2024-11-08T15:16:41-06:00 2023-12-31 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2023-01-01 161508597 GREATER ROME AFFILIATES INC GREA 3153387021 1500 NORTH JAMES STREET ROME NY 13440 NATHAN SMITH AVP FINANCE 3153387024 2024-11-02 1 1 PATRICK CAPELLA P01359200 3154463600 2024-11-02 2023 2024-10-15 13:58:12Z ANNEMARIE CZYZ 1500 NORTH JAMES STREET ROME NY 13440 95527 0 X ROMEHEALTH.ORG X 1995 NY SUPPORT CHARITABLE EFFORTS WITH ROME MEMORIAL HOSPITAL 6 6 0 6 0 0 0 0 0 0 95527 95527 0 0 95527 95527 0 0 0 0 0 0 0 0 0 143874 141744 143874 141744 -48347 -46217 1050401 1050945 423148 469909 627253 581036 SUPPORT CHARITABLE EFFORTS OF ROME MEMORIAL HOSPITAL 0 0 116717 95527 PROMOTE AND PROVIDE HEALTHCARE SERVICES TO THE ROME COMMUNITY 116717 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X NATHAN SMITH -ROME MEMORIAL HOSPITAL 3153387597 1500 NORTH JAMES STREET ROME NY 13440 X X LYNN G REESE ASST. VP 1.00 X X 0 0 0 JOHN RESTIVO VICE PRESIDENT 1.00 X X 0 0 0 DARLENE BURNS SECRETARY 1.00 X X 0 0 0 KRISTIN GRUNDER ASST. SECRETARY 1.00 X X 0 0 0 ANKUR DESAI PRESIDENT 1.00 X X 0 0 0 RYAN O'SHAUGHNESSY ASST. TREASURER 1.00 X X 0 0 0 ANNEMARIE CZYZ CEO 10.00 45.00 X 0 0 0 NATHAN SMITH AVP FINANCE 5.00 50.00 X 0 0 0 0 0 0 0 0 0 0 0 95527 95527 95527 0 0 95527 20712 20712 RESERVE RMG 95527 95527 PURCHASED SERVICES 25027 25027 BANK FEES 478 478 141744 116717 25027 0 401 945 1050000 1050000 1050401 1050945 19496 16000 403652 453909 423148 469909 X 627253 581036 627253 581036 1050401 1050945 -46217 0 X X 0 1 X 1 0 X X 1 ROME MEMORIAL HOSPITAL 161471634 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A PAGE 5 SECTION D LINE GRAI IS THE SOLE CORPORATE MEMBER AND, THEREFORE, THE PARENT OF ROME MEMORIAL HOSPITAL, THE SUPPORTED ORGANIZATION. THE BOARD OF TRUSTEES OF ROME MEMORIAL HOSPITAL, THE SUPPORTED ORGANIZATION, HAS A SIGNIFICANT VOICE IN THEIR ORGANIZATION'S INVESTMENT POLICIES AND IN DIRECTING THE USE OF THE ORGANIZATION'S INCOME OR ASSETS AT ALL TIMES DURING THE TAX YEAR. SCHEDULE A PAGE 5 SECTION E LINE 3A GRAI IS THE SOLE CORPORATE MEMBER, AND THEREFORE, THE PARENT OF ROME MEMORIAL HOSPITAL, THE SUPPORTED ORGANIZATION. AS DESCRIBED IN THE GRAI BYLAWS ARTICLE V, SECTION 7 POWERS AND DUTIES OF THE BOARD OF DIRECTORS. THE ANNUAL MEETING OF THE SOLE MEMBER SHALL BE HELD EACH YEAR AT A DATE, TIME AND PLACE DESIGNATED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER FOR THE PURPOSE OF THE APPOINTMENT OF TRUSTEES BY THE SOLE MEMBER AND TRANSACTING OTHER BUSINESS AS MAY COME BEFORE SAID BOARD OF DIRECTORS. SCHEDULE A PAGE 5 SECTION E LINE 3B GRAI IS THE SOLE CORPORATE MEMBER AND THEREFORE, THE PARENT OF ROME MEMORIAL HOSPITAL, THE SUPPORTED ORGANIZATION. AS DESCRIBED IN THE GRAI BYLAWS ARTICLE V, SECTION 7 POWERS AND DUTIES OF THE BOARD OF DIRECTORS. THE ANNUAL MEETING OF THE SOLE MEMBER SHALL BE HELD EACH YEAR AT A DATE, TIME AND PLACE DESIGNATED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER FOR THE PURPOSE OF THE APPOINTMENT OF TRUSTEES BY THE SOLE MEMBER AND TRANSACTING OTHER BUSINESS AS MAY COME BEFORE SAID BOARD OF DIRECTORS. 0 INVESTMENTS - OTHER 1050000 1050000 DUE TO ROME MEMORIAL HOSPITAL 436909 DUE TO 1819 BLACK RIVER BLVD. 17000 453909 X PART X, LINE 2: INCOME TAXES: GRAI, THE HOSPITAL AND PROPERTIES ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. GRAI, THE HOSPITAL AND PROPERTIES ARE SUBJECT TO FEDERAL INCOME TAXES ON UNRELATED BUSINESS INCOME UNDER SECTION 511 OF THE INTERNAL REVENUE CODE. RMH SERVICES, INC. AND ITS CONSOLIDATED SUBSIDIARIES, 1819 BLACK RIVER ASSOCIATES, LLC, CHESTNUT COMMONS, LLC AND RMH RETAIL PHARMACY, LLC; ROME MEDICAL GROUP,P.C., AND ROME MEDICAL PRACTICE, P.C. ARE FOR-PROFIT ENTITIES SUBJECT TO FEDERAL AND STATE INCOME TAXES. AS OF DECEMBER 31, 2023 AND 2022, THE SYSTEM 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 AUTHORITITES ARE 2020 THROUGH 2023 THE SYSTEM DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PREFORMED BY OR UNDER DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES TO ANNEMARIE CZYZ AS CEO. FORM 990, PART VI, SECTION B, LINE 11B IN SEPTEMBER OF 2024 A MEETING WILL BE HELD PRIOR TO FILIING THE RETURN TO REVIEW THE 2023 990. 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 CEO/PRESIDENT 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 MANAGER AND CEO/PRESIDENT FOR REVIEW. FORM 990, PART VI, SECTION C, LINE 18 990 FORMS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST FORM 990, PART VII: IN 990 PART VII, ANNEMARIE CZYZ IS LISTED AS AN OFFICER AND ASSUMED THE DUTIES OF CEO. THERE IS NO COMPENSATION LISTED AS THE INDIVIDUAL WAS HIRED THROUGH A SERVICE AGREEMENT WITH SJH (COMPENSATION THROUGH THE AGREEMENT TO ANNEMARIE CZYZ WAS $508,230). ANNEMARIE CZYZ IS NOT CONSIDERED A COMMON LAW EMPLOYEE. FORM 990 PART XII LINE 2C THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR ROME MEMORIAL HOSPITAL 1500 NORTH JAMES STREET ROME NY 13440 161471634 HOSPITAL NY 501(C)(3) 3 N/A 0 ROME MEMORIAL PROPERTIES 1500 NORTH JAMES STREET ROME NY 13440 161492003 SUPPORT HOSPITAL ACTIVITIES NY 501(C)(3) 12A,I GRA 0 RMH SERVICES 1500 N JAMES STREET ROME NY 13440 161490045 HOLDING COMPANY NY GRA C 198591 4047844 1.00000 0 ROME MEDICAL PRACTICE PC 1500 N JAMES STREET ROME NY 13440 203827393 MEDICAL SERVICES NY GRA C 2707717 815872 1.00000 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0