2020-11-03T08:31:26-07:00 2019-12-31 990 2019-01-01 204356115 CAYUGA MEDICAL ASSOCIATES PC CAYU 6072772365 101 Dates Drive Ithaca NY 14850 Martin Stallone President 6072744441 2020-11-02 98.159.210.253 2019 2021-01-29 14:40:06Z Cayuga Medical Associates PC 101 Dates Drive Ithaca NY 14850 60086787 0 X www.cayugamedicalassociates.org X 2006 NY To provide comprehensive medical services to the organization's service area. 4 0 411 0 0 0 18148900 23769077 31667161 36264433 3708644 718 23266 52559 53547971 60086787 0 0 0 0 35227975 41891322 0 0 0 17686163 20411565 52914138 62302887 633833 -2216100 6398726 5656746 5231263 6705383 1167463 -1048637 CAYUGA MEDICAL ASSOCIATES WILL DELIVER THE HIGHEST QUALITY HEALTHCARE, IN PARTNERSHIP WITH CAYUGA MEDICAL CENTER, ONE PERSON AT A TIME. 0 0 55644179 0 36316992 In 2019, the organization provided medical services to 62,192 patients in the course of conducting 234,847 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 2019, the organization's physicians conducted over 72,300 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 55644179 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 1 1 0 0 0 1 75 0 411 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 1175315 0 26276 Zaneb Yaseen MD Physician 40 X 951057 0 26276 Martin Stallone MD President 2.5 37.5 X X 0 807181 40688 Lavanya Kodali MD Physician 40 X 770334 0 26276 Benjamin Donohue MD Physician 40 X 667071 0 15825 Michael Waters MD Physician 40 X 632913 0 26276 David G Evelyn MD Treasurer 2.5 37.5 X X 0 508448 144638 Tony Votaw Secretary 2.5 37.5 X 0 361962 83441 Dirk Dugan MD Vice President 40 X X 313012 0 15825 David Schwed MD Board Member 40 X 250856 0 25141 Benjamin Negley COO 40 X X 96980 0 8837 Jeffrey Penoyer COO 40 X 68854 0 6192 4926392 1677591 445691 79 1 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Professional Medical Services 1592652 Cayuga Medical Center at Ithaca 101 Dates Drive Ithaca NY 14850 Professional Medical Services 1358858 University of Rochester Medical Center 607 Elmwood Ave Rochester NY 14642 Professional Medical Services 912223 Sally's Six 801 west Buffalo Street Ithaca NY 14850 Rents 711971 Brent-Park 15 Thornwood Drive Ithaca NY 14850 Rents 648345 28 0 0 0 23769077 0 0 0 23769077 Patient Fees 621110 31820723 31820723 0 0 Service Fees 621110 4023147 4023147 0 0 Miscellaneous 900099 420563 420563 0 0 0 0 0 0 36264433 718 0 0 718 0 0 0 0 0 0 0 0 52559 0 0 0 52559 0 52559 52559 0 0 0 0 0 0 60086787 36316992 0 718 0 0 0 0 0 0 0 0 785698 488986 296712 0 0 0 0 0 35062998 32130100 2932898 0 1250499 1141598 108901 0 2924160 2119072 805088 0 1867967 1639595 228372 0 0 0 0 0 109014 2110 106904 0 153896 0 153896 0 0 0 0 0 0 0 0 0 0 0 4631751 3631006 1000745 0 206349 206349 0 0 86064 0 86064 0 904997 904997 0 0 0 0 0 0 3840551 3276574 563977 0 51768 51768 0 0 0 0 0 0 0 0 0 0 2719 2719 0 0 0 0 0 0 616887 417595 199292 0 1356010 1180151 175859 0 Leased Medical Providers 1995697 1995697 0 0 Medical Supplies 1725880 1725880 0 0 Bad Debt 843243 843243 0 0 Contracted Medical Services 3886739 3886739 0 0 62302887 55644179 6658708 0 1350256 655746 11032 3061 0 0 2585458 2475910 0 0 0 0 0 0 0 0 300908 211646 6539955 4229572 2151072 2310383 0 0 0 0 0 0 0 0 0 0 6398726 5656746 1302085 2195317 0 0 0 0 0 0 0 0 0 0 0 0 33405 26789 3895773 4483277 5231263 6705383 X 1167463 -1048637 0 0 1167463 -1048637 6398726 5656746 -2216100 0 0 0 0 0 X X 0 1 X 1 0 X 13983354 14280583 16971343 18148900 23769077 87153257 22029514 23388292 27871606 31667161 36264433 141221006 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36012868 37668875 44842949 49816061 60033510 228374263 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 228374263 114 664 274 3708664 718 3710434 0 0 0 0 0 0 114 664 274 3708664 718 3710434 0 0 0 0 0 0 19439 21706 22306 22266 52559 138276 36032421 37691245 44865529 53546991 60086787 232222973 0.98343 0.9814 0.01598 0.0182 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 1890798 1050796 840002 0 4033195 2587000 1446195 0 615962 591776 24186 2310383 Accrued payroll liabilities 2795249 Accrued payroll 638726 Accrued expenses 1049302 4483277 59243544 0 0 0 0 0 59243544 0 843243 843243 60086787 61459644 0 0 0 0 0 61459644 0 843243 843243 62302887 Schedule D, Part XI, Line 4b Part XI, Line 4B - Other Adjustments: Bad Debt $843,243 Schedule D, Part XII, Line 4b Part XII, Line 4B - Other Adjustments: Bad Deb $843,243 X 1 1 X 0 0 0 0 0 0 1 0 0 Martin Stallone MD President 0 566111 0 241070 0 0 0 33900 0 6788 0 847869 0 0 Dirk Dugan MD Vice President 298429 0 14583 0 0 0 8400 0 7425 0 328837 0 0 0 David G Evelyn MD Treasurer 0 370018 0 138430 0 0 0 136900 0 7738 0 653086 0 0 David Schwed MD Board Member 236273 0 14583 0 0 0 7265 0 17876 0 275997 0 0 0 Tony Votaw Secretary 0 265000 0 96962 0 0 0 81400 0 2041 0 445403 0 0 Benjamin Negley COO 76089 0 20891 0 0 0 2650 0 6188 0 105818 0 0 0 Jeffrey Penoyer COO 61354 0 7500 0 0 0 0 0 6192 0 75046 0 0 0 Deidre Blake MD Physician 496129 0 679186 0 0 0 8400 0 17876 0 1201591 0 0 0 Zaneb Yaseen MD Physician 470317 0 480740 0 0 0 8400 0 17876 0 977333 0 0 0 Lavanya Kodali MD Physician 699080 0 71314 0 0 0 8400 0 17876 0 796670 0 0 0 Benjamin Donohue MD Physician 448429 0 218642 0 0 0 8400 0 7425 0 682896 0 0 0 Michael Waters MD Physician 422383 0 210530 0 0 0 8400 0 17876 0 659189 0 0 0 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 YEAR END BONUS PROGRAM FOR ALL EMPLOYEES, AT RELATED ORGANIZATION, WAS BASED ON THE 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: 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 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 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 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 23769077 Acknowledgment letter Cayuga Medical Center k 138377 Lease agreement Cayuga Medical Center l 3408116 Written agreement Cayuga Medical Center m 2188989 Written agreement Cayuga Medical Office Building Associates k 208592 Lease agreement Extension was filed.