0
0
-------------
0
17
Douglas R Niedzwiecki
VP Amb Svc & Med Group Ops
(i)
(ii)
335,805
-------------
0
60,443
-------------
0
320
-------------
0
14,000
-------------
0
33,106
-------------
0
443,674
-------------
0
0
-------------
0
Schedule J (Form 990) 2019
Schedule J (Form 990) 2019
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
FORM 990, SCHEDULE J, PART I, LINE 3
PURSUANT TO THE BYLAWS OF CHILDREN'S HOSPITAL OF CHICAGO MEDICAL CENTER ("MEDICAL CENTER") AND THE ORGANIZATION, THE GOVERNANCE COMMITTEE OF THE ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO ("LURIE CHILDREN'S") AND MEDICAL CENTER, SERVES AS THE COMPENSATION COMMITTEE OF LURIE CHILDREN'S AND THE ORGANIZATION. THE GOVERNANCE COMMITTEE IS CHARGED TO REVIEW AND APPROVE SENIOR EXECUTIVE COMPENSATION FOR THE MEDICAL CENTER AND ITS AFFILIATES AND THE COMPENSATION FOR ANY PHYSICIAN WHO MEETS THE CRITERIA FOR REVIEW AND APPROVAL BY THE COMMITTEE. THE GOVERNANCE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S SENIOR MANAGEMENT, INCLUDING THE PRESIDENT. THE GOVERNANCE COMMITTEE HAS ALSO APPROVED THE COMPENSATION PLAN AND COMPENSATION PHILOSOPHY FOR THE ORGANIZATION. THESE COMPENSATION PLANS AND PHILOSOPHIES ARE SUBJECT TO PERIODIC REVIEW BY THE GOVERNANCE COMMITTEE FOR CONTINUED APPROPRIATENESS IN THE CURRENT MARKET. WITH THE ASSISTANCE OF INDEPENDENT COMPENSATION CONSULTANTS AND INFORMATION FROM A VARIETY OF SOURCES (SPECIFIED ON SCHEDULE J), THE GOVERNANCE COMMITTEE CONFIRMED THE TOTAL AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. OUTSIDE LEGAL COUNSEL PERIODICALLY ADVISES THE GOVERNANCE COMMITTEE WITH RESPECT TO FEDERAL TAX REQUIREMENTS IN SETTING COMPENSATION AND THE ESTABLISHMENT OF THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE FEDERAL TAX LAW INTERMEDIATE SANCTIONS RULES. THE PROCESS FOLLOWED BY THE GOVERNANCE COMMITTEE, INCLUDING A DESCRIPTION OF THE DATA RELIED UPON AND THE GOVERNANCE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND CONTEMPORANEOUSLY DOCUMENTED. THE GOVERNANCE COMMITTEE HAS EXPRESSLY REVIEWED THE REASONABLENESS OF ALL SUCH PAYMENTS, AND HAS CONCLUDED, AS THE RESULT OF A PROCESS THAT IS DESIGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THAT ALL SUCH AMOUNTS ARE REASONABLE AND DO NOT EXCEED FAIR MARKET VALUE FOR THE SERVICES PROVIDED. THE GOVERNANCE COMMITTEE WAS COMPRISED OF MEMBERS OF THE MEDICAL CENTER AND LURIE CHILDREN'S BOARDS OF DIRECTORS WHO WERE DETERMINED TO BE DISINTERESTED (WHICH MEANS NO COMMITTEE MEMBER HAS A CONFLICT OF INTEREST) FOR THESE PURPOSES. THE GOVERNANCE COMMITTEE CONDUCTS AN ONGOING, REGULAR REVIEW OF THE DISINTERESTED STATUS OF ITS MEMBERS, AND WILL TAKE APPROPRIATE ACTION WITH RESPECT TO ANYONE HAVING AN INTEREST WITH RESPECT TO ONE OR MORE EXECUTIVES SO AS TO PRESERVE THE DISINTERESTED STATUS OF THE COMMITTEE AND, AS A RESULT, THE APPLICATION OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS. FORM 990, SCHEDULE J, PART I, QUESTION 4B ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO ("LURIE CHILDREN'S") MAINTAINS A DEFINED BENEFIT SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("DB SERP"), WHICH WAS EFFECTIVE ON JANUARY 1, 2001, AND IS CLOSED TO NEW PARTICIPANTS. THE DB SERP IS A DEFERRED COMPENSATION PLAN THAT ASSISTS IN PROVIDING COMPETITIVE TOTAL RETIREMENT BENEFITS TO A VERY LIMITED GROUP OF EXECUTIVE-LEVEL EMPLOYEES OF "LURIE CHILDREN'S" (INCLUDING ONE OR MORE PERSONS LISTED IN THIS FORM 990). THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR ALL OF THE EMPLOYEE'S YEARS OF SERVICE TO THE ORGANIZATION, AND THE COST OF THE BENEFITS WILL VARY FROM YEAR TO YEAR BASED ON INTEREST RATES, AGE, AND OTHER FACTORS. THE AMOUNTS ARE AT RISK AND WILL NOT BE PAID UNLESS AND UNTIL THE EMPLOYEE HAS PROVIDED SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. BENEFITS UNDER THE DC SERP VEST AT AGE 62, AND ARE FORFEITED IF THE EMPLOYEE LEAVES THE ORGANIZATION VOLUNTARILY BEFORE AGE 62 (EXCEPT UNDER THE SOLE DISCRETION OF THE LURIE CHILDREN'S BOARD, AND ONLY IF THE PARTICIPANT HAS REACHED AT LEAST AGE 55 WITH AT LEAST 10 YEARS OF SERVICE). PARTICIPANTS WHO VOLUNTARILY LEAVE THE ORGANIZATION BEFORE AGE 55 FORFEIT THEIR ENTIRE SERP BENEFIT UPON TERMINATION. LURIE CHILDREN'S MAINTAINS A DEFINED CONTRIBUTION SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("DC SERP"), WHICH WAS ESTABLISHED ON JANUARY 1, 2017 AND IS A NONQUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EMPLOYEES IN EXECUTIVE POSITIONS, WHO ARE NOT PARTICIPANTS IN THE DB SERP. THE BENEFITS IN THE DC SERP ARE IN THE FORM OF A FIXED ANNUAL CONTRIBUTION RATE AND AN EARNINGS CREDIT. EACH YEAR'S CONTRIBUTION AND EARNINGS ARE AT RISK AND WILL BECOME FULLY VESTED AND TAXABLE ONLY AFTER FIVE YEARS OF FUTURE EMPLOYMENT SERVICE, OR UPON REACHING AGE 62 WITH AT LEAST THREE YEARS OF SERVICE. SEVERAL LISTED PERSONS IN THIS FORM 990 PARTICIPATE IN THE DC SERP, AND THE UNVESTED CONTRIBUTIONS MADE FOR THEM ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SERP AND RECEIVED A VESTED PAYMENT DURING 2019 WHICH IS REPORTED IN COLUMN B (III): MICHAEL D. KELLEHER, MD $266,007 NANCY M. BORDERS $206,411 THE PAYMENT WAS ACCRUED AND RECEIVED IN 2019. SCHEDULE J, PART I, QUESTION 5B ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO ("LURIE CHILDREN'S"), A RELATED ORGANIZATION TO THE ORGANIZATION, ALSO PROVIDES ANNUAL INCENTIVE COMPENSATION TO SENIOR MANAGEMENT UNDER A SENIOR MANAGEMENT INCENTIVE COMPENSATION PLAN. THESE AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B (II). THE PLAN IS DESIGNED TO OFFER OPPORTUNITIES FOR ADDITIONAL COMPENSATION TIED TO PERFORMANCE AGAINST PRE-DETERMINED FINANCIAL, PATIENT SATISFACTION, PATIENT SAFETY AND INDIVIDUAL GOALS APPROVED IN ADVANCE BY THE GOVERNANCE COMMITTEE. THE GOVERNANCE COMMITTEE HAS EXPRESSLY REVIEWED THE REASONABLENESS OF ALL SUCH PAYMENTS AND HAS CONCLUDED, AS THE RESULT OF A PROCESS THAT IS DESIGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER FEDERAL TAX LAW, THAT ALL SUCH AMOUNTS ARE REASONABLE AND DO NOT EXCEED FAIR MARKET VALUE FOR THE SERVICES PROVIDED. FORM 990, SCHEDULE J, PART I, QUESTION 7 THE ORGANIZATION PROVIDES ANNUAL INCENTIVE COMPENSATION TO SENIOR MANAGEMENT UNDER A SENIOR MANAGEMENT INCENTIVE COMPENSATION PLAN. THESE AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B (II). THE PLAN IS DESIGNED TO OFFER OPPORTUNITIES FOR ADDITIONAL COMPENSATION TIED TO PERFORMANCE AGAINST PRE-DETERMINED FINANCIAL, PATIENT SATISFACTION, PATIENT SAFETY AND INDIVIDUAL GOALS APPROVED IN ADVANCE BY THE GOVERNANCE COMMITTEE OF THE ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO (LURIE CHILDREN'S) AND THE CHILDREN'S HOSPITAL OF CHICAGO MEDICAL CENTER (MEDICAL CENTER), WHICH SERVES AS THE COMPENSATION COMMITTEE OF LURIE CHILDREN'S AND MEDICAL CENTER. FORM 990, SCHEDULE J, PART II THE FOLLOWING INDIVIDUALS ARE NOT COMPENSATED BY THE REPORTING ORGANIZATION FOR HIS OR HER SERVICE AS A DIRECTOR OR OFFICER. RATHER, THE COMPENSATION REPORTED ON FORM 990, PART VII AND ON SCHEDULE J, PART II REFLECTS COMPENSATION PAID BY LURIE CHILDREN'S SURGICAL FOUNDATION, INC. FOR THE INDIVIDUAL'S SUBSTANTIAL AND FULL-TIME SERVICES AS AN EMPLOYEE. FOR MORE DETAILS, PLEASE REFER TO THE 2019 FORM 990 OF LURIE CHILDREN'S SURGICAL FOUNDATION, INC., FEIN 83-1650513. ERIK C. KING, MD MARLETA REYNOLDS, MD THE FOLLOWING INDIVIDUALS ARE NOT COMPENSATED BY THE REPORTING ORGANIZATION FOR HIS OR HER SERVICE AS A DIRECTOR OR OFFICER. RATHER, THE COMPENSATION REPORTED ON FORM 990, PART VII AND ON SCHEDULE J, PART II REFLECTS COMPENSATION PAID BY PEDIATRIC FACULTY FOUNDATION FOR THE INDIVIDUAL'S SUBSTANTIAL AND FULL-TIME SERVICES AS AN EMPLOYEE. FOR MORE DETAILS, PLEASE REFER TO THE 2019 FORM 990 OF PEDIATRIC FACULTY FOUNDATION, FEIN 36-3279680. MATTHEW DAVIS, MD MICHAEL D. KELLEHER, MD THOMAS P. SHANLEY, MD THE FOLLOWING INDIVIDUAL IS NOT COMPENSATED BY THE REPORTING ORGANIZATION FOR HIS OR HER SERVICE AS A DIRECTOR OR OFFICER. RATHER, THE COMPENSATION REPORTED ON FORM 990, PART VII AND ON SCHEDULE J, PART II REFLECTS COMPENSATION PAID BY CHILDREN'S HOSPITAL OF CHICAGO MEDICAL CENTER FOR THE INDIVIDUAL'S SUBSTANTIAL AND FULL-TIME SERVICES AS AN EMPLOYEE. FOR MORE DETAILS, PLEASE REFER TO THE 2019 FORM 990 OF CHILDREN'S HOSPITAL OF CHICAGO MEDICAL CENTER, FEIN 36-3357004. ELIZABETH J. PERLMAN, MD
Schedule J (Form 990) 2019
Additional Data
Software ID:
Software Version: