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ObjectId: 201413179349300421 - Submission: 2014-11-13
TIN: 04-2979430
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" to Form 990, Part IV, line 23.
Attach to Form 990.
See separate instructions.
Information about Schedule J (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
13
Open to Public Inspection
Name of the organization
Fairview Extended Care Services Inc
Employer identification number
04-2979430
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 in 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 in 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 in 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 in 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
No
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) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in 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," to line 5a or 5b, describe in Part III.
6
For persons listed in 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," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III
............
7
No
8
Were any amounts reported in 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" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?
.........................
9
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013
Page 2
Schedule J (Form 990) 2013
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 in 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
reported as deferred
in prior Form 990
(i)
Base compensation
(ii)
Bonus & incentive compensation
(iii)
Other reportable compensation
1
David E Phelps
CEO
(i)
(ii)
679,177
33,164
712,341
2
William C Jones Jr
President/Treas
(i)
(ii)
490,926
33,899
524,825
Schedule J (Form 990) 2013
Page 3
Schedule J (Form 990) 2013
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 III, Additional Information
In reference to Form 990, Part VII and Schedule J Part II, no compensation is paid by the filing entity to any director (trustee) for his or her role as director (trustee). The officers of the filing entity are all compensated by BHS Management Services, Inc., ("BHSMS")a supporting organization of the filing entity. A portion of the compensation amount paid to officers of the filing entity is allocated internally among the filing entity and its 26 associated non-profit, tax-exempt entities in order to reflect the division of the officers' time and effort among those various entities and each entity's relative contribution to the officers' total compensation. (See Below). Compensation of the chief executive officer of the filing entity is reviewed and established at least biannually by the independent volunteer governing body of the Berkshire Health Systems, Inc., (the parent company of BHSMS) based on performance reviews and comparison to independently established, regionally appropriate benchmarks for similar positions in similarly sized healthcare organizations, as verified by independent, nationally recognized compensation consultants. Compensation of the president of the filing entity is reviewed and established at least biannually the the independent volunteer governing body of Berkshire Healthcare Systems, Inc., (the filing entity or parent company of the filing entity) based on performance reviews and comparison to independently established, regionally appropriate benchmarks for similiar positions in similarly sized healthcare organizations, as verified by independent, nationally recognized compensation consultants. Compensation of any other officers and key employees is set in accordance with governing-body established principles based on comparable benchmarks identified by such independent consultants. The governing bodies currently target total compensation for management employees at the 60th percentile of appropriate benchmarks. David E. Phelps William C. Jones Hrs/Wk Dollars Hrs/Wk DollarsBourne Management Systems, Inc. 0.66 $ 8,971 3.57 $32,422Greenfield Management Systems, Inc. 0.61 $ 8,252 3.28 $29,823New Bedford Management Systems, Inc. 0.70 $ 9,458 3.76 $34,182Northampton Management Systems, Inc. 0.59 $ 8,077 3.21 $29,193East Longmeadow Management Systems, Inc. 0.34 $ 4,668 1.86 $16,872Danvers Management Systems, Inc. 0.32 $ 4,344 1.73 $15,699Peabody Management Systems, Inc. 0.58 $ 7,870 3.13 $28,442In reference to Schedule J Part 2, cont.South Yarmouth Management Systems, Inc. 0.37 $ 5,018 1.99 $18,137Berkshire Pennsylvania, Inc. 0.55 $ 7,492 2.98 $27,076Xenia East Management Systems, Inc. 0.15 $ 2,103 0.84 $ 7,600Willowood of Great Barrington, Inc. 0.50 $ 6,839 2.72 $24,715Willowood of North Adams, Inc. 0.58 $ 7,832 3.11 $28,306Willowood of Williamstown, Inc. 0.73 $ 9,900 3.94 $35,779Hillcrest Extended Care Services, Inc. 1.34 $18,195 7.23 $65,757Berkshire Retirement Community, Inc. 0.45 $ 6,180 2.46 $22,337Berkshire Extended Care Services, Inc. 0.04 $ 526 0.21 $ 1,900IntegriNurse, Inc. 0.12 $ 1,684 0.67 $ 6,087IntegriScript, Inc. 0.31 $ 4,267 1.70 $15,421Pittsfield Management Systems, Inc. 0.63 $ 8,625 3.43 $31,174HospiceCare in the Berkshires, Inc. 0.41 $ 5,535 2.20 $20,005Non Affiliated Entities 40.00 $543,324 0.00 $ 0Non Affiliated Life Insurance (one time) n/a $107,692
Schedule J (Form 990) 2013
Additional Data
Software ID:
13000170
Software Version:
2013v3.1