CANTON-POTSDAM HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CANTON-POTSDAM HOSPITAL (EIN 16-1012691)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-08-15
- IRS object ID
- 201422279349300527
- Schema version
- 2013v3.1
- 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 | 2014-08-15T07:23:56-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | 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 | GRAY AND GRAY CPAS PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 MAIN ST STE 101 | AddressLine1 |
| City | CANTON | City |
| State | NY | State |
| ZIP Code | 136171277 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | 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 | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | POTSDAM | City |
| State | NY | State |
| ZIP Code | 13676 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD JACOBS | PersonNm |
| Person Title | VICE PRESIDENT/CFO | PersonTitleTxt |
| Phone | 3152615103 | PhoneNum |
| Signature | 2014-08-13 | 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 | 2014-08-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | 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 | AddressLine1 |
| City | POTSDAM | City |
| State | NY | State |
| ZIP Code | 13676 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $116,026,800 | 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 | 19 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 1071 | TotalEmployeeCnt |
| Total Volunteers | 248 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $105,711 | PYContributionsGrantsAmt |
| CY Contributions Grants | $93,421 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $93,767,589 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $109,967,103 | CYProgramServiceRevenueAmt |
| PY Investment Income | $77,109 | PYInvestmentIncomeAmt |
| CY Investment Income | $43,675 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,503,650 | PYOtherRevenueAmt |
| CY Other Revenue | $5,393,754 | CYOtherRevenueAmt |
| PY Total Revenue | $99,454,059 | PYTotalRevenueAmt |
| CY Total Revenue | $115,497,953 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $56,775,634 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $63,316,474 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $38,598,191 | PYOtherExpensesAmt |
| CY Other Expenses | $43,963,261 | CYOtherExpensesAmt |
| PY Total Expenses | $95,373,825 | PYTotalExpensesAmt |
| CY Total Expenses | $107,279,735 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,080,234 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,218,218 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $83,497,339 | TotalAssetsBOYAmt |
| Total Assets EOY | $92,743,942 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $48,272,820 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $39,831,258 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $35,224,519 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $52,912,684 | 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 | $59,258,478 | ExpenseAmt |
| Revenue | $161,202,017 | RevenueAmt |
| Desc | ACUTE CARE: CANTON-POTSDAM HOSPITAL HAS 70 LICENSED BEDS FOR MEDICAL-SURGICAL, INTENSIVE CARE AND OBSTETRIC PATIENTS. IN 2013, THERE WERE 4,007 DISCHARGES, 12,757 PATIENT DAYS WITH 76% OF THE PATIENTS EITHER MEDICARE, MEDICAID OR UNINSURED. THE HOSPITALIST PROGRAM PROVIDES CONTINUITY OF MEDICAL PROFESSIONAL CARE TO THE PATIENTS WE SERVICE. HOSPITALIST PATIENT ENCOUNTERS INCREASED BY 4.8% FROM 2012. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $13,594,801 | ExpenseAmt |
| Revenue | $27,840,982 | RevenueAmt |
| Desc | HOSPITAL BASED CLINICS: THERE WAS SIGNIFICANT GROWTH OF THE HOSPITAL BASED CLINICS. OVERALL THERE WERE OVER 99,500 VISITS IN 2013, COMPARED TO OVER 87,000 IN 2012; ROUGHLY A 12% INCREASE. IN 2013, 53% OF THE TOTAL REVENUE GENERATED FOR THE CLINICS WAS MEDICAID, MEDICARE OR UNINSURED, AS COMPARED TO 52% IN 2012. THE HOSPITAL REMAINS FOCUSED ON PROVIDING NEW SERVICES TO OUR COMMUNITY AND CONTINUES TO MAKE INVESTMENTS INTO THE INFRASTRUCTURE OF BUILDINGS, TECHNOLOGY AND PHYSICIAN RECRUITING. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,412,028 | ExpenseAmt |
| Revenue | $13,473,491 | RevenueAmt |
| Desc | OPERATING ROOM: 53% AND 52% OF THE TOTAL REVENUE GENERATED FOR THE OPERATING ROOM WAS MEDICAID, MEDICARE OR UNINSURED FOR 2013 AND 2012 RESPECTIVELY. IN 2013, THE OPERATING ROOM NUMBER OF CASES INCREASED BY 15.06%, COMPARED TO 2012. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,988,496 | ExpenseAmt |
| Revenue | $9,256,050 | RevenueAmt |
| Desc | ONCOLOGY SERVICES: IN 2013, THE NUMBER OF RADIATION ONCOLOGY AND MEDICAL ONCOLOGY VISITS AVERAGED AN INCREASE OF 9.36% FROM 2012. IN 2013, 81% OF THE REVENUE GENERATED FOR ONCOLOGY SERVICES WAS FROM MEDICAID, MEDICARE OR UNINSURED. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $4,988,496 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $9,256,050 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $85,253,803 | 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 | false | 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 | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | 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 | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 275 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1071 | 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 | 19 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | 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 | false | LocalChaptersInd |
| 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 | AddressLine1 |
| City | POTSDAM | City |
| State | NY | State |
| ZIP Code | 13676 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 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) | $59,144 | $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 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JUDY CHASE | ||||||||
| SECRETARY | 2.00 | 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 | |||
| JOHN KAPLAN | ||||||||
| 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 | |||
| SPENCER THEW | ||||||||
| 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 | ||||||||
| VICE CHAIRMA | 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 | $386,043 | $0 | $44,930 | Yes (X) | |||
| RICHARD JACOBS | ||||||||
| ASSISTANT TR | 50.00 | $243,847 | $0 | $37,386 | Yes (X) | |||
| KRIS VANWAGNER MD | ||||||||
| 50.00 | $711,248 | $0 | $46,501 | Yes (X) | ||||
| JOHN SAVAGE MD | ||||||||
| 50.00 | $676,000 | $0 | $31,449 | Yes (X) | ||||
| ALEXANDER CLARK | ||||||||
| 50.00 | $663,584 | $0 | $38,903 | Yes (X) | ||||
| XIAOSONG SONG MD | ||||||||
| 50.00 | $523,443 | $0 | $31,449 | Yes (X) | ||||
| HOWARD GOLD MD | ||||||||
| 50.00 | $508,140 | $0 | $31,449 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,771,449 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $262,067 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 63 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NORTH STAR EMERGENCY PHYSICIANS | |||||
| PO BOX 5023 | POTSDAM | NY | 13676 | EMER DEPT PHYSI | $1,256,985 |
| NORTHERN TIER CONTRACTING INC | |||||
| 59 SOUTH GORDON STREET | GOUVERNEUR | NY | 13642 | CONS CONTRACTOR | $1,182,712 |
| WEATHERLY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | PHYS SERVICE | $665,731 |
| MAYO MEDICAL LABORATORIES | |||||
| PO BOX 9146 | MINNEAPOLIS | MN | 554809146 | REFERENCE LAB | $622,233 |
| MORRISON MANAGEMENT SPECIALISTS | |||||
| PO BOX 102289 | ATLANTA | GA | 303682289 | FOOD SERVICE | $508,248 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $45,480 | GovernmentGrantsAmt |
| All Other Contributions | $47,941 | AllOtherContributionsAmt |
| Total Contributions | $93,421 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $109,967,103 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $109,967,103 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $109,967,103 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,446 | TotalRevenueColumnAmt |
| Exclusion | $27,446 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8 | TotalRevenueColumnAmt |
| Exclusion | $8 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $391,133 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $375,137 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $15,996 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,996 | TotalRevenueColumnAmt |
| Exclusion | $15,996 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $164,931 | SecuritiesAmt |
| Other | $5,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $153,710 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $11,221 | SecuritiesAmt |
| Other | $5,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,221 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,221 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $5,000 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|
| OTHER | $2,014,325 | $2,014,325 |
| MEANINGFUL USE | $1,833,649 | $1,833,649 |
| 340B RETAIL PROGRAM | $1,829,944 | $1,829,944 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$300,160 | TotalRevenueColumnAmt |
| Exclusion | -$300,160 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $5,377,758 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $115,497,953 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $109,978,324 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $5,426,208 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,545,165 | TotalAmt |
| Program Services | $1,251,584 | ProgramServicesAmt |
| Management And General | $293,581 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,765,389 | TotalAmt |
| Program Services | $39,496,772 | ProgramServicesAmt |
| Management And General | $9,268,617 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,473,876 | TotalAmt |
| Program Services | $2,003,839 | ProgramServicesAmt |
| Management And General | $470,037 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,119,960 | TotalAmt |
| Program Services | $5,767,168 | ProgramServicesAmt |
| Management And General | $1,352,792 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,412,084 | TotalAmt |
| Program Services | $2,763,788 | ProgramServicesAmt |
| Management And General | $648,296 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $320,083 | TotalAmt |
| Management And General | $320,083 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,241 | TotalAmt |
| Management And General | $187,241 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,744 | TotalAmt |
| Management And General | $113,744 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,917,927 | TotalAmt |
| Program Services | $1,917,927 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $651,852 | TotalAmt |
| Program Services | $528,000 | ProgramServicesAmt |
| Management And General | $123,852 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,571,411 | TotalAmt |
| Program Services | $1,287,153 | ProgramServicesAmt |
| Management And General | $284,258 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $422,981 | TotalAmt |
| Program Services | $342,607 | ProgramServicesAmt |
| Management And General | $80,374 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,440 | TotalAmt |
| Program Services | $135,627 | ProgramServicesAmt |
| Management And General | $31,813 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $956,057 | TotalAmt |
| Program Services | $773,845 | ProgramServicesAmt |
| Management And General | $182,212 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,285,337 | TotalAmt |
| Program Services | $5,091,123 | ProgramServicesAmt |
| Management And General | $1,194,214 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,054,037 | TotalAmt |
| Program Services | $853,770 | ProgramServicesAmt |
| Management And General | $200,267 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $14,295,619 | $11,580,394 | $2,715,225 |
| PURCHASED/CONTRACTED SERV | $6,289,176 | $5,094,241 | $1,194,935 |
| EQUIPMENT RENTAL & MAINT | $3,707,189 | $3,010,672 | $696,517 |
| PROFESSIONAL FEES | $2,525,999 | $478,940 | $2,047,059 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,497,168 | TotalAmt |
| Program Services | $2,876,353 | ProgramServicesAmt |
| Management And General | $620,815 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,279,735 | TotalAmt |
| Program Services | $85,253,803 | ProgramServicesAmt |
| Management And General | $22,025,932 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $548,515 | BOYAmt |
| EOY | $887,400 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,524,363 | BOYAmt |
| EOY | $6,033,202 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,117,190 | BOYAmt |
| EOY | $11,980,905 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,270,113 | BOYAmt |
| EOY | $1,400,850 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,448,568 | BOYAmt |
| EOY | $1,732,846 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $104,251,957 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $63,372,475 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,198,294 | BOYAmt |
| EOY | $40,879,482 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $845,734 | BOYAmt |
| EOY | $899,860 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,544,562 | BOYAmt |
| EOY | $28,929,397 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,497,339 | BOYAmt |
| EOY | $92,743,942 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,943,738 | BOYAmt |
| EOY | $12,508,728 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,560,444 | BOYAmt |
| EOY | $16,146,137 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,680,428 | BOYAmt |
| EOY | $3,850,144 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,088,210 | BOYAmt |
| EOY | $7,326,249 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,272,820 | BOYAmt |
| EOY | $39,831,258 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,352,558 | BOYAmt |
| EOY | $51,454,159 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,152,203 | BOYAmt |
| EOY | $738,767 | 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 | $35,224,519 | BOYAmt |
| EOY | $52,912,684 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,497,339 | BOYAmt |
| EOY | $92,743,942 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $8,218,218 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $45,132 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $9,424,815 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 | $113,744 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $113,744 | 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 113,744 IN LOBBYING EXPENSE FOR 2013: 85,099 WILSON, ELSER. MOSKOWITZ - FEDERAL AND STATE LOBBYING AND REPRESENTATION 10,203 HEALTHCARE ASSOCIATION OF NY STATE - FEDERAL AND STATE ADVOCACY 5,827 IROQUOIS HEALTH ALLIANCE - FEDERAL AND STATE ADVOCACY 7,896 NORTH COUNTRY HEALTHCARE PROVIDERS - STATE ADVOCACY 4,719 AMERICAN HOSPITAL ASSOCIATION - FEDERAL AND STATE ADVOCACY | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $778,337 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $34,971 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $813,308 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $53,735,344 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,653,774 | DepreciationAmt |
| Book Value | $35,081,570 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,609,349 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,217,243 | DepreciationAmt |
| Book Value | $1,392,106 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,790,640 | OtherCostOrOtherBasisAmt |
| Depreciation | $43,501,458 | DepreciationAmt |
| Book Value | $3,289,182 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $379,572 | OtherCostOrOtherBasisAmt |
| Book Value | $379,572 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $40,879,482 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST IN CANTON HOSP FOUNDATION | $18,642,265 |
| DUE FROM ST. LAWRENCE HEALTH SYSTEM | $5,000,000 |
| OTHER NOTES & LOANS RECEIVABLE (NET) | $2,376,999 |
| ASSETS WHOSE USEFUL LIFE IS LIMITED | $2,123,465 |
| DUE FROM AFFILIATE | $331,303 |
| PHYSICIAN LOANS/NOTES RECEIV. (NET) | $302,363 |
| DEFERRED FINANCING COSTS | $153,002 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $28,929,397 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD PARTY SETTLEMENTS | $3,299,332 |
| ACCRUED RETIREMENT OBLIGATIONS | $1,604,102 |
| INTEREST RATE SWAP | $1,369,181 |
| ASSET RETIREMENT OBLIGATION | $1,053,634 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,326,249 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $115,873,090 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $375,137 | OtherRevenueAmt |
| Revenue Not Reported | $375,137 | RevenueNotReportedAmt |
| Revenue Subtotal | $115,497,953 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $115,497,953 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $107,654,872 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $375,137 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $375,137 | ExpensesNotReportedAmt |
| Expenses Subtotal | $107,279,735 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $107,279,735 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | RENTAL EXPENSES 375,137 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | RENTAL EXPENSES 375,137 |
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 | $560,068 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,188 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $534,880 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,171,414 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,651,377 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,520,037 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05150 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,731,482 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,676,565 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,054,917 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05640 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $471,751 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $471,751 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $200 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $200 | NetCommunityBenefitExpnsAmt |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,256,985 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,256,985 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01170 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,402 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,402 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,753,338 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,753,338 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01630 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,484,820 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,676,565 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,808,255 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07280 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,055,450 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,055,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00980 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,055,450 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,055,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00980 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,759,377 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,004,744 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $23,660,037 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $26,058,680 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,398,643 | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 LEROY STREET | AddressLine1 |
| City | POTSDAM | City |
| State | NY | State |
| ZIP Code | 13676 | ZIPCode |
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CPHOSPITAL.ORG | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Lawsuit | Yes (X) | LawsuitInd |
| Liens On Residences | Yes (X) | LiensOnResidencesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| 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 (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 3 | SEE PART VI |
| FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 4 | SEE PART VI |
| FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 5C | SEE PART VI |
| FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 20D | SEE PART VI |
| FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 22 | SEE PART VI |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | ADDITIONAL INFORMATION | FormAndLineReferenceDesc |
| Explanation | CANTON-POTSDAM HOSPITAL 2013-FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION 1.REQUIRED DESCRIPTIONS: PART 1 LINE 3C - CHARITY CARE - CANTON-POTSDAM HOSPITAL PROVIDES CHARITY CARE TO ITS PATIENTS BASED UPON A SLIDING DISCOUNT SCHEDULE RANGING FROM 100% OF FEDERAL POVERTY GUIDELINES TO 300% OF FEDERAL POVERTY GUIDELINES. ALL DISCOUNTS ARE BASED ON THE APPLICANTS PAST YEARS' INCOME AND AN OVERALL ASSET TEST IS ALSO A PART OF THE CHARITY DETERMINATION PROCESS. THE DISCOUNT RANGES FROM 100% DISCOUNT AT THE MINIMUM INCOME THRESHOLD OF 100% FPG TO A 4% DISCOUNT AT THE 300% LEVEL OF FPG. AMOUNTS DUE ARE CALCULATED FROM THE RATES PAID BY OUR MOST PREVALENT 3RD PARTY PAYER, NOT GROSS CHARGES. PART I LINE 7 G - THE 1,256,985 SHOWN ON LINE 7G REPRESENTS THE ORGANIZATION'S COST OF SUBSIDIZING THE COST FOR PHYSICIANS AND MIDLEVEL PROVIDERS NEEDED TO PROVIDES SERVICES TO THE PATIENTS OF THE HOSPITAL'S EMERGENCY DEPARTMENT. 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 2013. 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 2013 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 13 OF THE AUDITED FINANCIAL STATEMENTS. PART III SECTION B, LINE 8 - THE SHORTFALL CALCULATED ON LINE 7 OF 2,398,643 IS THE RECOGNIZED SHORTFALL BETWEEN MEDICARE COSTS AND MEDICARE REIMBURSEMENTS UTILIZING THE COST TO CHARGE RATIO AND INFORMATION PROVIDED ON THE ORGANIZATION'S 2013 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 3 - (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 COMPRISING 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 4 - CANTON-POTSDAM HOSPITAL'S CHNA WAS CONDUCTED WITH CLAXTON-HEPBURN MEDICAL CENTER, MASSENA MEMORIAL HOSPITAL AND E.J. NOBLE HOSPITAL, AND WAS LED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION, LOCATED IN JEFFERSON COUNTY. THE ASSESSMENT WAS A TRI-COUNTY ASSESSMENT. PART V, SECTION B, LINE 5D - THE CHNA WAS/IS POSTED TO THE ORGANIZATION'S CORPORATE EXTERNAL WEBSITE. PART V, SECTION B, LINE 20 - THE HOSPITAL USES THE HIGHEST VOLUME COMMERCIAL COVERAGE RATE, BLUE CROSS/BLUE SHIELD, WHICH IS GENERALLY THE LOWEST RATE CHARGED. PART V, SECTION B, LINE 22 - IT IS THE HOSPITAL'S POLICY TO CHARGE ITS GROSS CHARGE TO ALL PATIENTS AND/OR THEIR INSURANCE. TO THE EXTENT THE PATIENT QUALIFIES FOR DISCOUNT, IT IS APPLIED ACCORDINGLY. 2.NEEDS ASSESSMENT: (DESCRIBE HOW THE ORG. ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED IN PART V, SECTION B) 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. 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 WILL ALSO BE COMPLETED BY 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 2013, THE HOSPITAL INVESTED 244,000 IN THIS PARTNERSHIP. 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 2013 HEALTH FAIRS, THE IMAGING DEPARTMENT PROVIDED FREE HEEL BONE DENSITY SCREENING EXAMS TO THE COMMUNITY. THE APPROXIMATE COST FOR THIS SERVICE WAS 62,646. FREE MAMMOGRAM SCREENINGS WERE ALSO CONDUCTED FOR A TOTAL COST OF 10,926. 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 R | 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 | $382,731 | $3,312 | $17,850 | $27,080 | $430,973 |
| RICHARD JACOBS | |||||
| ASSISTANT TREASURER | $243,847 | $16,640 | $20,746 | $281,233 | |
| KRIS VANWAGNER MD | |||||
| $711,248 | $12,750 | $33,751 | $757,749 | ||
| JOHN SAVAGE MD | |||||
| $676,000 | $12,750 | $18,699 | $707,449 | ||
| ALEXANDER CLARK | |||||
| $663,584 | $5,100 | $33,803 | $702,487 | ||
| XIAOSONG SONG MD | |||||
| $523,443 | $12,750 | $18,699 | $554,892 | ||
| HOWARD GOLD MD | |||||
| $508,140 | $12,750 | $18,699 | $539,589 | ||
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 | BusinessNameLine1 |
| 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 | $3,020,000 | 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 | Yes (true) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (true) | EngageBondCounselContractsInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.02820 | PrivateBusUseByOthersPct |
| Total Private Business Use | 0.02820 | TotalPrivateBusinessUsePct |
| 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 20,921,702 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 | 2013 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, IS ALSO THE VICE PRESIDENT FOR FINANCE AT ST. LAWRENCE UNIVERSITY (SLU). OUR ORGANIZATION PROVIDES HEALTHCARE SERVICES AND STAFFS A CLINIC ON THE SLU CAMPUS. THE OPERATION COSTS OF THAT CLINIC IN 2013 WERE APPROXIMATELY 599,400, WHICH WERE REIMBURSED BY SLU ON A PASS THROUGH BASIS. 2.DONALD DANGREMOND, MICHAEL GRIFFIN, PAUL MCGRATH AND SPENCER THEW, 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 2013 WERE APPROXIMATELY 327,186, 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 59,144 FOR THIS SERVICE IN 2013. 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 2013, 35,425 WAS REMITTED TO HOSPICE FOR THESE SERVICES. BRIAN GARDAM AND BOARD MEMBER JUDY CHITTENDEN ARE ALSO REPRESENTATIVES ON THE NORTHERN LIGHTS BOARD. NORTHERN LIGHTS HOME HEALTH CARE AGENCY WAS FORMED BY A PARTNERSHIP OF FOUR OF ST. LAWRENCE COUNTY'S LEADING HEALTH CARE ORGANIZATIONS. THIS PARTNERSHIP WAS FORMED TO ENSURE THE CONTINUANCE OF QUALITY HOME HEALTH CARE SERVICES IN THE NORTH COUNTRY. THE FOUNDING MEMBERS ARE: OCLAXTON-HEPBURN MEDICAL CENTER (CHMC) OHOSPICE AND PALLIATIVE CARE OF ST. LAWRENCE VALLEY (HOSPICE) OCANTON-POTSDAM HOSPITAL (CPH) OUNITED HELPERS MANAGEMENT COMPANY (UNITED HELPERS) 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, 2013 WAS 1,486. 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, 2013 THE HOSPITAL WAS CURRENT ON ANY OBLIGATIONS DUE TO THE BANK. 7.BOARD MEMBERS MARGARET MADDEN AND JOHN KAPLAN ARE BOTH EMPLOYED BY THE STATE UNIVERSITY OF NEW YORK AT POTSDAM. MARGARET MADDEN IS THE PROVOST AND VICE PRESIDENT FOR ACADEMIC AFFAIRS AND JOHN KAPLAN IS CHIEF OF POLICE. SUNY POTSDAM OWNS ONE OF THE MEDICAL OFFICE BUILDINGS IN POTSDAM THAT HOUSES FOUR OF OUR OUT-PATIENT CLINICS. FOR 2013, THE HOSPITAL PAID 35,445 IN RENTAL PAYMENTS FOR THIS SPACE. 8.BOARD MEMBER JUNE PEOPLES IS EMPLOYED BY NORTH COUNTRY PUBLIC RADIO (NCPR) AS MEMBERSHIP DIRECTOR. NCPR HAS A LIFETIME LEASE AT THE HOSPITAL'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. 9.BOARD MEMBER MARK CORNETT IS A GENERAL MANAGER/CONSULTANT EMPLOYED BY SLIC NETWORK SOLUTIONS. SLIC RENTS OFFICE SPACE AT THE HOSPITAL'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4D | ONCOLOGY SERVICES: IN 2013, THE NUMBER OF RADIATION ONCOLOGY AND MEDICAL ONCOLOGY VISITS AVERAGED AN INCREASE OF 9.36% FROM 2012. IN 2013, 81% OF THE REVENUE GENERATED FOR ONCOLOGY SERVICES WAS FROM MEDICAID, MEDICARE OR UNINSURED. |
| 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 | WE ANNUALLY REVIEW DISCLOSURE STATEMENTS AND HAVE REPORTING MECHANISMS, IN CLUDING A CONFIDENTIAL HOTLINE, THAT ARE REGULARLY MONITORED BY THE COMPLI ANCE OFFICER. THE COMPLIANCE OFFICER ATTENDS ALL BOARD COMMITTEE MEETINGS AND PROVIDES A MONTHLY REPORT TO THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 15A | LINE 15A: THE AUDIT AND COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS W ILL ULTIMATELY BE RESPONSIBLE FOR THE COMPENSATION OF THE TOP MANAGEMENT A T CANTON-POTSDAM HOSPITAL. THEY WILL SEEK THE INPUT OF CONSULTING FIRMS W ITH 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 CONSULTANTS, THE AUDIT AND COMPENSATION COMMITTEE WILL OFFER ITS RECOMMENDATION TO THE FULL BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 15B | LINE 15B: THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED BY THE INPUT OF RECRUITING FIRMS, IF USED, BUT PRIMARILY BY THE WORK OF THE HUMAN RESOURCE DEPARTMENT. THE DEPARTMENT WILL REVIEW THE SURROUNDING MARKET AND USE DATA FROM VARIOUS HOSPITAL ORGANIZATIONS TO ESTABLISH SALARY RANGES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLIC Y AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | RENTAL EXPENSES 375,137 RENTAL EXPENSES -375,137 |
| FORM 990, PART XI, LINE 9 | CONTRIBUTIONS FOR CAPITAL 319,294 TEMPORARILY RESTRICTED CONTRIBUTIONS FOR CAPITAL 313,870 CHANGE IN NET ASSETS OF CPH FOUNDATION 6,706,277 CHANGE IN FUNDED STATUS EMPLOYEE BEN PLAN 7,103,163 CAPITAL CAMPAIGN GIFTS -302,306 TRANSFER TO CPH FOUNDATION -4,715,483 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Business Name Line2DisregardedEntityName/BusinessNameLine2 | Business Name Line2DirectControllingEntityName/BusinessNameLine2 | 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 SYSTEMS | |||||||||||||
| 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 | ||||
| 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 | Yes (true) | 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 | Yes (true) | 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 | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (9 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt | Business Name Line2OtherOrganizationName/BusinessNameLine2 |
|---|---|---|---|
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| B | $4,715,483 | CASH EXCHANGED | |
| NORTHERN LIGHTS HEALTH CARE | |||
| B | $244,000 | CASH EXCHANGED | PARTNERSHIP INC |
| CANTON-POTSDAM MEDICAL PRACTICE | |||
| D | $395,523 | FMV | PLLC |
| ST LAWRENCE HEALTH SYSTEMS INC | |||
| D | $5,000,000 | FMV | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| J | $9,360 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| K | $334,725 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| M | $425,000 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| P | $645,109 | CASH EXCHANGED | |
| CANTON-POTSDAM HOSPITAL FOUNDATION | |||
| G | $288,248 | CASH EXCHANGED | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R | FormAndLineReferenceDesc |
| Explanation | CANTON_-POTSDAM HOSPITAL FOUNDATION IS REPONSIBLE 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 (THE TAX EXEMPT APPLICATION IS IN PROCESS) ST. LAWRENCE HEALTH SYSTEM, FORMED DECEMBER 5, 2013, IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPITAL AND OTHER CORPORATIONS. NORTHERN LIGHTS HEALTH CARE PARTNERSHIP, INC. OPERATES A CERTIFIED HOME HEALTH AGENCY | ExplanationTxt |