2020-11-16T15:27:48-06:00 2019-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2019-01-01 160960470 CROUSE HEALTH HOSPITAL INC CROU 3154707111 736 IRVING AVENUE SYRACUSE NY 132101687 KIMBERLY BOYNTON CEO 3154707111 2020-11-12 1 THOMAS DALTON P00645802 7168472651 2020-11-12 2019 2022-09-23 18:48:47Z CROUSE HOSPITAL KIMBERLY BOYNTON 736 IRVING AVENUE SYRACUSE NY 132101687 445482124 0 X WWW.CROUSE.ORG X 1913 NY TO PROVIDE THE BEST IN PATIENT CARE AND TO PROMOTE COMMUNITY HEALTH 15 11 3356 364 138479 104178 4749648 6997346 418223141 427821192 7059286 1446959 10333751 9216627 440365826 445482124 0 0 0 0 226781993 230561160 0 0 0 217519568 207289104 444301561 437850264 -3935735 7631860 286982807 275053719 287513047 292790743 -530240 -17737024 THE MISSION OF CROUSE HEALTH HOSPITAL, INC. IS TO PROVIDE THE BEST IN PATIENT CARE AND TO PROMOTE COMMUNITY HEALTH. 0 0 378210837 427821192 PROVISION OF HEALTHCARE SERVICES. CROUSE HEALTH HOSPITAL, INC. PROVIDES A VARIETY OF HEALTHCARE SERVICES TO A 15-COUNTY AREA IN CENTRAL NEW YORK. THE HOSPITAL OPERATES 505 ACUTE-CARE BEDS INCLUDING 57 BASSINETS. CROUSE HOSPITAL SERVICES APPROXIMATELY 22,000 INPATIENTS, MORE THAN 62,600 EMERGENCY SERVICE PATIENTS, AND MORE THAN 452,300 OUTPATIENTS ANNUALLY. CROUSE HOSPITAL PROVIDED APPROXIMATELY $3.7 MILLION IN CHARITY CARE IN 2019. ADDITIONAL DETAILS ON CROUSE HOSPITAL'S EXEMPT PURPOSE ACHIEVEMENTS ARE FOUND IN "CROUSE HOSPITAL'S 2019-2021 COMMUNITY SERVICE PLAN" WHICH CAN BE ACCESSED ON THE HOSPITAL WEBSITE WWW.CROUSE.ORG. 378210837 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 315 0 1 3356 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X KEVIN RANDALL CFO 3154707589 736 IRVING AVENUE SYRACUSE NY 13210 PATRICK MANNION DIRECTOR, BOARD CHAIR 1.00 1.00 X X 0 0 0 ELIZABETH HARTNETT DIRECTOR, VICE CHAIR 1.00 1.00 X X 0 0 0 PAUL KRONENBERG MD DIRECTOR, VICE CHAIR 1.00 1.00 X X 0 0 0 EDWARD BARNO DIRECTOR 1.00 1.00 X 0 0 0 MARY COTTER DIRECTOR 1.00 1.00 X 0 0 0 THOMAS HARTZHEIM MD DIRECTOR 1.00 1.00 X 75000 0 0 RICHARD RUSSELL DIRECTOR 1.00 1.00 X 0 0 0 ROBERT MIRON DIRECTOR 1.00 1.00 X 0 0 0 BARBARA ASHKIN DIRECTOR 1.00 1.00 X 0 0 0 JAMES HUGHES DIRECTOR 1.00 1.00 X 0 0 0 PATTY BLACK DIRECTOR 1.00 1.00 X 0 0 0 JAMES LONGO MD DIRECTOR 1.00 1.00 X 0 474287 10900 KENT SYVERUD DIRECTOR 1.00 1.00 X 0 0 0 TIMOTHY KENNEDY DIRECTOR 1.00 1.00 X 0 0 0 HAYES WANAMAKER MD DIRECTOR 1.00 0.00 X 75925 0 0 KIMBERLY BOYNTON PRESIDENT AND CEO 39.00 4.00 X 779960 44643 79840 KIMBERLY ROSE CHIEF INFORMATION OFFICER 36.00 4.00 X 213331 24687 45606 SETH KRONENBERG MD BOARD SECRETARY, CMO 39.00 4.00 X 447246 23876 43989 KEVIN RANDALL CFO 37.00 6.00 X 179556 9212 44183 SOHEIL ALTAFI MD PHYSICIAN 40.00 X 493401 0 51263 NORMA COONEY MD PHYSICIAN 40.00 X 415345 0 28062 DAVID MASON MD PHYSICIAN EMERGENCY DEPT 40.00 X 413404 0 79309 RICHARD STEINMANN MC PHYSICIAN EMERGENCY DEPT 40.00 X 380388 0 74310 MICHAEL JOROLEMON MD PHYSICIAN EMERGENCY DEPT 40.00 X 369314 0 72410 3842870 576705 529872 309 0 1 0 LABORATORY ALLIANCE 1304 BUCKLEY RD SYRACUSE NY 13212 PROFESSIONAL MEDICAL 10998624 CERNER HEALTH SERVICES PO BOX 959156 ST LOUIS MO 63195 IT CONSULTING 4512169 CROUSE MEDICAL GROUP PC 401 N SALINA STREET SUITE 400 SYRACUSE NY 13203 PROFESSIONAL MEDICAL 4280114 AMERICAN ANESTHESIOLOGY OF NEW YORK PC PO BOX 281034 ATLANTA GA 30384 PROFESSIONAL MEDICAL 4152863 CRITICAL CARE ASSOCIATES OF SYRACUSE PC 736 IRVING AVE SYRACUSE NY 13210 PROFESSIONAL MEDICAL 1587000 65 6018711 108659 869976 6997346 PATIENT REVENUE 623000 424217311 424217311 PARKING 812930 2176106 2176106 NYS DSRIP PROGRAM REVENUE 623000 576376 576376 DSS REVENUE 623000 479034 479034 RENT 532000 372365 372365 427821192 1333682 1333682 111277 2000 0 0 111277 2000 113277 113277 OTHER REVENUE 623000 3541034 3541034 COLLEGE OF NURSING 611600 2720865 2720865 CAFETERIA 721110 2471636 2471636 483092 138479 344613 9216627 445482124 427821192 138479 10525107 1771018 1771018 181943681 169243922 12699759 6059327 6059327 27708564 26752447 956117 13078570 9154999 3923571 776699 776699 205000 205000 19468778 17883484 1585294 1842891 1842891 1674150 1037973 636177 7152651 4434644 2718007 12030401 7458849 4571552 60488 27814 32674 63358 39282 24076 4171749 4171749 20034868 12434393 7600475 5087835 3064299 2023536 SUPPLIES 81214625 81214625 PURCHASED SERVICES 26085690 22715946 3369744 ALL OTHER EXPENSES 18544680 11321785 7222895 MAINTENANCE CONTRACTS 4264776 2644161 1620615 4610465 4610465 437850264 378210837 59639427 0 X 25675 25625 17975477 15417736 48957364 49863793 5302828 2697346 8401430 9023311 8831350 9020495 384053248 258570369 137856730 125482879 361 361 59631592 63522173 286982807 275053719 53556366 57171867 85645802 82632533 2457223 1841844 145853656 151144499 287513047 292790743 X -30742858 -50641370 30212618 32904346 -530240 -17737024 286982807 275053719 X 7631860 474175 -25312819 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 66033 0 0 66033 0 PART II-B, LINE 1: CROUSE HEALTH HOSPITAL, INC. CONTRACTED WITH THE WLADIS LAW FIRM EFFECTIVE 3/18/19 TO 3/18/20 TO SERVE AS STRATEGIC PLANNING, ECONOMIC DEVELOPMENT, AND FUNDING OBJECTIVES COUNSEL TO THE HOSPITAL. THE FEE FOR THOSE SERVICES IS $65,200 ANNUALLY PLUS EXPENSES. FOR THE YEAR ENDED DECEMBER 31, 2019, CROUSE HEALTH HOSPITAL, INC. PAID THE FIRM $65,200 IN PROFESSIONAL FEES AND $833 IN ADMINISTRATIVE EXPENSE REIMBURSEMENT. 26074042 270273 4294127 721542 29916900 27601980 690564 -1306174 912328 26074042 24638882 356484 3732270 1125656 27601980 22278661 1062111 2083238 785128 24638882 24667814 104449 -1304218 1189384 22278661 0.35290 0.64710 0.00000 0 1 1 25888 25888 217546174 132427465 85118709 16520515 13810203 2710312 142014148 112332701 29681447 7946523 7946523 125482879 INTEREST IN NET ASSETS OF CROUSE HEALTH FOUNDATION 31372147 ASSETS WHOSE USE IS LIMITED 30309750 FUNDS HELD IN TRUST BY OTHERS 1532199 BCBS ADVANCE 308077 63522173 SELF INSURED PROFESSIONAL LIABILITY 18153966 ACCRUED PENSION LIABILITY 103937861 POST RETIREMENT OBLIGATIONS 10880630 ASSET RETIREMENT OBLIGATIONS 2791683 FUNDS HELD IN TRUST 245220 LIABILITIES TO THIRD PARTY PAYERS 14956079 DUE TO AFFILIATES 179060 151144499 X PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME. MANAGEMENT BELIEVES THE ORGANIZATION IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR YEARS PRIOR TO 2016. PART V, LINE 4 ENDOWMENT FUNDS - CROUSE HEALTH FOUNDATION, INC., A RELATED ORGANIZATION, IS IN POSSESSION OF ENDOWMENT FUNDS TO SUPPORT CROUSE HEALTH HOSPITAL INC. THESE ENDOWMENT FUNDS ARE VALUED AT APPROXIMATELY $30 MILLION AT DECEMBER 31, 2019. THE PRINCIPAL, WITH AN APPROXIMATE VALUE OF $12 MILLION, REMAINS UNTOUCHED, WHILE THE INVESTMENT INCOME IS USED TO FUND EQUIPMENT AND PROGRAMS REQUIRED FOR HOSPITAL SERVICES AND INITIATIVES. 1 1 X 1 X 1 X 1 1 1 0 1 1 4807249 2166228 2641021 0.00600 108764393 76530697 32233696 0.07360 113571642 78696925 34874717 0.07960 628755 628755 0.00140 14236518 5811884 8424634 0.01920 1502152 1009805 492347 0.00110 7602 7602 0.00000 346629 346629 0.00080 16721656 6821689 9899967 0.02250 130293298 85518614 44774684 0.10210 288986 288986 0.00070 288986 288986 0.00070 1 11012412 206429 75570962 88478596 -12907634 X 1 1 1 1 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 X X X X CROUSE HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X CROUSE.ORG X ONGOV.NET/HEALTH X 1 19 1 HTTP://CROUSE.ORG/ABOUT/COMMUNITY-SERVICE-PLAN/ 0 1 X 100.000000000000 400.000000000000 X X X 1 1 X X X X 1 X HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ X HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ X HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X 1 0 0 CROUSE HOSPITAL PART V, SECTION B, LINE 5: TO DEVELOP THE COMMUNITY HEALTH NEEDS ASSESSMENT CROUSE HEALTH WORKED WITH ONONDAGA COUNTY HEALTH DEPARTMENT AND USED THREE APPROACHES TO GATHER INPUT FROM THE COMMUNITY. A COMMUNITY HEALTH ENGAGEMENT SURVEY WAS DISTRIBUTED ONLINE AND ON PAPER IN ENGLISH AND SPANISH AND DISTRIBUTED THROUGH A VARIETY OF OUTLETS INCLUDING AGENCY WEBSITES AND SOCIAL MEDIA PAGES. CROUSE PROMOTED THE SURVEY THROUGH THE WEBSITE, EMPLOYEE NEWSLETTER AND THE 6,000 SPIRIT OF WOMEN EMAIL LIST. SECONDLY, FOCUS GROUPS WERE CONDUCTED TO IDENTIFY HEALTH ISSUES IN POPULATIONS AT HIGHER RISK FOR POOR HEALTH OUTCOMES AND POTENTIALLY UNDERREPRESENTED IN SURVEY RESPONSES. A SOCIAL DETERMINANTS OF HEALTH SURVEY WAS DEVELOPED AND ADMINISTERED IN PERSON AT THE SYRACUSE TRANSPORTATION CENTER. CROUSE HOSPITAL PART V, SECTION B, LINE 6A: CROUSE HEALTH'S CHNA WAS CONDUCTED WITH SAINT JOSEPH HOSPITAL HEALTH CENTER AND UPSTATE UNIVERSITY HOSPITAL. CROUSE HOSPITAL PART V, SECTION B, LINE 6B: THE CHNA WAS SPEARHEADED BY THE ONONDAGA COUNTY DEPARTMENT OF HEALTH. HEALTHECONNECTIONS, THE AREA RHIO, WAS ALSO A PARTICIPANT. CROUSE HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA/CHIP IS ALSO AVAILABLE ON OTHER AGENCIES' WEBSITES THROUGHOUT THE COUNTY. CROUSE HOSPITAL PART V, SECTION B, LINE 11: THE CHNA AND CHIP WERE BASED UPON NYS PREVENTION AGENDA 2019 - 2024. PRIORITY AREA 1: PREVENT CHRONIC DISEASES: TO SUPPORT HEALTHY FOOD CHOICES CROUSE WILL OFFER THE HEALTHY CHOICES EDUCATION PROGRAM INCLUDING PROVIDING HEALTHY RECIPES AND OFFER WEIGHT WATCHERS PROGRAM AT A LOWER COST. CROUSE WILL SCREEN FOR FOOD INSECURITY AND PROVIDE RESOURCES FOR THOSE WHO SCREEN POSITIVE. TO SUPPORT TOBACCO PREVENTION CROUSE CREATED A COMPUTER-BASED EDUCATION PROGRAM ABOUT VAPING FOR HIGH SCHOOL STUDENTS AND PROVIDE THE RESOURCE FREE OF CHARGE. CROUSE INCREASED THE REACH OF EVIDENCE-BASED SMOKING CESSATION TRAINING TO SUD COUNSELORS WORKING WITH HIGHER RISK PATIENTS. ANOTHER FOCUS AREA IS PREVENTIVE CARE AND MANAGEMENT WITH A GOAL TO INCREASE EARLY DETECTION OF CHRONIC DISEASE. CROUSE PARTICIPATES IN THE AHA'S BLOOD PRESSURE MONITORING PROGRAMS TO ENGAGE THE COMMUNITY IN SELF-MANAGEMENT OF HYPERTENSION. ANOTHER PRIORITY AREA IS TO PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS. THIS INCLUDES SUPPORTING TRAININGS TO INCREASE THE AVAILABILITY OF PROVIDERS WHO PRESCRIBE MAT AND TRAINING MEMBERS OF THE PUBLIC ON THE USE OF NALOXONE TO PREVENT OVERDOSE DEATHS. ALSO TO PREVENT OPIOID AND OTHER SUBSTANCE MISUSE AND DEATHS CROUSE WILL: WORK WITH THE JAIL-BASED POPULATION TO DEVELOP A TRANSITION PLAN TO ENSURE TREATMENT POST DISCHARGE; ESTABLISH ELECTRONIC REFERRALS TO TREATMENT AND PROVIDE ON-CALL PEER SUPPORT IN THE ED; ADMINISTER SUBOXONE IN ED AND SET UP NEXT DAY APPOINTMENT AND PUBLICIZE NATIONAL DRUG TAKE BACK DAYS. TO PREVENT AND ADDRESS ADVERSE CHILDHOOD EXPERIENCES CROUSE WILL WORK WITH PARTNERS TO PROVIDE ACE EDUCATION TO SPECIFIC PATIENT POPULATIONS IN SUD TREATMENT AND PROVIDE EVIDENCE-BASED TRAUMA PROGRAMS TO OUTPATIENTS WITH SUD. CROUSE WILL PROVIDE FREE GROUP MEETINGS WITH TRAINED CLINICIANS FOR PMAD AND WILL EDUCATE CLINICIANS TO WORK WITH WOMEN WITH PMAD. CROUSE WILL ENSURE THAT SUICIDE SCREENING IS PROVIDED THROUGHOUT THE HOSPITAL AND FOR THOSE WHO SCREEN POSITIVE PROVIDE RESOURCES AND DECREASE TIME TO RECEIVE FOLLOW-UP. CROUSE HOSPITAL PART V, SECTION B, LINE 18E: WAGE GARNISHMENTS AND LIENS ON BANK ACCOUNTS CROUSE HOSPITAL PART V, SECTION B, LINE 19E: UNINSURED PATIENTS WHO RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE INFORMED OF A RANGE OF FINANCIAL ASSISTANCE OPTIONS THAT INCLUDE ASSISTANCE IN APPLYING FOR MEDICAID AND FOR CHARITY CARE DISCOUNTS. THE HOSPITAL CHARGES CONSISTENTLY ACROSS ALL PAYORS. THEREFORE, THE BILL FOR UNINSURED PATIENTS WHO RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IS AT GROSS CHARGES. THE UNINSURED INDIVIDUAL ADJUSTMENT TO GROSS CHARGES IS BASED ON THE HOSPITALS INCOME GUIDELINES ADJUSTED AGAINST OUR LOWEST COMMERCIAL INSURANCE RATE. CROUSE HOSPITAL PART V, SECTION B, LINE 20E: THE HOSPITAL MAKES EVERY ATTEMPT TO WORK WITH PATIENTS TO SECURE FINANCIAL ASSISTANCE TO ALLOW THE CHARGE TO BE REDUCED TO A LOWER RATE FOR PAYMENT. CROUSE HOSPITAL PART V, SECTION B, LINE 21D: UNINSURED PATIENTS WHO RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE INFORMED OF A RANGE OF FINANCIAL ASSISTANCE OPTIONS THAT INCLUDE ASSISTANCE IN APPLYING FOR MEDICAID AND FOR CHARITY CARE DISCOUNTS. THE HOSPITAL CHARGES CONSISTENTLY ACROSS ALL PAYORS. THEREFORE, THE BILL FOR UNINSURED PATIENTS WHO RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IS AT GROSS CHARGES. THE UNISURED INDIVIDUAL ADJUSTMENT TO GROSS CHARGES IS BASED ON THE HOSPITALS INCOME GUIDELINES ADJUSTED AGAINST OUR LOWEST COMMERCIAL INSURANCE RATE. 10 1 - CROUSE HOSPITAL-410 SOUTH CROUSE DIV 410 SOUTH CROUSE AVENUE SYRACUSE NY 13210 CHEMICAL DEPENDENCY OUTPATIENT TREATMENT SERVICES 2 - CNY MEDICAL IMAGING CENTER 739 IRVING AVENUE SYRACUSE NY 13210 MEDICAL IMAGING TESTING CENTER 4 - CROUSE HOSPITAL-COMMONWEALTH DIVISION 6010 EAST MOLLY ROAD SYRACUSE NY 13211 RESIDENTIAL CHEMICAL DEPENDENCY REHABILITATION 5 - PHYSICAL THERAPY-LIVERPOOL 7375 OSWEGO ROAD LIVERPOOL NY 13090 PHYSICAL THERAPY CENTER 6 - POB SURGERY CENTER 723 IRVING AVENUE SYRACUSE NY 13210 OUTPATIENT ABULATORY SURGERY CENTER 7 - PHYSICAL THERAPY - DEWITT 5823 WIDEWATERS PARKWAY EAST SYRACUSE NY 13057 PHYSICAL THERAPY CENTER 8 - MADISON IRVING SURGERY CENTER 475 IRVING AVENUE SYRACUSE NY 13210 OUTPATIENT ABULATORY SURGERY CENTER 9 - PHYSICAL THERAPY - CNY 739 IRVING AVENUE SYRACUSE NY 13210 PHYSICAL THERAPY CENTER 11 - PHYSICAL THERAPY - BRITTONFIELD 5000 BRITTONFIELD PKWY STE A123 EAST SYRACUSE NY 13057 PHYSICAL THERAPY CENTER 12 - HELP PEOPLE 890 7TH NORTH ST SUITE 203 LIVERPOOL NY 13088 EMPLOYEE ASSISTANCE PROGRAM PART I, LINES 7(E) AND 7(I) PART I 7(E)COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE:PROVIDED MONTHLY, WEEKLY, BI-WEEKLY SUPPORT GROUPS FOR THE COMMUNITY INCLUDING SURVIVORS AND FAMILIES FOR OSTOMY, BREAST CANCER, STROKE AND WEIGHT LOSS. ALSO INCLUDES WEEKLY SUPPORT GROUP FOR PMAD AS WELL AS THE AVAILABILITY OF ONE-ON-ONE COUNSELING.PROVIDED HEALTH INFORMATION ON BREAST HEALTH, HEART HEALTH, PELVIC HEALTH, REPRODUCTIVE HEALTH AND WELLNESS AMONG OTHER TOPICS THROUGH FREE EVENTS AND EDUCATIONAL OUTREACH. ALSO INCLUDES A PROGRAM DEVELOPED ABOUT VAPING WHICH IS OFFERED FREE OF CHARGE TO ALL AREA HIGH SCHOOLS AND RESOURCE OFFICERS.PROVIDED THE FREE PROGRAM, VISIT TO HOSPITAL LAND, TO GRADE SCHOOL CHILDREN AND REFUGEES. THIS PROGRAM IS AN INTRODUCTION TO WHAT A HOSPITAL DOES AND WHEN IS THE CORRECT TIME TO SEEK CARE. THIS PROGRAM WAS OFFERED BOTH ONSITE AND AT THE SCHOOLS IF REQUESTED.PROVIDED FREE EDUCATIONAL PROGRAMS TO THE EMS COMMUNITY IN 14 COUNTIES. THIS INCLUDED A FULL DAY IN THE FALL, AND A SHORT PROGRAM IN THE SPRING AS WELL AS A COURSE SPECIFIC TO TRANSPORT CARE. PHYSICIANS, NURSE PRACTITIONERS, NURSES, TECHS AND SENIOR LEADERS ARE INVOLVED IN THESE PROGRAMS.COMMUNITY BENEFIT OPERATIONS INCLUDE:DEDICATED STAFF FOR COMMUNITY BENEFIT OPERATIONS WHICH INCLUDES DEVELOPING THE CHNA AND CHIP. STAFF ASSISTING CENTRAL NEW YORKERS IN ACCESSING MEDICAID.CROUSE PROVIDES SUPPORT FOR THE CME PROGRAMS GRANT ADMINISTRATION FOR COMMUNITY BENEFIT ACTIVITIES AND DISASTER PREPARATION AS WELL AS STAFF TIME FOR THE COLLABORATIVE WORKING TO DECREASE HEALTH DISPARITIES AND MEDICAID USE THROUGH TARGETED PROGRAMS. PART I 7(I)PROVIDED CASH SUPPORT FOR NON-PROFITS WORKING TO IMPROVE THE HEALTH OF THE COMMUNITYPROVIDED AID TO PATIENTS IN POVERTY INCLUDING MEDICATIONS OFFERED AT NO COST, TRANSPORTATION AND ORGANIZING DISCHARGE AND ADMINISTRATION OF THE PROGRAMS.PROVIDED IN-KIND ROOM RENTALS, PARKING AND CME ACTIVITIES AS WELL AS PUBLIC SERVICE BY CROUSE MANAGEMENT. PART III, LINE 2: BAD DEBT EXPENSE IS THE AMOUNT PRESENTED IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. PART II, OTHER CROUSE PROVIDED EDUCATIONAL OPPORTUNITIES BY OFFERING OBSERVATIONS, INTERNSHIPS AND CLINICALS. IN 2019 CROUSE PROVIDED 160,548 HOURS IN TOTAL. PART III, LINE 4: THE FOOTNOTE DESCRIBING THE ORGANIZATION'S BAD DEBT EXPENSE IS INCLUDED IN THE 'SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES' THAT BEGINS ON PAGE 6 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED IS THE MEDICARE COST REPORT FOR 2019. OUTPATIENT COSTS ARE REPRESENTED ON MEDICARE COST REPORT WORKSHEET D, PARTS V AND VI. INPATIENT COSTS ARE ON WORKSHEET D-4. PART VI, LINE 2: CROUSE HEALTH WORKED WITH THE STEERING COMMITTEE LED BY ONONDAGA COUNTY DEPARTMENT OF HEALTH TO DEVELOP THE 2019 - 2021 COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN. IN ADDITION CROUSE ASSESSES THE NEEDS OF ITS COMMUNITY THROUGH FOCUS GROUPS WITH TARGETED PATIENT POPULATIONS. ADDICTION TREATMENT SERVICES INTERVIEWS/SURVEYS OUTPATIENTS ABOUT THEIR NEEDS, ESPECIALLY WHEN DISCUSSING SOCIAL DETERMINANTS OF HEALTH. THE PATIENT AND GUEST SERVICES DEPARTMENT FREQUENTLY CONVENES PATIENTS AND THEIR FAMILIES TO DISCUSS PATIENT NEEDS. CROUSE SENIOR STAFF WORK WITH AGENCIES ACROSS THE HEALTH/SOCIAL SERVICES SPECTRUM TO LEARN ABOUT NEEDS IN THE COMMUNITY. CROUSE, ALONG WITH UPSTATE UNIVERSITY HOSPITAL, IS ONE OF NYS'S REGIONAL PERINATAL CENTERS AND GATHERING INFORMATION ABOUT MOTHERS AND BABIES IS AN IMPORTANT PART OF THE MISSION. CROUSE GATHERS INFORMATION FROM 18 BIRTHING HOSPITALS IN A 14 COUNTY REGION. CROUSE STAFF GATHERS INFORMATION ABOUT THE COMMUNITY IT SERVES DURING ALL OUTREACH ACTIVITIES AND THROUGH THE SPIRIT OF WOMEN OUTREACH WITH AN EMAIL LIST OF 6,000. PART VI, LINE 3: THERE ARE SEVERAL WAYS CROUSE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS, WAS WELL AS UNDER OUR ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THOSE METHODS INCLUDE: A DEDICATED HOSPITAL DEPARTMENT WITH FOUR FULL-TIME EMPLOYEES WHOSE SOLE RESPONSIBILITY IS TO HELP INDIVIDUALS APPLY FOR GOVERNMENT OR OTHER FREE INSURANCE PROGRAMS, AS WELL AS TO NAVIGATE PATIENTS THROUGH THE CROUSE HOSPITAL FINANCIAL ASSISTANCE POLICY. THE POLICY IS POSTED ON THE CROUSE HOSPITAL WEBSITE, WWW.CROUSE.ORG, AND THERE IS A LINK ON EVERY PAGE OF THE WEBSITE THAT PEOPLE CAN CLICK TO FIND HELP WITH THEIR HOSPITAL BILL. FOLLOWING BEST PRACTICE MODELS, CROUSE HOSPITAL HAS DEVELOPED AN ONLINE APPLICATION FOR FINANCIAL AID. IT APPEARS ON THE HOSPITAL'S WEBSITE ALONG WITH THE FINANCIAL AID POLICY. CROUSE HOSPITAL DEVELOPED A SIMPLER, ONE-PAGE APPLICATION THAT IS EASIER TO FILL OUT AND ELIMINATED DUPLICATION OF PAPERWORK AND DOCUMENTATION - THE HOSPITAL'S FINANCIAL ASSISTANCE STAFF BRING COMPUTERS DIRECTLY TO PATIENTS' BEDSIDES TO ELECTRONICALLY COMPLETE FINANCIAL AID APPLICATION. THIS PROCEDURE IS INTENDED TO ELIMINATE BARRIERS TO ACCESSING CARE AND FINANCIAL ASSISTANCE BY AVOIDING LITERACY CONCERNS, ALLOWING PATIENTS TO ASK QUESTIONS IN REAL TIME, AND RECEIVE TRANSLATION SERVICES AS NECESSARY. EVERY CROUSE HOSPITAL BILLING NOTIFICATION INCLUDES A STATEMENT AT THE BOTTOM REFERENCING THE AVAILABILITY OF FINANCIAL ASSISTANCE BY CALLING CROUSE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND/OR ACCESSING THE POLICY THROUGH THE CROUSE WEBSITE. THE POLICY IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY. THE POLICY IS ALWAYS AVAILABLE ON REQUEST. PART VI, LINE 4: ONONDAGA COUNTY IS CENTRALLY LOCATED IN NYS AND COVERS 780 SQUARE MILES. THERE IS A TOTAL OF 467,669 RESIDENTS, A POPULATION DENSITY OF 600 PERSONS PER SQUARE MILE. SYRACUSE IS THE COUNTY'S HUB WITH A POPULATION OF 144,405 RESIDENTS. THERE ARE ALSO 19 TOWNS AND 15 VILLAGES. THE ONONDAGA NATION TERRITORY FALLS WITHIN ONONDAGA COUNTY.SYRACUSE HAS A HIGHER PROPORTION OF RESIDENTS LESS THAN 5 YEARS OLD AND A LOWER PROPORTION OF RESIDENTS OVER AGE 65 THAN ONONDAGA COUNTY. SYRACUSE HAS A LOWER MEDIAN AGE (30.6) THAN ONONDAGA COUNTY (38.8). IN ONONDAGA COUNTY 5.7% OF THE POPULATION IS UNDER 5 YEARS WHILE 6.6% POPULATION IN UNDER 5 IN SYRACUSE. NEARLY 16% OF THE COUNTY'S POPULATION IS 65 OR OLDER. IN ONONDAGA COUNTY NEARLY 80% OF THE POPULATION IDENTIFIES AS WHITE (SYRACUSE 55%) WITH 11.2% IDENTIFYING AS BLACK OR AFRICAN AMERICAN (SYRACUSE 29%), 3.9% ASIAN, 0.9% AS AMERICAN INDIAN. NEARLY 5% OF THE COUNTY'S POPULATION (OF ALL RACES) IDENTIFIES AS HISPANIC. WITHIN SYRACUSE 9.1% IDENTIFY AS HISPANIC.90.8% OF ONONDAGA COUNTY RESIDENTS HAVE A HIGH SCHOOL EDUCATION OR HIGHER, SYRACUSE 81.5% HAVE A HIGH SCHOOL EDUCATION OR HIGHER. OVERALL 14.9% OF ONONDAGA COUNTY RESIDENTS LIVE IN POVERTY, IN SYRACUSE 32.6% LIVE IN POVERTY. MORE THAN A THIRD OF BLACK OR AFRICAN AMERICAN RESIDENTS IN ONONDAGA COUNTY LIVE IN POVERTY COMPARED TO 10.3% OF WHITES. THE CITY OF SYRACUSE HAS SEVERAL HIGH-POVERTY NEIGHBORHOODS, DEFINED AS CENSUS TRACTS WHERE MORE THAN 40% OF RESIDENTS LIVE IN POVERTY. PART VI, LINE 5: CROUSE PROMOTES COMMUNITY HEALTH THROUGH ACTIVITIES SUCH AS THOSE LISTED IN PART V. IN ADDITION CROUSE: PROVIDES CARE COORDINATION THROUGHOUT THE HOSPITAL PROVIDES PEER RECOVERY ADVOCATES 24/7 PROVIDES AN INFANT LOSS SUPPORT GROUP PROVIDES THE CHOICES PROGRAM TO HIGH SCHOOL STUDENTS WITH A YEARLONG INSIDE LOOK AT CLINICAL DEPARTMENTS HEALTHCARE PROXY CARD DISTRIBUTION PROGRAM MASSAGE THERAPY FOR VETERANS SUFFERING FROM PTSD WORK WITH OVER 50 OTHER AGENCIES ON THE COUNTY DRUG TASK FORCE SEMINARS ED CAN PROVIDE FIRST DOSE OF MEDICATION ASSISTED TREATMENT AND SCHEDULE FOLLOW UP OUTREACH TO APPROPRIATE AGENCIES WITHIN SYRACUSE TO REACH PREGNANT AND PARENTING WOMEN WHO ARE USING DRUGS OR ALCOHOL. ENCOURAGE AND SUPPORT ALL EMPLOYEE EFFORTS TO IMPROVE COMMUNITY HEALTH - COAT/CLOTHING DRIVES FOR THE ED AND ADDICTION TREATMENT SERVICES, SCHOOL SUPPLIES FOR SYRACUSE SCHOOL CHILDREN, MONTHLY VOLUNTEERING WITH AN AGENCY PROVIDING FOOD FOR THE HOMELESS PROVIDE FREE TRAINING TO CLINICIANS FROM ALL OVER CENTRAL NEW YORK IN HOW TO SUPPORT PATIENTS WITH PMAD PRODUCING PODCASTS WITH HEALTHCARE EXPERTS ON SPECIFIC TOPICS SUCH AS CONTROLLING PAIN AND VAPING THAT ARE AVAILABLE ON SOCIAL MEDIA PART VI, LINE 7, REPORTS FILED WITH STATES NY X 1 1 X X X X X X 0 0 0 0 0 0 0 1 0 JAMES LONGO MD DIRECTOR 0 474287 0 0 0 0 0 0 0 10900 0 485187 0 0 KIMBERLY BOYNTON PRESIDENT AND CEO 724381 41857 52938 2786 2641 0 20085 1057 57313 1385 857358 47085 0 0 KIMBERLY ROSE CHIEF INFORMATION OFFICER 213331 24687 0 0 0 0 7009 779 35048 2770 255388 28236 0 0 SETH KRONENBERG MD BOARD SECRETARY, CMO 447246 23876 0 0 0 0 6673 351 35578 1387 489497 25614 0 0 KEVIN RANDALL CFO 179556 9212 0 0 0 0 3536 393 37671 2583 220763 12188 0 0 SOHEIL ALTAFI MD PHYSICIAN 468401 0 25000 0 0 0 7273 0 43990 0 544664 0 0 0 NORMA COONEY MD PHYSICIAN 413695 0 1650 0 0 0 4180 0 23882 0 443407 0 0 0 DAVID MASON MD PHYSICIAN EMERGENCY DEPT 385179 0 28225 0 0 0 10991 0 68318 0 492713 0 0 0 RICHARD STEINMANN MC PHYSICIAN EMERGENCY DEPT 366789 0 13599 0 0 0 19907 0 54403 0 454698 0 0 0 MICHAEL JOROLEMON MD PHYSICIAN EMERGENCY DEPT 352710 0 16604 0 0 0 11116 0 61294 0 441724 0 0 0 PART I, LINE 1A KIMBERLY BOYNTON WAS REIMBURSED FOR SOCIAL CLUB DUES. PART I, LINE 7 AS STIPULATED BY EMPLOYMENT CONTRACT, THE HOSPITAL 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 EXECUTIVES' 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 2019 WAS BASED ON 2018 OBJECTIVES. A 2016A SYRACUSE LOCAL DEVELOPMENT CORPORATION 474795153 2016-03-09 12800000 CAPITAL IMPROVEMENT PROJECT 0 0 0 B 2016B SYRACUSE LOCAL DEVELOPMENT CORPORATION 474795153 2016-03-09 9820000 CAPITAL IMPROVEMENT PROJECT 0 0 0 C 2016C SYRACUSE LOCAL DEVELOPMENT CORPORATION 474795153 2016-03-09 20000000 CAPITAL IMPROVEMENT PROJECT 0 0 0 D 2017A SYRACUSE LOCAL DEVELOPMENT CORPORATION 474795153 2017-11-15 17465000 DEFEASANCE OF OLDER BONDS 0 0 0 A 1065000 12800000 12800000 2018 0 0 0 1 B 830000 9820000 9820000 2018 0 0 0 1 C 1730000 20000000 20000000 2018 0 0 0 1 D 17465000 17465000 2017 1 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 C 0 0 1 1 0 0 0 1 D 0 0 1 1 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A SERIES 2019A ONONDAGA CIVIC DEVELOPMENT CORPORATION 2019-03-13 22915000 REVENUE REFUNDING BONDS 0 0 0 A 22915000 22915000 2019 1 0 1 1 A 0 0 1 1 0 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 TWO EX OFFICIO DIRECTORS OF THE HOSPITAL BOARD OF DIRECTORS, THE HOSPITAL CEO AND THE PRESIDENT OF THE HOSPITAL AUXILIARY, SERVE WITHOUT VOTE. THE HOSPITAL BYLAWS AUTHORIZE THE USE OF AN EXECUTIVE COMMITTEE WHICH HAS THE RIGHT TO EXERCISE ALL THE AUTHORITY OF THE BOARD OF DIRECTORS BETWEEN MEETINGS OF THE BOARD AND WITH THE GENERAL POWER TO DISCHARGE THE DUTIES OF THE BOARD, EXCEPT AS SUCH POWER MAY BE LIMITED BY LAW, THE BYLAWS OR THE BOARD ITSELF. FORM 990, PART VI, SECTION A, LINE 2 PATRICIA BLACK PROVIDES FINANCIAL SERVICES ADVICE TO JAMES HUGHES. FORM 990, PART VI, SECTION A, LINE 6 CROUSE HEALTH SYSTEM, INC IS THE SOLE MEMBER OF CROUSE HEALTH HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A CROUSE HEALTH SYSTEM, INC APPROVES AND ELECTS THE BOARD OF DIRECTORS OF CROUSE HEALTH HOSPITAL, INC FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD OF DIRECTORS OF CROUSE HEALTH HOSPITAL, INC. SUCH AS APPOINTMENT OF THE HOSPITAL PRESIDENT, ARE SUBJECT TO APPROVAL BY CROUSE HEALTH SYSTEM, INC FORM 990, PART VI, SECTION B, LINE 11B HOSPITAL 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 THE HOSPITAL CFO. THE REVIEWED FORM IS THEN PRESENTED TO THE FINANCE AND AUDIT COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL. COPIES OF FORM 990 AND ALL REQUIRED SCHEDULES ARE MADE AVAILABLE TO OTHER MEMBERS OF THE 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 BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES OF CROUSE HEALTH HOSPITAL. 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 BOARD OF DIRECTORS UPON COMPLETION OF THE COMPLIANCE REVIEW. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE CEO IS BASED ON AN ANNUAL EXECUTIVE COMMITTEE REVIEW IN CONJUNCTION WITH HUMAN RESOURCES. THE COMPENSATION FOR ALL KEY EMPLOYEES, OFFICERS, AND THE REST OF SENIOR MANAGEMENT IS DETERMINED BY THE CEO AND REVIEWED WITH HUMAN RESOURCES. CURRENT COMPENSATION IS COMPARED TO THE NATIONAL SALARY SURVEY AND ANY NECESSARY ADJUSTMENTS ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY OF CROUSE HOSPITAL CAN BE FOUND ON THE HOSPITAL'S WEBSITE, WWW.CROUSE.ORG UNDER "CORPORATE COMPLIANCE HANDBOOK'. AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS OF CROUSE HOSPITAL ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART X, LINES 20 AND 23 DEFERRED FINANCING COSTS LESS RELATED ACCUMULATED AMORTIZATION FOR THE YEARS 2018 AND 2019 HAVE BEEN NETTED WITH THE RELATED LONG-TERM DEBT IN ACCORDANCE WITH ASU 2015-03, "INTEREST-IMPUTATION OF INTEREST (SUBTOPIC 835-30): SIMPLIFYING THE PRESENTATION OF DEBT ISSUANCE COSTS" TO CONFORM WITH THE PRESENTATION USED IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. FORM 990, PART XI, LINE 9: PENSION AND POST-RETIREMENT CHANGES OTHER THAN PERIOD COSTS -9,618,448. INCREASE IN INTEREST IN NET ASSETS OF CROUSE HEALTH FOUNDATION 2,527,183. CHANGE IN FUNDS HELD IN TRUST BY OTHERS 164,545. OTHER -10,573. EQUITY TRANSFER -18,375,526. FORM 990, PART XII, LINE 2C CROUSE HEALTH HOSPITAL, INC. HAS NOT CHANGED THE PROCESS BY WHICH IT SELECTS ITS INDEPENDENT ACCOUNTANT OR OVERSEES THE AUDIT PROCESS FROM LAST YEAR. FORM 990, PART IV, LINE 34 IN 2010 THE HOSPITAL FORMED CROUSE MEDICAL PRACTICE, PLLC ("PLLC"). THE PLLC WAS FORMED TO FURTHER THE HOSPITAL'S CHARITABLE PURPOSES THROUGH THE ACQUISITION OF PHYSICIAN PRACTICES AND THE EMPLOYMENT OF PHYSICIANS. THE PLLC BORROWED ITS START-UP CAPITAL ON A FAIR MARKET NOTE FROM THE HOSPITAL, WHICH ACCRUES INTEREST DAILY. BECAUSE THE HOSPITAL EFFECTIVELY CONTROLS THE PLLC THROUGH CONTRACTUAL ARRANGEMENTS AND MAINTAINS SIGNIFICANT FINANCIAL SUPPORT OF THE PLLC, THE PLLCS FINANCIAL STATEMENTS ARE CONSOLIDATED WITH THE SYSTEM FOR FINANCIAL STATEMENT PURPOSES. SETH KRONENBERG IS THE SOLE MEMBER OF THE PLLC. ALL MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS COMPLETE ANNUAL CONFLICT OF INTEREST DISCLOSURES. FORM 990, PART VII, LINE 2 ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE HOSPITAL, EXCEPT MEMBER KIMBERLY BOYNTON, ARE VOLUNTARY. NO COMPENSATION, EMPLOYEE BENEFITS, OR EXPENSE ACCOUNT ALLOWANCES ARE RECEIVED FOR BOARD SERVICES. COMPENSATION IS DISCLOSED FOR EMPLOYEE SERVICES PROVIDED TO THE HOSPITAL OR ITS RELATED ORGANIZATIONS. CROUSE HEALTH NETWORK LLC 736 IRVING AVENUE SYRACUSE NY 13210 472918011 ESTABLISH/OPERATE ACCTABLE CARE ORG OF CLINICALLY INTEGR HLTHCARE PROVIDERS NY 0 0 CROUSE HEALTH HOSPITAL INC CROUSE HEALTH SYSTEM INC 736 IRVING AVENUE SYRACUSE NY 13210 161560473 TO PROVIDE OFF SITE SPACE AND SECURE CAPITAL 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 MEDICAL PRACTICE PLLC 736 IRVING AVENUE SYRACUSE NY 13210 800548096 FURTHER HOSPITAL'S PURPOSE BY PROVIDING PROFESSIONAL MEDICAL SERVICES NY 501(C)(3) LINE 7 CROUSE HEALTH HOSPITAL 1 0 0 1 0 1 0 0 0 0 1 0 0 1 0 1 0 1 0 0 CROUSE MEDICAL PRACTICE PLLC O 949036 INTERCO AGREEMENT CROUSE HEALTH FOUNDATION INC C 5070246 CROUSE HEALTH SYSTEM INC J 13175 INTERCOMPANY TRANSACTIONS