SAMARITAN MEDICAL CENTER: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- SAMARITAN MEDICAL CENTER (EIN 15-0533577)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-13
- IRS object ID
- 201513179349303681
- Schema version
- 2014v5.0
- 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 | 2015-11-13T11:06:14-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | 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 | 2014-01-01 | 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 | SEAN MILLS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3157855702 | PhoneNum |
| Signature | 2015-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOSEPH J SCHLEGEL | PreparerPersonNm |
| PTIN | P00301329 | PTIN |
| Phone | 3154463600 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SEAN MILLS | 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 | $208,992,989 | 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 | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 1861 | TotalEmployeeCnt |
| Total Volunteers | 135 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,341,867 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,682,489 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $199,441,080 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $201,928,287 | CYProgramServiceRevenueAmt |
| PY Investment Income | $264,368 | PYInvestmentIncomeAmt |
| CY Investment Income | $506,011 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,616,398 | PYOtherRevenueAmt |
| CY Other Revenue | $2,796,024 | CYOtherRevenueAmt |
| PY Total Revenue | $204,663,713 | PYTotalRevenueAmt |
| CY Total Revenue | $208,912,811 | 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 | $111,540,486 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $110,353,204 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $302,667 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $86,332,314 | PYOtherExpensesAmt |
| CY Other Expenses | $90,125,094 | CYOtherExpensesAmt |
| PY Total Expenses | $197,872,800 | PYTotalExpensesAmt |
| CY Total Expenses | $200,478,298 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,790,913 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,434,513 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $205,390,346 | TotalAssetsBOYAmt |
| Total Assets EOY | $205,193,081 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $104,734,085 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $109,525,554 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $100,656,261 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $95,667,527 | 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 294-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 | $169,680,837 | ExpenseAmt |
| Revenue | $204,592,870 | RevenueAmt |
| Desc | PROVIDE CARE FOR 10,730 INPATIENT DISCHARGES IN ADDITION, SAMARITAN MEDICAL CENTER PROVIDED FOR 156,096 OUTPATIENT VISITS, 53,986 EMERGENCY ROOM VISITS, AND 105,358 FAMILY HEALTH CLINIC VISITS. | Desc |
| Total Program Service Expenses | $169,680,837 | 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 | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln 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 | 150 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1861 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | SEAN MILLS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3157796686 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 104 PADDOCK STREET | AddressLine1Txt |
| City | WATERTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13601 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| PAUL KRAEGER | |||||||||
| TREASURER, SR. VP OF FINANCE | 17.50 | 2.50 | Yes (X) | Yes (X) | $148,823 | $0 | $10,636 | ||
| DAVID FLINT MD | |||||||||
| TRUSTEE | 40.00 | Yes (X) | $325,122 | $0 | $39,319 | ||||
| DAVID RECHLIN DO | |||||||||
| TRUSTEE | 40.00 | Yes (X) | $241,697 | $0 | $7,821 | ||||
| JACK RUSH MD | |||||||||
| TRUSTEE | 40.00 | Yes (X) | $192,261 | $0 | $28,682 | ||||
| ROBERT KIMBALL MD | |||||||||
| TRUSTEE | 1.00 | 40.00 | Yes (X) | $355,257 | $0 | $39,021 | |||
| ALFRED CALLIGARIS | |||||||||
| CHAIRMAN OF FINANCE | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| PAUL CARR | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| BRUCE DINES DMD | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| REV FRED GARRY | |||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| KATHLEEN GEBO | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| COL MATTHEW MATTNER | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MELANIE PARKER-GUERTSEN | |||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| RONALD PERCIACCANTE MD | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARY PERRINE | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| CATHERINE BURNS QUENCER | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| DANIEL SAMANN | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| ROBERT SEAMAN | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| WALTER TODD | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOAN TREADWELL-WOODS | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JAN TURCOTTE MD | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| DANIEL VILLA | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| KERRY ROBERGE | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| RENEE WATERBURY | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| LISA WEBER | |||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MARTIN YENAWINE | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| THOMAS H CARMAN | |||||||||
| PRESIDENT & CEO | 40.00 | 4.00 | Yes (X) | $527,267 | $0 | $112,492 | |||
| SEAN MILLS | |||||||||
| CFO | 40.00 | 3.50 | Yes (X) | $174,990 | $0 | $20,258 | |||
| MICHAEL SHORT | |||||||||
| CIO | 40.00 | 1.00 | $199,505 | $0 | $25,525 | Yes (X) | |||
| MARIO VICTORIA | |||||||||
| CMO | 40.00 | 1.00 | $415,486 | $0 | $39,315 | Yes (X) | |||
| BRIAN O'HEARN | |||||||||
| VP PATIENT CARE/CNO | 40.00 | $228,792 | $0 | $33,241 | Yes (X) | ||||
| ANTHONY JOSEPH | |||||||||
| VP LONG TERM CARE | 40.00 | 1.00 | $180,531 | $0 | $30,892 | Yes (X) | |||
| ALEJANDRO RODRIGUEZ MD | |||||||||
| UROLOGIST | 40.00 | $697,447 | $0 | $39,320 | Yes (X) | ||||
| JOSEPH WETTERHAHN MD | |||||||||
| FAMILY PRACTICE MD | 40.00 | $495,327 | $0 | $38,898 | Yes (X) | ||||
| MOONJOHN KIM MD | |||||||||
| INTERVENTIONAL RADIOLOGIST | 40.00 | $566,412 | $0 | $39,474 | Yes (X) | ||||
| SHAHANDEH HAGHIR MD | |||||||||
| PATHOLOGIST | 40.00 | $440,602 | $0 | $34,530 | Yes (X) | ||||
| BRADFORD BILICKI | |||||||||
| SURGEON | 1.00 | 40.00 | $410,328 | $0 | $39,327 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,599,847 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $578,751 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 111 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 | $2,579,946 |
| NORTH COUNTRY ORTHOPAEDIC GROUP | |||||
| 1571 WASHINGTON ST | WATERTOWN | NY | 13601 | PURCHASED SERVICES | $1,063,829 |
| LOCUMTENENSCOM | |||||
| PO BOX 405547 | ATLANTA | GA | 30384 | PURCHASED SERVICES | $814,936 |
| NORTH COUNTRY EMERGENCY MEDICAL CONSULTA | |||||
| 830 WASHINGTON ST | WATERTOWN | NY | 13601 | PURCHASED SERVICES | $597,780 |
| NEUROSURGICAL ASSOCIATES OF CNY | |||||
| 750 EAST ADAMS ST | SYRACUSE | NY | 13211 | PURCHASED SERVICES | $512,333 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 30 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $112,959 | RelatedOrganizationsAmt |
| Government Grants | $2,065,979 | GovernmentGrantsAmt |
| All Other Contributions | $1,503,551 | AllOtherContributionsAmt |
| Total Contributions | $3,682,489 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $201,928,287 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $201,928,287 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $201,928,287 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $354,763 | TotalRevenueColumnAmt |
| Exclusion | $354,763 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $131,441 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $131,441 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $131,441 | TotalRevenueColumnAmt |
| Exclusion | $131,441 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,594 | SecuritiesAmt |
| Other | $229,832 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $80,178 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,594 | SecuritiesAmt |
| Other | $149,654 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $151,248 | TotalRevenueColumnAmt |
| Exclusion | $151,248 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| SOLD SERVICES | 541900 | $1,892,532 | $1,892,532 |
| CAFETERIA | 722210 | $715,760 | $715,760 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $56,291 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $56,291 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,664,583 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $208,912,811 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $204,592,870 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $637,452 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,982,715 | TotalAmt |
| Program Services | $834,902 | ProgramServicesAmt |
| Management And General | $2,147,813 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,070,269 | TotalAmt |
| Program Services | $73,174,633 | ProgramServicesAmt |
| Management And General | $10,848,514 | ManagementAndGeneralAmt |
| Fundraising | $47,122 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,066,622 | TotalAmt |
| Program Services | $5,180,109 | ProgramServicesAmt |
| Management And General | $886,513 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,164,672 | TotalAmt |
| Program Services | $9,481,279 | ProgramServicesAmt |
| Management And General | $1,622,606 | ManagementAndGeneralAmt |
| Fundraising | $60,787 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,068,926 | TotalAmt |
| Program Services | $5,182,076 | ProgramServicesAmt |
| Management And General | $886,850 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $827,424 | TotalAmt |
| Program Services | $11,495 | ProgramServicesAmt |
| Management And General | $815,929 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,223 | TotalAmt |
| Management And General | $137,412 | ManagementAndGeneralAmt |
| Fundraising | $16,811 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $355,765 | TotalAmt |
| Program Services | $354,648 | ProgramServicesAmt |
| Fundraising | $1,117 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,987,389 | TotalAmt |
| Program Services | $398,451 | ProgramServicesAmt |
| Management And General | $1,553,154 | ManagementAndGeneralAmt |
| Fundraising | $35,784 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,922,350 | TotalAmt |
| Program Services | $2,062,803 | ProgramServicesAmt |
| Management And General | $824,345 | ManagementAndGeneralAmt |
| Fundraising | $35,202 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,967,382 | TotalAmt |
| Program Services | $3,194,478 | ProgramServicesAmt |
| Management And General | $772,904 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $185,085 | TotalAmt |
| Program Services | $71,274 | ProgramServicesAmt |
| Management And General | $109,272 | ManagementAndGeneralAmt |
| Fundraising | $4,539 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,100 | TotalAmt |
| Program Services | $34,213 | ProgramServicesAmt |
| Management And General | $144,086 | ManagementAndGeneralAmt |
| Fundraising | $7,801 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $595,204 | TotalAmt |
| Program Services | $542,707 | ProgramServicesAmt |
| Management And General | $52,497 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,993 | TotalAmt |
| Management And General | $239,993 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,659,450 | TotalAmt |
| Program Services | $10,631,659 | ProgramServicesAmt |
| Management And General | $1,027,791 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,681,913 | TotalAmt |
| Program Services | $1,081,224 | ProgramServicesAmt |
| Management And General | $600,689 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| SUPPLIES | $27,222,811 | $26,828,805 | $370,213 | $23,793 |
| OTHER EXPENSES | $21,100,577 | $15,252,467 | $5,779,089 | $69,021 |
| PROVISION FOR BAD DEBT | $10,259,973 | $10,259,973 | ||
| EQUIP REPAIR & MAINT | $5,196,692 | $3,520,878 | $1,675,124 | $690 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,582,763 | TotalAmt |
| Program Services | $1,582,763 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200,478,298 | TotalAmt |
| Program Services | $169,680,837 | ProgramServicesAmt |
| Management And General | $30,494,794 | ManagementAndGeneralAmt |
| Fundraising | $302,667 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,684 | BOYAmt |
| EOY | $5,832 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,370,909 | BOYAmt |
| EOY | $36,708,575 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,806,482 | BOYAmt |
| EOY | $25,183,338 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,081,965 | BOYAmt |
| EOY | $2,224,336 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,587,049 | BOYAmt |
| EOY | $2,911,051 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $262,289,625 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $154,467,110 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $112,962,017 | BOYAmt |
| EOY | $107,822,515 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,341,360 | BOYAmt |
| EOY | $2,502,930 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,162,004 | BOYAmt |
| EOY | $20,200,130 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,072,876 | BOYAmt |
| EOY | $7,634,374 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $205,390,346 | BOYAmt |
| EOY | $205,193,081 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,223,310 | BOYAmt |
| EOY | $31,068,692 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,164,974 | BOYAmt |
| EOY | $48,624,891 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,345,801 | BOYAmt |
| EOY | $29,831,971 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,734,085 | BOYAmt |
| EOY | $109,525,554 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,604,838 | BOYAmt |
| EOY | $93,141,304 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,176,952 | BOYAmt |
| EOY | $1,651,752 | 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 | $100,656,261 | BOYAmt |
| EOY | $95,667,527 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $205,390,346 | BOYAmt |
| EOY | $205,193,081 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $8,434,513 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $4,676 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$13,427,922 | 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 | $2,051,423 | BeginningYearBalanceAmt |
| Contributions | $1,474,414 | ContributionsAmt |
| Other Expenditures | $999,614 | OtherExpendituresAmt |
| End Year Balance | $2,526,223 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,720,908 | BeginningYearBalanceAmt |
| Contributions | $1,183,545 | ContributionsAmt |
| Other Expenditures | $1,142,905 | OtherExpendituresAmt |
| End Year Balance | $9,761,548 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,686,419 | BeginningYearBalanceAmt |
| Contributions | $8,606,970 | ContributionsAmt |
| Other Expenditures | $572,481 | OtherExpendituresAmt |
| End Year Balance | $9,720,908 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.34620 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.65380 | 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 | $1,099,952 | OtherCostOrOtherBasisAmt |
| Book Value | $1,099,952 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $123,805,625 | OtherCostOrOtherBasisAmt |
| Depreciation | $41,250,098 | DepreciationAmt |
| Book Value | $82,555,527 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,363,765 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,331,842 | DepreciationAmt |
| Book Value | $1,031,923 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $133,213,140 | OtherCostOrOtherBasisAmt |
| Depreciation | $110,885,170 | DepreciationAmt |
| Book Value | $22,327,970 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $807,143 | OtherCostOrOtherBasisAmt |
| Book Value | $807,143 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $107,822,515 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (7 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| CSV OF OFFICERS LIFE INSURANCE | $424,882 | F |
| INVESTMENT IN NEWELL ST., LLC | $90,000 | C |
| DUE FROM AFFILIATES | $16,227,982 | C |
| ED PHYSICIAN CALL | $326,185 | C |
| FINANCING COSTS -SERIES B | $632,020 | C |
| INTEREST RATE SWAP | -$1,025,695 | F |
| MEDICAL MALPRACTICE LT INS RECOVERY | $3,524,756 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $20,200,130 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $5,049,174 |
| RETIREMENT PLAN OBLIGATIONS | $24,782,797 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $29,831,971 | 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, 2014 AND 2013, SAMARITAN DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2011 THROUGH 2014. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. |
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 | $1,378,090 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $413,775 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $964,315 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,002,312 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,221,532 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,780,780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04880 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,380,402 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,635,307 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,745,095 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05360 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $164,280 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $164,280 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,020,531 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,050 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $996,481 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,353,690 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,024,184 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,329,506 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01160 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,538,501 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,048,234 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,490,267 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01740 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $41,918,903 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $27,683,541 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,235,362 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07100 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,917,466 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $50,112,646 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $57,655,649 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$7,543,003 | 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 |
| 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 |
| CHNA Conducted | 13 | 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 | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SAMARITANHEALTH.COM | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SAMARITAN MEDICAL CENTER | PART V, SECTION B, LINE 5: THE GOAL OF THE COMMUNITY HEALTH SURVEY WAS TO ENGAGE RESIDENTS OF THE THREE-COUNTY REGION (JEFFERSON, LEWIS, ST. LAWRENCE COUNTIES) AND GAUGE THEIR PERCEPTIONS OF HEALTH NEEDS IN THE COMMUNITY. ULTIMATELY, THE SURVEY WAS DESIGNED TO INFORM THE REGIONAL CHA/CHIP PROCESS UNDERTAKEN THROUGH A COLLABORATION BETWEEN PUBLIC HEALTH AGENCIES, HOSPITALS AND COMMUNITY-BASED ORGANIZATIONS. THE INSTRUMENT WAS MODELED AFTER A SURVEY DISTRIBUTED WITHIN ST. LAWRENCE COUNTY FOR THE PURPOSE OF ASSESSING HEALTH NEEDS WITHIN THAT REGION. A VAST RANGE OF HEALTH RELATED TOPICS WERE COVERED, INCLUDING SPECIFIC DISEASES AND CONDITIONS, HEALTH RISKS, ACCESS TO CARE, PREVENTION, AND COMMUNITY HEALTH NEEDS. THE SURVEY WAS OPEN TO COMMUNITY RESIDENTS FROM JUNE 1ST THROUGH JULY 1ST, 2013. THE INSTRUMENT WAS DISTRIBUTED USING AN ONLINE SURVEY TOOL (SURVEY MONKEY). RESPONDENTS ACCESSED THE SURVEY BY FOLLOWING A WEB LINK. INFORMATION ABOUT THE SURVEY WAS SENT TO REGIONAL HEALTH ORGANIZATIONS/AGENCIES AND THEIR AFFILIATES, VARIOUS NEWS OUTLETS, SOCIAL MEDIA OUTLETS, AND PRIVATE MEDICAL PRACTICES (ALONG WITH RESPECTIVE PATIENT PORTALS). FLYERS WERE ALSO CREATED AND POSTED AT VARIOUS COMMUNITY SITES (E.G. CLINICS AND HOSPITALS). THE PRELIMINARY FINDINGS OF THIS REPORT WERE SHARED WITH THE NORTH COUNTRY HEALTH COMPASS PARTNERS DURING MONTHLY MEETINGS HELD SINCE APRIL 2013. PRELIMINARY DATA WAS ALSO SHARED AS FOLLOWS: IN AN ONLINE SURVEY TOOL TO ENGAGE STAKEHOLDERS IN THE SELECTION OF PREVENTION AGENDA PRIORITIES AND GOALS, WHICH WAS OPEN FROM JULY 29, 2013 TO AUGUST 15, 2013; AT THE "PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE" AD HOC WORK GROUP SESSION WHICH WAS HELD ON SEPTEMBER 9, 2013; AT THE "PREVENT CHRONIC DISEASES" AD HOC WORK GROUP SESSION WHICH WAS HELD ON SEPTEMBER 9, 2013; IN A MEETING WITH THE SOLE REGIONAL PEDIATRIC DENTIST TO BRAINSTORM STRATEGIES TO ADDRESS ORAL HEALTH ISSUES AFFECTING CHILDREN ON SEPTEMBER 13, 2013; AT THE "PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN" AD HOC WORK GROUP SESSION WHICH WAS HELD ON SEPTEMBER 16, 2013; AND IN A MEETING WITH THE FDRHPO PROVIDER EXECUTIVE COMMITTEE (PEC), COMPRISED OF PHYSICIANS WITHIN THE REGION, ON SEPTEMBER 25, 2013 |
| SAMARITAN MEDICAL CENTER | PART V, SECTION B, LINE 6A: SAMARITAN MEDICAL CENTER AS WELL AS CANTON-POTSDAM HOSPITAL, CARTHAGE AREA HOSPITAL, CLAXTON-HEPBURN MEDICAL CENTER, CLIFTON-FINE HOSPITAL, GOUVERNEUR HOSPITAL, LEWIS COUNTY GENERAL HOSPITAL, MASSENA MEMORIAL HOSPITAL, RIVER HOSPITAL |
| SAMARITAN MEDICAL CENTER | PART V, SECTION B, LINE 11: THE REGIONAL PRIORITIES WERE SELECTED AFTER CAREFULLY EVALUATING COMMUNITY HEALTH NEEDS, POPULATION HEALTH DATA, REGIONAL ASSETS, AND REGIONAL BARRIERS. THE PROCESS OF IDENTIFYING THE REGIONAL PRIORITIES INVOLVED INPUT FROM 28 STAKEHOLDERS INCLUDING HOSPITAL CEOS, HOSPITAL ADMINISTRATORS, PUBLIC HEALTH EMPLOYEES (DIRECTORS, HEALTH PLANNERS, NURSES AND EDUCATORS), AND REPRESENTATIVES FROM COMMUNITY-BASED ORGANIZATIONS ACROSS THE THREE COUNTIES. THE SELECTION OF PRIORITIES AND GOALS FOR REGIONAL HEALTH IMPROVEMENT WAS BASED ON EXPRESSED COMMUNITY HEALTH NEEDS AND POPULATION HEALTH DATA INDICATING THE HEALTH ISSUES THAT WERE OF GREATEST CONCERN. FACTORS THAT WERE CONSIDERED WHEN PRIORITIZING WHICH NEEDS WERE TO BE ADDRESSED INCLUDE: HEALTH OUTCOMES THAT DID NOT MEET STATE BENCHMARKS; HEALTH OUTCOMES THAT WERE REGIONAL (NOT COUNTY-SPECIFIC) PRIORITIES; AND AT LEAST ONE HEALTH DISPARITY. STAKEHOLDERS WERE ALSO ENCOURAGED TO CONSIDER THE FOLLOWING WHEN MAKING AN INFORMED DECISION ABOUT WHICH PRIORITIES SHOULD BE SELECTED: IMPACT ON OTHER HEALTH OUTCOMES; RESOURCES AVAILABLE; EASE OF IMPLEMENTING SOLUTIONS; LEADERSHIP SUPPORT AVAILABLE; AND IMPORTANCE TO THE PUBLIC HEALTH SYSTEM. ULTIMATELY, THOSE NEEDS THAT SAMARITAN'S COMMUNITY SERVICE PLAN DID NOT ADDRESS WERE SIMPLY A LOWER PRIORITY, WERE NOT ACHIEVABLE IN A REASONABLE TIMEFRAME OR DID NOT HAVE ADEQUATE RESOURCES TO MEET THE NEEDS.SAMARITAN MEDICAL CENTER IS AN ACTIVE MEMBER OF NORTH COUNTRY HEALTH COMPASS PARTNERS WHICH HAS GROWN TO A COALITION OF APPROXIMATELY 30 MEMBERS CONSISTING OF MEMBERS FROM A WIDE CROSS SECTION OF STAKEHOLDERS: PUBLIC HEALTH DEPARTMENTS, HEALTHCARE FACILITIES, HEALTHCARE AGENCIES, COMMUNITY BASED ORGANIZATIONS AND MOST RECENTLY FAITH-BASED ORGANIZATIONS AND PATIENT AND FAMILY ADVOCATE REPRESENTATION. THE FOCUS OF THE COALITION IS TO BROADLY IMPROVE POPULATION HEALTH FOR OUR REGION BY SUPPORTING THE NUMEROUS POPULATION HEALTH IMPROVEMENT STATE INITIATIVES. THROUGH INVOLVEMENT IN THESE INITIATIVES WE SEEK TO: ASSESS AND IMPROVE POPULATION HEALTH FOR THE 260,000 PEOPLE THAT LIVE WITHIN OUR TRI-COUNTY REGION; STRENGTHEN THE POPULATION HEALTH INFRASTRUCTURE; IMPROVE ACCESS TO PRIMARY AND PREVENTION CARE; AND FOCUS ON ELIMINATING HEALTH DISPARITIES. THE INITIATIVES THAT SAMARITAN MEDICAL CENTER IS ACTIVELY ENGAGED IN INCLUDE:RURAL HEALTH DEVELOPMENT PROGRAM - AWARDED IN 2013 THIS PROGRAM FUNDED THE DEVELOPMENT OF THE NORTH COUNTRY HEALTH COMPASS WEBSITE. IT HELPED DEVELOP A REGIONAL HEALTH ASSESSMENT AND REGIONAL HEALTH IMPROVEMENT PLAN WHICH HELPS GUIDE THE WORK BEING DONE BY THE COLLABORATIVE AND HELPED DETERMINE WHAT DSRIP INITIATIVES IT WOULD FOCUS ON FOR THE REGION. NY STATE'S DELIVERY SYSTEM REFORM INCENTIVE PROGRAM (DSRIP), FOR WHICH SAMARITAN MEDICAL CENTER IS THE LEAD REGIONAL APPLICANT, IS A 5 YEAR INITIATIVE TO REORGANIZE HEALTH CARE PROGRAMS TO MEET THE NEEDS OF NOT ONLY THE MEDICAID POPULATION BUT EVERYONE WHO WILL EVENTUALLY BECOME A PATIENT. THE GOALS OF DSRIP ARE TO PROVIDE A BETTER QUALITY EXPERIENCE, LOWER COST OF CARE AND IMPROVE OUTCOMES OVERALL. IT SEEKS TO ACCOMPLISH THIS BY: ENGAGING THE UNINSURED AND MEDICAID LOW-UTILIZERS, AND NON-UTILIZERS; STRENGTHEN THE MENTAL HEALTH AND SUBSTANCE ABUSE INFRASTRUCTURE AND INCREASE ACCESS TO HIGH-QUALITY CHRONIC DISEASE PREVENTION AND MANAGEMENT (SPECIFICALLY COLORECTAL CANCER AND COPD). POPULATION HEALTH IMPROVEMENT PROGRAM (PHIP) - WHILE NOT THE PROGRAM ADMINISTRATOR, SAMARITAN MEDICAL CENTER PLAYED AN ACTIVE ROLE IN THIS PROGRAM FOR THE TUG HILL SEAWAY REGION. THE ROLE OF THE PHIP IS TO: CONVENE STAKEHOLDERS; SERVE AS POPULATION HEALTH DATA RESOURCE; AND ADDRESS THE NEEDS OF THE POPULATION. STATE HEALTH INNOVATION PLAN (SHIP) - THE GOALS ARE TO: IMPROVE ACCESS TO QUALITY CARE FOR ALL REGIONAL RESIDENTS, PROMOTE POPULATION HEALTH, DEVELOP WORKFORCE STRATEGY, MAXIMIZE HEALTH INFORMATION TECHNOLOGY, AND ESTABLISH A PERFORMANCE MEASURE AND EVALUATION.REGIONAL PRIORITIES -THE DATA THAT HAS BEEN GATHERED HAS BEEN CONDENSED TO 192 INDICATORS. OF THESE, NINE HEALTH ISSUES BECAME REGIONAL PRIORITIES:COLORECTAL CANCER - RATES ARE HIGHER THAN THE STATE AVERAGETOBACCO USE - RATES ARE HIGHER THAN THE STATE AVERAGEHEART DISEASE - RATES ARE HIGHER THAN THE STATE AVERAGEDIABETES - RATES ARE HIGHER THAT THE STATE AVERAGECOMPREHENSIVE WELL CHILD CARE - APPROXIMATELY 50% RECEIVE WELL CHILD CARE; THE STATE GOAL IS 90%PEDIATRIC ORAL HEALTH - 40% OF OUR 3RD GRADERS HAVE UNTREATED TOOTH DECAYBINGE DRINKING - HIGHER THAT THE STATE AVERAGESELF-INFLICTED INJURY SUICIDES - DOUBLE THE STATEWIDE AVERAGE |
| SAMARITAN MEDICAL CENTER | PART V, SECTION B, LINE 22D: WE USED A PERCENTAGE OF GROSS CHARGES. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: | SAMARITANHEALTH.COM |
| SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE: | SAMARITANHEALTH.COM |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| SAMARITAN FAMILY HEALTH - CLAYTON | ||||
| 909 STRAWBERRY LANE | CLAYTON | NY | 13624 | PRIMARY CARE CLINIC |
| SAMARITAN FAMILY HEALTH - PLAZA | ||||
| 1575 WASHINGTON STREET | WATERTOWN | NY | 13601 | PRIMARY CARE CLINIC |
| SAMARITAN FAMILY HEALTH - UROLOGY | ||||
| 19324 US ROUTE 11 | WATERTOWN | NY | 13601 | OUTPATIENT UROLOGY CLINIC |
| SAMARITAN FAMILY HEALTH - LACONA | ||||
| 3 DEMOTT STREET | LACONA | NY | 13083 | PRIMARY CARE CLINIC |
| SAMARITAN FAMILY HEALTH - WBI | ||||
| 428 WASHINGTON STREET | WATERTOWN | NY | 13601 | OUTPATIENT IMAGING CLINIC |
| SAMARITAN OUTPATIENT BEHAVIOR HEALTH | ||||
| 165 COLEMAN STREET | WATERTOWN | NY | 13601 | OUTPATIENT PSYCHIATRIC CLINIC |
| SAMARITAN FAMILY HEALTH - LERAY | ||||
| 26908 INDEPENDENCE WAY | EVAN MILLS | NY | 13637 | PRIMARY CARE CLINIC/URGENT CARE |
| CAPE VINCENT CLINIC | ||||
| 782 E BROADWAY | CAPE VINCENT | NY | 13618 | PRIMARY CARE CLINIC |
Supplemental Information Detail SupplementalInformationDetail (11 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 2014 AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COSTS REPORTED WERE TAKEN DIRECTLY FROM THE 2014 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 2014 WAS APPROXIMATELY 38%. |
| PART III, LINE 9B: | IF CHARITY CARE ASSISTANCE IS GRANTED, PATIENT ACCOUNTS THAT HAVE BEEN REFERRED TO A COLLECTION AGENCY WITHIN 60 DAYS OF APPLICATION DATE ARE ELIGIBLE FOR CHARITY CARE DISCOUNT. ANY BILL AMOUNT REMAINING AFTER APPLICATION OF THE CHARITY CARE DISCOUNT IS THE RESPONSIBILITY OF THE PATIENT. THE PATIENT WILL BE ASSISTED BY THE HOSPITAL IN MAKING SHORT TERM ARRANGEMENT TO SATISFY ANY REMAINING BALANCE ON THE ACCOUNT. |
| PART VI, LINE 2: | SAMARITAN MEDICAL CENTER PARTICIPATED WITH COMMUNITY PARTNERS FROM JEFFERSON AND LEWIS COUNTY TO ASSESS THE COMMUNITY HEALTH NEEDS, IDENTIFY PREVENTION AGENDA PRIORITIES, DEFINE GOALS, OBJECTIVES AND WORK PLANS TO MEET THESE COMMUNITY HEALTH NEEDS. THESE PARTNERS INCLUDE FORT DRUM, JEFFERSON COUNTY PUBLIC HEALTH, LEWIS COUNTY PUBLIC HEALTH, CARTHAGE AREA HOSPITAL, LEWIS COUNTY GENERAL HOSPITAL, RIVER HOSPITAL, NORTH COUNTRY CHILDREN'S CLINIC, NORTHERN NEW YORK RURAL HEALTHCARE ALLIANCE, INC., FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION.SAMARITAN CONTINUES TO WORK WITH ITS PARTNERS, MEETING REGULARLY (AT MINIMUM, QUARTERLY AND AS FREQUENTLY AS MONTHLY) TO ASSESS THE EFFECTIVENESS OF OUR COLLABORATIVE ACTIVITIES.FINALLY, IN TERMS OF PRIORITIZING HEALTH ISSUES, THE RECOMMENDATIONS OF LOCAL, REGIONAL, STATE, AND NATIONAL HEALTH EXPERTS WERE REVIEWED AND CONSIDERED IN THE PROCESS OF IDENTIFYING PRIORITY ISSUES. THE PLANNING COMMITTEE SELECTED THE FINAL HEALTH PRIORITIES AS THEY RELATED TO THE NYS DOH PREVENTION AGENDA AND BY USING COMMUNITIES WORKING TOGETHER FOR A HEALTHIER NEW YORK. |
| PART VI, LINE 3: | THE CHARITY CARE PROGRAM CAN BE COMMUNICATED TO PATIENTS BY ANY SAMARITAN STAFF MEMBER; AS OUR CHARITY CARE PROGRAM IS AN EDUCATION TOPIC IN NEW EMPLOYEE ORIENTATION AND IS PART OF OUR ANNUAL MANDATORY EDUCATION REQUIREMENT. ADDITIONALLY, EACH PATIENT IS PROVIDED WITH A FINANCIAL ASSISTANCE APPLICATION AND RETURN ENVELOPE INCLUDED IN THE SAMARITAN PATIENT HANDBOOK. OUR GOVERNMENT INSURANCE LIAISON RECEIVES REFERRALS FROM PATIENT & FAMILY SERVICES REGARDING PATIENTS THAT MIGHT NEED ASSISTANCE OR EDUCATION REGARDING FEDERAL, STATE OR OTHER GOVERNMENT PROGRAMS. ADDITIONALLY, SHE ATTEMPTS TO CONTACT ALL SELF PAY ADMISSIONS. SAMARITAN PROVIDES SPACE FOR A NYS FACILITATED ENROLLER TO MEET WITH INDIVIDUALS INTERESTED IN APPLYING FOR NYS PROGRAMS. |
| PART VI, LINE 4: | SAMARITAN MEDICAL CENTER IS A 294 BED ACUTE CARE HOSPITAL SERVING SEVERAL COMMUNITIES IN UPSTATE NEW YORK. THE HOSPITAL IS LOCATED IN WATERTOWN, NEW YORK IN JEFFERSON COUNTY, WHICH LIES WITHIN A FEDERALLY DESIGNATED HPSA. THE POPULATION SERVED BY SAMARITAN MEDICAL CENTER PRIMARILY INCLUDES JEFFERSON COUNTY AND PORTIONS OF LEWIS, NORTHERN OSWEGO AND ST. LAWRENCE COUNTIES.SAMARITAN PROVIDES A FULL ARRAY OF INPATIENT AND OUTPATIENT HOSPITAL SERVICES, INCLUDING INPATIENT MEDICAL/SURGICAL, CRITICAL CARE, PEDIATRIC, MATERNITY, AND MENTAL HEALTH SERVICES AND AN EMERGENCY SERVICES DEPARTMENT.THE U.S. CENSUS REPORT LISTS THE 2009 ESTIMATED TOTAL POPULATION OF JEFFERSON COUNTY AT 118,719. THIS REPRESENTS A 6.2% GROWTH FROM THE 2000 CENSUS OF 111,738. THE INCREASE IN TOTAL POPULATION IS LARGELY DUE TO THE EXPANSION OF MILITARY PERSONNEL AT FORT DRUM. FORT DRUM DOES NOT OPERATE A HOSPITAL ON THE ARMY BASE, NOR DO THEY STAFF MEDICAL SPECIALISTS IN THEIR OUTPATIENT HEALTH CENTER.THE PERCENTAGE OF JEFFERSON COUNTY TOTAL POPULATION BELOW THE POVERTY LEVEL HAS GRADUALLY INCREASED FROM 11% IN 1990 TO 13.5% IN 2002 TO 14.6% IN 2008. MEDIAN HOUSEHOLD INCOME FOR 2008 FALLS SHORT OF STATEWIDE MEDIAN HOUSEHOLD INCOME BY APPROXIMATELY 20%. UNEMPLOYMENT IN JEFFERSON COUNTY IS APPROXIMATELY 8% - 9%. THE JEFFERSON COUNTY POPULATION CONTINUES TO BE PREDOMINANTLY CAUCASIAN, ALTHOUGH THERE ARE AN INCREASING NUMBER OF PERSONS OF OTHER RACE AND, IN PARTICULAR, HISPANIC, OR AFRICAN AMERICAN IN ORIGIN.THE CURRENT OVERALL (INPATIENT AND OUTPATIENT) PAYOR MIX EXPERIENCED AT SAMARITAN MEDICAL CENTER IS AS FOLLOWS:MEDICARE 38%, MEDICAID 17%, BLUE CROSS 13%, COMMERCIAL 10%, TRICARE 17%, NO FAULT 1%, WORKMEN'S COMPENSATION 1%, AND SELF PAY 3%. |
| PART VI, LINE 5: | SINCE 2006, SAMARITAN HAS RECRUITED AND RETAINED MORE THAN 80 PHYSICIANS TO THE AREA. PHASE III OF THE FACILITY MASTER PLAN BEGAN IN 2011 WHICH PROVIDES FOR RENOVATION OF THE EXISTING MAIN BUILDING. THIS RENOVATION AND RECONFIGURATION PROJECT WILL CONTRIBUTE DIRECTLY TO PROMOTING INCREASED OUTPATIENT SERVICES BY CONSOLIDATING HEALTHCARE SERVICES AND ENHANCE OUTPATIENT AND AMBULATORY CARE AT LEVELS THAT ARE BOTH EFFICIENT AND ACCESSIBLE.SAMARITAN MEDICAL CENTER EXPANDED SERVICES IN 2012 TO INCLUDE A ROBOTICALLY ASSISTED SURGICAL PROGRAM, SPINE CENTER OF EXCELLENCE AND NEUROSURGERY. PREVIOUSLY, THESE SERVICES WERE ONLY ACCESSIBLE TO COMMUNITY MEMBERS AT OUTSIDE REFERRAL CENTERS IN SYRACUSE AND BEYOND. |
| 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 (16 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 FINANCE | $135,294 | $0 | $0 | $0 | $13,529 | $0 | $10,615 | $0 | $21 | $0 | $159,459 | $0 | $0 | $0 |
| DAVID FLINT MD | ||||||||||||||
| TRUSTEE | $292,206 | $0 | $809 | $0 | $32,107 | $0 | $22,695 | $0 | $16,624 | $0 | $364,441 | $0 | $0 | $0 |
| DAVID RECHLIN DO | ||||||||||||||
| TRUSTEE | $130,000 | $0 | $86,697 | $0 | $25,000 | $0 | $7,800 | $0 | $21 | $0 | $249,518 | $0 | $0 | $0 |
| JACK RUSH MD | ||||||||||||||
| TRUSTEE | $140,543 | $0 | $6,313 | $0 | $45,405 | $0 | $12,058 | $0 | $16,624 | $0 | $220,943 | $0 | $0 | $0 |
| ROBERT KIMBALL MD | ||||||||||||||
| TRUSTEE | $353,257 | $0 | $2,000 | $0 | $0 | $0 | $22,615 | $0 | $16,406 | $0 | $394,278 | $0 | $0 | $0 |
| THOMAS H CARMAN | ||||||||||||||
| PRESIDENT & CEO | $485,960 | $0 | $19,042 | $0 | $22,265 | $0 | $90,900 | $0 | $21,592 | $0 | $639,759 | $0 | $0 | $0 |
| SEAN MILLS | ||||||||||||||
| CFO | $174,990 | $0 | $0 | $0 | $0 | $0 | $3,634 | $0 | $16,624 | $0 | $195,248 | $0 | $0 | $0 |
| MICHAEL SHORT | ||||||||||||||
| CIO | $190,005 | $0 | $0 | $0 | $9,500 | $0 | $13,300 | $0 | $12,225 | $0 | $225,030 | $0 | $0 | $0 |
| MARIO VICTORIA | ||||||||||||||
| CMO | $323,647 | $0 | $75,339 | $0 | $16,500 | $0 | $22,691 | $0 | $16,624 | $0 | $454,801 | $0 | $0 | $0 |
| BRIAN O'HEARN | ||||||||||||||
| VP PATIENT CARE/CNO | $211,946 | $0 | $6,346 | $0 | $10,500 | $0 | $16,617 | $0 | $16,624 | $0 | $262,033 | $0 | $0 | $0 |
| ANTHONY JOSEPH | ||||||||||||||
| VP LONG TERM CARE | $172,238 | $0 | $0 | $0 | $8,293 | $0 | $15,023 | $0 | $15,869 | $0 | $211,423 | $0 | $0 | $0 |
| ALEJANDRO RODRIGUEZ MD | ||||||||||||||
| UROLOGIST | $586,147 | $0 | $100,000 | $0 | $11,300 | $0 | $22,696 | $0 | $16,624 | $0 | $736,767 | $0 | $0 | $0 |
| JOSEPH WETTERHAHN MD | ||||||||||||||
| FAMILY PRACTICE MD | $284,502 | $0 | $11,801 | $0 | $199,024 | $0 | $22,274 | $0 | $16,624 | $0 | $534,225 | $0 | $0 | $0 |
| MOONJOHN KIM MD | ||||||||||||||
| INTERVENTIONAL RADIOLOGIST | $544,568 | $0 | $11,844 | $0 | $10,000 | $0 | $22,850 | $0 | $16,624 | $0 | $605,886 | $0 | $0 | $0 |
| SHAHANDEH HAGHIR MD | ||||||||||||||
| PATHOLOGIST | $430,702 | $0 | $0 | $0 | $9,900 | $0 | $22,698 | $0 | $11,832 | $0 | $475,132 | $0 | $0 | $0 |
| BRADFORD BILICKI | ||||||||||||||
| SURGEON | $349,755 | $0 | $35,373 | $0 | $25,200 | $0 | $22,703 | $0 | $16,624 | $0 | $449,655 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | PART I, LINE 4B: THOMAS H. CARMAN RECEIVED CONTRIBUTIONS TO AN IRC 457(F) PLAN OF $73,400 DURING 2014. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 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 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Capitalized InterestCapitalizedInterestAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | UnspentUnspentAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $31,660,000 | $883,291 | $1,623,236 | $27,750,175 | $3,169,880 | 2010 | 0 | 0 | 0 | Yes (1) |
| B | $23,945,000 | $737,831 | $1,388,843 | $18,830,508 | $4,463,480 | 2010 | Yes (1) | 0 | 0 | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 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 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 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 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | SAMARITAN MEDICAL CENTER ADOPTED THE PROVISIONS OF THE NEW YORK STATE NON PROFIT REVITALIZATION ACT. |
| FORM 990, PART VI, SECTION B, LINE 11 | 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 -6,508,058. VALUE OF INTEREST RATE SWAP 79,846. EQUITY TRANSFERS TO AFFILIATE -6,999,710. |
| FORM 990 PART XII LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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