SAMARITAN MEDICAL CENTER: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: SAMARITAN MEDICAL CENTER (EIN 15-0533577)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-11-10
IRS object ID: 201703149349302985
Schema version: 2016v3.0
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 D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-11-10T14:12:17-06:00	ReturnTs
Tax Period End	2016-12-31	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	2016-01-01	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	PAUL KRAEGER	PersonNm
Person Title	INTERIM CFO	PersonTitleTxt
Phone	3157855702	PhoneNum
Signature	2017-11-08	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	THOMAS J GIUFRE	PreparerPersonNm
PTIN	P00841958	PTIN
Phone	3154463600	PhoneNum
Preparation	2017-11-08	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	24.39.85.114	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2017-11-08	IPDt
IP Tm	11:14:19	IPTm
IP Timezone	ES	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	517AEBE328CBAAA90E396C2FD1060AA56161F780	AtSubmissionCreationDeviceId
At Submission Filing Device Id	02454C825BF74D5B05CA8C2679FAA2CC9611F4B4	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2017-02-10 21:41:12Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	PAUL KRAEGER	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	$221,996,536	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 294-BED FACILITY PROVIDES INPATIENT CARE, PSYCHIATRIC SERVICES, AMBULATORY SURGERY, PRIMARY AND EMERGENCY CARE AND OTHER OUTPATIENT SERVICES.	ActivityOrMissionDesc
Voting Members Governing Body	17	VotingMembersGoverningBodyCnt
Voting Members Independent	14	VotingMembersIndependentCnt
Total Employee	1939	TotalEmployeeCnt
Total Volunteers	120	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$3,920,187	PYContributionsGrantsAmt
CY Contributions Grants	$3,579,255	CYContributionsGrantsAmt
PY Program Service Revenue	$204,110,837	PYProgramServiceRevenueAmt
CY Program Service Revenue	$214,713,513	CYProgramServiceRevenueAmt
PY Investment Income	$530,750	PYInvestmentIncomeAmt
CY Investment Income	$121,432	CYInvestmentIncomeAmt
PY Other Revenue	$2,761,600	PYOtherRevenueAmt
CY Other Revenue	$2,769,041	CYOtherRevenueAmt
PY Total Revenue	$211,323,374	PYTotalRevenueAmt
CY Total Revenue	$221,183,241	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	$116,262,137	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$121,439,015	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$765,783	CYTotalFundraisingExpenseAmt
PY Other Expenses	$95,099,816	PYOtherExpensesAmt
CY Other Expenses	$90,962,529	CYOtherExpensesAmt
PY Total Expenses	$211,361,953	PYTotalExpensesAmt
CY Total Expenses	$212,401,544	CYTotalExpensesAmt
PY Revenues Less Expenses	-$38,579	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$8,781,697	CYRevenuesLessExpensesAmt
Total Assets BOY	$225,898,018	TotalAssetsBOYAmt
Total Assets EOY	$219,377,242	TotalAssetsEOYAmt
Total Liabilities BOY	$136,067,245	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$124,607,969	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$89,830,773	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$94,769,273	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	$180,841,870	ExpenseAmt
Revenue	$217,394,281	RevenueAmt
Desc	DURING 2016, SAMARITAN MEDICAL CENTER PROVIDED CARE FOR 9,810 INPATIENT DISCHARGES AND A TOTAL OF 290,219 OUTPATIENT VISITS. OF THE TOTAL OUTPATIENT VISITS, THERE WERE 50,461 EMERGENCY ROOM VISITS AND 112,801 FAMILY HEALTH CLINIC VISITS.	Desc
Total Program Service Expenses	$180,841,870	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	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
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	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 With Officer Ent	0	BusinessRlnWithOfficerEntInd
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	136	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	1939	EmployeeCnt
Employment Tax Returns Filed	0	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
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	17	GoverningBodyVotingMembersCnt
Independent Voting Member	14	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	PAUL KRAEGER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
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

Form990 Part VII Section A Form990PartVIISectionAGrp (37 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
REV FRED GARRY
CHAIR	1.00	Yes (X)	Yes (X)	$0	$0	$0
MELANIE PARKER-GEURTSEN
VICE CHAIR	1.00	Yes (X)	Yes (X)	$0	$0	$0
JAN TURCOTTE
SECRETARY	1.00	Yes (X)	Yes (X)	$0	$0	$0
ALFRED CALLIGARIS
FINANCE COMMITTEE CHAIR	1.00	Yes (X)		$0	$0	$0
PAUL KRAEGER
TREASURER, SR. VP OF FINAN	20.00	Yes (X)	Yes (X)	$148,825	$0	$10,844	4.00
LISA WEBER
IMMEDIATE PAST CHAIR	1.00	Yes (X)		$0	$0	$0
BERNARD BROWN
TRUSTEE	1.00	Yes (X)		$0	$0	$0
MARY WARDWELL DONAHUE
TRUSTEE	1.00	Yes (X)		$0	$0	$0
DAPHANE HENRY-FOLEY
TRUSTEE	1.00	Yes (X)		$0	$0	$0
MARIE HESS
TRUSTEE	1.00	Yes (X)		$0	$0	$0
HOWARD HUANG MD
TRUSTEE	1.00	Yes (X)		$0	$0	$0
MICHAEL KASKAN
TRUSTEE	1.00	Yes (X)		$0	$0	$0
KEVIN KIEFF
TRUSTEE	1.00	Yes (X)		$0	$0	$0
ROBERT KIMBALL MD
TRUSTEE	40.00	Yes (X)		$457,430	$0	$35,076	1.00
AL MALONEY MD
TRUSTEE	1.00	Yes (X)		$0	$0	$0
COL JOHN MCMURRAY
TRUSTEE	1.00	Yes (X)		$0	$0	$0
MARY PERRINE
TRUSTEE	1.00	Yes (X)		$0	$0	$0
THOMAS PICHE
TRUSTEE	1.00	Yes (X)		$0	$0	$0
CATHERINE QUENCER
TRUSTEE	1.00	Yes (X)		$0	$0	$0
DAVID RECHLIN DO
TRUSTEE	40.00	Yes (X)		$155,000	$0	$7,821
ROBERT SEAMON
TRUSTEE	1.00	Yes (X)		$0	$0	$0
JOAN TREADWELL WOODS
TRUSTEE	1.00	Yes (X)		$0	$0	$0
MARIA ALICEA
TRUSTEE	1.00	Yes (X)		$0	$0	$0
THOMAS H CARMAN
PRESIDENT & CEO OF SMC	40.00	Yes (X)	Yes (X)	$580,595	$0	$118,208	4.00
MARIO VICTORIA MD
CMO OF SMC	40.00	Yes (X)		$361,014	$0	$40,697	1.00
SEAN MILLS
CFO	40.00		Yes (X)	$138,626	$0	$13,005	3.00
MARY WHALEN
COO OF SMC	40.00			$316,837	$0	$51,820		Yes (X)
MICHAEL SHORT
CIO OF SMC	40.00			$225,039	$0	$30,793	1.00	Yes (X)
THOMAS SHATRAW
VP OF HR OF SMC	40.00			$202,173	$0	$28,930		Yes (X)
MOONJOHN KIM MD
INTERVENTIONAL RADIOLOGIST	40.00			$588,989	$0	$40,697			Yes (X)
ALEJANDRO RODRIGUEZ MD
UROLOGIST	40.00			$802,304	$0	$40,697			Yes (X)
JOSEPH WETTERHAHN MD
FAMILY PRACTICE	40.00			$520,809	$0	$40,697			Yes (X)
RAMAR DHANVENDRAN MD
PSYCHITRIST	40.00			$428,813	$0	$40,697			Yes (X)
KEVIN CHANDLER MD
UROLOGIST	40.00			$624,093	$0	$40,697			Yes (X)
DAVID FLINT MD
FORMER TRUSTEE	40.00			$298,429	$0	$40,674				Yes (X)
JACK RUSH MD
FORMER TRUSTEE	40.00			$163,706	$0	$31,171				Yes (X)
LAVERNE VANDEWALL MD
FORMER TRUSTEE	40.00			$136,269	$0	$3,609				Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$6,148,951	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$616,133	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	156	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
JEFFERSON ANESTHESIOLOGIST SERVICES
826 WASHINGTON ST	WATERTOWN	NY	13601	ANESTHESIA SERVICES	$2,644,236
NORTH COUNTRY ORTHOPAEDIC GROUP
1571 WASHINGTON ST SUITE 201	WATERTOWN	NY	13601	PURCHASED SERVICES	$871,302
LOCUMTENENS
PO BOX 405547	ATLANTA	GA	30384	PURCHASED SERVICES	$453,472
PULMONARY ASSOCIATES OF NNY
119320 US RTE 11	WATERTOWN	NY	13601	PURCHASED SERVICES	$434,728
DIVERSIFIED CLINICAL SERVICES
28525 NETWORK PLACE	CHICAGO	IL	60673	PURCHASED SERVICES	$409,982

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	20	CntrctRcvdGreaterThan100KCnt
Related Organizations	$260,126	RelatedOrganizationsAmt
Government Grants	$539,940	GovernmentGrantsAmt
All Other Contributions	$2,779,189	AllOtherContributionsAmt
Total Contributions	$3,579,255	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	PATIENT SERVICE REVENUE	Desc
Business	623000	BusinessCd
Total Revenue Column	$214,713,513	TotalRevenueColumnAmt
Related Or Exempt Func Income	$214,713,513	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$214,713,513	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$129,681	TotalRevenueColumnAmt
Exclusion	$129,681	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$804,851	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$716,578	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$88,273	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$88,273	TotalRevenueColumnAmt
Exclusion	$88,273	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$54	SecuritiesAmt
Other	$88,414	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$100	SecuritiesAmt
Other	$96,617	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	-$46	SecuritiesAmt
Other	-$8,203	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$8,249	TotalRevenueColumnAmt
Exclusion	-$8,249	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
SOLD SERVICES	541900	$1,635,802	$1,635,802
CAFETERIA	722210	$695,278	$695,278

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$349,688	TotalRevenueColumnAmt
Related Or Exempt Func Income	$349,688	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$2,680,768	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$221,183,241	TotalRevenueColumnAmt
Related Or Exempt Func Income	$217,394,281	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$209,705	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$2,922,735	TotalAmt
Program Services	$655,328	ProgramServicesAmt
Management And General	$2,267,407	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$93,495,771	TotalAmt
Program Services	$81,933,911	ProgramServicesAmt
Management And General	$11,070,545	ManagementAndGeneralAmt
Fundraising	$491,315	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$7,515,248	TotalAmt
Program Services	$6,437,561	ProgramServicesAmt
Management And General	$1,039,359	ManagementAndGeneralAmt
Fundraising	$38,328	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$10,673,545	TotalAmt
Program Services	$9,142,959	ProgramServicesAmt
Management And General	$1,476,151	ManagementAndGeneralAmt
Fundraising	$54,435	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$6,831,716	TotalAmt
Program Services	$5,852,048	ProgramServicesAmt
Management And General	$944,826	ManagementAndGeneralAmt
Fundraising	$34,842	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$780,436	TotalAmt
Program Services	$23,314	ProgramServicesAmt
Management And General	$757,122	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$137,971	TotalAmt
Management And General	$125,451	ManagementAndGeneralAmt
Fundraising	$12,520	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$9,163,220	TotalAmt
Program Services	$7,276,021	ProgramServicesAmt
Management And General	$1,887,199	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$327,364	TotalAmt
Program Services	$327,364	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,272,637	TotalAmt
Program Services	$309,770	ProgramServicesAmt
Management And General	$935,755	ManagementAndGeneralAmt
Fundraising	$27,112	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$3,377,280	TotalAmt
Program Services	$3,152,803	ProgramServicesAmt
Management And General	$203,577	ManagementAndGeneralAmt
Fundraising	$20,900	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$5,007,064	TotalAmt
Program Services	$4,945,366	ProgramServicesAmt
Management And General	$61,698	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$315,511	TotalAmt
Program Services	$107,812	ProgramServicesAmt
Management And General	$200,697	ManagementAndGeneralAmt
Fundraising	$7,002	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$87,291	TotalAmt
Program Services	$15,356	ProgramServicesAmt
Management And General	$69,540	ManagementAndGeneralAmt
Fundraising	$2,395	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$456,360	TotalAmt
Program Services	$321,001	ProgramServicesAmt
Management And General	$135,359	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$228,000	TotalAmt
Management And General	$228,000	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$12,521,738	TotalAmt
Program Services	$9,440,138	ProgramServicesAmt
Management And General	$3,081,600	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$1,562,099	TotalAmt
Program Services	$1,178,429	ProgramServicesAmt
Management And General	$383,670	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
SUPPLIES	$28,878,493	$27,953,404	$899,303	$25,786
OTHER EXPENSES	$11,252,635	$6,644,148	$4,557,339	$51,148
PROVISION FOR BAD DEBT	$11,072,116	$11,072,116
EQUIPMENT REPAIR AND MA	$2,843,615	$2,374,322	$469,293

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,678,699	TotalAmt
Program Services	$1,678,699	ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$212,401,544	TotalAmt
Program Services	$180,841,870	ProgramServicesAmt
Management And General	$30,793,891	ManagementAndGeneralAmt
Fundraising	$765,783	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$5,673	BOYAmt
EOY	$5,677	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$38,272,548	BOYAmt
EOY	$35,701,331	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$24,782,753	BOYAmt
EOY	$23,847,035	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$2,414,054	BOYAmt
EOY	$2,515,092	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$3,936,433	BOYAmt
EOY	$3,611,778	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$303,676,986	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$176,958,622	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$122,148,573	BOYAmt
EOY	$126,718,364	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$2,480,756	BOYAmt
EOY	$874,471	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$3,912,530	BOYAmt
EOY	$5,182,573	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$27,944,698	BOYAmt
EOY	$20,920,921	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$225,898,018	BOYAmt
EOY	$219,377,242	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$31,574,500	BOYAmt
EOY	$35,558,937	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$6,700,000	BOYAmt
EOY	$6,030,000	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$55,827,952	BOYAmt
EOY	$53,621,188	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$41,964,793	BOYAmt
EOY	$29,397,844	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$136,067,245	BOYAmt
EOY	$124,607,969	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$87,623,649	BOYAmt
EOY	$92,679,744	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,332,653	BOYAmt
EOY	$1,215,058	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$874,471	BOYAmt
EOY	$874,471	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$89,830,773	BOYAmt
EOY	$94,769,273	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$225,898,018	BOYAmt
EOY	$219,377,242	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$8,781,697	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$62,029	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$3,905,226	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 D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,207,124	BeginningYearBalanceAmt
Contributions	$2,416,457	ContributionsAmt
Other Expenditures	$2,534,052	OtherExpendituresAmt
End Year Balance	$2,089,529	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,526,223	BeginningYearBalanceAmt
Contributions	$1,796,358	ContributionsAmt
Other Expenditures	$2,115,457	OtherExpendituresAmt
End Year Balance	$2,207,124	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,051,423	BeginningYearBalanceAmt
Contributions	$1,474,414	ContributionsAmt
Other Expenditures	$999,614	OtherExpendituresAmt
End Year Balance	$2,526,223	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,910,899	BeginningYearBalanceAmt
Contributions	$657,922	ContributionsAmt
Other Expenditures	$1,517,398	OtherExpendituresAmt
End Year Balance	$2,051,423	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$9,761,548	BeginningYearBalanceAmt
Contributions	$147,073	ContributionsAmt
Other Expenditures	$6,997,722	OtherExpendituresAmt
End Year Balance	$2,910,899	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	0.41900	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.58100	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	$1,185,452	OtherCostOrOtherBasisAmt
Book Value	$1,185,452	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$144,529,964	OtherCostOrOtherBasisAmt
Depreciation	$49,038,741	DepreciationAmt
Book Value	$95,491,223	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,889,020	OtherCostOrOtherBasisAmt
Depreciation	$4,093,244	DepreciationAmt
Book Value	$2,795,776	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$145,251,060	OtherCostOrOtherBasisAmt
Depreciation	$123,826,637	DepreciationAmt
Book Value	$21,424,423	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,821,490	OtherCostOrOtherBasisAmt
Book Value	$5,821,490	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$126,718,364	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDesc	Book ValueBookValueAmt
DUE TO/FROM AFFILIATES	$14,836,507
OTHER RECEIVABLES	$3,809,180
AWUIL	$2,275,234

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$20,920,921	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDesc	AmtAmt
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS	$5,437,200
RETIREMENT PLAN OBLIGATIONS	$17,554,438
INSURANCE RESERVE PAYABLE	$4,130,972
AWUIL LIABILITY	$2,275,234

Field	Value	IRS element (for citing)
Total Liability	$29,397,844	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, 2016 AND 2015, SAMARITAN DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2013 THROUGH 2016.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
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	$525,424	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$465,760	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$59,664	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$40,259,053	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$27,432,402	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$12,826,651	NetCommunityBenefitExpnsAmt
Total Expense	0.06020	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$40,784,477	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$27,898,162	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$12,886,315	NetCommunityBenefitExpnsAmt
Total Expense	0.06050	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$91,321	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$91,321	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,156,923	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,156,923	NetCommunityBenefitExpnsAmt
Total Expense	0.00540	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,027,639	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,497,342	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,530,297	NetCommunityBenefitExpnsAmt
Total Expense	0.02100	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,275,883	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,497,342	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,778,541	NetCommunityBenefitExpnsAmt
Total Expense	0.02680	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$51,060,360	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$32,395,504	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$18,664,856	NetCommunityBenefitExpnsAmt
Total Expense	0.08730	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$11,072,116	BadDebtExpenseAmt
Reimbursed By Medicare	$50,437,559	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$67,434,669	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$16,997,110	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	16	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	16	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
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
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
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'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 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.
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 MEDICAL CENTER IS A PARTNER WITH THE FORT DRUM REGIONAL PLANNING ORGANIZATION (FDRHPO), WHICH PROVIDES LEADERSHIP IN PLANNING AND COORDINATING REGIONAL HEALTH CARE INITIATIVES AND A LEADING MEMBER OF THE NORTH COUNTRY INITIATIVE (NCI), A CONSORTIUM OF HOSPITALS, PHYSICIANS AND OTHER HEALTH CARE PROVIDERS WORKING TO REFORM AND IMPROVE THE DELIVERY OF QUALITY HEALTHCARE THROUGHOUT OUR TRI-COUNTY AREA. THE HOSPITAL IS AN ACTIVE PARTICIPANT IN THE FDRHPO'S NORTH COUNTRY HEALTH COMPASS PARTNERS (NCHCP), A COALITION OF MORE THAN 40 PUBLIC HEALTH DEPARTMENTS, HEALTHCARE FACILITIES AND AGENCIES, AND COMMUNITY-BASED ORGANIZATIONS WORKING TO IMPROVE THE REGION'S POPULATION HEALTH THROUGH COORDINATED SUPPORT OF NEW YORK STATE'S MANY POPULATION HEALTH IMPROVEMENT INITIATIVES. KEY WORK OF THE NCHCP IS TO ASSESS AND IMPROVE POPULATION HEALTH FOR THE 250,000 PEOPLE LIVING WITHIN THE TRI-COUNTY REGION, STRENGTHEN THE POPULATION HEALTH INFRASTRUCTURE, IMPROVE ACCESS TO PRIMARY AND PREVENTION CARE, AND FOCUS ON ELIMINATING HEALTH DISPARITIES. FDRHPO/NCHCP UNDERTOOK THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. DATA ASSEMBLED FROM A VARIETY OF STATE, FEDERAL AND LOCAL SOURCES - INCLUDING A REGIONAL COMMUNITY SURVEY - WERE COMPARED AND EVALUATED TO IDENTIFY DISPARITIES AND SIGNIFICANT ISSUES IMPACTING REGIONAL, AS WELL AS COUNTY-WIDE, POPULATION HEALTH. THE 2016 CHNA FOR JEFFERSON COUNTY (SAMARITAN'S PRIMARY SERVICE AREA) WERE AS FOLLOWS: " HIGH AND GROWING OBESITY RATES FOR ADULTS AND CHILDREN: TWO-THIRD OF ADULTS AND TWO-FIFTHS OF CHILDREN WERE IDENTIFIED AS OBESE OR OVERWEIGHT (2013-14 FIGURES). OBESITY IS A RISK FACTOR FOR HEART DISEASE, STROKE, CANCER IN MANY FORMS, DIABETES AND KIDNEY DISEASE, AND COULD OVERTAKE CANCER AS THE LEADING CAUSE OF PREVENTABLE DEATHS IN THE NEXT DECADE. " HOSPITALIZATIONS FOR SHORT-TIME DIABETES COMPLICATIONS ALMOST DOUBLED BETWEEN 2011 AND 2014. " THE CIGARETTE SMOKING RATE SHOWED A NON-SIGNIFICANT DECREASE SINCE THE LAST COMMUNITY ASSESSMENT, BUT REMAINS SIGNIFICANTLY HIGHER THAN THE NEW YORK STATE RATE. " THE RATE OF COLORECTAL CANCER SCREENING REMAINED BELOW NYS TARGETS." THE AREA'S SUICIDE RATE REMAINED HIGHER THAN STATEWIDE AND REGIONAL BENCHMARKS." ADULTS REPORTING BINGE DRINKING GREW BY SIX PERCENTAGE POINTS BETWEEN 2011 AND 2014, WITH 2014 RATE MORE THAN 7% HIGHER THAN THE STATE RATE." THE PERCENTAGE OF RESIDENTS SERVED BY OPTIMALLY FLUORIDATED COMMUNITY WATER SYSTEMS FELL FROM 79% TO 71% PERCENT BETWEEN 2012 AND 2015." THE PERCENTAGE OF CHILDREN IN PUBLIC INSURANCE PROGRAMS WITH RECOMMENDED WELL-CHILD VISITS REMAINED LOWER COMPARED TO THE STATEWIDE AVERAGE, ALTHOUGH THE RATE FOR ALL AGE GROUPS INCREASED SIX PERCENTAGE POINTS." DESPITE A SMALL DECREASE FROM 2011, THE 2014 PERCENTAGE OF UNINTENDED PREGNANCIES, AT 33% OF LIVE BIRTHS, REMAINED HIGHER THAN THE STATEWIDE AVERAGE OF 26.5%." THE PERCENTAGE OF WOMEN AGED 13-17 WITH HPV IMMUNIZATIONS REMAINED LOW, WITH ONLY 15.9% IMMUNIZED COMPARED TO 30.3% FOR THE STATE EXCLUDING NEW YORK CITY." ABOUT ONE-FIFTH OF JEFFERSON COUNTY RESIDENTS DO NOT HAVE A REGULAR HEALTH CARE PROVIDER. THIS IS HIGHER THAN THE STATEWIDE RATE OF 16%, AND WELL SHORT OF THE NEW YORK STATE'S PREVENTION AGENDA 2018 OBJECTIVE OF LESS THAN 10%. JEFFERSON COUNTY HAS FEWER PRIMARY CARE CLINICIANS PER POPULATION COMPARED TO THE STATEWIDE RATE.HOSPITALS AND COUNTY HEALTH DEPARTMENTS PARTICIPATING IN THE CHNA MET AT COUNTY LEVELS TO DISCUSS THE IDENTIFIED ISSUES AND PRIORITIZE NEEDS IN ALIGNMENT WITH THE NEW YORK STATE HEALTH DEPARTMENT'S PREVENTION AGENDA, CHOOSING SPECIFIC PRIORITIES TO MUTUALLY TACKLE. THESE COMMON PRIORITIES WERE THEN ADDRESSED BY EACH ORGANIZATION IN ITS OWN THREE-YEAR COMMUNITY SERVICE PLAN (CSP). IN DETERMINING WHICH PRIORITIES TO WORK ON, THESE COLLABORATING INSTITUTIONS CONSIDERED NOT ONLY THE ISSUES AND DISPARITIES, BUT THE IMPACT THESE DISPARITIES AND THEIR POSSIBLE SOLUTIONS MIGHT HAVE ON OTHER HEALTH OUTCOMES; AVAILABLE RESOURCES; EASE OF SOLUTION IMPLEMENTATION; LEADERSHIP SUPPORT AVAILABLE, AND IMPORTANCE TO THE PUBLIC HEALTH SYSTEM. ULTIMATELY, THOSE COMMUNITY NEEDS NOT DIRECTLY ADDRESSED IN THE COMMUNITY SERVICE PLAN WERE SIMPLY OF A LOWER PRIORITY, NOT ACHIEVABLE IN A REASONABLE TIMEFRAME OR DID NOT HAVE THE ADEQUATE RESOURCES AVAILABLE TO EFFECTIVELY IMPACT THE NEED. JEFFERSON COUNTY'S PUBLIC HEALTH DEPARTMENT AND THREE HOSPITALS AGREED TO WORK ON THE FOLLOWING TWO NYS PREVENTION AGENDA PRIORITIES DURING THE 2016-2018 CSP PERIOD: (1) PREVENT CHRONIC DISEASE, WITH A FOCUS ON REDUCING OBESITY IN CHILDREN AND ADULTS IN ORDER TO ADDRESS DISPARITIES RELATED TO HIGH OBESITY RATES AND DIABETES COMPLICATIONS AND (2) PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE, WITH A FOCUS ON STRENGTHENING INFRASTRUCTURE ACROSS SYSTEMS, IN ORDER TO TACKLE DISPARITIES RELATED TO SUICIDE RATES AND SUBSTANCE ABUSE.SAMARITAN'S CSP OUTLINES THE FOLLOWING SPECIFIC ACTIVITIES, INTERVENTIONS AND STRATEGIES. TO REDUCE OBESITY, THE HOSPITAL WILL: (1) PROVIDE COMMUNITY-BASED NUTRITION EDUCATION AND HEALTHY COOKING DEMONSTRATION CLASSES TO THE PUBLIC THROUGH SAMARITAN'S NETWORK OF SEVEN COMMUNITY-BASED PRIMARY CLINICS LOCATED THROUGHOUT THE HOSPITAL'S SERVICE AREA AND (2) IMPLEMENT AN AMERICAN ACADEMY OF DIABETES EDUCATION-ACCREDITED DIABETES SELF-MANAGEMENT EDUCATION PROGRAM, OFFERING CLASSES TO DIABETES AND PRE-DIABETES PATIENTS AND THEIR FAMILY MEMBERS. TO STRENGTHEN BEHAVIORAL HEALTH INFRASTRUCTURE, SAMARITAN WILL: (1) SCREEN ALL PATIENTS AT EACH OF THE HOSPITAL'S SEVEN PRIMARY CLINICS AT LEAST ONCE ANNUALLY FOR DEPRESSION USING PHQ-2 AND PHQ-9 COMPONENTS OF THE PATIENT HEALTH QUESTIONNAIRE, AND ESTABLISH SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT (SBIRT) PROCEDURES IN EACH CLINIC TO ENSURE PATIENTS ARE SCREENED FOR SUBSTANCE ABUSE RISK BEHAVIORS AND REFERRED FOR ADDITIONAL SERVICES AS NECESSARY AND (2) LOCATE A FULL- OR PART-TIME NYS-LICENSED CLINICAL SOCIAL WORKER (LCSW) IN EACH OF THE HOSPITAL'S SEVEN PRIMARY CARE CLINICS TO SUPPORT AND ASSIST MENTAL HEALTH PATIENTS AND THEIR FAMILIES. IN ADDITION TO THESE SPECIFIC ACTIVITIES, SAMARITAN WILL CONTINUE 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.

Field	Value	IRS element (for citing)
Facility	10	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 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	NE	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

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 6A:	SAMARITAN COMPLETES AND FILES THE COMMUNITY SERVICE PLAN ANNUALLY. A FULL REPORT IS COMPLETED AND SUBMITTED EVERY THREE YEARS, WITH UPDATES SUBMITTED EACH OF THE OTHER TWO YEARS. THE REPORTS ARE AVAILABLE TO THE PUBLIC VIA SAMARITAN'S WEBSITE (WWW.SAMARITANHEALTH.COM) OR BY CONTACTING THE SAMARITAN MARKETING OFFICE.
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 HOSPITAL RCC (COMPUTED USING WORKSHEET #2) TO THE PROVISION FOR BAD DEBT EXPENSE AS REPORTED IN OUR 2016 AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8:	MEDICARE ALLOWABLE COSTS REPORTED WERE TAKEN DIRECTLY FROM THE 2016 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 2016 WAS APPROXIMATELY 40%.
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 THREE 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.
PART VI, LINE 3:	ALL HOSPITAL EMPLOYEES ARE MADE AWARE OF SAMARITAN'S 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. 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 2016 POPULATION AT 114,006, FOR A POPULATION DENSITY OF 90 PERSONS PER SQUARE MILE. THE POPULATION IS APPROXIMATELY 88% CAUCASIAN, 7% 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 (2016 POPULATION ESTIMATE 25,900), 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 20,000 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 AVERAGE ANNUAL INCOME FOR JEFFERSON COUNTY HOUSEHOLDS EQUATES TO JUST 70% OF THE STATE'S AVERAGE, WHILE MEDIAN INCOME IS ONLY SLIGHTLY BETTER, AT 80% OF THE STATE FIGURE. 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 EMPLOYS MORE THAN 2,000 PEOPLE, RANKS SECOND ON THE JEFFERSON COUNTY ECONOMIC DEVELOPMENT COUNCIL'S LIST OF THE COUNTY'S LARGEST EMPLOYERS. 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 2016 TO SUPPORT THESE INITIATIVES INCLUDED (1) HIRING A REGISTERED NURSE CARE MANAGER AND A NON-CLINICAL CARE COORDINATOR TO PROVIDE EDUCATION, REFERRAL AND FOLLOW-UP SERVICES BETWEEN PATIENT CARE TEAM MEMBERS TO ENSURE APPROPRIATED CARE TRANSITIONS AND COORDINATION FOR PATIENTS; (2) EMPLOYING A LICENSED CLINICAL SOCIAL WORKER (LCSW) TO WORK IN OUR WATERTOWN-BASED PRIMARY CARE CLINIC; (3) DEVELOPING PLANS FOR ANNUAL SCREENING OF EVERY PRIMARY CARE PATIENT FOR DEPRESSION, AS WELL AS FOR SUBSTANCE ABUSE; (4) LAYING GROUNDWORK FOR A DEDICATED DIABETES EDUCATION/PREVENTION PROGRAM; (5) STRENGTHENING TECHNOLOGIES FOR PARTICIPATION IN THE REGIONAL HEALTH INFORMATION EXCHANGE, AND (6) CONTINUING DEVELOPMENT OF THE HOSPITAL'S SEVEN PRIMARY CARE PRACTICES INTO PATIENT-CENTERED MEDICAL HOMES (PCMH). 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 LAUNCHED IN 2016 INCLUDED THE 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; BREAKING GROUND ON A NEW CANCER TREATMENT CENTER THAT WILL ENABLE 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. SAMARITAN IN 2016 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. HOSPITAL DEPARTMENTS AND STAFF MEMBERS IN 2016 ALSO CONTINUED TO THEIR 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 WILL SUPPORT A COMMUNITY NEEDS STUDY, PROVIDE FINANCIAL RESOURCES, AND INSURE 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.
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	0	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
PAUL KRAEGER
TREASURER, SR. VP OF FINAN	$135,294	$0	$0	$0	$13,531	$0	$10,823	$0	$21	$0	$159,669	$0	$0	$0
ROBERT KIMBALL MD
TRUSTEE	$457,430	$0	$0	$0	$0	$0	$21,100	$0	$13,976	$0	$492,506	$0	$0	$0
DAVID RECHLIN DO
TRUSTEE	$130,000	$0	$25,000	$0	$0	$0	$7,800	$0	$21	$0	$162,821	$0	$0	$0
THOMAS H CARMAN
PRESIDENT & CEO OF SMC	$546,066	$0	$11,229	$0	$23,300	$0	$98,213	$0	$19,995	$0	$698,803	$0	$0	$0
MARIO VICTORIA MD
CMO OF SMC	$337,991	$0	$5,834	$0	$17,189	$0	$21,200	$0	$19,497	$0	$401,711	$0	$0	$0
SEAN MILLS
CFO	$132,748	$0	$5,878	$0	$0	$0	$0	$0	$13,005	$0	$151,631	$0	$0	$0
MARY WHALEN
COO OF SMC	$296,264	$0	$20,573	$0	$0	$0	$51,799	$0	$21	$0	$368,657	$0	$0	$0
MICHAEL SHORT
CIO OF SMC	$214,323	$0	$0	$0	$10,716	$0	$17,146	$0	$13,647	$0	$255,832	$0	$0	$0
THOMAS SHATRAW
VP OF HR OF SMC	$192,546	$0	$0	$0	$9,627	$0	$15,283	$0	$13,647	$0	$231,103	$0	$0	$0
MOONJOHN KIM MD
INTERVENTIONAL RADIOLOGIST	$578,989	$0	$10,000	$0	$0	$0	$21,200	$0	$19,497	$0	$629,686	$0	$0	$0
ALEJANDRO RODRIGUEZ MD
UROLOGIST	$687,304	$0	$115,000	$0	$0	$0	$21,200	$0	$19,497	$0	$843,001	$0	$0	$0
JOSEPH WETTERHAHN MD
FAMILY PRACTICE	$299,402	$0	$221,407	$0	$0	$0	$21,200	$0	$19,497	$0	$561,506	$0	$0	$0
RAMAR DHANVENDRAN MD
PSYCHITRIST	$269,062	$0	$159,751	$0	$0	$0	$21,200	$0	$19,497	$0	$469,510	$0	$0	$0
KEVIN CHANDLER MD
UROLOGIST	$503,850	$0	$120,243	$0	$0	$0	$21,200	$0	$19,497	$0	$664,790	$0	$0	$0
DAVID FLINT MD
FORMER TRUSTEE	$264,617	$0	$33,812	$0	$0	$0	$21,177	$0	$19,497	$0	$339,103	$0	$0	$0
JACK RUSH MD
FORMER TRUSTEE	$140,005	$0	$23,701	$0	$0	$0	$11,674	$0	$19,497	$0	$194,877	$0	$0	$0
LAVERNE VANDEWALL MD
FORMER TRUSTEE	$136,269	$0	$0	$0	$0	$0	$3,588	$0	$21	$0	$139,878	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 4B	FormAndLineReferenceDesc
Explanation	THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO AN IRC 457(F) PLAN DURING 2016: THOMAS CARMAN - $82,313 MARY WHALEN - $30,599 THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO AN IRC 457(B) PLAN DURING 2016: PAUL KRAEGER - $13,531	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
DORMITORY AUTHORITY OF THE STATE OF NEW YORK
A	146000293	649905DD5	2009-04-09	$31,660,000	CONSTRUCTION OF NEW PATIENT PAVILION AND PARKING GARAGE	0	0	0
DORMITORY AUTHORITY OF THE STATE OF NEW YORK
B	146000293	649905DE3	2009-04-09	$23,945,000	CONSTRUCTION OF NEW PATIENT PAVILION AND PARKING GARAGE, REFUND 1998 SERIESA	0	0	0
JEFFERSON COUNTY CIVIC FACILITY DEVELOPMENT CORPORATION
C	452491721		2015-12-23	$6,700,000	ACQUISITION OF A MEDICAL OFFICE BUILDING AND RELATED PROPERTY	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Capitalized InterestCapitalizedInterestAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	UnspentUnspentAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$30,000,000	$31,660,000	$883,291	$1,623,236	$27,750,175	$1,403,298	2010	0	Yes (1)
B		$23,945,000	$737,831	$1,388,843	$18,830,508	$2,987,818	2010	Yes (1)	Yes (1)
C		$6,700,000			$6,700,000		2015	0	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Any Research AgreementsAnyResearchAgreementsInd	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	0	0	0	0	0	0	0
B	0	0	0	0	0	0	0
C	0	0	0	0	0	0	0

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A	0	0	0	0	Yes (1)	0	0	0	0
B	0	0	0	0	Yes (1)	0	0	0	0
C	0	0	0	0	Yes (1)	0	0	0	0

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	0
B	0
C	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 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 POSTRETIREMENT LIABILITY 2,923,704. VALUE OF INTEREST RATE SWAP 268,336. EQUITY TRANSFERS TO AFFILIATE -7,097,266.
FORM 990 PART XII LINE 2C	THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

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	0
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	0
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	0
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	0
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	0
SAMARITAN HOME HEALTH
830 WASHINGTON STREET	WATERTOWN	NY	13601	461043637	HOME HEALTH AGENCY	NY	501(C)3	LINE 3 SCH A	SAMARITAN MEDICAL CENTER	0

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