2020-11-12T10:25:40-06:00 2019-12-31 390859910 BAKER TILLY US LLP 125 BAYLIS ROAD SUITE 300 MELVILLE NY 11747 990 2019-01-01 133964284 INDEPENDENCE CARE SYSTEM INC INDE 2125842500 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 REGINA ESTELA CO-PRESIDENT 2125842500 2020-11-04 1 ELLEN M LABITA CPA P00140777 6317527400 X 148.75.195.229 2020-11-04 09:59:40 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45D50D8E3994CEF8BF8842BFE43A81B55B26F885 2019 2021-01-29 14:40:06Z RICK SURPIN 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 10424062 0 X WWW.ICSNY.ORG X 1999 NY TO IMPROVE THE HEALTH OF, AND SERVICES FOR, PEOPLE REQUIRING CHRONIC OR LONG TERM HOME CARE. 7 6 322 6 0 0 166990 419155 436717690 9973686 152079 0 0 31221 437036759 10424062 0 0 0 0 29567437 9609652 0 0 0 475619088 3399271 505186525 13008923 -68149766 -2584861 33309364 5464015 162568069 20681626 -129258705 -15217611 X INDEPENDENCE CARE SYSTEM (ICS) IS A NONPROFIT ORGANIZATION COMMITTED TO ASSISTING PEOPLE WITH DISABILITIES TO LIVE INDEPENDENTLY AND PARTICIPATE FULLY IN COMMUNITY LIFE. WE SEEK TO BECOME A MODEL OF INTEGRATED HEALTH CARE AND SOCIAL SUPPORTS BASED ON COLLABORATION BETWEEN CONSUMERS, PROVIDERS AND CARE COORDINATORS. 1 1 9723992 9973686 ICS WAS A PARTIALLY CAPITATED MEDICAID MANAGED LONG-TERM CARE ORGANIZATION WHICH SUPPORTED ELIGIBLE LOW INCOME ADULTS WITH SEVERE DISABILITIES OR WHOM ARE ELDERLY; WHO REQUIRE MORE THAN 120 DAYS OF LONG TERM CARE, REMAIN AT HOME AND PARTICIPATE FULLY IN COMMUNITY LIFE.EFFECTIVE APRIL 1, 2019 AS A RESULT OF DISCUSSIONS WITH THE NYS-DOH, ICS CEASED OPERATIONS AS A MANAGED LONG TERM CARE PLAN (MLTC). THE NYS-DOH DESIGNATED ICS AS A HEALTH HOME FOR INDIVIDUALS WITH PHYSICAL DISABILITIES AND ICS ENTERED INTO A CARE MANAGEMENT AGREEMENT WITH VNS. THESE TWO AGREEMENTS ALLOWED ICS TO CONTINUE ITS MISSION OF SUPPORTING ADULTS WITH PHYSICAL DISABILITIES AND CHRONIC CONDITIONS TO LIVE AT HOME AND PARTICIPATE FULLY IN COMMUNITY LIFE. 9723992 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 479 0 322 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X KERRI O'NEILL 2125842500 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 REGINA ESTELA CO-PRESIDENT 35.00 0.00 X 251699 0 21583 RICK SURPIN BOD MEMBER & CO-PRESIDENT 35.00 0.00 X X 245286 0 21583 MARK T CORCORAN CHIEF FINANCIAL OFFICER 35.00 0.00 X 225085 0 21583 RACHAEL STACOM SVP-CARE MANAGEMENT 35.00 0.00 X 182811 0 12428 KERRI O'NEILL SVP-OPERATIONS/IT 35.00 0.00 X 184176 0 10277 HARRY K BONSU SVP-ADMINISTRATION/MEMBER SRVS 35.00 0.00 X 174199 0 0 CATHERINE BARUFALDI VP HUMAN RESOURCES 35.00 0.00 X 139770 0 21583 DONNA L LOONIE SVP-COMMUNICATIONS/MARKETING 35.00 0.00 X 158497 0 0 JEFFREY M KRAUSS BOD CHAIRPERSON 10.00 0.00 X X 0 0 0 CHRISTOPHER DUFF BOARD MEMBER & CO-PRESIDENT 1.00 0.00 X X 0 0 0 THOMAS K SMALL BOD MEMBER & TREASURER 4.00 20.00 X X 0 0 0 MICHAEL ELSAS BOD MEMBER & SECRETARY TO 5/19 2.00 0.00 X X 0 0 0 ANNA FLATTAU BOD MEMBER 1.00 0.00 X 0 0 0 NANCY J HOLLAND BOD MEMBER 1.00 0.00 X 0 0 0 GREGORY K NERSESSIAN BOD MEMBER 1.00 0.00 X 0 0 0 JODI STURGEON BOD MEMBER TO 5/19 2.00 40.00 X 0 211186 715 1561523 211186 109752 27 0 1 0 PRODUCTIVE PROGRAMMING 4901 PAGE LANE BLACK EARTH WI 53515 TRANSACTION SYSTEM SOFTWARE 378081 BAKER TILLY VIRCHOW KRAUSE LLP ONE PENN PLAZA SUITE 3000 NEW YORK NY 10019 AUDIT AND ACCOUNTING 110000 2 270000 149155 419155 MEDICAID PAYMENTS 621500 9973686 9973686 9973686 OXFORD HEALTH INSURANCE REIMBURSE 900099 19874 19874 MUTUAL OF AMERICA REIMBURSEMENT 900099 12053 12053 MISCELLANEOUS REVENUE 900099 -706 -706 31221 10424062 9973686 0 31221 786819 786819 6630404 6623835 6569 1657142 34921 1622221 535287 392793 142494 6953 6953 55100 55100 353080 210063 143017 7451 7451 546381 452729 93652 85730 71033 14697 957367 793247 164120 14221 9720 4501 1602 1045 557 885 885 528282 437719 90563 231272 191626 39646 REPAIRS & MAINTENANCE 379953 314818 65135 CLEANING 87361 72385 14976 DUES AND SUBSCRIPTIONS 56642 46932 9710 MISCELLANEOUS FEES 30922 25388 5534 56069 45738 10331 13008923 9723992 3284931 0 21759611 1121930 174555 9015475 702769 367668 123693 4149430 2852928 2019048 1296502 147562 2044566 33309364 5464015 143860885 1053755 1407982 0 17299202 19627871 162568069 20681626 X -129258705 -15382611 165000 -129258705 -15217611 33309364 5464015 X -2584861 116625955 X 0 1 X 1 0 X 391555 182944 61285 166990 419155 1221929 391915061 425573847 463175613 436717690 9973686 1727355897 392306616 425756791 463236898 436884680 10392841 1728577826 0 0 0 1728577826 88997 97713 144959 152079 483748 88997 97713 144959 152079 483748 31221 31221 392395613 425854504 463381857 437036759 10424062 1729092795 0.99970 0.99960 0.00030 0.00030 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER MISC REVENUE - 2019 AMOUNT: $ -706. OXFORD HEALTH INSURANCE REIMBURSEMENT - 2019 AMOUNT: $ 12,053. MUTUAL OF AMERICA REIMBURSEMENT - 2019 AMOUNT: $ 19,874. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1400574 648697 751877 2244935 1876396 368539 503921 327835 176086 1296502 ASSETS, DISCONTINUED OPERATIONS 1947004 SECURITY DEPOSITS 97562 2044566 LIABILITIES, DISCONTINUED OPERATIONS 19211235 DEFERRED RENT PAYABLE 416636 19627871 X 10424062 0 10424062 0 10424062 13008923 0 13008923 0 13008923 PART X, LINE 2: MANAGEMENT HAS EVALUATED ICS'S TAX POSITIONS AND CONCLUDED THAT ICS HAS NOT TAKEN ANY UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF ACCOUNTING STANDARDS CODIFICATION 740. X X X X 0 0 0 0 0 0 0 0 0 REGINA ESTELA CO-PRESIDENT 251699 0 0 0 0 0 0 0 21583 0 273282 0 0 0 RICK SURPIN BOD MEMBER & CO-PRESIDENT 245286 0 0 0 0 0 0 0 21583 0 266869 0 0 0 MARK T CORCORAN CHIEF FINANCIAL OFFICER 225085 0 0 0 0 0 0 0 21583 0 246668 0 0 0 RACHAEL STACOM SVP-CARE MANAGEMENT 182811 0 0 0 0 0 0 0 12428 0 195239 0 0 0 KERRI O'NEILL SVP-OPERATIONS/IT 184176 0 0 0 0 0 0 0 10277 0 194453 0 0 0 HARRY K BONSU SVP-ADMINISTRATION/MEMBER SRVS 174199 0 0 0 0 0 0 0 0 0 174199 0 0 0 CATHERINE BARUFALDI VP HUMAN RESOURCES 139770 0 0 0 0 0 0 0 21583 0 161353 0 0 0 DONNA L LOONIE SVP-COMMUNICATIONS/MARKETING 158497 0 0 0 0 0 0 0 0 0 158497 0 0 0 JODI STURGEON BOD MEMBER TO 5/19 0 211186 0 0 0 0 0 0 0 715 0 211901 0 0 PART I, LINE 3 COMPENSATION FOR THE PRESIDENT/CEO, CHIEF OPERATING OFFICER, AND CHIEF FINANCIAL OFFICER ARE BASED ON EMPLOYMENT CONTRACTS, WHICH WERE APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION FOR ALL OTHER POSITIONS WERE APPROVED BY THE CEO, COO, AND CFO BASED ON RECOMMENDATIONS BY THE VICE PRESIDENT OF HUMAN RESOURCES AFTER CONSIDERING JOB DUTIES AND COMPETITIVE SALARIES IN THE COMMUNITY; INSURING EQUITY WITHIN THE ORGANIZATION. JODI STURGEON SEE PART V 387081 PAYMENT FOR SUBLEASE 0 SCH L, PART IV: (B) AS OF SEPTEMBER 2013, JODI STURGEON IS A BOARD MEMBER OF INDEPENDENCE CARE SYSTEM AND THE PRESIDENT OF PARAPROFESSIONAL HEALTHCARE INSTITUTE. FORM 990, PART III, LINE 2 EFFECTIVE APRIL 1, 2019, THE NYS-DOH DESIGNATED ICS AS A HEALTH HOME FOR INDIVIDUALS WITH PHYSICAL DISABILITIES AND ICS ENTERED INTO A CARE MANAGEMENT AGREEMENT WITH VNS. FORM 990, PART III, LINE 3 EFFECTIVE APRIL 1, 2019 AS A RESULT OF DISCUSSIONS WITH THE NYS-DOH, ICS CEASED OPERATIONS AS A MANAGED LONG TERM CARE PLAN (MLTC). THE NYS-DOH DESIGNATED ICS AS A HEALTH HOME FOR INDIVIDUALS WITH PHYSICAL DISABILITIES AND ICS ENTERED INTO A CARE MANAGEMENT AGREEMENT WITH VNS. THESE TWO AGREEMENTS ALLOWED ICS TO CONTINUE ITS MISSION OF SUPPORTING ADULTS WITH PHYSICAL DISABILITIES AND CHRONIC CONDITIONS TO LIVE AT HOME AND PARTICIPATE FULLY IN COMMUNITY LIFE. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION DISTRIBUTES A COPY OF THE FINAL "DRAFT" OF THE FORM 990 TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EMPLOYEES ARE EXPECTED TO CONDUCT ACTIVITIES RELATING TO PERSONS, BUSINESSES, AND OTHER ORGANIZATIONS CLOSELY ASSOCIATED WITH THEM IN SUCH A WAY THAT NO CONFLICT MAY ARISE BETWEEN THE OTHER INTERESTS AND THE POLICIES, OPERATIONS OR INTERESTS (REAL OR APPARENT) OF INDEPENDENCE CARE SYSTEM, INC. THIS INCLUDES, BUT IS NOT LIMITED TO, OUTSIDE EMPLOYMENT. A CONFLICT OF INTEREST IS ANY DIRECT OR INDIRECT INTEREST IN A CONTRACTOR, REFERRER, OR RELATED ORGANIZATION, ON THE PART OF AN EMPLOYEE OR AN EMPLOYEE'S IMMEDIATE FAMILY, THAT MIGHT REASONABLY AFFECT THE EMPLOYEE'S JUDGMENT OR DECISIONS EXERCISED ON BEHALF OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE PRESIDENT/CEO, CHIEF OPERATING OFFICER, AND CHIEF FINANCIAL OFFICER ARE BASED ON EMPLOYMENT CONTRACTS, WHICH WERE APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION FOR ALL OTHER POSITIONS WERE APPROVED BY THE CEO, COO, AND CFO BASED ON RECOMMENDATIONS BY THE VICE PRESIDENT OF HUMAN RESOURCES AFTER CONSIDERING JOB DUTIES AND COMPETITIVE SALARIES IN THE COMMUNITY; INSURING EQUITY WITHIN THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: LOSS FROM DISCONTINUED OPERATIONS -14,016,239. NET GAIN FROM WIND-DOWN OF DISCONTINUED OPERATIONS 130,642,194. PARAPROFESSIONAL HEALTHCARE INSTITUTE 349 E 149 STREET BRONX NY 10451 133575492 IMPROVE QUALITY OF ELDER/DISABILITY SERVICES BY IMPROVEMENT OF WORKERS. NY 501(C)(3) LINE 7 N/A 0 PATHWAYS TO INDEPENDENCE 349 E 149 STREET BRONX NY 10451 204863650 BENEFITING PEOPLE W/DISABILITIES/LT HEALTH CARE BY SUPPORTING ICS. NY 501(C)(3) LINE 10 N/A 0 COOPERATIVE HOME CARE ASSOCIATES 349 E 149 STREET BRONX NY 10451 133238142 PERSONAL CARE AIDES NY N/A C 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 PARAPROFESSIONAL HEALTHCARE INSTITUTE - PHI K 378081 FMV