2022-11-11T08:59:48-06:00 2021-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2021-01-01 150533577 SAMARITAN MEDICAL CENTER SAMA 3157855702 830 WASHINGTON STREET WATERTOWN NY 13601 MAXINE BRIGGS CFO 3157855702 2022-11-07 1 MAXINE BRIGGS 999009999 PATRICK CAPELLA P01359200 3154463600 2022-11-07 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MAXINE BRIGGS 830 WASHINGTON STREET WATERTOWN NY 13601 300151623 0 X WWW.SAMARITANHEALTH.COM X 1881 NY 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. 22 20 2291 69 0 0 12173692 5204330 253273191 276875318 2581930 422095 10955303 17527162 278984116 300028905 0 0 0 0 135443349 144511369 0 0 686725 131401600 134255332 266844949 278766701 12139167 21262204 304286114 312272896 194867330 182612490 109418784 129660406 X 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. 0 0 243366987 296801884 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. 243366987 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 86 0 2291 1 0 0 0 0 0 0 0 0 0 0 0 0 X 22 20 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MAXINE BRIGGS 3157853605 104 PADDOCK WATERTOWN NY 13601 JAN TURCOTTE CHAIR 1.00 1.50 X X 0 0 0 BERNARD BROWN VICE CHAIR 1.00 X X 0 0 0 ALFRED CALLIGARIS FINANCE COMMITTEE CHAIR 1.00 X X 0 0 0 DENISE YOUNG SECRETARY 1.00 X X 0 0 0 JOHN BARRETT MD TRUSTEE (PRESIDENT OF MEDI 40.00 X 592000 0 44332 DAVID RECHLIN DO TRUSTEE 40.00 X 179981 0 20019 MARY WARDWELL DONAHUE TRUSTEE 1.00 2.50 X 0 0 0 DAPHANE HENRI-FOLEY TRUSTEE (CLIFTON FINE BOARD) 1.00 X 0 0 0 MARIE HESS TRUSTEE 1.00 X 0 0 0 TRACY LEONARD TRUSTEE 1.00 X 0 0 0 AL MALONEY MD TRUSTEE 1.00 X 0 0 0 TIMOTHY VIRKLER TRUSTEE 1.00 X 0 0 0 THOMAS PICHE TRUSTEE 1.00 X 0 0 0 CATHERINE QUENCER TRUSTEE 1.00 1.00 X 0 0 0 JOAN TREADWELL WOODS TRUSTEE 1.00 2.50 X 0 0 0 STEPHEN TODD TRUSTEE 1.00 X 0 0 0 PAUL BARTON TRUSTEE 1.00 X 0 0 0 BERLINE DODARD TRUSTEE (AUXILIARY PRESIDENT) 1.00 X 0 0 0 KIMBERLY LACLAIR TRUSTEE (CHAIR OF THE SMC 1.00 X 0 0 0 SAMUEL PURINGTON TRUSTEE (SKH AND SSV BOARD VICE CHAIR) 1.00 1.50 X 0 0 0 RORY SEARS DO VICE PRESIDENT OF MEDICAL STAFF 40.00 X 0 366374 32958 THOMAS H CARMAN PRESIDENT & CEO OF SMC 40.00 3.50 X 838514 0 44482 MAXINE BRIGGS TREASURER & CFO OF SMC 40.00 2.50 X 367502 0 44332 MARIO VICTORIA MD CMO OF SMC 40.00 1.00 X 400235 0 45622 MICHAEL SHORT COO OF SMC 40.00 1.00 X 379601 0 44092 CHRISTOPHER BASTIN AVP SUPPORT SERVICES 40.00 X 251620 0 15229 BARB MORROW VP FOR LONG TERM CARE AND 14.50 25.50 X 79619 138276 24378 JOEL BENWARE VP OF INFORMATION SERVICES & CHIEF INFORMATION OFF 40.00 X 215427 0 20155 KEVIN CHANDLER MD UROLOGIST-EMPLOYEE REPRESENTATIVE 40.00 X 824507 0 43912 NATHANIAL MILETTA MD DERMATOLOGY 40.00 X 790707 0 17301 DAVID REINDL GASTROENTROLOGIST 40.00 X 687489 0 25699 TONY CHUANG ENT 40.00 X 682834 0 23376 SCOTT MOLLISON ORTHOPEDIC SURGEON 40.00 X 676118 0 43912 SHAHANDEH HAGHIR MD PATHOLOGY 40.00 X 480166 0 40232 LEO GOSSELIN TRUSTEE (FORMER PRESIDENT OF MEDICAL STAFF) 1/21-3 40.00 X 518891 0 44332 7965211 504650 574363 15 1 1 0 NEW YORK STATE NURSES ASSOC PO BOX 12340 ALBANY NY 12212 PURCHASED SERVICES 5484892 JEFFERSON ANESTHESIOLOGIST SERVICES 826 WASHINGTON ST WATERTOWN NY 13601 ANESTHESIA SERVICES 4282477 APOGEE MEDICAL MANAGEMENT INC 15059 N SCOTTSDALE ROAD STE 600 SCOTTSDALE AZ 85254 PURCHASED SERVICES 3996677 LABORATORY CORPORATION OF AMERICA 2121 NORTH 117TH AVE STE 200 OMAHA NE 68164 PURCHASED SERVICES 3928477 MOHAWK HEALTHCARE PO BOX 27 UTICA NY 13503 PURCHASED SERVICES 3886456 5 313286 4533940 357104 5204330 PATIENT SERVICE REVENUE 623000 276875318 276875318 276875318 417595 417595 837313 122718 714595 714595 714595 4500 0 4500 4500 4500 SHARED SERVICES 541900 2463089 2463089 CAFETERIA 722210 417182 417182 13932296 13932296 16812567 300028905 293687885 0 1136690 3991001 1235663 2755338 109369003 95992682 12903197 473124 6228634 5342300 860174 26160 15975055 13701805 2206155 67095 8947676 7674422 1235674 37580 436540 25186 411354 204608 199822 4786 16475938 15709693 766245 862696 862646 50 1619061 266096 1338514 14451 6437081 6204232 232849 7705725 6821658 884067 236720 68848 166102 1770 29299 18003 11296 61643 61643 99840 99840 15284382 12951985 2332397 2466656 2112350 354306 SUPPLIES 53062345 49797127 3265068 150 OTHER EXPENSES 17410062 13756077 3592426 61559 PROVISION FOR BAD DEBT 5008570 5008570 EQUIPMENT REPAIR AND MA 4744999 4571123 173876 2109167 2109167 278766701 243366987 34712989 686725 5349 5083 72623549 83294433 36865191 36921009 5687066 5998864 3647321 4719287 417430547 251660694 172072128 165769853 874471 874471 3995844 4009026 8515195 10680870 304286114 312272896 42089708 41966259 80828251 79761784 12155467 12230500 59793904 48653947 194867330 182612490 X 107977902 127822146 1440882 1838260 109418784 129660406 304286114 312272896 X 21262204 -110185 -910396 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 24446 24446 0 PART II-B, LINE 1: 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. 1440882 4891044 4493666 1838260 2421545 10390355 11371018 1440882 12181208 2666210 12425873 2421545 2137591 13669647 3626030 12181208 2089529 2999187 295125 2137591 0.47570 0.52430 0 0 1216252 1216252 211476781 66833412 144643369 10566813 6378487 4188326 193866256 178448795 15417461 304445 304445 165769853 RIGHT OF USE LIABILITIES 5481674 OTHER LIABILITIES 15704758 CONTRACT LIABILITY - MEDICARE 27467515 48653947 X 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. 1 1 X 1 X 1 X 1 1 0 1 1 3575986 247013 3328973 0.01220 52946448 33674710 19271738 0.07040 56522434 33921723 22600711 0.08260 209382 209382 0.00080 1336295 1336295 0.00490 6171573 2123764 4047809 0.00150 7717250 2123764 5593486 0.00720 64239684 36045487 28194197 0.08980 1 5008570 55515858 54055281 1460577 X 1 1 1 1 SAMARITAN MEDICAL CENTER 830 WASHINGTON STREET WATERTOWN NY 13601 X X X SAMARITAN MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SAMARITANHEALTH.COM X NCNYHEALTHCOMPASS.ORG X 1 19 1 SAMARITANHEALTH.COM 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X 1 X SAMARITANHEALTH.COM X SAMARITANHEALTH.COM X X X 1 X 0 X X 1 X 0 0 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. 13 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 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 X X X X X 1 1 0 0 0 0 0 0 0 THOMAS H CARMAN PRESIDENT & CEO OF SMC 666411 0 166603 0 5500 0 11200 0 33282 0 882996 0 0 0 KEVIN CHANDLER MD UROLOGIST-EMPLOYEE REPRESENTATIVE 671257 0 153250 0 0 0 17000 0 26912 0 868419 0 0 0 NATHANIAL MILETTA MD DERMATOLOGY 748466 0 42241 0 0 0 17000 0 301 0 808008 0 0 0 SCOTT MOLLISON ORTHOPEDIC SURGEON 632118 0 44000 0 0 0 17000 0 26912 0 720030 0 0 0 DAVID REINDL GASTROENTROLOGIST 678434 0 9055 0 0 0 17000 0 8699 0 713188 0 0 0 TONY CHUANG ENT 636934 0 45900 0 0 0 17000 0 6376 0 706210 0 0 0 JOHN BARRETT MD TRUSTEE (PRESIDENT OF MEDI 568430 0 23570 0 0 0 17000 0 27332 0 636332 0 0 0 LEO GOSSELIN TRUSTEE (FORMER PRESIDENT OF MEDICAL 517391 0 1500 0 0 0 17000 0 27332 0 563223 0 0 0 SHAHANDEH HAGHIR MD PATHOLOGY 429000 0 46000 0 5166 0 17000 0 23232 0 520398 0 0 0 MARIO VICTORIA MD CMO OF SMC 381180 0 0 0 19055 0 17000 0 28622 0 445857 0 0 0 MICHAEL SHORT COO OF SMC 361525 0 0 0 18076 0 17000 0 27092 0 423693 0 0 0 MAXINE BRIGGS TREASURER & CFO OF SMC 350002 0 0 0 17500 0 17000 0 27332 0 411834 0 0 0 RORY SEARS DO VICE PRESIDENT OF MEDICAL STAFF 0 353754 0 12620 0 0 0 13914 0 19044 0 399332 0 0 CHRISTOPHER BASTIN AVP SUPPORT SERVICES 239171 0 0 0 12449 0 14348 0 881 0 266849 0 0 0 BARB MORROW VP FOR LONG TERM CARE AND 75828 131692 0 0 3791 6584 1517 2633 7391 12837 88527 153746 0 0 JOEL BENWARE VP OF INFORMATION SERVICES & CHIEF I 195684 0 9959 0 9784 0 0 0 20155 0 235582 0 0 0 DAVID RECHLIN DO TRUSTEE 133557 0 46424 0 0 0 5342 0 14677 0 200000 0 0 0 PART I, LINES 4A-B 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 A JEFFERSON COUNTY CIVIC FACILITY DEVELOP CORP 452491721 47325RATT 2017-11-07 88595042 SEE BELOW 0 1 0 A 88595042 5057775 328432 1272495 30334536 52563453 2020 1 0 0 1 A 0 1 1 1 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 SCHEDULE K PART 1 COLUMN A AND COLUMN F 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. 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. 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 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 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 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 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 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 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0