2015-11-16T14:52:19-06:00 2014-12-31 201767403 HOFFMAN EELLS & GRAY CPAS PC 1 MAIN STREET SUITE 101 CANTON NY 136171277 990 2014-01-01 460714367 CANTON-POTSDAM MED PRACTICE PLLC CANT 3152615100 50 LEROY STREET POTSDAM NY 13676 ROBERT T ROGERSII MD DIRECTOR 3152615100 2015-11-15 true JOHN J GRAY JR CPA P00076464 3153862925 2015-11-16 2014 2016-02-25 16:41:14Z ROBERT T ROGERS II MD 50 LEROY STREET POTSDAM NY 13676 2431486 false X N/A X PLLC 2012 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 2429788 0 40 1698 40 2431486 0 0 2701644 0 0 336587 1597660 336587 4299304 -336547 -1867818 95657 1743063 432203 72005 -336546 1671058 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. false false 1166662 1399145 OB/GYN OUTPATIENT CLINIC SERVICES: CANTON-POTSDAM MEDICAL PRACTICE OPERATED THREE OUTPATIENT OB/GYN CLINICS IN 2014. THEY SERVE THE SURROUNDING NORTH COUNTRY COMMUNITIES OF POTSDAM, CANTON, AND GOUVERNEUR, NEW YORK. A TOTAL OF APPROXIAMATELY 4,463 PATIENT VISITS WERE RECORDED IN 2014. THE POTSDAM OB/GYN LOCATION CLOSED IN AUGUST 2014 AND BECAME A HOSPITAL BASED CLINIC UNDER RELATED ORGANIZATION CANTON-POTSDAM HOSPITAL. 854149 2759642 URGENT CARE OUTPATIENT CLINIC SERVICES: CANTON-POTSDAM MEDICAL PRACTICE OPERATED AN URGENT CARE CENTER IN 2014. PATIENT VISITS TOTALED APPROXIMATELY 8,322. THE URGENT CARE CENTER OPENED IN MARCH OF 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. 427730 354740 FAMILY PRACTICE OUTPATIENT CLINIC SERVICES: CANTON-POTSDAM MEDICAL PRACTICE OPERATED AN OUTPATIENT FAMILY PRACTICE IN 2014. PATIENT VISITS TOTALED APPROXIMATELY 2,394. THIS FAMILY PRACTICE OPENED IN MARCH OF 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) COLTON, NEW YORK. 1036180 1004952 CANTON-POTSDAM MEDICAL PRACTICE OPERATES OTHER OUTPATIENT CLINIC LOCATIONS INCLUDING THE FOLLOWING: SURGICAL SERVICES: LOCATED IN POTSDAM, NY, THIS CLINIC OPENED IN AUGUST 2014 AND SERVED APPROXIMATELY 371 PATIENTS IN 2014. ENT SERVICES: LOCATED IN POTSDAM, NY, THIS CLINIC OPENED IN NOVEMBER 2014 AND SERVED APPROXIMATELY 170 PATIENTS IN 2014. GASTROENTEROLOGY SERVICES: LOCATED IN MASSENA, NY, THIS CLINIC OPENED IN OCTOBER 2014 AND SERVED APPROXIMATELY 435 PATIENTS IN 2014. 1036180 1004952 3484721 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 false false false false false false false false true false false false true 23 0 true 0 false false false false false false X 1 0 false true true false false false false true false false false true true true true true true true true false X CANTON-POTSDAM HOSPITAL 3152615100 50 LEROY STREET POTSDAM NY 13676 ROBERT T ROGERSII MD DIRECTOR 1.00 50.00 X 0 250656 18303 RICHARD D JACOBS FINANCE 8.00 50.00 X 0 249482 35084 500138 53387 2 false true false MILLY SMITH 727 WASHINGTON STREET WATERTOWN NY 13601 CONSULTING 229600 STAFF CARE INC PO BOX 281923 ATLANTA GA 303841923 STAFFING 114235 2 621400 2429788 2429788 2429788 OTHER OPERATING REVENUE 621400 1698 1698 1698 2431486 2431486 2198150 1809359 388791 503494 414440 89054 127899 127899 4224 330 3894 70339 57898 12441 181071 149045 32026 4665 3840 825 8421 6932 1489 230 190 40 93655 77090 16565 130520 105557 24963 PURCHASED SERVICES 566478 466284 100194 SUPPLIES 318238 318095 143 OTHER 59867 49278 10589 LICENSES AND DUES 28604 23544 5060 3449 2839 610 4299304 3484721 814583 0 1354 136845 1086186 4645 5430 585428 109336 93012 476092 1291 33865 95657 1743063 11481 63369 420722 8636 432203 72005 X -336546 1671058 -336546 1671058 95657 1743063 X -1867818 3875422 X false true true false X 102962 5518479 5621441 102962 5518479 5621441 5621441 40 1698 1738 103002 5520177 5623179 X PART III, LINE 12 1,738 11533 1922 9611 573895 107414 466481 476092 DUE TO AFFILIATES 8636 8636 X SCHEDULE D, PAGE 3, PART X INCOME TAXES OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS: THE HOSPITAL AND CPMP ARE A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL AND CPMP 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 HOSPITAL AND CPMP DID NOT RECOGNIZE THE EFFECT OF ANY UNCERTAIN INCOME TAX POSITIONS IN EITHER 2014 OR 2013. false false false false false false false false false ROBERT T ROGERSII MD DIRECTOR 250656 18303 268959 RICHARD D JACOBS FINANCE 249482 17369 17715 284566 FORM 990, PAGE 2, PART III, LINE 4D CANTON-POTSDAM MEDICAL PRACTICE OPERATES OTHER OUTPATIENT CLINIC LOCATIONS INCLUDING THE FOLLOWING: SURGICAL SERVICES: LOCATED IN POTSDAM, NY, THIS CLINIC OPENED IN AUGUST 2014 AND SERVED APPROXIMATELY 371 PATIENTS IN 2014. ENT SERVICES: LOCATED IN POTSDAM, NY, THIS CLINIC OPENED IN NOVEMBER 2014 AND SERVED APPROXIMATELY 170 PATIENTS IN 2014. GASTROENTEROLOGY SERVICES: LOCATED IN MASSENA, NY, THIS CLINIC OPENED IN OCTOBER 2014 AND SERVED APPROXIMATELY 435 PATIENTS IN 2014. 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 4 THE ARTICLES OF ORGANIZATION WERE RESTATED TO ENSURE COMPLIANCE WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986 GUIDELINES. THE RESTATEMENT INCLUDED VARIOUS CLARIFICATIONS INCLUDING THE PROHIBITION OF THE MEMBERS OF THE PLLC FROM RECEIVING DISTRIBUTIONS OF THE NET EARNINGS 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 CANTON-POTSDAM HOSPITAL'S FINANCE DEPARTMENT STAFF MEMBERS. UPON COMPLETION, A COPY WITH SUPPORTING DOCUMENTATION IS REVIEWED BY THE VICE PRESIDENT FOR FINANCE AND THE CONTROLLER. FURTHERMORE, THE FORM WAS PROVIDED TO THE CANTON-POTSDAM MEDICAL PRACTICE ADVISORY COMMITTEE FOR FURTHER REVIEW AND COMMENT. AFTER REVIEW, ANY CHANGES ARE MADE AND A COPY IS PRESENTED TO THE SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE, ROBERT T. ROGERS, II, MD FOR HIS REVIEW AND APPROVAL. 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 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 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 TRANSFER FROM AFFILIATE (CANTON-POTSDAM HOSPITAL) 3,875,422 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 false GOUVERNEUR HOSPITAL INC 77 WEST BARNEY STREET GOUVERNEUR NY 13642 464249555 HOSPITAL NY 501C3 SLHS false false false true false false false false false false false true false false false false false false false false CANTON-POTSDAM HOSPITAL C 4025423 FMV GOUVERNEUR HOSPITAL INC K 103253 CASH EXCHANGED SCHEDULE R ST. LAWRENCE HEALTH SYSTEM, INC. (SLHS) IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPITAL AND OTHER AFFILIATED CORPORATIONS.