2025-11-04T15:29:33-06:00 2024-12-31 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2024-01-01 150533577 SAMARITAN MEDICAL CENTER SAMA 3157855702 830 WASHINGTON STREET WATERTOWN NY 13601 MAXINE BRIGGS CFO 3157855702 2025-10-23 1 1 DESIREE M BENNETT P01263666 3154463600 2025-10-23 2024 2025-03-06 01:10:19Z MAXINE BRIGGS 830 WASHINGTON STREET WATERTOWN NY 13601 376706633 0 X WWW.SAMARITANHEALTH.COM X 1881 NY SAMARITAN MEDICAL CENTER OPERATES AN ACUTE CARE HOSPITAL FACILITY IN WATERTOWN, NEW YORK, SERVING JEFFERSON, OSWEGO AND ST. LAWRENCE COUNTIES. THIS 290-BED FACILITY PROVIDES INPATIENT CARE, PSYCHIATRIC SERVICES, AMBULATORY SURGERY, PRIMARY AND EMERGENCY CARE AND OTHER OUTPATIENT SERVICES. 21 17 2476 48 0 0 8418404 1136348 335130058 367962565 1384043 2056367 4258404 5439232 349190909 376594512 0 0 0 0 166609823 176857730 0 0 797413 169029045 183421243 335638868 360278973 13552041 16315539 282296477 310199120 151613089 169740669 130683388 140458451 X SAMARITAN MEDICAL CENTER OPERATES AN ACUTE CARE HOSPITAL FACILITY IN WATERTOWN, NEW YORK, SERVING JEFFERSON, LEWIS, OSWEGO, AND ST. LAWRENCE COUNTIES. THIS 290-BED FACILITY PROVIDES INPATIENT CARE, PSYCHIATRIC SERVICES, AMBULATORY SURGERY, PRIMARY AND EMERGENCY CARE AND OTHER OUTPATIENT SERVICES. 0 0 319718399 372730118 DURING 2024, SAMARITAN MEDICAL CENTER PROVIDED CARE FOR 9,819 INPATIENT DISCHARGES AND A TOTAL OF 282,302 OUTPATIENT VISITS. OF THE TOTAL OUTPATIENT VISITS, THERE WERE 35,267 EMERGENCY ROOM VISITS AND 181,889 FAMILY HEALTH CLINIC VISITS. 319718399 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 174 0 1 2476 1 0 0 0 0 0 0 0 0 0 0 1 0 X 21 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MAXINE BRIGGS 3157853605 104 PADDOCK WATERTOWN NY 13601 MELANIE PARKER-GEUTSEN IMMEDIATE PAST CHAIR 1.00 X X 0 0 0 DENISE YOUNG CHAIR 1.00 X X 0 0 0 JOHN WHEELER FINANCE COMMITTEE CHAIR 1.00 X X 0 0 0 THOMAS H CARMAN PRESIDENT & CEO OF SMC 40.00 4.50 X X 1132728 0 62942 MAXINE BRIGGS TREASURER & CFO OF SMC 40.00 3.50 X X 609760 0 52818 JOHN BARRETT MD TRUSTEE (PRESIDENT OF MEDI 40.00 X 565223 0 41574 DAVID RECHLIN DO TRUSTEE 40.00 X 161510 0 23477 KEVIN CHANDLER MD UROLOGIST/TRUSTEE 40.00 X 899920 0 40584 MARY WARDWELL DONAHUE SECRETARY 1.00 2.50 X X 0 0 0 MARIE HESS TRUSTEE 1.00 X 0 0 0 TRACY LEONARD TRUSTEE 1.00 X 0 0 0 TIMOTHY VIRKLER TRUSTEE 1.00 X 0 0 0 SHAWNA CUTULI TRUSTEE 1.00 1.00 X 0 0 0 JOAN TREADWELL WOODS TRUSTEE 1.00 2.50 X 0 0 0 STEPHEN TODD TRUSTEE 1.00 X 0 0 0 PAUL BARTON VICE CHAIR 1.00 X X 0 0 0 LYNNE FERRIS TRUSTEE 1.00 X 0 0 0 KIMBERLY LACLAIR TRUSTEE (CHAIR OF THE SMC 1.00 X 0 0 0 RORY SEARS DO VICE PRESIDENT OF MEDICAL 40.00 X 449827 0 43622 ASIM KISHLOO TRUSTEE 1.00 X 0 0 0 JAN TURCOTTE TRUSTEE 1.00 X 0 0 0 DIERDRA SORRELL TRUSTEE 1.00 X 184995 0 34269 SADIE HALL TRUSTEE (CLIFTON FINE BOAR 1.00 X 0 0 0 MARYLENE DUAH MD TRUSTEE 40.00 X 325498 0 40942 ROBERT ALIASSON JR TRUSTEE 1.00 X 0 0 0 COL CHRISTINA BUCHNER FORT DRUM LIAISON 1.00 X 0 0 0 JORDAN JONES TRUSTEE 1.00 X 0 0 0 MARIO VICTORIA MD CMO OF SMC 40.00 1.00 X 515079 0 55338 MICHAEL SHORT COO OF SMC 40.00 1.00 X 502510 0 51978 PATRICK CALLI VP OF LONG TERM CARE 40.00 X 0 370452 19342 ELIZABETH FIPPS VP OF FOUNDATION AND COMMU 40.00 X 281063 0 35953 ROBIN CLARK VP OF INFORMATION SERVICES 40.00 X 281342 0 19307 JOHN GREEN VP PATIENT CARE CHIEF CNO 40.00 X 185014 0 9916 ELIZABETH TESTANI VP CLINICS AND OUTPATIENT SERVICES 40.00 X 270723 0 15627 BRIAN ZAFONTE ORTHOPEDIC SURGEON 40.00 X 1108944 0 40734 JUSTIN BUDNIK ONCOLOGY 40.00 X 1049635 0 51798 NATHANIEL MILETTA MD DERMATOLOGIST 40.00 X 920982 0 21001 DAVID REINDL GASTROENTROLOGIST 40.00 X 769991 0 30559 DAVID GORDON OTOLARYNGOLOGIST 40.00 X 742969 0 45152 LEO GOSSELIN MD FORMER TRUSTEE 40.00 X 511686 0 52818 11469399 370452 789751 20 1 1 0 JEFFERSON ANESTHESIOLOGIST SERVICES 826 WASHINGTON ST WATERTOWN NY 13601 ANESTHESIA SERVICES 10627884 HEALTHCARE WORKFORCE LOGISTICS LLC 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 PURCHASED SERVICES 9711450 NEW YORK STATE NURSES ASSOC PO BOX 12340 ALBANY NY 12212 PURCHASED SERVICES 6404059 NORTH COUNTRY EMERGENCY MEDICAL 830 WASHINGTON ST WATERTOWN NY 13601 PURCHASED SERVICES 6009131 APOGEE MEDICAL MANAGEMENT INC SCOTTSDALE ROAD STE 600 SCOTTSDALE AZ 85250 PURCHASED SERVICES 5205446 5 139210 26500 970638 1136348 PATIENT SERVICE REVENUE 623000 357620581 357620581 340B PROGRAM REV 900099 9524861 9524861 PHYSICIAN INCENTIVE 900099 673291 673291 MEDICAL HOME INCENTIVE 900099 143832 143832 367962565 1848675 1848675 744879 73200 671679 671679 671679 246613 38921 207692 207692 207692 SHARED SERVICES 541900 2478937 2478937 CAFETERIA 722514 663855 663855 1624761 1624761 4767553 376594512 372730118 0 2728046 X 6893540 6576524 317016 134008469 114288392 19500837 219240 6270798 5379053 867878 23867 19639737 16846847 2718141 74749 10045186 8616700 1390254 38232 1019721 24600 995121 337054 331209 5845 22329 22329 58909606 54751325 4149658 8623 1015759 1532 1014028 199 1527780 355253 1159241 13286 7853238 6769932 1083306 8135212 7430581 704631 374901 124142 248382 2377 45236 20356 24880 232528 3811 228717 91642 91642 13614721 11646032 1968689 5047833 4302779 745054 MEDICAL SUPPLIES 62231238 61464240 733526 33472 PROVISION FOR BAD DEBT 13598013 13598013 EQUIPMENT REPAIR AND MA 4682623 4668233 14390 NYS GROSS RECEIPTS ASSE 2259509 2259509 2422300 590545 1771248 60507 360278973 319718399 39763161 797413 6400 5850 54206364 81063549 3263924 3196736 35020104 37592791 7152977 7413535 3870607 4398677 445951220 293062011 157269914 152889209 874471 874471 10545889 11383591 10085827 11380711 282296477 310199120 45521694 49539125 77523848 76322380 14282888 10584513 14284659 33294651 151613089 169740669 X 128189066 138496947 2494322 1961504 130683388 140458451 282296477 310199120 X 16315539 -6540476 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22329 22329 0 PART II-B, LINE 1: A PORTION OF ANNUAL MEMEBRSHIP DUES PAID TO HANYS AND IHA ARE RELATED TO LOBBYING ACTIVITIES 2494322 919888 1452706 1961504 1975708 6474860 5956246 2494322 1838260 1179037 1041589 1975708 1440882 4891044 4493666 1838260 2421545 10390355 11371018 1440882 0.44580 0.55420 0 0 1216252 1216252 226697876 78759870 147938006 10566813 7658165 2908648 207470279 206643976 826303 152889209 RIGHT OF USE LIABILITIES 3177367 OTHER LIABILITIES 30117284 33294651 X PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT SAMARITAN MEDICAL CENTER AND RELATED FACILITIES IN PROVIDING HEALTH CARE SERVICES TO THE PUBLIC. PART X, LINE 2: SAMARITAN QUALIFIES AS A TAX-EXEMPT, NOT-FOR-PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2024 AND 2023, SAMARITAN DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2021 THROUGH 2024. 1 1 X 1 X 1 X 1 1 0 1 1 9887240 891145 8996095 0.02590 69227095 36892638 32334457 0.09330 79114335 37783783 41330552 0.11920 662372 550763 111609 0.00030 1411805 50750 1361055 0.00390 12058081 8280655 3777426 0.01090 14132258 8882168 5250090 0.01510 93246593 46665951 46580642 0.13430 1 4180339 349971 59810645 56454780 3355865 X 1 1 1 1 SAMARITAN MEDICAL CENTER 830 WASHINGTON STREET WATERTOWN NY 13601 X X X X SAMARITAN MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X 1 1 X X X 1 X HTTPS://SAMARITANHEALTH.COM/FOR-PATIENTS/FINANCIAL-INFORMATION/ X HTTPS://SAMARITANHEALTH.COM/FOR-PATIENTS/FINANCIAL-INFORMATION/ X X X X 1 X 0 X X 1 X 0 0 SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 5: SAMARITAN MEDICAL CENTER PARTICIPATED IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DEVELOPED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO) IN COLLABORATION WITH NORTH COUNTRY HEALTH COMPASS PARTNERS (NCHCP). REPRESENTING BROAD INTERESTS OF THE COMMUNITY, NCHCP IS A THREE-COUNTY COALITION OF MORE THAN 40 HOSPITALS, COUNTY AGENCIES AND NONPROFIT HEALTH, SOCIAL, HUMAN SERVICE AND EDUCATION ORGANIZATIONS. CLIENT BASES OF THESE ENTITIES INCLUDE MANY UNDERSERVED AND LOW-INCOME POPULATIONS FROM POVERTY-RIDDEN AREAS IN OUR REGION AND FEDERALLY-DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS). THIS INCLUDES THOSE RECEIVING SERVICES FROM TWO FEDERALLY QUALIFIED HEALTH CENTERS, NORTH COUNTRY FAMILY HEALTH CENTER AND COMMUNITY HEALTH CENTER OF THE NORTH COUNTRY. NCHCP, WHICH MEETS MONTHLY, PROVIDED COMMENT AND FEEDBACK AT VARIOUS STAGES OF THE CHNA DEVELOPMENT THROUGHOUT 2022. FDRHPO AND NCHCP SINCE 2016 HAVE ANNUALLY COMMISSIONED A REGIONAL HEALTH SURVEY OF ADULTS TO UNDERSTAND AND MONITOR HEALTH CARE AND HEALTH HABITS OF COMMUNITY RESIDENTS. DATA FROM THE 2022 SURVEY (CONDUCTED IN MAY AND JUNE) WAS UTILIZED IN THE CHNA, ALONG WITH STATISTICAL INFORMATION GATHERED FROM ADDITIONAL LOCAL, STATE AND NATIONAL SOURCES. REGIONAL CHNA DATA WAS ULTIMATELY REFINED TO PRODUCE A SEPARATE CHNA FOR EACH OF THE THREE COUNTIES REPRESENTED. SAMARITAN, WHOSE SERVICE AREA IS PRIMARILY JEFFERSON COUNTY, USES THE JEFFERSON COUNTY CHNA FOR PLANNING PURPOSES. THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH WHO WERE INVOLVED IN CREATION OF THE JEFFERSON COUNTY CHNA INCLUDED THE JEFFERSON COUNTY PUBLIC HEALTH SERVICE'S PUBLIC HEALTH DIRECTOR AND PLANNER, AS WELL AS FDRHPO POPULATION HEALTH STAFF. SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES PARTICIPATING IN THE DEVELOPMENT OF THE CHNA, IN ADDITION TO SAMARITAN, WERE: CARTHAGE AREA HOSPITAL AND RIVER HOSPITAL IN JEFFERSON COUNTY; SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 6B: : JEFFERSON COUNTY ORGANIZATIONS INVOLVED IN CHNA CREATION: CREDO COMMUNITY CENTER FOR THE TREATMENT OF ADDICTIONS, FORT DRUM MEDDAC (MILITARY AND DEPENDENTS' HEALTH CLINIC), FDRHPO, JEFFERSON COUNTY CORNELL COOPERATIVE EXTENSION (EDUCATION, NUTRITION AND YOUTH SERVICES), JEFFERSON COUNTY COMMUNITY SERVICES (MENTAL HEALTH), JEFFERSON COUNTY OFFICE FOR THE AGING, JEFFERSON COUNTY PUBLIC HEALTH SERVICE, NORTH COUNTRY FAMILY HEALTH CENTER (HEALTH CLINIC FOR LOW INCOME), NORTH COUNTRY PRENATAL/PERINATAL COUNCIL (LOW INCOME WOMEN, INFANTS AND CHILDREN'S HEALTH SERVICES), NORTHERN REGIONAL CENTER FOR INDEPENDENT LIVING (SERVICES FOR THE HANDICAPPED AND DISABLED), PIVOT (ALCOHOL AND SUBSTANCE ABUSE PREVENTION), SALVATION ARMY, TRANSITIONAL LIVING SERVICES (BEHAVIORAL HEALTH), VOLUNTEER TRANSPORTATION CENTER (TRANSPORTATION FOR LOW INCOME), WATERTOWN FAMILY YMCA AND WATERTOWN URBAN MISSION (LOW INCOME SOCIAL SERVICES). SAMARITAN MEDICAL CENTER PART V, SECTION B, LINE 11: BASED ON CHNA DATA, JEFFERSON COUNTY'S HOSPITALS AND PUBLIC HEALTH SERVICE DEFINED SIGNIFICANT COMMUNITY HEALTH ISSUES. THESE ENTITIES, COLLABORATING WITH SEVERAL ADDITIONAL ORGANIZATIONS, SUBSEQUENTLY DEVELOPED THE 2022-2024 JEFFERSON COUNTY HEALTH IMPROVEMENT PLAN (CHIP), WHICH OUTLINES ACTIVITIES, INTERVENTIONS, GOALS AND MEASURES TO TACKLE THE ISSUES. THE CHIP'S CREATION WAS COORDINATED BY FDRHPO AND IS ALIGNED WITH GOALS ESTABLISHED IN NEW YORK STATE'S PREVENTION AGENDA, THE STATE'S HEALTH IMPROVEMENT PLAN. SIGNIFICANT ISSUES AND DISPARITIES IDENTIFIED INCLUDE OUR COMMUNITY'S HIGH INCIDENCE AND DEATH RATES DUE TO LUNG AND BRONCHUS CANCER; HIGH RATES OF OBESITY AND DIABETES, WIDESPREAD TOBACCO USE, AND OPIOID SUBSTANCE ABUSE. TO DEAL WITH THESE ISSUES, AS WELL AS WITH ADDITIONAL COMMUNITY CONCERNS ABOUT HIGH RATES OF DENTAL CARIES IN CHILDREN AND LOW VACCINATION RATES FOR THE HUMAN PAPILLOMA VIRUS, JEFFERSON COUNTY'S CHIP FOCUSES ON STATE PRIORITY AREAS RELATIVE TO: CHRONIC DISEASE PREVENTION AND MANAGEMENT; MENTAL AND SUBSTANCE USE DISORDERS TREATMENT AND PREVENTION; PROMOTION OF HEALTHY CHILDREN (PARTICULAR TO DENTAL HYGIENE) AND PREVENTION OF COMMUNICABLE DISEASES (PARTICULAR TO HPV). SAMARITAN'S ACTIVITIES IN THE COLLABORATIVE CHIP INCLUDE: TOBACCO USE SCREENING, REFERRAL, TREATMENT AND PREVENTION (SMOKING AND VAPING); ACCESS TO AN EVIDENCE-BASED DISEASE SELF-MANAGEMENT PROGRAMS FOR INDIVIDUALS WITH DIABETES; REFERRALS TO ADDITIONAL CHRONIC DISEASE PREVENTION AND MANAGEMENT PROGRAMS ALIGNED WITH PATIENT NEEDS; ROUTINE SCREENING, BRIEF BEHAVIORAL COUNSELING AND TREATMENT REFERRAL IN PRIMARY CARE CLINICS TO REDUCE UNHEALTHY ALCOHOL AND DRUG USE; AND IMPLEMENTATION OF THREE PROGRAMS COMBATTING OPIOID MISUSE: AN OUTPATIENT MEDICATION-ASSISTED TREATMENT PROGRAM, AN ALTERNATIVE TO OPIOIDS PRESCRIBING PROGRAM (IN THE EMERGENCY DEPARTMENT) AND AN INPATIENT OPIOID STEWARDSHIP PROGRAM. THE HOSPITAL'S PRIMARY CARE CLINICS LAUNCHED EFFORTS TO INCREASE PREVENTIVE DENTAL SERVICES (FLUORIDE VARNISHING) AND DENTAL REFERRALS FOR PEDIATRIC OUTPATIENTS. SAMARITAN ALSO AGREED TO SUPPORT FUTURE REGIONAL EFFORTS PROMOTING HPV VACCINATION. IN ADDITION TO THESE CHIP-SPECIFIC ACTIVITIES, SAMARITAN IN 2022 ALSO ENGAGED IN ACTIVITIES DESIGNED TO ABATE COMMUNITY HEALTH NEEDS AS FOLLOWS: (1) OUR CERTIFIED DIABETES EDUCATOR CONSULTED WITH PRIMARY CARE AND PHYSICIAN PRACTICES BOTH WITHIN AND OUTSIDE OF THE SAMARITAN HEALTH SYSTEM TO EDUCATE COMMUNITY PRACTITIONERS ON HOW TO ENGAGE DIABETES PATIENTS IN DISEASE SELF-MANAGEMENT. (2) THE HOSPITAL PARTNERED WITH LOCAL ORGANIZATIONS TO IMPLEMENT COMMUNITY-WIDE AWARENESS, EDUCATION AND PREVENTION ACTIVITIES RELATIVE TO CANCER. (3) OUTPATIENT CLINICS MAINTAINED CERTIFICATION AND COMMITMENT TO THE PATIENT-CENTERED MEDICAL HOME (PCMH) HEALTH CARE DELIVERY MODEL. (4) TWO WOMEN'S HEALTH CARE PRACTICES WERE CONSOLIDATED IN RENOVATED SPACE IN A BUILDING ALREADY HOUSING PRIMARY CARE AND BEHAVIORAL HEALTH CLINICS, AND A LABORATORY/RADIOLOGY TESTING SITE WAS RELOCATED TO THE SAME SITE, RESULTING IN CREATION OF A MEDICAL VILLAGE PROVIDING IMPROVED PATIENT ACCESS TO A BROAD RANGE OF SERVICES IN ONE CONVENIENT LOCATION. (5) PARTICIPATION, PARTNERSHIPS AND COLLABORATIONS CONTINUED WITH FDRHPO, THE NORTH COUNTRY INITIATIVE, REGIONAL COMMITTEES AND COUNTY COALITIONS TO IDENTIFY, PLAN AND IMPLEMENT INITIATIVES TO STRENGTHEN THE LOCAL HEALTH CARE SYSTEM. (6) THE HOSPITAL PARTICIPATED IN ACTIVITIES DEALING WITH ONGOING COMMUNITY HEALTH NEEDS, INCLUDING: PREVENTION AND AWARENESS EDUCATION ON THE REGION'S MOST PREVALENT CHRONIC DISEASES AND CONDITIONS; EARLY CANCER DETECTION SCREENINGS; SMOKING CESSATION CLASSES; PARTICIPATION IN HEALTH EDUCATION/AWARENESS CAMPAIGNS; PHYSICIAN RECRUITMENT/RETENTION; ADOPTION OF EVIDENCE-BASED MEDICAL AND CLINICAL IMPROVEMENTS TO ENHANCE PATIENT OUTCOMES; AND DEVELOPMENT OF TELEMEDICINE INFRASTRUCTURE AND TOOLS TO IMPROVE THE ACCESS OF THE REGION'S RURAL, UNDERSERVED POPULATION TO COST-EFFECTIVE, QUALITY HEALTH CARE. PART V, LINE 7A, HOSPITAL FACILITY'S WEBSITE: HTTPS://SAMARITANHEALTH.COM/ABOUT-SAMARITAN-HEALTH/ PART V, LINE 7B, OTHER WEBSITES FOR CHNA REPORT: HTTPS://WWW.JEFFERSONCOUNTYNY.GOV/DEPARTMENTS/PUBLICHEALTH/COMMUNITY-HEALTH-IMPROVEMENT-PLAN-DATA-AND-REPORTSHTTPS://WWW.FDRHPO.ORG/ PART V, LINE 10A, MOST RECENTLY ADOPTED IMPLEMENTATION STARTEGY'S WEBSITE: HTTPS://SAMARITANHEALTH.COM/ABOUT-SAMARITAN-HEALTH/ 17 1 - SAMARITAN FAMILY HEALTH - CLAYTON 909 STRAWBERRY LANE CLAYTON NY 13624 PRIMARY CARE CLINIC 2 - SAMARITAN FAMILY HEALTH CENTER-WATERTOWN 1575 WASHINGTON STREET WATERTOWN NY 13601 PRIMARY CARE CLINIC 3 - SAMARITAN UROLOGY CENTER 22567 SUMMIT DRIVE BUILDING 2 SUITE A WATERTOWN NY 13601 OUTPATIENT UROLOGY CLINIC 4 - SAMARITAN PAIN MANAGEMENT CENTER 826 WASHINGTON STREET THIRD FLOOR WATERTOWN NY 13601 SPECIALTY CARE CLINIC 5 - SAMARITAN OUTPATIENT BEHAVIOR HEALTH 1575 WASHINGTON STREET WATERTOWN NY 13601 OUTPATIENT PSYCHIATRIC CLINIC 6 - LERAY FAMILY HEALTH CENTER 26908 INDEPENDENCE WAY SUITE 101 EVAN MILLS NY 13637 PRIMARY CARE CLINIC/URGENT CARE 7 - CAPE VINCENT FAMILY HEALTH CENTER 782 EAST BROADWAY STREET CAPE VINCENT NY 13618 PRIMARY CARE CLINIC 8 - SAMARITAN WOUND CARE CENTER 165 COLEMAN AVENUE WATERTOWN NY 13601 OUTPATIENT WOUND CARE CLINIC 9 - SAMARITAN GASTROENTEROLOGY 26908 INDEPENDENCE WAY FIRST FLOOR EVAN MILLS NY 13637 SPECIALTY CARE CLINIC 10 - ADAMS FAMILY HEALTH CENTER 10881 US ROUTE 11 ADAMS NY 13605 OUTPATIENT PRIMARY CARE CLINIC 11 - WOMENS WELLNESS AND BREAST CARE 1575 WASHINGTON STREET WATERTOWN NY 13601 OUTPATIENT PRIMARY CARE CLINIC 12 - SAMARITAN RHEUMATOLOGY 629 WASHINGTON STREET 2ND FLOOR WATERTOWN NY 13601 OUTPATIENT PRIMARY CARE CLINIC 13 - SAMARITAN DERMATOLOGY AND MOHS SURGERY 826 WASHINGTON STREET SUITE 100 WATERTOWN NY 13601 OUTPATIENT PRIMARY CARE CLINIC 14 - SAMARITAN PULMONOLOGY 19320 US ROUTE 11 BUILDING 3 WATERTOWN NY 13601 OUTPATIENT PRIMARY CARE CLINIC 15 - SAMARITAN EAR NOSE AND THROAT 826 WASHINGTON STREET THIRD FLOOR WATERTOWN NY 13601 OUTPATIENT PRIMARY CARE CLINIC 16 - SMART CLINIC 1575 WASHINGTON STREET DOOR H WATERTOWN NY 13601 PRIMARY CARE CLINIC 17 - WALKER CENTER FOR CANCER CARE 830 WASHINGTON STREET WATERTOWN NY 13601 SPECIALTY CARE CLINIC PART I, LINE 6A: SAMARITAN IS A MEMBER OF THE HOSPITAL ASSOCIATION OF NEW YORK STATE, WHICH ANNUALLY GENERATES AN ECONOMIC AND COMMUNITY IMPACT REPORT FOR SAMARITAN MEDICAL CENTER INDICATING IN TOTAL DOLLARS THE COST OF CARE THE HOSPITAL PROVIDED IN THE PRIOR YEAR TO PEOPLE IN NEED, SUBSIDIZED CARE AND SERVICES TO LOW-INCOME, ELDERLY AND UNDER-SERVED COMMUNITIES, AND THE HOSPITAL'S INVESTMENT IN COMMUNITY HEALTH INITIATIVES. IN ADDITION TO THIS AMOUNT, THE REPORT INDICATES THE NUMBER OF OUTPATIENTS TREATED, EMERGENCY ROOM VISITS, HOSPITAL ADMISSIONS AND BABIES DELIVERED DURING THAT YEAR, AS WELL THE NUMBER OF JOBS GENERATED. THIS REPORT ALSO PROVIDES AN ESTIMATE IN DOLLARS OF THE ANNUAL ECONOMIC ACTIVITY AND TAX DOLLARS GENERATED IN THE COMMUNITY DUE TO THE HOSPITAL'S PRESENCE AND SPENDING. THIS INFORMATION, AS WELL AS MORE DETAIL, IS INCLUDED IN SAMARITAN'S ANNUAL REPORT TO THE COMMUNITY, A PUBLICATION WHICH IS MAILED TO KEY HOSPITAL AND COMMUNITY STAKEHOLDERS AND ALSO PUBLICLY AVAILABLE ON THE HOSPITAL'S WEBSITE. PART I, LINE 7: THE RATIO OF COST TO CHARGES METHODOLOGY WAS UTILIZED IN COMPUTING ALL EXPENSES REPORTED ON LINES 7A. THROUGH 7G. THE WORKSHEET (#1 THROUGH #6) TEMPLATES IN THE INSTRUCTIONS FOR SCHEDULE H WERE FOLLOWED TO COMPUTE COSTS REPORTED. PART I, LINE 7G: THE COSTS REPORTED ON THIS LINE REPRESENT THE NET EXPENSE FOR THE OUTPATIENT PRIMARY CARE CLINICS OPERATED BY SAMARITAN MEDICAL CENTER. THE "NET" EXPENSE WAS COMPUTED UTILIZING WORKSHEET 6 OF THE SCHEDULE H FORM. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 13,598,013. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, SAMARITAN MEDICAL CENTER (SMC), SAMARITAN MEDICAL PRACTICE, P.C. (SMP) AND SAMARITAN KEEP NURSING HOME, INC. (SKH) ANALYZE PAST PAYMENT HISTORY AND IDENTIFY TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, SMC, SMP AND SKH ANALYZE CONTRACTUALLY DUE AMOUNTS AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, SMC, SMP AND SKH ALSO ANALYZE AMOUNTS DUE AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN SMC, SMP AND SKH ESTABLISH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BOTH TAKE INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNT OF BAD DEBT AT COST REPORTED ON LINE #2 WAS CALCULATED BY APPLYING THE OVERALL IMPLICIT PRICE CONCESSION TO THE PROVISION FOR BAD DEBT EXPENSE AS REPORTED IN OUR 2024 AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS REPORTED WERE TAKEN DIRECTLY FROM THE 2024 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 OVERALL (INPATIENT AND OUTPATIENT) MEDICARE PAYOR MIX FOR 2024 WAS APPROXIMATELY 44%. 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 IN THE JEFFERSON COUNTY 2022-2024 COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) DEVELOPED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO) IN COLLABORATION WITH NORTH COUNTRY HEALTH COMPASS PARTNERS (NCHCP). REPRESENTING BROAD INTERESTS OF THE COMMUNITY, NCHCP IS A THREE-COUNTY COALITION OF MORE THAN 40 HOSPITALS, COUNTY AGENCIES AND NONPROFIT HEALTH, SOCIAL, HUMAN SERVICE, AND EDUCATION ORGANIZATIONS. CLIENT BASES OF THESE ENTITIES INCLUDE MANY UNDERSERVED AND LOW-INCOME POPULATIONS FROM POVERTY-RIDDEN AREAS IN OUR REGION AND FEDERALLY DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS). THIS INCLUDES THOSE RECEIVING SERVICES FROM TWO FEDERALLY QUALIFIED HEALTH CENTERS, NORTH COUNTRY FAMILY HEALTH CENTER AND COMMUNITY HEALTH CENTER OF THE NORTH COUNTRY. NCHCP, WHICH MEETS MONTHLY, PROVIDED COMMENTS AND FEEDBACK AT VARIOUS STAGES OF THE CHIP DEVELOPMENT THROUGHOUT 2022, AS WELL AS MONITORS AND ASKS FOR FEEDBACK ON PLAN PROGRESS FROM ALL THE HOSPITALS INVOLVED. REGIONAL DATA WAS REFINED TO PRODUCE A SEPARATE COMMUNITY HEALTH ASSESSMENT (CHA) FOR EACH OF THE THREE COUNTIES REPRESENTED. SAMARITAN, WHOSE SERVICE AREA IS PRIMARILY JEFFERSON COUNTY, USES THE JEFFERSON COUNTY CHA AND CHIP FOR PLANNING PURPOSES. IN ADDITION TO THE CHIP AND CHA, FDRHPO ALSO CONDUCTED A COMMUNITY HEALTH SURVEY IN 2024 OF JEFFERSON, LEWIS, AND ST. LAWRENCE COUNTIES. FDRHPO AND NCHCP HAVE ANNUALLY COMMISSIONED A REGIONAL HEALTH SURVEY OF ADULTS TO UNDERSTAND AND MONITOR HEALTH CARE AND HEALTH HABITS OF COMMUNITY RESIDENTS SINCE 2016. THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH WHO WERE INVOLVED IN CREATING THE JEFFERSON COUNTY CHA INCLUDED THE JEFFERSON COUNTY PUBLIC HEALTH SERVICE'S PUBLIC HEALTH DIRECTOR AND PLANNER, AS WELL AS FDRHPO POPULATION HEALTH STAFF. PART VI, LINE 3: ALL HOSPITAL EMPLOYEES ARE MADE AWARE OF SAMARITAN'S PATIENT FINANCIAL ASSISTANCE PROGRAM DURING NEW EMPLOYEE ORIENTATION AND THROUGH MANDATED ANNUAL TRAININGS FOR ALL EMPLOYEES. THIS ENSURES ALL STAFF UNDERSTAND THE PROGRAM'S AVAILABILITY AND APPLICATION PROCESS, SO THAT THEY MAY REFER PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE. INTERNAL POLICIES AND PROGRAM PROCEDURES ALSO ARE ACCESSIBLE THROUGH THE HOSPITAL'S INTRANET. APPLICATIONS FOR FINANCIAL ASSISTANCE ARE AVAILABLE IN BROCHURES FOR PATIENTS PROVIDED IN DISPLAY RACKS AT POINTS OF PUBLIC ENTRY TO THE HOSPITAL AND ITS PRIMARY CARE CLINICS. VERSIONS OF THE APPLICATION ARE AVAILABLE IN BOTH ENGLISH AND SPANISH. THE PUBLIC CAN ACCESS AND PRINT THIS INFORMATIONAL BROCHURE/APPLICATION FROM THE HOSPITAL'S WEBSITE. ALL HOSPITAL BILLING STATEMENTS REFERENCE THE FINANCIAL ASSISTANCE PROGRAM. WHEN A PATIENT APPLIES FOR ASSISTANCE, APPLICATION PROCESSING INCLUDES SCREENING FOR ELIGIBILITY FOR PARTICIPATION IN FEDERAL AND STATE HEALTHCARE EXPENSE ASSISTANCE PROGRAMS. PART VI, LINE 4: SITUATED APPROXIMATELY 60 MILES NORTH OF SYRACUSE IN NORTHERN NEW YORK STATE, JEFFERSON COUNTY IS HOME TO AN ESTIMATED POPULATION OF 116,637 PEOPLE, AS REPORTED FROM THE 2020 US CENSUS. THE COUNTY, CHARACTERIZED BY ITS PROXIMITY TO LAKE ONTARIO TO THE WEST AND THE ST. LAWRENCE RIVER TO THE NORTH, SHARES BORDERS WITH ST. LAWRENCE COUNTY TO THE NORTHEAST, LEWIS COUNTY TO THE EAST, AND OSWEGO COUNTY TO THE SOUTH. THE REGION BOASTS A VARIETY OF POPULATED AREAS, INCLUDING WATERTOWN, THE LARGEST CITY NORTH OF SYRACUSE AND THE SEAT OF COUNTY GOVERNMENT, WITH A POPULATION OF 24,685; FORT DRUM ARMY POST, HOUSING 16,749 RESIDENTS ACROSS TWO ZIP CODES (13602 AND 13603); AND CARTHAGE, INCORPORATING THE VILLAGES OF CARTHAGE AND WEST CARTHAGE AND SURROUNDING AREAS, WITH A POPULATION OF 10,560. ADDITIONAL COMMUNITIES ENRICHING THE COUNTY'S LANDSCAPE INCLUDE DEXTER, BLACK RIVER, CAPE VINCENT, CLAYTON, ALEXANDRIA BAY, CHAUMONT, SACKETS HARBOR, ADAMS, CALCIUM, EVANS MILLS, PHILADELPHIA, LAFARGEVILLE, REDWOOD, AND THERESA.THE POPULATION IS 80.7% WHITE, 8% HISPANIC, 6.7% BLACK, AND 1.9% ASIAN, WITH THE REMAINING 2.7% IDENTIFIED AS NATIVE HAWAIIAN/PACIFIC ISLANDER, AMERICAN INDIAN/ALASKAN NATIVE OR TWO OR MORE RACES. ETHNICALLY, 8% OF THE POPULATION IS HISPANIC/LATINO. THE POPULATION IS 53.1% MALE AND 46.9% FEMALE. 23.5% OF COUNTY RESIDENTS ARE UNDER THE AGE OF 18 AND 15.2% ARE AGED 65 OR OLDER. CENSUS HEALTH STATISTICS INDICATE 10.4% OF JEFFERSON COUNTY RESIDENTS UNDER THE AGE OF 65 HAVE A DISABILITY. THE PERCENTAGE OF RESIDENTS UNDER 65 WITHOUT HEALTH INSURANCE IS 5.1%. THE REGION LAGS ECONOMICALLY WHEN COMPARED TO NEW YORK STATE. 12.4% OF JEFFERSON COUNTY'S RESIDENTS LIVE IN POVERTY AND THE PER CAPITA MEDIAN INCOME IS 25.3% LOWER THAN THE STATE VALUE, ACCORDING TO THE CENSUS, AT $58,271. NYS DEPARTMENT OF LABOR STATISTICS INDICATE JEFFERSON COUNTY'S UNEMPLOYMENT RATE AT 3.8%. OUR SERVICE AREA INCLUDES THE SMALL CITY OF WATERTOWN (POPULATION APPROXIMATELY 24,575) AND IS HOME TO THE FORT DRUM U.S. ARMY POST (HOME OF THE 10TH MOUNTAIN DIVISION). FORT DRUM'S TRANSIENT MILITARY POPULATION INCLUDES 13,034, AS OF 2020, SOLDIERS AND A LIKE NUMBER OF DEPENDENTS. WITH NO HOSPITAL ON POST, SAMARITAN SERVES AS CHIEF PROVIDER OF ACUTE CARE FOR FORT DRUM SOLDIERS AND THEIR FAMILIES. THE REGION BENEFITS FROM ROBUST CONNECTIVITY, WITH INTERSTATE 81 BISECTING THE COUNTY AND PROVIDING A CRUCIAL LINK BETWEEN CANADA AND THE REST OF THE UNITED STATES. THIS INTERSTATE RUNS NORTHWARD THROUGH ADAMS AND WATERTOWN, SKIRTS THE MAIN GATE OF FORT DRUM, AND CROSSES INTO CANADA BETWEEN CLAYTON AND ALEXANDRIA BAY. ADDITIONALLY, WATERTOWN INTERNATIONAL AIRPORT, SITUATED FIVE MILES WEST OF WATERTOWN, AND A MILITARY AIRPORT ON THE FORT DRUM ARMY POST FACILITATE AIR TRAVEL.HEALTHCARE SERVICES IN JEFFERSON COUNTY ARE ROBUST, WITH THREE HOSPITALS CATERING TO THE COMMUNITY'S NEEDS. THESE INCLUDE CARTHAGE AREA HOSPITAL, A 25-BED NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL LOCATED IN CARTHAGE; RIVER HOSPITAL, A 24-BED NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL SITUATED IN ALEXANDRIA BAY; AND SAMARITAN MEDICAL CENTER, A 290-BED NOT-FOR-PROFIT HOSPITAL BASED IN WATERTOWN. PART VI, LINE 5: SAMARITAN PROVIDES LEADERSHIP ON THE REGION'S HEALTH PLANNING AND COLLABORATIVE ORGANIZATIONS (INCLUDING THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION, NORTH COUNTRY HEALTH COMPASS PARTNERS AND NORTH COUNTRY INITIATIVE) AND ACTIVELY SUPPORTS ACTIVITIES COORDINATED BY THESE AGENCIES. THE HOSPITAL PROVIDES A SEMI-ANNUAL, EDUCATIONAL "BOOT CAMP" ON LOCAL HEALTH ISSUES FOR ITS AFFILIATED GOVERNING BOARDS AND COMMUNITY LEADERS. GOVERNING BOARDS OF THE HOSPITAL AND ITS PRIMARY AFFILIATES ARE COMPOSED OF REPRESENTATIVES ACROSS A BROAD RANGE OF CONSTITUENCIES, INCLUDING LOCAL BUSINESS, EDUCATION, MILITARY, HEALTH/SOCIAL SERVICE, GOVERNMENT AND NONPROFIT LEADERS. HOSPITAL DEPARTMENTS AND STAFF MEMBERS, MANY OF WHOM SERVE ON LOCAL BOARDS AND COMMITTEES, REGULARLY HELP PLAN AND PROVIDE STRONG PARTICIPATION IN COMMUNITY-BASED HEALTH FAIRS, AWARENESS CAMPAIGNS AND OTHER ACTIVITIES PROMOTING POPULATION HEALTH. PART VI, LINE 6: SAMARITAN MEDICAL CENTER IS THE LEAD ORGANIZATION OF THE SAMARITAN HEALTH SYSTEM AND PARENT CORPORATION OF FIVE AFFILIATED CORPORATIONS: SAMARITAN KEEP NURSING HOME, A 272-BED LONG-TERM RESIDENTIAL CARE FACILITY; SAMARITAN SENIOR VILLAGE (A.K.A. SAMARITAN SUMMIT VILLAGE), A 288-BED ASSISTED LIVING AND SKILLED NURSING HOME; SAMARITAN HOME HEALTH, WHICH PROVIDES SHORT-TERM, IN-HOME NURSING AND THERAPEUTIC SERVICES; SAMARITAN MEDICAL PRACTICE, WHICH SUPPORTS DEVELOPMENT AND RETENTION OF PHYSICIAN SERVICES, AND THE SAMARITAN MEDICAL CENTER FOUNDATION OF NORTHERN NEW YORK, WHICH RAISES CHARITABLE FUNDS TO SUPPORT THE HEALTH SYSTEM. SAMARITAN ALSO IS AFFILIATED WITH CLIFTON-FINE HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN ST. LAWRENCE COUNTY, WHO IN 2024 BECAME THE FIRST RURAL EMERGENCY HOSPITAL IN NEW YORK. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X X 1 1 0 0 0 0 0 0 0 THOMAS H CARMAN PRESIDENT & CEO OF SMC 763173 0 364370 0 5185 0 13800 0 49142 0 1195670 0 0 0 BRIAN ZAFONTE ORTHOPEDIC SURGEON 1007864 0 101080 0 0 0 20700 0 20034 0 1149678 0 0 0 JUSTIN BUDNIK ONCOLOGY 1038885 0 10750 0 0 0 20700 0 31098 0 1101433 0 0 0 NATHANIEL MILETTA MD DERMATOLOGIST 840008 0 80974 0 0 0 20700 0 301 0 941983 0 0 0 KEVIN CHANDLER MD UROLOGIST/TRUSTEE 742920 0 157000 0 0 0 20700 0 19884 0 940504 0 0 0 DAVID REINDL GASTROENTROLOGIST 758772 0 11219 0 0 0 20700 0 9859 0 800550 0 0 0 DAVID GORDON OTOLARYNGOLOGIST 532569 0 210400 0 0 0 20700 0 24452 0 788121 0 0 0 MAXINE BRIGGS TREASURER & CFO OF SMC 494062 0 92698 0 23000 0 20700 0 32118 0 662578 0 0 0 JOHN BARRETT MD TRUSTEE (PRESIDENT OF MEDI 541062 0 24161 0 0 0 20700 0 20874 0 606797 0 0 0 MARIO VICTORIA MD CMO OF SMC 437008 0 56221 0 21850 0 20700 0 34638 0 570417 0 0 0 LEO GOSSELIN MD FORMER TRUSTEE 491686 0 20000 0 0 0 20700 0 32118 0 564504 0 0 0 MICHAEL SHORT COO OF SMC 415002 0 66758 0 20750 0 20700 0 31278 0 554488 0 0 0 RORY SEARS DO VICE PRESIDENT OF MEDICAL 422594 0 27233 0 0 0 20700 0 22922 0 493449 0 0 0 PATRICK CALLI VP OF LONG TERM CARE 0 317925 0 36657 0 15870 0 19066 0 276 0 389794 0 0 MARYLENE DUAH MD TRUSTEE 299998 0 25500 0 0 0 17710 0 23232 0 366440 0 0 0 ELIZABETH FIPPS VP OF FOUNDATION AND COMMU 238014 0 31148 0 11901 0 14904 0 21049 0 317016 0 0 0 ROBIN CLARK VP OF INFORMATION SERVICES 260000 0 8342 0 13000 0 4200 0 15107 0 300649 0 0 0 ELIZABETH TESTANI VP CLINICS AND OUTPATIENT SERVICES 251934 0 10000 0 8789 0 15246 0 381 0 286350 0 0 0 DIERDRA SORRELL TRUSTEE 184995 0 0 0 0 0 11100 0 23169 0 219264 0 0 0 JOHN GREEN VP PATIENT CARE CHIEF CNO 170147 0 6360 0 8507 0 0 0 9916 0 194930 0 0 0 DAVID RECHLIN DO TRUSTEE 133557 0 27953 0 0 0 5342 0 18135 0 184987 0 0 0 PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO AN IRC 457(B) PLAN DURING 2024: MICHAEL SHORT $20,750 MARIO VICTORIA $21,850 MAXINE BRIGGS $23,000 ROBIN CLARK $13,000 PATRICK CALLI $ 15,870 JOHN GREEN $ 8,507 ELIZABETH TESTANI $8,789 ELIZABETH FIPPS $,11,900 THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING 2024: N/A A JEFFERSON COUNTY CIVIC FACILITY DEVELOP CORP 452491721 47325RATT 2017-11-07 88595042 SEE BELOW 0 1 0 A 88595042 5057775 313747 1272495 30334536 52082453 2022 1 0 0 1 A 0 1 1 1 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 SCHEDULE K PART 1 COLUMN A AND COLUMN F SCHEDULE K, PART 1, BOND ISSUES: (A) ISSUERS NAME: JEFFERSON COUNTY CIVIC FACILITY DEVELOPMENT CORP (F) DESCRIPTION OF PURPOSE: CONSTRUCTION OF A NEW ADDITION TO THE HOSPITAL'S MAIN CAMPUS; RENOVATION OF CERTAIN HOSPITAL FACILITIES; PURCHASE EQUIPMENT; REFUND PRIOR BOND ISSUES. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S FORM 990 AND ACCOMPANYING SCHEDULES WERE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD PRIOR TO FILING. FORM 990 WAS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL DISCLOSURE STATEMENTS ARE REQUIRED BY ALL BOARD MEMBERS AND KEY PERSONS. WE HAVE BEEN AT 100% COMPLIANCE WITH THIS REQUIREMENT EACH YEAR. RESPONSES ARE REVIEWED INITIALLY BY THE CEO AND CHIEF COMPLIANCE OFFICER FOR ACCURACY AND COMPLETENESS. THIS INFORMATION IS THEN PUT INTO A FULL REPORT TO THE BOARD OF TRUSTEES FOR REVIEW AND CONSIDERATION IN UPCOMING DECISION MAKING. BOARD MEMBERS AND KEY PERSONS AFFIRM THEIR UNDERSTANDING OF THEIR DUTY TO REPORT ANY ADDITIONAL OR NEW POTENTIAL CONFLICTS THROUGHOUT THE YEAR. BOARD MEMBERS WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATION IN VOTING AND DECISION MAKING IN RELATED TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES AN EXTERNAL CONSULTANT TO ANALYZE AND ESTABLISH COMPENSATION AND BENEFITS FOR ALL EXECUTIVE POSITIONS. AN EVALUATION IS PERFORMED ANNUALLY. THE ANALYSIS INCLUDES A REVIEW OF MARKET DATA BASED ON REGION, FACILITY SIZE, AND RESPECTIVE RESPONSIBILITIES. THIS INFORMATION IS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FOR REVIEW AND SUBSEQUENTLY PRESENTED TO THE FULL BOARD OF TRUSTEES FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE FILED AS PART OF THE ANNUAL FORM 990 AND ANNUAL NYS DEPARTMENT OF HEALTH INSTITUTIONAL COST REPORT, AND ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 54,751,325. MANAGEMENT AND GENERAL EXPENSES 4,149,658. FUNDRAISING EXPENSES 8,623. TOTAL EXPENSES 58,909,606. FORM 990, PART XI, LINE 9: PENSION AND OTHER POSTRETIREMENT LIABLITY ADJUSTMENTS 1,822,950. EQUITY TRANSFERS TO AFFILIATE -8,253,472. OTHER COMPONENTS OF NET PERIODIC BENEFIT COST -109,954. FORM 990 PART XII LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SCHEDULE H, PART V, LINE 11 CONTINUED ENCOURAGEMENT AND HOPE TO PATIENTS, FAMILY AND VISITORS TO THE SAMARITAN CAMPUS. HOSPITAL STAFF AND PATIENTS AND THEIR FAMILIES ALSO PARTICIPATED IN THE OUT OF DARKNESS COMMUNITY WALK, A SUICIDE PREVENTION EVENT. -IMPLEMENTED A WALK-IN CLINIC FOR NEW PATIENTS AT THE HOSPITAL'S OUTPATIENT BEHAVIORAL HEALTH OFFICE, ELIMINATING WAIT LISTS AND RESULTING IN EASIER ACCESS TO SERVICES. -THROUGH ITS ADDICTION SERVICES CLINIC, ADDED AN ADDITIONAL INTENSIVE OUTPATIENT THERAPY GROUP TO SERVE A HIGHER VOLUME OF PATIENTS. IN ADDITION TO THESE SPECIFIC ACTIVITIES, SAMARITAN CONTINUED TO PARTICIPATE ON REGIONAL COMMITTEES AND IN INITIATIVES COORDINATED BY FDRHPO AND NCI THAT ADDRESS AREAS RELATIVE TO CHRONIC AND BEHAVIORAL HEALTH ISSUES, AS WELL AS PARTNER WITH THESE AND OTHER COMMUNITY PROVIDERS AND AGENCIES ON PROJECTS ADDRESSING ADDITIONAL REGIONAL POPULATION HEALTH CONCERNS THAT ARE NOT SPECIFICALLY TACKLED IN THE CURRENT CSP. THESE ONGOING ACTIVITIES INCLUDE PREVENTION AND AWARENESS EDUCATION ON THE REGION'S MOST PREVALENT CHRONIC DISEASES AND CONDITIONS, EARLY CANCER DETECTION SCREENINGS, SMOKING CESSATION CLASSES, PARTICIPATION IN AND SUPPORT FOR REGIONAL HEALTH CAMPAIGNS, PHYSICIAN RECRUITMENT/RETENTION ACTIVITIES, ADOPTION OF EVIDENCE-BASED MEDICAL AND CLINICAL IMPROVEMENTS TO ENHANCE PATIENT OUTCOMES, AND DEVELOPMENT OF TELEMEDICINE INFRASTRUCTURE AND TOOLS TO IMPROVE THE ACCESS OF OUR REGION'S RURAL, UNDER-SERVED POPULATION TO COST-EFFECTIVE, QUALITY HEALTH CARE. SAMARITAN KEEP NURSING HOME 133 PRATT STREET WATERTOWN NY 13601 160969838 SKILLED NURSING FACILITY NY 501(C)3 LINE 3 SCH A SAMARITAN MEDICAL CENTER 1 THE SAMARITAN MEDICAL CENTER FDN OF NORTHERN NEW YORK INC 830 WASHINGTON STREET WATERTOWN NY 13601 161490523 PROVIDES FUND FOR SAMARITAN MEDICAL CENTER AND AFFLIATES NY 501(C)3 LINE 7 SCH A SAMARITAN MEDICAL CENTER 1 EDWARD J NOBLE HOSPITAL- SAMARITAN 104 PADDOCK STREET SUITE 104 WATERTOWN NY 13601 237227989 HOSPITAL NY 501(C)3 LINE 3 SCH A SAMARITAN MEDICAL CENTER 1 SAMARITAN MEDICAL PRACTICE PC 830 WASHINGTON STREET WATERTOWN NY 13601 261528342 PHYSICIAN MEDICAL PRACTICE NY 501(C)3 LINE 3 SCH A SAMARITAN MEDICAL CENTER 1 SAMARITAN SENIOR VILLAGE INC 22691 CAMPUS DRIVE WATERTOWN NY 13601 454913668 SENIOR CITIZEN COMMUNITY NY 501(C)3 LINE 3 SCH A SAMARITAN MEDICAL CENTER 1 SAMARITAN HOME HEALTH 830 WASHINGTON STREET WATERTOWN NY 13601 461043637 HOME HEALTH AGENCY NY 501(C)3 LINE 3 SCH A SAMARITAN MEDICAL CENTER 1 CLIFTON-FINE HEALTH CARE CORPORATION 1014 OSWEGATCHIE TRAIL STAR LAKE NY 13690 900909506 HOSPITAL NY 501(C)3 SAMARITAN MEDICAL CENTER 0 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0