2023-11-13T12:33:20-06:00 2022-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL ROCHESTER NY 14534 990 2022-01-01 161279472 ST LAWRENCE HEALTH FOUNDATION INC CANT 3152615410 29 GROVE STREET POTSDAM NY 136762051 KELLY J CICCHINELLI MBA SLH VP OF FINANCE 3152615410 2023-11-08 1 KELLY CICCHINELLI MBA XXX-XX-XXXX 1 CHELSEY WYANT P01336644 5853811000 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z APRIL GRANT 29 GROVE STREET POTSDAM NY 136762051 6688546 0 X WWW.STLAWRENCEHEALTHSYSTEM.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, GOUVERNEUR HOSPITAL, AND MASSENA HOSPITAL. 16 14 0 0 0 0 530934 376194 0 0 2224220 1058792 224151 228699 2979305 1663685 266441 46495 0 0 0 0 0 0 329794 580520 571643 846961 618138 2132344 1045547 34796857 30633797 2753779 2539948 32043078 28093849 THE FOUNDATION'S PRIMARY PURPOSE IS TO SOLICIT, RECEIVE AND ADMINISTER GIFTS AND BEQUESTS MADE ON BEHALF OF CANTON-POTSDAM HOSPITAL, GOUVERNEUR HOSPITAL, AND MASSENA HOSPITAL. 0 0 67974 46495 ADMINISTRATION OF GIFTS MADE TO THE ST. LAWRENCE HEALTH FOUNDATION FOR THE BENEFIT OF THE AFFILIATED HOSPITALS. 67974 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X KELLY CICCHINELLI 3152615102 50 LEROY STREET POTSDAM NY 13676 X JOSEPH FITZSIMONNS CHAIR OF THE BOARD 1.00 0.00 X X 0 0 0 NANCY GRIFFIN SECRETARY 1.00 0.00 X X 0 0 0 BROOKS WASHBURN VICE CHAIR 1.00 0.00 X X 0 0 0 ANGELA GRAY TREASURER 1.00 0.00 X X 0 0 0 RYAN NILES DIRECTOR 1.00 0.00 X 0 0 0 MARY ANN HEALEY DIRECTOR 1.00 40.00 X 0 3340 0 RICHARD BURNS DIRECTOR 1.00 0.00 X 0 0 0 SHELBY CONNELLY DIRECTOR 1.00 0.00 X 0 0 0 STEPHEN EASTER DIRECTOR 1.00 0.00 X 0 0 0 MARK GOODNOW DIRECTOR 1.00 0.00 X 0 0 0 STACEY HOWLETT DIRECTOR 1.00 0.00 X 0 0 0 RENEE HOLSEN DIRECTOR 1.00 0.00 X 0 0 0 DAVID KIRWAN DIRECTOR 1.00 0.00 X 0 0 0 WILLIAM MELCHOIR DIRECTOR 1.00 0.00 X 0 0 0 RICHARD VANLEUVEN DIRECTOR 1.00 1.00 X 0 0 0 JAY SCHECHTER DIRECTOR 1.00 40.00 X 0 2154 0 KELLY MCCORMICK-SULLIVAN PRESIDENT, RRH FOUNDATIONS 0.00 55.00 X 0 297938 61492 0 303432 61492 0 0 1 0 0 376194 540 376194 525641 525641 532395 303696 228699 228699 228699 5254316 4721165 533151 533151 533151 1663685 0 0 1287491 X 46495 46495 143343 143343 396982 21479 60327 315176 9043 790 8253 6174 6174 1392 1392 968 968 7500 2527 4973 DONOR RECOGNITION AND C 6241 6241 618138 67974 220370 329794 1193155 1352022 14413 18829 9768975 2721193 7302834 7047782 26286455 22210189 4975 34796857 30633797 21635 119628 2050000 1870000 682144 550320 2753779 2539948 X 32043078 27963849 130000 32043078 28093849 34796857 30633797 1045547 -4994776 0 X X 0 1 X 1 0 X X X 3 CANTON-POTSDAM HOSPITAL 161012691 3 1 46495 0 GOUVERNEUR HOSPITAL 464249555 3 1 0 0 MASSENA HOSPITAL 843134268 3 1 0 0 3 46495 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 130000 130000 1.00000 0 0 9761924 2716285 7045639 7051 4908 2143 7047782 DUE TO AFFILIATES 550320 550320 X -3027395 -4994776 303696 -4691080 1663685 0 1663685 921834 303696 303696 618138 0 618138 PART X, LINE 2: THE FOUNDATION IS A NOT-FOR-PROFIT ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS A PRIVATE FOUNDATION. THE FOUNDATION HAS CONSIDERED THE RECOGNITION REQUIREMENTS FOR UNCERTAIN INCOME TAX POSITIONS. THE FOUNDATION BELIEVES THAT ITS INCOME TAX FILING POSITIONS WOULD BE SUSTAINED UPON EXAMINATION AND DOES NOT ANTICIPATE ANY ADJUSTMENTS THAT WOULD RESULT IN A MATERIAL ADVERSE EFFECT ON THE FOUNDATION'S FINANCIAL CONDITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 303,696. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 303,696. 1 CANTON POTSDAM HOSPITAL 50 LEROY ST POTSDAM NY 13676 161012691 501C3 46495 0 PROJECT FUNDING 1 PART I, LINE 2: PART II - ALL CONTRIBUTIONS ARE GIVEN SOLELY TO RELATED EXEMPT ORGANIZATIONS. 0 0 0 0 0 0 0 0 0 KELLY MCCORMICK-SULLIVAN PRESIDENT, RRH FOUNDATIONS 0 242707 0 55231 0 0 0 48959 0 12533 0 359430 0 0 PART I, LINE 3: 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 BASED ON PERFORMANCE REVIEW COMPLETED BY THE VICE PRESIDENT, WITH INPUT FROM THE BOARD. PART II, COLUMN C: RETIREMENT AND OTHER DEFERRED COMPENSATION - THIS COLUMN IS REFLECTIVE OF THE ACTUARIAL CHANGE IN DEFINED BENEFIT PENSION PLAN AND POST-RETIREMENT BENEFITS FOR THE TAX YEAR. A ST LAWRENCE COUNTY IDC 272614310 2010-08-30 21305000 SEE PART VI 0 1 0 A 19051703 20921703 11168176 9590000 1 0 0 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 0 0 0 1 A 1 PART I, LINE A - THIS FINANCING CONSISTS OF TWO SERIES OF BONDS - THE $17,720,000 ST. LAWRENCE COUNTY INDUSTRIAL DEVELOPMENT AGENCY CIVIC DEVELOPMENT COPORATION 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 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 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. IN 2022, THE HOSPITAL BONDS WERE REFUNDED AND REPLACED WITH SERIES 2022A TAX EXEMPT BONDS. THE FOUNDATION BONDS WERE NOT A PART OF THIS REFUNDING TRANSACTION. PART II, LINE 3 - TOTAL PROCEEDS OF ISSUE THE BONDS WERE ORIGINALLY ISSED AS "DRAW-DOWN BONDS" IN THE MAXIMUM PRINCIPAL AMOUNT OF $21,305,000, WHICH REPRESENTS THE ORGINAL ISSUE PRICE OF THE BONDS REPORTED ON IRS FORM 8038. ULTIMATELY, ONLY $20,921,703 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, PART VI, SECTION B, LINE 11B PRIOR TO FILING, A COPY OF THE FORM 990 IS PROVIDED TO, AND REVIEWED WITH, ALL MEMBERS OF THE AUDIT AND COMPLIANCE COMMITTEE. THIS REVIEW IS PREFORMED IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, AND IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND OTHER RELEVANT INFORMATION FOR THE APPROPRIATE TIME PERIOD. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY RENEW THE CODE OF CONDUCT AND CONFLICT OF INTEREST DISCLOSURE STATEMENTS. FORM 990, PART VI, SECTION B, LINE 15 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 PERFORMANCE REVIEW COMPLETED BY THE VICE PRESIDENT, WITH INPUT FROM THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ADMINISTRATIVE OFFICES OF THE AFFILIATED HEALTH SYSTEM AT 100 KING HIGHWAY SOUTH, ROCHESTER, NY 14617. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. FORM 990, PART VII, SECTION A, COLUMN (F): ESTIMATED AMOUNT OF OTHER COMPENSATION FROM THE ORGANIZATION AND RELATED ORGANIZATIONS - THIS COLUMN IS REFLECTIVE OF (1) THE ACTUARIAL CHANGE IN DEFINED BENEFIT PENSION PLAN AND POST-RETIREMENT BENEFITS FOR THE TAX YEAR AND (2) NON-TAXABLE BENEFITS. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 20,624. MANAGEMENT AND GENERAL EXPENSES 51,884. FUNDRAISING EXPENSES 308,080. TOTAL EXPENSES 380,588. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 855. MANAGEMENT AND GENERAL EXPENSES 8,443. FUNDRAISING EXPENSES 7,096. TOTAL EXPENSES 16,394. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CANTON-POTSDAM HOSPITAL 50 LEROY STREET POTSDAM NY 13676 161012691 HOSPITAL NY 501(C)(3) LINE 3 ST LAWRENCE HEALTH SYSTEM INC 1 GOVEURNEUR HOSPITAL 77 WEST BARNEY STREET GOUVERNEUR NY 13642 464249555 HOSPITAL NY 501(C)(3) LINE 3 ST LAWRENCE HEALTH SYSTEM INC 1 MASSENA HOSPITAL INC 1 HOSPITAL DRIVE MASSENA NY 13662 843134268 HOSPITAL NY 501(C)(3) LINE 3 ST LAWRENCE HEALTH SYSTEM INC 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 CANTON-POTSDAM HOSPITAL K 532395 FMV CANTON-POTSDAM HOSPITAL L 61083 FMV