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ObjectId: 201803159349300100 - Submission: 2018-11-10
TIN: 90-0779996
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
17
Open to Public Inspection
Name of the organization
CHILDREN'S HEALTHCARE OF ATLANTA GROUP RETURN
Employer identification number
90-0779996
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 in 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 in 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
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
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) 2017
Page 2
Schedule J (Form 990) 2017
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
Daniel Salinas MD
CMO/INDIV. TRUSTEE - ECH/SR/EA
(i)
(ii)
0
-------------
472,477
0
-------------
627,042
0
-------------
29,772
0
-------------
94,641
0
-------------
24,985
0
-------------
1,248,917
0
-------------
417,225
2
Ronald Frieson
Indiv Trustee - HSOC/PRES FDN
(i)
(ii)
0
-------------
378,815
0
-------------
171,596
0
-------------
25,296
0
-------------
40,383
0
-------------
15,382
0
-------------
631,472
0
-------------
37,823
3
Donna Hyland
Pres/CEO - ECH/SR/EAS/EPG/MAC
(i)
(ii)
0
-------------
1,055,846
0
-------------
1,771,918
0
-------------
34,880
0
-------------
301,001
0
-------------
19,308
0
-------------
3,182,953
0
-------------
1,311,852
4
Ruth Fowler
Treas ECH/SR/FDN/EAS/EPG/MAC
(i)
(ii)
0
-------------
537,388
0
-------------
659,685
0
-------------
33,103
0
-------------
107,094
0
-------------
19,568
0
-------------
1,356,838
0
-------------
465,793
5
Leslie Jones
Sec - ECH/SR/EAS/EPG/MAC/HSOC
(i)
(ii)
0
-------------
394,191
0
-------------
110,722
0
-------------
16,938
0
-------------
42,224
0
-------------
36,819
0
-------------
600,894
0
-------------
0
6
Mary Beth Bova
SVP OPS-ECH/IND TRUSTEE-HSOC
(i)
(ii)
252,029
-------------
0
69,690
-------------
0
41,451
-------------
0
0
-------------
0
20,666
-------------
0
383,836
-------------
0
0
-------------
0
7
Jill Strickland
SVP Physician Practices Ops
(i)
(ii)
267,667
-------------
0
72,726
-------------
0
11,821
-------------
0
29,236
-------------
0
26,163
-------------
0
407,613
-------------
0
0
-------------
0
8
Jim Fortenberry MD
Indiv Trustee - FDN
(i)
(ii)
0
-------------
363,002
0
-------------
86,952
0
-------------
17,696
0
-------------
36,252
0
-------------
26,894
0
-------------
530,796
0
-------------
0
9
Stacey Deweese
VP Operations - SR
(i)
(ii)
203,011
-------------
0
48,047
-------------
0
27,247
-------------
0
0
-------------
0
28,085
-------------
0
306,390
-------------
0
0
-------------
0
10
Pat Frias
Indvidual Trustee - MAC
(i)
(ii)
0
-------------
605,878
0
-------------
672,392
0
-------------
27,917
0
-------------
119,293
0
-------------
21,808
0
-------------
1,447,288
0
-------------
397,979
11
Lucky Jain
Ind Trustee-MAC/Exec Prac Dir
(i)
(ii)
239,631
-------------
0
29,230
-------------
0
10,377
-------------
0
0
-------------
0
2,274
-------------
0
281,512
-------------
0
0
-------------
0
12
Lynn Perez
Indi Trustee-MAC/VP Ops MAC
(i)
(ii)
207,784
-------------
0
20,681
-------------
0
12,966
-------------
0
0
-------------
0
31,569
-------------
0
273,000
-------------
0
0
-------------
0
13
Michael Riley
INDIV TRUSTEE-HSOC/VP FIN OPS
(i)
(ii)
232,927
-------------
0
55,878
-------------
0
9,629
-------------
0
0
-------------
0
27,527
-------------
0
325,961
-------------
0
0
-------------
0
14
Linda Cole
SVP Operations/CNO
(i)
(ii)
0
-------------
331,153
0
-------------
91,899
0
-------------
26,376
0
-------------
36,541
0
-------------
26,747
0
-------------
512,716
0
-------------
0
15
Andrew Reisner
Neurosurgeon
(i)
(ii)
816,206
-------------
0
83,487
-------------
0
34,938
-------------
0
0
-------------
0
27,747
-------------
0
962,378
-------------
0
0
-------------
0
16
William Boydston
Prac Dir Neursurgical Svcs
(i)
(ii)
878,605
-------------
0
90,101
-------------
0
32,438
-------------
0
0
-------------
0
25,849
-------------
0
1,026,993
-------------
0
0
-------------
0
17
TIM SCHRADER MD
INDIV TRUSTEE-ECH/SR/EAS/EPG
(i)
(ii)
25,074
-------------
0
132,549
-------------
0
85
-------------
0
0
-------------
0
2,091
-------------
0
159,799
-------------
0
0
-------------
0
18
DAVID WRUBEL
NEUROSURGEON
(i)
(ii)
769,279
-------------
0
77,678
-------------
0
19,027
-------------
0
0
-------------
0
28,331
-------------
0
894,315
-------------
0
0
-------------
0
19
BARUNASHISH BRAHMA
NEUROSURGEON
(i)
(ii)
733,704
-------------
0
75,165
-------------
0
30,247
-------------
0
0
-------------
0
25,040
-------------
0
864,156
-------------
0
0
-------------
0
20
JOSHUA CHERN
NEUROSURGEON
(i)
(ii)
667,039
-------------
0
68,696
-------------
0
30,570
-------------
0
0
-------------
0
26,030
-------------
0
792,335
-------------
0
0
-------------
0
21
Robert C Wilde
Former Trustee- HSOC/CTO
(i)
(ii)
319,951
-------------
86,642
-------------
30,939
-------------
0
-------------
0
28,867
-------------
0
466,399
-------------
0
0
-------------
0
22
Eugene Hayes
Former Pres FDN/SR Development
(i)
(ii)
84,095
-------------
10,547
-------------
4,837
-------------
0
-------------
0
9,171
-------------
0
108,650
-------------
0
0
-------------
0
23
Joe Williams
FORMER TRUSTEE
(i)
(ii)
32,156
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
32,156
-------------
0
0
-------------
0
Schedule J (Form 990) 2017
Page 3
Schedule J (Form 990) 2017
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
supplemental compensation
EMPLOYEES OF CHILDREN'S HEALTHCARE OF ATLANTA, INC. HAVE THE OPTION TO PARTICIPATE IN THE 403(B) RETIREMENT PLAN OFFERED BY THE ORGANIZATION. CHILDREN'S PROVIDES AN ANNUAL DISCRETIONARY CONTRIBUTION IN A 401(A) RETIREMENT PLAN FOR EMPLOYEES WHO WORK AT LEAST 1,000 HOURS IN THE CALENDAR YEAR AND ARE EMPLOYED ON 12/31/2017. ALL INDIVIDUALS ARE EMPLOYEES OF CHILDREN'S HEALTHCARE OF ATLANTA, INC. (THE "PARENT" EIN 58-2367819) WITH CHILDREN'S HEALTHCARE OF ATLANTA GROUP RETURN (THE "GROUP" EXEMPTION NUMBER 5857) ACTING AS THE COMMON PAYROLL AGENT FOR THE PARENT AND ALL ENTITIES WITHIN THE GROUP.
SCHEDULE J, PART I, LINE 1A
PURSUANT TO THE ORGANIZATION'S TRAVEL AND REIMBURSEMENT POLICY, THE CEO IS ENTITLED TO TRAVEL FIRST CLASS OR BUSINESS CLASS ON FLIGHTS LONGER THAN TWO HOURS TO ENABLE THE CEO TO GET WORK DONE MORE EFFICIENTLY AND EFFECTIVELY ON LONGER FLIGHTS. HOWEVER, THE CEO MUST GIVE STRONG CONSIDERATION TO THE FINANCIAL IMPLICATIONS OF TRAVELING FIRST OR BUSINESS CLASS. CHOA DOES NOT TREAT THE PAYMENTS FOR FIRST CLASS OR BUSINESS CLASS TRAVEL AS TAXABLE TO THE CEO GIVEN THE BUSINESS PURPOSE ASSOCIATED WITH SUCH FLIGHTS.
Schedule J, Part I, Line 4B
IN 2012, THE COMPENSATION AND BENEFITS COMMITTEE ELECTED TO OFFER AN ADDITIONAL EXECUTIVE RETIREMENT PLAN TO CERTAIN EXECUTIVES. THE BOARD APPROVED THIS RECOMMENDATION IN EARLY 2013. BELOW ARE THE PARTICIPANTS AND THE TOTAL AMOUNT CONTRIBUTED TO THE PLAN FOR EACH DURING 2017: DONNA HYLAND - $290,201 RUTH FOWLER - $107,094 DAN SALINAS - $94,641 PAT FRIAS - $119,293 RONALD FRIESON - $40,383 LINDA COLE - $36,541 JILL STRICKLAND - $29,236 LESLIE JONES - $42,224 JIM FORTENBERRY - $36,252 The approved plan called for a five year vesting period, after which payout to participants would occur as outlined in the plan documents. In 2017, payout occurred for participants still employed as of the vesting date (12/31/16). The SERP payout for the participants is reflected in the other reportable compensation amounts included in Sch J, Part II.
Schedule J, Part I, Lines 5a & 5b
EXECUTIVES ARE ELIGIBLE FOR AN ANNUAL INCENTIVE, WHICH INCLUDES A MEASUREMENT FOR ACHIEVEMENT OF BUDGETED OPERATING MARGIN. THESE INCENTIVES ARE CALCULATED AS A CERTAIN PERCENTAGE OF THE EXECUTIVE'S BASE COMPENSATION APPROVED BY THE COMPENSATION AND BENEFITS COMMITTEE.
Schedule J (Form 990) 2017
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