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Nonprofiteer
← CHMC SURGICAL FOUNDATION INC

Form 990 for tax year 2022

Filed by CHMC SURGICAL FOUNDATION INC.

Totals

Total revenue
$59,885,653
Total expenses
$42,419,465
Contributions and grants received
$274,142
Grants paid
$25,164
Program services expenses (Part IX)
$38,602,552
Management and general expenses
$3,816,913
Fundraising expenses
$0
Program service expenses (Part III)
$38,602,552

Program services were 91.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • Steven J Fishman MD

    President

    Total calculated
    $1,669,547
    From this org
    $1,561,228
    From related orgs
    $0
    Other
    $108,319
    Hours/week
    55 + 5 related

    Schedule J breakdown matched by us

    Base
    $1,226,000
    Bonus
    $273,829
    Other
    $61,399
    Deferred
    $61,000
    Nontaxable benefits
    $47,319
    Filer's total
    $1,669,547

  • Heung Bae Kim MD

    Clerk

    Total calculated
    $1,148,387
    From this org
    $1,038,272
    From related orgs
    $0
    Other
    $110,115
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $743,316
    Bonus
    $243,477
    Other
    $51,479
    Deferred
    $61,000
    Nontaxable benefits
    $49,115
    Filer's total
    $1,148,387

  • Tom Jaksic MD

    Treasurer

    Total calculated
    $919,946
    From this org
    $813,084
    From related orgs
    $0
    Other
    $106,862
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $702,608
    Bonus
    $48,610
    Other
    $61,866
    Deferred
    $61,000
    Nontaxable benefits
    $45,862
    Filer's total
    $919,946

  • Craig W Lillehei MD

    Director (10/22-2/23)

    Total calculated
    $717,704
    From this org
    $610,698
    From related orgs
    $0
    Other
    $107,006
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $523,793
    Bonus
    $49,979
    Other
    $36,926
    Deferred
    $61,000
    Nontaxable benefits
    $46,006
    Filer's total
    $717,704

  • Shawn J Rangel MD

    Director (2/23-9/23)

    Total calculated
    $944,892
    From this org
    $837,661
    From related orgs
    $0
    Other
    $107,231
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $528,984
    Bonus
    $261,794
    Other
    $46,883
    Deferred
    $61,000
    Nontaxable benefits
    $46,231
    Filer's total
    $944,892

  • Biren P Modi MD

    Director

    Total calculated
    $1,150,892
    From this org
    $900,615
    From related orgs
    $0
    Other
    $250,277
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $548,633
    Bonus
    $308,063
    Other
    $43,919
    Deferred
    $202,284
    Nontaxable benefits
    $47,993
    Filer's total
    $1,150,892

  • Brent Weil MD

    Director

    Total calculated
    $1,133,854
    From this org
    $850,601
    From related orgs
    $0
    Other
    $283,253
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $478,137
    Bonus
    $319,941
    Other
    $52,523
    Deferred
    $194,525
    Nontaxable benefits
    $88,728
    Filer's total
    $1,133,854

  • Jill M Zalieckas MD

    Director (10/22-2/23)

    Total calculated
    $949,951
    From this org
    $697,668
    From related orgs
    $0
    Other
    $252,283
    Hours/week
    48

    Schedule J breakdown matched by us

    Base
    $386,844
    Bonus
    $266,186
    Other
    $44,638
    Deferred
    $204,868
    Nontaxable benefits
    $47,415
    Filer's total
    $949,951

  • Terry L Buchmiller MD

    Director (2/23-9/23)

    Total calculated
    $1,162,559
    From this org
    $1,081,150
    From related orgs
    $0
    Other
    $81,409
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $713,128
    Bonus
    $322,360
    Other
    $45,662
    Deferred
    $61,000
    Nontaxable benefits
    $20,409
    Filer's total
    $1,162,559

  • Physicians Org at CH Inc

    Institutional Trustee

    Total calculated
    $0
    Hours/week
    2

  • Marc R Laufer MD

    Dept. Chief

    Total calculated
    $1,055,847
    From this org
    $946,958
    From related orgs
    $0
    Other
    $108,889
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $853,421
    Bonus
    $50,493
    Other
    $43,044
    Deferred
    $61,000
    Nontaxable benefits
    $47,889
    Filer's total
    $1,055,847

  • Konstantinos Papadakis MD

    Physician

    Total calculated
    $1,021,944
    From this org
    $912,779
    From related orgs
    $0
    Other
    $109,165
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $578,023
    Bonus
    $287,696
    Other
    $47,060
    Deferred
    $61,000
    Nontaxable benefits
    $48,165
    Filer's total
    $1,021,944

  • Benjamin Zendejas-Mummert MD

    Physician

    Total calculated
    $1,090,841
    From this org
    $831,027
    From related orgs
    $0
    Other
    $259,814
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $451,983
    Bonus
    $318,154
    Other
    $60,890
    Deferred
    $193,011
    Nontaxable benefits
    $66,803
    Filer's total
    $1,090,841

  • Belinda Hsi Dickie MD

    Physician

    Total calculated
    $1,124,550
    From this org
    $848,562
    From related orgs
    $0
    Other
    $275,988
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $494,664
    Bonus
    $287,508
    Other
    $66,390
    Deferred
    $203,145
    Nontaxable benefits
    $72,843
    Filer's total
    $1,124,550

  • Farokh R Demehri MD

    Physician

    Total calculated
    $1,023,611
    From this org
    $791,105
    From related orgs
    $0
    Other
    $232,506
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $457,541
    Bonus
    $266,186
    Other
    $67,378
    Deferred
    $190,141
    Nontaxable benefits
    $42,365
    Filer's total
    $1,023,611

  • Somala Mohammed MD

    Physician

    Total calculated
    $1,049,914
    From this org
    $790,288
    From related orgs
    $0
    Other
    $259,626
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $451,615
    Bonus
    $283,325
    Other
    $55,348
    Deferred
    $189,291
    Nontaxable benefits
    $70,335
    Filer's total
    $1,049,914

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 1a · Tax indemnification and gross-up payments
  • 1b · Written policy on the line-1a expenses
  • 2 · Substantiation required before reimbursing expenses
  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Form 990 of other organizations
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Part I, Line 1a
The Foundation provides gross-up payments for mortgage forgiveness, long-term disability insurance, and life insurance. These payments are included as taxable wages during the year. All permanent full-time employees of the Foundation are eligible for the gross-up payments.
Part I, Line 4b
CHMC Surgical Foundation, Inc. (the Foundation) established a Defined Benefit Pension Plan, effective October 1, 2006, to provide its employees with fair and adequate retirement benefits. The plan calls for benefits to be paid to eligible employees at retirement based upon years of service with the Foundation and compensation rates near retirement. Contributions to the plan reflect benefits attributed to employees' services to date, as well as services expected to be earned in the future. During the year ended September 30, 2023, the Foundation made the following contributions to the plan: Biren P. Modi, MD, $141,284; Jill Zalieckas, MD $143,868; Belinda Hsi Dickie, MD, $142,145; Brent Weil, MD $133,525; Benjamin Zendejas-Mummert, MD, $132,011; Farokah R. Demehri, MD, $129,141; and Somala Mohammed, MD, $128,291.
Part I, Line 7
Bonus compensation amounts are determined by the Chief of CHMC Surgical Foundation, Inc. (the Foundation). The amounts are discretionary based on job performance and the financial performance of the Foundation.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2022
Filed
30 July 2024
IRS schema version
2022v5.0
Source object
202442259349301374

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