ROME MEMORIAL HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ROME MEMORIAL HOSPITAL INC (EIN 16-1471634)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-10
IRS object ID
201243159349300509
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-10T12:21:38-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN161226221EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1FUST CHARLES CHAMBERS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15784 WIDEWATERS PARKWAYAddressLine1
CitySYRACUSECity
StateNYState
ZIP Code13214ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN161471634EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ROME MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlROMENameControl

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 NORTH JAMES STREETAddressLine1
CityROMECity
StateNYState
ZIP Code13440ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameNICHOLAS MAYHEWName
TitleCFOTitle
Phone3153387000Phone
Date Signed2012-11-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameANGELA M FRANCOName
PTINP00589741PTIN
Phone3154463600Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBASIL ARIGLIONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11500 NORTH JAMES STAddressLine1
CityROMECity
StateNYState
ZIP Code13440ZIPCode
FieldValueIRS element (for citing)
Gross Receipts90638142GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteROMEHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionPROVIDE QUALITY HEALTHCARE WITH COMPASSION.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees1211TotalNbrEmployees
Total Nbr Volunteers145TotalNbrVolunteers
Total Gross UBI248782TotalGrossUBI
Net Unrelated Business Txbl Income-8843NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year432566ContributionsGrantsPriorYear
Contributions Grants Current Year671957ContributionsGrantsCurrentYear
Program Service Revenue Prior Year84821455ProgramServiceRevenuePriorYear
Program Service Revenue CY87265361ProgramServiceRevenueCY
Investment Income Prior Year142569InvestmentIncomePriorYear
Investment Income Current Year169516InvestmentIncomeCurrentYear
Other Revenue Prior Year1034217OtherRevenuePriorYear
Other Revenue Current Year853414OtherRevenueCurrentYear
Total Revenue Prior Year86430807TotalRevenuePriorYear
Total Revenue Current Year88960248TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year48494172SalariesEtcPriorYear
Salaries Etc Current Year50792045SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year37880995OtherExpensePriorYear
Other Expenses Current Year38547911OtherExpensesCurrentYear
Total Expenses Prior Year86375167TotalExpensesPriorYear
Total Expenses Current Year89339956TotalExpensesCurrentYear
Revenues Less Expenses Prior Year55640RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-379708RevenuesLessExpensesCY
Total Assets BOY61433977TotalAssetsBOY
Total Assets EOY68210140TotalAssetsEOY
Total Liabilities BOY37037193TotalLiabilitiesBOY
Total Liabilities EOY44543290TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY24396784NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY23666850NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionABOUT 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change1SignificantChange
Expense34396392Expense
Revenue33482625Revenue
DescriptionINPATIENT CARE SERVICES, INPATIENT NURSING UNITS CONSIST OF THE FOLLOWING:ACUTE PHYSICAL REHABILITATION-4TH FLOOR,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.2011 INPATIENT DISCHARGES: 4,9302011 BIRTHS: 6332011 PATIENT DAYS: 22,237Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense10656077Expense
Revenue8008610Revenue
DescriptionRESIDENTIAL 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 HOMECARE, SHORT-TERM SUB-ACUTE REHABILITATION, AND RESPITE CARE- ALL LOCATED ON THE 3RD FLOOR.2011 PATIENT DAYS = 26,3532011 OCCUPANCY PERCENTAGE = 90.25%Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense6709012Expense
Revenue9555077Revenue
DescriptionEMERGENCY DEPARTMENT (ED)ROME MEMORIAL HOSPITAL EMERGENCY DEPARTMENT IS A SAFETY NET FOR THE MOST VULNERABLE POPULATIONS IN THE COMMUNITY. IN 2011, APPROXIMATELY 45% OF THE PATIENTS TREATED WERE LISTED AS UNINSURED OR UNDER INSURED. FOR LOWER LEVEL EMERGENCY DEPARTMENT VISITS, THIS POPULATION REPRESENTED MORE THAN 61% OF THE VISITS BECAUSE MANY PRIMARY CARE PHYSICIANS DO NOT ACCEPT MEDICAID.2011 ED ADMISSIONS: 3,0222011 ED VISITS: 25,918Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense23652349Expense
Revenue36219049Revenue
DescriptionALL OTHER ACHIEVEMENTS PROVIDE QUALITY, COMPASSIONATE CARE IN A SAFE ENVIRONMENT TO SERVE THE HEALTHCARE NEEDS OF THE PEOPLE OF ROME AND THE SURROUNDING COMMUNITIES.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp23652349TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev36219049TotalOfOtherProgramServiceRev
Total Program Service Expense75413830TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109641NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1211NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1NICHOLAS MAYHEW CFO ROME MEMORIALBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3153387024TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11500 NORTH JAMES STREETAddressLine1
CityROMECity
StateNYState
ZIP Code13440ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
CHESTER PATRICK MD
CHAIRMAN2.00XX000
DAVID NOLAN
VICE CHAIRMAN2.00XX000
KIM COOK
TREASURER2.00XX000
LYNN REESE
SECRETARY2.00XX000
W ROBERT HERMANN
DIRECTOR2.00X000
MARY DAVIS
DIRECTOR2.00X000
DR ANKUR DESAI
DIRECTOR2.00X000
SALLY HINMAN
DIRECTOR2.00X000
JULIE GROW-DENTON
DIRECTOR2.00X000
MICHAEL KRAMER
DIRECTOR2.00X000
BASIL ARIGLIO
CEO55.00X252542014017
WALEED ALBERT MD
CMO55.00279408014061X
RAYMOND CARNEVALE
COO55.0018562106781X
NICHOLAS MAYHEW
CFO55.00234796013988X
MARK SNYDERMAN
VP55.00141126010645X
SCOTT BURNS
PHARMACY DIRECTOR55.00133835011697X
DURINDA DURR
VP/CNO55.00128658010624X
DAVID LEE
PHARMACIST55.00125734010416X
BRUCE PETERSON
AVP/CIO55.00147224013847X
DARLENE BURNS
FORMER CEO55.0022580106768X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1854745TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation112844TotalOtherCompensation
Number Individuals GT100 K24NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CENTREX LABS
28 CAMPION RDNEW HARTFORDNY13413LAB SERVICES3401925
CHARTIS
PO BOX 10472NEWARKNJ07193WORKERS COMPENSATION687102
HUEBER BREUER
PO BOX 515SYRACUSENY13205ARCHITECT438579
MCKESSON
PO BOX 98347CHICAGOIL606938347HEALTHCARE INFORMATION TECHNOLOGY366635
ROME EMERGENCY SERVICES
484 TEMPLE HILL ROADNEW WINDSORNY12553ER SERVICES302895
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
Government Grants46500GovernmentGrants
All Other Contributions625457AllOtherContributions
Noncash Contributions301911NoncashContributions
Total Contributions671957TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionHOSPITALDescription
Business Code621990BusinessCode
Total Revenue Column87265361TotalRevenueColumn
Related Or Exempt Function Income87265361RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue87265361TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column52966TotalRevenueColumn
Exclusion$52,966ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real108741Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real135540Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-26799Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-26799TotalRevenueColumn
Exclusion-$26,799ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1658899Securities
Other5Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1479830Securities
Other62524Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities179069Securities
Other-62519Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column116550TotalRevenueColumn
Exclusion$116,550ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenueRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CAFETERIA SALES722210281077$281,077
ACCOUNTING & CONSULTIN541200180000180000
GAIN CHANGE ANGEL FUND9000995872$5,87200

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column413264TotalRevenueColumn
Unrelated Business Revenue68782UnrelatedBusinessRevenue
Exclusion$344,482ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue880213TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column88960248TotalRevenueColumn
Related Or Exempt Function Income87265361RelatedOrExemptFunctionIncome
Unrelated Business Revenue248782UnrelatedBusinessRevenue
Exclusion$774,148ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1001214Total
Management And General1001214ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total38906635Total
Program Services33002660ProgramServices
Management And General5903975ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1691485Total
Program Services1447783ProgramServices
Management And General243702ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6280009Total
Program Services6274068ProgramServices
Management And General5941ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2912702Total
Program Services2470707ProgramServices
Management And General441995ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total101255Total
Management And General101255ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total74292Total
Management And General74292ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total35421Total
Management And General35421ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total495585Total
Program Services185725ProgramServices
Management And General309860ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total803322Total
Program Services147154ProgramServices
Management And General656168ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total841558Total
Program Services666336ProgramServices
Management And General175222ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total100638Total
Program Services60559ProgramServices
Management And General40079ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total80400Total
Program Services35705ProgramServices
Management And General44695ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total637305Total
Program Services627488ProgramServices
Management And General9817ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4424071Total
Program Services3572779ProgramServices
Management And General851292ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total751762Total
Program Services91933ProgramServices
Management And General659829ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASE SERVICES73880656855487532578
BAD DEBT EXPENSE651906765190670
SUPPLIES5948926590950639420
PHARMACY29956262995626

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total7350618Total
Program Services4551247ProgramServices
Management And General2799371ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total89339956Total
Program Services75413830ProgramServices
Management And General13926126ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3031569BOY
EOY2912737EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2274926BOY
EOY3721436EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY11374729BOY
EOY14528649EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1388348BOY
EOY1685833EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1959094BOY
EOY2152446EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY806060BOY
EOY959969EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis83104387LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec43589530LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY38959245BOY
EOY39514857EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1640006BOY
EOY2734213EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY61433977BOY
EOY68210140EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY11529039BOY
EOY12560830EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY13736568BOY
EOY19697813EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY6575000BOY
EOY6215000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5196586BOY
EOY6069647EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY37037193BOY
EOY44543290EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY23772243BOY
EOY23078501EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY40494BOY
EOY2408EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY584051BOY
EOY585941EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY24396784BOY
EOY23666850EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY61433977BOY
EOY68210140EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-379708ReconcilationRevenueExpenses
Reconcilation Other Changes-350226ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$28,364DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB28364TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
Explanation$28,364 REPRESENTS THE PORTION OF THE 2011 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.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance624541BeginningOfYearBalance
Contributions1890Contributions
Investment Earnings Or Losses33673InvestmentEarningsOrLosses
Other Expenditures16151OtherExpenditures
End Of Year Balance643953EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance591605BeginningOfYearBalance
Contributions4471Contributions
Investment Earnings Or Losses28465InvestmentEarningsOrLosses
End Of Year Balance624541EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance338312BeginningOfYearBalance
Contributions120609Contributions
Investment Earnings Or Losses132684InvestmentEarningsOrLosses
End Of Year Balance591605EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance33374BeginningOfYearBalance
Contributions304938Contributions
End Of Year Balance338312EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.09000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.91000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis43031500OtherCostOrOtherBasis
Depreciation16468073Depreciation
Book Value26563427BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2204068OtherCostOrOtherBasis
Depreciation2117280Depreciation
Book Value86788BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis34839102OtherCostOrOtherBasis
Depreciation23063996Depreciation
Book Value11775107BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3029717OtherCostOrOtherBasis
Depreciation1940181Depreciation
Book Value1089535BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings39514857TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
LINE OF CREDIT$1,500,000
ASSET RETIREMENT$2,940,938
ADVANCE FROM THIRD PARTIES$570,000
THIRD PARTY PAYABLES$1,058,709
FieldValueIRS element (for citing)
Total Of Amounts6069647TotalOfAmounts
Total Revenue88960248TotalRevenue
Total Expenses89339956TotalExpenses
Excess Or Deficit For Year-379708ExcessOrDeficitForYear
Net Unrealized GL On Investments-189769NetUnrealizedGLOnInvestments
Other-$160,457OtherAmount
Total Adjustments-350226TotalAdjustments
Excess Or Deficit Per FS-729934ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt99519872TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments189769NetUnrealizedGainsInvestments
Other Revenues10405276OtherRevenues
Revenue Not Rptd F99010595045RevenueNotRptdF990
Revenue Subtotal88924827RevenueSubtotal
Other Revenues Not Included35421OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt35421RevenueNotRptdOnFinStmt
Total Revenue Per Form99088960248TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt99981853TotExpensesEtcAuditedFinclStmt
Other Expenses Included10677318OtherExpensesIncluded
Expenses Not Rptd F99010677318ExpensesNotRptdF990
Expenses Subtotal89304535ExpensesSubtotal
Other Expenses Not Included35421OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt35421ExpensesNotRptdOnFinStmt
Total Expenses Per Form99089339956TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: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.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE STANDARDS FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ESTABLISH A RECOGNITION THRESHOLD AND MEASUREMENT FOR INCOME TAX POSITIONS RECOGNIZED IN THE HOSPITAL'S CONSOLIDATED FINANCIAL STATEMENTS. THESE STANDARDS HAD NO IMPACT ON THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AS OF DECEMBER 31, 2011 AND 2010, 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 2008 THROUGH 2011. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS.
PART XI, LINE 8 - OTHER ADJUSTMENTS:TOTAL CHANGE IN INTEREST IN FOUNDATION -160,457.
PART XII, LINE 2D - REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER AFFILIATE INCOME - CONSOLIDATED FINANCIAL STATEMENTS $10,405,276 PART XII, LINE 4B - EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER INVESTMENT EXPENSES - CONSOLIDATED FINANCIAL STATEMENTS $35,421 PART XIII, LINE 2D - EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER AFFILIATE EXPENSES-CONSOLIDATED FINANCIAL STATEMENTS $10,677,318 PART XIII, LINE 4B - EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER INVESTMENT EXPENSES - CONSOLIDATED FINANCIAL STATEMENTS $35,421

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care0AmountsBudgetedForCharityCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense947665TotalCommunityBenefitExpense
Direct Offsetting Revenue450713DirectOffsettingRevenue
Net Community Benefit Expense496952NetCommunityBenefitExpense
Percent Of Total Expense0.00600PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense20242657TotalCommunityBenefitExpense
Direct Offsetting Revenue19607917DirectOffsettingRevenue
Net Community Benefit Expense634740NetCommunityBenefitExpense
Percent Of Total Expense0.00770PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense621606TotalCommunityBenefitExpense
Direct Offsetting Revenue439259DirectOffsettingRevenue
Net Community Benefit Expense182347NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense21811928TotalCommunityBenefitExpense
Direct Offsetting Revenue20497889DirectOffsettingRevenue
Net Community Benefit Expense1314039NetCommunityBenefitExpense
Percent Of Total Expense0.01590PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense78110TotalCommunityBenefitExpense
Direct Offsetting Revenue11356DirectOffsettingRevenue
Net Community Benefit Expense66754NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense28638TotalCommunityBenefitExpense
Direct Offsetting Revenue25936DirectOffsettingRevenue
Net Community Benefit Expense2702NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense106748TotalCommunityBenefitExpense
Direct Offsetting Revenue37292DirectOffsettingRevenue
Net Community Benefit Expense69456NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense21918676TotalCommunityBenefitExpense
Direct Offsetting Revenue20535181DirectOffsettingRevenue
Net Community Benefit Expense1383495NetCommunityBenefitExpense
Percent Of Total Expense0.01660PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense2200TotalCommunityBuildingExpense
Net Community Building Expense2200NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense2127TotalCommunityBuildingExpense
Direct Offsetting Revenue440DirectOffsettingRevenue
Net Community Building Expense1687NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense5179TotalCommunityBuildingExpense
Net Community Building Expense5179NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense287033TotalCommunityBuildingExpense
Net Community Building Expense287033NetCommunityBuildingExpense
Percent Of Total Expense0.00320PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense296539TotalCommunityBuildingExpense
Direct Offsetting Revenue440DirectOffsettingRevenue
Net Community Building Expense296099NetCommunityBuildingExpense
Percent Of Total Expense0.00330PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$2,213,100BadDebtExpenseAmount
Amount Attributable To328899AmountAttributableTo
Amount Reimbursed By Medicare21104225AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare27604175CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-6499950MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 GRIFFIS EYE CENTER LLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivitySEE SCHEDULE R PART VIIDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.30000OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.00000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.70000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ROME MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11500 NORTH JAMES STREETAddressLine1
CityROMECity
StateNYState
ZIP Code13440ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ROME MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
OtherXOther
Needs Assessment Conducted09NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities1OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed0AllNeedsAddressed
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Insurance StatusXInsuranceStatus
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities13NumberOfOtherFacilities

Other Facilities OtherFacilities (13 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
COMMUNITY RECOVERY CENTER
264 W DOMINICK STREETROMENY13440SUBSTANCE ABUSE COUNSELING
MOHAWK VALLEY RADIATION MEDICINE
107 E CHESTNUT STREETROMENY13440RADIATION ONCOLOGY
PHYSICAL THERAPY
107 E CHESTNUT STREETROMENY13440OFFSITE PHYSICAL THERAPY SERVICES
BOONVILLE FAMILY CARE
13407 STATE ROUTE 12BOONVILLENY13309PRIMARY CARE SERVICES
LABORATORY COLLECTION SITE
1801 BLACK RIVER BLVDROMENY13440OFFSITE LAB COLLECTION SITE
LABORATORY COLLECTION SITE
1617 N JAMES STREETROMENY13440OFFSITE LAB COLLECTION SITE
LABORATORY COLLECTION SITE
13407 STATE ROUTE 12BOONVILLENY13309OFFSITE LAB COLLECTION SITE
LABORATORY COLLECTION SITE
BEECHES OFFICE COMPLEX-TURIN RDROMENY13440OFFSITE LAB COLLECTION SITE
MEDICAL IMAGING
1617 N JAMES STREETROMENY13440OFFSITE RADIOLOGY SERVICES
MEDICAL IMAGING
1801 BLACK RIVER BLVDROMENY13440OFFSITE RADIOLOGY SERVICES
MEDICAL IMAGING
107 E CHESTNUT STREETROMENY13440OFFSITE RADIOLOGY SERVICES
MEDICAL IMAGING
1819 BLACK RIVER BLVDROMENY13440OFFSITE RADIOLOGY SERVICES
PRENATAL CARE CENTER
155 WEST DOMINICK STREETROMENY13440OFFSITE PRENATAL CARE SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 6A: ROME MEMORIAL HOSPITAL'S SECOND UPDATE OF ITS 2009-2012 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 2010-2013 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 CLACULATED 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, L7 COL(F): PERCENT OF TOTAL EXPENSE IS CALCULATED BY USING THE DENOMINATOR OF THE TOTAL FUNCTIONAL EXPENSES LESS BAD DEBT EXPENSE OF $6,519,067 (PER AUDITED FINANCIAL STATEMENTS).
PART II: PART I 7E,7F,7J: ROME MEMORIAL HOSPITAL HAS MAINTAINED A LONG-STANDING COMMITMENT TO WELLNESS AND PREVENTION THROUGH AN ACTIVE EDUCATION DEPARTMENT THAT PROVIDES ONGOING HEALTH EDUCATION LECTURES AND FREE SCREENINGS. IN ADDITION, THE HOSPITAL ASSURES ACCESS TO SERVICES BY CONTINUING TO PROVIDE CRITICAL SERVICES TO THE COMMUNITY, EVEN THOUGH THEY ARE OPERATED AT A LOSS TO THE HOSPITAL. THESE ARE SOME OF THE HOSPITAL'S PROGRAMS THAT SUPPORT THE STATE'S PREVENTION AGENDA AND PROMOTE HEALTH IN OUR COMMUNITY: HEALTHY MOTHERS, HEALTHY BABIES, HEALTHY CHILDREN THE MATERNITY DEPARTMENT'S WEIGH STATION PROVIDES MOTHERS WHO ARE BREASTFEEDING ADDED SUPPORT AND ENSURE THAT BABIES ARE GAINING WEIGHT AT A HEALTHY LEVEL. BABYCARE BASICS AND BREASTFEEDING EDUCATION PROGRAMS FOR NEW PARENTS HELP THEM ACQUIRE THE NECESSARY SKILLS FOR TAKING CARE OF A NEWBORN.CHRONIC DISEASE EDUCATION HEALTH NIGHT, SENIOR LIVE & LEARN, SPEAKER'S BUREAU LECTURES, AND OUTREACH AT HEALTH FAIRS PROVIDE COMMUNITY MEMBERS WITH THE LATEST INFORMATION AVAILABLE TO HELP THEM MODIFY THEIR LIFESTYLES TO PREVENT THE ONSET OF CHRONIC DISEASE OR BETTER MANAGE THEIR CHRONIC CONDITIONS. SMOKING CESSATION CLASSES FOR THE COMMUNITY AND HOSPITAL EMPLOYEES, ALONG WITH SMOKING PREVENTION PROGRAMS FOR AREA SCHOOLS PROVIDES ESSENTIAL OUTREACH TO ERADICATE THE LEADING CAUSE OF PREMATURE DEATH. SPONSORSHIP SUPPORT OF THE AMERICAN CANCER SOCIETY, AMERICAN HEART ASSOCIATION, AMERICAN DIABETES ASSOCIATION AND OTHER HEALTH-RELATED ORGANIZATIONS TO PROVIDE FINANCIAL RESOURCES FOR EDUCATION AND RESEARCH.ACCESS TO QUALITY HEALTHCARE FREE ROUTINE SCREENINGS, INCLUDING BLOOD PRESSURE, PSAS, COLORECTAL CANCER AND DIABETES SCREENING, ARE OFFERED TO THE COMMUNITY TO PROMOTE EARLY DETECTION OF DISEASE. FACILITATED ENROLLMENT EFFORTS HELP LINK THE UNINSURED TO AVAILABLE INSURANCE OPTIONS TO ENABLE THEM TO ESTABLISH A RELATIONSHIP WITH A PRIMARY CARE PROVIDER. IMMUNIZATION CLINICS ARE OFFERED IN THE COMMUNITY TO PROTECT RESIDENTS FROM THE FLU. EFFORTS TO RECRUIT ADDITIONIAL PHYSICIANS TO THE COMMUNITY ADDRESS THE FACT THAT THE MOHAWK VALLEY REGION HAS THE WORST PHYSICIAN TO POPULATION RATIO IN ALL OF NEW YORK STATE. THE NEWLY CONSTRUCTED DIAGNOSTIC CENTER INCLUDED INVESTMENTS IN THE LATEST TECHNOLOGY INCLUDING DIGITAL MAMMOGRAPHY AND A NEW MRI TO ENHANCE THE HOSPITAL'S DIAGNOSTIC CAPABILITIES. THE HOSPITAL ADDED A NURSE NAVIGATOR TO HELP COORDINATE CARE FOR PATIENTS WITH A POTENTIAL CANCER DIAGNOSIS.PHYSICAL FITNESS AND NUTRITION AN INDOOR WALKING PROGRAM HELPS AREA RESIDENTS INCORPORATE PHYSICAL FITNESS INTO THEIR LIVES TO PREVENT CHRONIC DISEASE AND ENHANCE THEIR MENTAL HEALTH.COMMUNITY SUPPORT AND COALITION BUILDING ROME MEMORIAL HOSPITAL'S LEADERS ALSO PARTICIPATE ON NUMEROUS COMMUNITY COMMITTEES INVOLVED IN ENHANCING HEALTH CARE OUTCOMES THROUGH PREVENTION, EARLY DETECTION AND INTERVENTION, AS WELL AS EMERGENCY PREPAREDNESS ACTIVITIES TO ENSURE A COORDINATED RESPONSE IN AN EVENT OF A DISASTER.
PART III, LINE 4: "SIGNIFICANT ESTIMATES MADE BY THE HOSPITAL INCLUDE, BUT ARE NOT LIMITED TO, THE RESERVE FOR UNCOLLECTIBLE ACCOUNTS, RESERVES FOR THIRD-PARTY CONTRACTUAL ADJUSTMENTS AND SETTLEMENTS AND INSURANCE RESERVES. THE CURRENT ECONOMIC ENVIRONMENT HAS INCREASED THE DEGREE OF UNCERTAINITY INHERENT IN THOSE ESTIMATES AND ASSUMPTIONS.""AN ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE IS ESTIMATED BY MANAGEMENT BASED ON PERIODIC REVIEWS OF THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE CONSIDERING HISTORICAL EXPERIENCE AND PREVAILING ECONOMIC CONDITIONS."FROM THE AGED ACCOUNTS RECEIVABLE TRIAL BALANCE, THE PAYOR CLASSES ARE SUMMARIZED INTO FOUR CATEGORIES: COLLECTION, SELF PAY, TIME PLAN AND OTHERS (ALL OTHER INSURANCE BALANCES) BY AGING BUCKET. IN ADDITION:THE ACCOUNTS THAT ARE "COLLECTION" ARE ALL PATIENT ACCOUNTS THAT HAVE BEEN SENT TO A COLLECTION AGENCY. FOR ALL ACCOUNTS THAT ARE CONSIDERED COLLECTION THESE ACCOUNTS ARE RESERVED AT:UNBILLED 150 DAYS - 98.63% LESS THE SURCHARGE PORTION OF THE SELF PAY OF 9.63%.151+ DAYS - 99.73% LESS THE SURCHARGE PORTION OF THE SELF PAY OF 9.63%.ACCOUNTS IN COLLECTION ARE NOW 100% WRITTEN OFF OUR ACCOUNTS RECEIVABLE. WE DO CALCULATE AN APPROXIMATE COLLECTION OF REVENUE FROM ACCOUNTS IN COLLECTION.FOR SELF PAY ACCOUNTS THE FOLLOWING PERCENTAGES ARE USED:UNBILLED - 30%0-30 DAYS - 45%31-60 DAYS - 60%61-90 DAYS - 70%91-120 DAYS - 75%121-150 DAYS - 85%151+ DAYS - 90%FOR TIME PLAN ACCOUNTS THE FOLLOWING PERCENTAGES ARE USED:UNBILLED - 62.38%0-30 DAYS - 62.38%31-60 DAYS - 62.38%61-90 DAYS - 62.38%91-120 DAYS - 62.38%121-150 DAYS - 62.38%151+ DAYS - 62.38%FOR OTHER ACCOUNTS THE FOLLOWING PERCENTAGES ARE USED:UNBILLED - 5%0-30 DAYS - 5%31-60 DAYS - 0%61-90 DAYS - 0%91-120 DAYS - 0%121-150 DAYS - 0%151+ DAYS - 0%THE BAD DEBT RESERVE THAT IS CALCULATED MONTHLY USING THIS ANALYSIS IS COMPARED TO ACTUAL RESERVE AT MONTH END. IF NECESSARY AN ADJUSTMENT WILL BE RECORDED.COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 & 3:RATIO OF PATIENT CARE COST TO CHARGESPART III, LINE 6; COSTING METHODOLOGY AND SOURCE:2011 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 CONTINUES TO RISE AS RESIDENTS LOSE THEIR JOBS OR THEIR ABILITY TO AFFORD THEIR INSURANCE PREMIUMS. IN 2011, ROME MEMORIAL HOSPITAL'S BAD DEBT AND CHARITY CARE TOTALED $8.7 MILLION, COMPARED TO $7.8 MILLION IN 2010. 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 25,918 IN 2011. 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 V, SECTION B, LINE 1J: THE HOSPITAL PARTICIPATES IN THE COMPREHENSIVE COUNTY WIDE COMMUNITY NEEDS ASSESSMENT. THE COUNTY 2010 - 2013 ASSESSMENT IS AVAILABLE ONLINE AT WWW.OCGOV.NET/HEALTH/COMMUNITY.HEALTH.ASSESSMENT. SEE PART VI, LINE 2, RESPONSE BELOW FOR REQUIRED DESCRIPTIONS FOR PART VI, LINE 1 SUB-SECTIONS.ROME MEMORIAL HOSPITAL
PART V, SECTION B, LINE 4: THE HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY THE ONEIDA AND HERKIMER COUNTY HEALTH DEPARTMENTS IN COLLABORATION WITH RMH, FAXTON-ST LUKES HEALTHCARE, ST. ELIZABETH MEDICAL CENTER, AND MULTIPLE COMMUNITY AGENCIES.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 PROVIDERSROME MEMORIAL HOSPITAL
PART V, SECTION B, LINE 19D: INDIVIDUALS WILL RECEIVE 50% DISCOUNT WITHOUT INSURANCE. IF APPROVED AND FAP-ELIGIBLE THE DISCOUNT WILL BE BASED ON BLUE CROSS RATES.ROME MEMORIAL HOSPITAL
PART VI, LINE 2: #2 NEEDS ASSESSMENT:ROME MEMORIAL HOSPITAL PARTICIPATES IN THE ASSESSMENT PROCESS LED BY THE ONEIDA COUNTY HEALTH DEPARTMENT, WHICH USES THE MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) FRAMEWORK TO CONDUCT THE MAJORITY OF ITS COMMUNITY HEALTH ASSESSMENT (CHA) ACTIVITIES. A COMMUNITY HEALTH ASSESSMENT PLANNING TEAM OF APPROXIMATELY 25-30 INDIVIDUALS WAS CONVENED IN JANUARY 2008 THAT CONSISTED OF THE STEERING COMMITTEE MEMBERS OF AN EXISTING COMMUNITY HEALTH PARTNERSHIP, THE ONEIDA COUNTY HEALTH COALITION, AND ADDITIONAL KEY COMMUNITY STAKEHOLDERS. THIS GROUP IS THE MAPP ADVISORY TEAM (MAT). SEVERAL SUB-COMMITTEES WERE CREATED TO ACCOMPLISH THE ASSESSMENT.THE COLLABORATING AGENCIES CONDUCTED PUBLIC VISIONING SESSIONS, HEALTHY CONVERSATION FOCUS GROUPS, AND COMMUNITY SURVEYS TO COLLECT THE PERCEPTIONS OF THOSE WHO ARE UNABLE TO ATTEND ONE OF THE FACE TO FACE SESSIONS. EFFORTS WERE MADE TO INCLUDE INPUT FROM MULTIPLE CONSTINUENCIES, INCLUDING SENIORS, FAMILIES, THE UNDERSERVED, THE BUSINESS COMMUNITY, ETC. THE SURVEY INSTRUMENT AND FOCUS GROUPS WERE PUBLICLY ADVERTISED. THE FEEDBACK FROM SURVEYS AND PUBLIC OUTREACH SESSIONS PROVIDE THE QUALITATIVE INFORMATION TO ENRICH THE STATISTICAL FINDINGS OF THE NEEDS ASSESSMENT TO ADDRESS THE PRIORITY HEALTH NEEDS OF THE COMMUNITY.BASED UPON THIS PROCESS, THE FOLLOWING FIVE ITEMS FROM NEW YORK STATE'S PREVENTION AGENDA WERE IDENTIFIED AS PRIORITIES FOR THE COUNTY:HEALTHY MOTHERS, HEALTHY BABIES, HEALTHY CHILDRENMENTAL HEALTH AND SUBSTANCE ABUSECHRONIC DISEASEACCESS TO QUALITY HEALTHCAREPHYSICAL ACTIVITY AND NUTRITIONTHE FULL 2010-2013 ONEIDA COUNTY COMMUNITY HEALTH ASSESSMENT, ALONG WITH ITS DETAILED DATA BOOK CAN BE FOUND ONLINE AT WWW.OCGOV.NET/HEALTH/COMMUNITY-HEALTH-ASSESSMENT.ROME MEMORIAL HOSPITAL ALSO PARTICIPATES AND COLLABORATES WITH NUMEROUS COMMUNITY AND PROFESSIONAL ORGANIZATIONS. WITHIN THIS FRAMEWORK, IT IS POSSIBLE TO GAIN A BETTER UNDERSTANDING OF DIFFERENT NEED PERSPECTIVES AND ALSO EVALUATE COMMUNITY RESOURCES. THE ONGOING ANALYSIS OF QUANTITATIVE AND QUALITATIVE DATA IS UTILIZED TO CREATE ROME MEMORIAL HOSPITAL'S STRATEGIC PLAN, WHICH SERVES AS A BLUEPRINT FOR ADAPTING OUR AVAILABLE RESOURCES TO RESPOND TO THE CHANGING NEEDS OF THE COMMUNITY. ALTHOUGH THE 2009 COMMUNITY SERVICE PLAN AND UPDATES THEREAFTER (9/15/2011) WERE DESIGNED TO SPECIFICALLY ADDRESS THE STATE'S PREVENTION AGENDA, IT IS IMPORTANT TO NOTE THAT RMH'S STRATEGIC PLAN INCLUDES MANY ADDITIONAL INITIATIVES TO ADDRESS OUR COMMUNITY'S NEEDS AND ENSURE THE HOSPITAL'S CONTINUED FINANCIAL VIABILITY.RMH'S STRATEGIC PLAN PROVIDES A FRAMEWORK THAT GUIDES OUR DECISIONS AND BRINGS US FOCUS. THE STRATEGIC PLAN FOR 2011-2013 HAS FOUR MAJOR OBJECTIVES THAT ARE STRAIGHT-FORWARD, YET THE TACTICS TO ACHIEVE THEM ARE MULTI-FACETED IN SCOPE.1. FOSTER A CULTURE OF PATIENT SERVICE AND PATIENT SAFETY - WITH A COMMITMENT TO CONTINUOUS QUALITY IMPROVEMENT, PROVIDE THE NECESSARY LEADERSHIP AND RESOURCES TO DELIVER EVIDENCE-BASED, PATIENT-CENTERED HEALTHCARE SERVICES IN SUPPORT OF OUR MISSION. IN 2011, RMH BECAME A BREAST CENTER OF EXCELLANCE UNDER THE NATIONAL QUALITY MEASURES FOR BREAST CENTERS PROGRAM TO BETTER COORDINATE AND BENCHMARK EXISTING SERVICES AND EXPAND THE CONTINUUM OF BREAST CANCER CARE FOR THE COMMUNITY. RMH HAS BEEN VERY SUCCESSFUL IN CREATING A CULTURE OF SAFETY AND SERVICE FOR ITS PATIENTS. AN EXAMPLE OF THIS IS RMH'S STRATEGIES FOR REDUCING THE RISK OF HEALTH ACQUIRED INFECTIONS. BY ADOPTING EVIDENCE BASED PRACTICES, THE HOSPITAL HAS NOT HAD A CENTRAL LINE INFECTION IN ITS ICU SINCE DECEMBER 2006. THE HOSPITAL WAS ONE OF ONLY EIGHT HOSPITALS IN THE NATION TO BE RECOGNIZED BY THE U.S. DEPARTMENT OF HEATH AND HUMAN SERVICES WITH AN "OUTSTANDING LEADERSHIP AWARD" FOR PROTECTING PATIENTS FROM LIFE-THREATENING BLOODSTREAM INFECTIONS. THE HOSPITAL RECRUITED A NEW GROUP OF EMERGENCY DEPARTMENT PHYSICIANS WITH A REPUTATION FOR WORKING COLLABORATIVELY WITH HOSPITAL STAFF TO DELIVER COMPASSIONATE AND EFFICIENT CARE. IN JUST THE TWO MONTHS, TEAMHEALTH REDUCED THE "DOOR TO DOC" TIME BY ABOUT 25 MINUTES AND THE AVERAGE LENGTH OF STAY BY AN HOUR.THE HOSPITAL CONTINUED ITS COMMITTMENT TO PREVENT HEALTHCARE ACQUIRED INFECTIONS BY IMPLEMENTING NEW TECHNOLOGY THAT USES HYDROGEN PEROXIDE VAPOR TO KILL DRUG- RESISTANT BACTERIA, VIRUSES, AND FUNGI IN HARD-TO-REACH PLACES. THE BIOQUELL SYSTEM WAS PURCHASED THROUGH THE GENEROSITY OF DONORS WHO CONTRIBUTED TO THE ROME HOSPITAL FOUNDATION.2. RECRUITMENT & RETENTION - CONTINUE TO RECRUIT AND RETAIN OUR MOST VALUABLE RESOURCES, OUR PHYSICIANS AND EMPLOYEES, WHO CONSISTENTLY DEMONSTRATE OUR ORGANIZATIONAL MISSION AND VISION. DURING 2011 RMH WELCOMED 44 NEW DOCTORS AND ALLIED HEALTH PROFESSIONALS ON STAFF, INCLUDING A GENERAL SURGEON AND A NEUROLOGIST. DUE TO NATIONAL PHYSICIAN SHORTAGES, THE IMPLEMENTATION OF THE NEW HOSPITALIST PROGRAM WAS DELAYED UNTIL EARLY 2012.3. INFORMATION TECHNOLOGY - TO EXTEND THE SCOPE AND APPLICATION OF INFORMATION TECHNOLOGY (IT) ACROSS THE CONTINUUM OF CARE, TO ENHANCE PATIENT SAFETY, EFFICIENCY AND AVAILABILITY OF INFORMATION. AFTER 18 MONTHS OF ASSESSING, BUILDING, TESTING AND TRAINING, RMH WENT LIVE ON A NEW HEALTH INFORMATION SYSTEM (HIS) JULY 2011 TO BETTER FACILITATE THE PROCESSING AND EXCHANGE OF CLINICAL, STATISTICAL, AND FINANCIAL INFORMATION. THE NEW HIS REPLACES MORE THAN 30 SEPARATE FINANCIAL, CLINICAL, AND ADMINISTRATIVE SYSTEMS - EVERYTHING FROM PATIENT REGISTRATION, BILLING AND PAYROLL TO PATIENT SCHEDULING, NURSING DOCUMENTATION, AND MEDICATION ADMINISTRATION. THE PROJECT INCLUDES SEVERAL NEW APPLICATIONS THAT ADDRESS THE HOSPITAL'S GOALS OF 1)CONVERTING FROM A PAPER-BASED PATIENT MEDICAL RECORD TO A FULLY ELECTRONIC HEALTH RECORD AND 2) PROVIDING ONLINE CLINICAL DECISION SUPPORT TO STANFARDIZE CARE, ADVANCE PATIENT SAFETY, AND ACHIEVE BETTER OUTCOMES.4. OPTIMIZE FINANCIAL PERFORMANCE BY --ENGAGING IN PRUDENT, ETHICAL BUSINESS PRACTICES TO OPTIMIZE PROFITABILITY THAT ALLOW US TO MEET THE PRIORITY HEALTHCARE NEEDS OF OUR COMMUNITY. THE STRATEGIES THAT ROME MEMORIAL HOSPITAL IMPLEMENTED IN 2011 TO DELIVER COST EFFECTIVE QUALITY CARE GENERATED MONIES FOR THE HOSPITAL TO REINVEST IN TECHNOLOGY AND SERVICES.-INCREASING THE UTILIZATION OF OUR HEALTHCARE SERVICES BY MAXIMIZING OPPORTUNITIES THAT MEET THE NEEDS OF OUR CUSTOMERS. IN 2011, ROME MEMORIAL HOSPITAL JOINED ITS THREE OPHTALMOLOGISTS TO BREAK GROUND ON A NEW EYE CENTER THAT WILL OPEN IN 2012. THE PROJECT ALIGNS WITH THE HOSPITAL'S NEED TO PROVIDE MORE AVAILABLE OPERATING ROOM TIME FOR NEWLY RECRUITED SURGEONS.PROGRESS ON A FEW OF THE OTHER MAJOR INITIATIVES INCLUDE:IN SEPTEMBER 2011, AFTER EVALUATION, RMH SENIOR BEHAVIORIAL HEALTH UNIT BECAME STATE CERTIFIED TO SERVE PATIENTS 55 AND OVER, AS OPPOSED TO 65 AND OVER AS IN PAST YEARS. EYE CENTER; THE CONSTRUCTION OF A NEW EYE CENTER AT GRIFFISS BUSINESS & TECHNOLOGY PARK WAS NEARING COMPLETION. THE JOINT VEBNTURE BETWEEN THE HOSPITAL AND ITS THREE OPTHALMOLOGISTS WILL PROVIDE A NEW STATE OF THE ART FACILITY THAT SPECIALIZES IN CATERACT, GLAUCOMA, AND EYELID SURGERY PROCEDURES. THE CENTER IS EXPECTED TO OPEN THE SECOND QUARTER OF 2012. HOSPITALISTS; PREPARATIONS HAVE BEEN MADE SO THAT IN EARLY 2012 A NEW 24-HOUR HOSPITALIST PROGRAM WILL BE LAUNCHED. THIS PROGRAM WILL PROVIDE COVERAGE FOR PATIENTS WHO DO NOT HAVE A PRIMARY CARE PHYSICIAN WHEN THEY ARE ADMITTED TO THE HOSPITAL. ALSO, THE PROGRAM WILL GIVE PHYSICIANS ON THE HOSPITAL'S STAFF THE OPTION OF UTILIZING THE HOSPITALISTS TO ATTEND TO THEIR PATIENTS, WHICH WOULD GIVE THEM THE OPPORTUNITY TO FOCUS ON THEIR OFFICE PRACTICE.
PART VI, LINE 3: #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: #4 COMMUNITY INFORMATION:ROME MEMORIAL HOSPITAL SERVES THE RESIDENTS OF ROME, A CITY OF 33,725 PEOPLE, AS WELL AS THE SURROUNDING RURAL TOWNS AND VILLAGES IN ONEIDA COUNTY. THE POPULATION OF THE PRIMARY MARKET IS APPROXIMATELY 100,000 PEOPLE. FOR SELECTED SPECIALTIES, SUCH AS SENIOR BEHAVIORAL HEALTH CARE, RMH'S SERVICE AREA EXTENDS INTO THE SURROUNDING COUNTIES OF MADISON, HERKIMER, LEWIS AND ONONDAGA COUNTIES.ACCORDING TO THE MOST RECENT CENSUS ESTIMATES AVAILABLE, OVERALL POPULATION GROWTH HAS DECLINED APPROXIMATELY 3.5% IN THE CITY OF ROME AND ONEIDA COUNTY SINCE 2000. RESEARCH SHOWS THAT SOCIOECONOMIC CHARACTERISTICS HAVE AN IMPACT ON COMMUNITY HEALTH AND ARE AS IMPORTANT TO HEALTH STATUS AS OUR GENES, OUR BEHAVIORS AND EVEN ACCESS TO MEDICAL CARE. WHEN COMPARED AGAINST STATE FIGURES, THE POPULATION IN ROME AND ONEIDA COUNTY IS OLDER, LESS EDUCATED AND EARNS LESS THAN THE AVERAGE NEW YORKER, WHICH PUTS THEM AT HIGHER RISK FOR HEALTH PROBLEMS. IN ONEIDA COUNTY, OVER 15% OF ADULTS OF ALL INCOMES AGED 18-64 ARE UNINSURED; THIS RATE IS HIGHER THAN NEW YORK STATE (EXCLUDING NEW YORK CITY) AT 13.6%. APPROXIMATELY 6% OF CHILDREN AGED 18 AND YOUNGER LACK INSURANCE. IN ADDITION, ACCORDING TO THE MOST RECENT ONEIDA COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013, THE NUMBER OF MEDICAID ELIGIBLE CHILDREN AGED 12-17 INCREASED FROM 3,970 IN 2000 TO 5,954 IN 2005. CHILD HEALTH PLUS ENROLLMENT FOR ONEIDA COUNTY WAS 5,454 AS OF JULY 2009. THE NUMBER OF MEDICAID ELIGIBLE ADULTS IN ONEIDA COUNTY AGED 18 AND OLDER INCREASED 18% FROM 22,398 IN 2000 TO 26,346 IN 2005.THE CHALLENGE IS COMPOUNDED BY THE FACT THAT ONEIDA COUNTY IS A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. IN ADDITION, THE CITY OF ROME AND TOWNS OF AVA, BOONVILLE, FORESTPORT, FLOYD, LEE, VERONA, WESTERN, ANNSVILLE, CAMDEN, FLORENCE AND VIENNA ARE FEDERALLY-DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS, WITH AN INADEQUATE NUMBER OF PRIMARY MEDICAL CARE PROVIDERS TO SERVE THE COMMUNITY.THE FOLLOWING TABLE HIGHLIGHTS AVAILABLE DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS OF OUR COMMUNITY.SOCIO-ECONOMIC PROFILE ONEIDA COUNTY NEW YORKPOPULATION, 2011 ESTIMATE 234,287 19,465,197POPULATION, % CHANGE, APRIL 2010 TO JULY 2011 -.3% .4%POPULATION, 2010 234,878 18,378,102PERSONS UNDER 5 YEARS OLD, PERCENT, 2011 5.6% 6.0%PERSONS UNDER 18 YEARS OLD, PERCENT, 2011 21.5% 22.0%PERSONS 65 YEARS OLD AND OVER, PERCENT, 2011 16.5% 13.7%FEMALE PERSONS, PERCENT, 2011 50.2% 51.5% ONEIDA COUNTY NEW YORKWHITE PERSONS, PERCENT, 2011 (A) 88.2% 71.5%BLACK PERSONS, PERCENT, 2011 (A) 6.7% 17.5%AMERICAN INDIAN/ALASKA NATIVE PERSONS,%,2011(A) 0.3% 1.0%ASIAN PERSONS, %, 2011 (A) 2.9% 7.8%NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER, %,2011(A) .1% .1%PERSONS REPORTING TWO OR MORE RACES, %, 2011 1.8% 2.2%PERSONS OF HISPANIC OR LATINO ORIGIN, %, 2011(B) 4.8% 18.0%WHITE PERSONS NOT HISPANIC, PERCENT, 2011 84.6% 58.0% ONEIDA COUNTY NEW YORK FOREIGN BORN PERSONS, PERCENT, 2006-2010 6.6% 21.7%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME, PCT AGE 5+, 2006-2010 10.8% 29.2%HIGH SCHOOL GRADUATES, PERCENT OF PERSONS AGE 25+, 2006-2010 86.0% 84.4%BACHELOR'S DEGREE OR HIGHER, PCT OF PERSONS AGE 25+, 2006-2010 21.5% 32.1%VETERNS, 2006-2010 21,171 1,025,496 ONEIDA COUNTY NEW YORK HOUSING UNITS, 210 104,180 8,108,103HOMEOWNERSHIP RATE, 2006-2010 67.9% 55.2%HOUSING UNITS IN MULTI-UNIT STRUCTURES, %,2006-2010 31.2% 50.6%MEDIAN VALUE OF OWNER-OCCUPIED HOUSING UNITS, 2006-2010 $101,900 $303,900 ONEIDA COUNTY NEW YORKHOUSEHOLDS, 2006-2010 92,058 7,205,740PERSONS PER HOUSEHOLD, 2006-2010 2.39 2.59MEDIAN HOUSEHOLD INCOME, 2006-2010 $46,708 $55,603PER CAPITA MONEY INCOME, 2006-2010 $23,458 $30,948PERSONS BELOW POVERTY LEVEL, PERCENT, 2009 14.9% 14.2% ROME NEW YORKPOPULATION, 2010 ESTIMATE 33,725 19,378,102POPULATION, % CHANGE, 4/1/2000 TO 7/1/2006 -3.5% 2.1%POPULATION, 2000 34,950 18,976,457PERSONS UNDER 5 YEARS OLD, PERCENT, 2010 6.1% 6.0%PERSONS UNDER 18 YEARS OLD, PERCENT, 2010 22.1% 24.7%PERSONS 65 YEARS OLD AND OVER, PERCENT, 2010 16.5% 13.5%FEMALE PERSONS, PERCENT, 2010 48.6% 51.6% ROME NEW YORKWHITE PERSONS, PERCENT, 2010 (A) 87.4% 65.7%BLACK PERSONS, PERCENT, 2010 (A) 7.1% 15.9%AMERICAN INDIAN & ALASKA NATIVE PERSONS, %, 2010 (A) 0.3% 0.6%ASIAN PERSONS, PERCENT, 2010 (A) 1.1% 7.3%NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER,%, 2010 (A) Z 0.0%PERSONS REPORTING TWO OR MORE RACES, PERCENT, 2010 2.7% 3.0%PERSONS OF HISPANIC OR LATINO ORIGIN, %, 2010 (B) 5.3% 17.6% ROME NEW YORK LIVING IN SAME HOUSE 1 YEAR & OVER, 2006-2010 81.7% 88.3%FOREIGN BORN PERSONS, PERCENT, 2006-2010 4.4% 21.7%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME, PCT AGE 5+,2006-2010 7.9% 29.2%HIGH SCHOOL GRADUATES, % PERSONS AGE 25+,2006-2010 83.0% 84.4%BACHELOR'S DEGREE OR HIGHER, PCT OF PERSONS AGE 25+,2006-2010 16.9% 32.1% ROME NEW YORKHOUSING UNITS, 2010 14,893 8,108,103HOMEOWNERSHIP RATE, 2006-2010 58.4% 55.2%MEDIAN VALUE OF OWNER-OCCUPIED HOUSING UNITS, 2006-2010 $85,200 $303,900 ROME NEW YORK HOUSEHOLDS, 2006-2010 13,730 7,205,740PERSONS PER HOUSEHOLD, 2006-2010 2.25 2.59MEDIAN HOUSEHOLD INCOME, 2006-2010 $42,779 $55,603PER CAPITA MONEY INCOME, 2006-2010 $21,989 $30,948PERSONS BELOW POVERTY, PERCENT, 2006-2010 15.3% 14.2% SOURCE: US CENSUS BUREAU STATE & COUNTY QUICKFACTS
PART VI, LINE 5: #5 PROMOTION OF COMMUNITY HEALTH: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: #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.
NYREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BASIL ARIGLIO
23146602107600000140170266559000
WALEED ALBERT MD
25342602598200000140610293469000
RAYMOND CARNEVALE
15960201600901001000067810192402000
NICHOLAS MAYHEW
183921018351032524000139880248784000
MARK SNYDERMAN
11890803680018538000106450151771000
BRUCE PETERSON
1428500154402830000138470161071000
DARLENE BURNS
13368704411404800000067680232569000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationTYPE OF BENEFIT: PAYMENT OF 2011 INITIATION FEE, 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 2011 FOR PERSON LISTED ABOVE.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
ONEIDA COUNTY INDUSTRIAL DEVELOPMENT AGENCY
1661582016824621LE2005-06-1611900000FINANCE CONSTRUCTION010
ONEIDA COUNTY LOCAL DEVELOPMENT CORPORATION
2731904222010-12-306900000FINANCE MRI CONSTRUCTION010
DORMITORY AUTHORITY OF THE STATE OF NEW YORK
1460002932011-10-277500000FINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT010
DORMITORY AUTHORITY OF THE STATE OF NEW YORK
1460002932007-09-211858108FINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT- CAT SCANN010

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowCapital ExpendituresCapitalExpenditures
1190000050909020060011
690000022284520090011
75000005882620110001196114396675999546
185810820070011

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001101
00001
001101
001101

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsBusiness Name Line2NameOfHedgeProvider/BusinessNameLine2Term Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
MANUFACTURERS AND
011TRUST5.00000000000001000
(no name)
010000
(no name)
000000
(no name)
000000

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierSCHEDULE K SUPPLENTAL INFORMATIONIdentifier
ExplanationTHE CAPITAL LEASE AGREEMENTS ARE ALL TELP (TAX EXEMPT LEASE - PURCHASE (FINANCING)) LEASES THROUGH THE COUNTY OR STATE.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1DORMITORY AUTHORITY OF THE STATE OF NEW YORKBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN146000293IssuerEIN
Date Issued2009-12-01DateIssued
Issue Price1935034IssuePrice
Description Of PurposeFINANCE EQUIPMENT THROUGH CAPITAL LEASE AGREEMENT - MRI EQUIPMENTDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer1OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds1935034TotalProceeds
Issuance Costs From Proceeds15338IssuanceCostsFromProceeds
Year Of Subst Completion2009YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty1MngmentCntrctBondFinancdPrprty
Engage Bond Counsel Contracts1EngageBondCounselContracts
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
MARY ANN JONES
SISTER OF KEY EMPLOYEE27704COMPENSATION0
DARLENE BURNS
FORMER OFFICER48000CONTRACT FOR CONSULTING SERVICES0
SCOTT BURNS
SON OF FORMER OFFICER138103COMPENSATION0

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable (5 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XMEDICAL EQUIPMENT9100072ACTUAL INVOICE COST
X2 NORTH RENOVATIONS192747ACTUAL INVOICE COST
XMRI/EMERGENCY ROOM PROJECT52244ACTUAL INVOICE COST
XBIOQUELL SYSTEM44850ACTUAL INVOICE COST
XIT SYSTEM111998ACTUAL INVOICE COST
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
CHANGES IN PROGRAM SERVICESFORM 990, PART III, LINE 3DURING SEPTEMBER 2011 RMH SENIOR BEHAVIORAL HEALTH UNIT OBTAINED STATE CERTIFICATION TO LOWER THE ELIGIBLE AGE FOR PATIENTS SERVED FROM 65 TO 55.
FORM 990, PART VI, SECTION A, LINE 6GREATER ROME AFFILIATES IS THE SOLE MEMBER OF ROME MEMORIAL HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7APER THE HOSPITAL BY-LAWS "THE SOLE CORPORATE MEMBER OF THE CORPORATION SHALL BE GREATER ROME AFFILIATES, INC. WHICH SHALL ACT HEREUNDER AS SUCH MEMBER BY DULY AUTHORIZED RESOLUTION OF ITS BOARD OF DIRECTORS AND WHICH SHALL COMMUNICATE ITS ACTIONS TO THIS BOARD THROUGH ITS PRESIDENT OR OTHER DULY AUTHORIZED OFFICER." GREATER ROME AFFILIATES APPOINTS THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11THE COMPLETED 2011 990 WAS PRESENTED TO THE BOARD BY THE CFO OF THE HOSPITAL AT ITS OCTOBER 2012 BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12CCONSISTENT WITH ROME HOSPITAL'S GIFTS, GRATUITIES AND CONFLICT OF INTEREST POLICY, THE COMPLIANCE OFFICER OF RMH HAS A CONFLICT OF INTEREST DISCLOSURE FORM COMPLETED ON AN ANNUAL BASIS BY ALL OFFICERS, DIRECTORS AND MANAGEMENT PERSONNEL. THE COMPLIANCE OFFICER COLLECTS AND REVIEWS THE BOARD OF TRUSTEES/FOUNDATION BOARD INTEREST DISCLOSURE FORMS ON AN ANNUAL BASIS. THE INFORMATION GATHERED ON THE DISCLOSURE IS REVIEWED AND ANY CONFLICTS ARE COMMUNICATED TO THE PRESIDENT/CEO, COMPLIANCE BOARD, AND BOARD OF TRUSTEES TO ENSURE ALL HOSPITAL TRANSACTION/BUSINESS ACTIVITIES ARE CONDUCTED IN A MANNER THAT IS FREE FROM UNLAWFUL OR OTHERWISE INAPPROPRIATE OFFERS OR SOLICITATIONS OF IMPROPER INDUCEMENTS IN EXCHANGE FOR INFLUENCE OR ASSISTANCE IN A TRANSACTION. POTENTIAL CONFLICTS THAT MAY ARISE THROUGHOUT THE YEAR ARE BROUGHT TO THE ATTENTION OF THE COMPLIANCE OFFICER AND PRESIDENT/CEO FOR REVIEW. ANY IDENTIFIED CONFLICTS ARE THEN REVIEWED AT THE CORPORATE COMPLIANCE COMMITTEE AND BY THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 15USE OF IROQUOIS DATA, ASSOCIATION FOR HEALTHCARE PHILANTHROPY SALARY DATA, AND THE ROME HOSPITAL HUMAN RESOURCE DEPARTMENT ARE UTILIZED TO DETERMINE COMPENSATION FOR THE ORGANIZATION'S EMPLOYEES.
FORM 990, PART VI, SECTION C, LINE 18FORMS ARE AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19FORMS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST OR THROUGH WWW.GUIDESTAR.ORG- A WEBSITE THAT PROVIDES NON-PROFIT INFORMATION TO THE PUBLIC. RMH MAKES ITS GOVERNING DOCUMENTS (BY - LAWS) AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC THROUGH RMH WEBSITE - WWW.ROMEHOSPITAL.ORG. ALSO, FINANCIAL FACTS AND FIGURES AND ECONOMIC IMPACT REPORTS CAN BE FOUND ON THIS WEBSITE.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -189,769. TOTAL CHANGE IN INTEREST IN FOUNDATION -160,457. TOTAL TO FORM 990, PART XI, LINE 5: -350,226.
FORM 990, PART XI, LINE 2CTHE 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,ADVISES,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 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

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
GREATER ROME AFFILIATES
1500 N JAMES STREETROMENY13440161508597PARENT CORPORATIONNY501C3LINE 11A, I0
ROME MEMORIAL PROPERTIES
1500 N JAMES STREETROMENY13440161492003SUPPORT HOSPITAL ACTIVITIESNY501C330GRA

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1GRIFFIS EYE CENTER LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1105 DART CIRCLEAddressLine1
CityROMECity
StateNYState
ZIP Code13441ZIPCode
FieldValueIRS element (for citing)
EIN263738675EIN
Primary ActivitySEE SCHEDULE R, PART VIIPrimaryActivity
Legal Domicile StateNYLegalDomicileState
Predominant Income TypeINVESTMENTPredominantIncomeType
Share Of Total Income-43821ShareOfTotalIncome
Share Of EOY Assets44597ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner
Percentage Ownership0.30000PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
RMH SERVICES INC
1500 N JAMES STREETROMENY13440161490045FOR PROFITNYGREATER ROME AFFILIATESC5607827577621.00000
ROME MEDICAL GROUP
1801 BLACK RIVER BLVDROMENY13440161464822CAPTIVE P.C.NYROME MEMORIAL HOSPITALC
ROME MEDICAL PRACTICE
1500 N JAMES STREETROMENY13440203827393CAPTIVE P.C.NYROME MEMORIAL HOSPITALC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
Return ReferenceSCHEDULE R, PART III, COLUMN (B) REGARDING GRIFFIS EYE CENTER, LLC.ReturnReference
ExplanationPRIMARY ACTIVITY: SINGLE SPECIALTY AMBULATORY SURGERY CENTER SPECIALIZING IN AND PROVIDING ONLY OPHTHALMOLOGY SERVICES.Explanation

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