2013-11-15T14:00:01-06:00 2012-12-31 PricewaterhouseCoopers LLP 677 BROADWAY ALBANY NY 12207 990 2012-01-01 160960470 CROUSE HEALTH HOSPITAL INC % KIMBERLY BOYNTON CROU 3154707111 736 IRVING AVENUE Suite SYRACUSE NY 132101687 KIMBERLY BOYNTON 3154707589 2013-11-14 true Jeffrey C Hamilton 5184622030 2012 2016-03-07 17:11:31Z CROUSE HOSPITAL Paul Kronenberg MD CEO 736 Irving Avenue Syracuse NY 13210 374748041 false X WWW.CROUSE.ORG X 1913 NY THE MISSION OF CROUSE HEALTH HOSPITAL, INC. IS TO PROVIDE THE BEST IN PATIENT CARE AND TO PROMOTE COMMUNITY HEALTH. 13 11 3122 400 203175 174218 222101 358132185 362823789 1432723 1628333 9216341 10004235 368955467 374678458 0 0 0 0 194824815 200669362 0 0 0 175903976 181362123 370728791 382031485 -1773324 -7353027 256697384 252459763 281763343 275881641 -25065959 -23421878 THE MISSION OF CROUSE HEALTH HOSPITAL, INC. IS TO PROVIDE THE BEST IN PATIENT CARE AND TO PROMOTE COMMUNITY HEALTH. false false 246896379 362823789 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 and 57 BASSINETS. crouse hospital serves more than 24,000 inpatients, 69,000 emergency service patients, and more than 270,000 outpatients annually. CROUSE HOSPITAL PROVIDED APPROXIMATELY $6.9 million IN CHARITY CARE IN 2012. Additional details on crouse hospital's exempt purpose achievements are found in "crouse hospital's 2010-2013 community service plan" which can be accessed on the hospital website. www.crouse.org 246896379 true true false true false false false false false true true false false true true false false true false false false false false false false false true true false false true true false false false false false false false true true true false false false false false true true true false false true 297 0 true 3122 true true true false false false false false false false false false X 13 11 true false false false true true true true true false false true true true true true true true true true true NY X X KIMBERLY BOYNTON 3154707376 736 IRVING AVENUE SYRACUSE NY 13210 ELIZABETH HARNETT ESQ 1.0 1.0 X Patrick Mannion 1.0 1.0 X X PAUL KRONENBERG MD 38.0 3.0 X X 649061 27127 38220 MELVIN STITH PHD 1.0 1.0 X MARY COTTER 1.0 1.0 X LOUIS GREEN MD 1.0 41.0 X 0 248795 8829 Ellen Bifano MD 1.0 1.0 X James Carrick 1.0 1.0 X RICHARD RUSSELL 1.0 1.0 X robert miron 1.0 1.0 X BARBARA ASKIN 1.0 1.0 X JAMES HUGHES 1.0 1.0 X PATTY BLACK 1.0 1.0 X ALBERT WERTHEIMER 1.0 1.0 X PAM REILLY 1.0 1.0 X MICHAEL DUFFY MD 1.0 1.0 X 7500 0 0 Derrick Suehs 40.0 1.0 X 235248 0 32541 KIMBERLY BOYNTON 38.0 3.0 X 428653 17685 44836 Mary Agnew 40.0 X 201561 0 30303 Ronald Stahl MD 40.0 X 342617 0 38307 Michael Dupuis 40.0 X 182408 0 34518 Richard Steinmann MD 40.0 X 387341 0 67254 Michael Jorolemon MD 40.0 X 337089 0 66693 sami abdul-malak md 40.0 X 345336 0 43802 HECTOR BIAGGI MD 40.0 X 346304 0 35199 CRISTINA TOPOR MD 40.0 X 324341 0 45215 3787459 293607 485717 201 false true false CROUSE MEDICAL GROUP PC 401 N SALINA STREET SUITE 400 SYRACUSE NY 13203 Professional Medical 2510882 CNY Anesthesia Group PC 736 IRVING AVE SYRACUSE NY 13210 Professional medical 2266033 haynor hoyt corporation 625 erie blvd w SYRACUSE NY 13204 construction 3644759 MAGNETIC DIAGNOSTIC RESOURCES OF CN 4567 CROSSROADS PARK DRIVE LIVERPOOL NY 13088 professional medical 1617000 UNIVERSITY MEDICAL ASSOCIATES 750 EAST ADAMS STREET CAB 322 SYRACUSE NY 13210 PROFESSIONAL MEDICAL 1673194 53 133961 88140 222101 PATIENT SERVICE REV 623000 174395828 174395828 MEDICARE/MEDICAID PAYMENTS 623000 182890535 182890535 PARKING 812930 2014335 2014335 PROPERTY MGT REV FROM AFFILIATE 531310 942912 942912 RENT 532000 522372 522372 2057807 2057807 362823789 1613318 1613318 0 0 0 0 0 84598 69583 15015 15015 15015 0 0 0 OTHER INVESTMENT INCOME 525990 1290067 203175 1086892 CAFETERIA 721110 1664963 1664963 COLLEGE OF NURSING 611600 2117744 2117744 4931461 4931461 10004235 374678458 362823789 203175 11429393 0 0 0 0 2039548 2039548 0 157043631 100222403 56821228 1494049 957464 536585 28556253 17867235 10689018 11535881 7190315 4345566 0 754925 754925 262880 262880 127390 127390 0 0 16988994 10611336 6377658 1199444 747614 451830 1688970 1047161 641809 2817972 1747143 1070829 0 10806333 6699926 4106407 158115 98031 60084 0 323841 200781 123060 2509835 2509835 0 17687700 11024744 6662956 3989152 2486438 1502714 PENSION EXPENSE 15871516 9892716 5978800 MAINTENANCE CONTRACTS 3794583 2352642 1441941 SUPPLIES 65060006 44474925 20585081 PURCHASED SERVICES 18972098 17899519 1072579 18348369 11375986 6972383 382031485 246896379 135135106 0 8375 8425 20602292 21123757 0 0 40993483 37667853 0 0 0 0 4336266 4661847 6425966 7092876 4901146 5323237 272206004 153287083 124397892 118918921 0 0 0 0 208027 208027 0 0 54823937 57454820 256697384 252459763 25370796 25967636 0 0 0 0 67320000 67630000 0 0 0 0 10527051 2203251 0 0 178545496 180080754 281763343 275881641 X -46220526 -46229557 9819329 11322706 11335238 11484973 -25065959 -23421878 256697384 252459763 X -7353027 -310929 9308037 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 154390 false false 154390 false ORG. EXEMPT UNDER SEC. 501(c)(3) - DIRECT CONTACT WITH LEGISLATORS PART II-B LINE 1G Crouse Health Hospital, Inc. contracted with the firm of Wilson, Elser, Moskowitz, Edelman & Dicker, LLP effective 2/11/12 to 3/10/13 to serve as legislative counsel to the Hospital. The fee for these services is $120,000 annually plus expenses. As of December 31, 2012, Crouse Hospital has paid the firm $120,000 in professional service fees and $7,390 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 or opposing legislation. Attendance at public health hearings, committee meeting, 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 the current status of pending legislation. Discussions and recommendations 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 communications, 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. 19814130 50269 2546629 38000 809092 28637 21535299 21220353 259960 -742382 41500 843933 38368 19814130 19569523 57126 2430827 28500 770515 38108 21220353 16978156 63493 3388889 28750 797265 35000 19569523 24198431 129183 -6351133 34000 929075 35250 16978156 0.40000 0.50000 0.10000 false true true 285832 285832 164721450 76483639 88237811 16374087 14799155 1574932 83232467 62004289 21228178 7592168 7592168 118918921 CROUSE HEALTH FOUNDATION 21353601 ASSETS WHOSE USE IS LIMITED 32042802 FUNDS HELD IN TRUST BY OTHERS 1454078 BOND ISSUANCE/CLOSING COSTS 2604339 57454820 0 SELF INSURED PROFESS. LIAB. 20664026 ACCRUED PENSION LIABILITY 129363821 POSTRETIREMENT OBLIGATION 13320080 ASSET RETIREMENT OBLIGATION 2732728 DUE TO/FROM RELATED PARTIES (N 2157824 FUNDS HELD IN TRUST 234336 LIABILITIES TO THIRD PARTY PAY 11188970 DEFERRED RENT & REBATE 418969 180080754 373305376 373305376 1373082 1373082 374678458 382031485 382031485 382031485 Reconciliation of Revenue Per Audited FS with Revenue Per Return Part XII, Line 2d & Line 4b net income from equity investments 1,290,067 investment income 68,000 net gain on sale of assets other than inventory 15,015 ___________ TOTAL 1,373,082 =========== Endowment Fund 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 $21.5 million at december 31, 2012. the principal, with an approximate value of $10.0 million, remains untouched; while the investment income is used to fund equipment and programs required for hospital services and initatives. true true X true X true X true true true false true true 6146663 2499863 3646800 0.00960 85899947 62198247 23701700 0.06230 92046610 64698110 27348500 0.07190 289694 289694 0.00070 10219731 5956745 4262986 0.01120 4642090 4368714 273377 0.00070 133022 133022 0.00040 15284537 10325459 4959079 0.01300 107331147 75023569 32307579 0.08490 1 43309 43309 1 2810 2810 2 46119 46119 true 13082903 88197784 93148629 -4950845 X true true LACNY INC LABORATORY SERVICES 0.33300 MDR LLC MAGNETIC RESONANCE IMAGING 0.25000 0.75000 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 true X X X X X X X X X true true true X X X X X X X X X X false false true true 100 true 300. true X X true true X X X X X X true X X X X true X X X X X X X X true false true 9 CROUSE HOSPITAL-410 SOUTH CROUSE DIVISIO

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

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URGENT CARE CENTER CROUSE HOSPITAL-COMMONWEALTH DIVISION

6010 EAST MOLLY RD SYRACUSE NY 13211

RESIDENTIAL CHEMICAL DEPENDENCY REHABILITATION PHYSICAL THERAPY-LIVERPOOL

7375 OSWEGO ROAD LIVERPOOL NY 13090

PHYSICAL THERAPY CENTER CROUSE ENDOSCOPY

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ENDOSCOPY TESTING CENTER POB SURGERY CENTER

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OUTPATIENT AMBULATORY SURGERY CENTER PHYSICAL THERAPY-DEWITT

5823 WIDEWATERS PARKWAY EAST SYRACUSE NY 13057

PHYSICAL THERAPY CENTER MADISON IRVING SURGERY CENTER

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OUTPATIENT AMBULATORY SURGERY CENTER SCHEDULE H PART VI LINE 1. Crouse Hospital's Community Health Outreach Manager spends 50% of her time (12 hours per week) working with health and social service agencies throughout the county and region to enhance healthcare for those living in poverty and/or with little access to care. These activities include serving on the boards of the Healthy Syracuse Coalition and the Onondaga County Health Department's Cancer Services Program, as well as the health committees for the Syracuse City School District, the school district's Say Yes to Education program, and Hughes Elementary School. The goal of this participation is to influence and positively affect health policies, as well as to enhance coalitions for improvement. Additionally, the hospital's Employee Wellness Coordinator and Asthma Education Staff work with the Healthy Syracuse Coalition specifically to reduce and eliminate tobacco consumption in Onondaga County, and to increase employers' knowledge and application of worksite wellness policies and procedures. Crouse was a major sponsor of the first Worksite Wellness Conference in Syracuse in 2012. SCHEDULE H PART VI LINE 2. Onondaga County Community Health Needs Assessment Community Engagement Process To assess the health care needs of the communities Crouse Hospital serves, the hospital and the Onondaga County Health Department (LHD) partnered with the other two hospitals in Onondaga County to conduct a community health assessment process that engaged health improvement efforts already underway and drew on local resources. The process was designed to result in a clear picture of the health of the community and to identify meaningful and realistic community health improvement initiatives that are supported by key constituencies. The process began with meetings between 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 (St. Joseph's Hospital Health Center, Crouse Hospital and Upstate University Hospital (including the Golisano Children's Hospital and Upstate at Community General)) to discuss the process and gain support of the leadership. The outcome of the meeting was an agreement that the community health assessment process would be a collaborative effort that would focus on building on existing partnerships to ensure that the outcome would incorporate initiatives that have a strong base of support. The community health assessment process undertaken in Onondaga County was also structured to meet the requirements of the New York State Prevention Agenda and Title IX of the Patient Protection and Affordable Care Act of 2010. The process was supported by 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. The Lerner Center for Public Health Promotion at the Maxwell School for Citizenship and Public Affairs at Syracuse University provided logistical support and assistance with recruiting forum participants in collaboration with the Onondaga County Advisory Board of Health, the Syracuse City Schools, and Say YES to Education. The forums were held at the Central New York Community Foundation Philanthropy Center; the school-focused forum was held at the Say Yes to Education offices. Altogether, 92 people participated in the forums. The purpose of the forums was to find out what health issues are perceived to be of importance in the community. These qualitative findings provided a backdrop against which data was collected and analyzed to better understand the concerns raised by community members. The results of the forum are summarized in a report issued in January of 2012 (included in an Appendix to Crouse Hospital's 2013 CHNA). The data collection and analysis phase followed. Data from a number of sources were utilized, including the New York State Prevention Agenda, the 2013 Community Needs Assessment Report developed by the United Way of CNY as well as internal information from the LHD and hospitals. Again, students from the CNYMPH program were engaged to support the community health assessment effort. Teams of students were paired with the hospitals and with the LHD to support data collection and analysis. The teams, at the direction of the hospital and LHD, collected and organized data that was used by the leadership of the organizations to understand the health needs of the community. The students provided formal reports to each of the organizations in the Spring of 2013. Over the course of 2012/2013, a task force composed of representatives from the LHD and the hospitals met regularly to review the data and explore areas for collaboration. During the course of the community health assessment, an issue related to neonatal abstinence syndrome, drug withdrawal in a baby, surfaced. The issue was identified initially by local physicians and hospital staff; it was brought to the Onondaga County Advisory Board of Health by a neonatologist. A review of the data revealed that Onondaga County has the highest rate of hospital discharges for newborns with drug-related issues. A community solution, detailed in later sections of the community health assessment, is under development and is one of the priority/focus areas chosen in Onondaga County. The findings of the community health assessment revealed that one of the priority issues revolved around chronic disease and more specifically physical activity and nutrition as it relates to chronic disease. The data supports the community perception that chronic disease is an important issue and will be discussed in later sections of the community health assessment as one of the priority/focus area chosen in Onondaga County. Through discussions with the task force and the leadership of the LHD and the hospitals, two priority areas were chosen: " Prevent Chronic Disease " Promote Mental Health and Substance Abuse o Neonatal Abstinence Syndrome At a meeting on May 1, 2013 of the Thursday Morning Roundtable, a community forum sponsored by Syracuse University, the Commissioner of Health and Chair of the Advisory Board of Health presented "The State of our County's Health: An Assessment of Onondaga County's Health". This presentation is also included as Appendix II. With the priority areas identified, the LHD and hospitals have collaborated to refine the focus areas and strategies, building on community health initiatives that are underway, that will be undertaken to address these issues. SCHEDULE H 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, as 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 government 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.http://www.crouse.org/visit/patients/financial-assistance/ - Crouse Hospital developed a simpler, one-page application that is easier to fill out and eliminates duplication of paperwork and documentation. - The Hospital's financial assistance staff bring computers directly to patients' bedsides to electronically complete financial aid applications. 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 please contact 315/470-5664 or 315/470-7030, and/or accessing the policy through the Crouse website, www.crouse.org - 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. SCHEDULE H PART VI LINE 4. No changes to Crouse Hospital's service area were made in 2012. Crouse Hospital serves a 15-county region in New York that extends south to Binghamton and north to Malone. Its primary service area is Onondaga County and the contiguous surrounding counties. Seventy-five percent of inpatient and outpatient admissions are from Onondaga County; 25 percent are from outside Onondaga County. A major contributor to out-of-county admissions is the fact that Crouse is the New York State-designated regional referral center for perinatal and neonatal intensive care services (60% of NICU admissions at Crouse come from outside Onondaga County). Onondaga County is included in the Syracuse, NY Metropolitan Statistical Area (MSA). The US Census data estimates the county's 2011 population at 467,000, with approximately 145,000 people residing in Syracuse. SCHEDULE H PART VI LINE 5. Crouse Hospital staff provide an abundance of community health improvement promotion throughout our service area, and in conjunction with community partners. Below are descriptions of actions taken to address the three priority areas outlined in Crouse Hospital's New York Prevention Agenda. They were selected in conjunction with the Onondaga County Health Department and the other local hospitals, for collaborative interventions from 2010-2012 in Onondaga County. Crouse Hospital Programs Addressing Tobacco Use " As a smoke-free hospital, Crouse provides ongoing smoking cessation programs for patients, employees, volunteers and college of nursing students. " All patients who identify themselves as smokers are counseled about quitting smoking before they leave the hospital. " Smoking cessation counselors provide necessary education to all patients in our outpatient diabetes program and to the nearly 2,000 individuals who annually participate in free community heart-health and pulmonary function screenings, as well as health fairs sponsored by the hospital. " Crouse staff members provide annual on-site smoking prevention/avoidance programs for students at Hughes Magnet Elementary School, a Syracuse city school located in an economically disadvantaged area, as well as for the Onondaga County BOCES middle school alternative program, for students at risk of dropping out of school. Crouse Hospital Programs Addressing Healthy Mothers, Healthy Babies, Healthy Children " Crouse Hospital, in partnership with SUNY Upstate Medical University, serves as the only New York State-designated Regional Perinatal Center Program in Central New York, caring for the highest risk and most complicated obstetrical and neonatal (NICU) patients in the 15-county region. Annually, Crouse sees 4,000 births and 900 NICU admissions. The region averages 19,000 births per year, with 1,582 of those births receiving NICU care. " Crouse Hospital's Walter R.G. Baker Neonatal Intensive Care Unit annually admits more than 900 premature and critically ill infants, with an on-site, round-the-clock staff of neonatologists, neonatal nurse practitioners and highly skilled registered nurses. " Unique pediatric care services at Crouse include extracorporeal membrane oxygenation for infants and the region's only pediatric cardiac catheterization program. " Crouse staff members facilitate a monthly infant-loss support group for parents and their families throughout the region. The infant-loss bereavement staff also provides training for medical residents and other OB/GYN staff. " Preventive healthcare offerings include a pediatric first-aid program and comprehensive childbirth education programs that promote the maternal/child benefits of waiting until 39 weeks for any scheduled birth, and breastfeeding, plus lactation consultant services for any mother needing assistance during and/or after her hospital stay. " Crouse continues working with the Children's Consortium of Central New York to offer parents the Baby Beginnings program (previously Ready, Set, Parent) to help reduce the risk of child abuse and increase parenting skills for those with children from infancy to age three. Offered free to parents, Crouse is the only local hospital that provides this program. Annually, the Baby Beginnings staff meets one-on-one with 2,000 mothers and teaches newborn care classes to nearly 800 mothers. " Since 1976 Crouse Hospital has been educating first-grade students throughout Onondaga County (more than 3,000 in the 2012-2013 school year) with our free Visit to Hospital-Land community service program. The program is designed to lessen the fears and confusion of young children who may have to visit a loved one in the hospital, or stay in a hospital themselves. " Crouse offers Babysitters Training Course for sixth grade students in several elementary schools across Onondaga County. In 2012 we equipped about 40 students with the skills and tools needed to provide safe care for younger children, as well as for staying home alone. " Crouse Hospital also continues its partnership with Hughes Magnet School in Syracuse and in 2012 launched a new nutrition education/cooking instruction program through a grant from a local foundation. The grant was renewed and expanded for the 2012/13 school year. " In addition, Crouse works with the Syracuse City School District to serve as wellness advisors and provide support for its health and wellness initiatives. The hospital provides: o health speakers for each grade; o free continuing medical education training for school nurses; o free heart health screenings for staff; and o placement of Crouse Hospital College of Nursing students in schools to assist school nurses. " Crouse Hospital Chemical Dependency Treatment Services provides comprehensive care that improves the health of our community's mothers, babies and children. - Staff provides substance abuse prevention education for parents, teachers and students in the Syracuse City School District and other rural school districts where substance abuse rates are highest. - Crouse Hospital provides a continuum of care for pregnant and post-partum mothers with alcohol and other substance abuse issues. Pregnant women can enter our residential treatment program at any time before delivery; continue to receive pre-natal care and then deliver at Crouse Hospital. Mothers also may return to treatment at any time following delivery. - Crouse Hospital's Chemical Dependency Treatment Services program serves teens between the ages of 13 and 17 with substance abuse disorders using gender-specific group training. - In collaboration with the Elmcrest Children's Center in Syracuse, Crouse Hospital supports an on-site chemical dependency treatment unit addressing the recovery needs of the children. We are integrating addiction treatment for children to provide them with a comprehensive system of support while they are residing at Elmcrest and when they move on to after-care in their community. - In 2012 Chemical Dependency Treatment Services continued a health and wellness fair for female clients focusing on heart health, breast health, nutrition and diabetes. " The Crouse Breast Health Center offers women the services of three dedicated Breast Health Navigators. The navigators help lessen the anxiety and apprehension of having routine mammograms and other diagnostic imaging or procedures, and guide women through any additional needed tests or procedures. Current Crouse Hospital Programs Addressing Access to Care " Crouse Hospital staff work closely with many local heath and social service agencies to provide free screenings for blood pressure, cholesterol and blood glucose levels to more than 2,000 individuals annually, most of whom are from underserved or underinsured groups. We also support dozens of community education health fairs and other events annually. " As a member of the Onondaga County Get Health Connected Consortium, Crouse annually plans and participates in an inner-city free health screening fair promoted to underinsured and uninsured individuals. In 2013 and 2011, Crouse Hospital served as the event organizer. In 2012, Crouse oversaw event publicity and advertising for the event. " Serving as a sponsor of Syracuse's annual Juneteenth Health Pavilion, Crouse nursing staff are on site providing free blood pressure checks, healthcare proxy cards, medication records and a wide variety of helpful health-related information. In 2011, 2012 and 2013, more than 300 people had their blood pressure checked and reviewed. " Working with the Syracuse Say Yes to Education staff and volunteers, Crouse provides leadership support and healthcare expertise for the program. Syracuse University and the Syracuse City School District have joined forces to develop and launch this first district-wide program that will promote lifelong success for Syracuse school district students and their families by increasing both high school and college graduation rates. " Crouse Hospital's Chemical Dependency Treatment Services Program provides several services that focus on access to care, including: a hospital intervention service for patients identified with addictive complications in their primary care that provides in-hospital clinical intervention and access to treatment after discharge; - the region's only medical detoxification unit; - the region's only opioid maintenance treatment program; - the region's only service for older adults suffering with addiction - and serving as the area's largest provider of addiction treatment to the Hispanic community in the patients' primary language and with cultural enhanced understanding of the Hispanic community. " As Central New York's first hospital designated as a NICHE organization (Nurses Improving Care for Healthcare Elders), Crouse continued its innovative Care Transitions program for patients with a variety of cardiac conditions (CHF, AFib, MI), COPD patients and patients with comp SCHEDULE H PART V SECTION B LINE 7. Crouse Hospital files a community benefit report in New York State only. SCHEDULE H PART V SECTION B LINE 16- Other Actions - Wage garnishments and liens on bank accounts SCHEDULE H PART V SECTION B LINE 17 - Other Actions - Wage garnishments and liens on bank accounts SCHEDULE H PART V SECTION B LINE 19 - Other -. 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 uninsured individual adjustment to gross charges is based on the hospitals income guidelines adjusted against our lowest commercial insurance rate. SCHEDULE H PART V SECTION B LINE 22 - Other - The hospital makes every attempt to work with patients to secure financial assistance to allow the charge to be reduced to a lower rate for payment. SCHEDULE H PART V SECTION B QUESTION 3 - 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 (most frequently the commissioner) 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. SCHEDULE H PART V SECTION B QUESTION 4 - The CHNA was conducted in conjunction with St. Joseph's Hospital Health Center and Upstate Medical Center University. SCHEDULE H PART V SECTION B QUESTION 5 - Other means of distributing CHNA: Mailing and e-mailing the report to public libraries, community organizations, local officials, business leaders, media, hospital employees, volunteers and physicians, the hospitals 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. SCHEDULE H PART V SECTION B QUESTION 7 - Due to limited resources, and the availability of other providers to help, Crouse Hospital will not be focusing its efforts on the following health needs of our community: improved sidewalks and transportation; primary care for an ever-growing refugee population; and suicide prevention. X true true X X X true false false false false false false true false PAUL KRONENBERG MD 509138 26595 137578 532 2345 0 14056 740 22848 576 685965 28443 0 0 Derrick Suehs 230448 0 4800 0 0 0 13134 0 19407 0 267789 0 0 0 KIMBERLY BOYNTON 347711 17315 80942 370 0 0 11811 622 31293 1110 471757 19417 0 0 LOUIS GREEN MD 0 245243 0 3552 0 0 0 0 0 8829 0 257624 0 0 Mary Agnew 199502 0 2059 0 0 0 2399 0 27904 0 231864 0 0 0 Richard Steinmann MD 373725 0 13616 0 0 0 19468 0 47786 0 454595 0 0 0 Ronald Stahl MD 335817 0 6800 0 0 0 7730 0 30577 0 380924 0 0 0 Michael Dupuis 178668 0 3740 0 0 0 6539 0 27979 0 216926 0 0 0 Michael Jorolemon MD 324233 0 12856 0 0 0 9310 0 57383 0 403782 0 0 0 sami abdul-malak md 339536 0 5800 0 0 0 8157 0 35645 0 389138 0 0 0 HECTOR BIAGGI MD 341522 0 4782 0 0 0 9103 0 26096 0 381503 0 0 0 CRISTINA TOPOR MD 318971 0 5370 0 0 0 8913 0 36302 0 369556 0 0 0 Continuation of Officers, Directors, Trustees, Key Employees, & Highest Compensated Part I 1a Health or social club dues: Paul Kronenberg was reimbursed for his social club dues. officers, directors, trustees, key employees & highest compensated employe Part II all individuals listed with the exception of #4 are employees of and compensated by Crouse Health Hospital, Inc. individual 4 is an employee of and compensated by a related organization, crouse medical practice, pllc. Compensation is disclosed for services provided to the Hospital or its related organizations. All members of the Board of Directors of the Hospital except the Ex-Officio members are voluntary. No compensation, employee benefits or expense account allowances are received for Board services. CHIEF EXECUTIVE OFFICER PART I, QUESTION 7 As stipulated by employment contract, the Hospital CEO receives incentive compensation in an amount determined by the Board of Directors, not to exceed 25% of base salary. The incentive is based upon the Executive's achievement of objectives that are mutually agreed upon by the Executive and the Board of Directors or a committee thereof. The objectives are established annually. The Board of Directors determines the amount of incentive compensation. Incentive compensation received in 2011 was based on achievement of 2011 objectives. CHIEF FINANCIAL OFFICER PART I, QUESTION 7 As stipulated by employment contract, the Hospital CFO receives incentive compensation in an amount to be determined by the Board of Directors, not to exceed 25% of base salary, based upon the CFO's achievement of reasonable objectives that are mutually agreed upon by the CFO and by the CEO and the Board or a committee thereof. The objectives are established annually and are not based upon the Hospital's financial performance. The Board in consultation with the CEO determines the amount of incentive compensation. Incentive compensation received in 2011 was based upon achievement of 2011 objectives. emergency department physicians part 1, question 7 In 2012 the emergency department physicians received incentive compensation. this compensation was based on productivity benchmarks and successful outcomes of patient satisfaction survey conducted during 2011. Severance Payment Part 1, Question 4a Mary Agnew received a severance of $110,812 during 2012. A 2003a onondaga county industrial development agenc 161093714 682747ea4 2003-09-25 7510000 refund portion of o/s series 96 bd false false false B 2003a syracuse industrial development agency 521380308 871720bt4 2003-09-25 20000000 refund portion of o/s series 96 bd false false false C 2007a onondaga county industrial development agen 161093714 682747gp9 2007-06-25 9000000 capital improvement project false false false D 2007a syracuse industrial development agency 521380308 871720bw7 2007-12-14 20000000 capital improvement project false false false A 0 0 0 0 0 0 0 0 0 0 0 0 2003 true false true true B 0 0 0 0 0 0 0 0 0 0 0 0 2003 true false true true C 0 0 0 0 0 0 25126 0 0 670747 0 0 2009 false false true true D 0 0 0 0 0 613750 0 0 0 19646952 0 0 2010 false false true true A false false false false false false 0.00000 0.00000 0.00000 0.00000 true B false false false false false false 0.00000 0.00000 0.00000 true C false false false false false false 0 true D false false false false false false 0.00000 0.00000 0.00000 true A false true true false 0 false false false 0 false true B false true true false 0 false false false 0 false true C false true true false 0 false false false 0 false true D false true true false 0 false false false 0 false true A true B true C true D true Dates of Rebate Calculations Part IV, Line 2C 2007A Onondaga County IDA - September 30, 2013 2007A Syracuse IDA - September 30, 2013 2007B Syracuse IDA - September 30, 2013 A 2007b syracuse industrial devel agency 521380308 871720bx5 2007-12-14 7850000 capital improvement project false false false A 0 0 0 0 0 0 0 0 0 0 0 0 2008 false false true true A false false false false false false 0.00000 0.00000 0.00000 A false true true false 0 false false false 0 false true A true ELLEN BIFANO MD SEE PART V EXPLANATION 317931 SEE PART V EXPLANATION false PAUL KRONENBERG MD SEE PART V EXPLANATION SEE PART V EXPLANATION false SCHEDULE L, PART IV LINE 1: Ellen Bifano, MD is a partner in neonatal associates of cny which provides neonatal services to the hospital and for which payments totaling $317,931 were received from the hospital in 2012. LINE 2: 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, PLCC AND THE HOSPITAL'S TRANSACTIONS WITH THIS ENTITY, PLEASE REFER TO SCHEDULE 0 AND SCHEDULE R. FORM 990, PART VI Question 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. Question 2: Richard Russell, a Director, provided accounting and tax advice to Albert Wertheimer, who is also a Director. Patrick Mannion has utilized services of MacKenzie Hughes law firm where Ms. Hartnett is a partner. QUESTION 6: CROUSE HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF CROUSE HEALTH HOSPITAL, INC. QUESTION 7A: CROUSE HEALTH SYSTEM, INC. APPROVES AND ELECTS THE BOARD OF DIRECTORS OF CROUSE HEALTH HOSPITAL, INC. QUESTION 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. QUESTION 11b: HOSPITAL ACCOUNTING STAFF PROVIDES DATA TO AN INDEPENDENT ACCOUNTING FIRM (PRICEWATERHOUSECOOPERS, LLP) 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. QUESTION 12C: CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE COMPLETED ANNUALLY BY THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES OF CROUSE HEALTH HOSPITAL, INC. 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. QUESTIONS 15A & 15B: The compensation for the CEO is based on an annual finance/compensation 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 finance/compensation committee. Current compensation is compared to the national salary survey and any necessary adjustments are reviewed by the finance and audit committee of the board. Question 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. GENERAL DISCLOSURE, CROUSE MEDICAL PRACTICE, PLLC In 2010 the Hospital formed Crouse Medical Practice, PLLC ("PLLC") with paul kronenberg, m.d. 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 PLLC's financial statements are consolidated with the System for financial statement purposes. dr. kronenberg's son is employed as a physician by the pllc. Louis Green, MD, a voting member of the Board of Directors, is an employee of the pllc. as a result, dr. green is considered as not an independent voting member of the hospital's board. All members of the Hospital's Board of Directors complete annual conflict of interest disclosures. The Board's conflict of interest policy would prevent Dr. Green from using his voting powers on the hospital Board of Directors to his own advantage as an employee of the PLLC. Part XI Reconciliation of net assets part xi line 5 Contributions for property acquisitions 1,794,487 Pension & post retirement changes other than periodic costs 5,860,438 Net decrease in interest in net assets of Crouse Health Foundation,Inc. 1,569,735 decrease in funds held in trust by others 83,377 ___________ TOTAL 9,308,037 =========== PART VII, LINE 2 All members of the Board of Directors of the Hospital except ex-officio member 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 SEE PART VII NY 501 C 3 11A NA false CROUSE HEALTH FOUNDATION INC 736 IRVING AVENUE SYRACUSE NY 13210 161035427 SEE PART VII NY 501 C 3 7 NA false crouse medical practice pllc 730 s crouse avenue ste 204 syracuse NY 13210 800548096 SEE PART VII NY SEE PT VII 7 SEE PART VII true false false true true true false false false false true false false true false true false true false false crouse medical practice pllc d 10052155 loan agreement crouse medical practice pllc o 292423 interco agrmt SCHEDULE R, PART II column b, line 1 - crouse health system, inc.'s primary activity is to provide off-site space and secure captial. column b, line 2 - crouse health foundation, inc.'s primary activity is fundraising for crouse health hospital, inc. column b, line 3 - crouse medical practice, pllc was formed to further the hospital's charitable purproses through the acquisition of physician practices and the employment of physicians. column d, line 3 - crouse medical practice, pllc filed irs form 1023, application for tax exempt status as a 501(c)(3) corporation on april 30, 2012. column f, line 3 - direct controlling entity is crouse health hospital, inc.