2017-11-10T14:12:17-06:00 2016-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2016-01-01 150533577 SAMARITAN MEDICAL CENTER SAMA 3157855702 830 WASHINGTON STREET WATERTOWN NY 13601 PAUL KRAEGER INTERIM CFO 3157855702 2017-11-08 1 THOMAS J GIUFRE P00841958 3154463600 2017-11-08 24.39.85.114 2017-11-08 11:14:19 ES P 517AEBE328CBAAA90E396C2FD1060AA56161F780 02454C825BF74D5B05CA8C2679FAA2CC9611F4B4 2016 2017-02-10 21:41:12Z PAUL KRAEGER 830 WASHINGTON STREET WATERTOWN NY 13601 221996536 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 294-BED FACILITY PROVIDES INPATIENT CARE, PSYCHIATRIC SERVICES, AMBULATORY SURGERY, PRIMARY AND EMERGENCY CARE AND OTHER OUTPATIENT SERVICES. 17 14 1939 120 0 0 3920187 3579255 204110837 214713513 530750 121432 2761600 2769041 211323374 221183241 0 0 0 0 116262137 121439015 0 0 765783 95099816 90962529 211361953 212401544 -38579 8781697 225898018 219377242 136067245 124607969 89830773 94769273 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 180841870 217394281 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. 180841870 1 1 0 0 0 0 0 0 0 1 1 0 0 1 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 1 136 0 1 1939 0 0 0 0 0 0 0 0 0 0 0 X 17 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X PAUL KRAEGER 3157855702 830 WASHINGTON STREET WATERTOWN NY 13601 REV FRED GARRY CHAIR 1.00 X X 0 0 0 MELANIE PARKER-GEURTSEN VICE CHAIR 1.00 X X 0 0 0 JAN TURCOTTE SECRETARY 1.00 X X 0 0 0 ALFRED CALLIGARIS FINANCE COMMITTEE CHAIR 1.00 X 0 0 0 PAUL KRAEGER TREASURER, SR. VP OF FINAN 20.00 4.00 X X 148825 0 10844 LISA WEBER IMMEDIATE PAST CHAIR 1.00 X 0 0 0 BERNARD BROWN TRUSTEE 1.00 X 0 0 0 MARY WARDWELL DONAHUE TRUSTEE 1.00 X 0 0 0 DAPHANE HENRY-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 MICHAEL KASKAN TRUSTEE 1.00 X 0 0 0 KEVIN KIEFF TRUSTEE 1.00 X 0 0 0 ROBERT KIMBALL MD TRUSTEE 40.00 1.00 X 457430 0 35076 AL MALONEY MD TRUSTEE 1.00 X 0 0 0 COL JOHN MCMURRAY 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 X 0 0 0 DAVID RECHLIN DO TRUSTEE 40.00 X 155000 0 7821 ROBERT SEAMON TRUSTEE 1.00 X 0 0 0 JOAN TREADWELL WOODS TRUSTEE 1.00 X 0 0 0 MARIA ALICEA TRUSTEE 1.00 X 0 0 0 THOMAS H CARMAN PRESIDENT & CEO OF SMC 40.00 4.00 X X 580595 0 118208 MARIO VICTORIA MD CMO OF SMC 40.00 1.00 X 361014 0 40697 SEAN MILLS CFO 40.00 3.00 X 138626 0 13005 MARY WHALEN COO OF SMC 40.00 X 316837 0 51820 MICHAEL SHORT CIO OF SMC 40.00 1.00 X 225039 0 30793 THOMAS SHATRAW VP OF HR OF SMC 40.00 X 202173 0 28930 MOONJOHN KIM MD INTERVENTIONAL RADIOLOGIST 40.00 X 588989 0 40697 ALEJANDRO RODRIGUEZ MD UROLOGIST 40.00 X 802304 0 40697 JOSEPH WETTERHAHN MD FAMILY PRACTICE 40.00 X 520809 0 40697 RAMAR DHANVENDRAN MD PSYCHITRIST 40.00 X 428813 0 40697 KEVIN CHANDLER MD UROLOGIST 40.00 X 624093 0 40697 DAVID FLINT MD FORMER TRUSTEE 40.00 X 298429 0 40674 JACK RUSH MD FORMER TRUSTEE 40.00 X 163706 0 31171 LAVERNE VANDEWALL MD FORMER TRUSTEE 40.00 X 136269 0 3609 6148951 0 616133 156 1 1 0 JEFFERSON ANESTHESIOLOGIST SERVICES 826 WASHINGTON ST WATERTOWN NY 13601 ANESTHESIA SERVICES 2644236 NORTH COUNTRY ORTHOPAEDIC GROUP 1571 WASHINGTON ST SUITE 201 WATERTOWN NY 13601 PURCHASED SERVICES 871302 LOCUMTENENS PO BOX 405547 ATLANTA GA 30384 PURCHASED SERVICES 453472 PULMONARY ASSOCIATES OF NNY 119320 US RTE 11 WATERTOWN NY 13601 PURCHASED SERVICES 434728 DIVERSIFIED CLINICAL SERVICES 28525 NETWORK PLACE CHICAGO IL 60673 PURCHASED SERVICES 409982 20 260126 539940 2779189 3579255 PATIENT SERVICE REVENUE 623000 214713513 214713513 214713513 129681 129681 804851 716578 88273 88273 88273 54 88414 100 96617 -46 -8203 -8249 -8249 SOLD SERVICES 541900 1635802 1635802 CAFETERIA 722210 695278 695278 349688 349688 2680768 221183241 217394281 0 209705 2922735 655328 2267407 93495771 81933911 11070545 491315 7515248 6437561 1039359 38328 10673545 9142959 1476151 54435 6831716 5852048 944826 34842 780436 23314 757122 137971 125451 12520 9163220 7276021 1887199 327364 327364 1272637 309770 935755 27112 3377280 3152803 203577 20900 5007064 4945366 61698 315511 107812 200697 7002 87291 15356 69540 2395 456360 321001 135359 228000 228000 12521738 9440138 3081600 1562099 1178429 383670 SUPPLIES 28878493 27953404 899303 25786 OTHER EXPENSES 11252635 6644148 4557339 51148 PROVISION FOR BAD DEBT 11072116 11072116 EQUIPMENT REPAIR AND MA 2843615 2374322 469293 1678699 1678699 212401544 180841870 30793891 765783 5673 5677 38272548 35701331 24782753 23847035 2414054 2515092 3936433 3611778 303676986 176958622 122148573 126718364 2480756 874471 3912530 5182573 27944698 20920921 225898018 219377242 31574500 35558937 6700000 6030000 55827952 53621188 41964793 29397844 136067245 124607969 X 87623649 92679744 1332653 1215058 874471 874471 89830773 94769273 225898018 219377242 X 8781697 62029 -3905226 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2207124 2416457 2534052 2089529 2526223 1796358 2115457 2207124 2051423 1474414 999614 2526223 2910899 657922 1517398 2051423 9761548 147073 6997722 2910899 0.41900 0.58100 0 0 1185452 1185452 144529964 49038741 95491223 6889020 4093244 2795776 145251060 123826637 21424423 5821490 5821490 126718364 DUE TO/FROM AFFILIATES 14836507 OTHER RECEIVABLES 3809180 AWUIL 2275234 20920921 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 5437200 RETIREMENT PLAN OBLIGATIONS 17554438 INSURANCE RESERVE PAYABLE 4130972 AWUIL LIABILITY 2275234 29397844 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, 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. 1 1 1 X 1 X 1 1 0 1 1 525424 465760 59664 0.00030 40259053 27432402 12826651 0.06020 40784477 27898162 12886315 0.06050 91321 91321 0.00040 1156923 1156923 0.00540 9027639 4497342 4530297 0.02100 10275883 4497342 5778541 0.02680 51060360 32395504 18664856 0.08730 1 11072116 50437559 67434669 -16997110 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 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 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. 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 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 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 X X X X X 0 1 0 0 0 0 0 0 0 PAUL KRAEGER TREASURER, SR. VP OF FINAN 135294 0 0 0 13531 0 10823 0 21 0 159669 0 0 0 ROBERT KIMBALL MD TRUSTEE 457430 0 0 0 0 0 21100 0 13976 0 492506 0 0 0 DAVID RECHLIN DO TRUSTEE 130000 0 25000 0 0 0 7800 0 21 0 162821 0 0 0 THOMAS H CARMAN PRESIDENT & CEO OF SMC 546066 0 11229 0 23300 0 98213 0 19995 0 698803 0 0 0 MARIO VICTORIA MD CMO OF SMC 337991 0 5834 0 17189 0 21200 0 19497 0 401711 0 0 0 SEAN MILLS CFO 132748 0 5878 0 0 0 0 0 13005 0 151631 0 0 0 MARY WHALEN COO OF SMC 296264 0 20573 0 0 0 51799 0 21 0 368657 0 0 0 MICHAEL SHORT CIO OF SMC 214323 0 0 0 10716 0 17146 0 13647 0 255832 0 0 0 THOMAS SHATRAW VP OF HR OF SMC 192546 0 0 0 9627 0 15283 0 13647 0 231103 0 0 0 MOONJOHN KIM MD INTERVENTIONAL RADIOLOGIST 578989 0 10000 0 0 0 21200 0 19497 0 629686 0 0 0 ALEJANDRO RODRIGUEZ MD UROLOGIST 687304 0 115000 0 0 0 21200 0 19497 0 843001 0 0 0 JOSEPH WETTERHAHN MD FAMILY PRACTICE 299402 0 221407 0 0 0 21200 0 19497 0 561506 0 0 0 RAMAR DHANVENDRAN MD PSYCHITRIST 269062 0 159751 0 0 0 21200 0 19497 0 469510 0 0 0 KEVIN CHANDLER MD UROLOGIST 503850 0 120243 0 0 0 21200 0 19497 0 664790 0 0 0 DAVID FLINT MD FORMER TRUSTEE 264617 0 33812 0 0 0 21177 0 19497 0 339103 0 0 0 JACK RUSH MD FORMER TRUSTEE 140005 0 23701 0 0 0 11674 0 19497 0 194877 0 0 0 LAVERNE VANDEWALL MD FORMER TRUSTEE 136269 0 0 0 0 0 3588 0 21 0 139878 0 0 0 PART I, LINE 4B 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 A DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 649905DD5 2009-04-09 31660000 CONSTRUCTION OF NEW PATIENT PAVILION AND PARKING GARAGE 0 0 0 B DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 649905DE3 2009-04-09 23945000 CONSTRUCTION OF NEW PATIENT PAVILION AND PARKING GARAGE, REFUND 1998 SERIESA 0 0 0 C JEFFERSON COUNTY CIVIC FACILITY DEVELOPMENT CORPORATION 452491721 2015-12-23 6700000 ACQUISITION OF A MEDICAL OFFICE BUILDING AND RELATED PROPERTY 0 0 0 A 30000000 31660000 883291 1623236 27750175 1403298 2010 0 0 0 1 B 23945000 737831 1388843 18830508 2987818 2010 1 0 0 1 C 6700000 6700000 2015 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 C 0 0 0 0 1 0 0 0 0 A 0 B 0 C 0 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. 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 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0