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ObjectId: 202411209349301411 - Submission: 2024-04-29
TIN: 06-1422741
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
AMERICARES FREE CLINICS INC
Employer identification number
06-1422741
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
Yes
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
.........
4b
No
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) 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
CHRISTINE SQUIRES
PRESIDENT & CEO
(i)
(ii)
0
-------------
500,579
0
-------------
50,000
0
-------------
0
0
-------------
20,665
0
-------------
40,532
0
-------------
611,776
0
-------------
0
2
RICHARD K TROWBRIDGE JR
CFO, TREASURER & SVP OF GIK OPERAT.
(i)
(ii)
0
-------------
293,317
0
-------------
0
0
-------------
0
0
-------------
18,550
0
-------------
40,532
0
-------------
352,399
0
-------------
0
3
M RASHAD MASSOUD MD MPH FACP
DIRECTOR (THRU 8/2022)
(i)
(ii)
0
-------------
239,775
0
-------------
0
0
-------------
53,045
0
-------------
14,653
0
-------------
0
0
-------------
307,473
0
-------------
0
4
MEGIN WOLFMAN
FORMER ASSISTANT SECRETARY
(i)
(ii)
0
-------------
247,070
0
-------------
0
0
-------------
0
0
-------------
14,955
0
-------------
40,533
0
-------------
302,558
0
-------------
0
5
KAREN GOTTLIEB
EXECUTIVE DIRECTOR
(i)
(ii)
210,091
-------------
0
0
-------------
0
0
-------------
0
12,988
-------------
0
12,964
-------------
0
236,043
-------------
0
0
-------------
0
6
NICOLAS E PALACIOS MEZA
PHYS., STAMFORD CLINIC (THRU 6/2023)
(i)
(ii)
185,700
-------------
0
1,000
-------------
0
0
-------------
0
0
-------------
0
12,261
-------------
0
198,961
-------------
0
0
-------------
0
7
DINA VALENTI
DIRECTOR, DANBURY CLINIC
(i)
(ii)
145,235
-------------
0
1,000
-------------
0
0
-------------
0
9,016
-------------
0
29,071
-------------
0
184,322
-------------
0
0
-------------
0
8
VERONICA SULLIVAN
DIR., NORWALK CLINIC (THRU 4/2023)
(i)
(ii)
117,891
-------------
0
1,000
-------------
0
0
-------------
0
7,363
-------------
0
25,727
-------------
0
151,981
-------------
0
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 4A
SEVERANCE OR CHANGE-OF-CONTROL PAYMENTS DIRECTOR, RASHAD MASSOUD, M.D. RECEIVED A SEVERANCE PAYMENT OF $53,045 IN CALENDAR YEAR 2022 FROM THE AMERICARES FOUNDATION, INC. THIS AMOUNT IS REPORTED IN FORM 990, SCHEDULE J, PART II, COLUMN B(III) AS COMPENSATION PAID FROM A RELATED ORGANIZATION. NICOLAS E. PALACIOS MEZA, DINA VALENTI AND VERONICA SILLIVAN RECEIVED A DISCRETIONARY BONUS IN CALENDAR YEAR 2022 FOR EXCEEDING CERTAIN PERFORMANCE-BASED OBJECTIVES ESTABLISHED BY THE COMPENSATION COMMITTEE. THE DETERMINATION TO ISSUE A BONUS IS BASED ON A RECOMMENDATION BY THE COMPENSATION COMMITTEE TO THE FULL BOARD, FOR BOARD APPROVAL. THESE INDIVIDUALS DID NOT PARTICIPATE IN THE DECISION-MAKING PROCESS TO AWARD THE BONUS.
PART I, LINE 7
THE PRESIDENT AND CEO IS ENTITLED TO AN ANNUAL BONUS PURSUANT TO HER EMPLOYMENT CONTRACT AT THE DISCRETION OF THE COMPENSATION COMMITTEE OF THE FOUNDATION'S BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE CONVENES EACH YEAR TO DETERMINE IF THE PRESIDENT HAS EXCEEDED CERTAIN PERFORMANCE-BASED CRITERIA, AND IF SHE HAS, THEY WILL AUTHORIZE A BONUS. IN CALENDAR YEAR 2022, THE PRESIDENT RECEIVED A $50,000 DISCRETIONARY BONUS. THE FOUNDATION HAS A BONUS POLICY IN PLACE THAT PERMITS BONUSES TO OTHER EMPLOYEES BASED ON CERTAIN FACTORS: RELOCATION BONUSES, SIGN-ON BONUSES, RETENTION BONUSES AND PERFORMANCE BONUSES. IN CALENDAR YEAR 2022, THE FOUNDATION ISSUED A FEW SMALL BONUSES TO THREE INDIVIDUALS REPORTED ON THE FORM 990, SCHEDULE J. THE AMERICARES STAFF ARE THE MAIN DRIVER OF ALL OF OUR WORK IN THE WORLD AND, AS SUCH, WE STRIVE TO RECOGNIZE THEIR CONTRIBUTIONS CONSISTENTLY IN WAYS THAT ARE COMPETITIVE, EQUITABLE AND TRANSPARENT, AS LAID OUT IN OUR COMPENSATION PHILOSOPHY. THERE ARE A SMALL NUMBER OF CIRCUMSTANCES IN WHICH WE MAY NEED TO GO ABOVE AND BEYOND THIS BASE COMPENSATION IN ORDER TO RECOGNIZE THE NEEDS AND EFFORTS OF OUR STAFF. THIS POLICY OUTLINES THE CIRCUMSTANCES IN WHICH BONUS PAY WILL BE CONSIDERED. HOWEVER, IT IS IMPORTANT TO NOTE THAT, AS A NON-PROFIT ORGANIZATION, AMERICARES ALSO TAKES OUR RESPONSIBILITY TO DONORS AND FUNDERS VERY SERIOUSLY. AS SUCH, WE CONSIDER BONUS PAY TO BE A VERY RARE OCCURRENCE, ONLY EMPLOYED WHEN THERE IS CLEAR NEED.
Schedule J (Form 990) 2022
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