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ObjectId: 202423129349302927 - Submission: 2024-11-07
TIN: 23-7383042
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
HENRY FORD HEALTH SYSTEM FOUNDATION
Employer identification number
23-7383042
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
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.
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) 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 G RINEY
TRUSTEE/ PRESIDENT/CEO
(i)
(ii)
0
-------------
2,165,620
0
-------------
1,535,761
0
-------------
766,542
0
-------------
27,441
0
-------------
29,598
0
-------------
4,524,962
0
-------------
0
2
ROBIN S DAMSCHRODER
TREASURER
(i)
(ii)
0
-------------
1,396,213
0
-------------
563,406
0
-------------
447,412
0
-------------
27,441
0
-------------
34,472
0
-------------
2,468,944
0
-------------
0
3
STEVEN N KALKANIS MD
PHYSICIAN TRUSTEE
(i)
(ii)
0
-------------
1,228,969
0
-------------
605,154
0
-------------
240,907
0
-------------
302,685
0
-------------
31,894
0
-------------
2,409,609
0
-------------
191,173
4
WILLIAM W O'NEILLMD
PHYSICIAN TRUSTEE
(i)
(ii)
0
-------------
1,750,977
0
-------------
250,000
0
-------------
31,575
0
-------------
27,441
0
-------------
26,382
0
-------------
2,086,375
0
-------------
0
5
MICHELLE JOHNSON TIDJANI ESQ
SECRETARY (THRU 9/2023)
(i)
(ii)
0
-------------
911,978
0
-------------
367,252
0
-------------
288,559
0
-------------
22,491
0
-------------
25,331
0
-------------
1,615,611
0
-------------
0
6
MARY JANE VOGT
TRUSTEE
(i)
(ii)
0
-------------
539,631
0
-------------
164,018
0
-------------
2,322
0
-------------
93,558
0
-------------
11,753
0
-------------
811,282
0
-------------
0
7
MANU K MALHOTRAMD
PHYSICIAN TRUSTEE
(i)
(ii)
0
-------------
428,954
0
-------------
118,206
0
-------------
162,584
0
-------------
27,441
0
-------------
30,426
0
-------------
767,611
0
-------------
0
8
HENRY W LIM MD
PHYSICIAN TRUSTEE
(i)
(ii)
0
-------------
554,872
0
-------------
0
0
-------------
18,798
0
-------------
27,441
0
-------------
27,127
0
-------------
628,238
0
-------------
0
9
CELESTE WILLIAMS MD
FORMER PHYSICIAN TRUSTEE
(i)
(ii)
0
-------------
410,799
0
-------------
25,368
0
-------------
30,249
0
-------------
27,441
0
-------------
5,109
0
-------------
498,966
0
-------------
0
10
TAMER A GHANEM MD
FORMER PHYSICIAN TRUSTEE
(i)
(ii)
0
-------------
231,392
0
-------------
20,905
0
-------------
43,600
0
-------------
16,109
0
-------------
19,919
0
-------------
331,925
0
-------------
0
11
MARJORIE A STATEN JD
SECRETARY (START 9/2023)
(i)
(ii)
0
-------------
187,185
0
-------------
33,653
0
-------------
2,398
0
-------------
2,866
0
-------------
11,829
0
-------------
237,931
0
-------------
0
12
WILLIAM A CONWAY MD
FORMER PHYSICIAN TRUSTEE
(i)
(ii)
0
-------------
167,405
0
-------------
0
0
-------------
0
0
-------------
11,691
0
-------------
22,684
0
-------------
201,780
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
PART I, LINE 1A
IT IS THE ORGANIZATION'S POLICY TO PAY OR REIMBURSE EMPLOYEES FOR BONAFIDE BUSINESS TRAVEL BASED ON THE MOST COST EFFECTIVE MEANS AVAILABLE. GENERALLY, WHEN AIR TRAVEL IS INVOLVED THIS EQUATES TO COACH CLASS AIR FARE. UNDER CERTAIN CIRCUMSTANCES, SUCH AS WHEN COACH CLASS IS NOT AVAILABLE OR THE TRIP IS OF AN EXTENSIVE DURATION, SENIOR LEADERSHIP HAS APPROVED BUSINESS CLASS, FIRST CLASS OR CHARTER TRAVEL. IN SUCH CIRCUMSTANCES, THE TRAVEL IS CONSIDERED TO BE FOR A BONAFIDE BUSINESS PURPOSE; ACCORDINGLY, NO TAXABLE INCOME IS REPORTED. CERTAIN MEMBERS OF THE ORGANIZATION'S SENIOR LEADERSHIP RECEIVE MEMBERSHIP TO SOCIAL CLUBS INTENDED TO FURTHER THE BUSINESS NEEDS OF THE ORGANIZATION. USAGE IS REIMBURSED ON A CASE-BY-CASE BASIS BASED UPON DOCUMENTATION OF BUSINESS PURPOSE. IN CONNECTION WITH THE RECRUITMENT AND EMPLOYMENT OF LEADERS AND PHYSICIANS, THE ORGANIZATION AGREES AT TIMES TO PROVIDE TEMPORARY HOUSING AND RELOCATION SERVICES. INTERNAL REVENUE SERVICE GUIDELINES ARE ADHERED TO REGARDING THE REPORTING AND TAXATION OF ALL SUCH ITEMS. THE VALUE OF SUCH SERVICES IS ALSO INCLUDED IN THE EVALUATION OF REASONABLE COMPENSATION. CERTAIN MEMBERS OF THE ORGANIZATION'S SENIOR LEADERSHIP TEAM PARTICIPATE IN A SUPPLEMENTAL RETIREMENT PROGRAM THAT RESULTS IN REPORTABLE TAXABLE INCOME AS THE BENEFITS ACCRUE, RATHER THAN AS THEY ARE PAID. THE ORGANIZATION ALSO OFFERS CERTAIN MEMBERS OF LEADERSHIP THE OPTION OF PARTICIPATING IN AN IRC SEC 457 BENEFIT PROGRAM WHICH ALSO RESULTS IN REPORTABLE TAXABLE INCOME AS BENEFITS ACCRUE, RATHER THAN AS THEY ARE PAID. IT IS AN ELEMENT OF THE PLAN DESIGN TO ABSORB THE ADVANCE TAX IMPACT OF THESE PLANS FOR THE PARTICIPANTS. IN SUCH CASES THE RELATED AMOUNTS ARE REPORTED AS TAXABLE INCOME TO THE INDIVIDUAL AND INCLUDED IN THE DETERMINATION OF REASONABLE COMPENSATION. SEE Q. 4B FOR THE REQUIRED LISTING OF THE PARTICIPATING INDIVIDUALS.
PART I, LINE 4B
SCH J, LINE 4B, PERSON PARTICIPATING IN HFHS NONQUALIFIED RETIREMENT PLANS SEC 457(F) - SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) VALUE OF TAXABLE NON TAXABLE REPORTABLE 2023 ACCRUAL NON VESTED DISTRIBUTIONS DISTRIBUTIONS W-2 AMOUNTS PARTICIPANT MICHELLE JOHNSON TIDJANI 220,161 - - - 220,161 STEVEN KALKANIS, M.D. 191,173 275,244 - - 191,173 ROBIN DAMSCHRODER 370,240 - - - 370,240 ROBERT RINEY 736,518 - - - 736,518 MARY JANE VOGT - 66,117 - - - CONTRIBUTIONS TO SEC 457(B)-NON-QUALIFIED DEFERRED COMPENSATION RETIREMENT PLAN EMPLOYEE EMPLOYER MEDICARE REPORTABLE 2023 CONTRIBUTIONS 2023 CONTRIBUTIONS TAX GROSS-UP W-2 AMOUNTS HENRY W. LIM, M.D. - 13,561 326 13,887 TAMER A. GHANEM, M.D. 12,350 - - 12,350 ROBIN DAMSCHRODER 22,500 - - 22,500 CELESTE THOMAS WILLIAMS 16,450 6,050 146 22,646 STEVEN KALKANIS, M.D. 22,500 - - 22,500 MICHELLE JOHNSON TIDJANI 19,904 - - 19,904 WILLIAM O'NEIL, M.D. - 22,500 541 23,041 MANU MALHOTRA, M.D. - 5,162 124 5,286 ROBERT RINEY 22,500 - - 22,500
Schedule J (Form 990) 2023
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