CANTON-POTSDAM HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- CANTON-POTSDAM HOSPITAL (EIN 16-1012691)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-08-18
- IRS object ID
- 201542309349300034
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-18T09:25:52-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 201767403 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOFFMAN EELLS & GRAY CPAS PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 MAIN STREET SUITE 101 | AddressLine1Txt |
| City | CANTON | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 136171277 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161012691 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANTON-POTSDAM HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CANT | BusinessNameControlTxt |
| Phone | 3152615103 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 LEROY STREET | AddressLine1Txt |
| City | POTSDAM | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13676 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD JACOBS | PersonNm |
| Person Title | VICE PRESIDENT/CFO | PersonTitleTxt |
| Phone | 3152615103 | PhoneNum |
| Signature | 2015-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN J GRAY JR CPA | PreparerPersonNm |
| PTIN | P00076464 | PTIN |
| Phone | 3153862925 | PhoneNum |
| Preparation | 2015-08-18 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RICHARD JACOBS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 LEROY STREET | AddressLine1Txt |
| City | POTSDAM | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13676 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $141,581,725 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CPHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1920 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | CANTON-POTSDAM HOSPITAL'S MISSION IS TO PROVIDE SKILLED, COMPASSIONATE COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS COMMUNITY NEEDS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 1227 | TotalEmployeeCnt |
| Total Volunteers | 275 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $93,421 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,111,375 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $109,967,103 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $129,916,602 | CYProgramServiceRevenueAmt |
| PY Investment Income | $43,675 | PYInvestmentIncomeAmt |
| CY Investment Income | $300,198 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,393,754 | PYOtherRevenueAmt |
| CY Other Revenue | $9,665,762 | CYOtherRevenueAmt |
| PY Total Revenue | $115,497,953 | PYTotalRevenueAmt |
| CY Total Revenue | $140,993,937 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $63,316,474 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $81,509,663 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $43,963,261 | PYOtherExpensesAmt |
| CY Other Expenses | $47,865,294 | CYOtherExpensesAmt |
| PY Total Expenses | $107,279,735 | PYTotalExpensesAmt |
| CY Total Expenses | $129,374,957 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,218,218 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $11,618,980 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $92,743,942 | TotalAssetsBOYAmt |
| Total Assets EOY | $100,388,006 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $39,831,258 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $47,393,323 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $52,912,684 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $52,994,683 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CANTON-POTSDAM HOSPITAL'S MISSION IS TO PROVIDE SKILLED, COMPASSIONATE COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS COMMUNITY NEEDS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $65,668,156 | ExpenseAmt |
| Revenue | $179,302,984 | RevenueAmt |
| Desc | 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 7% FROM 2013 TO 2014. TOTAL DISCHARGES INCREASED BY APPROXIMATELY 1% FROM 2013 TO 2014. OBSERVATION CASES INCREASED BY APPROXIMATELY 43% FROM 2013 TO 2014. CHEMICAL DEPENDENCY PROGRAM: CANTON-POTSDAM HOSPITAL OPERATES A 7 BED DETOXIFICATION AND 17 BED REHABILITATION PROGRAM. GROWTH CONTINUES IN BOTH PROGRAMS WHICH PROVIDE A HIGHLY NEEDED SERVICE TO RESIDENTS OF ST. LAWRENCE COUNTY AND IMMEDIATE SURROUNDING COUNTIES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $17,554,407 | ExpenseAmt |
| Revenue | $40,533,535 | RevenueAmt |
| Desc | HOSPITAL BASED CLINICS: THERE WAS SIGNIFICANT GROWTH OF THE HOSPITAL BASED CLINICS. OVERALL THERE WERE 108,274 VISITS IN 2014, COMPARED TO OVER 99,500 IN 2013; ROUGHLY AN 8.8% INCREASE. EIGHT NEW OUT PATIENT CLINIC LOCATIONS WERE ESTABLISHED, TO INCLUDE OUTPATIENT SERVICES FOR OB, ORTHOPEDICS, PODIATRY, PULMONOLOGY, PAIN MANAGEMENT AND GENERAL SURGERY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,672,723 | ExpenseAmt |
| Revenue | $14,524,366 | RevenueAmt |
| Desc | OPERATING ROOM: IN 2014, THE OPERATING ROOM NUMBER OF CASES INCREASED BY APPROXIMATELY 14%, COMPARED TO 2013. SIGNIFICANT INCREASES WERE DUE TO A 77% INCREASE IN ORTHOPEDICS, APPROXIMATELY 5% INCREASES IN BOTH GENERAL SURGERY AND GYNECOLOGY, AND THE ADDITION OF PODIATRY CASES. THE HOSPITAL ALSO EXPERIENCED A 15% INCREASE IN AMBULATORY SURGERY UNIT VISITS FROM 2013. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,163,695 | ExpenseAmt |
| Revenue | $8,370,596 | RevenueAmt |
| Desc | ONCOLOGY SERVICES: IN 2014, THE ONCOLOGY VISITS INCREASED FROM 8,440 IN 2013 TO 8,917 IN 2014, ROUGHLY A 5.7% INCREASE. THE NUMBER OF RADIATION ONCOLOGY VISITS DECREASED BY APPROXIMATELY 6%, WITH THE MEDICAL ONCOLOGY VISITS INCREASED BY APPROXIMATELY 14%. THE ONE MILLION DOLLAR INCREASE IN EXPENSES FOR THE ONCOLOGY DEPARTMENTS WAS LARGELY DUE TO THE INCREASE IN PHARMACEUTICALS EXPENSE, WHICH INCREASED 43.4% FROM FISCAL YEAR 2013. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $6,163,695 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $8,370,596 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $98,058,981 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | Yes (true) | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 323 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1227 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | Yes (true) | LocalChaptersInd |
| Policies Reference Chapters | Yes (true) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD JACOBS CANTON-POTSDAM HOSP | PersonNm |
| Phone | 3152615100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 LEROY STREET | AddressLine1Txt |
| City | POTSDAM | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13676 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MICHAEL TULLOCH MD | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $52,220 | $0 | $0 | |||
| RONALD BERRY | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| DONALD DANGREMOND | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KATHRYN MULLANEY | ||||||||
| TREASURER | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JUDY CHASE | ||||||||
| SECRETARY | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MICHAEL GRIFFIN | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| BRIAN GARDAM | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JUNE PEOPLES | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| MARGARET MADDEN | ||||||||
| CHAIRPERSON | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| LAURIE MAKI | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| PAUL MCGRATH | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JOANNE SCOTT | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JUDY CHITTENDEN | ||||||||
| VICE CHAIRPE | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| EDWARD MUCENSKI | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| MARK CORNETT | ||||||||
| 2ND VICE CHA | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PAUL COLE DVM | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES THEODORE | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID ACKER | ||||||||
| PRESIDENT & | 50.00 | $400,440 | $0 | $98,940 | Yes (X) | |||
| RICHARD JACOBS | ||||||||
| ASSISTANT TR | 50.00 | $249,482 | $0 | $35,084 | Yes (X) | |||
| MARCO BERNARD MD | ||||||||
| 50.00 | $816,020 | $0 | $40,807 | Yes (X) | ||||
| KRIS VANWAGNER MD | ||||||||
| 50.00 | $747,586 | $0 | $22,420 | Yes (X) | ||||
| JEFFREY HAASBEEK MD | ||||||||
| 50.00 | $706,529 | $0 | $33,955 | Yes (X) | ||||
| JOHN SAVAGE MD | ||||||||
| 50.00 | $676,432 | $0 | $30,556 | Yes (X) | ||||
| XIAOSONG SONG MD | ||||||||
| 50.00 | $601,221 | $0 | $31,144 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,249,930 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $292,906 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 120 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NORTHERN TIER CONTRACTING INC | |||||
| 39 SOUTH GORDON STREET | GOUVERNEUR | NY | 13642 | CONSTRUCTION | $961,280 |
| MAYO MEDICAL LABORATORIES | |||||
| PO BOX 9146 | MINNEAPOLIS | MN | 554809146 | REFERENCE LAB | $666,607 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | PHYSICIAN SERV. | $636,476 |
| DANKO CONSTRUCTION CORP | |||||
| PO BOX 239 | MASSENA | NY | 13662 | CONSTRUCTION | $618,318 |
| UNIVERSITY OF VERMONT MEDICAL CENTE | |||||
| PO BOX 1902 | BURLINGTON | VT | 054021902 | LAB SERVICES | $573,431 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 30 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,029,018 | GovernmentGrantsAmt |
| All Other Contributions | $82,357 | AllOtherContributionsAmt |
| Total Contributions | $1,111,375 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $129,916,602 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $129,916,602 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $129,916,602 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $180,668 | TotalRevenueColumnAmt |
| Exclusion | $180,668 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $552,375 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $422,840 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $129,535 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $129,535 | TotalRevenueColumnAmt |
| Exclusion | $129,535 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $159,838 | SecuritiesAmt |
| Other | $124,640 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $141,315 | SecuritiesAmt |
| Other | $23,633 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $18,523 | SecuritiesAmt |
| Other | $101,007 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $119,530 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,523 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $101,007 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|
| OTHER | $4,181,204 | $4,181,204 |
| 340B RETAIL PROGRAM | $2,952,948 | $2,952,948 |
| OTHER | $1,338,048 | $1,338,048 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,064,027 | TotalRevenueColumnAmt |
| Exclusion | $1,064,027 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $9,536,227 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $140,993,937 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $129,935,125 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $9,947,437 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,714,269 | TotalAmt |
| Program Services | $1,319,987 | ProgramServicesAmt |
| Management And General | $394,282 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,754,121 | TotalAmt |
| Program Services | $49,856,995 | ProgramServicesAmt |
| Management And General | $14,897,126 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,897,539 | TotalAmt |
| Program Services | $1,461,105 | ProgramServicesAmt |
| Management And General | $436,434 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,975,298 | TotalAmt |
| Program Services | $6,910,979 | ProgramServicesAmt |
| Management And General | $2,064,319 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,168,436 | TotalAmt |
| Program Services | $3,209,696 | ProgramServicesAmt |
| Management And General | $958,740 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $377,211 | TotalAmt |
| Management And General | $377,211 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $229,800 | TotalAmt |
| Management And General | $229,800 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,696 | TotalAmt |
| Management And General | $119,696 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $332,446 | TotalAmt |
| Program Services | $332,446 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $560,735 | TotalAmt |
| Program Services | $431,766 | ProgramServicesAmt |
| Management And General | $128,969 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,883,257 | TotalAmt |
| Program Services | $1,458,226 | ProgramServicesAmt |
| Management And General | $425,031 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $531,959 | TotalAmt |
| Program Services | $409,599 | ProgramServicesAmt |
| Management And General | $122,360 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,123 | TotalAmt |
| Program Services | $167,955 | ProgramServicesAmt |
| Management And General | $50,168 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $901,050 | TotalAmt |
| Program Services | $691,361 | ProgramServicesAmt |
| Management And General | $209,689 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,134,879 | TotalAmt |
| Program Services | $5,493,857 | ProgramServicesAmt |
| Management And General | $1,641,022 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,089,244 | TotalAmt |
| Program Services | $838,718 | ProgramServicesAmt |
| Management And General | $250,526 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $18,038,513 | $13,889,404 | $4,149,109 |
| PURCHASED/CONTRACTED SERV | $7,250,429 | $5,582,831 | $1,667,598 |
| EQUIPMENT RENTAL & MAINT | $4,001,744 | $3,099,778 | $901,966 |
| OTHER | $3,084,167 | $2,418,559 | $665,608 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,112,041 | TotalAmt |
| Program Services | $485,719 | ProgramServicesAmt |
| Management And General | $1,626,322 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,374,957 | TotalAmt |
| Program Services | $98,058,981 | ProgramServicesAmt |
| Management And General | $31,315,976 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $887,400 | BOYAmt |
| EOY | $3,537,041 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,033,202 | BOYAmt |
| EOY | $4,797,657 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,980,905 | BOYAmt |
| EOY | $14,127,336 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,400,850 | BOYAmt |
| EOY | $1,554,596 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,732,846 | BOYAmt |
| EOY | $2,180,554 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $111,478,774 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $69,486,817 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,879,482 | BOYAmt |
| EOY | $41,991,957 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $899,860 | BOYAmt |
| EOY | $909,653 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,929,397 | BOYAmt |
| EOY | $31,289,212 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,743,942 | BOYAmt |
| EOY | $100,388,006 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,508,728 | BOYAmt |
| EOY | $15,212,296 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,146,137 | BOYAmt |
| EOY | $14,819,212 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,850,144 | BOYAmt |
| EOY | $3,768,468 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,326,249 | BOYAmt |
| EOY | $13,593,347 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,831,258 | BOYAmt |
| EOY | $47,393,323 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,454,159 | BOYAmt |
| EOY | $51,896,132 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $738,767 | BOYAmt |
| EOY | $378,793 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $719,758 | BOYAmt |
| EOY | $719,758 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,912,684 | BOYAmt |
| EOY | $52,994,683 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,743,942 | BOYAmt |
| EOY | $100,388,006 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $11,618,980 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$4,678 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$11,532,303 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $119,696 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $119,696 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | CANTON POTSDAM HOSPITAL THROUGH ITS MEMBERSHIP OR FEES PAID TO THE FOLLOWING ORGANIZATIONS INCURRED 119,696 IN LOBBYING EXPENSES IN 2014: 85,006: WILSON, ELSER, MOSKOWITZ-FEDERAL AND STATE LOBBYING AND REPRESENTATION. 14,893: NORTH COUNTRY HEALTHCARE PROVIDERS-STATE ADVOCACY. 9,553: HANYS ANNUAL MEMBERSHIP DUES-FEDERAL AND STATE ADVOCACY. 5,431: IROQUOIS HEALTHCARE ALLIANCE-FEDERAL AND STATE ADVOCACY. 4,813: AMERICAN HOSPITAL ASSOCIATION ANNUAL MEMBERSHIP DUES-FEDERAL AND STATE ADVOCACY. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $899,859 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $9,794 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $909,653 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $845,727 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $54,132 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $899,859 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $820,749 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $24,978 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $845,727 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $831,307 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$10,558 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $820,749 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $813,308 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $17,999 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $831,307 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.79000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.21000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $737,052 | OtherCostOrOtherBasisAmt |
| Book Value | $737,052 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $56,161,089 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,545,190 | DepreciationAmt |
| Book Value | $35,615,899 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,609,349 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,333,989 | DepreciationAmt |
| Book Value | $1,275,360 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $51,440,195 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,607,638 | DepreciationAmt |
| Book Value | $3,832,557 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $531,089 | OtherCostOrOtherBasisAmt |
| Book Value | $531,089 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $41,991,957 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (8 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST IN CANTON HOSP FOUNDATION | $19,624,379 |
| DUE FROM ST. LAWRENCE HEALTH SYSTEM | $5,745,952 |
| ASSETS WHOSE USEFUL LIFE IS LIMITED | $2,384,490 |
| DUE FROM AFFILIATES | $1,456,968 |
| OTHER NOTES & LOANS RECEIVABLE (NET) | $972,270 |
| OTHER ASSETS | $927,805 |
| DEFERRED FINANCING COSTS | $92,426 |
| PHYSICIAN LOANS/NOTES RECEIV. (NET) | $84,922 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $31,289,212 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED RETIREMENT OBLIGATION | $6,620,886 |
| ESTIMATED THIRD PARTY SETTLEMENTS | $3,861,284 |
| ASSET RETIREMENT OBLIGATION | $1,600,383 |
| INTEREST RATE SWAP | $1,510,794 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $13,593,347 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $141,484,542 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $422,841 | OtherRevenueAmt |
| Revenue Not Reported | $422,841 | RevenueNotReportedAmt |
| Revenue Subtotal | $141,061,701 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$67,764 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$67,764 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $140,993,937 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $129,797,798 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $422,841 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $422,841 | ExpensesNotReportedAmt |
| Expenses Subtotal | $129,374,957 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $129,374,957 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | SEE PART X, OTHER LIABILITIES |
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | RENTAL EXPENSES 422,841 |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | GIFT AND BEQUESTS: 62,079 CHANGE OF FAIR MARKET VALUE OF INTEREST RATE SWAP -141,613 UNRESTRICTED ENDOWMENT INCOME: 21,926 REALIZED GAIN ON INVESTMENTS: 112,382 OTHER: -122,538 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | RENTAL EXPENSES 422,841 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $670,115 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,508 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $658,607 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,127,314 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $456,643 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,670,671 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09020 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,797,429 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $468,151 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,329,278 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09530 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $328,192 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $328,192 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,920 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $21,920 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $191,360 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $191,360 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $200 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $200 | NetCommunityBenefitExpnsAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $541,672 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $541,672 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00420 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,339,101 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $468,151 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,870,950 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09950 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $592,412 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $592,412 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $592,412 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $592,412 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,230,758 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $488,868 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $27,113,486 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $28,252,307 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,138,821 | MedicareSurplusOrShortfallAmt |
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANTON-POTSDAM HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 LEROY STREET | AddressLine1Txt |
| City | POTSDAM | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13676 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CPHOSPITAL.ORG | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANTON-POTSDAM HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CPHOSPITAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Legal Judicial Process | Yes (X) | PermitLegalJudicialProcessInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Engaged Legal Judicial Process | Yes (X) | EngagedLegalJudicialProcessInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 22D | SEE PART VI |
| FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 24 | SEE PART VI |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | ADDITIONAL INFORMATION | FormAndLineReferenceDesc |
| Explanation | CANTON-POTSDAM HOSPITAL 2014-FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION PART V, 20D: 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 2014. 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 2014 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. PART III SECTION B, LINE 8 - THE SHORTFALL CALCULATED ON LINE 7 OF 1,138,821 IS THE RECOGNIZED SHORTFALL BETWEEN MEDICARE COSTS AND MEDICARE REIMBURSEMENTS UTILIZING THE COST TO CHARGE RATIO AND INFORMATION PROVIDED ON THE ORGANIZATION'S 2014 MEDICARE COST REPORT. 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 - (IN CONDUCTING ITS MOST RECENT CHNA, DESCRIBE HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED) IN CONDUCTING ITS MOST RECENT CHNA, CANTON-POTSDAM HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE COMMUNITY THROUGH FORMAL AND INFORMAL MEETINGS OF THE HOSPITAL'S VOTING MEMBERSHIP (A GROUP OF APPROXIMATELY 300 PEOPLE REPRESENTING ALL PRIMARY AND SECONDARY SERVICE AREAS), INDIVIDUAL MEETINGS WITH PUBLIC HEALTH OFFICIALS, LOCAL COLLEGE PRESIDENTS, THE LEADERS OF OTHER AREA HEALTHCARE FACILITIES (UNITED HELPERS, INC., HOSPICE AND PALLIATIVE CARE OF THE ST. LAWRENCE VALLEY, CLAXTON-HEPBURN MEDICAL CENTER, MASSENA MEMORIAL HOSPITAL, E.J. NOBLE HOSPITAL, SAMARITAN MEDICAL CENTER, AND CLIFTON-FINE HOSPITAL), AND LOCAL GOVERNMENT OFFICIALS. ADDITIONAL INPUT WAS GATHERED FROM HOSPITAL BOARD MEMBERS REPRESENTING PUBLIC HEALTH, DENTISTRY, VETERINARY HEALTH, THE COLLEGES, HOSPICE, AND AREA BUSINESSES. INPUT IS ALSO SOUGHT THROUGH REGULAR OPEN FORUMS AND INFORMAL CONVERSATIONS WITH THE HOSPITAL'S TWO AUXILIARY GROUPS AND ITS CADRE OF VOLUNTEERS COMPRISING STUDENTS, THE ELDERLY, AND PEOPLE WITH DISABILITIES. IN 2013, CPH ESTABLISHED A PATIENT ADVISORY COUNCIL COMPRISED OF PATIENTS FROM A VARIETY OF SOCIOECONOMIC AND AGE CATEGORIES. CANTON-POTSDAM HOSPITAL PARTICIPATES AT THE BOARD LEVEL, ALONG WITH THE ST. LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT, ON THE ST. LAWRENCE HEALTH INITIATIVE, A NOT-FOR-PROFIT ORGANIZATION COORDINATING HEALTH ASSESSMENT AMONG ALL AREA HEALTH FACILITIES. THIS ORGANIZATION PROVIDES REGULAR AND FORMAL COORDINATION FOR ONGOING ASSESSMENT OF AND COLLABORATION ON PROGRAMS TO ADDRESS THE REGION'S NEEDS. PART V, SECTION B, LINE 6A&B - CANTON-POTSDAM HOSPITAL'S CHNA WAS CONDUCTED WITH CLAXTON-HEPBURN MEDICAL CENTER, MASSENA MEMORIAL HOSPITAL AND E.J. NOBLE HOSPITAL, AND WAS AUTHORED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION, LOCATED IN JEFFERSON COUNTY. THE ASSESSMENT WAS A TRI-COUNTY ASSESSMENT. PART V SECTION B, LINE 11 - (DESCRIBE HOW THE FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED.) CANTON-POTSDAM HOSPITAL PARTICIPATED IN A COUNTY-WIDE NEEDS ASSESSMENT PROCESS LED BY ITS COMMUNITY PARTNER, ST. LAWRENCE HEALTH INITIATIVE, AND THE ST. LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT. THIS EFFORT ASSESSED HEALTH NEEDS, EXISTENCE OF HEALTHCARE ORGANIZATIONS AND COMMUNITY ORGANIZATIONS ABLE TO ADDRESS THESE NEEDS, AND PRIORITIZED HEALTH NEEDS TO WHICH HOSPITALS AND OTHER HEALTHCARE ORGANIZATIONS COLLABORATIVELY COMMITTED TO ADDRESSING. THESE HIGH-PRIORITY HEALTH NEEDS INCLUDE CHRONIC DISEASE PREVENTION WITH A FOCUS ON OBESITY AND COLORECTAL CANCER, AND PROMOTION OF MENTAL HEALTH AND PREVENTION OF SUBSTANCE ABUSE. THESE PRIORITY AREAS ARE THE FOCUS OF THE HOSPITAL'S THREE-YEAR PLAN AND DOVETAIL WITH CPH'S ONGOING STRATEGIC PLANNING PROCESS, WHICH HAS CALLED FOR RECRUITMENT OF PRIMARY AND SPECIALTY PRACTITIONERS, EXPANSION OF OUTPATIENT SERVICES, AND CREATION OF A PRIMARY MEDICAL HOME MODEL. IN 2014, CPH'S POTSDAM MEDICAL HOME RECEIVED CERTIFICATION. CPH PLANS TO MEET HEALTH NEEDS THROUGH EXTENSIVE CONSULTATION WITH COMMUNITY GROUPS, LOCAL GOVERNMENT ENTITIES, EMPLOYEES AND VOLUNTEERS, LOCAL ECONOMIC DEVELOPMENT AGENCIES, HOSPITAL AUXILIARIES, EMERGENCY MANAGEMENT LEADERS, ACADEMIC LEADERS, AND HEALTHCARE PRACTITIONERS. IN 2013, CPH CREATED A PATIENT ADVISORY GROUP WHICH PROVIDES INVALUABLE INPUT ON THE PATIENT EXPERIENCE AND COMMUNITY NEEDS. IN ADDITION, CPH PRESENTED EXHAUSTIVE HEALTHCARE STATUS DATA AND SOUGHT FEEDBACK AS PART OF THE NEW YORK STATE HEALTHCARE REDESIGN COMMISSION, WHICH HELD A SERIES OF PUBLIC MEETINGS IN EARLY 2014. IN FURTHERANCE OF CPH'S STRATEGIC PLAN, CONSTRUCTION ON AN EXPANDED MEDICAL OFFICE BUILDING IN POTSDAM, NEW YORK WAS COMPLETED IN 2013 TO ACCOMMODATE MULTIPLE PHYSICIAN PRACTICES. RELATED CONSTRUCTION OF AN URGENT CARE CENTER WAS COMPLETED MARCH 2014. IN 2012, THE HOSPITAL, WITH THREE OTHER PARTNERS, FORMED NORTHERN LIGHTS HEALTH CARE PARTNERSHIP, INC. NORTHERN LIGHTS PROVIDES CERTIFIED HOME HEALTH CARE TO RESIDENTS OF ST. LAWRENCE COUNTY, NEW YORK. FORMATION OF THIS PARTNERSHIP WAS DUE TO DISCONTINUATION OF THESE SERVICES BY THE COUNTY. IN 2014, THE HOSPITAL INVESTED 117,500 IN THIS PARTNERSHIP. 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 55,000 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 2014 HEALTH FAIRS, THE IMAGING DEPARTMENT PROVIDED FREE HEEL BONE DENSITY SCREENING EXAMS TO THE COMMUNITY. THE APPROXIMATE COST FOR THIS SERVICE WAS 71,300. 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 47,600. THE HOSPITAL INVESTED 20,000 IN THE A.D.A.M. ONLINE EDUCATION RESOURCE. WITH THIS RESOURCE WE ARE ABLE TO PROVIDE WEBSITE VISITORS WITH THE MOST CURRENT, PHYSICIAN REVIEWED HEALTH ARTICLES. IN ADDITION TO EDUCATION AND RESEARCH, VISITORS CAN ALSO UTILIZE THE SYMPTOM NAVIGATOR TO BETTER DETERMINE THEIR HEALTH CONCERNS PRIOR TO VISITING THE EMERGENCY ROOM OR ANY OF OUR SERVICES. EDUCATION AND PATIENT SELF-MANAGEMENT IS CRITICAL IN PREVENTIVE MEDICINE; WITH THE ADDITION OF A.D.A.M. CONTENT, PATIENTS ARE NOW ABLE TO REVIEW AND PRINT INSTRUCTIONS FOR PROCEDURES OR FOLLOW-UP CARE RIGHT FROM THEIR OWN HOMES. THE CHEMICAL DEPENDENCY DEPARTMENT OF THE HOSPITAL DONATED TIME AS COUNSELORS TO THE COUNTY JAIL, SPOKE ABOUT CHEMICAL DEPENDENCY AT THE LOCAL COLLEGES, ATTENDS DRUG COURT TO ASSIST WITH | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| DAVID ACKER | |||||
| PRESIDENT & CEO | $399,342 | $1,098 | $75,920 | $23,020 | $499,380 |
| RICHARD JACOBS | |||||
| ASSISTANT TREASURER | $249,482 | $17,369 | $17,715 | $284,566 | |
| MARCO BERNARD MD | |||||
| $816,020 | $10,147 | $30,660 | $856,827 | ||
| KRIS VANWAGNER MD | |||||
| $747,586 | $13,000 | $9,420 | $770,006 | ||
| JEFFREY HAASBEEK MD | |||||
| $706,529 | $5,200 | $28,755 | $740,484 | ||
| JOHN SAVAGE MD | |||||
| $676,432 | $13,000 | $17,556 | $706,988 | ||
| XIAOSONG SONG MD | |||||
| $601,221 | $13,000 | $18,144 | $632,365 | ||
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST LAWRENCE COUNTY IDC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 272614310 | BondIssuerEIN |
| Bond Issued | 2010-08-30 | BondIssuedDt |
| Issue Price | $21,305,500 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | Yes (true) | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $4,275,000 | RetiredAmt |
| Total Proceeds | $20,921,703 | TotalProceedsAmt |
| Capital Expenditures | $11,168,176 | CapitalExpendituresAmt |
| Other Spent Proceeds | $9,590,000 | OtherSpentProceedsAmt |
| Substantial Completion | 2011 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | false | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (true) | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | Yes (true) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K - ADDITIONAL INFORMATION | FormAndLineReferenceDesc |
| Explanation | ST. LAWRENCE COUNTY IDC 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. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEE PART V | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | 2014 FORM 990, SCHEDULE L PART IV, SUPPLEMENTAL RESPONSE OUR ORGANIZATION HAS BUSINESS TRANSACTIONS INVOLVING CERTAIN MEMBERS OF OUR BOARD OF DIRECTORS, WHICH ARE DETAILED BELOW: 1.KATHRYN MULLANEY, OUR BOARD TREASURER, 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 2014 WERE APPROXIMATELY 586,463, WHICH WERE REIMBURSED BY SLU ON A PASS THROUGH BASIS. 2.DONALD DANGREMOND, MICHAEL GRIFFIN AND PAUL MCGRATH, BOARD MEMBERS, ARE 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 2014 WERE APPROXIMATELY 349,412 WHICH WERE REIMBURSED BY CU ON A PASS THROUGH BASIS. 3.DR. MICHAEL TULLOCH, BOARD MEMBER, IS CONTRACTED TO PERFORM INTERPRETATIONS OF CARDIOLOGY SERVICES PROVIDED AT OUR FACILITY. HE WAS COMPENSATED 52,220 FOR THIS SERVICE IN 2014. HIS PAYMENT FOR PROFESSIONAL SERVICES IS BASED ON A PER PROCEDURE FEE STRUCTURE. 4.BRIAN GARDAM, BOARD MEMBER, IS ALSO THE 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. IN 2014, 24,861 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, 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, 2014 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, IS A BOARD MEMBER OF COMMUNITY BANK, NA. AS OF DECEMBER 31, 2014 THE HOSPITAL WAS CURRENT ON ANY OBLIGATIONS DUE TO THE BANK. 7.BOARD MEMBER MARGARET MADDEN IS EMPLOYED BY THE STATE UNIVERSITY OF NEW YORK AT POTSDAM. MARGARET MADDEN IS THE PROVOST AND VICE PRESIDENT FOR ACADEMIC AFFAIRS. SUNY POTSDAM OWNS ONE OF THE MEDICAL OFFICE BUILDINGS IN POTSDAM THAT HOUSES FOUR OF OUR OUT-PATIENT CLINICS. 8.BOARD MEMBER JUNE PEOPLES IS EMPLOYED BY NORTH COUNTRY PUBLIC RADIO (NCPR) AS DIRECTOR OF GIVING AND FINANCE. NCPR HAS A LIFETIME LEASE AT THE HOSPITAL'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. 9.BOARD MEMBER MARK CORNETT IS A CONSULTANT EMPLOYED BY SLIC NETWORK SOLUTIONS. SLIC RENTS OFFICE SPACE AT THE HOSPITAL'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. CANTON-POTSDAM HOSPITAL REMITTED APPROXIMATELY 147,500 TO SLIC IN 2014 FOR TELECOMMUNICATION SERVICES. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | CANTON-POTSDAM HOSPITAL OPERATES A 7 BED DETOXIFICATION AND 17 BED REHABILITATION PROGRAM. GROWTH CONTINUES IN BOTH PROGRAMS WHICH PROVIDE A HIGHLY NEEDED SERVICE TO RESIDENTS OF ST. LAWRENCE COUNTY AND IMMEDIATE SURROUNDING COUNTIES. |
| FORM 990, PAGE 2, PART III, LINE 4D | ONCOLOGY SERVICES: IN 2014, THE ONCOLOGY VISITS INCREASED FROM 8,440 IN 2013 TO 8,917 IN 2014, ROUGHLY A 5.7% INCREASE. THE NUMBER OF RADIATION ONCOLOGY VISITS DECREASED BY APPROXIMATELY 6%, WITH THE MEDICAL ONCOLOGY VISITS INCREASED BY APPROXIMATELY 14%. THE ONE MILLION DOLLAR INCREASE IN EXPENSES FOR THE ONCOLOGY DEPARTMENTS WAS LARGELY DUE TO THE INCREASE IN PHARMACEUTICALS EXPENSE, WHICH INCREASED 43.4% FROM FISCAL YEAR 2013. |
| 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 | RENTAL EXPENSES 422,841 GIFT AND BEQUESTS: -62,079 CHANGE OF FAIR MARKET VALUE OF INTEREST RATE SWAP 141,613 UNRESTRICTED ENDOWMENT INCOME: -21,926 REALIZED GAIN ON INVESTMENTS: -112,382 OTHER: 122,538 RENTAL EXPENSES -422,841 |
| FORM 990, PART XI, LINE 9 | CONTRIBUTIONS FOR CAPITAL 184,691 TEMPORARILY RESTRICTED CONTRIBUTIONS FOR CAPITAL 248,311 CHANGE IN INTEREST IN NET ASSETS OF CPH FOUNDATION 1,300,148 CHANGE IN FUNDED STATUS OF EMPLOYEE BEN PLAN -6,711,707 CAPITAL CAMPAIGN GIFTS -318,034 TRANSFER TO CPH FOUNDATION -558,711 TRANSFER TO ST. LAWRENCE HEALTH SYSTEM -1,801,577 TRANSFER TO AFFILIATE (CANTON POTSDAM MEDICAL PRAC -3,875,423 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Business Name Line2DisregardedEntityName/BusinessNameLine2Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||||||||||||
| 29 GROVE STREET | POTSDAM | NY | 13676 | 161279472 | PART VII | NY | 501C3 | 11A | NA | false | |||
| CANTON-POTSDAM MEDICAL PRACTICEPLLC | |||||||||||||
| 50 LEROY STREET | POTSDAM | NY | 13676 | 460714367 | PART VII | NY | 501C3 | CANTON-POT | Yes (true) | PLLC | SDAM HOSPITAL | ||
| ST LAWRENCE HEALTH SYSTEM | |||||||||||||
| 50 LEROY STREET | POTSDAM | NY | 13676 | 464259168 | PART VII | NY | 501C3 | 11A | false | N/A | |||
| NORTHERN LIGHTS HEALTHCARE PARTNERS | |||||||||||||
| 732 FORD STREET | OGDENSBURG | NY | 13669 | 462500951 | PART VII | NY | 501C3 | false | N/A | ||||
| GOUVERNEUR HOSPITAL INC | |||||||||||||
| 77 W BARNEY STREET | GOUVERNEUR | NY | 13642 | 464249555 | HOSPITAL | NY | 501C3 | false | N/A | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (12 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt | Business Name Line2OtherOrganizationName/BusinessNameLine2Txt |
|---|---|---|---|
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| B | $558,711 | CASH EXCHANGED | |
| NORTHERN LIGHTS HEALTH CARE | |||
| B | $117,500 | CASH EXCHANGED | PARTNERSHIP INC |
| CANTON-POTSDAM MEDICAL PRACTICE | |||
| B | $4,025,423 | FMV | PLLC |
| ST LAWRENCE HEALTH SYSTEMS INC | |||
| B | $1,801,576 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| J | $9,360 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| K | $523,645 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| M | $492,322 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| P | $137,511 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| Q | $203,900 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| R | $67,711 | CASH EXCHANGED | |
| GOUVERNEUR HOSPITAL INC | |||
| J | $1,987,744 | FMV | |
| GOUVERNEUR HOSPITAL INC | |||
| K | $207,043 | FMV | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |