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ObjectId: 201623199349304242 - Submission: 2016-11-14
TIN: 11-1562701
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.
Information about Schedule J (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
15
Open to Public Inspection
Name of the organization
NORTH SHORE UNIVERSITY HOSPITAL
C/O NORTHWELL HEALTH INC
Employer identification number
11-1562701
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 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 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
Yes
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 non-fixed
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) 2015
Page 2
Schedule J (Form 990) 2015
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
1
MICHAEL J DOWLING
PRESIDENT & CEO
(i)
(ii)
0
-------------
1,468,126
0
-------------
1,728,000
0
-------------
25,659
0
-------------
29,150
0
-------------
23,422
0
-------------
3,274,357
0
-------------
0
2
HOWARD GOLD
EVP MANAGED CARE, BUSINESS DEV
(i)
(ii)
0
-------------
1,079,181
0
-------------
528,000
0
-------------
31,764
0
-------------
29,150
0
-------------
8,909
0
-------------
1,677,004
0
-------------
0
3
MARK J SOLAZZO
EVP, CHIEF OPERATING OFFICER
(i)
(ii)
0
-------------
1,267,281
0
-------------
900,000
0
-------------
29,284
0
-------------
538,262
0
-------------
18,117
0
-------------
2,752,944
0
-------------
0
4
ROBERT S SHAPIRO
EVP, CHIEF FINANCIAL OFFICER
(i)
(ii)
0
-------------
1,066,127
0
-------------
171,000
0
-------------
32,782
0
-------------
382,085
0
-------------
17,539
0
-------------
1,669,533
0
-------------
0
5
LAWRENCE G SMITH
EVP/PHYSICIAN IN CHIEF
(i)
(ii)
0
-------------
925,804
0
-------------
337,000
0
-------------
131,695
0
-------------
29,150
0
-------------
18,372
0
-------------
1,442,021
0
-------------
0
6
JEFFREY KRAUT
EVP,STRATEGIC PLANNING
(i)
(ii)
0
-------------
910,565
0
-------------
135,000
0
-------------
32,279
0
-------------
347,793
0
-------------
26,026
0
-------------
1,451,663
0
-------------
0
7
KATHLEEN GALLO RN PHD
CHF LEARNING OFFICER
(i)
(ii)
0
-------------
670,104
0
-------------
117,000
0
-------------
32,804
0
-------------
29,150
0
-------------
17,547
0
-------------
866,605
0
-------------
0
8
DONNA DRUMMOND
SVP, CONSOLIDATED SERVICES
(i)
(ii)
0
-------------
587,951
0
-------------
97,000
0
-------------
90,089
0
-------------
29,150
0
-------------
26,026
0
-------------
830,216
0
-------------
0
9
HARRY GINDI
ASSISTANT SECRETARY
(i)
(ii)
0
-------------
288,163
0
-------------
27,171
0
-------------
4,202
0
-------------
29,150
0
-------------
17,218
0
-------------
365,904
0
-------------
0
10
ALAN HARTMAN
MED SCHOOL CHAIR CTS
(i)
(ii)
1,956,447
-------------
0
40,000
-------------
0
61,764
-------------
0
29,150
-------------
0
26,026
-------------
0
2,113,387
-------------
0
0
-------------
0
11
RALPH NAPPI
TRUSTEE & EVC
(i)
(ii)
0
-------------
672,187
0
-------------
0
0
-------------
33,795
0
-------------
29,150
0
-------------
17,547
0
-------------
752,679
0
-------------
0
12
STANLEY KATZ
MED SCHOOL CHAIR CARDIOLOGY
(i)
(ii)
1,746,086
-------------
0
40,000
-------------
0
16,524
-------------
0
29,150
-------------
0
17,218
-------------
0
1,848,978
-------------
0
0
-------------
0
13
MICHAEL KIM
DIR, INTERVENTIONAL CARDIOLOGY
(i)
(ii)
1,752,180
-------------
0
0
-------------
0
19,030
-------------
0
29,150
-------------
0
25,419
-------------
0
1,825,779
-------------
0
0
-------------
0
14
LAURA PEABODY
SVP & CHIEF LEGAL OFFICER
(i)
(ii)
0
-------------
819,005
0
-------------
140,000
0
-------------
43,529
0
-------------
183,995
0
-------------
26,026
0
-------------
1,212,555
0
-------------
0
15
RAJ NARAYAN
MED SCHOOL CHAIR NEUROSURGERY
(i)
(ii)
1,431,021
-------------
0
213,450
-------------
0
32,793
-------------
0
29,150
-------------
0
17,547
-------------
0
1,723,961
-------------
0
0
-------------
0
16
EUGENE TANGNEY
SVP, CHIEF ADMIN OFFICER
(i)
(ii)
0
-------------
887,365
0
-------------
153,000
0
-------------
11,042
0
-------------
203,306
0
-------------
26,026
0
-------------
1,280,739
0
-------------
0
17
FRANK RIZZO
REGIONAL CFO
(i)
(ii)
518,290
-------------
0
88,435
-------------
0
51,397
-------------
0
29,150
-------------
0
25,526
-------------
0
712,798
-------------
0
0
-------------
0
18
ANDREW SCHULZ
SVP & GEN COUNSEL
(i)
(ii)
0
-------------
737,078
0
-------------
108,000
0
-------------
32,542
0
-------------
29,150
0
-------------
26,026
0
-------------
932,796
0
-------------
0
19
CHANTAL WEINHOLD
SVP/REGIONAL EXECUTIVE DIR
(i)
(ii)
0
-------------
870,675
0
-------------
120,000
0
-------------
32,804
0
-------------
361,518
0
-------------
17,547
0
-------------
1,402,544
0
-------------
0
20
ALESSANDRO BELLUCCI
EXECUTIVE DIRECTOR
(i)
(ii)
814,562
-------------
0
135,000
-------------
0
17,499
-------------
0
29,150
-------------
0
17,547
-------------
0
1,013,758
-------------
0
0
-------------
0
21
EUGENE KRAUSS
DIR, ORTHOPEDICS
(i)
(ii)
2,656,806
-------------
0
250,000
-------------
0
78,518
-------------
0
29,150
-------------
0
17,478
-------------
0
3,031,952
-------------
0
0
-------------
0
22
WINNIE MACK
SVP/REGIONAL EXECUTIVE DIR
(i)
(ii)
799,411
-------------
0
135,000
-------------
0
35,520
-------------
0
29,150
-------------
0
8,909
-------------
0
1,007,990
-------------
0
0
-------------
0
23
MICHAEL FENER
EXECUTIVE DIRECTOR
(i)
(ii)
619,358
-------------
0
76,000
-------------
0
29,996
-------------
0
238,358
-------------
0
23,329
-------------
0
987,041
-------------
0
0
-------------
0
24
ANTHONY FERRERI
EVP/CHF AFFILIATION OFFICER
(i)
(ii)
0
-------------
854,187
0
-------------
237,000
0
-------------
71,947
0
-------------
379,299
0
-------------
17,547
0
-------------
1,559,980
0
-------------
0
Schedule J (Form 990) 2015
Page 3
Schedule J (Form 990) 2015
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 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN
Certain individuals participate in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. Accordingly, the individual may never actually receive the unvested benefit amount and the amounts outlined herein were properly not reported in each individual's Form W-2, Box 5. These amounts are included in Schedule J, Column C for Mark J Solazzo ($509,112), Robert S Shapiro ($352,935), Jeffrey Kraut ($318,643), Laura Peabody ($154,845), Eugene Tangney ($174,156), Anthony Ferreri ($350,149)and Chantal Weinhold ($332,368).
PART I, LINE 5A - COMPENSATION CONTINGENT ON REVENUES
Pursuant to the persons listed in Form 990, Part VII, section A, line 1A, there is no contractual obligation to pay or accrue any compensation to officers of the Northwell based on the revenue of the organization. A listed person(s) that may qualify under this condition could be one or more of the physicians listed as a highly compensated employee.
PART I, LINE 7 - BONUS AND INCENTIVE COMPENSATION
On Form 990, Part VII, Section A, line 1A, the organization may provide non-fixed payments, not described on lines 5 and 6, to certain listed persons. The organization bases such payments on many performance based factors. Payments of this type appear on Schedule J, Part II, B (ii).
PART II, COLUMN (F) - SERP PAYOUT
The amount reported in Schedule J, Part II, Column (F) includes SERP amounts which were previously reported on Form 990, Schedule J, Part II, Column (C) in prior years. In accordance with the IRS instructions, these amounts were originally reported when contributions were made to the SERP plan and are now being reported for a second time upon receipt of distribution from the SERP plan.
Schedule J (Form 990) 2015
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