2011-11-14T18:09:05-06:00 2010-12-31 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2010-01-01 161471634 ROME MEMORIAL HOSPITAL ROME 1500 NORTH JAMES STREET ROME NY 13440 NICHOLAS MAYHEW 3153387000 2011-10-24 1 3154463600 2010 2016-02-24 21:20:13Z BASIL ARIGLIO 1500 NORTH JAMES ST ROME NY 13440 87854574 0 X ROMEHOSPITAL.ORG X 1995 NY PROVIDE QUALITY, COMPASSIONATE CARE IN A SAFE ENVIRONMENT TO SERVE THE HEALTHCARE NEEDS OF THE PEOPLE OF ROME AND THE SURROUNDING COMMUNITIES. 10 10 1204 125 253882 -214 246449 432566 80631908 84821455 -341034 142569 1003883 1034217 81541206 86430807 0 0 0 0 44982418 48494172 0 0 0 37190412 37880995 82172830 86375167 -631624 55640 56991481 61433977 32947164 37037193 24044317 24396784 X ABOUT ROME MEMORIAL HOSPITAL: OVERALL, ROME MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, SKILLED NURSING, AND EMERGENCY CARE SERVICES PRIMARILY FOR THE RESIDENTS OF ROME AND THE SURROUNDING AREAS. 0 1 37196573 32236495 INPATIENT 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.2010 INPATIENT DISCHARGES: 5,4672010 BIRTHS: 6182010 PATIENT DAYS: 25,556 6066487 6785205 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 TWO SPECIALITY INPATIENT UNITS FOR ACUTE-PHYSICAL MEDICINE & REHABILITATION AND 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.2010 PATIENT DAYS = 26,0332010 OCCUPANCY PERCENTAGE = 89% 9476614 0 9904064 EMERGENCY DEPARTMENT (ED)ROME MEMORIAL HOSPITAL EMERGENCY DEPARTMENT IS A SAFETY NET FOR THE MOST VULNERABLE POPULATIONS IN THE COMMUNITY. IN 2010, MORE THAN HALF OF THE PATIENTS LISTED NO PRIMARY CARE PHYSICIAN AND 45% WERE UNINSURED OR UNDER INSURED.2010 ED ADMISSIONS: 3,2732010 ED VISITS: 25,396 21555610 29184708 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. 21555610 29184708 74295284 1 1 0 1 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 1 46 0 1 1204 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NY X NICHOLAS MAYHEW CFO ROME MEMORIAL 3153387024 1500 NORTH JAMES STREET ROME NY 13440 CHESTER PATRICK MD 2.00 X X 0 0 0 DAVID NOLAN 2.00 X X 0 0 0 LYNN REESE 2.00 X X 0 0 0 MARY DAVIS 2.00 X 0 0 0 W ROBERT HERMANN 2.00 X 0 0 0 MICHAEL KRAMER 2.00 X 0 0 0 KIM COOK 2.00 X 0 0 0 RONALD CANTOR 2.00 X 0 0 0 DR ANKUR DESAI 2.00 X 0 0 0 SALLY HINMAN 2.00 X 0 0 0 DARLENE BURNS 55.00 X 319787 0 9513 WALEED ALBERT MD 55.00 X 258673 0 14874 BASIL ARIGLIO 55.00 X 248376 0 14874 NICHOLAS MAYHEW 55.00 X 204052 0 14803 RAYMOND CARNEVALE 55.00 X 165054 0 5871 BRUCE PETERSON 55.00 X 148182 0 14712 SCOTT BURNS 55.00 X 129443 0 11226 MARK SNYDERMAN 55.00 X 127719 0 11223 DEBRA WURZ 55.00 X 120552 0 11196 1721838 0 108292 22 0 1 0 CENTREX LABS 28 CAMPION RD NEW HARTFORD NY 13413 LAB SERVICES 4152631 CARDINAL HEALTH 6012 EAST MOLLOY ROAD SYRACUSE NY 13211 PHARMECEUTICALS 2194251 ROME EMERGENCY SERVICES 484 TEMPLE HILL ROAD NEW WINDSOR NY 12553 ER SERVICES 424583 HUEBER BREUER PO BOX 515 SYRACUSE NY 13205 ARCHITECT 362073 CHUL JO YANG MD 115 GENESEE STREET NEW HARTFORD NY 13413 PSYCHIATRY SERVICES 112667 5 43500 389066 133724 432566 HOSPITAL 621990 84821455 84821455 84821455 35251 35251 111033 135647 -24614 -24614 -24614 1330598 64840 1267797 20323 62801 44517 107318 107318 CAFETERIA SALES 722210 290037 290037 ACCOUNTING & CONSULTIN 541200 180000 180000 GAIN/LOSS CHANGE ANGEL 900099 664 0 664 588130 73882 514248 1058831 86430807 84821455 253882 922904 1084971 1084971 37364917 32527641 4837276 1523167 1343311 179856 5705139 5705129 10 2815978 2458269 357709 120286 120286 80316 80316 11238 11238 491448 201798 289650 798994 101197 697797 892877 840172 52705 104220 52847 51373 66991 43466 23525 626370 586975 39395 4198041 3696369 501672 1259288 58791 1200497 PURCHASE SERVICES 6820414 6367825 452589 0 SUPPLIES 6180701 6157102 23599 0 BAD DEBT EXPENSE 6147555 6147555 0 0 PHARMACY 2621499 2614773 6726 0 OTHER 2472998 796473 1676525 0 4987759 4595591 392168 86375167 74295284 12079883 0 24396 3031569 2456924 2274926 11270550 11374729 2509492 1388348 1592849 1959094 738790 806060 80041751 41082506 37096532 38959245 1301948 1640006 56991481 61433977 10769280 11529039 13625864 13736568 5712593 6575000 2839427 5196586 32947164 37037193 X 23585306 23772243 12024 40494 446987 584051 24044317 24396784 56991481 61433977 X 55640 296827 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 20844 0 0 20844 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: $20,844 REPRESENTS THE PORTION OF THE 2010 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. 591605 4471 28465 624541 338312 120609 132684 591605 33374 304938 338312 0.06000 0.94000 0 0 41294593 15588624 25705969 2197063 2051405 145658 30467079 21584470 8882609 6083016 1858007 4225009 38959245 LINE OF CREDIT 4000000 ASSET RETIREMENT 556928 ADVANCE FROM THIRD PARTIES 441000 THIRD PARTY PAYABLES 198658 5196586 86430807 86375167 55640 231197 65630 296827 352467 95986569 231197 9335803 9567000 86419569 11238 11238 86430807 95880402 9516473 9516473 86363929 11238 11238 86375167 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. PART X - LIABILITY UNDER FIN 48 FOOTNOTE RMH 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 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 FINANCIAL STATEMENTS. AS OF DECEMBER 31, 2010, THE HOSPITAL DID NOT HAVE ANY UNRECOGINIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2007 THROUGH 2010. PART XI, LINE 8 - RECONCILIATION OF CHANGES - OTHER AFFILIATE INCOME-CONSOLIDATED FINANCIAL STATEMENTS $ 9,555,768 AFFILIATE EXPENSES-CONSOLIDATED FINANCIAL STATEMENTS $-9,505,233 BOOK TO TAX DEPRECIATION DIFFERENCE $-4,198,041 BOOK/TAX DEPRECIATION DIFFERENCE $ 4,198,041 PART XII, LINE 2D - REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER AFFILIATE INCOME - CONSOLIDATED FINANCIAL STATEMENTS $9,555,768 PART XIII, LINE 2D - EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER AFFILIATE EXPENSES-CONSOLIDATED FINANCIAL STATEMENTS $ 9,505,233 PART XIII, LINE 4B - EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER BOOK TO TAX DEPRECIATION DIFFERENBCE $-4,198,041 BOOK /TAX DEPRECIATION DIFFERENCE $ 4,198,041 1 1 1 X 1 X 0 0 1 1 736642 297188 439454 0.00550 18353138 14685209 3667929 0.04570 562273 384532 177741 0.00220 19652053 15366929 4285124 0.05340 76946 31591 45355 0.00060 30920 29302 1618 0.00000 107866 60893 46973 0.00060 19759919 15427822 4332097 0.05400 789 494 295 0.00000 1979 0 1979 0.00000 75305 0 75305 0.00090 78073 494 77579 0.00090 0 2095202 166065 23850824 27906493 -4055669 X 1 0 12 1 ROME MEMORIAL HOSPITAL

1500 NORTH JAMES STREET ROME NY 13440

X X X 2 COMMUNITY RECOVERY CENTER

264 W DOMINICK STREET ROME NY 13440

SUBSTANCE ABUSE COUNSELING 3 MOHAWK VALLEY RADIATION MEDICINE

107 E CHESTNUT STREET ROME NY 13440

RADIATION ONCOLOGY 4 PHYSICAL THERAPY

107 E CHESTNUT STREET ROME NY 13440

OFFSITE PHYSICAL THERAPY SERVICES 5 BOONVILLE FAMILY CARE

13407 ROUTE 12 BOONVILE NY 13309

PRIMARY CARE SERVICES 7 LABORATORY COLLECTION SITE

1801 BLACK RIVER BLVD ROME NY 13440

OFFSITE LAB COLLECTION SITE 8 LABORATORY COLLECTION SITE

1617 N JAMES STREET ROME NY 13440

OFFSITE LAB COLLECTION SITE 9 LABORATORY COLLECTION SITE

13407 STATE ROUTE 12 BOONVILE NY 13309

OFFSITE LAB COLLECTION SITE 10 LABORATORY COLLECTION SITE

BEECHES OFFICE COMPLEX-TURIN RD ROME NY 13440

OFFSITE LAB COLLECTION SITE 11 MEDICAL IMAGING

1819 BLACK RIVER BLVD ROME NY 13440

OFFSITE RADIOLOGY SERVICES 12 MEDICAL IMAGING

1617 N JAMES STREET ROME NY 13440

OFFSITE RADIOLOGY SERVICES 13 MEDICAL IMAGING

1801 BLACK RIVER BLVD ROME NY 13440

OFFSITE RADIOLOGY SERVICES ROME MEMORIAL HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 PART I, LINE 6A: ROME MEMORIAL HOSPITAL PREPARED A COMMUNITY SERVICE PLAN WHICH WAS UPDATED ON 9/15/2010. THIS IS MADE AVAILABLE TO THE PUBLIC THROUGH THE HOSPITAL'S WEBSITE. 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 $6,147,555 (PER AUDITED FINANCIAL STATEMENTS). PART II: 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 HEALTHY 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 ADDITIONAL 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. 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%.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 CHARGES PART III, LINE 8: THE EXTENT TO WHICH THE SHORTFALL IN QUESTION 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT IS BEST DESCRIBED BY INFORMATION AVAILABLE IN ROME MEMORIAL HOSPITAL'S COMMUNITY SERVICE PLAN AND ANNUAL UPDATES:FINANCIAL AID PROGRAM A. SUCCESSES AND CHALLENGES WITH 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. THE ENROLLER IS LOCATED DOWNTOWN IN THE HOSPITAL'S BUSINESS OFFICE, 155 W. DOMINICK ST. 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 2010, ROME MEMORIAL HOSPITAL'S BAD DEBT AND CHARITY CARE TOTALED $7.8 MILLION, COMPARED TO $7.4 MILLION IN 2009. 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 WILL 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 25,400 IN 2010. MANY PHYSICIANS DON'T ACCEPT MEDICAID PATIENTS BECAUSE OF LOW REIMBURSEMENT RATES. IN ADDITION, SENIORS MAY SOON FACE THE SAME ACCESS PROBLEMS. 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. ONEIDA COUNTY IS HOME TO 54.6% OF THE DDSO BEDS IN THE CENTRAL NEW YORK REGION. OF THOSE BEDS, 47.7% (MORE THAN 500 DDSO CLIENTS) ARE LOCATED IN ROME. 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 IS EVALUATING THE VIABILITY OF SOME OF ITS SERVICES. AS A PART OF THE EVALUATION, RMH WILL ASSESS THE NUMBER OF PEOPLE SERVED AND AVAILABILITY OF OTHER SERVICES TO ADDRESS THE COMMUNITY NEED, IN ADDITION TO THE FINANCIAL BURDEN ON THE HOSPITAL. IN DECEMBER 2010, AFTER CONSIDERABLE EVALUATION, RMH DECIDED TO CLOSE THE ACUTE PHYSICAL REHABILITATION DEPARTMENT DUE TO FINANCIAL REASONS. WHILE ELIMINATING A SERVICE IS ALWAYS DIFFICULT, IT ASSURES THAT RESOURCES CAN BE REDIRECTED TO MEET A GREATER NEED AND PROTECT THE OVERALL VIABILITY OF THE HOSPITAL.COSTING METHODOLOGY AND SOURCE FOR LINE 6:2010 ICR EXHIBIT 46 AND TENTATIVE MEDICARE SETTLEMENT RATES ROME MEMORIAL HOSPITAL FILES A COMMUNITY SERVICE PLAN WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. 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. 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 FITNESS 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 (9/15/2010) 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 SIX MAJOR OBJECTIVES ARE STRAIGHT-FORWARD, YET THE TACTICS TO ACHIEVE THEM ARE MULTI-FACETED IN SCOPE.QUALITY - 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. FOR EXAMPLE, AMONG ONEIDA COUNTY HOSPITALS, ROME MEMORIAL HOSPITAL EARNED THE HIGHEST OVERALL MARKS FOR ENSURING THAT PAITENTS RECEIVE THE RECOMMENDED TREATMENTS FOR PNEUMONIA, HEART FAILURE, AND SURGICAL INFECTION PREVENTION FOR PATIENTS DISCHARGED JULY 1, 2009 TO JUNE 30, 2010, ACCORDING TO THE NYS DEPARTMENT OF HEALTH (FIGURES LAST UPDATED 7/15/2011)RECRUITMENT & RETENTION - CONTINUE TO RECRUIT AND RETAIN OUR MOST VALUABLE RESOURCES, OUR PHYSICIANS AND EMPLOYEES, WHO CONSISTENTLY DEMONSTRATE OUR ORGANIZATIONAL MISSION AND VISION. DURING 2010 RMH WELCOMED 15 NEW DOCTORS AND ALLIED HEALTH PROFESSIONALS ON STAFF. PHYSICAL PLANT - UTILIZE THE FACILITY MASTER PLAN TO PROVIDE SERVICES IN ENVIRONMENTS THAT ARE SAFE, EFFICIENT AND SUPPORT OUR ORGANIZATIONAL MISSION AND VISION. IN 2010, ROME MEMORIAL HOSPITAL UPDATED ITS FACILITY MASTER PLAN TO ESTABLISH A FRAMEWORK TO GUIDE ORDERLY GROWTH AND DEVELOPMENT OF THE HOSPITAL CAMPUS.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. DURING 2010, THE FOCUS WAS ON PREPARING FOR THE IMPLEMENTATION OF THE NEW HOSPITAL INFORMATION SYSTEM, NEW RADIOLOGY INFORMATION SYSTEM, AND PICTURE ARCHIVING AND CONTROL SYSTEM FOR MEDICAL IMAGING. BY THE END OF 2010 THE HOSPITAL HAD INVESTED MORE THAN $2.9 MILLION INOT WORK IN PROCESS REGARDING THE IT IMPLEMENTATION PROJECT. ROME HOSPITAL IS SCHEDULED TO "GO LIVE" WITH THE NEW SYSTEMS IN 2011. MARKET PENETRATION - INCREASE THE UTILIZATION OF OUR HEALTHCARE SERVICES BY MAXIMIZING OPPORTUNITIES THAT MEET THE NEEDS OF OUR CUSTOMERS. IN 2010, ROME MEMORIAL HOSPITAL JOINED ITS THREE OPHTALMOLOGISTS TO BREAK GROUND ON A NEW EYE CENTER THAT WILL OPEN IN 2011. THE PROJECT ALIGNS WITH THE HOSPITAL'S NEED TO PROVIDE MORE AVAILABLE OPERATING ROOM TIME FOR NEWLY RECRUITED GENERAL SURGEONS. FINANCE - ENGAGE 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 2010 TO DELIVER COST EFFECTIVE QUALITY CARE GENERATED A POSITIVE BOTTOM LINE FOR THE HOSPITAL TO REINVEST IN TECHNOLOGY AND SERVICES. 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 SERVICESTO THOSE WHO ARE UNABLE TO PAY, THE HOSPITAL POSTS INFORMATION ABOUT ITS FINANCIAL ASSISTANCEPOLICY 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 34,220 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 3.78% 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%. IN ADDITION, 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, 2010 ESTIMATE 234,878 19,378,102POPULATION, PERCENT CHANGE, 2000 TO 2010 -.3% 2.1%POPULATION ESTIMATES BASE (APRIL 1) 2000 235,461 18,976,811PERSONS UNDER 5 YEARS OLD, PERCENT, 2009 5.6% 6.3%PERSONS UNDER 18 YEARS OLD, PERCENT, 2009 21.5% 22.6%PERSONS 65 YEARS OLD AND OVER, PERCENT, 2009 16.3% 13.4%FEMALE PERSONS, PERCENT, 2009 50.0% 51.4% ONEIDA COUNTY NEW YORKWHITE PERSONS, PERCENT, 2010 (A) 87.1% 65.7%BLACK PERSONS, PERCENT, 2010 (A) 6.3% 15.9%AMERICAN INDIAN/ALASKA NATIVE PERSONS,%,2010(A) 0.3% 0.6%ASIAN PERSONS, %, 2010 (A) 2.8% 7.3%NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER, %,2010(A) Z 0.0%PERSONS REPORTING TWO OR MORE RACES, %, 2010 2.1% 3.0%PERSONS OF HISPANIC OR LATINO ORIGIN, %, 2010(B) 4.6% 17.6%WHITE PERSONS NOT HISPANIC, PERCENT, 2010 84.8% 58.3% ONEIDA COUNTY NEW YORK FOREIGN BORN PERSONS, PERCENT, 2005-2009 6.0% 21.3%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME, PCT AGE 5+, 2005-2009 10.1% 28.5%HIGH SCHOOL GRADUATES, PERCENT OF PERSONS AGE 25+, 2005-2009 85.6% 84.2%BACHELOR'S DEGREE OR HIGHER, PCT OF PERSONS AGE 25+, 2005-2009 20.9% 31.8%VETERNS, 2005-2009 21,701 1,064,754 ONEIDA COUNTY NEW YORK HOUSING UNITS, 2009 103,876 8,017,881HOMEOWNERSHIP RATE, 2005-2009 68.2% 55.7%HOUSING UNITS IN MULTI-UNIT STRUCTURES, %,2005-2009 30.7% 50.5%MEDIAN VALUE OF OWNER-OCCUPIED HOUSING UNITS, 2000 $97,000 $300,600 ONEIDA COUNTY NEW YORKHOUSEHOLDS, 2005-2009 92,544 7,137,013PERSONS PER HOUSEHOLD, 2005-2009 2.33 2.64MEDIAN HOUSEHOLD INCOME, 2009 $45,663 $54,554PER CAPITA MONEY INCOME, 2005-2009 $23,224 $30,634PERSONS BELOW POVERTY LEVEL, PERCENT, 2009 14.4% 14.2% ROME NEW YORKPOPULATION, 2006 ESTIMATE 34,220 19,306,183POPULATION, % CHANGE, 4/1/2000 TO 7/1/2006 -2.1% 1.7%POPULATION, 2000 34,950 18,976,457PERSONS UNDER 5 YEARS OLD, PERCENT, 2000 5.9% 6.5%PERSONS UNDER 18 YEARS OLD, PERCENT, 2000 22.1% 24.7%PERSONS 65 YEARS OLD AND OVER, PERCENT, 2000 17.2% 12.9%FEMALE PERSONS, PERCENT, 2000 48.8% 51.8% ROME NEW YORKWHITE PERSONS, PERCENT, 2000 (A) 87.9% 67.9%BLACK PERSONS, PERCENT, 2000 (A) 7.6% 15.9%AMERICAN INDIAN & ALASKA NATIVE PERSONS, %, 2000 (A) 0.3% 0.4%ASIAN PERSONS, PERCENT, 2000 (A) 0.9% 5.5%NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER,%, 2000 (A) Z ZPERSONS REPORTING TWO OR MORE RACES, PERCENT, 2000 2.0% 3.1%PERSONS OF HISPANIC OR LATINO ORIGIN, %, 2000 (B) 4.7% 15.1% ROME NEW YORK LIVING IN SAME HOUSE IN 1995 & 2000, PCT 5 YRS/OVER 60.9% 61.8%FOREIGN BORN PERSONS, PERCENT, 2000 3.8% 20.4%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME, PCT AGE 5+,2000 7.2% 28.0%HIGH SCHOOL GRADUATES, PCT OF PERSONS AGE 25+,2000 74.0% 79.1%BACHELOR'S DEGREE OR HIGHER, PCT OF PERSONS AGE 25+,2000 15.7% 27.4% ROME NEW YORKHOUSING UNITS, 2000 16,272 7,679,307HOMEOWNERSHIP RATE, 2000 57.1% 53.0%MEDIAN VALUE OF OWNER-OCCUPIED HOUSING UNITS,2000 $66,200 $148,700 ROME NEW YORK HOUSEHOLDS, 2000 13,653 7,056,860PERSONS PER HOUSEHOLD, 2000 2.3 2.61MEDIAN HOUSEHOLD INCOME, 1999 $33,643 $43,393PER CAPITA MONEY INCOME, 1999 $18,604 $23,389PERSONS BELOW POVERTY, PERCENT, 1999 15.0% 14.6% SOURCE: US CENSUS BUREAU STATE & COUNTY QUICKFACTS PART VI, LINE 6: #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 7: #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. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X X X 0 0 0 0 0 0 0 0 0 DARLENE BURNS 280298 0 39489 0 0 0 0 0 9513 0 329300 0 0 0 WALEED ALBERT MD 236426 0 22247 0 0 0 0 0 14874 0 273547 0 0 0 BASIL ARIGLIO 187484 0 18382 0 42510 0 0 0 14874 0 263250 0 0 0 NICHOLAS MAYHEW 165522 0 15917 0 22613 0 0 0 14803 0 218855 0 0 0 RAYMOND CARNEVALE 145082 0 12578 0 7394 0 0 0 5871 0 170925 0 0 0 BRUCE PETERSON 138081 0 10101 0 0 0 0 0 14712 0 162894 0 0 0 ONEIDA COUNTY INDUSTRIAL DEVELOPMENT AGENCY 166158201 6824621LE 2005-06-16 11900000 FINANCE CONSTRUCTION 0 1 0 ONEIDA COUNTY LOCAL DEVELOPMENT CORPORATION 273190422 2010-12-30 6900000 FINANCE MRI CONSTRUCTION 0 1 0 11900000 509090 2006 0 0 1 1 6900000 222845 2009 0 0 1 1 0 0 1 0 1 1 0 0 0 0 1 1 0 1 1 MANUFACTURERS AND TRUST 5.000000000000 0 1 0 0 0 0 1 0 0 0 0 MARY ANN JONES SISTER OF KEY EMPLOYEE 24023 COMPENSATION 0 SCOTT BURNS CHILD OF OFFICER 130435 COMPENSATION 0 X MEDICAL EQUIPMENT 5 36174 ACTUAL INVOICE COST X INFORMATION SYSTEMS 1 63760 ACTUAL INVOICE COST X EMERGENCY ROOM PROJECT 17882 ACTUAL INVOICE COST X MRI PROJECT 15908 ACTUAL INVOICE COST 0 1 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 ROME MEMORIAL HOSPITAL CLOSED THE ACUTE PHYSICAL REHABILITATION DEPARTMENT IN DECEMBER 2010 DUE TO FINANCIAL REASONS. 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 2010 990 WAS PRESENTED TO THE BOARD BY THE CFO OF THE HOSPITAL AT ITS SEPTEMBER 2011 BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C CONSISTENT WITH ROME HOSPITAL'S GIFTS, GRATUITIES AND CONFLICT OF INTEREST POLICY, THE COMPLIANCE MANAGER OF RMH HAS A CONFLICT OF INTEREST DISCLOSURE FORM COMPLETED ON AN ANNUAL BASIS BY ALL OFFICERS, DIRECTORS AND MANAGEMENT PERSONNEL. THE CEO COLLECTS AND REVIEWS THE BOARD OF TRUSTEES INTEREST DISCLOSURE FORMS ON AN ANNUAL BASIS. THE INFORMATION GATHERED ON THE DISCLOSURE IS REVIEWED AND ANY CONFLICTS ARE COMMUNICATED TO PRESIDENT/CEO AND BOARD OF TRUSTEES TO ENSURE ALL HOSPITAL TRANSACTIONS ARE COMPLETED FREE FROM OUTSIDE INFLUENCE. POTENTIAL CONFLICTS THAT MAY ARISE THROUGHOUT THE YEAR ARE BROUGHT TO THE ATTENTION OF THE COMPLIANCE OFFICER AND PRESIDENT/CEO FOR REVIEW. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 231,197. TOTAL CHANGE IN INTEREST IN FOUNDATION 32,272. CHANGE IN UNRESTRICTED INT IN FOUND 33,358. TOTAL TO FORM 990, PART XI, LINE 5: 296,827. FORM 990, PART XI, LINE 2C THE FINANCE/AUDIT COMMITTEE CONSISTES OF 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, RECOMMMENDS 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 RMH SERVICES INC 1500 N JAMES STREET ROME NY 13440 161490045 FOR PROFIT NY GREATER ROME AFFILIATES C 1.00000 ROME MEDICAL GROUP 1801 BLACK RIVER BLVD ROME NY 13440 161464822 CAPTIVE P.C. NY ROME MEMORIAL HOSPITAL C ROME MEDICAL PRACTICE 1500 N JAMES STREET ROME NY 13440 203827393 CAPTIVE P.C. NY ROME MEMORIAL HOSPITAL C 0 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 0 1