TY 2015 Form 990EZ

Part IIIStatement of Program Service Accomplishments (see the instructions for Part III) Check if the organization used Schedule O to respond to any question in this Part III . .	Expenses (Required for section 501(c)(3) and 501(c)(4) organizations; optional for others.)
What is the organization's primary exempt purpose? The purpose of the organization is:To insure that all patients admitted to or treated in any of the facilities, departments or services of Good Samaritan Hospital Medical Center, 1000 Montauk Highway, West Islip, NY 11795 (the Hospital) receive appropriate care consistent with community standards;To insure the professional performance of all practitioners authorized to practice in the Hospital through the appropriate delineation of the clinical privileges that each practitioner may exercise in the Hospital and through an ongoing review and evaluation of each practitioners performance in the Hospital;To provide an appropriate educational setting that will maintain scientific standards and that will lead to continuous advancement in professional knowledge and skill;To initiate and maintain rules and regulations for governance of the Medical Staff of the Hospital (Medical Staff) subject to the approval of the Governing Body of Trustees of Good Samaritan Hospital Medical Center (Governing
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 to appoint, reappoint, or revoke appointment to the Good Samaritan Hospital Medical Center's ("the Hospital") Medical Staff. SUCH APPOINTMENTS ARE CONDUCTED THROUGHOUT THE YEAR. THE APPOINTMENT PROCESS IS CONDUCTED THROUGH EXAMINATION OF THE PROFESSIONAL'S COMPETENCE,ETHICS AND CHARACTER INCLUDING EXAMINATION OF REFERENCES, BACKGROUND CHECKS AND APPRAISAL'S FROM THE CLINICAL DEPARTMENT IN WHICH PRIVILEGES ARE SOUGHT. THIS PROCESS HELPS TO FURTHER THE COMPENTENCY AND CREDENTIALS OF THE MEDICAL STAFF THEREBY FURTHERING QUALITY MEDICAL CARE TO ALL PATIENTS TREATED IN THE HOSPITAL. (Grants $ 46,500) If this amount includes foreign grants, check here ...			28a
29 ARRANGE FOR medical staff meetings AND SOCIALS. Medical staff meetings AND SOCIALS ARE CONDUCTED THROUGHOUT THE YEAR. THe meetings, lectures AND SOCIALS help TO FURTHER THE COMPENTENCY AND COMRADARE OF THE MEDICAL STAFF THEREBY fURTHERING QUALITY MEDICAL CARE TO ALL PATIENTS TREATED IN THE HOSPITAL. (Grants $ 31,774) If this amount includes foreign grants, check here ...			29a
30 TO CONTRIBUTE MONIES TO THE GOOD SAMARITAN HOSPITAL FUND. SUCH MONIES PURCHASE NECESSARY EQUIPMENT FOR THE HOSPITAL WHICH FURTHER THE QUALITY OF MEDICAL CARE TO ALL PATIENTS TREATED IN THE HOSPITAL. (Grants $ 60,000) If this amount includes foreign grants, check here ...			30a
TO ARRANGE AND PAY FOR GUEST LECTURERS IN CONNECTION WITH MEDICAL GROUND ROUNDS. MEDICAL GROUND ROUNDS ARE AN IMPORTANT TOOL FOR FURTHERING THE COMPENTENCY AND CREDENTIALS OF THE MEDICAL STAFF THEREBY FURTHERING QUALITY MEDICAL CARE TO ALL PATIENTS TREATED IN THE HOSPITAL. (Grants $ 3,250) If this amount includes foreign grants, check here ...
Provide continuing medical educational opportunities as are compatible with the professional, physical and fiscal resources available in the Hospital. Such medical continuing medical educational is designed to lead to the on-going advancement of the professional skills and knowledge of all health professionals at good samaritan hospital (Grants $ 8,885) If this amount includes foreign grants, check here ...
Provide small awards / appreciation / gifts to medical staff. Such awards / appreciation gifts are given to applicable medical staff members. The awarding of awards to the medical staff helps with staff morale thereby furthering the quality of care at good samaritan hospital (Grants $ 9,500) If this amount includes foreign grants, check here ...
31 Other program services (describe in Schedule O) ................ (Grants $ ) If this amount includes foreign grants, check here...	31a
32 Total program service expenses (add lines 28a through 31a)..........	32	159,909

(a) Name and title

(b) Average
hours per week
devoted to position

(c)Reportable compensation
(Forms W-2/1099-MISC) (if not paid, enter -0-)

(d) Health benefits, contributions to employee benefit plans,
and deferred compensation

(e) Estimated amount
of other compensation

JOSEPH ADIYODY

Treasurer

5.00

10,000

ANTHONY CAPIZZI

President

5.00

25,000

ROBERT CARLIN

Vice President

5.00

5,000

Yes

Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .......................

Is the organization a school as described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ..

49a

Did the organization make any transfers to an exempt non-charitable related organization?......

49a

If "Yes," was the related organization a section 527 organization?................

49b

Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."

(a) Name and title of each employee	(b) Average hours per week devoted to position	(c) Reportable compensation (Forms W-2/1099-MISC)	(d) Health benefits, contributions to employee benefit plans, and deferred compensation	(e) Estimated amount of other compensation
NONE

Total number of other employees paid over $100,000 ... bullet

Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."

(a) Name and business address of each independent contractor	(b) Type of service	(c) Compensation
NONE

Return Reference	Explanation
Grants and Similar Amounts Paid In Excess of $5,000.2	Class of Activity: CHARITABLE \| Donee's Name: GOOD SAMARITAN HOSPITAL \| Donee's Address: 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 \| Relationship of Donee: N/A \| Cash Amount Given: $60000
Other Expenses.1002	Office Expenses $367
Other Expenses.1	BIANNUAL MEETINGS $13023
Other Expenses.2	RESIDENT GRADUATION PARTY $10000
Other Expenses.3	AWARDS AND APPRECIATION GIFTS $9500
Other Expenses.4	CONTINUING MEDICAL EDUCATION $8885
Other Expenses.5	MEETINGS AND CATERING $8751
Other Expenses.6	CREDENTIALING $6500
Other Expenses.7	GRAND ROUNDS $3250

Return Reference

Explanation

Grants and Similar Amounts Paid In Excess of $5,000.2

Class of Activity: CHARITABLE | Donee's Name: GOOD SAMARITAN HOSPITAL | Donee's Address: 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 | Relationship of Donee: N/A | Cash Amount Given: $60000

Other Expenses.1002

Office Expenses $367

Other Expenses.1

BIANNUAL MEETINGS $13023

Other Expenses.2

RESIDENT GRADUATION PARTY $10000

Other Expenses.3

AWARDS AND APPRECIATION GIFTS $9500

Other Expenses.4

CONTINUING MEDICAL EDUCATION $8885

Other Expenses.5

MEETINGS AND CATERING $8751

Other Expenses.6

CREDENTIALING $6500

Other Expenses.7

GRAND ROUNDS $3250

1	Contributions, gifts, grants, and similar amounts received ....................	1
2	Program service revenue including government fees and contracts ...............	2
3	Membership dues and assessments ...........................	3	83,700
4	Investment income ...........................	4	631
5a	Gross amount from sale of assets other than inventory .....	5a
b	Less: cost or other basis and sales expenses .......	5b	0
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ......	5c
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000)	6a
b	Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the			sum of such gross income and contributions exceeds $15,000) ..	6b	0
c	Less: direct expenses from gaming and fundraising events ...	6c	0
d	Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)	6d
7a	Gross sales of inventory, less returns and allowances ......	7a
b	Less: cost of goods sold .............	7b	0
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .........	7c
8	Other revenue (describe in Schedule O) ..........	8
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 ..............	9	84,331

10	Grants and similar amounts paid (list in Schedule O) ............	10	60,000
11	Benefits paid to or for members ................	11
12	Salaries, other compensation, and employee benefits ................	12	40,000
13	Professional fees and other payments to independent contractors ............	13	3,465
14	Occupancy, rent, utilities, and maintenance ...................	14
15	Printing, publications, postage, and shipping ..............	15
16	Other expenses (describe in Schedule O) ..............	16	60,276
17	Total expenses. Add lines 10 through 16 ..............	17	163,741

18	Excess or (deficit) for the year (Subtract line 17 from line 9) ............	18	-79,410
19	Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
	end-of-year figure reported on prior year’s return) ............	19	388,030
20	Other changes in net assets or fund balances (explain in Schedule O) ..........	20
21	Net assets or fund balances at end of year. Combine lines 18 through 20 .......	21	308,620

Sign Here

	Signature of officer	Date

	Type or print name and title

Software ID:	15000324
Software Version:	2015v2.0

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures