2015-08-18T09:25:52-05:00 2014-12-31 201767403 HOFFMAN EELLS & GRAY CPAS PC 1 MAIN STREET SUITE 101 CANTON NY 136171277 990 2014-01-01 161012691 CANTON-POTSDAM HOSPITAL CANT 3152615103 50 LEROY STREET POTSDAM NY 13676 RICHARD JACOBS VICE PRESIDENT/CFO 3152615103 2015-08-15 true JOHN J GRAY JR CPA P00076464 3153862925 2015-08-18 2014 2016-04-25 22:37:26Z RICHARD JACOBS 50 LEROY STREET POTSDAM NY 13676 141581725 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. 17 6 1227 275 0 93421 1111375 109967103 129916602 43675 300198 5393754 9665762 115497953 140993937 0 0 63316474 81509663 0 0 43963261 47865294 107279735 129374957 8218218 11618980 92743942 100388006 39831258 47393323 52912684 52994683 X CANTON-POTSDAM HOSPITAL'S MISSION IS TO PROVIDE SKILLED, COMPASSIONATE COST-EFFECTIVE CARE THAT PROMOTES WELLNESS AND MEETS COMMUNITY NEEDS. false false 65668156 179302984 ACUTE CARE: CANTON-POTSDAM HOSPITAL HAS A TOTAL OF 94 LICENSED BEDS, COMPRISED OF 17 FOR CHEMICAL DEPENDENCY-REHABILITATION, 7 FOR CHEMICAL DEPENDENCY- DETOXIFICATION, 4 FOR CORONARY CARE, 2 FOR INTENSIVE CARE, 8 FOR MATERNITY AND 56 FOR MEDICAL/SURGICAL. PROFESSIONAL STAFF COVERAGE FOR OUR IN- PATIENT CENSUS IS PROVIDED BY A HOSPITALIST PROGRAM. TOTAL PATIENT DAYS INCREASED BY APPROXIMATELY 7% FROM 2013 TO 2014. TOTAL DISCHARGES INCREASED BY APPROXIMATELY 1% FROM 2013 TO 2014. OBSERVATION CASES INCREASED BY APPROXIMATELY 43% FROM 2013 TO 2014. CHEMICAL DEPENDENCY PROGRAM: CANTON-POTSDAM HOSPITAL OPERATES A 7 BED DETOXIFICATION AND 17 BED REHABILITATION PROGRAM. GROWTH CONTINUES IN BOTH PROGRAMS WHICH PROVIDE A HIGHLY NEEDED SERVICE TO RESIDENTS OF ST. LAWRENCE COUNTY AND IMMEDIATE SURROUNDING COUNTIES. 17554407 40533535 HOSPITAL BASED CLINICS: THERE WAS SIGNIFICANT GROWTH OF THE HOSPITAL BASED CLINICS. OVERALL THERE WERE 108,274 VISITS IN 2014, COMPARED TO OVER 99,500 IN 2013; ROUGHLY AN 8.8% INCREASE. EIGHT NEW OUT PATIENT CLINIC LOCATIONS WERE ESTABLISHED, TO INCLUDE OUTPATIENT SERVICES FOR OB, ORTHOPEDICS, PODIATRY, PULMONOLOGY, PAIN MANAGEMENT AND GENERAL SURGERY. 8672723 14524366 OPERATING ROOM: IN 2014, THE OPERATING ROOM NUMBER OF CASES INCREASED BY APPROXIMATELY 14%, COMPARED TO 2013. SIGNIFICANT INCREASES WERE DUE TO A 77% INCREASE IN ORTHOPEDICS, APPROXIMATELY 5% INCREASES IN BOTH GENERAL SURGERY AND GYNECOLOGY, AND THE ADDITION OF PODIATRY CASES. THE HOSPITAL ALSO EXPERIENCED A 15% INCREASE IN AMBULATORY SURGERY UNIT VISITS FROM 2013. 6163695 8370596 ONCOLOGY SERVICES: IN 2014, THE ONCOLOGY VISITS INCREASED FROM 8,440 IN 2013 TO 8,917 IN 2014, ROUGHLY A 5.7% INCREASE. THE NUMBER OF RADIATION ONCOLOGY VISITS DECREASED BY APPROXIMATELY 6%, WITH THE MEDICAL ONCOLOGY VISITS INCREASED BY APPROXIMATELY 14%. THE ONE MILLION DOLLAR INCREASE IN EXPENSES FOR THE ONCOLOGY DEPARTMENTS WAS LARGELY DUE TO THE INCREASE IN PHARMACEUTICALS EXPENSE, WHICH INCREASED 43.4% FROM FISCAL YEAR 2013. 6163695 8370596 98058981 true false false true false false false false false true true false false true true true true false false false false false false false false false true true false false true true false false true false false false false false false true false false false false false true true true false false true 323 0 true 1227 true false false false false false false false false false false X 17 6 false false false false false false false true true false true true 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 52220 0 0 RONALD BERRY DIRECTOR 2.00 X 0 0 0 DONALD DANGREMOND DIRECTOR 2.00 X 0 0 0 KATHRYN MULLANEY TREASURER 4.00 X X 0 0 0 JUDY CHASE SECRETARY 4.00 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 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 JUDY CHITTENDEN VICE CHAIRPE 4.00 X X 0 0 0 EDWARD MUCENSKI DIRECTOR 2.00 X 0 0 0 MARK CORNETT 2ND VICE CHA 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 400440 0 98940 RICHARD JACOBS ASSISTANT TR 50.00 X 249482 0 35084 MARCO BERNARD MD 50.00 X 816020 0 40807 KRIS VANWAGNER MD 50.00 X 747586 0 22420 JEFFREY HAASBEEK MD 50.00 X 706529 0 33955 JOHN SAVAGE MD 50.00 X 676432 0 30556 XIAOSONG SONG MD 50.00 X 601221 0 31144 4249930 292906 120 false true false NORTHERN TIER CONTRACTING INC 39 SOUTH GORDON STREET GOUVERNEUR NY 13642 CONSTRUCTION 961280 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 554809146 REFERENCE LAB 666607 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERV. 636476 DANKO CONSTRUCTION CORP PO BOX 239 MASSENA NY 13662 CONSTRUCTION 618318 UNIVERSITY OF VERMONT MEDICAL CENTE PO BOX 1902 BURLINGTON VT 054021902 LAB SERVICES 573431 30 1029018 82357 1111375 NET PATIENT SERVICE REVENUE 900099 129916602 129916602 129916602 180668 180668 552375 422840 129535 129535 129535 159838 124640 141315 23633 18523 101007 119530 18523 101007 OTHER 4181204 4181204 340B RETAIL PROGRAM 2952948 2952948 OTHER 1338048 1338048 1064027 1064027 9536227 140993937 129935125 9947437 1714269 1319987 394282 64754121 49856995 14897126 1897539 1461105 436434 8975298 6910979 2064319 4168436 3209696 958740 377211 377211 229800 229800 119696 119696 332446 332446 560735 431766 128969 1883257 1458226 425031 531959 409599 122360 218123 167955 50168 901050 691361 209689 7134879 5493857 1641022 1089244 838718 250526 SUPPLIES 18038513 13889404 4149109 PURCHASED/CONTRACTED SERV 7250429 5582831 1667598 EQUIPMENT RENTAL & MAINT 4001744 3099778 901966 OTHER 3084167 2418559 665608 2112041 485719 1626322 129374957 98058981 31315976 0 887400 3537041 6033202 4797657 11980905 14127336 1400850 1554596 1732846 2180554 111478774 69486817 40879482 41991957 899860 909653 28929397 31289212 92743942 100388006 12508728 15212296 16146137 14819212 3850144 3768468 7326249 13593347 39831258 47393323 X 51454159 51896132 738767 378793 719758 719758 52912684 52994683 92743942 100388006 11618980 -4678 -11532303 X false true X true false X false false false false false false false false true 119696 119696 false SCHEDULE C, PART II-B, LINE 1 CANTON POTSDAM HOSPITAL THROUGH ITS MEMBERSHIP OR FEES PAID TO THE FOLLOWING ORGANIZATIONS INCURRED 119,696 IN LOBBYING EXPENSES IN 2014: 85,006: WILSON, ELSER, MOSKOWITZ-FEDERAL AND STATE LOBBYING AND REPRESENTATION. 14,893: NORTH COUNTRY HEALTHCARE PROVIDERS-STATE ADVOCACY. 9,553: HANYS ANNUAL MEMBERSHIP DUES-FEDERAL AND STATE ADVOCACY. 5,431: IROQUOIS HEALTHCARE ALLIANCE-FEDERAL AND STATE ADVOCACY. 4,813: AMERICAN HOSPITAL ASSOCIATION ANNUAL MEMBERSHIP DUES-FEDERAL AND STATE ADVOCACY. 899859 9794 909653 845727 54132 899859 820749 24978 845727 831307 -10558 820749 813308 17999 831307 0.79000 0.21000 false false 737052 737052 56161089 20545190 35615899 2609349 1333989 1275360 51440195 47607638 3832557 531089 531089 41991957 INTEREST IN CANTON HOSP FOUNDATION 19624379 DUE FROM ST. LAWRENCE HEALTH SYSTEM 5745952 ASSETS WHOSE USEFUL LIFE IS LIMITED 2384490 DUE FROM AFFILIATES 1456968 OTHER NOTES & LOANS RECEIVABLE (NET) 972270 OTHER ASSETS 927805 DEFERRED FINANCING COSTS 92426 PHYSICIAN LOANS/NOTES RECEIV. (NET) 84922 31289212 ACCRUED RETIREMENT OBLIGATION 6620886 ESTIMATED THIRD PARTY SETTLEMENTS 3861284 ASSET RETIREMENT OBLIGATION 1600383 INTEREST RATE SWAP 1510794 13593347 X 141484542 422841 422841 141061701 -67764 -67764 140993937 129797798 422841 422841 129374957 129374957 SCHEDULE D, PAGE 3, PART X SEE PART X, OTHER LIABILITIES SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 422,841 SCHEDULE D, PAGE 4, PART XI, LINE 4B GIFT AND BEQUESTS: 62,079 CHANGE OF FAIR MARKET VALUE OF INTEREST RATE SWAP -141,613 UNRESTRICTED ENDOWMENT INCOME: 21,926 REALIZED GAIN ON INVESTMENTS: 112,382 OTHER: -122,538 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 422,841 true true true X true X true true false true true 670115 11508 658607 0.00510 12127314 456643 11670671 0.09020 12797429 468151 12329278 0.09530 328192 328192 0.00250 21920 21920 0.00020 191360 191360 0.00150 200 200 541672 541672 0.00420 13339101 468151 12870950 0.09950 592412 592412 0.00460 592412 592412 0.00460 true 2230758 488868 27113486 28252307 -1138821 true true 1 1 CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 WWW.CPHOSPITAL.ORG X X X CANTON-POTSDAM HOSPITAL 1 false false true X X X X X X X X X X 13 true true true true X WWW.CPHOSPITAL.ORG X true 14 false false false true X 100.000000000000 300.000000000000 true true X X X X true X X X X X X X true X X true X X X X X X true X false true FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 3J SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 5 SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 6A SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 6B SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 15E SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 22D SEE PART VI FACILITY 1, CANTON-POTSDAM HOSPITAL - PART V, LINE 24 SEE PART VI ADDITIONAL INFORMATION CANTON-POTSDAM HOSPITAL 2014-FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION PART V, 20D: THE HOSPITAL USES THE HIGHEST VOLUME COMMERCIAL COVERAGE RATE, FROM BLUE CROSS/BLUE SHIELD, WHICH IS ALSO GENERALLY THE LOWEST RATE CHARGED. 1.REQUIRED DESCRIPTIONS: PART II -COMMUNITY BUILDING ACTIVITIES - THE AMOUNT REPORTED ON PART II LINE 8 REPRESENTS THE INVESTMENT MADE IN RECRUITING NEW HEALTHCARE PRACTITIONERS TO OUR SERVICE AREA DURING 2014. DUE TO ITS INDIGENT POPULATION AND RURAL NATURE, MUCH OF THE REGION SURROUNDING THE HOSPITAL IS DESIGNATED AS A MANPOWER SHORTAGE AREA. PART III, SECTION A, LINES 2 & 3 THE COSTS ON LINE 2 ARE BASED UPON THE MEDICARE ICR FOR 2014 APPLIED TO THE GROSS CHARGES WRITTEN OFF. THE COSTS ON LINE 3 WERE CALCULATED IN ACCORDANCE WITH THE COSTING METHODOLOGY EMPLOYED BY THE NYS DOH BAD DEBT COSTING PROCESS. PART III SECTION A, LINE 4 - PAGE 14 OF THE AUDITED FINANCIAL STATEMENTS. PART III SECTION B, LINE 8 - THE SHORTFALL CALCULATED ON LINE 7 OF 1,138,821 IS THE RECOGNIZED SHORTFALL BETWEEN MEDICARE COSTS AND MEDICARE REIMBURSEMENTS UTILIZING THE COST TO CHARGE RATIO AND INFORMATION PROVIDED ON THE ORGANIZATION'S 2014 MEDICARE COST REPORT. PART III SECTION C, LINE 9B - THE ORGANIZATION APPLIES THE SAME COLLECTION PRINCIPLES TO AMOUNTS DUE FROM PATIENTS WHO HAVE QUALIFIED FOR PERCENTAGE DISCOUNTS BUT STILL HAVE A RESPONSIBILITY FOR A PORTION OF THEIR BILL BASED UPON THE SLIDING FEE SCHEDULE. NO SEPARATE DISTINCTION IS MADE FOR THE APPLICATION OF OUR COLLECTION PROCESSES IN THOSE CASES. PART V SECTION B, LINE 5 - (IN CONDUCTING ITS MOST RECENT CHNA, DESCRIBE HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED) IN CONDUCTING ITS MOST RECENT CHNA, CANTON-POTSDAM HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE COMMUNITY THROUGH FORMAL AND INFORMAL MEETINGS OF THE HOSPITAL'S VOTING MEMBERSHIP (A GROUP OF APPROXIMATELY 300 PEOPLE REPRESENTING ALL PRIMARY AND SECONDARY SERVICE AREAS), INDIVIDUAL MEETINGS WITH PUBLIC HEALTH OFFICIALS, LOCAL COLLEGE PRESIDENTS, THE LEADERS OF OTHER AREA HEALTHCARE FACILITIES (UNITED HELPERS, INC., HOSPICE AND PALLIATIVE CARE OF THE ST. LAWRENCE VALLEY, CLAXTON-HEPBURN MEDICAL CENTER, MASSENA MEMORIAL HOSPITAL, E.J. NOBLE HOSPITAL, SAMARITAN MEDICAL CENTER, AND CLIFTON-FINE HOSPITAL), AND LOCAL GOVERNMENT OFFICIALS. ADDITIONAL INPUT WAS GATHERED FROM HOSPITAL BOARD MEMBERS REPRESENTING PUBLIC HEALTH, DENTISTRY, VETERINARY HEALTH, THE COLLEGES, HOSPICE, AND AREA BUSINESSES. INPUT IS ALSO SOUGHT THROUGH REGULAR OPEN FORUMS AND INFORMAL CONVERSATIONS WITH THE HOSPITAL'S TWO AUXILIARY GROUPS AND ITS CADRE OF VOLUNTEERS COMPRISING STUDENTS, THE ELDERLY, AND PEOPLE WITH DISABILITIES. IN 2013, CPH ESTABLISHED A PATIENT ADVISORY COUNCIL COMPRISED OF PATIENTS FROM A VARIETY OF SOCIOECONOMIC AND AGE CATEGORIES. CANTON-POTSDAM HOSPITAL PARTICIPATES AT THE BOARD LEVEL, ALONG WITH THE ST. LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT, ON THE ST. LAWRENCE HEALTH INITIATIVE, A NOT-FOR-PROFIT ORGANIZATION COORDINATING HEALTH ASSESSMENT AMONG ALL AREA HEALTH FACILITIES. THIS ORGANIZATION PROVIDES REGULAR AND FORMAL COORDINATION FOR ONGOING ASSESSMENT OF AND COLLABORATION ON PROGRAMS TO ADDRESS THE REGION'S NEEDS. PART V, SECTION B, LINE 6A&B - CANTON-POTSDAM HOSPITAL'S CHNA WAS CONDUCTED WITH CLAXTON-HEPBURN MEDICAL CENTER, MASSENA MEMORIAL HOSPITAL AND E.J. NOBLE HOSPITAL, AND WAS AUTHORED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION, LOCATED IN JEFFERSON COUNTY. THE ASSESSMENT WAS A TRI-COUNTY ASSESSMENT. PART V SECTION B, LINE 11 - (DESCRIBE HOW THE FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED.) CANTON-POTSDAM HOSPITAL PARTICIPATED IN A COUNTY-WIDE NEEDS ASSESSMENT PROCESS LED BY ITS COMMUNITY PARTNER, ST. LAWRENCE HEALTH INITIATIVE, AND THE ST. LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT. THIS EFFORT ASSESSED HEALTH NEEDS, EXISTENCE OF HEALTHCARE ORGANIZATIONS AND COMMUNITY ORGANIZATIONS ABLE TO ADDRESS THESE NEEDS, AND PRIORITIZED HEALTH NEEDS TO WHICH HOSPITALS AND OTHER HEALTHCARE ORGANIZATIONS COLLABORATIVELY COMMITTED TO ADDRESSING. THESE HIGH-PRIORITY HEALTH NEEDS INCLUDE CHRONIC DISEASE PREVENTION WITH A FOCUS ON OBESITY AND COLORECTAL CANCER, AND PROMOTION OF MENTAL HEALTH AND PREVENTION OF SUBSTANCE ABUSE. THESE PRIORITY AREAS ARE THE FOCUS OF THE HOSPITAL'S THREE-YEAR PLAN AND DOVETAIL WITH CPH'S ONGOING STRATEGIC PLANNING PROCESS, WHICH HAS CALLED FOR RECRUITMENT OF PRIMARY AND SPECIALTY PRACTITIONERS, EXPANSION OF OUTPATIENT SERVICES, AND CREATION OF A PRIMARY MEDICAL HOME MODEL. IN 2014, CPH'S POTSDAM MEDICAL HOME RECEIVED CERTIFICATION. CPH PLANS TO MEET HEALTH NEEDS THROUGH EXTENSIVE CONSULTATION WITH COMMUNITY GROUPS, LOCAL GOVERNMENT ENTITIES, EMPLOYEES AND VOLUNTEERS, LOCAL ECONOMIC DEVELOPMENT AGENCIES, HOSPITAL AUXILIARIES, EMERGENCY MANAGEMENT LEADERS, ACADEMIC LEADERS, AND HEALTHCARE PRACTITIONERS. IN 2013, CPH CREATED A PATIENT ADVISORY GROUP WHICH PROVIDES INVALUABLE INPUT ON THE PATIENT EXPERIENCE AND COMMUNITY NEEDS. IN ADDITION, CPH PRESENTED EXHAUSTIVE HEALTHCARE STATUS DATA AND SOUGHT FEEDBACK AS PART OF THE NEW YORK STATE HEALTHCARE REDESIGN COMMISSION, WHICH HELD A SERIES OF PUBLIC MEETINGS IN EARLY 2014. IN FURTHERANCE OF CPH'S STRATEGIC PLAN, CONSTRUCTION ON AN EXPANDED MEDICAL OFFICE BUILDING IN POTSDAM, NEW YORK WAS COMPLETED IN 2013 TO ACCOMMODATE MULTIPLE PHYSICIAN PRACTICES. RELATED CONSTRUCTION OF AN URGENT CARE CENTER WAS COMPLETED MARCH 2014. IN 2012, THE HOSPITAL, WITH THREE OTHER PARTNERS, FORMED NORTHERN LIGHTS HEALTH CARE PARTNERSHIP, INC. NORTHERN LIGHTS PROVIDES CERTIFIED HOME HEALTH CARE TO RESIDENTS OF ST. LAWRENCE COUNTY, NEW YORK. FORMATION OF THIS PARTNERSHIP WAS DUE TO DISCONTINUATION OF THESE SERVICES BY THE COUNTY. IN 2014, THE HOSPITAL INVESTED 117,500 IN THIS PARTNERSHIP. 2.NEEDS ASSESSMENT: PLEASE REFERENCE THE ABOVE REQUIRED DESCRIPTIONS, PART V SECTION B, LINES 5 AND 11B. 3.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE ORGANIZATION CONSPICUOUSLY POSTS ITS FINANCIAL ASSISTANCE POLICY IN EACH REGISTRATION/RECEPTION AREA. PATIENTS ARE ENCOURAGED TO APPLY FOR ASSISTANCE AND GIVEN CONTACT INFORMATION AT THESE AREAS. IN ADDITION, ANY PATIENT THAT IS UNINSURED AND ADMITTED TO THE HOSPITAL FOR CARE IS PHYSICALLY VISITED BY A FINANCIAL COUNSELOR, AND AN EXPLANATION OF OUR PROGRAM IS MADE ALONG WITH AN APPLICATION. PATIENTS REQUESTING ASSISTANCE IN THE COMPLETION OF THE APPLICATION ARE GIVEN SUCH. ANY INFORMATION REQUIRED FOR APPLICATION FOR THE NYS MEDICAID APPLICATION PROCESS IS COLLECTED BY OUR FINANCIAL CASE MANAGERS AND COMMUNICATED TO THE APPROPRIATE CASE MANAGERS AT OUR COUNTY DEPARTMENT OF SOCIAL SERVICES FOR DETERMINATION OF MEDICAID ELIGIBILITY. 4.COMMUNITY INFORMATION: CANTON-POTSDAM HOSPITAL IS LOCATED IN ST. LAWRENCE COUNTY IN UPSTATE NEW YORK. ST. LAWRENCE COUNTY, THE LARGEST COUNTY IN NEW YORK, IS LOCATED IN THE NORTHERNMOST REACHES OF THE STATE BORDERING ON THE ST. LAWRENCE RIVER AND CANADA. IT IS A RURAL ENVIRONMENT CONSISTING OF 2,685 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 112,000 RESIDENTS. CANTON-POTSDAM HOSPITAL'S PRIMARY SERVICE AREA INCLUDES APPROXIMATELY 55,000 PEOPLE LIVING IN THE COMMUNITIES OF POTSDAM, CANTON AND NEARBY SMALLER COMMUNITIES AND INCLUDES THE STUDENT POPULATION OF FOUR COLLEGES IN CANTON AND POTSDAM. THE SECONDARY SERVICE AREA FOR THE HOSPITAL IS PREDOMINANTLY THE REMAINING COMMUNITIES WITHIN ST. LAWRENCE COUNTY WITH SOME RESIDENTS OF THE WESTERN FRANKLIN COUNTY AREA BEING SERVED. 5.PROMOTION OF COMMUNITY HEALTH: AT THE 2014 HEALTH FAIRS, THE IMAGING DEPARTMENT PROVIDED FREE HEEL BONE DENSITY SCREENING EXAMS TO THE COMMUNITY. THE APPROXIMATE COST FOR THIS SERVICE WAS 71,300. IN ADDITION TO THESE SCREENINGS, THE HOSPITAL HOSTS AND ATTENDS NUMEROUS HEALTH FAIRS THROUGHOUT THE YEAR, ALONG WITH HOSTING EVENTS SUCH AS "ASK THE PHYSICIAN", "PARTNERING IN YOUR CARE" LUNCHEONS AND WOMEN'S WELLNESS DAY EVENTS. THE APPROXIMATE VALUE OF THESE EFFORTS WAS 47,600. THE HOSPITAL INVESTED 20,000 IN THE A.D.A.M. ONLINE EDUCATION RESOURCE. WITH THIS RESOURCE WE ARE ABLE TO PROVIDE WEBSITE VISITORS WITH THE MOST CURRENT, PHYSICIAN REVIEWED HEALTH ARTICLES. IN ADDITION TO EDUCATION AND RESEARCH, VISITORS CAN ALSO UTILIZE THE SYMPTOM NAVIGATOR TO BETTER DETERMINE THEIR HEALTH CONCERNS PRIOR TO VISITING THE EMERGENCY ROOM OR ANY OF OUR SERVICES. EDUCATION AND PATIENT SELF-MANAGEMENT IS CRITICAL IN PREVENTIVE MEDICINE; WITH THE ADDITION OF A.D.A.M. CONTENT, PATIENTS ARE NOW ABLE TO REVIEW AND PRINT INSTRUCTIONS FOR PROCEDURES OR FOLLOW-UP CARE RIGHT FROM THEIR OWN HOMES. THE CHEMICAL DEPENDENCY DEPARTMENT OF THE HOSPITAL DONATED TIME AS COUNSELORS TO THE COUNTY JAIL, SPOKE ABOUT CHEMICAL DEPENDENCY AT THE LOCAL COLLEGES, ATTENDS DRUG COURT TO ASSIST WITH false false false false false false false false false DAVID ACKER PRESIDENT & CEO 399342 1098 75920 23020 499380 RICHARD JACOBS ASSISTANT TREASURER 249482 17369 17715 284566 MARCO BERNARD MD 816020 10147 30660 856827 KRIS VANWAGNER MD 747586 13000 9420 770006 JEFFREY HAASBEEK MD 706529 5200 28755 740484 JOHN SAVAGE MD 676432 13000 17556 706988 XIAOSONG SONG MD 601221 13000 18144 632365 A ST LAWRENCE COUNTY IDC 272614310 2010-08-30 21305500 SEE PART VI false true false A 4275000 20921703 11168176 9590000 2011 true false false true A false false false false 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 20,921,703 OF BOND PROCEEDS WERE ACTUALLY DRAWN. PART II, LINE 11 - OTHER SPENT PROCEEDS PROCEEDS OF THE BONDS IN THE PRINCIPAL AMOUNT OF 9,590,000 WERE SPENT ON SEPTEMBER 27, 2010 TO REDEEM CERTAIN OUTSTANDING TAX-EXEMPT BONDS ISSUED AUGUST 20, 2002 TO FINANCE HOSPITAL FACILITIES. SEE PART V false SCHEDULE L, PART V 2014 FORM 990, SCHEDULE L PART IV, SUPPLEMENTAL RESPONSE OUR ORGANIZATION HAS BUSINESS TRANSACTIONS INVOLVING CERTAIN MEMBERS OF OUR BOARD OF DIRECTORS, WHICH ARE DETAILED BELOW: 1.KATHRYN MULLANEY, OUR BOARD TREASURER, RETIRED AS THE VICE PRESIDENT FOR FINANCE AT ST. LAWRENCE UNIVERSITY (SLU)IN 2014. OUR ORGANIZATION PROVIDES HEALTHCARE SERVICES AND STAFFS A CLINIC ON THE SLU CAMPUS. THE OPERATION COSTS OF THAT CLINIC IN 2014 WERE APPROXIMATELY 586,463, WHICH WERE REIMBURSED BY SLU ON A PASS THROUGH BASIS. 2.DONALD DANGREMOND, MICHAEL GRIFFIN AND PAUL MCGRATH, BOARD MEMBERS, ARE EMPLOYEES OF CLARKSON UNIVERSITY (CU). OUR ORGANIZATION PROVIDES HEALTHCARE SERVICES AND STAFFS A CLINIC ON THE CU CAMPUS. THE OPERATION COSTS OF THAT CLINIC IN 2014 WERE APPROXIMATELY 349,412 WHICH WERE REIMBURSED BY CU ON A PASS THROUGH BASIS. 3.DR. MICHAEL TULLOCH, BOARD MEMBER, IS CONTRACTED TO PERFORM INTERPRETATIONS OF CARDIOLOGY SERVICES PROVIDED AT OUR FACILITY. HE WAS COMPENSATED 52,220 FOR THIS SERVICE IN 2014. HIS PAYMENT FOR PROFESSIONAL SERVICES IS BASED ON A PER PROCEDURE FEE STRUCTURE. 4.BRIAN GARDAM, BOARD MEMBER, IS ALSO THE EXECUTIVE DIRECTOR OF HOSPICE OF PALLIATIVE CARE OF ST. LAWRENCE VALLEY (HOSPICE). CANTON-POTSDAM HOSPITAL CONTRACTS WITH HOSPICE FOR INPATIENT HOSPICE SERVICES FOR SYMPTOM MANAGEMENT AND PAIN CONTROL. IN 2014, 24,861 WAS REMITTED TO HOSPICE FOR THESE SERVICES. CANTON-POTSDAM HOSPITAL ALSO REMITTED TO HOSPICE 2,000 TO SUPPORT THE TASTE OF SPRING AND TASTE OF AUTUMN ANNUAL HOSPICE FUNDRAISERS. 5.JAMES THEODORE, BOARD MEMBER, IS ALSO THE MORGAN STANLEY SMITH BARNEY LLC FINANCIAL ADVISOR FOR AN ACCOUNT HELD IN THE NAME OF CANTON-POTSDAM HOSPITAL FOUNDATION, INC. (A RELATED TAX-EXEMPT ORGANIZATION). THIS FOUNDATION ACCOUNT IS USED AS A PASS-THROUGH FOR DONATIONS OF STOCK. THE BALANCE IN THIS ACCOUNT AS OF DECEMBER 31, 2014 WAS 0. 6.DURING 2010, BOND ISSUES WERE OBTAINED FOR CANTON-POTSDAM HOSPITAL FROM COMMUNITY BANK, NA AND KEY BANK, AS DISCLOSED IN SCHEDULE K. THE COMMUNITY BANK, NA PORTION OF THESE BOND ISSUES WERE IN THE AMOUNT OF 3,585,000. IN 2011, THE HOSPITAL WAS ISSUED A MORTGAGE BY COMMUNITY BANK, NA FOR CONSTRUCTION OF THE E.J. NOBEL ANNEX BUILDING, IN THE AMOUNT OF 2,200,000. EDWARD MUCENSKI, BOARD MEMBER, IS A BOARD MEMBER OF COMMUNITY BANK, NA. AS OF DECEMBER 31, 2014 THE HOSPITAL WAS CURRENT ON ANY OBLIGATIONS DUE TO THE BANK. 7.BOARD MEMBER MARGARET MADDEN IS EMPLOYED BY THE STATE UNIVERSITY OF NEW YORK AT POTSDAM. MARGARET MADDEN IS THE PROVOST AND VICE PRESIDENT FOR ACADEMIC AFFAIRS. SUNY POTSDAM OWNS ONE OF THE MEDICAL OFFICE BUILDINGS IN POTSDAM THAT HOUSES FOUR OF OUR OUT-PATIENT CLINICS. 8.BOARD MEMBER JUNE PEOPLES IS EMPLOYED BY NORTH COUNTRY PUBLIC RADIO (NCPR) AS DIRECTOR OF GIVING AND FINANCE. NCPR HAS A LIFETIME LEASE AT THE HOSPITAL'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. 9.BOARD MEMBER MARK CORNETT IS A CONSULTANT EMPLOYED BY SLIC NETWORK SOLUTIONS. SLIC RENTS OFFICE SPACE AT THE HOSPITAL'S MEDICAL OFFICE BUILDING IN CANTON, NEW YORK. CANTON-POTSDAM HOSPITAL REMITTED APPROXIMATELY 147,500 TO SLIC IN 2014 FOR TELECOMMUNICATION SERVICES. FORM 990, PAGE 2, PART III, LINE 4A CANTON-POTSDAM HOSPITAL OPERATES A 7 BED DETOXIFICATION AND 17 BED REHABILITATION PROGRAM. GROWTH CONTINUES IN BOTH PROGRAMS WHICH PROVIDE A HIGHLY NEEDED SERVICE TO RESIDENTS OF ST. LAWRENCE COUNTY AND IMMEDIATE SURROUNDING COUNTIES. FORM 990, PAGE 2, PART III, LINE 4D ONCOLOGY SERVICES: IN 2014, THE ONCOLOGY VISITS INCREASED FROM 8,440 IN 2013 TO 8,917 IN 2014, ROUGHLY A 5.7% INCREASE. THE NUMBER OF RADIATION ONCOLOGY VISITS DECREASED BY APPROXIMATELY 6%, WITH THE MEDICAL ONCOLOGY VISITS INCREASED BY APPROXIMATELY 14%. THE ONE MILLION DOLLAR INCREASE IN EXPENSES FOR THE ONCOLOGY DEPARTMENTS WAS LARGELY DUE TO THE INCREASE IN PHARMACEUTICALS EXPENSE, WHICH INCREASED 43.4% FROM FISCAL YEAR 2013. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT STAFF MEMBERS. UPON COMPLETION, A COPY WITH SUPPORTING DOCUMENTATION IS REVIEWED BY THE VICE PRESIDENT FOR FINANCE AND THE CONTROLLER. AFTER REVIEW, ANY CHANGES ARE MADE AND A COPY IS PRESENTED TO THE FINANCE COMMITTEE. THE FINANCE COMMITTEE WILL THEN REVIEW AND MAY REQUEST CHANGES TO THE FORM. ONCE THE CHANGES ARE IMPLEMENTED, THE FORM 990 IS SUBMITTED TO THE FULL BOARD OF DIRECTORS FOR THEIR REVIEW, COMMENTS AND APPROVAL. FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBER CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED AND REVIEWED BY THE BOARD ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15A LINE 15A: THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS UTILIZES THE INPUT OF A NATIONAL CONSULTING FIRM WITH EXPERTISE IN EXECUTIVE COMPENSATION TO REVIEW THE COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AS WELL AS OUR COMPLIANCE WITH REGULATORY REQUIREMENTS FOR EXECUTIVE COMPENSATION FOR NOT-FOR-PROFIT HOSPITALS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE. FORM 990, PAGE 6, PART VI, LINE 15B LINE 15B: THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED PRIMARILY BY INFORMATION GATHERED FROM INDEPENDENT SURVEY DATA FROM NATIONAL AND SURROUNDING MARKETS COORDINATED BY THE HUMAN RESOURCE DEPARTMENT. THE CEO AND VICE PRESIDENT OF HUMAN RESOURCES REVIEW THE SURVEY DATA TO DETERMINE SALARY RANGES AND COMPENSATION PACKAGES. THE CEO BRINGS THE INFORMATION AND FINDINGS TO THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE OF THE BOARD FOR THEIR DELIBERATION AND CONSIDERATION. THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE WITH THEN BRING THEIR RECOMMENDATION TO THE FULL BOARD FOR THEIR FINAL APPROVAL. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 RENTAL EXPENSES 422,841 GIFT AND BEQUESTS: -62,079 CHANGE OF FAIR MARKET VALUE OF INTEREST RATE SWAP 141,613 UNRESTRICTED ENDOWMENT INCOME: -21,926 REALIZED GAIN ON INVESTMENTS: -112,382 OTHER: 122,538 RENTAL EXPENSES -422,841 FORM 990, PART XI, LINE 9 CONTRIBUTIONS FOR CAPITAL 184,691 TEMPORARILY RESTRICTED CONTRIBUTIONS FOR CAPITAL 248,311 CHANGE IN INTEREST IN NET ASSETS OF CPH FOUNDATION 1,300,148 CHANGE IN FUNDED STATUS OF EMPLOYEE BEN PLAN -6,711,707 CAPITAL CAMPAIGN GIFTS -318,034 TRANSFER TO CPH FOUNDATION -558,711 TRANSFER TO ST. LAWRENCE HEALTH SYSTEM -1,801,577 TRANSFER TO AFFILIATE (CANTON POTSDAM MEDICAL PRAC -3,875,423 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 SYSTEM 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 GOUVERNEUR HOSPITAL INC 77 W BARNEY STREET GOUVERNEUR NY 13642 464249555 HOSPITAL NY 501C3 N/A false false true false true false false false false false true true false true false false true true true false CANTON-POTSDAM HOSPITAL FOUNDATION B 558711 CASH EXCHANGED NORTHERN LIGHTS HEALTH CARE PARTNERSHIP INC B 117500 CASH EXCHANGED CANTON-POTSDAM MEDICAL PRACTICE PLLC B 4025423 FMV ST LAWRENCE HEALTH SYSTEMS INC B 1801576 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION J 9360 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION K 523645 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION M 492322 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION P 137511 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION Q 203900 CASH EXCHANGED CANTON-POTSDAM HOSPITAL FOUNDATION R 67711 CASH EXCHANGED GOUVERNEUR HOSPITAL INC J 1987744 FMV GOUVERNEUR HOSPITAL INC K 207043 FMV SCHEDULE R CANTON-POTSDAM HOSPITAL FOUNDATION IS RESPONSIBLE FOR RAISING, INVESTING AND MANAGING FUNDS FOR THE HOSPITAL. CANTON-POTSDAM MEDICAL PRACTICE, PLLC PROVIDES PHYSICIAN SERVICES IN AN OUTPATIENT CLINIC SETTING AS BENEFIT TO THE COMMUNITY AND HOSPITAL. ST. LAWRENCE HEALTH SYSTEM, FORMED DECEMBER 5, 2013, IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPITAL AND OTHER AFFILIATED CORPORATIONS. NORTHERN LIGHTS HEALTH CARE PARTNERSHIP, INC. OPERATES A CERTIFIED HOME HEALTH AGENCY. GOUVERNEUR HOSPITAL, INC., A NOT-FOR-PROFIT ORGANIZATION, IS THE AFFILIATE OF CANTON-POTSDAM HOSPITAL, AND SUPPORTED BY THE PARENT ORGANIZATION OF ST. LAWRENCE HEALTH SYSTEM.