2011-11-03T14:59:09-05:00 2010-12-31 SCIARABBA WALKER & CO LLP 200 E BUFFALO ST SUITE 402 ITHACA NY 14850 990 2010-01-01 204356115 CAYUGA MEDICAL ASSOCIATES PC CAYU 6072772365 101 DATES DRIVE ITHACA NY 14850 MARTY STALLONE 6072772365 2011-11-03 1 6072725550 2010 2016-03-07 17:11:31Z DANIEL ROB MCKENZIE 101 DATES DRIVE ITHACA NY 14850 14784878 0 X N/A X 2006 NY TO PROVIDE ACCESS TO PRIMARY CARE AND MEDICAL SPECIALTIES TO THE RESIDENTS OF TOMPKINS COUNTY. 2 0 101 0 0 0 3647914 5991261 6415537 8732302 1488 -2565 23973 60697 10088912 14781695 0 0 0 0 6473552 10067277 0 0 0 3965652 5093641 10439204 15160918 -350292 -379223 2193621 2308958 610444 1111855 1583177 1197103 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 14028514 8732302 IN 2010, THE ORGANIZATION PROVIDED MEDICAL SERVICES TO 14,836 PATIENTS IN THE COURSE OF CONDUCTING 58,825 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 2010, THE ORGANIZATIONS PHYSICIANS CONDUCTED OVER 5,261 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. 14028514 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 28 0 101 1 0 0 0 0 0 0 0 0 0 0 X 2 0 0 1 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 821 CLIFF ST ITHACA NY 14850 DANIEL ROB MACKENZIE MD 2.00 X X 0 417949 21524 DAVID GEORGE EVELYN MD 2.00 X X 0 295679 18524 TONY VOTAW 2.00 X 0 175422 2972 JOHN B RUDD 2.00 X 0 295679 21524 QUTAYBEH MAGHAYDAH MD 40.00 X 474040 0 23601 JONATHAN MAUSER MD 40.00 X 444030 0 23601 BARRY POLLACK MD 40.00 X 423645 0 23601 GERALD ZUPRUK MD 40.00 X 423473 0 23601 DIRK DUGAN MD 40.00 X 415376 0 25915 2180564 1184729 184863 26 0 1 0 WEATHERBY LOCUMS 6451 NORTH FEDERAL HIGHWAY SUITE 8 FORT LAUDERDALE FL 33308 STAFFING 552170 PRACTICE RESOURCES LLC 1001 WEST LAFAYETTE STREET STE 400 SYRACUSE NY 132042856 MEDICAL BILLING SERVICE 416605 CAYUGA ENT 2 ASCOT PLACE ITHACA NY 14850 PROFESSIONAL MEDICAL SERVICES 203820 SAMPSON & ASSOCIATES LLC 301 S GENEVA STREET SUITE 107 ITHACA NY 14850 PRACTICE CONSULTING & BOOKKEEPING 189887 MED-CARE ADMINISTRATORS LLC 587 MAIN ST NEW YORK MILLS NY 13417 PRACTICE MANAGEMENT 166609 5 5991261 5991261 PATIENT FEES 621110 7011523 7011523 HOSPITALIST REVENUE 621110 1560000 1560000 SERVICE FEES 621110 153506 153506 MISCELLANEOUS 900099 7273 7273 8732302 618 618 60697 60697 60697 60697 3183 -3183 -3183 -3183 14781695 8729119 0 61315 8820144 8820144 247383 247383 535265 535265 464485 464485 130333 130333 26503 26503 118990 118990 935783 79205 856578 191639 191639 42097 42097 84743 84743 1269858 1269858 54305 54305 220109 220109 623312 623312 LEASED MD'S 666536 666536 MEDICAL SUPPLIES 184465 184465 BAD DEBT EXPENSE 165637 165637 RECRUITING 68343 68343 COMMUNICATIONS 65348 65348 245640 245640 15160918 14028514 1132404 0 434917 94817 65595 6402 588364 767207 39294 73007 1927747 565622 1055884 1362125 4167 5400 5400 2193621 2308958 76974 379782 533470 732073 610444 1111855 X 1583177 1197103 1583177 1197103 2193621 2308958 X -379223 -6851 X X 0 1 1 X 0 X 6356795 3647914 5991261 15995970 1075285 2844218 3712629 6415537 8732302 22779971 1075285 2844218 10069424 10063451 14723563 38775941 0 0 0 38775941 471 387 7599 25461 61315 95233 471 387 7599 25461 61315 95233 1075756 2844605 10077023 10088912 14784878 38871174 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 618272 78146 540126 1302349 483328 819021 7126 4148 2978 1362125 ACCRUED PAYROLL LIABILITIES 32337 ACCRUED PAYROLL 218158 ACCRUED EXPENSES 481578 732073 14781695 15160918 -379223 -6851 -6851 -386074 14778027 3183 3183 14774844 6851 6851 14781695 15164101 3183 3183 15160918 0 15160918 PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 3,183. PART XII, LINE 4B - OTHER ADJUSTMENTS: SECTION 481(A) ADJUSTMENT- YEAR 3 6,851. PART XIII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 3,183. 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 2009, CMA HAS RECOGNIZED THE 3RD 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 348291 0 69658 0 0 0 4900 0 16624 0 439473 0 0 DAVID GEORGE EVELYN MD 0 254896 0 40783 0 0 0 1900 0 16624 0 314203 0 0 TONY VOTAW 0 151226 0 24196 0 0 0 2972 0 0 0 178394 0 0 JOHN B RUDD 0 254896 0 40783 0 0 0 4900 0 16624 0 317203 0 0 QUTAYBEH MAGHAYDAH MD 474040 0 0 0 0 0 7350 0 16251 0 497641 0 0 0 JONATHAN MAUSER MD 444030 0 0 0 0 0 7350 0 16251 0 467631 0 0 0 BARRY POLLACK MD 423645 0 0 0 0 0 7350 0 16251 0 447246 0 0 0 GERALD ZUPRUK MD 423473 0 0 0 0 0 7350 0 16251 0 447074 0 0 0 DIRK DUGAN MD 415376 0 0 0 0 0 12490 0 13425 0 441291 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 IN 2010, CAYUGA MEDICAL ASSOCIATES DELEGATED CONTROL OF ITS ACCOUNTING DUTIES TO AN EMPLOYEE OF ITS RELATED PARTY, CAYUGA 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 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 MEDICAL CENTER, THE BYLAWS PROVIDE THAT THE SECRETARY WILL BE A VICE-PRESIDENT OF MEDICAL CENTER. OTHER BOARD MEMBERS MAY BE OTHER PHYSICIANS WHO MAY BE EMPLOYEES OF THE CORPORATION, BUT THEIR APPOINTMENT IS SUBJECT TO THE APPROVAL OF 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: SECTION 481(A) ADJUSTMENT- YEAR 3 -6,851. TOTAL TO FORM 990, PART XI, LINE 5: -6,851. FORM 990, PART XI, 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 5991261 ACKNOWLEDGMENT LETTER CAYUGA MEDICAL CENTER J 21260 LEASE AGREEMENT