FURP.ORG / PUBLIC DATA EXPLORER

ROME MEMORIAL HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
ROME MEMORIAL HOSPITAL INC (EIN 16-1471634)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-02
IRS object ID
201723069349301757
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-02T14:03:00-05:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN161226221PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FUST CHARLES CHAMBERS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line15784 WIDEWATERS PARKWAYAddressLine1Txt
CitySYRACUSECityNm
State AbbreviationNYStateAbbreviationCd
ZIP13214ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN161471634EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ROME MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlROMEBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 NORTH JAMES STREETAddressLine1Txt
CityROMECityNm
State AbbreviationNYStateAbbreviationCd
ZIP13440ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDEWEY ROWLANDSPersonNm
Person TitleCFO/VP FINANCEPersonTitleTxt
Phone3153387000PhoneNum
Signature2017-10-30SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonANGELA M FRANCOPreparerPersonNm
PTINP00589741PTIN
Phone3154463600PhoneNum
Preparation2017-10-30PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address24.39.85.114IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-10-30IPDt
IP Tm17:23:33IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id9ED0318F8F0D15647C4BFB992883BD7B1D0B79ECAtSubmissionCreationDeviceId
At Submission Filing Device Id315614A2A569D91B0F4A84342C1D145A8997199DAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAVID LUNDQUISTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 NORTH JAMES STREETAddressLine1Txt
CityROMECityNm
State AbbreviationNYStateAbbreviationCd
ZIP13440ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$100,600,348GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressROMEHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization AssocYes (X)TypeOfOrganizationAssocInd
Formation1995FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionPROVIDE QUALITY HEALTHCARE WITH COMPASSION.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee1202TotalEmployeeCnt
Total Volunteers212TotalVolunteersCnt
Total Gross UBI$361,303TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$3,545,638PYContributionsGrantsAmt
CY Contributions Grants$19,064,968CYContributionsGrantsAmt
PY Program Service Revenue$78,849,856PYProgramServiceRevenueAmt
CY Program Service Revenue$79,995,161CYProgramServiceRevenueAmt
PY Investment Income$423,755PYInvestmentIncomeAmt
CY Investment Income$145,849CYInvestmentIncomeAmt
PY Other Revenue$1,262,912PYOtherRevenueAmt
CY Other Revenue$1,079,829CYOtherRevenueAmt
PY Total Revenue$84,082,161PYTotalRevenueAmt
CY Total Revenue$100,285,807CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$45,313,153PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$45,702,829CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$39,093,368PYOtherExpensesAmt
CY Other Expenses$39,785,087CYOtherExpensesAmt
PY Total Expenses$84,406,521PYTotalExpensesAmt
CY Total Expenses$85,487,916CYTotalExpensesAmt
PY Revenues Less Expenses-$324,360PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$14,797,891CYRevenuesLessExpensesAmt
Total Assets BOY$51,442,183TotalAssetsBOYAmt
Total Assets EOY$55,648,804TotalAssetsEOYAmt
Total Liabilities BOY$36,097,713TotalLiabilitiesBOYAmt
Total Liabilities EOY$25,230,438TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,344,470NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$30,418,366NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionABOUT 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$28,867,915ExpenseAmt
Revenue$27,326,276RevenueAmt
DescINPATIENT 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 BEHAVIORIAL HEALTH- 2ND FLOOR.2016 INPATIENT DISCHARGES: 4,0152016 BIRTHS: 5212016 PATIENT DAYS: 17,900Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$8,550,623ExpenseAmt
Revenue$7,189,781RevenueAmt
DescRESIDENTIAL 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 BEHAVIORIAL 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.2016 PATIENT DAYS = 28,0902016 OCCUPANCY PERCENTAGE = 95.94%Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$7,623,145ExpenseAmt
Revenue$10,896,992RevenueAmt
DescEMERGENCY DEPARTMENT (ED)ROME MEMORIAL HOSPITAL EMERGENCY DEPARTMENT IS A SAFETY NET FOR THE MOST VULNERABLE POPULATIONS IN THE COMMUNITY. IN 2016, APPROXIMATELY 47% OF THE PATIENTS TREATED WERE LISTED AS UNINSURED OR UNDER INSURED. FOR LOWER LEVEL EMERGENCY DEPARTMENT VISITS, THIS POPULATION REPRESENTED MORE THAN 60% OF THE VISITS BECAUSE MANY PRIMARY CARE PHYSICIANS DO NOT ACCEPT MEDICAID.2016 ED ADMISSIONS: 3,5772016 ED VISITS: 30,677Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$24,628,448ExpenseAmt
Revenue$34,582,112RevenueAmt
DescALL OTHER ACHIEVEMENTS PROVIDE QUALITY, COMPASSIONATE CARE IN A SAFE ENVIRONMENT TO SERVE THE HEALTHCARE NEEDS OF THE PEOPLE OF ROME AND THE SURROUNDING COMMUNITIES.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$24,628,448TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$34,582,112TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$69,670,131TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document39IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1202EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DEWEY ROWLANDS - ROME MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3153387024PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 NORTH JAMES STREETAddressLine1Txt
CityROMECityNm
State AbbreviationNYStateAbbreviationCd
ZIP13440ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
CHESTER PATRICK MD
CHAIRMAN2.00Yes (X)Yes (X)$0$0$0
LYNN REESE
VICE CHAIRMAN2.00Yes (X)Yes (X)$0$0$0
DARLENE BURNS
SECRETARY (3/1/16 - 12/31/16)2.00Yes (X)Yes (X)$0$0$0
JULIE GROW-DENTON
TREASURER2.00Yes (X)Yes (X)$0$0$0
ANKUR DESAI MD
DIRECTOR2.00Yes (X)$0$0$0
DAVID NOLAN
DIRECTOR2.00Yes (X)$0$0$0
DENNIS SURACE
DIRECTOR2.00Yes (X)$0$0$0
KIM COOK
DIRECTOR2.00Yes (X)$0$0$0
W ROBERT HERRMANN
DIRECTOR2.00Yes (X)$0$0$0
ANKUR DESAI MD
INTERIM CMO20.00Yes (X)Yes (X)$28,344$0$0
DAVID LUNDQUIST
CEO55.00Yes (X)$286,876$0$1,045
DARLENE BURNS
INTERIM CEO (1/1/16 - 2/28/16)55.00Yes (X)$88,846$0$144
DEWEY ROWLANDS
CFO55.00Yes (X)$207,343$0$7,740
BENJAMIN SOMMER
PHYSICIAN55.00$196,281$0$7,722Yes (X)
BRUCE PETERSON
AVP/CIO55.00$154,036$0$945Yes (X)
MARK SNYDERMAN
VP OUTPATIENT SERVICES55.00$151,043$0$3,224Yes (X)
DURINDA DURR
VP CLINICAL SERVICES55.00$141,658$0$4,141Yes (X)
SCOTT BURNS
DIRECTOR OF PHARMACY55.00$137,344$0$7,626Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,391,771TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$32,587TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K39IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CENTREX CLINICAL LABS INC
28 CAMPION RDNEW HARTFORDNY13413LAB SERVICES$4,187,515
EAGLE HOSPITAL PHYSICIANS LLC
16000 NORTH DALLAS PARKWAY SUITE 4DALLASTX75248HOSPITALIST SERVICES$1,688,346
MCKESSON
PO BOX 98347CHICAGOIL606938347HEALTHCARE INFORMATION TECHNOLOGY$798,854
STAT STAFF PROFESSIONALS
18 DIVISION STREETSARATOGA SPRINGSNY12866NURSE STAFFING$750,154
CENTURY LINEN & UNIFORM
335 NORTH MAIN STREETGLOVERSVILLENY12078LAUNDRY SERVICES$420,661
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K20CntrctRcvdGreaterThan100KCnt
Related Organizations$100,484RelatedOrganizationsAmt
Government Grants$18,870,227GovernmentGrantsAmt
All Other Contributions$94,257AllOtherContributionsAmt
Total Contributions$19,064,968TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
INPATIENT SERVICES622110$27,326,276$27,326,276
EMERGENCY DEPARTMENT621990$10,896,992$10,896,992
RESIDENTIAL HEALTHCARE FACILITY623990$7,189,781$7,189,781

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$34,582,112TotalRevenueColumnAmt
Related Or Exempt Func Income$34,582,112RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$79,995,161TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$78,040TotalRevenueColumnAmt
Exclusion$78,040ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$42,829RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$12,933RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$29,896RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$29,896TotalRevenueColumnAmt
Exclusion$29,896ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$298,550SecuritiesAmt
Other$70,867OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$292,696SecuritiesAmt
Other$8,912OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$5,854SecuritiesAmt
Other$61,955OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$67,809TotalRevenueColumnAmt
Exclusion$67,809ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
CAFETERIA SALES722514$285,302$285,302
ACCOUNTING & CONSULTING541200$202,127$202,127
HOUSEKEEPING561720$106,140$106,140

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$456,364TotalRevenueColumnAmt
Unrelated Business Revenue$53,036UnrelatedBusinessRevenueAmt
Exclusion$403,328ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,049,933OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$100,285,807TotalRevenueColumnAmt
Related Or Exempt Func Income$79,995,161RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$361,303UnrelatedBusinessRevenueAmt
Exclusion$864,375ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$620,337TotalAmt
Management And General$620,337ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$37,925,479TotalAmt
Program Services$33,664,473ProgramServicesAmt
Management And General$4,261,006ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$363,908TotalAmt
Program Services$318,264ProgramServicesAmt
Management And General$45,644ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,922,725TotalAmt
Program Services$3,911,459ProgramServicesAmt
Management And General$11,266ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,870,380TotalAmt
Program Services$2,507,192ProgramServicesAmt
Management And General$363,188ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$229,436TotalAmt
Management And General$229,436ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$97,500TotalAmt
Management And General$97,500ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$22,529TotalAmt
Management And General$22,529ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$10,263,547TotalAmt
Program Services$9,766,864ProgramServicesAmt
Management And General$496,683ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$121,289TotalAmt
Program Services$1,385ProgramServicesAmt
Management And General$119,904ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$327,973TotalAmt
Program Services$156,493ProgramServicesAmt
Management And General$171,480ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,426,030TotalAmt
Program Services$83,009ProgramServicesAmt
Management And General$1,343,021ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,046,448TotalAmt
Program Services$895,112ProgramServicesAmt
Management And General$151,336ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$83,510TotalAmt
Program Services$79,109ProgramServicesAmt
Management And General$4,401ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$70,875TotalAmt
Program Services$68,696ProgramServicesAmt
Management And General$2,179ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$358,372TotalAmt
Management And General$358,372ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,681,730TotalAmt
Program Services$2,064,689ProgramServicesAmt
Management And General$1,617,041ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$735,080TotalAmt
Management And General$735,080ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$5,037,687$4,875,380$162,307
BAD DEBT EXPENSE$4,396,358$4,396,358
PHARMACY$2,982,106$2,982,106
PURCHASE SERVICES$2,608,214$2,220,687$387,527

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$6,296,403TotalAmt
Program Services$1,678,855ProgramServicesAmt
Management And General$4,617,548ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$85,487,916TotalAmt
Program Services$69,670,131ProgramServicesAmt
Management And General$15,817,785ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,927,830BOYAmt
EOY$6,007,556EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$7,786,086BOYAmt
EOY$6,641,852EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$811,378BOYAmt
EOY$1,136,883EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,700,601BOYAmt
EOY$1,718,359EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$2,525,686BOYAmt
EOY$3,666,603EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$82,283,398LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$53,992,056LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$29,572,669BOYAmt
EOY$28,291,342EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,454,626BOYAmt
EOY$1,660,002EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$5,663,307BOYAmt
EOY$6,526,207EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$51,442,183BOYAmt
EOY$55,648,804EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$10,755,690BOYAmt
EOY$11,137,768EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$10,493,545BOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$4,630,000BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$10,218,478BOYAmt
EOY$14,092,670EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$36,097,713BOYAmt
EOY$25,230,438EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$14,592,915BOYAmt
EOY$29,714,081EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$165,614BOYAmt
EOY$118,344EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$585,941BOYAmt
EOY$585,941EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,344,470BOYAmt
EOY$30,418,366EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$51,442,183BOYAmt
EOY$55,648,804EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$14,797,891ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$53,781NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$222,224OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Direct Contact Legislators$17,449DirectContactLegislatorsAmt
Rallies Demonstrations0RalliesDemonstrationsInd
Other Activities0OtherActivitiesInd
Total Lobbying Expenditures$17,449TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
Explanation$17,449 REPRESENTS THE PORTION OF THE 2016 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.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$751,555BeginningYearBalanceAmt
Investment Earnings Or Losses-$12,601InvestmentEarningsOrLossesAmt
Other Expenditures$34,669OtherExpendituresAmt
End Year Balance$704,285EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$747,775BeginningYearBalanceAmt
Investment Earnings Or Losses$102,327InvestmentEarningsOrLossesAmt
Other Expenditures$98,547OtherExpendituresAmt
End Year Balance$751,555EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$925,258BeginningYearBalanceAmt
Investment Earnings Or Losses-$151,437InvestmentEarningsOrLossesAmt
Other Expenditures$26,045OtherExpendituresAmt
End Year Balance$747,775EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$953,476BeginningYearBalanceAmt
Investment Earnings Or Losses-$2,031InvestmentEarningsOrLossesAmt
Other Expenditures$26,187OtherExpendituresAmt
End Year Balance$925,258EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$643,953BeginningYearBalanceAmt
Investment Earnings Or Losses$314,851InvestmentEarningsOrLossesAmt
Other Expenditures$5,328OtherExpendituresAmt
End Year Balance$953,476EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY0.83200PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.16800TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$43,685,607OtherCostOrOtherBasisAmt
Depreciation$22,270,869DepreciationAmt
Book Value$21,414,738BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,475,341OtherCostOrOtherBasisAmt
Depreciation$2,240,983DepreciationAmt
Book Value$234,358BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$33,289,056OtherCostOrOtherBasisAmt
Depreciation$27,256,947DepreciationAmt
Book Value$6,032,109BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,833,394OtherCostOrOtherBasisAmt
Depreciation$2,223,257DepreciationAmt
Book Value$610,137BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$28,291,342TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
NET ASSETS OF FOUNDATION$905,071
OTHER LONG TERM ASSETS$5,533,867
BOND AMORTIZATION$87,269
FieldValueIRS element (for citing)
Total Book Value Other Assets$6,526,207TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
OTHER LIABILITIES$7,481,871
THIRD-PARTY PAYABLE, NET$5,841,844
DUE TO RELATED ENTITIES$768,955
FieldValueIRS element (for citing)
Total Liability$14,092,670TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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. AS OF DECEMBER 31, 2016 AND 2015, 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 2013 THROUGH 2016. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$700,789TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$323,508DirectOffsettingRevenueAmt
Net Community Benefit Expns$377,281NetCommunityBenefitExpnsAmt
Total Expense0.00470TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$20,952,683TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,759,596DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,193,087NetCommunityBenefitExpnsAmt
Total Expense0.03940TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$325,896TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$125,060DirectOffsettingRevenueAmt
Net Community Benefit Expns$200,836NetCommunityBenefitExpnsAmt
Total Expense0.00250TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$21,979,368TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$18,208,164DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,771,204NetCommunityBenefitExpnsAmt
Total Expense0.04660TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$119,200TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,219DirectOffsettingRevenueAmt
Net Community Benefit Expns$111,981NetCommunityBenefitExpnsAmt
Total Expense0.00140TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$37,072TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$28,773DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,299NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$156,272TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$35,992DirectOffsettingRevenueAmt
Net Community Benefit Expns$120,280NetCommunityBenefitExpnsAmt
Total Expense0.00150TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$22,135,640TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$18,244,156DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,891,484NetCommunityBenefitExpnsAmt
Total Expense0.04810TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$15,749TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$15,749NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$15,749TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$15,749NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$1,198,093BadDebtExpenseAmt
Bad Debt Expense Attributable$113,337BadDebtExpenseAttributableAmt
Reimbursed By Medicare$20,175,284ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$33,914,790CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$13,739,506MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn0FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line11 GRIFFIS EYE CENTER LLCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary ActivitiesSEE SCHEDULE R PART VIIPrimaryActivitiesTxt
Org Profit Or Ownership0.30000OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership0.00000OfcrEtcProfitOrOwnershipPct
Physicians Profit Or Ownership0.70000PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ROME MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 NORTH JAMES STREETAddressLine1Txt
CityROMECityNm
State AbbreviationNYStateAbbreviationCd
ZIP13440ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ROME MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.ROMEHOSPITAL.ORGOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLWWW.OCGOV.NETOtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLWWW.ROMEHOSPITAL.ORGStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.ROMEHOSPITAL.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.ROMEHOSPITAL.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.ROMEHOSPITAL.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back MedicareYes (X)LookBackMedicareInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
ROME MEMORIAL HOSPITALPART V, SECTION B, LINE 5: THIS 2016-2018 ONEIDA COUNTY COMMUNITY HEALTH ASSESSMENT (CHA)/COMMUNITY SERVICE PLAN (CSP) AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) IS AN APPENDIX AND UPDATE TO THE COMPREHENSIVE 2013-2017 ONEIDA COUNTY CHA/CSP AND CHIP. THE REPORT SUMMARIZES THE HEALTH STATUS OF THE COMMUNITY AND PUBLIC HEALTH AND HOSPITAL PREVENTION AGENDA HEALTH IMPROVEMENT GOALS FOR THE RESIDENTS OF THE COUNTY OF ONEIDA.A VARIETY OF DATA SOURCES WERE USED TO IDENTIFY AND CONFIRM PRIORITIES INCLUDING: THE NYS PREVENTION AGENDA DASHBOARD, HEALTHECONNECTIONS, NEW YORK STATE QUITLINE PARTNERS REPORTS, ONEIDA COUNTY TEEN ASSESSMENT PROJECT (TAP), AND THE PEDIATRIC NUTRITION SURVEILLANCE SYSTEM (PEDNSS) REPORTS. THE PLANNING TEAM ALSO REVIEWED DATA FROM THE JOHN SNOW, INC. COMMUNITY HEALTH ASSESSMENT FOR THE CENTRAL NEW YORK CARE COLLABORATIVE (CNYCC), THE COUNTY HEALTH RANKINGS, AND BRIDGES COMMUNITY SURVEY. THE PLANNING TEAM WORKED TO SOLICIT FEEDBACK FROM COMMUNITY MEMBERS THROUGHOUT THE YEAR. ROME MEMORIAL HOSPITAL HOSTED A COMMUNITY FORUM TO SOLICIT FEEDBACK FROM COMMUNITY MEMBERS AND PARTICIPATED IN THE CITY OF ROME'S HUD COMMUNITY NEEDS ASSESSMENT. ACCESS TO SPECIALTY, PRIMARY, URGENT CARE AND BEHAVIORAL HEALTH SERVICES WERE THE MAIN COMMUNITY NEEDS IDENTIFIED. ADDITIONALLY, THE PLANNING TEAM REVIEWED THE FINDINGS FROM THE CENTRAL NY CARE COLLABORATIVE (CNYCC) NEEDS ASSESSMENT IN WHICH SOME ITS KEY FINDINGS AND RECOMMENDATIONS ARE ADDRESSED IN THE SELECTED CHIP INTERVENTIONS AND TARGET POPULATIONS. FINALLY, THE ONEIDA COUNTY HEALTH DEPARTMENT ASKED SPECIFIC QUESTIONS AT HEALTH FAIRS AND EVENTS WHERE ITS STAFF INTERACTS WITH THE PUBLIC.THE ONEIDA COUNTY COMMUNITY HEALTH ASSESSMENT/COMMUNITY SERVICE PLAN & COMMUNITY HEALTH IMPROVEMENT PLAN (CHA/CSP/CHIP) PLANNING TEAM IDENTIFIED THE FOLLOWING AS ITS TOP TWO PREVENTION AGENDA PRIORITIES FOR THE 2016-2018 UPDATE: PREVENT CHRONIC DISEASES PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN THE PRIORITY AREAS HAVE REMAINED THE SAME SINCE 2013, HOWEVER THERE ARE SOME ADDITIONAL AREAS IDENTIFIED. THE PRIORITY TO PREVENT CHRONIC DISEASES IS BEING ADDRESSED THROUGH A FOCUS ON TOBACCO CESSATION. WE CONTINUE TO ADDRESS POLICIES PROMOTING USE OF THE NYS QUITLINE WITH PROVIDERS AND HAVE EXPANDED OUR INITIATIVE TO ALIGN WITH THE CENTRAL NEW YORK CARE COLLABORATIVE DSRIP CARDIOVASCULAR DISEASE MANAGEMENT (CVD) INITIATIVE REFERENCING THE TOBACCO STANDARDS OF CARE. WITHIN ITS LARGER GOAL OF PROMOTING TOBACCO USE CESSATION AMONG ADULTS, WE HAVE EXPANDED TO PREVENTING INITIATION OF TOBACCO USE BY YOUTH AND YOUNG ADULTS. EMERGING ISSUES INCLUDE THE USE OF E-CIGARETTES AS A METHOD TO QUIT, THE TREND OF YOUTH STARTING WITH E-CIGARETTES, AND WE HAVE FOUND AN INCREASE IN COMMUNITY INTEREST IN CESSATION CLASSES THAT WE HAVE NOT SEEN IN THE PAST. ROME MEMORIAL HOSPITAL'S EFFORTS TO IMPROVE COMMUNITY HEALTH EXTEND BEYOND THE TWO PRIORITIES IDENTIFIED THROUGH THE CHA/CSP/CHIP PROCESS. SOME OF THE HOSPITAL'S ADDITIONAL INITIATIVES INCLUDE:-OFFERING FREE HEALTH SCREENINGS AT AREA HEALTH FAIRS TO DETECT HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, DEPRESSION AND OBESITY.-CONDUCTING COLORECTAL HEALTH SCREENINGS EACH MARCH TO PROMOTE EARLY DETECTION OF CANCER.-CONDUCTING PSA SCREENINGS FOR THE EARLY DETECTION OF PROSTATE CANCER.-OFFERING FREE BLOOD PRESSURE SCREENINGS MONTHLY AT AREA PHARMACIES AND SENIOR CENTERS TO PROVIDE ONGOING MONITORING FOR PATIENTS THAT SUFFER FROM HIGH BLOOD PRESSURE AND EARLY DETECTION FOR THOSE WHO ARE AT RISK.-OFFERING FREE TYPE 2 DIABETES EDUCATION CLASSES EVERY MONTH FOR DIABETICS AND THEIR FAMILIES. THE NURSE EDUCATOR COVERS EXERCISE, DIET AND MEDICATION MANAGEMENT TO HELP NEWLY DIAGNOSED DIABETICS UNDERSTAND HOW TO MANAGE CONTROLLABLE RISK FACTORS AND PREVENT FUTURE COMPLICATIONS.-SPONSORING HEALTH LECTURES AT THE HOSPITAL AND PROVIDING SPEAKERS AND DISPLAYS FOR LOCAL ORGANIZATIONS AND BUSINESSES TO PROMOTE EARLY DETECTION, TREATMENT AND MANAGEMENT OF CHRONIC DISEASE.-PARTICIPATING WITH THE CANCER SERVICES PROGRAM TO PROVIDE FREE MAMMOGRAPHY SCREENING FOR THE UNINSURED AND UNDERINSURED TO PROMOTE EARLY DETECTION. THE NURSE NAVIGATOR FROM THE HOSPITAL'S BREAST CENTER WORKS CLOSELY WITH THE CSP TO HELP SECURE ADDITIONAL RESOURCES FOR UNDERSERVED WOMEN DIAGNOSED WITH BREAST CANCER.-CONDUCTING FLU VACCINATION CLINICS TO PROTECT RESIDENTS FROM THE FLU AND PREVENT UNNECESSARY HOSPITALIZATIONS.-INVESTING SIGNIFICANT RESOURCES TO RECRUIT ADDITIONAL PROVIDERS TO THE ROME AREA TO SOLVE THE PHYSICIAN SHORTAGE CONCERNS.-INVESTING PLANNING RESOURCES TO EXPAND ACCESS TO ESSENTIAL HEALTH CARE SERVICES IN 2017 INCLUDING MEDICATION ASSISTED TREATMENT AND URGENT CARE.-SPONSORING SUPPORT GROUPS FOR FAMILIES DEALING WITH ADDICTION AND CHRONIC DISEASE.-PARTICIPATING WITH THE CENTRAL NEW YORK CARE COLLABORATIVE IN SUPPORT OF THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT PROGRAM (DSRIP), AN INITIATIVE TO TRANSFORM THE HEALTH SYSTEM OF NEW YORK STATE, WITH THE GOALS OF REDUCING AVOIDABLE HOSPITAL USE AND IMPROVING HEALTH AND PUBLIC HEALTH MEASURES. -SEEKING PATIENT CENTERED MEDICAL HOME CERTIFICATION TO ENHANCE CARE COORDINATION IN THE HOSPITAL'S PRIMARY CARE PRACTICES-IMPLEMENTING STRATEGIES TO REDUCE HEALTH ACQUIRED INFECTIONS.-PROVIDING SMOKING CESSATION EDUCATION TO REDUCE THE MORTALITY AND MORBIDITY ASSOCIATED WITH SMOKING.-PROVIDING HEALTH INFORMATION THROUGH QUARTERLY NEWSLETTERS TO SENIORS.THE 2016-2018 CHNA OUTLINING THE PRIORITIES AND THE IMPACT OF PREVIOUS IMPLEMENTATION STRATEGIES IS AVAILABLE ONLINE AT WWW.ROMEHOSPITAL.ORG.
ROME MEMORIAL HOSPITALPART V, SECTION B, LINE 6A: THE 2016 CHNA WAS CONDUCTED IN COLLABORATION WITH MOHAWK VALLEY HEALTH SYSTEM (FAXTON-ST. LUKE'S HOSPITAL AND ST. ELIZABETH'S MEDICAL CENTER).
ROME MEMORIAL HOSPITALPART V, SECTION B, LINE 6B: THE 2016 CHNA WAS CONDUCTED IN CONJUNCTION WITH ONEIDA COUNTY HEALTH DEPARTMENT AND COMMUNITY ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF THE POPULATIONS SERVED BY THE COUNTY'S HOSPITALS.
ROME MEMORIAL HOSPITALPART V, SECTION B, LINE 11: ROME MEMORIAL HOSPITAL ADDRESSES THE SIGNIFICANT HEALTHCARE 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 IN SUPPORT OF ITS STRATEGIC PLAN, WHICH IS ORGANIZED UNDER THE FOLLOWING PILLARS: FOSTER A CULTURE OF QUALITY AND PATIENT SAFETY. FOSTER A CULTURE OF EXCEPTIONAL SERVICE. OPTIMIZE FINANCIAL PERFORMANCE. RECRUIT, DEVELOP AND RETAIN EXCEPTIONAL PEOPLE. IDENTIFY GROWTH OPPORTUNITIES CONSISTENT WITH THE HOSPITAL'S MISSION.UNMET COMMUNITY NEEDS ARE DUE TO A SHORTAGE OF PROVIDERS AND LIMITED FINANCIAL RESOURCES.
FieldValueIRS element (for citing)
Facility13FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - COMMUNITY RECOVERY CENTER
264 W DOMINICK STREETROMENY13440SUBSTANCE ABUSE COUNSELING
2 - MOHAWK VALLEY RADIATION MEDICINE
107 E CHESTNUT STREETROMENY13440RADIATION ONCOLOGY
3 - PHYSICAL THERAPY
107 E CHESTNUT STREETROMENY13440OFFSITE PHYSICAL THERAPY SERVICES
4 - BOONVILLE FAMILY CARE
13407 STATE ROUTE 12BOONVILLENY13309PRIMARY CARE SERVICES
5 - LABORATORY COLLECTION SITE
1801 BLACK RIVER BLVDROMENY13440OFFSITE LAB COLLECTION SITE
6 - LABORATORY COLLECTION SITE
1617 N JAMES STREETROMENY13440OFFSITE LAB COLLECTION SITE
7 - LABORATORY COLLECTION SITE
13407 STATE ROUTE 12BOONVILLENY13309OFFSITE LAB COLLECTION SITE
8 - MEDICAL IMAGING
1801 BLACK RIVER BLVDROMENY13440OFFSITE RADIOLOGY SERVICES
9 - MEDICAL IMAGING
107 E CHESTNUT STREETROMENY13440OFFSITE RADIOLOGY SERVICES
10 - PRENATAL CARE CENTER
155 WEST DOMINICK STREETROMENY13440OFFSITE PRENATAL CARE SERVICES
11 - DELTA MEDICAL CENTER
1819 BLACK RIVER BLVDROMENY13440PRIMARY CARE SERVICES
12 - REGIONAL WOUND CARE CENTER
267 HILL ROADROMENY13441ADVANCED WOUND CARE AND HYPERBARIC OXYGEN TREATMENT
13 - CAMDEN FAMILY CARE
5 MASONIC AVENUECAMDENNY13316PRIMARY CARE SERVICES

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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), UNREIMBURSED MEDICAID (7B) AND UNREIMBURSED COSTS - OTHER MEANS TESTED GOVERNMENT PROGRAMS (7C) 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 $4,396,358 (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 INITIATIVES TO ADDRESS DOMESTIC VIOLENCE, TEENAGE PREGNANCY, SUBSTANCE ABUSE AND LITERACY.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.
PART III, LINE 2:BAD DEBT EXPENSE IS CALCULATED BASED ON THE TOTAL BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS. FOR 2016, TOTAL BAD DEBT IS $4,396,358 (PER AUDITED FINANCIAL STATEMENTS). THE RATIO OF PATIENT CARE COST TO CHARGES FROM THE INSTITUTIONAL COST REPORT IS THEN APPLIED TO THE TOTAL BAD DEBT. FOR 2016, THAT PERCENTAGE IS 27.25. 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 2016, 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 11 THROUGH 13 FOR CURRENT FOOTNOTE LANGUAGE THAT DESCRIBES BAD DEBT. PART III, LINE 6; COSTING METHODOLOGY AND SOURCE:2016 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 NEARLY 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 8% OF RESIDENTS WHO ARE UNINSURED. IN 2016, ROME MEMORIAL HOSPITAL'S BAD DEBT AND CHARITY CARE TOTALED $5.8 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 30,677 IN 2016. 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 - ALWAYS ASSESSING NEEDS:IN ADDITION TO THE FORMAL CHNA REPORTED IN PART V, SECTION B, ROME MEMORIAL HOSPITAL CONTINUALLY ASSESSES THE COMMUNITY'S NEEDS THROUGH ONGOING OBSERVATION 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 AND PATIENT ENGAGEMENT SURVEYS.
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 PATIENT GUIDE, WHICH IS GIVEN TO ALL INPATIENTS AND OBSERVATION PATIENTS, INCLUDES THE PLAIN LANGUAGE SUMMARY OF THE POLICY.- A PAPER COPY OF THE PLAIN LANGUAGE SUMMARY IS OFFERED TO ALL OUTPATIENTS.-SIGNAGE IS LOCATED AT ALL INTAKE AREAS INCLUDING OFF-SITE CLINICS/LOCATIONS AND WITHIN THE BUSINESS OFFICE. 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.-BROCHURES/PLAIN LANGUAGE SUMMARIES ARE PROVIDED TO LOCAL COMMUNITY ORGANIZATIONS THAT SERVE INDIVIDUALS MOST LIKELY TO NEED FINANCIAL ASSISTANCE.
PART VI, LINE 4:LINE 4 - COMMUNITY INFORMATION:ROME MEMORIAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO APPROXIMATELY 68,000 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, CAMDEN, BOONVILLE, BLOSSVALE, REMSEN, TABERG, HOLLAND PATENT, ORISKANY, LEE CENTER, FORESTPORT, AVA, WESTMORELAND, SYLVAN BEACH, WESTERNVILLE, WEST LEYDEN, STITTVILLE, NORTH BAY, WOODGATE, PROSPECT, AND WESTDALE.RESIDENTS FROM ROME'S 13440 ZIP CODE WITH A POPULATION OF APPROXIMATELY 43,000 COMPRISE MORE THAN 55% OF RMH'S INPATIENT DISCHARGES. THE SURROUNDING COMMUNITIES ARE MOSTLY RURAL, WITH CAMDEN (POPULATION OF 6,460) AND BOONVILLE (POPULATION OF 5,889) AS THE TWO LARGEST TOWNS LOCATED IN THE PRIMARY SERVICES AREA.BASED ON THE 2010 CENSUS, THE POPULATION OF ONEIDA COUNTY IS 234,878. 21.4% OF THE POPULATION IS UNDER AGE 18 AND 16.8% IS 65 AND OLDER. THE POPULATION IS 88.7% WHITE, 6.6% AFRICAN AMERICAN AND 3.1 % ASIAN. 4.9% IDENTIFY THEMSELVES AS HISPANIC OR LATINO.ROME MEMORIAL HOSPITAL AND ITS AFFILIATES SERVE AS A SAFETY NET FOR A REGION THAT IS SOCIOECONOMICALLY CHALLENGED. APPROXIMATELY 17,750 MEDICAID BENEFICIARIES RESIDE IN ZIP CODES THAT COMPRISE THE HOSPITAL'S PRIMARY SERVICE AREA. AT $44,694, THE MEDIAN HOUSEHOLD INCOME IN ROME IS LESS THAN ONEIDA COUNTY'S MEDIAN INCOME OF $48,931 AND IS LESS THAN NEW YORK STATE'S AT $58,687. IN ROME, 17% OF THE POPULATION LIVES BELOW THE POVERTY LINE. THERE IS AN EDUCATIONAL ATTAINMENT GAP IN ROME WITH ONLY 19.5% OF RESIDENTS AGE 25+ EARNING A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 33.7% IN NEW YORK STATE.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).LACK OF ACCESS TO CARE IS LARGELY DUE TO PROVIDER SHORTAGES IN THE HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). MEDICAID ELIGIBLE - ONEIDA COUNTY MENTAL HEALTH PROFESSIONAL SHORTAGE AREA (ID#736999360I) AND THE MEDICAID-ELIGIBLE-ROME PRIMARY CARE SERVICE AREA HPSA (ID#136999363J), THE MEDICAID-ELIGIBLE-BOONVILLE PRIMARY CARE SERVICE AREA HPSA (ID# 13699936N1), AND THE CAMDEN SERVICE AREA HPSA (ID#13699936J1).
PART VI, LINE 5:LINE 5 - PROMOTION OF COMMUNITY HEALTH:ADDITIONAL WAYS THE HOSPITAL DEMONSTRATES 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.
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 STATESNY

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DAVID LUNDQUIST
CEO$286,876$0$0$0$0$0$0$0$1,045$0$287,921$0$0$0
DEWEY ROWLANDS
CFO$207,343$0$0$0$0$0$0$0$7,740$0$215,083$0$0$0
BENJAMIN SOMMER
PHYSICIAN$196,281$0$0$0$0$0$0$0$7,722$0$204,003$0$0$0
BRUCE PETERSON
AVP/CIO$154,036$0$0$0$0$0$0$0$945$0$154,981$0$0$0
MARK SNYDERMAN
VP OUTPATIENT SERVICES$151,043$0$0$0$0$0$0$0$3,224$0$154,267$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 1AFormAndLineReferenceDesc
ExplanationTYPE OF BENEFIT: PAYMENT OF 2016 MEMBERSHIP DUES AND GENERAL MAINTENANCE FEE FOR SOCIAL CLUB, AS AGREED UPON IN EMPLOYMENT CONTRACT. PERSON WHO RECEIVED BENEFIT: DAVID LUNDQUIST, CEO THIS BENEFIT WAS TREATED AS TAXABLE COMPENSATION IN 2016 FOR PERSON LISTED ABOVE.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
SCOTT BURNS
SON OF INTERIM CEO$144,194COMPENSATION0
SCOTT A GWILT
SON IN LAW OF BOARD DIRECTOR$39,961COMPENSATION0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6GREATER ROME AFFILIATES IS THE SOLE MEMBER OF ROME MEMORIAL HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7APER 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 11BTHE COMPLETED 2016 990 WAS PRESENTED TO THE BOARD BY THE CFO OF THE HOSPITAL AT ITS SEPTEMBER 2017 BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12CCONSISTENT 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 15USE 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 18FORMS ARE AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19FORMS 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 IX, LINE 11GLAB SERVICES: PROGRAM SERVICE EXPENSES 4,187,515. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,187,515. PHYSICIANS: PROGRAM SERVICE EXPENSES 2,702,418. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,702,418. NURSE STAFFING: PROGRAM SERVICE EXPENSES 1,031,389. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,031,389. SERVICE CONTRACT: PROGRAM SERVICE EXPENSES 1,153,833. MANAGEMENT AND GENERAL EXPENSES 404,408. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,558,241. CONSULTING: PROGRAM SERVICE EXPENSES 691,709. MANAGEMENT AND GENERAL EXPENSES 92,275. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 783,984.
FORM 990, PART XI, LINE 9:CHANGE IN UNRESTRICTED INTEREST IN FOUNDATION 98,089. BOOK/TAX DIFFERENCE OF GRIFFIS EYE CENTER 144,135. CHANGE IN TEMPORARY INTEREST IN FOUNDATION -20,000.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
GREATER ROME AFFILIATES
1500 N JAMES STREETROMENY13440161508597PARENT CORPORATIONNY501C3LINE 12A, I0
ROME MEMORIAL PROPERTIES
1500 N JAMES STREETROMENY13440161492003SUPPORT HOSPITAL ACTIVITIESNY501C330GRA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
RMH SERVICES INC
1500 N JAMES STREETROMENY13440161490045FOR PROFITNYGREATER ROME AFFILIATESC-$236,945$2,215,6661.000000
ROME MEDICAL GROUP
1801 BLACK RIVER BLVDROMENY13440161464822CAPTIVE P.C.NYROME MEMORIAL HOSPITALC0
ROME MEDICAL PRACTICE
1500 N JAMES STREETROMENY13440203827393CAPTIVE P.C.NYROME MEMORIAL HOSPITALC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd