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ObjectId: 201822259349302112 - Submission: 2018-08-13
TIN: 27-0440772
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
TUFTS MEDICAL CENTER GROUP RETURN
Employer identification number
27-0440772
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
Yes
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
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) 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
charles CASSIDY MD
TRUSTEE (until 12/16)
(i)
(ii)
0
-------------
681,451
0
-------------
354,167
0
-------------
11,595
0
-------------
36,400
0
-------------
22,890
0
-------------
1,106,503
0
-------------
0
2
NORMAND DESCHENE
TRUSTEE
(i)
(ii)
0
-------------
904,112
0
-------------
261,351
0
-------------
2,614,995
0
-------------
72,970
0
-------------
14,076
0
-------------
3,867,504
0
-------------
0
3
marvin a konstam md
TRUSTEE
(i)
(ii)
0
-------------
524,672
0
-------------
90,750
0
-------------
28,521
0
-------------
36,400
0
-------------
22,890
0
-------------
703,233
0
-------------
0
4
Matthew Larkin
trustee
(i)
(ii)
0
-------------
232,469
0
-------------
45,600
0
-------------
7,601
0
-------------
34,621
0
-------------
22,475
0
-------------
342,766
0
-------------
0
5
william c mackey md
trUSTEE
(i)
(ii)
0
-------------
486,552
0
-------------
57,375
0
-------------
13,581
0
-------------
36,400
0
-------------
22,890
0
-------------
616,798
0
-------------
0
6
deeb n salem md
TRUSTEE
(i)
(ii)
0
-------------
495,001
0
-------------
159,155
0
-------------
35,287
0
-------------
36,400
0
-------------
22,890
0
-------------
748,733
0
-------------
0
7
paul summergrad md
TRUSTEE
(i)
(ii)
0
-------------
428,152
0
-------------
40,500
0
-------------
15,322
0
-------------
36,400
0
-------------
22,802
0
-------------
543,176
0
-------------
0
8
margaret costello
trustee/president/ceo
(i)
(ii)
326,889
-------------
0
46,152
-------------
0
759
-------------
0
21,825
-------------
0
20,482
-------------
0
416,107
-------------
0
0
-------------
0
9
MICHAEL WAGNER md
TRUSTEE/presIDENT/CEO
(i)
(ii)
766,627
-------------
0
173,450
-------------
0
83,262
-------------
0
113,800
-------------
0
43,440
-------------
0
1,180,579
-------------
0
0
-------------
0
10
JEFFREY A WEINSTEIN
TRUSTEE/SENIOR VP/CLERK
(i)
(ii)
269,136
-------------
115,344
52,929
-------------
22,684
222,562
-------------
0
40,460
-------------
17,340
12,353
-------------
5,294
597,440
-------------
160,662
149,834
-------------
0
11
Joseph Frolkis md
Trustee/President/CEO
(i)
(ii)
392,176
-------------
0
51,200
-------------
0
4,191
-------------
0
0
-------------
0
4,199
-------------
0
451,766
-------------
0
0
-------------
0
12
nathan gagne
cfo/treasurer
(i)
(ii)
220,010
-------------
0
23,140
-------------
0
70
-------------
0
21,636
-------------
0
4,257
-------------
0
269,113
-------------
0
0
-------------
0
13
zachary redmond
clerk
(i)
(ii)
160,337
-------------
0
0
-------------
0
5,135
-------------
0
3,483
-------------
0
21,725
-------------
0
190,680
-------------
0
0
-------------
0
14
Kristine M Hanscom
SENIOR VP/TREASURER/CFO/TRustee
(i)
(ii)
322,502
-------------
0
57,750
-------------
0
42,258
-------------
0
34,148
-------------
0
26,031
-------------
0
482,689
-------------
0
29,523
-------------
0
15
ellen o'gorman
ceo
(i)
(ii)
160,021
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
160,021
-------------
0
0
-------------
0
16
THERESE HUDSON-JINKS
SENIOR VP AND CNO
(i)
(ii)
312,337
-------------
0
52,173
-------------
0
46,498
-------------
0
47,924
-------------
0
5,552
-------------
0
464,484
-------------
0
44,014
-------------
0
17
WILLIAM ShICKOLOVICH
SENIOR VP OPERATIONS MGMT/cio
(i)
(ii)
243,851
-------------
104,508
43,756
-------------
18,752
44,075
-------------
0
37,197
-------------
15,941
19,492
-------------
8,354
388,371
-------------
147,555
38,632
-------------
0
18
DEBORAH JOELSON
SR. VP STRATEGIC SERVICES
(i)
(ii)
63,198
-------------
287,904
13,067
-------------
59,527
56,738
-------------
0
9,578
-------------
43,631
5,014
-------------
22,840
147,595
-------------
413,902
46,737
-------------
0
19
SUSAN BLANCHARD
VP FOR RESEARCH ADMinistration
(i)
(ii)
219,349
-------------
0
30,169
-------------
0
30,260
-------------
0
31,828
-------------
0
25,738
-------------
0
337,344
-------------
0
27,379
-------------
0
20
kelly dougherty
vp cardiovascular
(i)
(ii)
184,399
-------------
0
7,260
-------------
0
4,178
-------------
0
0
-------------
0
0
-------------
0
195,837
-------------
0
0
-------------
0
21
patricia hayward until 717
vp human resources/risk mgmt.
(i)
(ii)
257,448
-------------
0
70,712
-------------
0
12,077
-------------
0
5,300
-------------
0
15,858
-------------
0
361,395
-------------
0
0
-------------
0
22
sean sullivan
vp human resources
(i)
(ii)
200,450
-------------
0
19,800
-------------
0
42,618
-------------
0
0
-------------
0
0
-------------
0
262,868
-------------
0
0
-------------
0
23
jeffrey syrek
vp sys CONTRACTING
(i)
(ii)
227,643
-------------
0
30,256
-------------
0
117
-------------
0
22,585
-------------
0
21,822
-------------
0
302,423
-------------
0
0
-------------
0
24
BROOKE TYSON-HYNES
VP PUBLIC AFFAIRS
(i)
(ii)
161,663
-------------
69,284
29,274
-------------
12,546
27,110
-------------
0
3,710
-------------
1,590
18,403
-------------
7,887
240,160
-------------
91,307
0
-------------
0
25
saul weingart
chief medical officer
(i)
(ii)
0
-------------
432,552
0
-------------
74,250
0
-------------
10,788
0
-------------
36,400
0
-------------
22,807
0
-------------
576,797
0
-------------
0
26
NANCY WETHERBEE
director of orbit
(i)
(ii)
226,703
-------------
0
45,485
-------------
0
1,320
-------------
0
4,438
-------------
0
5,760
-------------
0
283,706
-------------
0
0
-------------
0
27
PETER NEUMANN
special & scientific staff
(i)
(ii)
248,712
-------------
0
0
-------------
0
3,580
-------------
0
21,609
-------------
0
21,725
-------------
0
295,626
-------------
0
0
-------------
0
28
kathleen davis
corporate controller
(i)
(ii)
225,393
-------------
0
0
-------------
0
333
-------------
0
3,702
-------------
0
21,725
-------------
0
251,153
-------------
0
0
-------------
0
29
shelly dietz
dir. of clinical resource
(i)
(ii)
212,977
-------------
0
0
-------------
0
1,321
-------------
0
0
-------------
0
0
-------------
0
214,298
-------------
0
0
-------------
0
30
nancy gittelson
executive Director of Info. Services
(i)
(ii)
204,235
-------------
0
0
-------------
0
1,994
-------------
0
0
-------------
0
0
-------------
0
206,229
-------------
0
0
-------------
0
31
CHIBUEZE OKEY AGBA until 216
former Sr. VP/TREASURER/CFO/Trustee
(i)
(ii)
57,403
-------------
0
0
-------------
0
592,246
-------------
0
68,315
-------------
0
13,345
-------------
0
731,309
-------------
0
184,752
-------------
0
32
JEFFREY I LASKER MD
former TRUSTEE/PRESIDENT/CEO
(i)
(ii)
294,058
-------------
0
153,329
-------------
0
457
-------------
0
3,594
-------------
0
0
-------------
0
451,438
-------------
0
0
-------------
0
33
christine more until 1215
former interim - vp development
(i)
(ii)
101,671
-------------
0
0
-------------
0
7,664
-------------
0
0
-------------
0
0
-------------
0
109,335
-------------
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 1, line 4a:
The Lowell General Hospital has entered into a split-dollar life insurance agreement with Normand Deschene - President of board & CEO - the Lowell General Hospital. Premiums paid in calendar 2016 were $92,197. All premiums will be repaid to the Hospital. Normand Deschene's other reportable compensation includes two (2) years of vested contractual benefits for retirement earnings in the amount of $1,601,145. Chibueze Okey Agba received a separation agreement payment of $406,645.
Part 1, line 4b:
Section 457(f) retirement plan employer deferrals: michael wagner, $108,500 chibueze okey agba, $63,070 Jeffrey a. weinstein, $52,500 deborah c. joelson, $47,909 william j. shickolovich, $47,838 therese Hudson-jinks, $43,400 susan blanchard, $26,889 kristine hanscom, $28,848
Schedule J (Form 990) 2016
Additional Data
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