2022-06-21T17:37:24-07:00 2021-12-31 990 2021-01-01 204356115 CAYUGA MEDICAL ASSOCIATES PC CAYU 6072772365 101 Dates Drive Ithaca NY 14850 John Collett Chief Financial Officer 6072744441 2022-06-22 1 11 1 AAL2 X 2021 2022-09-23 18:48:47Z John Collett 101 Dates Drive Ithaca NY 14850 97237418 0 X www.cayugamedicalassociates.org X 2006 NY To provide comprehensive medical services to the organization's service area. 4 0 540 0 0 0 29715092 41450434 45324940 55719748 1021 1268 110016 65968 75151069 97237418 0 0 0 0 49093605 59534446 0 0 0 27861002 36834981 76954607 96369427 -1803538 867991 9685356 9424563 12537531 11408747 -2852175 -1984184 CAYUGA HEALTH SYSTEM WILL REMAIN THE REGION'S LEADING HEALTHCARE SYSTEM, AND MOST TRUSTED DRIVER OF INTEGRATED HEALTH SERVICES, TOGETHER WITH VALUED PARTNERS. WE WILL EMPOWER OUR PEOPLE AND EMPLOY OUR CAPABILITIES TO EQUITABLY IMPROVE THE WELL-BEING OF THE COMMUNITIES WE SERVE. 0 0 87316146 0 55786984 In 2021, the organization provided medical services to 74,632 patients in the course of conducting 276,303 patient visits. The organization provides medical care to all patients, regardless of inability 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 2021, the organization's physicians conducted over 93,413 visits with Medicaid and low income patients. The organization continues with the commitment to accept patients from the local physicians' referral center, regardless of inability to pay. 0 0 0 87316146 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 76 0 1 540 1 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 Administration 6072772365 1301 Trumansburg Rd Suite P Ithaca NY 14850 Deidre Blake MD Physician 40 X 1601230 0 0 Martin Stallone MD President 2 X X 0 973096 0 Alec Macaulay MD Physician 40 X 916014 0 0 Benjamin Donohue MD Physician 40 X 873583 0 0 Michael Waters MD Physician 40 X 842098 0 0 Lavanya Kodali MD Physician 40 X 811452 0 0 David G Evelyn MD Treasurer 2 X X 0 377584 0 Candice Oliver DO Vice President 40 X X 342665 0 0 Tony Votaw Secretary 2 X 0 320925 0 Jeffrey Penoyer COO 40 X 259262 0 0 Andrea de Lima MD Board Member/Physician 2.00 X 0 226542 0 5646304 1898147 0 123 0 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Professional Medical Services 1005711 URMC Neurosurgery 601 Elmwood Ave Box 888 Rochester NY 14642 Professional Medical Services 3112404 Sally's Six 801 west Buffalo Street Ithaca NY 14850 Rents 894623 Hayes Locums LLC PO Box 88122 Chicago IL 60680 Professinal medical services 716601 Brent-Park 15 Thornwood Drive Ithaca NY 14850 Rents 677719 36 0 0 0 0 41450434 0 0 41450434 Patient fees 621110 48687753 48687753 0 0 Service Fees 621110 6616698 6616698 0 0 Miscellaneous 900099 374359 374359 0 0 Other revenue 900099 40938 40938 0 0 0 0 0 0 55719748 1268 1268 0 0 0 0 0 0 0 0 0 0 65968 0 0 0 65968 0 65968 65968 0 0 0 0 0 0 97237418 55786984 0 0 0 0 0 0 0 0 0 0 368607 0 368607 0 50286795 46793463 3493332 0 1710901 1572115 138786 0 4990452 4120028 870424 0 2177691 1738170 439521 0 0 0 0 0 123495 0 123495 0 241944 0 241944 0 0 0 0 0 0 0 0 0 0 0 5664892 3208550 2456342 0 83385 83385 0 0 136874 114239 22635 0 1059844 1059844 0 0 0 0 0 0 4107215 3541062 566153 0 30339 30339 0 0 310 310 0 0 0 0 0 0 0 0 0 0 0 0 0 0 554583 412266 142317 0 2070701 1880976 189725 0 Contracted medical services 15850110 15850110 0 0 Leased medical providers 3213100 3213100 0 0 Medical supplies 2145373 2145373 0 0 Bad Debt 1552816 1552816 0 0 96369427 87316146 9053281 0 2538432 1847555 2923 1874 0 0 5282627 5534131 0 0 0 0 0 0 0 0 144559 591203 6851495 5401695 1716815 1449800 9685356 9424563 4011316 6028541 0 0 0 0 0 0 0 0 0 0 0 0 20174 10839 8506041 5369367 12537531 11408747 X -2852175 -1984184 0 0 -2852175 -1984184 9685356 9424563 X 867991 0 0 0 0 0 X X 0 1 X 1 1 1 X 16971343 18148900 23769077 29715092 41450434 130054846 27871606 31667161 36264433 45324940 55678810 196806950 0 0 0 0 0 0 0 0 0 0 0 0 44842949 49816061 60033510 75040032 97129244 326861796 0 0 0 0 0 0 0 0 0 0 0 0 0 0 326861796 274 3708664 718 1021 1268 3711945 0 0 0 0 274 3708664 718 1021 1268 3711945 0 0 0 0 0 0 22306 22266 52559 110016 106906 314053 44865529 53546991 60086787 75151069 97237418 330887794 0.98783 0.98548 0.01122 0.01368 X Schedule A, Part III, Line 12 Rental income RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1973099 1555584 417515 0 2004402 1580264 424138 0 2873994 2265847 608147 1449800 0 Accrued expenses 248042 Accrued payroll, taxes and benefits 4197746 Accrued rent expense 923579 5369367 95684602 0 0 0 0 0 95684602 0 1552816 1552816 97237418 94816611 0 0 0 0 0 94816611 0 1552816 1552816 96369427 Schedule D, Part XI, Line 4b Bad Debt $1,552,816 Schedule D, Part XII, Line 4b Bad Debt $1,552,816 X 1 1 X 0 0 0 0 0 0 1 0 0 Deidre Blake MD Physician 792992 0 808238 0 0 0 8700 0 23384 0 1633314 0 0 0 Alec Macaulay MD Physician 438728 0 477286 0 0 0 8700 0 0 0 924714 0 0 0 Benjamin Donohue MD Physician 448236 0 425347 0 0 0 8700 0 9125 0 891408 0 0 0 Michael Waters MD Physician 418884 0 423214 0 0 0 8700 0 19074 0 869872 0 0 0 Lavanya Kodali MD Physician 767348 0 44104 0 0 0 8700 0 23384 0 843536 0 0 0 Candice Oliver DO Vice President 329032 0 13633 0 0 0 8700 0 23384 0 374749 0 0 0 Martin Stallone MD President 0 868321 0 104775 0 0 0 0 0 0 0 973096 0 0 Andrea de Lima MD Board Member/Physician 0 226542 0 0 0 0 0 0 0 0 0 226542 0 0 David G Evelyn MD Treasurer 0 377584 0 0 0 0 0 0 0 0 0 377584 0 0 Tony Votaw Secretary 0 320925 0 0 0 0 0 0 0 0 0 320925 0 0 Jeffrey Penoyer COO 221692 0 37570 0 0 0 8029 0 23384 0 290675 0 0 0 Schedule J, Part I, Line 1a The organization subsidizes a portion of health club fees if employees attend the required number of visits per month. Schedule J, Part I, Line 6 YEAR END BONUS PROGRAM FOR ALL EMPLOYEES, AT RELATED ORGANIZATION, WAS BASED ON OPERATING MARGIN, PARTICIPATION IN THE ANNUAL SAFETY TRAINING AND REACHING PREDETERMINED SATISFACTION SCORES. Form 990, Part VI, Section A, Line 6 THE ORGANIZATION HAS ONE PHYSICIAN SHAREHOLDER WHO OWNS TWO HUNDRED 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 CORPORATION SHALL ALWAYS HAVE ONLY ONE SHAREHOLDER WHO MUST BE A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THE STATE OF NEW YORK EMPLOYED BY CAYUGA MEDICAL CENTER AT ITHACA AND WHO IS A PARTY TO A SHAREHOLDER AGREEMENT APPROVED IN ALL RESPECTS BY CAYUGA MEDICAL CENTER AT ITHACA. THE NUMBER OF DIRECTORS CONSTITUTING THE ENTIRE BOARD SHALL BE FOUR. 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 DIRECTORS APPOINTED BY THE PHYSICIAN ACTION COUNCIL NEED NOT BE SHAREHOLDERS OF THE CORPORATION, SO LONG AS THEY ARE LICENSED IN NEW YORK TO PRACTICE MEDICINE AND ARE EMPLOYEES OF THE CORPORATION. THE BOARD MEMBERS ELECTED BY THE PHYSICIAN ACTION COUNCIL ARE SUBJECT TO THE APPROVAL OF MEDICAL CENTER. IF A DIRECTOR RESIGNS, DIES OR IS REMOVED, A REPLACEMENT SHALL BE APPOINTED OR ELECTED IN THE SAME MANNER AS THE DEPARTING DIRECTOR. EACH DIRECTOR SHALL BE APPOINTED OR ELECTED AS SET FORTH ABOVE FOR A TERM OF TWO YEARS. EACH DIRECTOR SHALL HOLD OFFICE UNTIL HIS OR HER SUCCESSOR HAS BEEN DULY ELECTED AND QUALIFIED, OR UNTIL HIS OR HER DEATH, OR UNTIL HE OR SHE HAS RESIGNED OR HAS BEEN REMOVED AS HEREINAFTER PROVIDED IN THESE BY-LAWS. THE BOARD OF DIRECTORS SHALL INCLUDE UP TO SIX (6) NON-VOTING ADVISORY BOARD MEMBERS. UP TO THREE (3) PHYSICIANS MAY BE APPOINTED BY THE PHYSICIAN ACTION COUNCIL, SUBJECT TO APPROVAL BY THE VOTING BOARD MEMBERS. ONE OF THESE NON-VOTING ADVISORY BOARD MEMBERS MAY BE A PHYSICIAN WHO IS A MEMBER IN GOOD STANDING OF FINGER LAKES MANAGEMENT ASSOCIATES, DBA; CAYUGA AREA PHYSICIANS ALLIANCE, BUT WHO IS NOT AN EMPLOYEE OF THE CORPORATION. THE NON-VOTING ADVISORY BOARD MEMBERS SHALL BE SUBJECT TO THE QUALIFICATION OF ARTICLE IV SECTIONS 3 AND 4. UP TO THREE (3) NON-VOTING ADVISORY BOARD MEMBERS, BUT IN ANY EVENT 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 7b SEE ABOVE ANSWER TO 7A FOR COMPLETE EXPLANATION OF MEMBERSHIP STRUCTURE AND DECISION MAKING AUTHORITY. Form 990, Part VI, Section A, Line 8a ALL MINUTES OF MEETINGS ARE RECORDED AND FILED WITH CORPORATE DOCUMENTS ONCE APPROVED. Form 990, Part VI, Section A, Line 8b ALL MINUTES OF MEETINGS ARE RECORDED AND FILED WITH CORPORATE DOCUMENTS ONCE APPROVED. Form 990, Part VI, Section B, Line 11b 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 XI, Line 10 Difference is bad debt $1,552,816 Form 990, Part XII, Line 2c THE ORGANIZATION HAS NOT CHANGED THE OVERSIGHT PROCESS OR THE SELECTIONS PROCESS DURING THE TAX YEAR. Form 990, Part XII, Line 3a IN 2021, THE ORGANIZATION HAS UNDERGONE A SINGLE AUDIT, BY AN INDEPENDENT AUDITOR, FOR FEDERAL FUNDS RECEIVED OF OVER 750K IN THE THIRD QUARTER OF 2020. Form 990, Part XII, Line 3b IN 2021, THE ORGANIZATION HAS UNDERGONE A SINGLE AUDIT, BY AN INDEPENDENT AUDITOR, FOR FEDERAL FUNDS RECEIVED OF OVER 750K IN THE THIRD QUARTER OF 2020. Cayuga Physician Practice PLLC 101 Dates Drive Ithaca NY 14850 611915049 Process electronic payments NY 0 0 Cayuga Medical Associates PC CMA Medical Practice PLLC 101 Dates Drive Ithaca NY 14850 611871948 Process electronic payments NY 0 0 Cayuga Medical Associates PC Cayuga Medical Center 101 Dates Drive Ithaca NY 14850 222325405 Hospital NY 501 C(3) 170(B) (1) (A) N/A 0 Cayuga Medical Office Building Associates 101 Dates Drive Ithaca NY 14850 161261492 Rental NY Cayuga Medical Center Excluded 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 Cayuga Medical Center c 41450334 Acknowledgement letter Cayuga Medical Center k 241991 Lease agreement Cayuga Medical Center j 62826 Written agreement Cayuga Medical Center l 2837292 Written agreement Cayuga Medical Center m 4993977 Written agreement Cayuga Medical Office Building Associates k 243292 Lease agreement CMA routinely files an extension for our 990 and submits our tax filing by November 15th annually. Our preparer fell ill unexpectedly on April 14th and was unable to perform her work responsibilities. She was out of work and out of communication with the office due to her incapacitated nature, while awaiting surgery. Her illness resulted in surgery on 04/27, followed by a second emergency surgery on 05/04, which resulted in the staff member being out of the office and out of communication until mid-June 2022. Once the preparer returned to work, she realized the 990 extension never got filed (as our org routinely files an extension) and took immediate action to complete and file the return, as well as notified her immediate supervisors. Due to this oversight we have taken further action to ensure that this staff member's responsibilities are covered should an unexpected absence occur in the future. This department has gone through turnover and restructure in 2021 and this is also one of the reasons this was overlooked as new staff were not trained in this area at the time of this unexpected incident and staff did not know to ask if an extension was filed. We can provide medical documentation to support the above facts should you need it. We respectfully request that any penalty and fines be abated as this is a first offense and we have taken action within our organization to ensure this issue does not occur in the future.