2013-08-14T04:29:10-07:00 2012-12-31 Gray & Gray CPAs P C 1 Main St Suite 101 Canton NY 13617 990 2012-01-01 161012691 Canton-Potsdam Hospital CANT 3152615103 50 Leroy Street Potsdam NY 13676 Richard Jacobs 2013-08-14 true John J Gray Jr CPA P00076464 3153862925 2012 2016-02-24 21:20:13Z 99984182 false 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. 20 6 1028 288 0 89417 105711 91856399 93767589 38679 77109 1616723 5503650 93601218 99454059 0 0 51912814 56775634 0 0 40722826 38598191 92635640 95373825 965578 4080234 79271174 83497339 48669720 48272820 30601454 35224519 X Canton-Potsdam Hospital's mission is to provide skilled, compassionate, cost-effective care that promotes wellness and meets community needs. false false 48511729 143037380 OTHER PROGRAM SERVICESAcute Care:Canton-Potsdam Hospital has 70 licensed beds to care for Medical-Surgical, Intensive Care and Obstetric patients. In 2012, there were 4,005 discharges, 12,498 patient days with 77% 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 11.26% from 2011.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 .51% from 2011. 11472897 22010378 HOSPITAL BASED CLINICSThere was significant growth of the Afterhours and Family Health clinics with an average volume increase of 22.3%. Overall, there was over 87,000 visits in 2012, compared to nearly 77,000 in 2011; a 13.2% increase.In 2012, 51% of the total revenue generated for the clinics was Medicaid, Medicare or Uninsured, as compared to 50% in 2011.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. 6892646 11368367 OPERATING ROOM51% and 49% of the total revenue generated for the Operating Room was Medicaid, Medicare, or Uninsured for 2012 and 2011 respectively.In 2012, the Operating Room number of cases increased by 4.85%, compared to 2011. 4641007 47542779 71518279 true false false true false false false false false true true false false true true false true false false false false false false false false false true true false false true true false false true false false false false true true true false false false false false true false false false false true 256 0 true 1028 true false false false false false false false false 0 false false false false false false false false false false X 20 6 false false false false false false false true true false false true true true true true true true true false NY X Richard Jacobs 3152615100 Canton Potsdam Hospital 50 Leroy St Potsdam NY 13676 James Theodore 2.00 0.00 X 0 0 0 Paul Cole DVM 2.00 0.00 X 0 0 0 Mark Cornett 4.00 0.00 X X 0 0 0 Edward Mucenski 2.00 0.00 X 0 0 0 Michael Tulloch MD 2.00 0.00 X 41700 0 0 Judy Chittenden 4.00 0.00 X X 0 0 0 Spence Thew 2.00 0.00 X 0 0 0 David Patterson 2.00 0.00 X 0 0 0 Mary Anne Healey 2.00 0.00 X 0 0 0 Paul McGrath 2.00 0.00 X 0 0 0 Laurie Maki 2.00 0.00 X 0 0 0 Margaret Madden 4.00 0.00 X X 0 0 0 John Kaplan 2.00 0.00 X 0 0 0 June Peoples 2.00 0.00 X 0 0 0 Brian Gardam 2.00 0.00 X 0 0 0 Michael Griffin 2.00 0.00 X 0 0 0 Judy Chase 2.00 0.00 X X 0 0 0 Kathryn Mullaney 2.00 0.00 X X 0 0 0 Donald Dangremond 2.00 0.00 X 0 0 0 Ron Berry 2.00 0.00 X 0 0 0 Marlinda LaValley 50.00 0.00 X 124854 0 17724 Richard Jacobs 50.00 0.00 X 180415 0 21288 David Acker 50.00 0.00 X 316444 0 25909 Alexander Clark MD 50.00 0.00 X 1111773 0 34874 John Savage MD 50.00 0.00 X 676000 0 29804 Kris Vanwagner MD 50.00 0.00 X 696749 0 34825 Howard Gold MD 50.00 0.00 X 532264 0 29804 David Hauerstock MD 50.00 0.00 X 388750 0 29804 4068949 224032 48 false true false North Star Emergency Physicians PO Box 5023 Potsdam NY 13676 Emer Dept Physicians 1556923 Mayo Medical Laboratories PO Box 9146 Minneapolis MN 554809146 Reference Lab 481149 Heritage Homes Inc PO Box 746 Massena NY 13662 Construct Contractor 321375 Con Tech Building Systems Inc 4524 State Highway 58 Gouverneur NY 13642 Construc Contractor 340387 Comphealth Medical Staffing Inc PO Box 972670 Dallas TX 753972670 Physician Recruiting 510055 5 52500 53211 105711 Net Patient Revenue 900099 93767589 93767589 93767589 56805 56805 19 19 0 412769 394364 18405 18405 18405 156044 135759 20285 20285 20285 0 0 0 Other 900099 1184743 1184743 Meaningful Use 900099 1972077 1972077 340B Retail Program 900099 1376555 1376555 951870 951870 5485245 99454059 93767589 5580759 0 0 0 0 1397576 566888 830688 0 43861017 34229782 9631235 2311112 1776878 534234 6107651 4695814 1411837 3098278 2382084 716194 0 167714 167714 168749 168749 179751 179751 0 0 2149383 2149383 482345 385876 96469 0 0 0 1510546 887777 622769 375430 183315 192115 0 168259 104995 63264 1049700 619323 430377 0 5307037 3131152 2175885 926867 830646 96221 Other 1647581 1353797 293784 Equipment Rental & Maintenance 3034684 1255380 1779304 Purchased Services 6499782 4728855 1770927 Supplies 12406028 11486424 919604 2524335 749910 1774425 95373825 71518279 23855546 0 704337 548515 3071920 10524363 0 15549465 12117190 0 0 0 1152241 1270113 1109704 1448568 97245205 57046911 40716091 40198294 820749 845734 0 0 0 16146667 16544562 79271174 83497339 10926798 10943738 18582037 17560444 4573168 3680428 14587717 16088210 48669720 48272820 X 27904668 33352558 1977028 1152203 719758 719758 30601454 35224519 79271174 83497339 X 4080234 3927 538904 X false true X true false X false false false false false false false false false false true 179751 179751 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description Canton-Potsdam Hospital through its membership or fees paid to the following organizations incurred $179,751 in lobbying expenses for 2012. 84,800 Wilson, Elser and Moskowitz-Federal and State lobbying and representation 33,434 Healthcare Association on New York State-Federal and State advocacy 28,100 North Country Healthcare Providers-State advocacy 13,855 Iroquois Health Alliance-Federal and State advocacy 19,562 American Hospital Association-Federal and State advocacy 820749 24978 845727 831307 -10558 820749 813308 17999 831307 778337 34971 813308 881507 -106167 775340 false false false 713734 713734 50019334 16972706 33046628 2595844 1080615 1515229 43509103 38993590 4515513 407190 407190 40198294 Physician Loans/Notes Receivable 784838 Other Notes & Loans Receivable (Net) 1128641 Interest in Canton-Pots Hospital Foundat 12238294 Due From Affiliate 390154 Deferred Financing Costs 213575 Assets Whose Useful Life is Limited 1789060 16544562 Interest Rate Swap 2078371 Estimated Third Party Payor Settlements 3715241 Asset Retirement Obligation 622758 Accrued Retirement Obligation 9671840 16088210 99855396 394364 394364 99461032 -6973 -6973 99454059 95768189 394364 394364 95373825 95373825 Part XII, Line 2d Part XII, Line 2d: Other expenses and losses per audited F/S Rental Expenses $394364 Part XI, Line 2d Part XI, Line 2d: Other revenue amounts included in F/S but not included on form 990 Rental Expenses $394364 true true true X true X true true false false true true 568282 48507 519775 0.00540 6628344 1549524 5078820 0.05330 7196626 1598031 5598595 0.05870 339432 339432 0.00360 200 200 1857328 1857328 0.01950 25512 25512 0.00030 2222472 2222472 0.02340 9419098 1598031 7821067 0.08210 482386 482386 0.00510 482386 482386 0.00510 true 2481766 1206913 21438734 23869960 -2431226 X true true 1 1 Canton-Potsdam Hospital

50 Leroy Street Potsdam NY 13676

X X X true X X X X X X X X X 12 true true true X X X X X X X X X X X true false false true true 100.0000 true 300.0000 true X X X true true X X X X true X true X X X X X X true false true Part V - Explanation of Number of Facility Type SEE SCHEDULE H ATTACHMENT Number of Hospital Faciltiy - 1 Part V, Line 22 - Charge Patients Amount Equal Gross Charge for Services SEE SCHEDULE H ATTACHMENT Number of Hospital Faciltiy - 1 Part V, Line 5c - Description of Making Needs Assessment Widely Available SEE SCHEDULE H ATTACHMENT Number of Hospital Faciltiy - 1 Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment SEE SCHEDULE H ATTACHMENT Number of Hospital Faciltiy - 1 Part V, Line 3 - Account Input from Person Who Represent the Community SEE SCHEDULE H ATTACHMENT X X X X X false false false false false false false false false false Richard Jacobs 180415 12936 8352 201703 Kris Vanwagner MD 696749 12500 22325 731574 John Savage MD 676000 12500 17304 705804 Howard Gold MD 532264 12500 17304 562068 David Hauerstock MD 388750 12500 17304 418554 David Acker 315000 1444 17500 8409 342353 Alexander Clark MD 1111773 12500 22374 1146647 Sch J, Part III, Additional Information Part III, Additional Information The Audit and Compensation Committee of the Board of Directors will be responsible for making a recommendation 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. A St Lawrence County CDC 272614310 2010-08-30 21305000 See Part VI false true false A 1860000 20921703 11168176 9590000 true false false true A false false true true false 0.02790 0.02790 false false true A false true false false false true A true Supplemental Information Part VI See Attachment To Form 990, Schedule K, Part VI-Supplemental Information SEE SCHEDULE L ATTACHMENT true Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases Temporarily Resticted Contributions Spent For Capital = $414763 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases Contributions For Capital Acquisitions = $332679 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases Change in Net Assets of CPH Foundation = $1117774 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Decreases Change in Funded Status of Employee Benefit Plan = -$1086724 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Decreases Capital Campaign Gifts = -$239588 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. The department 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 11b Form 990, Part VI, Line 11b: 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 2012, there were 4,005 discharges, 12,498 patient days with 77% 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 11.26% from 2011.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 .51% from 2011. Canton-Potsdam Hospital Foundation 29 Grove Street Potsdam NY 13676 161279472 Raising, investing and managing funds for the hospital NY 501(c)(3) 11a N/A false false false false false false false false false false true true false false false false true true false false Canton-Potsdam Hospital Foundation q 1401286 Cash Exchanged Canton-Potsdam Hospital Foundation p 144100 Cash Exchanged Canton-Potsdam Hospital Foundation k 286335 Cash Exchanged Canton-Potsdam Hospital Foundation j 8580 Cash Exchanged