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ObjectId: 202032309349301338 - Submission: 2020-08-17
TIN: 90-0054984
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.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
18
Open to Public Inspection
Name of the organization
CAPE COD HEALTHCARE INC & AFFILIATES
Employer identification number
90-0054984
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) 2018
Page 2
Schedule J (Form 990) 2018
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
MICHAEL K LAUF
PRESIDENT/CEO/TRUSTEE
(i)
(ii)
0
-------------
997,055
0
-------------
400,000
0
-------------
227,344
0
-------------
250,847
0
-------------
36,631
0
-------------
1,911,877
0
-------------
163,550
2
ROBERT WILSTERMAN MD
TRUSTEE
(i)
(ii)
691,441
-------------
0
4,743
-------------
0
2,772
-------------
0
26,154
-------------
0
32,612
-------------
0
757,722
-------------
0
0
-------------
0
3
WILLIAM AGEL MD
TRUSTEE
(i)
(ii)
441,320
-------------
0
46,028
-------------
0
16,206
-------------
0
11,367
-------------
0
31,570
-------------
0
546,491
-------------
0
0
-------------
0
4
THEODORE CALIANOS MD
TRUSTEE
(i)
(ii)
370,702
-------------
0
1,608
-------------
0
1,806
-------------
0
11,288
-------------
0
29,607
-------------
0
415,011
-------------
0
0
-------------
0
5
PAUL HOULE MD
TRUSTEE
(i)
(ii)
932,440
-------------
0
160,000
-------------
0
22,566
-------------
0
31,813
-------------
0
31,612
-------------
0
1,178,431
-------------
0
0
-------------
0
6
MICHAEL L CONNORS
SENIOR VP FINANCE/CFO
(i)
(ii)
0
-------------
431,439
0
-------------
97,350
0
-------------
35,431
0
-------------
64,490
0
-------------
34,152
0
-------------
662,862
0
-------------
18,275
7
MICHAEL G JONES ESQ
Sr VP & Chief Legal Off/Clerk
(i)
(ii)
0
-------------
328,038
0
-------------
77,119
0
-------------
22,233
0
-------------
44,533
0
-------------
32,552
0
-------------
504,475
0
-------------
15,219
8
MICHAEL BUNDY
COO (UNTIL 1/19)
(i)
(ii)
0
-------------
396,437
0
-------------
90,000
0
-------------
630
0
-------------
35,478
0
-------------
25,308
0
-------------
547,853
0
-------------
0
9
DONALD A GUADAGNOLI MD
CMO CAPE COD HOSPITAL
(i)
(ii)
0
-------------
412,496
0
-------------
92,925
0
-------------
33,091
0
-------------
62,853
0
-------------
26,907
0
-------------
628,272
0
-------------
19,957
10
ALEXANDER HEARD MD
CMO FALMOUTH HOSPITAL
(i)
(ii)
84,330
-------------
352,395
0
-------------
134,312
0
-------------
7,553
0
-------------
58,669
0
-------------
32,723
84,330
-------------
585,652
0
-------------
0
11
PATRICK J KANE
SVP OF MRKTG,COMMUN AND DEVLP
(i)
(ii)
0
-------------
312,048
0
-------------
79,213
0
-------------
22,232
0
-------------
28,782
0
-------------
14,552
0
-------------
456,827
0
-------------
15,514
12
CHRISTIAN BROWN
SR VP MANAGED CARE
(i)
(ii)
0
-------------
313,201
0
-------------
75,913
0
-------------
19,692
0
-------------
46,980
0
-------------
30,217
0
-------------
486,003
0
-------------
14,125
13
EMILY SCHORER
SVP HUMAN RESOURCES
(i)
(ii)
0
-------------
267,249
0
-------------
65,280
0
-------------
16,466
0
-------------
25,820
0
-------------
30,342
0
-------------
405,157
0
-------------
12,950
14
KEVIN RALPH
SVP DEVELOPMENT (UNTIL 4/18)
(i)
(ii)
0
-------------
78,028
0
-------------
0
0
-------------
116,254
0
-------------
7,382
0
-------------
11,905
0
-------------
213,569
0
-------------
9,896
15
THERESA M AHERN
SVP STRAT, COMMUNITY/GOV REL.
(i)
(ii)
0
-------------
295,913
0
-------------
66,375
0
-------------
19,303
0
-------------
44,764
0
-------------
11,472
0
-------------
437,827
0
-------------
12,000
16
KEVIN J MULROY
SVP CHIEF QUALITY & SAFETY OFF
(i)
(ii)
0
-------------
367,439
0
-------------
86,269
0
-------------
28,035
0
-------------
46,974
0
-------------
33,152
0
-------------
561,869
0
-------------
18,750
17
JOHN PAUL SOLVERSON
SR VP & CIO
(i)
(ii)
0
-------------
420,766
0
-------------
100,031
0
-------------
1,806
0
-------------
20,789
0
-------------
14,524
0
-------------
557,916
0
-------------
0
18
JEFFREY S DYKENS
VP FINANCE & OPERATIONS
(i)
(ii)
0
-------------
246,289
0
-------------
0
0
-------------
55,149
0
-------------
31,526
0
-------------
33,010
0
-------------
365,974
0
-------------
13,250
19
NOELENE CERVIN
VP BUDGETING AND OPER. SUPPORT
(i)
(ii)
0
-------------
216,289
0
-------------
40,000
0
-------------
7,003
0
-------------
29,383
0
-------------
29,302
0
-------------
321,977
0
-------------
0
20
LORI JEWETT
CEO - FH
(i)
(ii)
0
-------------
249,221
0
-------------
42,000
0
-------------
10,146
0
-------------
45,210
0
-------------
1,554
0
-------------
348,131
0
-------------
10,375
21
ANNE MARIE PECKHAM
PRESIDENT VNA
(i)
(ii)
0
-------------
197,826
0
-------------
35,889
0
-------------
9,974
0
-------------
20,321
0
-------------
21,715
0
-------------
285,725
0
-------------
0
22
CARTER HUNT
ADMIN SPEC&HOSP BASED CARE
(i)
(ii)
0
-------------
197,544
0
-------------
20,688
0
-------------
2,207
0
-------------
36,908
0
-------------
33,046
0
-------------
290,393
0
-------------
0
23
REBECCA FRANCE
SEE SCHEDULE O
(i)
(ii)
0
-------------
119,911
0
-------------
15,000
0
-------------
137,714
0
-------------
2,083
0
-------------
5,416
0
-------------
280,124
0
-------------
0
24
JUDITH C QUINN
VP OF PATIENT CARE
(i)
(ii)
0
-------------
217,082
0
-------------
42,543
0
-------------
19,133
0
-------------
39,127
0
-------------
23,307
0
-------------
341,192
0
-------------
10,875
25
DEBRA ROBINSON
ASSOCIATE VP OF NURSING
(i)
(ii)
191,755
-------------
0
36,913
-------------
0
9,549
-------------
0
0
-------------
0
0
-------------
0
238,217
-------------
0
0
-------------
0
26
CYNTHIA MARLIN
VP PERIOPERATIVE & SURGICAL SV
(i)
(ii)
0
-------------
190,373
0
-------------
36,010
0
-------------
4,990
0
-------------
19,231
0
-------------
21,686
0
-------------
272,290
0
-------------
0
27
ELIZABETH DUNTON
ADMIN PRIMARY CARE PRACTICE
(i)
(ii)
0
-------------
205,168
0
-------------
20,050
0
-------------
378
0
-------------
15,237
0
-------------
1,554
0
-------------
242,387
0
-------------
0
28
RICHARD B ZELMAN MD
PHYSICIAN
(i)
(ii)
1,564,034
-------------
0
100,000
-------------
0
2,772
-------------
0
12,077
-------------
0
36,471
-------------
0
1,715,354
-------------
0
0
-------------
0
29
NICHOLAS COPPA MD
PHYSICIAN
(i)
(ii)
935,250
-------------
0
160,000
-------------
0
420
-------------
0
31,804
-------------
0
28,802
-------------
0
1,156,276
-------------
0
0
-------------
0
30
ACHILLES PAPAVASILIOU MD
PHYSICIAN
(i)
(ii)
932,440
-------------
0
160,000
-------------
0
630
-------------
0
31,804
-------------
0
31,612
-------------
0
1,156,486
-------------
0
0
-------------
0
31
GORDON NAKATA MD
PHYSICIAN
(i)
(ii)
932,440
-------------
0
160,000
-------------
0
630
-------------
0
31,804
-------------
0
31,612
-------------
0
1,156,486
-------------
0
0
-------------
0
32
PHILLIP J DOMBROWSKI MD
PHYSICIAN
(i)
(ii)
835,032
-------------
0
66,667
-------------
0
27,772
-------------
0
34,273
-------------
0
21,455
-------------
0
985,199
-------------
0
0
-------------
0
33
JEANNE FALLON
Former SR VP/CIO
(i)
(ii)
0
-------------
0
0
-------------
0
0
-------------
143,042
0
-------------
0
0
-------------
0
0
-------------
143,042
0
-------------
0
Schedule J (Form 990) 2018
Page 3
Schedule J (Form 990) 2018
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 4A
JEANNE FALLON, FORMER SR. VP AND CIO, RECEIVED SEVERANCE PAYMENTS OF $143,042 DURING CALENDAR YEAR 2018. THE ARRANGEMENT PROVIDES FOR CONTINUED PAYMENT OF THE INDIVIDUAL'S SALARY FOR A PERIOD OF FIFTEEN MONTHS. KEVIN RALPH, SVP OF DEVELOPMENT UNTIL 4/18, RECEIVED SEVERANCE PAYMENTS OF $86,539 DURING CALENDAR YEAR 2018. THE ARRANGEMENT PROVIDES FOR CONTINUED PAYMENT OF THE INDIVIDUAL'S SALARY AND BENEFITS FOR A PERIOD OF TWELVE MONTHS, INCLUDING MEDICAL AND DENTAL INSURANCE COVERAGE. REBECCA FRANCE, VP PATIENT FINANCIAL SERVICES & REVENUE CYCLE UNTIL 6/12/18, RECEIVED SEVERANCE PAYMENTS OF $125,500 DURING CALENDAR YEAR 2018. THE ARRANGEMENT PROVIDES FOR CONTINUED PAYMENT OF THE INDIVIDUAL'S SALARY AND BENEFITS FOR A PERIOD OF TWELVE MONTHS, INCLUDING MEDICAL AND DENTAL INSURANCE COVERAGE.
SCHEDULE J, PART I, LINE 4B - 457(F)
CAPE COD HEALTHCARE, INC. AND AFFILIATES SPONSORS A 457(F) VOLUNTARY PERSONAL DEFERRAL PLAN ("THE PLAN") FOR KEY EXECUTIVES. VESTING IS DEFERRED FOR AT LEAST TWO YEARS FROM THE DATE OF THE AWARD. THE PLAN OFFERS PARTICIPATING EMPLOYEES AN ANNUAL DEFERRAL OF CASH COMPENSATION. AMOUNTS DEFERRED UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AND AMOUNTS PAID UNDER THE PLAN DURING CALENDAR YEAR 2018 WERE AS FOLLOWS: - MICHAEL K. LAUF - $87,514 - MICHAEL G. JONES - $20,427 - MICHAEL L. CONNORS - $24,198 - JEFFREY S. DYKENS - $45,007 - PATRICK KANE - $19,460 - THERESA AHERN - $16,531 - DONALD GUADAGNOLI MD - $22,241 - EMILY SCHORER - $15,836 - KEVIN MULROY - $19,857 - CHRISTIAN BROWN - $16,920 - LORI JEWETT - $9,516 - JUDITH C. QUINN - $11,515 - KEVIN RALPH - $12,698 - REBECCA FRANCE - $2,094 CAPE COD HEALTHCARE, INC. AND AFFILIATES ALSO SPONSOR A NONQUALIFIED PENSION RESTORATION ACCOUNT PLAN FOR KEY EXECUTIVES. THE ORGANIZATION MAKES CONTRIBUTIONS OF TWO PERCENT OF THE INDIVIDUAL'S ANNUAL SALARY (INCLUDING BONUS) THROUGHOUT THE PLAN YEAR. AMOUNTS DEFERRED ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AND UNDER THE PLAN, PARTICIPANTS ARE ENTITLED TO CERTAIN BENEFITS UPON RETIREMENT, TERMINATION, OR DEATH. DURING CALENDAR YEAR 2018, MICHAEL LAUF ALSO PARTICIPATED IN A SECTION 457(F) PLAN. TWELVE PERCENT OF HIS BASE SALARY WAS CONTRIBUTED AND EACH CONTRIBUTION IS SUBJECT TO A THREE YEAR VESTING SCHEDULE. THE AMOUNT DEFERRED IN CALENDAR YEAR 2018 WAS $120,000 AND IS INCLUDED IN SCHEDULE J, PART II, COLUMN (C). IN ADDITION, $120,000 WAS PAID OUT FROM HIS CEO SUPPLEMENTAL PLAN, AND IS INCLUDED IN SCHEDULE J, PART II, COLUMN B(III).
SCHEDULE J, PART I, LINE 7
DISCRETIONARY BONUSES ARE AWARDED ANNUALLY BASED UPON BOTH THE PERFORMANCE OF THE ORGANIZATION AND THE INDIVIDUAL. BONUSES ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B(II).THE INDIVIDUALS REPORTED IN SCHEDULE J, PART II REPORTED AS BEING PAID FROM A RELATED ORGANIZATION WERE EMPLOYEES OF, AND COMPENSATED BY CAPE COD HEALTHCARE, INC., THE PARENT CORPORATION.
Schedule J (Form 990) 2018
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