CAYUGA MEDICAL ASSOCIATES PC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CAYUGA MEDICAL ASSOCIATES PC (EIN 20-4356115)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-13
IRS object ID
201323179349303682
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-13T13:45:22-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN161071694EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SCIARABBA WALKER & CO LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 E BUFFALO ST SUITE 402AddressLine1
CityITHACACity
StateNYState
ZIP Code14850ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN204356115EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CAYUGA MEDICAL ASSOCIATES PCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCAYUNameControl
Phone6072772365Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101 DATES DRIVEAddressLine1
CityITHACACity
StateNYState
ZIP Code14850ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID GEORGE EVELYNName
TitleVICE-PRESIDENTTitle
Phone6072772365Phone
Date Signed2013-11-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDAVID M STINSONName
PTINP00213287PTIN
Phone6072725550Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDANIEL ROB MCKENZIENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1101 DATES DRIVEAddressLine1
CityITHACACity
StateNYState
ZIP Code14850ZIPCode
FieldValueIRS element (for citing)
Gross Receipts23374112GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2006YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE ACCESS TO PRIMARY CARE AND MEDICAL SPECIALTIES TO THE RESIDENTS OF TOMPKINS COUNTY AND SURROUNDING AREAS.ActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees165TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6750387ContributionsGrantsPriorYear
Contributions Grants Current Year8806211ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10990039ProgramServiceRevenuePriorYear
Program Service Revenue CY14516281ProgramServiceRevenueCY
Investment Income Prior Year283InvestmentIncomePriorYear
Investment Income Current Year138InvestmentIncomeCurrentYear
Other Revenue Prior Year960OtherRevenuePriorYear
Other Revenue Current Year-2518OtherRevenueCurrentYear
Total Revenue Prior Year17741669TotalRevenuePriorYear
Total Revenue Current Year23320112TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12318755SalariesEtcPriorYear
Salaries Etc Current Year15807258SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5520889OtherExpensePriorYear
Other Expenses Current Year7107198OtherExpensesCurrentYear
Total Expenses Prior Year17839644TotalExpensesPriorYear
Total Expenses Current Year22914456TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-97975RevenuesLessExpensesPriorYear
Revenues Less Expenses CY405656RevenuesLessExpensesCY
Total Assets BOY2437569TotalAssetsBOY
Total Assets EOY3441971TotalAssetsEOY
Total Liabilities BOY1345292TotalLiabilitiesBOY
Total Liabilities EOY1944038TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1092277NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1497933NetAssetsOrFundBalancesEOY
Mission DescriptionCAYUGA MEDICAL ASSOCIATES, PC WAS FORMED EXCLUSIVELY FOR THE CHARITABLE PURPOSE OF SERVING THE HEALTH CARE NEEDS OF THE RESIDENTS OF TOMPKINS COUNTY AND SURROUNDING AREAS, AND EXISTS TO FURTHER THE CHARITABLE MISSION OF CAYUGA MEDICAL CENTER AT ITHACA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense20830694Expense
Revenue14516281Revenue
DescriptionIN 2012, THE ORGANIZATION PROVIDED MEDICAL SERVICES TO 22,245 PATIENTS IN THE COURSE OF CONDUCTING 88,741 PATIENT VISITS. THE ORGANIZATION PROVIDES MEDICAL CARE TO ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. THE ORGANIZATION ALSO OFFERS A FINANCIAL ASSISTANCE PROGRAM THAT, BASED ON FEDERAL POVERTY GUIDELINES, PROVIDES FREE OR REDUCED FEE CARE TO QUALIFYING INDIVIDUALS. IN 2012, THE ORGANIZATIONS PHYSICIANS CONDUCTED OVER 8,991 VISITS WITH MEDICAID AND LOW INCOME PATIENTS. THE ORGANIZATION CONTINUES WITH THE COMMITMENT TO ACCEPT PATIENTS FROM THE LOCAL PHYSICIANS REFERRAL CENTER, REGARDLESS OF ABILITY TO PAY.Description
Total Program Service Expense20830694TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109637NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees165NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CAYUGA MEDICAL ASSOCIATES PC ADMINBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6072772365TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11301 TRUMANSBURG RD SUITE PAddressLine1
CityITHACACity
StateNYState
ZIP Code14850ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedHighest Compensated EmployeeHighestCompensatedEmployee
MARTIN STALLONE MD
SECRETARY/TREASURER40.00XX357852022984
JOHN-PAUL MEAD MD
BOARD MEMBER40.00XX301543022984
DANIEL ROB MACKENZIE MD
PRESIDENT2.00XX04446212408338.00
DAVID GEORGE EVELYN MD
VICE PRESIDENT2.00XX02886272408338.00
STEPHANIE GOODWIN DO
PHYSICIAN40.00503389022984X
QUTAYBEH MAGHAYDAH MD
PHYSICIAN40.00478399022984X
BRETT YOUNG MD
PHYSICIAN40.00496387013159X
PETER HANNON DO
PHYSICIAN40.00486891022984X
BARRY POLLACK MD
PHYSICIAN40.00531868016282X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3156329TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs733248TotalReportableCompFrmRltdOrgs
Total Other Compensation192527TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PRACTICE RESOURCES LLC
1001 WEST LAFAYETTE STREET STE 400SYRACUSENY132042856MEDICAL BILLING SERVICE498556
ITHACA ORTHOPAEDIC GROUP
10 BRENTWOOD DRIVE SUITE BITHACANY14850PROFESSIONAL MEDICAL SERVICES368609
CAYUGA MEDICAL CENTER
101 DATES DRIVEITHACANY14850PROFESSIONAL MEDICAL SERVICES304170
CAYUGA ENT
2 ASCOT PLACEITHACANY14850PROFESSIONAL MEDICAL SERVICES218856
CRITICAL CARE ASSOCIATES OF SYRACUSE PC
736 IRVING AVESYRACUSENY13210PROFESSIONAL MEDICAL SERVICES192700
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Related Organizations8806211RelatedOrganizations
Total Contributions8806211TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT FEES6211101181345611813456
SERVICE FEES62111024437022443702
MISCELLANEOUS900099259123259123
FieldValueIRS element (for citing)
Total Program Service Revenue14516281TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column138TotalRevenueColumn
Exclusion$138ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real51482Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real54000Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-2518Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-2518TotalRevenueColumn
Exclusion-$2,518ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column23320112TotalRevenueColumn
Related Or Exempt Function Income14516281RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$2,380ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total705363Total
Program Services705363ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total12904011Total
Program Services12325107ProgramServices
Management And General578904ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total521047Total
Program Services452469ProgramServices
Management And General68578ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total917186Total
Program Services541368ProgramServices
Management And General375818ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total759651Total
Program Services463083ProgramServices
Management And General296568ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total39694Total
Management And General39694ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total92602Total
Management And General92602ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2057380Total
Program Services1542917ProgramServices
Management And General514463ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total112340Total
Program Services112340ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total349596Total
Program Services349596ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1316474Total
Program Services1199339ProgramServices
Management And General117135ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total47717Total
Program Services47717ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total277848Total
Program Services277848ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total676693Total
Program Services676693ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
MEDICAL SUPPLIES754080754080
LEASED MD'S452831452831
BAD DEBT392497392497
UTILITIES140176140176

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total397270Total
Program Services397270ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22914456Total
Program Services20830694ProgramServices
Management And General2083762ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY249730BOY
EOY961781EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY586BOY
EOY4298EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY898404BOY
EOY1132936EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY82992BOY
EOY57886EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2419683LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1140013LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1200457BOY
EOY1279670EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5400BOY
EOY5400EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2437569BOY
EOY3441971EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY275854BOY
EOY339737EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1069438BOY
EOY1604301EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1345292BOY
EOY1944038EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1092277BOY
EOY1497933EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1092277BOY
EOY1497933EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2437569BOY
EOY3441971EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses405656ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6356795CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3647914CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5991261CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6750387CurrentTaxYearMinus1Year
Current Tax Year8806211CurrentTaxYear
Total31552568Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3712629CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6415537CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8732302CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10983188CurrentTaxYearMinus1Year
Current Tax Year14516281CurrentTaxYear
Total44359937Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10069424CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10063451CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14723563CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17733575CurrentTaxYearMinus1Year
Current Tax Year23322492CurrentTaxYear
Total75912505Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50975912505PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7599CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years25461CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years61315CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year66043CurrentTaxYearMinus1Year
Current Tax Year51620CurrentTaxYear
Total212038Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7599CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years25461CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years61315CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year66043CurrentTaxYearMinus1Year
Current Tax Year51620CurrentTaxYear
Total212038Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10077023CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10088912CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14784878CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17799618CurrentTaxYearMinus1Year
Current Tax Year23374112CurrentTaxYear
Total76124543Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99720PublicSupportPercentage509
Prior Year Support Percentage0.99710PriorYearSupportPercentage
Investment Income Percentage0.00280InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00290PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis681171OtherCostOrOtherBasis
Depreciation192765Depreciation
Book Value488406BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1724751OtherCostOrOtherBasis
Depreciation940019Depreciation
Book Value784732BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis13761OtherCostOrOtherBasis
Depreciation7229Depreciation
Book Value6532BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1279670TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ACCRUED PAYROLL LIABILITIES$754,366
ACCRUED PAYROLL$153,726
ACCRUED EXPENSES$696,209
FieldValueIRS element (for citing)
Total Of Amounts1604301TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt22981615TotRevenueEtcAuditedFinclStmt
Other Revenues54000OtherRevenues
Revenue Not Rptd F99054000RevenueNotRptdF990
Revenue Subtotal22927615RevenueSubtotal
Other Revenues Not Included392497OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt392497RevenueNotRptdOnFinStmt
Total Revenue Per Form99023320112TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt22575959TotExpensesEtcAuditedFinclStmt
Other Expenses Included54000OtherExpensesIncluded
Expenses Not Rptd F99054000ExpensesNotRptdF990
Expenses Subtotal22521959ExpensesSubtotal
Other Expenses Not Included392497OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt392497ExpensesNotRptdOnFinStmt
Total Expenses Per Form99022914456TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 2D - OTHER ADJUSTMENTS:RENT EXPENSE ALLOCATION 54,000.
PART XI, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT 392,497.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENT EXPENSE ALLOCATION 54,000.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT 392,497.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARTIN STALLONE MD
SECRETARY/TREASURER3578520000075000154840380836000
JOHN-PAUL MEAD MD
BOARD MEMBER3015430000075000154840324527000
DANIEL ROB MACKENZIE MD
PRESIDENT0444621000005000019083046870400
DAVID GEORGE EVELYN MD
VICE PRESIDENT0288627000005000019083031271000
STEPHANIE GOODWIN DO
PHYSICIAN5033890000075000154840526373000
QUTAYBEH MAGHAYDAH MD
PHYSICIAN4783990000075000154840501383000
BRETT YOUNG MD
PHYSICIAN496387000007500056590509546000
PETER HANNON DO
PHYSICIAN4868910000075000154840509875000
BARRY POLLACK MD
PHYSICIAN531868000007500087820548150000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS ONE SHAREHOLDER WHO OWNS TWENTY COMMON SHARES.
FORM 990, PART VI, SECTION A, LINE 7ACMAS RELATIONSHIP WITH THE MEDICAL CENTER IS ESTABLISHED THROUGH THE CORPORATE DOCUMENTS, NAMELY THE BYLAWS AND A SHAREHOLDER AGREEMENT. THROUGH THESE DOCUMENTS, THE SOLE SHAREHOLDER AND PRESIDENT OF THE CORPORATION WILL BE THE PRESIDENT/CEO OR THE VICE PRESIDENT FOR MEDICAL AFFAIRS OF THE MEDICAL CENTER. NEW YORK LAW REQUIRES THAT ALL THE SHAREHOLDERS AND MEMBERS OF THE BOARD, EXCEPT THE SECRETARY, MUST BE PHYSICIANS. IN ORDER TO KEEP THE LINK TO THE MEDICAL CENTER, THE BYLAWS PROVIDE THAT SO LONG AS THERE IS ONLY ONE SHAREHOLDER, ONE OF THE NON-VOTING ADVISORY BOARD MEMBERS WHO IS A VICE-PRESIDENT OF THE MEDICAL CENTER MAY BE ELECTED BY THE VOTING BOARD MEMBERS TO SERVE AS THE SECRETARY OF THE CORPORATION. OTHER BOARD MEMBERS MAY BE OTHER PHYSICIANS WHO MAY BE EMPLOYEES OF THE CORPORATION, BUT THEIR APPOINTMENT IS SUBJECT TO THE APPROVAL OF THE MEDICAL CENTER. THE SHAREHOLDER AGREEMENT CONTROLS THE ACTIONS OF THE INDIVIDUAL MEDICAL CENTER EMPLOYEE WHO SERVES AS THE PRESIDENT AND SOLE SHAREHOLDER OF THE CORPORATION. IF THAT PERSON EVER LEAVES THEIR POSITION AT MEDICAL CENTER, THE SHARES MUST BE TENDERED TO ANOTHER PERSON WHO MEETS THE FOLLOWING QUALIFICATIONS: IS A PHYSICIAN, HOLDS THE TITLE PRESIDENT/CEO OR VICE PRESIDENT FOR MEDICAL AFFAIRS AND IS APPROVED BY MEDICAL CENTER. SO THAT THERE IS NO CONFUSION, THE SHAREHOLDER AGREEMENT MAKES CLEAR THAT THE SHAREHOLDER DESIGNATES ALL RIGHTS TO ANY DIVIDENDS TO MEDICAL CENTER. HOWEVER, UNDER THE BYLAWS, THERE WILL BE NO DIVIDENDS PAID. THEREFORE, CAYUGA MEDICAL ASSOCIATES SHALL BE ORGANIZED AND OPERATED EXCLUSIVELY FOR THE CHARITABLE PURPOSE OF SERVING THE HEALTH CARE NEEDS OF THE RESIDENTS OF TOMPKINS COUNTY AND ITS SURROUNDING AREA.
FORM 990, PART VI, SECTION A, LINE 7BSEE ABOVE ANSWER TO 7A FOR COMPLETE EXPLANATION OF MEMBERSHIP STRUCTURE AND DECISION MAKING AUTHORITY.
FORM 990, PART VI, SECTION B, LINE 11FORM 990 IS PROVIDED TO AND REVIEWED BY ITS BOARD OF DIRECTORS BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CCAYUGA MEDICAL ASSOCIATES HAS ADOPTED A CONFLICT OF INTEREST POLICY IN 2011, WHICH BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN ANNUALLY. THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY BY REVIEWING STATEMENTS ANNUALLY FOR CONFLICTS, IDENTIFYING ANY DISQUALIFIED PERSONS, AND RECORDING ALL PROCEEDING RELATED TO A CONFLICT OF INTEREST TRANSACTIONS.
FORM 990, PART VI, SECTION B, LINE 15IT IS THE POLICY AND PRACTICE OF CAYUGA MEDICAL ASSOCIATES, PC (CMA) TO COMPENSATE STAFF AT MARKET DRIVEN WAGES COMMENSURATE WITH INDIVIDUAL PERFORMANCE. OUTSIDE SOURCES ARE USED TO DETERMINE APPROPRIATE PAY RANGES FOR ALL ROLES, INCLUDING ANY EXECUTIVE COMPENSATION. PHYSICIAN AND KEY EMPLOYEE COMPENSATION IS DETERMINED BASED ON MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA) NATIONAL SURVEY DATA AND OTHER REGIONAL AND LOCAL COMPENSATION DATA. IT IS THE INTENT THAT PHYSICIANS ARE COMPENSATED APPROPRIATELY BASED ON THEIR INDIVIDUAL PRODUCTIVITY AS MEASURED IN COLLECTIONS, RVUS, WORK HOURS, DUTIES, ETC.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2C:NO CHANGES FROM PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CAYUGA MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 DATES DRIVEAddressLine1
CityITHACACity
StateNYState
ZIP Code14850ZIPCode
FieldValueIRS element (for citing)
EIN222325405EIN
Primary ActivitiesHOSPITALPrimaryActivities
Legal Domicile StateNYLegalDomicileState
Exempt Code Section501 C(3)ExemptCodeSection
Public Charity Status170(B)(1)(A)(III)PublicCharityStatus
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CAYUGA MEDICAL CENTER
C8806211ACKNOWLEDGMENT LETTER
CAYUGA MEDICAL CENTER
K29408LEASE AGREEMENT
CAYUGA MEDICAL CENTER
M274762WRITTEN AGREEMENT

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