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Nonprofiteer
← GOUVERNEUR HOSPITAL

Form 990 for tax year 2022

Filed by GOUVERNEUR HOSPITAL.

This return was superseded by a later amendment. matched by us It is kept because history is preserved rather than replaced.

What the amendment changed

Compared with the latest return for 2022 , filed 8 April 2024. matched by us Only the Part I totals and the names listed in Part VII are compared. We relate returns by organization, tax year and form, and order them by each return's own timestamp; the filer's own "amended return" checkbox is a separate fact.

Both are the same on the two returns, so the amendment changed something else.

Totals

Total revenue
$30,436,096
Total expenses
$29,588,845
Contributions and grants received
$3,168,078
Grants paid
$1,753
Program services expenses (Part IX)
$25,121,313
Management and general expenses
$4,467,532
Fundraising expenses
$0
Program service expenses (Part III)
$25,121,313

Program services were 84.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • ANDREW LEONARD

    CHAIR OF THE BOARD

    Total calculated
    $0
    Hours/week
    1

  • CHRISTINE BETRUS

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    1

  • MARK BRACKETT

    TREASURER/SECRETARY

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • KIMBERLY SMITH

    ASSISTANT SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • KELLY CICCHINELLI

    ASSISTANT TREASURER

    Total calculated
    $219,991
    From this org
    $0
    From related orgs
    $212,726
    Other
    $7,265
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $212,726 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0 + $7,265 related
    Filer's total
    $0 + $219,991 related

  • RICHARD DAVIS PHD

    CEO

    Total calculated
    $1,305,226
    From this org
    $0
    From related orgs
    $1,294,014
    Other
    $11,212
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,044,014 related
    Bonus
    $0 + $250,000 related
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0 + $11,212 related
    Filer's total
    $0 + $1,305,226 related

  • ROGER COOK

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • KURT HALLIDAY PHD

    DIRECTOR

    Total calculated
    $50,312
    From this org
    $0
    From related orgs
    $50,312
    Other
    $0
    Hours/week
    1 + 40 related

  • CAROLYN PISTOLESI

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • RYAN SCHERMERHORN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • THEODORE TOTTEN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • ANDREW WILLIAMS MD

    DIRECTOR

    Total calculated
    $162,030
    From this org
    $0
    From related orgs
    $162,030
    Other
    $0
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $30 related
    Bonus
    $0 + $162,000 related
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $162,030 related

  • KATHY SCHLEIDER

    PRESIDENT, GH (INTERIM)

    Total calculated
    $0
    Hours/week
    1

  • THOMAS CRILLY

    CFO

    Total calculated
    $1,101,091
    From this org
    $0
    From related orgs
    $1,333,009
    Other
    -$231,918
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $632,120 related
    Bonus
    $0 + $650,433 related
    Other
    $0 + $50,456 related
    Deferred
    $0 + -$244,610 related
    Nontaxable benefits
    $0 + $12,692 related
    Filer's total
    $0 + $1,101,091 related

  • HUGH THOMAS

    CAO

    Total calculated
    $1,269,539
    From this org
    $0
    From related orgs
    $1,464,024
    Other
    -$194,485
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $895,878 related
    Bonus
    $0 + $568,146 related
    Other
    $0
    Deferred
    $0 + -$207,017 related
    Nontaxable benefits
    $0 + $12,532 related
    Filer's total
    $0 + $1,269,539 related

  • PAYAM HADIAN MD

    PHYSICIAN

    Total calculated
    $355,602
    From this org
    $347,313
    From related orgs
    $0
    Other
    $8,289
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $313,313
    Bonus
    $34,000
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $8,289
    Filer's total
    $355,602

  • JOSEPH LAMB

    PHYSICIAN ASSISTANT

    Total calculated
    $229,267
    From this org
    $226,918
    From related orgs
    $0
    Other
    $2,349
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $225,918
    Bonus
    $1,000
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $2,349
    Filer's total
    $229,267

  • JOHN WELBORN

    NURSE PRACTITIONER

    Total calculated
    $185,326
    From this org
    $178,611
    From related orgs
    $0
    Other
    $6,715
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $177,111
    Bonus
    $1,500
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $6,715
    Filer's total
    $185,326

  • PEARL HERSH

    PHYSICIAN

    Total calculated
    $481,545
    From this org
    $479,229
    From related orgs
    $0
    Other
    $2,316
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $464,262
    Bonus
    $14,967
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $2,316
    Filer's total
    $481,545

  • REBECCA GILSON

    PHYSICIAN

    Total calculated
    $170,028
    From this org
    $170,028
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $170,028
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $170,028

  • ERIC BURCH

    FORMER CEO, GOUVERNEUR HOSPITAL

    Total calculated
    $167,841
    From this org
    $0
    From related orgs
    $167,841
    Other
    $0
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $167,841 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $167,841 related

  • JEREMY J SLAGA

    PRESIDENT, GH, FORMER

    Total calculated
    $321,798
    From this org
    $0
    From related orgs
    $318,882
    Other
    $2,916
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $240,236 related
    Bonus
    $0 + $78,646 related
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0 + $2,916 related
    Filer's total
    $0 + $321,798 related

  • ERIC BIEBER

    FORMER CEO

    Total calculated
    $47,654
    From this org
    $0
    From related orgs
    $47,360
    Other
    $294
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $47,360 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0 + $294 related
    Filer's total
    $0 + $47,654 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Written employment contract
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS SEEKS THE INPUT OF A CONSULTING FIRM WITH NATIONAL EXPERIENCE TO REVIEW THE COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AND THE REGULATORY COMPLIANCE ISSUES OF NOT-FOR-PROFITS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATONS OF THE COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE.
PART I, LINE 4B
SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS PROVIDE BENEFITS TO CERTAIN KEY EXECUTIVE EMPLOYEES OF ROCHESTER REGIONAL HEALTH. THE ORGANIZATION MAINTAINS A SECTION 457(F) PLAN WHICH WOULD BE CONSIDERED A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2022, THE CFO OF ROCHESTER REGIONAL HEALTH RECEIVED A DISTRIBUTION TOTALING $49,054.
PART II, COLUMN C:
RETIREMENT AND OTHER DEFERRED COMPENSATION - THIS COLUMN IS REFLECTIVE OF THE ACTUARIAL CHANGE IN DEFINED BENEFIT PENSION PLAN AND POST-RETIREMENT BENEFITS FOR THE TAX YEAR.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2022
Filed
9 November 2023
IRS schema version
2022v5.0
Source object
202333179349306203

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