2022-11-14T13:24:28-06:00 2021-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2021-01-01 161035427 CROUSE HEALTH FOUNDATION INC CROU 3154707702 736 IRVING AVENUE SYRACUSE NY 132101687 JOHN BARSANTI INTERIM EXECUTIVE DIRECTOR 3154702655 2022-11-11 1 JOHN BARSANTI XXX-XX-XXXX MARY MADONIA P00405803 7168472651 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JOHN BARSANTI 736 IRVING AVENUE SYRACUSE NY 132101687 5382590 0 X WWW.CROUSE.ORG X 1974 NY THE MISSION OF CROUSE HEALTH FOUNDATION, INC IS TO SUPPORT CROUSE HOSPITAL INC IN PROVIDING THE BEST IN PATIENT CARE AND PROMOTING COMMUNITY HEALTH. 43 35 0 100 0 0 1718657 2023533 0 0 747363 1465249 460846 69947 2926866 3558729 3631588 1561185 0 0 764216 681635 0 0 556793 390325 166355 4786129 2409175 -1859263 1149554 33421639 36778618 912155 812122 32509484 35966496 THE MISSION OF CROUSE HEALTH FOUNDATION, INC IS TO SUPPORT CROUSE HOSPITAL INC IN PROVIDING THE BEST IN PATIENT CARE AND PROMOTING COMMUNITY HEALTH. 0 0 1545176 1545176 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC FOR EQUIPMENT ACQUISTION, EDUCATION, AND SCHOLARSHIP. 16009 16009 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC BY UNDERWRITING EXPENSES ASSOCIATED WITH PATIENT AND GUEST RELATIONS, GRANT ADMINISTRATION AND OTHER PURPOSES. 1561185 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 43 35 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X THE ORGANIZATION 3154707702 736 IRVING AVENUE SYRACUSE NY 132101687 VINCENT SPINA TRUSTEE, BOARD CHAIR 1.00 X X 0 0 0 SANDRA POMEROY TRUSTEE, BOARD VICE CHAIR 1.00 X X 0 0 0 THOMAS R CURRAN JR MD TRUSTEE, BOARD VICE CHAIR 1.00 X X 0 0 0 KIMBERLY BOYNTON TRUSTEE, BOARD VICE CHAIR 1.00 42.00 X X 0 991847 76246 JOYCE MAWHINNEY MACKNIGHT TRUSTEE, BOARD SECRETARY 1.00 X X 0 0 0 JOHN O'CONNOR TRUSTEE, BOARD TREASURER 1.00 X X 0 0 0 LISA BETHMANN TRUSTEE, BOARD ASST SECRET 1.00 X X 0 0 0 CARRIE BERSE TO 111921 TRUSTEE,FOUNDATION PRESIDE 41.00 X X 193224 0 46545 CHRISTINE O'CONNELL MORE TRUSTEE 1.00 X 0 0 0 CARLENE LACEY TRUSTEE 1.00 X 0 0 0 DOUGLAS LOGAN TRUSTEE 1.00 X 0 0 0 FRANK SMITH MD TRUSTEE 1.00 X 0 20000 0 JEFFREY ASCENZO MD TRUSTEE 1.00 X 0 599242 45313 JOAN O DADEY TRUSTEE 1.00 40.00 X 0 77280 41574 JOHN GAAL TRUSTEE 1.00 X 0 0 0 TOLANI AJAGBE MD TRUSTEE 1.00 X 0 266436 44759 ANITA LOMBARDI TRUSTEE 1.00 X 0 0 0 MARK WORDEN TRUSTEE 1.00 X 0 0 0 LINDSEY H HAZELTON TRUSTEE 1.00 X 0 0 0 PATRICIA DEFERIO TRUSTEE 1.00 X 0 0 0 MARK RE TRUSTEE 1.00 X 0 0 0 MELVIN T STITH TRUSTEE 1.00 X 0 0 0 MICHELE C JOHNSON TRUSTEE 1.00 X 0 0 0 PAMELA A REILLY TRUSTEE 1.00 X 0 0 0 GREGORY BAUM MD TRUSTEE 1.00 X 0 0 0 SALVATORE J BELLAVIA TRUSTEE 1.00 X 0 0 0 LAURENCE G BOUSQUET TRUSTEE 1.00 X 0 0 0 TIMOTHY ATSEFF TRUSTEE 1.00 X 0 0 0 ZACHARY ZUCKERMAN TRUSTEE 1.00 X 0 0 0 PETER DERRENBACKER TRUSTEE 1.00 X 0 0 0 STEVEN ST AMOUR TRUSTEE 1.00 X 0 0 0 JUDY COWDEN TRUSTEE 1.00 X 0 0 0 SCOTT KINGSLEY TRUSTEE 1.00 X 0 0 0 EDWARD BARNO TRUSTEE 1.00 X 0 0 0 MICHELLE BODE MD TRUSTEE 1.00 40.00 X 0 267793 43708 ROCHELLE CUMMINGS TRUSTEE 1.00 X 0 0 0 PAUL SOLOMON TRUSTEE 1.00 X 0 0 0 JEREMY THURSTON TRUSTEE 1.00 X 0 0 0 JENNIFER JACKSON DONAHOE TRUSTEE 1.00 X 0 0 0 MEGAN GRANT TRUSTEE 1.00 X 0 0 0 JEFFREY PAWLOWSKI TRUSTEE 1.00 X 0 0 0 KEVIN RANDALL TRUSTEE, BOARD ASST TREASU 1.00 42.00 X X 0 301544 54091 ANTHONY FIORITO TRUSTEE 1.00 X 0 0 0 193224 2524142 352236 1 0 1 0 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 STAFF SERVICES 681635 POMEROY COLLEGE OF NURSING 765 IRVING AVE 1 SYRACUSE NY 13210 SCHOLARSHIP 106250 2 31243 133005 1859285 2023533 706317 706317 2469407 1710475 758932 758932 758932 183333 31243 113386 69947 69947 3558729 0 0 1535196 1561185 1561185 193224 38645 154579 346482 69296 277186 141929 28386 113543 9408 9408 9900 9900 34890 34890 11141 11141 55984 55984 27210 27210 1501 1501 CREDIT CARD FEES 9099 9099 DUES & SUBSCRIPTIONS 2996 2996 DONOR RELATIONS 2386 2386 OTHER EXPENSES 1840 1840 2409175 1561185 291197 556793 282834 763362 3317923 3239509 53364 54990 43722 43096 2127 626 29004257 32093620 630039 497663 131095 128848 33421639 36778618 904219 220419 0 586758 7936 4945 912155 812122 X 9495630 10376522 23013854 25589974 32509484 35966496 33421639 36778618 1149554 2307458 0 X X 0 1 X 1 0 X 3268869 3077650 2851596 1718657 2023533 12940305 3268869 3077650 2851596 1718657 2023533 12940305 3132686 9807619 438470 537875 655506 732062 706317 3070230 16010535 3114680 0.61260 0.53100 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 33210738 984073 2243853 712149 35726515 29916900 318485 3701292 725939 33210738 26074042 270273 4294127 721542 29916900 27601980 690564 -1306174 912328 26074042 24638882 356484 3732270 1125656 27601980 0.35780 0.64220 0.00000 1 0 43722 43096 626 626 LIABILITIES UNDER SPLIT-INTEREST AGREEMENT 4945 4945 X 5979573 2307458 113386 2420844 3558729 0 3558729 2522561 113386 113386 2409175 0 2409175 PART V, LINE 4: THE PURPOSE OF THE FOUNDATION'S ENDOWMENT FUND IS TO GIVE ANNUAL GRANTS TO CROUSE HOSPITAL TO UNDERWRITE HIGH-PRIORITY EQUIPMENT AND PROGRAM NEEDS. ALL DONOR RESTRICTIONS FOR ENDOWMENT FUNDS ARE HONORED. PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(1). THE FOUNDATION FOLLOWS US GAAP PERTAINING TO UNCERTAIN TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE FOUNDATION FILES ITS RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX IN THE U.S. FEDERAL JURISDICTION AND THE ANNUAL FILING OF CHARITABLE ORGANIZATION IN NEW YORK STATE. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST REVENUE 113,386. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST REVENUE 113,386. CROUSE CLASSIC GOLF EVENT 195909 24168 171741 17880 13896 32060 SPIRIT OF WOMAN EVENT 18667 7075 11592 2380 5493 3501 2 38176 214576 31243 183333 20260 19389 73737 113386 69947 1 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 160960470 501(C)(3) 1561185 0 EQUIPMENT ACQUISTION, SCHOLARSHIPS & PROGRAM EXPENSES 1 PART I, LINE 2: THE FOUNDATION REIMBURSES CROUSE HEALTH HOSPITAL, INC. ONCE DOCUMENTATION IS PROVIDED. DOCUMENTATION CONSISTS OF INVOICE COPY AND PROOF OF PAYMENT SUPPORTED BY CHECK COPY. 0 0 0 0 0 0 0 0 0 KIMBERLY BOYNTON TRUSTEE, BOARD VICE CHAIR 0 862103 0 126500 0 3244 0 25853 0 50393 0 1068093 0 0 JEFFREY ASCENZO MD TRUSTEE 0 499242 0 100000 0 0 0 11600 0 33713 0 644555 0 0 KEVIN RANDALL TRUSTEE, BOARD ASST TREASU 0 291544 0 10000 0 0 0 11013 0 43078 0 355635 0 0 MICHELLE BODE MD TRUSTEE 0 230868 0 36925 0 0 0 6406 0 37302 0 311501 0 0 TOLANI AJAGBE MD TRUSTEE 0 266436 0 0 0 0 0 6987 0 37772 0 311195 0 0 CARRIE BERSE TO 111921 TRUSTEE,FOUNDATION PRESIDE 193224 0 0 0 0 0 10700 0 35845 0 239769 0 0 0 FORM 990, PART VI, SECTION A, LINE 7B THE ELECTION OF OFFICERS AND TRUSTEES OF CROUSE HEALTH FOUNDATION BY THE BOARD OF TRUSTEES OF THE FOUNDATION IS RATIFIED AND APPROVED BY CROUSE HEALTH SYSTEMS. CROUSE HEALTH FOUNDATION BY-LAWS REQUIRE CROUSE HEALTH SYSTEMS TO APPROVE ANY AMENDMENTS TO THE FOUNDATION'S BY-LAWS OR CERTIFICATE OF INCORPORATION BEFORE THE AMENDMENT CAN BE EFFECTIVE. FORM 990, PART VI, SECTION B, LINE 11B INFORMATION IS PROVIDED TO AN INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE 990 AND ALL REQUIRED SCHEDULES. THE FOUNDATION PRESIDENT AND LEGAL FOR THE FOUNDATION WILL REVIEW THE 990 AND ALL REQUIRED SCHEDULES BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE COMPLETED ANNUALLY BY THE BOARD OF TRUSTEES, OFFICERS, AND KEY EMPLOYEES OF CROUSE HEALTH FOUNDATION. THE STATEMENTS ARE REVIEWED BY SENIOR STAFF. THE STATEMENTS ARE ALSO AVAILABLE FOR REVIEW BY AN INDEPENDENT AUDITOR AS PART OF THE ANNUAL FINANCIAL AUDIT. ALL POTENTIAL CONFLICTS OF INTEREST ARE EVALUATED, REPORTED TO THE AUDIT COMMITTEE, AND THEN DISCUSSED AMONG THE PARTIES. A REPORT IS THEN PROVIDED TO THE BOARD OF TRUSTEES UPON COMPLETION OF THE COMPLIANCE REVIEW. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR ALL KEY EMPLOYEES, OFFICERS, CEO AND THE REST OF SENIOR MANAGEMENT OF CROUSE HEALTH HOSPITAL IS DONE BASED ON ANNUAL BOARD OF DIRECTOR REVIEW IN CONJUNCTION WITH HUMAN RESOURCES. CURRENT COMPENSATION IS COMPARED TO NATIONAL SALARY SURVEYS FOR COMPARABLE ORGANIZATIONS AND ANY NECESSARY ADJUSTMENTS ARE DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF CROUSE HEALTH HOSPITAL FOLLOWING REQUIREMENTS OF 26 C.F.R SECTION 53.4958-6(C). FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS OF CROUSE HEALTH FOUNDATION ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CROUSE HEALTH FOUNDATION HAS THE SAME CONFLICT OF INTEREST POLICY AS ITS AFFILIATED ORGANIZATION, CROUSE HEALTH HOSPITAL. THE CONFLICT OF INTEREST POLICY CAN BE FOUND ON THE HOSPITAL'S WEBSITE WWW.CROUSE.ORG UNDER "CORPORATE COMPLIANCE PROGRAM HANDBOOK". THE FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 160960470 HEALTH CARE SERVICES NY 501(C)(3) LINE 3 CROUSE HEALTH SYSTEM INC 0 CROUSE HEALTH SYSTEM INC 736 IRVING AVE SYRACUSE NY 13210 161560473 PROVIDE OFF SITE SPACE AND SECURE CAPITAL FOR CROUSE HEALTH HOSPITAL, INC. NY 501(C)(3) LINE 12B, II N/A 0 CROUSE MEDICAL PRACTICE PLLC 736 IRVING AVE SYRACUSE NY 13210 800548096 FURTHER CROUSE HOSPITAL'S PURPOSE BY PROVIDING PROFESSIONAL MEDICAL SERVICES NY 501(C)(3) LINE 10 N/A 0 CROUSE HEALTH NETWORK LLC 736 IRVING AVE SYRACUSE NY 13210 472918011 ESTABLISH/OPERATE ACCTABLE CARE ORG OF CLINICALLY INTEGR HLTHCARE PROVIDERS NY 501(C)(3) LINE 3 CROUSE HEALTH HOSPITAL INC 0 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0