Civic Intelligence

Gouverneur Hospital

990 • Fiscal year 2017 • EIN 46-4249555

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

77 West Barney StreetGouverneur, NY 13642

(315) 287-1000

Siviq Scores

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

Liabilities / Assets

66th percentile

0.68x

Higher debt load relative to assets than 66% of similar nonprofits.

2017 filings • NTEE E • $10M-$25M nonprofits • Source year 2017

Liabilities / Revenue

64th percentile

0.43x

Higher debt load relative to revenue than 64% of similar nonprofits.

2017 filings • NTEE E • $10M-$25M nonprofits • Source year 2017

Net Margin

38th percentile

-0.8%

Higher net margin than 38% of similar nonprofits.

2017 filings • NTEE E • $10M-$25M nonprofits • Source year 2017

Top Officer Pay

52nd percentile

$351,301

Higher top officer pay than 52% of similar nonprofits.

Top officer pay equals 1.7% of source-year revenue.

2017 filings • NTEE E • $10M-$25M nonprofits • Source year 2017

Asset Growth

66th percentile

9.8%

Faster asset growth than 66% of similar nonprofits.

2017 filings • NTEE E • $10M-$25M nonprofits • Annualized from 2016 to 2017

Revenue Growth

54th percentile

6.4%

Faster revenue growth than 54% of similar nonprofits.

2017 filings • NTEE E • $10M-$25M nonprofits • Annualized from 2016 to 2017

Assets

Up

$12,847,542

Up $1,149,579 (+9.8%) from 2016

Net Assets

Up

$4,052,009

Up $1,621,154 (+67%) from 2016

Liabilities

Down

$8,795,533

Down $471,575 (-5.1%) from 2016

Revenue

Up

$20,417,624

Up $1,235,520 (+6.4%) from 2016

Expenses

Up

$20,573,267

Up $1,846,929 (+9.9%) from 2016

Net Income

Down

-$155,643

Down $611,409 (-134%) from 2016

Historical Trend

Balance Sheet Trend

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

$60M$40M$20M$0-$20MAssets 2013: $6,880,748Liabilities 2013: $9,009,753Net Assets 2013: -$2,129,0052013Assets 2014: $9,074,063Liabilities 2014: $8,593,646Net Assets 2014: $480,4172014Assets 2015: $9,880,241Liabilities 2015: $8,662,398Net Assets 2015: $1,217,8432015Assets 2016: $11,697,963Liabilities 2016: $9,267,108Net Assets 2016: $2,430,8552016Assets 2017: $12,847,542Liabilities 2017: $8,795,533Net Assets 2017: $4,052,0092017Assets 2018: $14,515,079Liabilities 2018: $8,921,591Net Assets 2018: $5,593,4882018Assets 2019: $16,154,381Liabilities 2019: $8,777,531Net Assets 2019: $7,376,8502019Assets 2020: $21,451,302Liabilities 2020: $8,974,904Net Assets 2020: $12,476,3982020Assets 2021: $22,324,244Liabilities 2021: $8,777,528Net Assets 2021: $13,546,7162021Assets 2022: $41,545,414Liabilities 2022: $27,314,511Net Assets 2022: $14,230,9032022Assets 2023: $32,251,939Liabilities 2023: $10,645,337Net Assets 2023: $21,606,6022023Assets 2024: $31,323,692Liabilities 2024: $8,292,612Net Assets 2024: $23,031,0802024

Highlighted filing

2017

Assets$12,847,542
Liabilities$8,795,533
Net Assets$4,052,009

Operations Trend

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

$40M$30M$20M$10M$0-$10MRevenue 2013: $0Expenses 2013: $0Net Income 2013: $02013Revenue 2014: $20,538,727Expenses 2014: $18,389,474Net Income 2014: $2,149,2532014Revenue 2015: $17,585,466Expenses 2015: $18,445,024Net Income 2015: -$859,5582015Revenue 2016: $19,182,104Expenses 2016: $18,726,338Net Income 2016: $455,7662016Revenue 2017: $20,417,624Expenses 2017: $20,573,267Net Income 2017: -$155,6432017Revenue 2018: $23,511,065Expenses 2018: $22,531,886Net Income 2018: $979,1792018Revenue 2019: $25,517,703Expenses 2019: $23,892,821Net Income 2019: $1,624,8822019Revenue 2020: $30,316,998Expenses 2020: $25,603,599Net Income 2020: $4,713,3992020Revenue 2021: $28,105,337Expenses 2021: $27,081,312Net Income 2021: $1,024,0252021Revenue 2022: $30,436,096Expenses 2022: $29,588,845Net Income 2022: $847,2512022Revenue 2023: $37,980,965Expenses 2023: $30,631,278Net Income 2023: $7,349,6872023Revenue 2024: $36,021,916Expenses 2024: $34,666,503Net Income 2024: $1,355,4132024

Highlighted filing

2017

Revenue$20,417,624
Expenses$20,573,267
Net Income-$155,643
Jump To
Filing Snapshot
Filing Period
Jan 1, 2017 to Dec 31, 2017
Signed
Aug 1, 2018
Return Version
2017v2.3
Gross Receipts
$20,636,611
Mission and Program Overview

Mission

Our mission is to provide skilled, compassionate, cost-effective care that promotes wellness and meets the community's healthcare needs.

Balance Sheet Detail
LineBeginningEndChange
Assets
Land, Buildings, and Equipment, Net$5,419,338$7,204,386▲ $1,785,048
Accounts Receivable$2,307,040$1,679,338▼ $627,702
Investments Other Securities$729,953$735,518▲ $5,565
Pledges and Grants Receivable$769,119$552,113▼ $217,006
Inventories for Sale or Use$416,268$373,848▼ $42,420
Cash and Non-Interest-Bearing Accounts$745,371$200,618▼ $544,753
Prepaid Expenses and Deferred Charges$208,901$137,841▼ $71,060
Total Assets$11,697,963$12,847,542▲ $1,149,579
Other Assets Total$1,101,973$1,963,880▲ $861,907
Liabilities
Other Liabilities$7,729,162$6,507,869▼ $1,221,293
Accounts Payable and Accrued Expenses$1,537,946$2,275,015▲ $737,069
Unsecured Notes Loans Payable-$12,649-
Total Liabilities$9,267,108$8,795,533▼ $471,575
Net Assets / Fund Balance
Unrestricted Net Assets$18,076$1,517,320▲ $1,499,244
Permanently Rstr Net Assets$1,436,128$1,502,372▲ $66,244
Temporarily Rstr Net Assets$976,651$1,032,317▲ $55,666
Total Net Assets Fund Balance$2,430,855$4,052,009▲ $1,621,154
Total Liabilities and Net Assets / Fund Balance$11,697,963$12,847,542▲ $1,149,579

Asset Categories

AssetBook ValueDepreciationBasis
Equipment$2,616,227$2,017,148$4,633,375
Buildings$3,911,055$452,985$4,364,040
Land$647,398-$647,398
Other Land Buildings$29,706-$29,706
Other Assets Org$78,115--
Other Securities$43,138--

Endowment Activity

PeriodBeginningContrib.Gain/LossOther UsesEnd
2017$2,412,779-▲ $121,910-$2,534,689
2016$1,637,555$1,806,389▲ $38,244$1,069,409$2,412,779
2015$1,672,801$61,715▼ $35,323$61,638$1,637,555
2014$54,334$1,878,461-$217,009$1,672,801
2013-$54,334--$54,334
Compensation and Service Providers

Employees

NameTitleFull / Part TimeBaseOtherTotal
David Bender CEOCEOFT$337,288$14,013$351,301
Alice Loving MdAnesthesioloFT$299,998$28,003$328,001
Nicole L Weber MdPhysicianFT$299,998$28,003$328,001
Eric BurchCFOPT$231,619$26,538$258,157
Richard Corcoran RpaPhysician asFT$174,006$21,447$195,453
Alice Loving MdAnesthesiologist-$174,006$21,447$195,453
Michael a Kiger RpaPhysician asFT$164,132$16,085$180,217
Richard Corcoran RpaPhysician Assistant-$164,132$16,085$180,217
Michael a Kiger RpaPhysician Assistant-$155,452$14,149$169,601

Board Members and Trustees

Highest Paid Contractors

ContractorServicesLocationCompensation
The Pike Company INCContractor1 CIRCLE STEET, Rochester, NY 14607$1,408,964
Canton-potsdam HospitalStaffing50 LEROY STREET, Potsdam, NY 13676$1,312,390
Delphi Hospitalist Services LLCHospitalist1160 CHILI AVE SUITE 200, Rochester, NY 14624$408,068
Brooks Washburn Architect PCArchitect22 DEPOT STREET SUITE 16, Potsdam, NY 13676$175,540
Fusion Medical Staffing LLCPharmacyPO BOX 82674, Lincoln, NE 68501-2674$152,857
Revenue and Support

Revenue Composition

Contributions and Grants
$77,149
Program Service Revenue
$18,347,130
Investment Income
$34,695
Other Revenue
$1,958,650
All Other Contributions
$67,333
Change in Net Assets
$-155,643

Audited Revenue Reconciliation

Revenue per Audited Statements
$20,417,624
Revenue Not Reported on Form 990
$218,987
Total Revenue per Audited Statements
$20,636,611
Total Revenue per Form 990
$20,417,624
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Salaries, Compensation, and Employee Benefits$12,250,672
Other Expenses$8,322,595
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Other Salaries and Wages$6,647,760$2,215,920-$8,863,680
Other Employee Benefits$1,358,254$452,752-$1,811,006
Depreciation Depletion$799,283$156,699-$955,982
Payroll Taxes$499,644$166,548-$666,192
Other Expenses$437,944$114,719-$552,663
Current Officers, Directors, Trustees, and Key Employees$408,057$136,019-$544,076
All Other Expenses$335,266$103,257-$438,523
Pension Plan Contributions$274,289$91,429-$365,718
Occupancy$293,312$57,504-$350,816
Insurance$212,934$41,746-$254,680
Advertising$146,684$48,894-$195,578
Fees for Services Accounting-$169,399-$169,399
Fees for Services Other$167,640--$167,640
Interest$114,900$38,300-$153,200
Fees for Services Legal-$83,220-$83,220
Travel$19,574$6,525-$26,099
Conferences and Meetings$8,443$2,815-$11,258
Fees for Services Lobbying-$4,712-$4,712
Total Functional Expenses$14,837,717$5,735,550$0$20,573,267

Audited Expense Reconciliation

Line ItemAmount
Total Expenses per Audited Statements$20,792,254
Expenses per Audited Statements$20,573,267
Total Expenses per Form 990$20,573,267
Expenses Not Reported on Form 990$218,987
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
Yes
Subject to proxy tax
No
Insider Transactions and Loans

Interested-Person Transactions

Interested PartyRelationshipDescriptionShared RevenueAmount
See Part V Below--No-
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Asset Retirement Obligation$4,258,349
Due to Affiliates$2,718,419
Estimated Third Party Settlements$-468,899
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
No
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
Yes
Management duties delegated
No

Governance Explanations

Form 990, Page 6, Part VI, Line 6

St. Lawrence health system, inc. Is a sole member.

Form 990, Page 6, Part VI, Line 7A

St. Lawrence health system, inc. Is a sole member, and has the ability to appoint members of the board of directors.

Form 990, Page 6, Part VI, Line 7B

The members shall have the following powers with regard to the corporation: -appoint the members of the board of directors. -appoint and remove the chief executive officer. -approve the adoption and amendment of bylaws. -approve the annual operating and capital budgets. -approve strategic plans. -approve and initiate the filing of certificate of need applications. -review and approve the annual audit of the corporation and any subsidiary corporations. -approve the dissolution of the corporation. -approve the sale, lease, mortgage or encumbrance of any asset other than any sale, lease or mortgage which is part of an approved budget. -approve the sale or transfer of all or substantially all of the assets of the corporations. -approve any merger, business consolidation, acquisition or joint venture. -approve the purchase or sale of physician practices other than any purchase or sale which is part of an approved budget. -approve and may initiate the commencement and settlement of litigation. -approve any filing of bankruptcy petition. -approve the incurrence of any debt other than debt which is incurred in the ordinary course of business and which is not inconsistent with an approved budget. -approve new clinical programs or the termination of existing clinical programs other than any action which is part of an approved budget. -approve any of the following agreements: (i) management services agreements other than any agreement which is part of an approved budget. (ii) contracts with a physician or a physician group. (iii) agreements for the outsourcing of a gouverneur hospital service or function. (iv) collective bargaining agreements, and (v) any agreements to participate in a risk bearing arrangement such as an accountable care organization or a bundled payment arrangement. -initiate, negotiate, and approve managed care agreements with managed care organizations and other payors other than any agreement which is part of an approved budget. -develop integrated services and mandate participation in such services (e.g., financial management, legal, quality assurance, risk management, contracting, and recruitment) -require the guarantee of loans through an obligated group structure that will support access to capital and include debt services.

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

The 990 is emailed to the board of directors for their review prior to the filing of the return.

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

On an annual basis, officers, directors, and key employees are required to complete a conflict of interest statement. Compliance with this requirement is monitored by the hospital administration.

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

The chief executive officer is evaluated by the st. Lawrence health system ceo. Hospital senior leadership is evaluated by the hospital's ceo. Yaffe and company provides executive compensation data for critical access hospitals which is utilized by the st. Lawrence health system ceo to determine appropriate compensation for the hospital's ceo. The same data is utilized by the hospital's ceo to determine appropriate compensation for the hospital's senior leadership.

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

X

Form 990, Page 6, Part VI, Line 19

The hospital makes its governing documents, conflict of interest policy and financial statement available to the public upon request.

Filing and Contact Details

Filer

Filer Name
Gouverneur Hospital
EIN
46-4249555
Phone
3152871000
Address
77 WEST BARNEY STREET, GOUVERNEUR, NY 13642

Signing Officer

Name
David Bender CEO
Title
CEO
Phone
3152871000
Signed
2018-08-01

Organization Details

Principal Officer
David Bender CEO
Formed
2013
Legal Domicile
Ny
Voting Board Members
8
Independent Board Members
4
Employees
244
Volunteers
2

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

There was significant growth in surgeries performed in 2017. There were 642 surgeries in 2017, compared to 383 in 2016, roughly an 40% increase.

Form 990, Part XI, Line 9

Contributions for capital acquisitions 1,500,000 net assets realeased from restrictions for capital 154,886 restricted contributions 432,082 net assets released from restrictions -376,416 change in fair value of funds held in trust by oth 66,245 total 1,776,797

Financial Statement Notes

Schedule D, Page 2, Part V, Line 4

The organization uses the income from the endowment funds for general operating purposes and lawful purposes at the discretion of the board of directors.

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

Schedule D, Page 4, Part XI, Line 2D

218,987

Schedule D, Page 4, Part XII, Line 2D

RENT EXPENSES 218,987

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IRS990/ProgSrvcAccomActy2Grp/Desc0IN 2017, THE ER VISITS SLIGHTLY DECREASED APPROXIMATELY .35% FROM 9,404 IN 2016 TO 9,371 IN 2017.
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IRS990/ProgSrvcAccomActyOtherGrp/Desc0THERE WAS SIGNIFICANT GROWTH IN SURGERIES PERFORMED IN 2017. THERE WERE 642 SURGERIES IN 2017, COMPARED TO 383 IN 2016, ROUGHLY AN 40% INCREASE.
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