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ObjectId: 202422429349300517 - Submission: 2024-08-29
TIN: 86-0422559
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
23
Open to Public Inspection
Name of the organization
Phoenix Children's Hospital
Employer identification number
86-0422559
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
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) 2023
Page 2
Schedule J (Form 990) 2023
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, 1099-MISC compensation, and/or 1099-NEC
(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
ROBERT L MEYER
DIRECTOR/PRESIDENT & CEO
(i)
(ii)
1,325,223
-------------
0
1,889,823
-------------
0
364,318
-------------
0
13,200
-------------
0
12,170
-------------
0
3,604,734
-------------
0
0
-------------
0
2
BLAKE BULLOCH MD
PRESIDENT, MEDICAL STAFF
(i)
(ii)
541,236
-------------
0
73,147
-------------
0
28,235
-------------
0
13,200
-------------
0
9,808
-------------
0
665,626
-------------
0
0
-------------
0
3
DUSTIN RAYHORN MD
VP, MEDICAL STAFF
(i)
(ii)
229,913
-------------
0
13,102
-------------
0
12,436
-------------
0
8,992
-------------
0
11,413
-------------
0
275,856
-------------
0
0
-------------
0
4
KARI CORNICELLI
EVP & CFO/TREASURER (TERMED 08/22)
(i)
(ii)
0
-------------
0
345,481
-------------
0
236,635
-------------
0
0
-------------
0
0
-------------
0
582,116
-------------
0
0
-------------
0
5
MICHELLE BRUHN
EVP & CFO/TREASURER (START 08/23)
(i)
(ii)
294,419
-------------
0
0
-------------
0
63,793
-------------
0
0
-------------
0
3,666
-------------
0
361,878
-------------
0
0
-------------
0
6
DENNIS BRUNS
EVP & CFO/TREASURER (TERMED 07/23)
(i)
(ii)
850,000
-------------
0
0
-------------
0
0
-------------
0
6,000
-------------
0
0
-------------
0
856,000
-------------
0
0
-------------
0
7
CARMEN NEUBERGER
SVP/GENERAL COUNSEL/SECRETARY
(i)
(ii)
529,044
-------------
0
566,800
-------------
0
137,220
-------------
0
13,200
-------------
0
11,911
-------------
0
1,258,175
-------------
0
0
-------------
0
8
PAGE BACHMAN
SVP, HUMAN RESOURCES (TERMED 05/22)
(i)
(ii)
0
-------------
0
138,717
-------------
0
38,365
-------------
0
0
-------------
0
0
-------------
0
177,082
-------------
0
0
-------------
0
9
BETSY KUZAS
SVP, CONSTRUCTION & SPECIAL PROJECTS (TERMED 12/21)
(i)
(ii)
0
-------------
0
88,667
-------------
0
14,615
-------------
0
0
-------------
0
154
-------------
0
103,436
-------------
0
0
-------------
0
10
KETY DURON
SVP, HUMAN RESOURCES
(i)
(ii)
452,075
-------------
0
90,733
-------------
0
45,669
-------------
0
13,200
-------------
0
8,100
-------------
0
609,777
-------------
0
0
-------------
0
11
DAVID HIGGINSON
EXECUTIVE VP & COO
(i)
(ii)
582,857
-------------
0
638,388
-------------
0
135,638
-------------
0
4,000
-------------
0
16,779
-------------
0
1,377,662
-------------
0
0
-------------
0
12
CHAD JOHNSON
SVP, PCCN
(i)
(ii)
399,042
-------------
0
293,625
-------------
0
28,543
-------------
0
13,200
-------------
0
16,278
-------------
0
750,688
-------------
0
0
-------------
0
13
TAMRA KAPLAN
SVP, OPERATIONS
(i)
(ii)
334,254
-------------
0
220,590
-------------
0
32,200
-------------
0
7,500
-------------
0
18,909
-------------
0
613,453
-------------
0
0
-------------
0
14
RUSS KORCUSKA
SVP, CONSTRUCTION & SPECIAL PROJECTS
(i)
(ii)
344,177
-------------
0
242,667
-------------
0
27,087
-------------
0
13,200
-------------
0
14,778
-------------
0
641,909
-------------
0
0
-------------
0
15
RICH LEHMUTH
SVP, STRATEGIC PLANNING
(i)
(ii)
434,384
-------------
0
348,800
-------------
0
30,617
-------------
0
13,200
-------------
0
7,257
-------------
0
834,258
-------------
0
0
-------------
0
16
BRIAN MEYER
SVP/CIO
(i)
(ii)
403,034
-------------
0
320,000
-------------
0
51,683
-------------
0
9,000
-------------
0
16,419
-------------
0
800,136
-------------
0
0
-------------
0
17
JARED MUENZER MD
SVP, COO, PCMG
(i)
(ii)
670,688
-------------
0
572,180
-------------
0
139,978
-------------
0
12,857
-------------
0
12,698
-------------
0
1,408,401
-------------
0
0
-------------
0
18
MARK GERBER MD
DIVISION CHIEF
(i)
(ii)
872,156
-------------
0
214,712
-------------
0
41,677
-------------
0
13,200
-------------
0
15,219
-------------
0
1,156,964
-------------
0
0
-------------
0
19
MARK MOLITOR JR MD
STAFF PHYSICIAN
(i)
(ii)
838,150
-------------
0
402,212
-------------
0
32,634
-------------
0
13,200
-------------
0
17,871
-------------
0
1,304,067
-------------
0
0
-------------
0
20
DAVID NOTRICA MD
PEDIATRIC SURGEON
(i)
(ii)
825,860
-------------
0
279,760
-------------
0
39,340
-------------
0
8,571
-------------
0
17,372
-------------
0
1,170,903
-------------
0
0
-------------
0
21
DANIEL OSTLIE MD
SURGEON IN CHIEF
(i)
(ii)
949,113
-------------
0
375,562
-------------
0
155,511
-------------
0
10,728
-------------
0
18,505
-------------
0
1,509,419
-------------
0
0
-------------
0
22
DANIEL VELEZ MD
STAFF PHYSICIAN
(i)
(ii)
1,456,526
-------------
0
111,201
-------------
0
36,589
-------------
0
13,200
-------------
0
14,398
-------------
0
1,631,914
-------------
0
0
-------------
0
Schedule J (Form 990) 2023
Page 3
Schedule J (Form 990) 2023
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
Schedule J, Part I, Line 4a Severance or change-of-control payment
SEVERANCE PAYMENTS WERE MADE IN 2023 TO: BETSY KUZAS - $14,615 KARI CORNICELLI - $236,635 PAGE BACHMAN - $38,365 THESE AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(III) AS OTHER REPORTABLE COMPENSATION.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
PHOENIX CHILDREN'S HOSPITAL OFFERS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO CERTAIN EXECUTIVES OF THE ORGANIZATION. ELIGIBLE PARTICIPANTS ARE SELECTED BY THE BOARD OF DIRECTORS. PARTICIPANT VESTING OCCURS UPON RETIREMENT, DISABILITY BEFORE SEPARATION, INVOLUNTARY SEPARATION (OTHER THAN FOR CAUSE) OR DEATH. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SERP PLAN DURING 2023 AND THEIR DEFERRED COMPENSATION AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C): RUSS KORCUSKA RICH LEHMUTH CHAD JOHNSON DANIEL OSTLIE, MD THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SERP PLAN AND RECEIVED TAXABLE SERP PAYOUTS DURING 2023 THAT ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AS OTHER REPORTABLE COMPENSATION: ROBERT L. MEYER - $321,405 CARMEN NEUBERGER - $94,302 KETY DURON - $8,788 DAVID HIGGINSON - $104,654 BRIAN MEYER - $23,285 JARED MUENZER, MD - $110,481 DANIEL OSTLIE, MD - $114,186
Schedule J, Part I, Line 7 Non-fixed payments
CERTAIN EXECUTIVES WERE ELIGIBLE FOR THE DISCRETIONARY EXECUTIVE INCENTIVE PLAN OF PHOENIX CHILDREN'S HOSPITAL IN WHICH ONE OF THE PERFORMANCE MEASURES WAS EARNINGS BEFORE INTEREST, DEPRECIATION AND AMORTIZATION. THIS INCENTIVE PLAN WAS APPROVED BY THE COMPENSATION COMMITTEE.
Schedule J, Part II ADDITIONAL INFORMATION
DUSTIN RAYHORN, MD AND BLAKE BULLOCH, MD RECEIVED COMPENSATION FOR MEDICAL SERVICES RENDERED IN THE CAPACITY OF STAFF PHYSICIAN FOR PHOENIX CHILDREN'S HOSPITAL, NOT FOR THEIR DUTIES AS BOARD MEMBERS.
Schedule J (Form 990) 2023
Additional Data
Software ID:
23017437
Software Version:
2023v5.1