2017-11-14T15:11:19-06:00 2016-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2016-01-01 119627400 UNITY HEALTH SYSTEM FOUNDATION UNIT 5859224800 1555 LONG POND RD ROCHESTER NY 14626 THOMAS R CRILLY CFO 5859224800 2017-11-13 1 ANGELA M FRANCO P00589741 3154463600 2017-11-13 24.39.85.114 2017-11-13 18:49:53 ES P 517AEBE328CBAAA90E396C2FD1060AA56161F780 517AEBE328CBAAA90E396C2FD1060AA56161F780 2016 2017-02-10 21:41:12Z X ERIC BIEBER MD 1555 LONG POND RD ROCHESTER NY 14626 2323090 0 X WWW.ROCHESTERREGIONAL.ORG X 1976 NY THE UNITY HEALTH FOUNDATION CONDUCTS ANNUAL FUND-RAISING EVENTS AND CULTIVATES AND SOLICITS CAPITAL GIFTS IN SUPPORT OF THE SYSTEM AS WELL AS THE COMMUNITY. THE UNITY HOSPITAL OF ROCHESTER, A MAJOR ENTITY OF THE SYSTEM, IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL WHICH PROVIDES QUALITY GENERAL AND ACUTE INPATIENT AND OUTPATIENT HOSPITAL CARE TO THE RESIDENTS OF ROCHESTER, NY AND THE SURROUNDING COMMUNITY REGARDLESS OF ABILITY TO PAY. X 30 27 7 20 0 0 1273440 1700262 0 0 1107925 377055 194767 205496 2576132 2282813 1273959 1210547 0 0 766939 971501 0 0 514481 680175 422419 2721073 2604467 -144941 -321654 15504055 0 927785 0 14576270 0 X THE UNITY HEALTH FOUNDATION CONDUCTS ANNUAL FUND-RAISING EVENTS AND CULTIVATES AND SOLICITS CAPITAL GIFTS IN SUPPORT OF THE SYSTEM AS WELL AS THE COMMUNITY. THE UNITY HOSPITAL OF ROCHESTER, A MAJOR ENTITY OF THE SYSTEM, IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL WHICH PROVIDES QUALITY GENERAL AND ACUTE INPATIENT AND OUTPATIENT HOSPITAL CARE TO THE RESIDENTS OF ROCHESTER, NY AND THE SURROUNDING COMMUNITY REGARDLESS OF ABILITY TO PAY. 0 1 1210547 1210547 THE UNITY HEALTH FOUNDATION CONDUCTS ANNUAL FUND-RAISING EVENTS AND CULTIVATIVE AND SOLICITS CAPITAL GIFTS IN SUPPORT OF ROCHESTER REGIONAL HEALTH (THE SYSTEM) AS WELL AS THE COMMUNITY. THE UNITY HOSPITAL OF ROCHESTER, A MAJOR ENTITY OF THE SYSTEM, IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL WHICH PROVIDES QUALITY GENERAL AND ACUTE INPATIENT AND OUTPATIENT HOSPITAL CARE TO THE RESIDENTS OF ROCHESTER, NY AND THE SURROUNDING COMMUNITY REGARDLESS OF ABILITY TO PAY. 1210547 1 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 3 0 1 7 0 0 0 0 0 1 1 1 1 0 0 0 0 X 30 27 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X TAMMY CLAFLIN 5859221745 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 ELIZABETH PATTON PHD CO-TREASURER 1.00 1.00 X 0 0 0 THOMAS RILEY DIRECTOR 1.00 1.00 X 0 0 0 TARUN KOTHARI MD DIRECTOR 1.00 1.00 X 0 0 0 LEON T SAWYKO CO-CHAIR 1.00 1.00 X 0 0 0 MARK MEYER DIRECTOR 1.00 1.00 X 0 0 0 TERESA M ROBACH DIRECTOR 1.00 1.00 X 0 0 0 JAMES VAZZANA DIRECTOR 1.00 1.00 X 0 0 0 ERIC BIEBER MD CEO 1.00 54.00 X X 0 3516820 1064908 CARL LUGER CO-TREASURER 1.00 1.00 X 0 0 0 CYNTHIA CHRISTY MD MEDICAL LIAISON 1.00 1.00 X 0 0 0 JOSEPHINE BRAITMAN DIRECTOR 1.00 1.00 X 0 0 0 DAVID N BROADBENT MD DIRECTOR 1.00 1.00 X 0 0 0 DONALD CAMERON DIRECTOR 1.00 1.00 X 0 0 0 LOUISE W EPSTEIN DIRECTOR 1.00 1.00 X 0 0 0 DAVID M GERMANO DIRECTOR 1.00 1.00 X 0 0 0 LOIS F IRWIN DIRECTOR 1.00 1.00 X 0 0 0 RAHUL KOHLI DIRECTOR 1.00 1.00 X 0 0 0 KATHERINE SCHUMACHER DIRECTOR 1.00 1.00 X 0 0 0 TIM SHANAHAN DIRECTOR 1.00 1.00 X 0 0 0 GWEN STERNS MD DIRECTOR 1.00 1.00 X 0 80533 2361 DON TWEITMEYER DIRECTOR 1.00 1.00 X 0 0 0 ROBERTA VAN WINKLE DIRECTOR 1.00 1.00 X 0 0 0 JAMES WHELEHAN DIRECTOR 1.00 1.00 X 0 0 0 JOHN G WHITE JR DIRECTOR 1.00 1.00 X 0 0 0 ROBERT W GEORGE MD CO-CHAIR 1.00 1.00 X 0 57697 7752 NANCY S FERRIS PHD SECRETARY 1.00 1.00 X 0 0 0 JAN AUGUST DIRECTOR 1.00 1.00 X 0 0 0 GREGORY P KAUSCH DIRECTOR 1.00 1.00 X 0 0 0 LEONARD OLIVIERI DIRECTOR 1.00 1.00 X 0 0 0 KEVIN OVERTON DIRECTOR 1.00 1.00 X 0 0 0 THOMAS R CRILLY CFO 0.00 55.00 X 0 1012616 427250 ROBERT NESSELBUSH COO 1.00 55.00 X 0 1608627 676261 HUGH THOMAS CAO 1.00 55.00 X 0 1230940 512645 MARK CLEMENT FORMER CEO 0.00 X 0 1373284 30715 0 8880517 2721892 0 1 1 0 0 22248 54285 5000 1618729 9498 1700262 292089 292089 84966 0 84966 84966 84966 27380 54285 40277 -12897 -12897 RENTAL REIMBURSEMENT 900099 218393 218393 218393 2282813 0 0 582551 1168596 1168596 41951 41951 771000 385500 385500 200501 100251 100250 32887 26248 6639 10634 10634 16634 16634 15769 15769 35277 35277 870 870 23206 23206 BAD DEBTS 275684 275684 DONOR RECOGNITION 11458 11458 2604467 1210547 879439 514481 23549 0 318124 0 3165787 0 0 0 0 399217 0 0 13734 0 0 772684 0 9466102 0 19906 0 0 0 1324952 0 15504055 0 68306 56223 803256 0 927785 0 X 1888252 0 6851280 0 5836738 0 14576270 0 15504055 0 X -321654 218781 -14473397 X X 0 1 X 1 0 X 4670427 3354888 2707275 1260235 1700262 13693087 4670427 3354888 2707275 1260235 1700262 13693087 10275182 3417905 312210 232529 302724 350942 292089 1490494 15183581 0.22510 0.36000 X ALTHOUGH THE AMOUNT ON PART II, SECTION C, LINE 14 DID NOT MEET THE 33 1/3% TEST, IT DOES MEET THE 10% SUPPORT LIMITATION TEST. DURING 2016, THE FOUNDATION MERGED WITH ROCHESTER GENERAL HOSPITAL FOUNDATION (EIN: 22-2229425), THIS CAUSED A SHIFT OF ACTIVITIES FROM THE FILING ORGANIZATION TO THE SURVIVING ORGANIZATION, RESULTING IN A LOWER PUBLIC SUPPORT PERCENTAGE FOR 2016. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 214799 35542 0 1 1 12688018 1274996 454763 1123224 13294553 13810966 635797 -627136 1131609 12688018 15915793 1805382 77081 3987290 13810966 15326920 2422245 290017 2123389 15915793 15069477 3905446 691026 4339029 15326920 0.00000 0.00000 1 0 0 2323090 40277 40277 2282813 0 2282813 1632134 40277 40277 1591857 1012610 1012610 2604467 PART V, LINE 4: PERMANENTLY RESTRICTED ENDOWMENTS ARE HELD IN PERPETUITY, THEIR INCOME IS AVAILABLE FOR USE BASED ON DONOR STIPULATIONS. EARNINGS ON THE ENDOWMENT ARE EARMARKED FOR EITHER UNRESTRICTED OPERATIONS OR SPECIFIC PURPOSE BASED ON DESIGNATION OF THE ENDOWMENT. TEMPORARILY RESTRICTED ENDOWMENT FUNDS ARE RELEASED FROM RESTRICTION FOR PROGRAM PURPOSES IN ACCORDANCE WITH DONOR REQUIREMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE 40,277. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE 40,277. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROJECT FUNDING 1,012,610. GOLF 81665 54285 27380 40277 81665 54285 27380 40277 40277 -12897 0 NORTH PARK NURSING HOME INC 700 ISLAND COTTAGE ROAD ROCHESTER NY 14626 223159644 9119 FACILITY RENOVATION, STAFF RECOGNITION & GENERAL PURPOSES FOR RESIDENTS PARK RIDGE NURSING HOME INC 1555 LONG POND RD ROCHESTER NY 14626 160978184 28026 FACILITY CONSTRUCTION, MEDICAL & OTHER EQUIPMENT, SUPPLIES & GENERAL PURPOSES THE UNITY HOSPITAL OF ROCHESTER 1555 LONG POND RD ROCHESTER NY 14626 237221763 959869 FACILITY EXPANSION & RENOVATION, MEDICAL & OTHER EQUIPMENT, STAFF TRAINING, SUPPLIES & GEN'L PURPOSES WOODLAND VILLAGE INC 1555 LONG POND RD ROCHESTER NY 14626 161588242 55460 FACILITY CONSTRUCTION AND GENERAL PURPOSES FOR RESIDENTS PARK RIDGE CHILD CARE CENTER 1555 LONG POND RD ROCHESTER NY 14626 222918126 6749 SECURITY EQUIPMENT & CLASSROOM SUPPLIES FORGIVABLE EMPLOYEE LOAN FOR LOW-INCOME HOME OWNERSHIP 4 12000 COPAY ASSISTANCE 27 5660 MEDICATIONS FOR UNDERINSURED 17 891 NURSING TUITION SCHOLARSHIP 14 21500 SECURITY DEPOSIT ASSISTANCE FOR CLIENTS 4 1900 PART I, LINE 2: THE FOUNDATION'S FINANCIAL COORDINATOR CONDUCTS MONTHLY RECONCILIATION AND MAINTAINS SUBSTANTIATED DOCUMENTATION OF ALL PAYMENTS FOR FULFILLMENT OF EVERY GRANT AWARDED. 1 1 0 0 0 0 0 0 0 ERIC BIEBER MD CEO 0 1116015 0 2400805 0 0 0 1011846 0 53062 0 4581728 0 1070317 THOMAS R CRILLY CFO 0 435307 0 577309 0 0 0 375536 0 51714 0 1439866 0 372767 ROBERT NESSELBUSH COO 0 747958 0 860669 0 0 0 624284 0 51977 0 2284888 0 556513 HUGH THOMAS CAO 0 547274 0 683666 0 0 0 466348 0 46297 0 1743585 0 442221 MARK CLEMENT FORMER CEO 0 0 0 0 0 1373284 0 26618 0 4097 0 1403999 0 1373284 PART I, LINE 3 COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS INCLUDING: - ERIC BIEBER, M.D. (PRESIDENT & CEO) - THOMAS CRILLY (CFO) - MARK CLEMENT (CEO UNTIL 11/30/14) - HUGH THOMAS (CAO) - ROBERT NESSELBUSH (COO) USED THE FOLLOWING TO ESTABLISH THEIR COMPENSATION AND BENEFITS: - COMPENSATION COMMITTEE, - INDEPENDENT COMPENSATION CONSULTANT, - FORM 990 OF OTHER ORGANIZATIONS, - 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, LINES 4A-B SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS PROVIDE BENEFITS TO CERTAIN KEY EXECUTIVE EMPLOYEES OF UNITY HEALTH SYSTEM FOUNDATION. THE ORGANIZATION MAINTAINS A SECTION 457(F) PLAN WHICH WOULD BE CONSIDERED A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THERE WERE NO DISTRIBUTIONS PAID IN 2016. IN 2014 AND PRIOR YEARS, THE TOTAL COMPENSATION OF THE FORMER CEO'S WAS DISCLOSED AS A COMBINATION OF CASH PAID BY THE ORGANIZATION AND DEFERRED COMPENSATION. THE CASH PAYMENTS TO THE FORMER CEO'S SHOWN ON THE 2016 TAX RETURNS REPRESENTS PAYMENTS OF COMPENSATION WHICH WAS RECOGNIZED IN PREVIOUS TAX RETURNS. THERE WAS NO INCREMENTAL EXPENSE RECOGNIZED BY THE ORGANIZATION IN 2016 FOR PAYMENTS MADE TO THE FORMER CEO'S. CASH AND CASH EQUIVALENTS 2016-12-31 460533 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) PLEDGES AND GRANTS RECEIVABLE 2016-12-31 3272439 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) NOTES AND LOANS RECEIVABLE 2016-12-31 13286 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) PREPAID EXPENSES AND DEFERRED CHARGES 2016-12-31 12723 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) PROPERTY, PLANT, EQUIPMENT, NET 2016-12-31 749478 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) INVESTMENTS, PUBLICLY TRADED SECURITIES 2016-12-31 2997290 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) INVESTMENTS, OTHER SECURITIES 2016-12-31 6052697 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) CASH SURRENDER VALUE LIFE INSURANCE POLICIES 2016-12-31 184393 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) CHARITABLE GIFT ANNUITY RESERVE 2016-12-31 682847 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) CHARITABLE REMAINDER TRUSTS 2016-12-31 478474 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) DUE FROM AFFILIATES 2016-12-31 216778 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) UNRESTRICTED NET ASSETS 2016-12-31 1177389 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) TEMPORARILY RESTRICTED NET ASSETS 2016-12-31 7112650 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) PERMANENTLY RESTRICTED NET ASSETS 2016-12-31 6181903 BOOK VALUE 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 501(C)(3) 1 0 0 0 1 1 1 0 0 PART I, LINE 2E: PERSON(S) INVOLVED: THE BOARD OF DIRECTORS FOR THE FILING ORGANIZATION IS THE SAME BOARD OF DIRECTORS FOR ROCHESTER GENERAL HOSPITAL FOUNDATION, THE SURVIVING ORGANIZATION AFTER MERGER. FORM 990, PART III, LINE 3 ON DECEMBER 31, 2016 UNITY HEALTH SYSTEM FOUNDATION (THE FILING ORGANIZATION) MERGED WITH ROCHESTER GENERAL HOSPITAL FOUNDATION (EIN: 22-2229425), THE SURVIVING CORPORATION. ALL PROGRAM SERVICE ACTIVITIES WERE TRANSFERRED TO THE SURVIVING CORPORATION AND THE FILING ORGANIZATION CEASED PROGRAM ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 1 EACH BOARD HAS AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD PLUS THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND SUCH OTHER DIRECTORS AS THE CHAIR MAY NOMINATE FROM TIME TO TIME FOR APPOINTMENT BY A MAJORITY VOTE OF THE ENTIRE BOARD. BETWEEN MEETINGS OF THE BOARD, AND TO THE EXTENT PERMITTED BY LAW, THE EXECUTIVE COMMITTEE SHALL POSSESS THE POWERS OF THE BOARD WITH RESPECT TO MANAGING AND CONDUCTING THE AFFAIRS OF THE CORPORATION, EXCEPT AS OTHERWISE PROVIDED BY LAW OR WITHIN CERTAIN BY-LAWS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A MEMBERSHIP (NOT A STOCK) CORPORATION UNDER NEW YORK STATE LAW. THE ORGANIZATION'S SOLE CORPORATE MEMBER IS ROCHESTER REGIONAL HEALTH, A RELATED NOT-FOR-PROFIT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B ROCHESTER REGIONAL HEALTH, AS THE SOLE CORPORATE MEMBER, ALSO HAS THE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY, INCLUDING AMENDMENT OF BYLAWS AND CHARTERS, REMOVAL OF MEMBERS OF THE GOVERNING BODY, AND THE DECISION TO DISSOLVE THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, A COPY OF THE FORM 990 IS PROVIDED TO, AND REVIEWED WITH, ALL MEMBERS OF THE AUDIT AND COMPLIANCE COMMITTEE. THIS REVIEW IS PERFORMED IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, AND IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND OTHER RELEVANT INFORMATION FOR THE APPROPRIATE TIME PERIOD. FORM 990, PART VI, SECTION B, LINE 12C UPON EMPLOYMENT, ALL EMPLOYEES RECEIVE THE ETHICAL STANDARD OF CONDUCT BOOKLET FOR WHICH THEY SIGN A RECEIPT OF ACKNOWLEDGEMENT. CONFLICT OF INTEREST IS DEFINED, AS IS MANAGEMENT OF A CONFLICT OF INTEREST. EMPLOYEES ARE REQUIRED TO DISCLOSE AND SEEK RESOLUTION TO ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST BEFORE TAKING A POTENTIALLY IMPROPER ACTION AND THEREAFTER, ANNUALLY, EACH KEY EMPLOYEE AND OFFICER OF THE ORGANIZATION IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM, PROVIDING MANAGEMENT WITH SUFFICIENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHIPS SO THAT MANAGEMENT CAN (1) DETERMINE WHETHER ANY ACTUAL OR PERCEIVED CONFLICT OF INTEREST EXISTS, AND (2) MONITOR WORK ASSIGNMENTS TO AVOID PLACING THE KEY EMPLOYEE OR OFFICER IN A POSITION WHERE THERE MAY BE A QUESTION AS TO HIS/HER OBJECTIVITY AS WELL AS TO AVOID ANY APPEARANCE OF IMPROPRIETY. THROUGHOUT THE YEAR, KEY EMPLOYEES AND OFFICERS OF THE ORGANIZATION ARE ALSO REQUIRED TO NOTIFY MANAGEMENT PROMPTLY IF ANY CHANGE TO THEIR DISCLOSURES OCCURS. BOARD MEMBERS LEAVE THE ROOM DURING DISCUSSIONS AND ABSTAIN FROM VOTING WHEN THEY HAVE A CONFLICT OF INTEREST. IN ADDITION, EACH MEMBER OF THE BOARD OF DIRECTORS MUST ALSO COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE FORM, WHICH MUST BE SUBMITTED TO THE GENERAL COUNSEL. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S OFFICER AND KEY EMPLOYEE COMPENSATION ARRANGEMENTS ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF ROCHESTER REGIONAL HEALTH, A RELATED NOT-FOR-PROFIT ORGANIZATION. INFORMATION REVIEWED FOR THE OFFICER/KEY EMPLOYEE INCLUDES COMPARABLE DATA FROM SIMILAR SIZE TAX EXEMPT ORGANIZATIONS IN THE WESTERN/CENTRAL NY COMMUNITY AS WELL AS COMPENSATION FOR THESE POSITIONS (AS DISCLOSED ON FORM 990) WITH OTHER ORGANIZATIONS IN THE HEALTH CARE INDUSTRY THAT ARE OF SIMILAR SIZE, DEMOGRAPHICS AND GEOGRAPHY. REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY THE COMPENSATION COMMITTEE IS DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ADMINISTRATIVE OFFICES OF THE AFFILIATED HEALTH SYSTEM AT 100 KINGS HIGHWAY SOUTH, ROCHESTER, NY 14617 AND ADMINISTRATIVE OFFICES OF THE FILING ORGANIZATION. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. FORM 990, PART XI, LINE 9: CHANGE-ANNUAL PENSION VALUATION OTHER COMPREHENSIVE INCOME -5,380. CHANGES IN MARKET VALUE OF CHARITABLE REMAINDCER TRUSTS -29,578. CHANGES IN VALUE OF CHARITABLE GIFT ANNUITIES 33,503. TRANSFER OF NET ASSETS TO RGHF -14,471,942. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 5471 FILED ON BEHALF STATEMENT STATEMENT PURSUANT TO TREAS REG SEC 1 6038-2(J)(3) THE FOLLOWING INFORMATION IS SUBMITTED WITH RESPECT TO UNITY HEALTH SYSTEM FOUNDATION FORM 5471 (INFORMATION RETURN OF U S PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS) FILING REQUIREMENT FOR THE ENTITY BELOW NAME OF FOREIGN CORPORATION HEALTH CARE CASUALTY INSURANCE LIMITED BEGINNING TAX YEAR OF FOREIGN CORPORATION JANUARY 1, 2016 ENDING TAX YEAR OF FOREIGN CORPORATION DECEMBER 31, 2016 THE FORM 5471 FILING REQUIREMENT FOR THIS FOREIGN CORPORATION FOR CATEGORIES 4 AND 5 HAVE BEEN SATISFIED BY INCLUSION IN THE FOLLOWING US FILER'S TAX RETURN NAME OF US FILER UNITY HEALTH SYSTEM, INC. ADDRESS OF US FILER 1555 LONG POND ROAD ROCHESTER, NY 14626 EIN OR SSN 22-2572873 ENDING TAX YEAR OF US FILER DECEMBER 31, 2016 TYPE OF RETURN FILED 990 IRS CENTER WHERE RETURN FILED OGDEN, UTAH 84201-0027. THE ROCHESTER GENERAL HOSPITAL 1425 PORTLAND AVENUE ROCHESTER NY 14621 160743134 HOSPITAL NY 501(C)(3) LINE 3 ROCHESTER REGIONAL HEALTH 1 GRHS FOUNDATION 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 223378111 R/E INV MGMT NY 501(C)(3) LINE 12A, I ROCHESTER REGIONAL HEALTH 1 THE ROCHESTER GENERAL HOSPITAL FOUNDATION 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222229425 FUNDRAISING NY 501(C)(3) LINE 12A, I ROCHESTER REGIONAL HEALTH 1 NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION DRIVING PARK AVENUE NEWARK NY 14513 222963015 FUNDRAISING NY 501(C)(3) LINE 12A, I NWCH 1 NEWARK WAYNE COMMUNITY HOSPITAL DRIVING PARK AVENUE NEWARK NY 14513 150584188 HOSPITAL NY 501(C)(3) LINE 3 ROCHESTER REGIONAL HEALTH 1 RGHS WORKERS' COMPENSATION TRUST 1425 PORTLAND AVENUE ROCHESTER NY 14621 166429300 SEE PART VII NY 501(C)(3) LINE 12A, I ROCHESTER REGIONAL HEALTH 1 CONTINUING CARE NETWORK INC (CCN) 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222963016 SUPPORT RGH NY 501(C)(3) LINE 12A, I ROCHESTER REGIONAL HEALTH 1 ROCHESTER GENERAL HUDSON HOUSING 2066 HUDSON AVENUE ROCHESTER NY 14621 223210351 LOW INC HOUSING NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 VIA HEALTH HOME CARE I 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 161504370 HOME HEALTH NY 501(C)(3) LINE 10 CCN 1 VIA HEALTH HOMECARE II 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 161538727 HOME HEALTH NY 501(C)(3) LINE 10 CCN 1 INDEPENDENT LIVING FOR SENIORS 2066 HUDSON AVENUE ROCHESTER NY 14617 161491059 ADULT DAY HC NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 ROCHESTER GENERAL LONG TERM CARE 1550 EMPIRE BLVD WEBSTER NY 14580 223187140 NH & REHAB NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 WESTERN NEW YORK MEDICAL PRACTICE PC 1425 PORTLAND AVENUE ROCHESTER NY 14621 611654232 PHYS PRAC NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 THE UNITY HOSPITAL OF ROCHESTER 1555 LONG POND RD ROCHESTER NY 14626 237221763 HOSPITAL NY 501(C)(3) LINE 3 ROCHESTER REGIONAL HEALTH 1 NORTH PARK NURSING HOME INC 1555 LONG POND RD ROCHESTER NY 14626 223159644 LONG TERM CARE FACILITY NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 PARK RIDGE NURSING HOME INC 1555 LONG POND RD ROCHESTER NY 14626 160978184 LONG TERM CARE FACILITY NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 ROCHESTER GENERAL HEALTH SYSTEM 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222551509 SYSTEM SUPPORT NY 501(C)(3) LINE 12A, I ROCHESTER REGIONAL HEALTH 1 PARK RIDGE CHILD CARE CENTER INC 1555 LONG POND RD ROCHESTER NY 14626 222918126 CHILD DAY CARE SERVICES NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 PARK RIDGE HOUSING DEVELOPMENT FUND 1555 LONG POND RD ROCHESTER NY 14626 222608311 LOW INCOME HOUSING PROJECT FOR ELDERLY NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 PARK RIDGE HOUSING INC 1555 LONG POND RD ROCHESTER NY 14626 222570457 SENIOR APARTMENT COMPLEX NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 PARKWAY COMMONS HOUSING DEVELOPMENT 1555 LONG POND RD ROCHESTER NY 14626 223130818 LOW INCOME HOUSING FOR ELDERLY/HANDICAPPED NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 STBERNARD'S HOUSING DEVELOPMENT FU 1555 LONG POND RD ROCHESTER NY 14626 161492955 LOW INCOME HOUSING PROJECT NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 UNITY AGING SERVICES INC 1555 LONG POND RD ROCHESTER NY 14626 841684195 MANAGEMENT AND DEVELOPMENT CO NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 UNITY HOUSING DEVELOPMENT FUND CORP 1555 LONG POND RD ROCHESTER NY 14626 300068596 RECEIPT AND DISBURSEMENTS OF SUBSIDIES NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 WOODLAND VILLAGE INC 1555 LONG POND RD ROCHESTER NY 14626 161588242 SENIOR APARTMENT COMPLEX NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 UNITY AMBULATORY SURGERY CENTER INC 1555 LONG POND RD ROCHESTER NY 14626 383871383 OUTPATIENT SURGERY NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 UNITY HEALTH SYSTEM INC 1555 LONG POND ROAD ROCHESTER NY 14626 222572873 SYSTEM SUPPORT NY 501(C)(3) LINE 12A, I ROCHESTER REGIONAL HEALTH 1 ROCHESTER REGIONAL HEALTH 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 471234999 SYSTEM PARENT NY 501(C)(3) LINE 12A, I N/A 1 UNITED MEMORIAL MEDICAL CENTER 127 NORTH STREET BOTAVIA NY 14020 160743029 HOSPITAL NY 501(C)(3) LINE 3 ROCHESTER REGIONAL HEALTH 1 HENRY FOSTER ASSOCIATES DBA CORPORATE CARE OF FINGER LAKES 4 COULTER ROAD CLIFTON SPRINGS NY 14432 161282294 EMPLOYEE ASSISTANCE PROGRAMS NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 CLIFTON SPRINGS HOSPITAL AND CLINIC 2 COULTER ROAD CLIFTON SPRINGS NY 14432 160743966 HOSPITAL NY 501(C)(3) LINE 3 ROCHESTER REGIONAL HEALTH 1 BEHAVIORAL HEALTH NETWORK INC 490 EAST RIDGE ROAD ROCHESTER NY 14621 166069131 MENTAL HEALTH NY 501(C)(3) LINE 10 ROCHESTER REGIONAL HEALTH 1 PRCD INC 1555 LONG POND RD ROCHESTER NY 14626 161311581 SUBSTANCE ABUSE TREATMENT & REHAB. NY 501(C)(3) LINE 7 ROCHESTER REGIONAL HEALTH 1 CLIFTON SPRINGS HOSPITAL & CLINIC FOUNDATION 2 COULTER ROAD CLIFTON SPRINGS NY 14432 161560033 FUNDRAISING NY 501(C)(3) LINE 11 ROCHESTER REGIONAL HEALTH 1 NW ASSOCIATES LP PO BOX 111 DRIVING PARK AVENUE NEWARK NY 14513 141674119 R/E LEASING NY NWCH RELATED 0 0 0.52570 PARMA SENIOR HOUSING 1555 LONG POND RD ROCHESTER NY 14626 432082116 HILTON PROJ NY N/A 0 0 UNITY SENIOR HOUSING 1555 LONG POND RD ROCHESTER NY 14626 061709927 MOORE PK NY N/A 0 0 GREATER ROCHESTER ASSURANCE COMPANY LTD GEORGE TOWN GRAND CAYMAN CJ INSURANCE CJ N/A C 1.00000 0 GRACO RISK RETENTION GROUP INC 1425 PORTLAND AVENUE ROCHESTER NY 14621 710933967 INSURANCE SC RGH C 1.00000 0 NWA INC DRIVING PARK AVENUE NEWARK NY 14513 141667339 R/E LEASING NY NWCH C 1.00000 0 GREATER ROCHESTER INDEPENDENT PRACTICE ASSOCIATION INC 100 KINGS HWY S SUITE 2500 ROCHESTER NY 14617 161507171 INDEPENDENT PRACTICE ASSOCIATION NY N/A C 0.50000 0 ROCHESTER GENERAL HEALTH SYSTEM DIALYSIS INC 1425 PORTLAND AVENUE ROCHESTER NY 14621 383912199 DIALYSIS NY RGHS C 1.00000 0 ACM MEDICAL LABORATORY INC 160 ELMGROVE PARK ROCHESTER NY 14624 161059691 CLINICAL LAB NY PRH INC C 0 PRH INC 1555 LONG POND ROAD ROCHESTER NY 14626 161329632 MEDICAL LAB NY ROCHESTER REGIONAL HEALTH C 0 GREATER ROCHESTER IMMEDIATE MEDICAL CARE PLLC DBA ROCHESTER IMMEDIATE CARE 265 BROOKVIEW CENTRE WAY SUITE 400 KNOXVILLE TN 37919 271453784 URGENT CARE CENTERS TN WESTERN NEW YORK MEDICAL PC C 1.00000 0 ROCHESTER MEDICINE PLLC 265 BROOKVIEW CENTRE WAY SUITE 400 KNOXVILLE TN 37919 812625325 OCCUPATIONAL MEDICINE TN WESTERN NEW YORK MEDICAL PC C 1.00000 0 PARMA SENIOR HOUSING LLC 1555 LONG POND ROAD ROCHESTER NY 14626 810671687 SENIOR HOUSING NY ROCHESTER REGIONAL HEALTH C 0 UNITY SENIOR HOUSING CORP 1555 LONG POND ROAD ROCHESTER NY 14624 061709925 SENIOR HOUSING NY ROCHESTER REGIONAL HEALTH C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 UNITY HOSPITAL OF ROCHESTER P 72233 FMV PRCD INC Q 136004 FMV UNITY HOSPITAL OF ROCHESTER B 922882 FMV WOODLAND VILLAGE INC B 55000 FMV SCHEDULE R, PART II, COLUMN (B): RELATED TAX-EXEMPT ORGANIZATION - PRIMARY ACTIVITY: RGHS WORKERS' COMPENSATION TRUST SUPPORTS THE ROCHESTER GENERAL HOSPITAL, NEWARK WAYNE COMMUNITY HOSPITAL, ROCHESTER GENERAL LONG TERM CARE, INDEPENDENT LIVING FOR SENIORS, VIAHEALTH HOMECARE I, VIAHEALTH HOMECARE II, BEHAVIORAL HEALTH NETWORK, INC, CLIFTON SPRINGS HOSPITAL & CLINIC AND UNITED MEMORIAL MEDICAL CENTER.