2017-11-15T15:50:36-06:00 2016-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2016-01-01 161035427 CROUSE HEALTH FOUNDATION INC CROU 3154707702 736 IRVING AVENUE SYRACUSE NY 132101687 CARRIE BERSE PRESIDENT 3154707702 2017-11-14 1 THOMAS DALTON P00645802 7168472651 2017-11-10 104.193.28.34 2017-11-14 14:07:59 ES P 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 8090CE85BEE6A8BCE091EED736A3D1F39CD2CC41 2016 2017-02-10 21:41:12Z CARRIE BERSE 736 IRVING AVENUE SYRACUSE NY 132101687 13569310 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. 34 28 0 100 4433 -3517 8290938 7395641 0 0 609750 866981 -277649 -270594 8623039 7992028 3331532 5672581 0 0 635850 816973 0 0 0 263973 247108 4231355 6736662 4391684 1255366 27709009 30580686 90197 438514 27618812 30142172 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 5506905 5506905 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC FOR EQUIPMENT ACQUISTION, EDUCATION, AND SCHOLARSHIP. 165676 165676 CONTRIBUTIONS TO CROUSE HEALTH HOSPITAL INC BY UNDERWRITING EXPENSES ASSOCIATED WITH PATIENT AND GUEST RELATIONS, GRANT ADMINISTRATION AND OTHER PURPOSES. 5672581 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 16 0 1 0 1 1 0 0 0 0 1 1 0 0 0 0 X 34 28 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 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 15000 0 HERBERT E MENDEL MD TRUSTEE 1.00 X 0 0 0 JOAN O DADEY TRUSTEE 1.00 40.00 X 0 107240 30414 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 JOYCE MAWHINNEY MACKNIGHT TRUSTEE, BOARD SECRETARY 1.00 X X 0 0 0 KELLI HARRIS TRUSTEE, BOARD ASST TREASU 1.00 41.00 X X 0 334202 39992 KIMBERLY BOYNTON TRUSTEE, BOARD VICE CHAIR 1.00 41.00 X X 0 738355 60528 LAURENCE G BOUSQUET TRUSTEE, BOARD CHAIR 1.00 X X 0 0 0 MARK WORDEN TRUSTEE 1.00 X 0 0 0 LINDSEY H HAZELTON TRUSTEE 1.00 X 0 0 0 MARK T HARRINGTON TRUSTEE 1.00 X 0 0 0 MARY-PAT 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 REBECCA RAPHAEL TRUSTEE 1.00 X 0 0 0 SAL J BELLAVIA TRUSTEE 1.00 X 0 0 0 SANDRA POMEROY TRUSTEE, BOARD VICE CHAIR 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 STEVEN MIRON TRUSTEE 1.00 X 0 0 0 THOMAS R CURRAN JR MD TRUSTEE, BOARD VICE CHAIR 1.00 X X 0 0 0 TIMOTHY ATSEFF TRUSTEE 1.00 X 0 0 0 ZACHARY ZUCKERMAN TRUSTEE 1.00 X 0 0 0 CARRIE BERSE PRESIDENT 40.00 X X 0 184873 36220 PETER DERRENBACKER TRUSTEE 1.00 X 0 0 0 BEN HIMPLER MD TRUSTEE 1.00 X 0 23750 0 JONATHAN SAYRE TRUSTEE 1.00 X 0 0 0 VINCE SPINA TRUSTEE 1.00 X 0 0 0 LISA BETHMAN 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 0 1403420 167154 0 0 1 0 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 STAFF SERVICES 816548 THE ONCENTER 800 S STATE STREET SYRACUSE NY 13202 CONVENTION CENTER 158559 2 960172 6435469 7395641 304825 4433 300392 5753494 5191338 562156 562156 562156 115350 960172 385944 -270594 -270594 7992028 0 4433 591954 5639163 5639163 33418 33418 625956 625956 191017 191017 8657 8657 14500 14500 72674 72674 29994 29994 8178 8178 32136 32136 27210 27210 726 726 1585 1585 BAD DEBTS 25000 25000 DONOR RELATIONS 8682 8682 OTHER EXPENSES 7160 7160 CREDIT CARD FEES 6124 6124 4482 4482 6736662 5672581 1064081 0 31012 298675 465321 651125 6910713 7737811 24185 34172 36215 35423 2377 792 14504602 14623255 5656078 7117421 114721 117435 27709009 30580686 68598 419849 21599 18665 90197 438514 X 3873005 6787404 12335499 11399256 11410308 11955512 27618812 30142172 27709009 30580686 1255366 1267994 0 X X 0 1 X 1 0 X 2106335 3027144 3075922 8395671 7510991 24116063 2106335 3027144 3075922 8395671 7510991 24116063 24116063 426922 287062 778621 337599 304825 2135029 26251092 0.91870 0.88820 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 22278661 1062111 2083238 785128 24638882 24667814 104449 -1304218 1189384 22278661 25312798 644533 461758 1751275 24667814 21535299 594965 3363504 180970 25312798 19814130 50269 2546629 38000 809092 28637 21535299 0.34090 0.48520 0.17390 1 0 36215 35423 792 792 ALTERNATIVE INVESTMENTS 7117421 F 7117421 LIABILITIES UNDER SPLIT-INTEREST AGREEMENT 18665 18665 X 9573292 1267994 385944 1653938 7919354 72674 72674 7992028 7049932 385944 385944 6663988 72674 72674 6736662 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 385,944. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES NETTED WITH INVESTMENT INCOME 72,674. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST REVENUE 385,944. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES NETTED WITH INVESTMENT INCOME 72,674. TRIBUTE EVENING 797056 714106 82950 1830 39261 110498 19106 71697 GOLF TOURNAMENT 193008 160608 32400 1080 22398 18856 18518 6945 85458 85458 75755 1075522 960172 115350 1080 24228 58117 129016 19106 154397 385944 -270594 1 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 160960470 501(C)(3) 5380406 EQUIPMENT ACQUISTION AND SCHOLARSHIPS GRANTS TO HOSPITAL EMPLOYEES IN NEED AS A RESULT OF CATTASTROPHIC CIRCUMSTANCES. 20 33418 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 KELLI HARRIS TRUSTEE, BOARD ASST TREASU 0 334202 0 0 0 0 0 11948 0 28044 0 374194 0 0 KIMBERLY BOYNTON TRUSTEE, BOARD VICE CHAIR 0 676304 0 58731 0 3320 0 17376 0 43152 0 798883 0 0 CARRIE BERSE PRESIDENT 0 184873 0 0 0 0 0 10313 0 25907 0 221093 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 THE NATIONAL SALARY 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 12A, I 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