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ST LAWRENCE HEALTH SYSTEM INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
ST LAWRENCE HEALTH SYSTEM INC (EIN 46-4259168)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-15
IRS object ID
202133199349324658
Schema version
2020v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2021-11-15T16:31:29-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN822624857PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GRAY & GRAY AND ASSOCIATES CPAS PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11 MAIN STREET SUITE 101AddressLine1Txt
CityCANTONCityNm
State AbbreviationNYStateAbbreviationCd
ZIP136171277ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN464259168EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ST LAWRENCE HEALTH SYSTEM INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSTLABusinessNameControlTxt
Phone3152615100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line150 LEROY STREETAddressLine1Txt
CityPOTSDAMCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13676ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDONNA MCGREGORPersonNm
Person TitleCFO/VP OF FINANCEPersonTitleTxt
Phone3152615100PhoneNum
Signature2021-10-19SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDONNAPersonFirstNm
Person LastMCGREGORPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOHN J GRAY JR CPAPreparerPersonNm
PTINP00076464PTIN
Phone3153862925PhoneNum
Preparation2021-11-15PreparationDt
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDONNA MCGREGORPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line150 LEROY STREETAddressLine1Txt
CityPOTSDAMCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13676ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,368,203GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.STLAWRENCEHEALTHSYSTEM.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2013FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionST. LAWRENCE HEALTH SYSTEM'S MISSION IS TO IMPROVE HEALTH, DELIVER BETTER CARE AND CONSUMER EXPERIENCE, AND LOWER COSTS IN ST. LAWRENCE COUNTY THROUGH COORDINATION AND INTEGRATION OF SERVICES.ActivityOrMissionDesc
Voting Members Governing Body17VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee123TotalEmployeeCnt
Total Volunteers97TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$251,928PYProgramServiceRevenueAmt
CY Program Service Revenue$505,523CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$1,931,557PYOtherRevenueAmt
CY Other Revenue$1,862,680CYOtherRevenueAmt
PY Total Revenue$2,183,485PYTotalRevenueAmt
CY Total Revenue$2,368,203CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$241,567PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$275,057CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,166,863PYOtherExpensesAmt
CY Other Expenses$4,174,039CYOtherExpensesAmt
PY Total Expenses$4,408,430PYTotalExpensesAmt
CY Total Expenses$4,449,096CYTotalExpensesAmt
PY Revenues Less Expenses-$2,224,945PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,080,893CYRevenuesLessExpensesAmt
Total Assets BOY$51,183,877TotalAssetsBOYAmt
Total Assets EOY$40,562,629TotalAssetsEOYAmt
Total Liabilities BOY$44,007,521TotalLiabilitiesBOYAmt
Total Liabilities EOY$43,531,124TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,176,356NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$2,968,495NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionST. LAWRENCE HEALTH SYSTEM'S MISSION IS TO IMPROVE HEALTH, DELIVER BETTER CARE AND CONSUMER EXPERIENCE, AND LOWER COSTS IN ST. LAWRENCE COUNTY THROUGH COORDINATION AND INTEGRATION OF SERVICES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$452,088ExpenseAmt
Revenue$505,523RevenueAmt
DescDURING 2020, THE CLINICAL RESEARCH PROGRAM INCLUDED 16 STUDIES CONDUCTED AND INCLUDED 34 ENROLLED PARTICIPANTS.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
DescDURING 2020, THE CLINICAL RESEARCH PROGRAM INCLUDED 16 STUDIES CONDUCTED AND INCLUDED 34 ENROLLED PARTICIPANTS.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$452,088TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemYes (true)BusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntYes (true)BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document53IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee123EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members17GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ST LAWRENCE HEALTH SYSTEMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3152615451PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line150 LEROY STREETAddressLine1Txt
CityPOTSDAMCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13676ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
DAVID ACKER
PRESIDENT/CE5.0050.00Yes (X)$785,218$0$39,570
KATHERINE SCHLEIDER
COO50.000.00$426,331$0$45,398Yes (X)
RICHARD JACOBS
PROJECT SPEC5.0050.00Yes (X)$389,565$0$33,225
DAVID BENDER
VP STRATEGIC50.000.00$353,769$0$26,139Yes (X)
ERIC BURCH
CEO50.000.00$338,872$0$23,868Yes (X)
JANET SCHAPIRO
VP NURSING50.000.00$306,209$0$24,216Yes (X)
SUSAN HODGSON
VP COMPLIANC50.000.00$276,773$0$23,062Yes (X)
MICHAEL TULLOCH MD
DIRECTOR5.002.00$0$218,432$34,538Yes (X)
DONNA MCGREGOR
CFO/VP OF FI5.0050.00Yes (X)$184,769$0$16,191
AMY IRISH-BICKNELL
ASSISTANT SE5.0040.00Yes (X)$69,965$0$20,515
RONALD BERRY
DIRECTOR5.002.00$0$0$0Yes (X)
MARK BRACKETT
TREASURER5.001.00Yes (X)$0$0$0Yes (X)
MARK J CORNETT
VICE CHAIR5.004.00Yes (X)$0$0$0Yes (X)
REAL FRENCHIE COUPAL
DIRECTOR5.000.00$0$0$0Yes (X)
DONALD R DANGREMOND
DIRECTOR5.002.00$0$0$0Yes (X)
ERIN DRAPER
DIRECTOR5.002.00$0$0$0Yes (X)
BRIAN D GARDAM
DIRECTOR5.002.00$0$0$0Yes (X)
MICHAEL GRIFFIN
DIRECTOR5.004.00$0$0$0Yes (X)
STEPHEN KNIGHT
DIRECTOR5.000.00$0$0$0Yes (X)
ANDREW LEONARD
DIRECTOR5.000.00$0$0$0Yes (X)
FLORENCE BERO MD
DIRECTOR5.002.00$0$0$0Yes (X)
EDWARD S MUCENSKI
CHAIR5.002.00Yes (X)$0$0$0Yes (X)
KATHRYN MULLANEY
DIRECTOR5.002.00$0$0$0Yes (X)
LORETTA PEREZ
DIRECTOR5.002.00$0$0$0Yes (X)
ANNE RICHEY
DIRECTOR5.000.00$0$0$0Yes (X)
JAMES C THEODORE
DIRECTOR5.002.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,131,471TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$218,432TotReportableCompRltdOrgAmt
Total Other Compensation$286,722TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K24IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtAddress Line2ContractorAddress/USAddress/AddressLine2TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MCDERMOTT WILL & EMERY LLP
500 N CAPITOL ST NWMCDERMOTT BUILDINGWASHINGTONDC200011531CONSULTING$1,403,418
EISENBERG VITAL & RYZE ADVERTISING
155 DOW STREET SUITE 300MANCHESTERNH03101ADVERTISING$337,625
KPMG LLP
DEPT 0511 PO BOX 120511DALLASTX753120511FINANCIAL SERVI$181,499
NEWPORT CREDENTIALING SOLUTIONS
15 GRUMMAN RD W 1400BETHPAGENY11714PROVIDER CONTRA$160,921
BENEFIT TECHNOLOGY RESOURCES LLC
PO BOX 26622TAMPAFL33623HR CONSULTING$157,751
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescCLINICAL RESEARCHDesc
Business621110BusinessCd
Total Revenue Column$505,523TotalRevenueColumnAmt
Related Or Exempt Func Income$505,523RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$505,523TotalProgramServiceRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RENTAL INCOME621110$1,454,733$1,454,733
INTEREST INCOME621110$407,947$407,947
FieldValueIRS element (for citing)
Other Revenue Total$1,862,680OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,368,203TotalRevenueColumnAmt
Related Or Exempt Func Income$2,368,203RelatedOrExemptFuncIncomeAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$260,832TotalAmt
Program Services$260,832ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$14,225TotalAmt
Program Services$14,225ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,263,909TotalAmt
Program Services$11,200ProgramServicesAmt
Management And General$1,252,709ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$69,992TotalAmt
Program Services$55,962ProgramServicesAmt
Management And General$14,030ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$75,370TotalAmt
Program Services$75,370ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$22,397TotalAmt
Program Services$20,262ProgramServicesAmt
Management And General$2,135ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,962TotalAmt
Program Services$1,962ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$421TotalAmt
Program Services$421ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,298,212TotalAmt
Management And General$1,298,212ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$978,086TotalAmt
Management And General$978,086ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$225TotalAmt
Management And General$225ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmt
ACO$450,612$450,612
SUPPLIES$7,821$999$6,822
OTHER DIRECT EXPENSE$5,032$5,032

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$4,449,096TotalAmt
Program Services$452,088ProgramServicesAmt
Management And General$3,997,008ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,537,760BOYAmt
EOY$2,189,674EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$126,674BOYAmt
EOY$205,432EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$11,072,684BOYAmt
EOY$12,526,565EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$1,600EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$27,673,462LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,143,519LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$24,927,584BOYAmt
EOY$24,529,943EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$12,519,175BOYAmt
EOY$1,109,415EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$51,183,877BOYAmt
EOY$40,562,629EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$197,460BOYAmt
EOY$2,495,343EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$26,152,670BOYAmt
EOY$25,255,670EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,657,391BOYAmt
EOY$15,780,111EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$44,007,521BOYAmt
EOY$43,531,124EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,176,356BOYAmt
EOY-$2,968,495EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,176,356BOYAmt
EOY-$2,968,495EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$51,183,877BOYAmt
EOY$40,562,629EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$2,080,893ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$8,063,958OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type2Yes (X)SupportingOrgType2Ind
Supported Organizations3SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp (3 entries)

Business Name Line2SupportedOrganizationName/BusinessNameLine2TxtEINEINOrganization TypeOrganizationTypeCdGoverning Document ListedGoverningDocumentListedIndSupportSupportAmtOther SupportOtherSupportAmt
GOUVERNEUR HOSPITAL
GOUVERNEUR HOSPITAL4642495553Yes (true)$0$0
CANTON-POTSDAM HOSPITAL
CANTON-POTSDAM HOSPITAL1610126913Yes (true)$0$0
MASSENA HOSPITAL INC
MASSENA HOSPITAL INC8431342683Yes (true)$0$0
FieldValueIRS element (for citing)
Supported Organizations Total3SupportedOrganizationsTotalCnt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgYes (true)OrganizationChangeSuprtOrgInd
Supported Org Class DesignatedfalseSupportedOrgClassDesignatedInd
Substitution Beyond Org CntlfalseSubstitutionBeyondOrgCntlInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd
FieldValueIRS element (for citing)
Majority Dir Trst Supported OrgfalseMajorityDirTrstSupportedOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, SECTION A, LINE 5AIN JULY 2019, SLHS EXECUTED AN ASSET PURCHASE AGREEMENT (APA) WITH THE TOWN OF MASSENA AND ITS HOSPITAL, MASSENA MEMORIAL HOSPITAL (MMH), SUBJECT TO VARIOUS APPROVALS AND CONDITIONS, TO ACQUIRE SUBSTANTIALLY ALL OF THE ASSETS OF MMH AND ASSUME CERTAIN OUTSTANDING LIABILITIES. THE TRANSACTION WAS OVERSEEN BY THE DOH IN RECOGNITION OF MMH'S PAST OPERATING PERFORMANCE. THE NECESSARY APPROVALS WERE GRANTED AND REQUIRED CONDITIONS MET AND LEGALLY BINDING ON JANUARY 1, 2020.
PART IV, SECTION C, LINE 1CANTON-POTSDAM HOSPITAL'S (CPH) BOARD CONSISTS OF 17 DIRECTORS. SEVEN (7) OF THESE DIRECTORS ARE MEMBERS OF THE ST. LAWRENCE HEALTH SYSTEM (SLHS) BOARD. THE BYLAWS OF THE SLHS BOARD PROVIDE THAT SLHS, AS SOLE MEMBER OF CPH, HAS THE FOLLOWING POWERS REGARDING CPH: A)APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS; B)APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER; C)APPROVE THE ADOPTION AND AMENDMENT OF BYLAWS; D)APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS; E)APPROVE STRATEGIC PLANS; F)APPROVE AND MAY INITIATE THE FILING OF CERTIFICATE OF NEED APPLICATIONS; AND G)APPROVE THE DISSOLUTION OF CPH. GOUVERNEUR HOSPITAL'S (GH) BOARD CONSISTS OF 9 DIRECTORS. ONE (1) DIRECTOR IS A MEMBER OF THE SLHS BOARD. THE BYLAWS OF THE SLHS BOARD PROVIDE THAT SLHS, AS SOLE MEMBER OF GH, HAS THE FOLLOWING POWERS REGARDING GH: A)APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS; B)APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER; C)APPROVE THE ADOPTION AND AMENDMENT OF BYLAWS; D)APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS; E)APPROVE STRATEGIC PLANS; F)APPROVE AND MAY INITIATE THE FILING OF CERTIFICATE OF NEED APPLICATIONS; G)APPROVE THE DISSOLUTION OF GH; H)APPROVE THE SALE, LEASE, MORTGAGE OR ENCUMBRANCE OF ANY ASSET OTHER THAN ANY SALE, LEASE OR MORTGAGE WHICH IS PART OF AN APPROVED BUDGET; I)APPROVE ANY MERGER, BUSINESS CONSOLIDATION, ACQUISITION OR JOINT VENTURE; J)APPROVE THE PURCHASE OR SALE OF PHYSICIAN PRACTICES OTHER THAN ANY PURCHASE OR SALE WHICH IS PART OF AN APPROVED BUDGET; K)APPROVE AND MAY INITIATE THE COMMENCEMENT AND SETTLEMENT OF LITIGATION; L)APPROVE ANY FILING OF A BANKRUPTCY PETITION; M)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; N)APPROVE NEW CLINICAL PROGRAMS OR THE TERMINATIONS OF EXISTING CLINICAL PROGRAMS OTHER THAN ANY ACTION WHICH IS PART OF AN APPROVED BUDGET; O)APPROVE ANY OF THE FOLLOWING AGREEMENTS: (A) MANAGEMENT SERVICES AGREEMENT OTHER THAN ANY AGREEMENT WHICH IS PART OF AN APPROVED BUDGET; (B) CONTRACTS WITH A PHYSICIAN OR PHYSICIAN GROUP; (C) AGREEMENTS FOR THE OUTSOURCING OF A HOSPITAL SERVICE OR FUNCTION; (D) COLLECTIVE BARGAINING AGREEMENTS; AND (E) ANY AGREEMENTS TO PARTICIPATE IN RISK BEARING ARRANGEMENT SUCH AS AN ACCOUNTABLE CARE ORGANIZATION OR A BUNDLED PAYMENT ARRANGEMENT. P)INITIATE, NEGOTIATE AND APPROVE MANAGED CARE AGREEMENTS WITH MANAGED CARE ORGANIZATIONS AND OTHER PAYORS OTHER THAN AGREEMENT WHICH IS PART OF AN APPROVED BUDGET; Q)DEVELOP INTEGRATED SERVICES AND MANDATE PARTICIPATION IN SUCH SERVICES (E.G., FINANCIAL MANAGEMENT, STRATEGIC PLANNING, HUMAN RESOURCES, INFORMATION TECHNOLOGY, LEGAL, QUALITY ASSURANCE, RISK MANAGEMENT, CONTRACTING AND RECRUITMENT); AND R)REQUIRE THE GUARANTEE OF LOANS THROUGH AN OBLIGATED GROUP STRUCTURE THAT WILL SUPPORT ACCESS TO CAPITAL AND MAY INCLUDE DEBT SERVICES. MASSENA HOSPITAL'S (MH) BOARD CONSISTS OF 9 DIRECTORS. NONE OF THESE DIRECTORS ARE MEMBERS OF THE ST. LAWRENCE HEALTH SYSTEM (SLHS) BOARD. THE BYLAWS OF THE SLHS BOARD PROVIDE THAT SLHS, AS SOLE MEMBER OF MH, HAS THE FOLLOWING POWERS REGARDING MH: A)APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS; B)APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER; C)APPROVE THE ADOPTION AND AMENDMENT OF BYLAWS; D)APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS; E)APPROVE STRATEGIC PLANS; F)APPROVE AND MAY INITIATE THE FILING OF CERTIFICATE OF NEED APPLICATIONS; AND G)APPROVE THE DISSOLUTION OF MH.

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$1,046,545InvestmentCostOrOtherBasisAmt
Book Value$1,046,545BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$24,973,396InvestmentCostOrOtherBasisAmt
Depreciation$2,467,752DepreciationAmt
Book Value$22,505,644BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$1,492,114InvestmentCostOrOtherBasisAmt
Depreciation$675,767DepreciationAmt
Book Value$816,347BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$161,407InvestmentCostOrOtherBasisAmt
Book Value$161,407BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$24,529,943TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
DUE TO AFFILIATES$5,982,463
TAXABLE BOND LIABILITY$5,899,000
NOTE-LT$3,594,613
OTHER LT LIAB-PAYROLL$304,035
FieldValueIRS element (for citing)
Total Liability$15,780,111TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$21,667,516TotalRevEtcAuditedFinclStmtAmt
Other Revenue$19,299,313OtherRevenueAmt
Revenue Not Reported$19,299,313RevenueNotReportedAmt
Revenue Subtotal$2,368,203RevenueSubtotalAmt
Total Revenue Per Form990$2,368,203TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$25,212,253TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$20,763,157OtherExpensesIncludedAmt
Expenses Not Reported$20,763,157ExpensesNotReportedAmt
Expenses Subtotal$4,449,096ExpensesSubtotalAmt
Total Expenses Per Form990$4,449,096TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 3, PART XTHE 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 TAXES 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 RECOGNITION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT 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 2DOTHER 19,299,313
SCHEDULE D, PAGE 4, PART XII, LINE 2DOTHER 20,763,157
SCHEDULE D, PAGE 4, PART XIIITHE 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 TAXES 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 RECOGNITION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE SYSTEM AND AFFILIATES DID NOT RECOGNIZE THE EFFECT OF ANY UNCERTAIN INCOME TAX POSITIONS IN EITHER 2020 OR 2019. REVENUE AND EXPENSES RELATED TO INTERCORPORATE TRANSACTIONS BETWEEN SLHS AND RELATED ENTITIES CPH, GH, AND MH ARE EXCLUDED FROM REVENUE AND EXPENSES. THESE ARE FOR CHARGES BILLED TO THE ENTITIES CPH, GH, AND MH (RECORDED AS BILLABLE EXPENSES) AND THEN CASH IS COLLECTED FOR THESE (RECORDED AS BILLABLE REVENUE).

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
DAVID ACKER
PRESIDENT/CEO$785,218$19,950$19,620$824,788
KATHERINE SCHLEIDER
COO$426,331$12,121$33,277$471,729
RICHARD JACOBS
PROJECT SPECIALIST$389,565$19,950$13,275$422,790
DAVID BENDER
VP STRATEGIC PLANNIN$353,769$14,100$12,039$379,908
ERIC BURCH
CEO$338,872$13,100$10,768$362,740
JANET SCHAPIRO
VP NURSING$306,209$12,175$12,041$330,425
SUSAN HODGSON
VP COMPLIANCE$276,773$12,135$10,927$299,835
MICHAEL TULLOCH MD
DIRECTOR$218,432$13,234$21,304$252,970
DONNA MCGREGOR
CFO/VP OF FINANCE$184,769$3,273$12,918$200,960

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART IIIFormAndLineReferenceDesc
ExplanationTHE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS SEEKS THE INPUT OF A CONSULTING FIRM WITH NATIONAL EXPERIENCE TO REVIEW THE COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AND THE REGULATORY COMPLIANCE ISSUES OF NOT FOR PROFITS. UPON FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE 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.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1ST LAWRENCE COUNTY IDA CIVIC DEVELBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN272614310BondIssuerEIN
Bond Issued2016-04-01BondIssuedDt
Issue Price$28,500,000IssuePriceAmt
PurposeTHE BOND ISSUANCE OF 28,500,000 IS TO FINANCE A PROJECT FOR THE BENEFIT OF ST. LAWRENCE HEALTH SYSTEPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$3,244,000RetiredAmt
Total Proceeds$28,500,000TotalProceedsAmt
Capitalized Interest$733,875CapitalizedInterestAmt
Issuance Costs From Proceeds$130,346IssuanceCostsFromProceedsAmt
Capital Expenditures$27,635,779CapitalExpendituresAmt
Substantial Completion2017SubstantialCompletionYr
Refunding Tax Exempt BondsfalseRefundingTaxExemptBondsInd
Refunding Taxable BondsfalseRefundingTaxableBondsInd
Final Allocation MadefalseFinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetYes (true)RebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssueYes (true)VariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePURPOSE OF ISSUE DESCRIPTIONFormAndLineReferenceDesc
ExplanationST. LAWRENCE COUNTY IDA CIVIC DEVEL THE BOND ISSUANCE OF 28,500,000 IS TO FINANCE A PROJECT FOR THE BENEFIT OF ST. LAWRENCE HEALTH SYSTEM AND CANTON-POTSDAM HOSPITAL CONSISTING OF (1) THE CONSTRUCTION OF AN APPROXIMATELY 60,000 SQ. FT., THREE-LEVEL MEDICAL OFFICE BUILDING LOCATED AT 6119 US HIGHWAY 11, IN THE TOWN OF CANTON, NEW YORK; (2) THE ACQUISITION AND INSTALLATION IN THE MEDICAL OFFICE BUILDING OF FURNITURE, MACHINERY AND EQUIPMENT; (3) THE RENOVATION AND IMPROVEMENT OF THE EXISTING HOPSITAL BUILDING LOCATED AT 50 LEROY STREET, IN THE VILLAGE OF POTSDAM, NEW YORK; (4) THE ACQUISITION AND INSTALLATION AT THE HOSPITAL OF FURNITURE, MACHINERY AND EQUIPMENT; AND (5) PAYING COSTS INCEDENTAL TO THE FINANCING THEREOF.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonSEE PART V ADDITIONAL INFORMATIONPersonNm
FieldValueIRS element (for citing)
Sharing Of RevenuesfalseSharingOfRevenuesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART VFormAndLineReferenceDesc
ExplanationDUE TO OUR BOARD MEMBERS' AFFILIATIONS WITH RELATED HOSPITALS CANTON- POTSDAM HOSPITAL (CPH) AND GOUVERNEUR HOSPITAL (GH) (AS DISCLOSED ON SCHEDULE R), WE ARE DISCLOSING THE FOLLOWING: 1. DONALD DANGREMOND, SLHS BOARD SECRETARY AND CPH BOARD MEMBER, RETIRED AS AN EMPLOYEE OF CLARKSON UNIVERSITY (CU). CPH PROVIDES HEALTHCARE SERVICES AND STAFFS A CLINIC ON THE CU CAMPUS. THE OPERATION COSTS OF THAT CLINIC IN 2020 WERE APPROXIMATELY 557,077 WHICH WERE REIMBURSED BY CU ON A PASS THROUGH BASIS. 2. BRIAN GARDAM, SLHS AND CPH BOARD MEMBER, WAS THE FORMER EXECUTIVE DIRECTOR OF HOSPICE OF PALLIATIVE CARE OF ST. LAWRENCE VALLEY (HOSPICE). BRIAN IS ALSO A BOARD MEMBER FOR NORTHERN LIGHTS HEALTH CARE. HOSPICE CONTRACTS WITH CPH FOR INPATIENT HOSPICE SERVICES FOR SYMPTOM MANAGEMENT AND PAIN CONTROL. 3. JAMES THEODORE, SLHS AND CPH BOARD MEMBER, IS ALSO THE MORGAN STANLEY SMITH BARNEY LLC FINANCIAL ADVISOR FOR AN ACCOUNT HELD IN THE NAME OF CANTON-POTSDAM HOSPITAL FOUNDATION, INC. (A RELATED TAX-EXEMPT ORGANIZATION TO CPH). THIS FOUNDATION ACCOUNT IS USED AS A PASS-THROUGH FOR DONATIONS OF STOCK. THE BALANCE IN THIS ACCOUNT AS OF DECEMBER 31, 2020 WAS 0. 4. DURING 2010, BOND ISSUES WERE OBTAINED FOR CPH FROM COMMUNITY BANK, NA AND KEY BANK, AS DISCLOSED IN SCHEDULE K OF CPH'S FORM 990. THE COMMUNITY BANK, NA PORTION OF THESE BOND ISSUES WERE IN THE AMOUNT OF 3,585,000. IN 2011, CPH WAS ISSUED A MORTGAGE BY COMMUNITY BANK, NA FOR CONSTRUCTION OF THE E.J. NOBEL ANNEX BUILDING, IN THE AMOUNT OF 2,200,000. EDWARD MUCENSKI, SLHS CHAIR AND CPH BOARD MEMBER, WAS A SHAREHOLDER AND A BOARD MEMBER OF COMMUNITY BANK, NA UNTIL DECEMBER 31, 2017. AS OF DECEMBER 31, 2020 CPH WAS CURRENT ON ANY OBLIGATIONS DUE TO THE BANK. 5. SLHS VICE CHAIR AND CPH BOARD MEMBER, MARK CORNETT, WAS A CONSULTANT FORMERLY EMPLOYED BY SLIC NETWORK SOLUTIONS. SLIC RENTS OFFICE SPACE AT CPH'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. CPH REMITTED APPROXIMATELY 276,425 TO SLIC IN 2020 FOR TELECOMMUNICATION SERVICES. 6. MARK BRACKETT, SLHS BOARD TREASURER AND GH BOARD MEMBER, WAS PRESIDENT OF KINNEY DRUGS FOUNDATION FROM JANUARY 1, 2014 UNTIL JUNE 30, 2014. HE REMAINS ON THE KINNEY DRUGS FOUNDATION BOARD OF DIRECTORS. KINNEY DRUGS FOUNDATION IS UNDER THE PARENT ORGANIZATION, KPH HEALTHCARE SERVICES. CPH AND GH PARTICIPATED WITH ONE OR MORE OF THE KPH HEALTHCARE CORPORATE DIVISIONS IN THE HOSPITALS' 340B PROGRAMS. 7. ANNE RICHEY, SLHS BOARD DIRECTOR, IS EXECUTIVE DIRECTOR OF UNITED CEREBRAL PALSY ASSOCIATION OF THE NORTH COUNTRY, INC., DBA COMMUNITY HEALTH CENTER OF THE NORTH COUNTRY. IN 2020, THE UNITED CEREBRAL PALSY ASSOCIATION RENTED OUTPATIENT CLINIC SPACE FROM GH, FOR APPROXIMATELY 9,843 PER MONTH FOR THE COMMUNITY HEALTH CENTER OF THE NORTH COUNTRY. 8. MICHAEL GRIFFIN, SLHS AND CPH (RELATED ORGANIZATION) BOARD MEMBER, RETIRED AS AN EMPLOYEE OF CLARKSON UNIVERSITY (CU) IN 2017. MICHAEL GRIFFIN SERVES AS A PAID CONSULTANT TO CLARKSON UNIVERSITY. CPH PROVIDES HEALTHCARE SERVICES AND STAFFS A CLINIC ON THE CU CAMPUS. THE OPERATION COSTS OF THAT CLINIC IN 2020 WERE 557,077 WHICH WERE REIMBURSED BY CU ON A PASS THROUGH BASIS. 9. DR. MICHAEL TULLOCH, BOARD MEMBER OF SLHS IS A CPH HOSPITALIST. DR. TULLOCH WAS COMPENSATED 252,971 FOR HIS SERVICES TO CPH. SLHS CLINICAL RESEARCH LEASES OFFICE SPACE FROM GAIL AND DR. MICHAEL TULLOCH IN POTSDAM, NEW YORK. SLHS REMITTED 19,200 TO GAIL AND DR. MICHAEL TULLOCH IN 2020 FOR RENT. 10. ANDREW LEONARD, BOARD MEMBER, IS ALSO THE PRESIDENT OF EMPIRE NORTHEAST MECHANICAL CONTRACTOR (ENI MECHANICAL, INC.). CANTON-POTSDAM HOSPITAL AND MASSENA HOSPITAL CONTRACT WITH ENI MECHANICAL, INC. FOR VARIOUS MECHANICAL PROJECTS. CPH AND MH REMITTED APPROXIMATELY A TOTAL OF 401,494 TO ENI MECHANICAL, INC. IN 2020 FOR MECHANICAL SERVICES.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4DDURING 2020, THE CLINICAL RESEARCH PROGRAM INCLUDED 16 STUDIES CONDUCTED AND INCLUDED 34 ENROLLED PARTICIPANTS.
FORM 990, PAGE 6, PART VI, LINE 11BTHE 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 12CBOARD MEMBER CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED AND REVIEWED BY THE BOARD ANNUALLY.
FORM 990, PAGE 6, PART VI, LINE 15ATHE 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 NOT-FOR-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 15BTHE 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 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9TRANSFER TO MMH -7,200,000 TRANSFER FROM CPH ACO 449,887 REV/EXP ADJ -1,463,845 TRANSFER FROM ROCHESTER RH 150,000 TOTAL -8,063,958

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
CANTON-POTSDAM HOSPITAL INC
50 LEROY STREETPOTSDAMNY13676161012691HOSPITALNY501C3SLHSYes (true)
GOUVERNEUR HOSPITAL INC
77 WEST BARNEY STREETGOUVERNEURNY13642464249555HOSPITALNY501C3SLHSYes (true)
CANTON-POTSDAM HOSPITAL FOUNDATION
29 GROVE STREETPOTSDAMNY13676161279472FUNDRAISGNY501C12ASLHSYes (true)
CANTON-POTSDAM MEDICAL PRACTICEPLLC
50 LEROY STREETPOTSDAMNY13676460714367OUT PATIENNY501C3SLHSYes (true)
ADIRONDACK HEALTH INSTITUTE
101 RIDGE STREETGLENS FALLSNY12801141698269CONSORTIUMNY501C3falseN/A
MASSENA MEMORIAL HOSPITAL
1 HOSPITAL DRIVEMASSENANY13662843134268HOSPITALNY501C3NAYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ACCOUNTABLE CARE ORGANIZATIONBusinessNameLine1Txt
Business Name Line2OF THE NORTH COUNTRY LLCBusinessNameLine2Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1555 WEST GRANADA BLVD 555AddressLine1Txt
CityORMOND BEACHCityNm
State AbbreviationFLStateAbbreviationCd
ZIP32174ZIPCd
FieldValueIRS element (for citing)
EIN454106154EIN
Primary ActivitiesSERV COORDPrimaryActivitiesTxt
Legal Domicile StateFLLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeTypeTxt
Share Of Total Income-$585,521ShareOfTotalIncomeAmt
Share Of EOY Assets$55,609ShareOfEOYAssetsAmt
Disproportionate AllocationsfalseDisproportionateAllocationsInd
General Or Managing PartnerfalseGeneralOrManagingPartnerInd
Ownership0.25500OwnershipPct
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
GOUVERNEUR HOSPITAL INC
Q$713,547FMV
CANTON-POTSDAM HOSPITAL
S$449,887CASH EXCHANGED