Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
ROCHESTER PRIMARY CARE NETWORK INC
 
Employer identification number
16-1293681
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) ROCHESTER GENERAL MEDICAL GROUP NORTHEAST HEALTH SERVICES
1425 PORTLAND AVENUE
ROCHESTER,NY14621 		16-0743134 501(C)3 136,556       SLIDING FEE SCALE DISCOUNTS FOR MEDICAL SERVICES, LABS AND X-RAYS
(2) ROCHESTER GENERAL MEDICAL GROUP NORTHEAST WOMEN'S CENTER
1415 PORTLAND AVENUE
ROCHESTER,NY14621 		16-0743134 501(C)3 9,490       SLIDING FEE SCALE DISCOUNTS FOR MEDICAL SERVICES, LABS AND X-RAYS
(3) ROCHESTER GENERAL MEDICAL GROUP CLINTON FAMILY HEALTH CENTER
293 UPPER FALLS BOULEVARD
ROCHESTER,NY14605 		16-0743134 501(C)3 45,097       SLIDING FEE SCALE DISCOUNTS FOR MEDICAL SERVICES, LABS AND X-RAYS
(4) ROCHESTER GENERAL MEDICAL GROUP CLINTON'S WOMEN'S CENTER
309 UPPER FALLS BOULEVARD
ROCHESTER,NY14605 		16-0743134 501(C)3 14,440       SLIDING FEE SCALE DISCOUNTS FOR MEDICAL SERVICES, LABS AND X-RAYS
(5) ROCHESTER GENERAL MEDICAL GROUP GENESEE HEALTH SERVICES
222 AND 224 ALEXANDER STREET
ROCHESTER,NY14607 		16-0743134 501(C)3 421,207       SLIDING FEE SCALE DISCOUNTS FOR MEDICAL SERVICES, LABS AND X-RAYS
(6) ROCHESTER GENERAL MEDICAL GROUPBEHAVIORAL HEALTH NETWORK
500 WEBSTER AVENUE
ROCHESTER,NY14609 		16-0743134 501(C)3 15,571       PROGRAM EXPENSE TO INCLUDE SALARY, FRINGE, MISC. ITEMS
(7) ROCHESTER GENERAL MEDICAL GROUPBEHAVIORAL HEALTH NETWORK
625 SCIO STREET
ROCHESTER,NY14605 		16-0743134 501(C)3 96,346       PROGRAM EXPENSE TO INCLUDE SALARY, FRINGE, MISC. ITEMS
(8) ROCHESTER GENERAL MEDICAL GROUPBEHAVIORAL HEALTH NETWORK
655 COLFAX STREET
ROCHESTER,NY14606 		16-0743134 501(C)3 178,083       PROGRAM EXPENSE TO INCLUDE SALARY, FRINGE, MISC. ITEMS
(9) UNITY HEALTH SYSTEM UNITY DENTAL CENTER
89 GENESEE STREET
ROCHESTER,NY14611 		23-7221763 501(C)3 93,784       SLIDING FEE SCALE DISCOUNTS FOR DENTAL SERVICES, LABS AND X-RAYS.
(10) UNITY HEALTH SYSTEM UNITY FAMILY MEDICINE AT ST MARY'S
89 GENESEE STREET
ROCHESTER,NY14611 		23-7221763 501(C)3 75,411       SLIDING FEE SCALE DISCOUNTS FOR DENTAL SERVICES, LABS AND X-RAYS.
(11) UNITY HEALTH SYSTEM UNITY FAMILY MEDICINE AT ORCHARD
158 ORCHARD STREET
ROCHESTER,NY14611 		23-7221763 501(C)3 196,032       SLIDING FEE SCALE DISCOUNTS FOR DENTAL SERVICES, LABS AND X-RAYS.
(12) UNITY HEALTH SYSTEM UNITY AT ST BERNARDS
2260 LAKE AVENUE
ROCHESTER,NY14612 		23-7221763 501(C)3 16,818       SLIDING FEE SCALE DISCOUNTS FOR DENTAL SERVICES, LABS AND X-RAYS.
(13) UNITY HEALTH SYSTEM UNITY PEDIATRICS & OBGYN
819 WEST MAIN STREET
ROCHESTER,NY14611 		23-7221763 501(C)3 8,499       SLIDING FEE SCALE DISCOUNTS FOR DENTAL SERVICES, LABS AND X-RAYS.
(14) UNITY HEALTH SYSTEM UNITY DENTAL CENTER AT RIDGEWAY
2655 RIDGEWAY AVENUE
ROCHESTER,NY14626 		23-7221763 501(C)3 44,787       SLIDING FEE SCALE DISCOUNTS FOR DENTAL SERVICES, LABS AND X-RAYS.
(15) ROCHESTER GENERAL MEDICAL GROUPBEHAVIORAL HEALTH NETWORK
100 KINGS HIGHWAY S
ROCHESTER,NY14617 		16-0743134 501(C)3 132,478       CHIF FUNDS TO START UP COSTS FOR SBHC PROGRAM TO INCLUDE SALARY, FRINGE, MISC. ITEMS.
(16) ROCHESTER GENERAL MEDICAL GROUP NORTHEAST DENTAL CENTER
1425 PORTLAND AVENUE
ROCHESTER,NY14621 		16-0743134 501(C)3 22,593       SLIDING FEE SCALE DISCOUNTS FOR MEDICAL SERVICES, LABS AND X-RAYS
(17) LIFESPAN OF GREATER ROCHESTER INC
1900 S CLINTON AVENUE
ROCHESTER,NY14618 		16-0986298 501(C)3 5,506       CHIF FUNDS FOR THE PROGRAM TO REDUCE FALLS IN THE SENIOR PROGRAM
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2016
Page 2

Schedule I (Form 990) 2016
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: THE MONITORING PROCESS IS PERFORMED THROUGH SEVERAL MEANS. RPCN'S CORPORATE COMPLIANCE OFFICER AUDITS THE SUBRECIPIENTS ADHERENCE TO THE SECTION 330 AND HEALTH CENTER PROGRAM, RPCN'S CEO IS AN AD HOC MEMBER OF BOTH SUBRECIPIENTS BOARDS. IN ADDITION, THE FINANCE STAFF REVIEWS MONTHLY VOUCHERS FOR COMPLIANCE WITH GRANT AGREEMENTS. THE SUBRECIPIENTS PARTICIPATE IN A COMBINED QI COMMITTEE AS WELL. SENIOR MANAGEMENT WORKS WITH THE SUBRECIPIENTS MANAGEMENT TO KEEP THEM UPDATED ON PROGRAMMATIC CHANGES.
Schedule I (Form 990) 2016



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