2013-11-12T11:13:10-06:00 2012-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2012-01-01 166069131 BEHAVIORAL HEALTH NETWORK INC FKA VIA HEALTH BEHAVIORAL HEALTH NETWORK BEHA 5859222500 490 EAST RIDGE ROAD ROCHESTER NY 14621 PAULA TINCH 5859222500 2013-11-06 1 ANGELA M FRANCO P00589741 3154463600 2012 2016-02-24 21:20:13Z ROCHESTER MENTAL HEALTH CENTER MARK C CLEMENT 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 8188397 0 X WWW.ROCHESTERGENERAL.ORG X 1995 NY OUR ORGANIZATION IS COMMITTED TO IMPROVING THE HEALTH OF THE PEOPLE WE SERVE BY PROVIDING HIGH QUALITY CARE, A COMPREHENSIVE RANGE OF SERVICES AND CONVENIENT AND TIMELY ACCESS WITH EXCEPTIONAL SERVICE WITH COMPASSION. 10 8 137 0 0 0 1358078 1354328 5513385 6813365 500 9600 25827 11104 6897790 8188397 0 0 0 0 6009747 5925752 0 0 0 2959336 3147485 8969083 9073237 -2071293 -884840 3771958 3223417 5893808 6230107 -2121850 -3006690 X OUR ORGANIZATION IS COMMITTED TO IMPROVING THE HEALTH OF THE PEOPLE WE SERVE BY PROVIDING HIGH QUALITY CARE, A COMPREHENSIVE RANGE OF SERVICES AND CONVENIENT AND TIMELY ACCESS WITH EXCEPTIONAL SERVICE WITH COMPASSION. 0 0 8200821 6824469 SEE SCHEDULE OTHE ORGANIZATION PROVIDES A VARIETY OF MENTAL HEALTH SERVICES TO THE MONROE COUNTY AREA INCLUDING AN ADULT CLINIC, EMERGENCY HEALTH EVALUATIONS AND TREATMENT FOR CHILDREN WITH SIGNIFICANT EMOTIONAL PROBLEMS AND THEIR FAMILIES AS WELL AS CRISIS INTERVENTION AND REFERRALS. THE FILING ORGANIZATION HAS NINE LOCATIONS ACROSS THE COMMUNITY, INCLUDING TWO OF THE AREA'S BEST MENTAL HEALTH CENTERS, ROCHESTER MENTAL HEALTH CENTER AND GENESEE MENTAL HEALTH CENTER, AND OVER 40 YEARS OF EXPERIENCE AND TRADITION. RMHC HAS COMPREHENSIVE SERVICES AND DEDICATED MENTAL HEALTH AND SUBSTANCE ABUSE PROFESSIONALS WORKING TO HELP PATIENTS ACHIEVE THEIR FULL POTENTIAL TO LIVE AND WORK AS PRODUCTIVE MEMBERS OF THE COMMUNITY. THE ORGANIZATION OFFERS: 1) A COMPREHENSIVE SYSTEM OF CLINICAL MENTAL HEALTH SERVICES, 2) READILY -ACCESSIBLE, CULTURALLY-SENSITIVE SERVICES UNIQUELY MATCHED TO THE INDIVIDUAL NEEDS OF EACH PATIENT AND THEIR FAMILY, 3) CONVENIENT ACCESS TO MENTAL HEALTH OUTPATIENT SERVICES WITH LOCATIONS THROUGHOUT THE GREATER ROCHESTER AREA, AND 4) AN UNWAVERING COMMITMENT TO SERVE THOSE IN THE COMMUNITY WHO HAVE EMOTIONAL NEEDS. 8200821 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 22 0 1 137 1 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X TAMMY CLAFLIN 5859221745 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 MARK CLEMENT 1.00 54.00 X X 14636 1370538 712572 LINDA BECKER 1.00 4.00 X 0 0 0 ROBERT DOBIES 1.00 4.00 X 0 0 0 JEANNE GROVE DO 1.00 4.00 X 0 0 0 ROBERT MAYO MD 1.00 39.00 X 0 331586 62910 DANIEL MEYERS 1.00 4.00 X 0 0 0 THOMAS PENN MD 1.00 4.00 X 0 0 0 JOHN REIDMAN 1.00 4.00 X 0 0 0 MARGARET SANCHEZ 1.00 4.00 X 0 0 0 ROBERT S SANDS 1.00 4.00 X 0 0 0 PAULA TINCH 1.00 54.00 X 2760 258397 57140 RICHARD GANGEMI 0.00 55.00 X 0 577058 129455 HUGH THOMAS 1.00 54.00 X 6146 575563 170710 KATHRYN MCGUIRE 0.00 55.00 X 0 381480 229950 JAMES MEAD 40.00 X 0 258036 61268 VISHNU CHALLAPALLI 40.00 X 0 191882 80222 ROOPA CHALLAPALLI 40.00 X 0 176051 53153 MARY MARROCCO 40.00 X 0 172975 39907 KASHINATH PATIL 40.00 X 0 162625 186702 23542 4456191 1783989 0 0 1 0 0 1354328 1354328 RESIDENT SERVICE REVEN 623000 6813365 6813365 6813365 9600 0 9600 9600 9600 MISCELLANEOUS OPERATIN 900099 11104 11104 11104 8188397 6824469 0 9600 X 4848715 4382498 466217 334000 301885 32115 364920 329832 35088 378117 341760 36357 3766 3404 362 1449508 1310134 139374 20949 18935 2014 113471 102560 10911 41561 37565 3996 696234 629289 66945 121251 109592 11659 222831 201405 21426 56351 50933 5418 OTHER EXPENSES 278897 252081 26816 BAD DEBT EXPENSE 142666 128948 13718 9073237 8200821 872416 0 1333230 1297138 618371 632316 3245 3248 88252 157457 3593096 2652121 951880 940975 776980 192283 3771958 3223417 1360413 918550 757006 883872 3776389 4427685 5893808 6230107 X -2121850 -3006690 -2121850 -3006690 3771958 3223417 -884840 0 X 0 1 X 1 1 1 X 1536401 1595569 1295832 1358078 1354328 7140208 7005591 6956830 6589523 5513385 6813365 32878694 8541992 8552399 7885355 6871463 8167693 40018902 0 0 0 40018902 54360 3227 57587 54360 3227 57587 585145 771153 220980 25827 11104 1614209 9181497 9326779 8106335 6897290 8178797 41690698 0.95990 0.94760 0.00140 0.00340 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2008 AMOUNT: $ 17,801. 2009 AMOUNT: $ 27,751. 2010 AMOUNT: $ 26,480. 2011 AMOUNT: $ 25,827. 2012 AMOUNT: $ 11,104. EXPENSE REIMBURSEMENT - 2008 AMOUNT: $ 567,344. 2009 AMOUNT: $ 743,402. 2010 AMOUNT: $ 194,500. 2011 AMOUNT: $ 0. 2012 AMOUNT: $ 0. 1374168 911707 462461 1856454 1461073 395381 362474 279341 83133 940975 DUE FROM AFFILIATE 34753 OTHER ASSETS 157530 192283 DUE TO AFFILIATES 1052410 DUE NYS OFFICE MENTAL HEALTH 166000 EST THIRD PARTY PAYABLES 2888490 ACCRUED SELF INSURED LIABILITIES 320785 4427685 8188397 0 8188397 0 8188397 9073237 0 9073237 0 9073237 0 1 0 0 0 0 0 0 0 MARK CLEMENT 7452 697859 6697 627102 487 45577 7477 700178 52 4865 22165 2075581 4200 393300 ROBERT MAYO MD 0 244550 0 59215 0 27821 0 55043 0 7867 0 394496 0 0 PAULA TINCH 2012 188376 456 42716 292 27305 557 52128 47 4408 3364 314933 0 0 RICHARD GANGEMI 0 315582 0 208139 0 53337 0 125174 0 4281 0 706513 0 123660 HUGH THOMAS 3468 324766 2086 195345 592 55452 1731 162062 73 6844 7950 744469 1063 99564 KATHRYN MCGUIRE 0 232034 0 120090 0 29356 0 224760 0 5190 0 611430 0 62400 JAMES MEAD 0 254106 0 0 0 3930 0 58760 0 2508 0 319304 0 0 VISHNU CHALLAPALLI 0 168836 0 0 0 23046 0 72468 0 7754 0 272104 0 0 ROOPA CHALLAPALLI 0 156147 0 0 0 19904 0 49869 0 3284 0 229204 0 0 MARY MARROCCO 0 172975 0 0 0 0 0 38195 0 1712 0 212882 0 0 KASHINATH PATIL 0 162625 0 0 0 0 0 182031 0 4671 0 349327 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 BOARD'S 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 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 ORGANIZATIONS 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. 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. IN ADDITION TO THE BOARD OF DIRECTORS, THE ORGANIZATION'S MANAGERS AND DIRECTORS WHO OVERSEE ITS OPERATIONS COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY AS WELL. 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 THE 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 NEW YORK COMMUNITY AS WELL AS COMPENSATION FOR THESE POSITIIONS (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 LOCATED AT 100 KINGS HIGHWAY SOUTH, ROCHESTER, NY 14617. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. OTHER FEES FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 1,310,134. MANAGEMENT AND GENERAL EXPENSES 139,374. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,449,508. STATEMENT PURSUANT TO TREAS REG SEC 1 6038-2(J)(3) FORM 5471 FILED ON BEHALF OF STATEMENT THE FOLLOWING INFORMATION IS SUBMITTED WITH RESPECT TO BEHAVIORAL HEALTH NETWORK, INC'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, 2012 ENDING TAX YEAR OF FOREIGN CORPORATION DECEMBER 31, 2012 THE FORM 5471 FILING REQUIREMENT FOR THIS FOREIGN CORPORATION FOR CATEGORIES 4 AND 5 HAVE BEEN SATISFIED BY INCLUSION IN THE FOLLOWING US FILER'S TAX RETURN NAME OF US FILER ROCHESTER GENERAL HEALTH SYSTEMS ADDRESS OF US FILER 100 KINGS HIGHWAY SOUTH ROCHESTER, NY 14617 EIN OR SSN 22-2551509 ENDING TAX YEAR OF US FILER DECEMBER 31, 2012 TYPE OF RETURN FILED 990-T IRS CENTER WHERE RETURN FILED OGDEN, UTAH 84201-0027 THE ROCHESTER GENERAL HOSPITAL 1425 PORTLAND AVENUE ROCHESTER NY 14621 160743134 HOSPITAL NY 501(C)(3) LINE 3 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 HOLDING COMPANY 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 DAY HC NY 501(C)(3) LINE 9 RGHS 0 ROCHESTER GENERAL LONG TERM CARE 1550 EMPIRE BLVD WEBSTER NY 14580 223187140 NH & REHAB 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 3 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 GRHS FOUNDATION 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 223378111 PROPERTY MANAGEMENT NY 501(C)(3) LINE 11B, II RGHS 0 NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION 1425 PORTLAND AVENUE ROCHESTER NY 14621 222963015 FUNDRAISING NY 501(C)(3) LINE 3 0 GREATER ROCHESTER ASSURANCE COMPANY LTD GEORGE TOWN GRAND CAYMAN CJ INSURANCE CJ N/A C 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 ROCHESTER GENERAL HEALTH SYSTEM O 113117 FMV ROCHESTER GENERAL LONG TERM CARE K 55080 FMV ROCHESTER GENERAL HEALTH SYSTEM WORKERS' COMPENSATION TRUST O 69125 FMV ROCHESTER GENERAL HOSPITAL O 260549 FMV RELATED TAX-EXEMPT ORGANIZATION - PRIMARY ACTIVITY 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.