efile Public Visual Render
ObjectId: 202343179349305899 - Submission: 2023-11-13
TIN: 15-0584188
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
22
Open to Public Inspection
Name of the organization
NEWARK-WAYNE COMMUNITY HOSPITAL
Employer identification number
15-0584188
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) 2022
Page 2
Schedule J (Form 990) 2022
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
RICHARD DAVIS PHD
CEO
(i)
(ii)
75,928
-------------
968,086
18,182
-------------
231,818
0
-------------
0
0
-------------
0
815
-------------
10,397
94,925
-------------
1,210,301
0
-------------
0
2
HUGH THOMAS
CAO
(i)
(ii)
65,155
-------------
830,723
41,320
-------------
526,826
0
-------------
0
-15,056
-------------
-191,961
911
-------------
11,621
92,330
-------------
1,177,209
10,015
-------------
127,685
3
THOMAS CRILLY
CFO
(i)
(ii)
45,972
-------------
586,148
47,304
-------------
603,129
3,670
-------------
46,786
-17,790
-------------
-226,821
923
-------------
11,769
80,079
-------------
1,021,011
7,685
-------------
97,984
4
DUSTIN RICCIO
PRESIDENT, EASTERN REGION
(i)
(ii)
175,852
-------------
332,865
94,492
-------------
173,235
0
-------------
0
-68,118
-------------
-124,883
5,710
-------------
10,469
207,936
-------------
391,686
0
-------------
0
5
MATHEW SCHIRALLI MD
MEDICAL STAFF PRESIDENT
(i)
(ii)
137,769
-------------
0
376,200
-------------
0
0
-------------
0
-82,452
-------------
0
10,432
-------------
0
441,949
-------------
0
0
-------------
0
6
RAJINDER SIDHU
PHYSICIAN
(i)
(ii)
349,913
-------------
0
91,232
-------------
0
0
-------------
0
-39,945
-------------
0
12,442
-------------
0
413,642
-------------
0
0
-------------
0
7
SOUFIANE KHELIL
PHYSICIAN
(i)
(ii)
319,968
-------------
0
92,462
-------------
0
0
-------------
0
-44,006
-------------
0
2,266
-------------
0
370,690
-------------
0
0
-------------
0
8
MARITA MICHELIN
CHIEF, EMERGENCY MEDICINE
(i)
(ii)
173,473
-------------
0
219,305
-------------
0
0
-------------
0
-48,905
-------------
0
11,569
-------------
0
355,442
-------------
0
0
-------------
0
9
ARUN KUMAR NAGPAUL MD
FORMER MEDICAL STAFF PRESIDENT
(i)
(ii)
333,535
-------------
0
127,483
-------------
0
0
-------------
0
-171,875
-------------
0
12,433
-------------
0
301,576
-------------
0
0
-------------
0
10
SERHIY SOSNIYENKO
PHYSICIAN
(i)
(ii)
395,476
-------------
0
105,366
-------------
0
0
-------------
0
-216,320
-------------
0
5,541
-------------
0
290,063
-------------
0
0
-------------
0
11
YULIYA REHAB
HOSPITALIST
(i)
(ii)
346,540
-------------
0
80,738
-------------
0
0
-------------
0
-226,854
-------------
0
12,442
-------------
0
212,866
-------------
0
0
-------------
0
12
ERIC BIEBER
FORMER CEO
(i)
(ii)
3,444
-------------
43,916
0
-------------
0
0
-------------
0
0
-------------
0
21
-------------
272
3,465
-------------
44,188
0
-------------
0
Schedule J (Form 990) 2022
Page 3
Schedule J (Form 990) 2022
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
COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS IS ESTABLISHED USING THE FOLLOWING: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACTS - COMPENSATION SURVEYS AND STUDIES - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE ON AN ANNUAL BASIS, THE ORGANIZATION USES AN INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE SALARIES FOR ALL EXECUTIVES TO ENSURE SUCH SALARIES ARE CONSISTENT WITH MARKET SALARIES PAID TO SIMILARLY SITUATED EXECUTIVES. IN ADDITION, A COMPENSATION COMMITTEE REVIEWS THIS INFORMATION ANNUALLY AND IT IS THEN APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. FINALLY, EXECUTIVES RECEIVE A WRITTEN LETTER OUTLINING THE SPECIFICS OF THE COMPENSATION AGREEMENT AND THEIR EXPECTED PERFORMANCE.
PART I, LINE 4B
SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS PROVIDE BENEFITS TO CERTAIN KEY EXECUTIVE EMPLOYEES OF ROCHESTER REGIONAL HEALTH. THE ORGANIZATION MAINTAINS A SECTION 457(F) PLAN WHICH WOULD BE CONSIDERED A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2022 THE CFO OF ROCHESTER REGIONAL HEALTH RECEIVED A DISTRIBUTION TOTALING $49,054.
PART II, COLUMN C:
RETIREMENT AND OTHER DEFERRED COMPENSATION - THIS COLUMN IS REFLECTIVE OF THE ACTUARIAL CHANGE IN DEFINED BENEFIT PENSION PLAN AND POST-RETIREMENT BENEFITS FOR THE TAX YEAR.
Schedule J (Form 990) 2022
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