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TIN: 44-0545297
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
St Lukes Hospital of Kansas City
Employer identification number
44-0545297
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
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) 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
JANI JOHNSON
CEO & ASSIST SECR & BOD MBR
(i)
(ii)
619,954
-------------
0
185,039
-------------
0
62,774
-------------
0
152,317
-------------
0
29,308
-------------
0
1,049,392
-------------
0
42,700
-------------
0
2
CAMILLE HONESTY MD
BOARD MEMBER
(i)
(ii)
0
-------------
266,114
0
-------------
24,606
0
-------------
1,381
0
-------------
18,850
0
-------------
734
0
-------------
311,685
0
-------------
0
3
JOHN HELZBERG MD
BOARD MEMBER
(i)
(ii)
0
-------------
533,768
0
-------------
2,000
0
-------------
6,468
0
-------------
14,500
0
-------------
25,558
0
-------------
582,294
0
-------------
0
4
CHEERAG UPADHYAYA MD
BOARD MEMBER
(i)
(ii)
0
-------------
970,522
0
-------------
0
0
-------------
1,200
0
-------------
13,050
0
-------------
12,191
0
-------------
996,963
0
-------------
0
5
LEANNA MOSHER MD
BOARD MEMBER
(i)
(ii)
0
-------------
364,550
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
364,550
0
-------------
0
6
DORIS ROGERS
FMR VP-HUMAN RESOURCES TERM END 4/2020
(i)
(ii)
0
-------------
402,238
0
-------------
134,525
0
-------------
33,901
0
-------------
118,764
0
-------------
28,529
0
-------------
717,957
0
-------------
18,775
7
DONNA KUNZ
VP-HUMAN RESOURCES
(i)
(ii)
240,000
-------------
0
42,950
-------------
0
28,188
-------------
0
11,600
-------------
0
1,947
-------------
0
324,685
-------------
0
0
-------------
0
8
CHARLES V ROBB
ASSISTANT SECRETARY
(i)
(ii)
0
-------------
671,852
0
-------------
311,608
0
-------------
439,783
0
-------------
558,589
0
-------------
25,058
0
-------------
2,006,889
0
-------------
198,847
9
DEBRA WILSON
VP & CHIEF NURSING OFFICER
(i)
(ii)
329,766
-------------
0
99,809
-------------
0
36,615
-------------
0
50,065
-------------
0
22,917
-------------
0
539,171
-------------
0
23,642
-------------
0
10
AMY NACHTIGAL
CHIEF FINANCIAL OFFICER
(i)
(ii)
404,856
-------------
0
118,175
-------------
0
54,677
-------------
0
70,703
-------------
0
33,169
-------------
0
681,580
-------------
0
45,500
-------------
0
11
JAMIE ALLEN
VP & ASSIST SECRETARY
(i)
(ii)
0
-------------
295,930
0
-------------
64,939
0
-------------
2,346
0
-------------
36,100
0
-------------
15,261
0
-------------
414,575
0
-------------
0
12
PETER HOLT MD
VP-MEDICAL AFFAIRS
(i)
(ii)
293,073
-------------
0
1,000
-------------
0
2,972
-------------
0
13,050
-------------
0
21,755
-------------
0
331,851
-------------
0
0
-------------
0
13
JANE PECK
CHIEF OPERATING OFFICER
(i)
(ii)
380,000
-------------
0
102,914
-------------
0
38,431
-------------
0
43,450
-------------
0
3,026
-------------
0
567,821
-------------
0
0
-------------
0
14
JANET GORDON
VP-PROVIDER BASED CLINICS
(i)
(ii)
185,398
-------------
0
24,342
-------------
0
1,981
-------------
0
8,810
-------------
0
28,666
-------------
0
249,197
-------------
0
0
-------------
0
15
TROY SYDZYIK
CHIEF PERFUSIONIST
(i)
(ii)
219,128
-------------
0
2,000
-------------
0
1,487
-------------
0
15,108
-------------
0
28,846
-------------
0
266,569
-------------
0
0
-------------
0
16
JOHN SPERTUS MD
PHYSICIAN
(i)
(ii)
404,244
-------------
0
2,000
-------------
0
60,577
-------------
0
18,850
-------------
0
4,356
-------------
0
490,028
-------------
0
0
-------------
0
17
LISA BURTIN
RN
(i)
(ii)
207,891
-------------
0
1,000
-------------
0
16,340
-------------
0
13,980
-------------
0
25,481
-------------
0
264,692
-------------
0
0
-------------
0
18
JEFF LITTLE
PHARMACY DIRECTOR
(i)
(ii)
204,654
-------------
0
2,000
-------------
0
259
-------------
0
9,643
-------------
0
18,984
-------------
0
235,539
-------------
0
0
-------------
0
19
SHAWN MOOREHEAD
CHIEF MEDICAL PHYSICIST
(i)
(ii)
243,586
-------------
0
2,000
-------------
0
219
-------------
0
11,421
-------------
0
26,655
-------------
0
283,881
-------------
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
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
ANNUALLY, THE SAINT LUKE'S HEALTH SYSTEM BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS, DISCUSSES, SETS AND APPROVES COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT EXECUTIVES AND OFFICERS. INDEPENDENT, EXTERNAL DIRECTORS SERVE ON THE COMPENSATION COMMITTEE. AN INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY PROVIDES A WRITTEN REPORT AND REASONABLENESS OPINION. THE CONSULTANT REVIEWS THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSPHY AND ANALYZES MARKET COMPETITIVENESS (IN TOTAL AND BY EACH COMPENSATION AND BENEFIT ELEMENT) FOR THE EXECUTIVES USING APPROPRIATE COMPARABILITY DATA. COMPENSATION COMMITTEE ACTIONS ARE CONTEMPORANEOUSLY DOCUMENTED. THE PROCESS SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
457(F) PARTICIPANT AND AMOUNT INCLUDED IN COLUMN C FOR THE PLAN: CHARLES ROBB: $452,179 FOR THE VARIOUS 457(F) PLANS, A PARTICIPANT'S BENEFIT IS PAID AT VESTING. VESTING GENERALLY OCCURS AT RETIREMENT AGE AND MAY BE SUBJECT TO CERTAIN RESTRICTIVE COVENANTS.
Schedule J, Part I, Line 7 Non-fixed payments
THE ORGANIZATION HAS ADOPTED A MANAGEMENT INCENTIVE COMPENSATION PLAN FOR CERTAIN MEMBERS OF SENIOR AND MIDDLE MANAGEMENT TO PROMOTE EFFECTIVE MANAGEMENT OF OPERATIONS, QUALITY OF CARE AND SERVICE, AND OPTIMAL USE OF RESOURCES. THE INCENTIVES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY CONTINGENT ON ACHIEVING QUALITY, PATIENT SATISFACTION, EMPLOYEE ENGAGEMENT, FINANCIAL AND OTHER OPERATIONAL PERFORMANCE TARGETS ESTABLISHED BY THE BOARD'S COMPENSATION COMMITTEE ON AN ANNUAL BASIS. INCENTIVE AWARDS ARE PAID AT THE DISCRETION OF THE BOARD OF DIRECTORS AND DO NOT ACCRUE TO THE BENEFIT OF THE INDIVIDUALS UNTIL AFTER FINANCIAL RESULTS HAVE BEEN DETERMINED FOR THE CALENDAR YEAR. THIS INCENTIVE COMPENSATION IS EVALUATED AS PART OF THE REVIEW OF MARKET COMPETITIVE DATA AND REASONABLENESS OF OVERALL COMPENSATION AND BENEFITS.
Schedule J, Part II PART II
CHARLES ROBB, DORIS ROGERS, JOHN HELZBERG, CHEERAG UPADHYAYA, CAMILLE HONESTY, MARC LARSEN, AND LEANNA MOSHER DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JAMIE ALLEN IS FOR SERVICES RENDERED TO THE FILING AND RELATED ORGANIZATIONS.
Schedule J (Form 990) 2021
Additional Data
Software ID:
21014044
Software Version:
2021v4.2