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ObjectId: 201813189349301591 - Submission: 2018-11-14
TIN: 34-0714585
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.
Information about Schedule J (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
17
Open to Public Inspection
Name of the organization
THE CLEVELAND CLINIC FOUNDATION
Employer identification number
34-0714585
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
COSGROVE DELOS M MD
DIRECTOR, PRESIDENT, CEO
(i)
(ii)
7,194,679
-------------
0
0
-------------
0
468,104
-------------
0
-51,339
-------------
0
17,492
-------------
0
7,628,936
-------------
0
0
-------------
0
2
DONLEY BRIAN G MD
DIRECTOR & CHIEF OF STAFF
(i)
(ii)
1,299,141
-------------
0
0
-------------
0
125,894
-------------
0
27,000
-------------
0
20,030
-------------
0
1,472,065
-------------
0
0
-------------
0
3
PHILLIPS MICHEAL MD
PHYSICIAN, DIRECTOR
(i)
(ii)
198,260
-------------
0
0
-------------
0
8,727
-------------
0
19,036
-------------
0
4,482
-------------
0
230,505
-------------
0
0
-------------
0
4
YERIAN LISA MD
PHYSICIAN, DIRECTOR - CCF
(i)
(ii)
343,739
-------------
0
0
-------------
0
8,175
-------------
0
27,000
-------------
0
20,782
-------------
0
399,696
-------------
0
0
-------------
0
5
ZEIN NIZAR MD
PHYSICIAN, DIRECTOR - CCF
(i)
(ii)
517,288
-------------
0
0
-------------
0
27,354
-------------
0
27,000
-------------
0
25,415
-------------
0
597,057
-------------
0
0
-------------
0
6
ERZURUM SERPIL MD
CHAIR OF RESEARCH INST
(i)
(ii)
551,010
-------------
0
0
-------------
0
32,600
-------------
0
925,584
-------------
0
1,490
-------------
0
1,510,684
-------------
0
0
-------------
0
7
GLASS STEVEN C
CFO & TREASURER
(i)
(ii)
1,464,141
-------------
0
0
-------------
0
141,647
-------------
0
34,900
-------------
0
18,030
-------------
0
1,658,718
-------------
0
0
-------------
0
8
HARRINGTON MICHAEL
CAO & CONTROLLER
(i)
(ii)
693,381
-------------
0
0
-------------
0
64,216
-------------
0
27,000
-------------
0
18,830
-------------
0
803,427
-------------
0
0
-------------
0
9
MEEHAN MICHAEL
RECORDING SECRETARY
(i)
(ii)
320,679
-------------
0
0
-------------
0
33,495
-------------
0
83,007
-------------
0
17,492
-------------
0
454,673
-------------
0
0
-------------
0
10
OBLANDER JASON
ASSISTANT SECRETARY
(i)
(ii)
204,933
-------------
0
0
-------------
0
1,846
-------------
0
7,337
-------------
0
14,613
-------------
0
228,729
-------------
0
0
-------------
0
11
PEACOCK WILLIAM
CHIEF OF OPERATIONS
(i)
(ii)
1,416,963
-------------
0
0
-------------
0
119,076
-------------
0
29,201
-------------
0
18,208
-------------
0
1,583,448
-------------
0
0
-------------
0
12
ROWAN DAVID W
SECRETARY & CHIEF LEGAL OFFICER
(i)
(ii)
1,343,989
-------------
0
0
-------------
0
135,423
-------------
0
27,000
-------------
0
19,182
-------------
0
1,525,594
-------------
0
0
-------------
0
13
MIHALJEVIC TOMISLAV
CHIEF EXEC OFFICER - CCAD
(i)
(ii)
1,321,758
-------------
0
0
-------------
0
763,509
-------------
0
27,000
-------------
0
108,916
-------------
0
2,221,183
-------------
0
0
-------------
0
14
MODIC MD MICHAEL
INSTITUTE CHAIR, PHYSICIAN (RETIREE)
(i)
(ii)
986,744
-------------
0
0
-------------
0
1,617,303
-------------
0
69,715
-------------
0
20,042
-------------
0
2,693,804
-------------
0
0
-------------
0
15
EINSTEIN DAVID
PHYSICIAN (RETIREE)
(i)
(ii)
415,327
-------------
0
0
-------------
0
1,385,749
-------------
0
214,326
-------------
0
9,936
-------------
0
2,025,338
-------------
0
0
-------------
0
16
NAJM HANI
PHYSICIAN
(i)
(ii)
1,486,463
-------------
0
0
-------------
0
272,194
-------------
0
27,000
-------------
0
22,275
-------------
0
1,807,932
-------------
0
0
-------------
0
17
SINGER ANNE
PHYSICIAN (RETIREE)
(i)
(ii)
95,117
-------------
0
0
-------------
0
1,610,523
-------------
0
11,340
-------------
0
1,724
-------------
0
1,718,704
-------------
0
0
-------------
0
18
SURI RAKESH
CHIEF OF STAFF
(i)
(ii)
1,217,650
-------------
0
0
-------------
0
466,375
-------------
0
27,000
-------------
0
119,283
-------------
0
1,830,308
-------------
0
0
-------------
0
19
HAMILTON THOMAS
FORMER OFFICER
(i)
(ii)
399,457
-------------
0
0
-------------
0
21,786
-------------
0
159,971
-------------
0
19,529
-------------
0
600,743
-------------
0
0
-------------
0
20
MCHUGH LINDA
FORMER OFFICER
(i)
(ii)
732,887
-------------
0
0
-------------
0
70,353
-------------
0
38,705
-------------
0
17,097
-------------
0
859,042
-------------
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
LISTED BENEFITS THE BENEFITS CHECKED IN PART I, QUESTION 1A, WERE PROVIDED TO CERTAIN PERSONS LISTED IN FORM 990, PART VII, SECTION A ON AN EXCEPTION BASIS ONLY FOR AN APPROPRIATE BUSINESS PURPOSE. ANY REIMBURSEMENT OF THE EXPENSES LISTED MET CLEVELAND CLINIC'S WRITTEN POLICY REGARDING SUBSTANTIATION AND REIMBURSEMENT. WHERE REQUIRED BY IRS RULES AND REGULATIONS, THE LISTED BENEFITS WERE INCLUDED IN TAXABLE INCOME.
PART I, LINE 4B
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DAVID EINSTEIN- PARTICIPATED IN AND RECEIVED PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. FOR MEDICARE TAX PURPOSES, $1,353,959 OF INCOME REPORTED IN PART VII AND SCHEDULE J REPRESENT THE AMOUNT VESTED IN THE PLAN. ANNE SINGER - PARTICIPATED IN AND RECEIVED PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. FOR MEDICARE TAX PURPOSES, $1,591,884 OF INCOME REPORTED IN PART VII AND SCHEDULE J REPRESENT THE AMOUNT VESTED IN THE PLAN. MICHAEL MODIC - PARTICIPATED IN AND RECEIVED PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. FOR MEDICARE TAX PURPOSES, $1,514,049 OF INCOME REPORTED IN PART VII AND SCHEDULE J REPRESENT THE AMOUNT VESTED IN THE PLAN. DELOS M. COSGROVE - PARTICIPATES IN A SPLIT DOLLAR LIFE INSURANCE PLAN FROM WHICH NO CASH PAYMENTS WERE RECEIVED. DR COSGROVE'S 2017 BASE SALARY INCLUDES A SINGLE, FIXED ANNUAL PAYMENT WHICH IS INTENDED TO OFFSET THE DILUTION IN THE ACTUARIAL VALUE OF HIS SUPPLEMENTAL RETIREMENT PLAN. THIS DILUTION IS A RESULT OF DR COSGROVE WORKING BEYOND HIS EXPECTED RETIREMENT AGE AS DEFINED BY THE PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATE IN A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND THE ANNUAL INCREASE OR DECREASE IN THE ACTUARIAL VALUE IS INCLUDED IN SCHEDULE J, PART II, COLUMN C, RETIREMENT AND OTHER DEFERRED COMPENSATION: DELOS M. COSGROVE - $78,339 DECREASE, DAVID EINSTEIN - $187,326 INCREASE, SERPIL ERZURUM - $898,584 INCREASE, THOMAS HAMILTON - $133,426 INCREASE, MICHAEL J. MEEHAN - $56,007 INCREASE, AND MICHAEL MODIC $42,715 INCREASE. THE FOLLOWING INDIVIDUALS PARTICIPATE IN A QUALIFIED DEFINED BENEFIT PLAN AND THE ANNUAL INCREASE OR DECREASE IN THE ACTUARIAL VALUE IS INCLUDED IN SCHEDULE J, PART II, COLUMN C, RETIREMENT AND OTHER DEFERRED COMPENSATION: STEVEN C. GLASS - $7,900 INCREASE, LINDA MCHUGH - $11,705 INCREASE, JASON OBLANDER - $1,007 INCREASE AND WILLIAM PEACOCK - $2,201 INCREASE.
Schedule J (Form 990) 2017
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