SAMARITAN MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SAMARITAN MEDICAL CENTER (EIN 15-0533577)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201313199349304556
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2013-11-15T11:04:00-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161226221 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUST CHARLES CHAMBERS LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5784 WIDEWATERS PARKWAY | AddressLine1 |
| City | SYRACUSE | City |
| State | NY | State |
| ZIP Code | 13214 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 150533577 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SAMA | NameControl |
| Phone | 3157855702 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 WASHINGTON STREET | AddressLine1 |
| City | WATERTOWN | City |
| State | NY | State |
| ZIP Code | 13601 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SEAN MILLS | Name |
| Title | CFO | Title |
| Phone | 3157855702 | Phone |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOSEPH J SCHLEGEL | Name |
| PTIN | P00301329 | PTIN |
| Phone | 3154463600 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SEAN MILLS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 WASHINGTON STREET | AddressLine1 |
| City | WATERTOWN | City |
| State | NY | State |
| ZIP Code | 13601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 197592272 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SAMARITANHEALTH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1881 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1897 | TotalNbrEmployees |
| Total Nbr Volunteers | 186 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1599400 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2946399 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 193307441 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 192654193 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 50085 | InvestmentIncomePriorYear |
| Investment Income Current Year | 156823 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1788275 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1834857 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 196745201 | TotalRevenuePriorYear |
| Total Revenue Current Year | 197592272 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 98941568 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 107399088 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 287912 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 77990547 | OtherExpensePriorYear |
| Other Expenses Current Year | 85736379 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 176932115 | TotalExpensesPriorYear |
| Total Expenses Current Year | 193135467 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 19813086 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4456805 | RevenuesLessExpensesCY |
| Total Assets BOY | 198607571 | TotalAssetsBOY |
| Total Assets EOY | 207881444 | TotalAssetsEOY |
| Total Liabilities BOY | 113262178 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 119258858 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 85345393 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 88622586 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 161577985 | Expense |
| Revenue | 194562920 | Revenue |
| Description | PROVIDE CARE FOR 10,734 INPATIENT DISCHARGES IN ADDITION, SAMARITAN MEDICAL CENTER PROVIDED FOR 108,579 OUTPATIENT VISITS, 52,854 EMERGENCY ROOM VISITS, AND 77,631 FAMILY HEALTH CLINIC VISITS. | Description |
| Total Program Service Expense | 161577985 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 111 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1897 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEAN MILLS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3157796686 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 104 PADDOCK STREET | AddressLine1 |
| City | WATERTOWN | City |
| State | NY | State |
| ZIP Code | 13601 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (29 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| DAVID FLINT | |||||||||
| TRUSTEE | 1.00 | X | 278934 | 0 | 36098 | ||||
| JACK RUSH | |||||||||
| TRUSTEE | 1.00 | X | 171526 | 0 | 27960 | ||||
| ROBERT KIMBALL MD | |||||||||
| TRUSTEE | 1.00 | X | 28700 | 278211 | 7433 | ||||
| BRUCE DINES | |||||||||
| CHAIRMAN | 1.00 | X | 245 | 0 | 0 | X | |||
| JAN TURCOTTE MD | |||||||||
| TRUSTEE | 1.00 | X | 0 | 27791 | 0 | ||||
| DANIEL VILLA | |||||||||
| IMMEDIATE PAST CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||||
| THOMAS HANLEY | |||||||||
| CHARIMAN OF FINANCE COMMITTEE | 1.00 | X | 0 | 0 | 0 | ||||
| REV FRED GARRY | |||||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | X | |||
| LISA WEBER | |||||||||
| VICE CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | |||
| MELANIE PARKER-GEURTSEN | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| RONALD PERCIACCANTE | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| MARY PERRINE | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| CATHERINE BURNS QUENCER | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| ALFRED CALLIGARIS | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| PAUL CARR | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| KATHLEEN GEBO | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| WENDY GRIMM | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| COL MARK THOMPSON | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| PETER WALTON | |||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||||
| THOMAS H CARMAN | |||||||||
| PRESIDENT & CEO | 40.00 | 739873 | 0 | 97615 | X | 4.50 | |||
| PAUL KRAEGER | |||||||||
| CFO & TREASURER | 40.00 | 490677 | 0 | 38858 | X | 4.00 | |||
| MICHAEL SHORT | |||||||||
| CIO | 40.00 | 193181 | 0 | 25275 | X | ||||
| MARIO VICTORIA MD | |||||||||
| VP MEDICAL AFFAIRS | 40.00 | 320862 | 0 | 36310 | X | ||||
| RICHARD BROOKS | |||||||||
| VP LONG TERM CARE | 40.00 | 206458 | 0 | 26158 | X | ||||
| SIMON OUAKNINE | |||||||||
| UROLOGIST | 40.00 | 525904 | 0 | 36092 | X | ||||
| JOSEPH WETTERHAHN | |||||||||
| FAMILY PRACTICE MD | 40.00 | 454215 | 0 | 36090 | X | ||||
| MOONJOHN KIM | |||||||||
| INTERVENTIONAL RADIOLOGIST | 40.00 | 544997 | 0 | 31097 | X | ||||
| SHAHANDEH HAGHIR | |||||||||
| PATHOLOGIST | 40.00 | 425202 | 0 | 31406 | X | ||||
| YILIN ZHANG | |||||||||
| PATHOLOGIST | 40.00 | 399284 | 0 | 20024 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 4780058 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 306002 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 450416 | TotalOtherCompensation |
| Number Individuals GT100 K | 86 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PURCELL-LECESSE | |||||
| 75 THRUWAY PARK DRIVE | WEST HENRIETTA | NY | 14586 | CONTRACTOR SERVICE | 41676628 |
| HAYNER HOYT CORPORATION | |||||
| 625 ERIE BLVD WEST | SYRACUSE | NY | 13204 | CONTRACTOR SERVICE | 10749173 |
| JEFFERSON ANESTHESIOLOGIST | |||||
| PO BOX 837 | WATERTOWN | NY | 13601 | ANESTHESIOLOGY SERVICES | 2541094 |
| LOCUMTENENSCOM | |||||
| PO BOX 405547 | ATLANTA | GA | 30384 | PURCHASED SERVICE | 2104604 |
| INTUITIVE SURGICAL | |||||
| PO BOX 39000 | SAN FRANSICO | CA | 94139 | PURCHASED SERVICE | 1831419 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 73 | NumberOfContractorsGT100K |
| Related Organizations | 310390 | RelatedOrganizations |
| Government Grants | 2488936 | GovernmentGrants |
| All Other Contributions | 147073 | AllOtherContributions |
| Total Contributions | 2946399 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 192654193 | TotalRevenueColumn |
| Related Or Exempt Function Income | 192654193 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 192654193 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 140311 | TotalRevenueColumn |
| Related Or Exempt Function Income | 140311 | RelatedOrExemptFunctionIncome |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4383 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4383 | RelatedOrExemptFunctionIncome |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 82953 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 82953 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 82953 | TotalRevenueColumn |
| Exclusion | $82,953 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4500 | Securities |
| Other | 7629 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4500 | Securities |
| Other | 7629 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12129 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12129 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| SOLD SERVICES | 541900 | 992310 | 992310 |
| CAFETERIA | 722210 | 703347 | 703347 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56247 | TotalRevenueColumn |
| Related Or Exempt Function Income | 56247 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1751904 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 197592272 | TotalRevenueColumn |
| Related Or Exempt Function Income | 194562920 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $82,953 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2790833 | Total |
| Program Services | 543463 | ProgramServices |
| Management And General | 2247370 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80320131 | Total |
| Program Services | 70162169 | ProgramServices |
| Management And General | 10104326 | ManagementAndGeneral |
| Fundraising | 53636 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8476088 | Total |
| Program Services | 7273990 | ProgramServices |
| Management And General | 1202098 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9783984 | Total |
| Program Services | 8337020 | ProgramServices |
| Management And General | 1377774 | ManagementAndGeneral |
| Fundraising | 69190 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6028052 | Total |
| Program Services | 5173140 | ProgramServices |
| Management And General | 854912 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 607909 | Total |
| Program Services | 18695 | ProgramServices |
| Management And General | 588384 | ManagementAndGeneral |
| Fundraising | 830 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 709203 | Total |
| Management And General | 695062 | ManagementAndGeneral |
| Fundraising | 14141 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 241004 | Total |
| Program Services | 745 | ProgramServices |
| Management And General | 238236 | ManagementAndGeneral |
| Fundraising | 2023 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1853801 | Total |
| Program Services | 495484 | ProgramServices |
| Management And General | 1347337 | ManagementAndGeneral |
| Fundraising | 10980 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2216491 | Total |
| Program Services | 1773193 | ProgramServices |
| Management And General | 434032 | ManagementAndGeneral |
| Fundraising | 9266 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3635269 | Total |
| Program Services | 2939178 | ProgramServices |
| Management And General | 696091 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 181336 | Total |
| Program Services | 107740 | ProgramServices |
| Management And General | 67505 | ManagementAndGeneral |
| Fundraising | 6091 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193358 | Total |
| Program Services | 47899 | ProgramServices |
| Management And General | 138144 | ManagementAndGeneral |
| Fundraising | 7315 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 653358 | Total |
| Program Services | 588610 | ProgramServices |
| Management And General | 64748 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3304850 | Total |
| Program Services | 3000000 | ProgramServices |
| Management And General | 304850 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10758270 | Total |
| Program Services | 8666436 | ProgramServices |
| Management And General | 2091834 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1763047 | Total |
| Program Services | 1131078 | ProgramServices |
| Management And General | 631969 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| SUPPLIES | 22317790 | 21978185 | 317943 | 21662 |
| CONTRACTED SERVICES AND | 20323316 | 13624603 | 6605935 | 92778 |
| PROVISION FOR BAD DEBT | 9815318 | 9815318 | ||
| EQUIP REPAIR & MAINT | 5599508 | 4338488 | 1261020 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1562551 | Total |
| Program Services | 1562551 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193135467 | Total |
| Program Services | 161577985 | ProgramServices |
| Management And General | 31269570 | ManagementAndGeneral |
| Fundraising | 287912 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4624 | BOY |
| EOY | 5153 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38525340 | BOY |
| EOY | 28526776 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29745918 | BOY |
| EOY | 25542253 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1979598 | BOY |
| EOY | 2156236 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2660952 | BOY |
| EOY | 2738914 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 254893704 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 131596593 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100809988 | BOY |
| EOY | 123297111 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1909989 | BOY |
| EOY | 2135074 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11974215 | BOY |
| EOY | 10657834 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10996947 | BOY |
| EOY | 12822093 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 198607571 | BOY |
| EOY | 207881444 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25710514 | BOY |
| EOY | 32026707 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53944423 | BOY |
| EOY | 51874135 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33607241 | BOY |
| EOY | 35358016 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113262178 | BOY |
| EOY | 119258858 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75583845 | BOY |
| EOY | 85711713 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8887077 | BOY |
| EOY | 2036402 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 874471 | BOY |
| EOY | 874471 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85345393 | BOY |
| EOY | 88622586 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 198607571 | BOY |
| EOY | 207881444 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 4456805 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 146539 | ReconciliationUnrealizedInvest |
| Reconcilation Prior Adjustment | 925106 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | -2251257 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9761548 | BeginningOfYearBalance |
| Contributions | 147073 | Contributions |
| Other Expenditures | -6997722 | OtherExpenditures |
| End Of Year Balance | 2910899 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9720908 | BeginningOfYearBalance |
| Contributions | 1183545 | Contributions |
| Other Expenditures | -1142905 | OtherExpenditures |
| End Of Year Balance | 9761548 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1686419 | BeginningOfYearBalance |
| Contributions | 8606970 | Contributions |
| Other Expenditures | -572481 | OtherExpenditures |
| End Of Year Balance | 9720908 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1772796 | BeginningOfYearBalance |
| Contributions | 1137000 | Contributions |
| Other Expenditures | -1223377 | OtherExpenditures |
| End Of Year Balance | 1686419 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1575443 | BeginningOfYearBalance |
| Contributions | 240587 | Contributions |
| Other Expenditures | -43234 | OtherExpenditures |
| End Of Year Balance | 1772796 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.30040 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.69960 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1124952 | OtherCostOrOtherBasis |
| Book Value | 1124952 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 116346818 | OtherCostOrOtherBasis |
| Depreciation | 32741262 | Depreciation |
| Book Value | 83605556 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2546991 | OtherCostOrOtherBasis |
| Depreciation | 2057868 | Depreciation |
| Book Value | 489123 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 121246600 | OtherCostOrOtherBasis |
| Depreciation | 96797463 | Depreciation |
| Book Value | 24449137 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13628343 | OtherCostOrOtherBasis |
| Book Value | 13628343 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 123297111 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (11 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CSV OF OFFICERS LIFE INSURANCE | 424882 | F |
| INVESTMENT IN NEWELL ST., LLC | 90000 | C |
| CWH NOTE RECEIVABLE | 20945 | C |
| DUE FROM AFFILIATES | 8502977 | C |
| GOODWILL INVESTMENT | 110750 | C |
| ED PHYSICIAN CALL | 825777 | C |
| LOC FEE - SERIES B | 38170 | C |
| FINANCING COSTS - SERIES B | 533141 | C |
| INTEREST RATE SWAP | -1934913 | F |
| FINANCING COSTS - KEY BANK | 158053 | C |
| MEDICAL MALPRACTICE LT INS RECOVERY | 1888052 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 10657834 | TotalOfBookValueSecurities |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER RECEIVABLES | Description |
| Book Value | 12822093 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 12822093 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $4,734,461 |
| RETIREMENT PLAN OBLIGATIONS | $30,623,555 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 35358016 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | 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. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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, 2012 AND 2011, SAMARITAN DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2009 THROUGH 2012. 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) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1679700 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 342942 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1336758 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00690 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23482900 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14366215 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9116685 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04720 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 25162600 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14709157 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10453443 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05410 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 901171 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9719 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 891452 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00460 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7937029 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4214867 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3722162 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01930 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16433 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 16433 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8854633 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4224586 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4630047 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02400 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 34017233 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18933743 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15083490 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07810 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,163,282 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 44395365 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 53423772 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -9028407 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 WASHINGTON STREET | AddressLine1 |
| City | WATERTOWN | City |
| State | NY | State |
| ZIP Code | 13601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 8 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (8 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 2012 AUDITED FINANCIAL STATEMENTS. | ||
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS REPORTED WERE TAKEN DIRECTLY FROM THE 2012 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 2012 WAS APPROXIMATELY 36%. | ||
| 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 V, SECTION B, LINE 20D: WE USED A PERCENTAGE OF GROSS CHARGES. | SAMARITAN MEDICAL CENTER | |
| 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 36%, MEDICAID 13%, BLUE CROSS 18%, COMMERCIAL 10%, TRICARE 18%, NO FAULT 1%, WORKMEN'S COMPENSATION 1%, AND SELF PAY 3%. | ||
| PART VI, LINE 5: SINCE 2006, SAMARITAN HAS RECRUITED AND RETAINED A TOTAL OF 79 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. | ||
| NY | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID FLINT | ||||||||||||||
| TRUSTEE | 268324 | 0 | 0 | 0 | 10610 | 0 | 20001 | 0 | 16097 | 0 | 315032 | 0 | 0 | 0 |
| JACK RUSH | ||||||||||||||
| TRUSTEE | 140544 | 0 | 0 | 0 | 30982 | 0 | 11863 | 0 | 16097 | 0 | 199486 | 0 | 0 | 0 |
| ROBERT KIMBALL MD | ||||||||||||||
| TRUSTEE | 0 | 278211 | 0 | 0 | 28700 | 0 | 0 | 0 | 0 | 7433 | 28700 | 285644 | 0 | 0 |
| THOMAS H CARMAN | ||||||||||||||
| PRESIDENT & CEO | 438486 | 0 | 77350 | 0 | 224037 | 0 | 76928 | 0 | 20687 | 0 | 837488 | 0 | 0 | 0 |
| PAUL KRAEGER | ||||||||||||||
| CFO & TREASURER | 266347 | 0 | 38350 | 0 | 185980 | 0 | 30352 | 0 | 8506 | 0 | 529535 | 0 | 0 | 0 |
| MICHAEL SHORT | ||||||||||||||
| CIO | 170707 | 0 | 13939 | 0 | 8535 | 0 | 13804 | 0 | 11471 | 0 | 218456 | 0 | 0 | 0 |
| MARIO VICTORIA MD | ||||||||||||||
| VP MEDICAL AFFAIRS | 295279 | 0 | 10819 | 0 | 14764 | 0 | 20213 | 0 | 16097 | 0 | 357172 | 0 | 0 | 0 |
| RICHARD BROOKS | ||||||||||||||
| VP LONG TERM CARE | 179984 | 0 | 17475 | 0 | 8999 | 0 | 14748 | 0 | 11410 | 0 | 232616 | 0 | 0 | 0 |
| SIMON OUAKNINE | ||||||||||||||
| UROLOGIST | 385008 | 0 | 25000 | 0 | 115896 | 0 | 19995 | 0 | 16097 | 0 | 561996 | 0 | 0 | 0 |
| JOSEPH WETTERHAHN | ||||||||||||||
| FAMILY PRACTICE MD | 284502 | 0 | 0 | 0 | 169713 | 0 | 19993 | 0 | 16097 | 0 | 490305 | 0 | 0 | 0 |
| MOONJOHN KIM | ||||||||||||||
| INTERVENTIONAL RADIOLOGIST | 534997 | 0 | 0 | 0 | 10000 | 0 | 15000 | 0 | 16097 | 0 | 576094 | 0 | 0 | 0 |
| SHAHANDEH HAGHIR | ||||||||||||||
| PATHOLOGIST | 415002 | 0 | 0 | 0 | 10200 | 0 | 19996 | 0 | 11410 | 0 | 456608 | 0 | 0 | 0 |
| YILIN ZHANG | ||||||||||||||
| PATHOLOGIST | 390584 | 0 | 0 | 0 | 8700 | 0 | 20003 | 0 | 21 | 0 | 419308 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | PART I, LINE 4B: THOMAS H. CARMAN RECEIVED CONTRIBUTIONS TO AN IRC 457(F) PLAN OF $61,928 DURING 2012. PART I, LINE 4B: PAUL KRAEGER RECEIVED CONTRIBUTIONS TO AN IRC 457(F) PLAN OF $10,059 DURING 2012. PART I, LINE 4B: ROBERT KIMBALL RECEIVED DISTRIBUTIONS FROM ED CALL PAY PLAN OF $28,700 DURING 2012. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| DORMITORY AUTHORITY OF THE STATE OF NEW YORK | ||||||||
| A | 146000293 | 649905DD5 | 2009-04-09 | 31660000 | 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 | 23945000 | CONSTRUCTION OF NEW PATIENT PAVILION AND PARKING GARAGE, REFUND 1998 SERIESA | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Capitalized InterestCapitalizedInterest | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Capital ExpendituresCapitalExpenditures | Amount UnspentAmountUnspent | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Other Spent ProceedsOtherSpentProceeds |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 30000000 | 31660000 | 1476106 | 1727382 | 148484 | 27750175 | 557853 | 2010 | 0 | 0 | 0 | 1 | |
| B | 23945000 | 513766 | 1084656 | 504577 | 18830508 | 794844 | 2010 | 1 | 0 | 0 | 1 | 2213649 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 -2,001,331. VALUE OF INTEREST RATE SWAP -249,926. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN KEEP 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 |
| EJ NOBLE | ||||||||||
| 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 | ||||||||||
| 830 WASHINGTON STREET | 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 Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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