2016-01-11T14:11:31-06:00 2013-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2013-01-01 464249555 GOUVERNEUR HOSPITAL GOUV 3152871000 77 WEST BARNEY STREET GOUVERNEUR NY 13642 MARLINDA LAVALLEY CEO 3152871000 2015-12-21 1 JOSEPH J SCHLEGEL P00301329 3154463600 2013 2016-04-25 22:37:26Z X MARLINDA LAVALLEY 77 WEST BARNEY STREET GOUVERNEUR NY 13642 0 0 X WWW.GVNRHOSPITAL.ORG X 2013 NY OUR MISSION IS TO PROVIDE SKILLED, COMPASSIONATE, COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS THE COMMUNITY'S HEALTHCARE NEEDS. 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6880748 9009753 -2129005 OUR MISSION IS TO PROVIDE SKILLED, COMPASSIONATE, COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS THE COMMUNITY'S HEALTHCARE NEEDS. 0 0 HOSPITAL WAS NOT LICENSED AS OF 12/31/13. OPERATIONS BEGAN ON JANUARY 1, 2014 AS GOUVERNEUR HOSPITAL REPLACED EDWARD JOHN NOBLE HOSPITAL. 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 0 0 0 0 0 0 NY X RICHARD T LANG 3152871000 77 WEST BARNEY STREET GOUVERNEUR NY 13642 X ANDREW LEONARD DIRECTOR 1.00 X 0 0 0 ROGER COOK DVM DIRECTOR 1.00 X 0 0 0 MICHAEL BURGESS CHAIRPERSON 1.00 X X 0 0 0 NICHOLAS GARDNER DDS VICE CHAIRPERSON 1.00 X X 0 0 0 MARK BRACKETT SECRETARY/TREASURER 1.00 X X 0 0 0 ANDREW WILLIAMS MD DIRECTOR 1.00 X 0 0 0 LAUREN FRENCH DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 293821 0 1202753 0 1762896 0 373885 0 46474 2929799 0 0 2929799 158703 0 112417 0 6880748 0 9009753 0 9009753 X -2183339 54334 0 0 -2129005 0 6880748 X 0 -2129005 X 0 0 0 X 230000 230000 1436626 1436626 1263173 1263173 2929799 DUE TO ST. LAWRENCE HEALTH SYSTEM 6620410 THIRD PARTY SETTLEMENTS 594972 DUE TO EDWARD JOHN NOBLE 1794371 9009753 FORM 990, PART VI, SECTION A, LINE 6 ST. LAWRENCE HEALTH SYSTEM, INC. IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A ST. LAWRENCE HEALTH SYSTEM, INC., AS THE SOLE MEMBER, HAS THE ABILITY TO APPOINT MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER SHALL HAVE THE FOLLOWING POWERS WITH REGARD TO THE CORPORATION: -APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS; -APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER; -APPROVE THE ADOPTION AND AMENDMENT OF BYLAWS; -APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS; -APPROVE STRATEGIC PLANS; -APPROVE AND INITIATE THE FILING OF CERTIFICATE OF NEED APPLICATIONS; -REVIEW AND APPROVE THE ANNUAL AUDIT OF THE CORPORATION AND ANY SUBSIDIARY CORPORATIONS; -APPROVE THE DISSOLUTION OF THE CORPORATION; -APPROVE THE SALE, LEASE, MORTGAGE OR ENCUMBRANCE OF ANY ASSET OTHER THAN ANY SALE, LEASE OR MORTGAGE WHICH IS PART OF AN APPROVED BUDGET; -APPROVE THE SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; -APPROVE ANY MERGER, BUSINESS CONSOLIDATION, ACQUISITION OR JOINT VENTURE; -APPROVE THE PURCHASE OR SALE OF PHYSICIAN PRACTICES OTHER THAN ANY PURCHASE OR SALE WHICH IS PART OF AN APPROVED BUDGET; -APPROVE AND MAY INITIATE THE COMMENCEMENT AND SETTLEMENT OF LITIGATION; -APPROVE ANY FILING OF A BANKRUPTCY PETITION; -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; -APPROVE NEW CLINICAL PROGRAMS OR THE TERMINATION OF EXISTING CLINICAL PROGRAMS OTHER THAN ANY ACTION WHICH IS PART OF AN APPROVED BUDGET; -APPROVE ANY OF THE FOLLOWING AGREEMENTS: (I) MANAGEMENT SERVICES AGREEMENT OTHER THAN ANY AGREEMENT WHICH IS PART OF AN APPROVED BUDGET; (II) CONTRACTS WITH A PHYSICIAN OR A PHYSICIAN GROUP; (III) AGREEMENTS FOR THE OUTSOURCING OF A GOUVERNEUR HOSPITAL SERVICE OR FUNCTION; (IV) COLLECTIVE BARGAINING AGREEMENTS; AND (V) ANY AGREEMENTS TO PARTICIPATE IN A RISK BEARING ARRANGEMENT SUCH AS AN ACCOUNTABLE CARE ORGANIZATION OR A BUNDLED PAYMENT ARRANGEMENT; -INITIATE, NEGOTIATE AND APPROVE MANAGED CARE AGREEMENTS WITH MANAGED CARE ORGANIZATIONS AND OTHER PAYORS OTHER THAN ANY AGREEMENT WHICH IS PART OF AN APPROVED BUDGET; -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 -REQUIRE THE GUARANTEE OF LOANS THROUGH AN OBLIGATED GROUP STRUCTURE THAT WILL SUPPORT ACCESS TO CAPITAL AND MAY INCLUDE DEBT SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS EMAILED TO THE BOARD OF DIRECTORS PRIOR TO THE FILING OF THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: LIABILITIES ASSUMED FROM EDWARD JOHN NOBLE HOSPITAL -2,129,005. CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 161012691 HOSPITAL NY 501(C)(3) LINE 3 ST LAWRENCE HEALTH SYSTEM INC 0 ST LAWRENCE HEALTH SYSTEM INC 50 LEROY STREET POTSDAM NY 13676 464259168 PROVIDES SUPPORT TO CANTON-POTSDAM HOSPITAL & AFFILIATES NY 501(C)(3) LINE 11B, II N/A 0 CANTON-POTSDAM MEDICAL PRACTICE PLLC 77 WEST BARNEY STREET GOUVERNEUR NY 13642 460714367 PHYSICIAN SERVICES NY 501(C)(3) LINE 9 ST LAWRENCE HEALTH SYSTEM INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0