2025-10-30T14:06:44-05:00 2024-12-31 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2024-01-01 261528342 SAMARITAN MEDICAL PRACTICE PC SAMA 3157854121 830 WASHINGTON STREET WATERTOWN NY 13601 MAXINE BRIGGS CFO 3157853605 2025-10-17 1 1 DESIREE M BENNETT P01263666 3154463600 2025-10-17 2024 2025-03-06 01:10:19Z MARIO VICTORIA MD 830 WASHINGTON STREET WATERTOWN NY 13601 5162070 0 X WWW.SAMARITANHEALTH.COM X 2007 NY THE MISSION OF SAMARITAN MEDICAL PRACTICE, P.C. IS TO SUPPORT THE CHARITABLE PURPOSES OF SAMARITAN MEDICAL CENTER WHICH INCLUDES PROVIDING PHYSICIAN SERVICES DESIGNED TO IMPROVE THE STANDARDS AND QUALITY OF HEALTH CARE AVAILABLE TO THE RESIDENTS OF JEFFERSON COUNTY AND OTHER AREAS SERVED BY THE HOSPITAL. FURTHERMORE, OUR PURPOSE IS TO PARTICIPATE IN ACTIVITIES TO PROMOTE AND IMPROVE THE OVERALL HEALTH OF, AND MEET THE MEDICAL CARE NEEDS OF THE COMMUNITY. 1 0 52 0 0 0 0 0 4838129 5162070 0 0 0 0 4838129 5162070 0 0 0 0 9206598 8653728 0 0 0 2413057 4761814 11619655 13415542 -6781526 -8253472 1713722 1915338 1713722 1915338 0 0 X THE MISSION OF SAMARITAN MEDICAL PRACTICE PC IS TO SUPPORT THE CHARITABLE PURPOSES OF SAMARITAN MEDICAL CENTER, INC. WHICH INCLUDES PROVIDING PHYSICIAN SERVICES DESIGNED TO IMPROVE THE STANDARDS AND QUALITY OF HEALTHCARE AVAILABLE TO THE RESIDENTS OF JEFFERSON COUNTY AND OTHER AREAS SERVED BY THE HOSPITAL. FURTHERMORE, OUR PURPOSE IS TO PARTICIPATE IN ACTIVITIES TO PROMOTE AND IMPROVE THE OVERALL HEALTH OF, AND MEET THE MEDICAL CARE NEEDS OF THE COMMUNITY. 0 0 13407297 5162070 PROVIDED PROFESSIONAL PHYSICIAN SERVICES IN MEDICAL SPECIALTY AREAS, SUCH AS GENERAL SURGERY, CARDIOLOGY, PLASTIC/COSMETIC, AND ORTHOPEDIC SURGERY. A TOTAL OF 26,599 TREATMENTS TO PATIENTS WERE PERFORMED. 13407297 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 0 1 52 1 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X MAXINE BRIGGS 3157853605 104 PADDOCK STREET WATERTOWN NY 13601 MARIO VICTORIA MD PRESIDENT/DIRECTOR 1.00 41.00 X X 0 515079 55337 THOMAS H CARMAN CEO OF SMC/SECRETARY 1.00 43.50 X 0 1132728 62942 MAXINE BRIGGS CFO OF SMC/TREASURER 1.00 42.50 X 0 609760 52818 EDUARDO BARAYUGA GENERAL SURGEON 40.00 X 529717 0 41974 DEANA E PALEY PLASTIC SURGEON 40.00 X 600067 0 21421 DANIEL BRYDEN GENERAL SURGEON 40.00 X 553408 0 51828 MAURICE TOM-PACK GENERAL SURGEON 40.00 X 610002 0 27425 BRIAN ZAFONTE ORTHOPEDIC SURGEON 40.00 X 1108944 0 41734 3402138 2257567 355479 14 0 1 0 CARDIOLOGY ASSOCIATES OF NNY 19436 HOWELL DRIVE STE A WATERTOWN NY 13601 CARDIOLOGY SERVICES 791677 1 PATIENT SERVICE REVENU 621400 5162070 5162070 5162070 5162070 5162070 0 0 X 7380906 7380906 1272822 1272822 8245 8245 3030930 3030930 41780 41780 453960 453960 2875 2875 8145 8145 28224 28224 458763 458763 PROVISION FOR BAD DEBTS 555121 555121 MEDICAL/PHARMACY CHARGE 153323 153323 DUES/MEMBERSHIP/BOOKS 16948 16948 TAXES 3500 3500 13415542 13407297 8245 0 507990 486320 505645 647717 6746 108912 1531643 1397169 109558 134474 583783 537915 1713722 1915338 358797 577044 1354925 1338294 1713722 1915338 X 0 0 1713722 1915338 X -8253472 8253472 X X 0 1 X 1 0 X 22876 22876 0 1508767 1374293 134474 134474 MALPRACTICE RECOVERY INSURANCE 295000 RIGHT OF USE ASSETS 242915 537915 AMOUNT DUE AFFILIATES 1093631 RIGHT OF USE LEASE LIABILITY 244663 1338294 X 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. X X X X X 0 1 0 0 0 0 0 0 0 THOMAS H CARMAN CEO OF SMC/SECRETARY 0 763173 0 364370 0 5185 0 13800 0 49142 0 1195670 0 0 BRIAN ZAFONTE ORTHOPEDIC SURGEON 1007864 0 101080 0 0 0 20700 0 21034 0 1150678 0 0 0 MAXINE BRIGGS CFO OF SMC/TREASURER 0 494062 0 92698 0 23000 0 20700 0 32118 0 662578 0 0 MAURICE TOM-PACK GENERAL SURGEON 610002 0 0 0 0 0 20700 0 6725 0 637427 0 0 0 DEANA E PALEY PLASTIC SURGEON 597294 0 2773 0 0 0 20700 0 721 0 621488 0 0 0 DANIEL BRYDEN GENERAL SURGEON 480796 0 72612 0 0 0 20700 0 31128 0 605236 0 0 0 EDUARDO BARAYUGA GENERAL SURGEON 465715 0 64002 0 0 0 20700 0 21274 0 571691 0 0 0 MARIO VICTORIA MD PRESIDENT/DIRECTOR 0 437008 0 56221 0 21850 0 20700 0 34637 0 570416 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO AN IRC 457(F) PLAN DURING 2024: N/A THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO AN IRC 457(B) PLAN DURING 2024: MAXINE BRIGGS- $23,000 MARIO VICTORIA- $21,850 FORM 990, PART VI, SECTION A, LINE 6 THE PRESIDENT OF THE ORGANIZATION IS THE SOLE SHAREHOLDER AND DIRECTOR. FORM 990, PART VI, SECTION A, LINE 7A SAMARITAN MEDICAL PRACTICE, P.C. IS A NEW YORK STATE PROFESSIONAL SERVICES CORPORATION WHICH IS A TAX-EXEMPT CAPTIVE P.C. PURSUANT TO SAMARITAN MEDICAL PRACTICE, P.C.'S BY-LAWS, THE BOARD OF TRUSTEES OF THE HOSPITAL IS RESPONSIBLE FOR ELECTING ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE NOT SUBJECT TO PRIOR APPROVAL OF SAMARITAN MEDICAL CENTER. THE SHAREHOLDER AGREEMENT NOW LIMITS THE ROLES OF SHAREHOLDER AND MEMBERSHIP(S) ON ITS GOVERNING BODY TO EMPLOYEES OF SAMARITAN MEDICAL CENTER. IF SAMARITAN MEDICAL CENTER DIRECTS THAT OWNERSHIP OF THE STOCK AND GOVERNING AUTHORITY BE TRANSFERRED TO ANOTHER EMPLOYEE OF SAMARITAN MEDICAL CENTER FOR ANY REASON, INCLUDING THE DISAPPROVAL OF ANY ACTION TAKEN BY SUCH INDIVIDUAL, THE EXISTING SHAREHOLDER SHALL RESIGN AS AN OFFICER AND DIRECTOR OF THE ORGANIZATION WITHIN TWO (2) BUSINESS DAYS. 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 CHIEF EXECUTIVE OFFICER AND THE CHIEF OPERATING 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 NYS DEPARTMENT OF HEALTH INSTITUTIONAL COST REPORT, AND ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,030,930. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,030,930. FORM 990, PART XI, LINE 9: EQUITY TRANSFER TO SAMARITAN MEDICAL CENTER 8,253,472. PART XII LINE 2C NO CHANGES FROM PRIOR YEAR. SCHEDULE A LINE 3 SAMARITAN MEDICAL PRACTICE, PC IS A CAPTIVE PHYSICIAN PRACTICE WHICH HAS AS ITS MAIN PURPOSE THE PROVISION OF MEDICAL SERVICES, IT APPROPRIATELY NOTED ON FORM 1023 THAT IT IS A HOSPITAL. THE STATE OF NEW YORK DOES NOT REQUIRE CAPTIVE PHYSICIAN PRACTICES TO BE LICENSED AS A HOSPITAL. AS A CAPTIVE PHYSICIAN PRACTICE, SAMARITAN MEDICAL PRACTICE, PC HAS AS ITS PRINCIPAL PURPOSE THE PROVISION OF MEDICAL CARE. ACCORDINGLY, IT WAS (I) PROPERLY IDENTIFIED AS A "HOSPITAL" ON FORM 1023; (II) PROPERLY IDENTIFIED AS A "HOSPITAL" ON FORM 990 SCHEDULE A; AND (III) SHOULD NOT BE DESIGNATED AS A "HOSPITAL/HOSPITAL FACILITY" ON FORM 990 SCHEDULE H. SAMARITAN MEDICAL CENTER 830 WASHINGTON STREET WATERTOWN NY 13601 150533577 HOSPITAL NY 501(C)(3) LINE 3 SCH A N/A 0 SAMARITAN KEEP NURSING HOME 133 PRATT STREET WATERTOWN NY 13601 160969838 SKILLED NURSING FACILITY NY 501(C)(3) LINE 3 SCH A SAMARITAN MEDICAL CENTER 0 EDWARD J NOBLE HOSPITAL 104 PADDOCK STREET SUIT 104 WATERTOWN NY 13601 237227989 HOSPITAL NY 501(C)(3) LINE 3 SCH A SAMARITAN MEDICAL CENTER 0 SAMARITAN SENIOR VILLAGE INC 22691 CAMPUS DRIVE WATERTOWN NY 13601 454913668 SENIOR CITIZEN COMMUNITY NY 501(C)(3) LINE 3 SCH A SAMARITAN MEDICAL CENTER 0 SMC FOUNDATION OF NNY INC 830 WASHINGTON STREET WATERTOWN NY 13601 161490523 PROVIDES FUNDS FOR SMC AND AFFILIATES NY 501(C)(3) LINE 7 SCH A SAMARITAN MEDICAL CENTER 0 SAMARITAN HOME HEALTH 165 COLEMAN AVENUE WATERTOWN NY 13601 461043637 CERTIFIED HOME HEALTH AGENCY NY 501 (C) (3) LINE 10 SCH A SAMARITAN MEDICAL CENTER 0 CLIFTON-FINE HEALTH CARE CORPORATION 1014 OSWEGATCHIE TRAIL STAR LAKE NY 13690 900909506 HOSPITAL NY 501 (C) (3) SAMARITAN MEDICAL CENTER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1