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ObjectId: 202042179349300719 - Submission: 2020-08-04
TIN: 02-0274905
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
Rockingham Visiting Nurse Association
and Hospice
Employer identification number
02-0274905
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 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
Jennifer Costain
Trustee
(i)
(ii)
0
-------------
180,711
0
-------------
14,893
0
-------------
4,820
0
-------------
12,352
0
-------------
17,403
0
-------------
230,179
0
-------------
0
2
Eliot DeSilvaMD
Trustee
(i)
(ii)
0
-------------
281,082
0
-------------
119,216
0
-------------
329
0
-------------
8,250
0
-------------
22,826
0
-------------
431,703
0
-------------
0
3
Neil Meehan DO
Trustee
(i)
(ii)
0
-------------
398,779
0
-------------
125,610
0
-------------
12,328
0
-------------
13,502
0
-------------
23,825
0
-------------
574,044
0
-------------
0
4
Kevin J Callahan
Chairman/Trustee/Ex-Offici
(i)
(ii)
0
-------------
656,192
0
-------------
225,000
0
-------------
68,529
0
-------------
8,250
0
-------------
17,707
0
-------------
975,678
0
-------------
0
5
Kevin J O'Leary
Treasurer/Trustee/Ex-Offic
(i)
(ii)
0
-------------
425,316
0
-------------
134,502
0
-------------
29,751
0
-------------
76,250
0
-------------
17,707
0
-------------
683,526
0
-------------
0
6
Susan Burns-Tisdale
Secretary/Trustee
(i)
(ii)
0
-------------
318,752
0
-------------
105,298
0
-------------
21,178
0
-------------
16,500
0
-------------
21,655
0
-------------
483,383
0
-------------
0
7
Karen Michel
President/Trustee
(i)
(ii)
160,216
-------------
0
18,083
-------------
0
614
-------------
0
3,607
-------------
0
8,863
-------------
0
191,383
-------------
0
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
Part I, Line 4b
The organization's parent (Exeter Health Resources, Inc.) maintains a split dollar supplemental retirement plan for two executives (listed below with amounts) selected by the Exeter Health Resources, Inc. Board of Trustees. The plan is closed to future participants. The Plan provides for annual payments of premiums for life insurance policies insuring the listed individuals. Those life insurance premiums are collaterally assigned to the corporation and any excess accumulated value in the policies (net of accumulated premium payments which are returned to the organization upon the executive attaining the age of 70 or at the death of the participant) is available to be paid to the participant once vested at age 62 and upon retirement from the organization. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance provided. Life insurance premium payments during tax year: Kevin J. Callahan $315,428 Kevin J. O'Leary $137,323 Excess Accumulated Value: Kevin J. Callahan $3,174,709 Kevin J. O'Leary $1,307,722 Certain of the listed employees participate in a nonqualified deferred compensation plan as described in Internal Revenue Code Section 457(f) sponsored by Exeter Health Resources, Inc. In the calendar year ended December 31, 2018, the contribution to the plan for the non-vested benefit of Kevin J. O'Leary was $68,000. The contribution is intended to provide a forfeitable supplemental retirement benefit. Participants in the 457(f) plan do not vest until age 62 when it is payable to the participant.
Part I, Line 7
Karen Michel, Sherry Ovens Burleigh, Mary Arnault, Linda Taylor and Diane Levasseur are also provided incentive bonus payments under a plan aligned with the strategic interests of RVNA. These incentive awards are approved by operating management and Human Resources.
Schedule J (Form 990) 2018
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