2014-08-15T07:23:56-05:00 2013-12-31 201767403 GRAY AND GRAY CPAS PC 1 MAIN ST STE 101 CANTON NY 136171277 990 2013-01-01 161279472 CANTON-POTSDAM HOSPITAL FOUNDATION CANT 3152615410 29 GROVE STREET POTSDAM NY 136762051 RICHARD JACOBS ASSISTANT TREASURER 3152615410 2014-08-13 true JOHN J GRAY JR CPA P00076464 3153862925 2014-08-13 2013 2015-11-30 17:44:51Z DAVID ACKER 29 GROVE STREET POTSDAM NY 13676 6383701 false X WWW.CPHOSPITAL.ORG X 1985 NY THE FOUNDATION'S PRIMARY PURPOSE IS TO SOLICIT, RECEIVE AND ADMINISTER GIFTS AND BEQUESTS MADE ON BEHALF OF CANTON-POTSDAM HOSPITAL 17 16 0 0 786339 677339 0 439342 1126857 12625 55841 1238306 1860037 0 0 171867 175785 0 215665 173304 177697 345171 353482 893135 1506555 16945677 22984257 4707383 4341992 12238294 18642265 X THE FOUNDATION'S PRIMARY PURPOSE IS TO SOLICIT, RECEIVE AND ADMINISTER GIFTS AND BEQUESTS MADE ON BEHALF OF CANTON-POTSDAM HOSPITAL false false 27510 677339 THE SOLICITED AND UNSOLICITED DONATIONS TO THE FOUNDATION ARE USED TO FUND THE PURCHASE, CONSTRUCTION AND RENOVATION OF VARIOUS PROPERTIES AND THE PURCHASE OF VARIOUS CAPITAL EQUIPMENT AND MINOR INSTRUMENTS FOR USE BY CANTON-POTSDAM HOSPITAL THE SOLICITED AND UNSOLICITED DONATIONS TO THE FOUNDATION ARE USED TO FUND THE PURCHASE, CONSTRUCTION AND RENOVATION OF VARIOUS PROPERTIES AND THE PURCHASE OF VARIOUS CAPITAL EQUIPMENT AND MINOR INSTRUMENTS FOR USE BY CANTON-POTSDAM HOSPITAL 27510 true true false false false false false false false false true false false false true false true false false false false false false false false false false false false true true false false true false false false false false false false false false false false false true false false false true 9 0 true 0 false false false false false true false false false false false false false X 17 16 false false false false false false false true true false false true true true true true true true false false NY X RICHARD JACOBS 3152615100 50 LEROY STREET POTSDAM NY 13676 RICHARD VANLEUVEN DIRECTOR 1.00 X 0 0 0 GINGER AKIN DIRECTOR 1.00 X 0 0 0 JOSEPH FITZSIMONS DIRECTOR 1.00 X 0 0 0 ELEANOR MENZ DIRECTOR 1.00 X 0 0 0 LOWELL WARNER DIRECTOR 1.00 X 0 0 0 GARY CANFIELD TREASURER 2.00 X X 0 0 0 CHARLOTTE RAMSAY DIRECTOR 1.00 X 0 0 0 PENELOPE RATTAN CHAIR 2.00 X X 0 0 0 DAVID KIRWAN DIRECTOR 1.00 X 0 0 0 SCOTT GOLDIE DIRECTOR 1.00 X 0 0 0 ANGELA M GRAY DIRECTOR 1.00 X 0 0 0 OWEN HALLORAN DIRECTOR 1.00 X 0 0 0 BROOKS WASHBURN DIRECTOR 1.00 X 0 0 0 WILLIAM KIRCHGASSER SECRETARY 2.00 X X 0 0 0 WILLIAM PUTNAM DIRECTOR 1.00 X 0 0 0 STACEY HOWLETT DIRECTOR 1.00 X 0 0 0 STEPHEN PUTMAN VICE CHAIR 2.00 X X 0 0 0 DAVID ACKER PRESIDENT 5.00 50.00 X 0 386043 44930 RICHARD JACOBS ASS'T TREASU 5.00 50.00 X 0 243847 37386 MARLINDA LAVALLEY VICE PRESIDE 5.00 50.00 X 0 148161 26571 778051 108887 false true false DANKO CONSTRUCTION CORPORATION PO BOX 239 MASSENA NY 13662 CONS CONTRACTOR 4633387 LAVALLEE BRENSINGER ARCHITECTS 155 DOW STREET SUITE 400 MANCHESTER NH 03101 ARCHITECTURAL 288808 2 677339 19213 677339 329263 329263 334725 278884 55841 55841 55841 5042374 4244780 797594 797594 797594 1860037 1182698 86945 26083 60862 52567 52567 36273 6782 29491 75 75 16677 16677 44486 44486 10000 10000 64996 4170 60826 1919 1919 27510 27510 95 95 2579 2579 RENT 9360 9360 353482 27510 110307 215665 364493 224857 870296 567990 428576 387470 1150 1500 9127876 490104 4141923 8637772 11139239 13164668 16945677 22984257 14867 18324 4302362 3992365 390154 331303 4707383 4341992 X 11367998 18074275 870296 567990 12238294 18642265 16945677 22984257 X 1506555 954562 3942854 X false true X true false X X X X false false false CANTON-POTSDAM HOSPITAL 161012691 3 true true true 772629 1 772629 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8596892 460279 8136613 29825 29825 501159 501159 8637772 DUE TO CANTON-POTSDAM HOSPITAL 331303 331303 3048997 954562 278884 1233446 1815551 44486 44486 1860037 1360509 1051513 1051513 308996 44486 44486 353482 SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 278,884 SCHEDULE D, PAGE 4, PART XII, LINE 2D CONTRIBUTIONS TO CPH 772,629 RENTAL EXPENSES 278,884 false false false false false false false false false DAVID ACKER PRESIDENT 382731 3312 17850 27080 430973 RICHARD JACOBS ASS'T TREASURER 243847 16640 20746 281233 MARLINDA LAVALLEY VICE PRESIDENT 148161 10313 16258 174732 A ST LAWRENCE COUNTY CDC 272614310 2010-08-30 21305500 SEE PART VI false true false A 3020000 20921703 11168176 9590000 2011 true false false true A false false true true false 0.02820 0.02820 false false true A false true false false true false false false true SCHEDULE K - ADDITIONAL INFORMATION ST. LAWRENCE COUNTY CDC CANTON-POTSDAM HOSPITAL FOUNDATION, INC. EIN: 16-1279472 ATTACHMENT TO FORM 990, SCHEDULE K PART VI - SUPPLEMENTAL INFORMATION PART I, LINE A THIS FINANCING CONSISTS OF TWO SERIES OF BONDS - THE 17,720,000 ST. LAWRENCE COUNTY INDUSTRIAL DEVELOPMENT AGENCY CIVIC DEVELOPMENT CORPORATION REVENUE BONDS (CANTON-POTSDAM HOSPITAL), SERIES 2010 (THE "HOSPITAL BONDS") AND 3,585,000 ST. LAWRENCE COUNTY INDUSTRIAL DEVELOPMENT AGENCY CIVIC DEVELOPMENT CORPORATION REVENUE BONDS (CANTON-POTSDAM HOSPITAL FOUNDATION, INC.), SERIES 2010 (THE "FOUNDATION BONDS"; THE FOUNDATION BONDS AND THE HOSPITAL BONDS ARE HEREINAFTER JOINTLY REFERRED TO AS THE "BONDS"). PROCEEDS OF THE HOSPITAL BONDS WERE USED TO FINANCE THE CONSTRUCTION AND EQUIPPING OF HEALTH CARE FACILITIES OWNED BY CANTON-POTSDAM HOSPITAL (THE "HOSPITAL"), AND TO REFUND OUTSTANDING TAX-EXEMPT OBLIGATIONS ISSUED AUGUST 20, 2002 TO FINANCE HOSPITAL FACILITIES. PROCEEDS OF THE FOUNDATION BONDS WERE ISSUED TO FINANCE THE ACQUISITION, CONSTRUCTION AND EQUIPPING OF MEDICAL FACILITIES OWNED BY CANTON-POTSDAM HOSPITAL FOUNDATION, INC. (THE "FOUNDATION") WHICH ARE LEASED TO THE HOSPITAL. THE HOSPITAL BONDS AND FOUNDATION BONDS WERE SOLD AT THE SAME TIME PURSUANT TO A COMMON PLAN OF FINANCING AND WILL BE PAID OUT OF SUBSTANTIALLY THE SAME SOURCE OF FUNDS. THEREFORE, PURSUANT TO TREASURY REGULATION SECTION 1.150-1(C), THE HOSPITAL BONDS AND THE FOUNDATION BONDS ARE TREATED AS A SINGLE ISSUE OF BONDS FOR TAX PURPOSES, IN THE AGGREGATE PRINCIPAL AMOUNT OF 21,305,000. CONSISTENT WITH THE CHARACTERIZATION OF THE BONDS AS A SINGLE ISSUE FOR TAX PURPOSES, THE HOSPITAL BONDS AND FOUNDATION BONDS ARE REPORTED AS A SINGLE ISSUE ON SCHEDULE K TO THE HOSPITAL'S FORM 990. PART II, LINE 3 - TOTAL PROCEEDS OF ISSUE THE BONDS WERE ORIGINALLY ISSUED AS "DRAW-DOWN BONDS" IN THE MAXIMUM PRINCIPAL AMOUNT OF 21,305,000, WHICH REPRESENTS THE ORIGINAL ISSUE PRICE OF THE BONDS REPORTED ON IRS FORM 8038. ULTIMATELY, ONLY 20,921,702 OF BOND PROCEEDS WERE ACTUALLY DRAWN. PART II, LINE 11 - OTHER SPENT PROCEEDS PROCEEDS OF THE BONDS IN THE PRINCIPAL AMOUNT OF 9,590,000 WERE SPENT ON SEPTEMBER 27, 2010 TO REDEEM CERTAIN OUTSTANDING TAX-EXEMPT BONDS ISSUED AUGUST 20, 2002 TO FINANCE HOSPITAL FACILITIES. FORM 990, PAGE 2, PART III, LINE 4D THE SOLICITED AND UNSOLICITED DONATIONS TO THE FOUNDATION ARE USED TO FUND THE PURCHASE, CONSTRUCTION AND RENOVATION OF VARIOUS PROPERTIES AND THE PURCHASE OF VARIOUS CAPITAL EQUIPMENT AND MINOR INSTRUMENTS FOR USE BY CANTON-POTSDAM HOSPITAL FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PREPARED BY STAFF MEMBERS OF THE CANTON-POTSDAM HOSPITAL FINANCE DEPARTMENT. UPON COMPLETION, A COPY WITH SUPPORTING DOCUMENTATION IS REVIEWED BY THE FOUNDATION EXECUTIVE DIRECTOR AND THE ASSISTANT TREASURER OF THE FOUNDATION (WHO IS ALSO THE HOSPITAL CFO). AFTER REVIEW, ANY CHANGES ARE MADE AND A COPY IS PRESENTED TO THE FOUNDATION FINANCE COMMITTEE. AFTER REVIEW, COMMENTS ARE SOLICITED AND BARRING ANY CHANGES, THE FINANCE COMMITTEE WILL APPROVE AND SUBMIT THE FORM 990 TO THE FULL FOUNDATION BOARD OF DIRECTORS FOR THEIR REVIEW, COMMENTS AND APPROVAL. FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBERS ANNUALLY RENEW THE CODE OF CONDUCT AND CONFLICT OF INTEREST DISCLOSURE STATEMENTS. WE UTILIZE THE HOSPITAL'S REPORTING MECHANISMS, INCLUDING A CONFIDENTIAL HOTLINE THAT IS REGULARLY MONITORED BY THE HOSPITAL'S COMPLIANCE OFFICER, WHO IS ALSO THE FOUNDATION'S VICE PRESIDENT. FORM 990, PAGE 6, PART VI, LINE 15A PAY RANGE DATA FOR THE EXECUTIVE DIRECTOR IS DETERMINED BASED ON COMPARABILITY DATA PROVIDED BY THE HOSPITAL'S HUMAN RESOURCES DEPARTMENT. PAY WITHIN THAT RANGE IS DETERMINED BASED ON LONGEVITY AND QUANTIFIED PERFORMANCEREVIEW COMPLETED BY THE VICE PRESIDENT, WITH INPUT FROM THE BOARD. FORM 990, PAGE 6, PART VI, LINE 19 THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE FINANCE DEPARTMENT OR FOUNDATION OFFICE. FORM 990, PART XI, LINE 9 RENTAL EXPENSES 278,884 CONTRIBUTIONS TO CPH -772,629 RENTAL EXPENSES -278,884 FORM 990, PART XI, LINE 9 TRANSFER FROM CANTON-POTSDAM HOSPITAL 4,715,483 SEE SCHEDULE O CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 161012691 HOSPITAL NY 501C 3 N/A false false false true false false false false false false true true true false false false true true false false CANTON-POTSDAM HOSPITAL C 4715483 CASH EXCHANGED CANTON-POTSDAM HOSPITAL J 334725 CASH EXCHANGED CANTON-POTSDAM HOSPITAL K 9360 CASH EXCHANGED CANTON-POTSDAM HOSPITAL L 425000 CASH EXCHANGED CANTON-POTSDAM HOSPITAL P 288248 CASH EXCHANGED CANTON-POTSDAM HOSPITAL Q 645109 CASH EXCHANGED