2019-09-09T14:20:52-05:00 2018-12-31 161071694 SCIARABBA WALKER & CO LLP 410 EAST UPLAND ROAD ITHACA NY 14850 990 2018-01-01 204356115 CAYUGA MEDICAL ASSOCIATES PC CAYU 6072772365 101 DATES DRIVE ITHACA NY 14850 MARTIN STALLONE PRESIDENT 6072772365 2019-09-09 1 RENATA DABROWSKA P01450486 6072725550 66.152.125.150 2019-09-09 15:20:45 ED P B0E87CBA238514C1E0E41FF392461A7CEBA23899 507C01BEDEAB4F280F6AC90DB4DC6DECC6FC59B7 2018 2019-02-21 02:37:17Z MARTIN STALLONE 101 DATES DRIVE ITHACA NY 14850 53547971 0 X N/A X 2006 NY TO PROVIDE COMPREHENSIVE MEDICAL SERVICES TO THE ORGANIZATION'S SERVICE AREA. 4 0 356 0 0 0 16971343 18148900 27871606 31667161 274 3708644 22306 23266 44865529 53547971 0 0 0 0 31129825 35227975 0 0 0 14532107 17686163 45661932 52914138 -796403 633833 4855482 6398726 4321852 5231263 533630 1167463 CAYUGA MEDICAL ASSOCIATES WILL DELIVER THE HIGHEST QUALITY HEALTHCARE, IN PARTNERSHIP WITH CAYUGA MEDICAL CENTER, ONE PERSON AT A TIME. 0 0 47176665 31690427 IN 2018, THE ORGANIZATION PROVIDED MEDICAL SERVICES TO 38,228 PATIENTS IN THE COURSE OF CONDUCTING 179,956 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 2018, THE ORGANIZATION'S PHYSICIANS CONDUCTED OVER 35,991 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. 47176665 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 60 0 356 1 0 0 0 0 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 ADMIN 6072772365 1301 TRUMANSBURG RD SUITE P ITHACA NY 14850 MARTIN STALLONE MD PRESIDENT 2.50 37.50 X X 0 398098 7158 DIRK DUGAN MD VICE PRESIDENT 40.00 X X 312534 0 16846 DAVID GEORGE EVELYN MD TREASURER 2.50 37.50 X X 0 413886 12138 DAVID SCHWED MD BOARD MEMBER 40.00 X 302607 0 29329 TONY VOTAW SECRETARY 5.00 X 0 285516 7696 BENJAMIN NEGLEY EXECUTIVE DIRECTOR 40.00 X 198922 0 27240 ZANEB YASEEN MD PHYSICIAN 40.00 X 799606 0 29329 LAVANYA KODALI MD PHYSICIAN 40.00 X 714741 0 29329 BENJAMIN DONOHUE MD PHYSICIAN 40.00 X 552171 0 16846 DEIDRE BLAKE MD PHYSICIAN 40.00 X 987885 0 29329 MICHAEL WATERS MD PHYSICIAN 40.00 X 648658 0 29329 4517124 1097500 234569 8 0 1 0 UNIVERSITY OF ROCHESTER MEDICAL CENTER 607 ELMWOOD AVE ROCHESTER NY 14642 PROFESSIONAL MEDICAL SERVICES 2491884 CAYUGA MEDICAL CENTER 101 DATES DRIVE ITHACA NY 14850 PROFESSIONAL MEDICAL SERVICES 1953436 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 PROFESSIONAL MEDICAL SERVICES 802536 BRENT PARK LLC 15 THORNWOOD DR ITHACA NY 14850 RENT 632411 HAYES LOCUMS LLC 6700 N ANDREWS AVE FORT LAUDERDALE FL 33309 PROFESSIONAL MEDICAL SERVICES 590669 23 X 18148900 18148900 PATIENT FEES 621110 27801714 27801714 SERVICE FEES 621110 3451756 3451756 MISCELLANEOUS 900099 413691 413691 31667161 399 399 23266 0 23266 23266 23266 3708245 0 3708245 3708245 3708245 53547971 31690427 0 3708644 X 887478 608107 279371 28913755 26771047 2142708 1125474 1065571 59903 2784358 2099497 684861 1516910 1342878 174032 46778 24696 22082 196743 196743 7112577 5540026 1572551 173295 173295 74018 74018 697857 697857 2232114 1953251 278863 44560 44560 2719 2719 510472 322756 187716 1202283 1137658 64625 LEASED MD'S 1906711 1906711 MEDICAL SUPPLIES 1483680 1483680 BAD DEBT 770148 770148 UTILITIES 479533 479533 752675 752675 52914138 47176665 5737473 0 202730 1350256 9532 11032 2259006 2585458 143885 300908 5763756 3612684 2240329 2151072 4855482 6398726 819182 1302085 40020 33405 3462650 3895773 4321852 5231263 X 533630 1167463 533630 1167463 4855482 6398726 633833 0 X X 0 1 X 1 0 X 11041589 13983354 14280583 16971343 18148900 74425769 20849719 22029514 23388292 27871606 31667161 125806292 31891308 36012868 37668875 44842949 49816061 200232061 0 0 0 200232061 59 114 664 274 3708644 3709755 59 114 664 274 3708644 3709755 19439 21706 22306 23266 86717 31891367 36032421 37691245 44865529 53547971 204028533 0.98140 0.99960 0.01820 X 1677907 897536 780371 3599088 2209683 1389405 486761 505465 -18704 2151072 ACCRUED PAYROLL LIABILITIES 2061363 ACCRUED PAYROLL 836244 ACCRUED EXPENSES 998166 3895773 52777823 0 52777823 770148 770148 53547971 52143990 0 52143990 770148 770148 52914138 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 770,148. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 770,148. X 1 1 X 0 0 0 0 0 0 1 0 0 MARTIN STALLONE MD PRESIDENT 0 369973 0 28125 0 0 0 0 0 7158 0 405256 0 0 DIRK DUGAN MD VICE PRESIDENT 312534 0 0 0 0 0 8250 0 8596 0 329380 0 0 0 DAVID GEORGE EVELYN MD TREASURER 0 355000 0 58886 0 0 0 5500 0 6638 0 426024 0 0 DAVID SCHWED MD BOARD MEMBER 302607 0 0 0 0 0 8250 0 21079 0 331936 0 0 0 TONY VOTAW SECRETARY 0 244076 0 41440 0 0 0 5500 0 2196 0 293212 0 0 BENJAMIN NEGLEY EXECUTIVE DIRECTOR 198922 0 0 0 0 0 6161 0 21079 0 226162 0 0 0 ZANEB YASEEN MD PHYSICIAN 476198 0 323408 0 0 0 8250 0 21079 0 828935 0 0 0 LAVANYA KODALI MD PHYSICIAN 611115 0 103626 0 0 0 8250 0 21079 0 744070 0 0 0 BENJAMIN DONOHUE MD PHYSICIAN 455016 0 97155 0 0 0 8250 0 8596 0 569017 0 0 0 DEIDRE BLAKE MD PHYSICIAN 511593 0 476292 0 0 0 8250 0 21079 0 1017214 0 0 0 MICHAEL WATERS MD PHYSICIAN 426792 0 221866 0 0 0 8250 0 21079 0 677987 0 0 0 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 8A AND 8B ALL MINUTES OF MEETINGS ARE RECORDED AND FILED WITH CORPORATE DOCUMENTS ONCE APPROVED. 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 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 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 VIII LINE 7A DEMUTUALIZATION OF INSURANCE POLICY IN 2018, THE ORGANIZATION WAS A POLICY HOLDER IN A MEDICAL INSURANCE COMPANY (THE COMPANY) THAT WAS DEMUTUALIZED AND CONTROL WAS ACQUIRED BY ANOTHER ENTITY (THE ACQUIRER). AS PART OF THE DEMUTUALIZATION, THE COMPANY WAS CONVERTED FROM MUTUAL INSURANCE COMPANY TO STOCK ISSUANCE. THE ACQUIRER PURCHASED 100% OF THE STOCK OF THE COMPANY. AS A RESULT OF THE TRANSITION, THE ORGANIZATION RECORDED A GAIN OF $3,708,245 ON THE SALE OF ITS STOCK. FORM 990, PART IX, LINE 11G HOUSEKEEPING/CUSTODIAL: PROGRAM SERVICE EXPENSES 251,760. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 251,760. CONTRACT LABOR: INTERPRETING & TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 269,060. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 269,060. PROFESSIONAL CLINICAL, RADIOLOGICAL & ECHO SERVICES : PROGRAM SERVICE EXPENSES 4,189,921. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,189,921. BILLING SERVICES : PROGRAM SERVICE EXPENSES 347,015. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 347,015. OTHER FEES : PROGRAM SERVICE EXPENSES 482,270. MANAGEMENT AND GENERAL EXPENSES 765,833. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,248,103. CONSULTING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 806,718. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 806,718. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED THE OVERSIGHT PROCESS OR THE SELECTIONS PROCESS DURING THE TAX YEAR. CAYUGA MEDICAL ASSOCIATES MEDICAL PRACTICE PLLC 101 DATES DRIVE ITHACA NY 14850 611871948 PROCESS ELECTRONIC PAYMENTS NY 0 0 CAYUGA MEDICAL ASSOCIATES CAYUGA MEDICAL CENTER 101 DATES DRIVE ITHACA NY 14850 222325405 HOSPITAL NY 501 C(3) 170(B)(1)(A)(III) 0 CAYUGA MEDICAL OFFICE BUILDING LP 101 DATES DRIVE ITHACA NY 14850 161261492 RENTAL NY CAYUGA MEDICAL CENTER NONE 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 CAYUGA MEDICAL CENTER C 18148900 ACKNOWLEDGMENT LETTER CAYUGA MEDICAL CENTER J 21206 RENTAL EQUIPMENT CAYUGA MEDICAL CENTER K 91076 LEASE AGREEMENT CAYUGA MEDICAL CENTER M 1871126 WRITTEN AGREEMENT CAYUGA MEDICAL CENTER L 3116723 WRITTEN AGREEMENT CAYUGA MEDICAL OFFICE BUILDING LP K 194084 LEASE AGREEMENT