2014-11-11T13:14:55-06:00 2013-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2013-01-01 223187140 ROCHESTER GENERAL LONG TERM CARE ROCH 5856714300 1550 EMPIRE BLVD WEBSTER NY 14580 PAULA TINCH SVP FINANCE & CFO 5856714300 2014-11-05 1 ANGELA M FRANCO P00589741 3154463600 2013 2015-11-30 17:44:51Z HILL HAVEN NURSING HOME HUGH THOMAS 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 25774501 0 X WWW.ROCHESTERGENERAL.ORG X 1993 NY TO OPERATE LONG TERM HEALTH FACILITIES AND SERVICES FOR THE CARE AND TREATMENT OF SICK, INVALID, INFIRM, AGED, DISABLED OR CONVALESCENT PERSONS. 8 7 473 59 0 0 6896027 5651 24759888 24548795 885 3047 609782 1217008 32266582 25774501 50 100 0 0 20554099 20895379 0 0 0 8081434 9152671 28635583 30048150 3630999 -4273649 19077294 22006861 14504033 15575360 4573261 6431501 TO ESTABLISH, AQUIRE, DEVELOP, OWN, OPERATE AND MAINTAIN LONG TERM HEALTH CARE FACILITIES AND SERVICES FOR THE CARE AND TREATMENT OF SICK, INVALID, INFIRM, AGED, DISABLED OR CONVALESCENT PERSONS IN ACCORDANCE WITH THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK. 0 0 22270530 100 25765803 THE ORGANIZATION PROVIDES 24-HOUR SKILLED NURSING CARE TO THOSE IN NEED OF REHABILITATION, LONG-TERM CARE, TRANSITIONAL CARE, HOSPICE CARE AND CARE FOR ALZEHEIMER'S -TYPE DEMENTIA. THE GOAL IS TO HELP RESIDENTS REACH THEIR GREATEST LEVEL OF PHYSICAL FUNCTIONING AND EMOTIONAL WELL-BEING. THE FACILITY IS A PARK-LIKE SETTING IN WEBSTER, NEW YORK WITH 355 BEDS, DEDICATED ROOMS FORMINGLING AND RECREATION, AND BEAUTIFULLY LANDSCAPED GROUNDS. RESIDNETS HAVE ACCESS TO IN-HOUSE MEDICAL CARE PROVIDED BY PHYSICIANS, NURSE PRACTITIONERS AND A RANGE OF MEDICAL AND REHABILITATION SPECIALISTS. THE ORGANIZATION IS COMMITTED TO HELPING SENIORS STAY AS CONNECTED TO THE COMMUNITY AS POSSIBLE WITH SPECIAL PROGRAMS AND AN OPEN DOOR FOR FAMILY AND FRIENDS. 22270530 1 0 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 24 0 1 473 1 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X HUGH CHISHOLM 5859221221 1550 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 LINDA BECKER CHAIR 1.00 4.00 X 0 0 0 MARK C CLEMENT PRESIDENT & CEO 2.00 53.00 X X 54393 1501404 643168 ROBERT DOBIES DIRECTOR 1.00 4.00 X 0 0 0 JEANNE GROVE DO DIRECTOR (UNTIL 6/2013) 1.00 4.00 X 0 0 0 ROBERT MAYO MD CMO 2.00 53.00 X 16042 422956 130842 DANIEL MEYERS DIRECTOR 1.00 4.00 X 0 0 0 THOMAS PENN MD SECRETARY/TREASURER 1.00 4.00 X 0 0 0 JOHN RIEDMAN DIRECTOR 1.00 4.00 X 0 0 0 MARGARET SANCHEZ DIRECTOR (UNTIL 6/2013) 1.00 4.00 X 0 0 0 ROBERT S SANDS DIRECTOR 1.00 4.00 X 0 0 0 MAURICE VAUGHAN MD DIRECTOR 1.00 4.00 X 0 0 0 PAULA TINCH SVP FINANCE & CFO 2.00 53.00 X 13769 380036 117632 STEPHEN ASH EXECUTIVE ADMINISTRATOR 40.00 X 0 0 0 HUGH THOMAS SVP & CORPORATE COUNSEL 2.00 53.00 X 22692 626350 173842 SCOTT SCHABEL MEDICAL DIRECTOR 40.00 X 144587 0 7088 BRENDA KLOSTER ASST DIRECTOR OF NURSING 40.00 X 107567 0 3 LOU RUPERT PHARMACIST 40.00 X 119230 0 11700 KATHY THURHEIMER PHARMACIST 40.00 X 138442 0 10067 616722 2930746 1094342 4 0 1 0 0 5651 5651 PATIENT/RESIDENT SERVICE REVENUE 623000 24548795 24548795 24548795 3047 3047 PHARMACY 446110 1011477 1011477 CAFETERIA 445100 73855 73855 GIFT SHOP 453220 2313 2313 129363 129363 1217008 25774501 25765803 0 3047 100 100 360878 313258 47620 15834549 11381933 4452616 772991 558199 214792 2804529 2025232 779297 1122432 810541 311891 9530 6882 2648 1767436 1276317 491119 17731 12804 4927 1569093 1133088 436005 13244 9564 3680 432821 312553 120268 17151 12385 4766 1017829 735004 282825 49473 35726 13747 HEALTH ASSESSMENT FACIL 1322386 1322386 PHARMACEUTICALS 1157791 836075 321716 BAD DEBTS 735604 735604 TAXES, LICENSES & DUES 79394 57333 22061 963188 695546 267642 30048150 22270530 7777620 0 2499 3345578 3185581 171160 213257 30154 17797 22789613 7147656 12651680 15641957 2878722 2945770 19077294 22006861 2328378 2385125 12175655 13190235 14504033 15575360 X 4573261 6431501 4573261 6431501 19077294 22006861 -4273649 6131889 X X 0 1 X 1 1 1 X 709 1161 1397 5218 5651 14136 27206988 26545612 27541997 24759888 24548795 130603280 27207697 26546773 27543394 24765106 24554446 130617416 0 0 0 130617416 1480 760 2038 885 3047 8210 1480 760 2038 885 3047 8210 419556 363711 399300 609783 1792350 27628733 26911244 27944732 25375774 24557493 132417976 0.98640 0.98830 0.00010 0.00020 X 16303232 2817899 13485333 1800912 1298334 502578 4685469 3031423 1654046 15641957 WORKERS COMP SELF INSURED 552432 RESIDENT CUSTODIAL FUNDS 243875 DUE FROM AFFILIATES 326771 INSURANCE RECOVERY RECEIVABLES 1689236 MISCELLANEOUS RECEIVABLE 133456 2945770 ESTIMATED THIRD PARTY PAYABLES 2333799 ACCRUED SELF-INSURED LIABILITY 4090615 DUE TO AFFILIATES 6765821 13190235 25774501 0 25774501 0 25774501 30048150 0 30048150 0 30048150 0 1 0 0 0 0 0 0 0 MARK C CLEMENT PRESIDENT & CEO 25889 714606 26618 734729 1886 52069 22305 615676 181 5006 76879 2122086 13897 383603 ROBERT MAYO MD CMO 11777 310498 2764 72880 1501 39578 4506 118791 276 7269 20824 549016 0 0 PAULA TINCH SVP FINANCE & CFO 9164 252939 3987 110037 618 17060 3954 109135 159 4384 17882 493555 0 0 HUGH THOMAS SVP & CORPORATE COUNSEL 12846 354573 8200 226343 1646 45434 5780 159534 298 8230 28770 794114 3518 97109 SCOTT SCHABEL MEDICAL DIRECTOR 110483 0 32854 0 1250 0 3850 0 3238 0 151675 0 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 2013, 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 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 NOMINIATING 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 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 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. BOARD MEMBERS LEAVE THE ROOM DURING DISCUSSIONS AND ABSTAIN FROM VOTING WHEN THEY HAVE A CONFLICT OF INTEREST. 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 HOSPITAL, 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 XII LINE 2C SAME PROCESS AS PRIOR YEAR. FORM 5471 FILED ON BEHALF OF STATEMENT THE FOLLOWING INFORMATION IS SUBMITTED WITH RESPECT TO ROCHESTER GENERAL LONG TERM CARE'S FORM 5471 (INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS) FILING REQUIREMENT FOR THE ENTITY BELOW: NAME OF FOREIGN CORPORATION: GREATER ROCHESTER ASSURANCE COMPANY, LTD. BEGINNING TAX YEAR OF FOREIGN CORPORATION: JANUARY 1, 2013 ENDING TAX YEAR OF FOREIGN CORPORATION: DECEMBER 31, 2013 THE FORM 5471 FILING REQUIREMENT FOR THIS FOREIGN CORPORATION FOR CATEGORIES 4 AND 5 HAVE BEEN SATISFIED BY INCLUSION IN THE FOLLOWING U.S. FILER'S TAX RETURN: NAME OF U.S. FILER: ROCHESTER GENERAL HEALTH SYSTEM ADDRESS OF U.S. FILER: 100 KINGS HIGHWAY SOUTH, ROCHESTER, NY 14617 EIN: 22-2551509 ENDING TAX YEAR OF U.S. FILER: DECEMBER 31, 2013 TYPE OF RETURN FILED: 990-T IRS SERVICE 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 RGHS 0 ROCHESTER MENTAL HEALTH CENTER 490 EAST RIDGE ROAD ROCHESTER NY 14621 166069131 MENTAL HEALTH NY 501(C)(3) LINE 9 RGHS 0 GRHS FOUNDATION 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 223378111 R/E INV MGMT NY 501(C)(3) LINE 11B, II RGHS 0 THE ROCHESTER GENERAL HOSPITAL FOUNDATION 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222229425 FUNDRAISING NY 501(C)(3) LINE 11B, II RGHS 0 NEWARK WAYNE COMMUNITY HOSPITAL DRIVING PARK AVENUE NEWARK NY 14513 150584188 HOSPITAL NY 501(C)(3) LINE 3 RGHS 0 RGHS WORKERS' COMPENSATION TRUST 1425 PORTLAND AVENUE ROCHESTER NY 14621 166429300 SEE PART VII NY 501(C)(3) LINE 11B, II RGHS 0 CONTINUING CARE NETWORK INC (CCN) 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222963016 SUPPORT RGH NY 501(C)(3) LINE 11B, II RGHS 0 ROCHESTER GENERAL HUDSON HOUSING 2066 HUDSON AVENUE ROCHESTER NY 14617 223210351 LOW INC HOUSING NY 501(C)(3) LINE 9 RGHS 0 INDEPENDENT LIVING FOR SENIORS 2066 HUDSON AVENUE ROCHESTER NY 14617 161491059 ADULT CARE NY 501(C)(3) LINE 9 RGHS 0 WESTERN NEW YORK MEDICAL PRACTICE PC 1425 PORTLAND AVENUE ROCHESTER NY 14621 611654232 PHYS PRAC NY 501(C)(3) LINE 9 RGHS 0 ROCHESTER GENERAL HEALTH SYSTEM 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222551509 SYSTEM PARENT NY 501(C)(3) LINE 11B, II N/A 0 NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION DRIVING PARK AVENUE NEWARK NY 14513 222963015 FUNDRAISING NY 501(C)(3) LINE 11B, II NWCH 0 VIA HEALTH HOME CARE I 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 161504370 HOME HEALTH NY 501(C)(3) LINE 9 CCN 0 VIA HEALTH HOMECARE II 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 161538727 HOME HEALTH NY 501(C)(3) LINE 9 CCN 0 GREATER ROCHESTER ASSURANCE COMPANY LTD GEORGE TOWN GRAND CAYMAN CJ INSURANCE CJ N/A C 0 ROCHESTER GENERAL HEALTH SYSTEM DIALYSIS INC 1425 PORTLAND AVE ROCHESTER NY 14621 383912199 DIALYSIS NY RGHS C 0 GREATER ROCHESTER INDEPENDENT PRACTICE ASSOCIATION INC 100 KINGS HIGHWAY SOUTH STE 2500 ROCHESTER NY 14617 161507171 INDEPENDENT PRACTICE ASSOCIATION NY N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 INDEPENDENT LIVING FOR SENIORS K 1946489 FMV INDEPENDENT LIVING FOR SENIORS P 62235 FMV ROCHESTER GENERAL HEALTH SYSTEM WORKERS' COMPENSATION TRUST O 902989 FMV ROCHESTER GENERAL HOSPITAL O 1045478 FMV ROCHESTER GENERAL HEALTH SYSTEM O 468052 FMV ROCHESTER MENTAL HEALTH CENTER L 68222 FMV 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 GENRAL LONG TERM CARE, ROCHESTER GENERAL HUDSON HOUSING, GRHS FOUNDATION, BEHAVIORAL HEALTH NETWORK, AND ROCHESTER GENERAL HEALTH SYSTEM.