CANTON-POTSDAM MEDICAL PRACTICE PLLC: Form 990, tax year 2021
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- Organization
- CANTON-POTSDAM MEDICAL PRACTICE PLLC (EIN 46-0714367)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202233189349302713
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T08:26:57-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161131146 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BONADIO & CO LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 171 SULLYS TRAIL | AddressLine1Txt |
| City | PITTSFORD | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14534 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460714367 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANTON-POTSDAM MED PRACTICE PLLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CANT | BusinessNameControlTxt |
| Phone | 5859221595 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 LEROY STREEY | AddressLine1Txt |
| City | POTSDAM | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13676 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THOMAS R CRILLY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5859221595 | PhoneNum |
| Signature | 2022-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | THOMAS | PersonFirstNm |
| Person Last | CRILLY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CHELSEY WYANT | PreparerPersonNm |
| PTIN | P01336644 | PTIN |
| Phone | 5853811000 | PhoneNum |
| Preparation | 2022-11-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DR RICHARD DAVIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 LEROY STREEY | AddressLine1Txt |
| City | POTSDAM | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13676 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $682,687 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STLAWRENCEHEALTHSYSTEM.ORG | WebsiteAddressTxt |
| Type Of Organization Other | Yes (X) | TypeOfOrganizationOtherInd |
| Other Organization Dsc | PLLC | OtherOrganizationDsc |
| Formation | 2012 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | CANTON-POTSDAM MEDICAL PRACTICE'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE PHYSICIAN SERVICES, IN AN OUTPATIENT CLINIC SETTING, THAT PROVIDES PUBLIC BENEFIT TO THE COMMUNITY AND CANTON-POTSDAM HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 1 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,448,197 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $682,334 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $38,442 | PYOtherRevenueAmt |
| CY Other Revenue | $353 | CYOtherRevenueAmt |
| PY Total Revenue | $1,486,639 | PYTotalRevenueAmt |
| CY Total Revenue | $682,687 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,487,566 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $982,906 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $655,069 | PYOtherExpensesAmt |
| CY Other Expenses | $494,497 | CYOtherExpensesAmt |
| PY Total Expenses | $3,142,635 | PYTotalExpensesAmt |
| CY Total Expenses | $1,477,403 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,655,996 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$794,716 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $209,847 | TotalAssetsBOYAmt |
| Total Assets EOY | $521,293 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,145,376 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,251,538 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$2,935,529 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$3,730,245 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CANTON-POTSDAM MEDICAL PRACTICE'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE PHYSICIAN SERVICES, IN AN OUTPATIENT CLINIC SETTING, THAT PROVIDE PUBLIC BENEFIT TO THE COMMUNITY AND CANTON-POTSDAM HOSPITAL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $752,174 | ExpenseAmt |
| Revenue | $363,926 | RevenueAmt |
| Desc | CANTON-POTSDAM MEDICAL PRACTICE OPERATED A GENERAL SURGERY CLINIC IN 2021. PATIENT VISITS TOTALED APPROXIMATELY 1,258. THIS CLINIC OPENED IN AUGUST 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $407,946 | ExpenseAmt |
| Revenue | $318,761 | RevenueAmt |
| Desc | CANTON-POTSDAM MEDICAL PRACTICE OPERATED A FAMILY MEDICAL PRACTICE IN 2021. PATIENT VISITS TOTALED APPROXIMATELY 3,281. THIS CLINIC OPENED IN MARCH 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $196,253 | ExpenseAmt |
| Desc | OTHER | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $196,253 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $1,356,373 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 1 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HOWARD GLASTONBURY | PersonNm |
| Phone | 5859221595 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 KINGS HIGHWAY SOUTH | AddressLine1Txt |
| City | ROCHESTER | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14617 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| ROBERT T ROGERS II MD | |||||||
| MEDICAL DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $255,737 | $61,646 | |
| ERIC BIEBER MD | |||||||
| CEO | 0.00 | 55.00 | Yes (X) | $0 | $4,273,339 | $538,689 | Yes (X) |
| THOMAS CRILLY | |||||||
| CFO | 0.00 | 55.00 | $0 | $1,019,950 | $162,808 | Yes (X) | |
| HUGH THOMAS | |||||||
| CAO | 0.00 | 55.00 | $0 | $1,151,485 | $234,804 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $6,700,511 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $997,947 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENU | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $682,334 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $682,334 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $682,334 | TotalProgramServiceRevenueAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $353 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $353 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $353 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $682,687 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $682,687 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $841,268 | TotalAmt |
| Program Services | $773,967 | ProgramServicesAmt |
| Management And General | $67,301 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,685 | TotalAmt |
| Program Services | $12,526 | ProgramServicesAmt |
| Management And General | $1,159 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,766 | TotalAmt |
| Program Services | $79,167 | ProgramServicesAmt |
| Management And General | $6,599 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,187 | TotalAmt |
| Program Services | $38,614 | ProgramServicesAmt |
| Management And General | $3,573 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,108 | TotalAmt |
| Management And General | $30,108 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,441 | TotalAmt |
| Program Services | $87,370 | ProgramServicesAmt |
| Management And General | $9,071 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,841 | TotalAmt |
| Program Services | $14,384 | ProgramServicesAmt |
| Management And General | $1,457 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,981 | TotalAmt |
| Program Services | $88,981 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $633 | TotalAmt |
| Management And General | $633 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,403 | TotalAmt |
| Program Services | $8,538 | ProgramServicesAmt |
| Management And General | $865 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,322 | TotalAmt |
| Program Services | $59,058 | ProgramServicesAmt |
| Management And General | $264 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| BAD DEBT EXPENSE | $167,408 | $167,408 |
| MEDICAL SUPPLIES | $26,360 | $26,360 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,477,403 | TotalAmt |
| Program Services | $1,356,373 | ProgramServicesAmt |
| Management And General | $121,030 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,912 | BOYAmt |
| EOY | $369,281 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $122,022 | BOYAmt |
| EOY | $56,353 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,518 | BOYAmt |
| EOY | $1,518 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,586 | BOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $199,574 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $183,630 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,348 | BOYAmt |
| EOY | $15,944 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,461 | BOYAmt |
| EOY | $78,197 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $209,847 | BOYAmt |
| EOY | $521,293 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,367 | BOYAmt |
| EOY | $151,632 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,087,009 | BOYAmt |
| EOY | $4,099,906 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,145,376 | BOYAmt |
| EOY | $4,251,538 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,935,529 | BOYAmt |
| EOY | -$3,730,245 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,935,529 | BOYAmt |
| EOY | -$3,730,245 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $209,847 | BOYAmt |
| EOY | $521,293 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$794,716 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,051,657 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,724,091 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,867,052 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,240,105 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,432,025 | CurrentTaxYearAmt |
| Total | $21,314,930 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,051,657 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,724,091 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,867,052 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,240,105 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,432,025 | CurrentTaxYearAmt |
| Total | $21,314,930 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $21,314,930 | PublicSupportTotal509Amt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,204 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $38,442 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $353 | CurrentTaxYearAmt |
| Total | $41,001 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,051,659 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,726,295 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,867,052 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,278,547 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,432,378 | CurrentTaxYearAmt |
| Total | $21,355,931 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99810 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99830 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART III, LINE 12-OTHER INCOME DETAIL | FormAndLineReferenceDesc |
| Explanation | VENDOR PURCHASE DISCOUNT $353.00 | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,024 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,185 | DepreciationAmt |
| Book Value | $4,839 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $186,550 | OtherCostOrOtherBasisAmt |
| Depreciation | $175,445 | DepreciationAmt |
| Book Value | $11,105 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $15,944 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER RECEIVABLES | Desc |
| Book Value | $78,197 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $78,197 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $4,099,906 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,099,906 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ERIC BIEBER MD | ||||||||||||||
| CEO | $0 | $1,256,909 | $0 | $3,016,430 | $0 | $0 | $0 | $526,816 | $0 | $11,873 | $0 | $4,812,028 | $0 | $0 |
| HUGH THOMAS | ||||||||||||||
| CAO | $0 | $658,710 | $0 | $492,775 | $0 | $0 | $0 | $222,372 | $0 | $12,432 | $0 | $1,386,289 | $0 | $0 |
| THOMAS CRILLY | ||||||||||||||
| CFO | $0 | $614,737 | $0 | $405,213 | $0 | $0 | $0 | $150,216 | $0 | $12,592 | $0 | $1,182,758 | $0 | $0 |
| ROBERT T ROGERS II MD | ||||||||||||||
| MEDICAL DIRECTOR | $0 | $201,781 | $0 | $53,956 | $0 | $0 | $0 | $48,536 | $0 | $13,110 | $0 | $317,383 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OTHER ADDITIONAL INFORMATION: | CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL AND ALL "EMPLOYEES" ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. AS SUCH, THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CANTON-POTSDAM HOSPITAL SEEKS INPUT OF A CONSULTING FIRM WITH NATIONAL EXPERIENCE TO REVIEW COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AND THE REGULATORY COMPLIANCE ISSUES OF NOT-FOR-PROFITS. UPON THE FINDINGS OF THE CONSULTANT AND DELIVERATIONS OF THE COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE RECOMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE. |
| 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. ADDITIONALLY, THIS COLUMN INCLUDES THE ACCRUAL OF INCENTIVE BASED WAGES WHICH REMAIN UNPAID. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | THE PROVIDERS IN THE CPMP DERMATOLOGY PRACTICE INTEGRATED WITH CPH OWNED OPERATIONS; A RELATED ENTITY. |
| FORM 990, PART VI, SECTION A, LINE 3 | CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL. ALL "EMPLOYEES", INCLUDING THOSE THAT PERFORM MANAGEMENT FUNCTIONS, ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. EMPLOYEES OF CANTON-POTSDAM HOSPITAL ARE LEASED TO CANTON- POTSDAM MEDICAL PRACTICE TO PROVIDE ALL MEDICAL STAFF AND MANAGEMENT SERVICES. SERVICE AGREEMENTS ARE IN PLACE BETWEEN THE TWO RELATED ORGANIZATIONS. CANTON-POTSDAM HOSPITAL INVOICES CANTON-POTSDAM MEDICAL PRACTICE FOR THESE SERVICES. KEY EMPLOYEE, DONNA MCGREGOR, IS AN EMPLOYEE OF CANTON-POTSDAM HOSPITAL WHO IS RESPONSIBLE FOR THE FINANCIAL REPORTING OF CANTON-POTSDAM MEDICAL PRACTICE. ROBERT T. ROGERS, II, MD, IS AN EMPLOYEE OF CANTON-POTSDAM HOSPITAL WHO IS THE SOLE MEMBER MANAGER OF THE PLLC. |
| 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 CANTON-POTSDAM HOSPITAL. THE SOLE CORPORATE MEMBER OF CANTON-POTSDAM HOSPITAL IS ST. LAWRENCE HEALTH SYSTEM, INC. THE SOLE CORPORATE MEMBER OF ST. LAWRENCE HEALTH SYSTEM, INC. IS ROCHESTER REGIONAL HEALTH, A RELATED NOT-FOR-PROFIT CORPORATION. |
| 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 | THE KEY EMPLOYEE AND SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE ARE EMPLOYEES OF CANTON-POTSDAM HOSPITAL, A RELATED ORGANIZATION. ALL EMPLOYEES ADHERE TO CANTON-POTSDAM HOSPITAL'S WRITTEN CONFLICT OF INTEREST POLICY. DISCLOSURE STATEMENTS ARE REVIEWED ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | AS STATED ABOVE IN THIS SCHEDULE O, CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL AND ALL "EMPLOYEES" ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, A RELATED TAX-EXEMPT ORGANIZATION. AS SUCH, THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CANTON-POTSDAM HOSPITAL SEEKS THE INPUT OF A CONSULTING FIRM WITH NATIONAL EXPERIENCE TO REVIEW THE COMPENSATION PACKAGE OFFERED TO TOP MANAGEMENT AND THE REGULATORY COMPLIANCE ISSUES FOR NOT-FOR-PROFITS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE. THE KEY EMPLOYEES AND SOLE MEMBER OF THE CANTON-POTSDAM MEDICAL PRACTICE ARE EMPLOYEES OF CANTON-POTSDAM HOSPITAL, A RELATED ORGANIZATION. COMPENSATION OF EMPLOYEES IS DETERMINED BY CANTON-POTSDAM HOSPITAL'S PROCESS FOR DETERMINING COMPLENSATION. THEY ARE AS FOLLOWS: THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED PRIMARILY BY INFORMATION GATHERED FROM INDEPENDENT SURVEY DATA FROM NATIONAL AND SURROUNDING MARKETS COORDINATED BY THE HUMAN RESOURCES DEPARTMENT. THE CEO AND VP OF HUMAN RESOURCES REVIEW THE SURVEY DATA TO DETERMINE SALARY RANGES AND COMPENSATION PACAKGES. THE CEO BRINGS THE INFORMATION AND FINDINGS TO THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR DELIBERATION AND CONSIDERATION. THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE WILL THEN BRING THEIR RECOMMENDATION TO THE FULL BOARD OF DIRECTORS FOR THEIR FINAL APPROVAL. |
| 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. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. |
| FORM 990, PART VII, SECTION A, COLUMN (F): | ESTIMATED AMOUNT OF OTHER COMPENSATION FROM THE ORGANIZATION AND RELATED ORGANIZATIONS - THIS COLUMN IS REFLECTIVE OF (1) THE ACTUARIAL CHANGE IN DEFINED BENEFIT PENSION PLAN AND POST-RETIREMENT BENEFITS FOR THE TAX YEAR, (2) THE ACCRUAL OF INCENTIVE BASED WAGES WHICH REMAIN UNPAID, AND (3) NON-TAXABLE BENEFITS. |
| FORM 990, PART XII, LINE 2C: | THE 2021 AUDIT WAS CONDUCTED IN CONJUNCTION WITH THAT OF RRH. THE AUDITED FINANCIAL STATEMENTS OF THE CORPORATION ARE CONSOLIDATED WITH ALL OF THE AFFILIATES OF ROCHESTER REGIONAL HEALTH. THE AUDIT AND COMPLIANCE COMMITTEE OF ROCHESTER REGIONAL HEALTH ARE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (40 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THE ROCHESTER GENERAL HOSPITAL | |||||||||||
| 1425 PORTLAND AVENUE | ROCHESTER | NY | 14621 | 160743134 | HOSPITAL | NY | 501(C)(3) | LINE 3 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| GRHS FOUNDATION | |||||||||||
| 100 KINGS HIGHWAY SOUTH | ROCHESTER | NY | 14617 | 223378111 | R/E INV MGMT | NY | 501(C)(3) | LINE 12B, II | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| ROCHESTER REGIONAL HEALTH FOUNDATION | |||||||||||
| 100 KINGS HIGHWAY SOUTH | ROCHESTER | NY | 14617 | 222229425 | FUNDRAISING | NY | 501(C)(3) | LINE 12B, II | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION | |||||||||||
| DRIVING PARK AVENUE | NEWARK | NY | 14513 | 222963015 | FUNDRAISING | NY | 501(C)(3) | LINE 12B, II | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| NEWARK WAYNE COMMUNITY HOSPITAL | |||||||||||
| DRIVING PARK AVENUE | NEWARK | NY | 14513 | 150584188 | HOSPITAL | NY | 501(C)(3) | LINE 3 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| RGHS WORKERS' COMPENSATION TRUST | |||||||||||
| 1425 PORTLAND AVENUE | ROCHESTER | NY | 14621 | 166429300 | SEE PART VII | NY | 501(C)(3) | LINE 12B, II | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| CONTINUING CARE NETWORK INC (CCN) | |||||||||||
| 100 KINGS HIGHWAY SOUTH | ROCHESTER | NY | 14617 | 222963016 | SUPPORT RGH | NY | 501(C)(3) | LINE 12B, II | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| ROCHESTER GENERAL HUDSON HOUSING | |||||||||||
| 2066 HUDSON AVENUE | ROCHESTER | NY | 14621 | 223210351 | LOW INC HOUSING | NY | 501(C)(3) | LINE 10 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| VIA HEALTH HOME CARE I | |||||||||||
| 100 KINGS HIGHWAY SOUTH | ROCHESTER | NY | 14617 | 161504370 | HOME HEALTH | NY | 501(C)(3) | LINE 10 | CCN | Yes (1) | |
| VIA HEALTH HOMECARE II | |||||||||||
| 100 KINGS HIGHWAY SOUTH | ROCHESTER | NY | 14617 | 161538727 | HOME HEALTH | NY | 501(C)(3) | LINE 10 | CCN | Yes (1) | |
| INDEPENDENT LIVING FOR SENIORS | |||||||||||
| 2066 HUDSON AVENUE | ROCHESTER | NY | 14617 | 161491059 | ADULT DAY HC | NY | 501(C)(3) | LINE 10 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| ROCHESTER GENERAL LONG TERM CARE | |||||||||||
| 1550 EMPIRE BLVD | WEBSTER | NY | 14580 | 223187140 | NH & REHAB | NY | 501(C)(3) | LINE 10 | ROCHESTER REGIONAL HEALTH | Yes (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 | Yes (1) | |
| THE UNITY HOSPITAL OF ROCHESTER | |||||||||||
| 1555 LONG POND RD | ROCHESTER | NY | 14626 | 237221763 | HOSPITAL | NY | 501(C)(3) | LINE 3 | ROCHESTER REGIONAL HEALTH | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| WOODLAND VILLAGE INC | |||||||||||
| 1555 LONG POND RD | ROCHESTER | NY | 14626 | 161588242 | SENIOR APARTMENT COMPLEX | NY | 501(C)(3) | LINE 10 | ROCHESTER REGIONAL HEALTH | Yes (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 | Yes (1) | |
| UNITY HEALTH SYSTEM INC | |||||||||||
| 1555 LONG POND ROAD | ROCHESTER | NY | 14626 | 222572873 | SYSTEM SUPPORT | NY | 501(C)(3) | LINE 12B, II | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| ROCHESTER REGIONAL HEALTH | |||||||||||
| 100 KINGS HIGHWAY SOUTH | ROCHESTER | NY | 14617 | 471234999 | SYSTEM PARENT | NY | 501(C)(3) | LINE 12B, II | Yes (1) | N/A | |
| UNITED MEMORIAL MEDICAL CENTER | |||||||||||
| 127 NORTH STREET | BATAVIA | NY | 14020 | 160743029 | HOSPITAL | NY | 501(C)(3) | LINE 3 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| CLIFTON SPRINGS HOSPITAL AND CLINIC | |||||||||||
| 2 COULTER ROAD | CLIFTON SPRINGS | NY | 14432 | 160743966 | HOSPITAL | NY | 501(C)(3) | LINE 3 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| BEHAVIORAL HEALTH NETWORK INC | |||||||||||
| 490 EAST RIDGE ROAD | ROCHESTER | NY | 14621 | 166069131 | MENTAL HEALTH | NY | 501(C)(3) | LINE 10 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| PRCD INC | |||||||||||
| 1555 LONG POND RD | ROCHESTER | NY | 14626 | 161311581 | SUBSTANCE ABUSE TREATMENT & REHAB. | NY | 501(C)(3) | LINE 7 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| ROCHESTER GENERAL HEALTH SYSTEM | |||||||||||
| 100 KINGS HIGHWAY SOUTH | ROCHESTER | NY | 14617 | 222551509 | SYSTEM SUPPORT | NY | 501(C)(3) | LINE 12B, II | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| UNITED MEMORIAL MEDICAL CENTER FOUNDATION | |||||||||||
| 127 NORTH STREET | BATAVIA | NY | 14020 | 222611543 | FUNDRAISING | NY | 501(C)(3) | LINE 12B, II | UNITED MEMORIAL MEDICAL CENTER | Yes (1) | |
| CLIFTON SPRINGS HOSPITAL & CLINIC FOUNDATION | |||||||||||
| 2 COULTER ROAD | CLIFTON SPRINGS | NY | 14432 | 161560033 | FUNDRAISING | NY | 501(C)(3) | LINE 12B, II | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| GENESEE REGION HOME CARE ASSOCIATION INC | |||||||||||
| 100 KINGS HIGHWAY | ROCHESTER | NY | 14617 | 160844109 | HOME HEALTH | NY | 501(C)(3) | LINE 10 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| GENESEE REGION HOME CARE ASSOCIATION ONTARIO COUNTY INC | |||||||||||
| 100 KINGS HIGHWAY | ROCHESTER | NY | 14617 | 223257719 | HOME HEALTH | NY | 501(C)(3) | LINE 10 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| CANTON-POTSDAM HOSPITAL | |||||||||||
| 50 LEROY STREET | POTSDAM | NY | 13676 | 161012691 | HOSPITAL | NY | 501(C)(3) | LINE 3 | ST LAWRENCE HEALTH SYSTEM INC | Yes (1) | |
| ST LAWRENCE HEALTH FOUNDATION INC | |||||||||||
| 29 GROVE STREET | POTSDAM | NY | 13676 | 161279472 | FUNDRAISING | NY | 501(C)(3) | LINE 12A, I | 0 | N/A | |
| GOVEURNEUR HOSPITAL | |||||||||||
| 77 WEST BARNEY STREET | GOUVERNEUR | NY | 13642 | 464249555 | HOSPITAL | NY | 501(C)(3) | LINE 3 | ST LAWRENCE HEALTH SYSTEM INC | Yes (1) | |
| MASSENA HOSPITAL INC | |||||||||||
| 1 HOSPITAL DRIVE | MASSENA | NY | 13662 | 843134268 | HOSPITAL | NY | 501(C)(3) | LINE 3 | ST LAWRENCE HEALTH SYSTEM INC | Yes (1) | |
| ST LAWRENCE HEALTH SYSTEM INC | |||||||||||
| 50 LEROY STREET | POTSDAM | NY | 13676 | 464259168 | SYSTEM SUPPORT | NY | 501(C)(3) | LINE 12A, I | ROCHESTER REGIONAL HEALTH | Yes (1) | |
| PARMA HOUSING DEVELOPMENT FUND CORP | |||||||||||
| 89 GENESEE STREET | ROCHESTER | NY | 14611 | 810671685 | LOW INCOME HOUSING FOR ELDERLY/HANDICAPPED | NY | 501(C)(3) | LINE 10 | ROCHESTER REGIONAL HEALTH | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|
| NW ASSOCIATES LP | ||||||||||
| PO BOX 111 DRIVING PARK AVENUE | NEWARK | NY | 14516 | 141674119 | R/E LEASING | NY | RELATED | 0 | 0 | 0.73610 |
| PARMA SENIOR HOUSING | ||||||||||
| 1555 LONG POND RD | ROCHESTER | NY | 14626 | 432082116 | HILTON PROJ | NY | 0 | 0 | ||
| UNITY SENIOR HOUSING | ||||||||||
| 1555 LONG POND RD | ROCHESTER | NY | 14626 | 061709927 | MOORE PK | NY | 0 | 0 | ||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (10 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GREATER ROCHESTER ASSURANCE COMPANY LTD | |||||||||||||||
| GEORGE TOWN | GRAND CAYMAN | CJ | INSURANCE | CJ | N/A | C | 1.00000 | 0 | |||||||
| GRACO RISK RETENTION GROUP INC | |||||||||||||||
| INSURANCE | C | 1.00000 | 0 | 1425 PORTLAND AVENUE | ROCHESTER | NY | 14621 | 710933967 | SC | RGH | |||||
| NWA INC | |||||||||||||||
| R/E LEASING | C | 1.00000 | 0 | DRIVING PARK AVENUE | NEWARK | NY | 14513 | 141667339 | NY | NWCH | |||||
| GREATER ROCHESTER INDEPENDENT PRACTICE ASSOCIATION INC | |||||||||||||||
| INDEPENDENT PRACTICE ASSOCIATION | N/A | C | 0.50000 | 0 | 100 KINGS HWY S SUITE 2500 | ROCHESTER | NY | 14617 | 161507171 | NY | |||||
| ROCHESTER GENERAL HEALTH SYSTEM DIALYSIS INC | |||||||||||||||
| DIALYSIS | C | 1.00000 | 0 | 1425 PORTLAND AVENUE | ROCHESTER | NY | 14621 | 383912199 | NY | RGHS | |||||
| ACM MEDICAL LABORATORY INC | |||||||||||||||
| CLINICAL LAB | C | 0 | 160 ELMGROVE PARK | ROCHESTER | NY | 14624 | 161059691 | NY | PRH INC | ||||||
| PRH INC | |||||||||||||||
| MEDICAL LAB | C | 0 | 1555 LONG POND ROAD | ROCHESTER | NY | 14626 | 161329632 | NY | ROCHESTER REGIONAL HEALTH | ||||||
| PARMA SENIOR HOUSING LLC | |||||||||||||||
| SENIOR HOUSING | C | 0 | 1555 LONG POND ROAD | ROCHESTER | NY | 14626 | 810671687 | NY | ROCHESTER REGIONAL HEALTH | ||||||
| UNITY SENIOR HOUSING CORP | |||||||||||||||
| SENIOR HOUSING | C | 0 | 1555 LONG POND ROAD | ROCHESTER | NY | 14624 | 061709925 | NY | ROCHESTER REGIONAL HEALTH | ||||||
| UNITY HEALTH SYSTEM PURCHASING GROUP LLC | |||||||||||||||
| SENIOR HOUSING | C | 0 | 1555 LONG POND ROAD | ROCHESTER | NY | 14626 | 222572873 | NY | ROCHESTER REGIONAL HEALTH | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANTON-POTSDAM HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | K | TransactionTypeTxt |
| Involved | $1,074,309 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART II, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | 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, BEHAVIORAL HEALTH NETWORK, INC, CLIFTON SPRINGS HOSPITAL & CLINIC, UNITED MEMORIAL MEDICAL CENTER, UNITY HOSPITAL OF ROCHESTER, GENESEE REGION HOME CARE ASSOCIATION AND GENESEE REGION HOME CARE OF ONTARIO COUNTY. | ExplanationTxt |