2013-11-13T12:42:51-06:00 2012-12-31 264298079 EFP ROTENBERG LLP 280 KENNETH DRIVE ROCHESTER NY 14623 990 2012-01-01 160743979 NICHOLAS H NOYES MEMORIAL HOSPITAL NICH 5853356001 111 CLARA BARTON STREET DANSVILLE NY 14437 AMY POLLARD 5853356001 2013-11-13 1 WILLIAM MCDONALD P01600766 5854278900 2013-11-13 2012 2016-02-25 16:41:14Z AMY POLLARD 111 CLARA BARTON STREET DANSVILLE NY 14437 48376217 0 X WWW.NOYES-HEALTH.ORG X 1927 NY NICHOLAS H. NOYES MEMORIAL HOSPITAL IS A 72 BED HOSPITAL WHICH PROVIDES ACUTE, SUB-ACUTE, EMERGENCY AND OTHER OUTPATIENT CARE AND WHOSE MISSION IS TO SUPPORT AND PROMOTE THE HEALTH OF OUR COMMUNITIES THROUGH COMPASSIONATE QUALITY CARE. 20 12 623 127 858259 -170850 397733 535141 48996147 44963366 69428 65961 1086057 1465350 50549365 47029818 0 0 0 0 27383376 25484324 0 0 58209 23477330 23209089 50860706 48693413 -311341 -1663595 39858292 38233892 21013443 19788711 18844849 18445181 NICHOLAS H. NOYES MEMORIAL HOSPITAL SUPPORTS AND PROMOTES THE HEALTH OF OUR COMMUNITIES THROUGH COMPASSIONATE QUALITY CARE. 0 0 37586424 44963366 NICHOLAS H. NOYES MEMORIAL HOSPITAL IS A 72 BED HOSPITAL WHICH PROVIDES ACUTE, SUB-ACUTE, AND OUTPATIENT CARE. 37586424 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 81 0 1 623 1 1 1 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X 20 12 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 0 0 NY X X JAY MASLYN 5853354306 111 CLARA BARTON STREET DANSVILLE NY 14437 GRAHAM FRAZER 2.00 X 0 0 0 JOHN LOCKHART 2.00 X 0 0 0 MICHAEL JOHNSEN 2.00 X 0 0 0 LESLIE COLE JR 2.00 X 0 0 0 GEOFFREY MARKOWSKI MD 1.00 X 0 0 0 AMY POLLARD 40.00 X X 178299 0 18711 JOAN FLENDER MD 1.00 X 0 0 0 MARK LYONS 1.00 X 0 0 0 THOMAS DWYER 1.00 X 0 0 0 LINDSAY QUINTILONE 1.00 X 0 0 0 ARIF QURESHI MD 2.00 X 0 0 0 PETER SOSCIA 1.00 X 0 0 0 SALLY WEST 1.00 X 0 0 0 MAUREEN WOLCOTT 1.00 X 0 0 0 MARILYN MOORE 5.00 X 0 0 0 JAMES CULBERTSON 1.00 X 0 0 0 ROBERT HART 1.00 X 0 0 0 ANDREW LONG 1.00 X 0 0 0 JAY MASLYN 40.00 X 137018 0 2809 DOUGLAS MAYHLE MD 40.00 X 364896 0 13971 ASAD MAJID MD 40.00 X 441320 0 16545 ROBERT CAPECCI MD 40.00 X 611144 0 9563 CHI KIM MD 40.00 X 249017 0 1756 VINAY AGGARWAL 25.00 X 196212 0 0 BARRY HAICKEN 40.00 X 188812 0 11567 JAMES R WISSLER 0.00 X 134192 0 0 2500910 0 74922 9 1 1 0 ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY UT 841081221 LAB TESTING SERVICES 682833 DANSVILLE ANESTHESIA & PAIN MGMT PO BOX 33058 PALM BEACH GARDENS FL 33420 ANESTHESIOLOGIST 670835 WESTERN HEALTHCARE LLC PO BOX 676649 DALLAS TX 752676649 ED PHYSICIAN SERVICES 383251 SLEEP INSIGHTS MANAGEMENT SVC 10 HAGEN DR SUITE 200 ROCHESTER NY 14625 POLYSOMNOGRAPHY SVC 359493 QUERESHI ARIF MD PC PO BOX 530 DANSVILLE NY 14437 RADIOLOGIST 272446 5 419954 115187 535141 PATIENT SERVICE REVENUE 621990 44963366 44963366 44963366 49014 49014 1276865 1259918 16947 16947 16947 28602 10095 18507 18507 155888 76386 79502 79502 OTHER REVENUE 541380 1210109 701027 509082 SEAGATE ALLIANCE, LLC 900000 157232 157232 1367341 47029818 45042868 858259 593550 715706 262832 452874 20220010 15922304 4269413 28293 380768 296350 80398 4020 2751169 2166964 580904 3301 1416671 1060339 354168 2164 15459 14600 859 194052 194052 42400 42400 66641 66641 68471 68471 4242581 3298909 943672 207237 48210 154386 4641 8281411 7587455 678166 15790 764572 573429 191143 1156417 443950 712467 14346 2604 11742 75648 65710 9938 431286 48214 383072 2268757 1262647 1006110 525431 430743 94688 OTHER PURCHASED SERVICE 1542865 1334622 208243 BAD DEBT 1469766 1469766 EQUIPMENT RENTAL 874348 643837 230511 REPAIRS & MAINTENANCE 619022 401800 217222 348379 251139 97240 48693413 37586424 11048780 58209 4360 5716 2942979 1593512 10313 5012983 5099254 835329 833562 1111004 653881 48183122 32306987 16364568 15876135 1360784 1464688 12215972 12707144 39858292 38233892 4763456 4988225 656700 936052 9102732 8502949 6490555 5361485 21013443 19788711 X 18068096 17660248 33047 41227 743706 743706 18844849 18445181 39858292 38233892 X -1663595 60334 1203593 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 55000 0 1 11641 66641 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: AS MEMBERS OF 3 ASSOCIATIONS (AHA - AMERICAN HOSPITAL ASSOCIATION, HANYS-THE HEALTHCARE ASSOCIATION OF NEW YORK STATE & RRHA/SEAGATE ALLIANCE) A PORTION OF THE DUES (TOTAL REFLECTED ABOVE) ARE PAID AS PART OF MEMBERSHIP AND REPRESENT AMOUNTS DESIGNATED FOR LOBBYING ACTIVITIES. THESE ASSOCIATE ORGANIZATIONS OF WHICH WE ARE MEMBERS HANDLE THE DIRECT LOBBYING/ADVOCACY ACTIVITIES ON BEHALF OF THEIR MEMBERS. 1449363 121879 10115 1561127 1434453 24558 9648 1449363 1335945 107551 9043 1434453 1155614 188466 8135 1335945 1614612 -273730 175000 10268 1155614 0.58770 0.41230 0 0 372690 372690 22248653 12785038 9463615 24168006 19521949 4646057 1393773 1393773 15876135 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 10260888 DEBT ORIGINATION COSTS - NET 457835 DUE FROM RELATED ENTITY 508329 MORTGAGE REPAYMENT ESCROW FUNDS 805638 OTHER 674454 12707144 DUE TO THIRD PARTY PAYORS- LONG TERM 1048460 DUE TO THIRD PARTY PAYORS- SHORT TERM 468241 LINE OF CREDIT 175000 PENSION LIABILITY 3522104 WORKERS COMPENSATION 147680 5361485 X 45664616 0 45664616 1365202 1365202 47029818 47328211 0 47328211 1365202 1365202 48693413 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: EMPLOYEE EDUCATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IN ACCORDANCE WITH ASC 740-10-50, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE SYSTEM RECOGNIZES THE TAX BENEFITS FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES. MANAGEMENT BELIEVES THAT THE SYSTEM IS CURRENTLY OPERATING IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS HAS BEEN INCLUDED ON THE SYSTEMS FINANCIAL STATEMENTS. THE EXEMPT SYSTEMS INFORMATIONAL RETURNS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES AND ITS OPEN AUDIT PERIODS ARE 2009 THROUGH 2011. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,469,766. EXPENSES FOR FUNDRAISING ACTIVITIES -104,564. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,469,766. EXPENSES FOR FUNDRAISING ACTIVITIES -104,564. GOLF TOURNAMENT 22530 22530 100 108 1910 3668 671 FLOWER SALE 6072 6072 3638 28602 28602 100 108 1910 3668 4309 10095 18507 1 1 0 1 X 1 1 1 0 1 1 586041 0 586041 0.01200 6847624 5923382 924242 0.01900 458867 464304 -5437 0.00000 7892532 6387686 1504846 0.03100 17 5990 80237 19710 60527 0.00120 3 149 152245 300 151945 0.00310 1 72 2068251 1916916 151335 0.00310 0 0 3 1991 39863 12473 27390 0.00060 24 8202 2340596 1949399 391197 0.00800 24 8202 10233128 8337085 1896043 0.03900 1 68 8197 8197 0.00020 1 68 8197 8197 0.00020 0 1469766 379640 7272342 7201833 70509 X 1 1 1 1 NICHOLAS H NOYES MEMORIAL HOSPITAL

111 CLARA BARTON STREET DANSVILLE NY 14437

X X X NICHOLAS H NOYES MEMORIAL HOSPITAL 1 1 0 1 300.000000000000 1 X X X 1 1 X X X X X 1 0 X X X 1 0 0 6 AFTER HOURS CARE CENTER

4440 LAKEVILLE ROAD GENESEO NY 14454

URGENT CARE CENTER LIVINGSTON HEALTH SERVICES

50 EAST SOUTH STREET GENESEO NY 14454

OUTPATIENT SURGERY AND DIAGNOSTIC MENTAL HEALTH CLINIC

1 MAIN STREET DANSVILLE NY 14437

MENTAL HEALTH CLINIC NOYES CTR FOR KIDNEY DISEASE & DIALYSIS

4616 MELLENIUM DRIVE GENESEO NY 14454

CHRONIC DIALYSIS CENTER AND NEPHROLOGIST OB-GYN ASSOC OF THE FINGER LAKES

253 MAIN STREET DANSVILLE NY 14437

OUTPATIENT PHYSICIAN CLINIC CREEKSIDE FAMILY MEDICINE

12 NORTH CHURCH ST CANASERAGA NY 14822

PRIMARY CARE PHYSICIAN OFFICE PART II: NOYES HOSPITAL STAFF ACTIVELY PARTICIPATES IN MULTIPLE COMMUNITY COALITIONS AND PARTNERSHIPS TO COLLABORATIVELY ADDRESS THE HEALTH CARE NEEDS OF OUR COMMUNITY. THE FOLLOWING IS A LIST OF AGENCY AND ORGANIZATIONAL COMMITTEES/TEAMS THAT NOYES PARTICIPATES ON TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE: GENESEE VALLEY HEALTH PARTNERSHIP (GVHP): EXECUTIVE BOARD AND GENERAL MEMBERSHIP GVHP LIVINGSTON COUNTY COMMUNITY HEALTH IMPROVEMENT (CHIP) WORK GROUPS: PREVENTION AND MANAGEMENT OF CHRONIC DISEASE (NOYES MEMBER) IMPROVE ACCESS TO HEALTH CARE STRENGTHEN SOCIAL AND EMOTIONAL HEALTH (NOYES MEMBER) PROMOTE SAFE COMMUNITIES (NOYES MEMBER) LIVINGSTON WELLNESS PARTNERSHIP LIVINGSTON COUNTY LONG TERM CARE COUNCIL LIVINGSTON COUNTY ACHIEVE (ACTION COMMUNITIES FOR HEALTH, INNOVATIONS AND ENVIRONMENTAL CHANGE) GRANT COMMITTEE LIVINGSTON COUNTY MATERNAL CHILD HEALTH COALITION (NOYES LEAD) LIVINGSTON COUNTY DIABETES COALITION (NOYES LEAD) LIVINGSTON COUNTY SEXUAL RESPONSIBILITY COALITION LIVINGSTON COUNTY TOBACCO ACTION COALITION LIVINGSTON COUNTY TRAFFIC SAFETY COALITION LIVINGSTON COUNTY OFFICE FOR AGING ADVISORY BOARD FAITH IN ACTION ADVISORY BOARD PART III, LINE 4: COSTING METHOD FOR BAD DEBT EXPENSE AT COST IS RATIO OF PATIENT CARE COST TO CHARGES FROM WORKSHEET 2 MULTIPLIED BY THE DEMOGRAPHICS OF PRIMARY SERVICE AREA FOR THOSE WHO WOULD RECEIVE CHARITY CARE IF GIVEN ENOUGH INFORMATION. PART III, LINE 8: THE SOURCE OF THE MEDICARE ALLOWABLE COSTS IS THE 2011 CMS 2552 WORKSHEET I-4. PART VI, LINE 2: NOYES HEALTH CONTINUES TO BE AN ACTIVE MEMBER OF THE GENESEE VALLEY HEALTH PARTNERSHIP (GVHP) WHOSE MEMBERSHIP INCLUDES OVER 40 AGENCIES AND COMMUNITY MEMBERS INVOLVED WITH HEALTH CARE SERVICES IN LIVINGSTON COUNTY. THE HOSPITAL CEO IS ON THE GENESEE VALLEY HEALTH PARTNERSHIP (GVHP) EXECUTIVE BOARD. THE GVHP COORDINATED THE LIVINGSTON COUNTY COMMUNITY NEEDS ASSESSMENT USING MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) PROCESS INITIATED IN 2010 TO DEVELOP THE LIVINGSTON COUNTY DOH COMMUNITY HEALTH IMPROVEMENT PLAN 2011-2015. IN 2011, THE MAPP ADVISORY BOARD CHARGED FOUR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) TEAMS TO FOCUS ON INDICATORS, RESOURCES, BARRIERS, OBJECTIVES, GOALS AND INTERVENTIONS TO ADDRESS THE TOP FOUR COMMUNITY HEALTH NEEDS.NOYES COMMUNITY OUTREACH STAFF ATTENDS THE QUARTERLY GENERAL MEMBERSHIP MEETINGS AND PARTICIPATE ON ONE OR MORE OF THE FOUR CHIP TEAMS THAT FOCUS ON PREVENTION AGENDA PRIORITIES SET IN OUR 2009 NOYES COMPREHENSIVE PLAN: PREVENTION AND MANAGEMENT OF CHRONIC DISEASE IMPROVE ACCESS TO HEALTH CARE STRENGTHEN SOCIAL AND EMOTIONAL HEALTH PROMOTE SAFE COMMUNITIES PART VI, LINE 3: IN 2012, NOYES HEALTH CONTINUED EFFORTS TO EFFECTIVELY COMMUNICATE OUR FINANCIAL AID POLICY. EVERY UNINSURED AND UNDERINSURED PATIENT RECEIVED A FINANCIAL AID PACKET CONSISTING OF THE FINANCIAL AID PROGRAM SUMMARY AND BROCHURE, A FINANCIAL AID (FA) APPLICATION AND INSTRUCTIONS ON HOW TO APPLY, AS WELL AS HOW TO RECEIVE ASSISTANCE IN APPLYING. WE HAVE A SOCIAL WORKER AND A DEDICATED FA BILLING REPRESENTATIVE WHO WORK SPECIFICALLY WITH ALL UNINSURED PATIENTS UPON ADMISSION. WE EMPLOY A FACILITATED ENROLLER FOR PRESUMPTIVE MEDICAID FOR PRENATAL CARE AND HEALTH EDUCATION/SUPPORT SERVICES. ALL OTHER FACILITATED ENROLLMENT NEEDS ARE REFERRED TO APPROPRIATE COUNTY ENROLLER.PATIENTS ARE MAILED FINANCIAL AID INFORMATION WITH THEIR FIRST STATEMENTS. INFORMATION ABOUT THE HOSPITALS FINANCIAL ASSISTANCE PROGRAM IS ALSO POSTED IN ALL PUBLIC AREAS THROUGHOUT THE HOSPITAL. THE FINANCIAL ASSISTANCE COMMITTEE MEETS AS NEED TO REVIEW/UPDATE POLICIES AND ADDRESS SPECIAL NEEDS. THE REVENUE CYCLE COMMITTEE MEETS MONTHLY AND INCLUDED FINANCIAL AID DATA REVIEW. PART VI, LINE 4: NOYES MEMORIAL HOSPITAL SERVES A RURAL COMMUNITY IN THE NEW YORK FINGER LAKES AREA. OUR PRIMARY MARKET SHARE ZIP CODE REPORT DEMONSTRATES THAT LIVINGSTON COUNTY IS OUR HEALTH CARE SYSTEMS PRIMARY SERVICE AREA AND WE ALSO SERVE RESIDENTS IN THE SURROUNDING COUNTIES INCLUDING STEUBEN, ALLEGANY, WYOMING AND ONTARIO RESPECTIVELY. LIVINGSTON COUNTY IS A RURAL COUNTY (55%) IN WESTERN NEW YORK COVERING 640 SQUARE MILES WITH POPULATION OF 65,070. 14% OF POPULATION OF 65+, 20% BELOW 18 YEARS OF AGE, 92% NON-HISPANIC WHITE, AND ONLY 1% NOT PROFICIENT IN ENGLISH. MEDIAN HOUSEHOLD INCOME IS $50,186 AND 22% CHILDREN ELIGIBLE FOR FREE LUNCH. LIVINGSTON COUNTY WAS RANKED #3 IN 2012 AND #1 IN 2013 OVER HEALTH RANKINGS ACCORDING TO THE COUNTY HEALTH RANKINGS AND ROADMAPS.HEALTH CARE SERVICES ARE PROVIDED AT THE FOLLOWING LOCATIONS THROUGHOUT LIVINGSTON COUNTY: NICHOLAS H. NOYES MEMORIAL HOSPITAL: A 72-BED ACUTE CARE HOSPITAL LOCATED IN DANSVILLE PROVIDING MEDICAL, SURGICAL, AND EMERGENCY INPATIENT/OUTPATIENT SERVICES THAT ALSO INCLUDE COMMUNITY OUTREACH WELLNESS, EDUCATION AND PREVENTION PROGRAMS. NOYES HEALTH SERVICES: AN AMBULATORY CARE FACILITY IN GENESEO THAT PROVIDES OUTPATIENT SURGICAL, RADIOLOGY, LABORATORY, PHYSICAL THERAPY, PAIN MANAGEMENT, AND PHYSICIAN SERVICES. NOYES AFTER HOUR CLINIC: WALK-IN URGENT CARE CLINIC HAS BEEN IN GENESEO (MID-COUNTY LOCATION) SINCE 2003 AND A NEW CLINIC WAS OPENED EARLY 2013 FOR DANSVILLE COMMUNITY (SOUTHERN COUNTY LOCATION). BOTH LOCATIONS SERVE PATIENTS EVENINGS AND WEEKENDS WHEN PHYCIAN OFFICES ARE CLOSED. NOYES MENTAL HEALTH: AN OUT-PATIENT CLINIC PROVIDING INDIVIDUAL, GROUP AND FAMILY COUNSELING SERVICES. NOYES PHYSICIAN SERVICE OFFICES GENESEE REGIONAL ORTHOPEDICS: DANSVILLE CREEKSIDE FAMILY PRACTICE: CANASERAGA NOYES SURGICAL SERVICS NOYES CENTER FOR KIDNEY DISEASE AND DIALYSIS: A 12 STATION OUTPATIENT DIALYSIS AND RENAL DISEASE MANAGEMENT CENTER IN GENESEO. PART VI, LINE 5: THE NOYES BOARD OF DIRECTORS HAS 13 ACTIVE COMMUNITY REPRESENTATIVES ON THEIR 20 MEMBER BOARD. NOYES HAS AN OPEN MEDICAL STAFF PROVIDING A VARIETY OF MEDICAL SERVICES INCLUDING: CARDIOLOGY, EARS/NOSE/THROAT, FAMILY MEDICINE, GASTROENTEROLOGY, ORTHOPEDICS, GENERAL AND VASCULAR SURGERY, INTERNAL MEDICINE, OB/GYN, NEPHROLOGY, OPHTHALMOLOGY, PEDIATRICS, PAIN MANAGEMENT, AND UROLOGY. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X X 1 0 0 0 0 0 0 0 0 AMY POLLARD 177248 0 0 0 1051 0 0 0 18711 0 197010 0 0 0 DOUGLAS MAYHLE MD 358161 0 0 0 6735 0 0 0 13971 0 378867 0 0 0 ASAD MAJID MD 440961 0 0 0 359 0 0 0 16545 0 457865 0 0 0 ROBERT CAPECCI MD 609499 0 0 0 1645 0 0 0 9563 0 620707 0 0 0 CHI KIM MD 249017 0 0 0 0 0 0 0 1756 0 250773 0 0 0 VINAY AGGARWAL 196212 0 0 0 0 0 0 0 0 0 196212 0 0 0 BARRY HAICKEN 187983 0 0 0 829 0 0 0 11567 0 200379 0 0 0 JAMES R WISSLER 0 0 0 0 134192 0 0 0 0 0 134192 0 0 0 A LIVINGSTON COUNTY INDUSTRIAL DEVELOPMENT AGENCY 161136853 538655AD3 2005-06-29 9471914 SEE PART VI 0 0 0 B LIVINGSTON COUNTY INDUSTRIAL DEVELOPMENT AGENCY 161136853 538655AE1 2007-12-20 615060 REFUND OF PRIOR BONDS (06/30/99) 0 0 1 A 2090000 9763548 805638 625676 189438 6449941 1692856 2006 1 0 1 1 B 212364 615060 12301 3084 10309 589366 2003 1 0 1 1 A 0 0 1 1 0 0.02400 0.02400 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 PART I, LINE A, COLUMN (F): ACQUISITION, RENOVATION, CONSTRUCTION AND EQUIPPING OF IMPROVEMENTS TO A HOSPITAL FACILITY; REFUNDING OF PRIOR BONDS (9/17/1998) PART I, LINE B, COLUMN (E) AND PART II, LINES 1 - 12, COLUMN B REPRESENTS AM ALLOCATION OF 12.24% OF THIS BOND ISSUE; THE REMAINING 87.76% IS ALLOCATED TO RED JACKET CENTER, INC., A RELATED ORGANIZATION. PART II, LINE 3, COLUMN A THE TOTAL PROCEEDS DO NOT AGREE WITH THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENTS EARNINGS. ROBERT BONVINO FORMER EMPLOYEE START-UP X 173535 178845 0 1 1 178845 NANCY JOHNSON WIFE OF BOARD MEMBER 58013 COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF DIRECTORS REGULARLY REVIEWS THE CONFLICT OF INTEREST POLICY AND ASSURES ITS COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE GOALS AND OBJECTIVES OF THE CEO ALONG WITH COMPARABILITY DATA TO DETERMINE HIS COMPENSATION. THE DELIBERATION AND DECISION IS RECORDED IN THE MINUTES OF THE EXECUTIVE COMMITTEE MEETING. FORM 990, PART VI, SECTION C, LINE 18 BY REQUEST TO THE CEO, CFO OR ADMINISTRATIVE ASSISTANT. ALSO AVAILABLE ON GUIDESTAR WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 BY REQUEST TO THE CEO, CFO OR ADMINISTRATIVE ASSISTANT. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII GRAHAM FRAZER - 8889 REEDS CORNERS ROAD, DANSVILLE, NY 14437. JOHN LOCKHART - 32 MAIN STREET, GENESEO, NY 14454. MICHAEL JOHNSEN - 3927 COLTON HILL ROAD, DALTON, NY 14836. LESLIE COLE, JR. - 3186 BRONSON HILL ROAD, LIVONIA, NY 14487. GEOFFREY MARKOWSKI, MD - 50 EAST SOUTH STREET, GENESEO, NY 14454. JOAN FLENDER, MD - P.O. BOX 499, DANSVILLE, NY 14437. MARK LYONS - 28 EAST MAIN STREET, ROCHESTER, NY 14614. THOMAS DWYER - 9107 RICKETTS ROAD, DANSVILLE, NY 14437. LINDSAY QUINTILONE - 2 COURT STREET, GENESEO, NY 14454. PETER SOSCIA - 4458 LATIMER ROAD, GROVELAND, NY 14462. SALLY WEST - 14 MAIN STREET, GENESEO, NY 14454. MAUREEN WOLCOTT - 10799 EDMOND ROAD, COHOCTON, NY 14826. MARILYN MOORE - 1856 DUNKLEY RD, LEICESTER, NY 14481. JAMES CULBERTSON - 5879 DIETER ROAD, DANSVILLE, NY 14437. ANDREW LONG - 5563 COTTONWOOD DRIVE, CONESUS, NY 14435. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION 842,434. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS 361,159. OVERSIGHT PROCESS PART XII, LINE 2C THE HOSPITAL DID NOT CHANGE THE OVERSIGHT PROCESS IN THE CURRENT YEAR. THE FOUNDATION FOR NOYES MEMORIAL HEALTH SYSTEM INC 111 CLARA BARTON ST DANSVILLE NY 14437 161584778 TO PROVIDE FUNDS FOR BENEFIT OF THE HOSPITAL NY 501(C)(3) 170(B)(1)(A) (VI) 0 RED JACKET CENTER INC 111 CLARA BARTON ST DANSVILLE NY 14437 161037658 TO MAINTAIN A BUILDING AND LEASE SPACE TO THE HOSPITAL NY 501(C)(3) SECTION 509 (A)(3) 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 RED JACKET CENTER INC Q 1453928 FOUNDATION FOR NOYES MEMORIAL HEALTH SYSTEM INC P 945599 RED JACKET CENTER INC K 520905