2018-11-02T13:30:50-05:00 2017-12-31 161071694 SCIARABBA WALKER & CO LLP 410 EAST UPLAND ROAD ITHACA NY 14850 990 2017-01-01 204356115 CAYUGA MEDICAL ASSOCIATES PC CAYU 6072772365 101 DATES DRIVE ITHACA NY 14850 MARTIN STALLONE PRESIDENT 6072772365 2018-11-02 1 RENATA DABROWSKA P01450486 6072725550 66.152.125.150 2018-11-02 14:30:39 ED P 0A33C264FA1FCCAC2D8BC59ED388F558F676C7BA 7CC27537FE24208C909857BA297C5FA635D2BA31 2017 2019-02-21 02:37:17Z MARTIN STALLONE 101 DATES DRIVE ITHACA NY 14850 44865529 0 X N/A X 2006 NY TO PROVIDE COMPREHENSIVE MEDICAL SERVICES TO THE ORGANIZATION'S SERVICE AREA. 4 0 284 0 0 0 14280583 16971343 23388292 27871606 664 274 21706 22306 37691245 44865529 0 0 0 0 26235696 31129825 0 0 0 11085292 14532107 37320988 45661932 370257 -796403 5039283 4855482 3709250 4321852 1330033 533630 CAYUGA MEDICAL ASSOCIATES WILL DELIVER THE HIGHEST QUALITY HEALTHCARE, IN PARTNERSHIP WITH CAYUGA MEDICAL CENTER, ONE PERSON AT A TIME. 0 0 41141265 27893912 IN 2017, THE ORGANIZATION PROVIDED MEDICAL SERVICES TO 35,126 PATIENTS IN THE COURSE OF CONDUCTING 163,793 PATIENT VISITS. THE ORGANIZATION PROVIDES MEDICAL CARE TO ALL PATIENTS, REGARDLESS OF INABILITY TO PAY. THE ORGANIZATION ALSO OFFERS A FINANCIAL ASSISTANCE PROGRAM THAT, BASED ON FEDERAL POVERTY GUIDELINES, PROVIDES FREE OR REDUCED FEE CARE TO QUALIFYING INDIVIDUALS. IN 2017, THE ORGANIZATION'S PHYSICIANS CONDUCTED OVER 27,922 VISITS WITH MEDICAID AND LOW INCOME PATIENTS. THE ORGANIZATION CONTINUES WITH THE COMMITMENT TO ACCEPT PATIENTS FROM THE LOCAL PHYSICIANS' REFERRAL CENTER, REGARDLESS OF INABILITY TO PAY. 41141265 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 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 50 0 284 1 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X CAYUGA MEDICAL ASSOCIATES PC ADMIN 6072772365 1301 TRUMANSBURG RD SUITE P ITHACA NY 14850 MARTIN STALLONE MD SECRETARY/TREASURER 40.00 X X 310090 0 21808 DIRK DUGAN MD DIRECTOR 40.00 X 345611 0 25419 HENRY GERSON MD VICE PRESIDENT 2.50 37.50 X X 0 191969 7368 DAVID GEORGE EVELYN MD PRESIDENT 2.50 37.50 X X 0 381010 12046 BENJAMIN NEGLEY EXECUTIVE DIRECTOR 40.00 X 173805 0 26371 MARCIS SODUMS MD PHYSICIAN 40.00 X 567512 0 25419 LAVANYA KODALI MD PHYSICIAN 40.00 X 567207 0 29065 PAUL STEFEK MD PHYSICIAN 40.00 X 569512 0 25419 DEIDRE BLAKE MD PHYSICIAN 40.00 X 646218 0 29179 MICHAEL WATERS MD PHYSICIAN 40.00 X 573094 0 24892 3753049 572979 226986 59 0 1 0 UNIVERSITY OF ROCHESTER MEDICAL CENTER 607 ELMWOOD AVE ROCHESTER NY 14642 PROFESSIONAL MEDICAL SERVICES 1974917 CAYUGA MEDICAL CENTER 101 DATES DRIVE ITHACA NY 14850 PROFESSIONAL MEDICAL SERVICES 1092989 PRACTICE RESOURCES LLC 1001 WEST FAYETTE STREET STE 400 SYRACUSE NY 132042856 MEDICAL BILLING SERVICE 770627 BRENT PARK LLC 15 THORNWOOD DR ITHACA NY 14850 RENT 603723 COMPHEALTH INC PO BOX 972651 DALLAS TX 75397 PROFESSIONAL MEDICAL SERVICES 524847 18 16971343 16971343 PATIENT FEES 621110 24355415 24355415 SERVICE FEES 621110 3013422 3013422 MISCELLANEOUS 900099 502769 502769 27871606 274 274 22306 0 22306 22306 22306 44865529 27893912 0 274 X 876460 676284 200176 25210577 23629583 1580994 1035875 966307 69568 2527553 2000389 527164 1479360 1352785 126575 28723 12752 15971 160349 500 159849 5085400 3731748 1353652 150400 150400 48847 44388 4459 608087 608087 2076428 1906170 170258 32479 32479 2719 2719 544535 363467 181068 1272655 1141722 130933 MEDICAL SUPPLIES 1389974 1389974 LEASED MD'S 1250137 1250137 BAD DEBT 794366 794366 UTILITIES 487910 487910 599098 599098 45661932 41141265 4520667 0 535458 202730 289 9532 2248277 2259006 190491 143885 5342541 3102212 2064768 2240329 5039283 4855482 1045245 819182 46636 40020 2617369 3462650 3709250 4321852 X 1330033 533630 1330033 533630 5039283 4855482 -796403 0 X X 0 1 X 1 0 X 8094486 11041589 13983354 14280583 16971343 64371355 19630444 20849719 22029514 23388292 27871606 113769575 27724930 31891308 36012868 37668875 44842949 178140930 0 0 0 178140930 134 59 114 664 274 1245 134 59 114 664 274 1245 19439 21706 22306 63451 27725064 31891367 36032421 37691245 44865529 178205626 0.99960 0.99940 0.00000 0.00030 X 1594529 728569 865960 3266919 1912405 1354514 481093 461238 19855 2240329 ACCRUED PAYROLL LIABILITIES 1602657 ACCRUED PAYROLL 663576 ACCRUED EXPENSES / RENT 1196417 3462650 44071163 0 44071163 794366 794366 44865529 44867566 0 44867566 794366 794366 45661932 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 794,366. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 794,366. X 1 1 X 0 0 0 0 0 0 1 0 0 MARTIN STALLONE MD SECRETARY/TREASURER 268762 0 41328 0 0 0 8100 0 13708 0 331898 0 0 0 DIRK DUGAN MD DIRECTOR 345611 0 0 0 0 0 8100 0 17319 0 371030 0 0 0 HENRY GERSON MD VICE PRESIDENT 0 191969 0 0 0 0 0 3909 0 3459 0 199337 0 0 DAVID GEORGE EVELYN MD PRESIDENT 0 327690 0 53320 0 0 0 5400 0 6646 0 393056 0 0 BENJAMIN NEGLEY EXECUTIVE DIRECTOR 173805 0 0 0 0 0 5406 0 20965 0 200176 0 0 0 MARCIS SODUMS MD PHYSICIAN 567512 0 0 0 0 0 8100 0 17319 0 592931 0 0 0 LAVANYA KODALI MD PHYSICIAN 474251 0 92956 0 0 0 8100 0 20965 0 596272 0 0 0 PAUL STEFEK MD PHYSICIAN 569512 0 0 0 0 0 8100 0 17319 0 594931 0 0 0 DEIDRE BLAKE MD PHYSICIAN 496236 0 149982 0 0 0 8100 0 21079 0 675397 0 0 0 MICHAEL WATERS MD PHYSICIAN 423876 0 149218 0 0 0 3927 0 20965 0 597986 0 0 0 PART I, LINE 6 YEAR END BONUS PROGRAM FOR ALL EMPLOYEES, AT RELATED ORGANIZATION, WAS BASED ON THE OPERATING MARGIN, PARTICIPATING IN THE ANNUAL SAFETY TRAINING AND REACHING PREDETERMINED CUSTOMER SATISFACTION SCORES. FORM 990 PART VI SECTION A LINE 8A AND 8B ALL MINUTES OF MEETINGS ARE RECORDED AND FILED WITH CORPORATE DOCUMENTS ONCE APPROVED. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE PHYSICIAN SHAREHOLDER WHO OWNS TWO HUNDRED COMMON SHARES. FORM 990, PART VI, SECTION A, LINE 7A EXPLANATION: CMAS RELATIONSHIP WITH THE MEDICAL CENTER IS ESTABLISHED THROUGH THE CORPORATE DOCUMENTS, NAMELY THE BYLAWS AND A SHAREHOLDER AGREEMENT. THROUGH THESE DOCUMENTS, THE CORPORATION SHALL ALWAYS HAVE ONLY ONE SHAREHOLDER WHO MUST BE A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THE STATE OF NEW YORK EMPLOYED BY CAYUGA MEDICAL CENTER AT ITHACA AND WHO IS A PARTY TO A SHAREHOLDER AGREEMENT APPROVED IN ALL RESPECTS BY CAYUGA MEDICAL CENTER AT ITHACA. THE NUMBER OF DIRECTORS CONSTITUTING THE ENTIRE BOARD SHALL BE FOUR. TWO OF THE BOARD MEMBERS SHALL BE APPOINTED BY MEDICAL CENTER AND SHALL BE PHYSICIANS LICENSED TO PRACTICE MEDICINE WHO ARE EMPLOYEES OF MEDICAL CENTER. TWO BOARD MEMBERS SHALL BE ELECTED BY THE PHYSICIAN ACTION COUNCIL. THE DIRECTORS APPOINTED BY THE PHYSICIAN ACTION COUNCIL NEED NOT BE SHAREHOLDERS OF THE CORPORATION, SO LONG AS THEY ARE LICENSED IN NEW YORK TO PRACTICE MEDICINE AND ARE EMPLOYEES OF THE CORPORATION. THE BOARD MEMBERS ELECTED BY THE PHYSICIAN ACTION COUNCIL ARE SUBJECT TO THE APPROVAL OF MEDICAL CENTER. IF A DIRECTOR RESIGNS, DIES OR IS REMOVED, A REPLACEMENT SHALL BE APPOINTED OR ELECTED IN THE SAME MANNER AS THE DEPARTING DIRECTOR. EACH DIRECTOR SHALL BE APPOINTED OR ELECTED AS SET FORTH ABOVE FOR A TERM OF TWO YEARS. EACH DIRECTOR SHALL HOLD OFFICE UNTIL HIS OR HER SUCCESSOR HAS BEEN DULY ELECTED AND QUALIFIED, OR UNTIL HIS OR HER DEATH, OR UNTIL HE OR SHE HAS RESIGNED OR HAS BEEN REMOVED AS HEREINAFTER PROVIDED IN THESE BY-LAWS. THE BOARD OF DIRECTORS SHALL INCLUDE UP TO SIX (6) NON-VOTING ADVISORY BOARD MEMBERS. UP TO THREE (3) PHYSICIANS MAY BE APPOINTED BY THE PHYSICIAN ACTION COUNCIL, SUBJECT TO APPROVAL BY THE VOTING BOARD MEMBERS. ONE OF THESE NON-VOTING ADVISORY BOARD MEMBERS MAY BE A PHYSICIAN WHO IS A MEMBER IN GOOD STANDING OF FINGER LAKES MANAGEMENT ASSOCIATES, DBA; CAYUGA AREA PHYSICIANS ALLIANCE, BUT WHO IS NOT AN EMPLOYEE OF THE CORPORATION. THE NON-VOTING ADVISORY BOARD MEMBERS SHALL BE SUBJECT TO THE QUALIFICATION OF ARTICLE IV SECTIONS 3 AND 4. UP TO THREE (3) NON-VOTING ADVISORY BOARD MEMBERS, BUT IN ANY EVENT A NUMBER EQUAL TO THE NUMBER OF PHYSICIANS APPOINTED BY THE PHYSICIAN ACTION COUNCIL, SHALL BE APPOINTED BY MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B SEE ABOVE ANSWER TO 7A FOR COMPLETE EXPLANATION OF MEMBERSHIP STRUCTURE AND DECISION MAKING AUTHORITY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO AND REVIEWED BY ITS BOARD OF DIRECTORS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CAYUGA MEDICAL ASSOCIATES HAS ADOPTED A CONFLICT OF INTEREST POLICY IN 2011, WHICH BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN ANNUALLY. THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY BY REVIEWING STATEMENTS ANNUALLY FOR CONFLICTS, IDENTIFYING ANY DISQUALIFIED PERSONS, AND RECORDING ALL PROCEEDING RELATED TO A CONFLICT OF INTEREST TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 IT IS THE POLICY AND PRACTICE OF CAYUGA MEDICAL ASSOCIATES, PC (CMA) TO COMPENSATE STAFF AT MARKET DRIVEN WAGES COMMENSURATE WITH INDIVIDUAL PERFORMANCE. OUTSIDE SOURCES ARE USED TO DETERMINE APPROPRIATE PAY RANGES FOR ALL ROLES, INCLUDING ANY EXECUTIVE COMPENSATION. PHYSICIAN AND KEY EMPLOYEE COMPENSATION IS DETERMINED BASED ON MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA) NATIONAL SURVEY DATA AND OTHER REGIONAL AND LOCAL COMPENSATION DATA. IT IS THE INTENT THAT PHYSICIANS ARE COMPENSATED APPROPRIATELY BASED ON THEIR INDIVIDUAL PRODUCTIVITY AS MEASURED IN COLLECTIONS, RVUS, WORK HOURS, DUTIES, ETC. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G HOUSEKEEPING/CUSTODIAL : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 233,392. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 233,392. CONTRACT LABOR:INTERPRETING SERVICE : PROGRAM SERVICE EXPENSES 273,514. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 273,514. PROFESSIONAL CLINICAL SERVICES : PROGRAM SERVICE EXPENSES 3,247,384. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,247,384. BILLING SERVICES : PROGRAM SERVICE EXPENSES 210,850. MANAGEMENT AND GENERAL EXPENSES 533,292. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 744,142. OTHER FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 407,366. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 407,366. CONSULTING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 179,602. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 179,602. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED THE OVERSIGHT PROCESS OR THE SELECTIONS PROCESS DURING THE TAX YEAR. CAYUGA MEDICAL CENTER 101 DATES DRIVE ITHACA NY 14850 222325405 HOSPITAL NY 501 C(3) 170(B)(1)(A)(III) 0 CAYUGA MEDICAL OFFICE BUILDING LP 101 DATES DRIVE ITHACA NY 14850 161261492 RENTAL NY CAYUGA MEDICAL CENTER NONE 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 CAYUGA MEDICAL CENTER C 16971343 ACKNOWLEDGMENT LETTER CAYUGA MEDICAL CENTER J 21206 RENTAL EQUIPMENT CAYUGA MEDICAL CENTER K 87206 LEASE AGREEMENT CAYUGA MEDICAL CENTER M 879686 WRITTEN AGREEMENT CAYUGA MEDICAL CENTER L 2837133 WRITTEN AGREEMENT CAYUGA MEDICAL OFFICE BUILDING LP K 190489 LEASE AGREEMENT