2025-11-17T13:21:06-06:00 2024-12-31 161131146 BONADIO & CO LLP 432 NORTH FRANKLIN STREET SYRACUSE NY 13204 990 2024-01-01 161449491 NORTH STAR HEALTH ALLIANCE INC NORT 3153933600 214 KING STREET OGDENSBURG NY 13669 ROB BLOOM CHIEF FINANCIAL OFFICER 3153933600 2025-11-17 1 0 TIMOTHY HAMMOND P01224809 3154227109 2025-11-17 2024 2025-03-06 01:10:19Z RICHARD DUVALL 214 KING STREET OGDENSBURG NY 13669 0 0 X N/A X 1993 NY THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR THE BENEFIT OF ITS MEMBERS, WHICH COMPRISE: CLAXTON-HEPBURN MEDICAL CENTER, CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION, AND CARTHAGE AREA HOSPITAL. THE CORPORATION MONITORS MISSION OBJECTIVES, ACTIVITIES, AND RESOURCES OF ITS MEMBERS, AND ADVISES IN RESPECT TO THE MONITORED MATTERS TO FURTHER THE PURPOSE OF PROMOTING EFFICIENT, EFFECTIVE, AND ECONOMICAL HEALTH CARE SERVICES IN RURAL AREAS OF NORTHERN NEW YORK. 10 9 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR THE BENEFIT OF ITS MEMBERS, WHICH COMPRISE: CLAXTON-HEPBURN MEDICAL CENTER, CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION, AND CARTHAGE AREA HOSPITAL. THE CORPORATION MONITORS MISSION OBJECTIVES, ACTIVITIES, AND RESOURCES OF ITS MEMBERS, AND ADVISES IN RESPECT TO THE MONITORED MATTERS TO FURTHER THE PURPOSE OF PROMOTING EFFICIENT, EFFECTIVE, AND ECONOMICAL HEALTH CARE SERVICES IN RURAL AREAS OF NORTHERN NEW YORK. 0 0 NORTH STAR HEALTH ALLIANCE (NORTH STAR) IS A PARENT COMPANY FOR HEALTHCARE ENTITIES AND THEIR RELATED FOUNDATIONS. MEMBERS OF NORTH STAR WILL HAVE THEIR CERTIFICATES OF INCORPORATION AND BYLAWS INDICATE THAT NORTH STAR IS THEIR SOLE MEMBER ALLOWING NORTH STAR TO BE EMPOWERED UNDER THE NEW YORK NOT-FOR-PROFIT CORPORATION LAW TO APPOINT THE BOARD OF DIRECTORS OF EACH MEMBER, TO AMEND CERTIFICATES OF INCORPORATION AND BYLAWS AND APPROVE DISSOLUTIONS, MERGERS, AND ACQUISITIONS. AS THE PARENT COMPANY, NORTH STAR WILL ACT TO PROMOTE HIGH QUALITY HEALTH CARE SERVICES TO THE COMMUNITY THROUGH EFFICIENT, EFFECTIVE, AND ECONOMICAL SYSTEMS. THE INCREASINGLY REGULATED, COMPETITIVE, AND COST-CONSCIOUS ENVIRONMENT HAS LED MEMBERS TO DECREASED RESOURCES AND AN INCREASED NEED FOR COLLABORATIVE APPROACHES TO THESE CHALLENGES. IN THE ROLE OF A PARENT COMPANY, IT IS NOT ANTICIPATED THAT NORTH STAR WILL ITSELF BECOME A PROVIDER OF HEALTHCARE SERVICES OR OTHER SERVICES DIRECTED TO THE PUBLIC BUT RATHER WILL CONTINUE TO COORDINATE EFFORTS IN A COLLABORATIVE MANNER TO ADDRESS THE CHALLENGES FACED BY ITS MEMBERS SPECIFICALLY BY REDUCING FUNCTIONAL OVERLAPS AND MAXIMIZING THE UTILIZATION OF AVAILABLE RESOURCES. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 NY X ROB BLOOM 3154931000 40 FRANKLIN STREET CARTHAGE NY 13619 RICHARD DUVALL PRESIDENT AND CEO 1.00 41.00 X X 0 1119012 39663 CHET TRUSKOWSKI CHAIRPERSON 1.00 3.00 X X 0 0 0 DALE KLOCK DIRECTOR 1.00 3.00 X 0 0 0 DALLAS SUTTON SECRETARY 1.00 3.00 X X 0 0 0 GARY ROWE VICE CHAIRPERSON 1.00 3.00 X X 0 0 0 JAMES THEW DIRECTOR 1.00 3.00 X 0 0 0 LAWRENCE HASSELER DIRECTOR 1.00 3.00 X 0 0 0 MAUREEN MISSERT DIRECTOR 1.00 3.00 X 0 0 0 TIM STURICK TREASURER 1.00 3.00 X X 0 0 0 ZVI SZAFRAN DIRECTOR 1.00 3.00 X 0 0 0 ADAM FULLER DIRECTOR 1.00 3.00 X 0 0 0 0 1119012 39663 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 X 0 0 0 X X 3 CLAXTON-HEPBURN MEDICAL CENTER 150559686 3 1 0 0 CARTHAGE AREA HOSPITAL 150622079 3 0 0 0 CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION INC 222488389 7 1 0 0 3 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART IV, SECTION A, LINE 1: CARTHAGE AREA HOSPITAL (CAH) BECAME A MEMBER OF NSHA SUBSEQUENT TO NSHA'S ESTABLISHMENT. THE PURPOSE OF CAH IS TO PROVIDE HEALTHCARE SERVICES, SIMILAR TO CHMC, ANOTHER SUPPORTED ORGANIZATION OF NSHA. THE PURPOSE OF NSHA IS TO OPERATE EXCLUSIVELY IN CONNECTION WITH AND FOR THE BENEFIT OF CHMC. THEREFORE, CAH IS DESIGNATED AS A SUPPORTED ORGANIZATION OF NSHA BY PURPOSE. PART IV, SECTION A, LINE 2: CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION, INC. (CHMC FOUNDATION) WAS ESTABLISHED AS A CODE SECTION 509(A)(3) SUPPORTING ORGANIZATION AND CONTINUES AS A FOUNDATION SUPPORTING CLAXTON-HEPBURN MEDICAL CENTER (CHMC), ANOTHER SUPPORTED ORGANIZATION OF NORTH STAR HEALTH ALLIANCE, INC. (NSHA). CHMC FOUNDATION IS IDENTIFIED AS A CODE SECTION 170(B)(1)(A)(VI) TYPE ORGANIZATION ON PART I LINE 12G(III) AS CHMC FOUNDATION WOULD QUALIFY AS A PUBLIC CHARITY UNDER CODE SECTION 170(B)(1)(A)(VI) IF IT WERE NOT A CODE SECTION 509(A)(3) SUPPORTING ORGANIZATION. PART I, LINE 12(G)(IV): CARTHAGE AREA HOSPITAL (CAH) BECAME A MEMBER OF NSHA SUBSEQUENT TO NSHA'S ESTABLISHMENT. THE PURPOSE OF CAH IS TO PROVIDE HEALTHCARE SERVICES, SIMILAR TO CHMC, ANOTHER SUPPORTED ORGANIZATION OF NSHA. THEREFORE CAH IS IDENTIFIED AS A SUPPORTED ORGANIZATION OF NSHA BY PURPOSE. NSHA IS IN THE PROCESS OF AMENDING ITS GOVERNING DOCUMENTS TO IDENTIFY CAH AS A SUPPORTED ORGANIZATION. 0 0 0 0 0 0 0 0 0 RICHARD DUVALL PRESIDENT AND CEO 0 981630 0 137382 0 0 0 6900 0 32763 0 1158675 0 0 PART I, LINE 3 THE BOARD OF DIRECTORS OF CLAXTON-HEPBURN MEDICAL CENTER CONTRACTS WITH AN INDEPENDENT SALARY COMPENSATION SPECIALIST TO ADVISE ITS EXECUTIVE COMMITTEE ON SETTING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, DIRECTORS ARE SENT A CONFLICT OF INTEREST FORM, AT WHICH TIME THEY CAN DECLARE AN "ACTUAL OR REASONABLY FORESEEABLE CONFLICT(S) OF INTEREST TO DISCLOSE." FORM 990, PART VI, SECTION C, LINE 19 THE CORPORATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CLAXTON-HEPBURN MEDICAL CENTER 214 KING STREET OGDENSBURG NY 13669 150559686 HEALTHCARE SERVICES NY 501(C)(3) LINE 3 NORTH STAR HEALTH ALLIANCE INC 1 CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION INC 125 NEW YORK AVENUE OGDENSBURG NY 13669 222488389 FUNDRAISING NY 501(C)(3) LINE 12B, II NORTH STAR HEALTH ALLIANCE INC 1 CLAXTON MEDICAL PC 214 KING STREET OGDENSBURG NY 13669 264009395 SPECIALTY HEALTHCARE SERVICES NY 501(C)(3) LINE 12B, II CLAXTON-HEPBURN MEDICAL CENTER 0 CARTHAGE AREA HOSPITAL 1001 WEST STREET CARTHAGE NY 13619 150622079 HEALTHCARE SERVICES NY 501(C)(3) LINE 3 NORTH STAR HEALTH ALLIANCE INC 1 MEADOWBROOK TERRACE INC 21957 COLE ROAD CARTHAGE NY 13619 454102458 ASSISTED LIVING NY 501(C)(3) LINE 10 CARTHAGE AREA HOSPITAL 0 CARTHAGE AREA HOSPITAL FOUNDATION INC 3 BRIDGE STREET CARTHAGE NY 13619 161467023 FUNDRAISING NY 501(C)(3) LINE 7 CARTHAGE AREA HOSPITAL 0 NORTH COUNTRY ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC 1571 WASHINGTON STREET SUITE 201 WATERTOWN NY 13601 731653922 SURGICAL SERVICES NY N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0