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ObjectId: 201800679349300930 - Submission: 2018-03-08
TIN: 95-2810095
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
16
Open to Public Inspection
Name of the organization
ALTAMED HEALTH SERVICES CORPORATION
Employer identification number
95-2810095
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 nonfixed
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) 2016
Page 2
Schedule J (Form 990) 2016
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
CASTULO DELA ROCHA JD
PRESIDENT & CEO
(i)
(ii)
701,002
-------------
0
272,800
-------------
0
145,908
-------------
0
146,798
-------------
0
0
-------------
0
1,266,508
-------------
0
0
-------------
0
2
JOSE U ESPARZA
SR. VP OF FINANCE & CFO
(i)
(ii)
370,358
-------------
0
94,767
-------------
0
52,913
-------------
0
10,400
-------------
0
0
-------------
0
528,438
-------------
0
0
-------------
0
3
MARIE TORRES
SR.VP OF GOV'T RELATIONS
(i)
(ii)
297,813
-------------
0
90,955
-------------
0
18,050
-------------
0
10,400
-------------
0
0
-------------
0
417,218
-------------
0
0
-------------
0
4
MARTIN LEE SEROTA MD
SVP, CHIEF MEDICAL OFFICER
(i)
(ii)
460,027
-------------
0
61,182
-------------
0
39,053
-------------
0
10,400
-------------
0
0
-------------
0
570,662
-------------
0
0
-------------
0
5
ZOILA ESCOBAR
SR.VP STRATEGIC DEV & COMM
(i)
(ii)
306,532
-------------
0
60,104
-------------
0
18,000
-------------
0
10,400
-------------
0
0
-------------
0
395,036
-------------
0
0
-------------
0
6
JENNIFER SPALDING
SR.VP CHIEF OPERATION OFFI
(i)
(ii)
351,576
-------------
0
85,750
-------------
0
18,075
-------------
0
9,824
-------------
0
0
-------------
0
465,225
-------------
0
0
-------------
0
7
JACQUELINE RITACCO
SR.VP CHIEF ADMINISTRATIVE OFFICER
(i)
(ii)
294,396
-------------
0
65,250
-------------
0
18,000
-------------
0
10,400
-------------
0
0
-------------
0
388,046
-------------
0
0
-------------
0
8
ANGELA ROBERTS
VP, FACILITY DEVELOPMENT & MGMT.
(i)
(ii)
305,168
-------------
0
41,307
-------------
0
18,050
-------------
0
10,084
-------------
0
0
-------------
0
374,609
-------------
0
0
-------------
0
9
CRISTIAN RICO MD
DIRECTOR, REGIONAL MEDICAL
(i)
(ii)
304,091
-------------
0
56,666
-------------
0
11,942
-------------
0
10,400
-------------
0
0
-------------
0
383,099
-------------
0
0
-------------
0
10
ALEX CHEN
VP, MEDICAL DIR QUALITY & SAFE
(i)
(ii)
279,127
-------------
0
37,290
-------------
0
7,000
-------------
0
10,400
-------------
0
0
-------------
0
333,817
-------------
0
0
-------------
0
11
HENRY HOLGUIN
SVP, GENERAL COUNSEL
(i)
(ii)
408,660
-------------
0
30,000
-------------
0
18,000
-------------
0
0
-------------
0
0
-------------
0
456,660
-------------
0
0
-------------
0
12
ESIQUIO CASILLAS
DIR., REGIONAL MEDICAL SENIOR CARE S
(i)
(ii)
316,680
-------------
0
65,427
-------------
0
13,180
-------------
0
10,400
-------------
0
0
-------------
0
405,687
-------------
0
0
-------------
0
Schedule J (Form 990) 2016
Page 3
Schedule J (Form 990) 2016
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
ALTAMED MAINTAINS A DISCRETIONARY SPENDING ACCOUNT FOR OFFICERS, KEY EMPLOYEES AND OTHERS WHERE THE COMPANY ALLOWS A CERTAIN AMOUNT TO BE USED AT THE DISCRETION OF THE PAYEE FOR BUSINESS EXPENSES SUCH AS AUTOMOBILE EXPENSES . ANY AMOUNTS USED FROM THE DISCRETIONARY ACCOUNT ARE TAXED TO THE RECIPIENT AS PART OF THEIR COMPENSATION. IN ADDITION, ALTAMED PROVIDES A HOUSING SUBSIDY OF $12,000 FOR THE CHIEF MEDICAL OFFICER.
PART I, LINE 4B
SCHEDULE J:AT THE PRESENT TIME THE PRESIDENT AND CEO ARE ELIGIBLE FOR THE ORGANIZATION'S SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ; FUNDING OF THIS PLAN IS DISCRETIONARY AND ASSETS OF THE PLAN ARE SUBJECT TO THE CLAIMS OF CREDITORS . RETIREMENT AND OTHER DEFERRED COMPENSATION INCLUDES $136,398 PAID TO THE SERP IN CALENDAR YEAR 2016.
PART I, LINE 7
SCHEDULE J :ALTAMED MAINTAINS A DISCRETIONARY EXECUTIVE AND DIRECTOR LEVEL BONUS PROGRAM THAT AWARDS INCENTIVE COMPENSATION BASED ON ACHIEVEMENT OF CERTAIN ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL, OPERATIONAL, QUALITY AND MISSION OBJECTIVES DURING THE FISCAL YEAR. MEMBERS OF THE EXECUTIVE AND DIRECTOR LEADERSHIP TEAM ARE EVALUATED ANNUALLY FOR THEIR ABILITY TO MEET THOSE ORGANIZATIONAL OBJECTIVES TO ARRIVE AT THE INCENTIVE AMOUNT, IF ANY, FOR THE FISCAL YEAR. OVERALL ALTAMED MUST ACHIEVE SPECIFIC FINANCIAL GOALS BEFORE ANY INCENTIVES CAN BE EARNED AND PAID.
Schedule J (Form 990) 2016
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