2012-11-14T12:59:54-06:00 2011-12-31 161071694 SCIARABBA WALKER & CO LLP 200 E BUFFALO ST SUITE 402 ITHACA NY 14850 990 2011-01-01 204356115 CAYUGA MEDICAL ASSOCIATES PC CAYU 6072772365 101 DATES DRIVE ITHACA NY 14850 DAVID GEORGE EVELYN 6072772365 2012-11-14 1 DAVID M STINSON P00213287 6072725550 2011 2016-02-24 21:20:13Z DANIEL ROB MCKENZIE 101 DATES DRIVE ITHACA NY 14850 17806469 0 X N/A X 2006 NY TO PROVIDE ACCESS TO PRIMARY CARE AND MEDICAL SPECIALTIES TO THE RESIDENTS OF TOMPKINS COUNTY. 4 0 125 0 0 0 5991261 6750387 8732302 10990039 -2565 283 60697 960 14781695 17741669 0 0 0 0 10067277 12318755 0 0 0 5093641 5520889 15160918 17839644 -379223 -97975 2308958 2437569 1111855 1345292 1197103 1092277 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 16469846 10990039 IN 2011, THE ORGANIZATION PROVIDED MEDICAL SERVICES TO 16,962 PATIENTS IN THE COURSE OF CONDUCTING 67,228 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 2011, THE ORGANIZATIONS PHYSICIANS CONDUCTED OVER 6,590 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. 16469846 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 0 1 19 0 125 1 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 1 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 821 CLIFF ST ITHACA NY 14850 X DANIEL ROB MACKENZIE MD 2.00 X X 0 459595 18472 MARTIN STALLONE MD 40.00 X X 356890 12000 25218 JOHN P MEAD MD 40.00 X X 258656 5000 25218 DAVID GEORGE EVELYN MD 2.00 X X 0 301426 18472 STEPHANIE GOODWIN MD 40.00 X 499027 0 16639 QUTAYBEH MAGHAYDAH MD 40.00 X 474036 0 22835 BRETT YOUNG MD 40.00 X 471473 0 9604 JONATHAN MAUSER MD 40.00 X 454949 0 22835 BARRY POLLACK MD 40.00 X 432110 0 16132 2947141 778021 175425 22 0 1 0 PRACTICE RESOURCES LLC 1001 WEST LAFAYETTE STREET STE 400 SYRACUSE NY 132042856 MEDICAL BILLING SERVICE 446002 MED-CARE ADMINISTRATORS LLC 587 MAIN ST NEW YORK MILLS NY 13417 PRACTICE MANAGEMENT 418569 ITHACA ORTHOPEADIC GROUP 10 BRENTWOOD DRIVE SUITE B ITHACA NY 14850 PROFESSIONAL MEDICAL SERVICES 393000 CAYUGA ENT 2 ASCOT PLACE ITHACA NY 14850 PROFESSIONAL MEDICAL SERVICES 359307 WEATHERBY LOCUMS 6451 NORTH FEDERAL HIGHWAY SUITE 8 FORT LAUDERDALE FL 33308 STAFFING 215707 5 6750387 6750387 PATIENT FEES 621110 9329486 9329486 HOSPITALIST REVENUE 621110 1560000 1560000 SERVICE FEES 621110 75070 75070 MISCELLANEOUS 900099 25483 25483 10990039 283 283 65760 64800 960 960 960 17741669 10990039 0 1243 10728863 10728863 358538 358538 711578 711578 519776 519776 26605 26605 93939 93939 1723871 474617 1249254 163167 163167 56891 56891 140973 140973 1208954 1208954 48375 48375 291609 291609 614947 614947 MEDICAL SUPPLIES 277526 277526 BAD DEBT 244900 244900 LEASED MD'S 236467 236467 COMMUNICATIONS 71361 71361 321304 321304 17839644 16469846 1369798 0 94817 249730 6402 586 767207 898404 73007 82992 2062622 862165 1362125 1200457 5400 5400 2308958 2437569 379782 275854 732073 1069438 1111855 1345292 X 1197103 1092277 1197103 1092277 2308958 2437569 X -97975 -6851 X X 0 1 1 X 0 X 6356795 3647914 5991261 6750387 22746357 2844218 3712629 6415537 8732302 10983188 32687874 2844218 10069424 10063451 14723563 17733575 55434231 0 0 0 55434231 387 7599 25461 61315 66043 160805 387 7599 25461 61315 66043 160805 2844605 10077023 10088912 14784878 17799618 55595036 0.99710 0.00290 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 618272 132835 485437 1437224 724084 713140 7126 5246 1880 1200457 ACCRUED PAYROLL LIABILITIES 202506 ACCRUED PAYROLL 344812 ACCRUED EXPENSES 522120 1069438 17741669 17839644 -97975 -6851 -6851 -104826 17799618 64800 64800 17734818 6851 6851 17741669 17904444 64800 64800 17839644 0 17839644 PART XI, LINE 8 - OTHER ADJUSTMENTS: SECTION 481(A) ADJUSTMENT -6,851. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT PAID TO LESSOR 64,800. PART XII, LINE 4B - OTHER ADJUSTMENTS: SECTION 481(A) ADJUSTMENT- YEAR 4 6,851. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENT PAID TO LESSOR 64,800. PART XI, LINE 8 AND PART XII, LINE 4B - SECTION 481(A) ADJUSTMENT. IN 2008, THE ORGANIZATION CHANGED ITS ACCOUNTING METHOD FROM CASH TO ACCRUAL FOR ITS AUDITED FINANCIAL STATEMENTS AND FOR FORM 990 REPORTING. AS A RESULT OF THE CHANGE IN ACCOUNTING METHOD, 2008 BEGINNING BALANCES WERE RESTATED ON THE ACCRUAL BASIS, RESULTING IN AN INCREASE TO NET ASSETS OF $27,401. FOR TAX PURPOSES THIS ADJUSTMENT IS RECOGNIZED OVER A FOUR YEAR PERIOD. FOR 2011, CMA HAS RECOGNIZED THE 4TH YEAR OF THE SECTION 481(A) INCOME ADJUSTMENT TOTALING $6,851, AS SHOWN ABOVE IN PART XI, LINE 8 AND PART XII, LINE 4B. X 0 0 0 0 0 0 0 0 0 DANIEL ROB MACKENZIE MD 0 357000 0 102595 0 0 0 4900 0 13572 0 478067 0 0 MARTIN STALLONE MD 341890 12000 15000 0 0 0 7350 0 17868 0 382108 12000 0 0 JOHN P MEAD MD 258656 5000 0 0 0 0 7350 0 17868 0 283874 5000 0 0 DAVID GEORGE EVELYN MD 0 254896 0 46530 0 0 0 4900 0 13572 0 319898 0 0 STEPHANIE GOODWIN MD 499027 0 0 0 0 0 1154 0 15485 0 515666 0 0 0 QUTAYBEH MAGHAYDAH MD 474036 0 0 0 0 0 7350 0 15485 0 496871 0 0 0 BRETT YOUNG MD 471473 0 0 0 0 0 3945 0 5659 0 481077 0 0 0 JONATHAN MAUSER MD 454949 0 0 0 0 0 7350 0 15485 0 477784 0 0 0 BARRY POLLACK MD 432110 0 0 0 0 0 7350 0 8782 0 448242 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 IN ACCORDANCE WITH CMAS MISSION TO BY A PHYSICIAN-LED ORGANIZATION, IN 2012, THE BOARD PROCEEDED WITH REVISING THE BY-LAWS SO THAT ADDITIONAL BOARD MEMBERS COULD BE RECRUITED. THE BY-LAWS STATED THAT BOARD MEMBERS SHALL CONSIST OF (4) VOTING MEMBERS. TWO OF THE BOARD MEMBERS SHALL BE APPOINTED BY MEDICAL CENTER AND SHALL BE PHYSICIANS LICENSED TO PRACTICE MEDICINE WHO ARE EMPLOYEES OF MEDICAL CENTER. TWO BOARD MEMBERS SHALL BE ELECTED BY THE PHYSICIAN ACTION COUNCIL. THE BOARD CAN ALSO CONSIST OF UP TO (6) NON-VOTING ADVISORY BOARD MEMBERS WITH UP TO (3) BEING PHYSICIANS. THESE (3) NON-VOTING ADVISORY BOARD MEMBERS, WILL BE A NUMBER EQUAL TO THE NUMBER OF PHYSICIANS APPOINTED BY THE PHYSICIAN ACTION COUNCIL, SHALL BE APPOINTED BY MEDICAL CENTER. 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. RELATED ORGANIZATION HOURS FORM 990, PART VII, COLUMN B: DRS MEAD AND STALLONE SPEND BETWEEN 1 TO 2 HOURS PER WEEK WORKING FOR ADVISORY GROUPS OF CAYUGA MEDICAL CENTER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: SECTION 481(A) ADJUSTMENT -6,851. TOTAL TO FORM 990, PART XI, LINE 5: -6,851. 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 1 0 0 0 0 0 0 0 0 CAYUGA MEDICAL CENTER C 6750387 ACKNOWLEDGMENT LETTER CAYUGA MEDICAL CENTER J 29368 LEASE AGREEMENT