Community Benefit Insight - Tax-exempt hospital

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Samaritan Medical Center

Samaritan Medical Center

830 Washington Street
Watertown, NY 13601

Bed count	287	Medicare provider number	330157	Member of the Council of Teaching Hospitals	YES	Children's hospital	NO

EIN: 150533577

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

10.11%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 3,328,973 1.19 %
Medicaid as % of operating expenses	$ 19,271,738 6.91 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 1,336,295 0.48 %
Subsidized health services as % of operating expenses	$ 4,047,809 1.45 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 209,382 0.08 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 5,008,570 1.80 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 243366987 including grants of $ 0) (Revenue $ 296801884)
DURING 2021, SAMARITAN MEDICAL CENTER PROVIDED CARE FOR 9,646 INPATIENT DISCHARGES AND A TOTAL OF 294,327 OUTPATIENT VISITS. OF THE TOTAL OUTPATIENT VISITS, THERE WERE 39,045 EMERGENCY ROOM VISITS AND 146,819 FAMILY HEALTH CLINIC VISITS.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

SAMARITAN MEDICAL CENTER
PART V, SECTION B, LINE 5: SAMARITAN MEDICAL CENTER PARTICIPATED IN THE 2019 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 2019. 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 2019 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 2019-2021 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 2019 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.

Supplemental Information

Schedule H (Form 990) Part VI

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 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 2020 AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
MEDICARE ALLOWABLE COSTS REPORTED WERE TAKEN DIRECTLY FROM THE 2021 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 2020 WAS APPROXIMATELY 42%.

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 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DEVELOPED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO) IN COLLABORATION WITH NORTH COUNTRY HEALTH COMPASS PARTNERS (NCHCP). THIS DATA WAS USED AND REFERRED TO IN 2021. IN ADDITIONAL TO THE CHNA, FDRHPO ALSO CONDUCTED A COMMUNITY HEALTH SURVEY IN 2021 OF JEFFERSON, LEWIS, AND ST. LAWRENCE COUNTIES. 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 2019. 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 2019 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.

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.

PART VI, LINE 7, REPORTS FILED WITH STATES
NY

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 PATIENT BROCHURES 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 THE 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:
LOCATED IN RURAL NORTHERN NEW YORK STATE, SAMARITAN MEDICAL CENTER'S SERVICE AREA COMPRISES JEFFERSON COUNTY, WHICH HAS A LAND MASS OF 1,268 SQUARE MILES, AND ADJACENT PORTIONS OF ST. LAWRENCE, LEWIS AND OSWEGO COUNTIES. DEMOGRAPHICS COMPILED ON THE NORTH COUNTRY HEALTH COMPASS WEBSITE (AND BASED ON U.S. CENSUS STATISTICS) INDICATE THE HOSPITAL'S SERVICE AREA IS POPULATED BY 116,295 PERSONS. THE POPULATION IS 81.3% WHITE, 7.7% HISPANIC, 6.6% BLACK, AND 1.8% ASIAN, WITH THE REMAINING 2.6% IDENTIFIED AS NATIVE HAWAIIAN/PACIFIC ISLANDER, AMERICAN INDIAN/ALASKAN NATIVE OR TWO OR MORE RACES. ETHNICALLY, 7.7% OF THE POPULATION IS HISPANIC/LATINO. THE POPULATION IS 52.8% MALE AND 47.2% FEMALE. ABOUT 24% OF COUNTY RESIDENTS ARE UNDER THE AGE OF 18 AND 14.6% ARE AGE 65 OR OLDER. CENSUS HEALTH STATISTICS INDICATE 10.5% OF JEFFERSON COUNTY RESIDENTS UNDER THE AGE OF 65 HAVE A DISABILITY. THE PERCENTAGE OF RESIDENTS UNDER 65 WITHOUT HEALTH INSURANCE IS 5.3%. THE REGION LAGS ECONOMICALLY WHEN COMPARED TO NEW YORK STATE. 13.1% OF JEFFERSON COUNTY'S RESIDENTS LIVE IN POVERTY AND THE PER CAPITA MEDIAN INCOME IS 26% LOWER THAN THE STATE VALUE, ACCORDING TO THE CENSUS. NYS DEPARTMENT OF LABOR STATISTICS INDICATE JEFFERSON CONSISTENTLY POSTS AMONG THE HIGHEST MONTHLY COUNTY UNEMPLOYMENT RATES. OUR SERVICE AREA INCLUDES THE SMALL CITY OF WATERTOWN (POPULATION APPROXIMATELY 25,224) AND IS HOME TO THE FORT DRUM U.S. ARMY POST (HOME OF THE 10TH MOUNTAIN DIVISION). FORT DRUM'S TRANSIENT MILITARY POPULATION INCLUDES 13,000 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. GEOGRAPHICALLY, JEFFERSON COUNTY IS SITUATED ADJACENT TO CANADA, WITH ITS WESTERN BORDER FORMED BY LAKE ONTARIO AND THE ST. LAWRENCE RIVER. THE SOUTHEASTERN SIDE OF THE COUNTY INCLUDES A PORTION OF THE TUG HILL PLATEAU WHILE THE ADIRONDACK FOOTHILLS LIE TO THE NORTH.

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."

Operating expenses	$ 278,766,701
Total amount spent on community benefits as % of operating expenses	$ 28,194,197 10.11 %