2017-08-17T14:54:22-05:00 2016-12-31 721396621 CARR RIGGS & INGRAM LLC 4210 SPICEWOOD SPRINGS RD STE 108 AUSTIN TX 787598653 990 2016-01-01 311624871 INTEGRATED CARE COLLABORATION INTE 5128042090 8627 N MOPAC NO 300 AUSTIN TX 78759 EDIE L MORRIS EXECUTIVE DIRECTOR & CFO 5128042090 2017-07-31 1 K DALE COOPER P00142251 5123461880 209.36.96.36 2017-07-31 11:24:26 CD P BBBDA53EF0ABBF1789FF37DE587FC9675C181F4E D592B11C6D9C2940ADBFB04C68415FA2DCFF185C 2016 2021-01-29 14:40:06Z EDIE L MORRIS 8627 N MOPAC NO 300 AUSTIN TX 78759 1606750 0 X WWW.ICC-CENTEX.ORG X 1998 TX THE ICC IS AN ALLIANCE OF HEALTH CARE SAFETY NET PROVIDERS THAT WORK TOGETHER TO IMPROVE THE EFFICIENCY AND QUALITY OF HEALTH CARE SERVICES AVAILABLE FOR UNINSURED INDIVIDUALS IN CENTRAL TEXAS (WILLIAMSON, TRAVIS, AND HAYS COUNTIES). ICC ACTS AS A CONVENER AND INCUBATOR AND IS NOT A HEALTH PROVIDER. 4 4 0 0 0 0 0 0 2142088 1606294 531 456 0 0 2142619 1606750 0 0 0 0 1008196 1052584 0 0 22522 1185777 1053791 2193973 2106375 -51354 -499625 1481429 949644 462654 430494 1018775 519150 X THE ICC IS AN ALLIANCE OF HEALTH CARE SAFETY NET PROVIDERS THAT WORK TOGETHER TO IMPROVE THE EFFICIENCY AND QUALITY OF HEALTH CARE SERVICES AVAILABLE FOR UNINSURED INDIVIDUALS IN CENTRAL TEXAS (WILLIAMSON, TRAVIS, AND HAYS COUNTIES). ICC ACTS AS A CONVENER AND INCUBATOR AND IS NOT A HEALTH PROVIDER. 0 0 1392672 1333224 ICARE SYSTEM/HEALTH INFORMATION TECHNOLOGY: ICC OWNS, MAINTAINS, AND OPERATES A REGIONAL HIE CALLED THE ICARE SYSTEM. THE SYSTEM ALLOWS ICC AND ITS MEMBERS TO:-ACHIEVE MEANINGFUL USE STANDARDS BY MAXIMIZING MEMBER OPPORTUNITIES TO DEMONSTRATE MEANINGFUL USE OF INFORMATION EXCHANGE, CARE COORDINATION AND PUBLIC HEALTH PARTICIPATION THROUGH HIE.-EXPAND AND ENHANCE CARE COORDINATION PROGRAMS.-IMPROVE HEALTH OUTCOMES AND COMMUNITY HEALTH.-EXPAND AND ENHANCE RESEARCH AND EVALUATION CAPABILITIES. 286507 273070 MEMBER ANALYTICS TO SUPPORT COMMUNITY COLLABORATION: ICARE INCLUDES A ROBUST DATA WAREHOUSE AND ANALYTICS SOLUTION THAT FACILITATES PERFORMANCE-BASED OUTCOMES AND VALIDATED PATIENT INFORMATION WHICH DRIVES EVIDENCE-BASED PROGRAMS. THE SOLUTION ALSO SUPPORTS COMMUNITY HEALTH RESEARCH BY TRACKING POPULATION CARE PATTERNS, MEASURING EFFECTS OF PUBLIC POLICY CHANGES AND IDENTIFYING HEALTHCARE UTILIZATION PATTERNS. ICC ANALYTICS PROVIDE VALUABLE DATA THAT HELPS TO INCREASE ACCESS TO CARE, IMPROVE CARE COORDINATION AND PROVIDE MORE EFFICIENT AND APPROPRIATE CARE. ACCESS AND COMMUNITY COLLABORATION: ICC FACILITATES COMMUNITY BASED ENROLLMENT FOR INCREASED ACCESS AND COMMUNITY INTEGRATION. ICC MEMBERS HAVE ACCESS TO A COMMON ELIGIBILITY PROGRAM, MEDICAIDER, THROUGH WHICH PATIENTS ARE SCREENED FOR ELIGIBILITY FOR THIRD PARTY FUNDING AND FEDERAL, STATE AND LOCAL HEALTH COVERAGE PROGRAMS. THE PATIENT PRESCRIPTION ASSISTANCE PROGRAM (PPAP) IS ALSO AVAILABLE TO MEMBERS. THIS PROGRAM ACTIVITY STOPPED THE END OF 2014. 1679179 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 1 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X EDIE MORRIS 5128042090 8627 N MOPAC SUITE 300 AUSTIN TX 78759 X EARL MAXWELL DIRECTOR 0.00 X 0 0 0 GREG HARTMAN DIRECTOR 0.00 X 0 0 0 TRISH YOUNG BROWN BOARD CHAIR & DIRECTOR 0.00 X 0 0 0 DAVID EVANS BOARD VICE CHAIR & DIRECTOR 0.00 X 0 0 0 EDIE MORRIS EXECUTIVE DIRECTOR & CFO 40.00 X 0 169060 0 TONY NELSON DIRECTOR, HIE OPERATIONS & SECURITY 40.00 X 0 105761 0 CAROLE TAMAYO DIRECTOR OF TECHNOLOGY 40.00 X 0 139019 0 JARROD KNOX SENIOR DEVELOPER ARCHITECT 40.00 X 0 135399 0 STEPHANIE DOZIER SENIOR BUSINESS DATA ANALYST 40.00 X 0 110313 0 0 659552 0 0 0 1 0 EMPLOYER FLEXIBLE 8134 EXCHANGE DRIVE AUSTIN TX 78754 PAYROLL 798677 NETWORK SCIENCES 14205 BURNET RD STE 110 AUSTIN TX 78728 MEDICAIDER PRODUCT & SERVICES 364200 CHANCELLOR MOPAC INVESTMENT 7200 NORTH MOPAC EXPY STE 450 AUSTIN TX 78731 RENT 306051 QUALITY SYSTEMS INC 12301-B RIATA TRACE PARKWAY SUITE AUSTIN TX 78727 ANNUAL LICENSES 282261 AUSTIN TRAVIS COUNTY INTEGRAL CARE PO BOX 3548 AUSTIN TX 78764 REIMBURSEMENT FOR PAYROLL AND BENEFITS 247344 5 MEMBERSHIP FEES 519100 1525095 1525095 MISCELLANEOUS REVENUE 519100 81199 81199 1606294 456 456 1606750 1606294 0 456 X 952238 685781 249437 17020 100346 62223 35608 2515 37308 37308 18000 18000 277383 277383 84082 37512 43583 2987 29049 27967 1082 75283 75283 1571 1571 478248 475464 2784 52867 35995 16872 2106375 1679179 404674 22522 71613 66019 665775 491232 67900 214067 163322 143756 3362179 3353823 486605 8356 26214 26214 1481429 949644 162654 130494 300000 300000 462654 430494 X 1018775 519150 1018775 519150 1481429 949644 -499625 0 X X 0 1 X 1 0 X 1082097 661914 1744011 1082097 661914 1744011 1744011 609 461 120 531 456 2177 26934 241619 115843 66995 81199 532590 2278778 9430369 0.76530 0.83990 X 3362179 3353823 8356 8356 X 1653538 46788 46788 1606750 0 1606750 2153163 46788 46788 2106375 0 2106375 PART X, LINE 2: FOOTNOTE TO FINANCIAL STATEMENTS REGARDING INCOME TAX STATUS: ICC QUALIFIES AS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CONSEQUENTLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT ANY PROVISIONS FOR INCOME TAXES. HOWEVER, ICC IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. ICC HAS TAKEN NO UNCERTAIN TAX POSITIONS DURING OR FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015. ICC CONTINUALLY EVALUATES THE TAX EFFECTS OF EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. IN ADDITION, ICC'S TAX RETURNS FOR THE LAST FOUR YEARS REMAIN SUBJECT TO EXAMINATION BY THE IRS FOR WHICH ICC COULD BE LIABLE. X 0 0 0 0 0 0 0 0 0 EDIE MORRIS EXECUTIVE DIRECTOR & CFO 0 169060 0 0 0 0 0 0 0 0 0 169060 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS, WHO ARE THE SAFETY NET PROVIDERS BELONGING TO THE ALLIANCE. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE BOARD TREASURER AND IS LATER PRESENTED AT THE NEXT BOARD MEETING FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE OFFICERS, DIRECTOR AND KEY EMPLOYEES ARE REQUIRED ANNUALLY TO SUBMIT A SIGNED STATEMENT AFFIRMING THAT THE POLICY HAS BEEN REVIEWED AND COMPLIED WITH. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD EVALUATES AND APPROVES ALL NEW EMPLOYEES' SALARIES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AVAILABLE ON REQUEST. FORM 990, PART IX, LINE 11G MIRTH FEES: PROGRAM SERVICE EXPENSES 275,777. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 275,777. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,606. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,606. FORM 990, PART VII, PAGE 7 ICC PERSONNEL ARE PAID THROUGH LONESTAR CIRCLE OF CARE (THROUGH 2/28/15), EMPLOYER FLEXIBLE AND AUSTIN TRAVIS COUNTY INTEGRAL CARE VIA A CONTRACTUAL ARRANGEMENT BETWEEN THE ENTITIES. ALL SALARIES AND BENEFITS ARE PAID BY LONESTAR CIRCLE OF CARE, EMPLOYER FLEXIBLE AND AUSTIN TRAVIS COUNTY INTEGRAL CARE AND ARE THEN INVOICED TO ICC. WHEN ICC PAYS THESE INVOICES, THE EXPENSES ARE CODED TO THE APPROPRIATE ACCOUNTS SUCH AS SALARY EXPENSE AND BENEFIT EXPENSE. ICC DOES NOT ISSUE W-2'S OR A W-3; ALL ARE ISSUED THROUGH LONESTAR CIRCLE OF CARE, EMPLOYER FLEXIBLE AND AUSTIN TRAVIS COUNTY INTEGRAL CARE. HOWEVER, COMPENSATION FOR THE EXECUTIVE DIRECTOR AND EMPLOYEES PAID OVER $100,000 ARE BEING REFLECTED IN COLUMN (E).