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ObjectId: 201742269349301319 - Submission: 2017-08-14
TIN: 04-3218267
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
Boston University Affiliated Physicians Inc
Employer identification number
04-3218267
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
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
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
RAVIN DAVIDOFF MD
PRESIDENT
(i)
(ii)
0
-------------
457,602
0
-------------
95,589
0
-------------
23,428
0
-------------
50,610
0
-------------
33,357
0
-------------
660,586
0
-------------
16,142
2
RICHARD SILVERIA
TREASURER
(i)
(ii)
0
-------------
501,057
0
-------------
104,391
0
-------------
23,642
0
-------------
48,750
0
-------------
32,997
0
-------------
710,837
0
-------------
16,342
3
DAVID BECK
CLERK
(i)
(ii)
0
-------------
375,145
0
-------------
77,781
0
-------------
4,386
0
-------------
43,250
0
-------------
21,175
0
-------------
521,737
0
-------------
1,333
4
KATHLEEN E WALSH
TRUSTEE
(i)
(ii)
0
-------------
1,012,006
0
-------------
286,563
0
-------------
112,049
0
-------------
91,925
0
-------------
5,207
0
-------------
1,507,750
0
-------------
50,875
5
CHARLES TIFT MD
TRUSTEE
(i)
(ii)
208,723
-------------
0
0
-------------
0
1,291
-------------
0
27,060
-------------
0
21,552
-------------
0
258,626
-------------
0
0
-------------
0
6
LOUIS SILVAGNOLI MD
TRUSTEE
(i)
(ii)
289,705
-------------
0
0
-------------
0
1,540
-------------
0
32,314
-------------
0
10,989
-------------
0
334,548
-------------
0
0
-------------
0
7
RICHARD RESS MD
PHYSICIAN
(i)
(ii)
270,191
-------------
0
0
-------------
0
1,764
-------------
0
33,855
-------------
0
68,462
-------------
0
374,272
-------------
0
0
-------------
0
8
JAMIE LEVY
DIRECTOR - PHYSICIAN PRACTICES
(i)
(ii)
129,892
-------------
0
5,156
-------------
0
0
-------------
0
3,947
-------------
0
19,331
-------------
0
158,326
-------------
0
0
-------------
0
9
MICHAEL MILLER MD
Physician
(i)
(ii)
217,946
-------------
0
0
-------------
0
2,361
-------------
0
28,335
-------------
0
29,182
-------------
0
277,824
-------------
0
0
-------------
0
10
JUDITH LYTLE MD
PHYSICIAN
(i)
(ii)
217,205
-------------
0
0
-------------
0
811
-------------
0
34,404
-------------
0
26,585
-------------
0
279,005
-------------
0
0
-------------
0
11
CHRISTOPHER PERKINS MD
PHYSICIAN
(i)
(ii)
367,873
-------------
0
0
-------------
0
592
-------------
0
35,197
-------------
0
24,957
-------------
0
428,619
-------------
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
SCHEDULE J, PART I, LINE 3
BOSTON UNIVERSITY AFFILIATED PHYSICIANS, INC. (BUAP) RELIED ON BOSTON MEDICAL CENTER (BMC), A RELATED ORGANIZATION OF BUAP, TO ESTABLISH ITS PRESIDENT/CEO'S COMPENSATION. THE METHOD UTILIZED BY BMC TO ESTABLISH THE PRESIDENT/CEO'S COMPENSATION ARE THE FOLLOWING: - COMPENSATION COMMITTEE - WRITTEN EMPLOYMENT CONTRACT - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - FORM 990 OF OTHER ORGANIZATIONS - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART I, LINE 4B CERTAIN EXECUTIVES DISCLOSED ON THE BUAP FORM 990, PART VII AND SCHEDULE J, PART II ARE COMPENSATED BY BMC, A RELATED ORGANIZATION, FOR SERVICES TO BMC. BOSTON MEDICAL CENTER PROVIDES A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO CERTAIN EXECUTIVES. AMOUNTS ARE CREDITED TO PARTICIPANTS' ACCOUNTS EACH YEAR. PLAN AMOUNTS ARE SUBJECT TO FORFEITURE AND PAYMENT ONLY IF CERTAIN CONDITIONS ARE MET, AS OUTLINED IN THE PLAN AGREEMENT. BOSTON MEDICAL CENTER MAINTAINS AN EXECUTIVE BENEFIT PLAN WHICH OFFERS PARTICIPATING EXECUTIVES THE OPTION OF ANNUALLY ALLOCATING BENEFIT DOLLARS TO A SUPPLEMENTAL RETIREMENT/PRE-TAX SAVINGS ACCOUNT. AMOUNTS VEST ON SPECIFIED DATES BASED ON CONTINUED EMPLOYMENT BUT NO LATER THAN THE EXECUTIVE'S 62ND BIRTHDAY. THE FOLLOWING AMOUNTS BECAME VESTED AND WERE PAID TO THE FOLLOWING EXECUTIVES IN CALENDAR YEAR 2015: DAVID BECK - $1,608 RAVIN DAVIDOFF - $20,650 RICH SILVERIA - $20,864 KATHLEEN WALSH - $55,794 BMC PROVIDED A SEPARATE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO KATHLEEN E. WALSH, PRESIDENT AND CEO AS OF MARCH 1, 2010. PURSUANT TO THE TERMS OF THE AGREEMENT, certain amounts were credited to the President and CEO's account in prior years. THESE AMOUNTS ARE SUBJECT TO FORFEITURE AND PAYMENT WILL BE MADE ONLY IF CERTAIN CONDITIONS ARE MET, AS OUTLINED IN THE AGREEMENT. FOR CALENDAR YEAR 2015 $48,477 WAS VESTED AND IS REFLECTED IN SCHEDULE J, PART II, COLUMN B(III). SCHEDULE J, PART I, LINE 7 BUAP PARTICIPATES IN A COST SHARING CONTRACT WITH A HEALTH INSURANCE COMPANY. IF BUAP PROFITS FROM THIS CONTRACT OVER A CERTAIN THRESHOLD, CERTAIN PHYSICIANS RECEIVE A PROPORTIONATE SHARE OF THE AMOUNT OVER THE LOWER THRESHOLD AND BELOW THE HIGHER THRESHOLD AS A BONUS, AND ALL PARTICIPATING PHYSICIANS RECEIVE 40% OF THEIR PROPORTIONATE SHARE FOR AMOUNTS OVER THE HIGHER THRESHOLD. BMC HAS AN ANNUAL EXECUTIVE PERFORMANCE INCENTIVE PLAN. PERFORMANCE TARGETS AND PAYOUT METRICS ARE ESTABLISHED AND APPROVED BY THE COMPENSATION COMMITTEE AT THE BEGINNING OF EACH PERFORMANCE CYCLE. FY15 PERFORMANCE BONUS PAYOUTS ARE APPROVED BY THE COMMITTEE AT THE COMPENSATION COMMITTEE MEETING HELD ON OCTOBER 26, 2015. THE COMMITTEE REVIEWED THE FY15 PERFORMANCE RESULTS AGAINST PRE-ESTABLISHED PERFORMANCE TARGETS, AND APPROVED THE FORMULA-BASED PAYOUTS ACCORDINGLY.
Schedule J (Form 990) 2015
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