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ObjectId: 201643199349305374 - Submission: 2016-11-14
TIN: 27-0158524
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
Jewish Home Lifecare Community Services
Employer identification number
27-0158524
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
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 in 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 non-fixed
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) 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
Audrey S Weiner
President and CEO
(i)
(ii)
20,247
-------------
669,336
0
-------------
0
20,653
-------------
682,749
1,359
-------------
44,937
537
-------------
17,767
42,796
-------------
1,414,789
0
-------------
0
2
Thomas J Gilmartin
Chief Administrative Officer
(i)
(ii)
15,450
-------------
481,509
0
-------------
0
1,380
-------------
42,993
2,026
-------------
63,155
1,560
-------------
48,617
20,416
-------------
636,274
0
-------------
0
3
Audrey Wathen
Senior VP Human Resources
(i)
(ii)
8,046
-------------
224,869
0
-------------
0
137
-------------
3,820
596
-------------
16,656
486
-------------
13,584
9,265
-------------
258,929
0
-------------
0
4
Bruce Nathanson
Senior VP Marketing
(i)
(ii)
2,615
-------------
199,287
0
-------------
0
27
-------------
2,029
198
-------------
15,110
358
-------------
27,287
3,198
-------------
243,713
0
-------------
0
5
Nancy Stoddard
Vice President IT
(i)
(ii)
8,911
-------------
249,068
0
-------------
0
46
-------------
1,294
664
-------------
18,549
993
-------------
27,766
10,614
-------------
296,677
0
-------------
0
6
Firouzeh Naima
Director of Finance
(i)
(ii)
6,628
-------------
185,240
0
-------------
0
46
-------------
1,294
488
-------------
13,643
417
-------------
11,654
7,579
-------------
211,831
0
-------------
0
7
Dale Cooper
Associate General Counselor
(i)
(ii)
6,028
-------------
168,465
0
-------------
0
71
-------------
1,985
422
-------------
11,783
571
-------------
15,950
7,092
-------------
198,183
0
-------------
0
8
Bridget Gallagher
Sr. VP. Community Services
(i)
(ii)
41,487
-------------
201,556
0
-------------
0
20,374
-------------
98,980
3,280
-------------
15,933
18,498
-------------
89,865
83,639
-------------
406,334
0
-------------
0
9
Regina Melly
VP Business Development
(i)
(ii)
8,895
-------------
248,620
0
-------------
0
25
-------------
692
511
-------------
14,296
769
-------------
21,506
10,200
-------------
285,114
0
-------------
0
10
Maryanne Morgan
Director of Finance
(i)
(ii)
5,907
-------------
165,086
0
-------------
0
25
-------------
692
442
-------------
12,341
786
-------------
21,979
7,160
-------------
200,098
0
-------------
0
11
Elizabeth Weingast
VP of Clinical Excellence
(i)
(ii)
5,711
-------------
159,612
0
-------------
0
16
-------------
451
453
-------------
12,670
1,615
-------------
45,131
7,795
-------------
217,864
0
-------------
0
12
Antonio Pilgrim
Director of Internal Audit
(i)
(ii)
5,306
-------------
148,299
0
-------------
0
71
-------------
1,985
0
-------------
0
930
-------------
25,991
6,307
-------------
176,275
0
-------------
0
13
Robert Lanfranchi
Director of IT
(i)
(ii)
7,010
-------------
195,932
0
-------------
0
25
-------------
692
403
-------------
11,266
0
-------------
0
7,438
-------------
207,890
0
-------------
0
14
Svetlana DeBellis
VP Managed Care
(i)
(ii)
3,119
-------------
200,340
0
-------------
0
16
-------------
446
0
-------------
0
1,295
-------------
36,191
4,430
-------------
236,977
0
-------------
0
15
Sirojni Jagmohan
Registered nurse
(i)
(ii)
154,429
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
154,429
-------------
0
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 1a
1) Tax indemnification and gross-up payments 2) Audrey S. Weiner, Thomas J. Gilmartin, and Bridget Gallagher 3) The amounts were treated as taxable compensation
Part I, Line 3
The salaries for the executives are determined by the parent company, Jewish Home Lifecare. The methods utilized include a Compensation Committee, independent compensation consultants, who perform independent compensation studies, and review approval of the recommendations of the Compensation Committee by the board.
Part I, Line 4b
Audrey S. Weiner participated in a supplemental defined benefit retirement plan. The accrual for the year was $27,083. During 2015, Audrey vested in the plan and as a result $699,701 was included in Ms. Weiner's W-2 reportable compensation. Thomas J. Gilmartin participated in a supplemental defined contribution retirement plan. The accrual for the year was $45,968. During 2015, Mr. Gilmartin's vesting in the plan resulted in an additional $42,004 of W-2 reportable compensation for Mr. Gilmartin. Bridget Gallagher participated in a supplemental defined contribution retirement plan. During 2015, Ms. Gallagher's vesting in the plan resulted in an additional $118,797 of W-2 reportable compensation for Ms. Gallagher and $95,205 of non-taxable benefit.
Schedule J (Form 990) 2015
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