2023-11-13T12:41:51-06:00 2022-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2022-01-01 264009395 CLAXTON MEDICAL PC CLAX 3157069762 214 KING STREET OGDENSBURG NY 13669 RICHARD A DUVALL SECRETARY 3157069762 2023-11-13 1 RICHARD DUVALL 264009395 0 JONATHAN MILLER P01322027 5853811000 2023-11-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z RICHARD A DUVALL 214 KING ST OGDENSBURG NY 13669 4822939 0 X NA X 2008 NY THE PURPOSES FOR WHICH CLAXTON MEDICAL, PC IS FORMED ARE TO ENGAGE IN THE PRACTICE OF MEDICINE AND TO OTHERWISE PROVIDE THOSE PROFESSIONAL SERVICES THAT A PHYSICIAN, DULY LICENSED AND REGISTERED UNDER THE LAWS OF THE STATE OF NEW YORK IS AUTHORIZED TO RENDER. IN ADDITION, CLAXTON MEDICAL, PC SHALL PROMOTE AND SUPPORT THE CHARITABLE PURPOSES OF CLAXTON-HEPBURN MEDICAL CENTER, WHICH INCLUDES PROVIDING SERVICES DESIGNED TO IMPROVE THE OVERALL HEALTH OF, AND TO OTHERWISE MEET THE MEDICAL CARE NEEDS OF, THE COMMUNITY. CLAXTON MEDICAL, PC SHALL PURSUE SUCH PURPOSES, IN PART, BY INCLUDING AMONG ITS PATIENTS, MEDICARE AND MEDICAID PATIENTS AND THOSE WHO ARE UNDER- OR UNINSURED. 2 0 0 0 0 0 0 0 8760975 4758461 0 0 0 64478 8760975 4822939 0 0 0 0 11819981 11167525 0 0 0 5174595 4693959 16994576 15861484 -8233601 -11038545 1758370 520261 55591281 65391717 -53832911 -64871456 X THE PURPOSES FOR WHICH CLAXTON MEDICAL, PC IS FORMED ARE TO ENGAGE IN THE PRACTICE OF MEDICINE AND TO OTHERWISE PROVIDE THOSE PROFESSIONAL SERVICES THAT A PHYSICIAN, DULY LICENSED AND REGISTERED UNDER THE LAWS OF THE STATE OF NEW YORK IS AUTHORIZED TO RENDER. IN ADDITION, CLAXTON MEDICAL, PC SHALL PROMOTE AND SUPPORT THE CHARITABLE PURPOSES OF CLAXTON-HEPBURN MEDICAL CENTER, WHICH INCLUDES PROVIDING SERVICES DESIGNED TO IMPROVE THE OVERALL HEALTH OF, AND TO OTHERWISE MEET THE MEDICAL CARE NEEDS OF, THE COMMUNITY. CLAXTON MEDICAL, PC SHALL PURSUE SUCH PURPOSES, IN PART, BY INCLUDING AMONG ITS PATIENTS, MEDICARE AND MEDICAID PATIENTS AND THOSE WHO ARE UNDER- OR UNINSURED. 0 0 3666636 2171862 SURGICAL GROUP HAS TWO FULL-TIME PHYSICIANS, ONE FULL-TIME PHYSICIAN'S ASSISTANT, AND THREE FULL-TIME MEDICAL ASSISTANTS. DURING 2022, SURGICAL GROUP HAD 4,164 OFFICE VISITS. 1498128 487647 PEDIATRICS HAS ONE FULL-TIME PHYSICIAN, TWO FULL-TIME NURSE PRACTITIONERS, TWO FULL-TIME LPNS, AND ONE FULL-TIME RECEPTIONIST. DURING 2022, PEDIATRICS HAD 3,997 VISITS. 1458810 864368 INTERNAL MEDICINE HAS ONE FULL-TIME PHYSICIAN, ONE 60% PHYSICIAN, ONE FULL-TIME PHYSICIAN ASSISTANT, TWO FULL-TIME NURSE PRACTITIONERS, THREE FULL-TIME MEDICAL ASSISTANTS/LPNS, AND 1.5 FTE RECEPTIONISTS. DURING 2022, INTERNAL MEDICINE HAD 8,429 OFFICE VISITS. 8011673 8011673 14635247 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 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 2 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X RICHARD A DUVALL 3153938880 214 KING STREET OGDENSBURG NY 13699 RICHARD A DUVALL SECRETARY 1.00 40.00 X X 0 653946 36814 MICHAEL S SEIDMAN PRESIDENT 1.00 40.00 X X 0 529898 9150 0 1183844 45964 0 0 1 0 0 PATIENT SERVICES 621400 4758461 4758461 4758461 OTHER REVENUE 900099 64478 64478 64478 4822939 4822939 0 0 9237138 8485425 751713 1930387 1773293 157094 8065 8065 7355 2761 4594 73210 2995 70215 15490 10854 4636 455532 441552 13980 PURCHASED SERVICES 3502604 3479296 23308 SUPPLIES 409133 394177 14956 OTHER EXPENSES 117411 11067 106344 TRAINING 79887 25019 54868 25272 8808 16464 15861484 14635247 1226237 0 231125 0 1510706 513710 16439 6451 100 100 1758370 520261 118437 236930 55472844 65154787 55591281 65391717 X -53832911 -64871456 -53832911 -64871456 1758370 520261 -11038545 0 X X 0 1 X 1 0 X X 1 CLAXTON-HEPBURN MEDICAL CENTER 150559686 3 1 0 11030106 1 0 11030106 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION C, LINE 1: THE RELATIONSHIP BETWEEN CLAXTON-HEPBURN MEDICAL CENTER AND CLAXTON MEDICAL, PC IS A CONTINUING RELATIONSHIP SINCE THE INCEPTION OF CLAXTON MEDICAL, PC IN 2008. THE PURPOSE OF CLAXTON MEDICAL, PC IS TO ENGAGE IN THE PRACTICE OF MEDICINE AND SERVE THE MEDICAL NEEDS OF THE COMMUNITY SERVED BY CLAXTON-HEPBURN MEDICAL CENTER, BY PROVIDING OFFICE BASED PRIMARY CARE AND SPECIALTY SERVICES. 0 DUE TO CLAXTON-HEPBURN MEDICAL CENTER 65043718 CASH OVERDRAFT 111069 65154787 X X X X X 0 0 0 0 0 0 0 0 0 RICHARD A DUVALL SECRETARY 0 653146 0 0 0 800 0 9150 0 27664 0 690760 0 0 MICHAEL S SEIDMAN PRESIDENT 0 529898 0 0 0 0 0 9150 0 0 0 539048 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PROVIDED TO CLAXTON MEDICAL, P.C.'S BOARD TO REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE CLAXTON-HEPBURN MEDICAL CENTER BOARD OF DIRECTORS CONTRACTS WITH YAFFE AND COMPANY TO WORK WITH THE CHMC EXECUTIVE COMMITTEE TO ENSURE COMPLIANCE WITH IRC 4598 AND CONFLICT OF INTEREST DISCLOSURE. THROUGH THIS PROCESS, THE CLAXTON MEDICAL PC OFFICERS DISCLOSE CONFLICTS OF INTEREST ANNUALLY IN WRITING, AFTER REVIEWING THE CORPORATE POLICY. THESE CONFLICTS ARE REVIEWED BY THE FULL CHMC BOARD ANNUALLY AND KEPT ON FILE. FORM 990, PART VI, SECTION B, LINE 15 THE CHMC BOARD CONTRACTS WITH YAFFE AND COMPANY, AN INDEPENDENT SALARY COMPENSATION SPECIALIST TO ADVISE ON THE EXECUTIVE SALARY PROCESS AND PHILOSOPHY. YAFFE WORKS WITH THE EXECUTIVE COMMITTEE TO ASSIST THE COMMITTEE IN SETTING ANNUAL SALARIES AND BENEFITS FOR SENIOR LEADERSHIP. FORM 990, PART VI, SECTION C, LINE 18 CLAXTON MEDICAL P.C.'S 990 IS AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION C, LINE 19 CLAXTON MEDICAL P.C.'S GOVERNING DOCUMENTS, FINANCIAL STATEMENT AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. CLAXTON-HEPBURN MEDICAL CENTER 214 KING ST OGDENSBURG NY 13669 150559686 NOT FOR PROFIT HOSPITAL NY 501(C)(3) LINE 3 1 CLAXTON HEPBURN MEDICAL CENTER FOUNDATION INC 503 MANSION AVE OGDENSBURG NY 13669 222488389 PROVIDE FINANCIAL SUPPORT TO CLAXTON HEPBURN MEDICAL CENTER NY 501(C)(3) LINE 12B, II 0 NORTHSTAR HEALTH ALLIANCE INC 214 KING ST OGDENSBURG NY 13669 161449491 PARENT HOLDING COMPANY NY 501(C)(3) LINE 12B, II 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 CLAXTON-HEPBURN MEDICAL CENTER D 65043718 FMV CLAXTON-HEPBURN MEDICAL CENTER Q 11030106 FMV