CROUSE MEDICAL PRACTICE PLLC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CROUSE MEDICAL PRACTICE PLLC (EIN 80-0548096)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202233199349313733
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T13:04:51-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 454051133 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREED MAXICK CPAS PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 424 MAIN STREET SUITE 800 | AddressLine1Txt |
| City | BUFFALO | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 142023508 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 800548096 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROUSE MEDICAL PRACTICE PLLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CROU | BusinessNameControlTxt |
| Phone | 3154707317 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 739 IRVING AVENUE 300 | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13210 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SETH KRONENBERG MD | PersonNm |
| Person Title | SOLE MEMBER | PersonTitleTxt |
| Phone | 3154707825 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SETH | PersonFirstNm |
| Person Last | KRONENBERG MD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARY MADONIA | PreparerPersonNm |
| PTIN | P00405803 | PTIN |
| Phone | 7168472651 | PhoneNum |
| Preparation | 2022-11-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SETH KRONENBERG MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 739 IRVING AVENUE 300 | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $39,486,299 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CROUSEMED.COM | WebsiteAddressTxt |
| Type Of Organization Other | Yes (X) | TypeOfOrganizationOtherInd |
| Other Organization Dsc | PLLC | OtherOrganizationDsc |
| Formation | 2010 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE CONSISTENT, QUALITY MEDICAL CARE AND SERVICE TO OUR PATIENTS AND TO PROMOTE A HEALTHY COMMUNITY. PLEASE SEE PART III FOR THE COMPLETE MISSION | ActivityOrMissionDesc |
| Voting Members Governing Body | 1 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 513 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,051,861 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,794,149 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $36,293,655 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,356,164 | PYOtherRevenueAmt |
| CY Other Revenue | $3,192,644 | CYOtherRevenueAmt |
| PY Total Revenue | $35,202,174 | PYTotalRevenueAmt |
| CY Total Revenue | $39,486,299 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $38,279,136 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $42,915,151 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,614,127 | PYOtherExpensesAmt |
| CY Other Expenses | $22,431,731 | CYOtherExpensesAmt |
| PY Total Expenses | $58,893,263 | PYTotalExpensesAmt |
| CY Total Expenses | $65,346,882 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$23,691,089 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$25,860,583 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,737,240 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,246,472 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,290,841 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,084,539 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $446,399 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $161,933 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CROUSE MEDICAL PRACTICE WAS ESTABLISHED TO SUPPORT THE CHARITABLE PURPOSES OF CROUSE HOSPITAL, A SECTION 501(C)(3) ORGANIZATION, TO INCLUDE THE PROVISION OF PHYSICIAN SERVICES DESIGNED TO IMPROVE THE QUALITY OF HEALTHCARE AVAILABLE TO RESIDENTS IN CROUSE HOSPITAL'S SERVICE AREA, AND TO INCLUDE THE PROVISION OF NON-DISCRIMINATORY HEALTH CARE SERVICES TO MEDICARE AND MEDICAID RECIPIENTS, AS WELL AS UTILIZATION OF A CHARITY CARE POLICY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $20,252,880 | ExpenseAmt |
| Revenue | $14,970,018 | RevenueAmt |
| Desc | INTERNAL MEDICINE | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $14,185,390 | ExpenseAmt |
| Revenue | $9,774,629 | RevenueAmt |
| Desc | CARDIOLOGY | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,450,484 | ExpenseAmt |
| Revenue | $4,498,503 | RevenueAmt |
| Desc | GENERAL SURGERY & BARIATRICS | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $17,632,762 | ExpenseAmt |
| Revenue | $10,243,149 | RevenueAmt |
| Desc | LAB, SPORTS MEDICINE, NEUROSURGERY, NEUROLOGY, CHRONIC CARE MANAGEMENT AND INTERVENTIONAL SPINE & PAIN MANAGEMENT. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $17,632,762 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $10,243,149 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $60,521,516 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 57 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 513 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 1 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SETH KRONENBERG MD | PersonNm |
| Phone | 3154707317 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 739 IRVING AVENUE SUITE 300 | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13210 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| SETH KRONENBERG MD | ||||||||
| PRESIDENT | 2.00 | 41.00 | Yes (X) | Yes (X) | $30,049 | $565,140 | $47,474 | |
| KEVIN RANDALL | ||||||||
| CFO | 4.00 | 39.00 | Yes (X) | $31,954 | $269,590 | $54,091 | ||
| KIMBERLY BOYNTON | ||||||||
| CEO | 2.00 | 41.00 | Yes (X) | $50,235 | $941,612 | $76,246 | ||
| DAVID PADALINO MD | ||||||||
| PHYSICIAN, NEUROSURGERY | 40.00 | 0.00 | $840,424 | $0 | $34,963 | Yes (X) | ||
| CLIFFORD B SOULTS MD | ||||||||
| PHYSICIAN, NEUROSURGERY | 40.00 | 0.00 | $697,250 | $0 | $12,248 | Yes (X) | ||
| RAGHU RAMASWAMY | ||||||||
| PHYSICIAN, NEUROSURGERY | 40.00 | 0.00 | $747,740 | $0 | $33,042 | Yes (X) | ||
| ANIL GEORGE MD | ||||||||
| PHYSICIAN, CARDIOLOGIST | 40.00 | 0.00 | $695,809 | $0 | $34,973 | Yes (X) | ||
| JOSEPH BATTAGLIA MD | ||||||||
| PHYSICIAN, CARDIOLOGY | 40.00 | 0.00 | $702,023 | $0 | $31,741 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,795,484 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,776,342 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $324,778 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 80 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CNY SURGICAL PHYSICIANS | |||||
| 739 IRVING AVE 450 | SYRACUSE | NY | 13210 | SURGICAL SERVICES | $5,722,316 |
| PRACTICE RESOURCES LLC | |||||
| 1001 W FAYETTE ST | SYRACUSE | NY | 13204 | BILLING COMPANY | $2,033,537 |
| MCCARTHY TENTS & EVENTS | |||||
| 3353 BRIGHTON HENRIETTA TOWN LINE R | ROCHESTER | NY | 14623 | RAC TENT VENDOR | $201,651 |
| JACKSON COKER | |||||
| 2655 NORTHWINDS PKWY | ALPHARETTA | GA | 30009 | LOCUM PROVIDER | $107,835 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | GROSS RECEIPTS/ PATIENT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $36,293,655 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,293,655 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $36,293,655 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $3,192,644 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,192,644 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,192,644 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,486,299 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,486,299 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,237 | TotalAmt |
| Management And General | $112,237 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,635,570 | TotalAmt |
| Program Services | $35,864,805 | ProgramServicesAmt |
| Management And General | $770,765 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,167,344 | TotalAmt |
| Program Services | $5,890,003 | ProgramServicesAmt |
| Management And General | $277,341 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,677 | TotalAmt |
| Management And General | $79,677 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,275 | TotalAmt |
| Management And General | $29,275 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,501 | TotalAmt |
| Management And General | $10,501 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,741 | TotalAmt |
| Program Services | $169,826 | ProgramServicesAmt |
| Management And General | $138,915 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,085,279 | TotalAmt |
| Program Services | $1,800,011 | ProgramServicesAmt |
| Management And General | $285,268 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $11,381,177 | $10,240,872 | $1,140,305 |
| OTHER EXPENSES | $5,771,866 | $4,083,710 | $1,688,156 |
| MEDICAL SUPPLIES | $1,868,937 | $1,868,937 | |
| REPAIRS AND MAINTENANCE | $513,328 | $379,649 | $133,679 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $382,950 | TotalAmt |
| Program Services | $223,703 | ProgramServicesAmt |
| Management And General | $159,247 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,346,882 | TotalAmt |
| Program Services | $60,521,516 | ProgramServicesAmt |
| Management And General | $4,825,366 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,300,820 | BOYAmt |
| EOY | $1,195,800 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $589,490 | BOYAmt |
| EOY | $508,384 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,293,101 | BOYAmt |
| EOY | $2,981,600 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,927 | BOYAmt |
| EOY | $175,343 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $621,211 | BOYAmt |
| EOY | $636,573 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,158,639 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,409,867 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $662,691 | BOYAmt |
| EOY | $748,772 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,085,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,737,240 | BOYAmt |
| EOY | $6,246,472 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,297,356 | BOYAmt |
| EOY | $5,782,161 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,485 | BOYAmt |
| EOY | $135,090 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,400,000 | BOYAmt |
| EOY | $167,288 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,290,841 | BOYAmt |
| EOY | $6,084,539 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $446,399 | BOYAmt |
| EOY | $161,933 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $446,399 | BOYAmt |
| EOY | $161,933 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,737,240 | BOYAmt |
| EOY | $6,246,472 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$25,860,583 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $25,576,117 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,115 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus1 Year | $2,051,861 | CurrentTaxYearMinus1YearAmt |
| Total | $2,052,976 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $28,523,761 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,487,864 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $30,575,890 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $35,202,174 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $39,486,299 | CurrentTaxYearAmt |
| Total | $162,275,988 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $28,524,876 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,487,864 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $30,575,890 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $37,254,035 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $39,486,299 | CurrentTaxYearAmt |
| Total | $164,328,964 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $164,328,964 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $28,524,876 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,487,864 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $30,575,890 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $37,254,035 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $39,486,299 | CurrentTaxYearAmt |
| Total | $164,328,964 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 1.00000 | PublicSupportCY509Pct |
| Public Support PY509 | 1.00000 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,038,740 | OtherCostOrOtherBasisAmt |
| Depreciation | $813,944 | DepreciationAmt |
| Book Value | $224,796 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,411,028 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,925,342 | DepreciationAmt |
| Book Value | $485,686 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $708,871 | OtherCostOrOtherBasisAmt |
| Depreciation | $670,581 | DepreciationAmt |
| Book Value | $38,290 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $748,772 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICARE PREPAYMENT | Desc |
| Amt | $167,288 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $167,288 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | CROUSE MEDICAL PRACTICE, PLLC IS A PROFESSIONAL SERVICES LIMITED LIABILITY COMPANY AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME AS A NOT-FOR-PROFIT, CHARITABLE ENTITY. MANAGEMENT BELIEVES THIS ENTITY IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR YEARS PRIOR TO 2018. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIMBERLY BOYNTON | ||||||||||||||
| CEO | $43,910 | $818,193 | $6,325 | $120,175 | $0 | $3,244 | $1,293 | $24,560 | $1,483 | $48,910 | $53,011 | $1,015,082 | $0 | $0 |
| DAVID PADALINO MD | ||||||||||||||
| PHYSICIAN, NEUROSURGERY | $840,424 | $0 | $0 | $0 | $0 | $0 | $11,600 | $0 | $23,363 | $0 | $875,387 | $0 | $0 | $0 |
| RAGHU RAMASWAMY | ||||||||||||||
| PHYSICIAN, NEUROSURGERY | $747,740 | $0 | $0 | $0 | $0 | $0 | $4,469 | $0 | $28,573 | $0 | $780,782 | $0 | $0 | $0 |
| JOSEPH BATTAGLIA MD | ||||||||||||||
| PHYSICIAN, CARDIOLOGY | $702,023 | $0 | $0 | $0 | $0 | $0 | $11,600 | $0 | $20,141 | $0 | $733,764 | $0 | $0 | $0 |
| ANIL GEORGE MD | ||||||||||||||
| PHYSICIAN, CARDIOLOGIST | $695,809 | $0 | $0 | $0 | $0 | $0 | $11,364 | $0 | $23,609 | $0 | $730,782 | $0 | $0 | $0 |
| CLIFFORD B SOULTS MD | ||||||||||||||
| PHYSICIAN, NEUROSURGERY | $697,250 | $0 | $0 | $0 | $0 | $0 | $11,600 | $0 | $648 | $0 | $709,498 | $0 | $0 | $0 |
| SETH KRONENBERG MD | ||||||||||||||
| PRESIDENT | $28,549 | $536,640 | $1,500 | $28,500 | $0 | $0 | $540 | $10,265 | $1,483 | $35,186 | $32,072 | $610,591 | $0 | $0 |
| KEVIN RANDALL | ||||||||||||||
| CFO | $30,954 | $260,590 | $1,000 | $9,000 | $0 | $0 | $1,101 | $9,912 | $2,815 | $40,263 | $35,870 | $319,765 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | CROUSE MEDICAL PRACTICE, PLLC IS A MEMBER MANAGED PROFESSIONAL LIMITED LIABILITY COMPANY. THE SOLE MEMBER, SETH KRONENBERG, M. D. IS EMPLOYED BY CROUSE HOSPITAL. HIS COMPENSATION IS COMPARED TO NATIONAL AND REGIONAL SALARY SURVEYS AND ANY NECESSARY ADJUSTMENTS ARE DETERMINED BY THE CHIEF EXECUTIVE OFFICER. A PORTION OF THE SOLE MEMBER'S ANNUAL COMPENSATION, INCLUDING BENEFITS, IS ALLOCATED AND CHARGED BACK TO CROUSE MEDICAL PRACTICE, PLLC BASED UPON THE AMOUNT OF TIME THE SOLE MEMBER DEVOTES TO CROUSE MEDICAL PRACTICE ACTIVITIES. |
| PART I, LINE 7 | AS STIPULATED BY HER EMPLOYMENT CONTRACT, THE PLLC CEO RECEIVED INCENTIVE COMPENSATION IN AN AMOUNT THAT WAS DETERMINED BY THE BOARD OF DIRECTORS, NOT TO EXCEED 10% OF BASE SALARY. THE INCENTIVE WAS BASED UPON THE EXECUTIVE'S ACHIEVEMENT OF OBJECTIVES THAT WERE MUTUALLY AGREED UPON BY THE EXECUTIVE AND THE BOARD OF DIRECTORS, OR A COMMITTEE THEREOF. THE OBJECTIVES WERE ESTABLISHED ANNUALLY. THE BOARD OF DIRECTORS DETERMINED THE AMOUNT OF INCENTIVE COMPENSATION. INCENTIVE COMPENSATION RECEIVED IN 2021 WAS BASED ON 2020 OBJECTIVES. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | SETH KRONENBERG, M.D. IS THE SOLE MEMBER OF THE PLLC. |
| FORM 990, PART VI, SECTION A, LINE 7A | ADMISSION OF ANY MEMBERS REQUIRES THE APPROVAL OF CROUSE HEALTH HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER HAS THE AUTHORITY TO ADMIT NEW MEMBERS AND MANAGE THE BUSINESS OF CROUSE MEDICAL PRACTICE, PLLC; PROVIDED, HOWEVER, CROUSE HOSPITAL HAS CERTAIN AUTHORITY TO APPROVE ACTIONS WHICH IMPACT THE GOVERNANCE OF THE COMPANY INCLUDING THE RIGHT TO APPROVE THE ADMISSION OF ANY NEW MEMBERS; APPROVE SETTLEMENTS OR CONFESS A JUDGMENT; DISSOLVE THE COMPANY; APPROVE SALE OF COMPANY ASSETS; APPROVE MERGER OR CONSOLIDATION; APPROVE BORROWING AMOUNTS IN EXCESS OF $1,000 (OTHER THAN DEBT INCURRED IN THE ORDINARY COURSE OF BUSINESS); APPROVE DEBTS PAYABLE OVER MORE THAN ONE YEAR; AND APPROVE AMENDMENT OF THE COMPANY'S ARTICLES OF ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | CROUSE MEDICAL PRACTICE PLLC ACCOUNTING STAFF PROVIDES DATA TO AN INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 AND ALL REQUIRED SCHEDULES. IT IS REVIEWED BY LEGAL COUNSEL AND MANAGEMENT. THE REVISED FORM IS THEN PRESENTED TO THE SOLE MEMBER AND THE PRESIDENT OF CROUSE MEDICAL PRACTICE PLLC FOR THEIR REVIEW AND APPROVAL, PRIOR TO FILING. THE FORM 990 IS ALSO PRESENTED TO THE FINANCE AND AUDIT COMMITTEE OF CROUSE HOSPITAL BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL. COPIES OF THE FORM 990 AND ALL REQUIRED SCHEDULES ARE MADE AVAILABLE TO OTHER MEMBERS OF THE CROUSE HOSPITAL BOARD OF DIRECTORS UPON THEIR REQUEST, PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE COMPLETED ANNUALLY BY THE CROUSE MEDICAL PRACTICE MEMBER AND OFFICER, CROUSE HOSPITAL BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES. ONCE COLLECTED, THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY MEMBERS OF THE CORPORATE COMPLIANCE OFFICE. ALL REPORTED POTENTIAL CONFLICTS OF INTEREST ARE EVALUATED AND DISCUSSED AMONG THE PARTIES. A REPORT IS PROVIDED TO THE CROUSE HOSPITAL BOARD OF DIRECTORS UPON COMPLETION OF THE COMPLIANCE REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE SOLE MEMBER, SETH KRONENBERG, M.D. IS EMPLOYED BY CROUSE HOSPITAL. HIS COMPENSATION IS COMPARED TO NATIONAL AND REGIONAL SALARY SURVEYS AND ANY ADJUSTMENTS ARE DETERMINED BY THE CHIEF EXECUTIVE OFFICER. A PORTION OF THE SOLE MEMBER'S ANNUAL COMPENSATION, INCLUDING BENEFITS, IS ALLOCATED AND CHARGED BACK TO CROUSE MEDICAL PRACTICE, PLLC BASED UPON THE AMOUNT OF TIME THE SOLE MEMBER DEVOTES TO CROUSE MEDICAL PRACTICE ACTIVITIES. |
| FORM 990, PART VI, SECTION C, LINE 19 | AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS OF CROUSE MEDICAL PRACTICE ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER TO CROUSE HEALTH HOSPITAL, INC., A RELATED PARTY 25,576,117. |
| FORM 990 PART XII, LINE 2C | NEITHER THE OVERSIGHT OR SELECTION PROCESS USED BY THE AUDIT COMMITTEE HAS CHANGED DURING THE CURRENT YEAR. |
| FORM 990, PART XI, LINE 9, EQUITY TRANSFER | THE PLLC HAD A NOTE PAYABLE WITH CROUSE HEALTH HOSPITAL ("CHH" A RELATED PARTY) FOR APPROXIMATELY $69,907,000. THE NOTE CONSISTED OF ORIGINAL CASH CONTRIBUTIONS TO FUND THE PLLC AND ADDITIONAL RECURRING CONTRIBUTIONS TO FUND ANY ADDITIONAL DEFICITS. THE BALANCE WAS FORGIVEN, AS THE PLLC WAS FORMED TO FURTHER THE CHARITABLE PURPOSE OF CHH, IT IS ANTICIPATED THAT CHH WILL CONTINUE TO FUND THE PLLC WITH NO EXPECTATION AS TO REPAYMENT OR ANY OTHER FORM OF CONSIDERATION. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CROUSE HEALTH HOSPITAL INC | |||||||||||
| 736 IRVING AVENUE | SYRACUSE | NY | 13210 | 160960470 | TO PROVIDE PATIENT CARE | NY | 501(C)(3) | LINE 3 | CROUSE HEALTH SYSTEM INC | 0 | |
| CROUSE HEALTH SYSTEM INC | |||||||||||
| 736 IRVING AVENUE | SYRACUSE | NY | 13210 | 161560473 | TO PROVIDE OFF-SITE SPACE AND SECURE CAPITAL FOR CROUSE HEALTH HOSPITAL | NY | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| CROUSE HEALTH FOUNDATION INC | |||||||||||
| 736 IRVING AVENUE | SYRACUSE | NY | 13210 | 161035427 | FUNDRAISING FOR CROUSE HEALTH HOSPITAL | NY | 501(C)(3) | LINE 7 | 0 | N/A | |
| CROUSE HEALTH NETWORK LLC | |||||||||||
| 736 IRVING AVENUE | 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 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROUSE HEALTH HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | O | TransactionTypeTxt |
| Involved | $738,462 | InvolvedAmt |
| Method Of Amount Determination | INTERCO AGREEMENT | MethodOfAmountDeterminationTxt |
Comments