2014-08-15T07:23:56-05:00 2013-12-31 201767403 GRAY AND GRAY CPAS PC 1 MAIN ST STE 101 CANTON NY 136171277 990 2013-01-01 161012691 CANTON-POTSDAM HOSPITAL CANT 3152615103 50 LEROY STREET POTSDAM NY 13676 RICHARD JACOBS VICE PRESIDENT/CFO 3152615103 2014-08-13 true JOHN J GRAY JR CPA P00076464 3153862925 2014-08-13 2013 2015-11-30 17:44:51Z RICHARD JACOBS 50 LEROY STREET POTSDAM NY 13676 116026800 false X WWW.CPHOSPITAL.ORG X 1920 NY CANTON-POTSDAM HOSPITAL'S MISSION IS TO PROVIDE SKILLED, COMPASSIONATE COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS COMMUNITY NEEDS 19 5 1071 248 0 105711 93421 93767589 109967103 77109 43675 5503650 5393754 99454059 115497953 0 0 56775634 63316474 0 0 38598191 43963261 95373825 107279735 4080234 8218218 83497339 92743942 48272820 39831258 35224519 52912684 X CANTON-POTSDAM HOSPITAL'S MISSION IS TO PROVIDE SKILLED, COMPASSIONATE COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS COMMUNITY NEEDS false false 59258478 161202017 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. 13594801 27840982 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. 7412028 13473491 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. 4988496 9256050 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. 4988496 9256050 85253803 true false false true false false false false false true true false false true true false true false false false false false false false false false true true false false true true false false true false false false false true true true false false false false false true false false false true 275 0 true 1071 true false false false false false false false false false false X 19 5 false false false false false false false true true false false true true true true true true true true false NY X RICHARD JACOBS CANTON-POTSDAM HOSP 3152615100 50 LEROY STREET POTSDAM NY 13676 MICHAEL TULLOCH MD DIRECTOR 2.00 X 59144 0 0 RONALD BERRY DIRECTOR 2.00 X 0 0 0 DONALD DANGREMOND DIRECTOR 2.00 X 0 0 0 KATHRYN MULLANEY TREASURER 2.00 X X 0 0 0 JUDY CHASE SECRETARY 2.00 X X 0 0 0 MICHAEL GRIFFIN DIRECTOR 2.00 X 0 0 0 BRIAN GARDAM DIRECTOR 2.00 X 0 0 0 JUNE PEOPLES DIRECTOR 2.00 X 0 0 0 JOHN KAPLAN DIRECTOR 2.00 X 0 0 0 MARGARET MADDEN CHAIRPERSON 4.00 X X 0 0 0 LAURIE MAKI DIRECTOR 2.00 X 0 0 0 PAUL MCGRATH DIRECTOR 2.00 X 0 0 0 JOANNE SCOTT DIRECTOR 2.00 X 0 0 0 SPENCER THEW DIRECTOR 2.00 X 0 0 0 JUDY CHITTENDEN VICE CHAIRPE 4.00 X X 0 0 0 EDWARD MUCENSKI DIRECTOR 2.00 X 0 0 0 MARK CORNETT VICE CHAIRMA 4.00 X X 0 0 0 PAUL COLE DVM DIRECTOR 2.00 X 0 0 0 JAMES THEODORE DIRECTOR 2.00 X 0 0 0 DAVID ACKER PRESIDENT & 50.00 X 386043 0 44930 RICHARD JACOBS ASSISTANT TR 50.00 X 243847 0 37386 KRIS VANWAGNER MD 50.00 X 711248 0 46501 JOHN SAVAGE MD 50.00 X 676000 0 31449 ALEXANDER CLARK 50.00 X 663584 0 38903 XIAOSONG SONG MD 50.00 X 523443 0 31449 HOWARD GOLD MD 50.00 X 508140 0 31449 3771449 262067 63 false true false NORTH STAR EMERGENCY PHYSICIANS PO BOX 5023 POTSDAM NY 13676 EMER DEPT PHYSI 1256985 NORTHERN TIER CONTRACTING INC 59 SOUTH GORDON STREET GOUVERNEUR NY 13642 CONS CONTRACTOR 1182712 WEATHERLY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYS SERVICE 665731 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 554809146 REFERENCE LAB 622233 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 FOOD SERVICE 508248 5 45480 47941 93421 NET PATIENT SERVICE REVENUE 900099 109967103 109967103 109967103 27446 27446 8 8 391133 375137 15996 15996 15996 164931 5000 153710 11221 5000 16221 11221 5000 OTHER 2014325 2014325 MEANINGFUL USE 1833649 1833649 340B RETAIL PROGRAM 1829944 1829944 -300160 -300160 5377758 115497953 109978324 5426208 1545165 1251584 293581 48765389 39496772 9268617 2473876 2003839 470037 7119960 5767168 1352792 3412084 2763788 648296 320083 320083 187241 187241 113744 113744 1917927 1917927 651852 528000 123852 1571411 1287153 284258 422981 342607 80374 167440 135627 31813 956057 773845 182212 6285337 5091123 1194214 1054037 853770 200267 SUPPLIES 14295619 11580394 2715225 PURCHASED/CONTRACTED SERV 6289176 5094241 1194935 EQUIPMENT RENTAL & MAINT 3707189 3010672 696517 PROFESSIONAL FEES 2525999 478940 2047059 3497168 2876353 620815 107279735 85253803 22025932 0 548515 887400 10524363 6033202 12117190 11980905 1270113 1400850 1448568 1732846 104251957 63372475 40198294 40879482 845734 899860 16544562 28929397 83497339 92743942 10943738 12508728 17560444 16146137 3680428 3850144 16088210 7326249 48272820 39831258 X 33352558 51454159 1152203 738767 719758 719758 35224519 52912684 83497339 92743942 8218218 45132 9424815 X false true X true false X false false false false false false false false true 113744 113744 false SCHEDULE C, PART II-B, LINE 1 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 845727 54132 899859 820749 24978 845727 831307 -10558 820749 813308 17999 831307 778337 34971 813308 false false 737052 737052 53735344 18653774 35081570 2609349 1217243 1392106 46790640 43501458 3289182 379572 379572 40879482 INTEREST IN CANTON HOSP FOUNDATION 18642265 DUE FROM ST. LAWRENCE HEALTH SYSTEM 5000000 OTHER NOTES & LOANS RECEIVABLE (NET) 2376999 ASSETS WHOSE USEFUL LIFE IS LIMITED 2123465 DUE FROM AFFILIATE 331303 PHYSICIAN LOANS/NOTES RECEIV. (NET) 302363 DEFERRED FINANCING COSTS 153002 28929397 ESTIMATED THIRD PARTY SETTLEMENTS 3299332 ACCRUED RETIREMENT OBLIGATIONS 1604102 INTEREST RATE SWAP 1369181 ASSET RETIREMENT OBLIGATION 1053634 7326249 115873090 375137 375137 115497953 115497953 107654872 375137 375137 107279735 107279735 SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 375,137 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 375,137 true true true X true X true true false true true 560068 25188 534880 0.00500 7171414 1651377 5520037 0.05150 7731482 1676565 6054917 0.05640 471751 471751 0.00440 200 200 1256985 1256985 0.01170 24402 24402 0.00020 1753338 1753338 0.01630 9484820 1676565 7808255 0.07280 1055450 1055450 0.00980 1055450 1055450 0.00980 true 2759377 1004744 23660037 26058680 -2398643 true true 1 1 CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 WWW.CPHOSPITAL.ORG X X X CANTON-POTSDAM HOSPITAL 1 true X X X X X X X X X X 13 true true true X WWW.CPHOSPITAL.ORG X X X X X X X X X X true false true true 100.000000000000 true 300.000000000000 true X X X true true X X X X true X true X X X X X true X false true 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 ADDITIONAL INFORMATION 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 false false false false false false false false false DAVID ACKER PRESIDENT & CEO 382731 3312 17850 27080 430973 RICHARD JACOBS ASSISTANT TREASURER 243847 16640 20746 281233 KRIS VANWAGNER MD 711248 12750 33751 757749 JOHN SAVAGE MD 676000 12750 18699 707449 ALEXANDER CLARK 663584 5100 33803 702487 XIAOSONG SONG MD 523443 12750 18699 554892 HOWARD GOLD MD 508140 12750 18699 539589 A ST LAWRENCE COUNTY IDC 272614310 2010-08-30 21305500 SEE PART VI false true false A 3020000 20921703 11168176 9590000 2011 true false false true A false false true true false 0.02820 0.02820 false false true A false true false false true false false false true SCHEDULE K - ADDITIONAL INFORMATION 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. SEE PART V false SCHEDULE L, PART V 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. 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 CANTON-POTSDAM HOSPITAL FOUNDATION 29 GROVE STREET POTSDAM NY 13676 161279472 PART VII NY 501C3 11A NA false CANTON-POTSDAM MEDICAL PRACTICEPLLC PLLC 50 LEROY STREET POTSDAM NY 13676 460714367 PART VII NY 501C3 CANTON-POT SDAM HOSPITAL true ST LAWRENCE HEALTH SYSTEMS 50 LEROY STREET POTSDAM NY 13676 464259168 PART VII NY 501C3 11A N/A false NORTHERN LIGHTS HEALTHCARE PARTNERS 732 FORD STREET OGDENSBURG NY 13669 462500951 PART VII NY 501C3 N/A false false true true true false false false true false true true false false true true false true true true CANTON-POTSDAM HOSPITAL FOUNDATION B 4715483 CASH EXCHANGED NORTHERN LIGHTS HEALTH CARE PARTNERSHIP INC B 244000 CASH EXCHANGED CANTON-POTSDAM MEDICAL PRACTICE PLLC D 395523 FMV ST LAWRENCE HEALTH SYSTEMS INC D 5000000 FMV CANTON-POTSDAM HOSPITAL FOUNDATION J 9360 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION K 334725 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION M 425000 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION P 645109 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION G 288248 CASH EXCHANGED SCHEDULE R 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