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ObjectId: 202112289349300901 - Submission: 2021-08-16
TIN: 04-2774441
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
19
Open to Public Inspection
Name of the organization
Children's Hospital Corporation
Employer identification number
04-2774441
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
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
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) 2019
Page 2
Schedule J (Form 990) 2019
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
Sandra Fenwick
CEO, Noncomp Director
(i)
(ii)
1,346,647
-------------
0
1,100,000
-------------
0
560,098
-------------
0
28,000
-------------
0
46,520
-------------
0
3,081,265
-------------
0
0
-------------
0
2
Kevin Churchwell MD
President & COO/Noncomp Director
(i)
(ii)
892,672
-------------
0
600,000
-------------
0
410,440
-------------
0
22,400
-------------
0
52,839
-------------
0
1,978,351
-------------
0
0
-------------
0
3
Doug Vanderslice
EVP, Treasurer & CFO
(i)
(ii)
792,869
-------------
0
396,900
-------------
0
304,249
-------------
0
22,400
-------------
0
46,221
-------------
0
1,562,639
-------------
0
0
-------------
0
4
Philip Rotner
Chief Investment Officer
(i)
(ii)
680,529
-------------
0
585,152
-------------
0
162,341
-------------
0
22,400
-------------
0
35,380
-------------
0
1,485,802
-------------
0
0
-------------
0
5
Michele Garvin Esq
General Counsel & Secretary
(i)
(ii)
614,302
-------------
0
318,212
-------------
0
123,531
-------------
0
22,400
-------------
0
39,685
-------------
0
1,118,130
-------------
0
0
-------------
0
6
James E Lock MD
Former Chief of Cardiology
(i)
(ii)
2,862
-------------
0
0
-------------
0
839,640
-------------
0
0
-------------
0
0
-------------
0
842,502
-------------
0
0
-------------
0
7
Demosthenes Argys
SVP, & Chief Administrative Officer
(i)
(ii)
506,969
-------------
0
166,372
-------------
0
90,582
-------------
0
25,200
-------------
0
20,318
-------------
0
809,441
-------------
0
0
-------------
0
8
Wendy Warring
SVP, Network Development
(i)
(ii)
497,153
-------------
0
154,744
-------------
0
84,113
-------------
0
25,200
-------------
0
20,548
-------------
0
781,758
-------------
0
0
-------------
0
9
Lynn Susman
President, Children's Hospital Trust
(i)
(ii)
452,020
-------------
0
165,242
-------------
0
80,109
-------------
0
30,800
-------------
0
28,487
-------------
0
756,658
-------------
0
0
-------------
0
10
Daniel Nigrin MD
SVP & Chief Information Officer
(i)
(ii)
482,952
-------------
0
149,700
-------------
0
83,311
-------------
0
22,400
-------------
0
16,495
-------------
0
754,858
-------------
0
0
-------------
0
11
Cynthia Haines
SVP, International Service
(i)
(ii)
461,593
-------------
0
146,210
-------------
0
83,828
-------------
0
19,600
-------------
0
26,741
-------------
0
737,972
-------------
0
0
-------------
0
12
Nader Rifai PhD
Director, Chemistry
(i)
(ii)
464,848
-------------
0
211,057
-------------
0
13,505
-------------
0
30,800
-------------
0
12,848
-------------
0
733,058
-------------
0
0
-------------
0
13
Laura J Wood DNP MS RN
SVP, Chief Nursing Officer
(i)
(ii)
455,449
-------------
0
142,629
-------------
0
84,207
-------------
0
25,200
-------------
0
25,224
-------------
0
732,709
-------------
0
0
-------------
0
14
Martin Kelly
Director, Investments
(i)
(ii)
378,482
-------------
0
307,653
-------------
0
1,910
-------------
0
22,400
-------------
0
19,547
-------------
0
729,992
-------------
0
0
-------------
0
15
Lisa Hogarty
SVP, RE Planning and Development
(i)
(ii)
434,771
-------------
0
138,455
-------------
0
77,808
-------------
0
19,600
-------------
0
26,652
-------------
0
697,286
-------------
0
0
-------------
0
16
Reginald Stover
VP, Human Resources
(i)
(ii)
473,200
-------------
0
123,000
-------------
0
69,689
-------------
0
0
-------------
0
18,054
-------------
0
683,943
-------------
0
18,500
-------------
0
17
Michael Gillespie
VP, Clinical Services
(i)
(ii)
389,020
-------------
0
97,419
-------------
0
65,604
-------------
0
22,400
-------------
0
14,310
-------------
0
588,753
-------------
0
0
-------------
0
18
August Cervini
VP, Research Administration
(i)
(ii)
286,397
-------------
0
92,974
-------------
0
48,648
-------------
0
16,800
-------------
0
23,290
-------------
0
468,109
-------------
0
0
-------------
0
19
Patricia Hickey PhD MBA RN NEA-BC
VP, Cardiovascular Service
(i)
(ii)
344,436
-------------
0
43,326
-------------
0
24,027
-------------
0
33,600
-------------
0
6,889
-------------
0
452,278
-------------
0
0
-------------
0
20
Bruce Balter
Asst Treasurer/Dir Corp Finance
(i)
(ii)
242,681
-------------
0
15,527
-------------
0
16,607
-------------
0
33,600
-------------
0
19,024
-------------
0
327,439
-------------
0
0
-------------
0
Schedule J (Form 990) 2019
Page 3
Schedule J (Form 990) 2019
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, Lines 4a-b
Boston Children's Hospital made contributions to the supplemental non-qualified retirement plan for the individuals listed below. Contribution amounts are generally based on a percentage of compensation. Participants of the supplemental executive retirement plan are fully vested. All payments with respect to a participant's separation from service will be made in a single sum following the separation from service unless participant has elected to receive the accrued interest portion of his or her account in three annual installments. Contributions were for employee benefits and not for Boston Children's Hospital Director or Officer of the Board services and/or responsibilities. Demosthenes Argys, received in 2019, a contribution of $59,639 August Cervini, received in 2019, a contribution of $26,004 Kevin Churchwell, received in 2019, a contribution of $284,000 Sandra Fenwick, received in 2019, a contribution of $516,000 Michele Garvin, received in 2019, a contribution of $87,913 Michael Gillespie, received in 2019, a contribution of $37,275 Cynthia Haines, received in 2019, a contribution of $53,353 Lisa Hogarty, received in 2019, a contribution of $47,988 Daniel Nigrin, received in 2019, a contribution of $56,223 Philip Rotner, received in 2019, a contribution of $137,638 Reginald Stover, received in 2019, a contribution of $12,704 Lynn Susman, received in 2019, a contribution of $52,414 Doug Vanderslice, received in 2019, a contribution of $206,411 Wendy Warring, received in 2019, a contribution of $55,888 Laura Wood, received in 2019, a contribution of $53,509 During Calendar Year 2019, the following individuals received supplemental executive retirement plan distributions: Reginald Stover, received in 2019, a distribution of $69,689 During Calendar Year 2019, the following individuals received severance payments: Reginald Stover, received in 2019, a severance payment of $205,000 James Lock, MD, received in 2019, a severance payment of $839,570
Schedule J (Form 990) 2019
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