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GOUVERNEUR HOSPITAL

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Company Details

Name: GOUVERNEUR HOSPITAL
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 05 Dec 2013 (12 years ago)
Entity Number: 4496686
ZIP code: 13642
County: St. Lawrence
Place of Formation: New York
Address: C/O CHIEF EXECUTIVE OFFICER, 77 WEST BARNEY STREET, GOUVERNEUR, NY, United States, 13642

Contact Details

Phone +1 315-562-1055

Phone +1 315-287-1000

Phone +1 315-287-4863

Phone +1 315-659-8993

Phone +1 315-347-3830

Phone +1 315-287-1903

Phone +1 315-287-1900

Fax +1 315-287-4863

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent C/O CHIEF EXECUTIVE OFFICER, 77 WEST BARNEY STREET, GOUVERNEUR, NY, United States, 13642

Unique Entity ID

Unique Entity ID:
KA3UNNL3MW33
CAGE Code:
771K3
UEI Expiration Date:
2025-12-20

Business Information

Activation Date:
2024-12-24
Initial Registration Date:
2014-08-06

Commercial and government entity program

CAGE number:
771K3
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2024-12-24
SAM Expiration:
2025-12-20

Contact Information

POC:
PENNY FISHEL
Corporate URL:
https://stlawrencehealthsystem.org/

National Provider Identifier

NPI Number:
1508581901
Certification Date:
2022-10-07

Authorized Person:

Name:
KELLY J CICCHINELLI
Role:
CFO
Phone:

Taxonomy:

Selected Taxonomy:
261QR1300X - Rural Health Clinic/Center
Is Primary:
Yes

Contacts:

History

Start date End date Type Value
2013-12-05 2019-03-18 Address 77 WEST BARNEY STREET, GOUVERNEUR, NY, 13642, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
201231000272 2020-12-31 CERTIFICATE OF AMENDMENT 2020-12-31
190318000606 2019-03-18 CERTIFICATE OF AMENDMENT 2019-03-18
131205000924 2013-12-05 CERTIFICATE OF INCORPORATION 2013-12-05

USAspending Awards / Financial Assistance

Date:
2022-05-27
Awarding Agency Name:
Department of Agriculture
Transaction Description:
ARP ECONOMIC DEVELOPMENT GRANT FOR RURAL HEALTH CARE FACILITIES
Obligated Amount:
9000000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2022-05-27
Awarding Agency Name:
Department of Agriculture
Transaction Description:
ARP ECONOMIC DEVELOPMENT GRANT FOR RURAL HEALTH CARE FACILITIES
Obligated Amount:
1000000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Tax Exempt

Employer Identification Number (EIN) :
46-4249555
In Care Of Name:
% RICHARD D JACOBS
Classification:
Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Ruling Date:
2014-09
National Taxonomy Of Exempt Entities:
Health Care: Hospitals and Related Primary Medical Care Facilities
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Determination Letters

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Date of last update: 26 Mar 2025

Sources: New York Secretary of State