Civic Intelligence

Canton-Potsdam Medical Practice PLLC

990 • Fiscal year 2017 • EIN 46-0714367

Jan 01, 2017 to Dec 31, 2017 • Filed on Aug 03, 2018

50 Leroy StreetPotsdam, NY 13676

(315) 261-5100

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

45th percentile

0.06x

Higher debt load relative to assets than 45% of similar nonprofits.

2017 filings • NTEE G • $1M-$5M nonprofits • Source year 2017

Liabilities / Revenue

22nd percentile

0.01x

Higher debt load relative to revenue than 22% of similar nonprofits.

2017 filings • NTEE G • $1M-$5M nonprofits • Source year 2017

Net Margin

4th percentile

-63%

Higher net margin than 4% of similar nonprofits.

2017 filings • NTEE G • $1M-$5M nonprofits • Source year 2017

Top Officer Pay

96th percentile

$387,267

Higher top officer pay than 96% of similar nonprofits.

Top officer pay equals 17.3% of source-year revenue.

2017 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2017

Asset Growth

1st percentile

-60%

Faster asset growth than 1% of similar nonprofits.

2017 filings • NTEE G • $1M-$5M nonprofits • Annualized from 2016 to 2017

Revenue Growth

5th percentile

-43%

Faster revenue growth than 5% of similar nonprofits.

2017 filings • NTEE G • $1M-$5M nonprofits • Annualized from 2016 to 2017

Assets

Down

$406,526

Down $614,874 (-60%) from 2016

Net Assets

Down

$382,407

Down $527,646 (-58%) from 2016

Liabilities

Down

$24,119

Down $87,228 (-78%) from 2016

Revenue

Down

$2,236,218

Down $1,654,848 (-43%) from 2016

Expenses

Down

$3,654,361

Down $3,399,484 (-48%) from 2016

Net Income

Up

-$1,418,143

Up $1,744,636 (+55%) from 2016

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$10M$5.0M$0-$5.0M-$10MAssets 2014: $1,743,063Liabilities 2014: $72,005Net Assets 2014: $1,671,0582014Assets 2015: $1,108,417Liabilities 2015: $27,354Net Assets 2015: $1,081,0632015Assets 2016: $1,021,400Liabilities 2016: $111,347Net Assets 2016: $910,0532016Assets 2017: $406,526Liabilities 2017: $24,119Net Assets 2017: $382,4072017Assets 2018: $216,731Liabilities 2018: $65,743Net Assets 2018: $150,9882018Assets 2019: $372,357Liabilities 2019: $1,651,790Net Assets 2019: -$1,279,4332019Assets 2020: $209,847Liabilities 2020: $3,145,376Net Assets 2020: -$2,935,5292020Assets 2021: $521,293Liabilities 2021: $4,251,538Net Assets 2021: -$3,730,2452021Assets 2022: $432,578Liabilities 2022: $6,089,411Net Assets 2022: -$5,656,8332022Assets 2023: $447,097Liabilities 2023: $7,339,149Net Assets 2023: -$6,892,0522023Assets 2024: $105,765Liabilities 2024: $7,142,975Net Assets 2024: -$7,037,2102024

Highlighted filing

2017

Assets$406,526
Liabilities$24,119
Net Assets$382,407

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$10M$5.0M$0-$5.0MRevenue 2014: $2,431,486Expenses 2014: $4,299,304Net Income 2014: -$1,867,8182014Revenue 2015: $3,295,294Expenses 2015: $5,537,026Net Income 2015: -$2,241,7322015Revenue 2016: $3,891,066Expenses 2016: $7,053,845Net Income 2016: -$3,162,7792016Revenue 2017: $2,236,218Expenses 2017: $3,654,361Net Income 2017: -$1,418,1432017Revenue 2018: $1,218,803Expenses 2018: $2,193,099Net Income 2018: -$974,2962018Revenue 2019: $1,964,831Expenses 2019: $3,395,252Net Income 2019: -$1,430,4212019Revenue 2020: $1,486,639Expenses 2020: $3,142,635Net Income 2020: -$1,655,9962020Revenue 2021: $682,687Expenses 2021: $1,477,403Net Income 2021: -$794,7162021Revenue 2022: $1,207,631Expenses 2022: $3,135,398Net Income 2022: -$1,927,7672022Revenue 2023: $848,336Expenses 2023: $2,083,555Net Income 2023: -$1,235,2192023Revenue 2024: $364,477Expenses 2024: $509,290Net Income 2024: -$144,8132024

Highlighted filing

2017

Revenue$2,236,218
Expenses$3,654,361
Net Income-$1,418,143
Jump To
Filing Snapshot
Filing Period
Jan 1, 2017 to Dec 31, 2017
Signed
Aug 3, 2018
Return Version
2017v2.3
Gross Receipts
$2,236,218
Mission and Program Overview

Mission

Canton-potsdam medical practice's primary exempt purpose is to provide physician services, in an outpatient clinic setting, that provide public benefit to the community and canton-potsdam hospital.

Balance Sheet Detail
LineBeginningEndChange
Assets
Accounts Receivable$502,081$297,083▼ $204,998
Land, Buildings, and Equipment, Net$460,727$75,929▼ $384,798
Cash and Non-Interest-Bearing Accounts$26,110$17,955▼ $8,155
Prepaid Expenses and Deferred Charges$22,131$6,725▼ $15,406
Inventories for Sale or Use$3,999$6,296▲ $2,297
Total Assets$1,021,400$406,526▼ $614,874
Other Assets Total$6,352$2,538▼ $3,814
Liabilities
Accounts Payable and Accrued Expenses$111,347$24,119▼ $87,228
Total Liabilities$111,347$24,119▼ $87,228
Net Assets / Fund Balance
Unrestricted Net Assets$910,053$382,407▼ $527,646
Total Net Assets Fund Balance$910,053$382,407▼ $527,646
Total Liabilities and Net Assets / Fund Balance$1,021,400$406,526▼ $614,874

Asset Categories

AssetBook ValueDepreciationBasis
Equipment$70,346$159,254$229,600
Leasehold Improvements$5,583$7,441$13,024
Compensation and Service Providers

Board Members and Trustees

NameTitle
Robert T Rogersii MdDirector
Richard D JacobsFinance

Highest Paid Contractors

ContractorServicesLocationCompensation
Kopp Billing Agency INCBilling/collectPO BOX 2337, Syracuse, NY 13220$167,503
Eclinical Works LLCElec. Med. Rec.PO BOX 847950, Boston, MA 02284-7950$137,883
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$2,236,216
Investment Income
$0
Other Revenue
$2
Change in Net Assets
$-1,418,143
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Salaries, Compensation, and Employee Benefits$2,772,415
Other Expenses$881,946
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Other Salaries and Wages$2,124,450$209,241-$2,333,691
Other Employee Benefits$399,388$39,336-$438,724
Occupancy$174,150$17,152-$191,302
Insurance$82,890$1,723-$84,613
Fees for Services Management-$78,650-$78,650
Depreciation Depletion$26,535$2,614-$29,149
Other Expenses$8,175$806-$8,981
Travel$7,093$699-$7,792
Conferences and Meetings$4,847$477-$5,324
All Other Expenses$1,326$131-$1,457
Interest$2--$2
Total Functional Expenses$3,270,048$384,313$0$3,654,361
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Interested-Person Transactions

Interested PartyRelationshipDescriptionShared RevenueAmount
Robert T Rogers Ii MdDirectorCompensationNo$387,267
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Backup withholding compliance
Yes
Business relationship with family members
No
Business relationship with organization members
Yes
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
Yes
Other officer compensation reviewed
Yes
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
No
Management duties delegated
Yes

Governance Explanations

Form 990, Page 6, Part VI, Line 3

Canton-potsdam medical practice does not have any employees on its payroll. All "employees" , including those that perform management functions, are contracted through canton-potsdam hospital, related tax exempt organization. Employees of canton-potdam hospital are leased to canton- potsdam medical practice to provide all medical staff and management services. Service agreements are in place between the two related organizations. Canton-potsdam hospital invoices canton-potsdam medical practice for these services. Key employee, richard jacobs, is an employee of canton-potsdam hospital who is responsible for the financial reporting of canton-potsdam medical practice. Robert t. Rogers, ii, md, is an employee of canton-potsdam hospital who is the sole member manager of the pllc.

Form 990, Page 6, Part VI, Line 8B

Canton-potsdam medical practice did not have any committees with authority to act on behalf of the governing body, and thus no committee meetings were held.

Form 990, Page 6, Part VI, Line 11B

The form 990 is prepared by canton-potsdam hospital's finance department staff members. Upon completion, a copy with supporting documentation is reviewed by the vice president for finance and the controller. Furthermore, the form was provided to the canton-potsdam medical practice advisory committee for further review and comment. After review, any changes are made and a copy is presented to the sole member of canton-potsdam medical practice, robert t. Rogers, ii, md for his review and approval.

Form 990, Page 6, Part VI, Line 12C

The key employee and sole member of canton-potsdam medical practice are employees of canton-potsdam hospital, related organization. All employees adhere to canton-potsdam hospital's written conflict of interest policy. Disclosure statements are reviewed annually.

Form 990, Page 6, Part VI, Line 15A

Line 15a: as stated above in this schedule o, canton-potsdam medical practice does not have any employees on its payroll and all "employees" are contracted through canton-potsdam hospital, related tax exempt organization. As such, the compensation committee of the board of directors of canton-potsdam hospital seeks the input of a consulting firm 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 consultant and deliberations of the compensation committee, the committee will then make a recommendation to the full board. The full board will then vote on the top officials compensation package.

Form 990, Page 6, Part VI, Line 15B

The key employee and sole member of canton-potsdam medical practice are employees of canton-potsdam hospital, related organization. Compensation of employees is determined by canton-potsdam hospital's processes for determining compensation. They are as follows: the compensation of other key employees is determined primarily by the work of the human resource department, the recommendation of the vice president of human resources (hr), and by information gathered from independent survey data of national and surrounding markets. The vice president of human resources will review the survey data to estimate salary ranges and compensation packages. The vp of hr makes the recommendation to the ceo. The ceo will bring the information to the compensation committee. After deliberations and considerations, the compensation committee will 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.

Filing and Contact Details

Filer

Filer Name
Canton-potsdam Med Practice Pllc
EIN
46-0714367
Phone
3152615100
Address
50 LEROY STREET, POTSDAM, NY 13676

Signing Officer

Name
Robert T Rogersii Md
Title
Director
Phone
3152615100
Signed
2018-08-03
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Robert T Rogersii Md
Formed
2012
Legal Domicile
Ny
Voting Board Members
1
Independent Board Members
0
Employees
0

Preparer

Firm
Gray & Gray and Associates Cpas Pc
Address
1 MAIN STREET SUITE 101, CANTON, NY 13617-1277
Preparer
John J Gray Jr CPA
Phone
3153862925
Supplemental Narrative

Additional Explanations

Form 990, Page 2, Part III, Line 4D

Canton-potsdam medical practice operates other outpatient clinic locations including the following: family practice: located in colton, ny, this clinic served approximately 2,568 patients in 2017.

Form 990, Part XI, Line 9

Transfer from affiliate (canton-potsdam hospital) 890,497 .

Financial Statement Notes

Schedule D, Page 3, Part X

The system and its affiliates are not-for-profit corporations as described in section 501(c)(3) of the internal revenue code (the code) and are exempt from the federal income taxes on related income pursuant to section 501(a) of the code. The system and its affiliates recognize the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than fifty percent likely of being realized upon settlement. Changes in recognition in measurement are reflected in the period in which the change in judgement occurs. The system and its affiliates did not recognize the effect of any uncertain income tax positions in either 2017 or 2016. On december 22, 2017, the president signed into law h.r.1, originally known as the tax cuts and jobs act. The new law (public law no. 115-97) includes substantial changes to the taxation of individuals, businesses, multinational enterprises and others. In addition to many generally applicable provisions, the law contains several specific provisions that result in changes to the tax treatment of tax-exempt organizations and their donors. The system has reviewed these provisions and the potential impact and concluded the enactment of h.r.1 will not have a material effect on the operations of the organization.

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IRS990/ProgSrvcAccomActy3Grp/Desc0CANTON-POTSDAM MEDICAL PRACTICE OPERATED A GASTROENTEROLOGY CLINIC IN 2017. PATIENT VISITS TOTALED APPROXIMATELY 3,466. THE GASTROENTEROLOGY CLINIC OPENED IN OCTOBER OF 2014 AND SERVES THE SURROUNDING NORTH COUNTRY COMMUNITIES OF (AND INCLUDING) POTSDAM, NEW YORK.
IRS990/ProgSrvcAccomActy3Grp/ExpenseAmt0789261
IRS990/ProgSrvcAccomActy3Grp/RevenueAmt02196347
IRS990/ProgSrvcAccomActyOtherGrp/Desc0CANTON-POTSDAM MEDICAL PRACTICE OPERATES OTHER OUTPATIENT CLINIC LOCATIONS INCLUDING THE FOLLOWING: FAMILY PRACTICE: LOCATED IN COLTON, NY, THIS CLINIC SERVED APPROXIMATELY 2,568 PATIENTS IN 2017.
IRS990/ProgSrvcAccomActyOtherGrp/ExpenseAmt0775214
IRS990/ProgSrvcAccomActyOtherGrp/RevenueAmt0431198
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IRS990/PYSalariesCompEmpBnftPaidAmt05785313
IRS990/PYTotalExpensesAmt07053845
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IRS990/ReconcilationRevenueExpnssAmt0-1418143
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IRS990/RevenueAmt0920747
IRS990ScheduleA/First5Years509Ind0X
IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt0MISCELLANEOUS INCOME 13,567
IRS990ScheduleA/Form990ScheduleAPartVIGrp/FormAndLineReferenceDesc0PART III, LINE 12
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IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus1YearAmt011044644
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus2YearsAmt09222226
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus3YearsAmt05518479
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus4YearsAmt0102962
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/TotalAmt031939968
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IRS990ScheduleA/OtherIncome509Grp/CurrentTaxYearMinus3YearsAmt01698
IRS990ScheduleA/OtherIncome509Grp/CurrentTaxYearMinus4YearsAmt040
IRS990ScheduleA/OtherIncome509Grp/TotalAmt013567
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IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus3YearsAmt05518479
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus4YearsAmt0102962
IRS990ScheduleA/Total509Grp/TotalAmt031939968
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IRS990ScheduleD/LeaseholdImprovementsGrp/DepreciationAmt07441
IRS990ScheduleD/LeaseholdImprovementsGrp/OtherCostOrOtherBasisAmt013024
IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0THE SYSTEM AND ITS AFFILIATES ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM THE FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM AND ITS AFFILIATES RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN FIFTY PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT. CHANGES IN RECOGNITION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. THE SYSTEM AND ITS AFFILIATES DID NOT RECOGNIZE THE EFFECT OF ANY UNCERTAIN INCOME TAX POSITIONS IN EITHER 2017 OR 2016. ON DECEMBER 22, 2017, THE PRESIDENT SIGNED INTO LAW H.R.1, ORIGINALLY KNOWN AS THE TAX CUTS AND JOBS ACT. THE NEW LAW (PUBLIC LAW NO. 115-97) INCLUDES SUBSTANTIAL CHANGES TO THE TAXATION OF INDIVIDUALS, BUSINESSES, MULTINATIONAL ENTERPRISES AND OTHERS. IN ADDITION TO MANY GENERALLY APPLICABLE PROVISIONS, THE LAW CONTAINS SEVERAL SPECIFIC PROVISIONS THAT RESULT IN CHANGES TO THE TAX TREATMENT OF TAX-EXEMPT ORGANIZATIONS AND THEIR DONORS. THE SYSTEM HAS REVIEWED THESE PROVISIONS AND THE POTENTIAL IMPACT AND CONCLUDED THE ENACTMENT OF H.R.1 WILL NOT HAVE A MATERIAL EFFECT ON THE OPERATIONS OF THE ORGANIZATION.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE D, PAGE 3, PART X
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0ROBERT T ROGERSII MD
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1RICHARD D JACOBS
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0DIRECTOR
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1FINANCE
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt0387267
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt1311186
IRS990ScheduleJ/SeverancePaymentInd0false
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL. ALL "EMPLOYEES", INCLUDING THOSE THAT PERFORM MANAGEMENT FUNCTIONS, ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. AS SUCH, THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CANTON-POTSDAM HOSPITAL SEEKS INPUT OF A CONSULTING FIRM WITH NATIONAL EXPERIENCE TO REVIEW COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AND THE REGULATORY COMPLIANCE ISSUES OF NON-FOR-PROFITS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE.
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE J, PART III
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd0false
IRS990ScheduleL/BusTrInvolveInterestedPrsnGrp/NameOfInterested/PersonNm0ROBERT T ROGERS II MD
IRS990ScheduleL/BusTrInvolveInterestedPrsnGrp/RelationshipDescriptionTxt0DIRECTOR
IRS990ScheduleL/BusTrInvolveInterestedPrsnGrp/SharingOfRevenuesInd0false
IRS990ScheduleL/BusTrInvolveInterestedPrsnGrp/TransactionAmt0387267
IRS990ScheduleL/BusTrInvolveInterestedPrsnGrp/TransactionDesc0COMPENSATION
IRS990ScheduleL/SupplementalInformationDetail/ExplanationTxt0CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION, HAS BUSINESS TRANSACTIONS INVOLVING ROBERT T. ROGERS, II, MD, AN EMPLOYEE AT CANTON-POTSDAM HOSPITAL AND DIRECTOR OF CANTON-POTSDAM MEDICAL PRACTICE, PLLC. CANTON-POTSDAM HOSPITAL REMITTED APPROXIMATELY 387,267 TO ROBERT T. ROGERS, II, MD FOR COMPENSATION.
IRS990ScheduleL/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE L, PART V
IRS990/ScheduleORequiredInd0true
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0CANTON-POTSDAM MEDICAL PRACTICE OPERATES OTHER OUTPATIENT CLINIC LOCATIONS INCLUDING THE FOLLOWING: FAMILY PRACTICE: LOCATED IN COLTON, NY, THIS CLINIC SERVED APPROXIMATELY 2,568 PATIENTS IN 2017.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL. ALL "EMPLOYEES" , INCLUDING THOSE THAT PERFORM MANAGEMENT FUNCTIONS, ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. EMPLOYEES OF CANTON-POTDAM HOSPITAL ARE LEASED TO CANTON- POTSDAM MEDICAL PRACTICE TO PROVIDE ALL MEDICAL STAFF AND MANAGEMENT SERVICES. SERVICE AGREEMENTS ARE IN PLACE BETWEEN THE TWO RELATED ORGANIZATIONS. CANTON-POTSDAM HOSPITAL INVOICES CANTON-POTSDAM MEDICAL PRACTICE FOR THESE SERVICES. KEY EMPLOYEE, RICHARD JACOBS, IS AN EMPLOYEE OF CANTON-POTSDAM HOSPITAL WHO IS RESPONSIBLE FOR THE FINANCIAL REPORTING OF CANTON-POTSDAM MEDICAL PRACTICE. ROBERT T. ROGERS, II, MD, IS AN EMPLOYEE OF CANTON-POTSDAM HOSPITAL WHO IS THE SOLE MEMBER MANAGER OF THE PLLC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2CANTON-POTSDAM MEDICAL PRACTICE DID NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY, AND THUS NO COMMITTEE MEETINGS WERE HELD.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE FORM 990 IS PREPARED BY CANTON-POTSDAM HOSPITAL'S FINANCE DEPARTMENT STAFF MEMBERS. UPON COMPLETION, A COPY WITH SUPPORTING DOCUMENTATION IS REVIEWED BY THE VICE PRESIDENT FOR FINANCE AND THE CONTROLLER. FURTHERMORE, THE FORM WAS PROVIDED TO THE CANTON-POTSDAM MEDICAL PRACTICE ADVISORY COMMITTEE FOR FURTHER REVIEW AND COMMENT. AFTER REVIEW, ANY CHANGES ARE MADE AND A COPY IS PRESENTED TO THE SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE, ROBERT T. ROGERS, II, MD FOR HIS REVIEW AND APPROVAL.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE KEY EMPLOYEE AND SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE ARE EMPLOYEES OF CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION. ALL EMPLOYEES ADHERE TO CANTON-POTSDAM HOSPITAL'S WRITTEN CONFLICT OF INTEREST POLICY. DISCLOSURE STATEMENTS ARE REVIEWED ANNUALLY.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5LINE 15A: AS STATED ABOVE IN THIS SCHEDULE O, CANTON-POTSDAM MEDICAL PRACTICE DOES NOT HAVE ANY EMPLOYEES ON ITS PAYROLL AND ALL "EMPLOYEES" ARE CONTRACTED THROUGH CANTON-POTSDAM HOSPITAL, RELATED TAX EXEMPT ORGANIZATION. AS SUCH, THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CANTON-POTSDAM HOSPITAL SEEKS THE INPUT OF A CONSULTING FIRM 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 CONSULTANT AND DELIBERATIONS OF THE COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIALS COMPENSATION PACKAGE.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6THE KEY EMPLOYEE AND SOLE MEMBER OF CANTON-POTSDAM MEDICAL PRACTICE ARE EMPLOYEES OF CANTON-POTSDAM HOSPITAL, RELATED ORGANIZATION. COMPENSATION OF EMPLOYEES IS DETERMINED BY CANTON-POTSDAM HOSPITAL'S PROCESSES FOR DETERMINING COMPENSATION. THEY ARE AS FOLLOWS: THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED PRIMARILY BY THE WORK OF THE HUMAN RESOURCE DEPARTMENT, THE RECOMMENDATION OF THE VICE PRESIDENT OF HUMAN RESOURCES (HR), AND BY INFORMATION GATHERED FROM INDEPENDENT SURVEY DATA OF NATIONAL AND SURROUNDING MARKETS. THE VICE PRESIDENT OF HUMAN RESOURCES WILL REVIEW THE SURVEY DATA TO ESTIMATE SALARY RANGES AND COMPENSATION PACKAGES. THE VP OF HR MAKES THE RECOMMENDATION TO THE CEO. THE CEO WILL BRING THE INFORMATION TO THE COMPENSATION COMMITTEE. AFTER DELIBERATIONS AND CONSIDERATIONS, THE COMPENSATION COMMITTEE WILL THEN BRING THEIR RECOMMENDATION TO THE FULL BOARD FOR THEIR FINAL APPROVAL.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8TRANSFER FROM AFFILIATE (CANTON-POTSDAM HOSPITAL) 890,497 .
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PAGE 2, PART III, LINE 4D
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PAGE 6, PART VI, LINE 3
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PAGE 6, PART VI, LINE 8B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PAGE 6, PART VI, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PAGE 6, PART VI, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PAGE 6, PART VI, LINE 15A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PAGE 6, PART VI, LINE 15B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7FORM 990, PAGE 6, PART VI, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8FORM 990, PART XI, LINE 9
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine1Txt2SLHS
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt0ST LAWRENCE HEALTH SYSTEM INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt1CANTON-POTSDAM HOSPITAL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt2GOUVERNEUR HOSPITAL INC
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0SEE VII
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt050 LEROY STREET
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt150 LEROY STREET
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt277 WEST BARNEY STREET
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm0POTSDAM
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm1POTSDAM
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm2GOUVERNEUR
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IRS990ScheduleR/SupplementalInformationDetail/ExplanationTxt0ST. LAWRENCE HEALTH SYSTEM, INC. (SLHS) IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPITAL, GOUVERNEUR HOSPITAL AND OTHER CORPORATIONS OF WHICH THE CORPORATION IS THE SOLE CORPORATE MEMBER INCLUDING THE CANTON-POTSDAM MEDICAL PRACTICE, PLLC.
IRS990ScheduleR/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE R
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IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt03270048
IRS990/TotalFunctionalExpensesGrp/TotalAmt03654361
IRS990/TotalGrossUBIAmt00
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