4A (Expenses $ 31053632 including grants of $ 0) (Revenue $ 33398673)
INPATIENT CARE SERVICES, INPATIENT NURSING UNITS CONSIST OF THE FOLLOWING:INTENSIVE CARE-2ND FLOOR, MATERNITY-4TH FLOOR, 2 EAST MEDICAL/SURGICAL-2ND FLOOR, 2 NORTH MEDICAL/SURGICAL WITH CARDIAC MONITORING-2ND FLOOR, PEDIATRICS-2ND FLOOR, AND SENIOR BEHAVIORAL HEALTH- 2ND FLOOR.2021 INPATIENT DISCHARGES: 3,7212021 BIRTHS: 7262021 PATIENT DAYS: 15,114

4B (Expenses $ 5138215 including grants of $ 0) (Revenue $ 4323446)
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 12 BED INPATIENT UNIT FOR SENIOR BEHAVIORAL HEALTHCARE FACILITY. OUR RESIDENTIAL HEALTHCARE FACILITY CONSISTS OF THE FOLLOWING: LONG-TERM NURSING HOME CARE, SHORT-TERM SUB-ACUTE REHABILITATION, AND RESPITE CARE- ALL LOCATED ON THE 3RD FLOOR.2021 PATIENT DAYS = 16,1242021 OCCUPANCY PERCENTAGE = 78.88%

4C (Expenses $ 5434386 including grants of $ 0) (Revenue $ 7729836)
EMERGENCY DEPARTMENT (ED)ROME MEMORIAL HOSPITAL EMERGENCY DEPARTMENT IS A SAFETY NET FOR THE MOST VULNERABLE POPULATIONS IN THE COMMUNITY. IN 2021, APPROXIMATELY 44.80% OF THE PATIENTS TREATED WERE LISTED AS UNINSURED OR UNDER INSURED. FOR LOWER LEVEL EMERGENCY DEPARTMENT VISITS, THIS POPULATION REPRESENTED 58.10% OF THE VISITS BECAUSE MANY PRIMARY CARE PHYSICIANS DO NOT ACCEPT MEDICAID.2021 ED ADMISSIONS: 2,7562021 ED VISITS: 25,506

4D (Expenses $ 36007848 including grants of $ 0) (Revenue $ 45523144)
ALL SERVICES TO PROVIDE QUALITY, COMPASSIONATE CARE IN A SAFE ENVIRONMENT TO SERVE THE HEALTHCARE NEEDS OF THE PEOPLE OF ROME AND THE SURROUNDING COMMUNITIES.

ROME MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: ONEIDA COUNTY HEALTH DEPARTMENT (OCHD), ROME MEMORIAL HOSPITAL (RMH) AND MOHAWK VALLEY HEALTH SYSTEM (MVHS) COLLABORATED WITH KEY COMMUNITY STAKEHOLDERS THROUGHOUT 2019 TO ASSESS AND PRIORITIZE THE HEALTHCARE NEEDS OF THE COMMUNITY. THE 2019-2021 ONEIDA COUNTY COMMUNITY HEALTH ASSESSMENT (CHA/COMMUNITY SERVICE PLAN (CSP)) AND COMMUNITY HEALTH IMPROVEMENT PLAN SUMMARIZES THE HEALTH STATUS OF THE COMMUNITY AND PUBLIC HEALTH AND HOSPITAL PREVENTION AGENDA HEALTH IMPROVEMENT GOALS FOR THE RESIDENTS OF THE COUNTY OF ONEIDATHE ASSESSMENT PROCESS INVOLVED DATA ANALYSIS, DATA COLLECTION, AND COMMUNITY ENGAGEMENT. THE IDENTIFICATION OF PRIORITIES AND FOCUS AREAS WAS GUIDED BY A PARTNERSHIP OF COMMUNITY AGENCIES, ORGANIZATIONS AND GROUPS. STRATEGIC COMMUNITY PARTNERS WERE SOLICITED TO PARTICIPATE IN A COMMUNITY STAKEHOLDER CONFERENCE TO INFORM THE ASSESSMENT PROCESS AS WELL AS TO OBTAIN INPUT ON PERCEPTIONS OF HEALTH ISSUES WITHIN THE COMMUNITY, CONSIDERING SOCIAL DETERMINANTS OF HEALTH AND PROVIDING INSIGHT ON SPECIFIC ASPECTS OF HEALTH PRIORITIES AS IT RELATES TO THE NYSDOH PREVENTION AGENDA. THE COMMITTEE ALSO SOLICITED INPUT FROM THE COMMUNITY THROUGH THE USE OF AN ON-LINE SURVEY, REACHING 898 RESIDENTS. THIS COMBINATION OF RESEARCH FINDINGS WAS USED AS REFERENCES FOR THE DEVELOPMENT OF THE 2019-2021 PRIORITIES. THE INITIAL FINDINGS OF THE COMMUNITY HEALTH ASSESSMENT AND PRIORITIES WERE DISTRIBUTED TO THE PUBLIC VIA A PRESS RELEASE, ANNOUNCING THE AVAILABILITY OF THE DRAFT EXECUTIVE SUMMARY OVERVIEW ON HEALTH DEPARTMENT AND HOSPITAL WEBSITES. FEEDBACK FROM THE PUBIC WAS SOLICITED AT THE TIME. MEDIA INTERVIEWS AND PRINT WERE AVENUES FOR FURTHER COMMUNICATING THE PRIORITY AREAS TO THE PUBLIC. THE COUNTY ALSO CONDUCTED FOCUS GROUPS IN THREE DIFFERENT AREAS OF THE COUNTY, TO URBAN AND ONE RURAL. THE FOCUS GROUPS VALIDATED THE PRIORITY AREAS AND PROVIDED ADDITIONAL DEPTH INTO THE CHALLENGES RESIDENTS FACE ACCESSING HEALTHCARE SERVICES, INCLUDING PRIMARY CARE AND MENTAL HEALTH, WHICH ARE CRITICAL TO IMPACTING THE IDENTIFIED HEALTH PRIORITIES. CONSISTENT WITH THE NEW YORK STATE VALUE BASED PAYMENT ROADMAP, THE HOSPITALS AND THEIR AFFILIATED PRIMARY CARE PRACTICES COMMIT TO LEVERAGING INFORMATION TECHNOLOGY SYSTEMS TO IDENTIFY AND CLOSE CARE GAPS TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY. SPECIFICALLY ADDRESSING SCREENING RATES AND THE OPIOID CRISIS WILL HAVE A POSITIVE IMPACT ON UTILIZATION MEASURES, INCLUDING POTENTIALLY PREVENTABLE VISITS, POTENTIALLY PREVENTABLE ADMISSIONS, AND POTENTIALLY PREVENTABLE READMISSIONS.THE DATA FROM THE CHA GUIDES THE HOSPITAL IN THE DEVELOPMENT OF TACTICS TO TRANSFORM OPERATIONS IN SUPPORT OF ITS STRATEGIC PLAN. THESE TACTICS ARE ORGANIZED UNDER THE PILLARS OF FISCAL SUSTAINABILITY; CONVENIENCE, QUALITY, ACCESS; AND ENGAGEMENT.THE 2019-2021 CHNA AND COMMUNITY HEALTH IMPROVEMENT PLAN OUTLINING THE PRIORITIES IS AVAILABLE ONLINE AT WWW.ROMEHOSPITAL.ORG.

ROME MEMORIAL HOSPITAL
PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE MOHAWK VALLEY HEALTH SYSTEM (FAXTON-ST. LUKE'S HOSPITAL AND ST. ELIZABETH'S MEDICAL CENTER), THE ONEIDA COUNTY HEALTH DEPARTMENT AND COMMUNITY ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF THE POPULATIONS SERVED BY THE COUNTY'S HOSPITALS.

ROME MEMORIAL HOSPITAL
PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE MOHAWK VALLEY HEALTH SYSTEM (FAXTON-ST. LUKE'S HOSPITAL AND ST. ELIZABETH'S MEDICAL CENTER), THE ONEIDA COUNTY HEALTH DEPARTMENT AND COMMUNITY ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF THE POPULATIONS SERVED BY THE COUNTY'S HOSPITALS.

ROME MEMORIAL HOSPITAL
PART V, SECTION B, LINE 7D: THE CHNA (INCLUDING AN IMPLEMENTATION PLAN) IS AVAILABLE AT THE HOSPITAL'S WEBSITE USING THE FOLLOWING URL: HTTP://WWW.ROMEHOSPITAL.ORG/ABOUTUS/COMMUNITY_HEALTH_ASSESSMENT/COMMUNITY_HEALTH_ASSESSMENT/THE CHNA IS ALSO AVAILABLE AT ONEIDA COUNTY'S WEBSITE USING THE FOLLOWING URL: HTTP://WWW.OCGOV.NET/HEALTH/COMMUNITY-HEALTH-ASSESSMENT

ROME MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: ROME MEMORIAL HOSPITAL ADDRESSES THE SIGNIFICANT HEALTH CARE NEEDS OF THE COMMUNITY THROUGH ITS CONTINUUM OF HEALTHCARE SERVICES/PROGRAMS AND RELATIONSHIPS WITH COMMUNITY PARTNERS. THE COMMUNITY HOSPITAL HAS 130 LICENSED ACUTE CARE BEDS, AN 80-BED SKILLED NURSING FACILITY, A BROAD ARRAY OF OUTPATIENT SERVICES AND THREE ARTICLE 28 PRIMARY CARE PRACTICES. IN ADDITION, THE HOSPITAL PROVIDES ESSENTIAL ACCESS TO PRIMARY CARE AND SPECIALTY PHYSICIAN SERVICES THROUGH TWO AFFILIATED CAPTIVE PCS.THE DATA FROM THE CHA GUIDES THE HOSPITAL IN THE DEVELOPMENT OF TACTICS TO TRANSFORM OPERATIONS IN SUPPORT OF ITS STRATEGIC PLAN. THESE TACTICS ARE ORGANIZED UNDER THE PILLARS OF FISCAL SUSTAINABILITY; CONVENIENCE, QUALITY, ACCESS; AND ENGAGEMENT.UNMET COMMUNITY NEEDS ARE DUE TO A SHORTAGE OF PROVIDERS AND LIMITED FINANCIAL RESOURCES.

PART V, SECTION B, LINE 20A:
ROME MEMORIAL HOSPITAL (RMH) DOES NOT PURSUE EXTRAORDINARY COLLECTION ACTIVITIES, INCLUDING LEGAL ACTION, TO OBTAIN PAYMENT FOR CARE. RMH DOES NOT SELL AN INDIVIDUAL'S DEBT TO ANOTHER PARTY OR REPORT ADVERSE INFORMATION ABOUT THE INDIVIDUAL TO CREDIT AGENCIES. RMH DOES NOT DEFER, DENY OR REQUIRE PAYMENT PROVIDING MEDICAL SERVICES.

PART I, LINE 6A:
THE COMBINED ONEIDA COUNTY COMMUNITY HEALTH ASSESSMENT (CHA)/COMMUNITY SERVICE PLAN (CSP)) AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) IS POSTED ON ROME MEMORIAL HOSPITAL'S WEBSITE AT WWW.ROMEHOSPITAL.ORG.

PART I, LINE 7:
FINANCIAL ASSISTANCE AT COST (7A) AND UNREIMBURSED MEDICAID (7B) 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. OTHER BENEFITS (7E & 7F) WERE CALCULATED BY DETERMINING ACTUAL COSTS AND ACTUAL REVENUE PER EVENT.THE MAIN SOURCE OR GUIDE OF HOW CALCULATIONS WERE DETERMINED WAS BY UTILIZING THE WORKSHEETS PROVIDED BY THE IRS AND THEN ADJUSTING ACCORDING TO ROME HOSPITAL SPECIFICS (IE. USING ACTUAL COSTS VS. COST TO CHARGE RATIO AS MENTIONED ABOVE).

PART I, LN 7 COL(F):
PERCENT OF TOTAL EXPENSE IS CALCULATED BY USING THE DENOMINATOR OF THE TOTAL FUNCTIONAL EXPENSES LESS BAD DEBT EXPENSE OF $3,393,841 (PER AUDITED FINANCIAL STATEMENTS).

PART II, COMMUNITY BUILDING ACTIVITIES:
ROME MEMORIAL HOSPITAL PARTICIPATES IN NUMEROUS COMMUNITY COMMITTEES INVOLVED IN ENHANCING HEALTHCARE OUTCOMES THROUGH PREVENTION, EARLY DETECTION AND INTERVENTION AS WELL AS EMERGENCY PREPAREDNESS ACTIVITIES TO ENSURE A COORDINATED RESPONSE IN AN EVENT OF A DISASTER. HOSPITAL EXPERTS ARE CALLED UPON TO PARTICIPATE IN MULTIPLE INITIATIVES TO ADDRESS ISSUES, SUCH AS DOMESTIC VIOLENCE, TEENAGE PREGNANCY, AND SUBSTANCE ABUSE.RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO ENHANCE ACCESS TO CARE IS ONE OF THE HOSPITAL'S MOST SIGNIFICANT INVESTMENTS IN COMMUNITY BUILDING ACTIVITIES. WITH EXISTING PROVIDER SHORTAGES, MANY PRACTICES ARE NOT ACCEPTING NEW PATIENTS AND SEVERAL PRIMARY CARE PHYSICIANS WITH LARGE PATIENT PANELS ARE NEARING RETIREMENT, WHICH WILL ONLY EXACERBATE THE PROBLEM. THE HOSPITAL RECRUITED SEVERAL ADVANCED PRACTICE PROVIDERS AND PHYSICIANS TO EXPAND LOCAL ACCESS TO CARE.ROME MEMORIAL HOSPITAL IS A CLINICAL SITE FOR ALLIED HEALTH PROFESSIONALS AND AN AFFILIATED CLINICAL SITE OF NEW YORK MEDICAL COLLEGE NEW YORK MEDICAL COLLEGE TO HELP DEVELOP THE NEXT GENERATION OF PROVIDERS. THE HOSPITAL IMPLEMENTED TNA TO CNA WORKFORCE DEVELOPMENT PROGRAMS TO CLOSE STAFFING GAPS IN ITS SKILLED NURSING FACILITY TO ENSURE SAFE STAFFING RATIOS FOR ITS RESIDENTS.IN OCTOBER 2021, THE HOSPITAL BROKE GROUND ON A NEW $11.4 MILLION PHYSICIAN CENTER ON ITS MAIN CAMPUS TO BRING TOGETHER PRIMARY CARE, SPECIALTY CARE, TESTING AND PHARMACY IN ONE CONVENIENT LOCATION TO EXPAND ACCESS TO CARE. THE NEW CENTER IS EXPECTED TO OPEN IN EARLY FALL 2022 WITH 41 EXAM AND PROCEDURE ROOMS.THE HOSPITAL ALSO BECAME A NATIONALLY ACCREDITED COMPREHENSIVE BARIATRIC CENTER TO IMPROVE LOCAL ACCESS TO SURGICAL AND MEDICAL WEIGHT LOSS PROGRAMS FOR THOSE WHO STRUGGLE WITH ACHIEVING A HEALTHY WEIGHT THROUGH DIET AND EXERCISE ALONE. OBESITY AND OVERWEIGHT ARE CURRENTLY THE SECOND LEADING PREVENTABLE CAUSE OF DEATH IN THE UNITED STATES AND MAY SOON OVERTAKE TOBACCO AS THE LEADING CAUSE OF DEATH. MORE THAN 35% OF THE COUNTY'S RESIDENTS ARE OBESE.

PART III, LINE 2:
BAD DEBT EXPENSE IS CALCULATED BASED ON THE TOTAL BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS. FOR 2021, TOTAL BAD DEBT IS $3,393,841. THE RATIO OF PATIENT CARE COST TO CHARGES FROM THE INSTITUTIONAL COST REPORT IS THEN APPLIED TO THE TOTAL BAD DEBT. FOR 2021, THAT PERCENTAGE IS 25.92%. THE CALCULATED AMOUNT IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS.

PART III, LINE 3:
TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, THE TOTAL PERCENTAGE OF FINANCIAL ASSISTANCE PROVIDED TO PATIENTS IS APPLIED TO THE CALCULATED BAD DEBT EXPENSE. FOR 2021, THE TOTAL PERCENTAGE OF FINANCIAL AID PROVIDED IS 9.38%. APPLYING THAT PERCENTAGE AGAINST THE CALCULATED BAD DEBT EXPENSE IN PART III LINE 2 RESULTS IN THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTED TO FINANCIAL AID ELIGIBLE PATIENTS.

PART III, LINE 4:
SEE AUDITED FINANCIAL STATEMENTS PAGES 10 THROUGH 14 FOR CURRENT FOOTNOTE LANGUAGE THAT DESCRIBES BAD DEBT. PART III, LINE 6; COSTING METHODOLOGY AND SOURCE:2021 ICR EXHIBIT 46 AND TENTATIVE MEDICARE SETTLEMENT RATES

PART VI, LINE 2:
LINE 2 - NEEDS ASSESSMENT:IN ADDITION TO THE FORMAL CHNA REPORTED IN PART V, SECTION B, ROME MEMORIAL HOSPITAL CONTINUALLY ASSESSES THE COMMUNITY'S NEEDS THROUGH ONGOING ANALYSIS OF AVAILABLE INTERNAL AND EXTERNAL DATA AND PARTICIPATION IN COMMUNITY COMMITTEES AND ORGANIZATIONS THAT REPRESENT A BROAD SEGMENT OF THE POPULATION. IN ADDITION, THE HOSPITAL ENCOURAGES COMMUNITY INPUT THROUGH ITS WEBSITE. INSIGHTS ARE ALSO GATHERED FROM MONITORING SOCIAL MEDIA.

PART VI, LINE 3:
"LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:TO ENSURE THAT PATIENTS ARE AWARE OF THE FINANCIAL ASSISTANCE PROGRAM, PATIENTS ARE NOTIFIED THE FOLLOWING WAYS:- THE PLAIN LANGUAGE SUMMARY OF THE POLICY IS INCLUDED IN THE PATIENT ADMISSION PACKET- SIGNAGE IS LOCATED AT ALL INTAKE AREAS INCLUDING OFF-SITE CLINICS. THESE AREAS HAVE PAPER COPIES AVAILABLE TO THE PUBLIC IN PERSON AND BY MAIL.- ALL BILLING STATEMENTS AND COLLECTION LETTERS NOTIFY PATIENTS ON HOW TO OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE VIA PHONE OR INTERNET.- INFORMATION IS AVAILABLE ON THE HOSPITAL'S WEBSITE WITH THE LINK TO ""FINANCIAL ASSISTANCE"" ACCESSIBLE FROM MULTIPLE PAGES"

PART VI, LINE 7, REPORTS FILED WITH STATES
NY

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 SOCIOECONOMICS OF THE COMMUNITY. THE MEDIAN HOUSEHOLD INCOME FOR ONEIDA COUNTY IS LOWER THAN THE STATE AVERAGE AND OVER 16% OF THE POPULATION LIVES BELOW THE POVERTY LINE. ALTHOUGH PEOPLE MAY HAVE INSURANCE, THEIR OUT-OF-POCKET COSTS ARE HIGH BECAUSE EMPLOYERS HAVE RAISED THEIR DEDUCTIBLES OR CO-PAYMENTS, OR REDUCED WHAT THEIR PLANS COVER.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, OUR HIGHEST VOLUME PAYER. ROME MEMORIAL HOSPITAL OFFERS DISCOUNTS TO THE UNINSURED/UNDERINSURED WHOSE INCOME IS UP TO 300% OF THE FEDERAL POVERTY LEVEL.BECAUSE LACK OF AWARENESS IS ONE OF THE BIGGEST BARRIERS, RMH PROVIDES INFORMATION ABOUT AVAILABLE PROGRAMS AT HEALTH FAIRS AND OTHER OUTREACH ACTIVITIES.CHANGES (ACTUAL OR POTENTIAL) IMPACTING COMMUNITY HEALTH, PROVISION OF CHARITY CARE, AND ACCESS TO SERVICES: REIMBURSEMENTS THAT FAIL TO KEEP PACE WITH RISING EXPENSES AND THE CONTINUED GROWTH IN UNCOMPENSATED CARE ARE SIGNIFICANT CHALLENGES THAT NEW YORK'S HOSPITALS FACE, INCLUDING RMH. OTHER CHALLENGES INCLUDE THE ESCALATION OF COSTS FOR DRUGS DUE TO INFLATION AND HAVING TO FIND ALTERNATE SUPPLIERS BECAUSE OF MANUFACTURER PRODUCTION SHORTAGES, SERVICES AND BAD DEBT, AND INVESTMENTS REQUIRED TO COMPLY WITH MANDATES. HERE ARE JUST A FEW EXAMPLES OF OUR CHALLENGES:UNCOMPENSATED CARE: THE COST OF FREE SERVICES PROVIDED TO OUR COMMUNITY REMAINS HIGH WITH THE RISE IN HIGH-DEDUCTIBLE PLANS AND THE APPROXIMATELY 7% OF RESIDENTS WHO ARE UNINSURED. IN 2021, ROME MEMORIAL HOSPITAL'S BAD DEBT AND CHARITY CARE TOTALED $4.1 MILLION.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 FROM 19,000 IN 2006 TO 25,692 IN 2021. 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 CHALLENGES, 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.TRANSITION TO VALUE BASED PAYMENTS: TO PREPARE FOR NEW PAYMENT MODELS THAT REWARD QUALITY AND EFFICIENCY, PROVIDERS NEED TO MAKE INVESTMENTS IN SOPHISTICATED ANALYTICS TO MANAGE RISK AND CARE MANAGERS TO BETTER COORDINATE CARE.

PART VI, LINE 4:
LINE 4 - COMMUNITY INFORMATION:ROME MEMORIAL HOSPITAL AND ITS AFFILIATES PROVIDE HEALTHCARE SERVICES TO THE RESIDENTS OF ROME AND THE SURROUNDING RURAL COMMUNITIES IN ONEIDA AND LEWIS COUNTIES. THE TWO-COUNTY REGION ENCOMPASSES MORE THAN 259,000 PEOPLE. THE HOSPITAL DRAWS 75% OF ITS INPATIENT DISCHARGES FROM THE FOLLOWING ZIP CODES: ROME, BOONVILLE, UTICA, CAMDEN, TABERG, LEE CENTER, BLOSSVALE AND WHITESBORO. MORE THAN 145,000 PEOPLE RESIDE IN RH'S PRIMARY SERVICE AREA. PATIENTS FROM NEW HARTFORD, HOLLAND PATENT, CLINTON AND REMSEN COMPRISE THE NEXT LARGEST SOURCE OF INPATIENT DISCHARGES.ROME MEMORIAL HOSPITAL AND ITS AFFILIATES SERVE AS A SAFETY NET FOR A REGION THAT IS SOCIOECONOMICALLY CHALLENGED AND AGING. MORE THAN 21 PERCENT OF THE POPULATION IS 65 AND OLDER WITH THE NUMBER OF SENIORS PROJECTED TO INCREASE BY 10 PERCENT IN THE NEXT FIVE YEARS. MORE THAN 20% OF HOUSEHOLDS HAVE INCOME LESS THAN $25,000. LESS THAN 20% OF THE POPULATION HAS A BACHELOR'S DEGREE OR GREATER, COMPARED TO MORE THAN 30% NATIONALLY.AVERAGE HOUSEHOLD INCOME FOR THE SERVICE AREA IS 27% LESS THAN THE NATIONAL AVERAGE.THE POPULATION IS 88% WHITE NON-HISPANIC, 3.9% BLACK NON-HISPANIC AND 4.5% HISPANIC.ROME MEMORIAL HOSPITAL IS THE ONLY HOSPITAL IN THE CITY OF ROME. THERE ARE TWO HOSPITALS IN SOUTHERN ONEIDA COUNTY (ST. ELIZABETH MEDICAL CENTER AND FAXTON-ST. LUKE'S HEALTHCARE

PART VI, LINE 5:
LINE 5 - PROMOTION OF COMMUNITY HEALTH:ADDITIONAL WAYS THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE:1. ROME MEMORIAL HOSPITAL PROVIDES EMERGENCY SERVICES TO EVERYONE REGARDLESS OF ABILITY TO PAY.2. THE HOSPITAL'S INDEPENDENT GOVERNING BODY IS COMPRISED OF INDIVIDUALS WHO RESIDE OR WORK IN THE PRIMARY SERVICE AREA TO REPRESENT THE INTERESTS OF THE COMMUNITY.3. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY.4. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE CARE, EXPAND FACILITIES, RECRUIT STAFF AND ADVANCE MEDICAL TRAINING AND COMMUNITY EDUCATION.IN 2021, ROME MEMORIAL HOSPITAL CONTINUED TO DEMONSTRATE ITS RESPONSIVENESS AS A CRITICAL PUBLIC SAFETY RESOURCE IN THE MIDST OF THE COVID-19 PANDEMIC. THE HOSPITAL PARTNERED WITH THE DEPARTMENT OF HEALTH AND OTHER LOCAL HOSPITALS TO PROTECT OUR COMMUNITY THROUGH PUBLIC HEALTH EDUCATION, MANAGING HOSPITALIZATION SURGES WITH CONSTRAINED RESOURCES, AND VACCINATING ELIGIBLE HEALTHCARE WORKERS AND COMMUNITY MEMBERS. YEARS OF PLANNING AND DRILLS ENABLED THE HOSPITAL SYSTEM TO MEET THE COMMUNITY'S NEEDS AS THEY EVOLVED

PART VI, LINE 6:
"LINE 6 - AFFILIATED HEALTH CARE SYSTEM:ROME MEMORIAL HOSPITAL, INC. (THE ""HOSPITAL"") IS A NEW YORK STATE NOT-FOR-PROFIT CORPORATION AND TAX EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (""IRC""), AND IS PART OF THE FOLLOWING CORPORATE STRUCTURE: GREATER ROME AFFILIATES, INC. (""GRA""), A NEW YORK STATE NOT-FOR-PROFIT CORPORATION, TAX EXEMPT UNDER SECTION 501(C)(3) OF THE IRC, IS THE SOLE CORPORATE MEMBER, AND THEREFORE, THE ""PARENT"" OF THE HOSPITAL, AS WELL AS ROME MEMORIAL PROPERTIES, INC., A NEW YORK STATE NOT-FOR-PROFIT CORPORATION, TAX EXEMPT UNDER SECTION 501(C)(3) OF THE IRC. GRA IS ALSO THE SOLE SHAREHOLDER OF RMH SERVICES, INC., A NEW YORK STATE BUSINESS CORPORATION, WHICH WAS ESTABLISHED TO UNDERTAKE CERTAIN FOR-PROFIT BUSINESS ACTIVITIES AND WHICH HAS AN EQUITY OWNERSHIP INTEREST IN, AND IS A MEMBER OF, THREE NEW YORK STATE LIMITED LIABILITY COMPANIES: 1819 BLACK RIVER ASSOCIATES, LLC; CHESTNUT COMMONS, LLC; AND RMH RETAIL PHARMACY, LLC. MEMBERS OF THE HOSPITAL'S BOARD OF TRUSTEES AND ADMINISTRATIVE STAFF HAVE OVERLAPPING RESPONSIBILITIES ON THE BOARDS OF THE AFFILIATED CORPORATIONS TO ENSURE THAT THE HOSPITAL'S BEST INTERESTS ARE BEING SERVED. ROME MEMORIAL HOSPITAL FOUNDATION, INC., A NEW YORK STATE NOT-FOR-PROFIT CORPORATION, TAX EXEMPT UNDER SECTION 501(C)(3) OF THE IRC, IS A SEPARATE CORPORATION ESTABLISHED FOR THE SOLE PURPOSE OF CONDUCTING FUND RAISING ACTIVITIES ON BEHALF OF THE HOSPITAL, INCLUDING THE RECEIPT OF GIFTS AND BEQUESTS ON BEHALF OF THE HOSPITAL, INVESTING SUCH ASSETS, AND TRANSFERRING THEM TO THE HOSPITAL IN SUPPORT OF ITS MISSION. IT IS GOVERNED BY A SEPARATE BOARD OF DIRECTORS, WHICH HAS AMONG ITS MEMBERS HOSPITAL TRUSTEES AND MEMBERS OF THE HOSPITAL'S MEDICAL STAFF.THE SYSTEM ALSO INCLUDES TWO CAPTIVE PROFESSIONAL CORPORATIONS, INCLUDING ROME MEDICAL GROUP, P.C., A MULTI-PHYSICIAN PRIMARY CARE PRACTICE, AND ROME MEDICAL PRACTICE, P.C., A MULTI-PHYSICIAN, SPECIALTY GROUP. THE PCS ARE THE VEHICLES THROUGH WHICH PHYSICIANS ARE EMPLOYED TO SERVE THE COMMUNITY. IN TODAY'S ENVIRONMENT, MANY PHYSICIANS PREFER TO BE EMPLOYED VS. GOING OUT IN PRIVATE PRACTICE."