2015-11-16T15:26:24-06:00 2014-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2014-01-01 160960470 CROUSE HEALTH HOSPITAL INC CROU 3154707111 736 IRVING AVENUE SYRACUSE NY 132101687 KELLI HARRIS CFO 3154707111 2015-11-13 1 THOMAS DALTON P00645802 7168472651 2015-11-13 2014 2016-03-07 17:11:31Z CROUSE HOSPITAL KIMBERLY BOYNTON 736 IRVING AVENUE SYRACUSE NY 132101687 398335203 0 X WWW.CROUSE.ORG X 1913 NY TO PROVIDE THE BEST IN PATIENT CARE AND TO PROMOTE COMMUNITY HEALTH 15 12 3122 500 152610 118338 2158425 2398966 358372825 381365073 2206711 1913822 11888201 11942895 374626162 397620756 0 0 0 0 194830409 202357086 0 0 0 168786588 179221255 363616997 381578341 11009165 16042415 265304935 289336283 201531464 256574471 63773471 32761812 THE MISSION OF CROUSE HEALTH HOSPITAL, INC. IS TO PROVIDE THE BEST IN PATIENT CARE AND TO PROMOTE COMMUNITY HEALTH. 0 0 250153176 381365073 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 506 ACUTE-CARE BEDS INCLUDING 57 BASSINETS. CROUSE HOSPITAL SERVES MORE THAN 23,500 INPATIENTS, 76,500 EMERGENCY SERVICE PATIENTS, AND MORE THAN 315,000 OUTPATIENTS ANNUALLY. CROUSE HOSPITAL PROVIDED APPROXIMATELY $5 MILLION IN CHARITY CARE IN 2014. ADDITIONAL DETAILS ON CROUSE HOSPITAL'S EXEMPT PURPOSE ACHIEVEMENTS ARE FOUND IN "CROUSE HOSPITAL'S 2014-2017 COMMUNITY SERVICE PLAN" WHICH CAN BE ACCESSED ON THE HOSPITAL WEBSITE WWW.CROUSE.ORG 250153176 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 1 1 1 0 0 0 0 0 1 1 1 0 0 1 308 0 1 3122 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NY X X KELLI HARRIS CFO 3154708058 736 IRVING AVENUE SYRACUSE NY 13210 ELIZABETH HARNETT ESQ DIRECTOR, VICE CHAIR 1.00 1.00 X X 0 0 0 PATRICK MANNION DIRECTOR, BOARD CHAIR 1.00 1.00 X X 0 0 0 PAUL KRONENBERG MD DIRECTOR, VICE CHAIR, EXEC VICE PRESIDENT 31.00 12.00 X X 590519 162225 33105 MELVIN STITH PHD DIRECTOR 1.00 1.00 X 0 0 0 MARY COTTER DIRECTOR 1.00 1.00 X 0 0 0 HAYES WANAMAKER MD DIRECTOR 1.00 1.00 X 27000 0 0 JAMES CARRICK DIRECTOR 1.00 1.00 X 0 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 13750 0 0 KIMBERLY BOYNTON BOARD PRESIDENT AND CEO 39.00 3.00 X X 529084 28468 53753 KENT SYVERUD DIRECTOR 1.00 1.00 X 0 0 0 BENJAMIN HIMPLER DIRECTOR 1.00 1.00 X 0 0 0 LINDA CLEARY DIRECTOR 1.00 1.00 X 0 0 0 DERRICK SUEHS BOARD SECRETARY, CQO 41.00 1.00 X 262280 0 34117 KELLI HARRIS BOARD TREASURER, CFO 38.00 4.00 X 291316 22419 36406 ANN SEDORE PHD RN CHIEF NURSING OFFICER 40.00 X 241579 0 11219 RONALD STAHL MD CHIEF MEDICAL OFFICER 40.00 X 341074 0 34449 SETH KRONENBERG MD CHIEF PHYSICIAN INTEGRATION OFFICER 22.00 19.00 X 140066 134743 28683 HECTOR BIAGGI MD PHYSICIAN CHEMICAL DEPENDANCY 40.00 X 460573 0 29997 JIANXIN MA PHYSICIAN 40.00 X 442642 0 50484 SAMI ABDUL-MALAK MD PHYSICIAN NEUROLOGY 40.00 X 414050 0 50922 RICHARD STEINMANN MD PHYSICIAN EMERGENCY DEPT 40.00 X 358189 0 60799 GINA HAYES PHYSICIAN 40.00 X 316180 0 45104 4428302 347855 469038 188 0 1 0 LABORATORY ALLIANCE 1304 BUCKLEY RD SYRACUSE NY 13212 PROFESSIONAL MEDICAL 10150927 CROUSE MEDICAL GROUP PC 401 N SALINA STREET SUITE 400 SYRACUSE NY 13203 PROFESSIONAL MEDICAL 3316895 BEACON CONSULTANTS 97 LIBBEY PARKWAY SUITE 310 WEYMOUTH MA 02189 IT CONSULTING 3156724 HAYNOR HOYT CORPORATION 625 ERIE BOULEVARD WEST SYRACUSE NY 13204 CONSTRUCTION 2985991 CNY ANESTHESIA GROUP PC 736 IRVING AVE SYRACUSE NY 13210 PROFESSIONAL MEDICAL 2591794 63 2281334 51721 65911 2398966 PATIENT REVENUE 623000 376653155 376653155 PARKING 812930 2225708 2225708 ARRA INCOME 623000 1112700 1112700 PROPERTY MGT REV FROM AFFILIATE 531310 896355 896355 RENT 532000 477155 477155 381365073 1886233 1886233 742036 714447 27589 27589 27589 COLLEGE OF NURSING 611600 3231783 3231783 OTHER REVENUE 623000 2827597 2827597 CAFETERIA 721110 1732788 1732788 4150727 152610 3998117 11942895 397620756 381365073 152610 13704107 2436668 2436668 156359843 96936817 59423026 1901485 1178921 722564 30245248 18752054 11493194 11413842 7076582 4337260 662538 662538 189206 189206 121443 121443 17066642 10581318 6485324 1235826 766212 469614 2275307 1410690 864617 3551148 2201712 1349436 11623094 7206318 4416776 80834 50117 30717 136593 84688 51905 2299291 2299291 16206534 10944728 5261806 2406674 2111618 295056 SUPPLIES 71320171 48497716 22822455 PURCHASED SERVICES 22363521 21021709 1341812 MAINTENANCE CONTRACTS 4002711 2243984 1758727 PENSION 1568708 5379163 -3810455 22111014 13708829 8402185 381578341 250153176 131425165 0 8300 8500 19744755 27579973 40652757 46037669 4862510 5350681 6792304 8039722 7666346 6860802 304246352 179675818 115023354 124570534 5665572 865549 208027 361 64681010 70022492 265304935 289336283 24787116 28270145 62895000 59145000 1168827 7309828 112680521 161849498 201531464 256574471 X 37023458 6147074 14538670 13776257 12211343 12838481 63773471 32761812 265304935 289336283 X 16042415 -634647 -46419427 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 235273 0 0 235273 0 PART II-B, LINE 1: CROUSE HEALTH HOSPITAL, INC. CONTRACTED WITH THE FIRM OF WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER, LLP EFFECTIVE 2/11/14 TO 2/10/15 TO SERVE AS LEGISLATIVE COUNSEL TO THE HOSPITAL. THE FEE FOR THOSE SERVICES IS $120,000 ANNUALLY PLUS EXPENSES. AS OF DECEMBER 31, 2014, CROUSE HOSPITAL HAS PAID THE FIRM $120,000 IN PROFESSIONAL SERVICE FEES AND $7,379 IN ADMINISTRATIVE EXPENSE REIMBURSEMENT. PROFESSIONAL SERVICES INCLUDE: LEGISLATIVE ADVOCACY ENCOMPASSING PRESENTATION OF HOSPITAL VIEWS TO THE LEGISLATIVE AND EXECUTIVE BRANCHES OF NEW YORK STATE GOVERNMENT, REVIEW AND ANALYSIS OF ALL PROPOSED NEW YORK STATE LEGISLATION OF POTENTIAL IMPACT, PREPARATION OF AFFIRMATIVE LEGISLATION, PREPARATION OF MEMORANDA SUPPORTING OF OPPOSING LEGISLATION, ATTENDANCE AT PUBLIC HEALTH HEARINGS, COMMITTEE MEETINGS, AND OTHER RELATED ACTIVITIES TO INSURE THAT LEGISLATORS ARE AWARE OF HOSPITAL VIEWS AND INFORMED OF THE IMPACT OF THE LEGISLATION AFFECTING HOSPITAL INTERESTS, PREPARATION OF REGULAR REPORTS ADVISING OF THE CURRENT STATUS PENDING LEGISLATION, DISCUSSIONS AND RECOMMENDATIOS REGARDING AN AFFIRMATIVE LEGISLATION PROGRAM, CONFERENCES WITH THE HOSPITAL OR ITS REPRESENTATIVES AS NECESSARY. ADMINISTRATIVE EXPENSE REIMBURSEMENT INCLUDES: TELEPHONE, FAXES AND ALL OTHER WIRELESS FORMS OF COMMUNICATION, POSTAGE AND DELIVERY SERVICES, REPRODUCTION AND PRESENTATION MATERIALS, IN-HOUSE COMPUTER SERVICES, RESEARCH AND DATABASE INTERFACES. PAID STAFF OF CROUSE HEALTH HOSPITAL, INC. HAD DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS AND LEGISLATIVE BODIES. THE COST OF THESE ACTIVITIES IS $27,000. CROUSE HEALTH HOSPITAL, INC. BELONGS TO PROFESSIONAL ORGANIZATIONS THAT PROVIDE LOBBYING ON BEHALF OF ITS MEMBERS. THESE ORGANIZATIONS ARE GREATER NEW YORK HOSPITAL ASSOCIATION, HOSPITAL ASSOCIATION OF NEW YORK STATE, AND CENTERSTATE CEO. CROUSE HEALTH HOSPITAL, INC. CONTRACTED WITH THE WLADIS LAW FIRM EFFECTIVE 3/17/14 TO 3/16/15 TO SERVE AS STRATEGIC PLANNING, ECONOMIC DEVELOPMENT, AND FUNDING OBJECTIVES COUNSEL TO THE HOSPITAL. THE FEE FOR THOSE SERVICES IS $72,000 ANNUALLY PLUS EXPENSES. AS OF DECEMBER 31, 2014, CROUSE HEALTH HOSPITAL, INC HAS PAID THE FIRM $60,000 IN PROFESSIONAL SERVICE FEES AND $570 IN ADMINISTRATIVE EXPENSE REIMBURSEMENT. CROUSE HEALTH HOSPITAL, INC. CONTRACTED WITH THE WHITEMAN, OSTERMAN & HANNA LLP EFFECTIVE 5/1/2014 TO 4/30/2015 TO PROVIDE LEGAL AND GOVERNMENTAL RELATIONS COUNSEL. THE FEE FOR THOSE SERVICES IS $30,000 ANNUALLY PLUS EXPENSES. AS OF DECEMBER 31, 2014, CROUSE HEALTH HOSPITAL, INC HAS PAID THE FIRM $20,000 IN PROFESSIONAL SERVICES FEES AND $324 IN ADMINISTRATIVE EXPENSE REIMBURSEMENT. 25312798 644533 461758 1751275 24667814 21535299 594965 3363504 180970 25312798 19814130 50269 2546629 38000 809092 28637 21535299 21220353 259960 -742382 41500 843933 38368 19814130 19569523 57126 2430827 28500 770515 38108 21220353 0.33400 0.45800 0.20800 0 1 1 285832 285832 169696675 92485769 77210906 18098798 14935677 3163121 108664875 72254372 36410503 7500172 7500172 124570534 CROUSE HEALTH FOUNDATION 25081798 ASSETS WHOSE USE IS LIMITED 41263089 FUNDS HELD IN TRUST BY OTHERS 1532940 BOND ISSUANCE/CLOSING COSTS 2144665 70022492 SELF INSURED PROFESSIONAL LIABILITY 18059808 ACCRUED PENSION LIABILITY 101940296 POST RETIREMENT OBLIGATIONS 14247538 ASSET RETIREMENT OBLIGATIONS 2587286 DUE TO RELATED PARTIES 4585679 FUNDS HELD IN TRUST 175380 LIABILITIES TO THIRD PARTY PAYERS 19988749 DEFERRED RENT AND REBATE 264762 161849498 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 2011. 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 $25 MILLION AT DECEMBER 31, 2014. THE PRINCIPAL, WITH AN APPROXIMATE VALUE OF $11 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 6212029 2534685 3677344 0.00960 90526322 67964884 22561438 0.05910 96738351 70499569 26238782 0.06870 766561 74764 691797 0.00180 12528394 6298845 6229549 0.01630 3014037 2497587 516450 0.00140 50289 50289 0.00010 192324 192324 0.00050 16551605 8871196 7680409 0.02010 113289956 79370765 33919191 0.08880 246774 246774 0.00060 26269 26269 0.00010 8355 8355 0.00000 281398 281398 0.00070 1 12035223 82143296 82454610 -311314 X 1 1 1 LACNY INC LABORTATORY SERVICES 0.33330 2 MDR LLC MAGNETIC RESONANCE IMAGING 0.25000 0.75000 3 SEA LLC ENDOSCOPY SERVICES 0.40000 0.60000 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 13 1 1 0 1 X CROUSE.ORG X X 1 13 1 HTTP://CROUSE.ORG/ABOUT/COMMUNITY/ 0 0 1 X 100.000000000000 300.000000000000 1 1 X X X X 1 X X X X X X X X X 1 X 0 X X X X 1 X 0 0 CROUSE HOSPITAL PART V, SECTION B, LINE 5: CROUSE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY IT SERVES, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF AND EXPERTISE IN PUBLIC HEALTH. OUR STAFF HAS WORKED CLOSELY WITH THE ONONDAGA COUNTY DEPARTMENT OF HEALTH ON OUR CHNA SINCE 2010. WE WERE GUIDED BY DR. TOM DENNISON, DIRECTOR OF SYRACUSE UNIVERSITY'S PROGRAM IN HEALTH SERVICES MANAGEMENT AND POLICY. HE ALSO IS THE ASSOCIATE DIRECTOR OF THE CNY MPH PROGRAM AND DIRECTOR FOR THE LERNER CENTER OF PUBLIC HEALTH. CROUSE HOSPITAL ALSO WORKED WITH COLLEAGUES FROM TWO OTHER LOCAL HOSPITALS, A MUTLITUDE OF HEALTH AGENCIES, LIKE THE AMERICAN CANCER SOCIETY, ACR HEALTH, MARCH OF DIMES AND SOCIAL SUPPORT AGENICES LIKE THE SPANISH ACTION LEAGUE OF CNY, THE NORTHEAST COMMUNITY CENTER, YMCA, ETC. USING MPH STUDENTS AND A RECENT COMMUNITY ASSESSMENT FROM THE UNITED WAY, WE CONDUCTED FOCUS GROUPS, AND INTERVIEWED CEOS AND EXECUTIVE DIRECTORS OF VARIOUS AGENCIES AND BUSINESSES, AS WELL AS THE SYRACUSE CITY SCHOOL DISTRICT, THE LARGEST AND MOST IMPOVERISHED DISTRICT IN OUR SERVICE AREA. CROUSE HOSPITAL PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN CONJUNCTION WITH ST. JOSEPH'S HOSPITAL HEALTH CENTER AND UPSTATE MEDICAL CENTER UNIVERSITY. WE ALSO WORKED WITH THE ONONDAGA COUNTY DEPARTMENT OF HEALTH AND THE LERNER CENTER OF PUBLIC HEALTH. CROUSE HOSPITAL PART V, SECTION B, LINE 7D: OTHER MEANS OF DISTRIBUTING CHNA: MAILING AND E-MAILING THE REPORT TO PUBLIC LIBRARIES, COMMUNITY ORGANIZATIONS, HOSPITAL EMPLOYEES, VOLUNTEERS AND PHYSICIANS, THE HOSPITAL'S BOARD OF DIRECTORS AND CROUSE HEALTH FOUNDATION TRUSTEES AND DONORS; PROVIDE COPIES AT COMMUNITY HEALTH FAIRS/SCREENINGS AND OTHER EDUCATIONAL EVENTS AS WELL AS TO POTENTIAL EMPLOYEES AND OUR COLLEGE OF NURSING STUDENTS. CROUSE HOSPITAL PART V, SECTION B, LINE 11: FOLLOWING IS A GENERAL OVERVIEW OF CROUSE HOSPITAL'S WORK TO ADDRESS TWO PRIORITY AREAS AFFECTED BY HEALTH DISPARITIES: PREVENTING CHRONIC DISEASE AND PROMOTING HEALTHY WOMEN, INFANTS AND CHILDREN. THE LATTER INCLUDES PROMOTING MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION WITH FOCUSED ATTENTION ON PREVENTING NEONATAL ABSTINENCE SYNDROME, A MAJOR PROBLEM IN OUR SERVICE AREA. DETAILED DESCRIPTIONS OF THIS WORK ARE INCLUDED IN THE HOSPITAL'S COMMUNITY SERVICE PLAN 2014 UPDATE AT CROUSE.ORG/ABOUT/COMMUNITY.CROUSE HOSPITAL IS ADDRESSING PREVENTION OF CHRONIC DISEASE WITH FREE HEALTH SCREENINGS, HEALTH FAIRS AND COMMUNITY SPEAKERS. THOSE ACTIVITIES ARE TARGETED TO INCREASE AWARENESS OF DIABETES RISK FACTORS AND PREVENTION AMONG HISPANIC/LATINO AND AFRICAN-AMERICAN POPULATIONS, WITH A FOCUS ON NUTRITION, OBESITY AND PHYSICAL ACTIVITY. ADDITIONALLY, CROUSE MAINTAINS BOARD AND COMMITTEE MEMBERSHIP WITH THE HEALTHY SYRACUSE COALITION, WHICH ADDRESSES DIABETES PREVENTION, YOUTH WELLNESS AND TOBACCO CONTROL. IN 2014, THE GROUP INTRODUCED AND IMPLEMENTED INTERVENTIONS TO PROMOTE NUTRITION AND REDUCE CHILDHOOD OBESITY. HEALTHY SYRACUSE ALSO WORKS TO REDUCE EXPOSURE TO OUTDOOR SECONDHAND SMOKE FOR SYRACUSE RESIDENTS AND EMPLOYEES.CROUSE ALSO SUPPORTS COLLABORATION AMONG LEADERS, PROFESSIONALS AND COMMUNITY MEMBERS WORKING IN MENTAL HEALTH PROMOTION, SUBSTANCE ABUSE AND OTHER MENTAL HEALTH DISORDERS AND CHRONIC DISEASE PREVENTION, TREATMENT AND RECOVERY. SPECIFICALLY, CROUSE HAS WORKED WITH AGENCIES AND WITHIN OUR FACILITY TO INCREASE SCREENINGS FOR BRIEF INTERVENTION (SBIRT), TOOK OUT "TO PREGNANT WOMEN", INCLUDING PARTICIPATING ON AND SBIRT ADVISORY GROUP FOR REACHING PREGNANT WOMEN. ADDITIONALLY, CROUSE HAS PARTICIPATED IN THE DEVELOPMENT OF EDUCATIONAL ADVERTISEMENTS AND A VIDEO TO HELP REDUCE THE NEGATIVE STIGMA OF TREATING INDIVIDUALS WITH SUBSTANCE USE DISORDER, PARTICULARLY PREGNANT WOMEN. CROUSE ALSO CONDUCTS A HEALTH FAIR WITH CHOLESTEROL, GLUCOSE AND BLOOD PRESSURE SCREENINGS FOR PATIENTS ENROLLED IN ITS CHEMICAL DEPENDENCY TREATMENT PROGRAMS. THOSE SAME PATIENTS RECEIVE NO-COST ACCESS TO CHILDBIRTH PREPARATION, CPR AND PARENTING CLASSES. ADDITIONALLY, CROUSE HOSPITAL'S POMEROY COLLEGE OF NURSING AND CHEMICAL DEPENDENCY TREATMENT STAFF DEVELOPED CLASSES FOR PREGNANT WOMEN IN TREATMENT FOR SUBSTANCE ABUSE. THESE INCLUDE BASIC BABY CARE; INFANT CPR AND FIRST AID; AND BREASTFEEDING. THE CLASSES, PROVIDED DURING TREATMENT, SERVE AS AN OPPORTUNITY TO ENCOURAGE PARTICIPANTS TO GET AND STAY HEALTHY, AS WELL AS LOOK FORWARD TO MOTHERHOOD, KNOWING THEY HAVE SKILLS TO SUCCEED.DUE TO LIMITED RESOURCES, CROUSE HOSPITAL IS NOT ABLE TO FOCUS EFFORTS ON THE FOLLOWING HEALTH NEEDS OF OUR COMMUNITY AT THIS TIME: IMPROVED SIDEWALKS AND TRANSPORTATION; PRIMARY CARE FOR AN EVER-GROWING REFUGEE POPULATION; AND SUICIDE PREVENTION. CROUSE HOSPITAL PART V, SECTION B, LINE 16I: CROUSE HOSPITAL'S FINANCIAL POLICY ALSO PRINTED IN THE HOSPITAL'S COMMUNITY BENEFIT REPORT WHICH IS ON THE HOSPITAL WEBSITE AND DISTRIBUTED WIDELY IN PRINT. 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. CROUSE HOSPITAL PART V, SECTION B, LINE 22D: THE HOSPITAL USED THE LARGEST VOLUME COMMERCIAL PAYOR RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CROUSE HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ CROUSE HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ CROUSE HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ 11 CROUSE HOSPITAL-410 SOUTH CROUSE DIV 410 SOUTH CROUSE AVENUE SYRACUSE NY 13210 CHEMICAL DEPENDENCY OUTPATIENT TREATMENT SERVICES CNY MEDICAL IMAGING CENTER 739 IRVING AVENUE SYRACUSE NY 13210 MEDICAL IMAGING TESTING CENTER CNY PROMPTCARE 739 IRVING AVENUE SYRACUSE NY 13210 URGENT CARE CENTER CROUSE HOSPITAL-COMMONWEALTH DIVISION 6010 EAST MOLLY ROAD SYRACUSE NY 13211 RESIDENTIAL CHEMICAL DEPENDENCY REHABILITATION PHYSICAL THERAPY-LIVERPOOL 7375 OSWEGO ROAD LIVERPOOL NY 13090 PHYSICAL THERAPY CENTER CROUSE ENDOSCOPY 739 IRVING AVENUE SYRACUSE NY 13210 ENDOSCOPY TESTING CENTER POB SURGERY CENTER 723 IRVING AVENUE SYRACUSE NY 13210 OUTPATIENT ABULATORY SURGERY CENTER PHYSICAL THERAPY - DEWITT 5823 WIDEWATERS PARKWAY EAST SYRACUSE NY 13057 PHYSICAL THERAPY CENTER MADISON IRVING SURGERY CENTER 475 IRVING AVENUE SYRACUSE NY 13210 OUTPATIENT ABULATORY SURGERY CENTER PHYSICAL THERAPY - CNY 739 IRVING AVENUE SYRACUSE NY 13210 PHYSICAL THERAPY CENTER HELP PEOPLE 600 E GENESEE STREET SYRACUSE NY 13202 EMPLOYEE ASSISTANCE PROGRAM PART III, LINE 2: BAD DEBT EXPENSE IS THE AMOUNT PRESENTED IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. 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 7 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED IS THE MEDICARE COST REPORT FOR 2014. 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 HOSPITAL PARTNERED WITH THE ONONDAGA COUNTY HEALTH DEPARTMENT (OCHD) AND TWO OTHER SYRACUSE HOSPITALS TO CONDUCT A COMMUNITY HEALTH ASSESSMENT PROCESS THAT ENGAGED AND BUILT ON HEALTH IMPROVEMENT EFFORTS ALREADY UNDERWAY, WHILE DRAWING ON LOCAL RESOURCES. THE PROCESS INCLUDED LEADERSHIP MEETINGS, A FORMAL STRUCTURE, PUBLIC FORUMS, DATA COLLECTION AND ANALYSIS. IT BEGAN WITH MEETINGS TO DISCUSS THE ASSESSMENT PROCESS AND GAIN SUPPORT OF THE LEADERSHIP OF THE ONONDAGA COUNTY HEALTH DEPARTMENT (COMMISSIONER OF HEALTH AND CHAIR OF THE ADVISORY BOARD OF HEALTH) WITH THE CHIEF EXECUTIVE OFFICERS OF THE THREE HOSPITALS IN THE COMMUNITY: CROUSE HOSPITAL, ST. JOSEPH'S HOSPITAL HEALTH CENTER, UPSTATE UNIVERSITY HOSPITAL.THE PROCESS WAS SUPPORTED WITH WORK DONE BY GRADUATE STUDENTS IN THE CENTRAL NEW YORK MASTER OF PUBLIC HEALTH PROGRAM (CNYMPH), A GRADUATE PROGRAM IN PUBLIC HEALTH SPONSORED BY SYRACUSE UNIVERSITY AND UPSTATE MEDICAL UNIVERSITY. THE GRADUATE STUDENTS BEGAN THEIR WORK BY CONVENING AND FACILITATING FIVE FORUMS IN OCTOBER AND NOVEMBER 2011. ALTOGETHER, 92 PEOPLE PARTICIPATED IN THE FORUMS. THE QUALITATIVE FINDINGS FROM THE FORUMS PROVIDED A BACKDROP AGAINST WHICH DATA WAS COLLECTED AND ANALYZED TO BETTER UNDERSTAND THE CONCERNS RAISED BY COMMUNITY MEMBERS. THE RESULTS OF THE FORUMS ARE SUMMARIZED IN A REPORT INCLUDED IN THE CHNA.THE DATA COLLECTION AND ANALYSIS PHASE FOLLOWED. DATA FROM A NUMBER OF SOURCES WERE UTILIZED, INCLUDING:O THE NEW YORK STATE PREVENTION AGENDA,O THE 2013 COMMUNITY NEEDS ASSESSMENT REPORT FROM THE UNITED WAY OF CNY,O INTERNAL INFORMATION FROM THE OCHD AND HOSPITALS, INCLUDING DISCHARGE DATA AND PROGRAM MEASUREMENTS.AGAIN, STUDENTS FROM THE CNYMPH PROGRAM WERE ENGAGED TO SUPPORT THE COMMUNITY HEALTH ASSESSMENT EFFORT. OVER THE COURSE OF 2012/2013, A LOCAL HEALTH IMPROVEMENT TASK FORCE COMPRISED OF REPRESENTATIVES FROM THE OCHD AND THE HOSPITALS MET REGULARLY TO REVIEW THE DATA AND EXPLORE AREAS FOR COLLABORATION. DATA GATHERED REFLECTED CONCERNS RELATED TO CHRONIC DISEASE, PARTICULARLY OBESITY, AFFECTED BY A LACK OF OPPORTUNITIES FOR PHYSICAL ACTIVITY AND ACCESS TO FRESH FRUITS AND VEGETABLES; SUBSTANCE ABUSE; HOMICIDE RATES; ACCESS TO CARE; TEEN PREGNANCY AND STDS; AND TOBACCO USE CESSATION. 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 GOVERNEMNET 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 YOUR 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. CROUSE HOSPITAL'S FINANCIAL ASSISTANCE IS POSTED IN THE FACILITY'S EMERGENCY ROOM, PROMPTCARE, AND WAITING ROOMS AS WELL AS IN THE HOSPITAL'S ADMISSIONS OFFICES. THE POLICY IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY. THE POLICY IS ALWAYS AVAILABLE ON REQUEST, AND IS EXPLAINED IN CROUSE HOSPITAL'S ANNUAL COMMUNITY SERVICE PLAN, WHICH IS WIDELY DISTRIBUTED TO THE PUBLIC AND IS POSTED ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: CROUSE HOSPITAL IS LOCATED IN NEW YORK'S ONONDAGA COUNTY IN THE CITY OF SYRACUSE. A 2012 ZIP CODE ANALYSIS OF DISCHARGES SHOWS 75 PERCENT OF CROUSE HOSPITAL'S INPATIENT AND OUTPATIENT ADMISSIONS ARE FROM ONONDAGA COUNTY - WITH 46 PERCENT OF THOSE FROM THE CITY OF SYRACUSE - AND 25 PERCENT OUTSIDE ONONDAGA COUNTY. A MAJOR CONTRIBUTOR TO OUT-OF-COUNTY ADMISSIONS IS THAT CROUSE IS THE NEW YORK STATE-DESIGNATED REGIONAL REFERRAL CENTER FOR PERINATAL AND NEONATAL INTENSIVE CARE SERVICES. IN ALL, CROUSE SERVES A 16-COUNTY REGION THAT EXTENDS SOUTH TO BINGHAMTON AND NORTH TO MALONE. CENTRALLY LOCATED IN NEW YORK STATE, ONONDAGA COUNTY COVERS 780 SQUARE MILES. ITS POPULATION IS 466,615, MAKING IT THE SIXTH MOST POPULOUS COUNTY IN UPSTATE NEW YORK. SYRACUSE IS THE LARGEST CITY IN THE CENTRAL NEW YORK (CNY) REGION, WITH A POPULATION OF 145,135. ITS RESIDENTS ACCOUNT FOR ALMOST ONE-THIRD OF THE TOTAL ONONDAGA COUNTY POPULATION, AND IT IS THE FOURTH LARGEST UPSTATE NEW YORK CITY, AFTER BUFFALO, ROCHESTER AND YONKERS. THE MEDIAN AGE IN ONONDAGA COUNTY IS 38.7 YEARS, GREATER THAN THE MEDIAN AGE OF 29.2 YEARS IN SYRACUSE, WITH A HIGHER PROPORTION OF RESIDENTS UNDER AGE FIVE YEARS AND A LOWER PROPORTION OVER AGE 65. WOMEN COMPRISE 51.8 PERCENT OF THE POPULATION OF ONONDAGA COUNTY AND 52.3 PERCENT OF THE POPULATION OF SYRACUSE. THERE ARE NEARLY 95,000 WOMEN IN THIS CATEGORY IN ONONDAGA COUNTY, WITH ROUGHLY 37,000 RESIDING IN SYRACUSE.AMONG ONONDAGA COUNTY RESIDENTS, 97.6 PERCENT IDENTIFIED AS BEING ONE RACE. OF THESE, 81.6 PERCENT ARE WHITE AND 10.9 PERCENT ARE BLACK. THE MAJORITY OF COUNTY'S BLACK RESIDENTS LIVE IN SYRACUSE, PARTICULARLY ON THE NEAR-SOUTH AND WEST SIDES OF THE CITY. ASIANS AND AMERICAN INDIAN/ALASKA NATIVES ARE THE OTHER ETHNIC GROUPS REPRESENTED IN COMPARATIVELY LARGE NUMBERS. THERE ARE 15,000 ASIANS LIVING IN THE COUNTY, COMPRISING 3.2 PERCENT OF THE TOTAL POPULATION. INDIVIDUALS OF NATIVE AMERICAN DESCENT ACCOUNT FOR 0.7 PERCENT OF THE POPULATION. HISPANIC ETHNICITY IS REPORTED BY MORE THAN 19,000 COUNTY RESIDENTS OF ALL RACES (4.1 PERCENT).IN ONONDAGA COUNTY, 7.3 PERCENT OF RESIDENTS ARE FOREIGN-BORN, WITH THE GREATEST PERCENTAGE BORN IN ASIA, FOLLOWED BY EUROPE, LATIN AMERICA AND AFRICA. AN ESTIMATED 12,000 REFUGEES AND FORMER REFUGEES CURRENTLY RESIDE IN SYRACUSE. NEWLY ARRIVED REFUGEES HAVE SPECIFIC HEALTHCARE NEEDS, AS WELL AS A UNIQUE SET OF BARRIERS TO ACCESSING APPROPRIATE CARE INCLUDING LANGUAGE, EDUCATION AND TRANSPORTATION. ALTHOUGH, ENGLISH IS THE MOST COMMONLY SPOKEN LANGUAGE, THE NEXT MOST COMMONLY SPOKEN LANGUAGE IS SPANISH.AMONG ADULTS AGE 25 YEARS AND OLDER IN ONONDAGA COUNTY, 89.3 PERCENT HAVE A HIGH SCHOOL EDUCATION OR HIGHER AND 32.6 PERCENT HAVE A BACHELOR'S DEGREE OR HIGHER. THESE FALL TO 80.2 PERCENT AND 26.1 PERCENT IN SYRACUSE, RESPECTIVELY.THERE ARE 18 SCHOOL DISTRICTS IN ONONDAGA COUNTY WITH AN ENROLLMENT OF APPROXIMATELY 70,000 STUDENTS, INCLUDING NEARLY 20,000 STUDENTS IN THE SYRACUSE CITY SCHOOL DISTRICT (SCSD). DISPARITIES IN EDUCATION BETWEEN SYRACUSE AND THE REST OF THE COUNTY ARE EVIDENT, AS SCSD STUDENTS CONSISTENTLY TEST SIGNIFICANTLY BELOW THE STATE AVERAGE ON STANDARDIZED TESTS. IN ADDITION, THE HIGH SCHOOL DROPOUT RATE IN SYRACUSE WAS 11 PERCENT FOR THE 2011-12 SCHOOL YEAR, SIGNIFICANTLY HIGHER THAN THE AVERAGE RATE OF ONE PERCENT SEEN IN SUBURBAN SCHOOLS. THE PERCENT OF GRADUATES IN SYRACUSE WHO WILL GO ON TO SOME TYPE OF COLLEGE IS 77.2 PERCENT, COMPARED WITH 86.8 PERCENT AMONG SUBURBAN STUDENTS. WITHIN THE SCSD, THE AVERAGE GRADUATION RATE IS 52 PERCENT COMPARED WITH SUBURBAN SCHOOL DISTRICTS IN ONONDAGA COUNTY THAT HAVE AN AVERAGE GRADUATION RATE OF 84.4 PERCENT.ACCORDING TO THE U.S. BUREAU OF LABOR STATISTICS, THE UNEMPLOYMENT RATE IN ONONDAGA COUNTY WAS 7.1 PERCENT IN APRIL 2013 AND HAS DECLINED SLOWLY FROM A HIGH OF 8.8 PERCENT IN JANUARY 2010. THE CURRENT UNEMPLOYMENT RATE IS NEARLY IDENTICAL TO THE STATEWIDE UNEMPLOYMENT RATE OF 7.3 PERCENT IN APRIL 2013. IN GENERAL, WHITE RESIDENTS HAVE LOWER UNEMPLOYMENT RATES THAN OTHER RACES. THE HIGHEST UNEMPLOYMENT IS SEEN IN THOSE WHO IDENTIFY AS SOME OTHER RACE.THE MEDIAN HOUSEHOLD INCOME IN ONONDAGA COUNTY IS $52,520. AMONG ALL RESIDENTS, 14.7 PERCENT HAD INCOME IN THE LAST 12 MONTHS THAT WAS BELOW THE FEDERAL POVERTY LEVEL. ESPECIALLY STRIKING IS THE POVERTY RATE AMONG CHILDREN IN SYRACUSE, WHERE 49.0 PERCENT OF THOSE UNDER AGE 18 LIVE IN POVERTY, COMPARED WITH 21 PERCENT IN ONONDAGA COUNTY. POVERTY RATES ARE CONSISTENTLY HIGHER IN SYRACUSE THAN IN ONONDAGA COUNTY, PEAKING AT 56.0 PERCENT AMONG FEMALE-HEADED HOUSEHOLDS WITH RELATED CHILDREN UNDER AGE 18. THE MEDIAN HOME VALUE IN ONONDAGA COUNTY IN 2010 WAS $134,700, COMPARED WITH $88,400 IN SYRACUSE. ALSO, IN ONONDAGA COUNTY, 9 PERCENT OF RESIDENTS DO NOT HAVE ANY HEALTH INSURANCE. THIS INCREASES TO 13 PERCENT IN SYRACUSE. PART VI, LINE 5: ADDITIONAL WAYS CROUSE HOSPITAL PROMOTES COMMUNITY HEALTH, FOR NO COST AND AVAILABLE TO ALL, ARE LISTED BELOW. - HEART HEALTH SCREENINGS FOR UNDERINSURED AND UNINSURED- MAMMOGRAM INFORMATION LADIES NIGHTS- HEALTH FAIRS FOR LOCAL EMPLOYERS, SCHOOLS AND CHURCH GROUPS- INFANT LOSS SUPPORT GROUP; OSTOMY SUPPORT GROUP; BREAST CANCER SURVIVOR SUPPORT GROUP- EXTRACORPOREAL MEMBRANE OXYGENATION FOR INFANTS AND THE REGION'S ONLY PEDIATRIC CARDIAC CATHETERIZATION PROGRAM, AS WELL AS A PEDIATRIC FIRST AID PROGRAM- BABY BEGINNINGS PROGRAM TO REDUCE RISK OF CHILD ABUSE/IMPROVE PARENTING SKILLS - VISIT TO HOSPITAL-LAND COMMUNITY SERVICE PROGRAM FOR FIRST-GRADERS - PARTNERSHIP WITH HEALTHY SYRACUSE COALITION AND THE SYRACUSE CITY SCHOOL DISTRICT TO SERVE AS WELLNESS ADVISORS AND PROVIDE SUPPORT FOR SCHOOL HEALTH AND WELLNESS INITIATIVES - CROUSE HOSPITAL CHEMICAL DEPENDENCY TREATMENT SERVICES PROVIDES COMPREHENSIVE CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY'S MOTHERS, BABIES AND CHILDREN- CROUSE BREAST HEALTH CENTER OFFERS WOMEN DEDICATED BREAST HEALTH NAVIGATORS- UTILIZE NATIONAL PROGRAMMING TO EDUCATE CONSUMERS AND CLINICIANS ON CARDIOVASCULAR DISEASE STATES AS THEY RELATE TO WOMEN- CROUSE ANNUALLY PLANS AND PARTICIPATES IN AN INNER-CITY FREE HEALTH SCREENING FAIR PROMOTED TO UNDERINSURED AND UNINSURED INDIVIDUALS- SPONSOR OF SYRACUSE'S ANNUAL JUNETEENTH HEALTH PAVILION- SUPPORT AND MEMBERS OF PARTNERSHIP FOR PATIENTS, A PUBLIC-PRIVATE PARTNERSHIP TO IMPROVE THE QUALITY, SAFETY AND AFFORDABILITY OF HEALTHCARE FOR ALL AMERICANS. - CHOICES PROGRAM PROVIDES HIGH SCHOOL STUDENTS WITH A YEAR-LONG "INSIDE LOOK" AT CLINICAL DEPARTMENTS WITHIN THE HOSPITAL INCLUDING MONTHLY TOURS AND SPEAKERS.- COMMUNITY EDUCATION SEMINARS PRESENTED BY PHYSICIANS AND OTHER CLINICIANS, OFFERED THROUGHOUT THE YEAR ON A VARIETY HEALTH AND WELLNESS TOPICS - DEDICATED MRSA UNIT WITH SPECIALLY TRAINED CLINICIANS - EMERGENCY MEDICAL SERVICE CLINICAL TRAININGS ON TOPICS SUCH AS STROKE CARE AND SEPSIS- DONATED FAMILY AND FRIENDS CPR AND FIRST AID TRAINING FOR PERSONS UNABLE TO PAY- HEALTH CARE PROXY CARD PROGRAM DISTRIBUTION BY MAIL AND AT COMMUNITY EVENTS/FORUMS (6,000 DISTRIBUTED IN 2014)- CROUSE HOSPITAL MEDICAL LIBRARY OPEN TO THE COMMUNITY, WITH STAFF SERVING AS HEALTH LITERACY NETWORK FOR CNY MEMBERS - REIKI THERAPY FOR PATIENTS FROM NURSES, VOLUNTEERS AND OTHER STAFF- SPEAKERS BUREAU PROVIDING PRESENTATIONS UPON REQUEST- STUDENT MENTORING PROGRAM FOR HUNDREDS OF HEALTHCARE STUDENTS EACH YEAR- EXCLUSIVE REGIONAL PROVIDER OF SPIRIT OF WOMEN WELLNESS AND EDUCATIONAL INITIATIVE PART VI, LINE 7, REPORTS FILED WITH STATES NY X 1 1 X X X 0 0 0 0 0 0 0 1 0 PAUL KRONENBERG MD DIRECTOR, VICE CHAIR, EXEC VICE PRES 471101 156104 116304 6121 3114 0 8913 2971 17651 3570 617083 168766 0 0 KIMBERLY BOYNTON BOARD PRESIDENT AND CEO 526213 28468 0 0 2871 0 15177 799 36844 933 581105 30200 0 0 DERRICK SUEHS BOARD SECRETARY, CQO 262280 0 0 0 0 0 10862 0 23255 0 296397 0 0 0 KELLI HARRIS BOARD TREASURER, CFO 291316 22419 0 0 0 0 10893 820 23391 1302 325600 24541 0 0 ANN SEDORE PHD RN CHIEF NURSING OFFICER 241579 0 0 0 0 0 5546 0 5673 0 252798 0 0 0 RONALD STAHL MD CHIEF MEDICAL OFFICER 341074 0 0 0 0 0 7672 0 26777 0 375523 0 0 0 SETH KRONENBERG MD CHIEF PHYSICIAN INTEGRATION OFFICER 140066 134743 0 0 0 0 3292 2693 14962 7736 158320 145172 0 0 HECTOR BIAGGI MD PHYSICIAN CHEMICAL DEPENDANCY 237669 0 222904 0 0 0 5944 0 24053 0 490570 0 0 0 JIANXIN MA PHYSICIAN 262805 0 179837 0 0 0 8730 0 41754 0 493126 0 0 0 SAMI ABDUL-MALAK MD PHYSICIAN NEUROLOGY 339090 0 74960 0 0 0 9189 0 41733 0 464972 0 0 0 RICHARD STEINMANN MD PHYSICIAN EMERGENCY DEPT 348814 0 9375 0 0 0 14742 0 46057 0 418988 0 0 0 GINA HAYES PHYSICIAN 278415 0 37765 0 0 0 6737 0 38367 0 361284 0 0 0 PART I, LINE 1A PAUL KRONENBERG AND KIMBERLY BOYNTON WERE REIMBURSED FOR SOCIAL CLUB DUES. PART I, LINE 7 AS STIPULATED BY EMPLOYMENT CONTRACT, THE PREVIOUS HOSPITAL CEO RECEIVED INCENTIVE COMPENSATION IN AN AMOUNT THAT WAS DETERMINED BY THE BOARD OF DIRECTORS, NOT TO EXCEED 25% OF BASE SALARY. THE INCENTIVE WAS BASED UPON THE EXECUTIVES ACHEIVEMENT 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 2014 WAS BASED ON 2013 OBJECTIVES. A 2003A ONONDAGA COUNTY INDUSTRIAL DEVELOPMENT AGENCY 161093714 682747EA4 2003-10-01 7510000 REFUND PORTION OF O/S SERIES 96 BD 0 0 0 B 2003A SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY 521380308 871720BT4 2003-10-01 20000000 REFUND PORTION OF O/S SERIES 96 BD 0 0 0 C 2007A ONONDAGA COUNTY INDUSTRIAL DEVELOPMENT AGENCY 161093714 682747GP9 2007-06-28 9000000 CAPITAL IMPROVEMENT PROJECT 0 0 0 D 2007A SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY 521380308 871720BW7 2007-12-20 20000000 CAPITAL IMPROVEMENT PROJECT 0 0 0 A 7510000 569963 6940037 2003 1 0 1 1 B 20000000 20000000 2003 1 0 1 1 C 9000000 8956437 43563 2009 0 0 1 1 D 20000000 20000000 2010 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 1 1 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 0 1 1 0 0 0 1 D 0 0 0 1 1 0 0 0 1 A 1 B 1 C 1 D 1 A 2007B SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY 521380308 871720BX5 2007-12-20 7850000 CAPITAL IMPROVEMENT PROJECT 0 0 0 A 7850000 7850000 2008 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 PAUL KRONENBERG MD SOLE MEMBER OF CROUSE MEDICAL PRACTICE PLLC 0 PAUL KRONENBERG, MD IS THE PHYSICIAN CEO AND SOLE MEMBER OF CROUSE MEDICAL PRACTICE PLLC. TO SEE A MORE DETAILED EXPLANATION OF CROUSE MEDICAL PRACTICE, PLLC AND THE HOSPITAL'S TRANSACTIONS WITH THIS ENTITY, PLEASE REFER TO SCHEDULE O AND SCHEDULE R. 0 JAMES LONGO MD PARTNER IN CARDIOLOGY PC 139791 JAMES LONGO, MD IS A PARTNER IN CARDIOLOGY PC WHICH PROVIDES CARDIOLOGY SERVICES TO THE HOSPITAL AND FOR WHICH PAYMENTS TOTALING $139,791 WERE RECEIVED FROM THE HOSPITAL IN 2014. 0 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 PATRICK MANNION HAS UTILIZED SERVICES OF MACKENZIE HUGHES LAW FIRM WHERE MS. HARTNETT IS A PARTNER. 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 11 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 BY THE EXECUTIVE COMMITTEE. 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 XI, LINE 9: PENSION AND POST-RETIREMENT CHANGES OTHER THAN PERIOD COSTS -46,280,254. DECREASE IN INTEREST IN NET ASSETS OF CROUSE HEALTH FOUNDATION -116,238. DECREASE IN FUNDS HELD IN TRUST BY OTHERS -22,935. 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") WITH PAUL KRONENBERG, MD - THEN HOSPITAL CEO AND NON-VOTING MEMBER OF THE HOSPITAL BOARD OF DIRECTORS AND SOLE MEMBER OF THE 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. DR KRONENBERG'S SON IS EMPLOYED AS A PHYSICIAN BY 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 MEMBERS KIMBERLY BOYNTON AND PAUL KRONENBERG, 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 SYSTEM INC 736 IRVING AVENUE SYRACUSE NY 13210 161560473 TO PROVIDE OFF SITE SPACE AND SECURE CAPITAL NY 501(C)(3) LINE 11A, I 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 THROUGH ACQUISITION OF PHYSICIAN PRACTICES NY 501(C)(3) LINE 7 CROUSE HEALTH HOSPITAL 1 0 0 1 1 1 0 0 0 0 1 0 0 1 0 1 0 1 0 0 CROUSE MEDICAL PRACTICE PLLC D 22837830 LOAN AGREEMENT CROUSE MEDICAL PRACTICE PLLC O 706358 INTERCO AGREEMENT CROUSE HEALTH FOUNDATION INC C 2509259 CROUSE HEALTH SYSTEM INC O 896357 INTERCO AGREEMENT CROUSE HEALTH SYSTEM INC J 3159507 LEASE AGREEMENT