2024-11-15T14:31:13-06:00 2023-12-31 161131146 BONADIO & CO LLP 432 NORTH FRANKLIN STREET SYRACUSE NY 13204 990 2023-01-01 264009395 CLAXTON MEDICAL PC CLAX 3157069762 214 KING STREET OGDENSBURG NY 13669 RICHARD A DUVALL SECRETARY 3157069762 2024-11-15 1 0 TIMOTHY HAMMOND P01224809 3154227109 2024-11-15 2023 2024-10-15 13:58:12Z RICHARD A DUVALL 214 KING STREET OGDENSBURG NY 13669 4309942 0 X HTTPS://WWW.CLAXTONHEPBURN.ORG/ X 2008 NY 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, TO 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. THE CORPORATION 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 4758461 4128385 0 0 64478 181557 4822939 4309942 0 0 0 0 11167525 9096579 0 0 0 4693959 6018318 15861484 15114897 -11038545 -10804955 520261 331991 65391717 76008402 -64871456 -75676411 X 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, TO 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. THE CORPORATION SHALL PURSUE SUCH PURPOSES, IN PART, BY INCLUDING AMONG ITS PATIENTS, MEDICARE AND MEDICAID PATIENTS AND THOSE WHO ARE UNDER- OR UNINSURED. 0 0 3027391 1160370 THE SURGICAL GROUP HAS TWO FULL-TIME PHYSICIANS, ONE FULL-TIME PHYSICIAN'S ASSISTANT, AND THREE FULL-TIME MEDICAL ASSISTANTS. DURING 2023, THE SURGICAL GROUP HAD 1,498 OFFICE VISITS. 1711179 577839 THE PEDIATRICS GROUP HAS ONE FULL-TIME PHYSICIAN AND TWO FULL-TIME NURSE PRACTITIONERS. DURING 2023, THE PEDIATRICS GROUP HAD 5,672 VISITS. 1300830 805222 THE INTERNAL MEDICINE GROUP HAS TWO FULL-TIME PHYSICIANS AND TWO FULL-TIME NURSE PRACTITIONERS. DURING 2023, THE INTERNAL MEDICINE GROUP HAD 8,288 OFFICE VISITS. 7247702 1766511 OTHER SPECIALTY MEDICAL SERVICES INCLUDING UROLOGY, PODIATRY, FAMILY MEDICINE, ENT, OBSTETRICS & GYNECOLOGY, CARDIOLOGY, NEPHROLOGY, PAIN MANAGEMENT, PULMONOLOGY, AND BARIATRICS. 7247702 1766511 13287102 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 0 0 0 X EMILY GAZDA 3154931000 40 FRANKLIN STREET CARTHAGE NY 13619 RICHARD A DUVALL SECRETARY 1.00 41.00 X X 0 649370 37353 MICHAEL S SEIDMAN PRESIDENT 1.00 41.00 X X 0 543436 9900 0 1192806 47253 0 0 1 0 0 PATIENT SERVICES 621400 4128385 4128385 4128385 OTHER REVENUE 900099 181557 181557 181557 4309942 4309942 0 0 X 7454845 6593696 861149 1641734 1452089 189645 4898984 4228884 670100 5854 5854 62609 3025 59584 23648 7667 15981 459179 459179 SUPPLIES 518406 501868 16538 OTHER EXPENSES 49638 40694 8944 15114897 13287102 1827795 0 0 220014 513710 111074 6451 803 100 100 520261 331991 236930 41693 65154787 75966709 65391717 76008402 X -64871456 -75676411 -64871456 -75676411 520261 331991 -10804955 0 X 0 1 X 1 0 X X 1 CLAXTON-HEPBURN MEDICAL CENTER 150559686 3 1 0 10487230 1 0 10487230 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 THE CORPORATION AND CLAXTON-HEPBURN MEDICAL CENTER (CHMC) IS A CONTINUING RELATIONSHIP SINCE THE INCEPTION OF THE CORPORATION IN 2008. THE PURPOSE OF THE CORPORATION IS TO ENGAGE IN THE PRACTICE OF MEDICINE AND SERVE THE MEDICAL NEEDS OF THE COMMUNITY SERVED BY CHMC, BY PROVIDING OFFICE BASED PRIMARY CARE AND SPECIALTY SERVICES. CHMC CONTROLS THE CORPORATION THROUGH SHAREHOLDER AND MANAGEMENT AGREEMENTS. 0 DUE TO CLAXTON-HEPBURN MEDICAL CENTER 75966709 75966709 0 0 0 0 0 0 0 0 0 RICHARD A DUVALL SECRETARY 0 649370 0 0 0 0 0 9900 0 27453 0 686723 0 0 MICHAEL S SEIDMAN PRESIDENT 0 543436 0 0 0 0 0 9900 0 0 0 553336 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 CLAXTON MEDICAL, P.C.'S BOARD OF DIRECTORS TO REVIEW. FORM 990, PART VI, SECTION B, LINE 12C CLAXTON-HEPBURN MEDICAL CENTER (CHMC)'S BOARD OF DIRECTORS CONTRACTS WITH AN EXTERNAL CONSULTING FIRM TO WORK WITH CHMC'S EXECUTIVE COMMITTEE TO ENSURE COMPLIANCE WITH IRC 4598 AND CONFLICT OF INTEREST DISCLOSURE FOR ALL AFFILIATES, INCLUDING THE CORPORATION. THROUGH THIS PROCESS, THE CORPORATION'S OFFICERS DISCLOSE CONFLICTS OF INTEREST ANNUALLY IN WRITING, AFTER REVIEWING THE CORPORATE POLICY. THESE CONFLICTS ARE REVIEWED BY THE FULL BOARD OF DIRECTORS OF CHMC ANNUALLY AND ARE KEPT ON FILE. 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. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,228,884. MANAGEMENT AND GENERAL EXPENSES 670,100. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,898,984. CLAXTON-HEPBURN MEDICAL CENTER 214 KING ST OGDENSBURG NY 13669 150559686 HEALTHCARE SERVICES NY 501(C)(3) LINE 3 NORTH STAR HEALTH ALLIANCE INC 0 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 0 NORTH STAR HEALTH ALLIANCE INC 214 KING ST OGDENSBURG NY 13669 161449491 HOLDING COMPANY NY 501(C)(3) LINE 12B, II N/A 0 CARTHAGE AREA HOSPITAL 1001 WEST STREET CARTHAGE NY 13619 150622079 HEALTHCARE SERVICES NY 501(C)(3) LINE 3 NORTH STAR HEALTH ALLIANCE INC 0 CARTHAGE AREA HOSPITAL FOUNDATION INC 3 BRIDGE STREET CARTHAGE NY 13619 161467023 FUNDRAISING NY 501(C)(3) LINE 7 CARTHAGE AREA HOSPITAL 0 MEADOWBROOK TERRACE INC 21957 COLE ROAD CARTHAGE NY 13619 564102458 ASSISTED LIVING NY 501(C)(3) LINE 10 CARTHAGE AREA HOSPITAL 0 NORTH COUNTRY ORTHOPEDIC AMBULATORY SURGERY CENTER LLC 1571 WASHINGTON STREET SUITE 201 WATERTOWN NY 13601 731653922 SURGICAL SERVICES NY N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0