2012-11-15T15:34:24-06:00 2011-12-31 ERNST & YOUNG US LLP 75 BEATTIE PLACE SUITE 800 GREENVILLE SC 29601 990 2011-01-01 150584188 NEWARK-WAYNE COMMUNITY HOSPITAL % RITA SZMIGEL NEWA 3153322456 1200 Driving Park Avenue Newark NY 14513 PAULA M TINCH 2012-11-14 8642425740 2011 2016-02-24 21:20:13Z X Mark Clement 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 82295194 false X www.rochestergeneral.org X 1952 NY TO OPERATE AN INPATIENT AND OUTPATIENT HOSPITAL, CLINICS AND TREATMENT CENTERS FOR THE DELIVERY OF ACUTE MEDICAL, SURGICAL AND PREVENTATIVE HEALTH CARE SERVICES. 15 14 996 223 3665449 108046 561529 1041133 75663909 80383790 109234 157178 586142 713093 76920814 82295194 0 0 0 0 42550967 45885283 0 0 0 29287720 32076092 71838687 77961375 5082127 4333819 60252893 84218966 36715665 56140024 23537228 28078942 X THE PURPOSES FOR WHICH THE CORPORATION IS FORMED ARE: (A) TO PLAN, DEVELOP, ESTABLISH, ORGANIZE, CONSTRUCT, ERECT, BUILD, ACQUIRE, ALTER, RECONSTRUCT, REHABILITATE, OWN, OPERATE, MAINTAIN, AND MANAGE ALL TYPES OF INPATIENT AND OUTPATIENT HOSPITALS, HOSPITAL FACILITIES, CLINICS, TREATMENT CENTERS, SERVICES, AND PROGRAMS FOR THE DELIVERY OF ACUTE MEDICAL, SURGICAL AND PREVENTIVE HEALTH CARE SERVICES, IN ACCORDANCE WITH THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK; (B) TO PLAN, DEVELOP, ESTABLISH, ORGANIZE, CONSTRUCT, ERECT, BUILD, ACQUIRE, ALTER, RECONSTRUCT, REHABILITATE, OWN, OPERATE, MAINTAIN AND MANAGE NURSING HOMES AND ALL TYPES OF LONG TERM INPATIENT, OUTPATIENT AND RESIDENTIAL HEALTH CARE FACILITIES, SERVICES, AND PROGRAMS FOR ELDERLY, SICK, INVALID, INFIRM, DISABLED AND CONVALESCANT PERSONS, IN ACCORDANCE WITH THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK; (C) TO PLAN, DEVELOP, ESTABLISH, ORGANIZE, CONSTRUCT, ERECT, BUILD, ACQUIRE, ALTER, RECONSTRUCT, REHABILITATE, OWN OPERATE false false 48706600 0 58617284 THE ORGANIZATION OPERATES A TAX EXEMPT HOSPITAL THAT PROVIDES INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE WAYNE COUNTY, NY AREA. See Schedule H for Charity Care detail. DURING 2011, THE HOSPITAL PROVIDED 572,231 OUTPATIENT VISITS, 20,311 INPATIENT DAYS AND HAD 427 BIRTHS. 12831686 0 22110318 THE ORGANIZATION ALSO OPERATES the Demay Nursing Home, which is a 180 bed skilled nursing facility offering 24 hour nursing care, ventilator dependent care and specialized care for individuals in the early and mid stages of alhzheimer's and other cognitive disorders of aging. DURING 2011, THE DEMAY NURSING HOME PROVIDED 9,336 ADULT DAY CARE DAYS AND 64,318 PATIENT DAYS. 61538286 true true false true false false false false false true true false false true true false true true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 56 0 true 996 true true true false false false false false false false false false X 15 14 false false false false true true true true true false false false true true true true false true true false NY X RITA SZMIGEL 5859221737 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 X Robert F Havrilla 1.0 X X 0 0 0 Norm Brust 1.0 X X 0 0 0 Gail F Bedell 1.0 X X 0 0 0 Margaret Churchill 1.0 X X 0 0 0 Mark Clement 5.0 X X 119833 1211653 789545 Joseph A DeSanto 1.0 X 0 0 0 Harvey E Fowler 1.0 X 0 0 0 James Hoffman 1.0 X 0 0 0 Robert W Hutteman 1.0 X 0 0 0 Michael P Jankowski 1.0 X 0 0 0 Paul E Johnson 1.0 X 0 0 0 Daniel M Meyers 1.0 X 0 0 0 John F Murphy 1.0 X 0 0 0 Mary Sue Napoleon MD 1.0 X X 0 0 0 James E Praino DDS 1.0 X 0 0 0 Scott Healy 1.0 X 0 0 0 Robert Nesselbush 5.0 X 58174 588200 255572 Mark Klyczek 55.0 X 118409 0 18770 Annette Leahy 55.0 X 224352 0 43785 Hugh Thomas 5.0 X 47882 484143 207940 Richard Gangemi MD 6.0 X 57482 517338 193226 JAMES SYRETT 40.0 X 332570 0 20952 EVE WILLIAMS 40.0 X 317672 0 45236 MICHAEL CUNNINGHAM 40.0 X 297829 0 46013 BRIAN LAUX 40.0 X 282923 0 36316 CYNTHIA MARTINEZ-CAPOLINO 40.0 X 313511 0 16450 2170637 2801334 1673805 15 false true false ALLIANCE HEALTHCARE SERVICES PO BOX 6600 NEWPORT BEACH CA 92658 HEALTHCARE SERVICES 811835 ANESTHESIA ASSOCIATES OF ROCHESTER 130 ALLENS CREEK RD ROCHESTER NY 14618 PHYSICIAN SERVICES 803010 MEDICAL STAFFING NETWORK PO BOX 203000 DALLAS TX 753203000 Agency Services 505175 FINGERS LAKES BONE AND JOINT 875 PREEMPTION RD GENEVA NY 14456 HEALTHCARE SERVICES 399996 GUARDSMARK LLC PO BOX 11407 BIRMINGHAM AL 352463000 Security Services 192321 7 452512 517517 71104 1041133 NET PATIENT REVENUE 621110 58273472 54613625 3659847 DEMAY NET PATIENT REVENUE 623000 22110318 22110318 80383790 157178 157178 0 0 188935 188935 188935 188935 0 0 0 0 CAFETERIA SALES 722210 174744 174744 EXTERNAL CLEANING SVC 812300 5602 5602 ALL OTHER REVENUE 900099 343812 343812 524158 82295194 77067755 3665449 520857 0 0 0 0 820785 710073 110712 0 36154686 27609883 8544803 1724869 1306740 418129 4882755 3735821 1146934 2302188 1762307 539881 0 55262 55262 84680 84680 9014 9014 0 0 6260743 4792549 1468194 4597 3519 1078 5465538 4183826 1281712 121750 93199 28551 0 1359762 1040887 318875 72081 55177 16904 0 0 718208 549783 168425 854307 854307 2649929 2028500 621429 758563 758563 BAD DEBT 3844460 3844460 LICENSES & TAXES 1329367 1329367 DUES & SUBSCRIPTIONS 4650 4650 MEDICAL SUPPLIES 8483181 8483181 77961375 61538286 16423089 0 11622541 20471627 7535918 5164039 0 0 8950260 7814511 0 0 0 0 0 0 934734 896423 945004 1091773 75489798 53722358 20795936 21767440 759360 9733948 0 0 0 0 0 0 8709140 17279205 60252893 84218966 5806209 6653305 0 0 0 0 12687386 19775000 0 0 0 0 0 0 0 0 18222070 29711719 36715665 56140024 X 22104827 26262781 1030402 1414162 401999 401999 23537228 28078942 60252893 84218966 X 4333819 207895 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X true false false false false true 9014 false false false 9014 false GRANTS TO OTHER ORGANIZATIONS SCHEDULE C, PART II-B, LINE 1F THE AMOUNT REFLECTED ON PART II-B, LINE 1F REPRESENTS THE PORTION OF DUES paid to Health Care Association of NYS attributable to lobbying activities. 401999 401999 400249 1750 401999 400249 400249 400249 400249 0.00000 1.00000 0.00000 false false 997157 997157 44736963 38761759 5975204 26560758 14960599 11600159 3194920 3194920 21767440 CUSTODIAL ACCOUNT 89460 ESTIMATED 3RD PARTY RECEIVABLE 730916 DUE FROM AFFILIATES 700909 INTEREST IN ASSETS OF FNDS 5083385 OTHER INVESTMENTS 1925724 INSURANCE RECOVERIES RECEIV. 7867401 UNAMORTIZED MORTGAGE COSTS 881410 17279205 0 CUSTODIAL ACCOUNTS 89460 ACCRUED INTEREST PAYABLE 68157 ESTIMATED 3RD PARTY PAYABLES 11332042 DUE TO AFFILIATES 6000009 ACCRUED SELF-INSURED LIABILITIES 12222051 29711719 82295194 77961375 4333819 207895 207895 4541714 81748981 81748981 546213 546213 82295194 77961375 77961375 77961375 RECONCILIATION OF CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 CHANGE IN INTEREST IN NEWARK WAYNE COMMUNITY HEALTH FND: $257,060 CHANGE IN INTEREST IN FINGER LAKES VISITING NURSE SERVICE: $8,363 CHANGE IN UNREALIZED LOSS ON INVESTMENTS: $(15,937) LOSS ON DEBT EXTINGUISHMENT: $(41,591) TOTAL: $207,895 RECONCILIATION OF REVENUE PER AFS TO RETURN SCHEDULE D, PART XII, LINE 4B CONTRIBUTIONS FOR LONG LIVED ASSETS - $52,110 CONTRIBUTIONS FROM NEWARK WAYNE COMMUNITY FOUNDATION - $452,512 LOSS ON DEBT EXTINGUISHMENT - $41,591 TOTAL - $546,213 INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE INTENDED USES OF THE ENDOWMENT FUNDS INCLUDE: 1) CAPITAL EXPANSION AND IMPROVEMENT AT THE HOSPITAL AND 2) THE ADVANCEMENT OF MEDICAL EDUCATION AND RESEARCH AND HEALTH CARE SERVICES. true true X true X true X true true true false true true 3398124 1730960 1667164 0.02250 25231142 22039848 3191294 0.04310 822072 1081514 -259442 0.00350 29451338 24852322 4599016 0.06210 76086 54616 21470 0.00030 15069552 11926839 3142713 0.04240 1295 0 1295 15146933 11981455 3165478 0.04270 44598271 36833777 7764494 0.10480 true 3844460 13738432 13514162 224270 X true true 1 1 Newark-Wayne Community Hospital

1200 Driving Park Avenue Newark NY 14513

X X X X X Newark-Wayne Community Hospital 1 true true 200. true 400. true X true true X X X X X X true false X X X X true X false false 4 Demay Living Center

100 sunset drive newark NY 14513

skilled nursing facility Myers Lab

6692 Middle Road Suite 1100 Sodus NY 14551

Laboratory Newark Hospital LAB

1200 Driving Park Avenue Newark NY 14513

Laboratory Williamson LAB

4425 Old Ridge Road Williamson NY 14589

Laboratory COSTING METHODOLOGY FOR CHARITY CARE AND OTHER COMMUNITY BENEFITS PART I, LINE 7 The costing methodology used was from the hospital's cost accounting system, which addresses all patient segments. The hospital's cost accounting system properly aligns revenue (charges) and expenses through reclasses and adjustments to department level expenses, and develops detailed department level Ratios of Cost-to-Charges. This methodology was used on all lines except line 7f, which uses the hospitals ICR, worksheet B, part I. COMMUNITY BENEFIT ACTIVITIES PART I, LINE 7E NEWARK WAYNE COMMUNITY HOSPITAL SPRING FEST SPRING FEST OFFERED COMMUNITY MEMBERS MANY HEALTH AND SAFETY RELATED SERVICES INCLUDING: FREE FITTING OF BIKE HELMETS TO OVER 400 CHILDREN; CHILDREN'S CAR SEAT SAFETY CHECKS; A BIKE RODEO TO TEACH CHILDREN ABOUT BIKE SAFETY; BLOOD PRESSURE AND GLUCOSE SCREENS; AND INFORMATION ON MANY HEALTH-RELATED TOPICS FROM NWCH AND PARTNER HEALTH AGENCIES FROM AROUND WAYNE COUNTY. DIABETES HEALTH FAIR DIABETES IS A MAJOR HEALTH PROBLEM FOR WAYNE COUNTY RESIDENTS, WITH OVER 7,000 DIAGNOSED DIABETICS OUT OF A POPULATION OF 93,436 (8.6%). FOR THIS REASON, NEWARK-WAYNE PARTICIPATES IN THE WAYNE COUNTY RURAL HEALTH NETWORK'S DIABETES HEALTH FAIR ANNUALLY. THIS INITIATIVE IS SPONSORED BY WAYNE COUNTY PUBLIC HEALTH, NEWARK-WAYNE COMMUNITY HOSPITAL AND OTHER COMMUNITY PARTNERS. IN 2010, THE DIABETES HEALTH FAIR ATTRACTED AROUND 150 RESIDENTS AND FOCUSED ON LIFESTYLE CHANGES THAT CAN POSITIVELY HAVE IMPACT ON DIABETICS/PRE-DIABETICS INCLUDING EXERCISE, NUTRITIONAL COUNSELING, THE PROPER USE OF MEDICATIONS AND MORE. ADDITIONAL WAYNE COUNTY COMMUNITY EVENTS: ST.MICHAEL'S/LYONS CENTRAL SCHOOL HEALTH FAIR NEWARK SCHOOL CAREER DAYS ORTHO SEMINAR AT BLUE HERON HILLS GOLF CLUB GREEN ANGELS HEALTH FAIR HEALTH FAIR - CHILDREN'S AT CLYDE, MARION, AND HOLIDAY HEALTH FAIR HEALTH FAIR - DIABETES/CHRONIC DISEASE DENTAL HYGIENE AND EDUCATION FOR SCHOOL CHILDREN SUBSIDIZED DENTAL SERVICES AT WC PUBLIC HEALTH DENTAL CENTER EMS - SUPPORT FOR EMS REFERENCE POCKET GUIDES FLCC SCHOLARSHIP SUPPORT FOR RN PROGRAM ADS FOR FACILITATED ENROLLMENT - HEALTH CARE ACCESS MARION KID'S FAIR SPRING FEST HEALTH FAIR COPD EDUCATION (3 SESSIONS) DIABETES HEALTH FAIR WAYNE COUNTRY FAIR HEALTH BOOTH UROLOGY SEMINAR IN CANANDAIGUA COLON RECTAL EDUCATION EVENT CARDIAC REHAB EDUCATION ST. MICHAELS/LYONS HEALTH FAIR DR. MEDEIROS EVENT PHYSICIAN CLINIC COSTS INCLUDED AS SUBSIDIZED HEALTH SERVICES PART I, LINE 7G N/A - NO PHYSICIAN CLINIC COSTS WERE INCLUDED IN LINE 7G AMOUNTS. BAD DEBT EXPENSE EXCLUDED PART I, LINE 7, COLUMN (F) TOTAL EXPENSE ON FORM 990, PART IX, LINE 25, COLUMN (A) IS $77,961,375. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS $3,844,460. AFTER BAD DEBT WAS DEDUCTED FROM TOTAL EXPENSES THE AMOUNT OF TOTAL EXPENSES USED TO CALCULATE THE PERCENT IN LINE 7, COLUMN (F) WAS $74,116,915. PART III, LINE 4: In 2011, the organization continued its enhanced process for obtaining additional financial information for uninsured and under-insured patients who have not supplied the requisite information to determine if they qualify for charity care. The additional information obtained was used by the organization to determine whether to qualify patients for charity care in accordance with the organization's policy. The application of this additional information in 2011 resulted in additional patients qualifying for charity care and thus re-classifying this amount from bad debt expense. Bad debt expense on Part III, Line 2 represents estimated uncollectible charges for those patients unwilling not unable to pay. Bad Debt Costing Methodology: Bad Debt Expense is recorded using the valuation method as outlined in Healthcare Financial Management Association Statement 15, which requires bad debt expense to be recorded at the amount that the payer is expected to pay. The provision for bad debts represents estimated uncollectible charges of patients unwilling to pay. In 2011, the organization continued its enhanced process for obtaining additional financial information for uninsured and underinsured patients who have not supplied the requisite information to determine if they qualify for charity care. The application of this additional information in 2011 resulted in additional patients qualifying for charity care and a reduction to bad debt expense. TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE HOSPITAL. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE HOSPITAL'S POLICIES. PART III, LINE 8: Medicare Costing Methodology: The organization used the filed 2011 CMS Cost Report to determine the Medicare allowable costs of care relating to payments received from Medicare. Medicare shortfalls which are costs incurred by the hospital to provide quality care and treatment to its patients should be treated as a community benefit. To not incur these costs would would potentially limit or even compromise the quality of service provided. PART III, Line 9b: At such time that a patient expresses a financial concern, the patient will be offered the opportunity to apply for charity care. Once the patient submits the completed charity care application, the account is placed on hold and all collection activities are suspended until an eligibility determination is made. If the patient is eligible for charity care, then the patient is notified of the level of charity care awarded. If 100% charity care awarded, than no bill is sent to the patient. If less than 100% charity care is awarded, than the patient will receive a bill pursuant to the private pay collection policy. Only after patient's liability has been determined following processing of applications for government assistance, charity care, and/or insurance carrier remittance will the patient statement be mailed for payment recovery. The hospital's collection practices set forth in its written debt collection policy apply to all patient types of the hospital. PART V, SECTION B, LINE 13G Also located in outpatient settings and lab depots. PART V, SECTION B, LINE 19D We bill actual charges, less 30% discount, plus 9.63% NYS surcharge PART VI, LINE 2 NEEDS ASSESSMENT In the spring of 2009 Wayne County Public Health (WCPH) carried out a comprehensive community health assessment of services, perceptions, and health care needs in Wayne County. The Wayne County Rural Health Network (WCRHN) partnered with the Wayne County Public Health Department (WCPH) to disseminate the survey and to encourage participation. IN JUNE 2009, Newark-Wayne Community Hospital (NWCH), the WCRHN, and WCPH met in three separate meetings with community and county leaders, including not-for-profit service agencies, to review the priorities identified in the needs assessment and to discuss WCPH's priorities for its plan and to discuss programs and plans to address county-wide needs. The meetings were also opportunities for NWCH, WCRHN, WCPH and providers and health and human service agencies to discuss how to leverage available funds to extend and complement the work and programs that are on-going, and, to agree on future program development opportunities. The WCRHN Board meets bi-monthly to discuss action plan items and to provide input and suggestions for changes and/or additions. As a result of those meetings, NWCH, in concert with WCRHN and key Medical and Hospital staff, then identified three priority areas for its community service activities and future program development opportunities. Those three priority areas are: 1.) Access to Health Care 2.) Chronic Disease 3.) Healthy Mothers/Healthy Babies/Healthy Children To date, the plan has moved ahead and no barriers have been encountered. The activities that remain open are still on track and targeted for completion. One amendment to the original plan for Access to Health Care is the inclusion of the Wayne Rx Discount Card program that WCRHN administers and which gives greater access to needed medications for Wayne County residents. It was an oversight that the discount card program was not included in the original plan, an unfortunate omission for such a high value initiative. A larger joint meeting was held on June X X true true false true false false false false false false false Mark Clement 61198 618784 53946 545458 4689 47411 70632 714165 427 4321 190892 1930139 25029 253075 Robert Nesselbush 32288 326469 22343 225912 3543 35819 22331 225790 671 6780 81176 820770 6683 67572 Hugh Thomas 28038 283497 15787 159624 4057 41022 18003 182030 712 7195 66597 673368 6075 61429 Richard Gangemi MD 33191 298715 19733 177600 4558 41023 18909 170180 414 3723 76805 691241 8370 75331 JAMES SYRETT 305171 0 10899 0 16500 0 18778 0 2174 0 353522 0 0 0 EVE WILLIAMS 306879 0 8043 0 2750 0 41129 0 4107 0 362908 0 0 0 MICHAEL CUNNINGHAM 285902 0 11927 0 0 0 38388 0 7625 0 343842 0 0 0 BRIAN LAUX 256266 0 4757 0 21900 0 26726 0 9590 0 319239 0 0 0 CYNTHIA MARTINEZ-CAPOLINO 287283 0 9728 0 16500 0 13237 0 3213 0 329961 0 0 0 Annette Leahy 61427 0 137651 0 25274 0 42602 0 1183 0 268137 0 0 0 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 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 ROBERT NESSELBUSH RICHARD GANGEMI, MD Charter travel and Health & Social Club benefits Schedule J, Part I, line 1 As part of their compensation package the OFFICERS AND KEY EMPLOYEES listed on FORM 990, Part VII are eligible to utilize specific charter travel arrangements to conduct business of the organization. Due to time constraints and the limited availability of non-stop flights, there are certain circumstances where charter travel is approved to make the best use of the executive's time. As part of their compensation package the CEO and other key employees, officers or trustees listed on 990, Part VII (with the approval of the CEO) are eligible to receive reimbursement for the initiation or monthly dues related to a specific social or recreational club. The dues are only paid for business purposes such as for meeting and luncheons related to fundraising and recruitment and have been included in the employee's Form W-2 as taxable compensation as required. METHODS 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. WAYNE COUNTY CIVIC FACILITY DEVELOPMENT CORP 320345910 XXXXXXXXX 2011-11-17 19775000 SEE PART IV true false false 0 8564845 19775000 0 0 8564845 395500 0 0 10814655 0 0 true false false false false false false 0.00000 0.00000 0.00000 true false false false 0 false 0 false false Schedule K, Part I, Column F TO DEFEASE OUTSTANDING 1993 BONDS & FINANCE HOSPITAL RENOVATIONS/EXPANSION Schedule K, Part V WRITTEN PROCEDURES ARE IN THE PROCESS OF BEING WRITTEN. 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 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 ROCHESTER GENERAL HEALTH SYSTEM, 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 OF FORM 990 FORM 990, PART VI, LINE 11B 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. 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 & 15B 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. 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 ITS AFFILIATED HEALTH SYSTEM AT 100 KINGS HIGHWAY SOUTH, ROCHESTER, NY 14617 AND AT THE ADMINISTRATIVE OFFICES OF THE FILING ORGANIZATION AT DRIVING PARK AVENUE, NEWARK, NY 14513. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. AVERAGE HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, COLUMN B ROBERT NESSELBUSH 39 HRS/WK ROCHESTER GENERAL HOSPITAL 1 HR/WK ROCHESTER MENTAL HEALTH CENTER 2 HRS/WK INDEPENDENT LIVING FOR SENIORS, INC. 2 HRS/WK ROCHESTER GENERAL LONG-TERM CARE, INC. 1 HR/WK GRHS FOUNDATION 1 HR/WK ROCHESTER GENERAL HEALTH SYSTEM 1 HR/WK RGHS WORKERS' COMPENSATION TRUST 1 HR/WK ROCHESTER GENERAL HUDSON HOUSING 1 HR/WK ROCHESTER GENERAL HOSPITAL FOUNDATION 1 HR/WK NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION HUGH THOMAS 41 HRS/WK ROCHESTER GENERAL HOSPITAL 1 HR/WK ROCHESTER MENTAL HEALTH CENTER 2 HRS/WK INDEPENDENT LIVING FOR SENIORS, INC. 2 HRS/WK ROCHESTER GENERAL LONG-TERM CARE, INC. 1 HR/WK GRHS FOUNDATION 1 HR/WK RGHS WORKERS' COMPENSATION TRUST 1 HR/WK ROCHESTER GENERAL HEALTH SYSTEM 1 HR/WK WESTERN NY MEDICAL PRACTICE, P.C. MARK CLEMENT 40 HRS/WK ROCHESTER GENERAL HOSPITAL 1 HR/WK ROCHESTER MENTAL HEALTH CENTER 2 HRS/WK INDEPENDENT LIVING FOR SENIORS, INC. 2 HRS/WK ROCHESTER GENERAL LONG-TERM CARE, INC. 1 HR/WK GRHS FOUNDATION 1 HR/WK ROCHESTER GENERAL HEALTH SYSTEM 1 HR/WK ROCHESTER GENERAL HUDSON HOUSING, INC. 1 HR/WK ROCHESTER GENERAL HOSPITAL FOUNDATION 1 HR/WK NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION RICHARD GANGEMI 46 HRS/WK ROCHESTER GENERAL HOSPITAL 2 HRS/WK ROCHESTER GENERAL LONG-TERM CARE, INC. 1 HR/WK WESTERN NY MEDICAL PRACTICE, P.C. ROBERT HAVRILLA 1 HR/WK ROCHESTER GENERAL HEALTH SYSTEM MARY SUE NAPOLEON 1 HR/WK ROCHESTER GENERAL HEALTH SYSTEM JAMES PRAINO 1 HR/WK NEWARK WAYNE COMMUNITY 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 SENIOR 1 HR/WK ROCHESTER GENERAL LONG-TERM CARE 1 HR/WK ROCHESTER GENERAL HEALTH SYSTEM OTHER CHANGES IN NET ASSETS OR FUND BALANCE FORM 990, PART XI, LINE 5 CHANGE IN INTEREST IN NEWARK WAYNE COMMUNITY HOSPITAL FDN: $257,060 CHANGE IN INTEREST IN FINGER LAKES VISITING NURSE SERVICE: $ 8,363 CHANGE IN UNREALIZED LOSS ON INVESTMENTS: $(15,937) LOSS ON DEBT EXTINGUISHMENT: $(41,591) ------- TOTAL $207,895 ROCHESTER GENERAL HEALTH SYSTEM 100 KINGS HIGHWAY SOUTH Rochester NY 14617 222551509 SYSTEM PARENT NY 501(C)(3) 11, TYPE II NA false ROCHESTER MENTAL HEALTH CENTER 490 East Ridge Road Rochester NY 14621 166069131 MENTAL HEALTH NY 501(C)(3) 9 RGHS false ROCHESTER GENERAL HOSPITAL FOUNDATION 1445 Portland Avenue Rochester NY 14621 222229425 FUNDRAISING NY 501(C)(3) 11, TYPE II RGHS false Western NY Medical Practice PC 1425 Portland Avenue Rochester NY 14621 611654232 Phys Prac NY 501(c)(3) 3 RGHS false INDEPENDENT LIVING FOR SENIORS 2066 Hudson Avenue Rochester NY 14617 161491059 ADULT DAY HC NY 501(C)(3) 9 RGHS false Rochester General Long Term Care 1550 Empire Blvd WEBSTER NY 14580 223187140 NH & rehab NY 501(C)(3) 9 RGHS false GRHS Foundation 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222963015 R/E INV MGMT NY 501(C)(3) 11, TYPE II RGHS false RGHS WORKERS COMPENSATION TRUST 1425 Portland Avenue Rochester NY 14621 169429300 SEE PART VII NY 501(C)(3) 11, TYPE II RGHS false THE ROCHESTER GENERAL HOSPITAL 1425 Portland Avenue Rochester NY 14621 160743134 HOSPITAL NY 501(C)(3) 3 RGHS false CONTINUING CARE NETWORK INC (CCN) 100 KINGS HIGHWAY SOUTH Rochester NY 14610 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 NEWARK WAYNE COMMUNITY HOSPITAL FND 1200 DRIVING PARK AVENUE NEWARK NY 14513 222963344 FUNDRAISING NY 501(C)(3) 11, TYPE II NWCH true Greater Rochester Assurance Company Ltd GEORGETOWN GRAND CAYMAN CJ 000000000 INSURANCE CJ na C CORP 0 0 0.00000 NWA INC DRIVING PARK AVENUE NEWARK NY 14513 141667339 REAL EST LEAS NY NWCH C CORP 3355 33165 1.00000 false false true true true false false false false false false true false false false false true false NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION C 452512 FMV NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION D 648078 FMV ROCHESTER GENERAL HOSPITAL E 2085896 FMV WORKERS COMPENSATION TRUST E 607948 FMV WORKERS COMPENSATION TRUST Q 1207000 FMV GREATER ROCHESTER ASSURANCE COMPANY LTD E 2021247 FMV ROCHESTER GENERAL HOSPITAL L 4104000 FMV BEHAVIORAL HEALTH NETWORK INC D 52831 FMV TAX EXEMPT RELATED 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.