2014-11-10T09:57:26-06:00 2013-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2013-01-01 161471634 ROME MEMORIAL HOSPITAL ROME 1500 NORTH JAMES STREET ROME NY 13440 DEWEY ROWLANDS CFO/VP FINANCE 3153387000 2014-11-06 1 ANGELA M FRANCO P00589741 3154463600 2013 2015-11-30 17:44:51Z BASIL ARIGLIO 1500 NORTH JAMES ST ROME NY 13440 83219854 0 X ROMEHOSPITAL.ORG X 1995 NY PROVIDE QUALITY HEALTHCARE WITH COMPASSION. 11 11 1147 0 247849 0 2837391 2073222 88352403 79290733 95725 155399 959980 626752 92245499 82146106 0 0 0 0 51362727 48379471 0 0 0 40253290 39504107 91616017 87883578 629482 -5737472 67911075 60933528 43197124 41802880 24713951 19130648 X ABOUT ROME MEMORIAL HOSPITAL: OVERALL, ROME MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, SKILLED NURSING, AND EMERGENCY CARE SERVICES PRIMARILY FOR THE RESIDENTS OF ROME AND THE SURROUNDING AREAS. 1 0 34784516 27309386 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.2013 INPATIENT DISCHARGES: 4,3662013 BIRTHS: 5732013 PATIENT DAYS: 21,216 8798740 6969140 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.2013 PATIENT DAYS = 27,2712013 OCCUPANCY PERCENTAGE = 93.39% 6498746 9577748 EMERGENCY DEPARTMENT (ED)ROME MEMORIAL HOSPITAL EMERGENCY DEPARTMENT IS A SAFETY NET FOR THE MOST VULNERABLE POPULATIONS IN THE COMMUNITY. IN 2013, APPROXIMATELY 42% OF THE PATIENTS TREATED WERE LISTED AS UNINSURED OR UNDER INSURED. FOR LOWER LEVEL EMERGENCY DEPARTMENT VISITS, THIS POPULATION REPRESENTED MORE THAN 59% OF THE VISITS BECAUSE MANY PRIMARY CARE PHYSICIANS DO NOT ACCEPT MEDICAID.2013 ED ADMISSIONS: 3,6152013 ED VISITS: 27,787 21066678 35434459 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. 21066678 35434459 71148680 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 1 0 0 0 1 40 0 1 1147 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X DEWEY ROWLANDS ROME MEMORIAL 3153387024 1500 NORTH JAMES STREET ROME NY 13440 CHESTER PATRICK MD CHAIRMAN 2.00 X X 0 0 0 DAVID NOLAN VICE CHAIRMAN 2.00 X X 0 0 0 KIM COOK TREASURER 2.00 X X 0 0 0 LYNN REESE SECRETARY 2.00 X X 0 0 0 W ROBERT HERMANN DIRECTOR 2.00 X 0 0 0 MARY DAVIS DIRECTOR 2.00 X 0 0 0 DR ANKUR DESAI DIRECTOR 2.00 X 0 0 0 SALLY HINMAN DIRECTOR 2.00 X 0 0 0 JULIE GROW-DENTON ASST TREASURER 2.00 X X 0 0 0 MICHAEL O'SHAUGHNESSY DIRECTOR 2.00 X 0 0 0 MICHAEL KRAMER DIRECTOR 2.00 X 0 0 0 DENNIS SURACE DIRECTOR 2.00 X 0 0 0 BASIL ARIGLIO CEO 55.00 X 326818 0 14305 NICHOLAS MAYHEW CFO 55.00 X 216128 0 16367 LEE SALTZGABER MD CMO 55.00 X 264723 0 14205 BRUCE PETERSON AVP/CIO 55.00 X 155212 0 14027 SCOTT BURNS DIRECTOR PHARMACY 55.00 X 130351 0 13987 DURINDA DURR VP/CNO 55.00 X 129809 0 10650 MARK ROWAN DIRECTOR TECHNICAL SERVICES 55.00 X 127693 0 8342 DAVID LEE PHARMACIST 55.00 X 125302 0 10643 1476036 0 102526 27 0 1 0 CENTREX LABS 28 CAMPION RD NEW HARTFORD NY 13413 LAB SERVICES 4091026 MCKESSON PO BOX 98347 CHICAGO IL 606938347 HEALTHCARE INFORMATION TECHNOLOGY 1672275 NY ACUTE CARE SPECIALISTS PO BOX 634850 CINCINNATI OH 45263 HOSPITALIST SERVICES 1294021 EAGLE HOSPITAL PHYSICIANS LLC 16000 NORTH DALLAS PARKWAY SUITE 4 DALLAS TX 75248 HOSPITALIST SERVICES 385000 ROBISON & SMITH COMPLETE TEXTILE 335 NORTH MAIN STREET GLOVERSVILLE NY 12078 LAUNDRY SERVICES 365909 25 1810100 263122 116922 2073222 HOSPITAL 621990 79290733 79290733 79290733 62042 62042 114570 147393 -32823 -32823 -32823 1015998 3714 846055 80300 169943 -76586 93357 93357 CAFETERIA SALES 722210 253931 253931 ACCOUNTING & CONSULTING 541200 190000 190000 GAIN LOSS CHANGE ANGEL FUND 900099 7196 7196 208448 57849 150599 659575 82146106 79290733 247849 534302 852547 852547 37597890 32522982 5074908 659719 564966 94753 6357785 6334264 23521 2911530 2465292 446238 28188 28188 55619 55619 90000 90000 250084 116666 133418 1180971 20206 1160765 1033786 838449 195337 92571 62259 30312 55966 9375 46591 563228 563228 4870061 2882033 1988028 897359 101192 796167 PURCHASE SERVICES 7765601 7273834 491767 BAD DEBT EXPENSE 5929420 5929420 SUPPLIES 5754634 5590531 164103 PHARMACY 2477556 2477393 163 8459063 3959818 4499245 87883578 71148680 16734898 0 3384532 1433942 2874389 14656436 11351689 1706342 1750436 1954263 1698749 1421058 2179347 82978500 47734450 37647200 35244050 2720708 4266855 4554607 67911075 60933528 13752691 11637910 17015223 14951207 5855000 5475000 6574210 9738763 43197124 41802880 X 23835179 18725044 292831 269663 585941 585941 24713951 19130648 67911075 60933528 X -5737472 151636 2533 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 26508 0 0 26508 0 PART II-B, LINE 1: $26,508 REPRESENTS THE PORTION OF THE 2013 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. 953476 -2031 26187 925258 643953 314851 5328 953476 624541 1890 33673 16151 643953 591605 4471 28465 624541 338312 120609 132684 591605 0.29000 0.63000 0.08000 0 0 43239849 18856482 24383367 2482556 2232709 249847 34053753 24610812 9442941 3202342 2034447 1167895 35244050 NET ASSETS OF FOUNDATION 994180 OTHER LONG TERM ASSETS 3473158 BOND AMORTIZATION 87269 4554607 LINE OF CREDIT 2000000 ASSET RETIREMENT 4559224 ADVANCE FROM THIRD PARTIES 3179539 9738763 X 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, 2013 AND 2012, 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 2010 THROUGH 2013. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. 1 1 1 X 1 X 0 0 1 1 998231 604169 394062 0.00480 22670610 20406184 2264426 0.02760 365461 235799 129662 0.00160 24034302 21246152 2788150 0.03400 130836 12083 118753 0.00140 27116 19396 7720 0.00090 157952 31479 126473 0.00230 24192254 21277631 2914623 0.03630 5921 410 5511 0.00010 4895 0 4895 0.00010 232084 0 232084 0.00260 242900 410 242490 0.00280 0 1863400 183655 18952461 27013441 -8060980 X 1 0 1 GRIFFIS EYE CENTER LLC SEE SCHEDULE R PART VII 0.30000 0.00000 0.70000 1 1 ROME MEMORIAL HOSPITAL 1500 NORTH JAMES STREET ROME NY 13440 X X X ROME MEMORIAL HOSPITAL 1 1 X X X X X X X X 13 1 1 1 X WWW.ROMEHOSPITAL.ORG X WWW.OCGOV.NET X X X X X X X X X 0 0 1 1 100.000000000000 1 300.000000000000 1 X X 1 1 X X 0 0 X X X X 1 X 0 0 ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: 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 AREAS 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. NOVEMBER 2013, ITS MEDICAL/SURGICAL UNIT CELEBRATED THREE YEARS WITHOUT A CATHETER ASSOCIATED URINARY TRACT INFECTION.-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 PART V, SECTION B, LINE 4: HOSPITAL CHNA PARTICIPANTS INCLUDE ROME MEMORIAL HOSPITAL, FAXTON-ST. LUKE'S HEALTHCARE AND ST. ELIZABETH'S MEDICAL CENTER. ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 7: THE MAJOR BARRIERS TO ADDRESSING ALL OF THE COMMUNITY'S HEALTHCARE NEEDS INCLUDE:-LIMITED FINANCIAL RESOURCES.-CHALLANGES WITH IMPACTING INDIVIDUAL LIFESTYLE BEHAVIORS.-SHORTAGE OF PRIMARY AND SPECIALITY PROVIDERS. ROME MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: INDIVIDUALS WILL RECEIVE 50% DISCOUNT WITHOUT INSURANCE. IF APPROVED AND FAP-ELIGIBLE THE DISCOUNT WILL BE BASED ON BLUE CROSS RATES. 14 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 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 $5,929,420 (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.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 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:2013 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 2013, ROME MEMORIAL HOSPITAL'S BAD DEBT AND CHARITY CARE TOTALED $8.7 MILLION, COMPARED TO 8.9 MILLION IN 2012. 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 27,787 IN 2013. 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. ROME MEMORIAL HOSPITAL CONDUCTED COMMUNITY OUTREACH SESSIONS IN 2012 AND 2013 WITH VARIOUS CONSTITUENCIES TO BETTER UNDERSTAND THE PERCEIVED GAPS IN THE COMMUNITY. PROVIDER SHORTAGE, ESPECIALLY IN PRIMARY CARE, WAS SEEN AS A BARRIER TO IMPROVING THE COMMUNITY'S HEALTH STATUS. A SURVEY OF LOCAL PHYSICIANS CONFIRMED THAT A SIGNIFICANT PERCENTAGE OF PRIMARY CARE PHYSICIANS ARE NOT ACCEPTING NEW PATIENTS BECAUSE THEIR PATIENT PANELS ARE AT CAPACITY. IT'S THIS PROCESS THAT RESULTED IN COMMUNITY EDUCATION TO HIGHLIGHT THE DANGERS OF SYNTHETIC DRUGS AND THE RE-EMERGENCE OF HEROIN AS A DRUG OF CHOICE AND THE REQUEST TO ADD AN ADDITIONAL INPATIENT PSYCHIATRIC BED TO THE HOSPITAL'S LICENSE. 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:THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE CITY OF ROME AND THE SURROUNDING RURAL TOWNS OF CAMDEN, BOONVILLE, ANNSVILLE, FLORENCE, VIENNA, LEE, AVA, WESTERN AND FLOYD. THE POPULATION OF THE PRIMARY MARKET IS APPROXIMATELY 67,000 PEOPLE. FOR SELECTED SPECIALTIES, SUCH AS SENIOR BEHAVIORIAL HEALTH CARE, THE HOSPITAL'S SERVICE ARE EXTENDS INTO THE SURROUNDING COUNTIES OF MADISON, HERKIMER, LEWIS AND ONONDAGA COUNTIES. 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.AT $48,382, THE MEDIAN HOUSEHOLD INCOME IN ONEIDA COUNTY IS LESS THAN NEW YORK STATE'S AT $56,951. THE PERCENT OF POPULATION BELOW THE POVERTY LINE WAS 15.1% BASED ON THE CENSUS BUREAU'S AMERICAN COMMUNITY SURVEY 2007-2011, HIGHER THAN THE RATE OF 14.5% FOR THE STATE. THERE IS AN EDUCATIONAL ATTAINMENT GAP IN ONEIDA COUNTY WITH ONLY 21.9% OF RESIDENTS AGE 25+ EARNING A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 32.5% IN NEW YORK STATE. NEARLY 60% OF ONEIDA COUNTY RESIDENTS AGE 16 AND OLDER ARE PART OF THE LABOR FORCE, THOUGH 4.3% ARE UNEMPLOYED.THE ROME 13440 ZIP CODE DEMOGRAPHICS GENERALLY MIRROR THE COUNTY'S NUMBERS. THE POPULATION OF ROME 13440 IS 42,986, WITH 48.9% FEMALE; 21% OF THE POPULATION IS UNDER AGE 18; AND 16.7% ARE 65 AND OLDER. THE POPULATION IS 89.5% WHITE, 5.7% AFRICAN AMERICAN AND 1% ASIAN; 4.4% INDENTIFYING THEMSELVES AS HISPANIC OR LATINO.AT $49,553, THE MEDIAN HOUSEHOLD INCOME IN ROME IS LESS THAN NEW YORK STATE. THE PERCENT OF POPULATION BELOW THE POVERTY LINE WAS 12.6%. THE EDUCATIONAL ATTAINMENT GAP IS EVEN GREATER FOR THE ROME POPULATION WITH ONLY 18.9% OF RESIDENTS AGE 25+ EARNING A BACHELOR'S DEGREE OR HIGHER. ABOUT 56% OF RESIDENTS AGE 16 AND OLDER ARE PART OF THE LABOR FORCE, WITH 4.7% UNEMPLOYED.ACCORDING TO COUNTYHEALTHRANKINGS.ORG, ONEIDA COUNTY MEASURES UP POORLY IN TERMS OF MORBIDITY (RANK #53 OUT OF 62 NYS COUNTIES), INCLUDING MENTAL HEALTH AND VARIOUS SOCIOECONOMIC FACTORS (#43 OUT OF 62 COUNTIES). AT THE SAME TIME, IT FARES BETTER THAN MOST COUNTIES REGARDING OVERALL CLINICAL CARE (#16), PARTICULARLY WITH RESPECT TO INSURANCE COVERAGE (DESPITE RELATIVELY FEWER PROVIDERS) AND PHYSICAL ENVIRONMENT (#17). RATES OF ADULT SMOKING, ADULT OBSEITY, PHYSICAL INACTIVITY AND TEEN BIRTH RATE ARE ALL HIGHER THAN THE STATE AND THE NATIONAL BENCHMARK. THE OVERALL RANK OF 50 REFLECTS YEARS OF POTENTIAL LIFE LOST (YPLL) BEFORE AGE 75 PER 100,000 POPULATION, A MEASURE OF PREMATURE MORTALITY.THE PERCENTAGE OF ADULTS WITH HEALTH INSURANCE BETWEEN THE AGES OF 18 AND 64 YEARS OLD IN ONEIDA COUNTY IS 87.4, COMPARED TO THE STATE AVERAGE OF 83.1.AT ROME MEMORIAL HOSPITAL, 34.1% OF PATIENTS ARE UNINSURED OR ON A MEDICAID PROGRAM. 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 X 1 1 X X X X 0 0 0 0 0 0 0 0 0 BASIL ARIGLIO CEO 298047 0 27766 0 1005 0 0 0 14305 0 341123 0 0 0 NICHOLAS MAYHEW CFO 191822 0 9075 0 15231 0 0 0 16367 0 232495 0 0 0 LEE SALTZGABER MD CMO 264648 0 75 0 0 0 0 0 14205 0 278928 0 0 0 BRUCE PETERSON AVP/CIO 147173 0 7725 0 314 0 0 0 14027 0 169239 0 0 0 PART I, LINE 1A TYPE OF BENEFIT: PAYMENT OF 2013 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 2013 FOR PERSON LISTED ABOVE. A ONEIDA COUNTY INDUSTRIAL DEVELOPMENT AGENCY 166158201 6824621LE 2005-06-16 11900000 FINANCE CONSTRUCTION 0 1 0 B ONEIDA COUNTY LOCAL DEVELOPMENT CORPORATION 273190422 2010-12-30 6900000 FINANCE MRI CONSTRUCTION 0 1 0 C DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 2011-10-27 7500000 FINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT 0 1 0 D DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 2007-09-21 1858108 FINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT- CAT SCANN 0 1 0 A 11900000 509090 2006 0 0 1 1 B 6900000 44569 222845 5999546 2009 0 0 1 1 C 7500000 25490 58827 2011 0 0 1 1 D 1858108 2007 0 0 1 1 A 0 0 1 1 0 1 0 0 B 0 0 0 0 1 0 0 C 0 0 1 1 0 1 0 0 D 0 0 1 1 0 1 0 0 A 0 0 0 0 1 1 MANUFACTURERS AND TRUST 5.000000000000 0 1 0 0 0 B 0 0 0 0 1 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 SCHEDULE K SUPPLENTAL INFORMATION THE CAPITAL LEASE AGREEMENTS ARE ALL TELP (TAX EXEMPT LEASE - PURCHASE (FINANCING)) LEASES THROUGH THE COUNTY OR STATE. A DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 2009-12-01 1935034 FINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT - MRI EQUIPMENT 0 1 0 A 1935034 15338 2009 0 0 1 1 A 0 0 1 1 0 1 0 0 A 0 0 0 0 0 0 0 0 0 A 0 MARY ANN JONES SISTER OF KEY EMPLOYEE 26216 COMPENSATION 0 SCOTT A GWILT SON IN LAW OF BOARD DIRECTOR 39661 COMPENSATION 0 X 2 NORTH RENOV 5 99989 ACTUAL INVOICE COST X MEDICAL EQUIP 2 16933 ACTUAL INVOICE COST 0 1 0 FORM 990, PART III, LINE 2 IN 2013 ROME MEMORIAL HOSPITAL ENGAGED IN THE FOLLOWING THREE SIGNIFICANT PROGRAM CHANGES: 1. IN APRIL 2013, ROME MEMORIAL HOSPITAL ESTABLISHED DELTA MEDICAL CENTER TO ENHANCE PRIMARY CARE ACCESS FOR AREA RESIDENTS FOLLOWING THE LOSS OF SEVERAL WELL-RESPECTED PHYSICIANS IN THE COMMUNITY DUE TO DEATH, RETIREMENT OR RELOCATION. DELTA MEDICAL IS LOCATED IN ROME, NEW YORK, WHICH IS IN HPSA 136999363J, MEDICAID ELIGIBLE-ROME PRIMARY CARE 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. 2. IN APRIL 2013, ROME MEMORIAL HOSPITAL ESTABLISHED THE WOUND CARE CENTER TO SERVE THE HIGH-RISK DIABETIC AND LONG-TERM CARE POPULATIONS IN THE COMMUNITY, WHO OFTEN FIND IT DIFFICULT TO TRAVEL OUT OF TOWN FOR TREATMENTS THAT REQUIRE MULTIPLE VISITS. ALTHOUGH THE PREVELANCE OF DIABETES IN ONEIDA COUNTY IS SIMILAR TO THE STATE AVERAGE, DIABETICS IN THE REGION WERE IDENTIFIED AS A POPULATION WITH AN ELEVATED RATE OF PREVENTABLE HOSPITAL ADMISSIONS. THE CENTER PROVIDES COMPREHENSIVE WOUND CARE SERVICES, HYPERBARIC OXYGEN TREATMENT, FOR HARD TO HEAL WOUNDS. 3. IN OCTOBER 2013, ROME MEMORIAL HOSPITAL ESTABLISHED THE LOW-DOSE CT LUNG CANCER SCREENING PROGRAM FOR ELIGIBLE HIGH RISK SMOKERS AND FORMER SMOKERS WHO MEET GUIDELINES AS RECOMMENDED BY THE NATIONAL COMPREHENSIVE CANCER NETWORK (NCCN). APPROXIMATELY 25% OF ONEIDA COUNTY RESIDENTS OVER THE AGE OF 18 USE TOBACCO, WHICH IS THE LEADING CAUSE OF LUNG CANCER. THE FIVE YEAR SURVIVAL RATE FOR LUNG CANCER IS ONLY 15.9% BECAUSE LUNG CANCER IS TYPICALLY DETECTED IN THE LATER STAGES OF THE DISEASE. SCREENING FOR LUNG CANCER BEFORE SYMPTOMS APPEAR INCREASES THE CHANCE OF BEING DIAGNOSED AT EARLY STAGES WHEN CANCER CAN BE MORE SUCCESSFULLY TREATED AND EVEN CURED. 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 2013 990 WAS PRESENTED TO THE BOARD BY THE CFO OF THE HOSPITAL AT ITS OCTOBER 2014 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 28,720. CHANGE IN NET ASSETS -26,187. 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 COMMITTE 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. 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 GRA 0 GRIFFIS EYE CENTER LLC 105 DART CIRCLE ROME NY 13441 263738675 SEE SCHEDULE R, PART VII NY INVESTMENT 111816 80528 0 0 0.30000 RMH SERVICES INC 1500 N JAMES STREET ROME NY 13440 161490045 FOR PROFIT NY GREATER ROME AFFILIATES C 155240 2559741 1.00000 0 ROME MEDICAL GROUP 1801 BLACK RIVER BLVD ROME NY 13440 161464822 CAPTIVE P.C. NY ROME MEMORIAL HOSPITAL C 0 ROME MEDICAL PRACTICE 1500 N JAMES STREET ROME NY 13440 203827393 CAPTIVE P.C. NY ROME MEMORIAL HOSPITAL C 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 0 1 SCHEDULE R, PART III COLUMN (B) GRIFFIS EYE CENTER, LLC. PRIMARY ACTIVITY: SINGLE SPECIALTY AMBULATORY SURGERY CENTER SPECIALIZING IN AND PROVIDING ONLY OPTHAMOLOGY SERVICES.