2021-11-15T14:17:11-06:00 2020-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2020-01-01 161035427 CROUSE HEALTH FOUNDATION INC CROU 3154707702 736 IRVING AVENUE SYRACUSE NY 132101687 CARRIE BERSE PRESIDENT 3154702655 2021-11-15 1 CARRIE BERSE XXX-XX-XXXX MARY MADONIA P00405803 7168472651 2021-11-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CARRIE BERSE 736 IRVING AVENUE SYRACUSE NY 132101687 3963935 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. 42 36 0 100 0 0 2851596 1718657 0 0 826622 747363 480005 460846 4158223 2926866 4344736 3631588 0 0 827255 764216 0 0 623973 278037 390325 5450028 4786129 -1291805 -1859263 31536697 33421639 164550 912155 31372147 32509484 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 2765800 2765800 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC FOR EQUIPMENT ACQUISTION, EDUCATION, AND SCHOLARSHIP. 865788 865788 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC BY UNDERWRITING EXPENSES ASSOCIATED WITH PATIENT AND GUEST RELATIONS, GRANT ADMINISTRATION AND OTHER PURPOSES. 3631588 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 5 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 42 36 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 STEVE MIRON TRUSTEE, BOARD CHAIR 1.00 2.00 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 887846 108338 JOYCE MAWHINNEY MACKNIGHT TRUSTEE, BOARD SECRETARY 1.00 X X 0 0 0 VINCENT SPINA 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 TRUSTEE,FOUNDATION PRESIDENT 41.00 X X 189208 0 45868 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 HERBERT E MENDEL MD TRUSTEE 1.00 X 0 0 0 JOAN O DADEY TRUSTEE 1.00 40.00 X 0 75542 41454 JOHN GAAL TRUSTEE 1.00 X 0 0 0 JOHN O'CONNOR TRUSTEE 1.00 X 0 0 0 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 245246 42625 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 269124 51041 189208 1497758 289326 1 0 1 0 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 STAFF SERVICES 764215 1 21385 133000 1564272 1718657 732062 732062 888371 873070 15301 15301 15301 624845 21385 163999 460846 460846 2926866 0 0 1208209 3621239 3621239 10349 10349 587471 117494 469977 176745 35349 141396 11678 11678 11400 11400 30864 30864 9626 9626 51520 51520 27210 27210 1501 1501 BAD DEBT 230065 230065 CREDIT CARD FEES 7933 7933 DONOR RELATIONS 4667 4667 OTHER EXPENSES 2725 2725 1136 1136 4786129 3631588 530568 623973 265397 282834 4315540 3317923 48672 53364 43722 41595 3628 2127 26104224 29004257 674050 630039 125186 131095 31536697 33421639 153722 904219 10828 7936 164550 912155 X 8482045 9495630 22890102 23013854 31372147 32509484 31536697 33421639 -1859263 2996600 0 X X 0 1 X 1 0 X 7395641 3268869 3077650 2851596 1718657 18312413 7395641 3268869 3077650 2851596 1718657 18312413 7172425 11139988 304825 438470 537875 655506 732062 2668738 20981151 3046697 0.53100 0.91660 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 29916900 318485 3701292 725939 33210738 26074042 270273 4294127 721542 29916900 27601980 690564 -1306174 912328 26074042 24638882 356484 3732270 1125656 27601980 22278661 1062111 2083238 785128 24638882 0.36730 0.63270 0.00000 1 0 43722 41595 2127 2127 LIABILITIES UNDER SPLIT-INTEREST AGREEMENT 7936 7936 X 6087465 2996600 163999 3160599 2926866 0 2926866 4950128 163999 163999 4786129 0 4786129 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 163,999. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST REVENUE 163,999. TRIBUTE EVENING 421464 0 421464 36500 1000 10245 GOLF TOURNAMENT 184978 21385 163593 19632 11475 24396 1 39788 0 39788 60751 646230 21385 624845 56132 11475 1000 95392 163999 460846 1 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 160960470 501(C)(3) 3621239 EQUIPMENT ACQUISTION, SCHOLARSHIPS & PROGRAM EXPENSES 1 GRANTS TO HOSPITAL EMPLOYEES IN NEED AS A RESULT OF CATASTROPHIC CIRCUMSTANCES. 2 10349 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 831168 0 55724 0 954 0 25921 0 82417 0 996184 0 0 KEVIN RANDALL TRUSTEE, BOARD ASST TREASU 0 269124 0 0 0 0 0 9506 0 41535 0 320165 0 0 MICHELLE BODE MD TRUSTEE 0 219434 0 25812 0 0 0 6180 0 36445 0 287871 0 0 CARRIE BERSE TRUSTEE,FOUNDATION PRESIDENT 189208 0 0 0 0 0 10506 0 35362 0 235076 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 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