# Good Samaritan Hospital of Suffern

Hospital in Suffern, NY. From the hospital's IRS filing, tax year 2024.

Good Samaritan Hospital of Suffern likely gives free care to households with a yearly income up to $39,900 for 1 person, $54,100 for 2, $68,300 for 3, $82,500 for 4, $96,700 for 5 or $110,900 for 6. It likely gives a discount to households with a yearly income up to $79,800 for 1 person, $108,200 for 2, $136,600 for 3, $165,000 for 4, $193,400 for 5 or $221,800 for 6.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $39,900 | $79,800 |
| 2 | $54,100 | $108,200 |
| 3 | $68,300 | $136,600 |
| 4 | $82,500 | $165,000 |
| 5 | $96,700 | $193,400 |
| 6 | $110,900 | $221,800 |

Dollar amounts use the 2026 federal poverty guidelines.

## How to apply

- Call (914) 368-5000 and ask for financial assistance.
- [Financial assistance policy named in the IRS filing](https://www.wmchealth.org/wp-content/uploads/2025/04/2024-Financial-Assistance-Policy-SACH-2-18-2025.pdf)
- We do not have the deadline yet. Apply as soon as you get a bill, and ask the billing office to pause collections while you apply.

## If you have insurance

If you have insurance, ask whether this policy helps with deductibles and copays.
Keep your insurance. Financial assistance covers bills from this one place only.

## State program in New York

### Hospital Financial Assistance Law (Public Health Law 2807-k(9-a))

Every hospital licensed by the New York State Department of Health must give financial help to patients with household income up to 400% of the federal poverty level. This covers people with no insurance. It also covers people with insurance who paid more than 10% of their income on medical bills in the last 12 months. Below 200% of the poverty level, the hospital must waive all charges. From 200% to 300%, an uninsured patient pays at most 10% of what Medicaid would pay. From 301% to 400%, the cap is 20%. Insured patients with high costs get the same caps on their share of the bill. Assets and immigration status do not count. You can apply at any time, even after a bill goes to collections. These rules apply to care on or after October 20, 2024. Hospitals run only by the Office of Mental Health are not covered.

Income levels in the program are free up to 200%, discount up to 400% of poverty level.

Applies to all hospitals licensed by the New York State Department of Health, whether or not they take part in the Indigent Care Pool; not facilities licensed only by other agencies such as the Office of Mental Health.

How to apply. Ask the hospital's financial assistance office for the New York State Uniform Financial Assistance Application. Every hospital in the state uses the same form. You do not have to pay the bill while your application is being reviewed. For free help with the application or an appeal, call Community Health Advocates at 888-614-5400.

> the hospital shall waive all charges. No nominal payment shall be collected

Source https://www.nysenate.gov/legislation/laws/PBH/2807-K, checked 2026-11-11

## Sources

- IRS Form 990 Schedule H, tax year 2024 https://apps.irs.gov/pub/epostcard/990/xml/2025/2025_TEOS_XML_11C.zip#202523169349306367_public.xml
- Policy link listed in the filing https://www.wmchealth.org/wp-content/uploads/2025/04/2024-Financial-Assistance-Policy-SACH-2-18-2025.pdf

Last checked IRS filing for tax year 2024.

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