Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Rex Hospital Inc
 
Employer identification number

56-1509260
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.
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.
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
Yes
 
b
Any related organization? ......................
6b
Yes
 
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) 2020
Page 2

Schedule J (Form 990) 2020
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
1GARY L PARK
CEO
(i)

(ii)
0
-------------
967,959
0
-------------
1,301,938
0
-------------
505,125
0
-------------
646,149
0
-------------
12,691
0
-------------
3,433,862
0
-------------
505,125
2MATEEN AKHTAR
PHYSICIAN
(i)

(ii)
1,516,422
-------------
0
198,034
-------------
0
0
-------------
0
4,596
-------------
0
16,377
-------------
0
1,735,429
-------------
0
0
-------------
0
3BENJAMIN ATKESON
PHYSICIAN
(i)

(ii)
1,190,758
-------------
0
454,236
-------------
0
0
-------------
0
13,000
-------------
0
15,062
-------------
0
1,673,056
-------------
0
0
-------------
0
4DEEPAK PASI
PHYSICIAN
(i)

(ii)
1,413,173
-------------
0
218,232
-------------
0
0
-------------
0
13,000
-------------
0
21,247
-------------
0
1,665,652
-------------
0
0
-------------
0
5JOSEPH FALSONE
PHYSICIAN
(i)

(ii)
1,367,674
-------------
0
248,382
-------------
0
0
-------------
0
12,408
-------------
0
20,460
-------------
0
1,648,924
-------------
0
0
-------------
0
6MOHIT PASI
PHYSICIAN
(i)

(ii)
1,286,643
-------------
0
306,094
-------------
0
0
-------------
0
11,474
-------------
0
20,460
-------------
0
1,624,671
-------------
0
0
-------------
0
7ERNEST L BOVIO JR
PRESIDENT
(i)

(ii)
576,278
-------------
0
143,174
-------------
0
6,468
-------------
0
103,000
-------------
0
21,360
-------------
0
850,280
-------------
0
0
-------------
0
8KIRSTEN RIGGS
COO
(i)

(ii)
318,422
-------------
0
85,241
-------------
0
6,380
-------------
0
53,239
-------------
0
21,205
-------------
0
484,487
-------------
0
0
-------------
0
9ANDREW K ZUKOWSKI
CFO & TREASURER
(i)

(ii)
354,964
-------------
0
75,601
-------------
0
530
-------------
0
54,750
-------------
0
20,460
-------------
0
506,305
-------------
0
0
-------------
0
10LINDA H BUTLER MD
VP/MEDICAL AFFAIRS, CMO & CMIO
(i)

(ii)
441,336
-------------
0
93,402
-------------
0
6,065
-------------
0
71,499
-------------
0
22,020
-------------
0
634,322
-------------
0
0
-------------
0
11JOEL D RAY
VP/PATIENT CARE SVCS & CNO
(i)

(ii)
311,294
-------------
0
64,870
-------------
0
1,456
-------------
0
49,528
-------------
0
290
-------------
0
427,438
-------------
0
0
-------------
0
12TATE BOMBARD
VP/GENERAL COUNSEL & SECRETARY
(i)

(ii)
0
-------------
257,692
0
-------------
57,438
0
-------------
81
0
-------------
34,758
0
-------------
21,205
0
-------------
371,174
0
-------------
0
13SYLVIA D HACKETT
VP/REX HEALTHCARE FOUNDATION
(i)

(ii)
296,041
-------------
0
62,505
-------------
0
15,770
-------------
0
52,635
-------------
0
13,258
-------------
0
440,209
-------------
0
0
-------------
0
14TIMOTHY M HESTER
VP
(i)

(ii)
202,443
-------------
0
41,469
-------------
0
 
-------------
0
8,205
-------------
0
22,020
-------------
0
274,137
-------------
0
0
-------------
0
15SUSAN G MOORE
VP/UNC REX PHYSICIANS
(i)

(ii)
515,383
-------------
0
144,805
-------------
0
5,795
-------------
0
64,294
-------------
0
21,205
-------------
0
751,482
-------------
0
0
-------------
0
16ROBERT D RICKER
VP/PHYSICIAN SERVICES
(i)

(ii)
276,692
-------------
0
58,615
-------------
0
10,689
-------------
0
89,644
-------------
0
12,945
-------------
0
448,585
-------------
0
0
-------------
0
17SEAN T TEHRANI MD
VP/REGIONAL HOSPITALISTS SERVI
(i)

(ii)
406,718
-------------
0
106,835
-------------
0
181,248
-------------
0
54,996
-------------
0
17,181
-------------
0
766,978
-------------
0
0
-------------
0
18ROY C TEMPKE
VP
(i)

(ii)
232,788
-------------
0
45,452
-------------
0
5,927
-------------
0
27,154
-------------
0
21,229
-------------
0
332,550
-------------
0
0
-------------
0
19BENJAMIN J MATHEW
ASST Treasury & ASST SECRETARY
(i)

(ii)
0
-------------
158,046
0
-------------
14,605
0
-------------
650
0
-------------
5,079
0
-------------
15,724
0
-------------
194,104
0
-------------
0
20A WESLEY BURKS MD
DIRECTOR
(i)

(ii)
0
-------------
948,107
0
-------------
1,538,262
0
-------------
12,600
0
-------------
556,149
0
-------------
12,691
0
-------------
3,067,809
0
-------------
0
21STEPHEN W BURRISS
DIRECTOR
(i)

(ii)
0
-------------
764,204
0
-------------
537,287
0
-------------
278,424
0
-------------
180,308
0
-------------
13,708
0
-------------
1,773,931
0
-------------
0
22RIG S PATEL MD
DIRECTOR
(i)

(ii)
785,340
-------------
0
25,345
-------------
0
650
-------------
0
13,000
-------------
0
21,360
-------------
0
845,695
-------------
0
0
-------------
0
Schedule J (Form 990) 2020
Page 3

Schedule J (Form 990) 2020
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: THE ORGANIZATION OFFERS COMPLIMENTARY MEMBERSHIPS TO REX WELLNESS CENTERS FOR THE EXECUTIVE STAFF, BOTH ACTIVE AND RETIRED BOARD MEMBERS AND MEDICAL DIRECTORS. ALL MEMBERS RECEIVING COMPLIMENTARY MEMBERSHIPS ARE REQUIRED TO COMPLETE THE SAME APPLICATION AND TESTING PROCEDURES AS OTHER MEMBERS. CURRENTLY, THERE ARE 10 INDIVIDUALS LISTED THAT RECEIVE COMPLIMENTARY MEMBERSHIPS. THE VALUE OF THE COMPLIMENTARY MEMBERSHIP IS TREATED AS TAXABLE COMPENSATION AND IS REPORTED ON THE INDIVIDUAL'S W-2.
Part I, Line 4A & 4B: SEAN TEHRANI, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $96,456. GARY PARK RECEIVED DISTRIBUTIONS TOTALING $505,125 FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN FUNDED AND CONTROLLED BY A RELATED ORGANIZATION, UNC HCS.
Part I, Line 6: EMPLOYEES IN MANAGERIAL ROLES PARTICIPATE IN AN ANNUAL INCENTIVE COMPENSATION PLAN. THE COMPENSATION EARNED UNDER THIS PLAN IS BASED PARTLY ON THE COMBINED EARNINGS OF REX HEALTHCARE INC. AND ITS SUBSIDIARIES. ADDITIONALLY, THE INCENTIVE COMPENSATION OF THE PRESIDENT AND CFO IS BASED PARTLY ON THE EARNINGS OF THE UNC HEALTH CARE SYSTEM. OTHER performance MEASURES USED TO DETERMINE INCENTIVE COMPENSATION ARE PHYSICIAN SATISFACTION, PATIENT CARE QUALITY OUTCOMES, EFFECTIVE USE OF TECHNOLOGY AND INDIVIDUAL GOALS.
Schedule J (Form 990) 2020

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