2020-10-14T11:43:51-05:00 2019-11-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2018-12-01 743001674 LONE STAR CIRCLE OF CARE LONE 5126860523 205 EAST UNIVERSITY AVENUE NO 200 GEORGETOWN TX 78626 JON CALVIN CHIEF FINANCIAL OFFICER 5126860523 2020-10-13 1 MICHAEL LUMSDEN P01262236 4159561500 2020-10-13 76.14.38.113 2020-10-13 15:50:45 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 00C4359F54289D19625D58AABAD73364CEA05A5F 2018 2021-01-29 14:40:06Z RHONDA MUNDHENK 205 EAST UNIVERSITY AVENUE NO 200 GEORGETOWN TX 78626 87273673 0 X HTTPS://LONESTARCARES.ORG/ X 2001 TX LONE STAR CIRCLE OF CARE PROVIDES EXCEPTIONAL & ACCESSIBLE PATIENT CENTERED HEALTHCARE FOR OUR TEXAS NEIGHBORS, FOCUSING ON THE UNDERSERVED. 13 13 707 13 0 0 19979953 21158710 59357844 65931929 57415 168153 200 0 79395412 87258792 0 0 0 0 45185771 52273548 0 0 1431560 26557233 30598688 71743004 82872236 7652408 4386556 46765059 51881578 9070726 9800689 37694333 42080889 X LONE STAR CIRCLE OF CARE PROVIDES EXCEPTIONAL AND ACCESSIBLE PATIENT CENTERED HEALTHCARE FOR OUR TEXAS NEIGHBORS. 0 0 61682468 0 52303017 MEDICAL PROGRAMS: LONE STAR CIRCLE OF CARE (LSCC) HAS MULTIPLE MEDICAL SERVICE LINES THAT PROVIDE PRIMARY & ACUTE MEDICAL CARE INCLUDING PREVENTION, DIAGNOSIS, AND TREATMENT OF CHRONIC CONDITIONS. IN THE PAST YEAR, LSCC PROVIDED 127,812 PEDIATRIC PATIENT VISITS, 82,288 FAMILY MEDICINE PATIENT VISITS, 10,111 SENIOR CARE PATIENT VISITS, 46,358 OB/GYN PATIENT VISITS (INCLUDING 1,831 BABY DELIVERIES), 1,840 OPTOMETRY VISITS, 649 CONVENIENT CARE VISITS, AND FILLED 180,739 PRESCRIPTIONS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION ABOUT THE SERVICES PROVIDED. 6705225 0 8762857 INTEGRATED BEHAVIORAL HEALTH: LSCC'S INTEGRATED BEHAVIORAL HEALTH MODEL ADDRESSES THE COMPLETE PRIMARY MEDICAL AND MENTAL HEALTH NEEDS OF ADULT, ADOLESCENT, SENIOR, AND PEDIATRIC PATIENTS. BY PROVIDING CONTINUOUS ACCESS TO TREATMENT AND MEDICATIONS, LSCC IS HELPING TO REDUCE EMERGENCY ROOM VISITS AND CRISES RELATED TO UNTREATED MENTAL HEALTH ISSUES. SERVICES PROVIDED INCLUDE PSYCHIATRY, PSYCHOTHERAPY, AND COUNSELING FOR SENIORS, ADULTS, ADOLESCENTS, AND CHILDREN. THE BEHAVIORAL HEALTH CLINICS PROVIDED 63,413 PATIENT VISITS LAST YEAR. 4074962 0 2913131 DENTAL CARE: LSCC PROVIDES GENERAL DENTISTRY SERVICES FOR ADULTS AND CHILDREN IN THE CENTRAL TEXAS COMMUNITY. LSCC'S GCC DENTAL CENTER IN GEORGETOWN AND DENTAL CLINICS IN ROUND ROCK, MARBLE FALLS, BASTROP, AND AUSTIN ARE DEDICATED TO PROVIDING AFFORDABLE, ACCESSIBLE CARE TO THE UNINSURED AND UNDER-SERVED. LSCC PROVIDED 21,203 PATIENT VISITS IN THE PAST YEAR. 0 0 1952924 OTHER PROGRAM REVENUES INCLUDE QUALITY INCENTIVE REVENUES, ELECTRONIC HEALTH RECORDS INCENTIVE REVENUE, AND MISCELLANEOUS ANCILLARY REVENUE. 0 0 1952924 72462655 1 1 0 1 0 0 0 0 1 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 1 0 0 0 0 0 0 0 0 1 39 0 1 707 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JON CALVIN CFO 5126860523 205 E UNIVERSITY AVE STE 200 GEORGETOWN TX 78626 JACK HUNNICUTT BOARD MEMBER - CHAIR 1.00 X 0 0 0 CYNTHIA BRIEN BOARD MEMBER - VICE CHAIR 1.00 X 0 0 0 SCOTT ALARCON BOARD MEMBER - VICE CHAIR 1.00 X 0 0 0 KAREN COLE BOARD MEMBER - SECRETARY 1.00 X 0 0 0 STEVE PENA BOARD MEMBER - TREASURER 1.00 X 0 0 0 DOAK FLING BOARD MEMBER THROUGH 2/2019 1.00 X 0 0 0 JOHN GUSTAINIS BOARD MEMBER 1.00 X 0 0 0 ELIZABETH JOHNSON BOARD MEMBER 1.00 X 0 0 0 AMY MEDRANO BOARD MEMBER 1.00 X 0 0 0 RUDOLPH METAYER BOARD MEMBER 1.00 X 0 0 0 SOFIA NELSON BOARD MEMBER 1.00 X 0 0 0 SHIRLEY ROBINSON BOARD MEMBER 1.00 X 0 0 0 MARK SCHROEDER BOARD MEMBER 1.00 X 0 0 0 ROLAND VALLE BOARD MEMBER 1.00 X 0 0 0 RHONDA MUNDHENK JD MPH CHIEF EXECUTIVE OFFICER 55.00 X 429735 0 20290 JON CALVIN CPA CMA CHFP CHIEF FINANCIAL OFFICER 55.00 X 305895 0 24613 KATHLEEN BUTLER MD MBA CMQ CPHQ CMO/CHIEF QUALITY OFFICER 40.00 X 370402 0 20290 LINDSEY TIPPIT MHA CHIEF OPERATING OFFICER 40.00 X 165578 0 15448 MELISSA R VALDEZ MD DIR OF PSYCH & BEHAVIORAL HEALTH 40.00 X 279346 0 15987 ADEYOYIN OKUNADE MD FAMILY PRACTICE MEDICAL DIRECTOR 40.00 X 229489 0 17796 ANDREW MAHAFFEY MD VP OF OB/GYN SERVICES 40.00 X 472912 0 12483 KIMBERLEE COLEMAN-HENDERSON MD OB/GYN 40.00 X 331046 0 10216 RICHARD SHEA MD OB/GYN 40.00 X 297105 0 13598 BROOKIE ARMSTRONG DDS CHIEF DENTAL OFFICER 40.00 X 289165 0 12483 TILLERY STOUT JD GENERAL COUNSEL 40.00 X 272202 0 10204 3442875 0 173408 124 0 1 0 ITENTIVE HEALTHCARE SOLUTIONS 1 PIERCE PLACE SUITE 400E ITASCA IL 60143 HOSTING AND MAINTENANCE 646142 QUEST DIAGNOSTICS PO BOX 841725 DALLAS TX 752841725 LAB SERVICES 532380 COLOMETRO INC PO BOX 340399 AUSTIN TX 78734 BROADBAND SERVICES 504930 AMERICAN INTERNATIONAL TRANSLATORS PO BOX 90848 AUSTIN TX 78709 TRANSLATION SERVICES 277888 CYRUS ONE 3581 SOLUTIONS CENTER CHICAGO IL 606773005 DATA CENTER 218396 11 9875741 11282969 4463534 21158710 PATIENT SERVICE REV 624100 63979005 63979005 QUALITY INCENTIVE REVE 621400 1312058 1312058 EHR REVENUE 621400 382500 382500 OTHER REVENUE 621400 258366 258366 65931929 183034 183034 14881 -14881 -14881 -14881 87258792 65931929 0 168153 2025977 718227 1023478 284272 41788651 37426378 3896453 465820 956944 860512 92419 4013 4519995 3968344 505588 46063 2981981 2597101 349316 35564 67061 67061 115300 115300 3468838 2758174 572173 138491 418213 332533 68983 16697 1476748 1174205 243585 58958 2260853 1797670 372920 90263 5810403 4957154 764128 89121 214028 170180 35303 8545 137900 109648 22746 5506 32601 10523 18456 3622 2193561 1967819 192596 33146 330301 238999 69335 21967 PHARMACEUTICAL SUPPLIES 7717557 7707342 10215 BAD DEBT EXPENSE 1723569 1723569 MEDICAL SUPPLIES 1218995 1209107 8247 1641 DUES & SUBSCRIPTIONS 406902 323540 67117 16245 3005858 2411630 482602 111626 82872236 72462655 8978021 1431560 1428790 992832 19131158 20332564 7296514 9371454 5721365 5824728 1263607 1693998 602583 784334 24673679 12989467 10822932 11684212 498110 1197456 46765059 51881578 6255494 7560565 25000 0 408000 408000 1159833 157116 1222399 1675008 9070726 9800689 X 29953180 32436888 7741153 9644001 37694333 42080889 46765059 51881578 4386556 0 X 0 1 X 1 1 1 X 18112617 16070902 17794696 19979953 21158710 93116878 18112617 16070902 17794696 19979953 21158710 93116878 36800589 56316289 1790 35522 47265 59664 183034 327275 93444153 277054964 0.60270 0.59920 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) AND THE TEXAS ASSOCIATION OF COMMUNITY HEALTH CENTERS (TACHC). A PORTION OF THESE DUES MAY BE USED FOR LOBBYING PURPOSES. 0 1 X 336850 336850 5700169 1649648 4050521 5965825 3743834 2221991 11398527 7412375 3986152 1272308 183610 1088698 11684212 DEFERRED RENT LIABILITY 1349646 DEFERRED COMPENSATION LIABILITY 325362 1675008 85718081 182858 -1723569 -1540711 87258792 0 87258792 81331525 182858 182858 81148667 1723569 1723569 82872236 PART IV, LINE 2B: THE ORGANIZATION SERVES AS A CUSTODIAN FOR FUNDS RECEIVED FROM ST. DAVID'S FOUNDATION, WHICH WILL BE USED TO PAY SPECIALISTS TO WHOM LSCC AND TWO ADDITIONAL FEDERALLY QUALIFIED HEALTH CENTERS REFER PATIENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -1,723,569. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,723,569. X X X 0 0 0 0 0 0 0 1 0 RHONDA MUNDHENK JD MPH CHIEF EXECUTIVE OFFICER 386777 0 42328 0 630 0 11000 0 9290 0 450025 0 0 0 JON CALVIN CPA CMA CHFP CHIEF FINANCIAL OFFICER 290517 0 15000 0 378 0 11000 0 13613 0 330508 0 0 0 KATHLEEN BUTLER MD MBA CMQ CPHQ CMO/CHIEF QUALITY OFFICER 365596 0 3000 0 1806 0 11000 0 9290 0 390692 0 0 0 LINDSEY TIPPIT MHA CHIEF OPERATING OFFICER 155326 0 10000 0 252 0 6640 0 8808 0 181026 0 0 0 MELISSA R VALDEZ MD DIR OF PSYCH & BEHAVIORAL HEALTH 275716 0 3000 0 630 0 5783 0 10204 0 295333 0 0 0 ADEYOYIN OKUNADE MD FAMILY PRACTICE MEDICAL DIRECTOR 225859 0 3000 0 630 0 4200 0 13596 0 247285 0 0 0 ANDREW MAHAFFEY MD VP OF OB/GYN SERVICES 440620 0 29520 0 2772 0 0 0 12483 0 485395 0 0 0 KIMBERLEE COLEMAN-HENDERSON MD OB/GYN 315416 0 15000 0 630 0 0 0 10216 0 341262 0 0 0 RICHARD SHEA MD OB/GYN 296139 0 0 0 966 0 0 0 13598 0 310703 0 0 0 BROOKIE ARMSTRONG DDS CHIEF DENTAL OFFICER 284359 0 3000 0 1806 0 0 0 12483 0 301648 0 0 0 TILLERY STOUT JD GENERAL COUNSEL 268782 0 3000 0 420 0 0 0 10204 0 282406 0 0 0 PART I, LINE 7 THE ORGANIZATION PROVIDED BONUS PAYMENTS TO CERTAIN INDIVIDUALS LISTED IN FORM 990, PART VII AND SCHEDULE J WHICH WERE DISCRETIONARY, AND THUS WOULD BE CONSIDERED "NON-FIXED PAYMENTS". X 1 4463534 FMV 0 0 1 0 PART I, COLUMN (B): ALL NON-CASH CONTRIBUTIONS RECEIVED WERE IN THE FORM OF VACCINES, WHICH WERE RECEIVED FROM ONE DONOR. FORM 990, PART III, LINE 1: ORGANIZATION'S MISSION: LONE STAR CIRCLE OF CARE PROVIDES EXCEPTIONAL AND ACCESSIBLE PATIENT CENTERED HEALTHCARE FOR OUR TEXAS NEIGHBORS. VISION STATEMENT: WE WILL ELIMINATE HEALTH INEQUALITIES TO FACILITATE WELLNESS AND OPTIMAL LIVING FOR ALL, HELPING STRENGTHEN OUR COMMUNITIES. CORE VALUES: COMPASSION, INTEGRITY, RESPECT, SERVICE, INNOVATION, EXCELLENCE LONE STATE CIRCLE OF CARE (LSCC) IS A 501(C)(3) NONPROFIT, FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER (FQHC) NETWORK THAT PROVIDES A PATIENT-CENTERED HEALTH CARE HOME TO UNINSURED AND UNDERINSURED RESIDENTS OF CENTRAL TEXAS. DURING THE 11/30/2019 FISCAL YEAR, LSCC OPERATED CLINICS THROUGHOUT WILLIAMSON, TRAVIS, BELL, BASTROP, BURNET, AND HARRIS COUNTIES. SERVICES INCLUDE: PRIMARY MEDICAL CARE THAT IS FOCUSED BY AGE GROUP (PEDIATRICS, ADOLESCENTS, ADULTS, AND SENIORS); COMPREHENSIVE OB/GYN SERVICES; GENERAL DENTISTRY; OPTOMETRY; PHARMACY SERVICES; AND ENABLING SERVICES SUCH AS INTERPRETERS AND INSURANCE ELIGIBILITY SCREENERS. A ROBUST AND FULLY INTEGRATED BEHAVIORAL HEALTH PROGRAM, WITH APPROXIMATELY 40 CLINICIANS ON STAFF, PROVIDES NECESSARY PSYCHIATRIC AND PSYCHOTHERAPY SERVICES TO PATIENTS WHO WOULD OTHERWISE NOT HAVE ACCESS TO CARE. LSCC ACCEPTS MEDICAID, CHILDREN'S HEALTH INSURANCE PROGRAM, MEDICARE AND OTHER PUBLICLY INSURED PATIENTS, AND UNINSURED PATIENTS PAY A SLIDING SCALE FEE BASED ON THEIR INCOME AND HOUSEHOLD SIZE. LSCC IS ACCREDITED BY THE JOINT COMMISSION (TJC) UNDER AMBULATORY CARE AND BEHAVIORAL HEALTH CARE STANDARDS. LSCC ALSO HOLDS PRIMARY CARE MEDICAL HOME (PCMH) CERTIFICATION FROM TJC. SINCE RECEIVING FQHC STATUS IN 2004, LSCC HAS FORGED NUMEROUS STRATEGIC PARTNERSHIPS, LEVERAGING FQHC BENEFITS WITH INVESTMENTS FROM OTHER STAKEHOLDERS, INCLUDING FOUNDATIONS, GOVERNMENT, AND HOSPITAL SYSTEMS. WITH THE SUPPORT OF THESE MANY PARTNERS, CAPACITY HAS GROWN FROM 10,000 VISITS IN 2002 TO 353,674 VISITS DURING THE 11/30/2019 FISCAL YEAR. LSCC WILL CONTINUE IDENTIFYING OPPORTUNITIES TO COLLABORATE AND LEVERAGE ITS RESOURCES TO PROVIDE SUSTAINABLE, QUALITY PRIMARY HEALTH CARE FOR THE REGION. FORM 990, PART III, LINE 4A MEDICAL PROGRAMS: LONE STAR CIRCLE OF CARE (LSCC) HAS MULTIPLE MEDICAL SERVICE LINES THAT PROVIDE PRIMARY AND ACUTE MEDICAL CARE INCLUDING PREVENTION, DIAGNOSIS AND TREATMENT OF CHRONIC CONDITIONS. IN THE PAST YEAR, LSCC PROVIDED 353,674 PATIENT VISITS ACROSS ALL SERVICE LINES. LSCC SERVICE LINES INCLUDE: 1) PEDIATRIC: PRIMARY AND ACUTE MEDICAL CARE FOR CHILDREN AND ADOLESCENTS. IN THE PAST YEAR, LSCC PROVIDED 127,812 VISITS. 2) FAMILY MEDICINE AND SENIOR CARE: LSCC PROVIDES A PRIMARY CARE HOME FOR A LARGE, UNINSURED ADULT POPULATION. PATIENTS HAVE ACCESS TO ROUTINE AND ACUTE CARE AS WELL AS CHRONIC DISEASE PREVENTION, TREATMENT AND MANAGEMENT. IN THE PAST YEAR, LSCC PROVIDED 82,288 PATIENT VISITS. 3) WOMEN'S HEALTH: OBSTETRICS AND GYNECOLOGY, INCLUDING THOROUGH PRENATAL CARE, LABOR AND DELIVERY, AND POSTPARTUM CARE. OB/GYN PROVIDERS PROVIDED 46,358 PATIENT VISITS, INCLUDING DELIVERING 1,831 BABIES THIS YEAR. 4) INTEGRATED BEHAVIORAL HEALTH: PSYCHIATRY, PSYCHOTHERAPY, AND COUNSELING FOR ADULTS, SENIORS, ADOLESCENTS, AND CHILDREN. IN THE PAST YEAR, LSCC PROVIDED 63,413 BEHAVIORAL HEALTH VISITS. 5) SENIOR: MEDICAL SERVICES TAILORED FOR OLDER ADULTS. LSCC PROVIDED 10,111 SENIOR VISITS OVER THE PAST YEAR. 6) CONVENIENT CARE: LSCC PROVIDED 649 CONVENIENT CARE VISITS. 7) DENTAL: LSCC'S DENTAL CLINIC PROVIDED 21,203 VISITS IN THE YEAR. 8) VISION: LSCC'S VISION CLINIC PROVIDED 1,840 VISITS IN THE YEAR. 9) HEALTH EDUCATION CLASSES: LSCC TEAMED UP WITH VARIOUS LOCAL PARTNERS TO PROVIDE FREE HEALTH EDUCATION CLASSES TO OUR PATIENTS AND THE LOCAL COMMUNITY. THESE CLASSES ARE A VALUABLE RESOURCE TO INDIVIDUALS AND FAMILIES WHO ARE: (I) LEARNING TO MANAGE DIABETES OR ASTHMA; (II) EXPECTING THEIR FIRST CHILD; (III) LEARNING ABOUT BEING ACTIVE AND EATING HEALTHY; AND (IV) TEACHING THEIR CHILDREN TO BE HEALTHY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. UPON RECEIPT OF THE FORM 990 FROM THE INDEPENDENT ACCOUNTANT, AND PRIOR TO SUBMISSION TO THE IRS, THE CFO REVIEWS THE RETURN FOR REASONABLENESS COMPARED TO THE FINAL AUDITED FINANCIAL STATEMENTS. THE FORM IS THEN DISTRIBUTED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND FEEDBACK BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS OR EXECUTIVE COMMITTEE SHALL COMPLETE AND SIGN A CONFLICT OF INTEREST CERTIFICATE ANNUALLY, AT THE START OF THE MEMBER'S TERM, OR AT THE START OF THE CORPORATION'S FISCAL YEAR, WHICHEVER COMES FIRST. SHOULD A CONFLICT ARISE, THE BOARD MEMBER WILL ABSTAIN FROM PARTICIPATING IN VOTING RELATED TO THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO COMPENSATION REVIEW WAS CONDUCTED BY THE EXECUTIVE COMMITTEE OF THE BOARD USING THIRD PARTY COMPENSATION RESOURCES FOR COMPARISON AND REASONABLENESS. A FORMAL EVALUATION OF THE CEO BY THE BOARD OF DIRECTORS WAS LAST COMPLETED ON JUNE 27, 2019. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WAS REVIEWED AND APPROVED BY THE CEO, WHO TAKES INTO ACCOUNT INDUSTRY COMPENSATION DATA, ALONG WITH THE SIZE AND COMPLEXITY OF THE COMPARABLE ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE MADE AVAILABLE UPON REQUEST. IN ADDITION, THE FORM 990 IS PUBLIC INFORMATION.