SAMARITAN MEDICAL CENTER: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SAMARITAN MEDICAL CENTER (EIN 15-0533577)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-11
- IRS object ID
- 202203159349301830
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-11T08:59:48-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161226221 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUST CHARLES CHAMBERS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5784 WIDEWATERS PARKWAY | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13214 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 150533577 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SAMA | BusinessNameControlTxt |
| Phone | 3157855702 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 WASHINGTON STREET | AddressLine1Txt |
| City | WATERTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13601 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MAXINE BRIGGS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3157855702 | PhoneNum |
| Signature | 2022-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MAXINE | PersonFirstNm |
| Person Last | BRIGGS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PATRICK CAPELLA | PreparerPersonNm |
| PTIN | P01359200 | PTIN |
| Phone | 3154463600 | PhoneNum |
| Preparation | 2022-11-07 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MAXINE BRIGGS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 WASHINGTON STREET | AddressLine1Txt |
| City | WATERTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $300,151,623 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SAMARITANHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1881 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | SAMARITAN MEDICAL CENTER OPERATES AN ACUTE CARE HOSPITAL FACILITY IN WATERTOWN, NEW YORK, SERVING JEFFERSON, OSWEGO AND ST. LAWRENCE COUNTIES. THIS 290-BED FACILITY PROVIDES INPATIENT CARE, PSYCHIATRIC SERVICES, AMBULATORY SURGERY, PRIMARY AND EMERGENCY CARE AND OTHER OUTPATIENT SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 22 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 20 | VotingMembersIndependentCnt |
| Total Employee | 2291 | TotalEmployeeCnt |
| Total Volunteers | 69 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $12,173,692 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,204,330 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $253,273,191 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $276,875,318 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,581,930 | PYInvestmentIncomeAmt |
| CY Investment Income | $422,095 | CYInvestmentIncomeAmt |
| PY Other Revenue | $10,955,303 | PYOtherRevenueAmt |
| CY Other Revenue | $17,527,162 | CYOtherRevenueAmt |
| PY Total Revenue | $278,984,116 | PYTotalRevenueAmt |
| CY Total Revenue | $300,028,905 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $135,443,349 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $144,511,369 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $686,725 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $131,401,600 | PYOtherExpensesAmt |
| CY Other Expenses | $134,255,332 | CYOtherExpensesAmt |
| PY Total Expenses | $266,844,949 | PYTotalExpensesAmt |
| CY Total Expenses | $278,766,701 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $12,139,167 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $21,262,204 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $304,286,114 | TotalAssetsBOYAmt |
| Total Assets EOY | $312,272,896 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $194,867,330 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $182,612,490 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $109,418,784 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $129,660,406 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SAMARITAN MEDICAL CENTER OPERATES AN ACUTE CARE HOSPITAL FACILITY IN WATERTOWN, NEW YORK, SERVING JEFFERSON, OSWEGO AND ST. LAWRENCE COUNTIES. THIS 290-BED FACILITY PROVIDES INPATIENT CARE, PSYCHIATRIC SERVICES, AMBULATORY SURGERY, PRIMARY AND EMERGENCY CARE AND OTHER OUTPATIENT SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $243,366,987 | ExpenseAmt |
| Revenue | $296,801,884 | RevenueAmt |
| Desc | DURING 2021, SAMARITAN MEDICAL CENTER PROVIDED CARE FOR 9,646 INPATIENT DISCHARGES AND A TOTAL OF 294,327 OUTPATIENT VISITS. OF THE TOTAL OUTPATIENT VISITS, THERE WERE 39,045 EMERGENCY ROOM VISITS AND 146,819 FAMILY HEALTH CLINIC VISITS. | Desc |
| Total Program Service Expenses | $243,366,987 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 86 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 2291 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 22 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 20 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAXINE BRIGGS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3157853605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 104 PADDOCK | AddressLine1Txt |
| City | WATERTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13601 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| JAN TURCOTTE | ||||||||||
| CHAIR | 1.00 | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| BERNARD BROWN | ||||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||||
| ALFRED CALLIGARIS | ||||||||||
| FINANCE COMMITTEE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||||
| DENISE YOUNG | ||||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||||
| JOHN BARRETT MD | ||||||||||
| TRUSTEE (PRESIDENT OF MEDI | 40.00 | Yes (X) | $592,000 | $0 | $44,332 | |||||
| DAVID RECHLIN DO | ||||||||||
| TRUSTEE | 40.00 | Yes (X) | $179,981 | $0 | $20,019 | |||||
| MARY WARDWELL DONAHUE | ||||||||||
| TRUSTEE | 1.00 | 2.50 | Yes (X) | $0 | $0 | $0 | ||||
| DAPHANE HENRI-FOLEY | ||||||||||
| TRUSTEE (CLIFTON FINE BOARD) | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| MARIE HESS | ||||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| TRACY LEONARD | ||||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| AL MALONEY MD | ||||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| TIMOTHY VIRKLER | ||||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| THOMAS PICHE | ||||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| CATHERINE QUENCER | ||||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOAN TREADWELL WOODS | ||||||||||
| TRUSTEE | 1.00 | 2.50 | Yes (X) | $0 | $0 | $0 | ||||
| STEPHEN TODD | ||||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| PAUL BARTON | ||||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| BERLINE DODARD | ||||||||||
| TRUSTEE (AUXILIARY PRESIDENT) | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| KIMBERLY LACLAIR | ||||||||||
| TRUSTEE (CHAIR OF THE SMC | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| SAMUEL PURINGTON | ||||||||||
| TRUSTEE (SKH AND SSV BOARD VICE CHAIR) | 1.00 | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| RORY SEARS DO | ||||||||||
| VICE PRESIDENT OF MEDICAL STAFF | 40.00 | Yes (X) | $0 | $366,374 | $32,958 | |||||
| THOMAS H CARMAN | ||||||||||
| PRESIDENT & CEO OF SMC | 40.00 | 3.50 | Yes (X) | $838,514 | $0 | $44,482 | ||||
| MAXINE BRIGGS | ||||||||||
| TREASURER & CFO OF SMC | 40.00 | 2.50 | Yes (X) | $367,502 | $0 | $44,332 | ||||
| MARIO VICTORIA MD | ||||||||||
| CMO OF SMC | 40.00 | 1.00 | $400,235 | $0 | $45,622 | Yes (X) | ||||
| MICHAEL SHORT | ||||||||||
| COO OF SMC | 40.00 | 1.00 | $379,601 | $0 | $44,092 | Yes (X) | ||||
| CHRISTOPHER BASTIN | ||||||||||
| AVP SUPPORT SERVICES | 40.00 | $251,620 | $0 | $15,229 | Yes (X) | |||||
| BARB MORROW | ||||||||||
| VP FOR LONG TERM CARE AND | 14.50 | 25.50 | $79,619 | $138,276 | $24,378 | Yes (X) | ||||
| JOEL BENWARE | ||||||||||
| VP OF INFORMATION SERVICES & CHIEF INFORMATION OFF | 40.00 | $215,427 | $0 | $20,155 | Yes (X) | |||||
| KEVIN CHANDLER MD | ||||||||||
| UROLOGIST-EMPLOYEE REPRESENTATIVE | 40.00 | $824,507 | $0 | $43,912 | Yes (X) | |||||
| NATHANIAL MILETTA MD | ||||||||||
| DERMATOLOGY | 40.00 | $790,707 | $0 | $17,301 | Yes (X) | |||||
| DAVID REINDL | ||||||||||
| GASTROENTROLOGIST | 40.00 | $687,489 | $0 | $25,699 | Yes (X) | |||||
| TONY CHUANG | ||||||||||
| ENT | 40.00 | $682,834 | $0 | $23,376 | Yes (X) | |||||
| SCOTT MOLLISON | ||||||||||
| ORTHOPEDIC SURGEON | 40.00 | $676,118 | $0 | $43,912 | Yes (X) | |||||
| SHAHANDEH HAGHIR MD | ||||||||||
| PATHOLOGY | 40.00 | $480,166 | $0 | $40,232 | Yes (X) | |||||
| LEO GOSSELIN | ||||||||||
| TRUSTEE (FORMER PRESIDENT OF MEDICAL STAFF) 1/21-3 | 40.00 | $518,891 | $0 | $44,332 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $7,965,211 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $504,650 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $574,363 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NEW YORK STATE NURSES ASSOC | |||||
| PO BOX 12340 | ALBANY | NY | 12212 | PURCHASED SERVICES | $5,484,892 |
| JEFFERSON ANESTHESIOLOGIST SERVICES | |||||
| 826 WASHINGTON ST | WATERTOWN | NY | 13601 | ANESTHESIA SERVICES | $4,282,477 |
| APOGEE MEDICAL MANAGEMENT INC | |||||
| 15059 N SCOTTSDALE ROAD STE 600 | SCOTTSDALE | AZ | 85254 | PURCHASED SERVICES | $3,996,677 |
| LABORATORY CORPORATION OF AMERICA | |||||
| 2121 NORTH 117TH AVE STE 200 | OMAHA | NE | 68164 | PURCHASED SERVICES | $3,928,477 |
| MOHAWK HEALTHCARE | |||||
| PO BOX 27 | UTICA | NY | 13503 | PURCHASED SERVICES | $3,886,456 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $313,286 | RelatedOrganizationsAmt |
| Government Grants | $4,533,940 | GovernmentGrantsAmt |
| All Other Contributions | $357,104 | AllOtherContributionsAmt |
| Total Contributions | $5,204,330 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $276,875,318 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $276,875,318 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $276,875,318 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $417,595 | TotalRevenueColumnAmt |
| Exclusion | $417,595 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $837,313 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $122,718 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $714,595 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $714,595 | TotalRevenueColumnAmt |
| Exclusion | $714,595 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,500 | TotalRevenueColumnAmt |
| Exclusion | $4,500 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| SHARED SERVICES | 541900 | $2,463,089 | $2,463,089 |
| CAFETERIA | 722210 | $417,182 | $417,182 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,932,296 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,932,296 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $16,812,567 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $300,028,905 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $293,687,885 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,136,690 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,991,001 | TotalAmt |
| Program Services | $1,235,663 | ProgramServicesAmt |
| Management And General | $2,755,338 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,369,003 | TotalAmt |
| Program Services | $95,992,682 | ProgramServicesAmt |
| Management And General | $12,903,197 | ManagementAndGeneralAmt |
| Fundraising | $473,124 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,228,634 | TotalAmt |
| Program Services | $5,342,300 | ProgramServicesAmt |
| Management And General | $860,174 | ManagementAndGeneralAmt |
| Fundraising | $26,160 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,975,055 | TotalAmt |
| Program Services | $13,701,805 | ProgramServicesAmt |
| Management And General | $2,206,155 | ManagementAndGeneralAmt |
| Fundraising | $67,095 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,947,676 | TotalAmt |
| Program Services | $7,674,422 | ProgramServicesAmt |
| Management And General | $1,235,674 | ManagementAndGeneralAmt |
| Fundraising | $37,580 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,540 | TotalAmt |
| Program Services | $25,186 | ProgramServicesAmt |
| Management And General | $411,354 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $204,608 | TotalAmt |
| Management And General | $199,822 | ManagementAndGeneralAmt |
| Fundraising | $4,786 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,475,938 | TotalAmt |
| Program Services | $15,709,693 | ProgramServicesAmt |
| Management And General | $766,245 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $862,696 | TotalAmt |
| Management And General | $862,646 | ManagementAndGeneralAmt |
| Fundraising | $50 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,619,061 | TotalAmt |
| Program Services | $266,096 | ProgramServicesAmt |
| Management And General | $1,338,514 | ManagementAndGeneralAmt |
| Fundraising | $14,451 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,437,081 | TotalAmt |
| Program Services | $6,204,232 | ProgramServicesAmt |
| Management And General | $232,849 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,705,725 | TotalAmt |
| Program Services | $6,821,658 | ProgramServicesAmt |
| Management And General | $884,067 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,720 | TotalAmt |
| Program Services | $68,848 | ProgramServicesAmt |
| Management And General | $166,102 | ManagementAndGeneralAmt |
| Fundraising | $1,770 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,299 | TotalAmt |
| Program Services | $18,003 | ProgramServicesAmt |
| Management And General | $11,296 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,643 | TotalAmt |
| Management And General | $61,643 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,840 | TotalAmt |
| Management And General | $99,840 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,284,382 | TotalAmt |
| Program Services | $12,951,985 | ProgramServicesAmt |
| Management And General | $2,332,397 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,466,656 | TotalAmt |
| Program Services | $2,112,350 | ProgramServicesAmt |
| Management And General | $354,306 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| SUPPLIES | $53,062,345 | $49,797,127 | $3,265,068 | $150 |
| OTHER EXPENSES | $17,410,062 | $13,756,077 | $3,592,426 | $61,559 |
| PROVISION FOR BAD DEBT | $5,008,570 | $5,008,570 | ||
| EQUIPMENT REPAIR AND MA | $4,744,999 | $4,571,123 | $173,876 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,109,167 | TotalAmt |
| Program Services | $2,109,167 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $278,766,701 | TotalAmt |
| Program Services | $243,366,987 | ProgramServicesAmt |
| Management And General | $34,712,989 | ManagementAndGeneralAmt |
| Fundraising | $686,725 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,349 | BOYAmt |
| EOY | $5,083 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,623,549 | BOYAmt |
| EOY | $83,294,433 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,865,191 | BOYAmt |
| EOY | $36,921,009 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,687,066 | BOYAmt |
| EOY | $5,998,864 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,647,321 | BOYAmt |
| EOY | $4,719,287 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $417,430,547 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $251,660,694 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $172,072,128 | BOYAmt |
| EOY | $165,769,853 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $874,471 | BOYAmt |
| EOY | $874,471 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,995,844 | BOYAmt |
| EOY | $4,009,026 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,515,195 | BOYAmt |
| EOY | $10,680,870 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $304,286,114 | BOYAmt |
| EOY | $312,272,896 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,089,708 | BOYAmt |
| EOY | $41,966,259 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,828,251 | BOYAmt |
| EOY | $79,761,784 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,155,467 | BOYAmt |
| EOY | $12,230,500 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,793,904 | BOYAmt |
| EOY | $48,653,947 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $194,867,330 | BOYAmt |
| EOY | $182,612,490 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,977,902 | BOYAmt |
| EOY | $127,822,146 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,440,882 | BOYAmt |
| EOY | $1,838,260 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,418,784 | BOYAmt |
| EOY | $129,660,406 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $304,286,114 | BOYAmt |
| EOY | $312,272,896 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $21,262,204 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$110,185 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$910,396 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $24,446 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $24,446 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF ANNUAL MEMBERSHIP DUES PAID TO HANYS AND IHA ARE RELATED TO LOBBYING ACTIVITIES. SAMARITAN PAYS AN ANNUAL RETAINER FEE TO LEGAL COUNCIL FOR GOVERNMENTAL RELATIONS WORK. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,440,882 | BeginningYearBalanceAmt |
| Contributions | $4,891,044 | ContributionsAmt |
| Other Expenditures | $4,493,666 | OtherExpendituresAmt |
| End Year Balance | $1,838,260 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,421,545 | BeginningYearBalanceAmt |
| Contributions | $10,390,355 | ContributionsAmt |
| Other Expenditures | $11,371,018 | OtherExpendituresAmt |
| End Year Balance | $1,440,882 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $12,181,208 | BeginningYearBalanceAmt |
| Contributions | $2,666,210 | ContributionsAmt |
| Other Expenditures | $12,425,873 | OtherExpendituresAmt |
| End Year Balance | $2,421,545 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,137,591 | BeginningYearBalanceAmt |
| Contributions | $13,669,647 | ContributionsAmt |
| Other Expenditures | $3,626,030 | OtherExpendituresAmt |
| End Year Balance | $12,181,208 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,089,529 | BeginningYearBalanceAmt |
| Contributions | $2,999,187 | ContributionsAmt |
| Other Expenditures | $295,125 | OtherExpendituresAmt |
| End Year Balance | $2,137,591 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.47570 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.52430 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,216,252 | OtherCostOrOtherBasisAmt |
| Book Value | $1,216,252 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $211,476,781 | OtherCostOrOtherBasisAmt |
| Depreciation | $66,833,412 | DepreciationAmt |
| Book Value | $144,643,369 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,566,813 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,378,487 | DepreciationAmt |
| Book Value | $4,188,326 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $193,866,256 | OtherCostOrOtherBasisAmt |
| Depreciation | $178,448,795 | DepreciationAmt |
| Book Value | $15,417,461 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $304,445 | OtherCostOrOtherBasisAmt |
| Book Value | $304,445 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $165,769,853 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| RIGHT OF USE LIABILITIES | $5,481,674 |
| OTHER LIABILITIES | $15,704,758 |
| CONTRACT LIABILITY - MEDICARE | $27,467,515 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $48,653,947 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT SAMARITAN MEDICAL CENTER AND RELATED FACILITIES IN PROVIDING HEALTH CARE SERVICES TO THE PUBLIC. |
| PART X, LINE 2: | SAMARITAN QUALIFIES AS A TAX-EXEMPT, NOT-FOR-PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2021 AND 2020, SAMARITAN DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2018 THROUGH 2021. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,575,986 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $247,013 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,328,973 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01220 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,946,448 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $33,674,710 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,271,738 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07040 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $56,522,434 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $33,921,723 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $22,600,711 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08260 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $209,382 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $209,382 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,336,295 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,336,295 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,171,573 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,123,764 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,047,809 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,717,250 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,123,764 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,593,486 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00720 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $64,239,684 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $36,045,487 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $28,194,197 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08980 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,008,570 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $55,515,858 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $54,055,281 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,460,577 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 WASHINGTON STREET | AddressLine1Txt |
| City | WATERTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SAMARITANHEALTH.COM | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | NCNYHEALTHCOMPASS.ORG | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SAMARITANHEALTH.COM | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SAMARITANHEALTH.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SAMARITANHEALTH.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SAMARITAN MEDICAL CENTER | PART V, SECTION B, LINE 5: SAMARITAN MEDICAL CENTER PARTICIPATED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DEVELOPED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO) IN COLLABORATION WITH NORTH COUNTRY HEALTH COMPASS PARTNERS (NCHCP). REPRESENTING BROAD INTERESTS OF THE COMMUNITY, NCHCP IS A THREE-COUNTY COALITION OF MORE THAN 40 HOSPITALS, COUNTY AGENCIES AND NONPROFIT HEALTH, SOCIAL, HUMAN SERVICE AND EDUCATION ORGANIZATIONS. CLIENT BASES OF THESE ENTITIES INCLUDE MANY UNDERSERVED AND LOW-INCOME POPULATIONS FROM POVERTY-RIDDEN AREAS IN OUR REGION AND FEDERALLY-DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS). THIS INCLUDES THOSE RECEIVING SERVICES FROM TWO FEDERALLY QUALIFIED HEALTH CENTERS, NORTH COUNTRY FAMILY HEALTH CENTER AND COMMUNITY HEALTH CENTER OF THE NORTH COUNTRY. NCHCP, WHICH MEETS MONTHLY, PROVIDED COMMENT AND FEEDBACK AT VARIOUS STAGES OF THE CHNA DEVELOPMENT THROUGHOUT 2019. FDRHPO AND NCHCP SINCE 2016 HAVE ANNUALLY COMMISSIONED A REGIONAL HEALTH SURVEY OF ADULTS TO UNDERSTAND AND MONITOR HEALTH CARE AND HEALTH HABITS OF COMMUNITY RESIDENTS. DATA FROM THE 2019 SURVEY (CONDUCTED IN MAY AND JUNE) WAS UTILIZED IN THE CHNA, ALONG WITH STATISTICAL INFORMATION GATHERED FROM ADDITIONAL LOCAL, STATE AND NATIONAL SOURCES. REGIONAL CHNA DATA WAS ULTIMATELY REFINED TO PRODUCE A SEPARATE CHNA FOR EACH OF THE THREE COUNTIES REPRESENTED. SAMARITAN, WHOSE SERVICE AREA IS PRIMARILY JEFFERSON COUNTY, USES THE JEFFERSON COUNTY CHNA FOR PLANNING PURPOSES. THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH WHO WERE INVOLVED IN CREATION OF THE JEFFERSON COUNTY CHNA INCLUDED THE JEFFERSON COUNTY PUBLIC HEALTH SERVICE'S PUBLIC HEALTH DIRECTOR AND PLANNER, AS WELL AS FDRHPO POPULATION HEALTH STAFF. |
| SAMARITAN MEDICAL CENTER | PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES PARTICIPATING IN THE DEVELOPMENT OF THE CHNA, IN ADDITION TO SAMARITAN, WERE: CARTHAGE AREA HOSPITAL AND RIVER HOSPITAL IN JEFFERSON COUNTY; |
| SAMARITAN MEDICAL CENTER | PART V, SECTION B, LINE 6B: : JEFFERSON COUNTY ORGANIZATIONS INVOLVED IN CHNA CREATION: CREDO COMMUNITY CENTER FOR THE TREATMENT OF ADDICTIONS, FORT DRUM MEDDAC (MILITARY AND DEPENDENTS' HEALTH CLINIC), FDRHPO, JEFFERSON COUNTY CORNELL COOPERATIVE EXTENSION (EDUCATION, NUTRITION AND YOUTH SERVICES), JEFFERSON COUNTY COMMUNITY SERVICES (MENTAL HEALTH), JEFFERSON COUNTY OFFICE FOR THE AGING, JEFFERSON COUNTY PUBLIC HEALTH SERVICE, NORTH COUNTRY FAMILY HEALTH CENTER (HEALTH CLINIC FOR LOW INCOME), NORTH COUNTRY PRENATAL/PERINATAL COUNCIL (LOW INCOME WOMEN, INFANTS AND CHILDREN'S HEALTH SERVICES), NORTHERN REGIONAL CENTER FOR INDEPENDENT LIVING (SERVICES FOR THE HANDICAPPED AND DISABLED), PIVOT (ALCOHOL AND SUBSTANCE ABUSE PREVENTION), SALVATION ARMY, TRANSITIONAL LIVING SERVICES (BEHAVIORAL HEALTH), VOLUNTEER TRANSPORTATION CENTER (TRANSPORTATION FOR LOW INCOME), WATERTOWN FAMILY YMCA AND WATERTOWN URBAN MISSION (LOW INCOME SOCIAL SERVICES). |
| SAMARITAN MEDICAL CENTER | PART V, SECTION B, LINE 11: BASED ON CHNA DATA, JEFFERSON COUNTY'S HOSPITALS AND PUBLIC HEALTH SERVICE DEFINED SIGNIFICANT COMMUNITY HEALTH ISSUES. THESE ENTITIES, COLLABORATING WITH SEVERAL ADDITIONAL ORGANIZATIONS, SUBSEQUENTLY DEVELOPED THE 2019-2021 JEFFERSON COUNTY HEALTH IMPROVEMENT PLAN (CHIP), WHICH OUTLINES ACTIVITIES, INTERVENTIONS, GOALS AND MEASURES TO TACKLE THE ISSUES. THE CHIP'S CREATION WAS COORDINATED BY FDRHPO AND IS ALIGNED WITH GOALS ESTABLISHED IN NEW YORK STATE'S PREVENTION AGENDA, THE STATE'S HEALTH IMPROVEMENT PLAN. SIGNIFICANT ISSUES AND DISPARITIES IDENTIFIED INCLUDE OUR COMMUNITY'S HIGH INCIDENCE AND DEATH RATES DUE TO LUNG AND BRONCHUS CANCER; HIGH RATES OF OBESITY AND DIABETES, WIDESPREAD TOBACCO USE, AND OPIOID SUBSTANCE ABUSE. TO DEAL WITH THESE ISSUES, AS WELL AS WITH ADDITIONAL COMMUNITY CONCERNS ABOUT HIGH RATES OF DENTAL CARIES IN CHILDREN AND LOW VACCINATION RATES FOR THE HUMAN PAPILLOMA VIRUS, JEFFERSON COUNTY'S CHIP FOCUSES ON STATE PRIORITY AREAS RELATIVE TO: CHRONIC DISEASE PREVENTION AND MANAGEMENT; MENTAL AND SUBSTANCE USE DISORDERS TREATMENT AND PREVENTION; PROMOTION OF HEALTHY CHILDREN (PARTICULAR TO DENTAL HYGIENE) AND PREVENTION OF COMMUNICABLE DISEASES (PARTICULAR TO HPV). SAMARITAN'S ACTIVITIES IN THE COLLABORATIVE CHIP INCLUDE: TOBACCO USE SCREENING, REFERRAL, TREATMENT AND PREVENTION (SMOKING AND VAPING); ACCESS TO AN EVIDENCE-BASED DISEASE SELF-MANAGEMENT PROGRAMS FOR INDIVIDUALS WITH DIABETES; REFERRALS TO ADDITIONAL CHRONIC DISEASE PREVENTION AND MANAGEMENT PROGRAMS ALIGNED WITH PATIENT NEEDS; ROUTINE SCREENING, BRIEF BEHAVIORAL COUNSELING AND TREATMENT REFERRAL IN PRIMARY CARE CLINICS TO REDUCE UNHEALTHY ALCOHOL AND DRUG USE; AND IMPLEMENTATION OF THREE PROGRAMS COMBATTING OPIOID MISUSE: AN OUTPATIENT MEDICATION-ASSISTED TREATMENT PROGRAM, AN ALTERNATIVE TO OPIOIDS PRESCRIBING PROGRAM (IN THE EMERGENCY DEPARTMENT) AND AN INPATIENT OPIOID STEWARDSHIP PROGRAM. THE HOSPITAL'S PRIMARY CARE CLINICS LAUNCHED EFFORTS TO INCREASE PREVENTIVE DENTAL SERVICES (FLUORIDE VARNISHING) AND DENTAL REFERRALS FOR PEDIATRIC OUTPATIENTS. SAMARITAN ALSO AGREED TO SUPPORT FUTURE REGIONAL EFFORTS PROMOTING HPV VACCINATION. IN ADDITION TO THESE CHIP-SPECIFIC ACTIVITIES, SAMARITAN IN 2019 ALSO ENGAGED IN ACTIVITIES DESIGNED TO ABATE COMMUNITY HEALTH NEEDS AS FOLLOWS: (1) OUR CERTIFIED DIABETES EDUCATOR CONSULTED WITH PRIMARY CARE AND PHYSICIAN PRACTICES BOTH WITHIN AND OUTSIDE OF THE SAMARITAN HEALTH SYSTEM TO EDUCATE COMMUNITY PRACTITIONERS ON HOW TO ENGAGE DIABETES PATIENTS IN DISEASE SELF-MANAGEMENT. (2) THE HOSPITAL PARTNERED WITH LOCAL ORGANIZATIONS TO IMPLEMENT COMMUNITY-WIDE AWARENESS, EDUCATION AND PREVENTION ACTIVITIES RELATIVE TO CANCER. (3) OUTPATIENT CLINICS MAINTAINED CERTIFICATION AND COMMITMENT TO THE PATIENT-CENTERED MEDICAL HOME (PCMH) HEALTH CARE DELIVERY MODEL. (4) TWO WOMEN'S HEALTH CARE PRACTICES WERE CONSOLIDATED IN RENOVATED SPACE IN A BUILDING ALREADY HOUSING PRIMARY CARE AND BEHAVIORAL HEALTH CLINICS, AND A LABORATORY/RADIOLOGY TESTING SITE WAS RELOCATED TO THE SAME SITE, RESULTING IN CREATION OF A MEDICAL VILLAGE PROVIDING IMPROVED PATIENT ACCESS TO A BROAD RANGE OF SERVICES IN ONE CONVENIENT LOCATION. (5) PARTICIPATION, PARTNERSHIPS AND COLLABORATIONS CONTINUED WITH FDRHPO, THE NORTH COUNTRY INITIATIVE, REGIONAL COMMITTEES AND COUNTY COALITIONS TO IDENTIFY, PLAN AND IMPLEMENT INITIATIVES TO STRENGTHEN THE LOCAL HEALTH CARE SYSTEM. (6) THE HOSPITAL PARTICIPATED IN ACTIVITIES DEALING WITH ONGOING COMMUNITY HEALTH NEEDS, INCLUDING: PREVENTION AND AWARENESS EDUCATION ON THE REGION'S MOST PREVALENT CHRONIC DISEASES AND CONDITIONS; EARLY CANCER DETECTION SCREENINGS; SMOKING CESSATION CLASSES; PARTICIPATION IN HEALTH EDUCATION/AWARENESS CAMPAIGNS; PHYSICIAN RECRUITMENT/RETENTION; ADOPTION OF EVIDENCE-BASED MEDICAL AND CLINICAL IMPROVEMENTS TO ENHANCE PATIENT OUTCOMES; AND DEVELOPMENT OF TELEMEDICINE INFRASTRUCTURE AND TOOLS TO IMPROVE THE ACCESS OF THE REGION'S RURAL, UNDERSERVED POPULATION TO COST-EFFECTIVE, QUALITY HEALTH CARE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 13 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - SAMARITAN FAMILY HEALTH - CLAYTON | ||||
| 909 STRAWBERRY LANE | CLAYTON | NY | 13624 | PRIMARY CARE CLINIC |
| 2 - SAMARITAN FAMILY HEALTH - PLAZA | ||||
| 1575 WASHINGTON STREET | WATERTOWN | NY | 13601 | PRIMARY CARE CLINIC |
| 3 - SAMARITAN FAMILY HEALTH - UROLOGY | ||||
| 19324 US ROUTE 11 | WATERTOWN | NY | 13601 | OUTPATIENT UROLOGY CLINIC |
| 4 - SAMARITAN FAMILY HEALTH - LACONA | ||||
| 3 DEMOTT STREET | LACONA | NY | 13083 | PRIMARY CARE CLINIC |
| 5 - SAMARITAN OUTPATIENT BEHAVIOR HEALTH | ||||
| 1575 WASHINGTON STREET | WATERTOWN | NY | 13601 | OUTPATIENT PSYCHIATRIC CLINIC |
| 6 - SAMARITAN FAMILY HEALTH - LERAY | ||||
| 26908 INDEPENDENCE WAY | EVAN MILLS | NY | 13637 | PRIMARY CARE CLINIC/URGENT CARE |
| 7 - CAPE VINCENT CLINIC | ||||
| 782 E BROADWAY | CAPE VINCENT | NY | 13618 | PRIMARY CARE CLINIC |
| 8 - SAMARITAN FAMILY HEALTH - WOUND CARE | ||||
| 165 COLEMAN STREET | WATERTOWN | NY | 13601 | OUTPATIENT WOUND CARE CLINIC |
| 9 - SAMARITAN FAMILY HEALTH - SACKETS HARBOR | ||||
| 105 BARRACKS DRIVE | SACKETS HARBOR | NY | 13685 | OUTPATIENT PRIMARY CARE CLINIC |
| 10 - ADAMS FAMILY HEALTH CENTER | ||||
| 10881 US ROUTE 11 | ADAMS | NY | 13605 | OUTPATIENT PRIMARY CARE CLINIC |
| 11 - WOMENS WELLNESS CENTER | ||||
| 1575 WASHINGTON STREET | WATERTOWN | NY | 13601 | OUTPATIENT PRIMARY CARE CLINIC |
| 12 - SAMARITAN FAMILY HEALTH - RHEUMATOLOGY | ||||
| 629 WASHINGTON STREET 2ND FLOOR | WATERTOWN | NY | 13601 | OUTPATIENT PRIMARY CARE CLINIC |
| 13 - SAMARITAN FAMILY HEALTH - DERMATOLOGY | ||||
| 826 WASHINGTON STREET SUITE 100 | WATERTOWN | NY | 13601 | OUTPATIENT PRIMARY CARE CLINIC |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | SAMARITAN IS A MEMBER OF THE HOSPITAL ASSOCIATION OF NEW YORK STATE, WHICH ANNUALLY GENERATES AN ECONOMIC AND COMMUNITY IMPACT REPORT FOR SAMARITAN MEDICAL CENTER INDICATING IN TOTAL DOLLARS THE COST OF CARE THE HOSPITAL PROVIDED IN THE PRIOR YEAR TO PEOPLE IN NEED, SUBSIDIZED CARE AND SERVICES TO LOW-INCOME, ELDERLY AND UNDER-SERVED COMMUNITIES, AND THE HOSPITAL'S INVESTMENT IN COMMUNITY HEALTH INITIATIVES. IN ADDITION TO THIS AMOUNT, THE REPORT INDICATES THE NUMBER OF OUTPATIENTS TREATED, EMERGENCY ROOM VISITS, HOSPITAL ADMISSIONS AND BABIES DELIVERED DURING THAT YEAR, AS WELL THE NUMBER OF JOBS GENERATED. THIS REPORT ALSO PROVIDES AN ESTIMATE IN DOLLARS OF THE ANNUAL ECONOMIC ACTIVITY AND TAX DOLLARS GENERATED IN THE COMMUNITY DUE TO THE HOSPITAL'S PRESENCE AND SPENDING. THIS INFORMATION, AS WELL AS MORE DETAIL, IS INCLUDED IN SAMARITAN'S ANNUAL REPORT TO THE COMMUNITY, A PUBLICATION WHICH IS MAILED TO KEY HOSPITAL AND COMMUNITY STAKEHOLDERS AND ALSO PUBLICLY AVAILABLE ON THE HOSPITAL'S WEBSITE. |
| PART I, LINE 7: | THE RATIO OF COST TO CHARGES METHODOLOGY WAS UTILIZED IN COMPUTING ALL EXPENSES REPORTED ON LINES 7A. THROUGH 7G. THE WORKSHEET (#1 THROUGH #6) TEMPLATES IN THE INSTRUCTIONS FOR SCHEDULE H WERE FOLLOWED TO COMPUTE COSTS REPORTED. |
| PART I, LINE 7G: | THE COSTS REPORTED ON THIS LINE REPRESENT THE NET EXPENSE FOR THE OUTPATIENT PRIMARY CARE CLINICS OPERATED BY SAMARITAN MEDICAL CENTER. THE "NET" EXPENSE WAS COMPUTED UTILIZING WORKSHEET 6 OF THE SCHEDULE H FORM. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, SAMARITAN MEDICAL CENTER (SMC), SAMARITAN MEDICAL PRACTICE, P.C. (SMP) AND SAMARITAN KEEP NURSING HOME, INC. (SKH) ANALYZE PAST PAYMENT HISTORY AND IDENTIFY TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, SMC, SMP AND SKH ANALYZE CONTRACTUALLY DUE AMOUNTS AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, SMC, SMP AND SKH ALSO ANALYZE AMOUNTS DUE AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN SMC, SMP AND SKH ESTABLISH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BOTH TAKE INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNT OF BAD DEBT AT COST REPORTED ON LINE #2 WAS CALCULATED BY APPLYING THE OVERALL IMPLICIT PRICE CONCESSION TO THE PROVISION FOR BAD DEBT EXPENSE AS REPORTED IN OUR 2020 AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COSTS REPORTED WERE TAKEN DIRECTLY FROM THE 2021 MEDICARE COST REPORT FILED WITH NATIONAL GOVERNMENT SERVICES. THE METHODOLOGY IS BASED ON APPLYING FACILITY RATIO OF COST TO CHARGES TO THE MEDICARE (PROGRAM) CHARGES, AS PROVIDED BY NATIONAL GOVERNMENT SERVICES IN THE PS&R REPORT.THE MEDICARE SHORTFALL REPORTED SHOULD BE TREATED AS COMMUNITY BENEFIT EXPENSE. SAMARITAN MEDICAL CENTER PROVIDES MEDICAL SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE COVERAGE. THE OVERALL (INPATIENT AND OUTPATIENT) MEDICARE PAYOR MIX FOR 2020 WAS APPROXIMATELY 42%. |
| PART III, LINE 9B: | IF CHARITY CARE ASSISTANCE IS GRANTED, PATIENT ACCOUNTS THAT HAVE BEEN REFERRED TO A COLLECTION AGENCY WITHIN 60 DAYS OF APPLICATION DATE ARE ELIGIBLE FOR CHARITY CARE DISCOUNT. ANY BILL AMOUNT REMAINING AFTER APPLICATION OF THE CHARITY CARE DISCOUNT IS THE RESPONSIBILITY OF THE PATIENT. THE PATIENT WILL BE ASSISTED BY THE HOSPITAL IN MAKING SHORT TERM ARRANGEMENT TO SATISFY ANY REMAINING BALANCE ON THE ACCOUNT. |
| PART VI, LINE 2: | SAMARITAN MEDICAL CENTER PARTICIPATED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DEVELOPED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO) IN COLLABORATION WITH NORTH COUNTRY HEALTH COMPASS PARTNERS (NCHCP). THIS DATA WAS USED AND REFERRED TO IN 2021. IN ADDITIONAL TO THE CHNA, FDRHPO ALSO CONDUCTED A COMMUNITY HEALTH SURVEY IN 2021 OF JEFFERSON, LEWIS, AND ST. LAWRENCE COUNTIES. REPRESENTING BROAD INTERESTS OF THE COMMUNITY, NCHCP IS A THREE-COUNTY COALITION OF MORE THAN 40 HOSPITALS, COUNTY AGENCIES AND NONPROFIT HEALTH, SOCIAL, HUMAN SERVICE AND EDUCATION ORGANIZATIONS. CLIENT BASES OF THESE ENTITIES INCLUDE MANY UNDERSERVED AND LOW-INCOME POPULATIONS FROM POVERTY-RIDDEN AREAS IN OUR REGION AND FEDERALLY-DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS). THIS INCLUDES THOSE RECEIVING SERVICES FROM TWO FEDERALLY QUALIFIED HEALTH CENTERS, NORTH COUNTRY FAMILY HEALTH CENTER AND COMMUNITY HEALTH CENTER OF THE NORTH COUNTRY. NCHCP, WHICH MEETS MONTHLY, PROVIDED COMMENT AND FEEDBACK AT VARIOUS STAGES OF THE CHNA DEVELOPMENT THROUGHOUT 2019. FDRHPO AND NCHCP SINCE 2016 HAVE ANNUALLY COMMISSIONED A REGIONAL HEALTH SURVEY OF ADULTS TO UNDERSTAND AND MONITOR HEALTH CARE AND HEALTH HABITS OF COMMUNITY RESIDENTS. DATA FROM THE 2019 SURVEY (CONDUCTED IN MAY AND JUNE) WAS UTILIZED IN THE CHNA, ALONG WITH STATISTICAL INFORMATION GATHERED FROM ADDITIONAL LOCAL, STATE AND NATIONAL SOURCES. REGIONAL CHNA DATA WAS ULTIMATELY REFINED TO PRODUCE A SEPARATE CHNA FOR EACH OF THE THREE COUNTIES REPRESENTED. SAMARITAN, WHOSE SERVICE AREA IS PRIMARILY JEFFERSON COUNTY, USES THE JEFFERSON COUNTY CHNA FOR PLANNING PURPOSES. THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH WHO WERE INVOLVED IN CREATION OF THE JEFFERSON COUNTY CHNA INCLUDED THE JEFFERSON COUNTY PUBLIC HEALTH SERVICE'S PUBLIC HEALTH DIRECTOR AND PLANNER, AS WELL AS FDRHPO POPULATION HEALTH STAFF. |
| PART VI, LINE 3: | ALL HOSPITAL EMPLOYEES ARE MADE AWARE OF SAMARITAN'S PATIENT FINANCIAL ASSISTANCE PROGRAM DURING NEW EMPLOYEE ORIENTATION AND THROUGH MANDATED ANNUAL TRAININGS FOR ALL EMPLOYEES. THIS ENSURES ALL STAFF UNDERSTAND THE PROGRAM'S AVAILABILITY AND APPLICATION PROCESS, SO THAT THEY MAY REFER PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE. INTERNAL POLICIES AND PROGRAM PROCEDURES ALSO ARE ACCESSIBLE THROUGH THE HOSPITAL'S INTRANET. APPLICATIONS FOR FINANCIAL ASSISTANCE ARE AVAILABLE IN PATIENT BROCHURES PROVIDED IN DISPLAY RACKS AT POINTS OF PUBLIC ENTRY TO THE HOSPITAL AND ITS PRIMARY CARE CLINICS. VERSIONS OF THE APPLICATION ARE AVAILABLE IN BOTH ENGLISH AND SPANISH. THE PUBLIC CAN ACCESS AND PRINT THE INFORMATIONAL BROCHURE/APPLICATION FROM THE HOSPITAL'S WEBSITE. ALL HOSPITAL BILLING STATEMENTS REFERENCE THE FINANCIAL ASSISTANCE PROGRAM. WHEN A PATIENT APPLIES FOR ASSISTANCE, APPLICATION PROCESSING INCLUDES SCREENING FOR ELIGIBILITY FOR PARTICIPATION IN FEDERAL AND STATE HEALTHCARE EXPENSE ASSISTANCE PROGRAMS. |
| PART VI, LINE 4: | LOCATED IN RURAL NORTHERN NEW YORK STATE, SAMARITAN MEDICAL CENTER'S SERVICE AREA COMPRISES JEFFERSON COUNTY, WHICH HAS A LAND MASS OF 1,268 SQUARE MILES, AND ADJACENT PORTIONS OF ST. LAWRENCE, LEWIS AND OSWEGO COUNTIES. DEMOGRAPHICS COMPILED ON THE NORTH COUNTRY HEALTH COMPASS WEBSITE (AND BASED ON U.S. CENSUS STATISTICS) INDICATE THE HOSPITAL'S SERVICE AREA IS POPULATED BY 116,295 PERSONS. THE POPULATION IS 81.3% WHITE, 7.7% HISPANIC, 6.6% BLACK, AND 1.8% ASIAN, WITH THE REMAINING 2.6% IDENTIFIED AS NATIVE HAWAIIAN/PACIFIC ISLANDER, AMERICAN INDIAN/ALASKAN NATIVE OR TWO OR MORE RACES. ETHNICALLY, 7.7% OF THE POPULATION IS HISPANIC/LATINO. THE POPULATION IS 52.8% MALE AND 47.2% FEMALE. ABOUT 24% OF COUNTY RESIDENTS ARE UNDER THE AGE OF 18 AND 14.6% ARE AGE 65 OR OLDER. CENSUS HEALTH STATISTICS INDICATE 10.5% OF JEFFERSON COUNTY RESIDENTS UNDER THE AGE OF 65 HAVE A DISABILITY. THE PERCENTAGE OF RESIDENTS UNDER 65 WITHOUT HEALTH INSURANCE IS 5.3%. THE REGION LAGS ECONOMICALLY WHEN COMPARED TO NEW YORK STATE. 13.1% OF JEFFERSON COUNTY'S RESIDENTS LIVE IN POVERTY AND THE PER CAPITA MEDIAN INCOME IS 26% LOWER THAN THE STATE VALUE, ACCORDING TO THE CENSUS. NYS DEPARTMENT OF LABOR STATISTICS INDICATE JEFFERSON CONSISTENTLY POSTS AMONG THE HIGHEST MONTHLY COUNTY UNEMPLOYMENT RATES. OUR SERVICE AREA INCLUDES THE SMALL CITY OF WATERTOWN (POPULATION APPROXIMATELY 25,224) AND IS HOME TO THE FORT DRUM U.S. ARMY POST (HOME OF THE 10TH MOUNTAIN DIVISION). FORT DRUM'S TRANSIENT MILITARY POPULATION INCLUDES 13,000 SOLDIERS AND A LIKE NUMBER OF DEPENDENTS. WITH NO HOSPITAL ON POST, SAMARITAN SERVES AS CHIEF PROVIDER OF ACUTE CARE FOR FORT DRUM SOLDIERS AND THEIR FAMILIES. GEOGRAPHICALLY, JEFFERSON COUNTY IS SITUATED ADJACENT TO CANADA, WITH ITS WESTERN BORDER FORMED BY LAKE ONTARIO AND THE ST. LAWRENCE RIVER. THE SOUTHEASTERN SIDE OF THE COUNTY INCLUDES A PORTION OF THE TUG HILL PLATEAU WHILE THE ADIRONDACK FOOTHILLS LIE TO THE NORTH. |
| PART VI, LINE 5: | SAMARITAN PROVIDES LEADERSHIP ON THE REGION'S HEALTH PLANNING AND COLLABORATIVE ORGANIZATIONS (INCLUDING THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION, NORTH COUNTRY HEALTH COMPASS PARTNERS AND NORTH COUNTRY INITIATIVE) AND ACTIVELY SUPPORTS ACTIVITIES COORDINATED BY THESE AGENCIES. THE HOSPITAL PROVIDES A SEMI-ANNUAL, EDUCATIONAL "BOOT CAMP" ON LOCAL HEALTH ISSUES FOR ITS AFFILIATED GOVERNING BOARDS AND COMMUNITY LEADERS. GOVERNING BOARDS OF THE HOSPITAL AND ITS PRIMARY AFFILIATES ARE COMPOSED OF REPRESENTATIVES ACROSS A BROAD RANGE OF CONSTITUENCIES, INCLUDING LOCAL BUSINESS, EDUCATION, MILITARY, HEALTH/SOCIAL SERVICE, GOVERNMENT AND NONPROFIT LEADERS. HOSPITAL DEPARTMENTS AND STAFF MEMBERS, MANY OF WHOM SERVE ON LOCAL BOARDS AND COMMITTEES, REGULARLY HELP PLAN AND PROVIDE STRONG PARTICIPATION IN COMMUNITY-BASED HEALTH FAIRS, AWARENESS CAMPAIGNS AND OTHER ACTIVITIES PROMOTING POPULATION HEALTH. |
| PART VI, LINE 6: | SAMARITAN MEDICAL CENTER IS THE LEAD ORGANIZATION OF THE SAMARITAN HEALTH SYSTEM AND PARENT CORPORATION OF FIVE AFFILIATED CORPORATIONS: SAMARITAN KEEP NURSING HOME, A 272-BED LONG-TERM RESIDENTIAL CARE FACILITY; SAMARITAN SENIOR VILLAGE (A.K.A. SAMARITAN SUMMIT VILLAGE), A 288-BED ASSISTED LIVING AND SKILLED NURSING HOME; SAMARITAN HOME HEALTH, WHICH PROVIDES SHORT-TERM, IN-HOME NURSING AND THERAPEUTIC SERVICES; SAMARITAN MEDICAL PRACTICE, WHICH SUPPORTS DEVELOPMENT AND RETENTION OF PHYSICIAN SERVICES, AND THE SAMARITAN MEDICAL CENTER FOUNDATION OF NORTHERN NEW YORK, WHICH RAISES CHARITABLE FUNDS TO SUPPORT THE HEALTH SYSTEM. SAMARITAN ALSO IS AFFILIATED WITH CLIFTON-FINE HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN ST. LAWRENCE COUNTY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (17 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS H CARMAN | ||||||||||||||
| PRESIDENT & CEO OF SMC | $666,411 | $0 | $166,603 | $0 | $5,500 | $0 | $11,200 | $0 | $33,282 | $0 | $882,996 | $0 | $0 | $0 |
| KEVIN CHANDLER MD | ||||||||||||||
| UROLOGIST-EMPLOYEE REPRESENTATIVE | $671,257 | $0 | $153,250 | $0 | $0 | $0 | $17,000 | $0 | $26,912 | $0 | $868,419 | $0 | $0 | $0 |
| NATHANIAL MILETTA MD | ||||||||||||||
| DERMATOLOGY | $748,466 | $0 | $42,241 | $0 | $0 | $0 | $17,000 | $0 | $301 | $0 | $808,008 | $0 | $0 | $0 |
| SCOTT MOLLISON | ||||||||||||||
| ORTHOPEDIC SURGEON | $632,118 | $0 | $44,000 | $0 | $0 | $0 | $17,000 | $0 | $26,912 | $0 | $720,030 | $0 | $0 | $0 |
| DAVID REINDL | ||||||||||||||
| GASTROENTROLOGIST | $678,434 | $0 | $9,055 | $0 | $0 | $0 | $17,000 | $0 | $8,699 | $0 | $713,188 | $0 | $0 | $0 |
| TONY CHUANG | ||||||||||||||
| ENT | $636,934 | $0 | $45,900 | $0 | $0 | $0 | $17,000 | $0 | $6,376 | $0 | $706,210 | $0 | $0 | $0 |
| JOHN BARRETT MD | ||||||||||||||
| TRUSTEE (PRESIDENT OF MEDI | $568,430 | $0 | $23,570 | $0 | $0 | $0 | $17,000 | $0 | $27,332 | $0 | $636,332 | $0 | $0 | $0 |
| LEO GOSSELIN | ||||||||||||||
| TRUSTEE (FORMER PRESIDENT OF MEDICAL | $517,391 | $0 | $1,500 | $0 | $0 | $0 | $17,000 | $0 | $27,332 | $0 | $563,223 | $0 | $0 | $0 |
| SHAHANDEH HAGHIR MD | ||||||||||||||
| PATHOLOGY | $429,000 | $0 | $46,000 | $0 | $5,166 | $0 | $17,000 | $0 | $23,232 | $0 | $520,398 | $0 | $0 | $0 |
| MARIO VICTORIA MD | ||||||||||||||
| CMO OF SMC | $381,180 | $0 | $0 | $0 | $19,055 | $0 | $17,000 | $0 | $28,622 | $0 | $445,857 | $0 | $0 | $0 |
| MICHAEL SHORT | ||||||||||||||
| COO OF SMC | $361,525 | $0 | $0 | $0 | $18,076 | $0 | $17,000 | $0 | $27,092 | $0 | $423,693 | $0 | $0 | $0 |
| MAXINE BRIGGS | ||||||||||||||
| TREASURER & CFO OF SMC | $350,002 | $0 | $0 | $0 | $17,500 | $0 | $17,000 | $0 | $27,332 | $0 | $411,834 | $0 | $0 | $0 |
| RORY SEARS DO | ||||||||||||||
| VICE PRESIDENT OF MEDICAL STAFF | $0 | $353,754 | $0 | $12,620 | $0 | $0 | $0 | $13,914 | $0 | $19,044 | $0 | $399,332 | $0 | $0 |
| CHRISTOPHER BASTIN | ||||||||||||||
| AVP SUPPORT SERVICES | $239,171 | $0 | $0 | $0 | $12,449 | $0 | $14,348 | $0 | $881 | $0 | $266,849 | $0 | $0 | $0 |
| BARB MORROW | ||||||||||||||
| VP FOR LONG TERM CARE AND | $75,828 | $131,692 | $0 | $0 | $3,791 | $6,584 | $1,517 | $2,633 | $7,391 | $12,837 | $88,527 | $153,746 | $0 | $0 |
| JOEL BENWARE | ||||||||||||||
| VP OF INFORMATION SERVICES & CHIEF I | $195,684 | $0 | $9,959 | $0 | $9,784 | $0 | $0 | $0 | $20,155 | $0 | $235,582 | $0 | $0 | $0 |
| DAVID RECHLIN DO | ||||||||||||||
| TRUSTEE | $133,557 | $0 | $46,424 | $0 | $0 | $0 | $5,342 | $0 | $14,677 | $0 | $200,000 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINES 4A-B | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO AN IRC 457(B) PLAN DURING 2021: MICHAEL SHORT $18,076 MARIO VICTORIA $19,055 MAXINE BRIGGS $17,500 CHRISTOPHER BASTIN $11,949 JOEL BENWARE $9,784 BARB MORROW $10,376 SHAHANDEH HAGHIR $5,166 THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING 2021: N/A | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFERSON COUNTY CIVIC FACILITY DEVELOP CORP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 452491721 | BondIssuerEIN |
| CUSIP | 47325RATT | CUSIPNum |
| Bond Issued | 2017-11-07 | BondIssuedDt |
| Issue Price | $88,595,042 | IssuePriceAmt |
| Purpose | SEE BELOW | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | Yes (1) | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $88,595,042 | TotalProceedsAmt |
| In Reserve Fund | $5,057,775 | InReserveFundAmt |
| Capitalized Interest | $328,432 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $1,272,495 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $30,334,536 | CapitalExpendituresAmt |
| Other Spent Proceeds | $52,563,453 | OtherSpentProceedsAmt |
| Substantial Completion | 2020 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (1) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K PART 1 COLUMN A AND COLUMN F | FormAndLineReferenceDesc |
| Explanation | SCHEDULE K, PART 1, BOND ISSUES: (A) ISSUERS NAME: JEFFERSON COUNTY CIVIC FACILITY DEVELOPMENT CORP (F) DESCRIPTION OF PURPOSE: CONSTRUCTION OF A NEW ADDITION TO THE HOSPITAL'S MAIN CAMPUS; RENOVATION OF CERTAIN HOSPITAL FACILITIES; PURCHASE EQUIPMENT; REFUND PRIOR BOND ISSUES. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S FORM 990 AND ACCOMPANYING SCHEDULES WERE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD PRIOR TO FILING. FORM 990 WAS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUAL DISCLOSURE STATEMENTS ARE REQUIRED BY ALL BOARD MEMBERS AND KEY PERSONS. WE HAVE BEEN AT 100% COMPLIANCE WITH THIS REQUIREMENT EACH YEAR. RESPONSES ARE REVIEWED INITIALLY BY THE CEO AND CHIEF COMPLIANCE OFFICER FOR ACCURACY AND COMPLETENESS. THIS INFORMATION IS THEN PUT INTO A FULL REPORT TO THE BOARD OF TRUSTEES FOR REVIEW AND CONSIDERATION IN UPCOMING DECISION MAKING. BOARD MEMBERS AND KEY PERSONS AFFIRM THEIR UNDERSTANDING OF THEIR DUTY TO REPORT ANY ADDITIONAL OR NEW POTENTIAL CONFLICTS THROUGHOUT THE YEAR. BOARD MEMBERS WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATION IN VOTING AND DECISION MAKING IN RELATED TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION USES AN EXTERNAL CONSULTANT TO ANALYZE AND ESTABLISH COMPENSATION AND BENEFITS FOR ALL EXECUTIVE POSITIONS. AN EVALUATION IS PERFORMED ANNUALLY. THE ANALYSIS INCLUDES A REVIEW OF MARKET DATA BASED ON REGION, FACILITY SIZE, AND RESPECTIVE RESPONSIBILITIES. THIS INFORMATION IS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FOR REVIEW AND SUBSEQUENTLY PRESENTED TO THE FULL BOARD OF TRUSTEES FOR APPROVAL. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE FILED AS PART OF THE ANNUAL FORM 990 AND ANNUAL NYS DEPARTMENT OF HEALTH INSTITUTIONAL COST REPORT, AND ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | PENSION AND OTHER POSTRETIREMENT LIABLITY ADJUSTMENTS 6,337,749. EQUITY TRANSFERS TO AFFILIATE -9,343,617. OTHER COMPONENTS OF NET PERIODIC BENEFIT COST 2,095,472. |
| FORM 990 PART XII LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| SCHEDULE H, PART V, LINE 11 CONTINUED | ENCOURAGEMENT AND HOPE TO PATIENTS, FAMILY AND VISITORS TO THE SAMARITAN CAMPUS. HOSPITAL STAFF AND PATIENTS AND THEIR FAMILIES ALSO PARTICIPATED IN THE OUT OF DARKNESS COMMUNITY WALK, A SUICIDE PREVENTION EVENT. -IMPLEMENTED A WALK-IN CLINIC FOR NEW PATIENTS AT THE HOSPITAL'S OUTPATIENT BEHAVIORAL HEALTH OFFICE, ELIMINATING WAIT LISTS AND RESULTING IN EASIER ACCESS TO SERVICES. -THROUGH ITS ADDICTION SERVICES CLINIC, ADDED AN ADDITIONAL INTENSIVE OUTPATIENT THERAPY GROUP TO SERVE A HIGHER VOLUME OF PATIENTS. IN ADDITION TO THESE SPECIFIC ACTIVITIES, SAMARITAN CONTINUED TO PARTICIPATE ON REGIONAL COMMITTEES AND IN INITIATIVES COORDINATED BY FDRHPO AND NCI THAT ADDRESS AREAS RELATIVE TO CHRONIC AND BEHAVIORAL HEALTH ISSUES, AS WELL AS PARTNER WITH THESE AND OTHER COMMUNITY PROVIDERS AND AGENCIES ON PROJECTS ADDRESSING ADDITIONAL REGIONAL POPULATION HEALTH CONCERNS THAT ARE NOT SPECIFICALLY TACKLED IN THE CURRENT CSP. THESE ONGOING ACTIVITIES INCLUDE PREVENTION AND AWARENESS EDUCATION ON THE REGION'S MOST PREVALENT CHRONIC DISEASES AND CONDITIONS, EARLY CANCER DETECTION SCREENINGS, SMOKING CESSATION CLASSES, PARTICIPATION IN AND SUPPORT FOR REGIONAL HEALTH CAMPAIGNS, PHYSICIAN RECRUITMENT/RETENTION ACTIVITIES, ADOPTION OF EVIDENCE-BASED MEDICAL AND CLINICAL IMPROVEMENTS TO ENHANCE PATIENT OUTCOMES, AND DEVELOPMENT OF TELEMEDICINE INFRASTRUCTURE AND TOOLS TO IMPROVE THE ACCESS OF OUR REGION'S RURAL, UNDER-SERVED POPULATION TO COST-EFFECTIVE, QUALITY HEALTH CARE. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN KEEP NURSING HOME | ||||||||||
| 133 PRATT STREET | WATERTOWN | NY | 13601 | 160969838 | SKILLED NURSING FACILITY | NY | 501(C)3 | LINE 3 SCH A | SAMARITAN MEDICAL CENTER | Yes (1) |
| THE SAMARITAN MEDICAL CENTER FDN OF NORTHERN NEW YORK INC | ||||||||||
| 830 WASHINGTON STREET | WATERTOWN | NY | 13601 | 161490523 | PROVIDES FUND FOR SAMARITAN MEDICAL CENTER AND AFFLIATES | NY | 501(C)3 | LINE 7 SCH A | SAMARITAN MEDICAL CENTER | Yes (1) |
| EDWARD J NOBLE HOSPITAL- SAMARITAN | ||||||||||
| 104 PADDOCK STREET SUITE 104 | WATERTOWN | NY | 13601 | 237227989 | HOSPITAL | NY | 501(C)3 | LINE 3 SCH A | SAMARITAN MEDICAL CENTER | Yes (1) |
| SAMARITAN MEDICAL PRACTICE PC | ||||||||||
| 830 WASHINGTON STREET | WATERTOWN | NY | 13601 | 261528342 | PHYSICIAN MEDICAL PRACTICE | NY | 501(C)3 | LINE 3 SCH A | SAMARITAN MEDICAL CENTER | Yes (1) |
| SAMARITAN SENIOR VILLAGE INC | ||||||||||
| 22691 CAMPUS DRIVE | WATERTOWN | NY | 13601 | 454913668 | SENIOR CITIZEN COMMUNITY | NY | 501(C)3 | LINE 3 SCH A | SAMARITAN MEDICAL CENTER | Yes (1) |
| SAMARITAN HOME HEALTH | ||||||||||
| 830 WASHINGTON STREET | WATERTOWN | NY | 13601 | 461043637 | HOME HEALTH AGENCY | NY | 501(C)3 | LINE 3 SCH A | SAMARITAN MEDICAL CENTER | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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