Civic Intelligence

Greater Rome Affiliates Inc

EIN 16-1508597 • 501(c)3 • Rome, NY

Profile

Support charitable efforts of rome memorial hospital

1500 North James StreetRome, NY 13440

romehospital.org

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

83rd percentile

0.49x

Higher debt load relative to assets than 83% of similar nonprofits.

501(c)3 • $1M-$5M nonprofits • Source year 2024

Liabilities / Revenue

97th percentile

5.42x

Higher debt load relative to revenue than 97% of similar nonprofits.

501(c)3 • $1M-$5M nonprofits • Source year 2024

Net Margin

7th percentile

-50%

Higher net margin than 7% of similar nonprofits.

501(c)3 • $1M-$5M nonprofits • Source year 2024

Top Officer Pay

Score unavailable

No value available

No filing with officer rows is available for this organization yet.

Asset Growth

38th percentile

0.1%

Faster asset growth than 38% of similar nonprofits.

501(c)3 • $1M-$5M nonprofits • Annualized from 2023 to 2024

Revenue Growth

35th percentile

0.1%

Faster revenue growth than 35% of similar nonprofits.

501(c)3 • $1M-$5M nonprofits • Annualized from 2023 to 2024

Balance Sheet
Liabilities / Assets83rd percentile

Assets

Up

$1,051,473

Up $528 (+0.1%) from 2023

Liabilities

Up

$517,967

Up $48,058 (+10%) from 2023

Net Assets

Down

$533,506

Down $47,530 (-8.2%) from 2023

Operations
Liabilities / Revenue97th percentileNet Margin7th percentile

Revenue

Up

$95,576

Up $49 (+0.1%) from 2023

Expenses

Up

$143,106

Up $1,362 (+1.0%) from 2023

Net Income

Down

-$47,530

Down $1,313 (-2.8%) from 2023

Trend Graphs

Balance Sheet Trend

Asset Growth38th percentile

Grouped bars show assets, liabilities, and net assets across loaded filings.

$6.0M$4.0M$2.0M$0Assets 2011: $4,147,572Liabilities 2011: $70,870Net Assets 2011: $4,076,7022011Assets 2012: $4,213,034Liabilities 2012: $123,054Net Assets 2012: $4,089,9802012Assets 2013: $4,271,658Liabilities 2013: $164,625Net Assets 2013: $4,107,0332013Assets 2014: $4,324,395Liabilities 2014: $213,597Net Assets 2014: $4,110,7982014Assets 2015: $4,339,853Liabilities 2015: $243,345Net Assets 2015: $4,096,5082015Assets 2016: $1,941,925Liabilities 2016: $267,343Net Assets 2016: $1,674,5822016Assets 2017: $1,562,854Liabilities 2017: $295,793Net Assets 2017: $1,267,0612017Assets 2018: $1,121,116Liabilities 2018: $317,677Net Assets 2018: $803,4392018Assets 2019: $1,083,681Liabilities 2019: $356,130Net Assets 2019: $727,5512019Assets 2020: $1,068,453Liabilities 2020: $353,630Net Assets 2020: $714,8232020Assets 2021: $1,050,754Liabilities 2021: $375,154Net Assets 2021: $675,6002021Assets 2022: $1,050,401Liabilities 2022: $423,148Net Assets 2022: $627,2532022Assets 2023: $1,050,945Liabilities 2023: $469,909Net Assets 2023: $581,0362023Assets 2024: $1,051,473Liabilities 2024: $517,967Net Assets 2024: $533,5062024

Highlighted filing

2024

Assets$1,051,473
Liabilities$517,967
Net Assets$533,506
Open 2024 Filing

Operations Trend

Revenue Growth35th percentile

Revenue, expenses, and net income by year, with the latest filing highlighted.

$4.0M$2.0M$0-$2.0M-$4.0MRevenue 2011: $88,754Expenses 2011: $62,554Net Income 2011: $26,2002011Revenue 2012: $75,930Expenses 2012: $62,652Net Income 2012: $13,2782012Revenue 2013: $61,902Expenses 2013: $44,849Net Income 2013: $17,0532013Revenue 2014: $47,312Expenses 2014: $43,547Net Income 2014: $3,7652014Revenue 2015: $31,890Expenses 2015: $46,180Net Income 2015: -$14,2902015Revenue 2016: $95,714Expenses 2016: $2,517,640Net Income 2016: -$2,421,9262016Revenue 2017: $95,571Expenses 2017: $503,092Net Income 2017: -$407,5212017Revenue 2018: $95,568Expenses 2018: $559,190Net Income 2018: -$463,6222018Revenue 2019: $90,045Expenses 2019: $165,933Net Income 2019: -$75,8882019Revenue 2020: $95,581Expenses 2020: $108,309Net Income 2020: -$12,7282020Revenue 2021: $95,527Expenses 2021: $134,750Net Income 2021: -$39,2232021Revenue 2022: $95,527Expenses 2022: $143,874Net Income 2022: -$48,3472022Revenue 2023: $95,527Expenses 2023: $141,744Net Income 2023: -$46,2172023Revenue 2024: $95,576Expenses 2024: $143,106Net Income 2024: -$47,5302024

Highlighted filing

2024

Revenue$95,576
Expenses$143,106
Net Income-$47,530
Open 2024 Filing

Filings

Most recent year

2024 • Form 990XML pending. An XML filing is linked for this year, but detailed extraction is still pending.

Open filing
Assets
$1,051,473
Liabilities
$517,967
Net assets
$533,506
Revenue
$95,576
Expenses
$143,106
Net income
-$47,530
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2024XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$1.05$0.52$0.53$0.10$0.14$0.05
2023Summary only. Only limited summary data is available for this year.$1.05$0.47$0.58$0.10$0.14$0.05
2022Summary only. Only limited summary data is available for this year.$1.05$0.42$0.63$0.10$0.14$0.05
2021Facts available. Structured filing facts are available, but richer extracted sections are limited.$1.05$0.38$0.68$0.10$0.13$0.04
2020XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$1.07$0.35$0.71$0.10$0.11$0.01
2019Summary only. Only limited summary data is available for this year.$1.08$0.36$0.73$0.09$0.17$0.08
2018XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$1.12$0.32$0.80$0.10$0.56$0.46
2017Summary only. Only limited summary data is available for this year.$1.56$0.30$1.27$0.10$0.50$0.41
2016Facts available. Structured filing facts are available, but richer extracted sections are limited.$1.94$0.27$1.67$0.10$2.52$2.42
2015Detailed filing. Detailed filing data is available for this year.$4.34$0.24$4.10$0.03$0.05$0.01
2014Detailed filing. Detailed filing data is available for this year.$4.32$0.21$4.11$0.05$0.04$0.00
2013Detailed filing. Detailed filing data is available for this year.$4.27$0.16$4.11$0.06$0.04$0.02
2012Summary only. Only limited summary data is available for this year.$4.21$0.12$4.09$0.08$0.06$0.01
2011Summary only. Only limited summary data is available for this year.$4.15$0.07$4.08$0.09$0.06$0.03
Latest Detailed Filing

The latest 2024 filing currently has linked XML that has not been fully parsed yet. Showing the latest detailed filing from 2021 below.

Jump To
Filing Snapshot
Filing Period
Jan 1, 2021 to Dec 31, 2021
Signed
Oct 26, 2022
Return Version
2021v4.2
Gross Receipts
$95,527
Mission and Program Overview

Mission

Support charitable efforts of rome memorial hospital

Support charitable efforts with rome memorial hospital

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$18,453$754▼ $17,699
Total Assets$1,068,453$1,050,754▼ $17,699
Other Assets Total$1,050,000$1,050,000→ $0
Liabilities
Other Liabilities$336,728$359,079▲ $22,351
Accounts Payable and Accrued Expenses$16,902$16,075▼ $827
Total Liabilities$353,630$375,154▲ $21,524
Net Assets / Fund Balance
Net Assets Without Donor Restrictions$714,823$675,600▼ $39,223
Total Net Assets Fund Balance$714,823$675,600▼ $39,223
Total Liabilities and Net Assets / Fund Balance$1,068,453$1,050,754▼ $17,699

Asset Categories

AssetBook ValueDepreciationBasis
Other Assets Org$1,050,000--
Compensation and Service Providers
Top Officer PayScore unavailable

Board Members and Trustees

NameTitle
Ankur DesaiPresident
John RestivoVice President
Kristin GrunderAsst. Secretary
RYAN O'SHAUGHNESSYAsst. Treasurer
Lynn G ReeseAsst. VP
Darlene BurnsSecretary
Julie Grow DentonTreasurer
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$95,527
Other Revenue
$0
Change in Net Assets
$-39,223
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$134,750
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Accounting$16,302--$16,302
Other Expenses$445$22,351-$445
Fees for Services Legal$125--$125
Total Functional Expenses$112,399$22,351$0$134,750
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Due to Rome Memorial Hospital$342,079
Due to 1819 Black River Blvd.$17,000
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section B, Line 11B

“In october of 2022 a meeting will be held prior to filiing the return to review the 2021 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”

Filing and Contact Details

Filer

Filer Name
Greater Rome Affiliates Inc
EIN
16-1508597
Phone
3153387021
Address
1500 NORTH JAMES STREET, ROME, NY 13440

Signing Officer

Name
Dewey Rowlands
Title
CFO/VP Finance
Phone
3153387024
Signed
2022-10-26
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Annemarie Czyz
Formed
1995
Legal Domicile
Ny
Voting Board Members
7
Independent Board Members
7
Employees
0
Volunteers
7

Preparer

Firm
Fust Charles Chambers Llp
Address
5784 WIDEWATERS PARKWAY, SYRACUSE, NY 13214
Preparer
Patrick Capella
Phone
3154463600
Supplemental Narrative

Additional Explanations

Form 990 Part XII Line 2C

“The organization has not changed either its oversight process or selection process during the tax year”

Financial Statement Notes

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., 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, 2021 and 2020, 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 2018 through 2021 the system does not anticipate that the total unrecognized tax benefits will change in the next 12 months.”

Raw XML AppendixShowing 400 of 430 raw XML fields

This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

Path#Value
IRS990/AccountantCompileOrReviewInd00
IRS990/AccountsPayableAccrExpnssGrp/BOYAmt016902
IRS990/AccountsPayableAccrExpnssGrp/EOYAmt016075
IRS990/ActivitiesConductedPrtshpInd00
IRS990/ActivityOrMissionDesc0SUPPORT CHARITABLE EFFORTS WITH ROME MEMORIAL HOSPITAL
IRS990/AnnualDisclosureCoveredPrsnInd01
IRS990/AuditCommitteeInd01
IRS990/BooksInCareOfDetail/BusinessName/BusinessNameLine1Txt0DEWEY ROWLANDS-ROME MEMORIAL HOSPITAL
IRS990/BooksInCareOfDetail/PhoneNum03153387024
IRS990/BooksInCareOfDetail/USAddress/AddressLine1Txt01500 NORTH JAMES STREET
IRS990/BooksInCareOfDetail/USAddress/CityNm0ROME
IRS990/BooksInCareOfDetail/USAddress/StateAbbreviationCd0NY
IRS990/BooksInCareOfDetail/USAddress/ZIPCd013440
IRS990/BusinessRlnWith35CtrlEntInd00
IRS990/BusinessRlnWithFamMemInd00
IRS990/BusinessRlnWithOrgMemInd00
IRS990/ChangeToOrgDocumentsInd00
IRS990/CntrctRcvdGreaterThan100KCnt00
IRS990/CollectionsOfArtInd00
IRS990/CompensationFromOtherSrcsInd00
IRS990/CompensationProcessCEOInd00
IRS990/CompensationProcessOtherInd00
IRS990/ConflictOfInterestPolicyInd01
IRS990/ConservationEasementsInd00
IRS990/ConsolidatedAuditFinclStmtInd01
IRS990/CreditCounselingInd00
IRS990/CYBenefitsPaidToMembersAmt00
IRS990/CYContributionsGrantsAmt00
IRS990/CYGrantsAndSimilarPaidAmt00
IRS990/CYInvestmentIncomeAmt095527
IRS990/CYOtherExpensesAmt0134750
IRS990/CYOtherRevenueAmt00
IRS990/CYProgramServiceRevenueAmt00
IRS990/CYRevenuesLessExpensesAmt0-39223
IRS990/CYSalariesCompEmpBnftPaidAmt00
IRS990/CYTotalExpensesAmt0134750
IRS990/CYTotalFundraisingExpenseAmt00
IRS990/CYTotalProfFndrsngExpnsAmt00
IRS990/CYTotalRevenueAmt095527
IRS990/DecisionsSubjectToApprovaInd00
IRS990/DeductibleArtContributionInd00
IRS990/DeductibleNonCashContriInd00
IRS990/DelegationOfMgmtDutiesInd00
IRS990/Desc0PROMOTE AND PROVIDE HEALTHCARE SERVICES TO THE ROME COMMUNITY
IRS990/DescribedInSection501c3Ind01
IRS990/DisregardedEntityInd00
IRS990/DocumentRetentionPolicyInd01
IRS990/DonorAdvisedFundInd00
IRS990/DonorRstrOrQuasiEndowmentsInd00
IRS990/ElectionOfBoardMembersInd00
IRS990/EmployeeCnt00
IRS990/EngagedInExcessBenefitTransInd00
IRS990/ExpenseAmt0112399
IRS990/FamilyOrBusinessRlnInd00
IRS990/FederalGrantAuditRequiredInd00
IRS990/FeesForServicesAccountingGrp/ProgramServicesAmt016302
IRS990/FeesForServicesAccountingGrp/TotalAmt016302
IRS990/FeesForServicesLegalGrp/ProgramServicesAmt0125
IRS990/FeesForServicesLegalGrp/TotalAmt0125
IRS990/ForeignActivitiesInd00
IRS990/ForeignFinancialAccountInd00
IRS990/ForeignOfficeInd00
IRS990/Form8282PropertyDisposedOfInd00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt01.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt11.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt21.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt31.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt41.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt51.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt61.00
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd0X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd1X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd2X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd3X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd4X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd5X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd6X
IRS990/Form990PartVIISectionAGrp/OfficerInd0X
IRS990/Form990PartVIISectionAGrp/OfficerInd1X
IRS990/Form990PartVIISectionAGrp/OfficerInd2X
IRS990/Form990PartVIISectionAGrp/OfficerInd3X
IRS990/Form990PartVIISectionAGrp/OfficerInd4X
IRS990/Form990PartVIISectionAGrp/OfficerInd5X
IRS990/Form990PartVIISectionAGrp/OfficerInd6X
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt00
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt10
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt20
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt30
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt40
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt50
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt60
IRS990/Form990PartVIISectionAGrp/PersonNm0LYNN G REESE
IRS990/Form990PartVIISectionAGrp/PersonNm1JOHN RESTIVO
IRS990/Form990PartVIISectionAGrp/PersonNm2JULIE GROW DENTON
IRS990/Form990PartVIISectionAGrp/PersonNm3DARLENE BURNS
IRS990/Form990PartVIISectionAGrp/PersonNm4KRISTIN GRUNDER
IRS990/Form990PartVIISectionAGrp/PersonNm5ANKUR DESAI
IRS990/Form990PartVIISectionAGrp/PersonNm6RYAN O'SHAUGHNESSY
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt00
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt10
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt20
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt30
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt40
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt50
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt60
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt00
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt10
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt20
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt30
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt40
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt50
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt60
IRS990/Form990PartVIISectionAGrp/TitleTxt0ASST. VP
IRS990/Form990PartVIISectionAGrp/TitleTxt1VICE PRESIDENT
IRS990/Form990PartVIISectionAGrp/TitleTxt2TREASURER
IRS990/Form990PartVIISectionAGrp/TitleTxt3SECRETARY
IRS990/Form990PartVIISectionAGrp/TitleTxt4ASST. SECRETARY
IRS990/Form990PartVIISectionAGrp/TitleTxt5PRESIDENT
IRS990/Form990PartVIISectionAGrp/TitleTxt6ASST. TREASURER
IRS990/Form990ProvidedToGvrnBodyInd01
IRS990/FormationYr01995
IRS990/FormerOfcrEmployeesListedInd00
IRS990/FSAuditedBasisGrp/ConsolidatedBasisFinclStmtInd0X
IRS990/FSAuditedInd01
IRS990/FundraisingActivitiesInd00
IRS990/GamingActivitiesInd00
IRS990/GoverningBodyVotingMembersCnt07
IRS990/GrantsToIndividualsInd00
IRS990/GrantsToOrganizationsInd00
IRS990/GrantToRelatedPersonInd00
IRS990/GrossReceiptsAmt095527
IRS990/GroupReturnForAffiliatesInd00
IRS990/IncludeFIN48FootnoteInd01
IRS990/IndependentAuditFinclStmtInd00
IRS990/IndependentVotingMemberCnt07
IRS990/IndivRcvdGreaterThan100KCnt00
IRS990/IndoorTanningServicesInd00
IRS990/InfoInScheduleOPartVIInd0X
IRS990/InfoInScheduleOPartXIIInd0X
IRS990/InvestmentIncomeGrp/ExclusionAmt095527
IRS990/InvestmentIncomeGrp/TotalRevenueColumnAmt095527
IRS990/InvestmentInJointVentureInd00
IRS990/IRPDocumentCnt00
IRS990/IRPDocumentW2GCnt00
IRS990/LegalDomicileStateCd0NY
IRS990/LoanOutstandingInd00
IRS990/LobbyingActivitiesInd00
IRS990/LocalChaptersInd00
IRS990/MaterialDiversionOrMisuseInd00
IRS990/MembersOrStockholdersInd00
IRS990/MethodOfAccountingAccrualInd0X
IRS990/MinutesOfCommitteesInd01
IRS990/MinutesOfGoverningBodyInd01
IRS990/MissionDesc0SUPPORT CHARITABLE EFFORTS OF ROME MEMORIAL HOSPITAL
IRS990/MoreThan5000KToIndividualsInd00
IRS990/MoreThan5000KToOrgInd00
IRS990/NetAssetsOrFundBalancesBOYAmt0714823
IRS990/NetAssetsOrFundBalancesEOYAmt0675600
IRS990/NetUnrelatedBusTxblIncmAmt00
IRS990/NoDonorRestrictionNetAssetsGrp/BOYAmt0714823
IRS990/NoDonorRestrictionNetAssetsGrp/EOYAmt0675600
IRS990/NoListedPersonsCompensatedInd0X
IRS990/NondeductibleContributionsInd00
IRS990/OfficerMailingAddressInd00
IRS990/OperateHospitalInd00
IRS990/Organization501c3Ind0X
IRS990/OrganizationFollowsFASB117Ind0X
IRS990/OtherAssetsTotalGrp/BOYAmt01050000
IRS990/OtherAssetsTotalGrp/EOYAmt01050000
IRS990/OtherChangesInNetAssetsAmt00
IRS990/OtherExpensesGrp/Desc0RESERVE RMG
IRS990/OtherExpensesGrp/Desc1PURCHASED SERVICES
IRS990/OtherExpensesGrp/Desc2BANK FEES
IRS990/OtherExpensesGrp/ManagementAndGeneralAmt022351
IRS990/OtherExpensesGrp/ProgramServicesAmt095527
IRS990/OtherExpensesGrp/ProgramServicesAmt1445
IRS990/OtherExpensesGrp/TotalAmt095527
IRS990/OtherExpensesGrp/TotalAmt122351
IRS990/OtherExpensesGrp/TotalAmt2445
IRS990/OtherLiabilitiesGrp/BOYAmt0336728
IRS990/OtherLiabilitiesGrp/EOYAmt0359079
IRS990/PartialLiquidationInd00
IRS990/PayPremiumsPrsnlBnftCntrctInd00
IRS990/PoliticalCampaignActyInd00
IRS990/PrincipalOfficerNm0ANNEMARIE CZYZ
IRS990/ProfessionalFundraisingInd00
IRS990/ProhibitedTaxShelterTransInd00
IRS990/PYBenefitsPaidToMembersAmt00
IRS990/PYContributionsGrantsAmt00
IRS990/PYExcessBenefitTransInd00
IRS990/PYGrantsAndSimilarPaidAmt00
IRS990/PYInvestmentIncomeAmt095581
IRS990/PYOtherExpensesAmt0108309
IRS990/PYOtherRevenueAmt00
IRS990/PYProgramServiceRevenueAmt00
IRS990/PYRevenuesLessExpensesAmt0-12728
IRS990/PYSalariesCompEmpBnftPaidAmt00
IRS990/PYTotalExpensesAmt0108309
IRS990/PYTotalProfFndrsngExpnsAmt00
IRS990/PYTotalRevenueAmt095581
IRS990/QuidProQuoContributionsInd00
IRS990/RcvFndsToPayPrsnlBnftCntrctInd00
IRS990/ReconcilationRevenueExpnssAmt0-39223
IRS990/RegularMonitoringEnfrcInd01
IRS990/RelatedEntityInd01
IRS990/RelatedOrganizationCtrlEntInd00
IRS990/ReportInvestmentsOtherSecInd00
IRS990/ReportLandBuildingEquipmentInd00
IRS990/ReportOtherAssetsInd01
IRS990/ReportOtherLiabilitiesInd01
IRS990/ReportProgramRelatedInvstInd00
IRS990/RevenueAmt095527
IRS990/SavingsAndTempCashInvstGrp/BOYAmt018453
IRS990/SavingsAndTempCashInvstGrp/EOYAmt0754
IRS990ScheduleA/Form990SchASupportingOrgGrp/Contribution35ControlledInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/ContributionControllerInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/ContributionFamilyInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/ControlledDisqualifiedPrsnInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/DisqualifiedPrsnControllIntInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/DisqualifiedPrsnOwnrIntInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/ExcessBusinessHoldingsRulesInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/ListedByNameGoverningDocInd01
IRS990ScheduleA/Form990SchASupportingOrgGrp/LoanDisqualifiedPersonInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/OrganizationChangeSuprtOrgInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/PaymentSubstantialContribtrInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportedOrgNotOrganizedUSInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportedOrgSectionC456Ind00
IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportNonSupportedOrgInd00
IRS990ScheduleA/Form990SchASupportingOrgGrp/SuprtOrgNoIRSDeterminationInd00
IRS990ScheduleA/Form990SchAType3FuncIntGrp/AppointElectMajorityOfficerInd01
IRS990ScheduleA/Form990SchAType3FuncIntGrp/ExerciseDirectionPoliciesInd01
IRS990ScheduleA/Form990SchAType3FuncIntGrp/ParentSupportedOrgInd0X
IRS990ScheduleA/Form990SchAType3SprtOrgAllGrp/OfficersCloseRelationshipInd01
IRS990ScheduleA/Form990SchAType3SprtOrgAllGrp/SupportedOrgVoiceInvestmentInd01
IRS990ScheduleA/Form990SchAType3SprtOrgAllGrp/TimelyProvidedDocumentsInd01
IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt0GRAI 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.
IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt1GRAI 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.
IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt2GRAI 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.
IRS990ScheduleA/Form990ScheduleAPartVIGrp/FormAndLineReferenceDesc0SCHEDULE A PAGE 5 SECTION D LINE
IRS990ScheduleA/Form990ScheduleAPartVIGrp/FormAndLineReferenceDesc1SCHEDULE A PAGE 5 SECTION E LINE 3A
IRS990ScheduleA/Form990ScheduleAPartVIGrp/FormAndLineReferenceDesc2SCHEDULE A PAGE 5 SECTION E LINE 3B
IRS990ScheduleA/OtherSupportSumAmt00
IRS990ScheduleA/SupportedOrganizationsCnt01
IRS990ScheduleA/SupportedOrganizationsTotalCnt01
IRS990ScheduleA/SupportedOrgInformationGrp/EIN0161471634
IRS990ScheduleA/SupportedOrgInformationGrp/GoverningDocumentListedInd01
IRS990ScheduleA/SupportedOrgInformationGrp/OrganizationTypeCd03
IRS990ScheduleA/SupportedOrgInformationGrp/OtherSupportAmt00
IRS990ScheduleA/SupportedOrgInformationGrp/SupportAmt00
IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine1Txt0ROME MEMORIAL HOSPITAL
IRS990ScheduleA/SupportingOrganization509a3Ind0X
IRS990ScheduleA/SupportingOrgType3FuncIntInd0X
IRS990ScheduleA/SupportSumAmt00
IRS990/ScheduleBRequiredInd00
IRS990ScheduleD/FootnoteTextInd0X
IRS990ScheduleD/OtherAssetsOrgGrp/BookValueAmt01050000
IRS990ScheduleD/OtherAssetsOrgGrp/Desc0INVESTMENTS - OTHER
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Amt0342079
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Amt117000
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Desc0DUE TO ROME MEMORIAL HOSPITAL
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Desc1DUE TO 1819 BLACK RIVER BLVD.
IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0INCOME 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., 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, 2021 AND 2020, 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 2018 THROUGH 2021 THE SYSTEM DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT 12 MONTHS.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0PART X, LINE 2:
IRS990ScheduleD/TotalBookValueLandBuildingsAmt00
IRS990ScheduleD/TotalBookValueOtherAssetsAmt01050000
IRS990ScheduleD/TotalLiabilityAmt0359079
IRS990/ScheduleJRequiredInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0IN OCTOBER OF 2022 A MEETING WILL BE HELD PRIOR TO FILIING THE RETURN TO REVIEW THE 2021 990.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1CONSISTENT 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2990 FORMS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION C, LINE 18
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990 PART XII LINE 2C
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd10
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt0GRA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt1GRA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN0161490045
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN1203827393
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt0C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt1C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd0NY
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd1NY
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/OwnershipPct01.00000
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/OwnershipPct11.00000
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt0HOLDING COMPANY
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt1MEDICAL SERVICES
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt0RMH SERVICES
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt1ROME MEDICAL PRACTICE PC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ShareOfEOYAssetsAmt04142312
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ShareOfEOYAssetsAmt1749701
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt01500 N JAMES STREET
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt11500 N JAMES STREET
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm0ROME
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm1ROME
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd0NY
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd1NY
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/ZIPCd013440
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/ZIPCd113440
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd10
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine1Txt0GRA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingNACd0N/A
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt0ROME MEMORIAL HOSPITAL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt1ROME MEMORIAL PROPERTIES
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN0161471634
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN1161492003
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt0501(C)(3)
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt1501(C)(3)
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd0NY
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd1NY
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0HOSPITAL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt1SUPPORT HOSPITAL ACTIVITIES
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt03
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt112A,I
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt01500 NORTH JAMES STREET
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt11500 NORTH JAMES STREET
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm0ROME
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm1ROME
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/StateAbbreviationCd0NY
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/StateAbbreviationCd1NY
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd013440
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd113440
IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd00
IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd01
IRS990ScheduleR/PaidEmployeesSharingInd01
IRS990ScheduleR/PerformOfServicesByOtherOrgInd00
IRS990ScheduleR/PerformOfServicesForOthOrgInd00
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd01
IRS990ScheduleR/ReimbursementPaidByOtherOrgInd00
IRS990ScheduleR/ReimbursementPaidToOtherOrgInd00
IRS990ScheduleR/RentalOfFacilitiesToOthOrgInd00
IRS990ScheduleR/RentalOfFcltsFromOthOrgInd00
IRS990ScheduleR/SharingOfFacilitiesInd01
IRS990ScheduleR/TransferFromOtherOrgInd00
IRS990ScheduleR/TransferToOtherOrgInd00
IRS990/SchoolOperatingInd00
IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/StatesWhereCopyOfReturnIsFldCd0NY
IRS990/SubjectToExcsTaxNetInvstIncInd00
IRS990/SubjectToProxyTaxInd00
IRS990/SubjToTaxRmnrtnExPrchtPymtInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TerminateOperationsInd00
IRS990/TotalAssetsBOYAmt01068453
IRS990/TotalAssetsEOYAmt01050754
IRS990/TotalAssetsGrp/BOYAmt01068453
IRS990/TotalAssetsGrp/EOYAmt01050754
IRS990/TotalCompGreaterThan150KInd00
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt022351
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt0112399
IRS990/TotalFunctionalExpensesGrp/TotalAmt0134750
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt0353630
IRS990/TotalLiabilitiesEOYAmt0375154
IRS990/TotalLiabilitiesGrp/BOYAmt0353630
IRS990/TotalLiabilitiesGrp/EOYAmt0375154
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt0714823
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt0675600
IRS990/TotalOtherCompensationAmt00
IRS990/TotalProgramServiceExpensesAmt0112399
IRS990/TotalReportableCompFromOrgAmt00
IRS990/TotalRevenueGrp/ExclusionAmt095527
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt00
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt095527
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt07
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt01068453
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt01050754
IRS990/TotReportableCompRltdOrgAmt00
IRS990/TrnsfrExmptNonChrtblRltdOrgInd00
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt01500 NORTH JAMES STREET
IRS990/USAddress/CityNm0ROME
IRS990/USAddress/StateAbbreviationCd0NY
IRS990/USAddress/ZIPCd013440
IRS990/VotingMembersGoverningBodyCnt07
IRS990/VotingMembersIndependentCnt07
IRS990/WebsiteAddressTxt0ROMEHOSPITAL.ORG
IRS990/WhistleblowerPolicyInd01
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/AuthenticationAssuranceLevelCd0AAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/IdentityAssuranceLevelCd0IAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/TrustedCustomerCd03

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