2012-11-15T14:38:37-06:00 2011-12-31 ERNST & YOUNG US LLP 75 BEATTIE PLACE SUITE 800 GREENVILLE SC 29601 990 2011-01-01 223187140 Rochester General Long Term Care % MATT MINISCE ROCH 5856714300 1550 Empire Blvd Webster NY 14580 PAULA M TINCH 2012-11-14 8642425740 2011 2016-02-24 21:20:13Z HILL HAVEN NURSING HOME Mark Clement 100 KINGS HIGHWAY SOUTH Rochester NY 14617 27944732 false 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. 10 8 563 240 0 0 1161 1397 26545612 27541997 760 2038 363711 399300 26911244 27944732 50 50 0 0 20432419 21087493 0 0 0 8247058 7958388 28679527 29045931 -1768283 -1101199 10955432 14067242 8911971 13124980 2043461 942262 X TO ESTABLISH, ACQUIRE, 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. false false 21513845 50 27786362 The organization provides 24-hour skilled nursing care to those in need of Rehabilitation, Long-term care, Transitional care, Hospice care and Care for Alzheimer'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 for mingling and recreation, and beautifully landscaped grounds. Residents 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. 21513845 true false false false false false false false false false true false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false false true 25 0 true 563 true false false false false false false false false false false X 10 8 false false false false true true true true true false false true true true true true true true false false NY X MATT MINISCE 5859221032 1550 EMPIRE BLVD Webster NY 14580 X Linda Becker 1.0 X X 0 0 0 Mark Clement 2.0 X X 53259 1278227 789546 John L Genier MD 1.0 X 0 17751 0 Jeanne Grove DO 1.0 X X 0 0 0 Daniel M Meyers 1.0 X 0 0 0 Robert Dobies 1.0 X 0 0 0 ELAINE SPAULL PHD 1.0 X 0 0 0 JUAN VILLANUEVA 1.0 X 0 0 0 GARY WAHL MD 1.0 X 0 303725 70941 Margaret Sanchez 1.0 X 0 0 0 Thomas Penn 1.0 X 0 0 0 Robert S Sands 1.0 X 0 0 0 Robert Mayo MD 1.0 X 0 353579 59979 John Riedman 1.0 X 0 0 0 ROBERT NESSELBUSH 2.0 X 25854 620520 255572 Stephen Ash 40.0 X 134786 0 49102 HUGH THOMAS 2.0 X 21280 510745 207940 RICHARD GANGEMI 2.0 X 22992 551827 193226 Scott Schabel 40.0 X 204757 0 77426 Cheryl Conrad 40.0 X 122413 0 19450 Lou A Rupert 40.0 X 102874 0 33827 Brenda Kloster 40.0 X 111596 0 36197 799811 3636374 1793206 5 false true false Nursefinders PO Box 910738 DALLAS TX 75391 Temp Nursing Svcs 247094 1 1397 1397 PATIENT/RESIDENT SERVICE REVENUE 623000 27541997 27541997 27541997 2038 2038 0 0 0 0 0 0 PHARMACY 446110 244365 244365 CAFETERIA 445100 89027 89027 GIFT SHOP 453220 6879 6879 59029 59029 399300 27944732 27786362 156973 0 50 50 0 0 365124 315885 49239 0 16346655 11783666 4562989 865631 612954 252677 2298113 1660780 637333 1211970 876454 335516 0 7561 7561 32521 32521 0 0 0 1714756 1240052 474704 8998 6507 2491 1741367 1259296 482071 9646 6976 2670 0 365916 264618 101298 13718 9920 3798 0 0 0 0 680124 491842 188282 103748 75027 28721 HEALTH ASSESSMENT FACILITY 1738214 1738214 BAD DEBTS 204510 204510 TAXES, LICENSES, & DUES 107442 77698 29744 PHARMACEUTICALS 285412 206400 79012 944455 682996 261459 29045931 21513845 7532086 0 73 1409484 0 0 0 0 4399332 3452497 0 0 0 0 0 0 208849 215114 27317 23691 12508243 5419524 5357548 7088719 0 0 0 0 0 0 0 0 962313 1877737 10955432 14067242 2353377 2794905 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6558594 10330075 8911971 13124980 X 2043461 942262 0 0 0 0 2043461 942262 10955432 14067242 -1101199 X false true true X true true X 4279 2946 709 1161 1397 10492 24847841 27243686 27206988 26545612 27541997 133386124 24852120 27246632 27207697 26546773 27543394 133396616 133396616 19118 24446 1480 760 2038 47842 19118 24446 1480 760 2038 47842 240986 409889 419556 363711 399300 1833442 25112224 27680967 27628733 26911244 27944732 135277900 0.98609 0.98829 0.00035 0.00040 X 6926807 1652651 5274156 1980194 1139416 840778 3601242 2627457 973785 7088719 WORKERS COMP SELF INSURED 495194 RESIDENT CUSTODIAL FUNDS 236091 DUE FROM AFFILIATES 122584 INSURANCE RECOVERY RECEIVABLES 1023868 1877737 0 ESTIMATED THIRD PARTY PAYABLES 2609875 ACCRUED SELF-INSURED LIABILITY 3002247 DUE TO AFFILIATES 4481862 RESIDENT FUNDS 236091 10330075 false true false false false false false false false Mark Clement 27199 652783 23976 575428 2084 50016 31392 753405 190 4559 84841 2036191 11124 266980 GARY WAHL MD 0 173599 0 116584 0 13542 0 62273 0 8668 0 374666 0 0 ROBERT NESSELBUSH 14350 344407 9930 238325 1574 37788 9925 238196 298 7153 36077 865869 2970 71285 HUGH THOMAS 12461 299074 7016 168395 1803 43276 8001 192032 316 7591 29597 710368 2700 64804 RICHARD GANGEMI 13276 318630 7893 189440 1823 43757 7564 181526 165 3971 30721 737324 3348 80353 Scott Schabel 178853 0 24604 0 1300 0 73370 0 4056 0 282183 0 0 0 Stephen Ash 100586 0 20400 0 13800 0 43488 0 5614 0 183888 0 0 0 Robert Mayo MD 0 295141 0 42000 0 16438 0 55244 0 4735 0 413558 0 0 PROCESSES USED TO ESTABLISH THE COMPENSATION OF THE CEO Schedule J, Part I, line 3 THE FILING ORGANIZATION'S RELATED NON-PROFIT ORGANIZATION, ROCHESTER GENERAL HOSPITAL, UTILIZED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B RGHS MAINTAINS A SECTION 457(F) PLAN WHICH WOULD BE CONSIDERED A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2011, NO DISTRIBUTIONS WERE PAID OUT. HOWEVER, THE FOLLOWING OFFICERS AND DIRECTORS 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 ROBERT NESSELBUSH RICHARD GANGEMI, MD Organization's Members Form 990, Part VI, 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. Members who may elect Members of the Governing Body Form 990, Part VI, 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. Decisions by Governing Body Subject to Approval Form 990, Part VI, 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. REVIEW PROCESS FOR THE FORM 990 Form 990, Part VI, line 11b Prior to filing, a copy of THE FORM 990 IS provided to all members of the governing board for their review. In addition, prior to filing, THE FORM 990 IS REVIEWED BY THE following members of the governing body of ROCHESTER GENERAL HEALTH SYSTEMS, A RELATED NOT FOR PROFIT ORGANIZATION AND THE sole corporate member OF THE FILING ORGANIZATION: 1) the CHAIRMAN OF THE BOARD OF DIRECTORS and 2) the governance and nominating committee. This review is performed IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, ERNST & YOUNG, LLP and iS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND OTHER RELEVANT INFORMATION FOR THE APPROPRIATE TIME PERIOD. CONFLICT OF INTEREST POLICY Form 990, Part VI, Line 12c Upon employment, all employees receive the Ethical Standard of Conduct booklet for which they sign a receipt of acknowledgement. In this booklet, 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 and disclosure 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. COMPENSATION APPROVAL PROCESS Form 990, Part VI, Line 15a THE ORGANIZATION'S OFFICER COMPENSATION ARRANGEMENTS FOR ITS EXECUTIVE ADMINISTRATOR ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF ROCHESTER GENERAL HOSPITAL, A RELATED NOT-FOR-PROFIT ORGANIZATION. INFORMATION REVIEWED FOR THE OFFICER INCLUDES COMPARABLE DATA FROM SIMILAR SIZE TAX EXEMPT ORGANIZATIONS IN THE WESTERN 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. ACCESS TO ORGANIZATIONAL DOCUMENTS Form 990, Part VI, 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 THE AFFILIATED HEALTH SYSTEM AT 100 KINGS HIGHWAY SOUTH, ROCHESTER, NY 14617 AND THE ADMINISTRATIVE OFFICES OF THE FILING ORGANIZATION. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. AVERAGE HOURS DEVOTED TO RELATED ORGANIZATIONS Form 990, Part VII, Section A, Column B LINDA BECKER: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Rochester General Health System 1 hr/wk Independent Living for Seniors MARK CLEMENT: 40 hrs/wk Rochester General Hospital 5 hrs/wk Newark-Wayne Community Hospital 1 hr/wk Rochester General Hudson Housing 1 hr/wk Rochester Mental Health Center 2 hrs/wk Independent Living for Seniors 1 hr/wk GRHS Foundation 1 hr/wk Rochester General Health System 1 hr/wk Rochester General Hospital Foundation 1 hr/wk Newark-Wayne Community Hospital Foundation JOHN GENIER: 1.25 hrs/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Independent Living for Seniors JEANNE GROVE: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Independent Living for Seniors 1 HR/WK Rochester General Hospital Foundation DANIEL MEYERS: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Independent Living for Seniors 1 hr/wk Newark Wayne Community Hospital 1 hr/wk Rochester General Health System ROBERT DOBIES: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Rochester General Health System 1 hr/wk Independent Living for Seniors ELAINE SPAULL: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Independent Living for Seniors JUAN VILLANUEVA: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Independent Living for Seniors GARY WAHL: 35 hrs/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Rochester General Health System 1 hr/wk Independent Living for Seniors ROBERT NESSELBUSH: 39 hrs/wk Rochester General Hospital 5 hrs/wk Newark-Wayne Community Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk GRHS Foundation 1 hr/wk Workers' Comp Trust 2 HRS/WK Independent Living for Seniors 1 hr/wk Rochester General Hudson Housing 1 hr/wk Newark-Wayne Community Hospital Foundation 1 hr/wk Rochester General Health System 1 hr/wk Rochester General Hospital Foundation HUGH THOMAS: 41 hrs/wk Rochester General Hospital 5 hrs/wk Newark-Wayne Community Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk GRHS Foundation 1 hr/wk Workers' Comp Trust 2 HRS/WK Independent Living for Seniors 1 hr/wk Rochester General Health System 1 hr/wk Western NY Medical Practice, P.C. RICHARD GANGEMI: 46 HRS/wk Rochester General Hospital 6 hrs/wk Newark-Wayne Community Hospital 1 hr/wk Western NY Medical Practice, P.C. MARGARET SANCHEZ: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Independent Living for Seniors THOMAS PENN: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Independent Living for Seniors JOHN RIEDMAN: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Independent Living for Seniors ROBERT SANDS: 1 hr/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Rochester General Hudson Housing 1 hr/wk Rochester General Health System 1 hr/wk Independent Living for Seniors ROBERT MAYO: 36 hrs/wk Rochester General Hospital 1 hr/wk Rochester Mental Health Center 1 hr/wk Independent Living for Seniors 1 hr/wk Rochester General Hudson Housing FORM 5471 FILED ON BEHALF OF STATEMENT STATEMENT PURSUANT TO TREAS. REG. SEC. 1.6038-2(j)(3) 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, 2011 Ending Tax Year of Foreign Corporation: December 31, 2011 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 Systems Address of U.S. Filer: 100 Kings Highway South Rochester, NY 14617 EIN or SSN: 22-2551509 Ending Tax Year of U.S. Filer: December 31, 2011 Type of Return Filed: 990-T IRS Service Center Where Return Filed: Ogden, Utah 84201-0027 ROCHESTER GENERAL HEALTH SYSTEM 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222551509 System Parent NY 501(c)(3) 11, Type II NA false THE ROCHESTER GENERAL HOSPITAL 1425 PORTLAND AVENUE ROCHESTER NY 14621 160743134 HOSPITAL NY 501(c)(3) 3 RGHS false RGHS WORKERS' COMPENSATION TRUST 1425 PORTLAND AVENUE ROCHESTER NY 14621 166429300 See Part VII NY 501(c)(3) 11, Type II RGHS false CONTINUING CARE NETWORK INC (CCN) 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222963016 Support RGH NY 501(c)(3) 11, Type II RGHS false ROCHESTER GENERAL HUDSON HOUSING 2066 HUDSON AVENUE ROCHESTER NY 14617 223210351 LOW INC HSING NY 501(c)(3) 9 RGHS false INDEPENDENT LIVING FOR SENIORS 2066 HUDSON AVENUE ROCHESTER NY 14617 161491059 ADULT Care NY 501(c)(3) 9 RGHS false Rochester Mental Health Center 490 EAST RIDGE ROAD ROCHESTER NY 14621 166069131 Mental Health NY 501(c)(3) 9 RGHS false GRHS FOUNDATION 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 223378111 R/E Inv Mgmt NY 501(c)(3) 11, Type II RGHS false THE ROCHESTER GENERAL HOSPITAL FDN 1445 PORTLAND AVENUE ROCHESTER NY 14621 222229425 Fundraising NY 501(c)(3) 11, Type II RGHS false Newark-Wayne Community Hospital 1200 Driving Park Avenue Newark NY 14513 150584188 Hospital NY 501(c)(3) 3 RGHS false Western NY Medical Practice PC 1425 Portland Avenue Rochester NY 14621 611654232 PHYS PRAC NY 501(c)(3) 3 RGHS false Greater Rochester Assurance Company Ltd Georgetown Grand Cayman Cayman Island CJ insurance CJ NA C Corp 0 0 0.00000 false false true true true false false false false true true true false false false false true true Independent Living for Seniors D 116824 FMV ROCHESTER WORKERS COMPENSATION TRUST E 1705588 FMV ROCHESTER WORKERS COMPENSATION TRUST Q 476229 FMV Rochester General Hospital E 2336727 FMV Greater Rochester Assurance Company Ltd E 317217 FMV Greater Rochester Assurance Company Ltd L 84663 FMV Rochester Mental Health Center K 58395 FMV Related Tax-Exempt Organization - Primary Activity Schedule R, Part II, Column B RGHS Workers' Compensation Trust supports Rochester General Hospital, Newark Wayne Community Hospital, Independent Living for Seniors, Rochester General Long Term Care, and Rochester General Health Systems.