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← CLIFTON SPRINGS HOSPITAL & CLINIC FOUNDATION INC

Form 990 for tax year 2022

Filed by CLIFTON SPRINGS HOSPITAL & CLINIC FOUNDATION INC.

Totals

Total revenue
$608,586
Total expenses
$2,685,703
Contributions and grants received
$308,056
Grants paid
$2,339,153
Program service revenue
$0
Investment income
$221,724
Other revenue
$78,806
Total assets, end of year
$11,209,677
Total liabilities, end of year
$1,190,632
Net assets or fund balances, end of year
$10,019,045
Program services expenses (Part IX)
$2,339,153
Management and general expenses
$188,597
Fundraising expenses
$157,953
Program service expenses (Part III)
$2,339,153

Program services were 87.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1f · All other contributions, gifts and grants

    $308,056

  • 3 · Investment income

    total $93,040 · excluded $93,040

  • 6a · Gross rents

    real property $82,500

  • 6b · Less rental expenses

    real property $0

  • 6c · Rental income or loss

    real property $82,500

  • 6d · Net rental income or loss

    total $82,500 · excluded $82,500

  • 7a · Gross sales of assets other than inventory

    securities $987,857

  • 7b · Less cost or other basis and sales expenses

    securities $859,173

  • 7c · Gain or loss

    securities $128,684

  • 7d · Net gain or loss

    total $128,684 · excluded $128,684

  • 8a · Fundraising events: gross income

    $4,475

  • 8b · Fundraising events: direct expenses

    $8,169

  • 8c · Net income from fundraising events

    total -$3,694 · excluded -$3,694

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $2,339,153 · program services $2,339,153

  • 7 · Other salaries and wages

    total $163,668 · management and general $57,284 · fundraising $106,384

  • 8 · Pension plan contributions

    total $13,152 · management and general $4,603 · fundraising $8,549

  • 9 · Other employee benefits

    total $8,533 · management and general $2,986 · fundraising $5,547

  • 10 · Payroll taxes

    total $11,435 · management and general $4,003 · fundraising $7,432

  • 11g · Fees: other

    total $8,934 · management and general $8,934

  • 12 · Advertising and promotion

    total $3,296 · fundraising $3,296

  • 13 · Office expenses

    total $2,126 · management and general $2,126

  • 16 · Occupancy

    total $6,256 · management and general $6,256

  • 19 · Conferences, conventions and meetings

    total $4,469 · management and general $4,469

  • 24a · Other expenses: DONOR CULTIVATION

    total $25,412 · management and general $22,558 · fundraising $2,854

  • 24b · Other expenses: UNCOLLECTIBLE PLEDGES

    total $16,769 · fundraising $16,769

  • 24e · All other expenses

    total $82,500 · management and general $75,378 · fundraising $7,122

Balance sheet

Part X, book values.

  • 3 · Pledges and grants receivable

    beginning of year $1,908,763 · end of year $1,790,515

  • 11 · Investments: publicly traded securities

    beginning of year $8,897,289 · end of year $6,959,162

  • 15 · Other assets

    beginning of year $2,699,102 · end of year $2,460,000

  • 17 · Accounts payable and accrued expenses

    beginning of year $230 · end of year $0

  • 25 · Other liabilities

    beginning of year $0 · end of year $1,190,632

  • 27 · Net assets without donor restrictions

    beginning of year $1,186,347 · end of year $3,261,192

  • 28 · Net assets with donor restrictions

    beginning of year $12,318,577 · end of year $6,757,853

Mission and programs · 2022

Mission

CLIFTON SPRINGS HOSPITAL & CLINIC FOUNDATION, INC. WAS FORMED TO SOLICIT, RECEIVE, MAINTAIN AND DISTRIBUTE FUNDS AND PROPERTY IN CONNECTION WITH AND FOR THE BENEFIT OF THE CHARITABLE PURPOSES OF CLIFTON SPRINGS SANITARIUM CO. D/B/A CLIFTON SPRINGS HOSPITAL AND CLINIC AND OTHER ORGANIZATIONS WITH SIMILAR PURPOSES.

  • CLIFTON SPRINGS HOSPITAL & CLINIC FOUNDATION, INC. WAS FORMED TO SOLICIT, RECEIVE, MAINTAIN AND DISTRIBUTE FUNDS AND PROPERTY IN CONNECTION WITH AND FOR THE BENEFIT OF THE CHARITABLE PURPOSES OF CLIFTON SPRINGS SANITARIUM CO. D/B/A CLIFTON SPRINGS HOSPITAL AND CLINIC AND OTHER ORGANIZATIONS WITH SIMILAR PURPOSES.

    Expenses $2,339,153 · Grants $2,339,153

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • ROBERT WOODHOUSE

    CHAIR OF THE BOARD

    Total calculated
    $0
    Hours/week
    1

  • LEWIS ZULICK MD

    TREASURER

    Total calculated
    $150,962
    From this org
    $0
    From related orgs
    $139,259
    Other
    $11,703
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $128,591 related
    Bonus
    $0 + $10,668 related
    Other
    $0
    Deferred
    $0 + -$3,060 related
    Nontaxable benefits
    $0 + $14,763 related
    Filer's total
    $0 + $150,962 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

  • AZFAR AHMED MD

    DIRECTOR

    Total calculated
    $707,752
    From this org
    $0
    From related orgs
    $698,069
    Other
    $9,683
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $361,052 related
    Bonus
    $0 + $337,017 related
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0 + $9,683 related
    Filer's total
    $0 + $707,752 related

  • KEVIN CHRISTIANO

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • SLAVE JANKULOSKI

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • MARY LUE MUELLER

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • DOUG TRIPLETT

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • BILL YOUNG

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • HOLLY ADAMS

    DIRECTOR

    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

  • DUSTIN RICCIO

    PRESIDENT, EASTERN REGION

    Total calculated
    $381,217
    From this org
    $0
    From related orgs
    $495,631
    Other
    -$114,414
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $322,396 related
    Bonus
    $0 + $173,235 related
    Other
    $0
    Deferred
    $0 + -$124,883 related
    Nontaxable benefits
    $0 + $10,469 related
    Filer's total
    $0 + $381,217 related

  • KELLY MCCORMICK-SULLIVAN

    PRESIDENT, FOUNDATIONS

    Total calculated
    $359,430
    From this org
    $0
    From related orgs
    $297,938
    Other
    $61,492
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $242,707 related
    Bonus
    $0 + $55,231 related
    Other
    $0
    Deferred
    $0 + $48,959 related
    Nontaxable benefits
    $0 + $12,533 related
    Filer's total
    $0 + $359,430 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, and on a Form 990-PF Part VIII's — 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

  • 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
COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS IS ESTABLISHED USING THE FOLLOWING: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACTS - COMPENSATION SURVEYS AND STUDIES - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE ON AN ANNUAL BASIS, THE ORGANIZATION USES AN INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE SALARIES FOR ALL EXECUTIVES TO ENSURE SUCH SALARIES ARE CONSISTENT WITH MARKET SALARIES PAID TO SIMILARLY SITUATED EXECUTIVES. IN ADDITION, A COMPENSATION COMMITTEE REVIEWS THIS INFORMATION ANNUALLY AND IT IS THEN APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. FINALLY, EXECUTIVES RECEIVE A WRITTEN LETTER OUTLINING THE SPECIFICS OF THE COMPENSATION AGREEMENT AND THEIR EXPECTED PERFORMANCE.
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

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.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

Provenance

Return type
form_990
Tax year
2022
Filed
6 November 2023
IRS schema version
2022v5.0
Source object
202323179349304672

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