2018-10-12T12:16:08-05:00 2017-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 125 BAYLIS ROAD SUITE 300 MELVILLE NY 11747 990 2017-01-01 133964284 INDEPENDENCE CARE SYSTEM INC INDE 2125842500 257 PARK AVE S 2ND FLR NEW YORK NY 100107304 MARK CORCORAN CFO 2125842500 2018-09-25 1 ELLEN M LABITA CPA P00140777 6317527400 X 216.255.126.197 2018-09-25 16:13:15 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45D50D8E3994CEF8BF8842BFE43A81B55B26F885 2017 2018-06-14 16:35:46Z RICK SURPIN 257 PARK AVE S 2ND FLR NEW YORK NY 100107304 463381857 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 5 448 5 0 0 182944 61285 425573847 463175613 97713 144959 0 0 425854504 463381857 0 0 0 0 32305328 34032123 0 0 19163 426563360 454765878 458868688 488798001 -33014184 -25416144 76310366 51768293 112003161 112877232 -35692795 -61108939 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 458156203 463175613 ICS IS A PARTIALLY CAPITATED MEDICAID MANAGED LONG-TERM CARE ORGANIZATION WHICH SUPPORTED 8,010 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. 458156203 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 1 875 0 1 448 1 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 257 PARK AVE S 2ND FLR NEW YORK NY 100107304 RICK SURPIN BOD MEMBER & PRESIDENT 35.00 8.00 X X 351956 0 24773 JEFFREY M KRAUSS CHAIRPERSON 5.00 0.00 X X 0 0 0 THOMAS K SMALL TREASURER 1.00 0.00 X X 0 49923 0 MICHAEL ELSAS SECRETARY 2.00 35.00 X X 0 107548 1254 CHRIS DUFF BOD MEMBER 1.00 0.00 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 1.00 40.00 X 0 201081 1165 REGINA ESTELA CHIEF OPERATING OFFICER 35.00 0.00 X 341573 0 35090 MARK CORCORAN CHIEF FINANCIAL OFFICER 35.00 0.00 X 309991 0 24773 RACHAEL STACOM SVP CARE MANAGEMENT 35.00 0.00 X 230210 0 12842 KERRI O'NEILL SVP OPERATIONS/INFO SYSTEMS 35.00 0.00 X 224378 0 21003 HARRY K BONSU SVP ADMIN. & MEMBER SERVICES 35.00 0.00 X 221952 0 1943 JOHN A CATICCHIO VP, FINANCE 35.00 0.00 X 196173 0 35090 DONNA L LOONIE SVP COMMUNICATION/MARKETING 35.00 0.00 X 189875 0 1943 2066108 358552 159876 34 0 1 0 CZAR SOLUTIONS LLC 78 EWART STREET SCARSDALE NY 10583 CARE MGMT IMPLEMENTATION SYSTEM 479710 SIMON DOES LLC 350 BLEECKER STREET SUITE LK NEW YORK NY 10014 CONSULTING/MARKETING/ADVERTISING 226335 PRODUCTIVE PROGRAMMING 4901 PAGE LANE BLACK EARTH WI 53515 CARE MGMT/CLAIMS SYSTEMS IMPLEMENTATION 214313 BAKER TILLY VIRCHOW KRAUSE LLP 125 BAYLIS RD - STE 300 MELVILLE NY 11747 ADUIT/TAX 193800 WINDSOR STRATEGY PTNRS LLC 196 PRINCETON HIGHTSTWN RD PRINCETON NJ 08550 ACTUARY 180000 9 61285 61285 MEDICAID PAYMENTS 621500 460734181 460734181 MEMBER SURPLUS PAYMENTS 621500 2441432 2441432 463175613 144959 144959 463381857 463175613 0 144959 1088156 1088156 25921844 9399628 16503053 19163 4992920 1875412 3117508 2029203 732192 1297011 109337 109337 152400 152400 5216526 256112 4960414 331100 196669 134431 1084150 643971 440179 2073258 1231488 841770 180455 107188 73267 37603 22336 15267 1173243 696891 476352 280025 166331 113694 MEDICAL EXPENSES 440926420 440926420 BAD DEBT 1708781 1014994 693787 EQUIPMENT & MAINTENANCE 902056 535810 366246 MISCELLANEOUS 471158 279859 191299 119366 70902 48464 488798001 458156203 30622635 19163 6820878 8598109 13934967 21607827 50984257 18009004 604639 527066 12799466 9934391 3804413 2865075 161212 161212 76310366 51768293 109930371 102103912 1416644 1424986 656146 9348334 112003161 112877232 X -35692795 -61108939 -35692795 -61108939 76310366 51768293 -25416144 0 X 0 1 X 1 0 X 77500 150320 391555 182944 61285 863604 266439291 325811231 391915061 425573847 463175613 1872915043 266516791 325961551 392306616 425756791 463236898 1873778647 0 0 0 1873778647 203802 127444 88997 97713 144959 662915 203802 127444 88997 97713 144959 662915 183424 133149 316573 266904017 326222144 392395613 425854504 463381857 1874758135 0.99950 0.99920 0.00040 0.00050 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CONSULTING REVENUE - 2013 AMOUNT: $ 180,930. 2014 AMOUNT: $ 15,460. OTHER MISC REVENUE - 2013 AMOUNT: $ 2,494. 2014 AMOUNT: $ 117,689. 3305857 2269822 1036035 8327622 6776088 1551534 1165987 888481 277506 2865075 PREMIUM LIABILITY - MEDICAID 8845608 DUE TO RELATED PARTY 16666 DEFERRED RENT PAYABLE 486060 9348334 X 463381857 0 463381857 0 463381857 488798001 0 488798001 0 488798001 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 0 0 0 0 0 0 0 0 0 RICK SURPIN BOD MEMBER & PRESIDENT 351956 0 0 0 0 0 0 0 24773 0 376729 0 0 0 JODI STURGEON BOD MEMBER 0 201081 0 0 0 0 0 0 0 1165 0 202246 0 0 REGINA ESTELA CHIEF OPERATING OFFICER 341573 0 0 0 0 0 0 0 35090 0 376663 0 0 0 MARK CORCORAN CHIEF FINANCIAL OFFICER 309991 0 0 0 0 0 0 0 24773 0 334764 0 0 0 RACHAEL STACOM SVP CARE MANAGEMENT 230210 0 0 0 0 0 0 0 12842 0 243052 0 0 0 KERRI O'NEILL SVP OPERATIONS/INFO SYSTEMS 224378 0 0 0 0 0 0 0 21003 0 245381 0 0 0 HARRY K BONSU SVP ADMIN. & MEMBER SERVICES 221952 0 0 0 0 0 0 0 1943 0 223895 0 0 0 JOHN A CATICCHIO VP, FINANCE 196173 0 0 0 0 0 0 0 35090 0 231263 0 0 0 DONNA L LOONIE SVP COMMUNICATION/MARKETING 189875 0 0 0 0 0 0 0 1943 0 191818 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 45627235 COOPERATIVE HOME CARE ASSOCIATES - CHCA 0 RICK SURPIN-JODI STURGEON SEE PART V 956995 PARAPROFESSIONAL HEALTHCARE INSTITUTE - PHI 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 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 COOPERATIVE HOME CARE ASSOCIATES - CHCA M 45573945 FMV PARAPROFESSIONAL HEALTHCARE INSTITUTE - PHI K 363326 FMV PARAPROFESSIONAL HEALTHCARE INSTITUTE - PHI M 567334 FMV