2018-11-08T13:48:23-06:00 2017-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2017-01-01 161035427 CROUSE HEALTH FOUNDATION INC CROU 3154707702 736 IRVING AVENUE SYRACUSE NY 132101687 CARRIE BERSE PRESIDENT 3154707702 2018-11-05 1 THOMAS DALTON P00645802 7168472651 2018-11-05 104.193.28.34 2018-11-05 12:28:09 ES P 81B56A05D8F48412CE9D3D11E933E5C72CA8DF76 2F55945E557C160355704803DA393A47E1E777C4 2017 2019-02-21 02:37:17Z CARRIE BERSE 736 IRVING AVENUE SYRACUSE NY 132101687 23810279 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 39 0 100 8524 0 7395641 3268869 0 0 866981 2401610 -270594 161207 7992028 5831686 5672581 4481135 0 0 816973 805814 0 0 0 247108 202759 6736662 5489708 1255366 341978 30580686 32199384 438514 312839 30142172 31886545 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 4264140 4264140 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC FOR EQUIPMENT ACQUISTION, EDUCATION, AND SCHOLARSHIP. 216995 216995 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC BY UNDERWRITING EXPENSES ASSOCIATED WITH PATIENT AND GUEST RELATIONS, GRANT ADMINISTRATION AND OTHER PURPOSES. 4481135 1 1 0 0 0 0 0 0 0 1 1 1 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 8 0 1 0 1 1 0 0 0 0 1 1 0 0 0 0 X 43 39 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X THE ORGANIZATION 3154707702 736 IRVING AVENUE SYRACUSE NY 132101687 LAURENCE G BOUSQUET TRUSTEE, BOARD CHAIR 1.00 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 41.00 X X 0 704544 64718 JOYCE MAWHINNEY MACKNIGHT TRUSTEE, BOARD SECRETARY 1.00 X X 0 0 0 SCOTT KINGSLEY TRUSTEE, BOARD TREASURER 1.00 X X 0 0 0 SHARON SLATER TRUSTEE, BOARD ASST SECRET 1.00 X X 0 0 0 KELLI HARRIS TRUSTEE, BOARD ASST TREAS (THRU NOVEMBER) 1.00 41.00 X X 0 320145 44272 CARRIE BERSE PRESIDENT 40.00 X X 0 179707 41628 CHRISTINE O'CONNELL MORE TRUSTEE 1.00 X 0 0 0 CORINNE RIBBLE TRUSTEE 1.00 X 0 0 0 DOUGLAS LOGAN TRUSTEE 1.00 X 0 0 0 FRANK SMITH MD TRUSTEE 1.00 X 0 17083 0 HERBERT E MENDEL MD TRUSTEE 1.00 X 0 0 0 JOAN O DADEY TRUSTEE 1.00 40.00 X 0 127856 38467 JOHN GAAL TRUSTEE 1.00 X 0 0 0 JOHN O'CONNOR TRUSTEE 1.00 X 0 0 0 LISA SMITH 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 PAT 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 2.00 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 SAL J BELLAVIA TRUSTEE 1.00 X 0 0 0 STEVEN MIRON 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 BEN HIMPLER MD TRUSTEE 1.00 X 0 0 0 JONATHAN SAYRE TRUSTEE 1.00 X 0 0 0 VINCE SPINA TRUSTEE 1.00 X 0 0 0 LISA BETHMANN 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 ESTELLA TAYLOR-GREENE 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 74583 0 FRANK MENTO TRUSTEE 1.00 X 0 0 0 MARK RE TRUSTEE 1.00 X 0 0 0 0 1423918 189085 0 0 1 0 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 STAFF SERVICES 805813 THE ONCENTER 800 S STATE STREET SYRACUSE NY 13202 CONVENTION CENTER 147734 2 304846 2964023 3268869 438470 8524 429946 19502479 17539339 1963140 1963140 1963140 600461 304846 439254 161207 161207 5831686 0 8524 2554293 4437313 4437313 43822 43822 615125 615125 190689 190689 27949 27949 14800 14800 46496 46496 11720 11720 38307 38307 27210 27210 1909 1909 1668 1668 DONOR RELATIONS 14669 14669 CREDIT CARD FEES 8758 8758 DUES & SUBSCRIPTIONS 5269 5269 OTHER EXPENSES 3456 3456 548 548 5489708 4481135 1008573 0 298675 452383 651125 0 7737811 6517510 34172 44792 43722 37091 792 6631 14623255 21592396 7117421 3468204 117435 117468 30580686 32199384 419849 296272 18665 16567 438514 312839 X 6787404 7613020 11399256 12255421 11955512 12018104 30142172 31886545 30580686 32199384 341978 1402395 0 X X 0 1 X 1 0 X 3027144 3075922 8395671 7395641 3268869 25163247 3027144 3075922 8395671 7395641 3268869 25163247 25163247 287062 778621 337599 304825 438470 2146577 27309824 0.92140 0.91870 X 24638882 356484 3732270 1125656 27601980 22278661 1062111 2083238 785128 24638882 24667814 104449 -1304218 1189384 22278661 25312798 644533 461758 1751275 24667814 21535299 594965 3363504 180970 25312798 0.34830 0.43540 0.21630 1 0 43722 37091 6631 6631 ALTERNATIVE INVESTMENTS 3468204 F 3468204 LIABILITIES UNDER SPLIT-INTEREST AGREEMENT 16567 16567 X 7626839 1402395 439254 1841649 5785190 46496 46496 5831686 5882466 439254 439254 5443212 46496 46496 5489708 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 GENERALLY ACCEPTED ACCOUNTING PRINCIPLES 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 439,254. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST REVENUE 439,254. TRIBUTE EVENING 627799 269575 358224 147734 9846 32400 47541 GOLF TOURNAMENT 191302 29715 161587 19129 17650 1169 30127 1 86206 5556 80650 300 930 15675 5357 1200 110196 905307 304846 600461 300 930 182538 32853 34769 187864 439254 161207 1 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 160960470 501(C)(3) 4264140 EQUIPMENT ACQUISTION AND SCHOLARSHIPS GRANTS TO HOSPITAL EMPLOYEES IN NEED AS A RESULT OF CATTASTROPHIC CIRCUMSTANCES. 15 43822 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 652490 0 49409 0 2645 0 17748 0 46970 0 769262 0 0 KELLI HARRIS TRUSTEE, BOARD ASST TREAS (THRU NOVE 0 320145 0 0 0 0 0 12499 0 31773 0 364417 0 0 CARRIE BERSE PRESIDENT 0 179707 0 0 0 0 0 9084 0 32544 0 221335 0 0 JOAN O DADEY TRUSTEE 0 127856 0 0 0 0 0 6014 0 32453 0 166323 0 0 FORM 990, PART VI, SECTION A, LINE 2 MARY COTTER AND MELVIN STITH 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 18 CROUSE HEALTH FOUNDATION, INC. IRS FORM 990 IS ALSO AVAILABLE AT WWW.GUIDESTAR.ORG 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 SUPPORT CROUSE HOSPITAL W/PHYSICIAN SERVICES TO IMPROVE HEALTHCARE QUALITY 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