2021-11-15T16:38:04-06:00 2020-12-31 822624857 GRAY & GRAY AND ASSOCIATES CPAS PC 1 MAIN STREET SUITE 101 CANTON NY 136171277 990 2020-01-01 843134268 MASSENA HOSPITAL INC MASS 3157694200 1 HOSPITAL DRIVE MASSENA NY 13662 DAVID BENDER CEO 3152615451 2021-10-25 DAVID BENDER 999009999 JOHN J GRAY JR CPA P00076464 3153862925 2021-11-15 2020 2022-09-23 18:48:47Z DAVID BENDER 1 HOSPITAL DRIVE MASSENA NY 13662 50698342 false X X 2019 NY MASSENA HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTHCARE AND THE BEST PATIENT EXPERIENCE. 9 6 451 27 0 7000189 37860381 67543 5656083 50584196 0 0 27227443 0 0 25961875 53189318 -2605122 43221308 18986948 24234360 X MASSENA HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTHCARE AND THE BEST PATIENT EXPERIENCE. false true 26600320 69965090 ACUTE CARE: MASSENA HOSPITAL IS AN ACUTE CARE, 25-BED HOSPITAL PROVIDING INPATIENT MEDICAL, SURGICAL, DETOX AND PEDIATRIC SERVICES IN ADDITION TO EMERGENCY CARE. ANCILLARY SERVICES INCLUDE A 24/7 LABORATORY, MRI, CT, ULTRASOUND AND MAMMOGRAPHY. TOTAL PATIENT DAYS INCREASED BY APPROXIMATELY 57.36% FROM 2019 TO 2020. OBSERVATION CASES DECREASED BY APPROXIMATELY 8.62% FROM 2019 TO 2020. VOLUME DECREASES WERE A RESULT OF THE COVID-19 IMPACT. 8001318 13022151 HOSPITAL BASED CLINICS: IM 2020, HOSPITAL BASED CLINICS VISITS DECREASED APPROXIMATELY 3.36% FROM 55,942 IN 2019 TO 54,061 IN 2020. VOLUME DECREASES WERE A RESULT OF THE COVID-19 IMPACT. 4795474 29746782 EMERGENCY ROOM: EMERGENCY ROOM VISITS DECREASED BY 18.90% FROM 2019 TO 2020. VOLUME DECREASES WERE A RESULT OF THE COVID-19 IMPACT. 3563652 7613052 IN 2020, OPERATING ROOM CASES DECREASED APPROXIMATELY 29% FROM 1,845 IN 2019 TO 1,310 IN 2020. 3563652 7613052 42960764 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 28 0 true 451 true false false false false false false false false X 9 6 false false false false true true true true true false true true true true true true true true true true false NY X DONNA M MCGREGOR 3152615451 50 LEROY STREET POTSDAM NY 13676 X DALKEITH FACEY MD MEDICAL DOCT 50.00 0.00 X 522591 0 48907 KEJAIN TANG MD MEDICAL DOCT 50.00 0.00 X 469586 0 48937 BIRINDER SINGH MD MEDICAL DOCT 50.00 0.00 X 472775 0 31649 NIMESH DESAI MD MEDICAL DOCT 50.00 0.00 X 416285 0 40789 JAYANT JHAVERI MD MEDICAL DOCT 50.00 0.00 X 403003 0 47831 DAVID BENDER CEO 50.00 0.00 X 0 353769 27382 PATRICK FACTEAU CFO 50.00 0.00 X 189736 0 24797 DONNA MCGREGOR CFO 50.00 0.00 X 0 184769 16191 MICHAEL COOK DIRECTOR 2.00 0.00 X 0 0 0 REAL FRENCHIE COUPAL VICE CHAIR 4.00 5.00 X X 0 0 0 DAWN HEWLETT DIRECTOR 2.00 0.00 X 0 0 0 DAVID LACLAIR DIRECTOR 2.00 0.00 X 0 0 0 LENORE LEVINE SECRETARY 4.00 0.00 X X 0 0 0 BEDROS BAKIRTZIAN MD DIRECTOR 2.00 0.00 X 0 0 0 MICHAEL MARESCA MD DIRECTOR 2.00 0.00 X 0 0 0 PAUL MORROW DIRECTOR 2.00 0.00 X 0 0 0 LORETTA PEREZ BOARD CHAIR 4.00 5.00 X X 0 0 0 2473976 538538 286483 36 false true false DELPHI HOSPITALIST SERVICES LLC 1160 CHILI AVE ROCHESTER NY 14624 PROVIDER STAFFI 1411793 SIEMENS MEDICAL SOLUTIONS USA PO BOX 120001-DEPT/0733 DALLAS TX 75312 CONTRACTED SERV 649632 DY STAFFING PO BOX 635715 CINCINNATI OH 45263 PROVIDER STAFFI 608957 JEFFREY SHOUB MD 4250 RUE FABRE MONTREAL CA H2J 3T6 PROVIDER STAFFI 350700 NIDAL MAKHOUL MD 12 EDGEWATER ESTATES PLATTSBURGH NY 12901 PROVIDER STAFFI 290600 11 6619258 380931 7000189 NET PATIENT SERVICE REVENUE 900099 37860381 37860381 37860381 32031 32031 100988 114146 -13158 -13158 -13158 35512 35512 35512 35512 340B RETAIL PROGRAM 3470874 3470874 DSH DISTRIBUTION 949292 949292 DIALYSIS LEASE 848788 848788 400287 400287 5669241 50584196 37860381 5723626 21936428 17768507 4167921 787109 637558 149551 2995051 2425991 569060 1508855 1222173 286682 175719 175719 75000 75000 7567 7567 478273 478273 63199 51191 12008 433173 348566 84607 11413 9245 2168 138932 112535 26397 1496246 1211959 284287 875759 709365 166394 PURCHASED/CONTRACTED SERV 11706220 9482038 2224182 SUPPLIES 8437639 6834488 1603151 OTHER - MISCELLANEOUS 742805 599732 143073 CONSULTING & MANAGEMENT F 476084 385628 90456 843846 683515 160331 53189318 42960764 10228554 0 189509 14080386 4346849 558357 294086 64477510 47267530 17209980 6542141 0 43221308 8396736 98530 10491682 0 18986948 X 24234360 0 24234360 0 43221308 X -2605122 26839482 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 7567 7567 false SCHEDULE C, PART II-B, LINE 1 HANYS ANNUAL MEMBERSHIP DUES: 4,986 FEDERAL AND STATE ADVOCACY IROQUIOS HEALTHCARE ALLIANCE: 1,907 FEDERAL AND STATE ADVOCACY AMERICAN HOSPITAL ASSOCIATION ANNUAL MEMBERSHIP DUES: 674 FEDERAL AND STATE ADVOCACY 495756 495756 32093059 18691435 13401624 61241 23585 37656 31450104 28552510 2897594 377350 377350 17209980 ASSETS WHOSE USEFUL LIFE IS LIMITED 4213203 GRANT RECEIVABLE- DOH 2000000 OTHER RECEIVABLES 328938 6542141 ESTIMATED THIRD-PARTY PAYOR SETTLEME 5313388 DUE TO AFFILIATES 2604347 SLHS BRIDGE FUNDING 2573947 10491682 X 50424140 114145 114145 50309995 274201 274201 50584196 52983364 52983364 205954 205954 53189318 SCHEDULE D, PAGE 3, PART X THE SYSTEM AND ITS AFFILIATES ARE NOT FOR PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE)AND ARE EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM AND AFFILIATES RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN FIFTY PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT. CHANGES IN RECOGNIZATION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. THE SYSTEM AND AFFILIATES DID NOT RECOGNIZE THE EFFECT OF ANY UNCERTAIN INCOME TAX POSITIONS IN EITHER 2020 OR 2019. SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 114,145 SCHEDULE D, PAGE 4, PART XI, LINE 4B GIFTS & BEQUESTS 233,114 OTHER 41,087 SCHEDULE D, PAGE 4, PART XII, LINE 4B RENTAL EXPENSES 114,145 BOOK / TAX DEPRECIATION DIFFERENCE 91,809 true true true X true X true true false true true 36014 36014 0.00070 12391426 4107031 8284395 0.15580 12427440 4107031 8320409 0.15640 46069 46069 0.00090 400 400 46469 46469 0.00090 12473909 4107031 8366878 0.15730 35742 35742 0.00070 35742 35742 0.00070 true 3132844 75717 8721356 14074543 -5353187 X true true 1 1 MASSENA HOSPITAL INC 1 HOSPITAL DRIVE MASSENA NY 136621056 WWW.MASSENAHOSPITAL.ORG X MASSENA HOSPITAL INC 1 false true true X X X X X X X X X X 19 true true false true X WWW.MASSENAHOSPITAL.ORG X true 19 false false false true X 100.000000000000 300.000000000000 true true X X X X true X WWW.MASSENAHOSPITAL.ORG X WWW.MASSENAHOSPITAL.ORG X WWW.MASSENAHOSPITAL.ORG X X X X X X true X X false X X true X false true FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 2 IN JULY 2019, ST. LAWRENCE HEALTH SYSTEM EXECUTED AN ASSET PURCHASE AGREEMENT WITH THE TOWN OF MASSENA AND IT'S HOSPITAL, MASSENA MEMORIAL HOSPITAL (MMH), TO ACQUIRE SUBSTANTIALLY ALL OF THE ASSETS OF MMH AND ASSUME CERTAIN OUTSTANDING LIABILITIES. THE NECESSARY APPROVALS WERE GRANTED AND REQUIRED CONDITIONS MET AND LEGALLY BINDING ON JANUARY 1, 2020. MASSENA HOSPITAL WAS FORMED TO RETAIN THE ACQUIRED ASSETS AND ASSUMED LIABILITIES OF THE FORMER MMH. FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 5 MASSENA HOSPITAL'S (MH'S) MOST RECENT CHNA WAS CONDUCTED BY ITS NEW YORK STATE DSRIP PPS, ADIRONDACK HEALTH INSTITUTE, AS WELL AS ITS LOCAL PARTNERS, THE ST. LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT AND THE ST. LAWRENCE HEALTH INSTITUTE. MH PARTICIPATES AT THE BOARD LEVEL ON THE ST. LAWRENCE HEALTH INITIATIVE, A NOT-FOR-PROFIT ORGANIZATION COORDINATING HEALTH ASSESSMENT AMONG ALL AREA HEALTH FACILITIES. THIS ORGANIZATION AND OUR DSRIP PPS PROVIDE FORMAL ONGOING COORDINATION OF NEEDS ASSESSMENT AND PROGRAMMING. THE CHNA WAS COMPLETED IN 2019 AND TAKES INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE COMMUNITY PRIMARILY THROUGH A TELEPHONE AND WEB SURVEY CONDUCTED IN THE SUMMER OF 2019 WITH RESIDENTS OF THE THREE- COUNTY REGION OF ST. LAWRENCE, LEWIS, AND JEFFERSON. MH ALSO SEEKS INPUT FORMALLY THROUGH AN ANNUAL FORUM WITH COMMUNITY LEADERS FROM ALL ACROSS OUR PRIMARY AND SECONDARY SERVICE AREAS, FREQUENT MEETINGS WITH PUBLIC HEALTH OFFICIALS, LOCAL COLLEGE PRESIDENTS, THE LEADERS OF OTHER AREA HEALTH FACILITIES, AND LOCAL GOVERNMENT OFFICIALS. ADDITIONAL INPUT WAS GATHERED FROM HOSPITAL AND HOSPITAL SYSTEM BOARD MEMBERS REPRESENTING PUBLIC HEALTH, DENTISTRY, HOSPICE AND PALLIATIVE CARE, VETERINARY HEALTH, AREA COLLEGES, AND AREA BUSINESSES. FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 6A MASSENA HOSPITAL'S CHNA WAS AUTHORED BY THE HOSPITAL USING DATA GATHERED BY THE ADIRONDACK HEALTH INSTITUTE (REPRESENTING A NINE-COUNTY NORTHERN NY REGION WHICH INCLUDES ST. LAWRENCE COUNTY) AND DATA GATHERED FOR ST. LAWRENCE, LEWIS, AND JEFFERSON COUNTIES ON BEHALF OF THE ST. LAWRENCE HEALTH INSTITUTE/INITIATIVE THROUGH FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION. FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 11 MASSENA HOSPITAL'S CHNA IDENTIFIED CHRONIC DISEASE PREVENTION AND MANAGEMENT AND MENTAL, EMOTIONAL, AND BEHAVIORAL (MEB) HEALTH AS THE TWO HIGHEST PRIORITY AREAS NEEDING TO BE ADDRESSED. WITHIN THESE AREAS, CHILD AND ADOLESCENT OBESITY, HEART FAILURE, DIABETES, AND COPD WERE IDENTIFIED AS THE MOST PRESSING NEEDS IN CHRONIC DISEASE MANAGEMENT; SUBSTANCE ABUSE AND SUICIDE PREVENTION WERE IDENTIFIED AS TOP NEEDS IN THE MEB HEALTH CATEGORY. THESE PRIORITY AREAS DOVETAIL WITH THE HOSPITAL'S STRATEGIC PLAN, THE PRIORITIES OF THE NEW YORK STATE DSRIP PPS PARTNERS IN A NINE-COUNTY NORTHERN NEW YORK REGION THAT ENCOMPASSES ST. LAWRENCE COUNTY, THE PRIORITIES OF THE NEW YORK STATE HEALTHCARE REDESIGN COMMISSION, THE PRIORITIES OF THE NEW YORK STATE PREVENTION AGENDA, AND THE GOALS OF THE AFFORDABLE CARE ACT TO INCREASE ACCESS, REDUCE COSTS, AND IMPROVE QUALITY. SPECIFIC GOALS AND METRICS HAVE BEEN IDENTIFIED AND THE HOSPITAL'S OUTREACH PROGRAMS ARE DESIGNED TO ADDRESS THESE. AMONG THESE PROGRAMS IS AN EXTENSIVE EDUCATION SERIES FOR THE COMMUNITY ON VARIOUS HEALTH ISSUES; EDUCATION TARGETED TO THOSE WITH SPECIFIC DIAGNOSES; SUPPORT FOR OTHER COMMUNITY ORGANIZATIONS FOR INTEGRATING HEALTHY FOOD CHOICES IN CHILDHOOD AND ADOLESCENT ACTIVITIES; AND SUPPORT FOR LOCAL FOOD BANKS AND A LOCAL NON-PROFIT FOOD SECURITY PROGRAM. MASSENA HOSPITAL, AS A PART OF ST. LAWRENCE HEALTH SYSTEM, CONTINUES TO ENRICH THE REGION IN RECRUITMENT OF PRIMARY CARE PRACTITIONERS AND SPECIALISTS IN TARGETED AREAS, INCLUDING SUBSTANCE USE DISORDER, RHEUMATOLOGY, NEUROLOGY, ENDOCRINOLOGY (FOR ASSISTANCE WITH DIABETES), INFECTIOUS DISEASE, NUTRITION, AND A PULMONOLOGY SPECIALIST WITH A BACKGROUND IN BEHAVIORAL HEALTH TO TAKE THE POSITION OF DIRECTOR OF POPULATION HEALTH. FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 15E THE ORGANIZATION CONSPICUOUSLY POSTS ITS FINANCIAL ASSISTANCE POLICY IN EACH REGISTRATION/RECEPTION AREA. PATIENTS ARE ENCOURAGED TO APPLY FOR ASSISTANCE AND GIVEN CONTACT INFORMATION AT THESE AREAS. IN ADDITION, ANY PATIENT THAT IS UNINSURED AND ADMITTED TO THE HOSPITAL FOR CARE IS PHYSICALLY VISITED BY A FINANCIAL COUNSELOR, AND AN EXPLANATION OF OUR PROGRAM IS MADE ALONG WITH AN APPLICATION. PATIENTS REQUESTING ASSISTANCE IN THE COMPLETION OF THE APPLICATION ARE GIVEN SUCH. ANY INFORMATION REQUIRED FOR APPLICATION FOR THE NYS MEDICAID APPLICATION PROCESS IS COLLECTED BY OUR FINANCIAL CASE MANAGERS AND COMMUNICATED TO THE APPROPRIATE CASE MANAGERS AT OUR COUNTY DEPARTMENT OF SOCIAL SERVICES FOR DETERMINATION OF MEDICAID ELIGIBILITY. FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 24 THE HOSPITAL USES THE HIGHEST VOLUME COMMERCIAL COVERAGE RATE, FROM BLUE CROSS/BLUE SHIELD, WHICH IS ALSO GENERALLY THE LOWEST RATE CHARGED. SCHEDULE H, PART II THE AMOUNT REPORTED ON PART II LINE 8 REPRESENTS THE INVESTMENT MADE IN RECRUITING NEW HEALTHCARE PRACTITIONERS TO OUR SERVICE AREA DURING 2020. DUE TO ITS INDIGENT POPULATION AND RURAL NATURE, MUCH OF THE REGION SURROUNDING THE HOSPITAL IS DESIGNATED AS A MANPOWER SHORTAGE AREA. SCHEDULE H, PART III, LINE 2 THE COSTS ON LINE 2 ARE BASED UPON THE MEDICARE ICR FOR 2020 APPLIED TO THE GROSS CHARGES WRITTEN OFF. SCHEDULE H, PART III, LINE 3 THE COSTS ON LINE 3 WERE CALCULATED IN ACCORDANCE WITH THE COSTING METHODOLOGY EMPLOYED BY THE NYS DOH BAD DEBT COSTING PROCESS. SCHEDULE H, PART III, LINE 4 PAGE 16 OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS (FN4B-PATIENT SERVICE RECEIVABLES) SCHEDULE H, PART III, LINE 8 DESCRIBE THE COSTING METHODOLOGY OR SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 (MCR ALLOWABLE COSTS OF CARE RELATED TO PAYMENTS): COSTS REPORTED ON LINE 6 INCLUDE TOTAL INPATIENT COSTS (ROUTINE, ICU, ANCILLARY AND CAPITAL), OBSERVATIONS COSTS, AND OUTPATIENT COSTS FROM MCR COST REPORT, WORKSHEETS D-1: PART II AND PART IV; AND WORKSHEET D: PART V. SCHEDULE H, PART III, LINE 9B THE ORGANIZATION APPLIES THE SAME COLLECTION PRINCIPLES TO AMOUNTS DUE FROM PATIENTS WHO HAVE QUALIFIED FOR PERCENTAGE DISCOUNTS BUT STILL HAVE A RESPONSIBILITY FOR A PORTION OF THEIR BILL BASED UPON THE SLIDING FEE SCHEDULE. NO SEPARATE DISTINCTION IS MADE FOR THE APPLICATION OF OUR COLLECTION PROCESSES IN THOSE CASES. SCHEDULE H, PART VI, LINE 3 THE ORGANIZATION CONSPICUOUSLY POSTS ITS FINANCIAL ASSISTANCE POLICY IN EACH REGISTRATION/RECEPTION AREA. PATIENTS ARE ENCOURAGED TO APPLY FOR ASSISTANCE AND GIVEN CONTACT INFORMATION AT THESE AREAS. IN ADDITION, ANY PATIENT THAT IS UNINSURED AND ADMITTED TO THE HOSPITAL FOR CARE IS PHYSICALLY VISITED BY A FINANCIAL COUNSELOR, AND AN EXPLANATION OF OUR PROGRAM IS MADE ALONG WITH AN APPLICATION. PATIENTS REQUESTING ASSISTANCE IN THE COMPLETION OF THE APPLICATION ARE GIVEN SUCH. ANY INFORMATION REQUIRED FOR APPLICATION FOR THE NYS MEDICAID APPLICATION PROCESS IS COLLECTED BY OUR FINANCIAL CASE MANAGERS AND COMMUNICATED TO THE APPROPRIATE CASE MANAGERS AT OUR COUNTY DEPARTMENT OF SOCIAL SERVICES FOR DETERMINATION OF MEDICAID ELIGIBILITY. SCHEDULE H, PART VI, LINE 4 MASSENA HOSPITAL IS LOCATED IN ST. LAWRENCE COUNTY IN UPSTATE NEW YORK. ST. LAWRENCE COUNTY, THE LARGEST COUNTY IN NEW YORK, IS LOCATED IN THE NORTHERNMOST REACHES OF THE STATE BORDERING ON THE ST. LAWRENCE RIVER AND CANADA. IT IS A RURAL ENVIRONMENT CONSISTING OF 2,685 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 112,000 RESIDENTS. SCHEDULE H, PART VI, LINE 6 ST. LAWRENCE HEALTH SYSTEM, FORMED DECEMBER 5, 2013, IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPITAL AND OTHER CORPORATIONS. AMONG OTHER BENEFITS, THE HEALTH SYSTEM MAY PROVIDE ADVICE AND ASSISTANCE CONCERNING LONG AND SHORT- RANGE PLANNING FOR, AND MONITOR AND PROVIDE ADVICE AND ASSISTANCE TO HELP COORDINATE THE ACTIVITIES OF THE SUPPORTED ORGANIZATION IN ELIMINATING DUPLICATIVE FUNCTIONS; PROVIDE MANAGEMENT CONSULTING ASSISTANCE TO THE SUPPORTED ORGANIZATION TO FURTHER IMPROVE AND ADVANCE HEALTH SERVICES TO THE RESIDENTS OF NEW YORK STATE AND COOPERATE WITH THE SUPPORTING ORGANIZATIONS IN CARRYING OUT THEIR CHARITABLE PURPOSES. SCHEDULE H, PART VI, LINE 7 NEW YORK X false false false false false false false false false DALKEITH FACEY MD MEDICAL DOCTOR 522591 12879 36028 571498 KEJAIN TANG MD MEDICAL DOCTOR 469586 12908 36029 518523 BIRINDER SINGH MD MEDICAL DOCTOR 472775 11996 19653 504424 NIMESH DESAI MD MEDICAL DOCTOR 416285 11866 28923 457074 JAYANT JHAVERI MD MEDICAL DOCTOR 403003 11803 36028 450834 DAVID BENDER CEO 353769 14250 13132 381151 PATRICK FACTEAU CFO 189736 7803 16994 214533 DONNA MCGREGOR CFO 184769 3273 12918 200960 FORM 990, PAGE 2, PART III, LINE 3 THE OBSTETRICS UNIT OF MASSENA HOSPITAL WAS CLOSED ON JULY 13, 2020. FORM 990, PAGE 2, PART III, LINE 4D IN 2020, OPERATING ROOM CASES DECREASED APPROXIMATELY 29% FROM 1,845 IN 2019 TO 1,310 IN 2020. FORM 990, PAGE 6, PART VI, LINE 6 ST. LAWRENCE HEALTH SYSTEM, INC. IS A SOLE MEMBER. FORM 990, PAGE 6, PART VI, LINE 7A ST. LAWRENCE HEALTH SYSTEM, INC. IS A SOLE MEMBER, AND HAS THE ABILITY TO APPOINT MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PAGE 6, PART VI, LINE 7B THE MEMBER SHALL HAVE THE FOLLOWING POWERS WITH REGARD TO THE CORPORATION: -APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS. -APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER. -APPROVE THE ADOPTION AND AMENDMENT OF BYLAWS. -APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS. -APPROVE STRATEGIC PLANS. -APPROVE AND INITIATE THE FILING OF CERTIFICATE OF NEED APPLICATIONS. -REVIEW AND APPROVE THE ANNUAL AUDIT OF THE CORPORATION AND ANY SUBSIDIARY CORPORATIONS. -APPROVE THE DISSOLUTION OF THE CORPORATION. -APPROVE THE SALE, LEASE, MORTGAGE OR ENCUMBRANCE OF ANY ASSET OTHER THAN ANY SALE, LEASE OR MORTGAGE WHICH IS PART OF AN APPROVED BUDGET. -APPROVE THE SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATIONS. -APPROVE ANY MERGER, BUSINESS CONSOLIDATION, ACQUISITION OR JOINT VENTURE. -APPROVE THE PURCHASE OR SALE OF PHYSICIAN PRACTICES OTHER THAN ANY PURCHASE OR SALE WHICH IS PART OF AN APPROVED BUDGET. -APPROVE AND MAY INITIATE THE COMMENCEMENT AND SETTLEMENT OF LITIGATION. -APPROVE ANY FILING OF BANKRUPTCY PETITION. -APPROVE THE INCURRENCE OF ANY DEBT OTHER THAN DEBT WHICH IS INCURRED IN THE ORDINARY COURSE OF BUSINESS AND WHICH IS NOT INCONSISTENT WITH AN APPROVED BUDGET; AND -REQUIRE THE GUARANTEE OF LOANS THROUGH AN OBLIGATED GROUP STRUCTURE THAT WILL SUPPORT ACCESS TO CAPITAL AND INCLUDE DEBT SERVICES. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT STAFF MEMBERS. UPON COMPLETION, THE FORM IS SUBMITTED TO A CPA FIRM FOR REVIEW AND PREPARED FOR FILING. A COPY OF THE DRAFT RETURN IS THEN REVIEWED BY THE SYSTEM CFO AND SYSTEM CONTROLLER. AFTER REVIEW, ANY CHANGES ARE MADE AND A COPY IS PRESENTED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW, COMMENTS AND APPROVAL (PRIOR TO IRS SUBMISSION). FORM 990, PAGE 6, PART VI, LINE 12C ENFORCEMENT OF CONFLICTS POLICY BOARD MEMBER CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED AND REVIEWED BY THE BOARD ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15A THE AUDIT, COMPLIANCE AND COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS UTILIZES THE INPUT OF A NATIONAL CONSULTING FIRM WITH EXPERTISE IN EXECUTIVE COMPENSATION TO REVIEW THE COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AS WELL AS OUR COMPLIANCE WITH REGULATORY REQUIREMENTS FOR EXECUTIVE COMPENSATION FOR NOTFOR-PROFIT HOSPITALS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE. FORM 990, PAGE 6, PART VI, LINE 15B THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED PRIMARILY BY INFORMATION GATHERED FROM INDEPENDENT SURVEY DATA FROM NATIONAL AND SURROUNDING MARKETS COORDINATED BY THE HUMAN RESOURCE DEPARTMENT. THE CEO AND VICE PRESIDENT OF HUMAN RESOURCES REVIEW THE SURVEY DATA TO DETERMINE SALARY RANGES AND COMPENSATION PACKAGES. THE CEO BRINGS THE INFORMATION AND FINDINGS TO THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE OF THE BOARD FOR THEIR DELIBERATION AND CONSIDERATION. THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE WILL THEN BRING THEIR RECOMMENDATION TO THE FULL BOARD FOR THEIR FINAL APPROVAL. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 TRANSFER TO ST. LAWRENCE HEALTH SYSTEM 7,200,000 EFFECT OF AQUISITION 19,639,482 TOTAL 26,839,482 MASSENA HOSPITAL FOUNDATION 1 HOSPITAL DRIVE PO BOX 625 MASSENA NY 13662 222586307 FOUNDATION NY 501C3 7 NA false ST LAWRENCE HEALTH SYSTEM 50 LEROY STREET POTSDAM NY 13676 464259168 HEALTHCARE NY 501C3 12A NA false GOUVERNEUR HOSPITAL 77 W BARNEY STREET GOUVERNEUR NY 13642 464249555 HOSPITAL NY 501C3 3 SLHS true CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 161012691 HOSPITAL NY 501C3 3 SLHS true CANTON-POTSDAM MEDICAL PRACTICE PL 50 LEROY STREET POTSDAM NY 13676 460714367 CLINIC NY 501C3 3 SLHS true false false true false false false false false false true true false true false false true false false false CANTON-POTSDAM HOSPITAL K 2094375 FMV