2019-11-11T15:19:57-06:00 2018-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2018-01-01 161035427 CROUSE HEALTH FOUNDATION INC CROU 3154707702 736 IRVING AVENUE SYRACUSE NY 132101687 CARRIE BERSE PRESIDENT 3154707702 2019-10-30 1 THOMAS DALTON P00645802 7168472651 2019-10-30 104.193.28.34 2019-10-30 09:27:00 ED P E210C69A99B6B409F535E460B7A96F986BBED713 44735036D0E1FE8958DBFFEAB8C73E820E4484E1 2018 2020-03-31 21:24:44Z CARRIE BERSE 736 IRVING AVENUE SYRACUSE NY 132101687 11640517 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 37 0 100 64497 59072 3268869 3077650 0 0 2401610 1215789 161207 474518 5831686 4767957 4481135 4214146 0 0 805814 828997 0 0 794047 202759 313207 5489708 5356350 341978 -588393 32199384 29254935 312839 409971 31886545 28844964 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 3606152 3606152 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC FOR EQUIPMENT ACQUISTION, EDUCATION, AND SCHOLARSHIP. 607994 607994 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC BY UNDERWRITING EXPENSES ASSOCIATED WITH PATIENT AND GUEST RELATIONS, GRANT ADMINISTRATION AND OTHER PURPOSES. 4214146 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 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 9 0 1 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 43 37 1 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 751000 65499 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 MICHAEL TENGERES THRU AUGUST TRUSTEE, BOARD ASST TREASURER 1.00 42.00 X X 0 360735 8252 CARRIE BERSE PRESIDENT 40.00 X X 0 180945 43974 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 76268 37755 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 MARY-PAT DONALDSON NORTHRUP 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 DELL FORD-JORDAN TRUSTEE 1.00 X 0 0 0 SCOTT KINGSLEY TRUSTEE 1.00 X 0 0 0 SHARON SLATER TRUSTEE 1.00 X 0 0 0 MARY COTTER TRUSTEE 1.00 2.00 X 0 0 0 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 DAVID LANDSBERG MD TRUSTEE 1.00 X 0 72813 0 FRANK MENTO TRUSTEE 1.00 X 0 0 0 MARK RE TRUSTEE 1.00 X 0 0 0 KELLI HARRIS FORMER ASST TREASURER 0.00 X 0 152703 20302 0 1614464 175782 0 1 1 0 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 STAFF SERVICES 827728 THE ONCENTER 800 S STATE STREET SYRACUSE NY 13202 CONVENTION CENTER 175576 2 151208 2926442 3077650 537875 64497 473378 7179559 6501645 677914 677914 677914 845433 151208 370915 474518 474518 4767957 0 64497 1625810 4181517 4181517 32629 32629 637983 127597 510386 191014 38203 152811 13708 13708 11400 11400 55508 55508 16243 16243 48317 48317 27210 27210 619 619 1501 1501 CAPITAL CAMPAIGN 66409 66409 ANNUAL APPEAL 37851 37851 DONOR RELATIONS 17395 17395 CREDIT CARD FEES 9195 9195 7851 7851 5356350 4214146 348157 794047 452383 215928 6517510 5417944 44792 44978 43722 38592 6631 5130 21592396 22806455 3468204 646390 117468 118110 32199384 29254935 296272 396433 16567 13538 312839 409971 X 7613020 6832915 12255421 0 12018104 22012049 31886545 28844964 32199384 29254935 -588393 -2453188 0 X X 0 1 X 1 0 X 3075922 8395671 7395641 3268869 3077650 25213753 3075922 8395671 7395641 3268869 3077650 25213753 25213753 778621 337599 304825 438470 537875 2397390 27611143 0.91320 0.92140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 27601980 690564 -1306174 912328 26074042 24638882 356484 3732270 1125656 27601980 22278661 1062111 2083238 785128 24638882 24667814 104449 -1304218 1189384 22278661 25312798 644533 461758 1751275 24667814 0.34140 0.45890 0.19970 1 0 43722 38592 5130 5130 LIABILITIES UNDER SPLIT-INTEREST AGREEMENT 13538 13538 X 2630176 -2453188 370915 -2082273 4712449 55508 55508 4767957 5671757 370915 370915 5300842 55508 55508 5356350 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 370,915. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST REVENUE 370,915. TRIBUTE EVENING 691849 97800 594049 8600 124536 20910 98732 GOLF TOURNAMENT 200970 34345 166625 18146 18053 33558 1 103822 19063 84759 16399 11628 1250 19103 996641 151208 845433 43145 154217 22160 151393 370915 474518 1 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 160960470 501(C)(3) 4106152 EQUIPMENT ACQUISTION AND SCHOLARSHIPS 1 GRANTS TO HOSPITAL EMPLOYEES IN NEED AS A RESULT OF CATASTROPHIC CIRCUMSTANCES. 17 32629 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. 1 0 0 0 0 0 0 0 0 KIMBERLY BOYNTON TRUSTEE, BOARD VICE CHAIR 0 693647 0 55585 0 1768 0 15100 0 50399 0 816499 0 0 MICHAEL TENGERES THRU AUGUST TRUSTEE, BOARD ASST TREASURER 0 360735 0 0 0 0 0 2718 0 5534 0 368987 0 0 CARRIE BERSE PRESIDENT 0 180945 0 0 0 0 0 10021 0 33953 0 224919 0 0 KELLI HARRIS FORMER ASST TREASURER 0 152703 0 0 0 0 0 5327 0 14975 0 173005 0 0 PART I, LINE 4A MICHAEL TENGERES RECEIVED SEVERANCE PAYMENTS FROM CROUSE HEALTH HOSPITAL OF $205,000 DURING 2018. THAT AMOUNT IS INCLUDED IN THE TOTAL WAGES REPORTED IN PART II OF SCHEDULE J. FORMER ASSISTANT TREASURER, KELLI HARRIS RECEIVED SEVERANCE PAYMENTS DURING 2018 FROM CROUSE HEALTH HOSPITAL WHICH MAKE UP THE ENTIRE AMOUNT OF COMPENSATION FOR THIS FORMER EMPLOYEE AS SHOWN ON FORM 990, PART VII AND IN PART II OF SCHEDULE J. FORM 990, PART VI, SECTION A, LINE 2 MARY COTTER AND ROBERT MIRON ARE BOARD MEMBERS OF CROUSE HEALTH HOSPITAL, INC. AND CROUSE HEALTH SYSTEM, INC. 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. 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 7 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