2021-10-28T09:07:53-05:00 2020-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2020-01-01 161471634 ROME MEMORIAL HOSPITAL ROME 3153387000 1500 NORTH JAMES STREET ROME NY 13440 DEWEY ROWLANDS CFO/VP FINANCE 3153387000 2021-10-27 1 DEWEY ROWLANDS XXX-XX-XXXX DEBORAH STUCK P01281391 3154463600 2021-10-27 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ANNMARIE CZYZ 1500 NORTH JAMES STREET ROME NY 13440 101559475 0 X ROMEHOSPITAL.ORG X 1995 NY PROVIDE QUALITY HEALTHCARE WITH COMPASSION. 12 11 1132 0 -91114 0 4409232 20057382 83690655 76963551 137441 270535 1289746 4220643 89527074 101512111 0 0 0 0 47972926 42985814 0 0 0 46579114 44771115 94552040 87756929 -5024966 13755182 47403294 64804521 30805077 34510426 16598217 30294095 X ABOUT ROME MEMORIAL HOSPITAL: OVERALL, ROME MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, SKILLED NURSING, AND EMERGENCY CARE SERVICES PRIMARILY FOR THE RESIDENTS OF ROME AND THE SURROUNDING AREAS. 0 0 28318056 25333325 INPATIENT CARE SERVICES, INPATIENT NURSING UNITS CONSIST OF THE FOLLOWING:INTENSIVE CARE-2ND FLOOR, MATERNITY-4TH FLOOR, 2 EAST MEDICAL/SURGICAL-2ND FLOOR, 2 NORTH MEDICAL/SURGICAL WITH CARDIAC MONITORING-2ND FLOOR, PEDIATRICS-2ND FLOOR, AND SENIOR BEHAVIORAL HEALTH- 2ND FLOOR.2020 INPATIENT DISCHARGES: 3,2032020 BIRTHS: 5722020 PATIENT DAYS: 13,314 7901164 6178302 RESIDENTIAL HEALTHCARE FACILITY (RHCF)BECAUSE OF OUR COMMITTMENT TO SERVE THE UNIQUE NEEDS OF SENIORS, WE HAVE AN 80-BED RESIDENTIAL HEALTH CARE FACILITY AND INPATIENT UNIT FOR SENIOR BEHAVIORAL HEALTH CARE. OUR RESIDENTIAL HEALTHCARE FACILITY CONSISTS OF THE FOLLOWING: LONG-TERM NURSING HOME CARE, SHORT-TERM SUB-ACUTE REHABILITATION, AND RESPITE CARE- ALL LOCATED ON THE 3RD FLOOR.2020 PATIENT DAYS = 21,1142020 OCCUPANCY PERCENTAGE = 80.12% 7989367 10413036 EMERGENCY DEPARTMENT (ED)ROME MEMORIAL HOSPITAL EMERGENCY DEPARTMENT IS A SAFETY NET FOR THE MOST VULNERABLE POPULATIONS IN THE COMMUNITY. IN 2020, APPROXIMATELY 43.10% OF THE PATIENTS TREATED WERE LISTED AS UNINSURED OR UNDER INSURED. FOR LOWER LEVEL EMERGENCY DEPARTMENT VISITS, THIS POPULATION REPRESENTED 58.22% OF THE VISITS BECAUSE MANY PRIMARY CARE PHYSICIANS DO NOT ACCEPT MEDICAID.2020 ED ADMISSIONS: 2,6882020 ED VISITS: 19,596 25737525 35038888 ALL SERVICES TO PROVIDE QUALITY, COMPASSIONATE CARE IN A SAFE ENVIRONMENT TO SERVE THE HEALTHCARE NEEDS OF THE PEOPLE OF ROME AND THE SURROUNDING COMMUNITIES. 25737525 35038888 69946112 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 44 0 1 1132 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X DEWEY ROWLANDS - ROME MEMORIAL HOSPITAL 3153387024 1500 NORTH JAMES STREET ROME NY 13440 X ANKUR DESAI MD CHAIRMAN 2.00 X X 0 0 0 LYNN REESE VICE CHAIRMAN 2.00 X X 0 0 0 DARLENE BURNS SECRETARY 2.00 X X 0 0 0 JULIE GROW-DENTON TREASURER 2.00 X X 0 0 0 DAVID NOLAN DIRECTOR 2.00 X 0 0 0 DONALD HANSON DIRECTOR 2.00 X 0 0 0 JOHN RESTIVO MD DIRECTOR 2.00 X 0 0 0 KIM COOK DIRECTOR 2.00 X 0 0 0 KRISTIN GRUNDER DIRECTOR 2.00 X 0 0 0 LORI KAPLAN FELICE DIRECTOR 2.00 X 0 0 0 RYAN O'SHAUGNESSY DIRECTOR 2.00 X 0 0 0 FRANCA ARMSTRONG DIRECTOR 2.00 X 0 0 0 KRISTIN MUCITELLI-HEATH ST. JOSEPH'S HEALTH LIAISO 2.00 X 0 0 0 DEWEY ROWLANDS CFO 48.00 7.00 X 202574 30270 6814 MARK MURPHY INTERIM CEO 45.00 10.00 X 0 0 0 SHARMILA RAVINDRANATHAN HOSPITALIST 55.00 X 204905 0 1598 SAMANTHA VINING CNO 55.00 X 169293 0 8134 MARK ROWAN CIO 55.00 X 162546 0 8465 SCOTT BURNS DIRECTOR OF PHARMACY 55.00 0.00 X 147795 0 8441 ROSEMEL ATKINSON VP PHYSICIAN PRACTICES 11.00 44.00 X 28379 113517 230 915492 143787 33682 5 0 1 0 LABCORP PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 5444341 PREMIER ANESTHESIA 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 HOSPITALIST SERVICES 1135591 ST JOSEPH'S PHYSICIANS 301 PORSPECT AVE SYRACUSE NY 13203 HOSPITALIST SERVICES 1009299 ALLSCRIPTS HEALTHCARE 222 MERCHANDISE MRT PLS STE 2024 CHICAGO IL 60654 HEALTHCARE IT 756829 ST JOSEPH HHC 301 PORSPECT AVE SYRACUSE NY 13203 PHYSICIAN STAFFING 644874 32 19599502 457880 20057382 INPATIENT SERVICES 622110 25333325 25333325 EMERGENCY DEPARTMENT 621990 10413036 10413036 RESIDENTIAL HEALTHCARE FACILITY 623990 6178302 6178302 35038888 35038888 76963551 141714 141714 58678 9869 48809 48809 48809 166316 37495 128821 128821 128821 340B REVENUE 541200 920022 920022 LAB REVENUE 621990 424767 424767 CAFETERIA SALES 722514 160454 160454 2666591 -91114 2757705 4171834 101512111 76963551 -91114 4582292 X 208502 208502 35237824 31219497 4018327 302576 266865 35711 4608634 4059073 549561 2628278 2315121 313157 155411 155411 78345 78345 17512 17512 13220531 12164657 1055874 156108 64625 91483 184972 106756 78216 1518446 1518446 1094861 898339 196522 41908 40721 1187 23769 13515 10254 152364 25541 126823 2805361 1942968 862393 1073667 1073667 SUPPLIES 7161361 6966349 195012 PURCHASE SERVICES 4476751 2224559 2252192 BAD DEBT EXPENSE 3737643 3737643 PHARMACY 2365864 2365864 6506241 1534019 4972222 87756929 69946112 17810817 0 349089 2598683 17709790 7376468 7724188 1675768 2081815 1902949 2455823 3589673 3848810 83565228 59825424 24803508 23739804 1156441 0 6549398 4645608 47403294 64804521 16541706 14258207 1190489 1373880 13072882 18878339 30805077 34510426 X 14876137 28653101 1722080 1640994 16598217 30294095 47403294 64804521 X 13755182 -59304 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 17512 0 0 17512 0 PART II-B, LINE 1: $17,512 REPRESENTS THE PORTION OF THE 2020 MEMBERSHIP DUES OF HANYS, AHA, AND IROQUOIS HEALTHCARE ALLIANCE, THAT RMH IS A MEMBER OF, THAT HAS BEEN DEEMED TO BE RELATED TO LOBBYING EXPENSES. THESE EXPENDITURES ARE DEFINED AS DIRECT COMMUNICATIONS WITH CERTAIN MEMBERS OF FEDERAL, STATE, OR LOCAL GOVERNMENTS TO INFLUENCE LEGISLATION. 1722080 -58864 22222 1640995 1932885 -179623 31182 1722080 714585 1267200 48900 1932885 704285 40484 30184 714585 751555 -12601 34669 704285 0 0 44370372 26174677 18195695 2477791 2442103 35688 33477688 28784509 4693179 3239377 2424135 815242 23739804 NET ASSETS OF FOUNDATION 1917307 OTHER LONG-TERM RECEIVABLES 2728301 4645608 OTHER LONG-TERM LIABILITIES 7049007 THIRD-PARTY PAYABLE, NET 11829332 18878339 X 97774235 0 97774235 3737876 3737876 101512111 84019286 0 84019286 3737643 3737643 87756929 PART V, LINE 4: INTENDED USE OF ENDOWMENT FUND IS THAT THE PRINCIPLE CAN BE INVESTED, WHILE KEPT INTACT IN PERPETUITY; ONLY THE INCOME GENERATED CAN BE USED BY THE ORGANIZATION. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAXES ON UNRELATED BUSINESS INCOME UNDER SECTION 511 OF THE INTERNAL REVENUE CODE. ROME MEDICAL GROUP AND ROME MEDICAL PRACTICE ARE FOR-PROFIT ENTITIES SUBJECT TO FEDERAL AND STATE INCOME TAXES. AS OF DECEMBER 31, 2020 AND 2019, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2017 THROUGH 2020. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. PART XI, LINE 4B - OTHER ADJUSTMENTS: GRIFFISS EYE SURGERY 1231 LOSS 233. BAD DEBT EXPENSE 3,737,643. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,737,643. 1 1 1 X 1 X 1 1 1 0 1 1 1207248 605678 601570 0.00720 20182498 15229810 4952688 0.05890 126365 126365 0.00150 21516111 15835488 5680623 0.06760 38459 6850 31609 0.00030 38459 6850 31609 0.00030 21554570 15842338 5712232 0.06790 78238 78238 0.00090 78238 78238 0.00090 0 1040621 98392 17585825 18104444 -518619 X 1 0 1 GRIFFISS EYE CENTER LLC SEE SCHEDULE R PART VII 0.22070 0.00000 0.77930 1 1 ROME MEMORIAL HOSPITAL 1500 NORTH JAMES STREET ROME NY 13440 X X X ROME MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE LINE 7D DESCRIPTION FOR FULL URL X SEE LINE 7D DESCRIPTION FOR FULL URL X 1 19 1 SEE LINE 7D DESCRIPTION FOR FULL URL 0 1 X 100.000000000000 300.000000000000 1 1 X X X X 1 X HTTP://WWW.ROMEHOSPITAL.ORG/FINANCIALASSISTANCE/ X HTTP://WWW.ROMEHOSPITAL.ORG/FINANCIALASSISTANCE/ X HTTP://WWW.ROMEHOSPITAL.ORG/FINANCIALASSISTANCE/ X X X X X X 1 X 0 X X 1 X 0 0 ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: ONEIDA COUNTY HEALTH DEPARTMENT (OCHD), ROME MEMORIAL HOSPITAL (RMH) AND MOHAWK VALLEY HEALTH SYSTEM (MVHS) COLLABORATED WITH KEY COMMUNITY STAKEHOLDERS THROUGHOUT 2019 TO ASSESS AND PRIORITIZE THE HEALTHCARE NEEDS OF THE COMMUNITY. THE 2019-2021 ONEIDA COUNTY COMMUNITY HEALTH ASSESSMENT (CHA/COMMUNITY SERVICE PLAN (CSP)) AND COMMUNITY HEALTH IMPROVEMENT PLAN SUMMARIZES THE HEALTH STATUS OF THE COMMUNITY AND PUBLIC HEALTH AND HOSPITAL PREVENTION AGENDA HEALTH IMPROVEMENT GOALS FOR THE RESIDENTS OF THE COUNTY OF ONEIDATHE ASSESSMENT PROCESS INVOLVED DATA ANALYSIS, DATA COLLECTION, AND COMMUNITY ENGAGEMENT. THE IDENTIFICATION OF PRIORITIES AND FOCUS AREAS WAS GUIDED BY A PARTNERSHIP OF COMMUNITY AGENCIES, ORGANIZATIONS AND GROUPS. STRATEGIC COMMUNITY PARTNERS WERE SOLICITED TO PARTICIPATE IN A COMMUNITY STAKEHOLDER CONFERENCE TO INFORM THE ASSESSMENT PROCESS AS WELL AS TO OBTAIN INPUT ON PERCEPTIONS OF HEALTH ISSUES WITHIN THE COMMUNITY, CONSIDERING SOCIAL DETERMINANTS OF HEALTH AND PROVIDING INSIGHT ON SPECIFIC ASPECTS OF HEALTH PRIORITIES AS IT RELATES TO THE NYSDOH PREVENTION AGENDA. THE COMMITTEE ALSO SOLICITED INPUT FROM THE COMMUNITY THROUGH THE USE OF AN ON-LINE SURVEY, REACHING 898 RESIDENTS. THIS COMBINATION OF RESEARCH FINDINGS WAS USED AS REFERENCES FOR THE DEVELOPMENT OF THE 2019-2021 PRIORITIES. THE INITIAL FINDINGS OF THE COMMUNITY HEALTH ASSESSMENT AND PRIORITIES WERE DISTRIBUTED TO THE PUBLIC VIA A PRESS RELEASE, ANNOUNCING THE AVAILABILITY OF THE DRAFT EXECUTIVE SUMMARY OVERVIEW ON HEALTH DEPARTMENT AND HOSPITAL WEBSITES. FEEDBACK FROM THE PUBIC WAS SOLICITED AT THE TIME. MEDIA INTERVIEWS AND PRINT WERE AVENUES FOR FURTHER COMMUNICATING THE PRIORITY AREAS TO THE PUBLIC. THE COUNTY ALSO CONDUCTED FOCUS GROUPS IN THREE DIFFERENT AREAS OF THE COUNTY, TO URBAN AND ONE RURAL. THE FOCUS GROUPS VALIDATED THE PRIORITY AREAS AND PROVIDED ADDITIONAL DEPTH INTO THE CHALLENGES RESIDENTS FACE ACCESSING HEALTHCARE SERVICES, INCLUDING PRIMARY CARE AND MENTAL HEALTH, WHICH ARE CRITICAL TO IMPACTING THE IDENTIFIED HEALTH PRIORITIES. CONSISTENT WITH THE NEW YORK STATE VALUE BASED PAYMENT ROADMAP, THE HOSPITALS AND THEIR AFFILIATED PRIMARY CARE PRACTICES COMMIT TO LEVERAGING INFORMATION TECHNOLOGY SYSTEMS TO IDENTIFY AND CLOSE CARE GAPS TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY. SPECIFICALLY ADDRESSING SCREENING RATES AND THE OPIOID CRISIS WILL HAVE A POSITIVE IMPACT ON UTILIZATION MEASURES, INCLUDING POTENTIALLY PREVENTABLE VISITS, POTENTIALLY PREVENTABLE ADMISSIONS, AND POTENTIALLY PREVENTABLE READMISSIONS.THE DATA FROM THE CHA GUIDES THE HOSPITAL IN THE DEVELOPMENT OF TACTICS TO TRANSFORM OPERATIONS IN SUPPORT OF ITS STRATEGIC PLAN. THESE TACTICS ARE ORGANIZED UNDER THE PILLARS OF FISCAL SUSTAINABILITY; CONVENIENCE, QUALITY, ACCESS; AND ENGAGEMENT.THE 2019-2021 CHNA AND COMMUNITY HEALTH IMPROVEMENT PLAN OUTLINING THE PRIORITIES IS AVAILABLE ONLINE AT WWW.ROMEHOSPITAL.ORG. ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE MOHAWK VALLEY HEALTH SYSTEM (FAXTON-ST. LUKE'S HOSPITAL AND ST. ELIZABETH'S MEDICAL CENTER), THE ONEIDA COUNTY HEALTH DEPARTMENT AND COMMUNITY ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF THE POPULATIONS SERVED BY THE COUNTY'S HOSPITALS. ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE MOHAWK VALLEY HEALTH SYSTEM (FAXTON-ST. LUKE'S HOSPITAL AND ST. ELIZABETH'S MEDICAL CENTER), THE ONEIDA COUNTY HEALTH DEPARTMENT AND COMMUNITY ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF THE POPULATIONS SERVED BY THE COUNTY'S HOSPITALS. ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA (INCLUDING AN IMPLEMENTATION PLAN) IS AVAILABLE AT THE HOSPITAL'S WEBSITE USING THE FOLLOWING URL: HTTP://WWW.ROMEHOSPITAL.ORG/ABOUTUS/COMMUNITY_HEALTH_ASSESSMENT/COMMUNITY_HEALTH_ASSESSMENT/THE CHNA IS ALSO AVAILABLE AT ONEIDA COUNTY'S WEBSITE USING THE FOLLOWING URL: HTTP://WWW.OCGOV.NET/HEALTH/COMMUNITY-HEALTH-ASSESSMENT ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: ROME MEMORIAL HOSPITAL ADDRESSES THE SIGNIFICANT HEALTH CARE NEEDS OF THE COMMUNITY THROUGH ITS CONTINUUM OF HEALTHCARE SERVICES/PROGRAMS AND RELATIONSHIPS WITH COMMUNITY PARTNERS. THE COMMUNITY HOSPITAL HAS 130 LICENSED ACUTE CARE BEDS, AN 80-BED SKILLED NURSING FACILITY, A BROAD ARRAY OF OUTPATIENT SERVICES AND THREE ARTICLE 28 PRIMARY CARE PRACTICES. IN ADDITION, THE HOSPITAL PROVIDES ESSENTIAL ACCESS TO PRIMARY CARE AND SPECIALTY PHYSICIAN SERVICES THROUGH TWO AFFILIATED CAPTIVE PCS.THE DATA FROM THE CHA GUIDES THE HOSPITAL IN THE DEVELOPMENT OF TACTICS TO TRANSFORM OPERATIONS IN SUPPORT OF ITS STRATEGIC PLAN. THESE TACTICS ARE ORGANIZED UNDER THE PILLARS OF FISCAL SUSTAINABILITY; CONVENIENCE, QUALITY, ACCESS; AND ENGAGEMENT.UNMET COMMUNITY NEEDS ARE DUE TO A SHORTAGE OF PROVIDERS AND LIMITED FINANCIAL RESOURCES. 13 1 - COMMUNITY RECOVERY CENTER 264 W DOMINICK STREET ROME NY 13440 SUBSTANCE ABUSE COUNSELING 2 - MOHAWK VALLEY RADIATION MEDICINE 107 E CHESTNUT STREET ROME NY 13440 RADIATION ONCOLOGY 3 - PHYSICAL THERAPY 107 E CHESTNUT STREET ROME NY 13440 OFFSITE PHYSICAL THERAPY SERVICES 4 - BOONVILLE FAMILY CARE 13407 STATE ROUTE 12 BOONVILLE NY 13309 PRIMARY CARE SERVICES 5 - LABORATORY COLLECTION SITE 1801 BLACK RIVER BLVD ROME NY 13440 OFFSITE LAB COLLECTION SITE 6 - LABORATORY COLLECTION SITE 1617 N JAMES STREET ROME NY 13440 OFFSITE LAB COLLECTION SITE 7 - LABORATORY COLLECTION SITE 13407 STATE ROUTE 12 BOONVILLE NY 13309 OFFSITE LAB COLLECTION SITE 8 - MEDICAL IMAGING 1801 BLACK RIVER BLVD ROME NY 13440 OFFSITE RADIOLOGY SERVICES 9 - MEDICAL IMAGING 107 E CHESTNUT STREET ROME NY 13440 OFFSITE RADIOLOGY SERVICES 10 - PRENATAL CARE CENTER 155 WEST DOMINICK STREET ROME NY 13440 OFFSITE PRENATAL CARE SERVICES 11 - DELTA MEDICAL CENTER 1819 BLACK RIVER BLVD ROME NY 13440 PRIMARY CARE SERVICES 12 - REGIONAL WOUND CARE CENTER 267 HILL ROAD ROME NY 13441 ADVANCED WOUND CARE AND HYPERBARIC OXYGEN TREATMENT 13 - CAMDEN FAMILY CARE 5 MASONIC AVENUE CAMDEN NY 13316 PRIMARY CARE SERVICES PART I, LINE 6A: THE COMBINED ONEIDA COUNTY COMMUNITY HEALTH ASSESSMENT (CHA)/COMMUNITY SERVICE PLAN (CSP)) AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) IS POSTED ON ROME MEMORIAL HOSPITAL'S WEBSITE AT WWW.ROMEHOSPITAL.ORG. PART I, LINE 7: FINANCIAL ASSISTANCE AT COST (7A) AND UNREIMBURSED MEDICAID (7B) WERE CALCULATED BY USING A COST TO CHARGE RATIO. THIS COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, SUPPLIED BY THE IRS. OTHER BENEFITS (7E & 7F) WERE CALCULATED BY DETERMINING ACTUAL COSTS AND ACTUAL REVENUE PER EVENT.THE MAIN SOURCE OR GUIDE OF HOW CALCULATIONS WERE DETERMINED WAS BY UTILIZING THE WORKSHEETS PROVIDED BY THE IRS AND THEN ADJUSTING ACCORDING TO ROME HOSPITAL SPECIFICS (IE. USING ACTUAL COSTS VS. COST TO CHARGE RATIO AS MENTIONED ABOVE). PART I, LN 7 COL(F): PERCENT OF TOTAL EXPENSE IS CALCULATED BY USING THE DENOMINATOR OF THE TOTAL FUNCTIONAL EXPENSES LESS BAD DEBT EXPENSE OF $3,737,643(PER AUDITED FINANCIAL STATEMENTS). PART II, COMMUNITY BUILDING ACTIVITIES: ROME MEMORIAL HOSPITAL PARTICIPATES IN NUMEROUS COMMUNITY COMMITTEES INVOLVED IN ENHANCING HEALTHCARE OUTCOMES THROUGH PREVENTION, EARLY DETECTION AND INTERVENTION AS WELL AS EMERGENCY PREPAREDNESS ACTIVITIES TO ENSURE A COORDINATED RESPONSE IN AN EVENT OF A DISASTER. HOSPITAL EXPERTS ARE CALLED UPON TO PARTICIPATE IN MULTIPLE INITIATIVES TO ADDRESS ISSUES, SUCH AS DOMESTIC VIOLENCE, TEENAGE PREGNANCY, AND SUBSTANCE ABUSE.ROME MEMORIAL HOSPITAL IS ALSO ONE OF 11 HOSPITALS THAT ARE MEMBERS OF THE CENTRAL NEW YORK CARE COLLABORATIVE (CNYCC), WHICH HAS IDENTIFIED 11 DSRIP PROJECTS TO ADDRESS GAPS IN CARE AND IMPROVE OUTCOMES INCLUDING: EXPANDING CAPACITY, ESPECIALLY FOR PRIMARY AND BEHAVIORAL HEALTH SERVICES, AND IMPLEMENTING CARE MANAGEMENT, CARE COORDINATION AND POPULATION HEALTH INITIATIVES. ROME MEMORIAL HOSPITAL IS A PARTNER IN 5 OF THE 11 PROJECTS.RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO ENHANCE ACCESS TO CARE IS ONE OF THE HOSPITAL'S MOST SIGNIFICANT INVESTMENTS IN COMMUNITY BUILDING ACTIVITIES. WITH EXISTING PROVIDER SHORTAGES, MANY PRACTICES ARE NOT ACCEPTING NEW PATIENTS AND SEVERAL PRIMARY CARE PHYSICIANS WITH LARGE PATIENT PANELS ARE NEARING RETIREMENT, WHICH WILL ONLY EXACERBATE THE PROBLEM.BUILDING ON ITS TRADITION OF SERVING AS A CLINICAL SITE FOR ALLIED HEALTH PROFESSIONALS, ROME MEMORIAL HOSPITAL ENTERED INTO AN AGREEMENT WITH NEW YORK MEDICAL COLLEGE TO HELP DEVELOP THE NEXT GENERATION OF PROVIDERS. PART III, LINE 2: BAD DEBT EXPENSE IS CALCULATED BASED ON THE TOTAL BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS. FOR 2020, TOTAL BAD DEBT IS $3,737,643. THE RATIO OF PATIENT CARE COST TO CHARGES FROM THE INSTITUTIONAL COST REPORT IS THEN APPLIED TO THE TOTAL BAD DEBT. FOR 2020, THAT PERCENTAGE IS 27.84%. THE CALCULATED AMOUNT IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS. PART III, LINE 3: TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, THE TOTAL PERCENTAGE OF FINANCIAL ASSISTANCE PROVIDED TO PATIENTS IS APPLIED TO THE CALCULATED BAD DEBT EXPENSE. FOR 2020, THE TOTAL PERCENTAGE OF FINANCIAL AID PROVIDED IS 9.46%. APPLYING THAT PERCENTAGE AGAINST THE CALCULATED BAD DEBT EXPENSE IN PART III LINE 2 RESULTS IN THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTED TO FINANCIAL AID ELIGIBLE PATIENTS. PART III, LINE 4: SEE AUDITED FINANCIAL STATEMENTS PAGES 10 THROUGH 14 FOR CURRENT FOOTNOTE LANGUAGE THAT DESCRIBES BAD DEBT. PART III, LINE 6; COSTING METHODOLOGY AND SOURCE:2020 ICR EXHIBIT 46 AND TENTATIVE MEDICARE SETTLEMENT RATES PART III, LINE 8: FINANCIAL AID PROGRAM THE SHORTFALL IN QUESTION 7 SHOULD BE TREATED AS COMMUNITY BENEFIT AS MEDICARE REIMBURSEMENTS FAIL TO COVER THE COSTS OF PROVIDING CARE TO MEDICARE BENEFICIARIES. DESPITE EFFORTS TO IMPROVE EFFICIENCY, EXPENSES FOR TECHNOLOGY, PHARMACEUTICAL, AND SALARY AND BENEFITS CONTINUE TO ESCALATE. THE HOSPITALS BAD DEBT EXPENSES IS IMPACTED BY THE SOCIOECONOMICS OF THE COMMUNITY. THE MEDIAN HOUSEHOLD INCOME FOR ONEIDA COUNTY IS LOWER THAN THE STATE AVERAGE AND OVER 16% OF THE POPULATION LIVES BELOW THE POVERTY LINE. ALTHOUGH PEOPLE MAY HAVE INSURANCE, THEIR OUT-OF-POCKET COSTS ARE HIGH BECAUSE EMPLOYERS HAVE RAISED THEIR DEDUCTIBLES OR CO-PAYMENTS, OR REDUCED WHAT THEIR PLANS COVER.TO HELP THOSE WHO ARE UNINSURED LEARN MORE ABOUT POSSIBLE OPTIONS, THE HOSPITAL'S PATIENT REGISTRATION DEPARTMENT PROVIDES INFORMATION FROM INSURERS WHICH OFFER FREE OR LOW-COST HEALTH INSURANCE THROUGH NEW YORK STATE'S CHILD HEALTH PLUS AND FAMILY HEALTH PLUS, ALONG WITH SPACE FOR REPRESENTATIVES TO ANSWER QUESTIONS AND ENROLL ELIGIBLE RESIDENTS.IN ADDITION, THE HOSPITAL HAS PARTNERED WITH THE MOHAWK VALLEY PERINATAL NETWORK, WHOSE FACILITATED ENROLLER CAN ASSIST INDIVIDUALS IN APPLYING FOR COVERAGE FROM CHILD HEALTH PLUS, FAMILY HEALTH PLUS, AND MEDICAID. IN ADDITION TO HELPING PEOPLE OBTAIN INSURANCE COVERAGE, THE HOSPITAL ALSO PROVIDES A FINANCIAL ASSISTANCE PROGRAM AND WORKS WITH PATIENTS TO SET UP AFFORDABLE PAYMENT PLANS.FINANCIAL ASSISTANCE BROCHURES ARE LOCATED IN THE HOSPITAL'S WAITING AREAS AND APPLICATIONS ARE AVAILABLE ON THE WEBSITE. RMH DISCOUNTS PATIENT ACCOUNTS UP TO 100% DEPENDING UPON FAMILY INCOME IN COMPARISON TO THE FEDERAL POVERTY LEVEL. DISCOUNTS ARE BASED UPON THE BLUE CROSS RATE, OUR HIGHEST VOLUME PAYER. ROME MEMORIAL HOSPITAL OFFERS DISCOUNTS TO THE UNINSURED/UNDERINSURED WHOSE INCOME IS UP TO 300% OF THE FEDERAL POVERTY LEVEL.BECAUSE LACK OF AWARENESS IS ONE OF THE BIGGEST BARRIERS, RMH PROVIDES INFORMATION ABOUT AVAILABLE PROGRAMS AT HEALTH FAIRS AND OTHER OUTREACH ACTIVITIES.CHANGES (ACTUAL OR POTENTIAL) IMPACTING COMMUNITY HEALTH, PROVISION OF CHARITY CARE, AND ACCESS TO SERVICES: REIMBURSEMENTS THAT FAIL TO KEEP PACE WITH RISING EXPENSES AND THE CONTINUED GROWTH IN UNCOMPENSATED CARE ARE SIGNIFICANT CHALLENGES THAT NEW YORK'S HOSPITALS FACE, INCLUDING RMH. OTHER CHALLENGES INCLUDE THE ESCALATION OF COSTS FOR DRUGS DUE TO INFLATION AND HAVING TO FIND ALTERNATE SUPPLIERS BECAUSE OF MANUFACTURER PRODUCTION SHORTAGES, SERVICES AND BAD DEBT, AND INVESTMENTS REQUIRED TO COMPLY WITH MANDATES. HERE ARE JUST A FEW EXAMPLES OF OUR CHALLENGES:UNCOMPENSATED CARE: THE COST OF FREE SERVICES PROVIDED TO OUR COMMUNITY REMAINS HIGH WITH THE RISE IN HIGH-DEDUCTIBLE PLANS AND THE APPROXIMATELY 7% OF RESIDENTS WHO ARE UNINSURED. IN 2020, ROME MEMORIAL HOSPITAL'S BAD DEBT AND CHARITY CARE TOTALED $7.1 MILLION. PHYSICIAN SHORTAGES: ROME MEMORIAL HOSPITAL HAS BEEN SUCCESSFUL IN RECRUITING SEVERAL NEW PHYSICIANS TO THE COMMUNITY, BUT AT A GREAT COST. TODAY'S PHYSICIAN WANTS TO BE EMPLOYED SO THEY DON'T HAVE TO BEAR THE RISK OF OPENING A NEW PRACTICE OR MANAGE THE ADMINISTRATIVE ASPECTS OF MEDICINE. ALTHOUGH THEY PROVIDE CRITICAL ACCESS TO CARE, THESE PRACTICES STRUGGLE TO BREAK EVEN. LACK OF PRIMARY CARE: PATIENTS WHO DON'T HAVE INSURANCE OR WHO ARE COVERED BY MEDICAID OFTEN DON'T HAVE A REGULAR PHYSICIAN FOR PREVENTATIVE CARE OR TO MANAGE CHRONIC CONDITIONS. AS A RESULT, THEY USE THE EMERGENCY DEPARTMENT AS THEIR PRIMARY CARE OR DELAY CARE UNTIL THEIR CONDITION IS MORE CRITICAL AND MORE EXPENSIVE TO TREAT. SINCE ROME MEMORIAL HOSPITAL'S NEW EMERGENCY DEPARTMENT OPENED, THE NUMBER OF PATIENT VISITS HAS STEADILY INCREASED FROM 19,000 IN 2006 TO 22,191 IN 2020. MANY PHYSICIANS DON'T ACCEPT MEDICAID PATIENTS BECAUSE OF LOW REIMBURSEMENT RATES. IN ADDITION, SENIORS MAY SOON FACE THE SAME ACCESS PROBLEMS IF CUTS TO PHYSICIAN MEDICARE RATES ARE IMPLEMENTED. PHARMACEUTICALS: THE HOSPITAL CONTINUES TO SEE SIGNIFICANT INCREASE IN DRUG COSTS DUE TO INFLATION AND MANUFACTURER PRODUCTION SHORTAGES. IN MANY CASES, THESE SHORTAGES FORCE US TO TURN TO ALTERNATE SUPPLIERS, WHO CHARGE A PREMIUM PRICE. INTERPRETER SERVICES: AS OUR POPULATION BECOMES MORE DIVERSE WITH BURMESE AND BOSNIAN REFUGEES AND SPANISH SPEAKING RESIDENTS, THERE IS A GREATER DEMAND FOR INTERPRETER SERVICES. DDSO POPULATION: THE HIGH CONCENTRATION OF DDSO CLIENTS IN ONEIDA COUNTY AND ROME PLACES A UNIQUE BURDEN ON ROME MEMORIAL HOSPITAL. WHEN DDSO CLIENTS REQUIRE HOSPITALIZATION, THEIR CASES ARE OFTEN VERY COMPLEX AND THEIR LENGTH OF STAY IS NEARLY TWICE AS LONG AS THE AVERAGE PATIENT. AS A RESULT, THE HOSPITAL IS ONCE AGAIN FACED WITH ABSORBING THE FINANCIAL LOSS OF CARING FOR THESE PATIENTS. PROGRAM VIABILITY: AS A RESULT OF THESE SIGNIFICANT FINANCIAL CHALLENGES, RMH CONTINUALLY EVALUATES THE VIABILITY OF SOME OF ITS SERVICES. AS A PART OF THE EVALUATION, RMH ASSESSES THE NUMBER OF PEOPLE SERVED AND AVAILABILITY OF OTHER SERVICES TO ADDRESS THE COMMUNITY NEED, IN ADDITION TO THE FINANCIAL BURDEN ON THE HOSPITAL.TRANSITION TO VALUE BASED PAYMENTS: TO PREPARE FOR NEW PAYMENT MODELS THAT REWARD QUALITY AND EFFICIENCY, PROVIDERS NEED TO MAKE INVESTMENTS IN SOPHISTICATED ANALYTICS TO MANAGE RISK AND CARE MANAGERS TO BETTER COORDINATE CARE. PART VI, LINE 2: LINE 2 - NEEDS ASSESSMENT:IN ADDITION TO THE FORMAL CHNA REPORTED IN PART V, SECTION B, ROME MEMORIAL HOSPITAL CONTINUALLY ASSESSES THE COMMUNITY'S NEEDS THROUGH ONGOING ANALYSIS OF AVAILABLE INTERNAL AND EXTERNAL DATA AND PARTICIPATION IN COMMUNITY COMMITTEES AND ORGANIZATIONS THAT REPRESENT A BROAD SEGMENT OF THE POPULATION. IN ADDITION, THE HOSPITAL ENCOURAGES COMMUNITY INPUT THROUGH ITS WEBSITE. INSIGHTS ARE ALSO GATHERED FROM MONITORING SOCIAL MEDIA. PART VI, LINE 3: LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:TO ENSURE THAT PATIENTS ARE AWARE OF THE FINANCIAL ASSISTANCE PROGRAM, PATIENTS ARE NOTIFIED THE FOLLOWING WAYS:- THE PLAIN LANGUAGE SUMMARY OF THE POLICY IS INCLUDED IN THE PATIENT ADMISSION PACKET- SIGNAGE IS LOCATED AT ALL INTAKE AREAS INCLUDING OFF-SITE CLINICS. THESE AREAS HAVE PAPER COPIES AVAILABLE TO THE PUBLIC IN PERSON AND BY MAIL.- ALL BILLING STATEMENTS AND COLLECTION LETTERS NOTIFY PATIENTS ON HOW TO OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE VIA PHONE OR INTERNET.- INFORMATION IS AVAILABLE ON THE HOSPITAL'S WEBSITE WITH THE LINK TO "FINANCIAL ASSISTANCE" ACCESSIBLE FROM MULTIPLE PAGES. PART VI, LINE 4: LINE 4 - COMMUNITY INFORMATION:ROME MEMORIAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO APPROXIMATELY 66,400 RESIDENTS IN ROME AND THE SURROUNDING RURAL COMMUNITIES IN ONEIDA COUNTY. FOR SELECTED SPECIALTIES, SUCH AS SENIOR BEHAVIORAL HEALTH CARE, ROME MEMORIAL HOSPITAL'S SERVICE AREA EXTENDS INTO THE SURROUNDING COUNTIES OF MADISON, HERKIMER LEWIS AND ONONDAGA.ROME MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA INCLUDES: ROME, AVA, BLOSSVALE, BOONVILLE, CAMDEN, LEE CENTER, TABERG, WESTDALE, WESTERNVILLE AND WEST LEYDEN.RESIDENTS FROM ROME'S 13440 ZIP CODE WITH A POPULATION OF APPROXIMATELY 42,000 COMPRISE MORE THAN 60% OF RMH'S INPATIENT DISCHARGES. THE SURROUNDING COMMUNITIES ARE MOSTLY RURAL, WITH CAMDEN (POPULATION OF 6,950) AND BOONVILLE (POPULATION OF 6,276) AS THE TWO LARGEST TOWNS LOCATED IN THE PRIMARY SERVICES AREA.ROME MEMORIAL HOSPITAL AND ITS AFFILIATES SERVE AS A SAFETY NET FOR A REGION THAT IS SOCIOECONOMICALLY CHALLENGED AND AGING. MORE THAN 21 PERCENT OF THE POPULATION IS 65 AND OLDER WITH THE NUMBER OF SENIORS PROJECTED TO INCREASE BY 10 PERCENT IN THE NEXT FIVE YEARS. MORE THAN 20% OF HOUSEHOLDS HAVE INCOME LESS THAN $25,000. LESS THAN 20% OF THE POPULATION HAS A BACHELOR'S DEGREE OR GREATER, COMPARED TO MORE THAN 30% NATIONALLY.AVERAGE HOUSEHOLD INCOME FOR THE SERVICE AREA IS 27% LESS THAN THE NATIONAL AVERAGE.THE POPULATION IS 88% WHITE NON-HISPANIC, 3.9% BLACK NON-HISPANIC AND 4.5% HISPANIC.ROME MEMORIAL HOSPITAL IS THE ONLY HOSPITAL IN THE CITY OF ROME. THERE ARE TWO HOSPITALS IN SOUTHERN ONEIDA COUNTY (ST. ELIZABETH MEDICAL CENTER AND FAXTON-ST. LUKE'S HEALTHCARE. PART VI, LINE 5: LINE 5 - PROMOTION OF COMMUNITY HEALTH:ADDITIONAL WAYS THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE:1. ROME MEMORIAL HOSPITAL PROVIDES EMERGENCY SERVICES TO EVERYONE REGARDLESS OF ABILITY TO PAY.2. THE HOSPITAL'S INDEPENDENT GOVERNING BODY IS COMPRISED OF INDIVIDUALS WHO RESIDE OR WORK IN THE PRIMARY SERVICE AREA TO REPRESENT THE INTERESTS OF THE COMMUNITY.3. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY.4. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE CARE, EXPAND FACILITIES, RECRUIT STAFF AND ADVANCE MEDICAL TRAINING AND COMMUNITY EDUCATION.IN 2020, ROME MEMORIAL HOSPITAL DEMONSTRATED ITS RESPONSIVENESS AS A CRITICAL PUBLIC SAFETY RESOURCE IN THE MIDST OF THE COVID-19 PANDEMIC. THE HOSPITAL PARTNERED WITH THE DEPARTMENT OF HEALTH AND OTHER LOCAL HOSPITALS TO PROTECT OUR COMMUNITY THROUGH PUBLIC HEALTH EDUCATION, MANAGING HOSPITALIZATION SURGES WITH CONSTRAINED RESOURCES, AND VACCINATING ELIGIBLE HEALTHCARE WORKERS AND COMMUNITY MEMBERS. YEARS OF PLANNING AND DRILLS ENABLED THE HOSPITAL SYSTEM TO MEET THE COMMUNITY'S NEEDS AS THEY EVOLVED.ROME MEMORIAL HOSPITAL ALSO PLAYED A CRITICAL ROLE IN RESPONDING TO TWO LARGE POST-EXPOSURE HEPATITIS A DRIVE-THROUGH VACCINATION CLINICS IN FEBRUARY AND MAY. IN COOPERATION WITH THE ONEIDA COUNTY HEALTH DEPARTMENT, THE NEW YORK STATE DEPARTMENT OF HEALTH BUREAU OF IMMUNIZATION PROVIDED THE PUBLICLY PURCHASED VACCINE, WHICH WAS ADMINISTERED BY HOSPITAL STAFF, AS PART OF ITS PUBLIC HEALTH EMERGENCY RESPONSE AND PREPAREDNESS ACTIVITIES. PART VI, LINE 6: LINE 6 - AFFILIATED HEALTH CARE SYSTEM:ROME MEMORIAL HOSPITAL, INC. (THE "HOSPITAL") IS A NEW YORK STATE NOT-FOR-PROFIT CORPORATION AND TAX EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ("IRC"), AND IS PART OF THE FOLLOWING CORPORATE STRUCTURE: GREATER ROME AFFILIATES, INC. ("GRA"), A NEW YORK STATE NOT-FOR-PROFIT CORPORATION, TAX EXEMPT UNDER SECTION 501(C)(3) OF THE IRC, IS THE SOLE CORPORATE MEMBER, AND THEREFORE, THE "PARENT" OF THE HOSPITAL, AS WELL AS ROME MEMORIAL PROPERTIES, INC., A NEW YORK STATE NOT-FOR-PROFIT CORPORATION, TAX EXEMPT UNDER SECTION 501(C)(3) OF THE IRC. GRA IS ALSO THE SOLE SHAREHOLDER OF RMH SERVICES, INC., A NEW YORK STATE BUSINESS CORPORATION, WHICH WAS ESTABLISHED TO UNDERTAKE CERTAIN FOR-PROFIT BUSINESS ACTIVITIES AND WHICH HAS AN EQUITY OWNERSHIP INTEREST IN, AND IS A MEMBER OF, THREE NEW YORK STATE LIMITED LIABILITY COMPANIES: 1819 BLACK RIVER ASSOCIATES, LLC; CHESTNUT COMMONS, LLC; AND RMH RETAIL PHARMACY, LLC. MEMBERS OF THE HOSPITAL'S BOARD OF TRUSTEES AND ADMINISTRATIVE STAFF HAVE OVERLAPPING RESPONSIBILITIES ON THE BOARDS OF THE AFFILIATED CORPORATIONS TO ENSURE THAT THE HOSPITAL'S BEST INTERESTS ARE BEING SERVED. ROME MEMORIAL HOSPITAL FOUNDATION, INC., A NEW YORK STATE NOT-FOR-PROFIT CORPORATION, TAX EXEMPT UNDER SECTION 501(C)(3) OF THE IRC, IS A SEPARATE CORPORATION ESTABLISHED FOR THE SOLE PURPOSE OF CONDUCTING FUND RAISING ACTIVITIES ON BEHALF OF THE HOSPITAL, INCLUDING THE RECEIPT OF GIFTS AND BEQUESTS ON BEHALF OF THE HOSPITAL, INVESTING SUCH ASSETS, AND TRANSFERRING THEM TO THE HOSPITAL IN SUPPORT OF ITS MISSION. IT IS GOVERNED BY A SEPARATE BOARD OF DIRECTORS, WHICH HAS AMONG ITS MEMBERS HOSPITAL TRUSTEES AND MEMBERS OF THE HOSPITAL'S MEDICAL STAFF.THE SYSTEM ALSO INCLUDES TWO CAPTIVE PROFESSIONAL CORPORATIONS, INCLUDING ROME MEDICAL GROUP, P.C., A MULTI-PHYSICIAN PRIMARY CARE PRACTICE, AND ROME MEDICAL PRACTICE, P.C., A MULTI-PHYSICIAN, SPECIALTY GROUP. THE PCS ARE THE VEHICLES THROUGH WHICH PHYSICIANS ARE EMPLOYED TO SERVE THE COMMUNITY. IN TODAY'S ENVIRONMENT, MANY PHYSICIANS PREFER TO BE EMPLOYED VS. GOING OUT IN PRIVATE PRACTICE. PART VI, LINE 7, REPORTS FILED WITH STATES NY 1 X X X X 0 0 0 0 0 0 0 0 0 DEWEY ROWLANDS CFO 202574 30270 0 0 0 0 0 0 5928 886 208502 31156 0 0 SHARMILA RAVINDRANATHAN HOSPITALIST 204905 0 0 0 0 0 0 0 1598 0 206503 0 0 0 SAMANTHA VINING CNO 169293 0 0 0 0 0 0 0 8134 0 177427 0 0 0 MARK ROWAN CIO 162546 0 0 0 0 0 0 0 8465 0 171011 0 0 0 SCOTT BURNS DIRECTOR OF PHARMACY 147795 0 0 0 0 0 0 0 8441 0 156236 0 0 0 SCOTT BURNS SON OF BOARD DIRECTOR 147795 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PREFORMED BY OR UNDER DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES TO MARK MURPHY AS INTERIM CEO. FORM 990, PART VI, SECTION A, LINE 6 GREATER ROME AFFILIATES IS THE SOLE MEMBER OF ROME MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A PER THE HOSPITAL BY-LAWS "THE SOLE CORPORATE MEMBER OF THE CORPORATION SHALL BE GREATER ROME AFFILIATES, INC. WHICH SHALL ACT HEREUNDER AS SUCH MEMBER BY DULY AUTHORIZED RESOLUTION OF ITS BOARD OF DIRECTORS AND WHICH SHALL COMMUNICATE ITS ACTIONS TO THIS BOARD THROUGH ITS PRESIDENT OR OTHER DULY AUTHORIZED OFFICER." GREATER ROME AFFILIATES APPOINTS THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED 2020 990 WAS PRESENTED TO THE BOARD BY THE CFO OF THE HOSPITAL AT ITS SEPTEMBER 2021 BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C CONSISTENT WITH ROME HOSPITAL'S GIFTS, GRATUITIES AND CONFLICT OF INTEREST POLICY, THE COMPLIANCE OFFICER OF RMH HAS A CONFLICT OF INTEREST DISCLOSURE FORM COMPLETED ON AN ANNUAL BASIS BY ALL OFFICERS, DIRECTORS AND MANAGEMENT PERSONNEL. THE COMPLIANCE OFFICER COLLECTS AND REVIEWS THE BOARD OF TRUSTEES/FOUNDATION BOARD INTEREST DISCLOSURE FORMS ON AN ANNUAL BASIS. THE INFORMATION GATHERED ON THE DISCLOSURE IS REVIEWED AND ANY CONFLICTS ARE COMMUNICATED TO THE PRESIDENT/CEO, COMPLIANCE BOARD, AND BOARD OF TRUSTEES TO ENSURE ALL HOSPITAL TRANSACTION/BUSINESS ACTIVITIES ARE CONDUCTED IN A MANNER THAT IS FREE FROM UNLAWFUL OR OTHERWISE INAPPROPRIATE OFFERS OR SOLICITATIONS OF IMPROPER INDUCEMENTS IN EXCHANGE FOR INFLUENCE OR ASSISTANCE IN A TRANSACTION. POTENTIAL CONFLICTS THAT MAY ARISE THROUGHOUT THE YEAR ARE BROUGHT TO THE ATTENTION OF THE COMPLIANCE OFFICER AND PRESIDENT/CEO FOR REVIEW. ANY IDENTIFIED CONFLICTS ARE THEN REVIEWED AT THE CORPORATE COMPLIANCE COMMITTEE AND BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 USE OF IROQUOIS DATA, ASSOCIATION FOR HEALTHCARE PHILANTHROPY SALARY DATA, AND THE ROME HOSPITAL HUMAN RESOURCE DEPARTMENT ARE UTILIZED TO DETERMINE COMPENSATION FOR THE ORGANIZATION'S EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 18 FORMS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 FORMS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST OR THROUGH WWW.GUIDESTAR.ORG- A WEBSITE THAT PROVIDES NON-PROFIT INFORMATION TO THE PUBLIC. RMH MAKES ITS GOVERNING DOCUMENTS (BY - LAWS) AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC THROUGH RMH WEBSITE - WWW.ROMEHOSPITAL.ORG. ALSO, FINANCIAL FACTS AND FIGURES AND ECONOMIC IMPACT REPORTS CAN BE FOUND ON THIS WEBSITE. FORM 990, PART XII, LINE 2C: IN 990 PART VII, MARK MURPHY IS LISTED AS AN OFFICER AS THE INTERIM ROLE ASSUMED THE DUTIES OF CEO. THERE IS NO COMPENSATION LISTED AS THE INDIVIDUAL WAS HIRED THROUGH A SERVICE AGREEEMNT WITH SJH (COMPENSATION THROUGH THE AGREEMENT WAS $585,000), AND MARK MURPHY IS NOT CONSIDERED A COMMON LAW EMPLOYEE. FORM 990, PART IX, LINE 11G PHYSICIANS: PROGRAM SERVICE EXPENSES 4,510,363. MANAGEMENT AND GENERAL EXPENSES 644,874. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,155,237. LAB SERVICES: PROGRAM SERVICE EXPENSES 5,639,058. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,639,058. SERVICE CONTRACT: PROGRAM SERVICE EXPENSES 735,393. MANAGEMENT AND GENERAL EXPENSES 224,281. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 959,674. NURSE STAFFING: PROGRAM SERVICE EXPENSES 350,498. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 350,498. CONSULTING: PROGRAM SERVICE EXPENSES 472,955. MANAGEMENT AND GENERAL EXPENSES 186,719. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 659,674. LAUNDRY SERVICE: PROGRAM SERVICE EXPENSES 456,390. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 456,390. FORM 990, PART XI, LINE 9: CHANGE IN UNRESTRICTED INTEREST IN FOUNDATION BOOK/TAX DIFFERENCE OF GRIFFIS EYE CENTER -59,304. CHANGE IN TEMPORARY INTEREST IN FOUNDATION CHANGE IN RELATED ORG ASSETS GREATER ROME AFFILIATES 1500 N JAMES STREET ROME NY 13440 161508597 PARENT CORPORATION NY 501C3 LINE 12C, III-FI 0 ROME MEMORIAL PROPERTIES 1500 N JAMES STREET ROME NY 13440 161492003 SUPPORT HOSPITAL ACTIVITIES NY 501C3 LINE 12A, I GRA 0 RMH SERVICES INC 1500 N JAMES STREET ROME NY 13440 161490045 FOR PROFIT NY GREATER ROME AFFILIATES C 1.00000 0 ROME MEDICAL GROUP 1801 BLACK RIVER BLVD ROME NY 13440 161464822 CAPTIVE P.C. NY ROME MEMORIAL HOSPITAL C 0 ROME MEDICAL PRACTICE 1500 N JAMES STREET ROME NY 13440 203827393 CAPTIVE P.C. NY ROME MEMORIAL HOSPITAL C 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 1 1 0 0