2013-11-13T13:45:22-06:00 2012-12-31 161071694 SCIARABBA WALKER & CO LLP 200 E BUFFALO ST SUITE 402 ITHACA NY 14850 990 2012-01-01 204356115 CAYUGA MEDICAL ASSOCIATES PC CAYU 6072772365 101 DATES DRIVE ITHACA NY 14850 DAVID GEORGE EVELYN 6072772365 2013-11-13 1 DAVID M STINSON P00213287 6072725550 2012 2016-02-24 21:20:13Z DANIEL ROB MCKENZIE 101 DATES DRIVE ITHACA NY 14850 23374112 0 X N/A X 2006 NY TO PROVIDE ACCESS TO PRIMARY CARE AND MEDICAL SPECIALTIES TO THE RESIDENTS OF TOMPKINS COUNTY AND SURROUNDING AREAS. 4 0 165 0 0 0 6750387 8806211 10990039 14516281 283 138 960 -2518 17741669 23320112 0 0 0 0 12318755 15807258 0 0 0 5520889 7107198 17839644 22914456 -97975 405656 2437569 3441971 1345292 1944038 1092277 1497933 CAYUGA 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. 0 0 20830694 14516281 IN 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. 20830694 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 37 0 165 1 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X CAYUGA MEDICAL ASSOCIATES PC ADMIN 6072772365 1301 TRUMANSBURG RD SUITE P ITHACA NY 14850 MARTIN STALLONE MD 40.00 X X 357852 0 22984 JOHN-PAUL MEAD MD 40.00 X X 301543 0 22984 DANIEL ROB MACKENZIE MD 2.00 38.00 X X 0 444621 24083 DAVID GEORGE EVELYN MD 2.00 38.00 X X 0 288627 24083 STEPHANIE GOODWIN DO 40.00 X 503389 0 22984 QUTAYBEH MAGHAYDAH MD 40.00 X 478399 0 22984 BRETT YOUNG MD 40.00 X 496387 0 13159 PETER HANNON DO 40.00 X 486891 0 22984 BARRY POLLACK MD 40.00 X 531868 0 16282 3156329 733248 192527 7 0 1 0 PRACTICE RESOURCES LLC 1001 WEST LAFAYETTE STREET STE 400 SYRACUSE NY 132042856 MEDICAL BILLING SERVICE 498556 ITHACA ORTHOPAEDIC GROUP 10 BRENTWOOD DRIVE SUITE B ITHACA NY 14850 PROFESSIONAL MEDICAL SERVICES 368609 CAYUGA MEDICAL CENTER 101 DATES DRIVE ITHACA NY 14850 PROFESSIONAL MEDICAL SERVICES 304170 CAYUGA ENT 2 ASCOT PLACE ITHACA NY 14850 PROFESSIONAL MEDICAL SERVICES 218856 CRITICAL CARE ASSOCIATES OF SYRACUSE PC 736 IRVING AVE SYRACUSE NY 13210 PROFESSIONAL MEDICAL SERVICES 192700 6 8806211 8806211 PATIENT FEES 621110 11813456 11813456 SERVICE FEES 621110 2443702 2443702 MISCELLANEOUS 900099 259123 259123 14516281 138 138 51482 54000 -2518 -2518 -2518 23320112 14516281 0 -2380 705363 705363 12904011 12325107 578904 521047 452469 68578 917186 541368 375818 759651 463083 296568 39694 39694 92602 92602 2057380 1542917 514463 112340 112340 349596 349596 1316474 1199339 117135 47717 47717 277848 277848 676693 676693 MEDICAL SUPPLIES 754080 754080 LEASED MD'S 452831 452831 BAD DEBT 392497 392497 UTILITIES 140176 140176 397270 397270 22914456 20830694 2083762 0 249730 961781 586 4298 898404 1132936 82992 57886 2419683 1140013 1200457 1279670 5400 5400 2437569 3441971 275854 339737 1069438 1604301 1345292 1944038 X 1092277 1497933 1092277 1497933 2437569 3441971 405656 0 X X 0 1 X 1 0 X 6356795 3647914 5991261 6750387 8806211 31552568 3712629 6415537 8732302 10983188 14516281 44359937 10069424 10063451 14723563 17733575 23322492 75912505 0 0 0 75912505 7599 25461 61315 66043 51620 212038 7599 25461 61315 66043 51620 212038 10077023 10088912 14784878 17799618 23374112 76124543 0.99720 0.99710 0.00280 0.00290 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 681171 192765 488406 1724751 940019 784732 13761 7229 6532 1279670 ACCRUED PAYROLL LIABILITIES 754366 ACCRUED PAYROLL 153726 ACCRUED EXPENSES 696209 1604301 22981615 54000 54000 22927615 392497 392497 23320112 22575959 54000 54000 22521959 392497 392497 22914456 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. X 0 0 0 0 0 0 0 0 0 MARTIN STALLONE MD 357852 0 0 0 0 0 7500 0 15484 0 380836 0 0 0 JOHN-PAUL MEAD MD 301543 0 0 0 0 0 7500 0 15484 0 324527 0 0 0 DANIEL ROB MACKENZIE MD 0 444621 0 0 0 0 0 5000 0 19083 0 468704 0 0 DAVID GEORGE EVELYN MD 0 288627 0 0 0 0 0 5000 0 19083 0 312710 0 0 STEPHANIE GOODWIN DO 503389 0 0 0 0 0 7500 0 15484 0 526373 0 0 0 QUTAYBEH MAGHAYDAH MD 478399 0 0 0 0 0 7500 0 15484 0 501383 0 0 0 BRETT YOUNG MD 496387 0 0 0 0 0 7500 0 5659 0 509546 0 0 0 PETER HANNON DO 486891 0 0 0 0 0 7500 0 15484 0 509875 0 0 0 BARRY POLLACK MD 531868 0 0 0 0 0 7500 0 8782 0 548150 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE SHAREHOLDER WHO OWNS TWENTY COMMON SHARES. FORM 990, PART VI, SECTION A, LINE 7A CMAS 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 7B SEE ABOVE ANSWER TO 7A FOR COMPLETE EXPLANATION OF MEMBERSHIP STRUCTURE AND DECISION MAKING AUTHORITY. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PROVIDED TO AND REVIEWED BY ITS BOARD OF DIRECTORS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CAYUGA 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 15 IT 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 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: NO CHANGES FROM PRIOR YEAR. CAYUGA MEDICAL CENTER 101 DATES DRIVE ITHACA NY 14850 222325405 HOSPITAL NY 501 C(3) 170(B)(1)(A)(III) 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 CAYUGA MEDICAL CENTER C 8806211 ACKNOWLEDGMENT LETTER CAYUGA MEDICAL CENTER K 29408 LEASE AGREEMENT CAYUGA MEDICAL CENTER M 274762 WRITTEN AGREEMENT