4A (Expenses $ 682912723 including grants of $ 272369) (Revenue $ 756081730)
GOOD SAMARITAN HOSPITAL MEDICAL CENTER IS A 437 BED MEDICAL CENTER LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN WEST ISLIP, NEW YORK. A PREMIER HEALTHCARE FACILITY, PROVIDING QUALITY AND COST EFFECTIVE HEALTH CARE SERVICES EXTENDING ACROSS THE CONTINUUM OF CARE TO ALL DISCIPLINES, BOTH FOR INPATIENTS AND OUTPATIENTS. IN 2021 THE MEDICAL CENTER PROVIDED INPATIENT SERVICES FOR 25,081 DISCHARGED INDIVIDUALS, MANAGED 83,803 EMERGENCY DEPARTMENT VISITS AND 35,949 CLINIC VISITS. THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH COMMUNITY SERVICE AND CHARITABLE ACTIVITIES.

4B (Expenses $ 9456732 including grants of $ 0) (Revenue $ 9312429)
GOOD SAMARITAN NURSING HOME IS LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN SAYVILLE, NEW YORK. THE 100 BED FACILITY HAS BEEN PART OF GOOD SAMARITAN HOSPITAL MEDICAL CENTER SINCE 1980. THE RESIDENT POPULATION OF THE NURSING HOME IS MEDICALLY COMPLEX AND REQUIRES FULL-TIME CARE. SKILLED NURSING CARE AT THE FACILITY PROVIDES ONGOING MEDICALLY COMPLEX CARE ALONG WITH GERIATRIC CARE, REHABILITATIVE CARE, AND DEMENTIA DISEASE CARE. 2021 PATIENT DAYS FOR THE NURSING HOME TOTALED 25,841.

PART V, SECTION B, LINE 3E
IN 2019, MEMBERS OF THE LONG ISLAND HEALTH COLLABORATIVE REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM HEALTH NEEDS PRIORITIES FOR THE 2019-2021 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM (PHIP), WITH THE PHIP SERVING AS THE CENTRALIZED DATA RETURN AND ANALYSIS HUB. COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION.

PART V, SECTION B, LINE 5
GOOD SAMARITAN HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ASSOCIATION WITH LONG ISLAND HEALTH COLLABORATIVE (LIHC) MEMBERS. THE LIHC IS A PARTNERSHIP OF LONG ISLAND'S HOSPITALS, COUNTY HEALTH DEPARTMENTS, HEALTH PROVIDERS, COMMUNITY-BASED SOCIAL AND HUMAN SERVICE ORGANIZATIONS, ACADEMIC INSTITUTIONS, HEALTH PLANS, LOCAL GOVERNMENT AND THE BUSINESS SECTOR, ALL ENGAGED IN IMPROVING THE HEALTH OF LONG ISLANDERS. THE LIHC IS THE MAIN WORKING GROUP ASSOCIATED WITH CARRYING OUT THE GOALS OF THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM. IN 2019, MEMBERS OF THE LIHC REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM PREVENTION AGENDA PRIORITIES FOR THE 2019-2021 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LIHC, WHICH SERVED AS THE CENTRALIZED DATA RETURN AND ANALYSIS HUB. PRIMARY DATA SOURCES INCLUDE THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT SURVEY (CHAS) AND THE RESULTS FROM FOCUS GROUPS AND KEY COMMUNITY-BASED ORGANIZATION LEADER INTERVIEWS. SECONDARY DATA SOURCES COMPRISED PUBLICALLY-AVAILABLE DATA SETS WHICH WERE REVIEWED TO DETERMINE CHANGE IN HEALTH STATUS AND EMERGING ISSUES WITHIN SUFFOLK COUNTY. SOURCES OF SECONDARY DATA INCLUDED STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM (SPARCS), NEW YORK STATE PREVENTION AGENDA DASHBOARD, PREVENTION QUALITY INDICATORS (PQI), BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), EXTENDED BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (EBRFSS), NEW YORK STATE COMMUNITY HEALTH INDICATOR REPORTS (CHIRS) AND NEW YORK STATE VITAL STATISTICS. THE ENGAGEMENT OF THE BROADER COMMUNITY, FOR ASSESSMENT PROCESSES, IS ACHIEVED THROUGH THE LIHC AND ITS PARTNERS' ONGOING DISTRIBUTION OF THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT (CHAS) SURVEY. THIS SURVEY IS OFFERED ONLINE VIA A SURVEYMONKEY LINK AND IS AVAILABLE TO RESIDENTS AT PUBLIC EVENTS, WORKSHOPS, EDUCATIONAL PROGRAMS, INTERVENTIONS, ETC., WHICH ARE OFFERED BY LIHC PARTNERS. IT IS ALSO DISTRIBUTED AMONG PHYSICIAN OFFICES, HOSPITAL WAITING AREAS, LIBRARIES, SCHOOLS, FEDERALLY-QUALIFIED HEALTH CLINICS, AND INSURANCE ENROLLMENT SITES, AMONG OTHER PUBLIC VENUES. THE LIHC AGGRESSIVELY PROMOTES THE SURVEY THROUGH SOCIAL MEDIA AND A LINK TO THE SURVEY IS ALSO AVAILABLE ON THE GOOD SAMARITAN HOSPITAL WEBSITE. RESULTS FROM THE CHAS ARE ANALYZED TWICE A YEAR. FINDINGS ARE SHARED WITH ALL LIHC PARTICIPANTS, WITH THE MEDIA AND POSTED ON THE LIHC WEBSITE. SURVEYS WERE DISTRIBUTED BY PAPER AND ELECTRONICALLY, THROUGH SURVEY MONKEY, TO COMMUNITY MEMBERS FROM JANUARY 1, 2018 THROUGH DECEMBER 31, 2018 WITH 810 SURVEYS COLLECTED IN SUFFOLK COUNTY. A CERTIFIED TRANSLATION OF THE SURVEY IS AVAILABLE IN THE FOLLOWING LANGUAGES: SPANISH, POLISH AND HAITIAN CREOLE. LARGE PRINT COPIES ARE ALSO AVAILABLE TO THOSE LIVING WITH VISION IMPAIRMENT. FOR THIS ASSESSMENT CYCLE, THE LIHC ALSO ENGAGED THE COMMUNITY THROUGH FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH LEADERS OF COMMUNITY-BASED ORGANIZATIONS (CBO). THE RESEARCH FIRM EUREKAFACTS, LLC., CONDUCTED THE FOCUS GROUPS AND CBO INTERVIEWS, INTERPRETED THE RESULTS, AND PRODUCED THE REPORT. FOCUS GROUPS WERE HELD IN LOW-INCOME COMMUNITIES, RIVERHEAD, AND WYANDANCH.

PART V, SECTION B, LINE 6A
LONG ISLAND COMMUNITY HOSPITAL, NORTHWELL HEALTH SYSTEM (HUNTINGTON HOSPITAL, SOUTHSIDE HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL, PECONIC BAY MEDICAL CENTER), ST. CHARLES HOSPITAL, ST. CATHERINE OF SIENA HOSPITAL, STONY BROOK SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY HOSPITAL AND VETERANS AFFAIRS MEDICAL CENTER.

PART V, SECTION B, LINE 6B
THE HOSPITAL'S CHNA WAS ALSO CONDUCTED WITH NASSAU AND SUFFOLK HEALTH DEPARTMENTS, STONY BROOK UNIVERSITY AND MORE THAN 40 COMMUNITY-BASED ORGANIZATIONS, COLLECTIVELY KNOWN AS THE LONG ISLAND HEALTH COLLABORATIVE (LIHC).

PART V, SECTION B, LINE 11
COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION. THE WORK PLAN FOR ADDRESSING THE IDENTIFIED NEEDS CAN BE FOUND IN THE CHNA APPENDIX E, PUBLICLY AVAILABLE ON THE HOSPITAL'S WEBSITE, HTTPS://GOODSAMARITAN.CHSLI.ORG/ PRIORITY 1: PREVENT CHRONIC DISEASE: GOOD SAMARITAN HOSPITAL OFFERS REGULARLY SCHEDULED PREVENTIVE HEALTH SCREENINGS IN LOCAL COMMUNITIES, PARTICULARLY THOSE IN MEDICALLY-UNDERSERVED COMMUNITIES. THESE INCLUDE BLOOD PRESSURE, BODY MASS INDEX (BMI), PROSTATE CANCER AND ORAL AND HEAD AND NECK CANCER SCREENINGS. THERE WERE 7 EVENTS PROVIDING 148 FREE BLOOD PRESSURE SCREENINGS. TWO EVENTS WERE HELD IN COLLABORATION WITH CALVARY BAPTIST CHURCH LENDING TABLES IN BAY SHORE. HOSPITAL STAFF PROVIDED BLOOD PRESSURE SCREEINGS AT THE SECOND ANNUAL VETERANS DRIVE THROUGH RESOURCE EVENT HELD AT THE H. LEE DENNISION BUILDING IN HAUPPAUGE. ON AUGUST 31ST, GOOD SAMARITAN HOSPITAL HOSTED A PROSTATE CANCER AWARENESS EVENT IN FRONT OF THE HOSPITAL WITH PATIENT, PHYSICIAN AND COMMUNITY SPEAKERS. FREE PROSTATE CANCER SCREENINGS WERE ALSO HELD ON SEPTEMBER 21 AT THE SHERIFF'S OFFICE IN RIVERHEAD AND ON SEPTEMBER 29TH AT GOOD SAMARITAN HOSPITAL. FOURTEEN MEN WERE SCREENED AND ONE WAS REFERRED FOR FOLLOW UP. GOOD SAMARITAN ALSO PROVIDED PROSTATE CANCER SCREENINGS FOR THE TOWN OF ISLIP EMPLOYEES ON NOVEMBER 12TH FOR SIX MEN AND ON NOVEMBER 19TH FOR THE SUFFOLK COUNTY POLICE DEPARTMENT IN YAPANK WHERE 43 MEN WERE SCREENED. HEALTHY SUNDAYS' COMMUNITY EVENTS ARE HELD IN COLLABORATION WITH HOUSES OF WORSHIP AND COMMUNITIES. THESE INCLUDE HEALTH SCREENINGS, EDUCATION AND REFERRALS TO CARE ALONG WITH SELECT PARTNERS OFFERING FREE OR DISCOUNTED SERVICES. HEALTHY SUNDAYS RESUMED IN MARCH WITH TWO EVENTS AT CALVARY BAPTIST CHURCH IN BAY SHORE. ON MARCH 20TH 15 PEOPLE WERE SCREENED AND TWO WERE REFERRED FOR FOLLOW-UP CARE. AT THE OTHER EVENT ON MARCH 27TH, EIGHT PEOPLE WERE SCREENED BUT THERE WERE NO REFERRALS. TWO HEALTHY SUNDAYS EVENTS WERE HELD IN SEPTEMBER AT ST. LUKE'S AND ST. ANNE'S, BOTH IN BRENTWOOD. SIXTY-THREE BLOOD PRESSURE SCREENINGS AND 64 FLU VACCINATIONS WERE PROVIDED. IN OCTOBER, 16 FLU VACCINES AND 2 BLOOD PRESSURE SCREEINGS WERE PROVIDED AT ANOTHER EVENT IN ST. JOSEPH'S PARISH. TWELVE GOOD SAMARITAN UNIVERSITY VIRTUAL CLASSES WERE HELD FROM JANUARY TO SEPTEMBER: HEART HEALTH (13,410 VIEWS), ATRIAL FIBRILLATION (3,751 VIEWS), COLORECTAL CANCER (6,899 VIEWS), NEW LUNG CANCER UPDATES (6,091 VIEWS), TAVAR (6,486 VIEWS), MENTAL HEALTH (3,304 VIEWS), STROKE UPDATES (1,243 VIEWS), PAIN MANAGEMENT (1,000 VIEWS), PROSTATE, MEN'S HEALTH (3,745 VIEWS), SCOLIOSIS (721 VIEWS), IMMUNIZATIONS - ADULTS NEED VACCINES (150 VIEWS), AND BREASTFEEDING BENEFITS AND SUPPORT (200 VIEWS). GSU VIRTUAL CLASSES SCHEDULED THROUGH DECEMBER. SMOKING CESSATION PROGRAMS ARE OFFERED TO REDUCE THE RISK OF DISEASES CAUSED BY OR AFFECTED BY SMOKING. IN-PERSON CLASSES FOR THE LEARN TO BE TOBACCO-FREE SMOKING CESSATION PROGRAM ARE SCHEDULED TO RESUME IN JANUARY 2022 IN COLLABORATION WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH. PRIORITY 2: PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS: PROMOTION OF ALL PROGRAMS, EVENTS AND EDUCATION OFFERED BY LIHC MEMBERS WHO SPEAK TO THE PREVENTION OF MENTAL AND SUBSTANCE USE DISORDERS. PARTICIPATION IN LOCAL TASK FORCES ADDRESSING OPIOID USE DISORDERS. SUPPORT GROUPS BRING TOGETHER PEOPLE WHO ARE GOING THROUGH OR WHO HAVE GONE THROUGH SIMILAR EXPERIENCES. GOOD SAMARITAN HOSPITAL OFFERS FREE SUPPORT GROUPS OPEN TO ALL COMMUNITY MEMBERS, INCLUDING CANCER, BREAST CANCER, PROSTATE CANCER, BARIATRIC/WEIGHT LOSS SURGERY, BRAIN ANEURYSM AND STROKE SUPPORT AND MORE THAN 10 TYPES OF SUPPORT GROUPS FOR NEW PARENTS/SIBLINGS AND BREASTFEEDING. THE BREAST CANCER GROUP CONTINUES TO MEET VIRTUALLY ON THE 2ND AND 4TH WEDNESDAY OF THE MONTH WITH AN AVERAGE OF 4 PEOPLE PARTICIPATING. PRIOR TO THE COVID-19 RESTRICTIONS, THE GROUP HAD AN AVERAGE OF 12 PEOPLE ATTEND THE BI-MONTHLY EVENING MEETINGS. THE LIFE GOES ON CANCER SUPPORT GROUP CONTINUED TO MEET WEEKLY BY CONFERENCE CALL DUE TO COVID-19 RESTRICTIONS. THERE ARE AN AVERAGE OF FOUR PARTICIPANTS ON THE CALL. IN-PERSON EVENTS HELD PRIOR TO APRIL HAD AN AVERAGE OF SIX PARTICIPANTS. MONTHLY MEETINGS OF THE BRAIN ANEURYSM AND STROKE GROUP HAVE AN AVERAGE ATTENDANCE OF FIVE. DURING COVID-19, THE GROUP CONTINUED TO MEET VIRTUALLY. BARIATRIC SUPPORT GROUPS MEET VIRTUALLY EVERY OTHER MONDAY NIGHT AND EVERY OTHER TUESDAY AFTERNOON WITH AN AVERAGE OF 20 PEOPLE IN ATTENDANCE. THE BREASTFEEDING SUPPORT GROUP MEETS WEEKLY WITH 13 MOTHERS ATTENDING. SUPPORT GROUPS FOR EXPECTANT COUPLES AND NEW PARENTS CONTINUED TO MEET VIRTUALLY: FIRST-TIME-AROUND PREPARED BIRTH COURSE FOR 19 COUPLES, BREASTFEEDING YOUR BABY CLASS FOR 19 COUPLES; CARING FOR YOUR BABY FOR 24 COUPLES; CESAREAN SECTION CLASS FOR 15 COUPLES; NEW MOTHER'S SUPPORT GROUP AND MOTHER'S CIRCLE OF HOPE WITH AN AVERAGE OF FOUR ATTENDEES; AND, A BIMONTHLY SUPPORT GROUP FOR WOMEN WHO HAVE EXPERIENCED A PERINATAL MOOD AND ANXIETY DISORDER AND HAVE ATTENDED OUR MOTHER'S CIRCLE OF HOPE GROUP, WITH AN AVERAGE OF FOUR ATTENDEES. CH'S MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE IS AVAILABLE FOR DOWNLOAD ON THE HOSPITAL'S WEBSITE. THE SHERPA PROGRAM, WHICH IS MADE UP OF PEER RECOVERY COACHES WHO MEET WITH OVERDOSE SURVIVORS AND THEIR FAMILIES IN THE EMERGENCY DEPARTMENT, IS OFFERED AT THE HOSPITAL. FROM MARCH TO JUNE THERE WERE SIX PEOPLE REFERRED TO SHERPA. THE PROGRAM IS RETURNING TO IN-PERSON VISITS TO THE EMERGENCY DEPARTMENT, AND GOOD SAMARITAN HOSPITAL WILL CONTINUE TO ENHANCE THE PROGRAM. IN COLLABORATION WITH THE SUFFOLK COUNTY POLICE DEPARTMENT AND THE US DRUG ENFORCEMENT ADMINISTRATION (DEA), GOOD SAMARITAN HOSPITAL HOSTED THE PRESCRIPTION DRUG TAKE BACK DAY ON OCTOBER 23RD. TWENTY-TWO POUNDS OF UNWANTED PRESCRIPTION DRUGS WERE BROUGHT TO THE HOSPITAL AND COLLECTED BY THE DEA. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY OUTREACH ACTIVITIES THAT ADDRESS OTHER NEW YORK STATE PREVENTION AGENDA PRIORITIES. GOOD SAMARITAN STAFF PARTICIPATE IN THE ANNUAL GLOBAL BIG LATCH ON DESIGNED TO PROMOTE AND SUPPORT BREASTFEEDING. IN 2021, THE BIG GLOBAL LATCH ON WAS HELD ON AUGUST 6TH. THE HOSPITAL ALSO HOSTS A BREASTFEEDING CAF TO PROMOTE THE HEALTH BENEFITS OF BREASTFEEDING AND PROVIDE PEER SUPPORT TO NURSING MOTHERS. THE BREASTFEEDING CAF CONTINUED VIRTUALLY WITH 12 MOTHERS ATTENDING WEEKLY MEETINGS. THERE WAS A ZOOM WORLD BREASTFEEDING WEEK CELEBRATION ON AUGUST 4TH WITH NINE ATTENDEES. GOOD SAMARITAN CONTINUES TO OFFER A CHILD PASSENGER SAFETY PROGRAM TO PROMOTE THE PROPER INSTALLATION OF CHILD SAFETY SEATS AND BOOSTER SEATS. GOOD SAMARITAN SERVES AS A COMMUNITY RESOURCE FOR CHILD PASSENGER SAFETY AND PROVIDES EDUCATION TO PARENTS BY APPOINTMENT ON PROPER TECHNIQUES FOR TRANSPORTING CHILDREN, ALONG WITH FREE CHILD SAFETY SEAT CHECKS. AS A MEMBER OF CATHOLIC HEALTH, GOOD SAMARITAN OFFERS OUTREACH SERVICES AS PART OF THE CH MISSION AND SOCIAL DETERMINANTS OF HEALTH. HOSPITAL STAFF PARTICPATED IN THE AMERICAN HEART ASSOCIATION LONG ISLAND HEART WALK MOVE MORE CHALLENGE ON SEPTEMBER 12TH AND THE AMERICAN CANCER SOCIETY MAKING STRIDES AGAINST BREAST CANCER IN-PERSON WALK ON OCTOBER 17TH. GOOD SAMARITAN HOSTED FIVE BLOOD DRIVES COLLECTING 476 PINTS OF BLOOD IN SUPPORT OF LONG ISLAND BLOOD SERVICES. GOOD SAMARITAN STAFF ALSO PARTICIPATED IN COLLECTION DRIVES FOR FOOD, CLOTHING AND SCHOOL SUPPLIES SUPPORTING LOCAL COMMUNITY ORGANIZATIONS IN UNDERSERVED AREAS. GOOD SAMARITAN HOSPITAL POSTS EDUCATIONAL VIDEOS ON YOUTUBE.COM/GSHMC ON VARIOUS TOPICS SUCH AS GENETIC COUNSELING, COLON CANCER PREVENTION AND DIAGNOSIS, AND OTHERS.

PART V, SECTION B, LINE 20E
GOOD SAMARITAN HOSPITAL HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES IN SEVERAL PROMINENT LOCATIONS WITHIN GOOD SAMARITAN HOSPITAL, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREAS. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH AND ARE CLEARLY VISIBLE TO THE PUBLIC. GOOD SAMARITAN HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE.

PART I, LINE 7 - RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET
RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 WAS THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A, 7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED BASED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THE SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS.

PART I, LINE 7A, COLUMN (D)
"DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE NEW YORK STATE (NYS) INDIGENT CARE POOL (ICP) WHICH IS SHOWN NET OF HOSPITAL CONTRIBUTIONS TO THE STATEWIDE POOL. THE FORMULA EMPLOYED BY NYS TO DETERMINE DISTRIBUTIONS TO HOSPITALS FROM THE ICP IS COMPLEX AND IS DERIVED FROM A HOSPITAL'S ""NEED"" CALCULATION. THIS CALCULATION CONSIDERS 100% OF A HOSPITAL'S ""NEED"" BASED ON A ""UNITS OF SERVICE"" METHODOLOGY FOR UNINSURED PATIENTS. THE CALCULATION ALSO MAKES ADJUSTMENTS BASED ON THE PROPORTION OF MEDICAID ELIGIBLE PATIENTS TREATED AT THE FACILITY. THE HOSPITAL HAS APPORTIONED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBT AND CHARITY CARE FOR 2021."

PART III, LINE 2,3 - BAD DEBT AS COMMUNITY BENEFIT
THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2021 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES. REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE FROM GOOD SAMARITAN HOSPITAL SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT SINCE CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR TAX EXEMPT PURPOSE, WHICH IS MEETING THE NEED FOR EMERGENCY AND NON-ELECTIVE MEDICAL CARE SERVICES IN THE COMMUNITY.

PART III, LINES 2 AND 4 - TEXT OF FOOTNOTE DISCUSSING BAD DEBT
PAGES 19 TO 24 OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PATIENT ACCOUNTS RECEIVABLE. THE FINANCIAL STATEMENTS ARE ATTACHED TO THIS RETURN.

PART III, LINE 8 - COSTING METHODOLOGY
THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2021 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES.

PART III, LINE 8 - MEDICARE SHORTFALL AS COMMUNITY BENEFIT
LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. GOOD SAMARITAN BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY BUT ALSO DOING SO WITH NO RECOURSE IN OBTAINING PAYMENT FOR THE COST OF PROVIDING CARE IN EXCESS OF THE MEDICARE PAYMENT. AS MEDICARE REVENUE DECLINES AND THE COST TO PROVIDE CUTTING-EDGE CARE TO THE COMMUNITY INCREASES, THE HOSPITAL WILL CARRY THE BURDEN. AS A PARTICIPATING PROVIDER AND A CHARITABLE ORGANIZATION, MEDICARE PATIENTS, THE MAJORITY OF WHOM ARE ELDERLY AND DISABLED ARE NOT TURNED AWAY. GOOD SAMARITAN WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY.

PART III, LINE 9B
THE HOSPITAL'S CHARITY CARE POLICY DESCRIBES THE POLICIES AND PROCEDURES RELATING TO THE PROVISION OF CHARITY CARE TO PERSONS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR BILL. NO INDIVIDUAL WILL BE DENIED MEDICALLY NECESSARY HOSPITAL SERVICES BASED ON A DEMONSTRATED INABILITY TO PAY FOR THOSE SERVICES. IN ADDITION, UPON APPLYING FOR CHARITY CARE, EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY WILL BE ASSESSED. ELIGIBILITY FOR ASSISTANCE: A REASONABLE REVIEW SHALL BE PERFORMED PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (I.E. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE CH CHARITY CARE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO MEET THE CHARITY CARE CRITERIA SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT FOR APPROPRIATE FOLLOW-UP. THE THIRD-PARTY COLLECTION AGENT SHALL ADVISE THE PATIENT/GUARANTOR OF THE HOSPITAL'S CHARITY CARE POLICY AND RETURN THE ACCOUNT IMMEDIATELY IF IT IS DETERMINED THAT THE QUALIFICATIONS ARE MET.

PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH
GOOD SAMARITAN HOSPITAL (GOOD SAMARITAN) IS A NOT-FOR-PROFIT COMPREHENSIVE HEALTH CARE FACILITY RENDERING INPATIENT, AMBULATORY, AND EMERGENCY MEDICAL CARE TO THE COMMUNITY. IN ADDITION, GOOD SAMARITAN OPERATES A NURSING HOME AND THE BISHOP MCHUGH HEALTH CENTER IN BABYLON, WHICH CARES FOR MEDICALLY-UNDESERVED RESIDENTS. IN 2021, THE HEALTH CENTER HAD MORE THAN 150 PATIENT VISITS. GOOD SAMARITAN HOSTS BLOOD DRIVES THROUGHOUT THE YEAR. DONORS INCLUDE GOOD SAMARITAN STAFF AND COMMUNITY MEMBERS.

PART VI, LINE 2 - ASSESSMENT OF COMMUNITY NEEDS AND GOALS
COMMUNITY HEALTH NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S COMMUNITY HEALTH AND EDUCATION DEPARTMENT MEETINGS, AT COLLABORATIVE SESSIONS WITH MEMBER HOSPITALS OF CATHOLIC HEALTH (CH), AND WITH PARTNERS AT COMMUNITY AGENCIES AND ORGANIZATIONS THAT ARE PART OF THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). THE LIHC COMMUNITY HEALTH ASSESSMENT SURVEYS ARE OFFERED YEAR-ROUND AT MULTIPLE OUTREACH SITES IN THE COMMUNITY. BY DISTRIBUTING COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH, SPANISH, POLISH, HAITAIN CREOLE AND LARGE PRINT) TO PARTICIPANTS AT SCREENING SITES, EVERY POINT OF CONTACT SERVES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED IN THE COMMUNITY SURROUNDING THE OUTREACH SITE AND ON CH'S WEBSITE. GOOD SAMARITAN HOSPITAL CONTINUES TO COLLABORATE WITH OTHER HOSPITALS, LOCAL HEALTH DEPARTMENTS, HEALTH CARE PROVIDERS, PUBLIC HEALTH SPECIALISTS FROM ACADEMIC INSTITUTIONS AND COMMUNITY-BASED ORGANIZATIONS AT LIHC EVENTS. LIHC'S WEBSITE OFFERS COMPREHENSIVE INFORMATION TO PROMOTE GOOD HEALTH AND PREVENT CHRONIC DISEASE. IN ADDITION TO PROVIDING NUMEROUS RESOURCES SUCH AS HEALTH PROGRAM INVENTORIES, HEALTH INSURANCE INFORMATION AND EDUCATIONAL VIDEOS, LIHC AND ITS MEMBERS HAVE ORGANIZED WALKING PROGRAMS, AND DEVELOPED A UNIVERSAL SCREENING TOOL TO HELP MEASURE THE EFFECTIVENESS OF COMMUNITY HEALTH EFFORTS. MORE INFORMATION CAN BE FOUND AT WWW.LIHEALTHCOLLAB.ORG. ADDITIONALLY, COMMUNITY NEEDS SURVEYS ARE COMPLETED BY PARTICIPANTS ATTENDING THE HOSPITAL'S HEALTH SCREENINGS AT LIBRARIES AND SENIOR CENTERS THROUGHOUT THE COUNTY; THE SURVEYS ARE ALSO AVAILABLE THROUGH A LINK ON THE HOSPITAL'S WEBSITE.

PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY
1. SINCE IT IS THE DUTY OF THE HOSPITAL TO ENSURE THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF THE CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS HAVE BEEN FULLY VERSED IN THE HOSPITAL'S CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. THE HOSPITAL HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, PATIENT ACCESS, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 3. THE HOSPITAL PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM, PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. 4. THE HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. THE HOSPITAL PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING THE HOSPITAL'S CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. 6. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, INFORMATION IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER DETAILS. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL.

PART VI, LINE 4 - COMMUNITY INFORMATION
FOUNDED IN 1959, GOOD SAMARITAN HOSPITAL IS A 537-BED (INCLUDING 100 NURSING HOME BEDS), NOT-FOR-PROFIT, ACUTE CARE COMMUNITY HOSPITAL. GOOD SAMARITAN HOSPITAL IS LOCATED IN WEST ISLIP, ON THE SOUTH SHORE OF LONG ISLAND, NEW YORK. GOOD SAMARITAN'S PRIMARY SERVICE AREA INCLUDES: AMITYVILLE, BABYLON, NORTH BABYLON, WEST BABYLON, BAY SHORE, BRENTWOOD, COPIAGUE, DEER PARK, LINDENHURST, WEST ISLIP, CENTRAL ISLIP, EAST ISLIP, AND WYANDANCH. THE SECONDARY CATCHMENT AREA COMPRISES EAST MASSAPEQUA, FARMINGDALE, ISLIP, ISLIP TERRACE, HOLBROOK, BOHEMIA, PATCHOGUE, SAYVILLE, OAKDALE AND RONKONKOMA. THE SERVICE AREA POPULATION IS COMPRISED OF SEVERAL COMMUNITIES WHERE INDIVIDUALS SPEAK A LANGUAGE OTHER THAN ENGLISH, SUCH AS THE SELECT, UNDERSERVED COMMUNITIES OF BAY SHORE, BRENTWOOD, AND CENTRAL ISLIP.

PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM
GOOD SAMARITAN HOSPITAL (GOOD SAMARITAN) IS AN ACUTE CARE HOSPITAL LOCATED ON A SINGLE CAMPUS IN WEST ISLIP, NY, WITH A SKILLED NURSING FACILITY ON A SEPARATE CAMPUS IN SAYVILLE, NY. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, GOOD SAMARITAN THROUGH ITS DAILY OPERATIONS, PROVIDES THE AREA WITH ACUTE, EMERGENT, AND OUTPATIENT CARE. GOOD SAMARITAN IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A CATHOLIC HEALTH)(CH), WHICH IS A NEW YORK, NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CH IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. AS OF DECEMBER 31, 2021, CH COMPRISED SIX HOSPITALS (MERCY HOSPITAL, ST. FRANCIS HOSPITAL, AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN HOSPITAL, ST. CHARLES HOSPITAL, AND ST. CATHERINE OF SIENA HOSPITAL IN SUFFOLK COUNTY), AS WELL AS THREE SKILLED NURSING FACILITIES (ST. CATHERINE OF SIENA NURSING & REHABILITATION, GOOD SAMARITAN NURSING & REHABILITATION, AND OUR LADY OF CONSOLATION NURSING & REHABILITATION, ALL IN SUFFOLK COUNTY), A REGIONAL HOME CARE AND HOSPICE NETWORK, AND A COMMUNITY-BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH MORE THAN 16,000 STAFF AND 4,600 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CH PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: WE, AT CATHOLIC HEALTH, HUMBLY JOIN TOGETHER TO BRING CHRIST'S HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. MEMBER ORGANIZATIONS OF CH OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. ALL OF CH'S MEMBER ORGANIZATIONS HAVE RETAINED THEIR INDIVIDUAL LINKS TO THEIR HISTORY AND THEIR DISTINCTIVE PERSONALITIES, AS WELL AS THE SERVICE SPECIALTIES WHICH THEY ARE KNOWN FOR, THUS EMBEDDING THE ORGANIZATION IN THE COMMUNITY AND SERVING IT EFFECTIVELY. CH ENTITIES PROVIDE AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS, PROVIDE FREE HEALTH SCREENINGS THROUGH THE SYSTEM'S HEALTHY SUNDAYS PROGRAMS, HEALTH FAIRS, AND OTHER PROGRAMS. SINCE 1907, CATHOLIC HEALTH HAS HAD A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF IMPROVING THE COMMUNITY'S HEALTH.