CANTON-POTSDAM HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CANTON-POTSDAM HOSPITAL (EIN 16-1012691)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-14
- IRS object ID
- 201233199349303428
- Schema version
- 2011v1.2
- 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) |
|---|---|---|
| Timestamp | 2012-11-14T10:24:03-08:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gray & Gray CPAs P C | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Main St Suite 101 | AddressLine1 |
| City | Canton | City |
| State | NY | State |
| ZIP Code | 13617 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161012691 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Canton-Potsdam Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CANT | NameControl |
| Phone | 3152615103 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Richard Jacobs | Name |
| Title | Vice President/CFO | Title |
| Date Signed | 2012-11-14 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | John J Gray Jr CPA | Name |
| Phone | 3153862925 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 94122314 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.cphospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1920 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | Canton-Potsdam Hospital's mission is to provide skilled, compassionate, cost-effective care that promotes wellness and meets community needs. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 993 | TotalNbrEmployees |
| Total Nbr Volunteers | 274 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 148665 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 89417 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 88047748 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 91856399 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -21078 | InvestmentIncomePriorYear |
| Investment Income Current Year | 38679 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1667248 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1616723 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 89842583 | TotalRevenuePriorYear |
| Total Revenue Current Year | 93601218 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 49578322 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 51912814 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 38615112 | OtherExpensePriorYear |
| Other Expenses Current Year | 40722826 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 88193434 | TotalExpensesPriorYear |
| Total Expenses Current Year | 92635640 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1649149 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 965578 | RevenuesLessExpensesCY |
| Total Assets BOY | 66411160 | TotalAssetsBOY |
| Total Assets EOY | 79271174 | TotalAssetsEOY |
| Total Liabilities BOY | 33228871 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 48669720 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 33182289 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 30601454 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Canton-Potsdam Hospital's mission is to provide skilled, compassionate, cost-effective care that promotes wellness and meets community needs. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 51697520 | Expense |
| Revenue | 126966852 | Revenue |
| Description | OTHER PROGRAM SERVICESAcute Care:Canton-Potsdam Hospital has 70 licensed beds to care for Medical-Surgical, Intensive Care and Obstetric patients. In 2011, there were 3,816 discharges, 12,255 patient days with 75% 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 27.4% from 2010.Chemical Dependency Program:Canton-Potsdam Hospital operates a 7 bed detoxification and 17 bed rehabilitation program. Growth continues in both programs which provide a highly needed service to residents of St. Lawrence County and immediate surrounding counties.Emergency Department:The Emergency Department visit volume increased by 4.64% from 2010. Additionally, new software for Emergency Department Health Record Documentation was implemented. The expected increase in net revenue for this system is projected to yield approximately $350,000 annually. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 9644993 | Expense |
| Revenue | 19956957 | Revenue |
| Description | HOSPITAL BASED CLINICSThere was significant growth of the specialty clinics in Cardiology, General Surgery, and Obstetrics which had been established in late 2010. Their additional volumes added over 5,000 visits to the clinics volumes in 2011.Overall, there was a total of nearly 77,000 visits in 2011 compared to 65,000 in 2010.In 2011, 50% of the total revenue generated for the clinics was Medicaid, Medicare or Uninsured, as compared to 51% in 2010.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. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6471928 | Expense |
| Revenue | 6331347 | Revenue |
| Description | OPERATING ROOMIn 2011 and 2010, 49% of the total revenue generated for the Operating Room was Medicaid, Medicare, or Uninsured.In 2011, the Operating Room number of cases decreased slightly by 1.43%, compared to 2010. This was mainly due to the departure of the Pain Clinic physician. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 4438411 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 41066588 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 72252852 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | true | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 237 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 993 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Quid Pro Quo Disclosure | false | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Form720 Filed | false | Form720Filed |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Richard Jacobs | NamePerson |
| Telephone Number | 3152615100 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Canton Potsdam Hospital 50 Leroy St | AddressLine1 |
| City | Potsdam | City |
| State | NY | State |
| ZIP Code | 13676 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (29 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| James Theodore | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Penelope Rattan | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Paul Cole DVM | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| John Dewar MD | ||||||||
| Vice Chairman | 50.00 | X | 108393 | 0 | 8391 | X | ||
| Duane Pelkey | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Michael Tulloch MD | ||||||||
| Director | 2.00 | X | 32980 | 0 | 0 | |||
| Judy Chittenden | ||||||||
| Vice Chairman | 4.00 | X | 0 | 0 | 0 | X | ||
| Spence Thew | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| David Patterson | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Mary Anne Healey | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Paul McGrath | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Laurie Maki | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Margaret Madden | ||||||||
| Chairperson | 4.00 | X | 0 | 0 | 0 | X | ||
| John Kaplan | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| June Peoples | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Brian Gardam | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Michael Griffin | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Judy Chase | ||||||||
| Secretary | 2.00 | X | 0 | 0 | 0 | X | ||
| Kathryn Mullaney | ||||||||
| Treasurer | 2.00 | X | 0 | 0 | 0 | X | ||
| Donald Dangremond | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Ron Berry | ||||||||
| Director | 2.00 | X | 0 | 0 | 0 | |||
| Marlinda LaValley | ||||||||
| Assistant Secretary | 50.00 | 124854 | 0 | 8328 | X | |||
| Richard Jacobs | ||||||||
| Assistant Treasurer | 50.00 | 180415 | 0 | 8353 | X | |||
| David Acker | ||||||||
| President & CEO | 50.00 | 315000 | 0 | 8409 | X | |||
| Alexander Clark MD | ||||||||
| Physician | 50.00 | 1159698 | 0 | 13861 | X | |||
| John Savage MD | ||||||||
| Physician | 50.00 | 669100 | 0 | 8797 | X | |||
| Kris Vanwagner MD | ||||||||
| Physician | 50.00 | 512419 | 0 | 13818 | X | |||
| Howard Gold MD | ||||||||
| Physician | 50.00 | 436620 | 0 | 8797 | X | |||
| David Hauerstock MD | ||||||||
| Physician | 50.00 | 377500 | 0 | 8797 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3916979 | TotalReportableCompFromOrg |
| Total Other Compensation | 87551 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PC Construction Company | |||||
| 193 Tilley Drive | South Burlington | VT | 05403 | Construc Contractor | 4581731 |
| North Star Emergency Physicians | |||||
| PO Box 5023 | Potsdam | NY | 13676 | Emer Dept Physicians | 1683734 |
| Labcorp | |||||
| PO Box 12140 | Burlington | NC | 272162140 | Reference Lab | 496544 |
| Heritage Homes Inc | |||||
| PO Box 746 | Massena | NY | 13662 | Construct Contractor | 1602454 |
| Comphealth Medical Staffing Inc | |||||
| PO Box 972670 | Dallas | TX | 753972670 | Physician Recruiting | 416771 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 26 | NumberOfContractorsGT100K |
| Government Grants | 60419 | GovernmentGrants |
| All Other Contributions | 28998 | AllOtherContributions |
| Total Contributions | 89417 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Net Patient Revenue | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 91856399 | TotalRevenueColumn |
| Related Or Exempt Function Income | 91856399 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 91856399 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 34675 | TotalRevenueColumn |
| Exclusion | $34,675 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15 | TotalRevenueColumn |
| Exclusion | $15 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 388994 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 370137 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 18857 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18857 | TotalRevenueColumn |
| Exclusion | $18,857 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 154948 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 150959 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3989 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3989 | TotalRevenueColumn |
| Exclusion | $3,989 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Student Health Services | 900099 | 823460 | $823,460 |
| Other | 900099 | 329060 | $329,060 |
| Cafeteria Revenue | 900099 | 261682 | $261,682 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 183664 | TotalRevenueColumn |
| Exclusion | $183,664 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1597866 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 93601218 | TotalRevenueColumn |
| Related Or Exempt Function Income | 91856399 | RelatedOrExemptFunctionIncome |
| Exclusion | $1,655,402 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1157510 | Total |
| Program Services | 371752 | ProgramServices |
| Management And General | 785758 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40383249 | Total |
| Program Services | 32220182 | ProgramServices |
| Management And General | 8163067 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1726379 | Total |
| Program Services | 1354478 | ProgramServices |
| Management And General | 371901 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5798147 | Total |
| Program Services | 4549094 | ProgramServices |
| Management And General | 1249053 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2847529 | Total |
| Program Services | 2234106 | ProgramServices |
| Management And General | 613423 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137413 | Total |
| Management And General | 137413 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127756 | Total |
| Management And General | 127756 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180723 | Total |
| Management And General | 180723 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2440114 | Total |
| Program Services | 2440114 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1657411 | Total |
| Program Services | 1135763 | ProgramServices |
| Management And General | 521648 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 287619 | Total |
| Program Services | 103952 | ProgramServices |
| Management And General | 183667 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104911 | Total |
| Program Services | 61880 | ProgramServices |
| Management And General | 43031 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 735084 | Total |
| Program Services | 499856 | ProgramServices |
| Management And General | 235228 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4341206 | Total |
| Program Services | 2952020 | ProgramServices |
| Management And General | 1389186 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 781682 | Total |
| Program Services | 696754 | ProgramServices |
| Management And General | 84928 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Supplies | 11580195 | 10568246 | 1011949 |
| Purchased Services | 5787075 | 3767225 | 2019850 |
| Other | 2022619 | 1649803 | 372816 |
| Equipment Rental | 2593240 | 1394713 | 1198527 |
| Bad Debt | 5442774 | 5442774 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2503004 | Total |
| Program Services | 810140 | ProgramServices |
| Management And General | 1692864 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92635640 | Total |
| Program Services | 72252852 | ProgramServices |
| Management And General | 20382788 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 261791 | BOY |
| EOY | 704337 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4715447 | BOY |
| EOY | 3071920 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12529468 | BOY |
| EOY | 15549465 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1147148 | BOY |
| EOY | 1152241 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 836631 | BOY |
| EOY | 1109704 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 93730434 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 53014343 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30902939 | BOY |
| EOY | 40716091 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 831307 | BOY |
| EOY | 820749 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15186429 | BOY |
| EOY | 16146667 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66411160 | BOY |
| EOY | 79271174 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11889327 | BOY |
| EOY | 10926798 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11368046 | BOY |
| EOY | 18582037 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1571205 | BOY |
| EOY | 4573168 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8400293 | BOY |
| EOY | 14587717 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33228871 | BOY |
| EOY | 48669720 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32198687 | BOY |
| EOY | 27904668 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 263844 | BOY |
| EOY | 1977028 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 719758 | BOY |
| EOY | 719758 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33182289 | BOY |
| EOY | 30601454 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66411160 | BOY |
| EOY | 79271174 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 965578 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -3546413 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $180,723 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 180723 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i | Identifier |
| Return Reference | Part II-B, Line 1i - Other Activities Description | ReturnReference |
| Explanation | Canton-Potsdam Hospital through its membership or fees paid to the following organizations incurred $180,723 in lobbying expenses for 2011. 92,167 Wilson, Elser and Moskowitz-Federal and State lobbying and representation 30,545 Healthcare Association on New York State-Federal and State advocacy 28,100 North Country Healthcare Providers-State advocacy 10,733 Iroquois Health Alliance-Federal and State advocacy 19,178 American Hospital Association-Federal and State advocacy | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 831307 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -10558 | InvestmentEarningsOrLosses |
| End Of Year Balance | 820749 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 813308 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 17999 | InvestmentEarningsOrLosses |
| End Of Year Balance | 831307 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 778337 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 34971 | InvestmentEarningsOrLosses |
| End Of Year Balance | 813308 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 713734 | OtherCostOrOtherBasis |
| Book Value | 713734 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 49687917 | OtherCostOrOtherBasis |
| Depreciation | 15400500 | Depreciation |
| Book Value | 34287417 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2057014 | OtherCostOrOtherBasis |
| Depreciation | 958735 | Depreciation |
| Book Value | 1098279 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 37450732 | OtherCostOrOtherBasis |
| Depreciation | 36655108 | Depreciation |
| Book Value | 795624 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3821037 | OtherCostOrOtherBasis |
| Book Value | 3821037 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 40716091 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Physician Loans/Notes Receivable | 658284 |
| Other Notes & Loans Receivable (Net) | 649690 |
| Interest in Canton-Pots Hospital Foundat | 11360108 |
| Due From Affiliate | 1076437 |
| Deferred Financing Costs | 274152 |
| Assets Whose Useful Life is Limited | 2127996 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 16146667 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Estimated Third Party Payor Settlements | $2,855,141 |
| Change in Interest Rate Swap | $1,992,161 |
| Asset Retirement Obligation | $580,044 |
| Accrued Pension | $9,160,371 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 14587717 | TotalOfAmounts |
| Total Revenue | 93601218 | TotalRevenue |
| Total Expenses | 92635640 | TotalExpenses |
| Excess Or Deficit For Year | 965578 | ExcessOrDeficitForYear |
| Other | -$3,546,413 | OtherAmount |
| Total Adjustments | -3546413 | TotalAdjustments |
| Excess Or Deficit Per FS | -2580835 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 93953872 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -11028 | NetUnrealizedGainsInvestments |
| Other Revenues | 370147 | OtherRevenues |
| Revenue Not Rptd F990 | 359119 | RevenueNotRptdF990 |
| Revenue Subtotal | 93594753 | RevenueSubtotal |
| Investment Expenses Not Included | 6465 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 6465 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 93601218 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 99293811 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 6664636 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 6664636 | ExpensesNotRptdF990 |
| Expenses Subtotal | 92629175 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 6465 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 6465 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 92635640 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part XIII, Line 2d | Part XIII, Line 2d: Other expenses and losses per audited F/S | Change in Net Assets of CPH Foundation $85630 Change in Pension Plan Funded Status $5594824 Rental Expense $370147 $17493 Change in Interest Rate Swap $594076 $2466 |
| Part XII, Line 2d | Part XII, Line 2d: Other revenue amounts included in F/S but not included on form 990 | Contributions For Capital Acquisitions $431885 Contributions For Capital Acquisitions $840702 Change in Interest in CPH Foundation $872482 Rental Expense $370147 $614035 $-3129251 370147 $370147 |
| Part XI, Line 8 | Part XI, Line 8: Other Changes in Net Assets or Fund Balances | Capital Campaign Gifts $846040 Contributions For Capital Acquisitions $431885 Temporarily Resticted Money Spent For Capital $840702 Change in funded status of employee benefit plan $ -5594824 Unrealized Loss on Investments $ -11028 Change in Net Assets of CPH Foundation $ -59188 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 633601 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 49882 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 583719 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00630 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7695441 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1311398 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6384043 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06890 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8329042 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1361280 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6967762 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07520 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 325927 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 325927 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00350 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10700 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 10700 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2315666 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2315666 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02500 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19523 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 19523 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2671816 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2671816 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02880 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11000858 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1361280 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9639578 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10400 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 379859 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 379859 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00410 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 379859 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 379859 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00410 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $2,353,814 | BadDebtExpenseAmount |
| Amount Attributable To | 942411 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 18544313 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 19907248 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1362935 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 0 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Canton-Potsdam Hospital | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Canton-Potsdam Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | true | CollectionActivities |
| Lawsuit | X | Lawsuit |
| Lien On Residence | X | LienOnResidence |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part V - Explanation of Number of Facility Type | SEE SCHEDULE H ATTACHMENT | |
| Part V, Line 21 - Charge Patients Amount Equal Gross Charge for Services | SEE SCHEDULE H ATTACHMENT | Number of Hospital Faciltiy - 0 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|
| Richard Jacobs | ||
| 180415 | 8353 | 188768 |
| Kris Vanwagner MD | ||
| 512419 | 13818 | 526237 |
| John Savage MD | ||
| 669100 | 8797 | 677897 |
| Howard Gold MD | ||
| 436620 | 8797 | 445417 |
| David Hauerstock MD | ||
| 377500 | 8797 | 386297 |
| David Acker | ||
| 315000 | 8409 | 323409 |
| Alexander Clark MD | ||
| 1159698 | 13861 | 1173559 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Sch J, Part III, Additional Information | Identifier |
| Return Reference | Part III, Additional Information | ReturnReference |
| Explanation | The Audit and Compensation Committee of the Board of Directors will ultimately be responsible for the compensation of the CEO/Executive Director at Canton-Potsdam Hospital. They will seek the input of consulting firms with national experience to review the compensation packages offered to top management and the regulatory compliance issues of not-for-profits. Upon the findings of the consultants, the Audit and Compensation Committee will offer its recommendation to the full Board. A written employment agreement is signed by the CEO and the Board Chairman. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Lawrence County CDC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 272614310 | IssuerEIN |
| Date Issued | 2010-08-30 | DateIssued |
| Issue Price | 21305000 | IssuePrice |
| Description Of Purpose | See Part VI | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | true | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 730000 | AmountRetired |
| Total Proceeds | 21305000 | TotalProceeds |
| Capital Expenditures | 11168176 | CapitalExpenditures |
| Other Spent Proceeds | 9590000 | OtherSpentProceeds |
| Amount Unspent | 546824 | AmountUnspent |
| Year Of Subst Completion | 2011 | YearOfSubstCompletion |
| Current Refunding | true | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | false | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | true | MngmentCntrctBondFinancdPrprty |
| Engage Bond Counsel Contracts | true | EngageBondCounselContracts |
| Any Research Agreements | false | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.02890 | PrcntgePrvtBusinessUseByOthers |
| Total Private Business Use | 0.02890 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | true | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | false | Form8038TFiled |
| Variable Rate Issue | true | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Exception To Rebate | true | ExceptionToRebate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fed Tax Requirements Compliance | X | FedTaxRequirementsCompliance |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SEE SCHEDULE L ATTACHMENT | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sharing Of Revenues | true | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part VI, Line 19 | Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. |
| Form 990, Part VI, Line 15b | Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | Line 15a: The Audit and Compensation Committee of the Board of Directors will ultimately be responsible for the compensation of the top management at Canton-Potsdam Hospital. They will seek the input of consulting firms with national experience to review the compensation packages offered to top management and the regulatory compliance issues of not-for-profits. Upon the findings of the consultants, the Audit and Compensation Committee will offer its recommendation to the full board.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 who will review the surrounding market and use data from various hospital organizations to establish salary ranges. |
| Form 990, Part VI, Line 12c | Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | We annually review disclosure statements and have reporting mechanisms, including a confidential hotline, that are regularly monitored by the Compliance Officer. The Compliance Officer attends all Board committee meetings and provides a monthly report to the Board. |
| Form 990, Part VI, Line 11 | Form 990, Part VI, Line 11: Form 990 Review Process | 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, Part III, Line 4d | Form 990, Part III, Line 4d : Other Program Services Description | OTHER PROGRAM SERVICES 4: OTHER PROGRAM SERVICESAcute Care:Canton-Potsdam Hospital has 70 licensed beds to care for Medical-Surgical, Intensive Care and Obstetric patients. In 2011, there were 3,816 discharges, 12,255 patient days with 75% 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 27.4% from 2010.Chemical Dependency Program:Canton-Potsdam Hospital operates a 7 bed detoxification and 17 bed rehabilitation program. Growth continues in both programs which provide a highly needed service to residents of St. Lawrence County and immediate surrounding counties.Emergency Department:The Emergency Department visit volume increased by 4.64% from 2010. Additionally, new software for Emergency Department Health Record Documentation was implemented. The expected increase in net revenue for this system is projected to yield approximately $350,000 annually. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Canton-Potsdam Hospital Foundation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 29 Grove Street | AddressLine1 |
| City | Potsdam | City |
| State | NY | State |
| ZIP Code | 13676 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161279472 | EIN |
| Primary Activities | Raising, investing and managing funds for the hospital | PrimaryActivities |
| Legal Domicile State | NY | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 11a | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Canton-Potsdam Hospital Foundation | ||
| p | 292384 | Cash Exchanged |
| Canton-Potsdam Hospital Foundation | ||
| o | 136117 | Cash Exchanged |
| Canton-Potsdam Hospital Foundation | ||
| j | 286335 | Cash Exchanged |
| Canton-Potsdam Hospital Foundation | ||
| i | 8210 | Cash Exchanged |