Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 01-01-2014 , and ending 12-31-2014
BCheck if applicable:
CName of organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1000 SOUTH AVENUE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ROCHESTER, NY14620
D Employer identification number

16-0743037
E Telephone number

G Gross receipts $ 312,781,392
F Name and address of principal officer:
STEVEN GOLDSTEIN
1000 SOUTH AVENUE
ROCHESTER,NY14620
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
http://www.urmc.rochester.edu/hh/
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1889
M State of legal domicile: NY
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: OPERATION OF AN ACUTE CARE HOSPITAL COMMITTED TO SERVICE EXCELLENCE IN THE HEALTHCARE INDUSTRY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 17
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 13
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 3,011
6 Total number of volunteers (estimate if necessary) ............. 6 354
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 592,483 131,925
9 Program service revenue (Part VIII, line 2g) ......... 288,411,216 295,660,316
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 690,492 733,950
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 13,242,258 16,255,201
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 302,936,449 312,781,392
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 180,247,043 182,666,698
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 106,209,489 108,842,032
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 286,456,532 291,508,730
19 Revenue less expenses. Subtract line 18 from line 12....... 16,479,917 21,272,662
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 290,273,684 314,435,013
21 Total liabilities (Part X, line 26)............. 131,740,872 176,253,572
22 Net assets or fund balances. Subtract line 21 from line 20..... 158,532,812 138,181,441
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: HIGHLAND HOSPITAL OF ROCHESTER ("HIGHLAND") PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. HIGHLAND OPERATES A 261 BED ACUTE CARE HOSPITAL, AS WELL AS 13 PRIMARY CARE SATELLITE CLINICS, AN OB/MIDWIFERY CLINIC, BREASTCARE CLINIC AND THREE RADIATION ONCOLOGY TREATMENT CENTERS. HIGHLAND IS ALSO A TEACHING AFFILIATE OF THE UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY. HIGHLAND'S SERVICE AREA INCLUDES MONROE COUNTY, NEW YORK, AS WELL AS SEVERAL COUNTIES SURROUNDING THE ROCHESTER, NEW YORK REGION. IN 2014, HIGHLAND HAD 15,778 ADULT ADMISSIONS, DELIVERED 3,200 NEWBORNS AND HAD 42,375 PATIENTS TREATED IN ITS EMERGENCY DEPARTMENT. HIGHLAND IS COMMITTED TO SERVICE EXCELLENCE IN HEALTHCARE- ONE PERSON AT A TIME. HIGHLAND'S MISSION IS TO BE THE COMMUNITY HEALTHCARE PROVIDER RENOWNED FOR UNMATCHED SERVICE, EXCELLENCE AND BEST PATIENT OUTCOMES. HIGHLAND'S POLICY IS TO TREAT PATIENTS IN NEED OF MEDICAL SERVICES WITHOUT REGARD TO THEIR A
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 249,026,321 including grants of $ 0 ) (Revenue $ 311,915,517 )
PROVISION OF HEALTHCARE SERVICES, INCLUDING INPATIENT SERVICES, ANCILLARY SERVICES AND ED/CLINIC/AMBULATORY SERVICES. ALSO SEE ATTACHMENT 1.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet249,026,321
Form 990 (2014)
Form 990 (2014)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
Yes
 
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III
Click to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV
.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
221
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
3,011
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?
.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2014)
Form 990 (2014)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
17
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NY
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletADAM ANOLIK
1000 SOUTH AVENUE
ROCHESTER,NY14620 (585) 275-3033
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) STEVEN I GOLDSTEIN........................................................................
CEO
8.0
.......................56.5
X   X       0 942,378 280,988
(2) BRENT DUBESHTER MD........................................................................
BOARD MEMBER
2.0
.......................55.0
X           0 1,171,901 47,378
(3) AMY KATES........................................................................
SECRETARY
2.0
.......................0.0
X   X       0 0 0
(4) ANN MARIE COOK........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(5) BELINDA LISCHERELLI........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(6) KAREN LAMY........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(7) DAVID DEJOY........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(8) JOSEPH JOHNSON MD........................................................................
BOARD CHAIR
2.0
.......................55.0
X   X       0 645,855 42,925
(9) CHRISTIAN MODESTI........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(10) RICHARD LEFROIS........................................................................
BOARD MEMBER (THRU JUNE 2014)
2.0
.......................0.0
X           0 0 0
(11) TED HIROKAWA MD........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(12) HON FRANCIS AFFRONTI........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(13) MARK EIDLIN........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(14) BILAL AHMED........................................................................
BOARD MEMBER
2.0
.......................55.0
X           0 352,136 67,644
(15) MICHAEL RIORDAN........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(16) KATHLEEN WHELEHAN........................................................................
VICE CHAIR & TREASURER
2.0
.......................0.0
X   X       0 0 0
(17) J STEVEN BURKHART MD........................................................................
BOARD MEMBER
3.0
.......................0.0
X           9,636 0 0
Form 990 (2014)
Form 990 (2014)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) NED NICOSIA........................................................................
BOARD MEMBER
2.0
.......................0.0
X           0 0 0
(19) CINDY BECKER........................................................................
COO
40.0
.......................1.0
    X       301,536 0 90,406
(20) ADAM ANOLIK........................................................................
CFO
9.0
.......................54.0
    X       0 320,751 47,308
(21) RAYMOND MAYEWSKI MD........................................................................
CHIEF MEDICAL OFFICER
9.0
.......................51.5
      X     0 604,132 117,066
(22) TOMMYE HINTON........................................................................
CHIEF NURSING OFFICER
40.0
.......................4.0
      X     228,099 0 31,029
(23) LORI FERRIS MD........................................................................
PHYSICIAN
40.0
.......................0.0
        X   429,490 0 67,291
(24) JULIETTA FISCELLA MD........................................................................
PHYSICIAN
40.0
.......................0.0
        X   377,554 0 64,555
(25) JEFFREY HANSON MD........................................................................
PHYSICIAN
40.0
.......................0.0
        X   325,918 0 60,097
(26) GREGORY RYAN MD........................................................................
PHYSICIAN
40.0
.......................0.0
        X   318,884 0 63,821
(27) MAUREEN PERRY........................................................................
PHYSICIAN
40.0
.......................0.0
        X   235,754 0 58,454
(28) LEONARD J SHUTE........................................................................
FORMER EXECUTIVE VP & CFO
0.0
.......................0.0
          X 0 271,929 25,318




1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,226,871 4,309,082 1,064,280
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet82
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
HOLDSWORTH KLIMOWSKI CONSTRUCTION L,
51 GOODWAY DRIVE SOUTH
ROCHESTER,NY14623
GENERAL CONSTRUCTION 2,745,222
LECHASE CONSTRUCTION,
205 INDIGO CREEK DRIVE
ROCHESTER,NY14626
GENERAL CONSTRUCTION 1,417,338
DGA BUILDERS LLC,
1170 PITTSFORD-VICTOR RD STE 100
PITTSFORD,NY14534
GENERAL CONTRACTOR 1,101,596
EXECUTIVE HEALTH,
15 CAMPUS BLVD
NEWTOWN SQUARE,PA19073
PHYSICIAN CONSULTING 755,474
MED-SCRIBE INC,
535 WILLOWBROOK OFFICE PARK
FAIRPORT,NY14450
TRANSCRIPTION 321,838
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet16
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 131,925
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above
1f
 
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 131,925
 Program Service RevenueAmt Business Code
2a NET PATIENT SERVICE REVENUES 900099 295,660,316 295,660,316    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 295,660,316
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 733,950 0 0 733,950
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA REVENUE 900099 775,058 775,058    
b PARKING REVENUE 900099 1,199,963 1,199,963    
c CONTRACT PHARMACY REVENUE 900099 4,648,093 4,648,093    
d All other revenue .... 9,632,087 9,632,087    
e Total. Add lines 11a–11d ...... MediumBullet 16,255,201
12 Total revenue. See Instructions......MediumBullet 312,781,392 311,915,517 0 733,950
Form 990 (2014)
Form 990 (2014)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 0  
2 Grants and other assistance to domestic individuals. See Part IV, line 22 .... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............ 0  
4 Benefits paid to or for members .... 0  
5 Compensation of current officers, directors, trustees, and key employees .... 529,635 0 529,635 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages .... 142,219,418 118,042,117 24,177,301 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 8,756,018 7,442,615 1,313,403 0
9 Other employee benefits ....... 22,622,968 19,229,523 3,393,445 0
10 Payroll taxes ........... 8,538,659 7,257,860 1,280,799 0
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 290,856 0 290,856 0
c Accounting ........... 168,992 0 168,992 0
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 2,328,872 1,863,098 465,774 0
12 Advertising and promotion .... 514,491 0 514,491 0
13 Office expenses ....... 2,864,655 2,291,724 572,931 0
14 Information technology ...... 1,525,476 915,286 610,190 0
15 Royalties .. 0      
16 Occupancy ........... 3,648,552 3,648,552 0 0
17 Travel ............ 47,405 45,035 2,370 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 1,470,491   1,470,491  
21 Payments to affiliates ....... 356,748 356,748 0 0
22 Depreciation, depletion, and amortization ..... 17,456,332 13,239,697 4,216,635 0
23 Insurance .............. 0      
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a PHARMA & MED SUPPLIES 46,723,681 46,723,681 0 0
b MISCELLANEOUS EXPENSES 8,533,872 8,533,872 0 0
c LAB OUTSIDE PROCESSING 4,517,961 4,517,961 0 0
d EQUIPMENT MAINT/REPAIRS 1,947,361 1,557,889 389,472 0
e All other expenses 16,446,287 13,360,663 3,085,624  
25 Total functional expenses. Add lines 1 through 24e 291,508,730 249,026,321 42,482,409 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 26,680,992 1 31,553,764
2 Savings and temporary cash investments ......... 63,250,989 2 74,663,150
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 17,337,660 4 19,750,100
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 3,977,284 8 4,514,965
9 Prepaid expenses and deferred charges .......... 1,557,131 9 1,890,312
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 306,208,102
b Less: accumulated depreciation ..... 10b 171,116,210 128,977,630 10c 135,091,892
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 48,491,998 15 46,970,830
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 290,273,684 16 314,435,013
Liabilities 17 Accounts payable and accrued expenses ......... 22,685,201 17 25,436,624
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 469,988 19 867,598
20 Tax-exempt bond liabilities ............. 33,416,474 20 30,676,538
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 75,169,209 25 119,272,812
26 Total liabilities. Add lines 17 through 25......... 131,740,872 26 176,253,572
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 158,532,812 27 138,181,441
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 158,532,812 33 138,181,441
34 Total liabilities and net assets/fund balances ........ 290,273,684 34 314,435,013
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
312,781,392
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
291,508,730
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
21,272,662
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
158,532,812
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-41,624,033
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
138,181,441
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? .................
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total    

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors (explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7   Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
 
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions
 
9 Distributable amount for 2014 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2014
(iii)
Distributable
Amount for 2014
1 Distributable amount for 2014 from Section C, line
6
 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)
 
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2014 distributable amount  
i Carryover from 2009 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2014 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2014 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2014, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)
 
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)
 
7 Excess distributions carryover to 2015. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$ 0
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$ 0
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2014

Schedule C (Form 990 or 990-EZ) 2014
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in)
(a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e))
 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))
 
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2014


Schedule C (Form 990 or 990-EZ) 2014
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
17,483
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
17,483
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
DETAIL OF LOBBYING HIGHLAND HOSPITAL IS A MEMBER OF REGIONAL, STATE AND FEDERAL HEALTHCARE ORGANIZATIONS AND PAYS DUES ON AN ANNUAL BASIS. A PORTION OF THESE DUES HAS BEEN DETERMINED TO HAVE BEEN ALLOCATED BY THESE ORGANIZATIONS TO SUPPORT LOBBYING ACTIVITIES. THE TOTAL AMOUNT ALLOCATED FROM HIGHLAND HOSPITAL'S DUES IN 2014 WAS ESTIMATED TO BE $17,483.
Schedule C (Form 990 or 990EZ) 2014

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 3,229,007 3,029,833 2,865,502 3,043,521 2,985,938
b Contributions ........ 2,060 3,256 27,086 2,350 2,390
c Net investment earnings, gains, and losses -29,638 195,918 137,245 -180,369 55,193
d Grants or scholarships .....   0 0 0 0
e Other expenditures for facilities
and programs ........
  0 0 0 0
f Administrative expenses ....   0 0 0 0
g End of year balance ...... 3,201,429 3,229,007 3,029,833 2,865,502 3,043,521
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   232,769 232,769
b Buildings ................   147,286,139 72,473,510 74,812,629
c Leasehold improvements ............   989,773 726,942 262,831
d Equipment ................   147,996,122 97,915,758 50,080,364
e Other .................   9,703,299   9,703,299
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 135,091,892
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) OTHER RECEIVABLES 26,346,341
(2) ASSETS WHOSE USE IS LIMITED 4,211,589
(3) DEFERRED AND OTHER INTANGIBLES 1,073,922
(4) OTHER ASSETS 4,066,048
(5) RECEIVABLE FROM HLC, INC. 1,785,300
(6) RECEIVABLE FROM HCDC 325,384
(7) RECEIVABLE FROM UNIV OF ROCH 1,448,288
(8) RECEIVABLE FROM THE MEADOWS 121,878
(9) INSURANCE CLAIMS RECEIVABLE 7,592,080
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 46,970,830
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ACCRUED PENSION LIABILITY 89,916,047
EST. PROFESSIONAL LIABILITY 8,178,600
ACCRUED WORKERS' COMP LIABILIT 10,505,956
EST. THIRD PARTY SETTLEMENTS 10,672,209





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 119,272,812
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
FORM 990, SCHEDULE D, PART V, LINES 3A & 4 DETAIL OF ENDOWMENT FUNDS ALL ENDOWMENT FUNDS ARE HELD AND ADMINISTERED BY HIGHLAND FOUNDATION INC., A RELATED IRC SECTION 501(c)(3) ORGANIZATION, FOR THE BENEFIT OF HIGHLAND HOSPITAL IN FURTHERANCE OF ITS CHARITABLE HEALTH CARE SERVICES.
Schedule D (Form 990) 2014

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the TreasuryInternal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
    8,653,523 3,808,486 4,845,037 1.660 %
b Medicaid (from Worksheet 3,
column a) ....
    71,741,736 63,993,203 7,748,533 2.660 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
           
d Total Financial Assistance
and Means-Tested
Government Programs .
    80,395,259 67,801,689 12,593,570 4.320 %
Other Benefits
           
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
    10,585,502 3,556,796 7,028,706 2.410 %
g Subsidized health services
(from Worksheet 6) ..
    36,305,788 27,443,839 8,861,949 3.040 %
h Research (from Worksheet 7)     1,541,043 1,541,043    
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
    17,000 0 17,000 0.010 %
j Total. Other Benefits ..     48,449,333 32,541,678 15,907,655 5.460 %
k Total. Add lines 7d and 7j .     128,844,592 100,343,367 28,501,225 9.780 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
4,623,890
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
166,200
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
136,897,700
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
129,423,900
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
7,473,800
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 HIGHLAND HOSPITAL
1000 SOUTH AVENUE
ROCHESTER,NY14620
http://www.urmc.rochester.edu/hh/
LICENSE# 2701001H
X X   X     X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HIGHLAND HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?....................... 1 Yes  
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.......... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12.................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................ 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public? .............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website? ........ 10 Yes  
a If "Yes" (list url): SEE SUPPLEMENTAL DISCLOSURE
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HIGHLAND HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Financial Assistance Policy (FAP)
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?....... 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HIGHLAND HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?......... 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................ 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................ 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
PART V, SECTION B, LINE 5- INPUT FROM COMMUNITY COMMUNITY INPUT IS AN ONGOING PROCESS IN MONROE COUNTY AND COLLABORATION AMONG THE HOSPITALS AND THE COMMUNITY IS VITAL TO INFORM OUR AGENDA. EACH OF THE HOSPITAL SYSTEMS INCLUDED IN THE CHNA: UNIVERSITY OF ROCHESTER MEDICAL CENTER STRONG MEMORIAL HOSPITAL, HIGHLAND HOSPITAL, AND ROCHESTER REGIONAL HEALTH SYSTEM TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY. THE MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH WAS REPRESENTED AT EACH COMMUNITY BENEFITS MEETING BY EITHER ANNE KERN, PUBLIC HEALTH PROGRAM COORDINATOR, OR BYRON KENNEDY, MD, PHD, MPH, DIRECTOR OF THE HEALTH DEPARTMENT. BOTH ARE AWARE OF COMMUNITY NEEDS, OVERSEE THE ADULT HEALTH SURVEY AND ARE EXPERTS IN EFFECTIVE PUBLIC HEALTH ASSESSMENT AND INTERVENTION. THERESA GREEN, DIRECTOR OF COMMUNITY HEALTH POLICY AND ANDREA DEMEO, EXECUTIVE DIRECTOR AND CHIEF OPERATING OFFICER, BOTH FOR THE URMC CENTER FOR COMMUNITY HEALTH, PROVIDED EXPERT ADVICE ON COMMUNITY ENGAGEMENT AND EVIDENCE BASED INTERVENTIONS. IN ADDITION, FINGER LAKES HEALTH SYSTEM AGENCY, WHO REPRESENTS THE COMMUNITY VOICE AND WHO MANAGES BOTH THE AFRICAN AMERICAN HEALTH COALITION AND THE LATINO HEALTH COALITION AND THE BLOOD PRESSURE COLLABORATIVE FOR MONROE COUNTY, WAS REPRESENTED AT EACH MEETING BY EITHER WADE NORWOOD, DIRECTOR OF COMMUNITY ENGAGEMENT OR AL BRADLEY, SENIOR MANAGER. THIS HIGH LEVEL COLLABORATION AMONG COMMUNITY MEMBERS, PUBLIC HEALTH PROVIDERS AND HOSPITAL SYSTEMS, ALONG WITH THE ROBUST HEALTH ACTION PROCESS OF COMMUNITY INPUT GATHERING, PROVIDES A TRULY COMMUNITY BASED HEALTH NEEDS ASSESSMENT AND IMPROVEMENT PLAN. --------------------
PART V, SECTION B, LINE 6A & 6B- JOINT CHNA THE CHNA WAS CONDUCTED WITH OTHER HOSPITALS. AN ASSESSMENT OF MONROE COUNTY WAS CONDUCTED JOINTLY BY UNIVERSITY OF ROCHESTER MEDICAL CENTER STRONG MEMORIAL HOSPITAL, HIGHLAND HOSPITAL, AND ROCHESTER REGIONAL HEALTH SYSTEM, UNITY HEALTH SYSTEM AND LAKESIDE HEALTH SYSTEM, ALONG WITH THE FINGER LAKES HEALTH SYSTEM AGENCY AND THE MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH. --------------------
PART V, SECTION B, LINE 7 & 10- CHNA & IMP. PLAN PUBLIC AVAILABILITY A COPY OF THE ORGANIZATION'S CHNA AND IMPLEMENTATION/IMPROVEMENT PLAN CAN BE FOUND AT: HTTP://WWW.URMC.ROCHESTER.EDU/COMMUNITY-ENGAGEMENT/ OUR CHNA AND IMPLEMENTATION/IMPROVEMENT PLAN ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND ARE ALSO POSTED THE HOSPITAL SYSTEM'S WEBSITE AND ON THE MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH'S WEBSITE. --------------------
PART V, SECTION B, LINE 11- ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA FOR A COMPLETE DESCRIPTION ON HOW THE ORGANIZATION IS ADDRESSING THE NEEDS IDENTIFIED IN THE MOST RECENTLY COMPLETED CHNA, SEE THE FOLLOWING: https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/ community/document s/MC-JCSP-Progress-Report-2014-6.pdf URMCMedia/community/document s/MC-JCSP-Progress-Report-2014-6.pdf
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?22
Name and address Type of Facility (describe)
1 DAISY MARQUIS JONES RADIATION ONCOLOGY
1561 LONG POND ROAD
ROCHESTER,NY14626
RADIATION ONCOLOGY CENTER
2 HIGHLAND FAMILY MEDICINE CENTER
777 SOUTH CLINTON AVENUE
ROCHESTER,NY14620
FAMILY MEDICINE CLINIC
3 SANDS CANCER CENTER
350 PARRISH STREET
CANANDAIGUA,NY14424
RADIATION ONCOLOGY CENTER
4 CULVER MEDICAL GROUP
913 CULVER ROAD
ROCHESTER,NY14609
PRIMARY CARE CLINIC
5 CALEDONIA FAMILY MEDICINE
3350 BROWN ROAD
CALEDONIA,NY14423
PRIMARY CARE CLINIC
6 PENFIELD FAMILY MEDICINE
2212 PENFIELD ROAD
PENFIELD,NY14526
PRIMARY CARE CLINIC
7 EAST RIDGE FAMILY MEDICINE
999 EAST RIDGE ROAD
ROCHESTER,NY14621
PRIMARY CARE CLINIC
8 FAMILY MEDICINE OF WEBSTER
1672 EMPIRE BLVD
WEBSTER,NY14580
PRIMARY CARE CLINIC
9 HIGHLAND BREAST CARE CENTER
500 RED CREEK DRIVE
ROCHESTER,NY14623
BREAST CARE DIAGNOSTIC SERVICE
10 CALKINS CREEK FAMILY MEDICINE
200 RED CREEK DRIVE SUITE 100
ROCHESTER,NY14623
PRIMARY CARE CLINIC
11 AVON FAMILY MEDICINE
470 COLLINS STREET
AVON,NY14414
PRIMARY CARE CLINIC
12 GREECE MEDICAL GROUP
2300 WEST RIDGE ROAD
ROCHESTER,NY14626
PRIMARY CARE CLINIC
13 CORNHILL INTERNAL MEDICINE
757 SOUTH AVENUE SUITE 100
ROCHESTER,NY14620
PRIMARY CARE CLINIC
14 GENESEE VALLEY FAMILY MEDICINE
118 MAIN STREET PO BOX 99
MOUNT MORRIS,NY14510
PRIMARY CARE CLINIC
15 GENESEE VALLEY FAMILY MEDICINE LAKEVILLE
3509 THOMAS DRIVE SUITE 4
LAKEVILLE,NY14480
PRIMARY CARE CLINIC
16 STRONG HEALTH MIDWIFERY GROUP
909 CULVER ROAD
ROCHESTER,NY14609
OB/GYN CLINIC
17 PENFIELD MEDICAL IMAGING
2212 PENFIELD ROAD SUITE 300
PENFIELD,NY14526
OUTPATIENT DIAGNOSTIC RADIOLOGY SERVICES
18 GENESEE VALLEY FAMILY MEDICINE GENESEO
4400 LAKEVILLE ROAD
GENESEO,NY14454
PRIMARY CARE CLINIC
19 HIGHLAND BREAST IMAGING
2212 PENFIELD ROAD SUITE 500
PENFIELD,NY14526
BREAST CARE DIAGNOSTIC SERVICE
20 HIGHLAND WOMEN'S HEALTH
990 SOUTH AVENUE SUITE 103
ROCHESTER,NY14620
OB/GYN PRACTICE
21 HIGHLAND BREAST IMAGING AT AJHC
82 HOLLAND STREET ROOM 101E
ROCHESTER,NY14605
BREAST CARE DIAGNOSTIC SERVICE
22 HIGHLAND MEDICAL IMAGING AT AJHC
82 HOLLAND STREET
ROCHESTER,NY14605
OUTPATIENT DIAGNOSTIC RADIOLOGY SERVICE
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
SUPPLEMENTAL DISCLSOURES PART I, LINE 7- COSTING METHODOLOGY USED THE COSTING METHODOLOGY USED IN CALCULATING THE AMOUNTS REPORTED ON THE LINE 7 TABLE ARE BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. -------------------- PART III, SECTION A, LINE 2- BAD DEBT EXPENSE THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 ARE BASED ON ACTUAL CHARGES WRITTEN OFF (AMOUNTS THAT ARE DEEMED TO BE UNCOLLECTIBLE). -------------------- PART III, SECTION A, LINE 4- BAD DEBT EXPENSE FOOTNOTE THE TEXT OF THE BAD DEBT FOOTNOTE CAN BE FOUND ON PAGES 9-10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. --------------------
PART III, SECTION B, LINE 8- COSTING METHODOLOGY, MEDICARE SHORTFALL THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 6 IS BASED ON THE AN OVERALL RCC METHODOLOGY PER THE HOSPITAL'S MEDICARE COST REPORT FILING FOR THE YEAR. CONSISTENT WITH THE CHARITABLE HEALTHCARE MISSION OF THE HOSPITAL AND THE COMMUNITY BENEFIT STANDARD SET FORTH IN IRS REVENUE RULING 69-545, THE HOSPITAL PROVIDES CARE FOR ALL PATIENTS COVERED BY MEDICARE SEEKING MEDICAL CARE. SUCH CARE IS PROVIDED REGARDLESS OF WHETHER THE REIMBURSEMENT PROVIDED FOR SUCH SERVICES MEETS OR EXCEEDS THE COSTS INCURRED BY THE HOSPITAL TO PROVIDE SUCH SERVICES. AS A RESULT, THE HOSPITAL VIEWS ANY SHORTFALL REPORTED IN LINE 7 AS AN ADDITIONAL ITEM OF COMMUNITY BENEFIT PROVIDED BY THE ORGANIZATION. -------------------- PART III, SECTION C, LINE 9B (COLLECTION PRACTICES) HIGHLAND HOSPITAL'S MISSION IS OUR COMMITTMENT TO EXCELLENCE IN HEALTH CARE, WITH PATIENTS AND THEIR FAMILIES AT THE HEART OF ALL THAT WE DO. LAWS, REGULATIONS, CATASTROPHIC ILLNESSES AND THE RISING COSTS OF NEW TECHNOLOGY HAVE CREATED A CATEGORY OF PATIENTS WHO ARE EITHER UNINSURED OR UNDERINSURED. THIS FINANCIAL ASSISTANCE PROGRAM HAS BEEN DEVELOPED TO HELP THE HOSPITAL MEET THE NEEDS OF THESE PATIENTS AND, CONCURRENTLY, MAINTAIN THE FINANCIAL VIABILITY OF THE HOSPITAL FOR FUTURE GENERATIONS. THIS FINANCIAL ASSISTANCE POLICY EXPLAINS HOW THE HOSPITAL ASSISTS PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE ESSENTIAL MEDICAL CARE THEY RECEIVE. PRINCIPLES: HIGHLAND HOSPITAL PROACTIVELY CONVEYS INFORMATION ABOUT THIS FINANCIAL ASSISTANCE POLICY TO PATIENTS AND THEIR FAMILIES. - WE BELIEVE THAT FEAR OF A HOSPITAL BILL SHOULD NEVER GET IN THE WAY OF ESSENTIAL HEALTH SERVICES. THE PROVISION OF URGENT OR EMERGENT HEALTHCARE IS NEVER DELAYED PENDING A FINANCIAL ASSISTANCE DETERMINATION. SIGNS ANNOUNCING THE FINANCIAL ASSISTANCE PROGRAM ARE POSTED IN THE HOSPITAL (E.G. EMERGENCY DEPARTMENT, ADMITTING OFFICE) TO PROACTIVELY CONVEY THIS MESSAGE TO PROSPECTIVE PATIENTS AND THE PUBLIC IN GENERAL. - WE MAINTAIN FINANCIAL AID POLICIES THAT ARE CONSISTENT WITH THE MISSION, VALUES AND CAPACITY OF THE HOSPITAL AND THAT TAKE INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. - WE COMMUNICATE THE AVAILABILITY OF FINANCIAL AID IN A MANNER THAT IS CLEAR, UNDERSTANDABLE, SENSITIVE TO THE PATIENT'S DIGNITY, AND IN MULTIPLE LANGUAGES. A NOTICE IS AVAILABLE AT REGISTRATION SITES THAT INFORMS PATIENTS OF THIS PROGRAM AND PROVIDES THE PHONE NUMBER TO CALL TO OBTAIN MORE INFORMATION AND TO APPLY FOR THIS PROGRAM. DESIGNATED STAFF ARE PROVIDED DETAILED TRAINING SO THAT THEY CAN PROVIDE INFORMATION AND ANSWER QUESTIONS ABOUT THE FINANCIAL ASSISTANCE PROGRAM. INFORMATION IS GENERALLY AVAILABLE IN BOTH ENGLISH AND SPANISH. WHEN REQUESTED, IT WILL ALSO BE MADE AVAILABLE IN OTHER LANGUAGES. - WE IMPLEMENT FINANCIAL AID PROCEDURES THAT ARE CONSUMER-FRIENDLY, RESPECTFUL, AND CONFIDENTIAL, AS WELL AS DEBT COLLECTION POLICIES THAT REFLECT THE MISSION AND VALUES OF THIS HOSPITAL. - WE WORK WITH GOVERNMENT, PAYERS, BUSINESS, CONSUMER GROUPS AND OTHERS TO ADDRESS THE UNDERLYING PROBLEM THAT TOO MANY NEW YORKERS LACK HEALTH INSURANCE. GENERAL GUIDELINES: AS PART OF FINANCIAL PLANNING ASSISTANCE, WE PROVIDE PATIENTS, AND/OR THEIR LEGAL REPRESENTATIVE, WITH INFORMATION ABOUT THE CRITERIA THAT MUST BE MET IN ORDER TO OBTAIN MEDICAID, MEDICARE, OR OTHER HEALTH INSURANCES. PATIENTS ARE ASSISTED IN MAKING APPLICATIONS FOR ANY OF THESE INSURANCES OR DISCOUNTED FEE PLANS. PATIENTS ARE EXPECTED TO PARTICIPATE FULLY IN ALL EFFORTS TO OBTAIN ANY INSURANCE FOR WHICH THEY MAY QUALIFY. UNDER CERTAIN CIRCUMSTANCES, AS DETERMINED BY THE FINANCIAL CASE MANAGERS OR OTHER HOSPITAL SENIOR ADMINISTRATORS, APPLICATIONS FOR MEDICAID, MEDICARE OR OTHER INSURANCE PROGRAMS MAY BE WAIVED WHEN DEEMED UNNECESSARY. IF AVAILABLE INSURANCE BENEFITS ARE NOT SUFFICIENT TO COVER THE COST OF THEIR CARE, PATIENTS MAY THEN APPLY FOR ASSISTANCE FROM THE FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE APPLICATIONS MUST BE COMPLETED AND RETURNED TO THE HOSPITAL WITH THE REQUESTED INCOME DOCUMENTATION. PATIENTS WILL NOT RECEIVE FINANCIAL ASSISTANCE IF THEY (A) DO NOT COMPLETE THE APPLICATION PROCESS FOR MEDICAID OR OTHER INSURANCE FOR WHICH THEY MAY QUALIFY, (B) ELECT NOT TO MAKE APPLICATION FOR FINANCIAL ASSISTANCE, OR (C) HAVE ADEQUATE RESOURCES OR INCOME TO PAY PRIVATELY FOR THEIR CARE. IN THESE SITUATIONS, THEY WILL REMAIN FINANCIALLY RESPONSIBLE FOR FULL PAYMENT OF THEIR HOSPITAL BILLS. FINANCIAL ASSISTANCE IS AVAILABLE FOR PATIENTS WHO RESIDE IN NEW YORK STATE AND RECEIVE EMERGENCY HOSPITAL SERVICES, INCLUDING EMERGENCY TRANSFERS, AND TO PATIENTS WHO RESIDE IN HIGHLAND HOSPITAL'S PRIMARY SERVICE AREA IN NEW YORK STATE WHO RECEIVE SERVICES IN DESIGNATED HIGHLAND HOSPITAL PROGRAMS, INCLUDING MOST INPATIENT AND OUTPATIENT SERVICES. IN ADDITION, THE HOSPITAL MAY, IN ITS DISCRETION, GRANT FINANCIAL ASSISTANCE TO INDIVIDUALS WHO RESIDE OUTSIDE OF NEW YORK STATE. FINANCIAL ASSISTANCE DOES NOT COVER MEDICALLY UNNECESSARY CARE, COSMETIC ALTERATION, TELEPHONE, TELEVISION AND PRIVATE ROOM CHARGES. IT DOES NOT COVER SERVICES GENERATED BY AN INSURED PATIENT WHO CHOOSES TO RECEIVE CARE AT AN OUT-OF-NETWORK HOSPITAL, OR WHO FAILS TO COMPLY WITH INSURANCE POLICY REQUIREMENTS (E.G. UNAUTHORIZED SERVICES) NOR DOES IT APPLY TO NON-RESIDENT ALIENS (UNLESS APPROVED IN ADVANCE OF CARE BEING PROVIDED), TO DRUGS NOT ADMINISTERED IN THE HOSPITAL, TO TRANSPORTATION FURNISHED BY THIRD PARTY VENDORS, OR TO CARE, SERVICES, DRUGS OR SUPPLIES FOR THE PURPOSE OF GENDER RE-ASSIGNMENT. SPECIFIC QUESTIONS ABOUT SERVICES THAT ARE NOT COVERED SHOULD BE DIRECTED TO THE PATIENT ACCOUNTS MANAGER OR HER DELEGATE. FINANCIAL GUIDELINES: FINANCIAL AID IS INTENDED TO ASSIST THOSE INDIVIDUALS WHO CANNOT AFFORD TO PAY IN PART OR IN FULL FOR THEIR CARE. IT SHOULD TAKE INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. HOSPITAL FINANCIAL AID SHOULD NOT BE VIEWED AS A SUBSTITUTE FOR EMPLOYER-SPONSORED OR INDIVIDUALLY PURCHASED INSURANCE. PATIENTS WITHOUT INSURANCE AND WITH INCOME THAT WOULD QUALIFY THEM FOR THE FINANCIAL ASSISTANCE PROGRAM BUT ALSO HAVE SUBSTANTIAL RESOURCES (OTHER THAN TAX-DEFERRED OR COMPARABLE RETIREMENT SAVINGS OR COLLEGE SAVINGS ACCOUNTS) MAY BE EXPECTED TO PAY PART OF THEIR BILLS(S). CHARITY CARE ASSISTANCE IS GENERALLY AVAILABLE TO INDIVIDUALS WHOSE INCOME IS LESS THAN OR EQUAL TO 400% OF THE FEDERAL POVERTY LEVEL. HOWEVER, PATIENTS WHO HAVE EXHAUSTED THEIR INSURANCE BENEFITS, EXCEEDED FINANCIAL ELIGIBILITY CRITERIA, FACE EXTRAORDINARY MEDICAL COSTS, OR WHO HAVE OTHER UNIQUE CIRCUMSTANCES MAY BE CONSIDERED FOR FINANCIAL ASSISTANCE APPROVAL IN THE HOSPITAL'S SOLE DISCRETION. WHILE APPLICATION FOR MEDICAID OR OTHER INSURANCE IS USUALLY REQUIRED, THE HOSPITAL MAY, AT ITS SOLE DISCRETION, IN APPROPRIATE CASES, ALSO CONSIDER PATIENTS FOR FINANCIAL ASSISTANCE WHEN THEY MEET THE FINANCIAL CRITERIA OF THIS PROGRAM, BUT HAVE NOT SATISFACTORILY COMPLETED ALL THE REQUIREMENTS OF THE FINANCIAL ASSISTANCE APPLICATION PROCESS. THIS MAY INCLUDE PATIENTS WHO HAVE BEEN SANCTIONED BY MEDICAID, HAVE FILED BANKRUPTCY OR APPEAR TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON AVAILABLE INFORMATION. ELIGIBILITY DETERMINATIONS IN COMPLEX CASE CIRCUMSTANCES WILL BE MADE AFTER CONSIDERATION BY THE FINANCIAL ASSISTANCE REVIEW TEAM THAT INCLUDES THE FINANCIAL ASSISTANCE OFFICER, FINANCIAL CASE MANAGER AND/OR THEIR MANAGERS, OR MAY BE MADE BY SENIOR HOSPITAL ADMINISTRATORS. THE AMOUNT OF THE DISCOUNT AFFORDED TO QUALIFIED FINANCIAL ASSISTANCE PATIENTS WILL BE DETERMINED THROUGH ASSESSMENT OF THE RESPONSIBLE PARTY'S ANNUAL HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE IN THE HOME, AS A PERCENTAGE OF THE FEDERAL POVERTY GUIDELINE AMOUNTS FOR SAME SIZE HOUSEHOLDS. THE FINANCIAL GUIDELINES WILL BE UPDATED ANNUALLY IN CONJUNCTION WITH THE FEDERAL POVERTY UPDATES PUBLISHED BY CMS. PATIENTS MAY RECEIVE FULL OR PARTIAL DISCOUNT FROM THE COST OF CARE, DEPENDING ON THE PERCENTAGE OF THE GUIDELINES MATCHED BY THE PATIENT'S HOUSEHOLD INCOME. ANY BILL AMOUNT REMAINING AFTER APPLICATION OF A PARTIAL FINANCIAL ASSISTANCE DISCOUNT IS THE RESPONSIBILITY OF THE PATIENT. THE AMOUNT AN APPROVED FINANCIAL ASSISTANCE PATIENT WILL GENERALLY BE EXPECTED TO PAY FOR SERVICES COVERED BY THE POLICY WILL BE LIMITED TO THE LOWER OF THE AMOUNT THAT THE HOSPITAL WOULD HAVE RECEIVED FOR THE SAME SERVICE UNDER MEDICARE PARTS A AND B, (INCLUDING COINSURANCE, CO-PAYMENTS AND DEDUCTIBLES) OR THE USUAL AND CUSTOMARY CHARGES. THE PATIENT WILL BE ASSISTED BY THE HOSPITAL IN MAKING ARRANGEMENTS TO SATISFY ANY BALANCE REMAINING ON THE ACCOUNT(S) AFTER THE APPLICATION OF THE APPROPRIATE FINANCIAL ASSISTANCE DISCOUNT BY USE OF A PAYMENT PLAN. THE MONTHLY PAYMENTS UNDER SUCH PLANS SHALL NOT EXCEED TEN PERCENT (10%) OF THE ELIGIBLE PATIENT'S GROSS MONTHLY INCOME. THE RATE OF INTEREST ON UNPAID BALANCES SHALL NOT EXCEED THE US TREASURY RATE FOR 90 DAY SECURITIES PLUS 0.5%
PART VI, LINE 2- NEEDS ASSESSMENT THE NEEDS OF MONROE COUNTY ARE ASSESSED THROUGH HEALTH ACTION, A ROBUST COMMUNITY-WIDE PROCESS ESTABLISHED IN 1995 THAT IS LED BY THE MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH (MCDPH). IT INVOLVES ALL FOUR LOCAL HEALTH SYSTEMS, LOCAL INSURERS, AND OTHER KEY COMMUNITY STAKEHOLDERS. THROUGH THIS PROCESS, COMMUNITY PRIORITIES, GOALS, AND INTERVENTIONS ARE IDENTIFIED AND IMPLEMENTED. THESE PRIORITIES ALIGN WITH THE HEALTH PRIORITIES AND INDICATORS AS PUBLISHED BY NEW YORK STATE'S DEPARTMENT OF HEALTH (DOH) AND INCLUDE ACCESS TO QUALITY HEALTH CARE, TOBACCO USE, HEALTHY MOTHERS/HEALTHY BABIES/HEALTHY CHILDREN, PHYSICAL ACTIVITY/NUTRITION, UNINTENTIONAL INJURY, HEALTHY ENVIRONMENTS, CHRONIC DISEASE, AND MENTAL HEALTH/ SUBSTANCE ABUSE. FIVE HEALTH STATUS "REPORT CARDS" IN SPECIFIC AGE GROUPS AND CATEGORIES ARE USED TO MEASURE PROGRESS TOWARDS HEALTH STATUS IMPROVEMENT. THEY INCLUDE MATERNAL AND CHILD HEALTH, ADOLESCENT HEALTH, ADULT HEALTH, OLDER ADULT HEALTH AND ENVIRONMENTAL HEALTH, EACH OF WHICH CONTAIN GOALS FOR IMPROVING HEALTH. PRIORITIES FOR EACH AREA ARE SELECTED BASED ON INPUT FROM FOCUS GROUPS WITH RESIDENTS, AND HEALTH AND SOCIAL SERVICE PROFESSIONALS. UPDATED REPORT CARDS ARE PRODUCED AND DISTRIBUTED ON AVERAGE EVERY 4-6 YEARS FOR EACH SPECIFIC AGE GROUP. THESE PRIORITIES SERVE AS A FOUNDATION FOR COMMUNITY HEALTH IMPROVEMENT AND COMMUNITY BUILDING EFFORTS AND HELP TO ENSURE COLLABORATIVE AND COORDINATED USE OF HEALTH SYSTEM RESOURCES TO ADDRESS THE MOST PRESSING NEEDS. THE PRIORITY SETTING PROCESS IS A SIX-STEP PROCESS THAT INCLUDES: 1. ASSESS HEALTH STATUS: DATA DETAILING HEALTH STATUS, ACCESS TO HEALTH CARE AND HEALTH BEHAVIORS ARE COMPILED AND ANALYZED TO IDENTIFY TRENDS AND DISPARITIES AND TO COMPARE OUR COUNTY TO OTHER COMMUNITIES. FOR EACH LIFECYCLE GROUP, AN ADVISORY COMMITTEE, WITH REPRESENTATION FROM AREA HOSPITALS, HELPS TO INTERPRET THE DATA AND DEVELOP HEALTH GOALS BASED ON THE DATA. A REPORT CARD CONTAINING THE DATA AND HEALTH GOALS IS PUBLISHED. 2. CHOOSE PRIORITY GOALS: THE ADVISORY COMMITTEE HOSTS COMMUNITY FORUMS TO ADDRESS HEALTH IMPROVEMENT PRIORITIES. THE ADVISORY COMMITTEE THEN MAKES RECOMMENDATIONS TO THE MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH ON PRIORITIES. 3. DEFINE THE LEADERSHIP: PARTNERS ARE IDENTIFIED TO SUPPORT THE PRIORITIES FOR ACTION. THE MEDICAL CENTER PROVIDES SALARY SUPPORT FOR FACULTY AND STAFF TO CONTRIBUTE THEIR ACADEMIC AND CLINICAL EXPERTISE TO HELP IDENTIFY AND IMPLEMENT THE MOST EFFECTIVE INTERVENTIONS ON THE HEALTH PRIORITIES. 4. DEVELOP IMPROVEMENT PLANS: EACH PARTNERSHIP DEVELOPS IMPROVEMENT PLANS TO ADDRESS HEALTH GOALS. 5. PERFORM INTERVENTIONS: EACH PARTNERSHIP, ALONG WITH THE STEERING COMMITTEE, WHICH INCLUDES THE MEDICAL CENTER, OVERSEES THE IMPLEMENTATION OF INTERVENTIONS IN VARIOUS VENUES THAT INCLUDE SCHOOLS, DAY CARE CENTERS, PLACES OF WORSHIP, COMMUNITY BASED ORGANIZATIONS AND WITHIN THE HEALTH SYSTEMS. 6. MEASURE THE IMPACT: EACH PARTNERSHIP EVALUATES THE INTERVENTION. --------------------
PART VI, LINE 3- PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN ALL AREAS OF HIGHLAND HOSPITAL AND ITS OFF-SITE LOCATIONS. CHARITY CARE INFORMATION IS POSTED IN INPATIENT AND OUTPATIENT REGISTRATION AREAS; THE EMERGENCY DEPARTMENT; ADMITTING; HIGHLAND FAMILY MEDICINE; AND ALL PRIMARY CARE SITES. THE HOSPITAL PROVIDES A COPY OF THE CHARITY CARE POLICY AND FINANCIAL ASSISTANCE CONTACTS TO PATIENTS AS PART OF ITS ADMITTING PROCESS. HIGHLAND ALSO PROVIDES PRINTED INFORMATION ABOUT CHARITY CARE ASSISTANCE WITH DISCHARGE MATERIALS WHEN IT HAS BEEN DETERMINED THAT A PATIENT IS IN FINANCIAL NEED. AS PART OF FINANCIAL PLANNING ASSISTANCE, WE PROVIDE PATIENTS WITH INFORMATION ABOUT THE CRITERIA THAT MUST BE MET IN ORDER TO OBTAIN MEDICAID, MEDICARE, OR OTHER HEALTH INSURANCES. PATIENTS ARE ASSISTED IN MAKING APPLICATIONS FOR INSURANCE OR DISCOUNTED FEE PLANS. PATIENTS ARE EXPECTED TO PARTICIPATE FULLY IN ALL EFFORTS TO OBTAIN ANY INSURANCE FOR WHICH THEY MAY QUALIFY. UNDER CERTAIN CIRCUMSTANCES, AS DETERMINED BY THE FINANCIAL CASE COUNSELOR OR OTHER HOSPITAL SENIOR ADMINISTRATOR, APPLICATIONS FOR MEDICAID, MEDICARE OR OTHER INSURANCE PROGRAMS MAY BE WAIVED WHEN DEEMED UNNECESSARY. IF AVAILABLE INSURANCE BENEFITS ARE NOT SUFFICIENT TO COVER THE COST OF THEIR CARE, PATIENTS MAY THEN APPLY FOR ASSISTANCE FROM THE CHARITY CARE PROGRAM. --------------------
PART VI, LINE 4- COMMUNITY INFORMATION HIGHLAND HOSPITAL IS LOCATED IN THE CITY OF ROCHESTER, COUNTY OF MONROE (POPULATION 747,016) IN THE FINGER LAKES REGION OF NEW YORK STATE. THE FINGER LAKES REGION EXTENDS APPROXIMATELY 100 MILES NORTH TO SOUTH AND 100 MILES EAST TO WEST. THE REGION ENCOMPASSES URBAN, SUBURBAN AND RURAL COMMUNITIES WITHIN NEW YORK STATE. THE REGION (INCLUDING MONROE COUNTY) HAS A POPULATION OF 1,736,369. HIGHLAND HOSPITAL'S PRIMARY SERVICE AREA (PSA) IS MONROE COUNTY AND THE SECONDARY SERVICE AREA (SSA) ENCOMPASSES THE 15 COUNTIES SURROUNDING MONROE INCLUDING: ALLEGANY, CATTARAUGUS, CAYUGA, CHEMUNG, GENESEE, LIVINGSTON, ONTARIO, ORLEANS, SCHUYLER, SENECA, STEUBEN, TOMPKINS, WAYNE, WYOMING, AND YATES. THERE ARE FIFTEEN FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS WITHIN THIS 16 COUNTY REGION. HEALTH CARE ENVIRONMENT- THE PRIMARY SERVICE AREA IS HOME TO TWO MULTI-HOSPITAL SYSTEMS EACH WITH SEVERAL LONG-TERM CARE, HOME CARE AND OTHER TYPES OF AFFILIATES. THE UNIVERSITY OF ROCHESTER MEDICAL CENTER CONSISTS OF STRONG MEMORIAL HOSPITAL AND AFFILIATES HIGHLAND HOSPITAL AND FF THOMPSON HEALTH SYSTEM, ROCHESTER REGIONAL HEALTH SYSTEM CONSISTS OF ROCHESTER GENERAL HOSPITAL, NEWARK WAYNE COMMUNITY HOSPITAL, UNITY HEALTH SYSTEM, CLIFTON SPRINGS HOSPITAL, AND UNITED MEMORIAL MEDICAL CENTER. THERE ARE ROUGHLY TWENTY SMALLER COMMUNITY HOSPITALS THAT OPERATE IN THE FIFTEEN COUNTIES SURROUNDING MONROE COUNTY WITH BED CAPACITY RANGING FROM AS FEW AS 25 BEDS TO AS MANY AS 224 BEDS. OVER 50 RESIDENTIAL HEALTH CARE FACILITIES; MANY PUBLIC AND PRIVATE AGENCIES PROVIDING COMMUNITY AND HOME HEALTH SERVICES; SEVERAL STATE AND FEDERAL FACILITIES; AND A FULL RANGE OF HEALTH CARE PROFESSIONALS, INCLUDING THOUSANDS OF PHYSICIANS, DENTISTS, NURSES, TECHNICIANS, ADMINISTRATORS, EDUCATORS, AND SUPPORT PERSONNEL PROVIDE SERVICES WITHIN THE SIXTEEN COUNTY SERVICE AREA. DEMOGRAPHIC ANALYSIS- HISTORICALLY UNDER REPRESENTED ETHNIC GROUPS INCLUDING BLACK NON-HISPANIC, HISPANIC AND OTHER POPULATIONS COMPRISE ROUGHLY 23% OF THE POPULATION OF MONROE COUNTY. ACCORDING TO U.S. CENSUS DATA ROUGHLY 12.6% OF THE POPULATION OF MONROE COUNTY IS NON-ENGLISH SPEAKING. MEDIAN HOUSEHOLD INCOME FOR THE PRIMARY SERVICE AREA IS $52,394 VERSUS THE NATIONAL MEDIAN OF $53,046. ACCORDING TO THE US CENSUS, 14.5% OF INDIVIDUALS IN MONROE COUNTY WERE CONSIDERED BELOW THE POVERTY LEVEL. THE PERCENTAGE OF THE MONROE COUNTY POPULATION AGE 65 AND OLDER WAS 15.9% IN 2014 AND IS ANTICIPATED TO GROW TO 18.1% IN 2020. MONROE COUNTY'S POPULATION OF SENIORS OUTPACES THE NATIONAL AVERAGE OF 14.5%. UNDER REPRESENTED ETHNIC GROUPS COMPRISE ROUGHLY 11.0% OF THE POPULATION IN THE FIFTEEN COUNTIES SURROUNDING MONROE COUNTY. MEDIAN HOUSEHOLD INCOME FOR THE FIFTEEN-COUNTY SERVICE AREA WAS $53,227 VERSUS THE US MEDIAN OF $53,046. THE 65 AND OLDER POPULATION COMPRISED 16.7% OF THE POPULATION AND IS ANTICIPATED TO GROW TO 19.3% BY 2018. THE RATE OF UNINSURED IN MONROE COUNTY IS 9.4 %, COMPARED TO 12% US AVERAGE. ACCORDING TO THE NEW YORK STATE DEPARTMENT OF HEALTH, ROUGHLY 13.9% OF THE POPULATION OF MONROE COUNTY IS ENROLLED IN MEDICAID COMPARED TO 20.0% FOR NEW YORK STATE. --------------------
PART VI, LINE 5- PROMOTION OF COMMUNITY HEALTH Highland Hospital conducts many community health initiatives throughout the year. Examples include free or low-cost health education programs on topics related to geriatric health, diabetes management, joint pain/joint replacement, and bariatric surgery. Also, Highland's Breast Imaging Center sponsors free mammography screening days several times a year for uninsured/underinsured women. Highland's staff also provides health information and wellness screenings at numerous community events such as annual health fairs - The Family Health and Fitness Fair held every October in Rochester draws several thousand people. Other examples include Highland-staffed booths at Rochester's Lilac Festival, the Highland Family Planning Health and Resource Fair, the 2015 Baby Boomer & Senior Expo in Lyons, and the RWM's Ultimate Health & Wellness Expo. At all of these events, staff provided information, as well as referrals to Highland patient education opportunities. These events serve several purposes: they raise awareness of the breadth of services offered by Highland to the community, especially those in the urban area of Rochester for whom Highland is their closest hospital; they encourage community members to engage in proactive wellness efforts, such as recommended annual mammograms for women over 40 and those at risk; and they educate community members on steps they can take to lead healthy lives through positive lifestyle choices. In addition, Highland collaborates with other hospitals in western New York, including Strong Memorial Hospital, in jointly filing a community service plan to the New York State Department of Health. This unique effort, done in collaboration with the Monroe County Department of Public Health and the Finger Lakes Health System Agency, demonstrates true community assessment and improvement planning for Monroe County and its surrounding neighborhoods. The Joint Community Service Plan is focusing on reducing obesity, reducing illness related to tobacco, and increasing access to chronic disease prevention. The University of Rochester Center for Community Health serves as a facilitating agency. --------------------
PART VI, LINE 5- PROMOTION OF COMMUNITY HEALTH- OTHER INFORMATION HIGHLAND'S BOARD OF DIRECTORS IS COMPRISED OF A DIVERSE GROUP OF MEMBERS OF THE ROCHESTER COMMUNITY. THE BOARD INCLUDES URMC AND HIGHLAND SENIOR LEADERS; EMPLOYED URMC FACULTY BASED AT HIGHLAND HOSPITAL AND PRIVATE COMMUNITY PHYSICIANS; MEMBERS OF THE BUSINESS COMMUNITY AND LOCAL PHILANTHROPISTS WITH AN INTEREST IN ADVOCATING FOR HEALTH CARE. HIGHLAND EXTENDS MEDICAL STAFF PRIVILEGES TO EMPLOYED HIGHLAND PHYSICIANS; URMC FACULTY PHYSICIANS; AND ALL ELIGIBLE PRIVATE PHYSICIANS WHO PRACTICE AT HIGHLAND AND/OR ADMIT PATIENTS TO THE HOSPITAL. HIGHLAND USES SURPLUS FUNDS TO CONTINUALLY REINVEST IN ITS FACILITY; THE 124-YEAR-OLD HOSPITAL HAS IN RECENT YEARS MADE MANY CAPITAL UPDATES TO ITS FACILITY, INCLUDING: ITS EMERGENCY DEPARTMENT IN RESPONSE TO RISING PATIENT VOLUMES, VIRTUALLY DOUBLING ITS CAPACITY TO MEET CURRENT AND FUTURE PATIENT NEEDS, RADIATION ONCOLOGY DEPARTMENT, SEVERAL INPATIENT CARE UNITS AND THE COMMUNITY OB/GYN CLINIC. OTHER ENHANCEMENTS INCLUDE THE ADDITION OF A NEW OUTPATIENT PHARMACY AND EXPANDED LOBBY/SURGICAL WAITING AREA TO ACCOMMODATE SURGICAL VOLUME GROWTH. THE HOSPITAL HAS COMPLETED CONSTRUCTION OF A NEW NEUROMEDICINE UNIT TO PROVIDE INTEGRATED NEUROLOGY/NEUROSURGERY CARE TO STROKE, HEAD INJURY AND NEUROSURGERY PATIENTS.IT HAS COMPLETED CONSTRUCTION OF TWO NEW OPERATING ROOMS AND EXPANSION OF ITS PERIOPERATIVE SERVICES AREA TO MEET DEMAND FOR OR USAGE. MAJOR CAPITAL EQUIPMENT ACQUISITIONS TO MEET COMMUNITY NEEDS INCLUDE AN UPGRADED LINEAR ACCELERATOR AND DaVINCI ROBOTIC SURGICAL SYSTEM. THE HOSPITAL CONTINUES TO REVIEW AND UPGRADE ALL KEY INFORMATION TECHNOLOGY SYSTEMS, INCLUDING THE ELECTRONIC MEDICAL RECORD. FINALLY, THE HOSPITAL BEGAN THE FIRST PHASE OF ITS $28M MASTER FACILITY PLAN, TO BE COMPLETED @ JUNE 2017, TO CONSTRUCT A DEDICATED 26 BED OBSERVATION UNIT, ALONG WITH A STATE OF THE ART PERIOPERATIVE UNIT. -------------------- --------------------
PART VI, LINE 6- DETAIL REGARDING AFFILIATED HEALTH CARE SYSTEM ROLES THE UNIVERSITY OF ROCHESTER MEDICAL CENTER IS AN INTEGRATED ACADEMIC HEALTH CENTER THAT COMPRISES THE SCHOOL OF MEDICINE AND DENTISTRY, INCLUDING ITS FACULTY PRACTICE (UNIVERSITY OF ROCHESTER MEDICAL FACULTY GROUP); STRONG MEMORIAL HOSPITAL; HIGHLAND HOSPITAL; GOLISANO CHILDREN'S HOSPITAL; JAMES P. WILMOT CANCER CENTER; STRONG WEST; SCHOOL OF NURSING; EASTMAN INSTITUTE FOR ORAL HEALTH; VISITING NURSE SERVICE; HIGHLANDS AT PITTSFORD; THE HIGHLANDS LIVING CENTER, INC.; HIGHLANDS AT BRIGHTON, AND FF THOMPSON HEALTH SYSTEM, INC. UR MEDICAL CENTER AND THE AFFILIATED HEALTH CARE ENTITIES HAVE EMBRACED A COMPREHENSIVE APPROACH TO COMMUNITY HEALTH, WHICH EMPLOYS THE MULTIDISCIPLINARY SKILLS FOUND IN AN ACADEMIC MEDICAL CENTER TO BOTH PROVIDE IMPORTANT COMMUNITY SERVICES AND CONDUCT COMMUNITY-BASED RESEARCH. THESE ACTIVITIES HELP INFORM POLICYMAKERS AND THE COMMUNITY ABOUT LOCAL HEALTH CHALLENGES, EVALUATE THE EFFECTIVENESS OF INTERVENTIONS, AND SERVE AS A FOUNDATION FOR EVIDENCE-BASED PRACTICES TO IMPROVE HEALTH AND OVERALL QUALITY OF LIFE. - THE UNIVERSITY'S HEALTH CARE DELIVERY NETWORK IS ANCHORED BY STRONG MEMORIAL HOSPITAL, AN 830 BED TEACHING HOSPITAL, WHICH INCLUDES A CHILDREN'S HOSPITAL-GOLISANO CHILDREN'S HOSPITAL. PATIENTS BENEFIT FROM THE MEDICAL CENTER'S ROBUST TEACHING AND BIOMEDICAL RESEARCH PROGRAMS. STUDENT ROSTERS INCLUDE APPROXIMATELY 400 MEDICAL STUDENTS, 500 GRADUATE STUDENTS, AND 700 RESIDENTS AND FELLOWS WHO ARE ENGAGED IN COMMUNITY SERVICE THROUGHOUT THEIR EDUCATION. - EASTMAN INSTITUTE FOR ORAL HEALTH PROVIDES COMMUNITY DENTAL CARE IN A NUMBER OF CLINICS, AS WELL AS CLINICAL EDUCATION TO DENTAL STUDENTS ENROLLED AT THE UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY. IT OFFERS GENERAL DENTISTRY, PEDIATRIC AND ORTHODONTIC CLINICS, AND AN URGENT CARE DENTAL CLINIC THAT SEES 10 - 50 PATIENTS PER DAY. IT OPERATES LOW-INCOME CLINICS AT SCHOOLS AND A DOWNTOWN LOCATION. ADDITIONALLY, FOUR SMILEMOBILES PROVIDE A DENTAL OFFICE ON WHEELS, ALLOWING THE CITY'S CHILDREN INCREASED ACCESS TO MUCH NEEDED DENTAL CARE. - THE JAMES P. WILMOT CANCER CENTER IS ORGANIZED AROUND A MULTIDISCIPLINARY CARE MODEL, WHICH LEADING CANCER EXPERTS BELIEVE IS THE GOLD STANDARD IN CANCER CARE IN THE 21ST CENTURY. ITS MODEL UNDERSCORES A COMMITMENT TO PROVIDE PATIENTS IN THE ROCHESTER AREA WITH THE MOST UP-TO-DATE INFORMATION AND AVAILABLE TREATMENTS, BASING OUR RECOMMENDATIONS ON THE BEST EVIDENCE. IT IS THE ONLY CENTER IN THE ROCHESTER AND FINGER LAKES REGION OFFERING THIS TEAM APPROACH TO CARE. A VARIETY OF FREE PREVENTIVE EDUCATION EVENTS ARE HELD THROUGHOUT THE YEAR, INCLUDING MEN'S HEALTH DAY, WHICH INCLUDES NUMEROUS FREE HEALTH SCREENINGS; FREE SKIN CANCER SCREENINGS; AND BREAST CANCER SCREENINGS FOR THE UNINSURED AND UNDERINSURED. - GOLISANO CHILDREN'S HOSPITAL, HOUSED IN STRONG MEMORIAL HOSPITAL, IS A 132-BED CHILDREN'S HOSPITAL THAT SERVES AS THE REFERRAL CENTER FOR UPSTATE NEW YORK, SURROUNDING STATES AND CANADA. IT COMBINES AWARD-WINNING RESEARCH, INTERNATIONALLY ACCLAIMED EDUCATION AND COMPASSIONATE CARE TO SERVE CHILDREN AND FAMILIES. PEDIATRIC SPECIALTIES INCLUDE ORTHOPAEDICS, NEUROLOGY/NEUROSURGERY, CANCER AND NEONATAL CARE. IN ADDITION TO THESE TRADITIONAL MEDICAL SERVICES, GOLISANO CHILDREN'S HOSPITAL IS THE NATION'S MODEL FOR "COMMUNITY PEDIATRICS", A PHILOSOPHY THAT EMBRACES THE IDEA THAT A CHILD'S COMMUNITY AND ENVIRONMENT AFFECT HIS HEALTH AND, THEREFORE, HE CANNOT BE TREATED SOLELY IN AN EXAM ROOM. THE HOSPITAL ENCOURAGES PHYSICIANS AND STAFF TO PARTNER WITH COMMUNTIY ORGANIZAITONS TO IMPROVE VACCINATION RATES, EDUCATIONAL OPPORTUNITIES, SAFETY AT HOME AND ON PLAYGROUNDS, AND HEALTH INSURANCE AND HEALTH CARE ACCESS. - THE STRONG WEST CAMPUS, WHICH IS LOCATED APPROXIMATELY 20 MILES WEST OF ROCHESTER IN BROCKPORT, NY WAS ACQUIRED BY THE UNIVERSITY IN 2013. IT IS THE SITE OF THE FORMER 61 BED LAKESIDE MEMORIAL HOSPITAL, WHICH ANNOUNCED IT WAS CLOSING IN APRIL, 2013, LEAVING THE COMMUNITY WITHOUT AN EMERGENCY ROOM AND LOCAL ACCESS TO OTHER HEALTH CARE SERVICES. STRONG MEMORIAL HOSPITAL NOW OPERATES A FREE-STANDING EMERGENCY ROOM ON THE STRONG WEST CAMPUS, IN ADDITION TO OFFERING AMBULATORY SURGERY, HEALTH IMAGING, LABORATORY SERVICES, PRIMARY CARE, ORTHOPAEDICS, CARDIAC CARE, ONCOLOGY AND HEMATOLOGY, SLEEP MEDICINE, NEUROLOGY, AND UROLOGY SERVICES. THE UNIVERSITY'S WHOLY OWNED HEALTH CARE AFFILIATES ARE: - HIGHLAND HOSPITAL OF ROCHESTER (HIGHLAND) PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. HIGHLAND OPERATES A 261-BED ACUTE CARE HOSPITAL, AS WELL AS 13 PRIMARY CARE SATELLITE CLINICS, AND OB/MIDWIFERY CLINIC, BREAST CARE CLINIC, AND THREE RADIATION ONCOLOGY TREATMENT CENTERS. HIGHLAND IS ALSO A TEACHING AFFILIATE OF THE UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY. HIGHLAND'S SERVICE AREA INCLUDES MONROE COUNTY, NEW YORK, AS WELL AS SEVERAL COUNTIES SURROUNDING THE ROCHESTER, NEW YORK REGION. - VISITING NURSE SERVICE OF ROCHESTER AND MONROE COUNTY, INC. AND COMMUNITY CARE OF ROCHESTER, INC. D/B/A VISITING NURSE SIGNATURE CARE PROVIDE HOME AND COMMUNITY BASED CARE TO OVER 13,000 PEOPLE ANNUALLY, INCLUDING NURSING, REHABILITATION THERAPY, PERSONAL CARE, HOSPICE AND MEALS ON WHEELS. THE AGENCY IS NATIONALLY RECOGNIZED FOR ITS ABILITY TO REDUCE UNNECESSARY HOSPITALIZATIONS. DURING 2013, AFFILIATES FINGER LAKES VISITING NURSE SERVICE, INC. AND FINGER LAKES HOME CARE, INC. JOINED THE SYSTEM, EXTENDING THE HOME CARE AFFILIATES' PROVISION OF HIGH QUALITY HOME HEALTH CARE SERVICES TO THE FINGER LAKES REGION. - THE HIGHLANDS AT PITTSFORD CAMPUS INCLUDES TWO SEPARATE CORPORATIONS WITH DIFFERENT ACTIVITIES OFFERING SKILLED NURSING CARE, AS WELL AS ASSISTED AND INDEPENDENT LIVING FOR SENIORS. THE HIGHLANDS LIVING CENTER IS A 122-BED SKILLED NURSING FACILITY THAT ALSO OFFERS AN ADULT DAY CARE PROGRAM. THE 60-BED ASSISTED LIVING, 171-BED INDEPENDENT LIVING, AND COMMUNITY EDUCATION ARE PROVIDED BY HIGHLAND COMMUNITY DEVELOPMENT CORPORATION D/B/A/THE HIGHLANDS AT PITTSFORD AND LAURELWOOD AT THE HIGHLANDS. THE HIGHLANDS OFFER A COMPREHENSIVE SERIES OF COMMUNITY EDUCATION PROGRAMS ON CURRENT HEALTH TOPICS, INCLUDING HEART HEALTH, NUTRITION, ORAL HEALTH, AND DIABETES PREVENTION, TO NAME A FEW. - THE HIGHLANDS AT BRIGHTON IS A 145-BED SKILLED NURSING FACILITY THAT SPECIALIZES IN CARE FOR THE MOST MEDICALLY COMPLEX CASES, INCLUDING A NEUROBEHAVIORAL UNIT, VENTILATOR UNIT, AND BEHAVIORAL STEP-DOWN/DEMENTIA CARE UNIT IN ADDITION TO TRANSITIONAL, POST-ACUTE CARE AND REHABILITATION SERVICES. THROUGH ITS TRANSITIONAL CARE MODEL, THE HIGHLANDS AT BRIGHTON ACCEPTS PATIENTS WHO NO LONGER REQUIRE HOSPITAL CARE BUT ARE DIFFICULT TO DISCHARGE DUE TO THE COMPLEXITY OF THEIR MEDICAL OR BEHAVIORAL NEEDS, PROVIDING THEM WITH SUPPORTIVE CARE AND IN MANY CASES, HELPING THEM TRANSITION TO MORE APPROPRIATE LEVELS OF CARE IN THE COMMUNITY. - FF THOMPSON HEALTH SYSTEM IS COMPRISED OF THE FREDERICK FERRIS THOMPSON HOSPITAL (FF THOMPSON). FF THOMPSON IS A 113-BED ACUTE CARE HOSPITAL THAT IS LOCATED IN CANANDAIGUA, NY, APPROXIMATELY 30 MILES SOUTH OF ROCHESTER AND SERVES THE FINGER LAKES REGION. ITS SERVICES INCLUDE MEDICAL/SURGICAL CARE, INTENSIVE CARE, MATERNITY AND EMERGENCY CARE. IN ADDITION, THE HOSPITAL OWNS AND OPERATES 9 EXTENSION CLINICS, 8 OF WHICH PROVIDE PRIMARY HEALTH CARE SERVICE AND 2 OF WHICH PROVIDE OUTPATIENT PHYSICAL AND/OR OCCUPATIONAL THERAPY. - M.M. EWING CONTINUING CARE CENTER INC. IS A NOT-FOR-PROFIT CORPORATION THAT OPERATES A 188-BED SKILLED NURSING FACILITY AND ADULT DAY CARE PROGRAM ADJACENT TO F.F. THOMPSON HOSPITAL. - F.F.T. SENIOR COMMUNITIES, INC. IS A NOT-FOR-PROFIT CORPORATION THAT OPERATES FERRIS HILLS AT WESTLAKE, A RESIDENTIAL COMMUNITY CONSISTING OF 84 INDEPENDENT LIVING UNITS AND 48 ENRICHED LIVING UNITS. --------------------
Schedule H (Form 990) 2014
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1STEVEN I GOLDSTEINCEO (i)
(ii)
0
...............................
880,628
0
...............................
0
0
...............................
61,750
0
...............................
277,469
0
...............................
3,519
0
...............................
1,223,366
0
...............................
0
2BRENT DUBESHTER MDBOARD MEMBER (i)
(ii)
0
...............................
1,101,901
0
...............................
70,000
0
...............................
0
0
...............................
25,069
0
...............................
22,309
0
...............................
1,219,279
0
...............................
0
3JOSEPH JOHNSON MDBOARD CHAIR (i)
(ii)
0
...............................
578,355
0
...............................
50,000
0
...............................
17,500
0
...............................
25,069
0
...............................
17,856
0
...............................
688,780
0
...............................
0
4LEONARD J SHUTEFORMER EXECUTIVE VP & CFO (i)
(ii)
0
...............................
188,188
0
...............................
0
0
...............................
83,741
0
...............................
9,585
0
...............................
15,733
0
...............................
297,247
0
...............................
0
5CINDY BECKERCOO (i)
(ii)
301,536
...............................
0
0
...............................
0
0
...............................
0
62,600
...............................
0
27,806
...............................
0
391,942
...............................
0
0
...............................
0
6LORI FERRIS MDPHYSICIAN (i)
(ii)
429,490
...............................
0
0
...............................
0
0
...............................
0
33,900
...............................
0
33,391
...............................
0
496,781
...............................
0
0
...............................
0
7JULIETTA FISCELLA MDPHYSICIAN (i)
(ii)
377,554
...............................
0
0
...............................
0
0
...............................
0
47,700
...............................
0
16,855
...............................
0
442,109
...............................
0
0
...............................
0
8JEFFREY HANSON MDPHYSICIAN (i)
(ii)
325,918
...............................
0
0
...............................
0
0
...............................
0
44,900
...............................
0
15,197
...............................
0
386,015
...............................
0
0
...............................
0
9GREGORY RYAN MDPHYSICIAN (i)
(ii)
318,884
...............................
0
0
...............................
0
0
...............................
0
33,000
...............................
0
30,821
...............................
0
382,705
...............................
0
0
...............................
0
10RAYMOND MAYEWSKI MDCHIEF MEDICAL OFFICER (i)
(ii)
0
...............................
560,195
0
...............................
0
0
...............................
43,937
0
...............................
100,069
0
...............................
16,997
0
...............................
721,198
0
...............................
0
11BILAL AHMEDBOARD MEMBER (i)
(ii)
0
...............................
352,136
0
...............................
0
0
...............................
0
0
...............................
25,659
0
...............................
41,985
0
...............................
419,780
0
...............................
0
12TOMMYE HINTONCHIEF NURSING OFFICER (i)
(ii)
228,099
...............................
0
0
...............................
0
0
...............................
0
12,352
...............................
0
18,677
...............................
0
259,128
...............................
0
0
...............................
0
13ADAM ANOLIKCFO (i)
(ii)
0
...............................
320,626
0
...............................
0
0
...............................
125
0
...............................
30,355
0
...............................
16,953
0
...............................
368,059
0
...............................
0
14MAUREEN PERRYPHYSICIAN (i)
(ii)
235,754
...............................
0
0
...............................
0
0
...............................
0
36,900
...............................
0
21,554
...............................
0
294,208
...............................
0
0
...............................
0
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
FORM 990, SCHEDULE J, PART I, LINE 3 TOP MANAGEMENT COMPENSATION AS PROVIDED IN THE FORM 990, SCHEDULE J INSTRUCTIONS, SINCE THE ORGANIZATION RELIES ON A RELATED ORGANIZATION WHICH USES ONE OR MORE OF THE METHODS DESCRIBED IN LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIALS' COMPENSATION, THIS QUESTION HAS BEEN LEFT UNANSWERED. REFER TO SCHEDULE O, DESCRIPTION OF COMPENSATION REVIEW AND APPROVAL PROCESS. --------------------
FORM 990, SCHEDULE J, PART I, LINE 4B PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BOX 4(B) HAS BEEN CHECKED YES, SINCE CERTAIN OFFICERS OF HIGHLAND HOSPITAL OF ROCHESTER PARTICIPATE IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PROVIDED BY THE UNIVERSITY OF ROCHESTER, A RELATED IRC SECTION 501(C) (3) ORGANIZATION. THESE AMOUNTS ARE INCUDED IN DEFERRED COMPENSATION, FOR THE FOLLOWING INDIVIDUALS: STEVEN I. GOLDSTEIN SERP PLAN $159,400 STEVEN I. GOLDSTEIN 457(F) PLAN $93,000 RAYMOND MAYEWSKI, MD SERP PLAN $75,000 --------------------
Schedule J (Form 990) 2014

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990.

SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number
16-0743037
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer
(i) Pool
financing
Yes No Yes No Yes No
A COUNTY OF MONROE INDUSTRIAL DEVELOPMENT AGENCY
 
16-1005429 610752DY0 06-23-2005 36,194,096 REFUND 1997 BONDS/ BLDING & EQUIP   X   X   X
B DORMITORY AUTHORITY OF STATE OF NEW YORK
 
14-6000293 649905W93 06-25-2010 10,932,064 MEDICAL FACILTY, EQUIP & TECHNLGY   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 15,442,558 1,007,064    
2 Amount of bonds legally defeased . . . . . . . . . . . 0 0    
3 Total proceeds of issue . . . . . . . . . . . . . . 36,194,096 10,932,064    
4 Gross proceeds in reserve funds . . . . . . . . . . . . 3,358,494 428,710    
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0    
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 0    
7 Issuance costs from proceeds . . . . . . . . . . . . 323,708 218,641    
8 Credit enhancement from proceeds . . . . . . . . . . . 0 0    
9 Working capital expenditures from proceeds . . . . . . . . . 0 0    
10 Capital expenditures from proceeds . . . . . . . . . . . 14,228,315 10,284,713    
11 Other spent proceeds . . . . . . . . . . . . . . 18,283,579 0    
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0    
13 Year of substantial completion . . . . . . . . . . . . 2006 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X   X        
15 Were the bonds issued as part of an advance refunding issue? . . . . . X     X        
16 Has the final allocation of proceeds been made? . . . . . . . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X        
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X   X        
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X        
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0 % 0 %    
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0 % 0 %    
6 Total of lines 4 and 5 . . . . . . . . . . . . . 0 % 0 %    
7 Does the bond issue meet the private security or payment test? . . . . .   X   X        
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X        
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. 0 % 0 %    
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X   X        
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? . . . . . . .
X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .   X   X        
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X   X        
b Exception to rebate? . . . . . . . . X   X          
c No rebate due? . . . . . . . .   X   X        
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .   X   X        
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X        
b Name of provider . . . . . . . . . 0
 
0
 
 
 
 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X        
b Name of provider . . . . . . . . . 0
 
0
 
 
 
 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X        
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X          
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X          
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
FORM 990, SCHEDULE K, PART III, LINES 3B & 3D SUPPLEMENTAL INFORMATION HIGHLAND HOSPITAL DOES NOT HAVE ANY MANAGEMENT CONTRACTS, SERVICE CONTRACTS OR RESEARCH AGREEMENTS BUT WOULD ENGAGE BOND COUNSEL OR OTHER OUTSIDE COUNSEL TO REVIEW BEFORE ENTERING INTO ANY SUCH AGREEMENTS.
Schedule K (Form 990) 2014

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11 FORM 990 REVIEW PROCESS THE FORM 990 OF HIGHLAND HOSPITAL IS PREPARED BY FINANCE STAFF AND PROVIDED TO PRICEWATERHOUSECOOPERS LLP AND SENIOR MANAGEMENT FOR REVIEW PRIOR TO FILING. THE FORM 990 WAS ALSO PROVIDED TO THE HOSPITAL'S AUDIT COMMITTEE PRIOR TO FILING. THE COMMITTEE'S QUESTIONS AND COMMENTS WERE ADDRESSED AT A COMMITTEE MEETING PRIOR TO FILING. THE 2014 FORM 990 WAS PRESENTED TO THE AUDIT COMMITTEE BY PRICEWATERHOUSECOOPERS LLP PRIOR TO FILING. THE FORM 990 WAS ALSO PROVIDED TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO FILING. --------------------
FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY DIRECTORS, COMMITTEE MEMBERS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE A CONFLICT OF INTEREST: (A) PRIOR TO VOTING ON OR OTHERWISE DISCHARGING THEIR DUTIES WITH RESPECT TO ANY MATTER INVOLVING THE CONFLICT WHICH COMES BEFORE THE BOARD OR ANY COMMITTEE; (B) PRIOR TO ENTERING INTO ANY CONTRACT OR TRANSACTION INVOLVING THE CONFLICT; (C) AS SOON AS POSSIBLE AFTER THE DIRECTOR, COMMITTEE MEMBER OR OFFICER LEARNS OF THE CONFLICT; AND (D) ON AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. THE FORM IS DISTRIBUTED ANNUALLY AND REQUIRES DISCLOSURE OF ALL CONFLICTS OF INTEREST, INCLUDING SPECIFIC INFORMATION CONCERNING THE TERMS OF ANY CONTRACT OR TRANSACTION WITH THE HOSPITAL THAT INVOLVES A POTENTIAL CONFLICT OF INTEREST FOR THE INDIVIDUAL. THE FORMS ARE REVIEWED BY THE BOARD CHAIR AND LEGAL COUNSEL, AND CONFLICTS DISCLOSED ON THE FORMS OR ON AN AD HOC BASIS ARE REVIEWED BY A BOARD COMMITTEE. THE COMMITTEE CONSIDERS THE MATERIAL FACTS CONCERNING ANY PROPOSED CONTRACT OR TRANSACTION, INCLUDING THE PROCESS BY WHICH THE DECISION WAS MADE TO APPROVE OR RECOMMEND ENTERING INTO THE ARRANGEMENT ON THE TERMS PROPOSED, AND APPROVES SUCH CONTRACTS OR TRANSACTIONS ONLY IF THE TERMS ARE FAIR AND REASONABLE TO THE HOSPITAL AND THE ARRANGEMENTS ARE CONSISTENT WITH THE BEST INTERESTS OF THE HOSPITAL. --------------------
FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW AND APPROVAL WRITTEN SELF-EVALUATIONS AND PERFORMANCE EVALUATIONS FOR HIGHLAND HOSPITAL'S OFFICERS AND KEY EMPLOYEES ANNUALLY ARE REVIEWED BY THE COMMITTEE ON COMPLIANCE AND COMPENSATION OF THE UNIVERSITY OF ROCHESTER MEDICAL CENTER BOARD. THE COMMITTEE HAS AVAILABLE THE EVALUATIONS FROM HIGHLAND HOSPITAL'S BOARD, AS WELL AS FROM THE CEO OF URMC HEALTH SYSTEM AND IN SOME CASES HIGHLAND'S CEO. THE COMMITTEE REVIEWS AND APPROVES TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES AND CONSIDERS, IN ADDITION TO THE EVALUATIONS, THE SCOPE OF THE INDIVIDUAL'S JOB RESPONSIBILITIES, PREVIOUS COMPENSATION AND COMPARABLE COMPENSATION PAID TO PEOPLE WITH SIMILAR RESPONSIBILITIES AT COMPARABLE INSTITUTIONS. THE COMPARABLE INFORMATION IS PROVIDED BY AN INDEPENDENT CONSULTANT AND IS BASED ON LOCAL, REGIONAL AND NATIONAL COMPENSATION SURVEYS. --------------------
FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS HIGHLAND HOSPITAL'S FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. HIGHLAND HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE NOT ROUTINELY MADE AVAILABLE TO THE PUBLIC. --------------------
FORM 990, PART VII & FORM 990, SCHEDULE J, PART II COMPENSATION INFORMATION CERTAIN OFFICERS, DIRECTORS AND KEY EMPLOYEES OF HIGHLAND HOSPITAL RECEIVE COMPENSATION FROM THE UNIVERSITY OF ROCHESTER, A RELATED IRC SECTION 501(C)(3) ORGANIZATION. A PORTION OF THE SALARIES OF THESE INDIVIDUALS IS ALLOCATED TO HIGHLAND HOSPITAL AND IS INCLUDED AS A PART OF OTHER SALARY AND WAGES ON THE STATEMENT OF FUNCTIONAL EXPENSES. CERTAIN OFFICERS AND KEY EMPLOYEES OF HIGHLAND HOSPITAL ALSO DEVOTE SIGNIFICANT TIME EACH WEEK TO OTHER RELATED ORGANIZATIONS. JOSEPH JOHNSON, MD CURRENTLY SERVES AS THE CHIEF OF SURGERY AT HIGHLAND HOSPITAL. A PORTION OF THE TOTAL HOURS AND COMPENSATION REPORTED RELATES TO HIS SERVICES PERFORMED IN THIS ROLE. NONE OF THE BOARD MEMBERS OF HIGHLAND HOSPITAL ARE COMPENSATED FOR THEIR BOARD SERVICE. --------------------
FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B MEMBERSHIP INFORMATION THE SOLE MEMBER OF HIGHLAND HOSPITAL IS STRONG PARTNERS HEALTH SYSTEM, INC. ("SPHS"). SPHS, ACTING THROUGH ITS BOARD OF DIRECTORS, HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF HIGHLAND HOSPITAL, AND CERTAIN DECISIONS OF THE HIGHLAND HOSPITAL BOARD ARE SUBJECT TO THE APPROVAL OF THE SPHS BOARD. SUCH DECISIONS INCLUDE APPOINTMENT OF THE HIGHLAND HOSPITAL PRESIDENT AND CEO, AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS, APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION, AND APPROVAL OF CAPITAL AND OPERATING BUDGETS, STRATEGIC PLANS, AND INCURRENCE OF CERTAIN DEBT. --------------------
FORM 990, PART XI, LINE 9 RECONCILIATION OF NET ASSETS DETAIL OF OTHER CHANGES IN NET ASSETS OR FUND BALANCES: CHANGE IN ACCRUED PENSION LIABILITY ($41,624,033) ----------- TOTAL CHANGES IN NET ASSETS: ($41,624,033)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet
Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HIGHLAND HOSPITAL OF ROCHESTER
 
Employer identification number

16-0743037
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1) UNIVERSITY OF ROCHESTER
910 GENESEE STREET STE 200

ROCHESTER,NY14611
16-0743209
SCHOOL NY 501(c)(3) 2 NA
 
 
No
(2) THE HIGHLAND FOUNDATION INC
1000 SOUTH AVENUE

ROCHESTER,NY14620
23-7310662
FUNDRAISING NY 501(c)(3) 11A, 1 HIGHLD HOSP
 
Yes
 
(3) HIGHLAND FACILITIES DEVELOPMENT CORP
1000 SOUTH AVENUE

ROCHESTER,NY14620
22-3039077
MEDICAL BLDG NY 501(c)(3) 9 HIGHLD HOSP
 
Yes
 
(4) STRONG PARTNERS HEALTH SYSTEM INC
601 ELMWOOD AVENUE BOX 706

ROCHESTER,NY14642
16-1499099
SUPPORT ORG NY 501(c)(3) 11A, 1 UNIV OF ROCH
 
 
No
(5) THE MEADOWS AT WESTFALL INC
5901 LAC DE VILLE BLVD

ROCHESTER,NY14618
16-1502303
HEALTHCARE NY 501(c)(3) 9 SPHS
 
 
No
(6) THE HIGHLANDS LIVING CENTER INC
500 HAHNEMANN TRAIL

PITTSFORD,NY14534
22-3240227
HEALTHCARE NY 501(c)(3) 9 SPHS
 
 
No
(7) HIGHLAND COMMUNITY DEVELOPMENT CORP
100 HAHNEMANN TRAIL

PITTSFORD,NY14534
22-3154715
ELDER CARE NY 501(c)(3) 9 SPHS
 
 
No
(8) STRONG HOME CARE GROUP
2180 EMPIRE BOULEVARD

WEBSTER,NY14580
22-2577664
FUNDRAISING NY 501(c)(3) 7 UNIV OF ROCH
 
 
No
(9) VISITING NURSE SRVC OF ROCHESTER & MONRO
2180 EMPIRE BOULEVARD

WEBSTER,NY14580
16-0743215
HEALTHCARE NY 501(c)(3) 9 SHCG
 
 
No
(10) COMMUNITY CARE OF ROCHESTER
2180 EMPIRE BOULEVARD

WEBSTER,NY14580
16-1561691
HEALTHCARE NY 501(c)(3) 9 SHCG
 
 
No
(11) EXCELL PARTNERS INC
222 west ridge rd suite 156-1

ROCHESTER,NY14615
20-1862628
ECONOMIC DEV NY 501(c)(4) N/A UNIV OF ROCH
 
 
No
(12) ROCHESTER BIOVENTURE CENTER INC
601 ELMWOOD AVENUE BOX 706

ROCHESTER,NY14642
20-2485999
BIOTECH INCUB NY 501(c)(3) 11A, 1 UNIV OF ROCH
 
 
No
(13) HIGH TECH ROCHESTER INC
150 LUCIUS GORDON DRIVE SUITE 100

WEST HENRIETTA,NY14586
16-1195028
BUSINESS INCU NY 501(c)(3) 7 UNIV OF ROCH
 
 
No
(14) CRITTENDEN BOULEVARD HOUSING CO INC
249 NORTON VILLAGE LANE

ROCHESTER,NY14609
23-7035414
SUPPORT ORG NY 501(c)(3) 11B, II UNIV OF ROCH
 
 
No
(15) UNIVERSITY OF ROCHESTER EMPLOYEE BEN TRS
910 GENESEE STREET SUITE 200

ROCHESTER,NY14611
16-1600112
EMPL BEN TRST NY 501(c)(9) N/A UNIV OF ROCH
 
 
No
(16) U OF R BROADCASTING CORPORATION
201 WILSON COMMONS

ROCHESTER,NY14627
16-0743209
BROADCAST LIC NY 501(c)(4) N/A UNIV OF ROCH
 
 
No
(17) UR REAL ESTATE CORPORATION
263 WALLIS HALL

ROCHESTER,NY14627
27-1140014
SUPPORT ORG NY 501(c)(3) 11D, III-OT UNIV OF ROCH
 
 
No
(18) FRAMEMED FOUNDATION INC
263 WALLIS HALL

ROCHESTER,NY14627
16-1490497
SUPPORT ORG NY 501(c)(3) 7 UNIV OF ROCH
 
 
No
(19) MELIORA REAL ESTATE CORPORATION
263 WALLIS HALL

ROCHESTER,NY14627
45-2464788
SUPPORT ORG NY 501(c)(3) 11D, III-OT UNIV OF ROCH
 
 
No
(20) FF THOMPSON HEALTH SYSTEM INC
350 PARRISH STREET

CANANDAIGUA,NY14424
22-2959987
SUPPORT ORG NY 501(C)(3) 11A UNIV OF ROCH
 
 
No
(21) THE FREDERICK FERRIS THOMPSON HOSPITAL
350 PARRISH STREET

CANANDAIGUA,NY14424
16-0743024
HOSPITAL NY 501(C)(3) 3 THS
 
 
No
(22) MM EWING CONTINUING CARE CENTER
350 PARRISH STREET

CANANDAIGUA,NY14424
23-7046583
HEALTHCARE NY 501(C)(3) 3 THS
 
 
No
(23) FFT SENIOR COMMUNITIES INC
1 FERRIS HILLS

CANANDAIGUA,NY14424
16-1557494
ELDER CARE NY 501(C)(3) 9 THS
 
 
No
(24) THE FF THOMPSON FOUNDATION INC
350 PARRISH STREET

CANANDAIGUA,NY14424
22-2959984
FUNDRAISING NY 501(C)(3) 7 THS
 
 
No
(25) FINGER LAKES HOMECARE INC
756 PRE-EMPTION ROAD

GENEVA,NY14456
16-1489133
HEALTHCARE NY 501(C)(3) 9 VNSR
 
 
No
(26) FINGER LAKES VISITING NURSE SERVICE INC
756 PRE-EMPTION ROAD

GENEVA,NY14456
22-3067627
HEALTHCARE NY 501(C)(3) 9 VNSR
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) EXCELL INNOVATE NY FUND LP

222 WEST RIDGE ROAD BLDG 28 STE 1
ROCHESTER,NY14615
46-2405519
FUNDING START UPS NY EXCEL TECH VENT
 
                 












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) MEDICAL ADMINISTRATIVE ASSOCIATES INC

777 SOUTH CLINTON AVENUE
ROCHESTER,NY14620
16-1354319
RETAIL PHARMACY NY HIGHLAND HOSP
 
C CORP -440,973 2,243,807 100.000 % Yes  
(2) UR EQUITY HOLDINGS INC

110 OFFICE PARK WAY
PITTSFORD,NY14534
27-3040889
HOLDING COMPANY NY UNIV OF ROCH
 
C CORP         No
(3) FFTH PROPERTIES AND SERVICES INC

350 PARRISH STREET
CANANDAIGUA,NY14424
16-1286518
HOLDING COMPANY NY THS
 
C CORP         No
(4) EXCELL TECHNOLOGY VENTURES INC

222 WEST RIDGE ROAD STE 156-1
ROCHESTER,NY14615
80-0909149
BIOTECH INCUBATOR NY ROCH BIO CTR
 
C CORP         No
(5) FINGER LAKES COMUNITY CARE NETWORK INC

350 PARRISH STREET
CANANDAIGUA,NY14424
16-1423442
INACTIVE NY THS
 
C CORP         No
(6) ACCOUNTABLE HEALTH PARTNERS LLC

135 CORPORATE WOODS STE 320
ROCHESTER,NY14623
30-0787967
ACCT CARE NETWORK NY UNIV OF ROCH
 
C CORP         No


Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) THE HIGHLAND FOUNDATION INC

C,M,N 131,925 FMV GIFT
(2) MEDICAL ADMINISTRATIVE ASSOCIATES INC

J,O,Q 807,472 SERVICE COST
(3) HIGHLAND FACILITIES DEVELOPMENT CORPORATION

K,L,O 252,933 NET EXPENSES



Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2014
Additional Data


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