2023-11-14T17:11:07-06:00 2022-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2022-01-01 222488389 CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION CLAX 3153939175 125 NEW YORK AVE OGDENSBURG NY 13669 PETER SINAGRA EXECUTIVE DIRECTOR 3153939175 2023-11-14 1 PETER SINAGRA 999009999 1 JONATHAN MILLER P01322027 5853811000 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z PETER SINAGRA 125 NEW YORK AVE OGDENSBURG NY 13669 8272580 0 X WWW.CLAXTONHEPBURN.ORG X 1983 NY TO PROVIDE FINANCIAL SUPPORT TO THE CLAXTON-HEPBURN MEDICAL CENTER. 15 13 0 15 0 0 369525 425960 0 0 809525 610219 23198 2284 1202248 1038463 270007 137403 0 0 162029 117387 0 0 134113 155167 4742111 587203 4996901 615045 -3958438 20135966 13432288 12602 59580 20123364 13372708 TO PROVIDE FINANCIAL SUPPORT TO THE CLAXTON-HEPBURN MEDICAL CENTER BY ENGAGING THE COMMUNITY, INCREASING PHILANTHROPIC REVENUE, AND ENSURING CONSCIENTIOUS STEWARDSHIP OF THE FUNDS AND RESOURCES AND RESOUNRCES PLACED IN OUR CARE. 0 0 4793487 137403 HELPED TO RAISE FUNDS TO SUPPORT THE DONATION OF NEW AND RENOVATED HEALTHCARE FACILITIES TO CLAXTON-HEPBURN MEDICAL CENTER (THE MEDICAL CENTER). DURING THE CALENDAR YEAR ENDED DECEMBER 31, 2022, THE FOUNDATION SUPPORTED THE MEDICAL CENTER THROUGH EXTENDING A $3.5 MILLION LINE OF CREDIT, GUARANTEEING $5.2 MILLION IN EXTERNAL THIRD PARTY LOANS FOR THE MEDICAL CENTER, AND CONTRIBUTING $137,000 TO THE MEDICAL CENTER TO SUPPORT THEIR INITIATIVES. 4793487 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X PETER SINAGRA 3153939175 125 NEW YORK AVE OGDENSBURG NY 13669 CATHY PICHE CHAIR 1.00 0.00 X X 0 0 0 WILLIAM A FLYNN VICE CHAIR 1.00 0.00 X X 0 0 0 MARCIA L LEMAY ESQ TREASURER 1.00 0.00 X X 0 0 0 COURTNEY BLOODOUGH BOARD MEMBER 1.00 0.00 X 0 0 0 SHERIN C CUNNINGHAM BOARD MEMBER 1.00 0.00 X 0 0 0 MARY EDWARDS BOARD MEMBER 1.00 0.00 X 0 0 0 NICHOLE KENNEDY BOARD MEMBER 1.00 0.00 X 0 0 0 DARLENE LISCUM BOARD MEMBER 1.00 0.00 X 0 0 0 RICARDO LUNDI DPM BOARD MEMBER 1.00 0.00 X 0 133069 16852 PATRICIA MAHONEY DMD BOARD MEMBER 1.00 0.00 X 0 0 0 JANE MCGRATH BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL OAKLEY BOARD MEMBER 1.00 40.00 X 0 642667 36814 ANDREA SMITH BOARD MEMBER 1.00 0.00 X 0 0 0 RICHARD TACCHINO BOARD MEMBER 1.00 0.00 X 0 0 0 DONALD TEBO BOARD MEMBER 1.00 0.00 X 0 0 0 AMANDA A HITTERMAN EXECUTIVE DIRECTOR 40.00 0.00 X 0 114770 25033 0 890506 78699 0 0 1 0 0 425960 425960 398713 398713 7445623 7234117 211506 211506 211506 MISCELLANEOUS REVENUE 900099 2284 2284 2284 1038463 0 0 612503 137403 137403 92395 23099 23099 46197 24639 6160 6160 12319 353 88 88 177 775 775 67652 16913 16913 33826 8408 2102 2102 4204 10503 10503 15401 3850 3850 7701 4379 1095 1095 2189 BAD DEBT EXPENSES 4602528 4602528 FUNDRAISING 16501 16501 SERVICE CONTRACTS 14970 14970 OTHER MISC. 994 249 249 496 4996901 4793487 69301 134113 674267 514503 165163 157609 1676477 46900 7726 0 5285 5285 0 0 13105742 9076118 4506591 3637158 20135966 13432288 12602 59580 12602 59580 X 16913933 10248314 3209431 3124394 20123364 13372708 20135966 13432288 -3958438 -2792218 0 X X 0 1 X 1 0 X X 1 CLAXTON-HEPBURN MEDICAL CENTER 150559686 3 0 93628 0 1 93628 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 19249516 188109 2181999 21619624 17786377 261167 1471979 270007 19249516 18014803 209671 1531917 1970014 17786377 16430046 378284 2648123 1441650 18014803 17017498 169525 -607981 148996 16430046 0 0 5285 5285 0 0 FIXED SECURITIES 3637158 F 3637158 -1753755 -2792218 -2792218 1038463 0 1038463 4996901 0 4996901 0 4996901 PART V, LINE 4: THE FOUNDATION'S ENDOWMENTS CONSIST OF FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. ITS ENDOWMENTS INCLUDE BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS. DURING 2022, THE FOUNDATION DETERMINED CERTAIN FUNDS THAT HAD BEEN PREVIOUSLY TREATED AS ENDOWED FUNDS WERE NOT ENDOWED BASED ON DONOR INTENT. IN ADDITION, THE FOUNDATION LIQUIDATED $3,369,741 OF BOARD DESIGNATED NET ASSETS TO SUPPORT THE MEDICAL CENTER. 1 CLAXTON-HEPBURN MEDICAL CENTER 214 KING STREET OGDENSBURG NY 13669 150559686 501(C)(3) 93628 0 CHMC CAPITAL PROJECTS AND HOSPITAL IMPROVEMENTS 1 0 PART I, LINE 2: THE HOSPITAL SUBMITS A BUDGETED FOR CAPITAL AND SPECIAL PROJECTS TO THE FOUDNATION. THE HOSPITAL THEN APPROVES OF THE GRANTS TO THE HOSPITAL. THE HOSPITAL INCURRS EXPENDITURES, PROVIDES SUPPORT TO THE FOUNDATION FOR THE AMOUNT AND REQUESTS REIMBURSEMENT. 0 0 0 0 0 0 0 0 0 MICHAEL OAKLEY BOARD MEMBER 0 642667 0 0 0 0 0 9150 0 27664 0 679481 0 0 PART I, LINE 3 THE EXECUTIVE DIRECTOR OF THE FOUNDATION IS AN EMPLOYEE OF CLAXTON-HEPBURN MEDICAL CENTER. THE EXECUTIVE DIRECTOR'S COMPENSATION IS ESTABLISHED AS PART OF THE MEDICAL CENTER'S ANNUAL BUDGET PROCESS. THE COMPENSATION IS BASED ON COMPARABLE POSITIONS AT SIMILAR SIZE ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 6 NORTH STAR HEALTH ALLIANCE, INC. A NOT-FOR-PROFIT HOLDING COMPANY, IS THE SOLE CORPORATE MEMBER OF THE ORGANTIZATION. FORM 990, PART VI, SECTION A, LINE 7A NORTH STAR HEALTH ALLIANCE, INC. SHALL HAVE AND EXERCISE ALL THE RIGHTS AND POWERS OF CORPORATE MEMBERSHIP CREATED BY THE LAWS OF THE STATE OF NEW YORK OR THE CERTIFICATE OF INCORPORATION OR BYLAWS BY THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS SENT TO THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION DISCUSSES AND ENFORCES COMPLIANCE WITH THE WRITTEN CONFLICT OF INTEREST POLICY ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS A COMMITTEE THAT MAKES RECOMMENDATIONS TO THE BOARD FOR DETERMINING THE COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES. THE COMMITTEE USES COMPARABILITY DATA IN THEIR DECISION AND DOCUMENTS THEIR DELIBERATION. 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. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. NORTH STAR HEALTH ALLIANCE INC 214 KING STREET OGDENSBURG NY 13669 161449491 PARENT HOLDING COMPANY NY 501(C)(3) 12B N/A 0 CLAXTON-HEPBURN MEDICAL CENTER 214 KING STREET OGDENSBURG NY 13669 150559686 PROVIDES MEDICAL SERVICES TO THE PUBLIC NY 501(C)(3) 3 N/A 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0