2025-10-31T15:16:05-05:00 2024-12-31 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2024-01-01 161508597 GREATER ROME AFFILIATES INC GREA 3153387021 1500 NORTH JAMES STREET ROME NY 13440 NATHAN SMITH AVP FINANCE 3153387024 2025-10-30 1 1 DESIREE M BENNETT P01263666 3154463600 2025-10-30 2024 2025-03-06 01:10:19Z ANNEMARIE CZYZ 1500 NORTH JAMES STREET ROME NY 13440 95576 0 X WWW.ROMEHEALTH.ORG X 1995 NY SUPPORT CHARITABLE EFFORTS WITH ROME MEMORIAL HOSPITAL 6 6 0 6 0 0 0 0 0 0 95527 95576 0 0 95527 95576 0 0 0 0 0 0 0 0 0 141744 143106 141744 143106 -46217 -47530 1050945 1051473 469909 517967 581036 533506 SUPPORT CHARITABLE EFFORTS OF ROME MEMORIAL HOSPITAL 0 0 116589 95576 PROMOTE AND PROVIDE HEALTHCARE SERVICES TO THE ROME COMMUNITY 116589 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 1 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 DR JOHN RESTIVO MD CHAIR 1.00 X X 0 0 0 DARLENE BURNS SECRETARY 1.00 X X 0 0 0 KRISTIN GRUNDER VICE CHAIR 1.00 X X 0 0 0 ANNEMARIE CZYZ CEO 10.00 45.00 X X 0 188660 12528 LORI KAPLAN FELICE ASST. SECRETARY 1.00 X X 0 0 0 NICOLE CHUBBUCK TREASURER 1.00 X X 0 0 0 NATHAN SMITH AVP FINANCE 5.00 50.00 X 0 144067 13095 0 332727 25623 0 0 1 0 0 95576 95576 95576 0 0 95576 20521 20521 RESERVE RMG 95576 95576 PURCHASED SERVICES 26517 26517 BANK FEES 492 492 143106 116589 26517 0 945 1473 1050000 1050000 1050945 1051473 16000 26341 453909 491626 469909 517967 X 581036 533506 581036 533506 1050945 1051473 -47530 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 3 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 474626 DUE TO 1819 BLACK RIVER BLVD. 17000 491626 X PART X, LINE 2: INCOME TAXES: GRAI 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. GRAI IS SUBJECT TO FEDERAL INCOME TAXES ON UNRELATED BUSINESS INCOME UNDER SECTION 511 OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2024 AND 2023, GRAI 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 2021 THROUGH 2024. GRAI DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. 0 0 0 0 0 0 0 0 0 ANNEMARIE CZYZ CEO 0 188660 0 0 0 0 0 8420 0 4108 0 201188 0 0 NATHAN SMITH AVP FINANCE 0 144067 0 0 0 0 0 11086 0 2009 0 157162 0 0 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. IN JUNE 2024, ANNEMARIE CZYZ BECAME AN EMPLOYEE OF RMH. FORM 990, PART VI, SECTION B, LINE 11B IN SEPTEMBER OF 2025 A MEETING WILL BE HELD PRIOR TO FILIING THE RETURN TO REVIEW THE 2024 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. PRIOR TO JUNE 2024, ANNEMARIE CZYZ WAS HIRED THROUGH A SERVICE AGREEMENT WITH SJH. ANNEMARIE CZYZ WAS HIRED BY ROME MEMORIAL HOSPITAL IN JUNE 2024. 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 1772160 2326207 1.00000 0 ROME MEDICAL PRACTICE PC 1500 N JAMES STREET ROME NY 13440 203827393 MEDICAL SERVICES NY GRA C 1885860 772951 1.00000 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0