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TIN: 23-1352166
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
20
Open to Public Inspection
Name of the organization
THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Employer identification number
23-1352166
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
Yes
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
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) 2020
Schedule J (Form 990) 2020
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
BRYAN WOLF MD PHD
EXECUTIVE VP & CSO
(i)
(ii)
607,297
-------------
0
16,255
-------------
0
286,768
-------------
0
17,145
-------------
0
10,389
-------------
0
937,854
-------------
0
0
-------------
0
2
CALVIN ALLEN
EVP & CHIEF HR OFFICER
(i)
(ii)
564,011
-------------
0
14,420
-------------
0
65,852
-------------
0
15,393
-------------
0
32,668
-------------
0
692,344
-------------
0
0
-------------
0
3
DOUG HOCK
EXECUTIVE VP & COO
(i)
(ii)
978,682
-------------
0
24,872
-------------
0
93,622
-------------
0
19,950
-------------
0
44,094
-------------
0
1,161,220
-------------
0
0
-------------
0
4
JEFFREY D KAHN
ASSISTANT SECRETARY
(i)
(ii)
673,343
-------------
0
17,203
-------------
0
53,800
-------------
0
28,596
-------------
0
37,773
-------------
0
810,715
-------------
0
0
-------------
0
5
JENNY CHAN
SVP & CHIEF INVESTMENT OFFICER
(i)
(ii)
531,832
-------------
0
13,588
-------------
0
31,866
-------------
0
19,950
-------------
0
15,669
-------------
0
612,905
-------------
0
0
-------------
0
6
JOSEPH W ST GEME III MD
TRUSTEE
(i)
(ii)
0
-------------
963,610
0
-------------
19,846
0
-------------
69,862
0
-------------
25,650
0
-------------
9,748
0
-------------
1,088,716
0
-------------
0
7
KISHA HAWTHORNE
SVP & CHIEF INFO. OFFICER
(i)
(ii)
531,944
-------------
0
13,519
-------------
0
31,179
-------------
0
19,950
-------------
0
13,147
-------------
0
609,739
-------------
0
0
-------------
0
8
MADELINE BELL
CEO & TRUSTEE
(i)
(ii)
1,506,131
-------------
0
38,093
-------------
0
150,300
-------------
0
28,596
-------------
0
14,657
-------------
0
1,737,777
-------------
0
0
-------------
0
9
MATTHEW BAYLEY MD
SVP & CHIEF STRATEGY OFFICER
(i)
(ii)
92,142
-------------
0
0
-------------
0
483,774
-------------
0
0
-------------
0
1,308
-------------
0
577,224
-------------
0
0
-------------
0
10
MONICA TAYLOR LOTTY
EVP & CHIEF DEVELOP. OFFICER
(i)
(ii)
480,876
-------------
0
12,252
-------------
0
27,444
-------------
0
19,950
-------------
0
15,871
-------------
0
556,393
-------------
0
0
-------------
0
11
N SCOTT ADZICK MD
TRUSTEE
(i)
(ii)
0
-------------
1,355,852
0
-------------
34,750
0
-------------
103,028
0
-------------
25,650
0
-------------
12,915
0
-------------
1,532,195
0
-------------
0
12
PAULA AGOSTO
SVP & CHIEF NURSING OFFICER
(i)
(ii)
495,399
-------------
0
12,770
-------------
0
31,277
-------------
0
31,446
-------------
0
32,386
-------------
0
603,278
-------------
0
0
-------------
0
13
STEVEN G DOCIMO
SVP & COO OF CARE NETWORK
(i)
(ii)
598,337
-------------
0
115,236
-------------
0
46,888
-------------
0
19,950
-------------
0
27,833
-------------
0
808,244
-------------
0
0
-------------
0
14
SUSAN FURTH
EVP & CHIEF SCIENTIFIC OFFICER
(i)
(ii)
464,750
-------------
0
0
-------------
0
3,417
-------------
0
0
-------------
0
0
-------------
0
468,167
-------------
0
0
-------------
0
15
THOMAS J TODOROW
ASSISTANT TREASURER
(i)
(ii)
891,667
-------------
0
22,660
-------------
0
83,064
-------------
0
25,746
-------------
0
38,624
-------------
0
1,061,761
-------------
0
0
-------------
0
16
THOMAS R DOLE
SVP OPERATIONS
(i)
(ii)
438,178
-------------
0
97,917
-------------
0
25,219
-------------
0
28,596
-------------
0
26,186
-------------
0
616,096
-------------
0
0
-------------
0
17
NICHOLAS P PROCYK
FMR SVP&CHIEF INVESTMENT OFF.
(i)
(ii)
0
-------------
0
0
-------------
0
141,449
-------------
0
0
-------------
0
0
-------------
0
141,449
-------------
0
0
-------------
0
Schedule J (Form 990) 2020
Schedule J (Form 990) 2020
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
SCHEDULE J, PART I, LINE 1
THE CHILDREN'S HOSPITAL OF PHILADELPHIA PROVIDED THE HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES OF MADELINE BELL TO A CLUB THAT DOES NOT HAVE CORPORATE MEMBERSHIPS, TO ENABLE THE HOSPITAL TO USE THE CLUB'S FACILITIES FOR HOSPITAL MEETINGS AND EVENTS. THE HEALTH OR SOCIAL CLUB DUES ARE TREATED AS NON-TAXABLE COMPENSATION TO THE INDIVIDUAL. THE INDIVIDUAL IS PERSONALLY RESPONSIBLE FOR, AND BEARS THE COST OF, ANY EXPENSES THAT MAY ARISE FROM HER PRIVATE USE OF THE CLUB. SCHEDULE J, PART I, LINE 4A MATTHEW BAYLEY MD - 483,774 NICHOLAS P PROCYK - 141,449 SCHEDULE J, PART I, LINE 4B MADELINE BELL - 135,515 N SCOTT ADZICK MD - 135,976 THOMAS J TODOROW - 67,981 DOUG HOCK - 77,659 JOSEPH W ST GEME III MD - 96,010 BRYAN WOLF MD, PHD - 220,098 JEFFREY D KAHN - 44,099 MONICA TAYLOR LOTTY - 22,435 KISHA HAWTHORNE - 27,979 PAULA AGOSTO - 24,703 THOMAS R DOLE - 18,053 STEVEN G DOCIMO - 34,495 CALVIN ALLEN - 31,923 JENNY CHAN - 28,280 SCHEDULE J, PART I, LINE 5A The Long Term Incentive Program for members of Senior Management and Department Chairs for Fiscal Years 2018, 2019 and 2020 was paid in Fiscal Year 2021 with a metric related to Gross Operating Cashflow.
SCHEDULE J, PART I, LINE 7
INCENTIVES ARE AVAILABLE FOR MEMBERS OF SENIOR MANAGEMENT AND DEPARTMENT CHAIRS BASED ON ACHIEVEMENT OF ORGANIZATION AND INDIVIDUAL GOALS TYPICALLY RELATED TO QUALITY, OPERATING, AND FINANCIAL PERFORMANCE AS WELL AS OTHER SIGNIFICANT CLINICAL, QUALITY, AND SCIENTIFIC ACHIEVEMENTS. PAYMENT OF INCENTIVES IS DEPENDENT UPON ACHIEVING SUFFICIENT OPERATING MARGIN TO FUND THE INCENTIVES.
SCHEDULE J, PART II, COLUMN (C)
THE AMOUNT REPORTED HERE MAY INCLUDE CHANGES IN ACTUARIAL VALUES OF SERPS AS REQUIRED TO BE REPORTED BY THE IRS.
Schedule J (Form 990) 2020
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