2021-11-03T08:21:02-07:00 2020-12-31 990 2020-01-01 204356115 CAYUGA MEDICAL ASSOCIATES PC CAYU 6072772365 101 Dates Drive Ithaca NY 14850 Martin Stallone President 6072744441 2021-11-12 1 11 1 AAL2 X 2020 2022-09-23 18:48:47Z Martin Stallone MD President 101 Dates Drive Ithaca NY 14850 75151069 0 X www.cayugamedicalassociates.org X 2006 NY To provide comprehensive medical services to the organization's service area. 4 0 486 0 0 0 23769077 29715092 36264433 45324940 718 1021 52559 110016 60086787 75151069 0 0 0 0 41891322 49093605 0 0 0 20411565 27861002 62302887 76954607 -2216100 -1803538 5656746 9685356 6705383 12537531 -1048637 -2852175 CAYUGA MEDICAL ASSOCIATES WILL DELIVER THE HIGHEST QUALITY HEALTHCARE, IN PARTNERSHIP WITH CAYUGA MEDICAL CENTER, ONE PERSON AT A TIME. 0 0 67628840 0 45435977 In 2020, the organization provided medical services to 62,434 patients in the course of conducting 223,307 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 2020, the organization's physicians conducted over 73,903 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 67628840 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 1 486 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 0 X 1466211 10000 0 Martin Stallone MD President 2 0 X X 0 817183 43826 Benjamin Donohue MD Physician 40 0 X 840158 0 0 Lavanya Kodali MD Physician 40 0 X 828024 0 0 Alec Macaulay MD Physician 40 0 X 716369 0 0 Michael Waters MD Physician 40 0 X 669667 0 0 David G Evelyn MD Treasurer 2 X 0 398589 80326 Andrea de Lima MD Board Member/Physician 40 0 X 311585 0 0 Tony Votaw Secretary 2 X 0 295987 0 Dirk Dugan MD VP/Physician 40 0 X X X 266192 0 0 Jeffrey Penoyer COO 40 0 X 186697 0 0 5284903 1521759 124152 117 1 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Professional Medical Services 1833113 URMC Neurosurgery 601 Elmwood Ave Box 888 Rochester NY 14642 Professional Medical Services 1177093 Sally's Six 801 west Buffalo Street Ithaca NY 14850 Rents 990161 555 Marchuska LLC 408 Commerce Rd Vestal NY 13850 Rents 867404 Brent-Park 15 Thornwood Drive Ithaca NY 14850 Rents 646755 22 0 0 0 29715092 0 0 0 29715092 Patient fees 621110 37672526 37672526 0 0 Service fees 621110 5163732 5163732 0 0 Miscellaneous 900099 2488682 2488682 0 0 0 0 0 0 45324940 1021 1021 0 0 0 0 0 0 0 0 0 0 110016 0 0 0 110016 0 110016 110016 0 0 0 0 0 0 75151069 45435977 0 0 0 0 0 0 0 0 0 0 342348 0 342348 0 0 0 0 0 40315217 37276208 3039009 0 1962102 1836093 126009 0 3836763 2907467 929296 0 2637175 1351633 1285542 0 0 0 0 0 81904 0 81904 0 205760 0 205760 0 0 0 0 0 0 0 0 0 0 0 4521392 2283150 2238242 0 99963 99963 0 0 131379 62838 68541 0 815310 815310 0 0 0 0 0 0 4341657 3652008 689649 0 58367 58367 0 0 0 0 0 0 0 0 0 0 2719 2719 0 0 0 0 0 0 617540 438308 179232 0 1866948 1726713 140235 0 Leased Medical Providers 2267178 2267178 0 0 Medical supplies 1518938 1518938 0 0 Bad debt 785484 785484 0 0 Contracted Medical Services 10546463 10546463 0 0 0 0 0 0 76954607 67628840 9325767 0 655746 2538432 3061 2923 0 0 2475910 5282627 0 0 0 0 0 0 0 0 211646 144559 6563927 4847112 2310383 1716815 0 0 0 0 0 5656746 9685356 2195317 4011316 0 0 0 0 0 0 0 0 0 0 0 0 26789 20174 4483277 8506041 6705383 12537531 X -1048637 -2852175 0 0 -1048637 -2852175 5656746 9685356 X -1803538 0 0 0 0 0 X X 0 1 X 1 0 X 14280583 16971343 18148900 23769077 29715092 102884995 23388292 27871606 31667161 36264433 45324940 164516432 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 37668875 44842949 49816061 60033510 75040032 267401427 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 267401427 664 274 3708664 718 1021 3711341 0 0 0 0 0 664 274 3708664 718 1021 3711341 0 0 0 0 0 21706 22306 22266 52559 110016 228853 37691245 44865529 53546991 60086787 75151069 271341621 0.98548 0.98343 0.01368 0.01598 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 1914771 1405662 509109 0 1883345 1405663 477682 0 2765811 2035787 730024 1716815 Accrued expenses 153372 Accrued payroll, taxes and benefits 4631657 Liability due to a related party 2841000 Accrued rent expense 880012 8506041 74365585 0 0 0 0 0 74365585 0 785484 785484 75151069 76169123 0 0 0 0 0 76169123 0 785484 785484 76954607 Schedule D, Part XI, Line 4b Part XI, Line 4B - OTHER ADJUSTMENTS: Bad Debt $785,484 Schedule D, Part XII, Line 4b Part XII, Line 4B - OTHER ADJUSTMENTS: Bad Debt $785,484 X 1 1 X 0 0 0 0 0 0 1 0 0 Martin Stallone MD President 0 712408 0 104775 0 0 0 0 0 0 0 817183 0 0 Dirk Dugan MD VP/Physician 266192 0 0 0 0 0 8700 0 7425 0 282317 0 0 0 David G Evelyn MD Treasurer 0 398589 0 0 0 0 0 0 0 0 0 398589 0 0 Andrea de Lima MD Board Member/Physician 299727 0 11858 0 0 0 5460 0 10854 0 327899 0 0 0 Tony Votaw Secretary 0 295987 0 0 0 0 0 0 0 0 0 295987 0 0 Jeffrey Penoyer COO 181697 0 5000 0 0 0 3865 0 13557 0 204119 0 0 0 Deidre Blake MD Physician 755656 0 710555 0 0 10000 8700 0 13557 0 1488468 10000 0 0 Schedule J, Part I, Line 1a Schedule J, Part I, Line 1a - The organization subsidizes a portion of health club fees if employees attend the required visits per month. Schedule J, Part I, Line 6 Schedule J, Part I, Line 6 - YEAR END BONUS PROGRAM FOR ALL EMPLOYEES, AT RELATED ORGANIZATION, WAS BASED ON OPERATING MARGIN, PARTICIPATING IN THE ANNUAL SAFETY TRAINING AND REACHING PREDETERMINED CUSTOMER 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 EXPLANATION: CMA'S 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 THE 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 (IN THE BY-LAWS). 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 $785,484 Form 990, Part XII, Line 2c THE ORGANIZATION HAS NOT CHANGED THE OVERSIGHT PROCESS OR THE SELECTIONS PROCESS DURING THE TAX YEAR. 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 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 Cayuga Medical Center c 29715092 Acknowledgement letter Cayuga Medical Center k 229439 Lease agreement Cayuga Medical Center j 106874 Written agreement Cayuga Medical Center e 2841000 Loan - EMAC Cayuga Medical Center l 2701668 Written agreement Cayuga Medical Center m 2508111 Written agreement Cayuga Medical Office Building Associates k 250455 Lease agreement