2021-11-15T16:31:29-06:00 2020-12-31 822624857 GRAY & GRAY AND ASSOCIATES CPAS PC 1 MAIN STREET SUITE 101 CANTON NY 136171277 990 2020-01-01 161012691 CANTON-POTSDAM HOSPITAL CANT 3152615103 50 LEROY STREET POTSDAM NY 13676 DONNA MCGREGOR CFO 3152615103 2021-10-20 true DONNA MCGREGOR 999009999 JOHN J GRAY JR CPA P00076464 3153862925 2021-11-15 2020 2022-09-23 18:48:47Z DONNA MCGREGOR 50 LEROY STREET POTSDAM NY 13676 219738471 false X WWW.CPHOSPITAL.ORG X 1920 NY CANTON-POTSDAM HOSPITAL'S MISSION IS TO PROVIDE SKILLED, COMPASSIONATE, COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS COMMUNITY NEEDS. 18 5 1467 92 0 2188095 14019668 193142376 177283029 1803975 514112 24891864 27231227 222026310 219048036 0 0 126390974 126014155 0 0 79653775 84012841 206044749 210026996 15981561 9021040 157784645 195532189 64735800 89100911 93048845 106431278 X CANTON-POTSDAM HOSPITAL'S MISSION IS TO PROVIDE SKILLED, COMPASSIONATE COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS COMMUNITY NEEDS. false false 108245288 257222850 ACUTE CARE: CANTON-POTSDAM HOSPITAL HAS A TOTAL OF 94 LICENSED BEDS, COMPRISED OF 17 FOR CHEMICAL DEPENDENCY-REHABILITATION, 6 FOR INTENSIVE CARE, 8 FOR MATERNITY AND 63 FOR MEDICAL/SURGICAL. PROFESSIONAL STAFF COVERAGE FOR OUR IN-PATIENT CENSUS IS PROVIDED BY A HOSPITALIST PROGRAM. TOTAL PATIENT DAYS DECREASED BY APPROXIMATELY 11.31% FROM 2019 TO 2020. OBSERVATION CASES DECREASED BY APPROXIMATELY 21.62% FROM 2019 TO 2020. EMERGENCY ROOM VISITS DECREASED BY 22% FROM 2019 TO 2020. VOLUME DECREASED AS A RESULT OF COVID-19 IMPACT. 43944527 52228406 HOSPITAL BED CLINICS: THERE WAS A DECLINE OF THE HOSPITAL BASED CLINICS. THERE WERE 206,297 VISITS IN 2019, COMPARED TO 178,769 IN 2020; ROUGHLY A 13% DECREASE. VOLUME DECREASED AS A RESULT OF THE COVID-19 IMPACT. 9758329 24087894 OPERATING ROOM: IN 2020, THE OPERATING ROOM NUMBER OF CASES DECREASED BY APPROXIMATELY 22% COMPARED TO 2019. VOLUME DECREASED AS A RESULT OF COVID-19 IMPACT. 8567410 13069402 IN 2020, THE ONCOLOGY VISITS DECREASED APPROXIMATELY 4.97% FROM 10,577 IN 2019 TO 10,051 IN 2020. 8567410 13069402 170515554 true false false true false false false false false true true false false true true true false true false false false false false false false false true true false false true true false false true false false false false true false false false false false false false true true true false false true 214 0 true 1467 true false false false false false false false false false false false false false false X 18 5 false false false false true true true true true false true true true true true true true true true true false NY X DONNA MCGREGOR CANTON-POTSDAM HOSP 3152615451 50 LEROY STREET POTSDAM NY 13676 HUNG CHIN HO MD MEDICAL DOCT 50.00 0.00 X 1207978 0 23855 JEFFREY HAASBEEK MD MEDICAL DOCT 50.00 0.00 X 800010 0 47377 THOMAS KNEIFEL MD MEDICAL DOCT 50.00 0.00 X 795098 0 47377 DAVID ACKER PRESIDENT & 50.00 0.00 X 0 785218 39570 ROBERT CUMMINGS MD MEDICAL DOCT 50.00 0.00 X 754116 0 47377 CHINYERE M NWOSU DORCIS MD MEDICAL DOCT 50.00 0.00 X 746077 0 48336 RICHARD JACOBS PROJECT MANA 50.00 0.00 X 0 389565 33225 MICHAEL TULLOCH MD MEDICAL DIRE 50.00 0.00 X 218432 0 34538 DONNA MCGREGOR CFO 50.00 0.00 X 0 184769 16191 CATHERINE BLEVINS DIRECTOR 2.00 0.00 X 0 0 0 JUDITH CHASE SECRETARY 4.00 0.00 X X 0 0 0 MARK CORNETT BOARD CHAIR 4.00 5.00 X X 0 0 0 PAUL COLE DVM DIRECTOR 2.00 0.00 X 0 0 0 DONALD DANGREMOND 2ND VICE CHA 4.00 5.00 X X 0 0 0 ERIN DRAPER DIRECTOR 2.00 0.00 X 0 0 0 BRIAN GARDAM DIRECTOR 2.00 5.00 X 0 0 0 MICHAEL GRIFFIN 1ST VICE CHA 4.00 5.00 X X 0 0 0 JACQUELYN KUNO DIRECTOR 2.00 0.00 X 0 0 0 FLORENCE BERO MD DIRECTOR 2.00 5.00 X 0 0 0 PAUL MCGRATH TREASURER 4.00 0.00 X X 0 0 0 EDWARD MUCENSKI DIRECTOR 2.00 0.00 X 0 0 0 KATHRYN MULLANEY DIRECTOR 2.00 0.00 X 0 0 0 LENORE VANDERZEE PHD DIRECTOR 2.00 0.00 X 0 0 0 JOANNE SCOTT DIRECTOR 2.00 0.00 X 0 0 0 JAMES THEODORE DIRECTOR 2.00 0.00 X 0 0 0 RICHARD VANLEUVEN DIRECTOR 2.00 0.00 X 0 0 0 4521711 1359552 337846 6 false true false MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 LAB SERVICES 2161126 MEDEFIS INC 2121 N 117TH AVE OMAHA NE 68164 HEALTH CRE MANA 1682924 BIOFIRE DIAGNOSTICS 515 COLORWOW DR SALT LAKE CITY UT 84108 BIOTECH 1249264 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 STAFFING 868666 THE UNIVERSITY OF VERMONT 194 SOUTH PROSPECT STREET BURLINGTON VT 05401 LAB SERVICES & 809759 41 13973353 46315 14019668 NET PATIENT SERVICE REVENUE 900099 177283029 177283029 177283029 217499 217499 229448 539540 -310092 -310092 -310092 157405 290103 150895 6510 290103 296613 296613 340B RETAIL PROGRAM 18595696 18595696 ALL OTHER REVENUE 4940365 4940365 OTHER 4005258 4005258 27541319 219048036 177283029 27745339 103882510 85178844 18703666 3551757 2912441 639316 13004547 10663729 2340818 5575341 4571780 1003561 274658 274658 295373 295373 17303 17303 152372 152372 524354 429970 94384 3720045 3090780 629265 331847 272115 59732 337113 276433 60680 1073907 880604 193303 7062168 5790978 1271190 2079642 1705306 374336 SUPPLIES 30595301 25088147 5507154 PURCHASED/CONTRACTED SERV 23907470 19604077 4303393 EQUIPMENT RENTAL & MAINT 7278939 6005664 1273275 MISC. 2726253 2321709 404544 3636096 1570605 2065491 210026996 170515554 39511442 0 3865438 9718004 1314408 15558459 21247670 21484245 2310027 2680070 3339459 4143742 161161611 110552741 53510064 50608870 987553 1041596 71210026 90297203 157784645 195532189 30247832 34451147 9115306 8335306 1342096 1154582 24030566 45159876 64735800 89100911 X 93048845 105711520 719758 93048845 106431278 157784645 195532189 X 9021040 47534 4313859 X false true X true false X false false false false false false false false true 17303 17303 false SCHEDULE C, PART II-B, LINE 1 IROQUOIS HEALTHCARE ALLIANCE: 1,883: FEDERAL AND STATE ADVOCACY HANYS ANNUAL MEMBERSHIP DUES: 10,677: FEDERAL AND STATE ADVOCACY AMERICAN HOSPITAL ASSOCIATION ANNUAL MEMBERSHIP DUES: 4,742: FEDERAL AND STATE ADVOCACY 987553 54043 1041596 894657 92896 987553 948837 -54180 894657 907013 41824 948837 894097 12916 907013 0.69000 0.31000 false false 4633337 4633337 56358924 29070799 27288125 10296039 5894474 4401565 89463642 75587468 13876174 409669 409669 50608870 ASSETS WHOSE USEFUL LIFE IS LIMITED 36304701 INTEREST IN CANTON HOSP FOUNDATION 28588308 OTHER NOTES & LOANS RECEIVABLE (NET) 9420695 DUE FROM ST. LAWRENCE HEALTH SYSTEM 8825805 OTHER ASSETS 6520077 DUE FROM CPH FOUNDATION 547268 DUE FROM AFFILIATES 90349 90297203 ESTIMATED THIRD PARTY SETTLEMENTS 30912460 OTHER LIABILITIES 7833999 DUE TO AFFILIATES 5705475 INTEREST RATE SWAP 707942 45159876 X 218834638 539539 539539 218295099 752937 752937 219048036 210566536 539540 539540 210026996 210026996 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 539,539 SCHEDULE D, PAGE 4, PART XI, LINE 4B GIFT AND BEQUESTS: 46,315 CHANGE OF FAIR MARKET VALUE OF INTEREST RATE SWAP -17,390 UNRESTRICTED ENDOWMENT INCOME: 18,836 NET REALIZED GAIN (LOSS) ON INVESTMENTS: -1,328 OTHER GAINS, NET 176,974 NET PERIODIC PENSION (COST) GAIN, NON-SERVICE RELATED 529,530 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 539,540 true true true X true X true true false true true 165339 165339 0.00080 42123701 21911818 20211883 0.09620 42289040 21911818 20377222 0.09700 100047 100047 0.00050 523067 523067 0.00250 7400 7400 630514 630514 0.00300 42919554 21911818 21007736 0.10000 634782 634782 0.00300 634782 634782 0.00300 true 2834193 1115727 31274233 40331426 -9057193 X true true 1 1 CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 HTTPS://WWW.STLAWRENCEHEALTHSYSTEM.ORG X X X CANTON-POTSDAM HOSPITAL 1 false false true X X X X X X X X X X 19 true true true true X HTTPS://WWW.STLAWRENCEHEALTHSYSTEM.ORG X true 19 false false false true X 100.000000000000 300.000000000000 true true X X X X true X HTTPS://WWW.STLAWRENCEHEALTHSYSTEM.ORG X HTTPS://WWW.STLAWRENCEHEALTHSYSTEM.ORG X HTTPS://WWW.STLAWRENCEHEALTHSYSTEM.ORG X X X X X X true X X false X X true X false true FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 3E SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 5 SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 6A SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 6B SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 15E SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 24 SEE PART VI SCHEDULE H, PART VI PART V, 24: THE HOSPITAL USES THE HIGHEST VOLUME COMMERCIAL COVERAGE RATE, FROM BLUE CROSS/BLUE SHIELD, WHICH IS ALSO GENERALLY THE LOWEST RATE CHARGED. 1.REQUIRED DESCRIPTIONS: PART II -COMMUNITY BUILDING ACTIVITIES - 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. PART III, SECTION A, LINES 2 & 3 THE COSTS ON LINE 2 ARE BASED UPON THE MEDICARE ICR FOR 2020 APPLIED TO THE GROSS CHARGES WRITTEN OFF. THE COSTS ON LINE 3 WERE CALCULATED IN ACCORDANCE WITH THE COSTING METHODOLOGY EMPLOYED BY THE NYS DOH BAD DEBT COSTING PROCESS. PART III SECTION A, LINE 4 - PAGE 14 OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS (FN4B-PATIENT SERVICE RECEIVABLES) PART III SECTION B, 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, OUTPATIENT COSTS AND SWING BED COSTS FROM MCR COST REPORT, WORKSHEETS D-1: PART II AND PART IV; WORKSHEET D: PART V; AND WORKSHEET E, E-2 AND D-3. PART III SECTION C, 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. PART V SECTION B, LINE 5 - CANTON-POTSDAM HOSPITAL'S (CPH'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. CPH 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. CPH 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. CPH PARTNERED IN LATE 2015 WITH ACTIVE INVOLVEMENT ON THE BOARD OF DIRECTORS OF THE ST. LAWRENCE COUNTY COMMUNITY DEVELOPMENT PROGRAM, WHICH OPERATES FOOD BANKS IN OUR SERVICE AREA, TO OFFER HEALTH SERVICES AND TO SEEK INPUT FROM THOSE SERVED BY THE FOOD BANKS. INPUT IS ALSO SOUGHT THROUGH THE HOSPITAL'S AND SYSTEM'S AUXILIARY GROUPS, AND FORUMS WITH ITS VOLUNTEERS, COMPRISING STUDENTS, THE ELDERLY, AND THOSE LIVING WITH DISABILITIES. IN 2013, A PATIENT ADVISORY GROUP, REFLECTING THE DIVERSITY OF THE COMMUNITY, WAS FORMED. THIS GROUP PROVIDES INVALUABLE FEEDBACK ON THE PATIENT EXPERIENCE AND COMMUNITY NEEDS. PART V, SECTION B, LINE 6A&B - CANTON-POTSDAM 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. PART V SECTION B, LINE 11 - CANTON-POTSDAM 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, SUCH AS THE POTSDAM RECREATION DEPARTMENT AND THE SCHOOL SYSTEM, FOR INTEGRATING HEALTHY FOOD CHOICES IN CHILDHOOD AND ADOLESCENT ACTIVITIES; AND SUPPORT FOR LOCAL FOOD BANKS AND A LOCAL NON- PROFIT FOOD SECURITY PROGRAM. PARTNERSHIP PROGRAMS WITH NORTH COUNTRY CHILDREN'S MUSEUM, NORTH COUNTRY JR. IRON CHEF, SEAWAY VALLEY PREVENTION COUNCIL, AND HOSPICE AND PALLIATIVE CARE OF ST. LAWRENCE VALLEY HELP ADDRESS CHILDHOOD OBESITY, SUICIDE PREVENTION, AND MENTAL HEALTH ILLNESSES, AS WELL AS SUBSTANCE USE PREVENTION. CANTON-POTSDAM HOSPITAL 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. 2.NEEDS ASSESSMENT: PLEASE REFERENCE THE ABOVE REQUIRED DESCRIPTIONS, PART V SECTION B, LINES 5 AND 11B. 3.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: 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. 4.COMMUNITY INFORMATION: CANTON-POTSDAM 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. CANTON-POTSDAM HOSPITAL'S PRIMARY SERVICE AREA INCLUDES APPROXIMATELY 58,000 PEOPLE LIVING IN THE COMMUNITIES OF POTSDAM, CANTON AND NEARBY SMALLER COMMUNITIES AND INCLUDES THE STUDENT POPULATION OF FOUR COLLEGES IN CANTON AND POTSDAM. THE SECONDARY SERVICE AREA FOR THE HOSPITAL IS PREDOMINANTLY THE REMAINING COMMUNITIES WITHIN ST. LAWRENCE COUNTY WITH SOME RESIDENTS OF THE WESTERN FRANKLIN COUNTY AREA BEING SERVED. 5.PROMOTION OF COMMUNITY HEALTH: THE HOSPITAL HOSTS AND ATTENDS NUMEROUS HEALTH FAIRS THROUGHOUT THE YEAR, ALONG WITH HOSTING EVENTS SUCH AS "WALK WITH A DOC", "CREATING A HEALTH COMMUNITY" ATP CARDIO HEALTH PANEL, MEDICAL MINUTE AND WISE COMMUNITY. THE APPROXIMATE VALUE OF THESE EFFORTS WAS 8,720. THE HOSPITAL'S LIFELINE DEPARTMENT HAS PROVIDED THE COMMUNITY WITH 79 FREE LIFELINE INSTALLS. THE TOTAL COST OF THESE INSTALLS FOR 2020 WAS 2,528. THE HOSPITAL'S BIRTHPLACE PROVIDES CHILDBIRTH CLASSES, BREASTFEEDING CLASSES, EARLY PREGNANCY CLASSES AND INFANT CPR CLASSES. THE APPROXIMATE 2020 COST ASSOCIATED WITH THESE BENEFITS WAS 1,475 THE HOSPITAL CONDUCTS A BREAST CANCER SUPPORT GROUP ONCE A MONTH, AS WELL AS SPONSORS A CANCER SURVIVOR'S DAY AND BREAST CANCER SURVIVOR DINNER. THE HOSPITAL CONDUCTS PERIODIC FREE CANCER SCREENINGS AND PROVIDES THE COMMUNITY INFORMATION AT A VARIETY OF EVENTS. THE TOTAL APPROXIMATE COST OF THESE BREAST CANCER EDUCATION AND AWARENESS ACTIVITIES FOR 2020 WAS 196. 6.AFFILIATED HEALTH CARE SYSTEM: ST. LAWRENCE HEALTH SYSTEM, FORMED DECEMBER 5, 2013, IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPI X X X X X false false false false false false false false false HUNG CHIN HO MD MEDICAL DOCTOR 1207978 14100 9755 1231833 JEFFREY HAASBEEK MD MEDICAL DOCTOR 800010 14100 33277 847387 THOMAS KNEIFEL MD MEDICAL DOCTOR 795098 14100 33277 842475 DAVID ACKER PRESIDENT & CEO 785218 19950 19620 824788 ROBERT CUMMINGS MD MEDICAL DOCTOR 754116 14100 33277 801493 CHINYERE M NWOSU DORCIS MD MEDICAL DOCTOR 746077 14100 34236 794413 RICHARD JACOBS PROJECT MANAGER 389565 19950 13275 422790 MICHAEL TULLOCH MD MEDICAL DIRECTOR 218432 13234 21304 252970 DONNA MCGREGOR CFO 184769 3273 12918 200960 SCHEDULE J, PART III THE 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 THE 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. THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED PRIMARILY BY THE WORK OF THE HUMAN RESOURCE DEPARTMENT, THE RECOMMENDATION OF THE VICE PRESIDENT OF HUMAN RESOURCES (HR), AND BY INFORMATION GATHERED FROM INDEPENDENT SURVEY DATA OF NATIONAL AND SURROUNDING MARKETS. THE VICE PRESIDENT OF HUMAN RESOURCES WILL REVIEW THE SURVEY DATA TO ESTIMATE SALARY RANGES AND COMPENSATION PACKAGES. THE VP OF HR MAKES THE RECOMMENDATION TO THE CEO. THE CEO WILL BRING THE INFORMATION TO THE COMPENSATION COMMITTEE. AFTER DELIBERATIONS AND CONSIDERATIONS, THE COMPENSATION COMMITTEE WILL THEN BRING THEIR RECOMMENDATION TO THE FULL BOARD FOR THEIR FINAL APPROVAL. A ST LAWRENCE COUNTY IDC 272614310 2010-08-30 21305500 SEE PART VI false true false A 10125000 20921703 11168176 9590000 2011 true false false true A false false false false false false true A false true false false true false false false true A true PURPOSE OF ISSUE DESCRIPTION ST. LAWRENCE COUNTY IDC SEE PART VI ADDITIONAL INFORMATION ST. LAWRENCE COUNTY IDC CANTON-POTSDAM HOSPITAL FOUNDATION, INC. EIN: 16-1279472 ATTACHMENT TO FORM 990, SCHEDULE K PART VI - SUPPLEMENTAL INFORMATION PART I, LINE A THIS FINANCING CONSISTS OF TWO SERIES OF BONDS - THE 17,720,000 ST. LAWRENCE COUNTY INDUSTRIAL DEVELOPMENT AGENCY CIVIC DEVELOPMENT CORPORATION REVENUE BONDS (CANTON-POTSDAM HOSPITAL), SERIES 2010 (THE "HOSPITAL BONDS") AND 3,585,000 ST. LAWRENCE COUNTY INDUSTRIAL DEVELOPMENT AGENCY CIVIC DEVELOPMENT CORPORATION REVENUE BONDS (CANTON-POTSDAM HOSPITAL FOUNDATION, INC.), SERIES 2010 (THE "FOUNDATION BONDS-; THE FOUNDATION BONDS AND THE HOSPITAL BONDS ARE HEREINAFTER JOINTLY REFERRED TO AS THE "BONDS"). PROCEEDS OF THE HOSPITAL BONDS WERE USED TO FINANCE THE CONSTRUCTION AND EQUIPPING OF HEALTH CARE FACILITIES OWNED BY CANTON-POTSDAM HOSPITAL (THE "HOSPITAL"), AND TO REFUND OUTSTANDING TAX-EXEMPT OBLIGATIONS ISSUED AUGUST 20, 2002 TO FINANCE HOSPITAL FACILITIES. PROCEEDS OF THE FOUNDATION BONDS WERE ISSUED TO FINANCE THE ACQUISITION, CONSTRUCTION AND EQUIPPING OF MEDICAL FACILITIES OWNED BY CANTON-POTSDAM HOSPITAL FOUNDATION, INC. (THE "FOUNDATION") WHICH ARE LEASED TO THE HOSPITAL. THE HOSPITAL BONDS AND FOUNDATION BONDS WERE SOLD AT THE SAME TIME PURSUANT TO A COMMON PLAN OF FINANCING AND WILL BE PAID OUT OF SUBSTANTIALLY THE SAME SOURCE OF FUNDS. THEREFORE, PURSUANT TO TREASURY REGULATION SECTION 1.150-1(C), THE HOSPITAL BONDS AND THE FOUNDATION BONDS ARE TREATED AS A SINGLE ISSUE OF BONDS FOR TAX PURPOSES, IN THE AGGREGATE PRINCIPAL AMOUNT OF 21,305,000. CONSISTENT WITH THE CHARACTERIZATION OF THE BONDS AS A SINGLE ISSUE FOR TAX PURPOSES, THE HOSPITAL BONDS AND FOUNDATION BONDS ARE REPORTED AS A SINGLE ISSUE ON SCHEDULE K TO THE HOSPITAL'S FORM 990. PART II, LINE 3 - TOTAL PROCEEDS OF ISSUE THE BONDS WERE ORIGINALLY ISSUED AS "DRAW-DOWN BONDS" IN THE MAXIMUM PRINCIPAL AMOUNT OF 21,305,000, WHICH REPRESENTS THE ORIGINAL ISSUE PRICE OF THE BONDS REPORTED ON IRS FORM 8038. ULTIMATELY, ONLY 20,921,703 OF BOND PROCEEDS WERE ACTUALLY DRAWN. PART II, LINE 11 - OTHER SPENT PROCEEDS PROCEEDS OF THE BONDS IN THE PRINCIPAL AMOUNT OF 9,590,000 WERE SPENT ON SEPTEMBER 27, 2010 TO REDEEM CERTAIN OUTSTANDING TAX-EXEMPT BONDS ISSUED AUGUST 20, 2002 TO FINANCE HOSPITAL FACILITIES. SEE PART V false SCHEDULE L, PART V OUR ORGANIZATION HAS BUSINESS TRANSACTIONS INVOLVING CERTAIN MEMBERS OF OUR BOARD OF DIRECTORS, WHICH ARE DETAILED BELOW: 1.DONALD DANGREMOND, MICHAEL GRIFFIN, ERIN DRAPER AND PAUL MCGRATH, BOARD MEMBERS, ARE/WERE EMPLOYEES OF CLARKSON UNIVERSITY (CU). OUR ORGANIZATION 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, BOARD MEMBER, IS ALSO THE FORMER EXECUTIVE DIRECTOR OF HOSPICE OF PALLIATIVE CARE OF ST. LAWRENCE VALLEY (HOSPICE). CANTON- POTSDAM HOSPITAL CONTRACTS WITH HOSPICE FOR INPATIENT HOSPICE SERVICES FOR SYMPTOM MANAGEMENT AND PAIN CONTROL. BRIAN GARDAM IS ALSO ON THE BOARD OF DIRECTORS FOR NORTHERN LIGHTS HEALTH CARE. 3.DURING 2010, BOND ISSUES WERE OBTAINED FOR CANTON-POTSDAM HOSPITAL FROM COMMUNITY BANK, NA AND KEY BANK, AS DISCLOSED IN SCHEDULE K. THE COMMUNITY BANK, NA PORTION OF THESE BOND ISSUES WERE IN THE AMOUNT OF 3,585,000. IN 2011, THE HOSPITAL 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, BOARD MEMBER, IS A BOARD MEMBER OF COMMUNITY BANK, NA. AS OF DECEMBER 31, 2020 THE HOSPITAL WAS CURRENT ON ANY OBLIGATIONS DUE TO THE BANK. 4.BOARD MEMBER MARK CORNETT IS FORMERLY A CONSULTANT FOR SLIC NETWORK SOLUTIONS. SLIC RENTS OFFICE SPACE AT THE HOSPITAL'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. CANTON-POTSDAM HOSPITAL REMITTED APPROXIMATELY 276,425 TO SLIC IN 2020 FOR TELECOMMUNICATION SERVICES. 5.BOARD MEMBER CATHERINE BLEVINS IS EMPLOYED AT SLIC NETWORK SOLUTIONS/NICHOLVILLE TELEPHONE. CANTON-POTSDAM HOSPITAL PAID SLIC 276,425 IN 2020 FOR TELECOMMUNICATION SERVICES. 6.JAMES THEODORE, 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). 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. 7.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. FORM 990, PAGE 2, PART III, LINE 4D IN 2020, THE ONCOLOGY VISITS DECREASED APPROXIMATELY 4.97% FROM 10,577 IN 2019 TO 10,051 IN 2020. FORM 990, PAGE 6, PART VI, LINE 6 MEMBERS FORM 990, PAGE 6, PART VI, LINE 7A AS PER BYLAWS FORM 990, PAGE 6, PART VI, LINE 7B BOARD APPOINTMENTS FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT STAFF MEMBERS. UPON COMPLETION, THE FORM IS SUBMITTTED 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 BOARD MEMBER CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED AND REVIEWED BY THE BOARD ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15A 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 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 15B 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 CONTRIBUTIONS FOR CAPITAL ACQUISITIONS 191,184 CHANGE IN INTEREST IN NET ASSETS OF CPH FOUNDATION 3,423,036 CHANGE IN FUNDED STATUS OF EMPLOYEE BEN PLAN 1,227,901 TRANSFER TO ST. LAWRENCE HEALTH SYSTEM -599,887 OTHER GAINS, NET 71,625 TOTAL 4,313,859 CANTON-POTSDAM HOSPITAL FOUNDATION 29 GROVE STREET POTSDAM NY 13676 161279472 PART VII NY 501C3 12A SLHS true CANTON-POTSDAM MEDICAL PRACTICEPLLC PLLC 50 LEROY STREET POTSDAM NY 13676 460714367 PART VII NY 501C3 3 SLHS true ST LAWRENCE HEALTH SYSTEM 50 LEROY STREET POTSDAM NY 13676 464259168 PART VII NY 501C3 12A N/A false NORTHERN LIGHTS HEALTHCARE PARTNERS 732 FORD STREET OGDENSBURG NY 13669 462500951 PART VII NY 501C3 N/A false GOUVERNEUR HOSPITAL 77 W BARNEY STREET GOUVERNEUR NY 13642 464249555 HOSPITAL NY 501C3 3 SLHS true MASSENA HOSPITAL INC 1 HOSPITAL DRIVE MASSENA NY 13662 843134268 HOSPITAL NY 501C3 3 SLHS true false false false false false false false false false true true false true false false false true true false CANTON-POTSDAM MEDICAL PRACTICE PLLC J 2538697 FMV CANTON-POTSDAM HOSPITAL FOUNDATION K 532395 CASH EXCHANGED GOUVERNEUR HOSPITAL INC J 888206 FMV CANTON-POTSDAM HOSPITAL FOUNDATION J 6174 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION R 35184 CASH EXCHANGED ST LAWRENCE HEALTH SYSTEM R 449887 CASH EXCHANGED MASSENA HOSPITAL J 2094375 FMV CANTON-POTSDAM HOSPITAL FOUNDATION Q 325674 CASH EXCHANGED CANTON-POTSDAM MEDICAL PRACTICE PLLC J 30330 FMV CANTON-POTSDAM HOSPITAL FOUNDATION M 129138 CASH EXCHANGED GOUVERNEUR HOSPITAL K 55575 FMV SCHEDULE R CANTON-POTSDAM HOSPITAL FOUNDATION IS RESPONSIBLE FOR RAISING, INVESTING AND MANAGING FUNDS FOR THE HOSPITAL. CANTON-POTSDAM MEDICAL PRACTICE, PLLC PROVIDES PHYSICIAN SERVICES IN AN OUTPATIENT CLINIC SETTING AS BENEFIT TO THE COMMUNITY AND HOSPITAL. 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 AFFILIATED CORPORATIONS. NORTHERN LIGHTS HEALTH CARE PARTNERSHIP, INC. OPERATES A CERTIFIED HOME HEALTH AGENCY. GOUVERNEUR HOSPITAL, A NOT-FOR-PROFIT ORGANIZATION, IS THE AFFILIATE OF CANTON-POTSDAM HOSPITAL, AND SUPPORTED BY THE PARENT ORGANIZATION OF ST. LAWRENCE HEALTH SYSTEM. MASSENA HOSPITAL INC., A NOT-FOR-PROFIT ORGANIZATION, IS THE AFFILIATE OF CANTON-POTSDAM HOSPITAL, AND SUPPORTED BY THE PARENT ORGANIZATION OF ST. LAWRENCE HEATLH SYSTEM.