2017-11-15T15:50:36-06:00 2016-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2016-01-01 160960470 CROUSE HEALTH HOSPITAL INC CROU 3154707111 736 IRVING AVENUE SYRACUSE NY 132101687 KELLI HARRIS CFO 3154707111 2017-11-10 1 THOMAS DALTON P00645802 7168472651 2017-11-10 104.193.28.34 2017-11-10 11:10:11 ES P 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 6CCE69B8D4AB845C63AC932EFE73665EABB1BF6F 2016 2021-01-29 14:40:06Z CROUSE HOSPITAL KIMBERLY BOYNTON 736 IRVING AVENUE SYRACUSE NY 132101687 421043599 0 X WWW.CROUSE.ORG X 1913 NY TO PROVIDE THE BEST IN PATIENT CARE AND TO PROMOTE COMMUNITY HEALTH 17 13 3319 570 260579 0 3030983 5656802 403636993 401232216 4993104 2122108 12584332 12032473 424245412 421043599 0 0 0 0 219173396 219618104 0 0 0 201759594 201440905 420932990 421059009 3312422 -15410 294743020 317879374 250310310 277035931 44432710 40843443 THE MISSION OF CROUSE HEALTH HOSPITAL, INC. IS TO PROVIDE THE BEST IN PATIENT CARE AND TO PROMOTE COMMUNITY HEALTH. 0 0 270268420 401232216 PROVISION OF HEALTHCARE SERVICES. CROUSE HEALTH HOSPITAL, INC. PROVIDES A VARIETY OF HEALTHCARE SERVICES TO A 15-COUNTY AREA IN CENTRAL NEW YORK. THE HOSPITAL OPERATES 506 ACUTE-CARE BEDS INCLUDING 57 BASSINETS. CROUSE HOSPITAL SERVICES MORE THAN 22,700 INPATIENTS, 82,200 EMERGENCY SERVICE PATIENTS, AND MORE THAN 441,000 OUTPATIENTS ANNUALLY. CROUSE HOSPITAL PROVIDED APPROXIMATELY $4.5 MILLION IN CHARITY CARE IN 2016. ADDITIONAL DETAILS ON CROUSE HOSPITAL'S EXEMPT PURPOSE ACHIEVEMENTS ARE FOUND IN "CROUSE HOSPITAL'S 2016-2018 COMMUNITY SERVICE PLAN" WHICH CAN BE ACCESSED ON THE HOSPITAL WEBSITE WWW.CROUSE.ORG. 270268420 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 312 0 1 3319 1 1 1 0 0 0 0 0 0 0 0 0 X 17 13 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NY X X KELLI HARRIS CFO 3154708058 736 IRVING AVENUE SYRACUSE NY 13210 ELIZABETH HARNETT ESQ DIRECTOR, VICE CHAIR 1.00 1.00 X X 0 0 0 PATRICK MANNION DIRECTOR, BOARD CHAIR 1.00 1.00 X X 0 0 0 PAUL KRONENBERG MD DIRECTOR, VICE CHAIR 1.00 1.00 X X 0 0 0 MELVIN STITH PHD DIRECTOR 1.00 1.00 X 0 0 0 MARY COTTER DIRECTOR 1.00 1.00 X 0 0 0 HAYES WANAMAKER MD DIRECTOR 1.00 1.00 X 27000 0 0 JAMES CARRICK DIRECTOR 1.00 1.00 X 0 0 0 RICHARD RUSSELL DIRECTOR 1.00 1.00 X 0 0 0 ROBERT MIRON DIRECTOR 1.00 1.00 X 0 0 0 BARBARA ASHKIN DIRECTOR 1.00 1.00 X 0 0 0 JAMES HUGHES DIRECTOR 1.00 1.00 X 0 0 0 PATTY BLACK DIRECTOR 1.00 1.00 X 0 0 0 JAMES LONGO MD DIRECTOR 1.00 1.00 X 0 472307 11437 KENT SYVERUD DIRECTOR 1.00 1.00 X 0 0 0 LEOLA RODGERS MPH DIRECTOR 1.00 1.00 X 0 0 0 TIMOTHY KENNEDY DIRECTOR 1.00 1.00 X 0 0 0 DAVID LANDSBERG DIRECTOR 1.00 1.00 X 56875 0 0 KIMBERLY BOYNTON PRESIDENT AND CEO 39.00 3.00 X 698510 39845 60528 DERRICK SUEHS BOARD SECRETARY (THRU JUNE), CQO 41.00 1.00 X 399244 0 31576 KELLI HARRIS BOARD TREASURER, CFO 37.00 5.00 X 301501 32701 39992 KIMBERLY ROSE CHIEF INFORMATION OFFICER 34.00 6.00 X 199653 35233 31964 SETH KRONENBERG MD CHIEF MEDICAL OFFICER, BOARD SEC (AFTER JUNE) 37.00 6.00 X 357166 35004 40045 ELIZABETH O'CONNOR CHIEF NURSING OFFICER 40.00 X 228921 0 40047 DAVID MASON PHYSICIAN EMERGENCY DEPT 40.00 X 440563 0 55645 GINA HAYES PHYSICIAN 40.00 X 385683 0 46522 RICHARD STEINMANN MD PHYSICIAN EMERGENCY DEPT 40.00 X 380212 0 64803 NAVEEN SETH PHYSICIAN 40.00 X 377963 0 43849 MICHAEL JOROLEMON PHYSICIAN 40.00 X 370058 0 58665 4223349 615090 525073 284 0 1 0 HAYNER HOYT 625 ERIE BLVD WEST SYRACUSE NY 13204 CONTRACTOR 10783477 LABORATORY ALLIANCE 1304 BUCKLEY RD SYRACUSE NY 13212 PROFESSIONAL MEDICAL 8847314 KPMG LLP DEPT 0511 PO BOX 120511 DALLAS TX 75312 IT CONSULTANT 8753682 CERNER HEALTH SERVICES PO BOX 959156 ST LOUIS MO 63195 IT CONSULTANT 6829757 CROUSE MEDICAL GROUP PC 401 N SALINA STREET SUITE 400 SYRACUSE NY 13203 PROFESSIONAL MEDICAL 4537519 69 5247516 99621 309665 5656802 PATIENT REVENUE 623000 397912989 397912989 PARKING 812930 2194014 2194014 PROPERTY MGT REV FROM AFFILIATE 531310 510852 510852 RENT 532000 466556 466556 NYS DSRIP PROGRAM REVENUE 623000 147805 147805 401232216 2094012 2094012 28096 0 28096 28096 28096 OTHER REVENUE 623000 3360664 3360664 COLLEGE OF NURSING 611600 2603375 2603375 CAFETERIA 721110 2422567 2422567 3645867 260579 3385288 12032473 421043599 401232216 260579 13894002 2268870 2268870 171170153 106011406 65158747 2309223 1431718 877505 31371781 19450504 11921277 12498077 7748808 4749269 529147 529147 190000 190000 148357 148357 19162911 11881005 7281906 1534458 951364 583094 2287839 1418460 869379 4872690 3021068 1851622 13150069 8153043 4997026 123687 76686 47001 49855 30910 18945 2012964 2012964 18482505 11459153 7023352 3442839 2134560 1308279 SUPPLIES 75223385 51151902 24071483 PURCHASED SERVICES 25015972 23515014 1500958 MAINTENANCE CONTRACTS 4871190 3020138 1851052 PENSION -1644674 -1019698 -624976 31987711 19832379 12155332 421059009 270268420 150790589 0 9300 23450 19121361 17632719 48953148 52022837 5885623 6640014 8764567 7527039 6477611 6653264 357541706 209264028 132439627 148277678 361 361 73091422 79102012 294743020 317879374 37060127 41692196 55220000 76717609 6352712 4769106 151677471 153857020 250310310 277035931 X 15386020 9271426 16208504 18186660 12838186 13385357 44432710 40843443 294743020 317879374 X -15410 -565091 -3008766 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 165172 0 0 165172 0 PART II-B, LINE 1: CROUSE HEALTH HOSPITAL, INC. CONTRACTED WITH THE WLADIS LAW FIRM EFFECTIVE 3/18/16 TO 3/18/17 TO SERVE AS STRATEGIC PLANNING, ECONOMIC DEVELOPMENT, AND FUNDING OBJECTIVES COUNSEL TO THE HOSPITAL. THE FEE FOR THOSE SERVICES IS $72,000 ANNUALLY PLUS EXPENSES. FOR THE YEAR ENDED DECEMBER 31, 2016, CROUSE HEALTH HOSPITAL, INC. PAID THE FIRM $72,000 IN PROFESSIONAL SERVICE FEES AND $107 IN ADMINISTRATIVE EXPENSE REIMBURSEMENT. CROUSE HEALTH HOSPITAL, INC. CONTRACTED WITH THE WHITEMAN, OSTERMAN & HANNA LLP EFFECTIVE 5/1/2015 TO 4/30/2016 TO PROVIDE LEGAL AND GOVERNMENTAL RELATIONS COUNSEL. THE FEE FOR THOSE SERVICES IS $90,000 ANNUALLY PLUS EXPENSES. FOR THE YEAR ENDED DECEMBER 31, 2016, CROUSE HEALTH HOSPITAL, INC. PAID THE FIRM $20,400 IN PROFESSIONAL SERVICES FEES AND $418 IN ADMINISTRATIVE EXPENSE REIMBURSEMENT. CROUSE HEALTH HOSPITAL, INC. CONTRACTED WITH SHENKER RUSSO & CLARK LLP EFFECTIVE 11/1/2015 TO 12/31/2016 TO PROVIDE GOVERNMENT AFFAIRS COUNSEL AND TO LOBBY ON BEHALF OF THE HOSPITAL IN NEW YORK STATE. THE FEE FOR THOSE SERVICES IS $72,000 PLUS EXPENSES FOR 2016. FOR THE YEAR ENDED DECEMBER 31, 2016 CROUSE HEALTH HOSPITAL, INC. PAID THE FIRM $72,000 IN PROFESSIONAL SERVICES FEES AND $247 IN ADMINISTRATIVE EXPENSE REIMBURSEMENT. 22278661 1062111 2083238 785128 24638882 24667814 104449 -1304218 1189384 22278661 25312798 644533 461758 1751275 24667814 21535299 594965 3363504 180970 25312798 19814130 50269 2546629 38000 809092 28637 21535299 0.34090 0.48520 0.17390 0 1 1 285832 285832 178168907 107826813 70342094 17840230 14738819 3101411 140183439 86698396 53485043 21063298 21063298 148277678 CROUSE HEALTH FOUNDATION 30142172 ASSETS WHOSE USE IS LIMITED 44041705 FUNDS HELD IN TRUST BY OTHERS 1429845 BOND ISSUANCE/CLOSING COSTS, NET 3180213 BCBS ADVANCE 308077 79102012 SELF INSURED PROFESSIONAL LIABILITY 16483812 ACCRUED PENSION LIABILITY 100694586 POST RETIREMENT OBLIGATIONS 9692137 ASSET RETIREMENT OBLIGATIONS 2611674 DUE TO RELATED PARTIES 4113954 FUNDS HELD IN TRUST 268521 LIABILITIES TO THIRD PARTY PAYERS 19885008 DEFERRED RENT AND REBATE 107328 153857020 X PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME. MANAGEMENT BELIEVES THE ORGANIZATION IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR YEARS PRIOR TO 2013. PART V, LINE 4 ENDOWMENT FUNDS - CROUSE HEALTH FOUNDATION, INC., A RELATED ORGANIZATION, IS IN POSSESSION OF ENDOWMENT FUNDS TO SUPPORT CROUSE HEALTH HOSPITAL INC. THESE ENDOWMENT FUNDS ARE VALUED AT APPROXIMATELY $30 MILLION AT DECEMBER 31, 2016. THE PRINCIPAL, WITH AN APPROXIMATE VALUE OF $12 MILLION, REMAINS UNTOUCHED, WHILE THE INVESTMENT INCOME IS USED TO FUND EQUIPMENT AND PROGRAMS REQUIRED FOR HOSPITAL SERVICES AND INITIATIVES. 1 1 X 1 X 1 X 340.000000000000 1 1 1 0 1 1 4675612 1668253 3007359 0.00710 100008672 66917348 33091324 0.07860 104684284 68585601 36098683 0.08570 597390 597390 0.00140 13395383 5930682 7464701 0.01770 1551652 1008504 543148 0.00130 276360 276360 0.00070 15820785 6939186 8881599 0.02110 120505069 75524787 44980282 0.10680 270480 270480 0.00060 270480 270480 0.00060 1 7251259 75576264 84280750 -8704486 X 1 1 1 MDRCROUSE TECHNICAL SERVICES LLC IMAGING 0.25000 0.75000 1 1 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 X X X X CROUSE HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X CROUSE.ORG X X 1 16 1 HTTP://CROUSE.ORG/ABOUT/COMMUNITY/ 0 1 X 100.000000000000 340.000000000000 1 1 X X X X 1 X HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ X HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ X HTTP://CROUSE.ORG/VISIT/PATIENTS/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X 1 0 0 CROUSE HOSPITAL PART V, SECTION B, LINE 5: IN 2016, CROUSE HEALTH WORKED WITH THE ONONDAGA COUNTY HEALTH DEPARTMENT AND OTHERS TO DEVELOP THE 2016 - 2018 COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN. A COMMUNITY ENGAGEMENT SURVEY WAS IMPLEMENTED THAT REACHED OVER 3,000 COUNTY RESIDENTS. FOCUS GROUPS WERE CONDUCTED TO IDENTIFY ISSUES IN POPULATIONS AT HIGHER RISK FOR POOR HEALTH OUTCOMES, THESE INCLUDED: RISE, THE NEW AMERICANS AT REFUGEE & IMMIGRANT SELF-EMPOWERMENT; COUNTY EAST FAMILY RESOURCE CENTER OF P.E.A.C.E. INC.; SYRACUSE HEALTHY START EXECUTIVE COUNCIL; THE GREATER SYRACUSE H.O.P.E. ANTI-POVERTY COALITION HEALTH COMMITTEE AND THE ONONDAGA COUNTY DRUG TASK FORCE. CROUSE HOSPITAL PART V, SECTION B, LINE 6A: CROUSE HEALTH'S CHNA WAS DEVELOPED BY A STEERING COMMITTEE CONVENED BY THE ONONDAGA COUNTY HEALTH DEPARTMENT. THE OTHER HOSPITALS INCLUDED WERE ST. JOSEPH'S HOSPITAL HEALTH CENTER AND UPSTATE UNIVERSITY HOSPITAL. CROUSE HOSPITAL PART V, SECTION B, LINE 6B: THE CHNA STEERING COMMITTEE INCLUDED REPRESENTATIVES FROM SYRACUSE UNIVERSITY'S LERNER CENTER FOR PUBLIC HEALTH; HEALTHECONNECTIONS, POPULATION HEALTH IMPROVEMENT PROGRAM AND THE CENTRAL NEW YORK CARE COLLABORATIVE, A PERFORMING PROVIDER SYSTEM ORGANIZED TO WORK TOWARDS NEW YORK STATE'S GOALS TO REDUCE MEDICAID USE. CROUSE HOSPITAL PART V, SECTION B, LINE 11: A LIST OF THE ACTIVITIES THE CROUSE HEALTH WILL PLAN AND IMPLEMENT DURING THE 2016 - 2018 CHNA IS INCLUDED IN THE CHNA AS WELL AS CROUSE'S COMMUNITY SERVICE PLAN.SOME OF CROUSE'S ACTIVITIES ARE:PRIORITY AREA: PREVENT CHRONIC DISEASES. FOCUS AREA 1: REDUCE OBESITY IN CHILDREN AND ADULTS.GOAL 1: CREATE COMMUNITY ENVIRONMENTS THAT SUPPORT HEALTHY FOOD AND BEVERAGE CHOICES AND PHYSICAL ACTIVITY.- CROUSE WILL EXPAND THE "SIMPLY WELL" NUTRITION, EXERCISE AND WELLNESS PROGRAM.GOAL 2: EXPAND THE ROLE OF HEALTHCARE AND HEALTH SERVICE PROVIDERS AND INSURERS IN OBESITY PREVENTION.- CROUSE WILL COLLABORATE WITH UPSTATE UNIVERSITY HOSPITAL TO ENCOURAGE WOMEN TO ENTER CENTERINGPREGNANCY PROGRAM FOR SUBSTANCE ABUSING WOMEN.- CROUSE WILL ACHIEVE ALL NYS DOH MANDATES RELATED TO BREAST FEEDING AND MOVE TOWARD BABY FRIENDLY DESIGNATION.FOCUS AREA 2: REDUCE ILLNESS, DISABILITY AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE EXPOSURE.GOAL 1: PROMOTE TOBACCO USE CESSATION, ESPECIALLY AMONG LOW SES POPULATIONS AND THOSE WITH POOR MENTAL HEALTH.- CROUSE WILL CONTINUE AND EXPAND "QUIT FOR LIFE" PROGRAM.- CROUSE WILL STRENGTHEN SMOKING CESSATION AND SUPPORT FOR PATIENTS IN OUTPATIENT CHEMICAL DEPENDENCY SERVICES.- CROUSE WILL WORK WITH CROUSE MEDICAL PRACTICE TO IMPLEMENT MILLION HEARTS CAMPAIGN.- CROUSE WILL WORK THROUGH CROUSE HEART CARING PROGRAM TO INITIATE 100 CONGREGATIONS FOR MILLION HEARTS CAMPAIGN.- CROUSE WILL JOIN THE EFFORT TO RAISE THE SALE AGE FOR TOBACCO PRODUCTS TO 21.FOCUS AREA 3: INCREASE ACCESS TO HIGH QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN BOTH CLINICAL AND COMMUNITY SETTINGS.- CROUSE WILL PROVIDE OUTREACH TO REFUGEE COMMUNITIES THROUGH EDUCATION DURING VISIT TO HOSPITAL LAND AND PROGRAMS THROUGH HEART CARING INITIATIVES.- CROUSE WILL INCREASE USE OF DATA WITH MEDICAL PRACTICES FOR CHRONIC CARE MANAGEMENT INCLUDING CARE COORDINATION TO INCREASE NUMBER OF PATIENTS REFERRED TO CHRONIC DISEASE SELF-MANAGEMENT CLASSES.PRIORITY AREA: PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE.FOCUS AREA: PREVENT SUBSTANCE ABUSE AND OTHER MEB DISORDERS.GOAL 1: PREVENT UNDERAGE DRINKING, NONMEDICAL USE OF PRESCRIPTION DRUGS BY YOUTH, AND EXCESSIVE ALCOHOL CONSUMPTION BY ADULTS.- CROUSE WILL PROVIDE EDUCATION TO INPATIENTS' PROVIDERS ON PATIENT PAIN MANAGEMENT.- CROUSE WILL INCREASE DATA SHARING ON PATIENTS' PAIN MANAGEMENT WITHIN THE CROUSE NETWORK.- CROUSE WILL ENHANCE EXISTING PROGRAM AND STRENGTHEN PARTNERSHIPS WITH CBOS TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH.- CROUSE WILL PROMOTE ONONDAGA COUNTY'S COMMUNITY EDUCATION WEBSITE ON HOSPITAL WEBSITE AND AT ALL EVENTS.- CROUSE WILL PROVIDE PRESCRIBER EDUCATION ON OPIOIDS TO MEDICAL STUDENTS WHO ATTEND PROGRAMS AT CROUSE'S SUBSTANCE USE DISORDER TREATMENT PROGRAMS.- CROUSE WILL CONTINUE AND ENHANCE THE HOSPITAL'S INTERVENTION SERVICE.- CROUSE WILL WORK COLLABORATIVELY WITH OTHER AREA HOSPITALS FOR INPATIENT ASSESSMENT FOR SUBSTANCE ABUSE FOR MEDICAID PATIENTS.- TO INCREASE REFERRALS FOR PATIENTS WITH SUBSTANCE USE DISORDER CROUSE WILL EXPAND THE USE OF SBIRT IN THE ED AND WILL CREATE LINKS TO COMBAT HEROIN WEBSITE AND THE PREVENTION NETWORK'S LIST OF RESOURCES. CROUSE HOSPITAL PART V, SECTION B, LINE 16J: CROUSE HOSPITAL'S FINANCIAL POLICY ALSO PRINTED IN THE HOSPITAL'S COMMUNITY BENEFIT REPORT WHICH IS ON THE HOSPITAL WEBSITE AND DISTRIBUTED WIDELY IN PRINT. CROUSE HOSPITAL PART V, SECTION B, LINE 21D: UNINSURED PATIENTS WHO RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE INFORMED OF A RANGE OF FINANCIAL ASSISTANCE OPTIONS THAT INCLUDE ASSISTANCE IN APPLYING FOR MEDICAID AND FOR CHARITY CARE DISCOUNTS. THE HOSPITAL CHARGES CONSISTENTLY ACROSS ALL PAYORS. THEREFORE, THE BILL FOR UNINSURED PATIENTS WHO RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IS AT GROSS CHARGES. THE UNISURED INDIVIDUAL ADJUSTMENT TO GROSS CHARGES IS BASED ON THE HOSPITALS INCOME GUIDELINES ADJUSTED AGAINST OUR LOWEST COMMERCIAL INSURANCE RATE. 12 1 - CROUSE HOSPITAL-410 SOUTH CROUSE DIV 410 SOUTH CROUSE AVENUE SYRACUSE NY 13210 CHEMICAL DEPENDENCY OUTPATIENT TREATMENT SERVICES 2 - CNY MEDICAL IMAGING CENTER 739 IRVING AVENUE SYRACUSE NY 13210 MEDICAL IMAGING TESTING CENTER 3 - CNY PROMPTCARE 739 IRVING AVENUE SYRACUSE NY 13210 URGENT CARE CENTER 4 - CROUSE HOSPITAL-COMMONWEALTH DIVISION 6010 EAST MOLLY ROAD SYRACUSE NY 13211 RESIDENTIAL CHEMICAL DEPENDENCY REHABILITATION 5 - PHYSICAL THERAPY-LIVERPOOL 7375 OSWEGO ROAD LIVERPOOL NY 13090 PHYSICAL THERAPY CENTER 6 - CROUSE ENDOSCOPY 739 IRVING AVENUE SYRACUSE NY 13210 ENDOSCOPY TESTING CENTER 7 - POB SURGERY CENTER 723 IRVING AVENUE SYRACUSE NY 13210 OUTPATIENT ABULATORY SURGERY CENTER 8 - PHYSICAL THERAPY - DEWITT 5823 WIDEWATERS PARKWAY EAST SYRACUSE NY 13057 PHYSICAL THERAPY CENTER 9 - MADISON IRVING SURGERY CENTER 475 IRVING AVENUE SYRACUSE NY 13210 OUTPATIENT ABULATORY SURGERY CENTER 10 - PHYSICAL THERAPY - CNY 739 IRVING AVENUE SYRACUSE NY 13210 PHYSICAL THERAPY CENTER 11 - HELP PEOPLE 600 E GENESEE STREET SYRACUSE NY 13202 EMPLOYEE ASSISTANCE PROGRAM 12 - PHYSICAL THERAPY - BRITTONFIELD 5000 BRITTONFIELD PKWY STE A123 EAST SYRACUSE NY 13057 PHYSICAL THERAPY CENTER PART I, LINES 7(E) AND 7(I) COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE:- MANY STAFF MEMBERS WORKED WITH THE CENTRAL NEW YORK CARE COLLABORATIVE TO DECREASE HEALTH DISPARITIES AND MEDICAID USE THROUGH TARGETED PROGRAMS.- PROVIDED OPIOID AND DRUG ADDICTION AND PREVENTION RESOURCE EDUCATION TO COMMUNITY MEMBERS THROUGH EDUCATIONAL EVENTS AT SCHOOLS, CLUBS, ETC. SIT ON PANELS. PROVIDE INFORMATION AND EXPERTISE TO COMMUNITY-BASED ORGANIZATIONS.- PROVIDED EDUCATION/INFORMATION CONCERNING STROKE AND EDUCATION ON SPINE HEALTH TO THE COMMUNITY.- PROVIDED MONTHLY, WEEKLY, BI-WEEKLY SUPPORT GROUPS FOR THE COMMUNITY INCLUDING SURVIVORS AND FAMILIES FOR OSTOMY, BREAST CANCER, STROKE, PERINATAL MOOD DISORDER AND WEIGHT LOSS.- PROVIDED HEALTH INFORMATION ON BREAST HEALTH, HEART HEALTH, REPRODUCTIVE HEALTH, STRESS REDUCTION AMONG OTHER TOPICS THROUGH SPIRIT OF WOMEN FREE EVENTS, HEALTH FAIRS, AND EDUCATIONAL OUTREACH.- PROVIDED FREE CLASSES ON NEWBORN CARE, CPR AS WELL AS FREE VISIT TO HOSPITAL LAND, AN EDUCATIONAL PROGRAM ON WHAT A HOSPITAL DOES, TO GRADE SCHOOL CHILDREN AND REFUGEES.- CROUSE PROVIDES BREAST FEEDING EDUCATION TO NEW MOTHERS IN BOTH THE L & D RECOVERY ROOM AND THE NEONATAL INTENSIVE CARE UNIT.- CROUSE HAD DEDICATED STAFF TO COMMUNITY BENEFIT OPERATIONS AS WELL AS STAFF TIME SPENT ON DEVELOPING THE CHNA AND THE COMMUNITY SERVICE PLAN.- PROVIDED FREE TEACHING DAYS TO THE EMS COMMUNITY SEVERAL TIMES A YEAR.COMMUNITY BENEFIT OPERATIONS INCLUDE:- CAMPAIGN CHAIRS FOR COMMUNITY BENEFIT NON-PROFITS.- AID FOR PATIENTS IN POVERTY INCLUDING MEDICATIONS OFFERED AT NO COST, TRANSPORTATION PROVIDED AND ADMINISTRATIVE SUPPORT.- CROUSE PROVIDED IN-KIND SUPPORT TO SUPPORT GROUPS, EDUCATIONAL ACTIVITIES AND TRAINING.- CROUSE MANAGEMENT GAVE VOLUNTEER HOURS TO VARIOUS COMMUNITY-BASED ORGANIZATIONS WORKING TOWARDS COMMUNITY HEALTH.- CROUSE PROVIDED CASH SUPPORT TO COMMUNITY BENEFIT ACTIVITIES.- STAFF PROVIDED GRANT ADMINISTRATIVE SUPPORT OF PUBLIC HEALTH BENEFIT ACTIVITIES. PART III, LINE 2: BAD DEBT EXPENSE IS THE AMOUNT PRESENTED IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. PART II, LINE 3 CROUSE PROVIDES EDUCATIONAL OPPORTUNITIES TO STUDENTS THROUGH CLINICALS, OBSERVATIONS AND INTERNSHIPS. IN 2016 CROUSE PROVIDED 163,928 HOURS TO 1,091 STUDENTS FROM 100 SCHOOLS. 15% OF THOSE STUDENTS WERE FROM UNDER-REPRESENTED POPULATIONS. PART III, LINE 4: THE FOOTNOTE DESCRIBING THE ORGANIZATION'S BAD DEBT EXPENSE IS INCLUDED IN THE 'SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES' THAT BEGINS ON PAGE 6 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED IS THE MEDICARE COST REPORT FOR 2016. OUTPATIENT COSTS ARE REPRESENTED ON MEDICARE COST REPORT WORKSHEET D, PARTS V AND VI. INPATIENT COSTS ARE ON WORKSHEET D-4. PART VI, LINE 2: IN ADDITION TO THE CHNA PROCESS SPEARHEADED BY THE ONONDAGA COUNTY HEALTH DEPARTMENT CROUSE PARTICIPATED IN THE COMMUNITY NEEDS ASSESSMENT IMPLEMENTED IN 2014 FOR THE STATE'S DELIVERY SYSTEM REFORM INCENTIVE PAYMENT PROCESS. THE ASSESSMENT WAS COMPLETED BY THE CENTRAL NEW YORK CARE COLLABORATIVE AS THE PERFORMING PARTNER SYSTEM. THE NEEDS IDENTIFIED IN THAT REPORT CORRESPOND TO THE 2016 - 2018 CHNA.CROUSE HEALTH ASSESSES THE NEEDS OF ITS COMMUNITY THROUGH FOCUS GROUPS WITH SPECIFIC PATIENT POPULATIONS. THE HOSPITAL'S CHEMICAL DEPENDENCY TREATMENT SERVICES GATHERS INFORMATION FROM OUTPATIENTS ON THEIR NEEDS ESPECIALLY WHEN DISCUSSING NEEDS BASED ON THE SOCIAL DETERMINANTS OF HEALTH. THE PATIENT AND GUEST SERVICES DEPARTMENT FREQUENTLY CONVENES PATIENTS AND THEIR FAMILIES TO DISCUSS PATIENT NEEDS. CROUSE, ALONG WITH UPSTATE UNIVERSITY HOSPITAL, IS ONE OF THE NEW YORK STATE'S REGIONAL PERINATAL CENTERS WHICH GATHER A LARGE AMOUNT OF DATA ABOUT MOTHERS AND BABIES FROM A 14 COUNTY REGION. THIS INFORMATION INFORMS THE SERVICES PROVIDED IN THAT SERVICE LINE. CROUSE GATHERS INFORMATION ABOUT THE COMMUNITY IT SERVES DURING ALL OUTREACH ACTIVITIES. PART VI, LINE 3: THERE ARE SEVERAL WAYS CROUSE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS, WAS WELL AS UNDER OUR ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THOSE METHODS INCLUDE: A DEDICATED HOSPITAL DEPARTMENT WITH FOUR FULL-TIME EMPLOYEES WHOSE SOLE RESPONSIBILITY IS TO HELP INDIVIDUALS APPLY FOR GOVERNEMNET OR OTHER FREE INSURANCE PROGRAMS, AS WELL AS TO NAVIGATE PATIENTS THROUGH THE CROUSE HOSPITAL FINANCIAL ASSISTANCE POLICY. THE POLICY IS POSTED ON THE CROUSE HOSPITAL WEBSITE, WWW.CROUSE.ORG, AND THERE IS A LINK ON EVERY PAGE OF THE WEBSITE THAT PEOPLE CAN CLICK TO FIND HELP WITH THEIR HOSPITAL BILL. FOLLOWING BEST PRACTICE MODELS, CROUSE HOSPITAL HAS DEVELOPED AN ONLINE APPLICATION FOR FINANCIAL AID. IT APPEARS ON THE HOSPITAL'S WEBSITE ALONG WITH THE FINANCIAL AID POLICY. CROUSE HOSPITAL DEVELOPED A SIMPLER, ONE-PAGE APPLICATION THAT IS EASIER TO FILL OUT AND ELIMINATED DUPLICATION OF PAPERWORK AND DOCUMENTATION - THE HOSPITAL'S FINANCIAL ASSISTANCE STAFF BRING COMPUTERS DIRECTLY TO PATIENTS' BEDSIDES TO ELECTRONICALLY COMPLETE FINANCIAL AID APPLICATION. THIS PROCEDURE IS INTENDED TO ELIMINATE BARRIERS TO ACCESSING CARE AND FINANCIAL ASSISTANCE BY AVOIDING LITERACY CONCERNS, ALLOWING PATIENTS TO ASK QUESTIONS IN REAL TIME, AND RECEIVE TRANSLATION SERVICES AS NECESSARY. EVERY CROUSE HOSPITAL BILLING NOTIFICATION INCLUDES A STATEMENT AT THE BOTTOM REFERENCING THE AVAILABILITY OF FINANCIAL ASSISTANCE BY CALLING CROUSE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND/OR ACCESSING THE POLICY THROUGH THE CROUSE WEBSITE. CROUSE HOSPITAL'S FINANCIAL ASSISTANCE IS POSTED IN THE FACILITY'S EMERGENCY ROOM, PROMPTCARE, AND WAITING ROOMS AS WELL AS IN THE HOSPITAL'S ADMISSIONS OFFICES. THE POLICY IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY. THE POLICY IS ALWAYS AVAILABLE ON REQUEST, AND IS EXPLAINED IN CROUSE HOSPITAL'S ANNUAL COMMUNITY SERVICE PLAN, WHICH IS WIDELY DISTRIBUTED TO THE PUBLIC AND IS POSTED ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: ONONDAGA COUNTY COVERS 780 SQUARE MILES IN CENTRAL NEW YORK STATE. WITH A POPULATION OF 468,463 (2015), ONONDAGA IS THE SIXTH MOST POPULOUS COUNTY IN UPSTATE NEW YORK. ONONDAGA COUNTY IS COMPRISED PRIMARILY OF FORESTS AND AGRICULTURAL LANDS, RESULTING IN A POPULATION DENSITY OF 600 PERSONS/MI. THE COUNTY SEAT IS THE CITY OF SYRACUSE, WHERE NEARLY ONE-THIRD OF COUNTY RESIDENTS RESIDE. IN ADDITION TO SYRACUSE, 19 TOWNS, 15 VILLAGES, AND THE ONONDAGA NATION TERRITORY LIE WITHIN THE COUNTY'S BORDERS. INTERSTATES 90 AND 81 ARE MAJOR EAST-WEST AND NORTH-SOUTH HIGHWAYS THAT INTERSECT JUST NORTH OF SYRACUSEWITH A POPULATION OF 144,142 (2015) SYRACUSE IS THE LARGEST CITY IN THE CENTRAL NEW YORK REGION AND THE FOURTH LARGEST UPSTATE NEW YORK CITY. THE SUBSTANTIAL DIFFERENCES IN THE SOCIO-DEMOGRAPHICS BETWEEN RESIDENTS OF SYRACUSE AND THE REST OF ONONDAGA COUNTY LEAD TO GEOGRAPHIC DISPARITIES IN HEALTH STATUS AND ARE A CRUCIAL CONSIDERATION DURING THE COMMUNITY HEALTH PLANNING PROCESS. IN ONONDAGA COUNTY THE MEDIAN AGE IS 38.8 YEARS WHILE IN SYRACUSE THE MEDIAN AGE IS 29.9 YEARS. WOMEN COMPRISE 51.8% OF THE POPULATION IN THE COUNTY AND 53% IN SYRACUSE. THERE ARE NEARLY 94,000 WOMEN OF CHILDBEARING AGE IN ONONDAGA COUNTY WITH ROUGHLY 37,000 RESIDING IN SYRACUSE. IN ONONDAGA COUNTY 80.4% SELF-IDENTIFY AS WHITE AND 11.1% AS BLACK WHILE IN THE CITY OF SYRACUSE 55% SELF-IDENTIFY AS WHITE AND 29% AS BLACK. ASIAN POPULATION IS 4% IN THE COUNTY AND 7% IN SYRACUSE. OVER 21,000 COUNTY RESIDENTS REPORT HISPANIC ETHNICITY AND AN ESTIMATED 12,000 REFUGEES AND FORMER REFUGEES CURRENTLY RESIDE IN SYRACUSE. CURRENT DATA SHOW THAT SYRACUSE HAS 30 "EXTREME POVERTY" CENSUS TRACTS (WHERE MORE THAN 40% OF RESIDENTS LIVE IN POVERTY). THE POVERTY RATE AMONG CHILDREN UNDER AGE 18 IN SYRACUSE IS 50% COMPARED TO 23% OF CHILDREN COUNTY-WIDE. CURRENTLY, ONLY 47.2% OF CHILDREN IN ONONDAGA COUNTY AND 42.8% IN SYRACUSE PARTICIPATE IN PRESCHOOL PROGRAMS. THERE ARE 18 PUBLIC SCHOOL DISTRICTS IN ONONDAGA COUNTY WITH AN ENROLLMENT OF APPROXIMATELY 70,000 STUDENTS, INCLUDING NEARLY 20,000 STUDENTS IN THE SYRACUSE CITY SCHOOL DISTRICT (SCSD). THIRTY-FOUR PRIVATE OR PAROCHIAL SCHOOLS IN THE COUNTY EDUCATE AN ADDITIONAL 8,000 STUDENTS. DISPARITIES IN EDUCATION OUTCOMES BETWEEN SYRACUSE AND THE REST OF THE COUNTY ARE EVIDENT, AS SCSD STUDENTS CONSISTENTLY SCORE SIGNIFICANTLY BELOW THE STATE AVERAGE ON STANDARDIZED TESTS. THE DISTRICT IS GENERALLY CONSIDERED ONE OF THE LOWEST PERFORMING IN NYS. IN ADDITION, THE HIGH SCHOOL DROPOUT RATE IN SYRACUSE WAS 11% FOR THE 2015-2016 SCHOOL YEAR, COMPARED TO 4% COUNTY-WIDE. THE PERCENT OF GRADUATES IN SYRACUSE WHO WILL GO ON TO SOME TYPE OF COLLEGE IS 71%, COMPARED WITH 81% COUNTY-WIDE.HOUSING IN ONONDAGA COUNTY REMAINS RELATIVELY AFFORDABLE. THE AGE AND CONDITION OF HOUSING STOCK VARIES ACROSS THE COUNTY. SYRACUSE IS AN OLDER CITY, WITH 43.7% OF THE HOUSING BUILT PRIOR TO 1940, AND 72.5% BUILT BEFORE 1960. MOST OF THE RECENT NEW HOME BUILDING HAS OCCURRED IN THE COUNTY SUBURBS, THOUGH A RECENT DOWNTOWN REVITALIZATION EFFORT HAS LED TO AN INCREASE IN HIGH END APARTMENTS AND CONDOMINIUMS IN POPULAR BUSINESS AND SHOPPING DISTRICTS. SYRACUSE HOUSING UNITS ARE LESS LIKELY TO BE OWNER-OCCUPIED (38.5%) COMPARED TO ONONDAGA COUNTY (81.0%), WHICH CONTRIBUTES TO SOME OF THE POOR HOUSING CONDITIONS THAT EXIST WITHIN SPECIFIC SYRACUSE NEIGHBORHOODS. PART VI, LINE 5: CROUSE HEALTH PROMOTES COMMUNITY HEALTH THROUGH ACTIVITIES SUCH AS THOSE LISTED IN PART V. IN ADDITION CROUSE PROVIDES:- CARE NAVIGATION IN THE EMERGENCY DEPARTMENT AND BREAST HEALTH CENTER- PROVIDES AN INFANT LOSS SUPPORT GROUP- IS NOW IN THE PLANNING STAGES TO PROVIDE LARC TO NEW MOTHERS ON MEDICAID AT NO COST- PROVIDES THE CHOICES PROGRAM TO HIGH SCHOOL STUDENTS WITH A YEARLONG "INSIDER LOOK" AT CLINICAL DEPARTMENTS- HEALTHCARE PROXY CARD DISTRIBUTION PROGRAM- REIKI THERAPY- MASSAGE THERAPY FOR VETERANS SUFFERING FROM PTSD- WORKS WITH OVER 50 OTHER AGENCIES ON THE COUNTY DRUG TASK FORCE- PROVIDES SPEAKERS TO COMMUNITY EVENTS WHEN REQUESTED- ENCOURAGES AND SUPPORTS ALL EMPLOYEE EFFORTS TO IMPROVE THE COMMUNITY'S HEALTH - COAT/CLOTHING DRIVES FOR THE ED AND CHEMICAL DEPENDENCY AREAS, CHRISTMAS BUREAU DONATIONS, SCHOOL SUPPLIES FOR SYRACUSE GRADE SCHOOL STUDENTS, ETC.- COLLABORATING WITH SU AND OTHERS TO BUILD A PROGRAM FOR NAS BABIES AND THEIR MOTHERS PART VI, LINE 7, REPORTS FILED WITH STATES NY X 1 1 X X X 1 0 0 0 0 0 0 1 0 JAMES LONGO MD DIRECTOR 0 472307 0 0 0 0 0 10600 0 837 0 483744 0 0 KIMBERLY BOYNTON PRESIDENT AND CEO 639396 36908 55794 2937 3320 0 16507 869 42131 1021 757148 41735 0 0 DERRICK SUEHS BOARD SECRETARY (THRU JUNE), CQO 399244 0 0 0 0 0 12580 0 18996 0 430820 0 0 0 KELLI HARRIS BOARD TREASURER, CFO 301501 32701 0 0 0 0 10754 1194 26002 2042 338257 35937 0 0 KIMBERLY ROSE CHIEF INFORMATION OFFICER 199653 35233 0 0 0 0 3611 637 24662 3054 227926 38924 0 0 SETH KRONENBERG MD CHIEF MEDICAL OFFICER, BOARD SEC (AF 357166 35004 0 0 0 0 6097 677 31229 2042 394492 37723 0 0 ELIZABETH O'CONNOR CHIEF NURSING OFFICER 228921 0 0 0 0 0 13514 0 26533 0 268968 0 0 0 DAVID MASON PHYSICIAN EMERGENCY DEPT 398088 0 42475 0 0 0 6951 0 48694 0 496208 0 0 0 GINA HAYES PHYSICIAN 363033 0 22650 0 0 0 7052 0 39470 0 432205 0 0 0 RICHARD STEINMANN MD PHYSICIAN EMERGENCY DEPT 373962 0 6250 0 0 0 15573 0 49230 0 445015 0 0 0 NAVEEN SETH PHYSICIAN 344630 0 33333 0 0 0 3359 0 40490 0 421812 0 0 0 MICHAEL JOROLEMON PHYSICIAN 361445 0 8613 0 0 0 9959 0 48706 0 428723 0 0 0 PART I, LINE 1A KIMBERLY BOYNTON WAS REIMBURSED FOR SOCIAL CLUB DUES. PART I, LINE 4A DERRICK SUEHS RECEIVED SEVERANCE PAYMENTS OF $205,711 DURING 2016. THAT AMOUNT IS INCLUDED IN THE TOTAL WAGES REPORTED IN PART II OF THIS SCHEDULE. PART I, LINE 7 AS STIPULATED BY EMPLOYMENT CONTRACT, THE HOSPITAL CEO RECEIVED INCENTIVE COMPENSATION IN AN AMOUNT THAT WAS DETERMINED BY THE BOARD OF DIRECTORS, NOT TO EXCEED 25% OF BASE SALARY. THE INCENTIVE WAS BASED UPON THE EXECUTIVES ACHEIVEMENT OF OBJECTIVES THAT WERE MUTUALLY AGREED UPON BY THE EXECUTIVE AND THE BOARD OF DIRECTORS, OR A COMMITTEE THEREOF. THE OBJECTIVES WERE ESTABLISHED ANNUALLY. THE BOARD OF DIRECTORS DETERMINED THE AMOUNT OF INCENTIVE COMPENSATION. INCENTIVE COMPENSATION RECEIVED IN 2016 WAS BASED ON 2015 OBJECTIVES. A 2003A ONONDAGA COUNTY INDUSTRIAL DEVELOPMENT AGENCY 161093714 682747EA4 2003-10-01 7510000 REFUND PORTION OF O/S SERIES 96 BD 0 0 0 B 2003A SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY 521380308 871720BT4 2003-10-01 20000000 REFUND PORTION OF O/S SERIES 96 BD 0 0 0 C 2007A ONONDAGA COUNTY INDUSTRIAL DEVELOPMENT AGENCY 161093714 682747GP9 2007-06-28 9000000 CAPITAL IMPROVEMENT PROJECT 0 0 0 D 2007A SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY 521380308 871720BW7 2007-12-20 20000000 CAPITAL IMPROVEMENT PROJECT 0 0 0 A 7510000 569963 6940037 2003 1 0 1 1 B 20000000 20000000 2003 1 0 1 1 C 9000000 8956437 43563 2009 0 0 1 1 D 20000000 20000000 2010 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 1 1 1 0 0 0 1 B 0 0 1 1 1 0 0 0 1 C 0 0 1 1 1 0 0 0 1 D 0 0 0 1 1 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: 2003A ONONDAGA COUNTY INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2013 ISSUER NAME: 2003A SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2013 ISSUER NAME: 2007A ONONDAGA COUNTY INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/28/2012 ISSUER NAME: 2007A SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/20/2012 ISSUER NAME: 2007B SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/20/2012 A 2007B SYRACUSE INDUSTRIAL DEVELOPMENT AGENCY 521380308 871720BX5 2007-12-20 7850000 CAPITAL IMPROVEMENT PROJECT 0 0 0 B 2016A SYRACUSE LOCAL DEVELOPMENT CORPORATION 474795153 2016-03-09 12800000 CAPITAL IMPROVEMENT PROJECT 0 0 0 C 2016B SYRACUSE LOCAL DEVELOPMENT CORPORATION 474795153 2016-03-09 9820000 CAPITAL IMPROVEMENT PROJECT 0 0 0 D 2016C SYRACUSE LOCAL DEVELOPMENT CORPORATION 474795153 2016-03-09 20000000 CAPITAL IMPROVEMENT PROJECT 0 0 0 A 7850000 7850000 2008 0 0 1 1 B 12800000 12800000 0 0 0 1 C 9820000 9820000 0 0 0 1 D 20000000 20000000 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 1 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 0 0 SETH KRONENBERG MD SOLE MEMBER OF CROUSE MEDICAL PRACTICE PLLC AS OF 7/1/15 SETH KRONENBERG, MD TOOK OVER AS THE PHYSICIAN CEO AND SOLE MEMBER OF CROUSE MEDICAL PRACTICE PLLC AS OF JULY 1, 2015. TO SEE A MORE DETAILED EXPLANATION OF CROUSE MEDICAL PRACTICE, PLLC AND THE HOSPITAL'S TRANSACTIONS WITH THIS ENTITY, PLEASE REFER TO SCHEDULE O AND SCHEDULE R. 0 FORM 990, PART VI, SECTION A, LINE 1 TWO EX OFFICIO DIRECTORS OF THE HOSPITAL BOARD OF DIRECTORS, THE HOSPITAL CEO AND THE PRESIDENT OF THE HOSPITAL AUXILIARY, SERVE WITHOUT VOTE. THE HOSPITAL BYLAWS AUTHORIZE THE USE OF AN EXECUTIVE COMMITTEE WHICH HAS THE RIGHT TO EXERCISE ALL THE AUTHORITY OF THE BOARD OF DIRECTORS BETWEEN MEETINGS OF THE BOARD AND WITH THE GENERAL POWER TO DISCHARGE THE DUTIES OF THE BOARD, EXCEPT AS SUCH POWER MAY BE LIMITED BY LAW, THE BYLAWS OR THE BOARD ITSELF. FORM 990, PART VI, SECTION A, LINE 2 PATRICK MANNION HAS UTILIZED SERVICES OF MACKENZIE HUGHES LAW FIRM WHERE MS. HARTNETT IS A PARTNER. PATRICIA BLACK PROVIDES FINANCIAL SERVICES ADVICE TO JAMES HUGHES. FORM 990, PART VI, SECTION A, LINE 6 CROUSE HEALTH SYSTEM, INC IS THE SOLE MEMBER OF CROUSE HEALTH HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A CROUSE HEALTH SYSTEM, INC APPROVES AND ELECTS THE BOARD OF DIRECTORS OF CROUSE HEALTH HOSPITAL, INC FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD OF DIRECTORS OF CROUSE HEALTH HOSPITAL, INC. SUCH AS APPOINTMENT OF THE HOSPITAL PRESIDENT, ARE SUBJECT TO APPROVAL BY CROUSE HEALTH SYSTEM, INC FORM 990, PART VI, SECTION B, LINE 11B HOSPITAL ACCOUNTING STAFF PROVIDES DATA TO AN INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 AND ALL REQUIRED SCHEDULES. IT IS REVIEWED BY LEGAL COUNSEL AND THE HOSPITAL CFO. THE REVIEWED FORM IS THEN PRESENTED TO THE FINANCE AND AUDIT COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL. COPIES OF FORM 990 AND ALL REQUIRED SCHEDULES ARE MADE AVAILABLE TO OTHER MEMBERS OF THE BOARD OF DIRECTORS, UPON THEIR REQUEST, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE COMPLETED ANNUALLY BY THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES OF CROUSE HEALTH HOSPITAL. ONCE COLLECTED, THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY MEMBERS OF THE CORPORATE COMPLIANCE OFFICE. ALL REPORTED POTENTIAL CONFLICTS OF INTEREST ARE EVALUATED AND DISCUSSED AMONG THE PARTIES. A REPORT IS PROVIDED TO THE BOARD OF DIRECTORS UPON COMPLETION OF THE COMPLIANCE REVIEW. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE CEO IS BASED ON AN ANNUAL EXECUTIVE COMMITTEE REVIEW IN CONJUNCTION WITH HUMAN RESOURCES. THE COMPENSATION FOR ALL KEY EMPLOYEES, OFFICERS, AND THE REST OF SENIOR MANAGEMENT IS DETERMINED BY THE CEO AND REVIEWED BY THE EXECUTIVE COMMITTEE. CURRENT COMPENSATION IS COMPARED TO THE NATIONAL SALARY SURVEY AND ANY NECESSARY ADJUSTMENTS ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY OF CROUSE HOSPITAL CAN BE FOUND ON THE HOSPITAL'S WEBSITE, WWW.CROUSE.ORG UNDER "CORPORATE COMPLIANCE HANDBOOK'. AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS OF CROUSE HOSPITAL ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: PENSION AND POST-RETIREMENT CHANGES OTHER THAN PERIOD COSTS -5,534,093. INCREASE IN INTEREST IN NET ASSETS OF CROUSE HEALTH FOUNDATION 2,523,360. INCREASE IN FUNDS HELD IN TRUST BY OTHERS 1,967. FORM 990, PART XII, LINE 2C CROUSE HEALTH HOSPITAL, INC. HAS NOT CHANGED THE PROCESS BY WHICH IT SELECTS ITS INDEPENDENT ACCOUNTANT OR OVERSEES THE AUDIT PROCESS FROM LAST YEAR. FORM 990, PART IV, LINE 34 IN 2010 THE HOSPITAL FORMED CROUSE MEDICAL PRACTICE, PLLC ("PLLC"). THE PLLC WAS FORMED TO FURTHER THE HOSPITAL'S CHARITABLE PURPOSES THROUGH THE ACQUISITION OF PHYSICIAN PRACTICES AND THE EMPLOYMENT OF PHYSICIANS. THE PLLC BORROWED ITS START-UP CAPITAL ON A FAIR MARKET NOTE FROM THE HOSPITAL, WHICH ACCRUES INTEREST DAILY. BECAUSE THE HOSPITAL EFFECTIVELY CONTROLS THE PLLC THROUGH CONTRACTUAL ARRANGEMENTS AND MAINTAINS SIGNIFICANT FINANCIAL SUPPORT OF THE PLLC, THE PLLCS FINANCIAL STATEMENTS ARE CONSOLIDATED WITH THE SYSTEM FOR FINANCIAL STATEMENT PURPOSES. SETH KRONENBERG IS THE SOLE MEMBER OF THE PLLC. ALL MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS COMPLETE ANNUAL CONFLICT OF INTEREST DISCLOSURES. FORM 990, PART VII, LINE 2 ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE HOSPITAL, EXCEPT MEMBER KIMBERLY BOYNTON, ARE VOLUNTARY. NO COMPENSATION, EMPLOYEE BENEFITS, OR EXPENSE ACCOUNT ALLOWANCES ARE RECEIVED FOR BOARD SERVICES. COMPENSATION IS DISCLOSED FOR EMPLOYEE SERVICES PROVIDED TO THE HOSPITAL OR ITS RELATED ORGANIZATIONS. CROUSE HEALTH NETWORK LLC 736 IRVING AVENUE SYRACUSE NY 13210 472918011 ESTABLISH/OPERATE ACCTABLE CARE ORG OF CLINICALLY INTEGR HLTHCARE PROVIDERS NY 0 0 CROUSE HEALTH HOSPITAL INC CROUSE HEALTH SYSTEM INC 736 IRVING AVENUE SYRACUSE NY 13210 161560473 TO PROVIDE OFF SITE SPACE AND SECURE CAPITAL NY 501(C)(3) LINE 12A, I N/A 0 CROUSE HEALTH FOUNDATION INC 736 IRVING AVENUE SYRACUSE NY 13210 161035427 FUNDRAISING FOR CROUSE HEALTH HOSPITAL NY 501(C)(3) LINE 7 N/A 0 CROUSE MEDICAL PRACTICE PLLC 736 IRVING AVENUE SYRACUSE NY 13210 800548096 FURTHER HOSPITAL'S PURPOSE THROUGH ACQUISITION OF PHYSICIAN PRACTICES NY 501(C)(3) LINE 7 CROUSE HEALTH HOSPITAL 1 0 0 1 1 1 0 0 0 0 1 0 0 1 0 1 0 1 0 0 CROUSE MEDICAL PRACTICE PLLC D 51990940 LOAN AGREEMENT CROUSE MEDICAL PRACTICE PLLC O 754610 INTERCO AGREEMENT CROUSE HEALTH FOUNDATION INC C 5380406 CROUSE HEALTH SYSTEM INC O 510852 INTERCO AGREEMENT CROUSE HEALTH SYSTEM INC J 3119019 LEASE AGREEMENT