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ObjectId: 201841309349300974 - Submission: 2018-05-10
TIN: 02-0395296
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
Visiting Nurse Association of Manchester
and Southern New Hampshire Inc
Employer identification number
02-0395296
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
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
Anita Ritenour
Trustee (end 5/17)
(i)
(ii)
0
-------------
306,156
0
-------------
30,705
0
-------------
18,357
0
-------------
27,232
0
-------------
17,450
0
-------------
399,900
0
-------------
0
2
Douglas F Dean
CEO
(i)
(ii)
0
-------------
157,118
0
-------------
0
0
-------------
89,258
0
-------------
33,692
0
-------------
13,253
0
-------------
293,321
0
-------------
70,740
3
Arnold Gary Muller
Interim CEO (end 8/16)
(i)
(ii)
0
-------------
37,500
0
-------------
0
0
-------------
218,860
0
-------------
0
0
-------------
0
0
-------------
256,360
0
-------------
0
4
James L Woodward
CEO (end 7/16)
(i)
(ii)
0
-------------
355,214
0
-------------
0
0
-------------
17,022
0
-------------
76,040
0
-------------
8,674
0
-------------
456,950
0
-------------
0
5
Joseph Ingold
CFO
(i)
(ii)
0
-------------
325,088
0
-------------
0
0
-------------
43,292
0
-------------
0
0
-------------
0
0
-------------
368,380
0
-------------
0
6
Jeffrey Rooney
Interim CFO (end 1/17)
(i)
(ii)
0
-------------
645,970
0
-------------
0
0
-------------
36,854
0
-------------
0
0
-------------
0
0
-------------
682,824
0
-------------
0
7
Carla Braveman
VP Home Health and Comm. Svcs.
(i)
(ii)
227,077
-------------
0
21,272
-------------
0
697
-------------
0
4,887
-------------
0
1,011
-------------
0
254,944
-------------
0
0
-------------
0
8
Richard Elwell
Former CFO
(i)
(ii)
0
-------------
281,823
0
-------------
68,200
0
-------------
625,979
0
-------------
16,563
0
-------------
6,185
0
-------------
998,750
0
-------------
607,979
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 3
The CEO of VNA of Manchester and Southern New Hampshire, Inc. is compensated by a related organization, The Elliot Hospital of the City of Manchester. The Hospital uses a compensation committee, an independent compensation consultant, Forms 990 of other organizations, compensation studies, and approval by the Board or a compensation committee to establish the compensation for the CEO.
Part I, Lines 4a-b
Arnold Gary Muller, an officer of the filing organization who was employed by a related organization, The Elliot Hospital of the City of Manchester, received a severance payment of $130,000 during calendar year 2016. This amount is reported in Schedule J, Part II, Column B(iii). 2016 contributions to the 457(f) plan of The Elliot Hospital of the City of Manchester, a related organization, during the year were: James Woodward-$70,740; Richard Elwell-$16,563.
Part I, Line 7
The Organization has adopted an incentive pay program that provides designated management employees an opportunity to earn a designated percentage of salary based on the achievement by the Organization of a number of critical success factors. The critical success factors are established annually by the independent executive compensation committee of the Board of Trustees with assistance from an independent national compensation consulting company. The maximum potential incentive payments under the plan are considered by the compensation consultant in ensuring that management compensation is reasonable.
Schedule J, Part II:
During the year, Mr. Dean and Mr. Elwell withdrew funds from their deferred compensation plans ($70,740 and $607,979, respectively). These amounts are reported as taxable compensation in Part III, Column B(iii). It should be noted that, when appropriate, these amounts were reported, or would have been reported if the individual was required to be reported in Form 990, Part VII, in prior years as deferred compensation in Part II, Column C. Accordingly, these total amounts are reflected in Part II, Column F so as to not overstate compensation in the current year that was earned over a period of years.
Form 990, Part VII-A and Schedule J, Part II:
Jeffrey Rooney, who served as Chief Financial Officer until January 2017, and Joseph Ingold, who took over as Chief Financial Officer at that time, were both contracted employees through Martinville Dunn, LLC and Ingold & Associates, LLC, respectively. Both LLCs are unrelated to VNA of Manchester & Southern New Hampshire, Inc. and were paid by The Elliot Hospital of the City of Manchester, a related organization. Compensation in the amount of $645,970 was paid to Martinville, Dunn, LLC by the Hospital for Mr. Rooney's services. The total compensation paid to Mr. Ingold's LLC for his services, both as CFO and in a non-officer capacity prior to his role as CFO, during 2016 was $325,088. Additionally, Mr. Rooney received a housing allowance in the amount of $36,854 during 2016 from the Hospital and Mr. Ingold received a similar housing allowance in the amount of $43,292 during the calendar year. As the fees paid to each LLC were paid for services to the entire related party system, an accurate breakdown of the fees relative to the filing organization is not readily determinable. In accordance with IRS instructions, these fees have been reported as compensation on Form 990, Part VII-A and Schedule J, Part II and further disclosed in Schedule O for Form 990, Part VI, Line 3. See also Schedule L.
Schedule J (Form 990) 2016
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