efile Public Visual Render
ObjectId: 202243149349304834 - Submission: 2022-11-10
TIN: 43-1874215
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
21
Open to Public Inspection
Name of the organization
DUNN ROAD MANOR INC
C/O LUTHERAN SENIOR SERVICES
Employer identification number
43-1874215
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 on 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 on 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
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) 2021
Page 2
Schedule J (Form 990) 2021
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, 1099-MISC compensation, and/or 1099-NEC
(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
JOHN KOTOVSKY
CHIEF MISSION OFFICER
(i)
(ii)
0
-------------
496,187
0
-------------
486,218
0
-------------
0
0
-------------
1,473
0
-------------
3,361
0
-------------
987,239
0
-------------
0
2
GARRY ANDERSON
PRESIDENT/CEO/COO
(i)
(ii)
0
-------------
298,133
0
-------------
51,281
0
-------------
1,584
0
-------------
52,925
0
-------------
5,976
0
-------------
409,899
0
-------------
0
3
CHAD SNEED
SENIOR VP OF FINANCE
(i)
(ii)
0
-------------
244,847
0
-------------
0
0
-------------
529
0
-------------
22,368
0
-------------
10,672
0
-------------
278,416
0
-------------
0
4
LISA NORWINE
CHIEF ADVANCEMENT OFFICER
(i)
(ii)
0
-------------
203,003
0
-------------
18,446
0
-------------
918
0
-------------
22,317
0
-------------
10,331
0
-------------
255,015
0
-------------
0
5
LISA WILLIAMS
SR VP OF WORKFORCE EXCELLENCE
(i)
(ii)
0
-------------
222,557
0
-------------
0
0
-------------
2,136
0
-------------
21,895
0
-------------
6,009
0
-------------
252,597
0
-------------
0
6
PAUL OGIER
SENIOR ADVISOR
(i)
(ii)
0
-------------
232,192
0
-------------
6,619
0
-------------
2,468
0
-------------
2,213
0
-------------
5,343
0
-------------
248,835
0
-------------
0
7
VALERIE COOPER
VP OF OPER & EXEC DIRECTOR
(i)
(ii)
0
-------------
188,206
0
-------------
5,000
0
-------------
252
0
-------------
21,999
0
-------------
7,354
0
-------------
222,811
0
-------------
0
8
COLLEEN BOTTENS
VP SUPPORT SVCS & EXEC DIR
(i)
(ii)
0
-------------
166,947
0
-------------
0
0
-------------
343
0
-------------
32,534
0
-------------
7,350
0
-------------
207,174
0
-------------
0
9
BRIAN REINHOLD
VP OF RISK/SAFETY/COMPLIANCE
(i)
(ii)
0
-------------
156,976
0
-------------
0
0
-------------
129
0
-------------
21,643
0
-------------
10,928
0
-------------
189,676
0
-------------
0
10
JOSH KING
VP OF INFORMATION TECHNOLOGY
(i)
(ii)
0
-------------
149,338
0
-------------
0
0
-------------
104
0
-------------
20,791
0
-------------
11,091
0
-------------
181,324
0
-------------
0
11
DREW REDMAN
EXECUTIVE DIRECTOR
(i)
(ii)
0
-------------
150,935
0
-------------
0
0
-------------
94
0
-------------
10,599
0
-------------
7,345
0
-------------
168,973
0
-------------
0
12
DAVID CARTER
EXEC DIR OF HOME CARE SERVICES
(i)
(ii)
0
-------------
141,906
0
-------------
0
0
-------------
116
0
-------------
11,460
0
-------------
7,997
0
-------------
161,479
0
-------------
0
13
RITA VICARY
VP OF MARKETING COMM AND SALES
(i)
(ii)
0
-------------
135,211
0
-------------
20,000
0
-------------
613
0
-------------
1,575
0
-------------
3,195
0
-------------
160,594
0
-------------
0
14
RACHEL LITTLE
DIR OF CLINICAL COMPLIANCE
(i)
(ii)
0
-------------
151,656
0
-------------
5,000
0
-------------
184
0
-------------
1,567
0
-------------
306
0
-------------
158,713
0
-------------
0
15
TODD YOUNG
NETWORK DIRECTOR
(i)
(ii)
0
-------------
146,971
0
-------------
0
0
-------------
122
0
-------------
1,512
0
-------------
4,150
0
-------------
152,755
0
-------------
0
16
MARY HEMPHILL
RN
(i)
(ii)
0
-------------
137,603
0
-------------
3,760
0
-------------
35
0
-------------
1,080
0
-------------
8,664
0
-------------
151,142
0
-------------
0
17
BEN CAFFEY
EXEC DIR OF SALES GROWTH & STRATEGY
(i)
(ii)
0
-------------
144,266
0
-------------
0
0
-------------
115
0
-------------
1,402
0
-------------
5,351
0
-------------
151,134
0
-------------
0
Schedule J (Form 990) 2021
Page 3
Schedule J (Form 990) 2021
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 PARENT ORGANIZATION, LUTHERAN SENIOR SERVICES, USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR.
PART I, LINE 4B
DEPOSITS MADE INTO ACCOUNTS BY ORGANIZATION: GARRY ANDERSON - SEC 457(B) PLAN - $50,000 LISA NORWINE - SEC 457(B) PLAN - $20,000 LISA WILLIAMS - SEC 457(B) PLAN - $20,000 DAVID CARTER SEC 457(B) PLAN - $10,000 DREW REDMAN SEC 457(B) PLAN - $10,000 CHAD SNEED - SEC 457(B) PLAN - $20,000 BRIAN REINHOLD - SEC 457(B) PLAN - $20,000 JOSH KING - SEC 457(B) PLAN - $20,000 VALERIE COOPER - SEC 457(B) PLAN - $20,000 COLLEEN BOTTENS - SEC 457(B) PLAN - $20,000 PAUL OGIER - SEC 457(F) PLAN - $6,619 GARRY ANDERSON - SEC 457(F) PLAN - $26,281 LISA NORWINE - SEC 457(F) PLAN - $18,446 PAYMENTS RECEIVED FROM PLAN: PAUL OGIER - SEC 457(B) PLAN - $28,017 JOHN KOTOVSKY - SEC 457(B) PLAN - $68,446 JOHN KOTOVSKY - SEC 457(F) PLAN - $1,079,880
Schedule J (Form 990) 2021
Additional Data
Software ID:
Software Version: