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ObjectId: 201813139349303771 - Submission: 2018-11-09
TIN: 34-0714357
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 Hospital Medical Center of Akron
Employer identification number
34-0714357
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
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
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) 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
WILLIAM CONSIDINE
CHIEF EXECUTIVE OFFICER
(i)
(ii)
1,413,827
-------------
0
450,100
-------------
0
510,390
-------------
0
61,022
-------------
0
21,712
-------------
0
2,457,051
-------------
0
0
-------------
0
2
SHAWN LYDEN
EXECUTIVE VP
(i)
(ii)
613,254
-------------
0
135,100
-------------
0
3,782
-------------
0
18,900
-------------
0
25,355
-------------
0
796,391
-------------
0
0
-------------
0
3
MICHAEL TRAINER
CHIEF FINAN OFFICER/TREASURER
(i)
(ii)
486,453
-------------
0
115,100
-------------
0
6,187
-------------
0
18,900
-------------
0
9,878
-------------
0
636,518
-------------
0
0
-------------
0
4
GRACE WAKULCHIK
PRESIDENT
(i)
(ii)
585,750
-------------
0
150,100
-------------
0
9,544
-------------
0
158,838
-------------
0
15,161
-------------
0
919,393
-------------
0
0
-------------
0
5
JOHN CROW MD
CHAIRMAN,PEDIATRIC SURGERY
(i)
(ii)
1,117,345
-------------
0
0
-------------
0
3,612
-------------
0
18,900
-------------
0
18,804
-------------
0
1,158,661
-------------
0
0
-------------
0
6
NORMAN CHRISTOPHER MD
CHAIRMAN, DEPT OF PEDS
(i)
(ii)
492,777
-------------
0
66,153
-------------
0
5,893
-------------
0
134,250
-------------
0
33,320
-------------
0
732,393
-------------
0
0
-------------
0
7
ROBERT MCGREGOR MD
CHIEF MEDICAL OFFICER
(i)
(ii)
505,374
-------------
0
120,000
-------------
0
3,231
-------------
0
18,900
-------------
0
18,499
-------------
0
666,004
-------------
0
0
-------------
0
8
ANTHEA DANIELS
VP - GENERAL COUNSEL
(i)
(ii)
98,138
-------------
0
25,000
-------------
0
201
-------------
0
0
-------------
0
98
-------------
0
123,437
-------------
0
0
-------------
0
9
LAURA POLLAUF MD
PRESIDENT, MEDICAL STAFF
(i)
(ii)
349,873
-------------
0
10,000
-------------
0
806
-------------
0
112,155
-------------
0
29,784
-------------
0
502,618
-------------
0
0
-------------
0
10
LISA AURILIO
CHIEF OPERATING OFFICER
(i)
(ii)
380,713
-------------
0
100,000
-------------
0
718
-------------
0
95,020
-------------
0
10,702
-------------
0
587,153
-------------
0
0
-------------
0
11
LINDA GENTILE
VP, SUPPORT SERVICES
(i)
(ii)
258,721
-------------
0
51,318
-------------
0
3,078
-------------
0
139,924
-------------
0
20,577
-------------
0
473,618
-------------
0
0
-------------
0
12
WALTER SCHWOEBLE TERM 82017
VP, HUMAN RESOURCES
(i)
(ii)
245,019
-------------
0
108,500
-------------
0
111,553
-------------
0
5,365
-------------
0
20,435
-------------
0
490,872
-------------
0
0
-------------
0
13
CYNTHIA DORMO
VP, DEPT OF PEDS
(i)
(ii)
270,036
-------------
0
54,019
-------------
0
1,727
-------------
0
201,102
-------------
0
10,507
-------------
0
537,391
-------------
0
0
-------------
0
14
SHARON HRINA
VP, MAHONING VALLEY ENTERPRISE
(i)
(ii)
274,835
-------------
0
52,003
-------------
0
3,307
-------------
0
75,678
-------------
0
10,642
-------------
0
416,465
-------------
0
0
-------------
0
15
CRAIG MCGHEE
VP, SURGICAL SUBSPECIALTY
(i)
(ii)
230,756
-------------
0
44,502
-------------
0
1,537
-------------
0
15,702
-------------
0
18,174
-------------
0
310,671
-------------
0
0
-------------
0
16
OLIVER SOLDES MD
PEDIATRIC GENERAL SURGEON
(i)
(ii)
706,986
-------------
0
58,127
-------------
0
3,318
-------------
0
16,200
-------------
0
28,255
-------------
0
812,886
-------------
0
0
-------------
0
17
ANTON MILO MD
DIRECTOR OF ENT
(i)
(ii)
1,341,059
-------------
0
0
-------------
0
7,482
-------------
0
18,900
-------------
0
30,968
-------------
0
1,398,409
-------------
0
0
-------------
0
18
TSULEE CHEN MD
DIRECTOR, NEUROSURGERY
(i)
(ii)
747,285
-------------
0
140,001
-------------
0
703
-------------
0
13,500
-------------
0
10,134
-------------
0
911,623
-------------
0
0
-------------
0
19
SCOTT BOULANGER MD
PEDIATRIC GENERAL SURGEON
(i)
(ii)
754,345
-------------
0
33,750
-------------
0
1,587
-------------
0
16,200
-------------
0
11,439
-------------
0
817,321
-------------
0
0
-------------
0
20
ROBERT PARRY MD
DIRECTOR, GENERAL SURGERY
(i)
(ii)
828,931
-------------
0
75,001
-------------
0
7,482
-------------
0
18,900
-------------
0
29,489
-------------
0
959,803
-------------
0
0
-------------
0
21
LINDA HETSON
VP PROFESSIONAL SERVICES
(i)
(ii)
220,419
-------------
0
39,397
-------------
0
2,978
-------------
0
305,619
-------------
0
10,419
-------------
0
578,832
-------------
0
0
-------------
0
22
BERNETT WILLIAMS
DIRECTOR
(i)
(ii)
245,283
-------------
0
45,135
-------------
0
456
-------------
0
15,977
-------------
0
16,742
-------------
0
323,593
-------------
0
0
-------------
0
23
Harun Rashid
Chief Information Officer
(i)
(ii)
325,777
-------------
0
15,000
-------------
0
2,649
-------------
0
14,211
-------------
0
18,503
-------------
0
376,140
-------------
0
0
-------------
0
24
Christine Young
Chief Nursing Officer
(i)
(ii)
196,247
-------------
0
-------------
0
673
-------------
0
8,137
-------------
0
18,804
-------------
0
223,861
-------------
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
Part I, Line 1a - Fringe or Expense Explanation
William Considine, CEO and Shawn Lyden, Executive VP, had a 2017 country club membership that was used by them for business purposes. William Considine also received grossed up payments for his automobile, life and other insurance payments made by CHMCA.
Part I, Line 4 - Severance, Nonqualified, and Equity Based Payments
William Considine is a participant in the Supplemental Executive Retirement Plan as of January 1, 2010. The Plan is a nonqualified deferred compensation plan. It is an unfunded plan maintained primarily for the purpose of providing deferred compensation benefits. The participant receives credits in the plan for each full calendar year of service and he is 100% vested. The non-qualified deferred payment to William Considine in 2017 was $364,000. Walter Schwoeble, former key employee, received a severance payment of $108,154 during 2017.
Part I, Line 7 - Non Fixed Payments Provided
CHMCA does have contracts with certain physicians that earn bonuses based on Work Relative Value Units (WRVU's). Physicians work RVU: the relative level of time, skill, training and intensity to provide a given service. Each Current Procedural Terminology (CPT) code is targeted for review at least every five years to determine the work RVU for a particular service. A code with a higher RVU work takes more time, more intensity or some combination of the two.
Schedule J (Form 990) 2017
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