EXTENDED TO NOVEMBER 16, 2015 990 Return of Organization Exempt From Income Tax Form Under section 601(c), 827, of 4947(o)(1) of the Internal Revenue Code (except private foundation > Donnot enter socte! security numbers on tis form asi may be made publ sett ny 'A For the 2016 calendar year or tax year beginning 8 ey, [Name of oganzaton (Cost | ROCHESTER GENERAL HEALTH SYSTEM TERR» [Doing business as, 22-2551509 ‘andonding 1D Employer identication number [ERS [rumbor and stroot or? 0 boxtmas nl deerd to sieetaares) | Roomfuie|E Telephone numbor Civ | 100 KINGS HIGHWAY SOUTH 585-922-3000 ERP cay ortown, stator provnco, cout, and Zor feign postal code Gaemmwmes 18,010,821. Cisae| ROCHESTER, NY 14617 Ha) Is this a group return for subordinates? ... Ives EXINo fpincpaloticerERIC J. BIEBER, MD (Colter F ame and address Hib) ae orate ean] 08 RGENERAL OR aon: tite fie tenia Toe] ‘Summary’ 11 Bioty describe the organization's mission or most signficent activities: SEE SCHEDULE O. i 2 Gheakihisbor Be [Tite organization dsconinsed it operations or daposed of more than 25% oe rat anata j ‘8. Numboraf vting members of ho governing body Part Vine ta a 5 3 4. numberof independant voting mambersof the governing body (Pr Vino 1b) [a 4 i 6. Total numberof individuals employed in calendar year 2014 (Part V, line 28) 5. 9 {6 Total number of volunteers (eatimate i nec0888N) fo o | 7 Tota uroatd businoss revenue rom Part Vl, column () ra =20, 707. ‘Not unvelaed businass taxable Income rom Form 9907, ne 94 7 =24, 967. Prior Year Curent Year 8 Contributions ane grant Pari ne th) oO, oO. Program sence revenue Pat Vil tne 25) T5,115,109.| 17,887,874 40 Investment nome art Vil cote (kno 84 and 73) 8,168. 11. Other everuo Pat Vil column (A nes 6,64, 8c, 8, 10x, and 114). 0, 32. Total ovonue 2d ings 8 through 11 (ust equal Part Vil, column ins 12). i5,123,277.| 18,010,821. “8. Grants and siar amounts pad Part, column (ines +3), . o. 0. +4. Benefts paid oor for mambors Pat IX column no 4) o. 0 18. Salas, oer componestion, employee benef Part, column 7,318,541. 5,395,272. o. ‘6a Professional fundraising fees (Part X, coum (ne 176). te Total fundrasing expenses (Pat IX, column (0), tine 25) 17 Other expenses (Pat I, column (A), Ines Tat 1d, 111246) 418. Total oxponsos. Add lings 13-17 (must equal Pat column (A), no 25). 88,7: o| 15,095,599. 19 Revenue loss expenses, Subtract ine 18 from Une 12 sass 2,434,483.[ 2,915,222. [Besining ot urea Your | End ot Yes 20. Tota assets PAREKH 19) aan . 11,414, 500.| 8,106,197. 24 Total bie Pan X, no 26)". * (3510137243, 194, 608, 755 186,502,558. te suas 123,598,743 Part i | Signature Bloc! ‘Under poets of perry, | dace tat have eared is lr ncludng accompanying soeduls and sali, and tothe best of my knowedge and bolt, is ws, coven, and tpl. Dolton o papa (ote thn fees based on al informatio of which preparer as any tnowiedg. I 5,312, 147.| 9,700,327. sin |D Saramccronar a Horo THOMAS R. CRILLY, CFO “ype cr pint name ands PriniType preparers name Preparer’ signature E p= Cp Pm Pad [ANGELA M._ FRANCO ELA _M. FRANCO stews POOSBITAL Fimisrame_ ye FUST RS_ LLP: TimstN 16-1226221 Use ony [Fins acdessp. 5784 WIDEWATERS PARKWAY SYRACUSE, NY 13214 Form 990 2014)Fom: Partlv | ChocKIat of Required Schedules 41. le th organization desorbed in section 501(}6) or 4947(aK}) (other than a private foundation)? 11 es," compote Schedule A, {2 ls the organization requred to complete Schedule B, Schedule of Contnbutord Did ho organization engage in drt or ndectpaltcal campaign acts on Beha fern opposition to candidates or ble office? i "Yas," complete Schedule C, PAID axis 4 Section £01) organizations. Othe oxgarizatonongage in bbbying alive, or have ection 60) election in fect uring the tax yaar? I "Yes," complete SohedUe C, Pat. {5 Isthe organization a section SOE, SOCKS), 501106) organization tha receives membership des, assessments or siar amounts as defined in Revenue Procedure 98192 if "Ye," completo Schedule C, Part il! se {6 Did tne organization mettain any donor advised funds or any smlar fund or accounts fr which dors havo the ight to provide advice on the dietrbution or Investment of amounts in such funds or accounts? I "Yes," complete Schedule O, Pat 7 Ddthe organization receive or hold a conservation easemont, Ickding easements to preserve open space, the envionment, histori land areas, or histore structures? I "Yes," complete Schedule D, Part I, {8 Did the organization maintain colections of works of at, historical treasures, or other srr assets? i "Yes, Schedule O, Parti {8 Didtne organization report en amount in Part Xin 21, for eaorow or usted account labifty,save asa custodian for ‘amounte not sted in Part X; of provide credit counseling, debt management, credit repair, or debt negotiation series? 10 °¥es,* compete Schedule D, Part IV 40 Cid the organization, drecty or trough a elated organization, hold assets in temporary rosie endows endowments, or quastendownanta? "es," complete Schedule D, Part V 11th organization's answer to any of the following questions fs "Yes," than complete Schedule, Parts VI Vl, Vil Dt orX 188 apptcable ‘Did the organization report an amount for land, buldings, and equipment in Pat X,lne 107 I "Yes," completo Schedule D, Part VI ner 'b Did the organization repor en amount for investments - ter secures in Part X, ‘assets reported in Pat X, na 167 I "Yes," complete Schedule D, Pat VI... «© id te organization report an amount for investments program lated in Pat no tha is 36 or more of ot assots reported in Part X line 167 if "Yes," complete Schedule D, Pat Vl, «Did th organization report an amount footer aos n Pat X, ie 15 tht 56 or mor of oil aoss repaid in Part X, no 162 if "Yes," compote Schedule D, Part ‘ic the orgenzation report an amount for othe abit in Part X, Sine 25? "Yaa," compte Schedule O, Part X., {id the organization's separate or consolidated tiancil etatemants forthe tax year Inlude a footnote that addresses ‘the organization's lablty for uncertain tax poatlons under FIN 48 (ASC 740}? I "Yas," complete Schedule D, Part X 4120. id te organization obtain seperate, independent audited financial statements forthe tax year? If "Yes," compte ‘Schedule D, Pate X1 and Xt bb Was th organization incudedin consolidated, independent audited nancial statomont forthe tax yoar? 11 "Yes," and ifthe erganiation answered "Not ine 125, then completing Schedula D, Pats XI and is optional 48s tho organization a choo! doacribed n ection 170%) NANI? if "Yes," compibte Schedule E ‘aid the organization maintain an ofc, employees, or agents outside ofthe United S28? 'b Did the organization have aggregate revenues cr expenses of more than $10,000 from grantmaking undrasing, business, investment, and program service actives outside the United States, or aggrogato foreign investments valued at $100,000, ‘ormore? i "Yes," complete Scheduie F, Parts land 1V : ee 16 Did the organization report on Part col (ne 3, mare than $5,000 of grants ther assistance t ofr any foreign organization? if "Yes," complete Schedule F, Pats and V 16 Did the organization repert on Part X, column A}, ne , mere than $5; (of for foreign indviduals? 1 "Yes," compiote Schedule F, Parts Il and 17 Did the organization report total of more than $15,000 of expenses for profesional fundraing gorvices on Pat IX ‘column (A), nes 6 and 116? if "Yes," complete SchedUe GPa! omg 18 Did the organization report more than $16,000 total of undralsing event goss Income and contbutons on Part Vil ines ‘1c and 6a? I "Yes," complete Sched , Parti ae 19 Did the organization report more than $16,000 of goss income from gaming eaves on Pat Vl no 8a "Ye," ‘complete Schedule G, Pat It {20a Did the organization operate one or more noel facies? I "Yes," complete Schedule H Ip Yee to ti 20a, oth ofits aucted allt "12 that is 586 or more oft total of aggregate grants or ether asitance to Yes [ne a|x 2 x a 4 5 x 8 x Eri x 2 x. 2 x 0 x aa] 1X 11 X [sto] | x. sia} X 310] X aw] 1x. x sao] X C3. x val 1X. sao| X 16 x 16 x Eid x 6 x 0 x goa 1x "Fo 000 ra) 3 10231105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_0110231105 781828 20097.3000 nto tho rumberroperted ln Box 3 of Form 1086 Enter 0 not applablo vee [1 29) Enter the number of Forms W-2G included in line 1a. Enter-O-¥ not applicable a ‘tb 9} Did the organization comply wih bacep witiblding es fr reportable payments o vendors and reportable gaming {ganbling) wings to prize wine? senvamoenoncns [30K Extrthe numberof employees reported on Form W, raat of Wage and Tx Stalarons ted ortho calondar year ending wth or within te oar covered by his retum La Itatieat one ie reported online 2, dd the organization fle al oqued fodoral employment tax retus? = Note, Ifthe sum of ines 1a. and 2 greater than 250, you may be required to 6 (s0 Instructions) Did th organization hve related businoss gross income of $1,000 or more during the yea? Loa | x. 11*%o0,*haa it fed a Form S80 fr tla yer? No," tone 3, provide an explanation n Schedule © ~ [ee ‘At any tie daring the calendar yar, cl tho orgrizaton have an interest oa sgnature or ther autho over fancla account na foreign county uch a8 bank account, ecuties acount, o ther feancll acount. {x if ea" enar the name of the orgn county: > CAYMAN ISLANDS ‘Se insstos fring oqurements for FNCEN Form 14, Rapod of Forign Bank and Financ Aovounta FAR. ‘Was tho organization e party toa prohibited tax shale aneastin at any ene ding the RY? enn ~ [of tx ‘id any taxable party not the organization tha twas cis a party toa prohibited tax shot ransaction?,.. | 1x iF"¥65 toe Sao 5b, id he organization le FO BBBET? ono e scion | ‘oes the organization have annual gross receipts that ar normaly gator than $100,000, and did the organization soit any contrbutions that were not tax dadvotbia as chartable cortiBULONE? muss oa| |x if*¥e' ol th organization notte th evry otto an expres statement that such conto or ts wore not ax doduetb? i | ‘Organizations that may receive deductible contibutlons under cecton 17042). (it xganzaton eae peyrentn excess 85 mad prt as contbutan and pry fr oad and xvi proves oth payor? x if "¥0," is he oxgriation not tho dona ofthe valu of he goods or sors provided? rs (i the organization sl, xchange, ratervise dapose of tangible personal propery fr which woo required to fle Form 2627 | |x "Yes" ndeats the numba of Forma 8282 ed ding te oar Di he organization ecsive ay funds, crct or indole pay premiums on 8 persona benef contact? re|_|x id the organization, ding tho yar ay promlums, cect or indirectly, on a personal Benet contact? nf |x I tne organization received a cotbuton of uae ineectual property, ds the organization fe Form 8860 as requir? | Tp Ifthe organization eceved a contrbuton of car, boat, planes, or other vbiles, da the organization fle a Frm 10867 | Zh ‘Sponsoring orgenizations maintaining donor advised funds. Oda donor advise fund mantaned by the sponerngergarizaton have exose business lng tay ire ding tho YOM? uy = wove |B ‘Sponsoring organizations maintaining donor advised funds. i the sponserng organization make any taxable stbutons under section 4966? - [90 (id he sponsringorpntzaton make ads toa dona, don avian, of tod pereON? nssncscnevnncnes 8D ‘Saotion 601(0K7) organizations Enter: Initiation fs ana captal ontibuttons included on Pat Vl ne 12 108 ‘ross receipts, included on Form 990, Pat il fe 12, forpubtc use of co Tacitias 0b Section 801(c(12) organizations. Enter: Gross income from members sharcelders 7 ‘te Grose income from ther souroos (Do not net anaunis dus or aldo other sources agaist amounts duo orreceived trom them) . La ‘Section 4947(a\(1) non-exempt charitable wuss. 0817 20 1f"¥ee" enter he amount oftaxaxemp interest recolved or accrued ding tho Yea an Section 5016/29) qualified nonprofit health insurance issuers. 'nthe organization ieanae to lus quatiid hath plane mo than one 810? on Note. S00 the instructs for adatona! information the rgrization mst report on Schedia Enter the amount of reserves the organization i roquted 1 marta bythe states in which the xgarization i conse ofssuequaifed heath plans = sb Enter the amount ef reserves on had ii ‘2 wel 1 [sap Foam 990 (2018) 2014.04030 ROCHESTER GENERAL HEALTH S¥ 20097_01oe nOcma igs weapann vs ‘Compensation of Officers, fi Compensated Employees, and Independent Contractors eck ened O contain response or not to ay nein hi Pat oO & iK and Highest ed Employees. “Compe hie able for a pereon oquired ob stad. Rapot compensation rhe clear yoar odin wor wn teagan ax yor. 6 Ust af the organization's current ocr, deco, usec (whether Indiv or argaizatons), regards of amount of compensation. ener S'rrastams Bu rand f) ne conpaneston was pad deve en 'S Usta ofthe coenizeons current key ampbyes an. See ratuctions for dfnon of "oy empty. * Lstne organization's ive erentighastconponsated employes (ther than an fle, droctr, tus, koy employe) who ced ope abe conponeton on of Pos We aro Boxe Fa 1008046) moe tan 100 80am tho eganzat andy rosea organza. ‘stl of th organizaton’s former ofcos, toy emplovons an highest compasated employees who recsved ore than SY00800of ‘epatabl compensation om te organization ard any lated organizers Lint aot organza former dretor or trustees rat receive, nha capacty a8 a ormer dtr orto ofthe evanizaton, mara then S10 000 of roportabie compancaton tm bs oparizason and an ote organs. Ls pron ne fling rr: nd tutes or rector tte aos fey oy emloyee; ges compere onpoyens sa former von pores TL Lotesktis box nother ho onarzaton nr an ists eraanzation compensated ay curent offer, reco, ortste, 7 7 a e a ao AEE Sone eee ae pores | mereen | ome ne gee lee ist any, i the orgenizat ‘compensation oo |] eee | nasi | ete rowed {| (w2noooMiso) ganization tain || |p man cor [2la/al EMA (1) ERIC BIEBER, MD 1.00 ‘PRESIDENT & CEO. 54.00/x) x 0.) 101,380.) 189,013. ee fie vice cute 1.00 0 0. O. eae a 43 ‘SECRETARY 1.00/x 0. 0. oO. aoe itt ‘CHATR 1.00|x 0 0.| oO. Siena mess a ‘TREASURER 1.00/x 0. oO. (6) MARK CLEMENT 0.00 @B0_(unrrn 11/30/74) 55.00 Xx 0.| 3,233, 272.| 2090584. en te ns SFO. X, 0.| 642,585.| 60,281. go x GeO (umn, 31/30/14) 55.00 x. 0.] 1,069,997.| 6420216. (9) ROBERT MESSELBUSH 0.00 00° 5 00 |X 0.| 1,511,074.| 86,315. (10) HUGH THOMAS 0.00 CRO. 55.00 x 0.| 1,268,000.| 70,527. ] 2010 [mati | —iazoie | —aaors [aaa [oto 8. Amount fom ine 8 {00 gow rgomo tom cende, payments reeted on Secures tone rent, royaion Bed Income mn eur coress bUnebse buses abl ome es sectn 61 a) for bshesses Acquire a 0090, 1975 © Add 108d 100 14° Net income tom uelied Bs Sten not ncided inne 10D, Airtel tw fuses ib Tuev ured on ‘Sssote (Explanin Part Vi) 48, Total suppor anes, 10% 1,002), 14 First fe years. ‘Section C. Computation of Public Support Percentage “1 Puc support percentage for 2014 fine 8, cum () died by Ino 75, coun (0). % 18. Pube support petcontage from 2018 Schedule A, Part I ine 18 38 % Section D. Computation of Investment Income Percentage 17 Investment income percentage for 20%4 na 10 column () died by ie 1, colar) 18 Investment income percentage fom 2019 Schade A Pat in 17, = 484 83 179% support tests - 2044, Ith organization didnt check the boon ne 14, and ine 15 is moe than 33 173%, and tno 17 erat ‘more than 313%, check his box and top here. Te organization quails asa publicly supperted organization 1 38 1/9% suppor tests - 2018 the organization dé not check abo on ne 14 or tno 1, anne 16 is mare than 391/38, and line 18 is not more than 33 1/99, check his box and stop here. The organzaton qualifies es a publicly supported organization... PL] 22. Private foundation he exganzatlon didnot check a bok on Be 1, 18a, or 19b, check tis boxe ee insuctons “sues ob ‘Schedule A(Form 900 or 000-EZ) 2014 15 10231105 781828 20097.3000 —-2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01Supporting Organizations (contned) 41 Has he ocanization secopted a gift or contribution from any ofthe folowing persons? ‘8A person who drectly onde contol, ether alone or together with persons dascitbed in (b) and () below, the governing body ofa supported organization? 1b A fanily member ofa person deacribed ina) above? © A.35% controled entity ota person described In (a) or (| above?tt*Yos" to a,b, ore, provide detail Pat a8 [aw te Section B. Type | Supporting Organizations, +1 Did the drectors, trustees, or membership of ene or more supported organizations have the power to regulary appoint or elect at least a majorty of the organization's directors or tustes at al times during tho ‘axyoar?If’No,*desorbe in Part V. how the supported organization(s) effectively operate, supervised, or ‘contaed the ergenizaton’s activites. [the organization had more than one supported organization, describe how the powers to appoint endiar remove diectors or bustees ware alocsted among the supported orgarizations and what conations or rebetons, any, apple to such powers during the tex year. 2 Did the organization operate forthe benefit of any supported organization otha than the supported organization(s) that operated, supervised, or controled the supporting organization’ if Yes," expan in Part! how proving such boneft card out the purposes ofthe supported orgenzations) that operated, or controled te organization. x z x Yes | No. Section C. Type il Supporting Organizations 41 Wore a majority of the organization's director or tustees during tho tax year also a majority ofthe rectors Cor trustee ofeach ofthe organization's supported organizations)? "No," descnbein Part W hovr control ‘ormanagement ofthe supporting organization was vested in the same persons thet controled or managed the supported organizations). Section D. Type il Supporting Ofganizations 11 Did the organization provide to each ofits supported organizations, by the ast day ofthe ith month ofthe ‘organization's tax year, (1) a wrtten roti detorbing the type and amount of eupport provided during the prio tax year, (2) copy of the Form 990 that was most recently fled as of th dato of notification, and (9) copies ofthe ‘organization's governing documents in effect onthe date of notiication, to the extant not previously provided? 2 Were any of the organization's officers, dkectrs, or tustees ether) appoint or elected by the supported ‘organization(s or () serving on the governing body of a auppetad organization? if Ne," expan in Part W how the organization maintained a close and continuous werking relationship with th supported organizations) ‘8 By reason ofthe relationship desorbed in (2), dd the organization's supported organizations have a signfcant voi in the organization's Investment potci and in ciecting the use ofthe organization's income or asset at lltimes during the tax year? if "Yes," describe in Part VI the role the organization's _supplrted ofganiations plajed inthis raged. Section E. Type ll Functionally-integrated Supporting Organizations 11 Check the box next othe method thet the organization used o sais the Integral Part Test ung the yaree mstuctone) a [_) The organization satisfied the Activites Test. Complete tine 2_ below. tb [2] The organization is the parent of each of ts supported organizations. Complete ne 3. below. © [2] Trearganization supported a governmental entity. Describe in Part Vi how you supported ¢ goverment entity (see 2 Activ Tot. Answor and () below. ‘Did aubetatialy a ofthe organization's acts curing the tax year ct further tho exempt purposes of the supported organization(s) to which the organization was responsive? M1 "Yes," then n Part VW ideniy those supported organiatons and explain how these actives ect furthered thir exempt purposes, how tho organization was responsive otheeesupperted organtations, and how the organization determined that these activites consttutod substantial al oft ects 'b Did th acts desorbed in (@ constitute acts tha, but forthe organization's involvement, one or more ‘ofthe organization's supported organization(s) would have been engaged in? "Yes," explain in Part the reasons forthe organization's positon thats supported argenzaons) would have engaged n these activites but forthe organizations invaaent ‘3 Parent of Supported Organizations. Answer end () below. 2 id the organization have the power to regulary appoint or elect a maorty ofthe ofcers, directors, or trustes of each ofthe supported organizations? Provide dotls in Part Vi. Dane cxganaton ein a substan dog of drecon ote ples, programs, ar ace of ch 17 Yeo | No. Sehedule A (Form 690 or 990-EZ) 2044 10231105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01‘Section D - Distributions fount paid to eupporied erganialone to Accomplish evempt purposes "2 Amounts paldto perform activly that cect urhers exempt purposes of eupported ‘iganlzations, in ox0088 of income from activity ‘2 Administrative expenses pal to scbomolsh 8 pas oa ignition “4. Amounts pa to aoqulo exemotuse assets ‘5 Qualified set aside amounts (lor RS approval equred) {8 _ Other cetbutions (describe in Part VP. Seo instructions. 7__Total annual distributions. Add nes 1 trough 6. {8 Distrutlons to attentive supported organizations to which the organization is responsive {provide details in Part Vp. S00 instructions. 1B Distributable amount for 2014 from Section G toe 8 10 Line 8 amount divided by Line 9 amount o @ ‘Section €- Detrbutlon Allocations (290 instructions) poems | eres ee xe-204 | “L_Distibutabe amount for 2014 tom Seaton G ine 6 wo Dietrbutab |__Amounttor2014__ "2 Underaltrbutions, I any, for years porto 2014 [eéscnabte causo roqulads60 instructors) 'S_Excess disbutions earyover, any, to 2014, b e From2013 4 Tota offines Ga through @ ‘aa Anpied to undercitbutions of por years ‘h-Appled o'2014.cletrbutable amount 1. Carryover from 2009 not apie fs inetactons) “| Reinsinder. Subtact nes 6g, 3h, and ai from 3. “ _Dstrbutions for 2014 from Section D, Boe: $ 2. Applied to undoraistibutons ofpioryears 'b- Apple to 2014 catibuiabie amount ¢Remainder, Subtract ines da and Ab from 4 '& Remaining underaistibutos for years prior to 2014, ‘any. Subtvact nes 9g and 4 fom tne 2 if mount greater than 2270, 460 instructions), Remaining underdistibutons for 2074, Subtract ines Sh ‘and 4b trom tne 1 (if amount grater than zero, see instrvctions 7 Excese alstributione carryover to 2016, Add ines 3j and de. '_Broakdown afin 7 Excess from 2019 To Excess tromz0t4 “Schedule A (Form 900 or 000-E2)2014 19 10231105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01poled sigarizations (continuation) | ‘Wamoantotmonciay | (Ww AToint oT support ‘er supper ROCHESTER GENERAL HUDSON HOUSING 2-3210351| 9 x 0. VIA HEALTH HOME | CARE I 6-1504370) 9 x 0. VIA HEALTH HOME | CARE 17 6-15387271 2 x 0. WESTERN NEW YORK MEDICAL PRACTICE. BC61-165423. 3 x 0.1 | | ‘Continuation Totals fasion ort “Sehedule A (Form 060 oF 880-2) 21 | 10231105 781828 20097.3000 —_2014.04030 ROCHESTER GENERAL HEALTH SY 20097_0110231105 781828 20097.3000 '& Check T_T ifthe ting organization belongs to an aflatd group (and ist in Par IV each ailted group member's name, adress EIN, ‘expenses, and share of excess lobbying expenditures. B._Chook Be [1 isthe ting cipanition checked box A and "irited contro provisions apply Fig | wAtiaes Limits on Lobbying Expenses arganeatine | ets ‘oie (The torm “expencitures* means amounts pald or incurred) “Ta Total lobbying expenditures to nfuence public ophion (grassroots lobbying) 'b Total ibbying expenditures to uence a legislative body (act Ibn) ‘2 Total lobbying exponsitures (add lines 18206 18) ..inwitnninennn {Other exompt purpose expendtures © Total exempt purpose expenditures (add Ines fo and 16) { Lobbying nontaxable amount, Enter the amount rom the folowing tabi in both column, the amount online 12, column (a) or(8)'s;_| The lobbying nontaxable amount i Not over $500,000 2096 ofthe amount on tne 19. ‘Over $500,000 but nat over $7,000,000 | $100,000 pis 16% of he excess over $500,000, ‘Over $1,000,000 but not over $1,500,000 _| $175,000 pus 10% of he ‘Over $1,500,000 but not over $17,000,000 | $226,000 plus 6% ofthe excess ver $1,500,000. ‘Over $17,000,000 $1,000,000. “9 Grassroots nontaxable amount (enter 26% oftne 1) 1h Subtract ine 1 fom tine a. if zero or lss, enter 0 1 Subtract ine 1f rom tne to, 260 or oes, tor {there is an amount othr than zero on other in th or En i cd the organization te Form 4720 reporting egction 4811 tax for this yoar? z “-Year Averaging Period Under section 6013) Clves Cone. (Some organization that made 2 section 801(h) election do not have to complete al ofthe five columns below. ‘See the eoparato instructions for ings 2a through 21) Lobbying Expenditures During 4 Veor Averaging Period Calendar yoar : pel tetony (201 (wy20r2 (oy2013 (ay2014 (total 2a Lobbying nontaxable amount 'b Lobbying ceiling amount (150% of ine 2a, cotumn(a) © Total lobbying expendi 1 Grassroots nontaxable amount fe Grassr00t8 oeling amount (150% of ine 2d, column) 1 Grassroots bing expentias 23 “Schedule © (Form 980 or 680-EZ) 2014 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01Supplemental Financial Statements > clr ttn exgeizatin arawore "Yor" f erm 0, Pee et ers, ror at eto ‘SCHEDULE D (orm 950) ‘Open to Publlo Ingpection Employer identication number 22-2551509 a ye ay Se TE Sir Shnilar Funds OF Accounts Compe the “ogaization anewored "Vee" to Form 920, Part WV, tno 6. Tay Donor advised funds (by Fires and oor aocounts 1 Tota!numbor at end of yar. 2 Aggregate value of contibutions to uring yea) 3 Aagragao vauo of grants trom (uring your) 4 6 ‘Aggregate value at end of year id the organization inform all donors and donor advisors in wring thatthe asots held dono advised funds ‘ate te organzation’s property, subject to the organization’ exclusive egal con, {6 Date organization norm al grantees, donor, and donor adviors in wring that grant und canbe used only {or chartable purpoees and nat forthe benef of the donor or donor advisor, or for any other purpose confering Coyes [Ino in Easements. Compote the oganizalion answered "Yes" to Form 990, Part IV, ine 7. ‘1 Purpose(e of conservation ensements hold by the organization (check al th apy). 1 Preservation of land for public use (0.g., recreation or education) —_ [__] Preservation of shistorioally important and area J Protection of natural habitat [Preservation of a certified historic structure (| Preservation of open space 2. Complete ines 2a through 2d i the orpanization hald a quailed conservation contibuton inthe frm ofa conservation easement onthe last ‘day ofthe tax year Held athe nd ofthe Te Year 4 Total numberof consonation easements un ry bb Tota acreage restricted by conservation easements . fae ‘© Number of consewation easements on a corte histo 20. a Number of conservation easoments Included Ine acquired after 8/17/06, and not on ahistoi stucture let nthe National Register your 4+ umber dais vow propery suc ocr aso sete 6 Dow the eanzalin fave awilen pte wprdng he perede mono, rapota, handing at Vai, and onfrcoent lh coeerton essa hl? ve ne 4. Staten enter ars develo mento, mapetn, an rain cout eaxsmara Ging tu yurBe 7 nun of expense neured motte, epectng. and enor coment stant tn th oor 8, 4 Dour each craton eeamert pore on tw 2 above ante eure of acon t7OCNANEN tution TOOMMIEND? eee ph Ove Cn 0 tnPan a desta howe satan pats coaovaon semen Fits ren and epueesalaer and bance see. and hha aptoad, texto he ots othe ergnzati's ancl feet ecb he oxaratn's acai fr Parti Organizations Maintaining Calloctions of AA, Historical Treasures, or Other Similar Assots. [Complete ithe organization answored "Yoo" to Form 880, Part Vine 8. “ie iftheorgantzation elected, aa permitted undor SFAS 116 (ASC 858), not to report in Rs revenue statement an balance sheot works of art, tistoval treasure, or oer similar assets held for pubic exhibition, education, er esearch in furtherance of public service, provide, in Pat XI, the text ofthe footnote to ts tanclaltatoments that describes these tems. 'b Ifthe organization elected, a permitted under SFAS 116 (ASC 958), to repor ints rovenue statement and balance sheet works of at historical treasures, o ther snilar assets held for pub exhibition, education, or research in furtherance of pubic earvie, provide the fotowing amounts relating to these items: (0) venue inctudad In Form 880, Part Vl, inet Ss se ms (i Ass0t8 included in Form 990, PBIEX agua 2 the organization recelved or held works of at torical teasu 12 simlar assets for financial gain, prove the folowing amounts required ta be reported under SFAS 116 (ASC 968) relating to those ltoms: ‘Revenue included in Ferm 990, Part Vil ne 1, Assets included in Form 900, Part X ms ms ‘THA Fer Paperwork Reduction Act Notioe, soe the Instruations for Form 860. “Schedule D (Form 850) 2018 25 10231105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH S¥ 20097_01organization answered "Vos" to Form 990, Part Vn 11. See Form 990, Part ine 12 Ta) DesorpUon of secur oF caleO1ymavsrgrane ceri |) Book valve {6} Mathod of valuation: Gost or ond-ofyer marke vale 1) Financial derivatives. 2) Closelyold equity interests ® other @ OTHER SECURITIES 465,000.| Cosp FESsssss Fo gs 13, (2) Description of ivestrront {) Mathes of valuation: Coat or end-oyoar rare vai =) Form 680, Parco (ne 1B) 1X] Other Assets. ifthe orgation answered "Yes" to Form 600, Pat W, tne 114. S00 Form 990, Part, no 15. Ta) Daserinion Book vane CASH _Vi ~_bEFE IN! E 5S. ‘DUE FROM AFFILIATES, NET 443,044. m Fi Part X | Other Liabilities. ‘Gone if tne oiganization anewored "Yes" to Form 890, Part Iv, ne 112 oF 111.00 Form 990, Prt x no 25. cn (@) Description of labilty (8) Book value (G)_ Federalincome taxes ACCRUED PENSION LIBBILT’ 164,879,318. (@_ACCRUED POST RETIREMENT BENEFITS 16,372, 254.| @ DUE TO AFFILIATES, LT 2,755,226 (S| DEFERRED COMPENSATION _ 467,290. © ia a. @) ‘Total. (Column @) rust equal Form 690, Part col (8) ne 26) _p| 184, 474, 088. 2 anit func postin Par, prove tx hon o een fencl ilorarts at pe te ‘Schedule D (Form €80)2014 27 10231105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01‘SCHEDULE F} Statement of Activities Outside the United States 01 (Form 980) > Complete if the organization answered "Yes" on Ferm 900, Part, lin 14b, 18, oF 18. ener be Tey Pe Ace ie ane ‘Open fa Pubs Bitenereuetuae” | De information about Schedule F (Form 960) and its instructions is at wwwts;povilomm960. Inspection "Name ofthe organization ‘Employer identification number CE i 122-2551509 _ [Part 1_| General Information on Activities Outside the United States. Complete fhe organization answorod Form 990, Part Sno 146, + For grantmalers. Doe the organization manan records to substantia the anourt ofits gran and oie assistance, tho grantoos' eligi for the grants or asletance and the selection enor used to award the grants or assistance? —] Yes [] No 2 For grantmakers, Describe in Part V the organization's procedures fr monitoring the use of ts grants and other assistance outside the Unita Stats Actos por Region. (he fing Part tne 3 able can be pated I adiona ope neaded) (2) gion {b) Number of [fo]Number ot] (c) Actos conducted inegin | (e) act ietedin @) | (Tata offices ey'ype) (09, undalsng progam | Isaproyamsanice, | extends nen rogen | pat | sercnsvestons gers to | asso pete re | years orkaain | recoitslocatedintverecn) | ofsevessinregen | Vinregon CHIRAL AMERICA AND nevesraTS ‘re CARIANERD 0 296.20, 3a Suu a 106.140, Total tom continuation 2008810 PA ae 2 9. © Totals add ies 3a and3bL 2 06.240, TRA For Paperwork Reduction At Notice, ee the intvuctions for Form 080. ‘Schedule F (Form 000)2014 29 10231105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_017102 (066 wos) 4 empeyos a Mgt | csummeeue | ‘Setx| manemmeme | maser | mos | ccouey | emma nennorauen seat | Ee [soete| SE Losey | tht TT RET RT TOOT ena on wos uno).paanna nln oars sag pen on ope mpnpcIeeeeTy ROT Nee Mea om ene WHISKS HVIWSH IWSaNeO GaLSHHOOW FOE CSE OTT TBSa CHESTER ‘Supplemental Information Provide the information required by Pat, ine 2 (monitoring of funds; Pat |, ne 3, columa ( (accounting method: amounts of Investments vs. expenditures per region; Part I Ene 1 (accounting method}; Part il (accounting method}; and Pat, tum (e) {estimated number of recpionts), a8 applicable. Also compat tis pat to prove any addtional Infomation “eaore onaere “Schedule F (Form 090) 2014 33 10231105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01owlosounsde sree 7 o a} 0 i o a o a ‘ a o ol o a 6 a o oy o ans B8z Pies ete t [eso Lc PSLB"29. r06S"SOS |"e00 cee |"cO OLP : Pe re : Hl r “OSL OE oe Lost |O6T'L “0 “0 ro *€L9"ZeT Pete" O6PL |*9T0"S o “oO ro “0 MEEMATA Tee "L 70 ro ro "hee cee | 958 eee Ss | tss py = Fo i *0 e6E 06e POs = ro ro ces wg asap pov temveducs | See ru, pu eum) (@) uuirgoo (atte) swjeusg Pauayop 40490 Lvonesvediuco (a) |suuryoojo ox (2)| egexeuoN (a) | pve qwawamou (o)| uoResvedwee OSIN-G60% J0/AUE ZM JO unopTEaIG “opp yta Jo} stnour @) pu () uno erreandde | ou y YOR20G IA Wed ‘066 UNO yo YOURE 0} ot FENbe SMU ENpAIPL pare owe 05 ENE) SALTO JO WN SUL “HON02 065 wo) ¢ Complete It the organization answered "Yes" on Form 990, Pat I line 258, 250, 26, 27,260, ‘28, o 280, of Form 860-2, Part V, line 38a or 40D. 'P Attach to Form 000 or Form 990-E2. tm 990 or 9902) an is instruction is at wns. govforms0 Employer Identifcation somber 22-2551509 seetion 601(0)4), and SOT(O2W) organizations only). ‘Complete the organization anewered "Yes" on For 960, Part 1 ins 26a or 256, or Foxm 990.2, Part, in 40D, ; eer nono daquseaponon | ©) Fete betwen den (awa femctin SiR swe” | Delaformtion about Schedule Tiare of tre organtaton far Carectos? Yes | No @ Enlarthe amount of fax noured by the organization managers oF elsquallied poreons Gurng the year under 800109 HOB nner : {8 Enterthe amount of tax irany, on ne 2, above, reimbursed by the organization Partit] Loans to and/or From Interested Persons. ‘Complete tte organization anewored "Yas" on Ferm S902, Pr V, Ine aor Form 990, Part W, Io 26; ori te orgarzatin PattX, ine 8,6, 0°22 TaiName of {e)Rltensip|() Purpoee.|iemiee!] a) Orgnal | Banco avo | _cqhin FR)ROEOy nite inerested person [inorpnizatn] “ofloan |g f@@25| principal amount astaut? | ommte [enenen? “To [From Yea N No [Yes | No or ing Interested Persons. Complat if tho organization Yes" on Form 990, Part ine 27. {a Namo of interested person {() Relationship betwoen | (c) Amount of (Purpose of Interested person and ‘assistance ‘assistance the organization [THA For Paperwork Reduction Act Notice, eee the Insuctions for Form 80 or 990-EZ. “Schedule L (Form 060 or 690-EZ) 2014 Balke 39 10231105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01: niin inn ‘Supplemental Information to Form 990 or 990-EZ ni Comets to prowdehfomaton or eoponeas to vec questions on 2014 tm 800 or 990-0 to froce any edeona information. Detach to Fg $0 990-F ‘pen to Pubic . formaoo._| ‘Employer dentioation number SCHEDULE {Form 990 oF 990-£2) eect Nam of he orgaizalon ROCHESTER GENERAL HEALTH SYSTEM FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: PART IIT, LINE 7 ION OF, SSION: ROCHESTER GENERAL HEALT! ROVIDES PA’ cE, TOR HOUSING, LABORATORY SERVICES, AND COMMUNITY OUTREACH TO RESIDENTS AND OTHER CLIENTS IN MONROE COUNTY G AND_SEVE! RROUNDIN TES. FORM 990, PART III, LINE 2, NEW PROGRAM SERVICES: OCHESTER REGIONAL HEALTH WAS 3H_A CORPORATE RESTRUCTURI! WHICH BROUGHT TOGETHER ROCHES' ALTH SYS: D ITs AFFLIATES AND UNITY HEALTH M$ AFFILIATES ON JULY 1, 2014. ROCHESTER REGIONAL HEALTH SEEKS 10 BE THE PROVIDER OF CHOICE, WHILE ADDRESSING BOTH THE AFFORDABILITY AND ITY OF HEALTHCARE SERVICES THAT IT PROVIDES IN UPSTATE/WESTERN NEW YORK. FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: ROCHESTER GENERAL HEALTH SYSTEM (RGHS) HAS PROVIDED HIGH QUALITY HEALTHCARE SERVICES TO THE GREATER ROCHESTER NY AREA AND SURROUNDING RT. or MORE THAN 150 -RGHS_HAS A NATIONALLY RECOGNIZED PROGRAM AND A NATIONALLY ACCREDITED IR CENTER. RGHS OFFERS PATIENT: MANY OF THE SAME LEADING EDGE TREATMENT OPTIONS FOUND AT THE COUNTRY'S. FINEST MEDICAL CENTERS. FROM SURGERY TO ORTHOPEDICS, WOMEN'S HEALTH TO ‘Schedule O Form 960 or 960-£2) (2014) LLHA. For Paperwork Reduction Act Notice, see the Instructions for Form 980 or 80-EZ. 11021105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01‘Shed Ofom 990 org90em (agi) ___Pageg. ‘Name ofthe organization ‘Employer identification number _—___________ ROCHESTER GENERAL HEALTH System _______]__22-2551509 _ RESIDENTS THAN ANY OTHER HOSPITAL IN THE REGION AND, AS A TERTIARY CARE FACILITY, HAS STRONG REFERRAL RELATIONSHIPS WITH SEVERAL REGIONAL 108) 7 RGH CARED ETHAN 124,000 ENTS IN THE AND_OVER. 10,000 INPATTENT 8,001 PATIENT ENCOUNTERS. ESTER GENERAL OFFERS A FULL Al F SERVICES TO MEET THE MEDICAL NEEDS OF UPSTATE NEW YORK, INCLUDING IALLY_RECOGNIZED PR‘ IAC, CANCER, ORTHOPEDIC VASCULAR, SURGICAL AND _D: 8 |. DISTINCTIONS LITY INCLUDE SIGNATION AS A_SOLUCI: TOP 100 CARDIi SPITAL, ‘TIMES AND DESIGNATION BY YORK STATE AND AS AN ‘TED STROKE CENTER. HIGH Y CLINICAL CARE PROVIDED AT_ROCHES' NEI AMPLIFIED BY RELATIONSHIPS AND AFFILIATIONS WITH NATIONALLY RENOWNED INSTITUTIONS SUCH AS THE CLEVELAND CLINIC (FOR CARDIAC CARE) AND ROSWELL PARK CANCER INSTITUTE. ‘NEWARK-WAYNE ITY HOSPITAL (NWCH) HAS SERVED GENERATIONS OF iz co RESIDENTS SINCE 1957 HAVE BECOME ERS _OF OUR GROWING HEALTHCARE FAMILY. WITH NEW, LEADING-EDGE MEDICAL TECHNOLOGY, A. bu PARTNERSHIP WITH ‘TER GENERAL HOSPT' 1D HIGHLY TRAINED STAFF DRIVEN BY OUR EXCELLENCE EVERY DAY PROGRAM, NWCH CONTINUES TO IN EVERY ASPECT OF ITS DELIVERY. PITAL IS LICENSED TO OPERATE 120 ACUTE CARE BEDS, WHICH INCLUDES: 82 MEDICAL/SURGICAL BEDS, 16 ADULT MENTAL HEALTH BEDS, 8 ICU BEDS AND 14 OBSTETRICAL BEDS. NWCH ALSO OFFERS A FULL ARRAY OF OUTPATIENT SERVICES uDU ¥ DEPARTMENT, CARD! EHABILITATI SERVICES, DIAC IC. IMAGING, REHAB: rc zx WEL AS Ti DRAW STATIONS AND PATIENT IMAGING UNITS IN OTHER PARTS OF WAYNE COUNTY. RESPONSE 1 D, IVING CENTER IN Fs ear ‘Schedule © (Form 990 or 990-EZ) (2014) 11021105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01Booz ‘Schedule 0 (Form 999 or 99082) 12014). ‘Employer Identification number "Name of th organization ROCHESTER GENERAL HEALTH SYSTEM 22-2551509 IPPORTIVE SERVI‘ iB ILS Pi ALL-1 IVE CARE FOR THI ELDERLY (PACE. PROVEN THAT INTEGRATING HEALTH CARE SERVICES CAN HAVE A POWERF! BENEFICH PACT ON INDIVI! Hw AND -BE: NOW HAVE A CHOICE TO LI THEIR LIVES IN THEIR ITY - ENJOYING FAMILY, ING THEIR HEALTH, MAKING NEW FRIENDS. > SIMPL: THEY 3B _AND PAY F( EDED LONG-TERM ILS HEALTH. AND SOCIAL SERVICES NEEDED TO HELP AGING INTAL R_INDEPEND®! pre oF LIFE E_OF_ SERVI‘ .B_AVAILAB) zi TP; INCLUD DAY. PRIMARY TORY} X-RAY. ROCHESTER GI ‘TERM HILL HAN ROVIDES 24-HOUR LED NURSING CARE TO THOSE IN NEED 0) = -REHABILITATION LONG-TERM CARE TRANSITIONAL CARE =HOSPICE CARE =CARE FOR ALZHEIMER'S-TYPE DEMENTIA THE GOAL IS. LP RESIDENTS REACH THEIR GREATEST LEVEL OF PI AL 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 PED GR ._ RESIDENT! 71 ESS..TO_IN-H AL CARE PROVIDED BY PHYSICH E & ‘Schedule 0 Form 990 or 680-E2) (2014) 11021105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01‘Benedule 0 Form 90 or DEH (2014 Pane 2 Employer Identification number "Name of to organization ____ ROCHESTER GENERAL HEALTH SysTEM _| __22-2551509 _ FORM 990, PART VI, SECTION A, LINE 4: U_SYSTEM, INC. D/B, sTER_REGT HEALTH, IS A YORK NOT-FOR-PROFIT CORPORATION THAT COORDINATES AND MANAGES THE DELIVERY OF SING AND HEALTH “RELATED _SER' EDUCATION BY_ITs TE: (ATES). ROC! EGIONAL AS_FORI Ou RATE RESTRUCTURING, EFFECTIVE AS OF JULY 1, 2014, WHICH BROUGHT TOGETHER TER GENERAL HEALTH SYSTEM AND ITS AFFILIATES. ITY HEALTH SYST! D_ITS$ AFFILIATES. AS A RE! 01 ORPORATE REORGANIZATION, ROCHESTER REGIONAL HEALTH SERVES AS THE SOLE CORPORATE MEMBER OF THE ENTITIES LISTED BELOW (THE "EXEMPT AFFILIATES"). IRS FORM 1023 APPLICATION FOR TAX-EXEMPT. HAS BEEN FILED FOR ROCHESTER REGI! HEALTH, SEEKING EXEMPT STA‘ ER SECTION 501 INTERNAL REVENUE CODE. HE CORPORATE RESTRUCTURING WHICH CRI THE ROCHESTER REGIONAL HEALTH WAS MPLISHED VIA CHANGES TO THE GOVERNING DOCUMENTS OF THE T AFFILIATES, AS FOLLOWS: (‘A)ROCHESTER REGIONAL HEALTH WAS NAMED AS THE EXEMPT AFFILIATES’ SOLE CORPORATE MEMBER; B)ROCHESTER REGIONAL HEALTH WAS GRANTED THE AUTHORITY TO APPOINT AND REMOVE THE GOVERNING BOARD OF THE EXEMPT AFFILIATES; AND C)CERTAIN ACTIONS OF THE EXEMPT AFFILIATE AND/OR ITS GOVERNING BOARD. WERE MADE SUBJECT TO THE APPROVAL OF THE GOVERNING BOARD OF ROCHESTER REGIONAL. HEALTH. ae 11021105 781828 20097.3000 _2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01 ‘Schedule © (Form 990 or 990-E2) (2014)Pago: ‘Employer ilentiication number |__22-2551509 __ FORM 990, PART VI, SECTION B, LINE 11: PRIOR TO FILING, PY OF Tl IS PROVIDED TO, AND REVIEWED WI ALL MEMBERS OF THE AUDIT AND COMP: E rt THIS REVIEW IS PERI IN CONSULTATION WITH THE 0) 's TAX ADVI! AND IS BASED ON RGANIZATION' TED FINANCIAL STATEMENTS HER RELEVANT INFORMATZ FOR THE APPROPRIATE TIME PERIOD. FORM 990, PART VI, SECTION B. 12c: UPON EMPLOYMENT, ALL EMPLOY! EIVE THE ETHICAL ST: F_CONDUCT BOOKLET FOR WHICH THEY SIG! EIPT OF |EDGEMENT . ‘ICT_OF INTEREST I$ DEFINED, AS IS MANAGEMENT OF A CONFLICT OF INTEREST. EMPLOYERS JIRED TO DISCLOSE AND SEEK RESOLUTION TO ANY JAL_OR POPE! ICT OF INTERI RE TAKING A POTENTIALLY IMPROPER ACTY( TER, ANNUALLY, EY EMPLOYEE FFICER OF THE ORGANIZATION REQUIRED "TO ONFLIOT OF FORM IDING EMENT WIT! PFICIENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHI! THAT MAN) 1 IETHER ANY ACTUAL OR PERCEIVED zt EXISTS, AND MONITOR ASSIGI TO_AVOID PLACING THE KEY EMPLOYEE OR OFFICER IN A POSITI 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 EN THEY HAVE A CONFLICT OF 1 it. _IN_ADDI' EACH ME} FP THE ARD. must. LETE_A_CO! FI DISCLOSURE ae ‘Scherlule © (Form 990 or 960-2) (2014) 11021105 781828 20097.3000 201.4.04030 ROCHESTER GENERAL HEALTH SY 20097_01(MANAGEMENT AND GENERAL EXPENSES Os FUNDRAISING EXPENSES On TOTAL EXPENSES 1,505,931. OTHER PURCHASED SERVICES: PR -E_EXPENSES. 22,655. MANAGEMENT AND GENERAL EXPENSES 0 FUNDRAISING EXPENSES Os TOTAL EXPENSES 922,655. TOT IER FEES ON FORM 0, PART 11 ce 4,565 » iM 0, PART X: NE Cc! i ACTUARIAL LOSS 63,694,289. K/TAX DIFFER] FOR _P! = = 7, 601. IRTIZATION O} IOR SERVIC! ‘DIT -567,147. TOTAL TO FORM 990, PART XI, LINE 9 65,819,037 aR, Schule 0 Form 000 o 60-2 20%8) 11021105 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01(Kaunoe uBsen ouEzueti pore: 0 20.098) ojoRLO F607 favger oeuue 1g pur “ssaippe “SUN e @ @ Sonemuesi9 yduerg-#] poi 1 VoReoyMUpLIeYoREMUBNCD [THE] WHLSAS HLTWGH TWHENES UALSHHON —“wesuRITaRpAES(neo see og | StorI00 =, some)eae gf xl moo ba ean {Yenay 40 uopesodiog © se o1qexe| suoRETIuEEI9 pere|ey Jo YORE DUNLAP Jo UORENURUOD [Re] WHISAS HIER TWHONED WHISHENnoctesueousrones a ee genni SEER wen ‘oe Sa ees) Te ss oy eto) eo” |e, w ‘s ° Sa RST a A SS SSS STR eh (enuonos ss016 Jo siesse RO} Ka pemsEoW) soe suo wodted Bry UBLA Bow paonpueD LORETLEGHO iA UO YEAR Gusieued 8 $e pay Ane YES 10} LONE} BuaMOres exh OPO "£6 009A ve ‘096 who. Wo ,89A, ParemouE uoRERUEBO ou y gecUED YsHOULIEY e Se O}GExEy SUOREZIUEEIO PANTEMN IA Ed emForm 6909 ev. 12014) ‘© Ifyou ae fing for an Adctional (Nok Automatlo) Month Extension, complete ony Part i and check this box ‘Note, Ont compat Prt youha aad ben saad an automat vont eenion on a prev fe Fer 3808. * ityou are fing fr an Automatic 3-Month Extanalon, complete oy Part Parti] Additional (Not Automatic) 3-Month, Etenalon of Tene Only Hla The igna fio Cops needa, Enter ‘Type or | Namo of exempt organization or other fle, seo instructions. Employer Kentiietion number (EIN) or print rweyse ROCHESTER GENERAL HEALTH SYSTEM 22-2551509 ‘edie umber, ate, and room or auteno. if P.O. box, see Instructions Social securty number SN) ‘timate [LOO KINGS HIGHWAY SOUTH. smoton cy, town of pos ols stl, and ZIP code Fora eelgn een ROCHESTER, NY 14617 Ertor the Return cod fr tho rotumn that this application Is fr (lea separate application for eech return) ‘pplication Return [Application Co oO G08. 02 i 03, ox 9 05, 08. HUGH CHISHOLM : 1 The books are in tho care ot > 100. HWAY SOUTH - ESTER, NY 14617 jophono No. 585-922-1221. FaxNo, & 585-922-: $330 = » ‘© ifthe organization doos not have an office or place of business inthe United States, check this Box... «tis ra oup Rtn, rer he cpanzten' er di coup Exton Number [1 . Wit is for part ot the roup, check this box. nd attach alist with the names “4 [request an addtional month oxtansion of te unt Cea 16,2015. 5 Forcalendar yoar 2014 , or other tax year beginning and enc, {6 Miho axyoarenteredin ne stores than 12 months, Gheckroasors [Tino Finalatur J change in accounting period 7. Stato in dotat why you nood the ADDITIONAL 13 NEEDED 10 THE INFORMATION NECES: TO FD COMPLETE AND ACCURATE TAX RETURN. ‘a thie appication is for Forms O90.L, OB0-PF, 9907, 4720, or 6068, entor the tentative tax, oss ary nonrefundable crecits. See instructions 'b_Ifthis application i or Forms Go0-PF, 60-7, 4720, or 6009, enter any refundable credits and estimated 12x payments made, Include any pir year overpayment alowed as a credit and any amount paid previously with Form 8968, © Bolance due. Subtract ine b fom ine Ga Include your payment with tis frm, required, by using [EFTPS (Bentonic Fedora! Tax Payfnont Syste). Seo instructions. 20 ‘Signature and Verification must be completed for Part If only. Under penalties of pir, | decte that have examined this form inlusing accompanying sehecues an lates, and tote best of my knowadgo and bait, Iota ores ana complete, and tat am authored to prepare this for. Sonate ise CFO. > oo | $ o. Form 6808 (Rev. 12044) 69 10231105 781828 20097.3000 _2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01x0. 204 Part ili] Tax Computation Po? Part iv] Tax and Payments ‘95 Organizations Taxable ex Corporations. Se nsucins for wx compulation ‘Controlled group members (sections 1661 and 1563) check here > [_] See instructions and: «pr mn 550 a ni: “ @is_____} ig a _ tb Ener organizations share of (1) Adtional 5% tx (not mre than $1,750) (2) Addtonal 3% tax (ot mare than $100.00), «Income tax one amount one 34 36 Tass Texabl at Tat Rates. Se isrctins or tx compan. eae aon he aunt on re 4 on (1 Taxtate senedule or [Schedule 0 (Form 104)... 37 Prony tax. See instructions 30 Aernatv minimum tat... ould es 37 and is. “404 Foran tx cre (corporations aanh Form 1118; wuss aah Form 1116)... ae 'b Ota cra (ste instucton) a 405 © Ganarelbusiness re, Attach For 3800 406 Cee for rir year imu ax tach For 8801 8827) Total ered. Ad tines 408 though 406, 41° Subtract ine 400 om ne 38... 42 Other tars. Check rome) Form dass L—}Fomaeit CET ex ae CF Form eas CT tr in ces * fa “43° Total tax. Add lines 41 and 42 eee “ 7 43. 0. dha Pts 420 epee [ii 1 3 marina pare a | © cue nom 8 ae ‘reunion ial dos oi tit f ¢ bey doe) : mn + Cont only nn ios anil ao ¢ 0ba cesta Eedramate ; Ciremese lone Lue 4 Tolpquem iia taona z rn ‘46 Estimated tax pena (se nstutons).Oheck Fm 2220s rl 446 ‘47 Tax ue. ifline 45 is less than the total of lines 43 and 46, enter amount owed AT 0 48 Overpayment. If line 45 is largor than the total of lines 43 and 46, enter amount overpaid... ~T ple] priererempeteripert iad” pe [Pasty | Statomonts garding Gortats actos oan ie ‘any tine during th 2014 calendar yar, ck th organization have an intrest in ara signature or ler athartyovera rani account an, eo) nan cy? ES Be roi eo fem Nam 14 oF Bankand nancial ‘name fhe fran county tae D> CAYMAN ISLANDS id Eniormatod of anon vauton Be NZL 7 2 3 4a Asst ten 29h eta he) Tnvertary atbegining ofa... [1 ventory at nd of year Porchasos (2 T Costot goods sold, Subvactine 6 Cost tibar. 3 ‘fom ne 5 Enter here ann Pat ne 2 1 Do tha ules of section 2898 respect. 1 Oter costs atch schedule)... [Ab propery produced or eer fo res pry to -$_ Total, pos ough ab 5. tisoranaton? epoca hl angie oe uaa aemn ended cay air a Ho, sign | sea Sate Sos tn ee atten strane otek pupae ay sae Here pessrrar Ie — i [Ei PrinvType prepares ame Prepare’ slonatre mat Paid sel-enoloyed Preperor 0 ELA 00589741 Use Only [Fitisnane ® FUST_CHARLES CHAMBERS LLP Femgin> _16~1226227 5764 WIDEWATERS PARKWAY Fin’sadses & SYRACUSE, NY 13214 ine 315-446-3600 Form 990-T 014) 10201104 781828 20097.3000 63 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01fom 3907 2014) ROCHRSTI HEALT! | ‘Schedule G - Investment income of a Section 501(c)(), (9), or (17) Organization Naren) = noe | SS | ese, | Se : ® fkcoeay | tatty | Sia oO) (2) e 4) imesocn oe Totals > 0 De ‘Schedule | - Exploited Exempt Activity Income, Other Than Advertising Income Sie Teen tontema | anaGoStBine | seus | Mgumeesiane | eras | Seem onus =| Vion | SERS | east | EEEae | “Gee | Ses cm a @) o [| ee mee > Ou 9 Oe ‘Gohsdute T= Aaverieing ome pee ranean Part | neomne From Perlodioals Reported ov a ConsOlGatod Baas ttt 4am. | tere. (SEEE| Seer | toe | SERRE : ‘aime? | etre [ol Se sae a ; i 3) 4 I (carry to Part I, line} >| 0. PERSrTiacSrts EIS) werodlcals Roported on a Sapsrate Baas Formch prada mora PanT mam Ceunme eeu? onatnenytne eat 7 oe, 8. oct, Somme | Oemarnie | satsoentiats — Hie | Sian = mm | See 4) a oI 4) Tetals:from Part! - >| 0. 0. Beas | Bead nite, L omen rece te OT ORTars, DVSSOTS, and THURtees ar TTOTEAD “CEL | eae = ie =| om Z Fi a Ss F 4) Total, Enver here and on pape §, Part lie 14 > 0 Fae BOOT a) 65 10201104 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01is! ‘Adjusted Current Earnings (ACE) Worksheet > Son ACE Worshent Into. 4 Preaustmen AUT Ent the znunt Kom he 3 of arm 4826, = =24,,96" 2 ACE deprecation ahstment: AMT E0207 anc 2a 1 ACE deprecation: (1) Pose 38) nnn LM (2) Post 1989, pre-1994 propery nn (EY (8) Pres860 MACRS propery, an (4) P1990 rial ACRS property ua) (6) Propet esebedinsectons eR (6) ter operty ano (2) Tot ACE depen. ais (1) rou 206), «ACE éreciatn aden Sub! ne 27) tom in 28 2 {+ Ieson ACE ofa ced in earings and pots (ESP Taxnongtineastnoone | a8 » Death ert om fe sues cons oe € Alor dations ome sree containing S06) oe [8 4 Is bul of undoes none nse COMO... 4 «ter iams se Repltos secon 1560-6 tough i) forapacalie) se 4 Total iras to AGE fom nin ACE tose ERP Ad es 9 tough Se a 4 Dsalovars oft ot adil rm EAP: 4 ora ian csv a ions pall on nin preted sok of pubis ies hat dea un 82109247 eran rm ¢ Dhients pul toan ESP ia ae dul udesdion 040) ae 4 Nonpabenage didnds a pad and deduce uder scion 1306) 7 “ «othr ns Regains stor 1.88) 6S) and (fora partis, {Totnes io AE because of dsaflonacs ams a edb ort EAP Ad in a 5 other agusnentsbasad onus to fouing EA: 4 Itangl etng oss ' Girelatoneendtras ¢ Organzaton penis UF Otvenryadustnants «instar ss : “ ¢ Total ter E4Padstnons Cabins ato sf 6 Diaioware oss on care of 61 008 un 3 7 Aequston penss ote nsane compas or quid aig convo z ® Depo 6 {Bal adstnors in normiing gr los Fan al or onan p10 popey as 0 inp. Contin nes 1,2, and trough, Ent resul ea one ot : 4 24,967. 10201104 781828 20097.3000 67 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01SCHEDULE O Consent Plan and Apportionment Schedule ater 120 (rare for a Controlled Group com sess tex oor) |S angen wo Form S120, 120, HOR HEDFEG Hy HEREC, HAERET, oF HBR Brerceazme | etn tacet stasan Gumi cas tains ean nese = Tee Ta aaa ROCHESTER GENERAL HEALTH SYSTEM 29-2581508 “Appsrtionment Blan Information ‘of controled group: 2] Pacent-subsiary group Brother sisor group Combined group Life insurance companies ony | 4 2 Th corporatin has boon a member of hi rv ‘a [] For the entire year. bL_J From, uni 3 This corporation consents and represents to: a [_] Adopt an apportionment plan. All the other members of this group are adopting an apportionment plan effective forthe ‘current tax year which ends on, ‘and forall succeeding tax years. ‘Amend the current apportionment plan. Althe olher members ofthis group are currently amending a previously adopted. plan, which was in effect for the tex year ending, and forall succeeding tax years. ¢[_] Terminate the current apportionment plan and not adopt a new plan, All the other members of this group are not adopting fan apportionment plan. 4 [X] Terminate the current apportionment pian and adopt a new plan. All the other members of this group are adopting an ‘apportionment plan effective forthe current tax year which ends on DECEMBER 31, 2014 _, and for all ‘succeeding tex yee, 4 If you checked box 3¢ oF 3d above, check the applicable box below to indicate if the termination of the current apportionment lan was: Elected by the component members ofthe grou. b [] Required for the component members ofthe group. 5 Ifyou did not check a box on line 3 above, check the applicable box below conceming the status of the group's apportionment plan (608 instructions. [__] No apportionment plan is in effect and none is being adopted, ‘6 _] An apportionment plan is already in effec. It was adopted for the tax year ending all succeeding tax years. . and for {6 fall the members of this group are adopting a plan or amending the current plan fora tax year after the due dato (including extensions) ofthe tax return for this corporation, is there atleast one year remaining on the statute of imitations from the date this corporation fled its amended return for such tax year for assessing any resulting deficiency? See instructions, Yos. [__] Tre statute of limitations for this year wil expire on Jon "this corporation entered info an agreement wih the Internal Revenue Service to ‘end the statute of iitalions for purposes of assessment unt : 1» [X] No. The members may not adopt or amend an apportionment plan, 17 Required information and elections for component members. Check the applicable box(es) (see instructions) ‘The corporation will determine its tax liability by applying the maximum tax rate imposed by section 11 to th offs tvabl income ©] the corporation nd the other members ofthe group eect the FIFO method (rather than defauling to the propartonste method) or aloctng ne actltonal aes for the group imposed by section 410). ¢(T the comporeton tas a sor tax yea tet doesnot nce December 94 TsO (Form 190) ev 129013) racine for Form 1120, For Paperwork Reduction Act Nalco, e0eee mo seed omnes Te ssT EL BOSS OO VETS OO TTT Tr a ‘ 2 wo ore 9 —— oss os a8 OES NOTINGIZY NSTY_oowso + TO"SES"E oT 0700 oF 6 00 TEES IO LOT | ane Re ane wewaneo wevsaHoou9 Tors a0 a TLTaSOH STNOASOO ann RTGS Ta “ast ‘Noravannos sap? wT 50 "THITESOR croranas wansaioo¥e TUF WI ar Pos fos hs or “oar ‘wz wore 38 or oo a8 SISK aan Tewaao wexsen00u + (O) ufnona (a) ene 4% xs se we | ose wa atetend (6) 0 ) (p) e) @) ‘wounopoddy x61 ou000 Peer eostsse-2z (eros) weaned ra 30501 TN TlOezr TERI ET LTO MONS WSESKS HUTWaN TeYENED waESaHOONInformation Return of U.S. Persons With Respect To Certain Foreign Corporations > Formers intrmaton abost Foun 6471, see wnw.e.govforms7'. Information fried fr the foreign erporatons annual accountng period (xyear equred by (OM Wo, 1545-0704 roo S471 (December 2012) ame of person fling ROCHESTER GENERAL HEALTH S¥sTaM —___| _22-2551509 ___ FES acento 0 Dr ne tv teri HOTT —13 aga fa (Su nuslons Choo pp bane 100 KINGS HIGHWAY SOUTH dt 4 2 3 4 © Ener tol percrian oe fron eapoaen's voting stack (iy ara, tt, and ZP code ROCHESTER, NY 14617 you owned at he endo is amualaecaintngpeiod 100.00 % ‘tachment Sequence Ho. 724 A tdeniying number Flloe’staxyear beginning JAN 1. 2014 ,andondng DEC 31 2014 ‘D_ Person(s) on whase behalf this information return is filed Smt 4 nae eyes oping unc fe ae ‘CONTE 00 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 2-2963016 GRHS FOUNDATION, [333 HUMBOLDT oT ROCHES INC Wy 14610 ba-3376111 ‘important: Fir al eppicable thes and schedules. Alinformation must be in Engish. Al amounts must be stated in U.S. dollars unless othanvse inceated. ‘a Nae and adres of oegn corporation At) Enmpoyrenteaon ruber, any GREATER ROCHESTER ASSURANCE COMPANY, LTD 000000000 94 SOLARIS AVENUE, SECOND FLOOR Wf) Patereon 0 number (ee skuctons) CAMANA BAY, GRAND CAYMAN CAYMAN ISLANDS our ander woos ave neopraed CAYMAN. ISLANDS: 7 Dats at To Paar pcs oT bans Fahne Ta Pra ames oy Fanconalcureney incorporation ages aay" TNSORANCE 9 ISLANDS 524290 ITED STATES 2 Prove th folg frmlion fort frgn export’ acsouning sod sd above, 1 ama, ass, and ientigng numberof branch ofc or agent (ary) inte Uned States 1 a wre an ed, ROCHESTER GENERAL HEALTH SYSTEM a ves) | (US: tae xpd 100 KINGS HIGHWAY SOUTH (Fava incor or (oss) | (ati al crs) ROCHESTER NY 14617 2,798,001. 22-2551509 7 peasant aes ara Rae cee bm Eorpratn, andthe xt ech boos an acs, arent ‘Schedule Al Stock of the Foreign Comoration {i ia of are ast and onsen (0) Desctn of cach class of stosk Weeciing of annual | (End of anaal scouring pod taining prod COMMON 450,00. 450,000 Ferm GATT (Rav. 122012) THA For Paperwork Redvtion Act Notice, 14501103 781828 20097.3000 _2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01ROCHESTER GENERAL HEALTH SYSTEM 22-2551509 Fer 5471 (Rev. 12-2012) ‘Schedule E] income, War Profits, and Excess Profits Taxes Paid or Accrued ‘Anowa a fae of county or US. possession © o idles Iateoptueny | consort nus os ‘Schedule F | Balance Sheet. Important: fepor al amounts in U.S. dolarspropared end tenslated In accordance with U.S. GAAP. See instructions for an exception far DAST corporations. : ‘ faa weal | coed coum | tebe, 2,454,170.[ 4,277,587. r t 1 528,268, G00, 594. C88 nn ry Trade notes and accounts receivable Less alowance or bat debs Ivette nnn Othe curt asonsatar stfoment) : Loans to sharnotersandcter alte persons 8 tnvestmantin ubsdaries(atah statement, 7 Otherovestments (aac statement. 8 Buldngs and oterdeprecible assets 'bLoss accumulate deprecation. Depleable asst. Lass accumulated dpition 10 Land (net ofany amortization) 11 Intangible assets: 8 GOB > Organzation costs Patents, ademas, 44 Loss aoounuiaed amortization oie 11a b an 12 Other assets (atch statement. i 67,089,073.| 63,432,536. ss] 70,071,511. 68,120,717 18_Tololabsis iso Liabilities and Shareholders’ Equity 7 77,078 673,774. 16 | 13,710,137.| 12,407, 850. 16 | 49,145,378. 46,248,933. re 18 Other eurontlablitas tach statement) 18 Loans om strshoters and oer elated $7 Ofer Habits (atch state) 18 Captlstcke Proteredsock . in Common stock 2 100 450,000. 450,000. 1 Paitin or capi sips (ach rconlaon) 19 20° tad CTI... ainsrantinease | 6,688,918.| 8,330,160. 21 Less cost ot easy tak oe paede in 3 22_Tol bites tarot’ sgn | 70,071,511] 66,110,717. eam G474 (fe. 12-2012) 14501103 781828 20097.3000 — 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01Grozei ne here wed rempeKoS “29g ug 305 suogoneu ein o9s eonON3o¥ woRINPSH HoMeded 04 _vETT “Ean Sov It | cay Sov TT ; ‘yun srins ¢ ou) 0060 PURE Pesh "So TT i aa ca pace Asoo fs PLSe" ESET Pase"ase"T Ese L9eT ooaas aa TAING w SCS" LE0 OT | 9e9"L60 OT Teak jo Buraaibeg ie SueES Gere | eacon Sony oueaneag | fadosnu » | Gamrateoese | eomea aioe suuuryeo euquica) ‘a vedens Ww | ipower sto (| pate souneg O votes mt 6) ‘Geos poe (658 Sueno) drape Aenonais() 790000000 SS WETS WEEREWD sareananns Gone comin sency samy GOSTSSC-eE WHISKS HWA TWHENED URISHHOOE orannorapacenrnta at coc 5 | Sas 4 aman 25008 burg wu: ynoge vonewoyH seated a, UoReIOdI0D uBIEI04 paljouoD jo (Ltvg unos) (223) Sisoig pue sbuywe payenlunooy e-71nqaHosROCHESTER GENERAL HEALTH SYSTEM 22-2551509 FORM 5471 PERSON(S) ON WHOSE BEHALF THIS STATEMENT 4 INFORMATION RETURN IS PILED (4) CHECK APPLI- CABLE BOX(ES) (3) IDENTIFYING SHR- OFFI DIREC (1) NAME (2) ADDRESS NUMBER © HLDR ~CER -TOR 16-6429300 ROCHESTER GEN HEALTH 1425 PORTLAND AVENUE SYS WORKERS COMP TR ROCHESTER GENERAL HOSPITAL LT CARE INDEPENDENT LIVING FOR SENIORS BEHAVIORAL HEALTH NETWORK ROCHESTER GENERAL HOSPITAL FOUNDATION ROCHESTER GENERAL HUDSON HOUSING ROCHESTER GENERAL HOSPITAL NEWARK WAYNE COMMUNITY HOSPITAL ROCHESTER NY 14621 1550 EMPIRE BOULEVARD WEBSTER 22-3187140 NY 14580 2066 HUDSON AVENUE ROCHESTER 16-1491059 NY 14617 490 EAST RIDGE ROAD ROCHESTER 16-6069131 NY 14621 1445 PORTLAND AVENUE 22-2229425 ROCHESTER NY 14621 2066 HUDSON AVENUE ROCHESTER 22-3210351 NY 14621 1425 PORTLAND AVENUE 16-0743134 ROCHESTER NY 14621 DRIVING PARK AVENUE NEWARK NY"15-0584188 14513 WESTERN NEW YORK 1425 PORTLAND AVENUE 61-1654232 MEDICAL PRACTICE PC ROCHESTER NY 14621 FORM 5471 OTHER INCOME STATEMENT 5 FUNCTIONAL © EXCHANGE DESCRIPTION CURRENCY RATE U.S. DOLLAR NET PREMIUMS EARNED 3,247,913. INVESTMENT INCOME 3,605,797. TOTAL TO 5471, SCHEDULE C, LINE 8 6,853,710. 14501103 781828 20097.3000 STATEMENT(S) 4, 5 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01ROCHESTER GENERAL HEALTH SYSTEM 22-2551509 Neen ee ee EEE Ere FORM 5471 OTHER LIABILITIES STATEMENT 10 BEG. OF ANNUAL END OF ANNUAL | ‘ACCOUNTING ACCOUNTING DESCRIPTION PERIOD PERIOD RESERVES-LOSSES & LOSS ADJ EXPEN 49,145,378. 46,248,933. TOTAL TO 5471, PAGE 3, SCHEDULE F, LINE 17 49,145,378. 46,248,933. FORM 5471 OTHER NET ADJUSTMENTS STATEMENT 11 NET NET DESCRIPTION ADDITIONS SUBTRACTIONS TAX ADJ FOR UNDERWRITING LOSSES 163,628. NON-INSURANCE PREMIUMS PAYMENTS 1,593,772. TOTAL TO 5471, PAGE 4, SCHEDULE H, LINE 2H 163 , 628. 1,593,772. ee STATEMENT(S) 10, 121 14501103 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01ROCHESTER GENERAL HEALTH SYSTEM 22-2551509 Page 2ot2 CT-2@2014) Form CT-186- filers only 40 Excise taxon tslacommunicatin services -NYS 41 Taxon gross income -NYS 42 MTAaurcharge related to telecommunleation services 48 MTAcurchargo on gross Income 44 NoCTS.9€ fied and ne 1 ie over $1,000- NYS a enn gL [ileeanmenemncerel) al al) 45 NoCTS9E fd and tno 1's over $1,000-MTA &.— Ch fl) fl al 46 NoCTS.GE fled and tne 2is over $1,000- NYS 47 NoCTS.GE fad and tne 2 ls over $1,000-MTA 48 Add tnes Band 9-NYS 49. Addlinas 8 and 9-MTA 80 Balance duo NYS 81 Balance du - MTA 52 Provided telecommunication service in the MOTD ths yoar? (None = 0, Y= 1, N= 2, Both = 3) HOOOODOUGHOOO00 Fl 58 Suto super fe parma of Publ Save and pred ty saves na MCTO'N lar? one 0, Y= 1, w= 2, Boe = 62 —] 54 Overpayment credited to next you's tax-NYS fl {65 Overpayment credited to next yoar's tax: MTA, LC 58 Refund of ovomaymont -NYS fel 57 Refund of overpayment MTA | me 58 Refund of unused tx croits-NYS al ICI 59 Refund of unused tax credits - MTA Fine eeenseceemeeeee | [e] {60 Refundable tax eredits tobe crested to next year's tax-NYS. aL 61 onde tax cots to be creed ones yore: MTA i eee] [ed] BER. 1019 541002141019 WYATT A APage 20f3 CT-13 2014) Have you been auted by the Internal Revenua Savio inthe past years? Yes [] wo [K], ves tstyeers___ Federal retum was don: 9007 [KX] other: O ‘Attach @ complete copy of yourfoderal return, Schedule A - Unrelated business allocation It you did not maintain arogular place of business outside New York Stato, leave tis schedule blank. A regular place of business any office, factory, ‘warehouse, or other apage regulary used by tho expan ils Ureated tuslness. you clam thi allocation attach a let of exch place of business, the location, nature of activites, and number and dutes ofampoyees.. 5 a Now York State Everywhere ‘Average value of: 26 Real estate ned 27 Gross rents attach FS) ves 28 Inventocos owned ne ‘29 Other tangible personal property owned. 90 Total (a lines 26 trough 29) ae : {81 Percentage in New York State avi ina 30, column A, by kine 80, coluran B) Receipts in the regular course of business from: ‘82, Salos of tangible personal property shinped to es pont wn New York Stato, oe 29 Asal of tangible prenal propery * [aa 24 Sones petorMed ni ~ [aa 5 Rentals o roperty ~ [a 238 Other busines recip ra 36 31 Tota add ies 32 trough SB a7 98. Poreantage in Now York Stato (vido line $7, column A, by ine 37, column B) i ise %) ‘90 Wage, ales, another compensation of employees (orca gnarl eaUth@ M8) coon 2 40 Percentage a New York State ais lino 39, cotnn A, bye 2, comm B) coon fa % 44 Total of New York State percentages fd ines 81, 38, nd 4) oe cntacsattonnes Hl % usnas aocaton 1b ee ory a % mposition of prepaym ‘on lin ‘Bato paid’ “Amount 49 Payient with extension request, Frm CTS, ne | 05-15-15 “250. ‘44a Socond instalment rom Form C7400 te 44 The ntament om Form CTACD so a ‘4e. Fourth natalmant om Form CT-00 ae {48 Amount of overpayment cxolod om pir Yar sone a [as ar 250. {48 Totlpropaymonts (ad ines 43 through 48; entree and on ine 1 : + Taxpayers subject othe unrelated businss income tax are not requ to make estimated tax payments Ityou id make thes unvoqured payments, epart them on ines 44a, 4b, ana-44. ‘Amended return information it fing an amended tum, mark an x inthe boxer any Kame thet apply and attach documentation. O marke, ener date of determination: ® Fin! federal determination Not operating lots (NOL) campback ,. ¢[_] Capital tosscanyback Fem 1199 [7] arded Form 80. Federal retum ted amie anROCHESTER GENERAL HEALTH SYSTEM 22-2551509 FOOTNOTES STATEMENT 1 NOL CARRYFORWARD TO 2014 ADD: NOL GENERATED NOL CARRYFORWARD TO 2015 65,604. 24,717. 90,321. STATEMENT(S) 1r Send with oe and attachments te CHARS00 Sched atareycows’ | 2014 NYS Annual Filing for Charitable Organizations oO A a") Open to Public ‘www.CharitiesN'YS.com reer Inspection 4.General Information For Fecal Year Beginning inmvddiyon) 01/01/2014 — endendng mnladinny) 12/31/2014 ‘heck t Appia Nam of Organization: Employer nieation Numibor EINE [1 Adress Change | ROCHESTER GENERAL ‘TH SYSTEM _ 22-2551509 I] Name Change | Maling Address: (NY Registration Number: (inating 100 KINGS HIGHWAY SOUTH 03-60-97 I Final Fiing ‘Gity / State / ZIP: Telephon: J amondedFiing | ROCHESTER, NY 14617 585 922-3000 I) reg 10 Pending — | Website: Emak: _WWIW. ROCHESTERGENERAL . ORG Find you registration category inthe eck yor oganizaon’s ropsatonategoye Ci] 7aenty CCleprieny Cl oua.caacony Clexemer ftvaundsti sae hs 2. Certification [See ne:uotions (or caliicalion roqukements. improper cortfication is voaton of tw that may be subject to penalties. We cortty under ponte of perry that we reviowed ths report, Inuding al attachments, and tothe best of cur krowtede and bate, ‘hey re tue, coneot and camper in accordance wih the ws of th State of Now York epplicable to this report HUGH THOMAS President or Authorized Offer: Sonam ‘int Name and Tile ate ‘THOMAS R. CRILLY (Chiot Financial Ofc or Treasurer Senaiwe Print Name and Tite ‘ato ‘Annual Re ‘hock the exemption() that apply to your fing. your erganization fs laring an exemption undar the catogory (TA end EPTL only fra r both Cctegories (DUAL. ters) that apply to your registration, complata only pars 1,2, and 3, and submit the ceriied CharS00. No fee, schedules, o- ‘daltionalatachments are requitd. I you cannot claim an exemption or ar a DUAL fer that claims onty one exemption, you must fle appicable ‘schedules and attachments and pay applicable foos. 38:22 ion: Total contrbutions from NY State including reeidents, foundations, government agencies, etc, did not ‘exceod $25,000 and the organization ais not engage a protesslonal fund ralsor(PFR) or fund raising counsel (FAG) to soft ‘contributions during th ical year. Or the organization quate for another 7A exemption (e inetruction). (Jab: £P1 ning exemption: Gross receipts did not exceed $25,000 and the market valve of assets did not exceed $25,000 at any time luring the cl yoar. 4 Schedules and Attachments Soothe folowina pape] foracheckset of — |] Yes DX] No 4a. Did your organization use a professional fund rasa, fund raising counselor commercial coventur schedules and for fund rising activity in NY Stato? if yes, complste Schedule 4, attachments to complete your fing. |[—] Yes [3k] No 4b, Did the organization receive government grants? Ifyes, complete Schedule 4b. 6. Fee ‘eo the checkist on the ing too: ETL ng foo al fo See eeaaasre eee ae ‘Total ke a single check or money order io feof) Indicate o0() you reser ‘Department of Law are cubmiting her $ 25. |S. 25. | §, 50. $914 1018 CHARSOO Annual Filing for Charitable Organizations (Updated Docomber 2014) Paget 1 10201104 781828 20097.3000 2014.04030 ROCHESTER GENERAL HEALTH SY 20097_01