2019-11-01T13:46:35-05:00 2018-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 125 BAYLIS ROAD SUITE 300 MELVILLE NY 11747 990 2018-01-01 133964284 INDEPENDENCE CARE SYSTEM INC INDE 2125842500 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 MARK CORCORAN CFO 2125842500 2019-10-31 1 ELLEN M LABITA CPA P00140777 6317527400 X 148.75.192.64 2019-10-31 13:17:44 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45D50D8E3994CEF8BF8842BFE43A81B55B26F885 2018 2020-03-31 21:24:44Z X RICK SURPIN 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 437036759 0 X WWW.ICSNY.ORG X 1999 NY TO IMPROVE THE HEALTH OF, AND SERVICES FOR, PEOPLE REQUIRING CHRONIC OR LONG TERM HOME CARE. 9 5 420 5 0 265617 61285 166990 463175613 436717690 144959 152079 0 0 463381857 437036759 0 0 0 0 34032123 29567437 0 0 0 454765878 475619088 488798001 505186525 -25416144 -68149766 51768293 33309364 112877232 162568069 -61108939 -129258705 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. 0 0 486012895 436717690 ICS WAS A PARTIALLY CAPITATED MEDICAID MANAGED LONG-TERM CARE ORGANIZATION WHICH SUPPORTED 7,290 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. 486012895 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 1 753 0 420 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MARK CORCORAN 2125842500 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 RICK SURPIN BOD MEMBER & PRESIDENT 35.00 8.00 X X 350097 0 19114 JEFFREY M KRAUSS BOD CHAIRPERSON 10.00 0.00 X X 0 0 0 THOMAS K SMALL BOD MEMBER & TREASURER 4.00 40.00 X X 0 0 0 MICHAEL ELSAS BOD MEMBER & SECRETARY 2.00 0.00 X X 0 5649 0 CHRIS DUFF BOD MEMBER 1.00 0.00 X 0 0 0 ANN 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 2.00 40.00 X 0 206319 691 REGINA ESTELA CHIEF OPERATING OFFICER 35.00 0.00 X 334183 0 18460 MARK T CORCORAN CHIEF FINANCIAL OFFICER 35.00 0.00 X 318270 0 19115 RACHAEL STACOM SVP-CARE MANAGEMENT 35.00 0.00 X 238703 0 9502 KERRI O'NEILL SVP-OPERATIONS/IT 35.00 0.00 X 238703 0 10157 HARRY K BONSU SVP-ADMINISTRATION/MEMBER SERVICES 35.00 0.00 X 214680 0 4529 DONNA L LOONIE SVP-COMMUNICATIONS/MARKETING 35.00 0.00 X 198766 0 4043 CATHERINE BARUFALDI-HARREN VP HUMAN RESOURCES 35.00 0.00 X 185000 0 18589 2078402 211968 104200 47 0 1 0 CZAR SOLUTIONS LLC 78 EWART STREET SCARSDALE NY 10583 CARE MANAGEMENT SOFTWARE/SYSTEM CONFIGUR 355769 PRODUCTIVE PROGRAMMING 4901 PAGE LANE BLACK EARTH WI 53515 TRANSACTION SYSTEM SOFTWARE 212469 MASTER CLEANING SERVICES 58 SALISBURY AVENUE GARDEN CITY NY 11530 CLEANING, MAINTENANCE AND COURIER SERVIC 199290 WINDSOR PARTNERS LLC 777 ALEXANDER ROAD SUITE 201 PRINCETON NJ 08540 ACTUARIAL SERVICES 180000 THE EXECUSEARCH GROUP LLC PO BOX 844276 BOSTON MA 02284 TEMPORARY HELP/RECRUITMENT 107201 7 166990 166990 MEDICAID PAYMENTS 621500 435045991 435045991 MEMBER SURPLUS PAYMENTS 621500 1671699 1671699 436717690 152079 152079 437036759 436717690 0 152079 1059239 1059239 22278660 13628624 8650036 4533785 2895576 1638209 1695753 1046035 649718 71914 71914 95300 95300 1377190 467747 909443 197536 197536 906138 431574 474564 1945122 1223095 722027 119828 75348 44480 77154 77154 903106 903106 279101 279101 MEDICAL EXPENSES 465202603 465202603 CLAIM PROCESSING 2238032 2238032 BAD DEBT 986402 986402 REPAIRS & MAINTENANCE 825315 825315 394347 55891 338456 505186525 486012895 19173630 0 8598109 0 21607827 21759611 18009004 9015475 527066 367668 12855473 10836425 2865075 2019048 161212 147562 51768293 33309364 102103912 143860885 1424986 1407982 9348334 17299202 112877232 162568069 X -61108939 -129258705 -61108939 -129258705 51768293 33309364 -68149766 0 X 0 1 X 1 0 X 150320 391555 182944 61285 166990 953094 325811231 391915061 425573847 463175613 436717690 2043193442 325961551 392306616 425756791 463236898 436884680 2044146536 0 0 0 2044146536 127444 88997 97713 144959 152079 611192 127444 88997 97713 144959 152079 611192 133149 133149 326222144 392395613 425854504 463381857 437036759 2044890877 0.99960 0.99950 0.00030 0.00040 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CONSULTING REVENUE - 2014 AMOUNT: $ 15,460. OTHER MISC REVENUE - 2014 AMOUNT: $ 117,689. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3325857 2424940 900917 8363628 7467816 895812 1165988 943669 222319 2019048 PREMIUM LIABILITY - MEDICAID 16675467 DEFERRED RENT PAYABLE 623735 17299202 X 437036759 0 437036759 0 437036759 505186525 0 505186525 0 505186525 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 X 0 0 0 0 0 0 0 0 0 RICK SURPIN BOD MEMBER & PRESIDENT 350097 0 0 0 0 0 0 0 19114 0 369211 0 0 0 JODI STURGEON BOD MEMBER 0 206319 0 0 0 0 0 0 0 691 0 207010 0 0 REGINA ESTELA CHIEF OPERATING OFFICER 334183 0 0 0 0 0 0 0 18460 0 352643 0 0 0 MARK T CORCORAN CHIEF FINANCIAL OFFICER 318270 0 0 0 0 0 0 0 19115 0 337385 0 0 0 RACHAEL STACOM SVP-CARE MANAGEMENT 238703 0 0 0 0 0 0 0 9502 0 248205 0 0 0 KERRI O'NEILL SVP-OPERATIONS/IT 238703 0 0 0 0 0 0 0 10157 0 248860 0 0 0 HARRY K BONSU SVP-ADMINISTRATION/MEMBER SERVICES 214680 0 0 0 0 0 0 0 4529 0 219209 0 0 0 DONNA L LOONIE SVP-COMMUNICATIONS/MARKETING 198766 0 0 0 0 0 0 0 4043 0 202809 0 0 0 CATHERINE BARUFALDI-HARREN VP HUMAN RESOURCES 185000 0 0 0 0 0 0 0 18589 0 203589 0 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. RICK SURPIN-MICHAEL ELSAS SEE PART V 45226073 PAYMENT FOR SERVICES 0 RICK SURPIN-JODI STURGEON SEE PART V 434829 PAYMENT FOR SUBLEASE 0 SCH L, PART IV: (B) - RICK SURPIN IS PRESIDENT OF INDEPENDENCE CARE SYSTEM AND ALSO CHAIRMAN OF THE BOARD OF COOPERATIVE HOME CARE ASSOCIATES. MICHAEL ELSAS IS A BOARD MEMBER OF INDEPENDENCE CARE SYSTEM AND ALSO THE PRESIDENT OF COOPERATIVE HOME CARE ASSOCIATES. (B) - RICK SURPIN IS PRESIDENT OF INDEPENDENCE CARE SYSTEM AND A BOARD MEMBER OF PARAPROFESSIONAL HEALTHCARE INSTITUTE. AS OF SEPTEMBER 2013, JODI STURGEON IS A BOARD MEMBER OF INDEPENDENCE CARE SYSTEM AND THE PRESIDENT OF PARAPROFESSIONAL HEALTHCARE INSTITUTE. 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. 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 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 COOPERATIVE HOME CARE ASSOCIATES - CHCA M 45226073 FMV PARAPROFESSIONAL HEALTHCARE INSTITUTE - PHI K 434829 FMV