2012-11-14T10:24:03-08:00 2011-12-31 Gray & Gray CPAs P C 1 Main St Suite 101 Canton NY 13617 990 2011-01-01 161012691 Canton-Potsdam Hospital CANT 3152615103 50 Leroy Street Potsdam NY 13676 Richard Jacobs 2012-11-14 true John J Gray Jr CPA 3153862925 2011 2016-02-24 21:20:13Z 94122314 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. 21 11 993 274 0 148665 89417 88047748 91856399 -21078 38679 1667248 1616723 89842583 93601218 0 0 49578322 51912814 0 0 38615112 40722826 88193434 92635640 1649149 965578 66411160 79271174 33228871 48669720 33182289 30601454 X Canton-Potsdam Hospital's mission is to provide skilled, compassionate, cost-effective care that promotes wellness and meets community needs. false false 51697520 126966852 OTHER PROGRAM SERVICESAcute Care:Canton-Potsdam Hospital has 70 licensed beds to care for Medical-Surgical, Intensive Care and Obstetric patients. In 2011, there were 3,816 discharges, 12,255 patient days with 75% 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 27.4% from 2010.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 4.64% from 2010. Additionally, new software for Emergency Department Health Record Documentation was implemented. The expected increase in net revenue for this system is projected to yield approximately $350,000 annually. 9644993 19956957 HOSPITAL BASED CLINICSThere was significant growth of the specialty clinics in Cardiology, General Surgery, and Obstetrics which had been established in late 2010. Their additional volumes added over 5,000 visits to the clinics volumes in 2011.Overall, there was a total of nearly 77,000 visits in 2011 compared to 65,000 in 2010.In 2011, 50% of the total revenue generated for the clinics was Medicaid, Medicare or Uninsured, as compared to 51% in 2010.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. 6471928 6331347 OPERATING ROOMIn 2011 and 2010, 49% of the total revenue generated for the Operating Room was Medicaid, Medicare, or Uninsured.In 2011, the Operating Room number of cases decreased slightly by 1.43%, compared to 2010. This was mainly due to the departure of the Pain Clinic physician. 4438411 41066588 72252852 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 237 0 true 993 true false false false false false false false false false false false 0 false false false false false false false false false false false X 21 11 false false false false false false false true true false false false true true true true true true true true false false X Richard Jacobs 3152615100 Canton Potsdam Hospital 50 Leroy St Potsdam NY 13676 James Theodore 2.00 X 0 0 0 Penelope Rattan 2.00 X 0 0 0 Paul Cole DVM 2.00 X 0 0 0 John Dewar MD 50.00 X X 108393 0 8391 Duane Pelkey 2.00 X 0 0 0 Michael Tulloch MD 2.00 X 32980 0 0 Judy Chittenden 4.00 X X 0 0 0 Spence Thew 2.00 X 0 0 0 David Patterson 2.00 X 0 0 0 Mary Anne Healey 2.00 X 0 0 0 Paul McGrath 2.00 X 0 0 0 Laurie Maki 2.00 X 0 0 0 Margaret Madden 4.00 X X 0 0 0 John Kaplan 2.00 X 0 0 0 June Peoples 2.00 X 0 0 0 Brian Gardam 2.00 X 0 0 0 Michael Griffin 2.00 X 0 0 0 Judy Chase 2.00 X X 0 0 0 Kathryn Mullaney 2.00 X X 0 0 0 Donald Dangremond 2.00 X 0 0 0 Ron Berry 2.00 X 0 0 0 Marlinda LaValley 50.00 X 124854 0 8328 Richard Jacobs 50.00 X 180415 0 8353 David Acker 50.00 X 315000 0 8409 Alexander Clark MD 50.00 X 1159698 0 13861 John Savage MD 50.00 X 669100 0 8797 Kris Vanwagner MD 50.00 X 512419 0 13818 Howard Gold MD 50.00 X 436620 0 8797 David Hauerstock MD 50.00 X 377500 0 8797 3916979 87551 9 false true false PC Construction Company 193 Tilley Drive South Burlington VT 05403 Construc Contractor 4581731 North Star Emergency Physicians PO Box 5023 Potsdam NY 13676 Emer Dept Physicians 1683734 Labcorp PO Box 12140 Burlington NC 272162140 Reference Lab 496544 Heritage Homes Inc PO Box 746 Massena NY 13662 Construct Contractor 1602454 Comphealth Medical Staffing Inc PO Box 972670 Dallas TX 753972670 Physician Recruiting 416771 26 60419 28998 89417 Net Patient Revenue 900099 91856399 91856399 91856399 34675 34675 15 15 0 388994 370137 18857 18857 18857 154948 150959 3989 3989 3989 0 0 0 Student Health Services 900099 823460 823460 Other 900099 329060 329060 Cafeteria Revenue 900099 261682 261682 183664 183664 1597866 93601218 91856399 1655402 0 0 0 0 1157510 371752 785758 0 40383249 32220182 8163067 1726379 1354478 371901 5798147 4549094 1249053 2847529 2234106 613423 0 137413 137413 127756 127756 180723 180723 0 0 2440114 2440114 0 0 0 0 1657411 1135763 521648 287619 103952 183667 0 104911 61880 43031 735084 499856 235228 0 4341206 2952020 1389186 781682 696754 84928 Supplies 11580195 10568246 1011949 Purchased Services 5787075 3767225 2019850 Other 2022619 1649803 372816 Equipment Rental 2593240 1394713 1198527 Bad Debt 5442774 5442774 2503004 810140 1692864 92635640 72252852 20382788 0 261791 704337 4715447 3071920 0 12529468 15549465 0 0 0 1147148 1152241 836631 1109704 93730434 53014343 30902939 40716091 831307 820749 0 0 0 15186429 16146667 66411160 79271174 11889327 10926798 11368046 18582037 1571205 4573168 8400293 14587717 33228871 48669720 X 32198687 27904668 263844 1977028 719758 719758 33182289 30601454 66411160 79271174 X 965578 -3546413 X false true true X false false X false false false false false false false false false false true 180723 180723 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 $180,723 in lobbying expenses for 2011. 92,167 Wilson, Elser and Moskowitz-Federal and State lobbying and representation 30,545 Healthcare Association on New York State-Federal and State advocacy 28,100 North Country Healthcare Providers-State advocacy 10,733 Iroquois Health Alliance-Federal and State advocacy 19,178 American Hospital Association-Federal and State advocacy 831307 -10558 820749 813308 17999 831307 778337 34971 813308 false false false 713734 713734 49687917 15400500 34287417 2057014 958735 1098279 37450732 36655108 795624 3821037 3821037 40716091 Physician Loans/Notes Receivable 658284 Other Notes & Loans Receivable (Net) 649690 Interest in Canton-Pots Hospital Foundat 11360108 Due From Affiliate 1076437 Deferred Financing Costs 274152 Assets Whose Useful Life is Limited 2127996 16146667 Estimated Third Party Payor Settlements 2855141 Change in Interest Rate Swap 1992161 Asset Retirement Obligation 580044 Accrued Pension 9160371 14587717 93601218 92635640 965578 -3546413 -3546413 -2580835 93953872 -11028 370147 359119 93594753 6465 6465 93601218 99293811 6664636 6664636 92629175 6465 6465 92635640 Part XIII, Line 2d Part XIII, Line 2d: Other expenses and losses per audited F/S Change in Net Assets of CPH Foundation $85630 Change in Pension Plan Funded Status $5594824 Rental Expense $370147 $17493 Change in Interest Rate Swap $594076 $2466 Part XII, Line 2d Part XII, Line 2d: Other revenue amounts included in F/S but not included on form 990 Contributions For Capital Acquisitions $431885 Contributions For Capital Acquisitions $840702 Change in Interest in CPH Foundation $872482 Rental Expense $370147 $614035 $-3129251 370147 $370147 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Capital Campaign Gifts $846040 Contributions For Capital Acquisitions $431885 Temporarily Resticted Money Spent For Capital $840702 Change in funded status of employee benefit plan $ -5594824 Unrealized Loss on Investments $ -11028 Change in Net Assets of CPH Foundation $ -59188 true true true X true X true true true false true true 633601 49882 583719 0.00630 7695441 1311398 6384043 0.06890 8329042 1361280 6967762 0.07520 325927 325927 0.00350 10700 10700 0.00010 2315666 2315666 0.02500 19523 19523 0.00020 2671816 2671816 0.02880 11000858 1361280 9639578 0.10400 379859 379859 0.00410 379859 379859 0.00410 true 2353814 942411 18544313 19907248 -1362935 X true true 1 0 Canton-Potsdam Hospital

50 Leroy Street Potsdam NY 13676

X X X Canton-Potsdam Hospital 1 false true true 100.0000 true 300.0000 true 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 - 0 Part V, Line 21 - Charge Patients Amount Equal Gross Charge for Services SEE SCHEDULE H ATTACHMENT X X X X false false false false false false false false false false Richard Jacobs 180415 8353 188768 Kris Vanwagner MD 512419 13818 526237 John Savage MD 669100 8797 677897 Howard Gold MD 436620 8797 445417 David Hauerstock MD 377500 8797 386297 David Acker 315000 8409 323409 Alexander Clark MD 1159698 13861 1173559 Sch J, Part III, Additional Information Part III, Additional Information The Audit and Compensation Committee of the Board of Directors will ultimately be responsible 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. St Lawrence County CDC 272614310 2010-08-30 21305000 See Part VI false true false 730000 21305000 11168176 9590000 546824 2011 true false false true false false true true false 0.02890 0.02890 true false true false false false true X SEE SCHEDULE L ATTACHMENT true 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 who 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 11 Form 990, Part VI, Line 11: 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 2011, there were 3,816 discharges, 12,255 patient days with 75% 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 27.4% from 2010.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 4.64% from 2010. Additionally, new software for Emergency Department Health Record Documentation was implemented. The expected increase in net revenue for this system is projected to yield approximately $350,000 annually. 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 true true false false false false true true false false Canton-Potsdam Hospital Foundation p 292384 Cash Exchanged Canton-Potsdam Hospital Foundation o 136117 Cash Exchanged Canton-Potsdam Hospital Foundation j 286335 Cash Exchanged Canton-Potsdam Hospital Foundation i 8210 Cash Exchanged