2020-11-16T12:44:35-06:00 2019-12-31 822624857 GRAY & GRAY AND ASSOCIATES CPAS PC 1 MAIN STREET SUITE 101 CANTON NY 136171277 990 2019-01-01 460714367 CANTON-POTSDAM MED PRACTICE PLLC CANT 3152615100 50 LEROY STREET POTSDAM NY 13676 ROBERT T ROGERSII MD DIRECTOR 3152615100 2020-09-21 true JOHN J GRAY JR CPA P00076464 3153862925 2020-11-13 64.88.174.3 2020-11-16 12:44:35 CS P 5AD7CE22C8D8FEE865ED4FE35A3226D1F0874B8F 7CC34E0763C8963CB33744DE705BAE3AB1C43AEB 2019 2021-01-29 14:40:06Z ROBERT T ROGERSII MD 50 LEROY STREET POTSDAM NY 13676 1964831 false X N/A X PLLC 2012 NY CANTON-POTSDAM MEDICAL PRACTICE'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE PHYSICIAN SERVICES, IN AN OUTPATIENT CLINIC SETTING, THAT PROVIDE PUBLIC BENEFIT TO THE COMMUNITY AND CANTON-POTSDAM HOSPITAL. 1 0 0 0 0 1216598 1964831 0 2205 0 1218803 1964831 0 0 1731589 2753247 0 0 461510 642005 2193099 3395252 -974296 -1430421 216731 372357 65743 1651790 150988 -1279433 X CANTON-POTSDAM MEDICAL PRACTICE'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE PHYSICIAN SERVICES, IN AN OUTPATIENT CLINIC SETTING, THAT PROVIDE PUBLIC BENEFIT TO THE COMMUNITY AND CANTON-POTSDAM HOSPITAL. true false 1105621 2443253 CANTON-POTSDAM MEDICAL PRACTICE OPERATED A GASTROENTEROLOGY CLINIC IN 2019. PATIENT VISITS TOTALED APPROXIMATELY 3,584. THE GASTROENTEROLOGY CLINIC OPENED IN OCTOBER OF 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. 683759 866772 CANTON-POTSDAM MEDICAL PRACTICE OPERATED A GENERAL SURGERY CLINIC IN 2019. PATIENT VISITS TOTALED APPROXIMATELY 1,098. THIS CLINIC OPENED IN AUGUST OF 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. 956376 1915669 CANTON-POTSDAM MEDICAL PRACTICE OPERATED A DERMATOLOGY PRACTICE IN 2019. PATIENT VISITS TOTALED APPROXIMATELY 6,188. THIS CLINIC OPENED IN 2019 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. 475265 641358 CANTON-POTSDAM MEDICAL PRACTICE OPERATES OTHER PROGRAM SERVICES. 475265 641358 3221021 true false false false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false true false false false false false false false true false false false true 10 0 true 0 false false false false false false false false X 1 0 false true false false true false false true false false false true true true true true true true true false X DONNA MCGREGOR 3152615451 50 LEROY STREET POTSDAM NY 13676 RICHARD D JACOBS FINANCE 8.00 50.00 X 0 346295 31517 ROBERT T ROGERSII MD DIRECTOR 1.00 50.00 X 0 326991 18765 673286 50282 false true false KOPP BILLING AGENCY INC PO BOX 2337 SYRACUSE NY 13220 BILLING/COLLECT 111393 1 PROGRAM SERVICE REVENUE 621400 1964831 1964831 1964831 1964831 1964831 2347389 2242808 104581 405858 387776 18082 30108 30108 182415 174288 8127 2003 1914 89 13679 13070 609 2 2 15565 14872 693 72616 72335 281 PURCHASED SERVICES 198943 190080 8863 SUPPLIES 79214 78530 684 OTHER 28885 27598 1287 LICENSES AND DUES 15162 14487 675 3413 3261 152 3395252 3221021 174231 0 46578 54015 117926 256359 1188 1086 3997 6267 223962 169332 47042 54630 216731 372357 65743 47838 1603952 65743 1651790 X 150988 -1279433 150988 -1279433 216731 372357 X -1430421 X false true X true false X 9222226 11044644 6051657 3724091 5867052 35909670 9222226 11044644 6051657 3724091 5867052 35909670 35909670 31 11796 2 2205 14034 9222257 11056440 6051659 3726296 5867052 35923704 0.99960 0.99960 0.00000 0.00000 X PART III, LINE 12 VENDOR PURCHASE DISCOUNT 14,034 13024 8930 4094 210938 160402 50536 54630 DUE TO AFFILIATES 1603952 1603952 X 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 THEN 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 2019 OR 2018. ON DECEMBER 22, 2017 THE PRESIDENT SIGNED INTO LAW H.R.1, ORIGINALLY KNOWN AS THE TAX CUTS AND JOBS ACT. THE NEW LAW (PUBLIC LAW NO 115-97) INCLUDES SUBSTANTIAL CHANGES TO THE TAXATION OF INDIVIDUALS, BUSINESSES, MULTINATIONAL ENTERPRISES, AND OTHERS. IN ADDITION TO MANY GENERALLY APPLICABLE PROVISIONS THE LAW CONTAINS SEVERAL SPECIFIC PROVISIONS THAT RESULT IN CHANGES TO THE TAX TREATMENT OF TAX-EXEMPT ORGANIZATIONS AND DONORS. THE SYSTEM HAS REVIEWED THESE PROVISIONS AND THE POTENTIAL IMPACT AND CONCLUDED THE ENACTMENT OF H.R.1 DOES NOT HAVE A MATERIAL EFFECT ON THE OPERATIONS OF THE ORGANIZATION. false false false false false false false false false RICHARD D JACOBS FINANCE 346295 19600 11917 377812 ROBERT T ROGERSII MD DIRECTOR 326991 5600 13165 345756 SCHEDULE J, PART III CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL. ALL "EMPLOYEES", INCLUDING THOSE THAT PERFORM MANAGEMENT FUNCTIONS, ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. AS SUCH, THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CANTON-POTSDAM HOSPITAL SEEKS INPUT OF A CONSULTING FIRM WITH NATIONAL EXPERIENCE TO REVIEW COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AND THE REGULATORY COMPLIANCE ISSUES OF NON-FOR-PROFITS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE. ROBERT T ROGERS II MD DIRECTOR 345757 COMPENSATION false SCHEDULE L, PART V CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION, HAS BUSINESS TRANSACTIONS INVOLVING ROBERT T. ROGERS, II, MD, AN EMPLOYEE AT CANTON-POTSDAM HOSPITAL AND DIRECTOR OF CANTON-POTSDAM HOSPITAL. CANTON-POTSDAM HOSPITAL REMITTED APPROXIMATELY 345,757 TO ROBERT T. ROGERS, II, MD FOR COMPENSATION. FORM 990, PAGE 2, PART III, LINE 2 CANTON-POTSDAM MEDICAL PRACTICE OPERATED A DERMATOLOGY CLINIC IN 2019. PATIENT VISITS TOTALED APPROXIMATELY 6,188. THE DERMATOLOGY CLINIC OPENED IN 2019 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. FORM 990, PAGE 2, PART III, LINE 4D CANTON-POTSDAM MEDICAL PRACTICE OPERATES OTHER PROGRAM SERVICES. FORM 990, PAGE 6, PART VI, LINE 3 CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL. ALL "EMPLOYEES" , INCLUDING THOSE THAT PERFORM MANAGEMENT FUNCTIONS, ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. EMPLOYEES OF CANTON-POTDAM HOSPITAL ARE LEASED TO CANTON- POTSDAM MEDICAL PRACTICE TO PROVIDE ALL MEDICAL STAFF AND MANAGEMENT SERVICES. SERVICE AGREEMENTS ARE IN PLACE BETWEEN THE TWO RELATED ORGANIZATIONS. CANTON-POTSDAM HOSPITAL INVOICES CANTON-POTSDAM MEDICAL PRACTICE FOR THESE SERVICES. KEY EMPLOYEE, RICHARD JACOBS, IS AN EMPLOYEE OF CANTON-POTSDAM HOSPITAL WHO IS RESPONSIBLE FOR THE FINANCIAL REPORTING OF CANTON-POTSDAM MEDICAL PRACTICE. ROBERT T. ROGERS, II, MD, IS AN EMPLOYEE OF CANTON-POTSDAM HOSPITAL WHO IS THE SOLE MEMBER MANAGER OF THE PLLC. FORM 990, PAGE 6, PART VI, LINE 8B CANTON-POTSDAM MEDICAL PRACTICE DID NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY, AND THUS NO COMMITTEE MEETINGS WERE HELD. 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 REVIEW AND 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 CANTON-POTSDAM MEDICAL PRACTICE ADVISORY COMMITTEE AND TO THE SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE, ROBERT T. ROGERS, II, MD FOR FURTHER REVIEW AND COMMENT (PRIOR TO IRS SUBMISSION). FORM 990, PAGE 6, PART VI, LINE 12C THE KEY EMPLOYEE AND SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE ARE EMPLOYEES OF CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION. ALL EMPLOYEES ADHERE TO CANTON-POTSDAM HOSPITAL'S WRITTEN CONFLICT OF INTEREST POLICY. DISCLOSURE STATEMENTS ARE REVIEWED ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15A LINE 15A: AS STATED ABOVE IN THIS SCHEDULE O, CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL AND ALL "EMPLOYEES" ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. AS SUCH, THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CANTON-POTSDAM HOSPITAL 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 OFFICIALS COMPENSATION PACKAGE. FORM 990, PAGE 6, PART VI, LINE 15B THE KEY EMPLOYEE AND SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE ARE EMPLOYEES OF CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION. COMPENSATION OF EMPLOYEES IS DETERMINED BY CANTON-POTSDAM HOSPITAL'S PROCESSES FOR DETERMINING COMPENSATION. THEY ARE AS FOLLOWS: 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 FROM AFFILIATE (CANTON-POTSDAM HOSPITAL) 0 ASSET TRANSFER TO CPH 0 ST LAWRENCE HEALTH SYSTEM INC 50 LEROY STREET POTSDAM NY 13676 464259168 SEE VII NY 501C3 NA false CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 161012691 HOSPITAL NY 501C3 SLHS true GOUVERNEUR HOSPITAL INC 77 WEST BARNEY STREET GOUVERNEUR NY 13642 464249555 HOSPITAL NY 501C3 SLHS true false false false false false false false false false false true false false false false false false false false CANTON-POTSDAM HOSPITAL K 2809524 FMV SCHEDULE R ST. LAWRENCE HEALTH SYSTEM, INC. (SLHS) IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPITAL, GOUVERNEUR HOSPITAL AND OTHER CORPORATIONS OF WHICH THE CORPORATION IS THE SOLE CORPORATE MEMBER, INCLUDING THE CANTON-POTSDAM MEDICAL PRACTICE, PLLC.