2019-11-14T15:51:31-06:00 2018-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2018-01-01 150533577 SAMARITAN MEDICAL CENTER SAMA 3157855702 830 WASHINGTON STREET WATERTOWN NY 13601 MAXINE BRIGGS CFO 3157855702 2019-11-12 1 DEBORAH STUCK P01281391 3154463600 2019-11-12 24.39.85.114 2019-11-12 13:37:53 ES P FD62137317EE26C9F26E40FD83CAC65FE1294EC8 B8C5F40B2B3D88A0A8DAC4C2F3911A4184EEA169 2018 2020-03-31 21:24:44Z MAXINE BRIGGS 830 WASHINGTON STREET WATERTOWN NY 13601 268217600 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. 23 20 2150 188 0 0 3844342 14871976 213905983 234501080 53153 560823 3264158 18096179 221067636 268030058 0 0 0 0 125366851 134004701 0 0 856398 93404693 103031594 218771544 237036295 2296092 30993763 257536551 268660652 169581421 162003085 87955130 106657567 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 202500501 2242033122 DURING 2018, SAMARITAN MEDICAL CENTER PROVIDED CARE FOR 10,212 INPATIENT DISCHARGES AND A TOTAL OF 266,739 OUTPAITENT VISITS. OF THE TOTAL OUTPATIENT VISITS, THERE WERE 46,126 EMERGENCY ROOM VISITS AND 126,475 FAMILY HEALTH CLINIC VISITS. 202500501 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 1 149 0 1 2150 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 23 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 3157855702 830 WASHINGTON STREET WATERTOWN NY 13601 MELANIE PARKER-GEURTSEN CHAIR 1.00 2.50 X X 0 0 0 JAN TURCOTTE VICE CHAIR 1.00 X X 0 0 0 BERNARD BROWN SECRETARY 1.00 X X 0 0 0 ALFRED CALLIGARIS FINANCE COMMITTEE CHAIR 1.00 X X 0 0 0 PAUL KRAEGER TREASURER, CFO 40.00 5.00 X X 419721 0 18509 REV FRED GARRY IMMEDIATE PAST CHAIR 1.00 X 0 0 0 CHRISTINE CISCO TRUSTEE 1.00 X 0 0 0 MARY WARDWELL DONAHUE TRUSTEE 1.00 2.50 X 0 0 0 DAPHINE HENRI-FOLEY TRUSTEE 1.00 X 0 0 0 MARIE HESS TRUSTEE 1.00 X 0 0 0 HOWARD HUANG MD TRUSTEE 1.00 X 0 0 0 DIERDA SORRELL TRUSTEE 1.00 X 0 0 0 ADDISON VARS III TRUSTEE 1.00 2.50 X 0 0 0 AL MALONEY MD TRUSTEE 1.00 X 0 0 0 COL BRANDON BOWLINE TRUSTEE 1.00 X 0 0 0 MARY PERRINE 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 DAVID RECHLIN DO TRUSTEE 40.00 X 155000 0 6153 JOAN TREADWELL WOODS TRUSTEE 1.00 2.50 X 0 0 0 LISA WEBER TRUSTEE 1.00 1.00 X 0 0 0 STEPHEN TODD TRUSTEE 1.00 X 0 0 0 LEO GOSSELIN MD TRUSTEE 1.00 X 0 0 0 STEVEN PIERCE TRUSTEE 1.00 1.00 X 0 0 0 DENISE YOUNG TRUSTEE 1.00 X 0 0 0 THOMAS H CARMAN PRESIDENT & CEO OF SMC 40.00 3.50 X X 1118097 0 40038 ROBERT KIMBALL MD TRUSTEE 40.00 X 440035 0 34122 KEVIN KIEFF TRUSTEE 1.00 X 0 0 0 ROBERT SEAMON TRUSTEE 1.00 X 0 0 0 MARIO VICTORIA MD CMO OF SMC 40.00 1.00 X 405847 0 39657 MICHAEL SHORT COO OF SMC 40.00 1.00 X 368497 0 30596 KIMBERLY THIBERT VP OF PATIENT CARE/CNO 40.00 X 262260 0 15243 KEITH ROBISON VP INFORMATION SERVICES & CHIEF INFORMATION OFFICE 40.00 X 192223 0 821 RANDALL FIPPS AVP OPERATIONS & BEHAVORIAL HEALTH 40.00 X 211648 0 8874 CHRISTOPHER BASTIEN AVP SUPPORT SERVICES 40.00 X 209558 0 8166 ALEJANDRO RODRIGUES MD UROLOGIST 40.00 X 583396 0 35121 JOSEPH WETTERHAHN MD FAMILY MEDICINE 40.00 X 561706 0 17819 KEVIN CHANDLER MD UROLOGIST 40.00 X 721838 0 38637 AARON CAMPBELL DO HOSPITALIST 40.00 X 392954 0 15381 JAMES STILLERMAN MD WOUND CARE 40.00 X 376494 0 20339 DAVID FLINT FORMER TRUSTEE 17.00 X 138974 0 12090 JACK RUSH FORMER TRUSTEE 40.00 X 213607 0 12530 LAVERENE VANDERWALL FORMER TRUSTEE 20.00 X 133093 0 7220 6904948 0 361316 190 1 1 0 JEFFERSON ANESTHESIOLOGIST SERVICES 826 WASHINGTON ST WATERTOWN NY 13601 ANESTHESIA SERVICES 3395840 CONTINENTAL CONSTRUCTION LLC 2125 STATE HIGHWAY 812 PO BOX 358 GOUVERNEUR NY 13642 PURCHASED SERVICES 1383215 FRESENIUS MANAGEMENT SERVICES INC 16343 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 PURCHASED SERVICES 587283 TRUSTAFF TRAVEL NURSES LLC 4675 CORNELL ROAD CINCINNATI OH 45241 PURCHASED SERVICES 546797 MEDPARTNERS LOCUM TENENS LLC 5810 CORAL RIDGE DRIVE STE 250 CORAL SPRINGS FL 33076 PURCHASED SERVICES 507981 5 104818 676906 14090252 14871976 PATIENT SERVICE REVENUE 623000 234501080 234501080 234501080 110429 110429 814629 113620 701009 701009 701009 394293 130023 0 73922 394293 56101 450394 450394 MLMIC 524298 9863128 9863128 SHARED SERVICES 541900 1503001 1503001 CAFETERIA 722210 718790 718790 5310251 5310251 17395170 268030058 242033122 0 11124960 3510910 161152 3349758 100673925 88488904 11630148 554873 4761333 4050942 685156 25235 17325177 14740261 2493093 91823 7733356 6579539 1112830 40987 579928 5625 574303 159373 146408 12965 101336 101336 10341122 9474183 866939 719668 2577 717091 1426520 275900 1132996 17624 4653815 4487715 162700 3400 7539197 6377383 1161814 400121 195578 195908 8635 90858 31059 58900 899 189068 189068 216000 216000 14399447 11078935 3320512 2054257 1545224 509033 SUPPLIES 35729864 34843419 864302 22143 OTHER EXPENSES 13891136 9967241 3846081 77814 PROVISION FOR BAD DEBT 5486612 5486612 EQUIPMENT REPAIR AND MA 3062757 2528669 534088 1990515 1990515 237036295 202500501 33679396 856398 5773 4586 71268435 58368194 24821718 27064260 2954827 4789916 4196141 4360548 361217382 204478321 140432320 156739061 874471 874471 6438156 3768390 6544710 12691226 257536551 268660652 37494747 41987437 83826263 82866186 18060582 16368513 30199829 20780949 169581421 162003085 X 85817539 94476359 1263120 11306737 874471 874471 87955130 106657567 257536551 268660652 X 30993763 -14995 -12276331 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 101336 101336 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. 2137591 13669647 3626030 12181208 2089529 2999187 295125 2137591 2207124 2416457 2534052 2089529 2526223 1796358 2115457 2207124 2051423 1474414 999614 2526223 0.07180 0.92820 0 0 1216252 1216252 172900895 59736851 113164044 8611199 4815599 3795600 169409042 139925871 29483171 9079994 9079994 156739061 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 7613210 RETIREMENT PLAN OBLIGATIONS 14140192 INSURANCE RESERVE PAYABLE 4137163 DUE TO/FROM AFFILIATES -5109616 20780949 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, 2018 AND 2017, SAMARITAN DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2015 THROUGH 2018. 1 1 X 1 X 1 X 1 1 0 1 1 714007 257521 456486 0.00190 46386353 30226041 16160312 0.06820 47100360 30483562 16616798 0.07010 90523 90523 0.00040 1448989 1448989 0.00610 7301153 5704041 1597112 0.00670 8840665 5704041 3136624 0.01320 55941025 36187603 19753422 0.08330 1 5486609 434891 55405860 61007479 -5601619 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 16 1 1 1 1 X SAMARITANHEALTH.COM X NCNYHEALTHCOMPASS.ORG X 1 16 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 X 1 X 0 0 SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 5: SAMARITAN MEDICAL CENTER'S 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS PREPARED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO) IN COLLABORATION WITH NORTH COUNTRY HEALTH COMPASS PARTNERS (NCHCP). THE LATTER GROUP IS AN FDRHPO-ALIGNED COALITION OF REPRESENTATIVES FROM HOSPITALS, COUNTY HEALTH DEPARTMENTS AND AGENCIES, AND COMMUNITY-BASED ORGANIZATIONS WORKING TOGETHER TO DEVELOP, IMPLEMENT AND EVALUATE HEALTH IMPROVEMENT INITIATIVES WITHIN A THREE-COUNTY REGION. NCHCP MEMBERS, WHO MEET MONTHLY, PROVIDED INPUT AND FEEDBACK THROUGHOUT THE CHNA'S DEVELOPMENT. THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH WHO WERE INVOLVED IN THE PROCESS INCLUDED THE JEFFERSON COUNTY PUBLIC HEALTH SERVICE'S DIRECTOR AND PUBLIC HEALTH PLANNER; LEWIS COUNTY PUBLIC HEALTH'S DIRECTOR AND SUPERVISING PUBLIC HEALTH NURSE, AND THE ST. LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT'S DIRECTOR AND PREVENTIVE SERVICES DIRECTOR. SAMARITAN'S SERVICE AREA COVERS ALL OF JEFFERSON COUNTY AND ADJACENT PORTIONS OF LEWIS AND ST. LAWRENCE COUNTIES; THE INDIVIDUALS FROM THE HEALTH DEPARTMENTS OF THESE THREE COUNTIES REPRESENT THE BROAD INTERESTS OF RESIDENTS LIVING IN THE COMMUNITIES SERVED BY SAMARITAN MEDICAL CENTER. 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; LEWIS COUNTY GENERAL HOSPITAL IN LEWIS COUNTY AND CLAXTON-HEPBURN MEDICAL CENTER, CLIFTON-FINE HOSPITAL AND E.J. NOBLE HOSPITAL/GOUVERNEUR IN ST. LAWRENCE COUNTY. SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 6B: IN ADDITION TO THE HOSPITALS, THE CHNA ALSO WAS CONDUCTED IN PARTNERSHIP WITH THE PUBLIC HEALTH DEPARTMENTS OF JEFFERSON, LEWIS AND ST. LAWRENCE COUNTIES, WITH COORDINATION AND CHNA OVERSIGHT PROVIDED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION. THROUGH THE NCHCP, COMMUNITY-BASED AGENCIES ALSO RECEIVED INFORMATION AS THE CHNA WAS DEVELOPED AND HAD OPPORTUNITY TO PROVIDE FEEDBACK. THESE INCLUDED: CREDO COMMUNITY CENTER FOR THE TREATMENT OF ADDICTIONS, MOUNTAINVIEW PREVENTION SERVICES, NORTH COUNTRY FAMILY HEALTH CENTER, NORTH COUNTRY PRENATAL-PERINATAL COUNCIL, PIVOT ALCOHOL AND SUBSTANCE ABUSE COUNCIL OF JEFFERSON COUNTY, ST. LAWRENCE-LEWIS BOARD OF COOPERATIVE EDUCATIONAL SERVICES, ST. LAWRENCE COUNTY COMMUNITY SERVICES, SEAWAY VALLEY PREVENTION COUNCIL, UNITED HEALTH GROUP, WATERTOWN CHAMBER OF COMMERCE AND WATERTOWN FAMILY YMCA. SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 11: SAMARITAN'S COMMUNITY SERVICE PLAN OUTLINED ACTIVITIES AND STRATEGIES IN TWO AREAS ALIGNED WITH NEW YORK STATE'S PREVENTION AGENDA: PREVENT CHRONIC DISEASE AND PROMOTE MENTAL HEALTH/PREVENT SUBSTANCE ABUSE. DURING 2018 SAMARITAN CONTINUED TO SUPPORT THE DEVELOPMENT AND WORK OF A CERTIFIED DIABETES EDUCATOR (CDE), WHO IS ALSO A REGISTERED DIETITIAN. THIS STAFF MEMBER IMPLEMENTED ONE-ON-ONE DIABETES SELF-MANAGEMENT EDUCATION (DSME) TO PATIENTS DIAGNOSED WITH DIABETES FOR MEDICAL NUTRITIONAL THERAPY (MNT). DURING 2018, SHE PROVIDED 324 DIABETES PATIENTS WITH DSME AND WORKED ON DEVELOPMENT OF A GROUP DSME CLASS FOR CERTIFICATION. THE CDE ALSO CONSULTED THROUGHOUT THE YEAR WITH PRIMARY CARE AND PHYSICIAN PRACTICES BOTH WITHIN AND OUTSIDE OF THE SAMARITAN HEALTH SYSTEM TO EDUCATE PRACTITIONERS ON HOW TO WORK WITH DIABETES PATIENTS TO PROMOTE DISEASE SELF-MANAGEMENT. SAMARITAN PARTNERED WITH OTHER LOCAL ORGANIZATIONS TO ENGAGE IN COMMUNITY-WIDE AWARENESS, EDUCATION AND PREVENTION ACTIVITIES IN THE AREAS OF DIABETES, AS WELL AS CANCER. DURING THE YEAR, SAMARITAN ALSO ENGAGED A CHRONIC CARE MANAGER, A REGISTERED NURSE WHO ASSESSED THE RECORDS OF NEARLY 300 OUTPATIENTS SUFFERING FROM TWO OR MORE CHRONIC CONDITIONS. SHE THEN WORKED WITH INDIVIDUAL PATIENTS TO DEVELOP PLANS THAT IDENTIFIED BARRIERS TO CARE, PROVIDED COUNSELING AND REFERRALS TO PROVIDERS AND COMMUNITY-BASED ORGANIZATIONS THAT ADDRESSED MEDICAL AND SOCIAL DETERMINANTS OF HEALTH ISSUES, AND PROVIDED COORDINATION AND INTERVENTION WHEN OBSTACLES AROSE DURING IMPLEMENTATION OF INDIVIDUAL PLANS.SAMARITAN CONTINUED IMPLEMENTATION OF PROTOCOLS TO INTEGRATE MENTAL, EMOTIONAL AND BEHAVIORAL (MEB) HEALTH SCREENINGS IN PRIMARY CARE SETTINGS. IT ALSO CONTINUED TO INCREASE PATIENT ACCESS TO BEHAVIORAL HEALTHCARE AND RELATED SUPPORTS IN ITS PRIMARY CARE CLINICS AND WORK TO LESSEN THE STIGMA OF SEEKING MEB TREATMENT. NEARLY 30,000 OUTPATIENTS UNDERWENT INITIAL DEPRESSION SCREENINGS DURING PRIMARY CARE VISITS AND MORE THAN 2,000 OF THESE INDIVIDUALS UNDERWENT ADDITIONAL SCREENINGS WITH APPROPRIATE FOLLOW-UPS AND REFERRALS FOR TREATMENT. OUTPATIENT CLINIC PRACTITIONERS ALSO ENGAGED SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT WITH MORE THAN 19,000 OUTPATIENTS. IN ADDITION, THE NUMBER OF LICENSED CLINICAL SOCIAL WORKERS IN THE HOSPITAL'S OUTPATIENT CLINICS INCREASED FROM ONE TO THREE. LCSWS ASSIST INDIVIDUALS WITH MEB DIAGNOSES IN OBTAINING THE NECESSARY COUNSELING AND SUPPORT. IN ADDITION TO THESE SPECIFIC ACTIVITIES, SAMARITAN CONTINUED TO PARTICIPATE ON REGIONAL COMMITTEES AND IN INITIATIVES COORDINATED BY FDRHPO AND THE NORTH COUNTRY INITIATIVE 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. 10 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 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 2018 AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS REPORTED WERE TAKEN DIRECTLY FROM THE 2018 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 2018 WAS APPROXIMATELY 38%. 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: AS REPORTED IN DETAIL IN PART V, SECTION B, SAMARITAN MEDICAL CENTER PARTICIPATED IN A COMPREHENSIVE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT PREPARED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO) IN COLLABORATION WITH NORTH COUNTRY HEALTH COMPASS PARTNERS (NCHCP). THE LATTER GROUP IS A COALITION OF REPRESENTATIVES FROM HOSPITALS, COUNTY HEALTH DEPARTMENTS AND AGENCIES, AND COMMUNITY-BASED ORGANIZATIONS WORKING TOGETHER TO DEVELOP, IMPLEMENT AND EVALUATE HEALTH IMPROVEMENT INITIATIVES ACROSS JEFFERSON, LEWIS AND ST. LAWRENCE COUNTIES. DURING MONTHLY MEETINGS OF THE NCHCP, RESULTS OF THE CHNA WERE DISCUSSED AND USED NOT ONLY TO DEVELOP AND COORDINATE COMMUNITY HEALTH IMPROVEMENT INITIATIVES, BUT ALSO INFORM PLANS FOR ONGOING MONITORING AND ASSESSMENT OF TARGETED NEEDS AND POPULATIONS IN THE COMING MONTHS AND YEAR. FDRHPO AND NCHCP CONDUCTED A 2018 COMMUNITY SURVEY OF ADULT RESIDENTS WHICH PROVIDED COMPARATIVE AND SUPPLEMENTARY DATA TO THE INFORMATION ORIGINALLY COMPILED FOR THE 2016 COMPREHENSIVE ASSESSMENT AND FOR THE 2017 COMMUNITY SURVEY OF ADULTS. 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 EMPLOYEES UNDERSTAND THE PROGRAM'S AVAILABILITY AND APPLICATION PROCESS, SO THAT THEY ARE ABLE TO REFER PATIENTS WHO MAY NEED FINANCIAL SUPPORT TO THE HOSPITAL'S PATIENT REGISTRATION OFFICE FOR ASSISTANCE. INTERNAL POLICIES AND PROCEDURES ABOUT THE PROGRAM ALSO ARE AVAILABLE TO EMPLOYEES THROUGH THE HOSPITAL'S INTRANET. APPLICATIONS FOR FINANCIAL ASSISTANCE ARE AVAILABLE IN PATIENT HANDOUTS AND ALSO PROVIDED IN DISPLAY RACKS AT ALL POINTS OF PUBLIC ENTRY TO THE FACILITY, AS WELL AS ENTRY POINTS TO THE PRIMARY CARE CLINICS OPERATED AT THE HOSPITAL'S EXTENSION SITES. THE PUBLIC CAN ALSO ACCESS AND PRINT THE INFORMATION BROCHURE/APPLICATION FROM THE HOSPITAL'S WEBSITE. PATIENTS ALSO MAY VIEW THEIR BILLS ELECTRONICALLY THROUGH THIS WEBSITE. ALL HOSPITAL BILLING STATEMENTS ADDITIONALLY 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 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. SAMARITAN'S PATIENTS ARE PREDOMINANTLY JEFFERSON COUNTY RESIDENTS. THE U.S. CENSUS ESTIMATED JEFFERSON COUNTY'S 2018 POPULATION AT 111,775, FOR A POPULATION DENSITY OF 88 PERSONS PER SQUARE MILE. THE POPULATION IS APPROXIMATELY 90% CAUCASIAN, 8% BLACK OR AFRICAN AMERICAN, WITH THE REMAINDER DESIGNATED AS MEMBERS OF NATIVE POPULATIONS OR OF MULTIPLE RACES. POPULATION CENTERS IN OUR LARGELY RURAL COUNTY INCLUDE THE SMALL CITY OF WATERTOWN (2018 POPULATION ESTIMATE 25,290), THE FORT DRUM U.S. MILITARY POST (HOME OF THE 10TH MOUNTAIN DIVISION), AND SEVERAL SMALL VILLAGES. THE TRANSIENT MILITARY POPULATION ASSIGNED TO FORT DRUM INCLUDES, AT ANY GIVEN TIME, NEARLY 15,000 SOLDIERS AND A LIKE NUMBER OF FAMILY MEMBERS. HOUSING IS AVAILABLE ON POST TO SOME BUT NOT ALL MILITARY FAMILIES; THERE ARE NO HOSPITALS OR PRIMARY/SECONDARY SCHOOLS LOCATED ON FORT DRUM, WITH THE ARMY INSTEAD RELYING ON LOCAL COMMUNITY RESOURCES FOR ADDITIONAL HOUSING, ACUTE CARE AND SPECIALTY MEDICAL SERVICES, AND THE EDUCATION OF SOLDIERS' CHILDREN. BECAUSE OF THIS, THE FORT DRUM COMMUNITY IS WELL INTEGRATED IN AND SUPPORTED BY THE REGION'S CIVILIAN COMMUNITY.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. VARYING PORTIONS OF THE COUNTY EACH WINTER ENDURE RECURRENT BOUTS OF SEVERE WEATHER, DUE LARGELY TO HEAVY LAKE EFFECT SNOWSTORMS BLOWING IN FROM LAKE ONTARIO AND ACROSS THE TUG HILL, GENERATING SOME OF THE NATION'S LARGEST ANNUAL SNOWFALLS. THE COUNTY LAGS ECONOMICALLY WHEN COMPARED TO NEW YORK STATE. THE MEDIAN INCOME FOR JEFFERSON COUNT HOUSEHOLDS IS 20% LOWER THAT THE STATE'S MEDIAN INCOME. U.S. CENSUS FIGURES FURTHER INDICATE THAT 15% OF JEFFERSON COUNTY RESIDENTS LIVE IN POVERTY. COUNTY UNEMPLOYMENT ALSO RUNS CONSISTENTLY HIGHER THAN THE REST OF THE STATE. WHILE THE U.S. ARMY IS FAR AND AWAY THE LARGEST EMPLOYER IN JEFFERSON COUNTY WITH APPROXIMATELY 25,000 EMPLOYEES (MILITARY AND CIVILIAN), THE SAMARITAN HEALTH SYSTEM (WHICH INCLUDES SAMARITAN MEDICAL CENTER AND SEVERAL AFFILIATED FACILITIES AND AGENCIES), WHICH HAS NEARLY 2,200 FULL-TIME EQUIVALENT EMPLOYEES, IS THE COMMUNITY'S LARGEST PRIVATE EMPLOYER. IN ADDITION TO GOVERNMENT, HEALTH AND HUMAN SERVICES AND EDUCATION JOBS, OTHER KEY SECTORS OF EMPLOYMENT INCLUDE AGRICULTURE, TOURISM, RETAIL AND MANUFACTURING. SAMARITAN'S PAYER MIX ANNUALLY SHOWS 35% TO 40% OF HOSPITALIZATIONS AND PATIENT VISITS ARE COVERED BY MEDICARE AND ANOTHER 20% BY MEDICAID, WITH THE NEXT LARGEST PERCENTAGES COVERED BY TRICARE (THE U.S. DEPT. OF DEFENSE'S INSURANCE PROGRAMS) AND COMMERCIAL INSURANCE. ABOUT 3% OF SAMARITAN'S VISITS AND HOSPITALIZATIONS ARE NOT COVERED BY AN INSURANCE PROGRAM. PART VI, LINE 5: SAMARITAN IS INVOLVED WITH A WIDE VARIETY OF INITIATIVES, PARTNERSHIPS AND COMMITTEES WORKING TO TRANSFORM THE REGIONAL HEALTH SYSTEM THROUGH PROJECTS WHOSE GOALS ARE TO (1) CREATE AN INTEGRATED HEALTHCARE DELIVERY SYSTEM FOCUSED ON EVIDENCED-BASED MEDICINE AND POPULATION HEALTH MANAGEMENT; (2) IMPLEMENT ADOPTION OF THE PATIENT-CENTERED MEDICAL HOME MODEL OF HEALTHCARE; (3) CREATE "MEDICAL VILLAGES" ENABLING PATIENTS TO ACCESS MULTIPLE HEALTHCARE FUNCTIONS FOR OUTPATIENT CARE IN SINGLE CONVENIENT LOCATIONS; (4) PROMOTE CARE TRANSITION INTERVENTIONS TO INCREASE PATIENT AWARENESS AND UNDERSTANDING OF FOLLOW-UP CARE IN ORDER TO REDUCE HOSPITAL READMISSIONS FOR CHRONIC CONDITIONS; (5) ENGAGE/EDUCATE PATIENTS AND IMPLEMENT STRATEGIES TO PROMOTE USE OF COMMUNITY-BASED CARE AND PREVENTION ACTIVITIES TO REDUCE EMERGENCY ROOM VISITS AND OTHER COSTLY HEALTHCARE SERVICES; (6) INTEGRATE PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES; (7) ADOPT EVIDENCE-BASED STRATEGIES FOR DISEASE MANAGEMENT IN HIGH RISK/AFFECTED POPULATIONS, PARTICULARLY IN THE AREAS OF CARDIOVASCULAR CONDITIONS AND DIABETES; (8) IMPLEMENT EVIDENCED-BASED STRATEGIES IN THE COMMUNITY TO ADDRESS CHRONIC DISEASE THROUGH PREVENTION ACTIVITIES; (9) STRENGTHEN MENTAL HEALTH AND SUBSTANCE ABUSE INFRASTRUCTURE ACROSS SYSTEMS THROUGH COLLABORATION AMONG COMMUNITY LEADERS, HEALTHCARE PROFESSIONALS AND COMMUNITY MEMBERS WORKING IN THE AREAS OF MENTAL/EMOTIONAL/BEHAVIORAL HEALTH, AND (10) INCREASE ACCESS TO HIGH-QUALITY CHRONIC DISEASE PREVENTION CARE AND MANAGEMENT IN CLINICAL AND COMMUNITY SETTINGS. SAMARITAN'S SPECIFIC ACTIVITIES IN 2018 TO SUPPORT THESE INITIATIVES INCLUDED (1) CONTINUED LEVEL III PATIENT CENTERED MEDICAL HOME (PCMH) RECOGNITION FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE FOR ALL OF THE HOSPITAL'S OUTPATIENT CLINICS; (2) COMMENCEMENT OF RENOVATION OF THE SAMARITAN MEDICAL PLAZA TO CREATE A "MEDICAL VILLAGE" THAT CONSOLIDATES WOMEN'S OUTPATIENT SERVICES IN THE SAME LOCATION THAT HOUSES A SAMARITAN FAMILY HEALTH CENTER (PRIMARY CARE CLINIC) AND OUTPATIENT MENTAL HEALTH SERVICES AND BEHAVIORAL HEALTH AND ADDICTION SERVICES; (3) ADDITION OF TWO LICENSED CLINICAL SOCIAL WORKERS IN PRIMARY CLINICS (BRINGING TOTAL NUMBER OF CLINIC-BASED LCSWS TO THREE) TO CONTINUE INTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES; (4) ANNUAL SCREENING OF EVERY PRIMARY CARE PATIENT FOR DEPRESSION, AS WELL AS SCREENINGS AND REFERRALS AS NECESSARY FOR SUBSTANCE ABUSE; (5) ONE-ON-ONE DIABETES SELF-MANAGEMENT EDUCATION BY A CERTIFIED DIABETES EDUCATOR FOR DIABETIC PATIENTS UNDERGOING MEDICAL NUTRITIONAL THERAPY; AND (6) ENGAGEMENT OF A CHRONIC CARE MANAGER TO DEVELOP AND SUPPORT IMPLEMENTATION OF INDIVIDUALIZED PLANS FOR OUTPATIENTS DEALING WITH TWO OR MORE CHRONIC MEDICAL CONDITIONS. SAMARITAN IS GOVERNED BY A BOARD COMPOSED OF COMMUNITY AND HOSPITAL LEADERS. THE BOARD CONSIDERS IDENTIFIED AND CHANGING COMMUNITY NEEDS IN CONJUNCTION WITH EXISTING RESOURCES AND ECONOMIC REALITIES WHEN DECIDING TO INVEST IN THE DEVELOPMENT OF PROGRAMS THAT EXPAND CRITICALLY-NEEDED SERVICES AND IMPROVE CARE QUALITY. PROJECTS UNDERWAY IN 2018 INCLUDED THE CONTINUED PHYSICAL CONSOLIDATION OF THE HOSPITAL'S MATERNITY AND PEDIATRIC FLOORS INTO A WOMEN'S AND CHILDREN'S CENTER TO IMPROVE PATIENT ACCESS AND SERVICE QUALITY; OPENING OF A NEW CANCER TREATMENT CENTER THAT ENABLED THE EXPANSION OF SERVICES, INCLUDING MODES OF CARE THAT CANCER PATIENTS AND FAMILIES PREVIOUSLY COULD ACCESS ONLY THROUGH TRAVEL OUTSIDE OUR AREA; AND RENOVATION OF OUR INPATIENT MENTAL HEALTH UNIT TO IMPROVE QUALITY OF CARE. A PATIENT FAMILY ADVISORY COUNCIL, COMPRISED OF STAFF AND COMMUNITY MEMBERS, IDENTIFIES OPPORTUNITIES AND INFORMS INITIATIVES FOR IMPROVEMENT IN PATIENT CARE; VOLUNTEER PATIENT ADVOCATES SUPPORT THIS EFFORT THROUGH PERSONAL VISITS TO EACH PATIENT WITHIN 48 HOURS OF THEIR ADMISSION TO THE HOSPITAL.SAMARITAN IN 2018 CONTINUED TO RECRUIT PHYSICIANS AND ENGAGE IN RETENTION ACTIVITIES IN RESPONSE TO THE AREA'S PHYSICIAN AND PROVIDER SHORTAGES. SINCE 2006, SAMARITAN HAS RECRUITED MORE THAN 80 PHYSICIANS. IN 2018 SAMARITAN CONTINUED PLANNING FOR THE POSSIBLE EXPANSION OF ITS GRADUATE MEDICAL EDUCATION PROGRAM TO INCLUDE COMPONENTS EXPOSING RESIDENTS TO RURAL PRACTICE. HOSPITAL DEPARTMENTS AND STAFF MEMBERS IN 2018 ALSO ENGAGED IN STRONG PARTICIPATION IN COMMUNITY-BASED HEALTH FAIRS, AWARENESS CAMPAIGNS AND OTHER ACTIVITIES PROMOTING POPULATION HEALTH. PART VI, LINE 6: SAMARITAN MEDICAL CENTER IS THE PARENT ORGANIZATION OF SEVERAL AFFILIATED FACILITIES AND AGENCIES. A THREE-YEAR VITAL ACCESS PROVIDER GRANT OBTAINED IN 2016 IS SUPPORTING A COMMUNITY NEEDS STUDY, PROVIDING FINANCIAL RESOURCES, AND INSURING THE PRESERVATION OF LONG-TERM RESIDENTIAL CARE BEDS IN THE COMMUNITY FOR SAMARITAN KEEP HOME, A 272-BED NURSING HOME AND SAMARITAN SUMMIT VILLAGE, A 167-BED SKILLED NURSING/120-BED ASSISTED LIVING FACILITY. SAMARITAN MEDICAL CENTER FURTHER ASSISTS CITIZENS LIVING IN THE COMMUNITY WHO REQUIRE HOME MEDICAL SERVICES FOR REHABILITATION AND RECOVERY THROUGH SAMARITAN HOME HEALTH, AN AGENCY WHICH PROVIDES HEALTH CARE SUPPORT TO INDIVIDUALS AT THEIR HOMES. THROUGH ANOTHER AFFILIATED ENTITY, SAMARITAN MEDICAL PRACTICE PC, OPPORTUNITIES AND SUPPORT ARE PROVIDED TO LOCAL PHYSICIANS AND PRACTITIONERS, HELPING TO RETAIN MEDICAL PROVIDERS IN OUR UNDERSERVED COMMUNITY. THE SAMARITAN MEDICAL CENTER FOUNDATION OF NORTHERN NEW YORK RAISES FUNDS AND GENERATES COMMUNITY SUPPORT FOR THE HOSPITAL AND ITS AFFILIATES. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X X 0 1 0 0 0 0 0 0 0 PAUL KRAEGER TREASURER, CFO 328630 0 42315 0 48776 0 16500 0 2009 0 438230 0 0 0 DAVID RECHLIN DO TRUSTEE 130000 0 25000 0 0 0 5500 0 653 0 161153 0 0 0 THOMAS H CARMAN PRESIDENT & CEO OF SMC 577434 0 97515 0 443148 0 11000 0 29038 0 1158135 0 101283 0 ROBERT KIMBALL MD TRUSTEE 419994 0 20041 0 0 0 16200 0 17922 0 474157 0 0 0 MARIO VICTORIA MD CMO OF SMC 354962 0 33003 0 17882 0 16500 0 23157 0 445504 0 0 0 MICHAEL SHORT COO OF SMC 325206 0 27041 0 16250 0 15746 0 14850 0 399093 0 0 0 KIMBERLY THIBERT VP OF PATIENT CARE/CNO 233672 0 16500 0 12088 0 14350 0 893 0 277503 0 0 0 KEITH ROBISON VP INFORMATION SERVICES & CHIEF INFO 183070 0 0 0 9153 0 0 0 821 0 193044 0 0 0 RANDALL FIPPS AVP OPERATIONS & BEHAVORIAL HEALTH 203658 0 7990 0 0 0 8466 0 408 0 220522 0 0 0 CHRISTOPHER BASTIEN AVP SUPPORT SERVICES 198858 0 10200 0 500 0 7765 0 401 0 217724 0 0 0 ALEJANDRO RODRIGUES MD UROLOGIST 583000 0 396 0 0 0 16500 0 18621 0 618517 0 0 0 JOSEPH WETTERHAHN MD FAMILY MEDICINE 299999 0 239869 0 21838 0 16500 0 1319 0 579525 0 0 0 KEVIN CHANDLER MD UROLOGIST 594838 0 127000 0 0 0 16500 0 22137 0 760475 0 0 0 AARON CAMPBELL DO HOSPITALIST 277202 0 115252 0 500 0 14930 0 451 0 408335 0 0 0 JAMES STILLERMAN MD WOUND CARE 354994 0 21500 0 0 0 16500 0 3839 0 396833 0 0 0 DAVID FLINT FORMER TRUSTEE 114237 0 14227 0 10510 0 2780 0 9310 0 151064 0 0 0 JACK RUSH FORMER TRUSTEE 180003 0 33604 0 0 0 11472 0 1058 0 226137 0 0 0 LAVERENE VANDERWALL FORMER TRUSTEE 119600 0 13493 0 0 0 6130 0 1090 0 140313 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO AN IRC 457(F) PLAN DURING 2018: THOMAS CARMAN - $86,308 PAUL KRAEGER - $14,364 ALSO DURING 2018 THOMAS CARMAN RECEIVED DISTRIBUTIONS OF $322,940 FROM THE 457(F) PLAN, OF WHICH $101,283 WAS VESTED PRIOR TO 12/31/2017 AND REPORTED IN A PRIOR YEAR FORM 990. THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO AN IRC 457(B) PLAN DURING 2018: THOMAS CARMAN - $18,500 PAUL KRAEGER - $18,500 MARIO VICTORIA, M.D. - $17,882 MICHAEL SHORT - $16,250 KIMBERLY THIBERT - $12,088 KEITH ROBISON - $9,153 A JEFFERSON COUNTY CIVIC FACILITY DEVELOP CORP 452491721 47325RATT 2017-11-07 88595042 SEE BELOW 0 1 0 A 88595042 5057775 305834 1272495 18699203 52082629 11177106 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 -3,843,155. EQUITY TRANSFERS TO AFFILIATE -8,433,176. PENSION AND OTHER POSTRETIREMENT LIABLITY ADJUSTMENTS 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