2014-11-14T10:46:13-06:00 2013-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2013-01-01 150559686 CLAXTON-HEPBURN MEDICAL CENTER CLAX 3153938880 214 KING STREET OGDENSBURG NY 13669 KELLEY TIERNAN CFO 3153938880 2014-09-09 1 JOSEPH J SCHLEGEL P00301329 3154463600 2013 2015-11-30 17:44:51Z KELLEY TIERNAN 214 KING STREET OGDENSBURG NY 13669 93868952 0 X WWW.CHMED.ORG X 1917 NY CLAXTON-HEPBURN MEDICAL CENTER (HOSPITAL) OPERATES ACUTE CARE AND PSYCHIATRIC FACILITIES IN OGDENSBURG, NEW YORK. THE HOSPITAL IS THE SOLE ACUTE CARE PROVIDER IN OGDENSBURG, NY SERVICING PATIENTS PRIMARILY FROM ST. LAWRENCE COUNTY. 20 20 900 44 0 0 1924381 2731949 90770714 89725606 -1213 71520 1001075 1270470 93694957 93799545 0 0 0 0 51671807 51000322 0 0 0 38127557 37686452 89799364 88686774 3895593 5112771 99160621 102972855 62313831 48517478 36846790 54455377 TO MEET OUR REGION'S HEALTHCARE NEEDS WITH COMPASSION AND EXELLENCE. SIGNIFICANT ACTIVITES: INPATIENT, OUTPATIENT, AND EMERGENCY CARE. 0 0 69718771 90861868 CLAXTON-HEPBURN MEDICAL CENTER IS LOCATED IN OGDENSBURG, NY, AND IS A NOT-FOR-PROFIT HOSPITAL. THE HOSPITAL PROVIDES ACUTE INPATIENT PRIMARY CARE, MEDICAL, SURGICAL, INTENSIVE CARE, OBSTETRICS, NURSERY, MAINTAINS AN EMERGENCY DEPT, AMBULATORY SURGERY, HOME HEMODIALYSIS AND MENTAL HEALTH CENTER ACUTE REHAB TO THE PUBLIC. ACUTE PATIENT DAYS WERE 23,230. ADMISSIONS WERE 3,841, AND ER VISITS WERE 17,953. $1,045,520 OF CHARITY HEALTHCARE WAS GIVEN TO THE COMMUNITY. 69718771 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 74 0 900 1 0 0 0 0 0 0 0 0 0 0 X 20 20 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X KELLEY TIERNAN 3153938880 214 KING STREET OGDENSBURG NY 136691191 REV THOMAS PATTERSON DIRECTOR 1.00 X 0 0 0 RUSSELL STRAIT TREASURER 1.00 X X 0 0 0 JOSEPH TRACY CHAIRPERSON 1.00 X X 0 0 0 CHET TRUSKOWSKI VICE-CHAIRPERSON 1.00 X X 0 0 0 PHILIP COSMO DIRECTOR 1.00 X X 0 0 0 SR MARY TERESA LABRAKE GNSH DIRECTOR 1.00 X 0 0 0 MARY LACOMBE DIRECTOR 1.00 X 0 0 0 TED LAWRENCE DIRECTOR 1.00 X 0 0 0 MAUREEN MISSERT DIRECTOR 1.00 X X 0 0 0 MICHAEL SEIDMAN MD DIRECTOR 1.00 X 267588 0 18441 MACREENA DOYLE DIRECTOR 1.00 X 0 0 0 M SANDRA LYONS DIRECTOR 1.00 X 0 0 0 CLIVE CHAMBERS DIRECTOR 1.00 X 0 0 0 MARK MASHAW DIRECTOR 1.00 X 0 0 0 LAWRENCE SEARS DIRECTOR 1.00 X 0 0 0 BRIAN FELITTO SECRETARY 1.00 X X 0 0 0 LINDA FAY DIRECTOR 1.00 X 0 0 0 JAMES THEW DIRECTOR 1.00 X 0 0 0 CHRISTOPHER BRANDY MD DIRECTOR 1.00 X 0 0 0 SR MARY ELIZABETH LOOBY GNSH DIRECTOR 1.00 X 0 0 0 SR DONNA FRANKLIN DC DIRECTOR 1.00 X 0 0 0 ERIC PELLEGRINO EDD DIRECTOR 1.00 X 0 0 0 KIRI BRANDY MD DIRECTOR 1.00 X 0 0 0 MARK WEBSTER PRESIDENT/EXECUTIVE OFFICE 40.00 X 376488 0 28265 KELLEY TIERNAN CHIEF FINANCIAL OFFICER 40.00 X 203061 0 25500 DAVID FERRIS VP OF NURSING 40.00 X 169063 0 20217 GARY HART CHIEF MEDICAL OFFICER 40.00 X 271877 0 28029 VICKI PERRINE CHIEF OPERATING OFFICER 40.00 X 190433 0 18522 JOHN GERBERT MD PHYSICIAN 40.00 X 856345 0 18575 THOMAS HERZOG MD PHYSICIAN 40.00 X 653412 0 23856 JUAN-DIEGO HARRIS MD PHYSICIAN 40.00 X 621386 0 28573 GEETANJLI SANGWAN MD PHYSICIAN 40.00 X 358211 0 22019 LUCILLE ALSTON MD PHYSICIAN 40.00 X 405339 0 8825 4373203 0 240822 52 0 1 0 EMERGENCY PHYSICIAN ASSOCIATES 307 SOUTH EVERGREEN AVE WOODBURY NJ 08096 EMERGENCY ROOM PHYSICIAN SERVICES 910000 HEALOGICS NATIONAL WOUND 6400 CONGRESS AVE SUITE 2200 BOCA RATON FL 33489 WOUND SERVICES 805585 LOCUMTENENSCOM 3650 MANSELL RD STE 310 ALPHARETTA GA 30022 CONTRACTED LABOR 542371 CENTREX CLINICAL LAB 1656 CHAMPLAIN AVE UTICA NY 13502 LAB CONSULTING/TEST 451255 LAB CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB CONSULTING/TEST 359076 26 1413880 1318069 2731949 PATIENT SERVICES 621990 88278713 88278713 340B RETAIL 621990 1446893 1446893 89725606 275135 69407 205728 205728 205728 71520 0 71520 71520 71520 OTHER 900099 418099 418099 CAFETERIA 900099 302275 302275 AUXILIARY 900099 244601 244601 99767 99767 1064742 93799545 90861868 0 205728 1331457 299907 1031550 37811824 31708065 6103759 2859862 2338547 521315 6269417 5126584 1142833 2727762 2230527 497235 257042 3800 253242 212581 212581 205995 38724 167271 153779 48040 105739 172004 79882 92122 1073046 794054 278992 4658458 3447259 1211199 SUPPLIES - MEDICAL 12501678 12418498 83180 PURCHASED SERVICES 6752744 4484004 2268740 CONTRACTS & LEASES 3645591 2439605 1205986 BAD DEBT EXPENSE 2069847 2069847 5983687 2191428 3792259 88686774 69718771 18968003 0 2563235 1685959 12275236 8787832 185426 0 16817996 15439396 1222765 1500416 1043236 1089392 631830 703127 109294797 64998138 42466755 44296659 21954142 29470074 99160621 102972855 40402941 26472996 19926503 20659233 1984387 1385249 62313831 48517478 X 35431410 52871777 810633 893279 604747 690321 36846790 54455377 99160621 102972855 X 5112771 12495816 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1415380 168220 0 1583600 1489845 495268 569733 1415380 2225966 -8703 727418 1489845 861939 1297151 66876 2225966 837598 24401 861939 0.43590 0.56410 0 1 1 432509 432509 58723329 27997443 30725886 2028878 96368 1932510 46797403 36640918 10156485 1312678 263409 1049269 44296659 DEBT ISSUANCE COSTS 809071 INTEREST IN NET ASSETS OF AFFILIATE 14446685 AMOUNTS HELD BY HOSPITAL AND THIRD PARTIES 402339 DUE FROM AFFILIATES 8598817 DEFERRED COMPENSATION 233395 EQUITY INVESTMENTS 402726 CORPORATE CAPITAL RESERVE ACCOUNT 4577041 29470074 INTEREST RATE SWAP LIABILITY 1385249 1385249 X PART V, LINE 4: TERM ENDOWMENTS ARE AVAILABLE FOR HOSPITAL RENOVATION PROJECT, HEALTH CARE SERVICES, AND CHARITABLE ANNUITY RESERVE. PERMANENT ENDOWMENTS ARE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES AND THE MEDICAL LIBRARY. PART X, LINE 2: THE HOSPITAL QUALIFIES AS A TAX-EXEMPT, NOT-FOR-PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2013 AND 2012, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2010 THROUGH 2013. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. 1 1 X 1 X 1 X 250.000000000000 0 1 1 0 1 1 668883 668883 0.00750 12275369 1245075 11030294 0.12440 12944252 1245075 11699177 0.13190 68500 68500 0.00080 1700 1700 0.00000 923 923 0.00000 71123 71123 0.00080 13015375 1245075 11770300 0.13270 3075 3075 0.00000 500 500 0.00000 2375 2375 0.00000 5950 5950 0 2069847 34336 21722835 8489743 13233092 X 1 1 1 1 CLAXTON-HEPBURN MEDICAL CENTER 214 KING STREET OGDENSBURG NY 13669 X X X CLAXTON-HEPBURN MEDICAL CENTER 1 1 X X X X X X X X X 13 1 1 1 X WWW.CHMED.ORG X X X X X 0 0 1 1 300.000000000000 1 300.000000000000 1 X 1 1 X 1 X 0 1 X 0 1 CLAXTON-HEPBURN MEDICAL CENTER PART V, SECTION B, LINE 3: CLAXTON-HEPBURN MEDICAL CENTER WORKED WITH THE OTHER ST. LAWRENCE COUNTY HOSPITALS AS WELL AS THE ST. LAWRENCE HEALTH INITIATIVE AND THE COUNTY PUBLIC HEALTH TO CONDUCT A COMMUNITY NEEDS ASSESSMENT. THE PARTNERS DEVELOPED A COMPREHENSIVE SURVEY TOOL THAT WAS DISTRIBUTED THROUGHOUT THE COUNTY AND WAS AVAILABLE TO COMPLETE ONLINE, WITH JUST OVER 800 SURVEYS COMPLETED. FOCUS GROUPS WERE HELD IN CANTON AND MORRISTOWN TO TRY TO GATHER DATA MORE REPRESENTATIVE OF THE COUNTY. KEY COMMUNITY LEADERS WERE ALSO INTERVIEWED TO ASSIST IN IDENTIFYING THE ISSUES MOST IN NEED OF ATTENTION. THE MEDICAL CENTER ALSO LOOKS TO ITS BOARD OF DIRECTORS FOR GUIDANCE AND FOR THE IDENTIFICATION OF COMMUNITY NEEDS. CLAXTON-HEPBURN MEDICAL CENTER PART V, SECTION B, LINE 4: MASSENA MEMORIAL HOSPITALCANTON-POTSDAM HOSPITALCLIFTON-FINE HOSPITALE.J. NOBLE HOSPITALST. LAWRENCE COUNTY PUBLIC HEALTHST. LAWRENCE HEALTH INITIATIVE CLAXTON-HEPBURN MEDICAL CENTER PART V, SECTION B, LINE 7: 10 NEEDS WERE IDENTIFIED FROM THE CHNA. THE CSP WORK GROUP DECIDED ON THREE PRIORITY AREAS TO ADDRESS BASED PRIORITIZING TECHNIQUES. CHMC IS EXPECTED TO WORK COLLABORATIVELY WITH OTHER ORGANIZATIONS WITHIN THE COMMUNITY TO ADDRESS THOSE THREE PRIORITY AREAS. CHMC WORKED WITH THOSE GROUPS TO SELECT THE THREE ISSUES ON WHICH TO FOCUS FOR THE NEXT THREE YEARS. CLAXTON-HEPBURN MEDICAL CENTER PART V, SECTION B, LINE 20D: CLAXTON-HEPBURN MEDICAL CENTER USES ITS NEGOTIATED RATE FROM THEIR LARGEST COMMERCIAL PAYOR. CLAXTON-HEPBURN MEDICAL CENTER PART V, SECTION B, LINE 22: GROSS CHARGES ARE BILLED TO PATIENTS WITH A NOTICE STATING IF THEY ARE ELIGIBLE FOR A DISCOUNT. ALSO, INSTRUCTIONS TO CONTACT OUR OFFICE AS TO HOW TO APPLY ARE PROVIDED. 7 CANTON HEALTH CENTER 39 WEST MAIN STREET CANTON NY 13617 CLINIC CLAXTON-HEPBURN HEALTH CENTER 100 HORWOOD PLACE OGDENSBURG NY 13669 CLINIC WOUND HEALING CENTER 100 HORWOOD PLACE OGDENSBURG NY 13669 CLINIC MADRID HEALTH CENTER 16 CHURCH STREET MADRID NY 13660 CLINIC HEUVELTON HEALTH CENTER 103 RENSSELAER ST RENSSELAER ST NY 13654 CLINIC WADDINGTON HEALTH CENTER 4 MONTGOMERY HEIGHTS WADDINGTON NY 13694 CLINIC HAMMOND HEALTH CENTER 225 ST LAWRENCE AVE HAMMOND NY 13646 CLINIC PART I, LINE 3C: FINANCIAL ASSISTANCE CONSIDERATION WILL BE GIVEN TO THOSE PATIENTS WHO DEMONSTRATE THAT THEY HAVE BEEN UNABLE TO SECURE HEALTH CARE COVERAGE THROUGH A PUBLICLY SPONSORED NEW YORK STATE PROGRAM AND ARE UNABLE TO OBTAIN FINANCIAL HELP THROUGH OTHER PRIVATE FUNDING RESOURCES. ELIGIBILITY IS BASED ON:-SIZE OF FAMILY-HOUSEHOLD INCOME-AVAILABLE RESOURCES-EXTENT OF EXISTING INSURANCE COVERAGE-DOLLAR AMOUNT OF HOSPITAL CHARGESCLAXTON-HEPBURN MEDICAL CENTER IS COMMITTED TO EVALUATING A PATIENT'S ELIGIBILITY ON A CASE-BY-CASE BASIS, PARTICULARLY WHEN COMPLICATED FINANCIAL SITUATIONS ARE PRESENT. IN ADDITION, THE HOSPITAL WILL ALSO CONSIDER A PATIENT'S LIVING EXPENSES, DEBTS, NET WORTH, AND HEALTH CARE NEEDS. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS A COST-TO-CHARGE RATIO. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART I, LN 7 COL(F): BAD DEBT EXPENSE INCLUDED IN PART IX LINE 25A THAT IS SUBTRACTED OUT FOR THE PURPOSES OF CALCULATING LINE 7 COLUMN F IS $2,069,847. PART I LINE 7: ST. LAWRENCE COUNTY, INCIDENCES OF CANCER AND CHRONIC DISEASE RANK FAR ABOVE STATE AND NATIONAL RANKINGS.IN 2011, THE AMERICAN CANCER SOCIETY ESTIMATES THAT IN NEW YORK STATE 107,260 NEW CANCER CASES WILL BE DIAGNOSED AND 34,350 CANCER DEATHS WILL OCCUR. OVERALL, NEW YORK STATE HAS A HIGHER CANCER INCIDENCE RATE THAN THE NATION AS A WHOLE, BUT HAS A LOWER DEATH RATE.IN ST. LAWRENCE COUNTY, 12 INDIVIDUALS ARE DIAGNOSED WITH CANCER EACH WEEK AND FIVE INDIVIDUALS DIE FROM CANCER EACH WEEK. THE BURDEN IN ST. LAWRENCE COUNTY REFLECTS THAT ANNUAL INCIDENCE RATES HAVE INCREASED. THERE WAS AN AVERAGE OF 492.8 CASES PER 100,000 PEOPLE PER YEAR IN 1994-1998. THIS RATE WAS 534.5 FOR 2004-2008, WHICH IS AN INCREASED RATE OF 8.5%. ANNUAL MORTALITY RATES HAVE DECREASED. THERE WAS AN AVERAGE OF 223.9 DEATHS PER 100,000 PEOPLE PER YEAR IN 1994-1998. THIS RATE WAS 216.3 FOR 2004-2008. THE ANNUAL MORTALITY RATE HAS DECREASED 3.4%. FOUR CANCER SITES REPRESENT 54.8% OF ALL NEW CANCER CASES AND 52.7% OF ALL NEW CANCER DEATHS IN ST. LAWRENCE COUNTY. THEY ARE LUNG AND BRONCHUS, PROSTATE, FEMALE BREAST, AND COLORECTAL CANCERS. CANCER TAKES A TOLL ON NEW YORK STATE. ONE IN TWO MEN AND ONE IN THREE WOMEN WILL GET A CANCER DIAGNOSIS IN THEIR LIFETIME. CANCER IS THE SECOND MOST COMMON CAUSE DEATH AFTER HEART DISEASE. IT IS WELL DOCUMENTED THAT THE BEST CANCER SURVIVAL RATES OCCUR FOR THOSE WHO ARE DIAGNOSED WITH EARLY STAGE DISEASE. ACCESS TO ADEQUATE HEALTH CARE HAS A SIGNIFICANT IMPACT ON AN INDIVIDUAL'S CHANCE OF SURVIVING CANCER. THERE IS A CLEAR NEED FOR POLICIES THAT REDUCE THE OCCURRENCE OF CANCER, HELP IDENTIFY THE DISEASE AT ITS EARLIEST (AND MOST TREATABLE) PHASE, AND TO HELP ALLEVIATE THE ECONOMIC TOLL AND IMPROVE QUALITY OF LIFE FOR THOSE DIAGNOSED WITH CANCER. CLAXTON-HEPBURN TAKES THE LEAD IN OUR COUNTY BY PROVIDING MANY VARIOUS CANCER SCREENINGS THROUGHOUT THE YEAR TO MAKE IT EASIER FOR PEOPLE TO GET SCREENED. IN 2012, THE MEDICAL CENTER SPONSORED ONE FREE COUNTY-WIDE SKIN CANCER SCREENINGS AND TWO FREE BREAST CANCER SCREENINGS AND 20 FREE COLONOSCOPIES. 36 PEOPLE PARTICIPATED IN THE SKIN CANCER SCREENINGS AND 11 WOMEN PARTICIPATED IN THE BREAST CANCER SCREENINGS. THE COST INCURRED TO THE MEDICAL CENTER FOR THESE SCREENINGS INCLUDE STAFF TIME, AND FEES ASSOCIATED WITH THE SCREENINGS SUCH AS XRAY COSTS. MAJOR CAUSES OF MORBIDITY AND MORTALITY IN THE UNITED STATES ARE RELATED TO POOR DIET AND PHYSICAL INACTIVITY. BY MAINTAINING A HEALTHY DIET AND BEING PHYSICALLY ACTIVE, INDIVIDUALS CAN ACHIEVE A HEALTHY WEIGHT AND REDUCE THEIR RISK OF CHRONIC DISEASES SUCH AS DIABETES, HEART DISEASE AND SOME FORMS OF CANCER, AND STRENGTHEN BONES TO REDUCE THE RISK OF OSTEOPOROSIS.OBESITY, WHICH MAY BE ADDRESSED THROUGH PROPER NUTRITION AND PHYSICAL ACTIVITY, IS A MAJOR RISK FACTOR FOR MANY CHRONIC DISEASES, AND HAS REACHED EPIDEMIC PROPORTIONS BOTH IN NEW YORK AND ACROSS THE NATION. THE PERCENTAGE OF OBESE ADULTS IN NEW YORK MORE THAN DOUBLED FROM 10% IN 1997 TO 24.2% IN 2009 AND, NATIONALLY, OBESITY AMONG CHILDREN AND ADOLESCENTS HAS TRIPLED OVER THE PAST THREE DECADES. ACCORDING TO A REPORT BY THE NEW YORK STATE COMPTROLLER'S OFFICE, NEW YORK RANKS SECOND AMONG STATES IN ADULT OBESITY-RELATED MEDICAL EXPENDITURES, WITH TOTAL SPENDING ESTIMATED AT NEARLY $7.6 BILLION (81% OF WHICH IS PAID BY MEDICAID AND MEDICARE), AND FAR EXCEEDING THE NATIONAL AVERAGE OF 52%. PHYSICAL INACTIVITY, POOR NUTRITION, CONSUMPTION OF SUGAR-SWEETENED BEVERAGES AND TELEVISION VIEWING CAN CONTRIBUTE TO EXCESS WEIGHT GAIN IN CHILDREN AND ADULTS. IN 2009, 26.4% OF ADULT NEW YORKERS REPORTED NO PHYSICAL ACTIVITY IN THE PAST 30 DAYS.IN A RECENT NEEDS ASSESSMENT COMPLETED IN COORDINATION WITH THE ST. LAWRENCE COUNTY PUBLIC HEALTH, ST. LAWRENCE HEALTH INITIATIVE AND ST. LAWRENCE COUNTY HOSPITALS, HIGHEST RANKED PROBLEMS:-ACCESS TO CARE-DRUG ABUSE -ALCOHOL ABUSE/UNDERAGE DRINKING-CANCER-POOR NUTRITION-LACK OF PHYSICAL ACTIVITY-DEPRESSION/MENTAL ILLNESS -SMOKING/TOBACCO USE -LUNG DISEASE/COPD (CLRD)-DIABETES -BEHAVIORAL PROBLEMS IN CHILDRENTYPES 1 AND 2 DIABETES AFFECTS A LARGE PERCENTAGE OF THE POPULATION BECAUSE THEY AFFECT SUCH A WIDE AGE RANGE. DATA GATHERED IN ST. LAWRENCE COUNTY SHOWS THAT DIABETES TRENDS ARE SIMILAR FOR ST. LAWRENCE COUNTY; A LARGE PERCENTAGE OF INDIVIDUALS ARE DIAGNOSED WITH DIABETES BETWEEN THE AGES OF 41 AND 60. IT WAS NOTED THAT 6372 PEOPLE OR 5.69% OF ST. LAWRENCE COUNTY INDIVIDUALS HAVE DIABETES AND THAT 7.5% OF THE POPULATION WITH DIABETES IN ST. LAWRENCE COUNTY DOES NOT RECEIVE MEDICATION FOR THEIR CONDITION DUE TO LACK OF ACCESS TO CARE. STUDIES SHOW THAT EARLY RECOGNITION OF DIABETES AS WELL AS PERSISTENT MANAGEMENT OF THE DISEASE IS NECESSARY TO FIGHT THE NEGATIVE EFFECTS THAT DIABETES CAN HAVE ON AN INDIVIDUAL. WITH IMPROVED EDUCATION, SCREENING AND PREVENTIVE CARE, DIABETES RATES IN ST. LAWRENCE COUNTY MAY BE REDUCED TO MINIMAL LEVELS. CLAXTON-HEPBURN PLAYS A VITAL ROLE IN CHRONIC DISEASE SELF-MANAGEMENT AND A PROACTIVE APPROACH TO SLOW PROGRESSION OF CHRONIC DISEASE IN OUR COMMUNITY BY OFFERING NUMEROUS FREE PROGRAMS AND EVENTS TO THE COMMUNITY. IN 2011, THE MEDICAL CENTER SCREENED 970 PEOPLE FOR CANCER, PERIPHERAL VASCULAR DISEASE, HYPERTENSION, HYPERLIPIDEMIA, DIABETES AND BODY MASS INDEX. THE MEDICAL CENTER ALSO PARTICIPATED IN 16 COMMUNITY HEALTH FAIRS PROVIDING FREE EDUCATIONAL MATERIALS, INTERACTIVE WORKSHOPS, FREE SCREENINGS AND HEALTH RELATED GIVEAWAYS. ON AN AVERAGE, FIVE OR MORE SERVICE LINES ATTEND THE EVENTS.CLAXTON-HEPBURN PROVIDED TWO CHRONIC DISEASE MANAGEMENT COURSES THAT COVERED A SIX-WEEK TIME PERIOD WITH TWO INSTRUCTORS. ALL MATERIALS, SPACE AND REFRESHMENTS AND SNACKS WERE PROVIDED TO THE PARTICIPANTS FOR FREE BY CLAXTON-HEPBURN. THE MEDICAL CENTER ALSO PROVIDED SEVERAL FREE SUPPORT GROUPS THAT MEET ONCE A MONTH ON THE HOSPITAL CAMPUS. THEY ARE THE TOBACCO CESSATION, DIABETES AND OSTOMY SUPPORT, THE LOOK GOOD, FEEL BETTER PROGRAM THAT MEETS MONTHLY FOR 2 HOURS IN CRM CONFERENCE ROOM AND THE FREE DIABETES EDUCATION DAY. PART I LINE 6A: ANNUALLY, CHMC PRODUCES A COMMUNITY SERVICE PLAN THAT IS SHARED WITH THE PUBLIC VIA THE MEDICAL CENTER'S WEBSITE, A BROCHURE THAT IS HANDED OUT AT COMMUNITY EVENTS AND IN A PAPER FORM WHEN REQUESTED. PART II, COMMUNITY BUILDING ACTIVITIES: CLAXTON-HEPBURN PARTNERS WITH 5 LOCAL SCHOOLS PROVIDING FREE INTERACTIVE HEALTH ORIENTED WORKSHOPS AND EDUCATIONAL LECTURES ON A MONTHLY BASIS. STAFF CONSISTS OF A VARIETY OF EMPLOYEES THROUGHOUT THE MEDICAL CENTER FROM NURSING TO CLERICAL STAFF. GENERALLY THE VISITS LAST ABOUT ONE AND ONE-HALF HOURS AND ARE OFFERED TEN TIMES A YEAR. CLAXTON-HEPBURN ALSO PARTNERS WITH LOCAL BUSINESSES AND ORGANIZATIONS SUCH AS COLLEGES PROVIDING FREE HEALTH SCREENINGS, EDUCATIONAL WORKSHOPS AND EMPLOYEE/STUDENT WELLNESS PROGRAMMING. THE MEDICAL CENTER DOES NOT CHARGE FOR THESE SERVICES AND DOES INCUR THE EXPENSE OF EMPLOYEE TIME (WHICH INCLUDES PLANNING AND PRESENTING, TRAVEL TIME AND MATERIALS AND SUPPLIES USED FOR THE EVENTS.)ALSO CPR, ACLS, PALS, NALS, SAFE SITTER COURSE, LET'S NOT MEET BY ACCIDENT DRILL, YEARLY 5K AND FAMILY WELLNESS DAY. THE LET'S NOT MEET BY ACCIDENT DRILL HAD ABOUT 50 ATTENDEES. THERE WAS NO REVENUE FOR THIS. THE EXPENSES INCURRED WERE STAFF TIME, SPACE AND FOOD AND BEVERAGES. THE STAFF INCLUDED CHERY'L O'BRIEN, STEVE KARLBERG, DON BURLINGAME, AMY ROBINSON AND MICHELE CATLIN. THE FAMILY WELLNESS DAY GARNERED NO REVENUE. ABOUT 250 PEOPLE ATTENDED THE EVENT. EXPENSES FOR THE EVENT WERE $2500. STAFF VOLUNTEERED THEIR TIME. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL AND CORPORATION ANALYZE PAST PAYMENT HISTORY AND IDENTIFY TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL AND CORPORATION ANALYZE CONTRACTUALLY DUE AMOUNTS AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL AND CORPORATION ALSO ANALYZE AMOUNTS DUE AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN THE HOSPITAL AND CORPORATION ESTABLISH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BOTH TAKE INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S AND CORPORATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 13.4% AND 11.8% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT DECEMBER 31, 2013 AND 2012, RESPECTIVELY. THIS INCREASE RELATES TO NEGATIVE TRENDS EXPERIENCED IN THE COLLECTION OF AMOUNTS FROM SELF-PAY PATIENTS IN RECENT YEARS AS A RESULT OF UNSTABLE ECONOMIC CONDITIONS. PART III, LINE 8: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT OF MEDICARE ALLOWABLE COSTS IS A COST-TO- CHARGE RATIO. PART III, LINE 9B: CLAXTON- HEPBURN MEDICAL CENTER WILL PROVIDE CHARITY CARE TO PATIENTS WHO HAVE BEEN ESTABLISHED AS HAVING INADEQUATE MEANS TO PAY FOR MEDICAL SERVICES. THE IDENTIFICATION OF INADEQUATE MEANS WILL BE BASED ON CRITERIA ESTABLISHED BY PATIENT FINANCIAL SERVICES AND APPROVED BY ADMINISTRATION. PART VI, LINE 2: CLAXTON-HEPBURN USES A VARIETY OF RESOURCES TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. WE USE LOCAL PUBLIC HEALTH DATA, NATIONAL RANKINGS DATA, AS WELL AS DATA FROM THE NEW YORK STATE DEPARTMENT OF HEALTH AND THE NEW YORK STATE HOSPITAL ASSOCIATION AND A RECENT COMMUNITY NEEDS ASSESSMENT. WE ALSO GATHER DATA ON OUR OWN THROUGH SURVEYS AND QUESTIONNAIRES UTILIZED AT COMMUNITY EVENTS THAT WE ATTEND. WE WORK WITH THE LOCAL HEALTH INITIATIVE AND COUNTY PUBLIC HEALTH TO ASSESS COMMUNITY HEALTH NEEDS. PART VI, LINE 3: ALL PATIENTS WITH SELF PAY BALANCES OVER $500.00 RECEIVE A LETTER FROM THE PATIENT FINANCIAL SERVICES DEPARTMENT. THE LETTER INCLUDES INFORMATION REGARDING THE CHARITY CARE PROGRAM. PATIENT FINANCIAL SERVICES STAFF VERBALLY COMMUNICATE WITH PATIENTS ABOUT CHARITY CARE AS THEY WORK ACCOUNTS. HEALTH CENTERS AND OTHER INTAKE AREAS HAVE CHARITY CARE INFORMATIONAL SHEETS TO HANDOUT TO PATIENTS IN NEED. ALL SELF PAY INPATIENTS ARE REFERRED TO AHC TO BE SCREENED FOR MEDICAID. SOCIAL WORKERS IN RENAL AND CANCER CARE SERVICES WORK CLOSELY WITH THE PATIENT FINANCIAL SERVICES STAFF WHEN SELF PAY PATIENTS ARE IN NEED OF SERVICES. PART VI, LINE 4: CLAXTON-HEPBURN MEDICAL CENTER IS A PRIVATE, NOT-FOR-PROFIT, 130-BED COMMUNITY HOSPITAL AND REGIONAL REFERRAL CENTER. CLAXTON-HEPBURN INCLUDES 67 ACUTE CARE BEDS, A 10-BED INTENSIVE CARE UNIT, A 10-BED BIRTHING CENTER, A 28-BED MENTAL HEALTH CENTER, AND A 15-BED ACUTE REHABILITATION UNIT. THE MEDICAL CENTER PROVIDES PRIMARY CARE TO NEARLY 40,000 RESIDENTS OF OGDENSBURG AND SURROUNDING COMMUNITIES, AND REGIONAL SERVICES TO THE 110,000 PEOPLE OF ST. LAWRENCE COUNTY. CHMC HAS AN ACTIVE MEDICAL STAFF OF MORE THAN 50 PHYSICIANS REPRESENTING MOST SPECIALTIES. REGIONAL AND COUNTY-WIDE SERVICES INCLUDE SIX AREA HEALTH CENTERS, RADIATION AND MEDICAL ONCOLOGY PROVIDED BY THE RICHARD E. WINTER CANCER CENTER, DIALYSIS TREATMENT PROVIDED BY THE DR. RAVINDER N. AGARWAL RENAL CENTER, THE REV. THOMAS T. PATTERSON WOUND HEALING CENTER, AND A STATE-OFTHE-ART DIAGNOSTIC IMAGING DEPARTMENT.OVERALL, THE PERCENT CHANGE IN POPULATION IN ST. LAWRENCE COUNTY HAS REMAINED FAIRLY STATIC AS COMPARED TO PERCENT POPULATION CHANGE IN NEW YORK STATE AS A WHOLE. THE VERY LARGE PERCENT OF POPULATION CHANGE IN 2010 SHOWS A DECREASE IN POPULATION WITHIN ST. LAWRENCE COUNTY FROM 1990 TO 2000. POPULATIONS IN MOST OF THE VILLAGES AND CITIES DECREASED BETWEEN 1990 AND 2000, WITH ONLY THE VILLAGES OF HAMMOND, HEUVELTON, AND RENSSELAER FALLS INCREASING IN POPULATION. THE TOWNS, WITH THEIR MORE RURAL AREAS HOWEVER, HAVE MOSTLY GROWN SINCE THE TIME OF THE LAST CENSUS. ONLY THE TOWNS OF CANTON, CLIFTON, FINE, MASSENA, AND POTSDAM HAVE DECREASED IN SIZE.THE COMMUNITY NEEDS ASSESSMENT SHOWED THAT POVERTY IS PREVALENT IN ST. LAWRENCE COUNTY. THE COUNTY'S POVERTY RATE IS 17.8% MAKING IT 3.6% HIGHER THAN THE STATE RATE AND 2.5% HIGHER THAN THE FEDERAL RATE. THE POVERTY RATE FOR CHILDREN IS 22.9% WHICH IS 2.7% ABOVE THE STATE RATE AND 1.3% ABOVE THE FEDERAL RATE. STUDIES HAVE SHOWN THAT POVERTY IS THE SINGLE MOST POWERFUL PREDICTOR OF POOR HEALTH AMONG CHILDREN AND THAT POVERTY IS ASSOCIATED WITH POOR NUTRITION, SUBSTANDARD HOUSING, DISRUPTIVE SOCIAL ENVIRONMENT AND LACK OF HEALTH INFORMATION. POOR CHILDREN ARE MORE APT TO BECOME ILL, SUFFER ADVERSE CONSEQUENCES FROM ILLNESS AND DIE THAN CHILDREN WITH GREATER ECONOMIC RESOURCES. PART VI, LINE 5: WE HAVE AN OPEN MEDICAL STAFF, AN ACTIVE VOLUNTEER BOARD OF DIRECTORS, AND PROVIDE A VARIETY OF FREE HEALTH SCREENINGS AT HEALTH FAIRS, IN THE COMMUNITY AND AT THE MEDICAL CENTER. THEY ARE PROMOTED IN PRINT ADVERTISING AND NEW RELEASES. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X X 0 0 0 0 0 0 0 0 0 MICHAEL SEIDMAN MD DIRECTOR 267588 0 0 0 0 0 0 0 18441 0 286029 0 0 0 MARK WEBSTER PRESIDENT/EXECUTIVE OFFICE 340396 0 36092 0 0 0 12750 0 15515 0 404753 0 0 0 KELLEY TIERNAN CHIEF FINANCIAL OFFICER 196621 0 6440 0 0 0 10402 0 15098 0 228561 0 0 0 DAVID FERRIS VP OF NURSING 162791 0 6272 0 0 0 5217 0 15000 0 189280 0 0 0 GARY HART CHIEF MEDICAL OFFICER 259002 0 12875 0 0 0 12750 0 15279 0 299906 0 0 0 VICKI PERRINE CHIEF OPERATING OFFICER 182670 0 7763 0 0 0 9550 0 8972 0 208955 0 0 0 JOHN GERBERT MD PHYSICIAN 856345 0 0 0 0 0 7650 0 10925 0 874920 0 0 0 THOMAS HERZOG MD PHYSICIAN 578412 0 75000 0 0 0 7650 0 16206 0 677268 0 0 0 JUAN-DIEGO HARRIS MD PHYSICIAN 446386 0 175000 0 0 0 12750 0 15823 0 649959 0 0 0 GEETANJLI SANGWAN MD PHYSICIAN 285334 0 72877 0 0 0 12750 0 9269 0 380230 0 0 0 LUCILLE ALSTON MD PHYSICIAN 405339 0 0 0 0 0 7650 0 1175 0 414164 0 0 0 A ST LAWRENCE COUNTY INDUSTRIAL DEVELOPMENT AGENCY 222757318 791097EJ3 2006-10-11 20000000 REFINANCE 1999 BONDS AND FUND HOSPITAL IMPROVEMENTS AND EQUIPMENT 0 0 0 A 10908009 20180750 272741 9000000 2006 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 LINDA FAY BOARD MEMBER 173152 LINDA FAY IS A BOARD MEMBER AND THE HOSPITAL RENTS A CLINIC FROM HER HUSBAND IN CANTON, NY. 0 FORM 990, PART VI, SECTION A, LINE 6 CLAXTON-HEPBURN HEALTH SYSTEMS, INC., A NOT-FOR-PROFIT HOLDING COMPANY, IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A CLAXTON-HEPBURN HEALTH SYSTEM ELECTS THE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF CLAXTON-HEPBURN HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PROVIDED TO CLAXTON-HEPBURN MEDICAL CENTER'S BOARD FOR REVIEW BEFORE FILING THE FORM. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS CONTRACTS WITH YAFFE AND COMPANY TO WORK WITH THE EXECUTIVE COMMITTEE TO ENSURE COMPLIANCE WITH IRC 4958 AND CONFLICT OF INTEREST DISCLOSURE, AND MAINTAINS MINUTES OF MEETINGS. BOARD MEMBERS DISCLOSE CONFLICTS OF INTEREST ANNUALLY IN WRITING, AFTER REVIEWING THE CORPORATE POLICY. THESE CONFLICTS ARE REVIEWED BY THE FULL BOARD ANNUALLY AND KEPT ON FILE. FORM 990, PART VI, SECTION B, LINE 15 THE CHMC BOARD CONTRACTS WITH YAFFE AND COMPANY, AN INDEPENDENT SALARY COMPENSATION SPECIALIST TO ADVISE ON THE EXECUTIVE SALARY PROCESS AND PHILOSOPHY. YAFFE WORKS WITH THE EXECUTIVE COMMITTEE TO ASSIST THE COMMITTEE IN SETTING ANNUAL SALARIES AND BENEFITS FOR SENIOR LEADERSHIP. FORM 990, PART VI, SECTION C, LINE 18 CLAXTON-HEPBURN MEDICAL CENTER'S 990 IS AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION C, LINE 19 CLAXTON-HEPBURN MEDICAL CENTER'S GOVERNING DOCUMENTS, FINANCIAL STATEMENT AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY IN CHANGE IN FOUNDATION - UNRESTRICTED ASSETS 350,323. PENSION AND POSTRETIREMENT RELATED CHANGES 11,601,294. EQUITY IN CHANGE IN FOUNDATION - TEMPORARILY RESTRICTED ASSETS 82,646. EQUITY IN CHANGE IN FOUNDATION - PERMANENTLY RESTRICTED ASSETS 85,574. EQUITY TRANSFER TO THE FOUNDATION -119,300. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 599,138. CHANGE IN UNREALIZED GAINS/LOSSES 74,378. EQUITY IN CHANGE IN NORTHERN LIGHTS - PERMANENTLY RESTRICTED ASSETS -178,237. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CLAXTON-HEPBURN HEALTH SYSTEMS INC 214 KING STREET OGDENSBURG NY 13669 161449491 PARENT HOLDING COMPANY FOR CLAXTON-HEPBURN MEDICAL CENTER NY 501(C)(3) 509(A)(3) N/A 0 CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION INC 503 MANSION AVENUE OGDENSBURG NY 13669 222488389 TO CONDUCT FUND RAISING ACTIVITIES TO SUPPORT CLAXTON-HEPBURN MEDICAL CENTER NY 501(C)(3) 509(A)(3) CLAXTON-HEPBURN HEALTH SYSTEMS INC 0 CLAXTON MEDICAL PC 214 KING STREET OGDENSBURG NY 13669 264009395 ATTRACTING AND RETAINING SPECIALIZED MEDICAL PRACTITIONERS NY 501(C)(3) 509(A)(3) CLAXTON-HEPBURN MEDICAL CENTER 0 ST LAWRENCE HEALTH ALLIANCE INC 3 LYON PLACE OGDENSBURG NY 13669 161489843 MANAGEMENT SERVICES NY CLAXTON-HEPBURN HEALTH SYSTEMS INC C -5577 1452634 1.00000 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0