2013-11-14T15:04:50-06:00 2012-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2012-01-01 223378111 GRHS FOUNDATION INC GRHS 5859221743 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 PAULA TINCH 5859221743 2013-11-11 1 ANGELA M FRANCO P00589741 3154463600 2012 2016-02-24 21:20:13Z MARK C CLEMENT 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 14645109 0 X WWW.ROCHSTERGENERAL.ORG X 1995 NY THE FOUNDATION IS ORGANIZED AND OPERATED EXCLUSIVELY TO BENEFIT ROCHESTER GENERAL HOSPITAL, NEWARK-WAYNE COMMUNITY HOSPITAL, ROCHESTER MENTAL HEALTH CENTER AND ROCHESTER GENERAL LONG TERM CARE. 3 0 0 0 75913 0 0 4209000 1380682 9682311 125 402 204771 315052 1585578 14206765 0 0 0 0 56395 2344302 0 0 0 1033629 6716373 1090024 9060675 495554 5146090 14962493 51883789 11180621 42955827 3781872 8927962 X TO BENEFIT ROCHESTER GENERAL HOSPITAL, NEWARK-WAYNE COMMUNITY HOSPITAL, ROCHESTER MENTAL HEALTH CENTER AND ROCHESTER GENERAL LONG TERM CARE.TO ACCEPT, HOLD, INVEST, REINVEST AND ADMINISTER GIFTS, GRANTS, BEQUESTS, CONTRIBUTIONS, DEVISES, BENEFITS OF TRUSTS, ENDOWMENTS AND PROPERTY OF ANY KIND, WITHOUT LIMITATION AS TO AMOUNT OR VALUE FOR THE FOREGOING PURPOSES.TO USE, DISBURSE OR PAY THE INCOME AND/OR PRINCIPAL THEREOF EXCLUSIVELY FOR THE FOREGOING PURPOSES. TO DO ANY OTHER ACT OR THING INCIDENTAL TO OR CONNECTED WITH THE FOREGOING PURPOSES OR IN ADVANCEMENT THEREOF, BUT NOT FOR THE PECUNIARY PROFIT OR FINANCIAL GAIN OF ITS MEMBERS, DIRECTORS, OFFICERS OR ANY OTHER PRIVATE PERSON. 0 0 3205173 4087692 OPERATING REAL PROPERTY INVESTMENTS, INCLUDING MEDICAL/OFFICE BUILDINGS, A PARKING GARAGE, AN ADULT DAYCARE FACILITY AND PARCELS OF LAND, AS WELL AS MAINTAINING FINANCIAL INVESTMENTS ON BEHALF OF AFFILIATES. 3761702 5598876 AMBULATORY SURGERY CENTER 6966875 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X RITA SZMIGEL 5859221737 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 HUGH THOMAS 1.00 54.00 X 0 581709 170710 MARK C CLEMENT 1.00 54.00 X X 0 1385174 712572 RICHARD GANGEMI 0.00 55.00 X X 0 577058 129455 PAULA TINCH 1.00 54.00 X 0 261157 57140 0 2805098 1069877 5 0 1 0 0 4209000 4209000 LATTIMORE PATIENT REV 621493 5596830 5596830 HAGEN DRIVE RENTAL INCOME 532000 2897992 2897992 GARAGE RENTAL 532000 633668 633668 CARTER STREET RENTAL INCOME 532000 250191 250191 OFFICE/DAY CARE 532000 241830 241830 61800 61800 9682311 402 402 673226 438344 234882 234882 234882 JANITORIAL CLEANING REVENUE 812900 75913 75913 MISCELLANEOUS REVENUE 900099 4257 4257 80170 14206765 9686568 75913 235284 2011357 1285091 726266 44033 28991 15042 125870 71275 54595 163042 107347 55695 721836 421026 300810 109574 194 109380 55200 36344 18856 391660 321614 70046 97390 59999 37391 327781 215811 111970 11117 7319 3798 1018388 1018388 1127365 1127365 67867 67867 LATTIMORE EXPENSES 1727022 1137071 589951 LICENSE FEES AND TAXES 411696 411696 HAGEN DRIVE EXPENSES 262060 262060 PARNALL EXPENSES 201575 201575 185842 185842 9060675 6966875 2093800 0 582382 2832357 218417 703977 270808 464407 59512309 14385197 3919582 45127112 9971304 2755936 14962493 51883789 477626 941940 902995 30091257 9800000 11922630 11180621 42955827 X 3781872 8927962 3781872 8927962 14962493 51883789 5146090 0 X X 0 1 X 1 0 X X X 0 0 0 THE ROCHESTER GENERAL HOSPITAL 160743134 3 1 1 1 0 NEWARK WAYNE COMMUNITY HOSPITAL 150584188 3 1 1 1 0 ROCHESTER MENTAL HEALTH CENTER 166069131 9 1 1 1 0 ROCHESTER GENERAL LONG TERM CARE 223187140 9 1 1 1 0 4 0 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART I, LINE 11(H)(VII): DURING 2012, GRHS FOUNDATION PROVIDED NON-MONETARY SUPPORT TO ITS SUPPORTED ORGANIZATION, ROCHESTER GENERAL HOSPITAL, BY LEASING FACILITIES TO RGH FOR $153,586.98 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2352207 2352207 57160102 14385197 42774905 45127112 DUE FROM AFFILIATE 528650 INVESTMENT LATTIMORE 1840572 LINDEN OAKS UNAMORTIZED 386714 2755936 DUE TO AFFILIATE 11922630 11922630 14645109 438344 438344 14206765 0 14206765 9499019 438344 438344 9060675 0 9060675 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 438,344. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 438,344. 0 1 0 0 0 0 0 0 0 HUGH THOMAS 0 328234 0 197431 0 56044 0 163793 0 6917 0 752419 0 100627 MARK C CLEMENT 0 705311 0 633799 0 46064 0 707655 0 4917 0 2097746 0 397500 RICHARD GANGEMI 0 315582 0 208139 0 53337 0 125174 0 4281 0 706513 0 123660 PAULA TINCH 0 190388 0 43172 0 27597 0 52685 0 4455 0 318297 0 0 PART I, LINE 3 THE FILING ORGANIZATION'S RELATED NON-PROFIT ORGANIZATION, ROCHESTER GENERAL HEALTH SYSTEM, UTILIZES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B RGHS MAINTAINS A SECTION 457(F) PLAN WHICH WOULD BE CONSIDERED A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2012, NO DISTRIBUTIONS WERE PAID OUT. THE FOLLOWING OFFICERS AND KEY EMPLOYEES LISTED ON FORM 990, PART VII, SECTION A WOULD BE ELIGIBLE PARTICIPANTS IN THE PLAN SINCE THEY WOULD BE ENTITLED TO A DISTRIBUTION UPON SEPARATION FROM SERVICE: HUGH THOMAS MARK CLEMENT RICHARD GANGEMI 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 GENERAL HEALTH SYSTEM (RGHS), A RELATED NOT-FOR-PROFIT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A IN ACCORDANCE WITH THE TERMS AND REQUIREMENTS OF ITS GOVERNING DOCUMENTS (I.E. BYLAWS), THE ORGANIZATION'S DIRECTORS ARE DIVIDED INTO THREE CLASSES, AND THE CLASSES SERVE FOR STAGGERED THREE-YEAR TERMS. AT EACH ANNUAL MEETING, DIRECTORS IN A CLASS ARE ELECTED BY A MAJORITY VOTE OF THE DIRECTORS THEN IN OFFICE. DIRECTORS ARE ELECTED FROM AMONG NOMINEES CHOSEN BY THE GOVERNANCE AND NOMINATING COMMITTEE OF THE FILING ORGANIZATION'S SOLE CORPORATE MEMBER, ROCHESTER GENERAL HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B RGHS, AS THE SOLE CORPORATE MEMBER, ALSO HAS THE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY INCLUDING THE 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 11 PRIOR TO FILING, A COPY OF THE FORM 990 IS PROVIDED TO, AND REVIEWED WITH, ALL MEMBERS OF THE EXECUTIVE COMPENSATION 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 GENERAL HEALTH SYSTEM, 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 INSURANCE 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 AFFLILIATED HEALTH SYSTEM AT 100 KINGS HIGHWAY SOUTH ROCHESTER, NY 14617 AND THE ADMINSTRATIVE OFFICES OF THE FILING ORGANIZATION. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ROCHESTER GENERAL HEALTH SYSTEM 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222551509 SYSTEM PARENT NY 501(C)(3) LINE 11B, II N/A 1 THE ROCHESTER GENERAL HOSPITAL FOUNDATION 100 KINGS HIGHWAY SOUTH STE 2300 ROCHESTER NY 14617 222229425 FUNDRAISING NY 501(C)(3) LINE 11B, II RGHS 1 NEWARK WAYNE COMMUNITY HOSPITAL DRIVING PARK AVENUE NEWARK NY 14513 150584188 HOSPITAL NY 501(C)(3) LINE 3 RGHS 1 RGHS WORKERS' COMPENSATION TRUST 1425 PORTLAND AVENUE ROCHESTER NY 14621 169429300 SEE PART VII NY 501(C)(3) LINE 11B, II RGHS 1 CONTINUING CARE NETWORK INC (CCN) 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222963016 SUPPORT RGH NY 501(C)(3) LINE 11B, II RGHS 1 ROCHESTER GENERAL HUDSON HOUSING 2066 HUDSON AVENUE ROCHESTER NY 14617 223210351 LOW INC HOUSING NY 501(C)(3) LINE 9 RGHS 1 INDEPENDENT LIVING FOR SENIORS 2066 HUDSON AVENUE ROCHESTER NY 14617 161491059 ADULT DAY CARE NY 501(C)(3) LINE 9 RGHS 1 ROCHESTER GENERAL LONG TERM CARE 1550 EMPIRE BLVD WEBSTER NY 14580 223187140 NH & REHAB NY 501(C)(3) LINE 9 RGHS 1 WESTERN NEW YORK MEDICAL PRACTICE PC 1425 PORTLAND AVENUE ROCHESTER NY 14621 611654232 PHYS PRAC NY 501(C)(3) LINE 3 RGHS 1 ROCHESTER MENTAL HEALTH CENTER 490 EAST RIDGE ROAD ROCHESTER NY 14621 166069131 MENTAL HEALTH NY 501(C)(3) LINE 9 RGHS 1 THE ROCHESTER GENERAL HOSPITAL 1425 PORTLAND AVENUE ROCHESTER NY 14621 160743134 HOSPITAL NY 501(C)(3) LINE 3 N/A 1 GRHS LLC 125 LATTIMORE ROAD ROCHESTER NY 14620 453685937 AMBULATORY SURGERY CENTER NY 501(C)(3) LINE 11B, II GRSHF INC 1 NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION DRIVING PARK AVENUE ROCHESTER NY 14513 222963015 FUNDRAISING NY 501(C)(3) LINE 11B, II NWCH 1 VIA HEALTH HOME CARE I 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 161504370 HOME HEALTH NY 501(C)(3) LINE 9 CCN 1 VIA HEALTH HOMECARE II 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 161538727 HOME HEALTH NY 501(C)(3) LINE 9 CCN 1 NW ASSOCIATES LP PO BOX 111 DRIVING PARK AVENUE NEWARK NY 14513 141674119 R/E LEASING NY NWCH RELATED 159237 654465 0 0 0.52570 GREATER ROCHESTER ASSURANCE COMPANY LTD GEORGE TOWN GRAND CAYMAN CJ INSURANCE CJ N/A C 7565885 66638488 1.00000 1 GRACO RISK RETENTION GROUP INC 1425 PORTLAND AVENUE ROCHESTER NY 14621 710933967 INSURANCE NY RGH C 1603050 11558960 1.00000 1 NWA INC DRIVING PARK AVENUE NEWALK NY 14513 141667339 R/E LEASING NY NWCH C 467981 1398318 1.00000 1 GREATER ROCHESTER INDEPENDENT PRACTICE ASSOCIATION INC 100 KINGS HIGHWAY SOUTH STE 2500 ROCHESTER NY 14617 161507171 INDEPENDENT PRACTICE ASSOCIATION NY RGHS C -927637 948270 0.50000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 ROCHESTER GENERAL HOSPITAL P 2397281 FMV RELATED TAX-EXEMPT ORGANIZATION - PRIMARY ACTIVITY FORM 990, SCHEDULE R, PART II, COLUMN B: RGHS WORKERS' COMPENSATION TRUST SUPPORTS THE GENESEE HOSPITAL, ROCHESTER GENERAL HOSPITAL, ROCHESTER GENERAL HOSPITAL FOUNDATION, NEWARK WAYNE COMMUNITY HOSPITAL, NEWARK COMMUNITY HOSPITAL FOUNDATION, INDEPENDENT LIVING FOR SENIORS, ROCHESTER GENERAL LONG TERM CARE, ROCHESTER GENERAL HUDSON HOUSING, GRHS FOUNDATION, BEHAVIORAL HEALTH NETWORK, AND ROCHESTER GENERAL HEALTH SYSTEMS.