2016-11-15T09:25:29-06:00 2015-12-31 201767403 HOFFMAN EELLS & GRAY CPAS PC 1 MAIN STREET SUITE 101 CANTON NY 136171277 990 2015-01-01 464259168 ST LAWRENCE HEALTH SYSTEM INC STLA 3152615100 50 LEROY STREET POTSDAM NY 13676 RICHARD JACOBS ASSISTANT TREASURER 3152615100 2016-11-15 JOHN J GRAY JR CPA P00076464 3153862925 2016-11-14 2015 2017-02-10 21:41:12Z DAVID ACKER 50 LEROY STREET POTSDAM NY 13676 154377 false X WWW.STLAWRENCEHEALTHSYSTEM.ORG X 2013 NY ST. 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. 12 1 0 0 0 0 0 314100 154377 314100 154377 0 0 0 0 0 353167 370386 353167 370386 -39067 -216009 7008461 15351110 5745952 13608575 1262509 1742535 ST. 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. false false ST. 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. 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 true false false false false false true true true false false true 15 0 0 false false false false false false false false false false false false X 12 1 false false false false false false false true true false false true true true true true false true true false NY X ST LAWRENCE HEALTH SYSTEM 3152615100 50 LEROY STREET POTSDAM NY 13676 MICHAEL J TULLOCH MD DIRECTOR 5.00 40.00 X 0 120809 0 JUDY C CHITTENDEN DIRECTOR 5.00 4.00 X 0 0 0 MARK J CORNETT VICE CHAIR 5.00 4.00 X X 0 0 0 KATHRYN L MULLANEY TREASURER 5.00 4.00 X X 0 0 0 DONALD R DANGREMOND DIRECTOR 5.00 2.00 X 0 0 0 BRIAN D GARDAM DIRECTOR 5.00 2.00 X 0 0 0 EDWARD S MUCENSKI CHAIR 5.00 2.00 X X 0 0 0 JAMES C THEODORE DIRECTOR 5.00 2.00 X 0 0 0 MARK BRACKETT DIRECTOR 5.00 1.00 X 0 0 0 MICHAEL BURGESS SECRETARY 5.00 1.00 X X 0 0 0 ANNE RICHEY DIRECTOR 5.00 X 0 0 0 STEPHEN KNIGHT DIRECTOR 5.00 X 0 0 0 DAVID ACKER PRESIDENT/CE 5.00 50.00 X 0 508974 100650 RICHARD JACOBS ASSISTANT TR 5.00 50.00 X 0 278876 28264 KIMBERLY A SMITH ASSISTANT SE 5.00 40.00 X 0 47326 10199 955985 139113 false true false THE PIKE COMPANY INC 1 CIRCLE STEET ROCHESTER NY 14607 CONSTRUCTION 766995 LATRIC SYSTEMS PO BOX 845087 BOSTON MA 022845087 HEALTH INFO SER 170042 MCDERMOTT WILL & EMERY LLP THE MCDERMOTT BUILDING 500 NORTH CAPITOL ST NW WASHINGTON DC 200011531 CONSULTING 140464 3 OTHER REVENUE 621110 154377 154377 154377 154377 154377 166066 166066 1028 1028 4540 4540 25142 25142 669 669 154377 154377 14781 14781 REAL ESTATE TAXES 3358 3358 OTHER DIRECT EXPENSES 300 300 LICENSES AND DUES 125 125 370386 0 370386 0 816993 3996035 4900103 4762234 8084 5935617 939413 5935617 351952 649140 7008461 15351110 2256344 6000000 5745952 5352231 5745952 13608575 X 1262509 1742535 1262509 1742535 7008461 15351110 -216009 696035 X false true X true false X X 2 GOUVERNEUR HOSPITAL GOUVERNEUR HOSPITAL 464249555 3 true 630430 0 CANTON-POTSDAM HOSPITAL CANTON-POTSDAM HOSPITAL 161012691 3 true 0 0 2 630430 0 true false false false false false false false false false false false false false false false PART IV, SECTION C, LINE 1 NO SUPPLEMENTAL INFORMATION CANTON-POTSDAM HOSPITAL'S (CPH) BOARD CONSISTS OF 18 DIRECTORS. EIGHT (8) 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 7 DIRECTORS. TWO (2) OF THESE DIRECTORS ARE MEMBERS 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. 943342 943342 4992275 4992275 5935617 NOTE-LT 4456760 DUE TO AFFILIATES 895471 5352231 X 154377 154377 154377 370386 370386 370386 SCHEDULE D, PAGE 3, PART X FOOTNOTE 1U - INCOME TAXES OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS: 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 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 2015 OR 2014. false false false false false false false false false DAVID ACKER PRESIDENT/CEO 506380 2594 86050 14600 609624 RICHARD JACOBS ASSISTANT TREASURER 278876 18442 9822 307140 SCHEDULE J, PART III THE ST. LAWRENCE HEALTH SYSTEM (SLHS) DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL. THE PRESIDENT/CEO OF SLHS IS AN EMPLOYEE OF RELATED (AND CONTROLLED) ORGANIZATION, CANTON-POTSDAM HOSPITAL. 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. SEE PART V ADDITIONAL INFORMATION false SCHEDULE L, PART V DUE 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.KATHRYN MULLANEY, THE SLHS AND CPH BOARD TREASURER, RETIRED AS THE VICE PRESIDENT FOR FINANCE AT ST. LAWRENCE UNIVERSITY (SLU) IN 2014. CPH PROVIDES HEALTHCARE SERVICES AND STAFFS A CLINIC ON THE SLU CAMPUS. THE OPERATION COSTS OF THAT CLINIC IN 2015 WERE APPROXIMATELY 614,361, WHICH WERE REIMBURSED BY SLU ON A PASS THROUGH BASIS. 2.DONALD DANGREMOND, SLHS AND CPH BOARD MEMBER, RETIRED AS AN EMPLOYEE OF CLARKSON UNIVERSITY (CU) AS OF JUNE 30, 2015. CPH PROVIDES HEALTHCARE SERVICES AND STAFFS A CLINIC ON THE CU CAMPUS. THE OPERATION COSTS OF THAT CLINIC IN 2015 WERE APPROXIMATELY 331,760, WHICH WERE REIMBURSED BY CU ON APASS THROUGH BASIS. 3.DR. MICHAEL TULLOCH, BOARD MEMBER OF SLHS AND CPH, IS CONTRACTED TO PERFORM INTERPRETATIONS OF CARDIOLOGY SERVICES PROVIDED AT CPH. HE WAS COMPENSATED 120,809 FOR THIS SERVICE IN 2015. HIS PAYMENT FOR PROFESSIONAL SERVICES IS BASED ON A PER PROCEDURE FEE STRUCTURE. 4.BRIAN GARDAM, SLHS AND CPH BOARD MEMBER, IS ALSO THE EXECUTIVE DIRECTOR OF HOSPICE OF PALLIATIVE CARE OF ST. LAWRENCE VALLEY (HOSPICE). HOSPICE CONTRACTS WITH CPH FOR INPATIENT HOSPICE SERVICES FOR SYMPTOM MANAGEMENT AND PAIN CONTROL. IN 2015, 5,690 WAS REMITTED TO HOSPICE FOR THESE SERVICES. CANTON-POTSDAM HOSPITAL ALSO REMITTED TO HOSPICE 2,000 TO SUPPORT THE TASTE OF SPRING AND TASTE OF AUTUMN ANNUAL HOSPICE FUNDRAISERS. 5.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, 2015 WAS 0. 6.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, IS A BOARD MEMBER OF COMMUNITY BANK, NA. AS OF DECEMBER 31, 2015 CPH WAS CURRENT ON ANY OBLIGATIONS DUE TO THE BANK. 7.SLHS VICE CHAIR AND CPH BOARD MEMBER, MARK CORNETT, IS A CONSULTANT EMPLOYED BY SLIC NETWORK SOLUTIONS. SLIC RENTS OFFICE SPACE AT CPH'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. CPH REMITTED APPROXIMATELY 161,577 TO SLIC IN 2015 FOR TELECOMMUNICATION SERVICES. 8.MARK BRACKETT, SLHS DIRECTOR AND GH BOARD SECRETARY/TREASURER, 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. 9.MICHAEL BURGESS, SLHS BOARD SECRETARY AND GH BOARD CHAIR, IS VP OF FINANCIAL PLANNING AND TREASURY WITH KPH HEALTHCARE SERVICES, INC. CORPORATE DIVISIONS OF KPH HEALTHCARE SERVICES ARE KINNEY DRUGS, HEALTH DIRECT INSTITUTIONAL PHARMACY SERVICES, PROACT AND NOBLE SPECIALTY PHARMACY. CPH AND GH PARTICIPATED WITH ONE OR MORE OF THE CORPORATE DIVISIONS IN THE HOSPITALS' 340B PROGRAMS. 10.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 2015, THE UNITED CEREBRAL PALSY ASSOCIATION RENTED OUTPATIENT CLINIC SPACE FROM GH, FOR APPROXIMATELY 9,844 PER MONTH FOR THE COMMUNITY HEALTH CENTER OF THE NORTH COUNTRY. IN 2015, CPH LEASED A NURSE PRACTITIONER TO THE SAME CLINIC AND INVOICED THE CLINIC FOR TELEPHONE/DATA SERVICE. AT YEAR END, CEREBRAL PALSY WAS CURRENT IN THEIR OBLIGATIONS TO CPH AND GH. 11.STEPHEN KNIGHT, SLHS BOARD MEMBER, IS ALSO ON THE BOARD OF NORTHERN LIGHTS HEALTH CARE PARTNERSHIP, INC. CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION, HAS AN INTEREST IN NORTHERN LIGHTS. IN 2015, THERE WERE NO FINANCIAL TRANSACTIONS BETWEEN CANTON-POTSDAM HOSPITAL AND NORTHERN LIGHTS. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PREPARED BY FINANCE OFFICE 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 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 ST. LAWRENCE HEALTH SYSTEM DOES NOT HAVE ANY EMPLOYEES AND THERE IS NO COMPENSATION FOR DIRECTORS. THE ORGANIZATION'S CEO IS PAID BY THE RELATED ORGANIZATION, CANTON-POTSDAM HOSPITAL, AND CPH'S COMPENSATION PROCEDURES ARE FOLLOWED ACCORDINGLY. FORM 990, PAGE 6, PART VI, LINE 15B ST. LAWRENCE HEALTH SYSTEM DOES NOT HAVE ANY EMPLOYEES AND THERE IS NO COMPENSATION FOR DIRECTORS. THE ORGANIZATION'S OTHER OFFICERS ARE PAID BY THE RELATED ORGANIZATION, CANTON-POTSDAM HOSPITAL, AND CPH'S COMPENSATION PROCEDURES ARE FOLLOWED ACCORDINGLY. DR. TULLOCH RECEIVES COMPENSATION FOR PROVIDING CERTAIN CONTRACTED MEDICAL SERVICES TO CPH. THESE PAYMENTS ARE FOR SERVICES DR. TULLOCH PROVIDES AS A PHYSICIAN AND NOT AS A BOARD MEMBER. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 TRANSFER TO GH -630,430 TRANSFER FROM CPH 1,326,465 TOTAL 696,035 CANTON-POTSDAM HOSPITAL INC 50 LEROY STREET POTSDAM NY 13676 161012691 HOSPITAL NY 501C 3 SLHS true GOUVERNEUR HOSPITAL INC 77 WEST BARNEY STREET GOUVERNEUR NY 13642 464249555 HOSPITAL NY 501C 3 SLHS true CANTON-POTSDAM HOSPITAL FOUNDATION 29 GROVE STREET POTSDAM NY 13676 161279472 FUNDRAISG NY 501C 3 N/A false CANTON-POTSDAM MEDICAL PRACTICEPLLC 50 LEROY STREET POTSDAM NY 13676 460714367 OUT PATIEN NY 501C 3 SLHS true ACCOUNTABLE CARE ORGANIZATION OF THE NORTH COUNTRY LLC 555 WEST GRANADA BLVD 555 ORMOND BEACH FL 32174 454106154 SERV COORD FL NA RELATED 370597 39312 false false 0.25500 false true true false false false false false false true false false false false false true true false false CANTON-POTSDAM HOSPITAL C 3172616 CASH EXCHANGED CANTON-POTSDAM HOSPITAL P 1846151 CASH EXCHANGED GOUVERNEUR HOSPITAL INC B 630430 CASH EXCHANGED ACCOUNTABLE CARE ORG OF NC LLC THE NORTH COUNTRY LLC B 348771 CASH EXCHANGED GOUVERNER HOSPITAL INC J 154743 FMV GOUVERNEUR HOSPITAL INC Q 164865 FMV