2016-11-15T09:25:29-06:00 2015-12-31 201767403 HOFFMAN EELLS & GRAY CPAS PC 1 MAIN STREET SUITE 101 CANTON NY 136171277 990 2015-01-01 460714367 CANTON-POTSDAM MED PRACTICE PLLC CANT 3152615100 50 LEROY STREET POTSDAM NY 13676 ROBERT T ROGERSII MD DIRECTOR 3152615100 2016-11-15 true JOHN J GRAY JR CPA P00076464 3153862925 2016-11-08 2015 2017-02-10 21:41:12Z ROBERT T ROGERSII MD 50 LEROY STREET POTSDAM NY 13676 3295294 false X N/A X PLLC 2012 NY CANTON-POTSDAM MEDICAL PRACTICE'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE PHYSICIAN SERVICES, IN AN OUTPATIENT CLINIC SETTING, THAT PROVIDE PUBLIC BENEFIT TO THE COMMUNITY AND CANTON-POTSDAM HOSPITAL. 1 0 0 0 0 2429788 3295263 0 1698 31 2431486 3295294 0 0 2701644 4062450 0 0 1597660 1474576 4299304 5537026 -1867818 -2241732 1743063 1108417 72005 27354 1671058 1081063 X CANTON-POTSDAM MEDICAL PRACTICE'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE PHYSICIAN SERVICES, IN AN OUTPATIENT CLINIC SETTING, THAT PROVIDE PUBLIC BENEFIT TO THE COMMUNITY AND CANTON-POTSDAM HOSPITAL. false false 944861 1405075 CATON-POTSDAM MEDICAL PRACTICE OPERATED A GENERAL SURGERY CLINIC IN 2015. PATIENT VISITS TOTALED APPROXIMTELY 1,116. THIS CLINIC OPENED IN AUGUST OF 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. 822212 2274103 CANTON-POTSDAM MEDICAL PRACTICE OPERATED AN URGENT CARE CENTER IN 2015. PATIENT VISITS TOTALED APPROXIMATELY 12,745. THE URGENT CARE CENTER OPENED IN MARCH OF 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK. 804190 2134036 CANTON-POTSDAM MEDICAL PRACTICE OPERATED A GASTROENTEROLOGY CLINIC IN 2015. PATIENT VISITS TOTALED APPROXIMATELY 3,270. THE CLINIC OPENED IN OCTOBER 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) MASSENA, NEW YORK. 2246443 3409012 CANTON-POTSDAM MEDICAL PRACTICE OPERATES OTHER OUTPATIENT CLINIC LOCATIONS INCLUDING THE FOLLOWING: OB SERVICES: LOCATED IN CANTON, NY AND GOUVERNEUR, NY, THESE CLINICS SERVED APPROXIMATELY 2539 PATIENTS IN 2015. OB SERVICES WERE DISCONTINUED AS PART OF THIS ORGANIZATION AS OF THE END OF 2015 AND BECAME PRACTICES UNDER RELATED ORGANIZATION, CANTON-POTSDAM HOSPITAL. ENT SERVICES: LOCATED IN POTSDAM, NY, THIS CLINIC OPENED IN NOVEMBER 2014 AND SERVED APPROXIMATELY 3,083 PATIENTS IN 2015. FAMILY PRACTICE: LOCATED IN COLTON, NY, THIS CLINIC SERVED APPROXIMATELY 2463 PATIENTS IN 2015. 2246443 3409012 4817706 true false false false false false false false false false true false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 21 0 true 0 false false false false false false X 1 0 false true false false false false false true false false false true true true true true true true true false X CANTON-POTSDAM HOSPITAL 3152615100 50 LEROY STREET POTSDAM NY 13676 ROBERT T ROGERSII MD DIRECTOR 1.00 50.00 X 0 274633 15314 RICHARD D JACOBS FINANCE 8.00 50.00 X 0 278876 28264 553509 43578 false true false WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PROF. STAFFING 209080 1 PROGRAM SERVICE REVENUE 621400 3295263 3295263 3295263 OTHER OPERATING REVENUE 621400 31 31 31 3295294 3295294 3474244 3113342 360902 588206 527104 61102 196055 196055 8042 7207 835 245834 220297 25537 9351 8380 971 4501 4033 468 11 10 1 112893 101166 11727 146959 140070 6889 PURCHASED SERVICES 429175 384593 44582 SUPPLIES 227546 227081 465 OTHER 60218 53963 6255 LICENSES AND DUES 30845 27641 3204 3146 2819 327 5537026 4817706 719320 0 136845 131365 1086186 527216 4645 7142 5430 19103 625258 222229 476092 403029 33865 20562 1743063 1108417 63369 27354 8636 72005 27354 X 1671058 1081063 1671058 1081063 1743063 1108417 X -2241732 1651737 X false true X true false X 102962 5518479 9222226 14843667 102962 5518479 9222226 14843667 14843667 40 1698 31 1769 103002 5520177 9222257 14845436 X PART III, LINE 12 1,769 18978 6139 12839 606280 216090 390190 403029 X SCHEDULE D, PAGE 3, PART X INCOME TAXES OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS: THE HOSPITAL AND CPMP ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL AND CPMP RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN FIFTY PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT. CHANGES IN RECOGNITION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE HOSPITAL AND CPMP DID NOT RECOGNIZE THE EFFECT OF ANY UNCERTAIN INCOME TAX POSITIONS IN EITHER 2015 OR 2014. false false false false false false false false false ROBERT T ROGERSII MD DIRECTOR 274633 5300 10014 289947 RICHARD D JACOBS FINANCE 278876 18442 9822 307140 SCHEDULE J, PART III CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL AND ALL "EMPLOYEES" ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. AS SUCH, THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CANTON-POTSDAM HOSPITAL SEEKS INPUT OF A CONSULTING FIRM WITH NATIONAL EXPERIENCE TO REVIEW COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AND THE REGULATORY COMPLIANCE ISSUES OF NON-FOR-PROFITS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE. FORM 990, PAGE 2, PART III, LINE 4D CANTON-POTSDAM MEDICAL PRACTICE OPERATES OTHER OUTPATIENT CLINIC LOCATIONS INCLUDING THE FOLLOWING: OB SERVICES: LOCATED IN CANTON, NY AND GOUVERNEUR, NY, THESE CLINICS SERVED APPROXIMATELY 2539 PATIENTS IN 2015. OB SERVICES WERE DISCONTINUED AS PART OF THIS ORGANIZATION AS OF THE END OF 2015 AND BECAME PRACTICES UNDER RELATED ORGANIZATION, CANTON-POTSDAM HOSPITAL. ENT SERVICES: LOCATED IN POTSDAM, NY, THIS CLINIC OPENED IN NOVEMBER 2014 AND SERVED APPROXIMATELY 3,083 PATIENTS IN 2015. FAMILY PRACTICE: LOCATED IN COLTON, NY, THIS CLINIC SERVED APPROXIMATELY 2463 PATIENTS IN 2015. FORM 990, PAGE 6, PART VI, LINE 3 CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL. ALL "EMPLOYEES" , INCLUDING THOSE THAT PERFORM MANAGEMENT FUNCTIONS, ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. EMPLOYEES OF CANTON-POTDAM HOSPITAL ARE LEASED TO CANTON- POTSDAM MEDICAL PRACTICE TO PROVIDE ALL MEDICAL STAFF AND MANAGEMENT SERVICES. SERVICE AGREEMENTS ARE IN PLACE BETWEEN THE TWO RELATED ORGANIZATIONS. CANTON-POTSDAM HOSPITAL INVOICES CANTON-POTSDAM MEDICAL PRACTICE FOR THESE SERVICES. KEY EMPLOYEE, RICHARD JACOBS, IS AN EMPLOYEE OF CANTON-POTSDAM HOSPITAL WHO IS RESPONSIBLE FOR THE FINANCIAL REPORTING OF CANTON-POTSDAM MEDICAL PRACTICE. ROBERT T. ROGERS, II, MD, IS AN EMPLOYEE OF CANTON-POTSDAM HOSPITAL WHO IS THE SOLE MEMBER MANAGER OF THE PLLC. FORM 990, PAGE 6, PART VI, LINE 8B CANTON-POTSDAM MEDICAL PRACTICE DID NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY, AND THUS NO COMMITTEE MEETINGS WERE HELD. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PREPARED BY CANTON-POTSDAM HOSPITAL'S FINANCE DEPARTMENT STAFF MEMBERS. UPON COMPLETION, A COPY WITH SUPPORTING DOCUMENTATION IS REVIEWED BY THE VICE PRESIDENT FOR FINANCE AND THE CONTROLLER. FURTHERMORE, THE FORM WAS PROVIDED TO THE CANTON-POTSDAM MEDICAL PRACTICE ADVISORY COMMITTEE FOR FURTHER REVIEW AND COMMENT. AFTER REVIEW, ANY CHANGES ARE MADE AND A COPY IS PRESENTED TO THE SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE, ROBERT T. ROGERS, II, MD FOR HIS REVIEW AND APPROVAL. FORM 990, PAGE 6, PART VI, LINE 12C THE KEY EMPLOYEE AND SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE ARE EMPLOYEES OF CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION. ALL EMPLOYEES ADHERE TO CANTON-POTSDAM HOSPITAL'S WRITTEN CONFLICT OF INTEREST POLICY. DISCLOSURE STATEMENTS ARE REVIEWED ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15A LINE 15A: AS STATED ABOVE IN THIS SCHEDULE O, CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL AND ALL "EMPLOYEES" ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. AS SUCH, THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CANTON-POTSDAM HOSPITAL SEEKS THE INPUT OF A CONSULTING FIRM WITH NATIONAL EXPERIENCE TO REVIEW THE COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AND THE REGULATORY COMPLIANCE ISSUES OF NOT-FOR-PROFITS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIALS COMPENSATION PACKAGE. FORM 990, PAGE 6, PART VI, LINE 15B THE KEY EMPLOYEE AND SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE ARE EMPLOYEES OF CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION. COMPENSATION OF EMPLOYEES IS DETERMINED BY CANTON-POTSDAM HOSPITAL'S PROCESSES FOR DETERMINING COMPENSATION. THEY ARE AS FOLLOWS: THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED PRIMARILY BY THE WORK OF THE HUMAN RESOURCE DEPARTMENT, THE RECOMMENDATION OF THE VICE PRESIDENT OF HUMAN RESOURCES (HR), AND BY INFORMATION GATHERED FROM INDEPENDENT SURVEY DATA OF NATIONAL AND SURROUNDING MARKETS. THE VICE PRESIDENT OF HUMAN RESOURCES WILL REVIEW THE SURVEY DATA TO ESTIMATE SALARY RANGES AND COMPENSATION PACKAGES. THE VP OF HR MAKES THE RECOMMENDATION TO THE CEO. THE CEO WILL BRING THE INFORMATION TO THE COMPENSATION COMMITTEE. AFTER DELIBERATIONS AND CONSIDERATIONS, THE COMPENSATION COMMITTEE WITH THEN BRING THEIR RECOMMENDATION TO THE FULL BOARD FOR THEIR FINAL APPROVAL. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 TRANSFER FROM AFFILIATE (CANTON-POTSDAM HOSPITAL) 1,650,435 CONTRIBUTIONS FOR CAPITAL ACQUISITIONS 1,302 TOTAL 1,651,737 ST LAWRENCE HEALTH SYSTEM INC 50 LEROY STREET POTSDAM NY 13676 464259168 SEE VII NY 501C3 NA false CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 161012691 HOSPITAL NY 501C3 SLHS false GOUVERNEUR HOSPITAL INC 77 WEST BARNEY STREET GOUVERNEUR NY 13642 464249555 HOSPITAL NY 501C3 SLHS false false false false false false false false false false false true false false false false false false false false CANTON-POTSDAM HOSPITAL K 4206155 FMV CANTON-POTSDAM HOSPITAL K 133750 FMV GOUVERNEUR HOSPITAL INC K 89162 CASH EXCHANGED SCHEDULE R ST. LAWRENCE HEALTH SYSTEM, INC. (SLHS) IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPITAL AND OTHER AFFILIATED CORPORATIONS.