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TIN: 01-0782751
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
Nationwide Childrens Hospital Group Return
Employer identification number
01-0782751
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
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
Yes
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
No
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
Luke Brown
TREASURER / SR VP / CFO - NCH
(i)
(ii)
557,781
-------------
0
204,188
-------------
0
150,370
-------------
0
64,150
-------------
0
24,137
-------------
0
1,000,626
-------------
0
75,000
-------------
0
2
Richard Miller
COO - NCH
(i)
(ii)
1,114,047
-------------
0
454,555
-------------
0
19,500
-------------
0
39,150
-------------
0
30,087
-------------
0
1,657,339
-------------
0
0
-------------
0
3
Timothy C Robinson
DIRECTOR / CEO - NCH
(i)
(ii)
295,989
-------------
0
218,750
-------------
0
1,019,500
-------------
0
39,150
-------------
0
23,287
-------------
0
1,596,676
-------------
0
0
-------------
0
4
Lynn Rosenthal
PRES / DIRECTOR - CCFA
(i)
(ii)
195,064
-------------
0
48,000
-------------
0
2,442
-------------
0
32,960
-------------
0
11,221
-------------
0
289,687
-------------
0
0
-------------
0
5
Rustin Morse MD
CHIEF MEDICAL OFFICER - NCH
(i)
(ii)
565,910
-------------
0
125,000
-------------
0
19,500
-------------
0
39,150
-------------
0
30,337
-------------
0
779,897
-------------
0
0
-------------
0
6
Lee Ann Wallace
SR VP & CHIEF NURSING OFFICER - NCH
(i)
(ii)
427,397
-------------
0
198,502
-------------
0
0
-------------
0
39,150
-------------
0
23,591
-------------
0
688,640
-------------
0
0
-------------
0
7
RAJESH KRISHNAMURTHY MD
DIRECTOR - CRI
(i)
(ii)
554,056
-------------
0
92,715
-------------
0
19,500
-------------
0
39,150
-------------
0
31,116
-------------
0
736,537
-------------
0
0
-------------
0
8
SHAMLAL MANGRAY MD
DIRECTOR - PPAC
(i)
(ii)
378,010
-------------
0
69,600
-------------
0
5,200
-------------
0
39,150
-------------
0
31,328
-------------
0
523,288
-------------
0
0
-------------
0
9
Meredith Merz Lind MD
DIRECTOR - NCH (To 12/2021)
(i)
(ii)
463,713
-------------
0
81,998
-------------
0
19,500
-------------
0
39,150
-------------
0
27,168
-------------
0
631,529
-------------
0
0
-------------
0
10
Oluyinka Olutoye MD
DIRECTOR - CSA
(i)
(ii)
736,217
-------------
0
306,281
-------------
0
26,923
-------------
0
39,150
-------------
0
22,091
-------------
0
1,130,662
-------------
0
0
-------------
0
11
Joseph Tobias MD
DIRECTOR - CAA
(i)
(ii)
547,892
-------------
0
150,000
-------------
0
19,500
-------------
0
39,150
-------------
0
28,578
-------------
0
785,120
-------------
0
0
-------------
0
12
Shilpi Banerjee
ASST SECRETARY - RINCH (As of 8/2021)
(i)
(ii)
141,236
-------------
0
32,262
-------------
0
0
-------------
0
0
-------------
0
9,577
-------------
0
183,075
-------------
0
0
-------------
0
13
John A Barnard MD
PRESIDENT - RINCH
(i)
(ii)
339,935
-------------
0
256,942
-------------
0
0
-------------
0
34,200
-------------
0
22,290
-------------
0
653,367
-------------
0
0
-------------
0
14
Rhonda Comer
SECRETARY / SR VP / LEGAL SRVCS - NCH
(i)
(ii)
595,155
-------------
0
360,915
-------------
0
0
-------------
0
139,150
-------------
0
31,125
-------------
0
1,126,345
-------------
0
0
-------------
0
15
Sara Evans
ASST SECRETARY - FOUNDATION
(i)
(ii)
252,982
-------------
0
0
-------------
0
0
-------------
0
24,413
-------------
0
38,883
-------------
0
316,278
-------------
0
0
-------------
0
16
Andrew Lenobel
ASST SECRETARY - CAA
(i)
(ii)
162,861
-------------
0
0
-------------
0
0
-------------
0
11,164
-------------
0
32,074
-------------
0
206,099
-------------
0
0
-------------
0
17
Stephen Testa
PRES - NCH FOUNDATION
(i)
(ii)
451,511
-------------
0
214,436
-------------
0
0
-------------
0
89,150
-------------
0
28,578
-------------
0
783,675
-------------
0
0
-------------
0
18
Marissa Larouere
VP CLINICAL SERVICES - NCH
(i)
(ii)
206,324
-------------
0
0
-------------
0
0
-------------
0
18,128
-------------
0
28,967
-------------
0
253,419
-------------
0
0
-------------
0
19
Patricia McClimon
SR VP / PLAN & DEV'T - NCH
(i)
(ii)
561,278
-------------
0
236,835
-------------
0
19,500
-------------
0
139,150
-------------
0
27,587
-------------
0
984,350
-------------
0
0
-------------
0
20
Dennis Minzler
VP / CIO - NCH
(i)
(ii)
305,930
-------------
0
0
-------------
0
0
-------------
0
26,210
-------------
0
17,652
-------------
0
349,792
-------------
0
0
-------------
0
21
Amy Roscoe
VICE PRESIDENT - RINCH
(i)
(ii)
261,342
-------------
0
0
-------------
0
0
-------------
0
22,519
-------------
0
1,255
-------------
0
285,116
-------------
0
0
-------------
0
22
Lorina Wise
VP / HR - NCH
(i)
(ii)
427,829
-------------
0
234,638
-------------
0
19,500
-------------
0
39,150
-------------
0
12,572
-------------
0
733,689
-------------
0
0
-------------
0
23
Denise Zabawski
VP / CIO - NCH
(i)
(ii)
476,042
-------------
0
25,000
-------------
0
0
-------------
0
26,210
-------------
0
21,591
-------------
0
548,843
-------------
0
0
-------------
0
24
Mark Galantowicz MD
CHIEF OF CT SURGERY - CSA
(i)
(ii)
1,310,959
-------------
0
600,739
-------------
0
19,500
-------------
0
39,150
-------------
0
23,273
-------------
0
1,993,621
-------------
0
0
-------------
0
25
Richard Kirschner MD
PLASTIC SURGEON - CSA
(i)
(ii)
801,577
-------------
0
368,033
-------------
0
19,500
-------------
0
39,150
-------------
0
28,578
-------------
0
1,256,838
-------------
0
0
-------------
0
26
Kevin Klingele MD
ORTHOPEDIC SURGEON - CSA
(i)
(ii)
790,193
-------------
0
421,925
-------------
0
19,500
-------------
0
39,150
-------------
0
28,578
-------------
0
1,299,346
-------------
0
0
-------------
0
27
Jeffrey Leonard MD
NEUROSURGEON - CSA
(i)
(ii)
835,606
-------------
0
634,369
-------------
0
0
-------------
0
39,150
-------------
0
26,819
-------------
0
1,535,944
-------------
0
0
-------------
0
28
Walter Samora MD
ORTHOPEDIC SURGEON - CSA
(i)
(ii)
516,639
-------------
0
626,782
-------------
0
0
-------------
0
39,150
-------------
0
28,578
-------------
0
1,211,149
-------------
0
0
-------------
0
29
Wanda Stackpole
FORMER VP/EXEC DIRECTOR - NCH HOMECARE
(i)
(ii)
246,641
-------------
0
875
-------------
0
0
-------------
0
15,907
-------------
0
11,947
-------------
0
275,370
-------------
0
0
-------------
0
30
Steve Allen MD
FORMER DIRECTOR / CEO
(i)
(ii)
-590,430
-------------
0
0
-------------
0
1,575,019
-------------
0
0
-------------
0
0
-------------
0
984,589
-------------
0
555,404
-------------
0
31
Karen Days
FORMER PRES / DIRECTOR - CCFA
(i)
(ii)
256,488
-------------
0
0
-------------
0
0
-------------
0
22,405
-------------
0
13,108
-------------
0
292,001
-------------
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 1a Health or social club dues or initiation fees
NATIONWIDE CHILDREN'S HOSPITAL PROVIDED HEALTH OR SOCIAL CLUB DUES FOR RUSTIN MORSE, M.D., KAREN DAYS, AND PATRICIA MCCLIMON. THESE WERE TREATED AS TAXABLE COMPENSATION TO THE EMPLOYEE. NATIONWIDE CHILDREN'S HOSPITAL ALSO PROVIDED HEALTH OR SOCIAL CLUB DUES FOR KAREN DAYS; TIMOTHY ROBINSON AND STEPHEN TESTA. THESE WERE DETERMINED TO BE BUSINESS EXPENSES AND WERE NOT TREATED AS COMPENSATION TO THE EMPLOYEE.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: , STEVEN ALLEN, M.D., STEPHEN TESTA, PATRICIA MCCLIMON, LUKE BROWN, RHONDA COMER, AND JOHN BARNARD, M.D. PAYOUT OF SRP AMOUNT THAT HAD BEEN PREVIOUSLY FUNDED, OCCURRED FOR THE FOLLOWING EMPLOYEES: LUKE BROWN $120,370 STEVEN ALLEN, M.D. $1,575,019 ($555,404 PREVIOUSLY REPORTED ON A 990) CONTRIBUTIONS WERE MADE ON BEHALF OF THE FOLLOWING EMPLOYEES: RHONDA COMER $100,000 LUKE BROWN $25,000 STEPHEN TESTA $50,000 PATRICIA MCCLIMON $100,000 EFFECTIVE FOR PLAN YEAR 2010, NATIONWIDE CHILDREN'S HOSPITAL CHOSE TO ELIMINATE FUTURE CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. CURRENT BALANCES OF THIS PLAN ARE MAINTAINED IN THE ACCOUNTS. FOR CHILDREN'S RADIOLOGICAL INSTITUTE, INC., CONTRIBUTIONS ARE STILL BEING MAINTAINED, BUT THERE WAS A PLAN DESIGN CHANGE ALLOWING ANNUAL CONTRIBUTIONS TO BE VESTED AFTER 5 YEARS.
Schedule J, Part I, Line 6a Compensation contingent on net earnings of the organization
A PORTION OF NATIONWIDE CHILDREN'S HOSPITAL'S MANAGEMENT'S COMPENSATION CONTAINS A VARIABLE PIECE THAT IS BASED ON THE HOSPITAL'S INCENTIVE PROGRAM. THIS VARIABLE COMPENSATION IS BASED IN PART ON THE FINANCIAL PERFORMANCE OF THE ORGANIZATION, RELATIVE TO BUDGETED FINANCIAL PERFORMANCE. THE INCENTIVE PROGRAM ALSO INCLUDES PERFORMANCE MEASURES RELATED TO QUALITY OF CARE AND PATIENT SATISFACTION.
Schedule J (Form 990) 2021
Additional Data
Software ID:
21014044
Software Version:
2021v4.2