ROME MEMORIAL HOSPITAL INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: ROME MEMORIAL HOSPITAL INC (EIN 16-1471634)
Tax period: 2014-01-01 to 2014-12-31
Filed: 2015-11-04
IRS object ID: 201513089349302001
Schema version: 2014v5.0
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule K
Schedule L
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2015-11-04T15:51:09-06:00	ReturnTs
Tax Period End	2014-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	161226221	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	FUST CHARLES CHAMBERS LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	5784 WIDEWATERS PARKWAY	AddressLine1Txt
City	SYRACUSE	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13214	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2014-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	161471634	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ROME MEMORIAL HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	ROME	BusinessNameControlTxt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1500 NORTH JAMES STREET	AddressLine1Txt
City	ROME	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13440	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	DEWEY ROWLANDS	PersonNm
Person Title	CFO/VP FINANCE	PersonTitleTxt
Phone	3153387000	PhoneNum
Signature	2015-10-28	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	ANGELA M FRANCO	PreparerPersonNm
PTIN	P00589741	PTIN
Phone	3154463600	PhoneNum

Field	Value	IRS element (for citing)
Tax	2014	TaxYr
Build TS	2016-03-07 17:11:31Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	DARLENE BURNS	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1500 NORTH JAMES ST	AddressLine1Txt
City	ROME	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13440	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$82,943,929	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	ROMEHOSPITAL.ORG	WebsiteAddressTxt
Type Of Organization Assoc	Yes (X)	TypeOfOrganizationAssocInd
Formation	1995	FormationYr
Legal Domicile State	NY	LegalDomicileStateCd
Activity Or Mission	PROVIDE QUALITY HEALTHCARE WITH COMPASSION.	ActivityOrMissionDesc
Voting Members Governing Body	9	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	1158	TotalEmployeeCnt
Total Volunteers	0	TotalVolunteersCnt
Total Gross UBI	$290,432	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$33,806	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$2,073,222	PYContributionsGrantsAmt
CY Contributions Grants	$1,517,772	CYContributionsGrantsAmt
PY Program Service Revenue	$79,290,733	PYProgramServiceRevenueAmt
CY Program Service Revenue	$79,362,300	CYProgramServiceRevenueAmt
PY Investment Income	$155,399	PYInvestmentIncomeAmt
CY Investment Income	-$20,581	CYInvestmentIncomeAmt
PY Other Revenue	$626,752	PYOtherRevenueAmt
CY Other Revenue	$1,184,367	CYOtherRevenueAmt
PY Total Revenue	$82,146,106	PYTotalRevenueAmt
CY Total Revenue	$82,043,858	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$48,379,471	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$44,950,970	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$39,504,107	PYOtherExpensesAmt
CY Other Expenses	$40,044,684	CYOtherExpensesAmt
PY Total Expenses	$87,883,578	PYTotalExpensesAmt
CY Total Expenses	$84,995,654	CYTotalExpensesAmt
PY Revenues Less Expenses	-$5,737,472	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$2,951,796	CYRevenuesLessExpensesAmt
Total Assets BOY	$60,933,528	TotalAssetsBOYAmt
Total Assets EOY	$56,943,171	TotalAssetsEOYAmt
Total Liabilities BOY	$41,802,880	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$41,096,874	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$19,130,648	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$15,846,297	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	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.	MissionDesc
Significant New Program Srvc	Yes (1)	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$29,851,530	ExpenseAmt
Revenue	$26,363,735	RevenueAmt
Desc	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 BEHAVIORIAL HEALTH- 2ND FLOOR.2014 INPATIENT DISCHARGES: 4,1092014 BIRTHS: 5432014 PATIENT DAYS: 18,958	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$8,001,412	ExpenseAmt
Revenue	$6,846,657	RevenueAmt
Desc	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 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.2014 PATIENT DAYS = 26,4142014 OCCUPANCY PERCENTAGE = 90.46%	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$6,475,917	ExpenseAmt
Revenue	$9,669,215	RevenueAmt
Desc	EMERGENCY DEPARTMENT (ED)ROME MEMORIAL HOSPITAL EMERGENCY DEPARTMENT IS A SAFETY NET FOR THE MOST VULNERABLE POPULATIONS IN THE COMMUNITY. IN 2014, APPROXIMATELY 39% OF THE PATIENTS TREATED WERE LISTED AS UNINSURED OR UNDER INSURED. FOR LOWER LEVEL EMERGENCY DEPARTMENT VISITS, THIS POPULATION REPRESENTED MORE THAN 58% OF THE VISITS BECAUSE MANY PRIMARY CARE PHYSICIANS DO NOT ACCEPT MEDICAID.2014 ED ADMISSIONS: 3,4312014 ED VISITS: 30,233	Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

Field	Value	IRS element (for citing)
Expense	$24,311,972	ExpenseAmt
Revenue	$36,482,693	RevenueAmt
Desc	ALL 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

Field	Value	IRS element (for citing)
Total Other Prog Srvc Expense	$24,311,972	TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue	$36,482,693	TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses	$68,640,831	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	Yes (1)	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	40	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	1158	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	9	GoverningBodyVotingMembersCnt
Independent Voting Member	9	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	NY	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DEWEY ROWLANDS - ROME MEMORIAL HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	3153387024	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1500 NORTH JAMES STREET	AddressLine1Txt
City	ROME	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13440	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
CHESTER PATRICK MD
CHAIRMAN	2.00	Yes (X)	Yes (X)	$0	$0	$0
DAVID NOLAN
VICE CHAIRMAN	2.00	Yes (X)	Yes (X)	$0	$0	$0
LYNN REESE
SECRETARY	2.00	Yes (X)	Yes (X)	$0	$0	$0
JULIE GROW-DENTON
TREASURER	2.00	Yes (X)	Yes (X)	$0	$0	$0
W ROBERT HERMANN
DIRECTOR	2.00	Yes (X)		$0	$0	$0
SALLY HINMAN
DIRECTOR	2.00	Yes (X)		$0	$0	$0
ANKUR DESAI MD
DIRECTOR	2.00	Yes (X)		$0	$0	$0
MICHAEL O'SHAUGHNESSY
DIRECTOR	2.00	Yes (X)		$0	$0	$0
DENNIS SURACE
DIRECTOR	2.00	Yes (X)		$0	$0	$0
KIM COOK
DIRECTOR	2.00	Yes (X)		$0	$0	$0
BASIL ARIGLIO
CEO	55.00		Yes (X)	$322,471	$0	$13,674
DEWEY ROWLANDS
CFO	55.00		Yes (X)	$168,443	$0	$13,425
NICHOLAS MAYHEW
CFO	55.00		Yes (X)	$74,038	$0	$120
BRUCE PETERSON
AVP/CIO	55.00			$153,777	$0	$13,881	Yes (X)
LEE SALTZGABER
CMO	55.00			$147,774	$0	$13,871	Yes (X)
DURINDA DURR
VP/CNO	55.00			$136,480	$0	$13,373	Yes (X)
GREGORY MATTACOLA
VP HOSPITAL COUNSEL	55.00			$140,653	$0	$5,616	Yes (X)
SCOTT BURNS
DIRECTOR PHARMACY	55.00			$132,018	$0	$13,846	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,275,654	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$87,806	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	22	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
CENTREX CLINICAL LABS INC
28 CAMPION RD	NEW HARTFORD	NY	13413	LAB SERVICES	$3,544,168
EAGLE HOSPITAL PHYSICIANS LLC
16000 NORTH DALLAS PARKWAY SUITE 4	DALLAS	TX	75248	HOSPITALIST SERVICES	$1,251,723
MCKESSON
PO BOX 98347	CHICAGO	IL	606938347	HEALTHCARE INFORMATION TECHNOLOGY	$543,647
ROBISON & SMITH COMPLETE TEXTILE
335 NORTH MAIN STREET	GLOVERSVILLE	NY	12078	LAUNDRY SERVICES	$397,413
ACCELECARE WOUND CENTERS
40 24TH STREET	PITTSBURGH	PA	15222	HYBERBARIC MANAGEMENT SERVICES	$374,867

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	23	CntrctRcvdGreaterThan100KCnt
Related Organizations	$477,219	RelatedOrganizationsAmt
Government Grants	$978,102	GovernmentGrantsAmt
All Other Contributions	$62,451	AllOtherContributionsAmt
Total Contributions	$1,517,772	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Business	621990	BusinessCd
Total Revenue Column	$79,362,300	TotalRevenueColumnAmt
Related Or Exempt Func Income	$79,362,300	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$79,362,300	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$75,401	TotalRevenueColumnAmt
Exclusion	$75,401	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$46,852	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$18,255	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$28,597	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$28,597	TotalRevenueColumnAmt
Exclusion	$28,597	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$783,699	SecuritiesAmt
Other	$2,135	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$634,214	SecuritiesAmt
Other	$247,602	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$149,485	SecuritiesAmt
Other	-$245,467	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$95,982	TotalRevenueColumnAmt
Exclusion	-$95,982	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
CAFETERIA SALES	722210	$253,880	$253,880
ACCOUNTING & CONSULTING	541200	$190,000		$190,000
GAIN LOSS CHANGE ANGEL FUND	900099	$1,795	$1,795

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$710,095	TotalRevenueColumnAmt
Unrelated Business Revenue	$100,432	UnrelatedBusinessRevenueAmt
Exclusion	$609,663	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$1,155,770	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$82,043,858	TotalRevenueColumnAmt
Related Or Exempt Func Income	$79,362,300	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$290,432	UnrelatedBusinessRevenueAmt
Exclusion	$873,354	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$592,171	TotalAmt
Management And General	$592,171	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$36,200,636	TotalAmt
Program Services	$31,639,796	ProgramServicesAmt
Management And General	$4,560,840	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$298,450	TotalAmt
Program Services	$257,564	ProgramServicesAmt
Management And General	$40,886	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$5,118,517	TotalAmt
Program Services	$5,087,547	ProgramServicesAmt
Management And General	$30,970	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,741,196	TotalAmt
Program Services	$2,357,758	ProgramServicesAmt
Management And General	$383,438	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$181,095	TotalAmt
Management And General	$181,095	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$128,584	TotalAmt
Management And General	$128,584	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$135,222	TotalAmt
Program Services	$1,090	ProgramServicesAmt
Management And General	$134,132	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$268,716	TotalAmt
Program Services	$149,086	ProgramServicesAmt
Management And General	$119,630	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,388,357	TotalAmt
Program Services	$41,391	ProgramServicesAmt
Management And General	$1,346,966	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,128,768	TotalAmt
Program Services	$873,419	ProgramServicesAmt
Management And General	$255,349	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$89,433	TotalAmt
Program Services	$78,651	ProgramServicesAmt
Management And General	$10,782	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$75,071	TotalAmt
Program Services	$64,086	ProgramServicesAmt
Management And General	$10,985	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$505,483	TotalAmt
Management And General	$505,483	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$4,518,501	TotalAmt
Program Services	$2,491,418	ProgramServicesAmt
Management And General	$2,027,083	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$1,002,057	TotalAmt
Management And General	$1,002,057	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
PURCHASE SERVICES	$7,868,909	$7,513,020	$355,889
BAD DEBT EXPENSE	$6,284,531	$6,284,531
SUPPLIES	$5,134,612	$5,027,111	$107,501
PHARMACY	$2,853,097	$2,853,097

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$8,482,248	TotalAmt
Program Services	$3,921,266	ProgramServicesAmt
Management And General	$4,560,982	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$84,995,654	TotalAmt
Program Services	$68,640,831	ProgramServicesAmt
Management And General	$16,354,823	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,433,942	BOYAmt
EOY	$3,170,380	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$11,351,689	BOYAmt
EOY	$7,998,806	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$1,750,436	BOYAmt
EOY	$975,968	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,698,749	BOYAmt
EOY	$1,730,357	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$2,179,347	BOYAmt
EOY	$2,695,649	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$82,379,459	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$50,318,872	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$35,244,050	BOYAmt
EOY	$32,060,587	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$2,720,708	BOYAmt
EOY	$2,812,029	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$4,554,607	BOYAmt
EOY	$5,499,395	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$60,933,528	BOYAmt
EOY	$56,943,171	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$11,637,910	BOYAmt
EOY	$12,361,611	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$14,951,207	BOYAmt
EOY	$12,436,473	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$5,475,000	BOYAmt
EOY	$5,050,000	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$9,738,763	BOYAmt
EOY	$11,248,790	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$41,802,880	BOYAmt
EOY	$41,096,874	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$18,725,044	BOYAmt
EOY	$15,168,176	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$269,663	BOYAmt
EOY	$92,180	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$585,941	BOYAmt
EOY	$585,941	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$19,130,648	BOYAmt
EOY	$15,846,297	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$60,933,528	BOYAmt
EOY	$56,943,171	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$2,951,796	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$97,497	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$235,058	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	Yes (1)	DirectContactLegislatorsInd
Direct Contact Legislators	$20,139	DirectContactLegislatorsAmt
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	0	OtherActivitiesInd
Total Lobbying Expenditures	$20,139	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	$20,139 REPRESENTS THE PORTION OF THE 2014 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

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$643,953	BeginningYearBalanceAmt
Investment Earnings Or Losses	$314,851	InvestmentEarningsOrLossesAmt
Other Expenditures	$5,328	OtherExpendituresAmt
End Year Balance	$953,476	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$624,541	BeginningYearBalanceAmt
Contributions	$1,890	ContributionsAmt
Investment Earnings Or Losses	$33,673	InvestmentEarningsOrLossesAmt
Other Expenditures	$16,151	OtherExpendituresAmt
End Year Balance	$643,953	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$591,605	BeginningYearBalanceAmt
Contributions	$4,471	ContributionsAmt
Investment Earnings Or Losses	$28,465	InvestmentEarningsOrLossesAmt
End Year Balance	$624,541	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.12300	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.78400	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.09300	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$43,653,353	OtherCostOrOtherBasisAmt
Depreciation	$20,023,934	DepreciationAmt
Book Value	$23,629,419	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,676,078	OtherCostOrOtherBasisAmt
Depreciation	$2,298,387	DepreciationAmt
Book Value	$377,691	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$33,321,282	OtherCostOrOtherBasisAmt
Depreciation	$25,894,950	DepreciationAmt
Book Value	$7,426,332	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,728,746	OtherCostOrOtherBasisAmt
Depreciation	$2,101,601	DepreciationAmt
Book Value	$627,145	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$32,060,587	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDesc	Book ValueBookValueAmt
NET ASSETS OF FOUNDATION	$759,122
OTHER LONG TERM ASSETS	$4,653,004
BOND AMORTIZATION	$87,269

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$5,499,395	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
LINE OF CREDIT	$1,850,000
OTHER LIABILITIES	$6,186,912
ADVANCE FROM THIRD PARTIES	$3,211,878

Field	Value	IRS element (for citing)
Total Liability	$11,248,790	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART V, LINE 4:

INTENDED USE OF ENDOWMENT FUND IS THAT THE PRINCIPLE CAN BE INVESTED, WHILE KEPT IN TACT 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, 2014 AND 2013, 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 2011 THROUGH 2014. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent100	Yes (X)	Percent100Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	0	FreeCareMedicallyIndigentInd
Financial Assistance Budget	0	FinancialAssistanceBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$977,079	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$539,044	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$438,035	NetCommunityBenefitExpnsAmt
Total Expense	0.00550	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$17,957,680	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$15,715,880	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,241,800	NetCommunityBenefitExpnsAmt
Total Expense	0.02840	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$450,805	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$307,567	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$143,238	NetCommunityBenefitExpnsAmt
Total Expense	0.00180	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,385,564	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$16,562,491	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,823,073	NetCommunityBenefitExpnsAmt
Total Expense	0.03570	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$143,060	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,280	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$132,780	NetCommunityBenefitExpnsAmt
Total Expense	0.00150	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$31,935	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$30,788	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,147	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$174,995	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$41,068	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$133,927	NetCommunityBenefitExpnsAmt
Total Expense	0.00160	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,560,559	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$16,603,559	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,957,000	NetCommunityBenefitExpnsAmt
Total Expense	0.03730	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,874	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,874	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,783	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,783	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$241,078	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$241,078	NetCommunityBenefitExpnsAmt
Total Expense	0.00310	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$254,735	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$254,735	NetCommunityBenefitExpnsAmt
Total Expense	0.00490	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReportedInd
Bad Debt Expense	$1,804,837	BadDebtExpenseAmt
Bad Debt Expense Attributable	$143,988	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$20,994,398	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$27,646,282	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$6,651,884	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	0	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

Field	Value	IRS element (for citing)
Business Name Line1	1 GRIFFIS EYE CENTER LLC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Primary Activities	SEE SCHEDULE R PART VII	PrimaryActivitiesTxt
Org Profit Or Ownership	0.30000	OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership	0.00000	OfcrEtcProfitOrOwnershipPct
Physicians Profit Or Ownership	0.70000	PhysiciansProfitOrOwnershipPct

Field	Value	IRS element (for citing)
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ROME MEMORIAL HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1500 NORTH JAMES STREET	AddressLine1Txt
City	ROME	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13440	ZIPCd

Field	Value	IRS element (for citing)
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	ROME MEMORIAL HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
CHNA Conducted	13	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	WWW.ROMEHOSPITAL.ORG	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	WWW.OCGOV.NET	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	13	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.ROMEHOSPITAL.ORG	StrategyWebsiteURLTxt
Strategy Attached	0	StrategyAttachedInd
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	100.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	FPGFamilyIncmLmtDscntCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
FAP Actions On Nonpayment	0	FAPActionsOnNonpaymentInd
Collection Activities	0	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
ROME MEMORIAL HOSPITAL	PART V, SECTION B, LINE 5: ROME MEMORIAL HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS DERIVED FROM ITS PARTICIPATION IN THE COMPREHENSIVE COUNTYWIDE COMMUNITY NEEDS ASSESSMENT. THE COMMUNITY HEALTH ASSESSMENT (CHA) FOR ONEIDA COUNTY WAS DEVELOPED WITHIN THE FRAMEWORK OF THE NEW YORK STATE PREVENTION AGENDA AND DREW UPON A VARIETY OF DATA SOURCES, BOTH QUALITATIVE AND QUANTITATIVE. FACULTY AND STAFF FROM THE CENTRAL NEW YORK MASTER OF PUBLIC HEALTH PROVIDED TECHNICAL SUPPORT TO A TEAM MADE UP OF REPRESENTATIVES OF THE ONEIDA COUNTY HEALTH DEPARTMENT, LOCAL HOSPITALS AND COMMUNITY AGENCIES.A STEERING COMMITTEE COMPRISED OF A VARIETY OF AGENCIES AND LED BY THE ONEIDA COUNTY HEALTH DEPARTMENT, MET REGULARLY STARTING IN THE FALL OF 2012. THE COMMITTEE'S FOCUS WAS TO OUTLINE THE CHA PROCESS AND, ROLES AND RESPONSIBILITIES FOR THE NEXT SEVERAL MONTHS. A COMMUNITY HEALTH FORUM, HELD ON MAY 20, 2013, MARKED THE FORMAL LAUNCH OF THE CHA PROCESS. OVER 65 PARTICIPANTS FROM A VARIETY OF AGENCIES GATHERED TO PROVIDE INPUTS ON THE STRENGTHS, WEAKNESSES, THREATS, OPPORTUNITIES AND MAJOR HEALTH SYSTEM AND HEALTH STATUS ISSUES FACING THE COUNTY. PARTICIPANTS WORKED IN SMALL GROUPS TO IDENTIFY AND PRIORITIZE KEY HEALTH SYSTEM AND HEALTH STATUS ISSUES. THE COLLABORATIVE PROCESS ENSURED BROAD PARTICIPATION IN THE ANALYSIS OF DATA AND SELECTION OF PRIORITY AREAS.ORGANIZATIONS PARTICIPATING IN THE STEERING COMMITTEE:ONEIDA COUNTY HEALTH DEPARTMENTONEIDA COUNTY DEPARTMENT OF MENTAL HEALTH ROME MEMORIAL HOSPITALFAXTON-ST. LUKE'S HEALTHCAREST. ELIZABETH'S MEDICAL CENTERUTICA COMMUNITY HEALTH CENTER (FQHC)COMMUNITY AGENCIES AND A VARIETY OF PROGRAM REPRESENTATIVESSYRACUSE UNIVERSITYTHE TARGETED GROUPS LISTED BELOW COLLABORATED DURING THE SECOND HALF OF 2013 TO DEVELOP OBJECTIVES AND IMPLEMENTATION STRATEGIES AROUND EACH OF THE FOCUS AREAS.ONEIDA COUNTY HEALTH DEPARTMENT ROME MEMORIAL HOSPITALFAXTON-ST. LUKE'S HEALTHCAREST. ELIZABETH'S MEDICAL CENTERMOHAWK VALLEY PERINATAL NETWORKMOHAWK VALLEY BREASTFEEDING NETWORKONEIDA COUNTY WOMEN, INFANTS AND CHILDREN PROGRAMCOMMUNITY AGENCIESTOBACCO CESSATION CENTERONEIDA COUNTYUTICA COMMUNITY HEALTH CENTER (FQHC)AMERICAN CANCER SOCIETYHEALTHY FAMILIES ONEIDA COUNTY/KIDS ONEIDANEIGHBORHOOD CENTER/MOHAWK VALLEY COMMUNITY ACTION AGENCYFOLLOWING THE PUBLIC PARTICIPATION AND INPUT PERIOD, THE HEALTH PRIORITIES WERE CHOSEN BASED UPON THE FOLLOWING CRITERIA:-THE PRIORITY AREA WAS CONSISTENT WITH THE CURRENT NYS DEPARTMENT OF HEALTH PREVENTION AGENDA AREAS.-THE PRIORITY AREA WAS SUPPORTED BY DATA SHOWING HEALTH STATUS INDICATORS OR HEALTH NEEDS WERE BELOW THE NEW YORK STATE AVERAGE FOR THE ENTIRE POPULATION OR FOR A SUBSET OF THE POPULATION WITH A MEASURABLE DISPARITY.-THE PRIORITY AREA WAS IDENTIFIED/RECOMMNDED DURING THE PUBLIC INPUT PROCESS.-AVAILABILITY OF COLLABORATIVE PARTNERS, RESOURCES AND CAPACITY FOR MEANINGFUL IMPACT.THE WORK GROUP THAT MADE THE FINAL SELECTION OF THE PRIORITY AREAS INCLUDED REPRESENTATIVES FROM THE ONEIDA COUNTY DEPARTMENT OF HEALTH AND THE COUNTY'S THREE HOSPITALS, WITH INPUT FROM FACULTY AND STAFF FROM THE CENTRAL NEW YORK MASTER OF PUBLIC HEALTH PROGRAM.THE COUNTYWIDE HEALTH PRIORITIES TO PROMOTE POPULATION HEALTH INCLUDED:-PROMOTE TOBACCO USE CESSATION AMONG ADULTS.-INCREASE THE PROPORTION OF ONEIDA COUNTY BABIES WHO ARE BREASTFED.ROME MEMORIAL HOSPITAL'S EFFORTS TO IMPROVE COMMUNITY HEALTH EXTEND BEYOND THE TWO PRIORITIES IDENTIFIED THROUGH THE CHA AND CSP PROCESS. SOME OF THE HOSPITAL'S ADDITIONAL INITIATIVES INCLUDE:-HOSTING COUCH TO 5K PROGRAMS AND WALKING PROGRAMS TO PROMOTE PHYSICAL ACTIVITY.-OFFERING FREE HEALTH SCREENINGS AT AREA HEALTH FAIRS TO DETECT HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, DIABETES, AND GLAUCOMA.-CONDUCTING COLORECTAL HEALTH SCREENINGS EACH MARCH IN BOONVILLE, ROME AND CAMDEN TO PROMOTE EARLY DETECTION OF CANCER.-CONDUCTING PSA SCREENINGS EACH SEPTEMBER FOR THE EARLY DETECTION OF PROSTRATE 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 MONTHLY 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 CLINCS ANNUALLY 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. -EXPLORING COLLABORATIVE RELATIONSHIPS WITH OTHER ORGANIZATIONS TO IMPROVE THE COORDINATION OF HIGH QUALITY, COST-EFFECTIVE CARE.-INTRODUCING NEW SERVICES INCLUDING LYMPHADEMA, LOW-DOSE CT LUNG CANCER SCREENING AND ADVANCED WOUND CARE TO ADDRESS UNMET NEEDS IN THE COMMUNITY.-PARTNERING WITH THE ALZHEIMER'S ASSOCIATION TO PROVIDE AN EDUCATIONAL SERIES FOR CAREGIVERS.-PARTNERING WITH THE LOCAL YMCA TO ENHANCE WELLNESS PROGRAMS FOR THE HOSPITAL EMPLOYEES AND PATIENTS OF RMH-OWNED PHYSICIAN PRACTICES.-EXPANDING RMH'S WELLNESS INITIATIVES FOR EMPLOYEES, SUCH AS OFFERING YOGA CLASSES AND POSTING NUTRITIONAL INFORMATION FOR FOOD OFFERED IN THE CAFETERIA.-IMPLEMENTING STARTEGIES TO REDUCE HEALTH ACQUIRED INFECTIONS. RMH HASN'T HAD A CENTRAL LINE INFECTION IN THE ICU SINCE 2006. -PROVIDING SMOKING PREVENTION EDUCATION AT LOCAL SCHOOLS TO DETER CHILDREN FROM BECOMING ADULT SMOKERS.-PROVIDING HEALTH INFORMATION THROUGH QUARTERLY NEWSLETTERS TO SENIORS.ROME MEMORIAL HOSPITAL IS ALSO ONE OF 11 HOSPITALS THAT ARE MEMBERS OF THE CENTRAL NEW YORK CARE COLLABORATIVE (CNYCC), WHICH CONDUCTED A COMMUNITY HEALTH ASSESSMENT (CHA) IN 2014 FOR THE SIX-COUNTY REGION AS PART OF NEW YORK STATE'S DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP)PROGRAM. THE CONSULTANT, JSI, INC., SOUGHT INPUT FROM REPRESENTATIVES FROM HEALTH AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH DEPARTMENTS, COMMUNITY ADVOCACY GROUPS, BUSINESSES AND OTHER COMMUNITY MEMBERS. BASED UPON ANALYSIS OF THE QUANTITATIVE AND QUALITATIVE DATA, JSI IDENTIFIED SEVERAL PROGRAMMATIC STRATEGIES 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. CNYCC HAS IDENTIFIED 11 PROJECTS TO ADDRESS THE NEEDS OF THE SIX-COUNTY REGION. ROME MEMORIAL HOSPITAL WILL BE A PARTNER IN MANY OF THE PROJECTS.
ROME MEMORIAL HOSPITAL	PART V, SECTION B, LINE 6A: HOSPITAL CHNA PARTICIPANTS INCLUDE ROME MEMORIAL HOSPITAL, FAXTON-ST. LUKE'S HEALTHCARE AND ST. ELIZABETH'S MEDICAL CENTER.THE 2014 CHA, CONDUCTED BY JSI, INCLUDED ALL OF THE HOSPITALS IN CAYUGA, LEWIS, MADISON, ONEIDA, ONONDAGA AND OSWEGO COUNTIES.
ROME MEMORIAL HOSPITAL	PART 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.
ROME MEMORIAL HOSPITAL	PART V, SECTION B, LINE 22D: INDIVIDUALS WILL RECEIVE 50% DISCOUNT WITHOUT INSURANCE. IF APPROVED AND FAP-ELIGIBLE A TIERED DISCOUNT WILL BE APPLIED BASED ON THE BLUE CROSS CONTRACTED RATES AND THE INDIVIDUAL FPG PERCENTAGE.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE:	WWW.ROMEHOSPITAL.ORG
ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:	WWW.ROMEHOSPITAL.ORG
ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 16C WEBSITE:	WWW.ROMEHOSPITAL.ORG

Field	Value	IRS element (for citing)
Facility	15	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (15 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
COMMUNITY RECOVERY CENTER
264 W DOMINICK STREET	ROME	NY	13440	SUBSTANCE ABUSE COUNSELING
MOHAWK VALLEY RADIATION MEDICINE
107 E CHESTNUT STREET	ROME	NY	13440	RADIATION ONCOLOGY
PHYSICAL THERAPY
107 E CHESTNUT STREET	ROME	NY	13440	OFFSITE PHYSICAL THERAPY SERVICES
BOONVILLE FAMILY CARE
13407 STATE ROUTE 12	BOONVILLE	NY	13309	PRIMARY CARE SERVICES
LABORATORY COLLECTION SITE
1801 BLACK RIVER BLVD	ROME	NY	13440	OFFSITE LAB COLLECTION SITE
LABORATORY COLLECTION SITE
1617 N JAMES STREET	ROME	NY	13440	OFFSITE LAB COLLECTION SITE
LABORATORY COLLECTION SITE
13407 STATE ROUTE 12	BOONVILLE	NY	13309	OFFSITE LAB COLLECTION SITE
LABORATORY COLLECTION SITE
BEECHES OFFICE COMPLEX-TURIN RD	ROME	NY	13440	OFFSITE LAB COLLECTION SITE
MEDICAL IMAGING
1617 N JAMES STREET	ROME	NY	13440	OFFSITE RADIOLOGY SERVICES
MEDICAL IMAGING
1801 BLACK RIVER BLVD	ROME	NY	13440	OFFSITE RADIOLOGY SERVICES
MEDICAL IMAGING
107 E CHESTNUT STREET	ROME	NY	13440	OFFSITE RADIOLOGY SERVICES
PRENATAL CARE CENTER
155 WEST DOMINICK STREET	ROME	NY	13440	OFFSITE PRENATAL CARE SERVICES
DELTA MEDICAL CENTER
1819 BLACK RIVER BLVD	ROME	NY	13440	PRIMARY CARE SERVICES
REGIONAL WOUND CARE CENTER
267 HILL ROAD	ROME	NY	13441	ADVANCED WOUND CARE AND HYPERBARIC OXYGEN TREATMENT
CAMDEN FAMILY CARE
5 MASONIC AVENUE	CAMDEN	NY	13316	PRIMARY CARE SERVICES

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 6A:	ROME MEMORIAL HOSPITAL'S 2013 COMMUNITY SERVICE PLAN IS POSTED ON ITS WEBSITE AT: WWW.ROMEHOSPITAL.ORG. THE HOSPITAL'S COMMUNITY SERVICE PLAN IS DERIVED FROM ITS PARTICIPATION IN THE COMPREHENSIVE COUNTYWIDE COMMUNITY NEEDS ASSESSMENT. THE COUNTY 2013 COMMUNITY HEALTH ASSESSMENT IS AVAILABLE ONLINE AT: HTTP://WWW.OCGOV.NET/HEALTH/COMMUNITY-HEALTH-ASSESSMENT.
PART I, LINE 7:	CHARITY CARE AT COST (7A) 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.UNREIMBURSED MEDICAID (7B) WAS CALCULATED BY USING ACTUAL COSTS.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 $6,284,531 (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. 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 2014, THAT AMOUNT IS $6,284,531 (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 2014, THAT PERCENTAGE IS 28.72. 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 TOTAL BAD DEBT EXPENSE. FOR 2014, THE TOTAL PERCENTAGE OF FINANCIAL AID PROVIDED IS 7.98. APPLYING THAT PERCENTAGE AGAINST THE TOTAL 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 12 AND 13 FOR CURRENT FOOTNOTE LANGUAGE THAT DESCRIBES BAD DEBT. PART III, LINE 6; COSTING METHODOLOGY AND SOURCE:2014 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 TOUGH ECONOMIC TIMES BATTERING THE COUNTRY, MANY PEOPLE HAVE LOST THEIR HEALTH INSURANCE. MANY CANNOT AFFORD RISING PREMIUMS, WHILE OTHERS HAVE LOST THEIR JOBS COMPLETELY. SOME PEOPLE HAVE INSURANCE, BUT THEIR OUT-OF-POCKET COSTS ARE HIGH BECAUSE EMPLOYERS HAVE RAISED THEIR DEDUCTIBLES OR CO-PAYMENTS, OR REDUCED WHAT THEIR PLANS COVER. AS A RESULT, THE AMOUNT OF UNCOMPENSATED CARE PROVIDED BY RMH CONTINUES TO GROW.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. 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 AS RESIDENTS LOSE THEIR JOBS OR THEIR ABILITY TO AFFORD THEIR INSURANCE PREMIUMS. IN 2014, ROME MEMORIAL HOSPITAL'S BAD DEBT AND CHARITY CARE TOTALED $8.4 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 BY 19,000 IN 2006 TO 30,233 IN 2014. 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 CHALLANGES, 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.
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'S STRATEGIC PLANNING PROCESS INCLUDES QUARTERLY UPDATES THAT TAKE INTO CONSIDERATION EMERGING INFORMATION. SURVEYS ARE PROVIDED AT COMMUNITY LECTURES AND FAIRS ASKING RESIDENTS TO IDENTIFY AREAS OF INTEREST FOR FUTURE PROGRAMS.
PART VI, LINE 3:	LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:TO ENSURE THAT THE COMMUNITY IS AWARE OF THE HOSPITAL'S COMMITMENT TO PROVIDE HEALTHCARE SERVICES TO THOSE WHO ARE UNABLE TO PAY, THE HOSPITAL POSTS INFORMATION ABOUT ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY CONFORMS WITH THE GUIDELINES ESTABLISHED BY THE HEALTHCARE ASSOCIATION OF NEW YORK STATE. THIS POLICY INCLUDES DETAILED INFORMATION REGARDING ELIGIBILITY, THE APPLICATION PROCESS, FINANCIAL GUIDELINES, TYPES OF FINANCIAL ASSISTANCE AVAILABLE, AND THE APPEAL PROCESS. RMH'S WEBSITE ALSO LISTS CONTACT INFORMATION IF YOU NEED HELP DETERMINING IF YOU QUALIFY FOR A DISCOUNT OR HAVE QUESTIONS REGARDING THE PROCESS. FREE, CONFIDENTIAL ASSISTANCE IS AVAILABLE BY CONTACTING THE ROME MEMORIAL HOSPITAL BUSINESS OFFICE. IF YOU DO NOT SPEAK ENGLSH, SOMEONE WILL HELP IN YOUR OWN LANGUAGE. ALSO, ROME MEMORIAL HOSPITAL HOSTS ENROLLMENT REPRESENTATIVES WHO CAN HELP ENROLL IN FREE OR LOW-COST INSURANCE PROGRAMS, SUCH AS MEDICAID, CHILD HEALTH PLUS AND FAMILY HEALTH PLUS.
PART VI, LINE 4:	LINE 4 - SERVICE AREA AND COMMUNITY DEMOGRAPHICS: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. THE ZIP CODES THAT COMPRISE THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDE: ZIP CODES POPULATIONAVA (13303) 1,153BLOSSVALE (13308) 3,625BOONVILLE (13309) 5,889CAMDEN (13316) 6,460LEE CENTER (13363) 2,315ROME (13440) 42,986ROME (13441) 51TABERG (13471) 3,540WESTDALE (13483) 256WESTERNVILLE (13486) 815WESTMORELAND (13490) 1,361MOST ZIP CODES IN THE PRIMARY SERVICE AREA ARE LOCATED IN ONEIDA COUNTY. RESIDENTS FROM ROME'S 13440 ZIP CODE WITH A POPULATION OF ALMOST 43,000 COMPRISE APPROXIMATELY TWO-THIRDS OF RMH'S INPATIENT DISCHARGES. THE SURROUNDING COMMUNITIES ARE MOSTLY RURAL, WITH CAMDEN 13316 (POPULATION OF 6,460) AND BOONVILLE 13309 (POPULATION OF 5,889) AS THE TWO LARGEST TOWNS LOCATED IN THE PRIMARY SERVICE AREA.BASED UPON THE 2010 CENSUS, THE POPULATION OF ONEIDA COUNTY IS 234,878, WITH 50.2% FEMALE; 21.4% OF THE POPULATION WAS UNDER THE AGE OF 18; AND 16.8% WERE 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 (INCLUDING 6,260 CHILDREN) RESIDE IN ZIP CODES THAT COMPRISE THE HOSPITAL'S PRIMARY SERVICE AREA. AT $49,533, THE MEDIAN HOUSEHOLD INCOME IN ROME MIRRORS ONEIDA COUNTY'S MEDIAN INCOME OF $48,148 AND IS LESS THAN NEW YORK STATE'S AT $56,951. IN ROME, 12.6% OF THE POPULATION LIVES BELOW THE POVERTY LINE. THERE IS AN EDUCATIONAL ATTAINMENT GAP IN ROME WITH ONLY 18.9% OF RESIDENTS AGE 25+ EARNING A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 32.5% 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).ALTHOUGH ROME MEMORIAL HOSPITAL IS NOT IN A DESIGNATED MEDICALLY UNDERSERVED AREA, IT IS IN A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA FOR PRIMARY CARE HPSA 136999363J, MEDICAID ELIGIBLE-ROME PRIMARY CARE SERVICE AREA AND MENTAL HEALTH HPSA 736999360I, MEDICAID ELIGIBLE-ONEIDA COUNTY.
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 STATES	NY

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
BASIL ARIGLIO
CEO	$302,471	$0	$20,000	$0	$0	$0	$0	$0	$13,674	$0	$336,145	$0	$0	$0
DEWEY ROWLANDS
CFO	$168,443	$0	$0	$0	$0	$0	$0	$0	$13,425	$0	$181,868	$0	$0	$0
BRUCE PETERSON
AVP/CIO	$146,127	$0	$7,650	$0	$0	$0	$0	$0	$13,881	$0	$167,658	$0	$0	$0
LEE SALTZGABER
CMO	$147,774	$0	$0	$0	$0	$0	$0	$0	$13,871	$0	$161,645	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 1A	FormAndLineReferenceDesc
Explanation	TYPE OF BENEFIT: PAYMENT OF 2014 MEMBERSHIP DUES AND GENERAL MAINTENANCE FEE FOR SOCIAL CLUB, AS AGREED UPON IN EMPLOYMENT CONTRACT. PERSON WHO RECEIVED BENEFIT: CEO THIS BENEFIT WAS TREATED AS TAXABLE COMPENSATION IN 2014 FOR PERSON LISTED ABOVE.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
ONEIDA COUNTY INDUSTRIAL DEVELOPMENT AGENCY
A	166158201	6824621LE	2005-06-16	$11,900,000	FINANCE CONSTRUCTION	0	Yes (1)	0
ONEIDA COUNTY LOCAL DEVELOPMENT CORPORATION
B	273190422		2010-12-30	$6,900,000	FINANCE MRI CONSTRUCTION	0	Yes (1)	0
DORMITORY AUTHORITY OF THE STATE OF NEW YORK
C	146000293		2011-10-27	$7,500,000	FINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT	0	Yes (1)	0
DORMITORY AUTHORITY OF THE STATE OF NEW YORK
D	146000293		2007-09-21	$1,858,108	FINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT- CAT SCANN	0	Yes (1)	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	Total ProceedsTotalProceedsAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Substantial CompletionSubstantialCompletionYr	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	Capitalized InterestCapitalizedInterestAmt	Capital ExpendituresCapitalExpendituresAmt
A	$11,900,000	$509,090	2006	Yes (1)	Yes (1)
B	$6,900,000	$222,845	2009	Yes (1)	Yes (1)	$59,425	$5,999,546
C	$7,500,000	$58,827	2011	Yes (1)	Yes (1)	$37,256
D	$1,858,108		2007	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd
A	Yes (1)	Yes (1)	Yes (1)
B	0		Yes (1)
C	Yes (1)	Yes (1)	Yes (1)
D	Yes (1)	Yes (1)	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Business Name Line2HedgeProviderName/BusinessNameLine2Txt	Term Of HedgeTermOfHedgePct	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
MANUFACTURERS AND
A	0	0	0	0	Yes (1)	Yes (1)	TRUST	5.000000000000	0	Yes (1)	0	0	0
(no name)
B	0	0	0	0	Yes (1)	0					0	0	0
(no name)
C	0	0	0	0	0	0					0	0	0
(no name)
D	0	0	0	0	0	0					0	0	0

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	0
B	0
C	0
D	0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE K SUPPLENTAL INFORMATION	FormAndLineReferenceDesc
Explanation	THE CAPITAL LEASE AGREEMENTS ARE ALL TELP (TAX EXEMPT LEASE - PURCHASE (FINANCING)) LEASES THROUGH THE COUNTY OR STATE.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	DORMITORY AUTHORITY OF THE STATE OF NEW YORK	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	146000293	BondIssuerEIN
Bond Issued	2009-12-01	BondIssuedDt
Issue Price	$1,935,034	IssuePriceAmt
Purpose	FINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT - MRI EQUIPMENT	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	Yes (1)	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	$1,935,034	TotalProceedsAmt
Issuance Costs From Proceeds	$15,338	IssuanceCostsFromProceedsAmt
Substantial Completion	2009	SubstantialCompletionYr
Current Refunding	0	CurrentRefundingInd
Advance Refunding	0	AdvanceRefundingInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	Yes (1)	MgmtContractBondFincdPropInd
Engage Bond Counsel Contracts	Yes (1)	EngageBondCounselContractsInd
Any Research Agreements	0	AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test	Yes (1)	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	0	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	0	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	0	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	0	ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
MARY ANN JONES
SISTER OF KEY EMPLOYEE	$25,840	COMPENSATION	0
SCOTT A GWILT
SON IN LAW OF BOARD DIRECTOR	$39,717	COMPENSATION	0

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Desc	PRIVATE ROOM CONVERSIONS/LOBBY SECURITY MIRRORS	Desc
Contribution	1	ContributionCnt
Noncash Contributions Rpt F990	$225,350	NoncashContributionsRptF990Amt
Method Of Determining Revenues	ACTUAL INVOICE COST	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (1)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	0	ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 2	IN DECEMBER 2014, ROME MEMORIAL HOSPITAL ESTABLISHED CAMDEN FAMILY CARE TO ENHANCE PRIMARY CARE ACCESS FOR AREA RESIDENTS. CAMDEN FAMILY CARE IS LOCATED IN CAMDEN, NEW YORK, WHICH IS IN HPSA 13699936J1, MEDICAID ELIGIBLE-CAMDEN SERVICE AREA. ACCORDING TO A 2010 NEW YORK STATE PHYSICIAN WORKFORCE REPORT, THE MOHAWK VALLEY REGION HAS THE LOWEST RATIO OF PHYSICIANS PER 100,000 POPULATION IN ALL OF NEW YORK STATE.
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 11	THE COMPLETED 2014 990 WAS PRESENTED TO THE BOARD BY THE CFO OF THE HOSPITAL AT ITS SEPTEMBER 2015 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 XI, LINE 9:	CHANGE IN INTEREST IN FOUNDATION -10,058. CHANGE IN NET ASSETS -225,000.
FORM 990, PART XII, LINE 2C	THE FINANCE/AUDIT COMMITTEE CONSISTS OF NO LESS THAN 3 AND NOT MORE THAN 7 MEMBERS. THIS COMMITTEE IS RESPONSIBLE FOR GENERAL OVERSIGHT OF THE FINANCIAL AFFAIRS OF THE HOSPITAL. THE COMMITTEE REVIEWS, AVISES AND REPORTS TO THE BOARD OF TRUSTEES ON THE INVESTMENT AND MANAGEMENT OF THE FINANCIAL RESOURCES OF THE CORPORATION AND SHALL REVIEW THE ANNUAL BUDGET AND CAPITAL PLANS, FUND MANAGEMENT PROCEDURES AND INTERNAL CONTROLS RELATING TO THE SAFEGUARD OF FINANCIAL ASSETS. THE COMMITTEE ACTS AS FINANCIAL ADVISOR, REVIEWS PROPOSED SCOPE OF THE ANNUAL AUDITS PERFORMED BY INDEPENDENT AUDITORS, REVIEWS INDEPENDENT AUDITORS MANAGEMENT LETTERS, REVIEWS THE ADEQUACY OF ACCOUNTING POLICIES AND INTERNAL CONTROL STRUCTURES, RECOMMENDS THE APPOINTMENT OF INDEPENDENT AUDITORS TO THE BOARD OF TRUSTEES AND REVIEWS PERIODICALLY THE CONFLICTS OF INTEREST POLICIES, AS WELL AS OVERSEES COMPLIANCE THEREWITH.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
GREATER ROME AFFILIATES
1500 N JAMES STREET	ROME	NY	13440	161508597	PARENT CORPORATION	NY	501C3	LINE 11A, I	0
ROME MEMORIAL PROPERTIES
1500 N JAMES STREET	ROME	NY	13440	161492003	SUPPORT HOSPITAL ACTIVITIES	NY	501C3	3	0	GRA

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	GRIFFIS SURGERY CENTER LLC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	105 DART CIRCLE	AddressLine1Txt
City	ROME	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13441	ZIPCd

Field	Value	IRS element (for citing)
EIN	263738675	EIN
Primary Activities	SEE SCHEDULE R, PART VII	PrimaryActivitiesTxt
Legal Domicile State	NY	LegalDomicileStateCd
Predominant Income Type	INVESTMENT	PredominantIncomeTypeTxt
Share Of Total Income	$358,573	ShareOfTotalIncomeAmt
Share Of EOY Assets	$379,101	ShareOfEOYAssetsAmt
Disproportionate Allocations	0	DisproportionateAllocationsInd
General Or Managing Partner	0	GeneralOrManagingPartnerInd
Ownership	0.30000	OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd
RMH SERVICES INC
1500 N JAMES STREET	ROME	NY	13440	161490045	FOR PROFIT	NY	GREATER ROME AFFILIATES	C	$15,269	$2,649,339	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

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	Yes (1)	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (1)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE R, PART III COLUMN (B)	FormAndLineReferenceDesc
Explanation	EXPLANATION: GRIFFIS SURGERY CENTER, LLC MULTI-SPECIALTY AMBULATORY SURGERY CENTER.	ExplanationTxt