2022-11-15T13:04:51-06:00 2021-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2021-01-01 800548096 CROUSE MEDICAL PRACTICE PLLC CROU 3154707317 739 IRVING AVENUE 300 SYRACUSE NY 13210 SETH KRONENBERG MD SOLE MEMBER 3154707825 2022-11-14 1 SETH KRONENBERG MD 999009999 MARY MADONIA P00405803 7168472651 2022-11-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z SETH KRONENBERG MD 739 IRVING AVENUE 300 SYRACUSE NY 13210 39486299 0 X WWW.CROUSEMED.COM X PLLC 2010 NY 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 1 0 513 0 0 0 2051861 0 29794149 36293655 0 0 3356164 3192644 35202174 39486299 0 0 0 0 38279136 42915151 0 0 0 20614127 22431731 58893263 65346882 -23691089 -25860583 7737240 6246472 7290841 6084539 446399 161933 X 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. 0 0 20252880 14970018 INTERNAL MEDICINE 14185390 9774629 CARDIOLOGY 8450484 4498503 GENERAL SURGERY & BARIATRICS 17632762 10243149 LAB, SPORTS MEDICINE, NEUROSURGERY, NEUROLOGY, CHRONIC CARE MANAGEMENT AND INTERVENTIONAL SPINE & PAIN MANAGEMENT. 17632762 10243149 60521516 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 57 0 1 513 1 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X SETH KRONENBERG MD 3154707317 739 IRVING AVENUE SUITE 300 SYRACUSE NY 13210 SETH KRONENBERG MD PRESIDENT 2.00 41.00 X X 30049 565140 47474 KEVIN RANDALL CFO 4.00 39.00 X 31954 269590 54091 KIMBERLY BOYNTON CEO 2.00 41.00 X 50235 941612 76246 DAVID PADALINO MD PHYSICIAN, NEUROSURGERY 40.00 0.00 X 840424 0 34963 CLIFFORD B SOULTS MD PHYSICIAN, NEUROSURGERY 40.00 0.00 X 697250 0 12248 RAGHU RAMASWAMY PHYSICIAN, NEUROSURGERY 40.00 0.00 X 747740 0 33042 ANIL GEORGE MD PHYSICIAN, CARDIOLOGIST 40.00 0.00 X 695809 0 34973 JOSEPH BATTAGLIA MD PHYSICIAN, CARDIOLOGY 40.00 0.00 X 702023 0 31741 3795484 1776342 324778 80 0 1 0 CNY SURGICAL PHYSICIANS 739 IRVING AVE 450 SYRACUSE NY 13210 SURGICAL SERVICES 5722316 PRACTICE RESOURCES LLC 1001 W FAYETTE ST SYRACUSE NY 13204 BILLING COMPANY 2033537 MCCARTHY TENTS & EVENTS 3353 BRIGHTON HENRIETTA TOWN LINE R ROCHESTER NY 14623 RAC TENT VENDOR 201651 JACKSON COKER 2655 NORTHWINDS PKWY ALPHARETTA GA 30009 LOCUM PROVIDER 107835 4 GROSS RECEIPTS/ PATIENT REVENUE 621110 36293655 36293655 36293655 OTHER INCOME 900099 3192644 3192644 3192644 39486299 39486299 0 0 112237 112237 36635570 35864805 770765 6167344 5890003 277341 79677 79677 29275 29275 10501 10501 308741 169826 138915 2085279 1800011 285268 PURCHASED SERVICES 11381177 10240872 1140305 OTHER EXPENSES 5771866 4083710 1688156 MEDICAL SUPPLIES 1868937 1868937 REPAIRS AND MAINTENANCE 513328 379649 133679 382950 223703 159247 65346882 60521516 4825366 0 1300820 1195800 589490 508384 3293101 2981600 184927 175343 621211 636573 6158639 5409867 662691 748772 1085000 0 7737240 6246472 5297356 5782161 593485 135090 1400000 167288 7290841 6084539 X 446399 161933 446399 161933 7737240 6246472 X -25860583 25576117 X X 0 1 X 1 0 X 1115 2051861 2052976 28523761 28487864 30575890 35202174 39486299 162275988 28524876 28487864 30575890 37254035 39486299 164328964 0 0 0 164328964 28524876 28487864 30575890 37254035 39486299 164328964 1.00000 1.00000 0.00000 X 1038740 813944 224796 4411028 3925342 485686 708871 670581 38290 748772 MEDICARE PREPAYMENT 167288 167288 X PART X, LINE 2: 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. 0 0 0 0 0 0 0 1 0 KIMBERLY BOYNTON CEO 43910 818193 6325 120175 0 3244 1293 24560 1483 48910 53011 1015082 0 0 DAVID PADALINO MD PHYSICIAN, NEUROSURGERY 840424 0 0 0 0 0 11600 0 23363 0 875387 0 0 0 RAGHU RAMASWAMY PHYSICIAN, NEUROSURGERY 747740 0 0 0 0 0 4469 0 28573 0 780782 0 0 0 JOSEPH BATTAGLIA MD PHYSICIAN, CARDIOLOGY 702023 0 0 0 0 0 11600 0 20141 0 733764 0 0 0 ANIL GEORGE MD PHYSICIAN, CARDIOLOGIST 695809 0 0 0 0 0 11364 0 23609 0 730782 0 0 0 CLIFFORD B SOULTS MD PHYSICIAN, NEUROSURGERY 697250 0 0 0 0 0 11600 0 648 0 709498 0 0 0 SETH KRONENBERG MD PRESIDENT 28549 536640 1500 28500 0 0 540 10265 1483 35186 32072 610591 0 0 KEVIN RANDALL CFO 30954 260590 1000 9000 0 0 1101 9912 2815 40263 35870 319765 0 0 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. 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. 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 N/A 0 CROUSE HEALTH FOUNDATION INC 736 IRVING AVENUE SYRACUSE NY 13210 161035427 FUNDRAISING FOR CROUSE HEALTH HOSPITAL NY 501(C)(3) LINE 7 N/A 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 CROUSE HEALTH HOSPITAL INC O 738462 INTERCO AGREEMENT