2018-08-14T11:55:10-04:00 2017-12-31 822624857 GRAY & GRAY AND ASSOCIATES CPAS PC 1 MAIN STREET SUITE 101 CANTON NY 136171277 990 2017-01-01 161012691 CANTON-POTSDAM HOSPITAL CANT 3152615103 50 LEROY STREET POTSDAM NY 13676 RICHARD JACOBS VP FOR FINANCE/CFO 3152615103 2018-08-13 true JOHN J GRAY JR CPA P00076464 3153862925 2018-08-13 2017 2022-09-23 18:48:47Z RICHARD JACOBS CANTON-POTSDAM HOSPITAL POTSDAM NY 13676 192999118 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 7 1421 114 0 1987093 1242051 154589787 175072794 224146 184793 14444593 15912733 171245619 192412371 0 0 106029483 114598940 0 0 58287676 66989047 164317159 181587987 6928460 10824384 109663722 127816584 54220056 61347176 55443666 66469408 X CANTON-POTSDAM HOSPITAL'S MISSION IS TO PROVIDE SKILLED, COMPASSIONATE COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS COMMUNITY NEEDS. false false 92595315 253418129 ACUTE CARE: CANTON-POTSDAM HOSPITAL HAS A TOTAL OF 94 LICENSED BEDS, COMPRISED OF 17 FOR CHEMICAL DEPENDENCY-REHABILITATION, 7 FOR CHEMICAL DEPENDENCY- DETOXIFICATION, 4 FOR CORONARY CARE, 2 FOR INTENSIVE CARE, 8 FOR MATERNITY AND 56 FOR MEDICAL/SURGICAL. PROFESSIONAL STAFF COVERAGE FOR OUR IN- PATIENT CENSUS IS PROVIDED BY A HOSPITALIST PROGRAM. TOTAL PATIENT DAYS INCREASED BY APPROXIMATELY 1.09% FROM 2016 TO 2017. TOTAL DISCHARGES INCREASED BY APPROXIMATELY .10% FROM 2016 TO 2017. OBSERVATION CASES INCREASED BY APPROXIMATELY 12.18% FROM 2016 TO 2017. EMERGENCY ROOM VISITS INCREASED BY 2.94% FROM 2016 TO 2017. 32967800 55172738 HOSPITAL BASED CLINICS: THERE WAS SIGNIFICANT GROWTH OF THE HOSPITAL BASED CLINICS. THERE WERE OVER 171,021 VISITS IN 2017, COMPARED TO OVER 155,000 IN 2016; ROUGHLY A 10% INCREASE. 9839402 20399954 OPERATING ROOM: IN 2017, THE OPERATING ROOM NUMBER OF CASES INCREASED BY APPROXIMATELY 1.5%, COMPARED TO 2016. 7863731 10592681 IN 2017, THE ONCOLOGY VISITS INCREASED APPROXIMATELY 7% FROM 10,100 IN 2016 TO 10,865 IN 2017. 7863731 10592681 143266248 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 false false true false false false false false true true true false false true 244 0 true 1421 true false false false false false false false false false false false false X 18 7 false false false false true true true true true false true true true true true true true true true true false NY X RICHARD JACOBS CANTON-POTSDAM HOSP 3152615100 50 LEROY STREET POTSDAM NY 13676 MICHAEL TULLOCH MD DIRECTOR 2.00 5.00 X 229756 0 25125 RONALD BERRY DIRECTOR 2.00 5.00 X 0 0 0 DONALD DANGREMOND AT LARGE MEM 2.00 5.00 X 0 0 0 KATHRYN MULLANEY TREASURER 4.00 5.00 X X 0 0 0 JUDITH CHASE SECRETARY 4.00 X X 0 0 0 MICHAEL GRIFFIN 2ND VICE CHA 4.00 5.00 X 0 0 0 BRIAN GARDAM DIRECTOR 2.00 5.00 X 0 0 0 PAUL MCGRATH DIRECTOR 2.00 X 0 0 0 JOANNE SCOTT DIRECTOR 2.00 X 0 0 0 JUDY CHITTENDEN VICE CHAIRPE 4.00 X X 0 0 0 EDWARD MUCENSKI DIRECTOR 2.00 5.00 X 0 0 0 PAUL COLE DVM DIRECTOR 2.00 X 0 0 0 JAMES THEODORE DIRECTOR 2.00 X 0 0 0 MARK CORNETT BOARD CHAIR 4.00 5.00 X X 0 0 0 FLORENCE BERO MD DIRECTOR 2.00 X 0 0 0 RICHARD VANLEUVEN DIRECTOR 2.00 2.00 X 0 0 0 ERIN DRAPER DIRECTOR 2.00 X 0 0 0 LENORE VANDERZEE DIRECTOR 2.00 X 0 0 0 DAVID ACKER PRESIDENT & 50.00 5.00 X 518486 0 110808 RICHARD JACOBS VP FOR FINAN 50.00 5.00 X 279369 0 31817 JEFFREY HAASBEEK MD PHYSICIAN 50.00 X 1044361 0 46893 KRIS VANWAGNER MD PHYSICIAN 50.00 X 776477 0 23566 RICHARD WESSEL MD PHYSICIAN 50.00 X 757455 0 46393 THOMAS KNEIFEL MD PHYSICIAN 50.00 X 750000 0 46893 LUC PERRIER MD PHYSICIAN 50.00 X 700000 0 46393 5055904 377888 189 false true false CROWE HORWATHE LLP PO BOX 71570 CHICAGO IL 606941570 CONSULTING 1651125 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 554809146 LAB SERVICES 1464427 NORTHERN TIER CONTRACTING INC 329A SCOTCH SETTLEMENT ROAD GOUVERNEUR NY 13642 CONSTRUCTION 805159 ENI MECHANICAL INC 39 SOUTH GORDON STREET GOUVERNEUR NY 13642 CONSTRUCTION 759361 UNIVERSITY OF VERMONT MEDICAL CENTE PO BOX 1902 BURLINGTON VT 054021902 LAB SERVICES 707335 36 1151032 91019 1242051 NET PATIENT SERVICE REVENUE 900099 175072794 175072794 175072794 168943 168943 484098 491338 -7240 -7240 -7240 107470 3789 95409 12061 3789 15850 15850 340B RETAIL PROGRAM 10027585 10027585 ALL OTHER MISC REVENUE 4313386 4313386 OTHER 1466543 1466543 112459 112459 15919973 192412371 175072794 16097526 2744959 2195967 548992 91003313 72798448 18204865 4251097 3400878 850219 10897583 8718066 2179517 5701988 4561590 1140398 316930 316930 274021 274021 50365 50365 115279 115279 1059926 847941 211985 3670722 2939070 731652 542361 433888 108473 341446 273157 68289 900589 719951 180638 6858375 5486700 1371675 1590451 1272361 318090 SUPPLIES 26525060 21219463 5305597 PURCHASED/CONTRACTED SERV 12249720 9799775 2449945 EQUIPMENT RENTAL & MAINT 5751521 4606632 1144889 OTHER 4126300 3353886 772414 2615981 523196 2092785 181587987 143266248 38321739 0 376836 457737 1699950 2996190 18007547 20951477 1700714 2018844 2425616 2561387 129227073 89775863 39789139 39451210 907013 948837 44756907 58430902 109663722 127816584 21075461 23791660 12357315 11464214 4191916 2910468 16595364 23180834 54220056 61347176 X 54694137 65747150 29771 2500 719758 719758 55443666 66469408 109663722 127816584 10824384 35984 165374 X false true X true false X false false false false false false false false true 50365 50365 false SCHEDULE C, PART II-B, LINE 1 IROQUOIS HEALTHCARE ALLIANCE: 5,353: FEDERAL AND STATE ADVOCACY HANYS ANNUAL MEMBERSHIP DUES: 9,499: FEDERAL AND STATE ADVOCACY AMERICAN HOSPITAL ASSOCIATION ANNUAL MEMBERSHIP DUES: 4,596: FEDERAL AND STATE ADVOCACY WILSON, ELSER, MOSKOWITZ: 30,917: FEDERAL AND STATE LOBBYING AND REPRESENTATION 907013 41824 948837 894097 12916 907013 909653 -15556 894097 899859 9794 909653 845727 54132 899859 0.76000 0.24000 false false 4198531 4198531 39260468 23401661 15858807 9739094 4524844 5214250 75313495 61849358 13464137 715485 715485 39451210 INTEREST IN CANTON HOSP FOUNDATION 22269889 ASSETS WHOSE USEFUL LIFE IS LIMITED 21574279 DUE FROM ST. LAWRENCE HEALTH SYSTEM 5114412 OTHER NOTES & LOANS RECEIVABLE (NET) 3907943 OTHER ASSETS 3229179 DUE FROM AFFILIATES 2306692 PHYSICIAN LOANS/NOTES RECEIV. (NET) 28508 58430902 DUE TO AFFILIATES 9009307 ESTIMATED THIRD PARTY SETTLEMENTS 6227832 457 & ASSET RETIREMENT OBLIGATION 4135720 ACCRUED RETIREMENT OBLIGATION 2913416 INTEREST RATE SWAP 894559 23180834 X 192600815 491339 491339 192109476 302895 302895 192412371 182079329 491339 491339 181587990 -3 -3 181587987 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 THE FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM AND ITS 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 JUDGEMENT OCCURS. THE SYSTEM AND ITS AFFILIATES DID NOT RECOGNIZE THE EFFECT OF ANY UNCERTAIN INCOME TAX POSITIONS IN EITHER 2017 OR 2016. 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 THEIR DONORS. THE SYSTEM HAS REVIEWED THESE PROVISIONS AND THE POTENTIAL IMPACT AND CONCLUDED THE ENACTMENT OF H.R.1 WILL NOT HAVE A MATERIAL EFFECT ON THE OPERATIONS OF THE ORGANIZATION. SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 491,339 SCHEDULE D, PAGE 4, PART XI, LINE 4B GIFT AND BEQUESTS: 44,469 CHANGE OF FAIR MARKET VALUE OF INTEREST RATE SWAP 230,103 UNRESTRICTED ENDOWMENT INCOME: 19,860 REALIZED LOSS ON INVESTMENTS: 8,463 OTHER: 0 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 491,339 SCHEDULE D, PAGE 4, PART XII, LINE 4B MISCELLANEOUS -3 true true true X true X true true false true true 503724 1601 502123 0.00280 40085121 24310308 15774813 0.08690 40588845 24311909 16276936 0.08970 197289 197289 0.00110 832316 832316 0.00460 200 200 1029805 1029805 0.00570 41618650 24311909 17306741 0.09540 571132 571132 0.00310 571132 571132 0.00310 true 2815676 733278 34441797 36923494 -2481697 X true true 1 1 CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 WWW.CPHOSPITAL.ORG X X X CANTON-POTSDAM HOSPITAL 1 false false true X X X X X X X X X X 16 true true true true X WWW.CPHOSPITAL.ORG X true 14 false false false true X 100.000000000000 300.000000000000 true true X X X X true X WWW.CPHOSPITAL.ORG X WWW.CPHOSPITAL.ORG X WWW.CPHOSPITAL.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 . FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 3J 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 ADDITIONAL INFORMATION 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 2017. 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 2017 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 AUDITED FINANCIAL STATEMENTS (FN3-PATIENT ACCOUNTS RECEIVABLE AND RELATED ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS). 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-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 2016 AND TAKES INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE COMMUNITY PRIMARILY THROUGH A TELEPHONE AND WEB SURVEY CONDUCTED IN THE SUMMER OF 2016 WITH 679 RESPONDENT 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 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 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. 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. CANTON-POTSDAM HOSPITAL HAS LED THE REGION IN RECRUITMENT OF PRIMARY CARE PRACTITIONERS AND SPECIALISTS IN TARGETED AREAS, INCLUDING A RHEUMATOLOGIST, ENDOCRINOLOGIST (FOR ASSISTANCE WITH DIABETES), AN INFECTIOUS DISEASE SPECIALIST, 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: AT THE 2017 HEALTH FAIRS, THE IMAGING DEPARTMENT PROVIDED FREE HEEL BONE DENSITY SCREENING EXAMS TO THE COMMUNITY. THE APPROXIMATE COST FOR THIS SERVICE WAS 62,640. IN ADDITION TO THESE SCREENINGS, THE HOSPITAL HOSTS AND ATTENDS NUMEROUS HEALTH FAIRS THROUGHOUT THE YEAR, ALONG WITH HOSTING EVENTS SUCH AS "ASK THE PHYSICIAN", "PARTNERING IN YOUR CARE" LUNCHEONS AND WOMEN'S WELLNESS DAY EVENTS. THE APPROXIMATE VALUE OF THESE EFFORTS WAS 20,000. THE HOSPITAL'S LIFELINE DEPARTMENT HAS PROVIDED THE COMMUNITY WITH 124 FREE LIFELINE INSTALLS. THE TOTAL COST OF THESE INSTALLS FOR 2017 WAS 3,968. THE HOSPITAL'S BIRTHPLACE PROVIDES CHILDBIRTH CLASSES, BREASTFEEDING CLASSES, EARLY PREGNANCY CLASSES AND INFANT CPR CLASSES. THE APPROXIMATE 2017 COST ASSOCIATED WITH THESE BENEFITS WAS 16,900. 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 2017 WAS 10,578. ADDITIONALLY 6 FREE MAMMOGRAMS WERE CONDUCTED, FOR AN APPROXIMATE VALUE OF 2,754. 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 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 PRO X X X X X false false false false false false false false false MICHAEL TULLOCH MD DIRECTOR 229756 14259 10866 254881 DAVID ACKER PRESIDENT & CEO 518486 93650 17158 629294 RICHARD JACOBS VP FOR FINANCE/CFO 279369 18900 12917 311186 JEFFREY HAASBEEK MD PHYSICIAN 1044361 13500 33393 1091254 KRIS VANWAGNER MD PHYSICIAN 776477 13500 10066 800043 RICHARD WESSEL MD PHYSICIAN 757455 13500 32893 803848 THOMAS KNEIFEL MD PHYSICIAN 750000 13500 33393 796893 LUC PERRIER MD PHYSICIAN 700000 13500 32893 746393 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 7375000 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 SCHEDULE K - 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.KATHRYN MULLANEY, OUR BOARD TREASURER, WAS RETIRED AS THE VICE PRESIDENT FOR FINANCE AT ST. LAWRENCE UNIVERSITY (SLU) IN 2014. OUR ORGANIZATION PROVIDES HEALTHCARE SERVICES AND STAFFS A CLINIC ON THE SLU CAMPUS. THE OPERATION COSTS OF THAT CLINIC IN 2017 WERE APPROXIMATELY 580,179 WHICH WERE REIMBURSED BY SLU ON A PASS THROUGH BASIS. 2.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 2017 WERE APPROXIMATELY 418,374 WHICH WERE REIMBURSED BY CU ON A PASS THROUGH BASIS. 3.DR. MICHAEL TULLOCH, BOARD MEMBER, IS EMPLOYED TO PERFORM INTERPRETATIONS OF CARDIOLOGY SERVICES PROVIDED AT OUR FACILITY. HE WAS COMPENSATED 229,756 FOR THIS SERVICE IN 2017. 4.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. CANTON-POTSDAM HOSPITAL REMITTED TO HOSPICE 3,500 TO SUPPORT THE TASTE OF SPRING AND TASTE OF AUTUMN ANNUAL HOSPICE FUNDRAISERS. BRIAN GARDAM IS ALSO ON THE BOARD OF DIRECTORS FOR NORTHERN LIGHTS HEALTH CARE. 5.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, 2017 WAS 0. 6.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, WAS A BOARD MEMBER OF COMMUNITY BANK, NA UNTIL DECEMBER 31, 2017. AS OF DECEMBER 31, 2017 THE HOSPITAL WAS CURRENT ON ANY OBLIGATIONS DUE TO THE BANK. 7.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 209,130 TO SLIC IN 2017 FOR TELECOMMUNICATION SERVICES. 8.BOARD MEMBER FLORENCE BERO, MD IS IN PRACTICE WITH CANTON FAMILY PHYSICIANS WHICH LEASES SPACE FROM THE HOSPITAL. IN 2017, CPH CHARGED THE PRACTICE 44,118 FOR RENT. FORM 990, PAGE 2, PART III, LINE 4D IN 2017, THE ONCOLOGY VISITS INCREASED APPROXIMATELY 7% FROM 10,100 IN 2016 TO 10,865 IN 2017. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT STAFF MEMBERS. UPON COMPLETION, A COPY WITH SUPPORTING DOCUMENTATION IS REVIEWED BY THE VICE PRESIDENT FOR FINANCE AND THE CONTROLLER. AFTER REVIEW, ANY CHANGES ARE MADE AND A COPY IS PRESENTED TO THE FINANCE COMMITTEE. THE FINANCE COMMITTEE WILL THEN REVIEW AND MAY REQUEST CHANGES TO THE FORM. ONCE THE CHANGES ARE IMPLEMENTED, THE FORM 990 IS SUBMITTED TO THE FULL BOARD OF DIRECTORS FOR THEIR REVIEW, COMMENTS AND APPROVAL. 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 WITH 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 251,524 TEMPORARILY RESTRICTED CONTRIBUTIONS FOR CAPITAL 2,500 CHANGE IN INTEREST IN NET ASSETS OF CPH FOUNDATION 2,229,562 CHANGE IN FUNDED STATUS OF EMPLOYEE BEN PLAN 2,135,125 CAPITAL CAMPAIGN GIFTS -5,531 TRANSFER TO ST. LAWRENCE HEALTH SYSTEM -3,909,040 TRANSFER TO AFFILIATE (CANTON POTSDAM MEDICAL PRAC -890,498 TRANSFER FROM CPH FOUNDATION 351,732 TOTAL 165,374 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 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 SLHS true false true false false false false false false false true true false true false false true true true false CANTON-POTSDAM MEDICAL PRACTICE PLLC J 2851066 FMV ST LAWRENCE HEALTH SYSTEM INC B 1500000 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION K 532395 CASH EXCHANGED GOUVERNEUR HOSPITAL INC J 1149205 FMV CANTON-POTSDAM HOSPITAL FOUNDATION J 6735 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION R 62103 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION P 45249 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION Q 233909 CASH EXCHANGED CANTON-POTSDAM MEDICAL PRACTICE PLLC J 84237 FMV CANTON-POTSDAM HOSPITAL FOUNDATION M 460360 CASH EXCHANGED GOUVERNEUR HOSPITAL INC K 924293 FMV ST LAWRENCE HEALTH SYSTEM INC R 415003 CASH EXCHANGED 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, INC., A NOT-FOR-PROFIT ORGANIZATION, IS THE AFFILIATE OF CANTON-POTSDAM HOSPITAL, AND SUPPORTED BY THE PARENT ORGANIZATION OF ST. LAWRENCE HEALTH SYSTEM.