2023-09-26T10:47:54-05:00 2022-12-31 390859910 BAKER TILLY US LLP 1500 RXR PLAZA WEST TOWER UNIONDALE NY 11556 990 2022-01-01 133964284 INDEPENDENCE CARE SYSTEM INC INDE 8774272525 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 REGINA ESTELA CEO AND PRESIDENT 8774272525 2023-09-07 1 REGINA ESTELA XXX-XX-XXXX 1 ELLEN M LABITA CPA P00140777 6317527400 X 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z REGINA ESTELA 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 14067563 0 X WWW.ICSNY.ORG X 1999 NY TO IMPROVE THE HEALTH OF, AND SERVICES FOR, PEOPLE REQUIRING CHRONIC OR LONG TERM HOME CARE. 12 11 129 11 0 0 3634293 330448 14691318 13480671 40886 66590 176518 175424 18543015 14053133 0 0 0 0 11949425 11991094 0 0 0 3625116 3392749 15574541 15383843 2968474 -1330710 10653055 14082337 1670654 7199051 8982401 6883286 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 10364167 0 13480671 EFFECTIVE APRIL 1, 2019, INDEPENDENCE CARE SYSTEM (ICS) IS THE FIRST AND ONLY "HEALTH HOME" PROGRAM IN NEW YORK STATE TO PROMOTE THE HEALTH AND INDEPENDENCE FOR INDIVIDUALS WITH SPINAL CORD INJURIES, MULTIPLE SCLEROSIS AND OTHER PHYSICAL DISABILITIES THAT LIMIT THEIR MOBILITY. THE NEW YORK STATE DEPARTMENT OF HEALTH (DOH) DESIGNATED ICS AS A HEALTH HOME FOR INDIVIDUALS WITH PHYSICAL DISABILITIES AND ICS ENTERED INTO A CARE MANAGEMENT AGREEMENT WITH VNS CHOICE. 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. 10364167 1 1 0 1 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 0 0 0 0 0 0 0 0 0 0 1 72 0 129 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 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 6468317215 25 ELM PLACE 5TH FLOOR BROOKLYN NY 11201 JEFFREY M KRAUSS CHAIRPERSON 10.00 0.00 X X 0 0 0 THOMAS K SMALL TREASURER 1.00 0.00 X X 0 0 0 GERRY DICKERSON BOARD MEMBER 1.00 0.00 X 0 0 0 CHRIS DUFF BOARD MEMBER 1.00 0.00 X 0 0 0 CARLA BOUTIN- FOSTER BOARD MEMBER 1.00 0.00 X 0 0 0 DONNA GALENO BOARD MEMBER 1.00 0.00 X 0 0 0 BILL GUERCI BOARD MEMBER 1.00 0.00 X 0 0 0 JOSE HERNANDEZ BOARD MEMBER 1.00 0.00 X 0 0 0 JANINE KNUDSEN BOARD MEMBER 1.00 0.00 X 0 0 0 GREGORY NERSESSIAN BOARD MEMBER 1.00 0.00 X 0 0 0 ADRIA POWELL BOARD MEMBER 1.00 0.00 X 0 0 0 RICK SURPIN BOARD MEMBER 1.00 0.00 X 51000 0 0 REGINA ESTELA CEO/PRESIDENT 35.00 0.00 X 295234 0 23877 KERRI O'NEILL SVP-OPERATIONS & INFORMATION SYSTEMS 35.00 0.00 X 246656 0 22564 RACHAEL STACOM SVP, CLINIC PROG & POPULATION HEALTH 35.00 0.00 X 248101 0 0 HARRY K BONSU SVP, ADMINISTRATIVE & MEMBER SERVICES 35.00 0.00 X 219473 0 0 DONNA LOONIE SVP, COMMUNICATIONS & MARKETING 35.00 0.00 X 201582 0 0 CATHERINE H BARUFALDI VP, HUMAN RESOURCES 35.00 0.00 X 191850 0 25071 HOPE HENRY-SOULES DIRECTOR, NURSING AND HEALTH HOME 35.00 0.00 X 162737 0 0 1616633 0 71512 22 0 1 0 SUPERSUM SOLUTIONS INC 112-20 72ND DRIVE STE A37 FLUSHING NY 11375 IT CONSULTING 249210 MASTER CLEANING 55 WILLOW STREET GARDEN CITY NY 11530 CLEANING SERVICES 114440 3 330448 330448 MEDICAID PAYMENTS 621500 13480671 13480671 13480671 64643 64643 77328 14430 62898 62898 62898 1947 0 1947 1947 1947 HEALTH CARE WORKERS BONUS 900099 112526 112526 112526 14053133 13480671 0 242014 588330 588330 8744950 6989372 1755578 1878769 15658 1863111 779045 526566 252479 12087 9949 2138 59260 48776 10484 30000 24692 5308 733450 645123 88327 12916 12916 292501 240752 51749 259191 213334 45857 1290331 1065437 224894 13767 11331 2436 281393 231608 49785 178166 146697 31469 CLEANING 104258 84961 19297 REPAIRS AND MAINTENANCE 47433 38190 9243 MISCELLANEOUS FEES 32760 28810 3950 VEHICLE OPERATING EXPEN 32095 32095 13141 10816 2325 15383843 10364167 5019676 0 444672 225707 1702512 144351 105570 837489 970945 221201 398115 4777733 3853877 1078621 923856 1609665 1898137 4614544 9560007 10653055 14082337 930004 923757 740650 6275294 1670654 7199051 X 8838901 6688916 143500 194370 8982401 6883286 10653055 14082337 X -1330710 -148170 -352757 -267478 X 0 1 X 1 0 X 166990 419155 214420 3634293 330448 4765306 436717690 9973686 15577334 14691318 13480671 490440699 436884680 10392841 15791754 18325611 13811119 495206005 0 0 0 495206005 152079 38915 113589 141971 446554 152079 38915 113589 141971 446554 31927 102475 113618 112526 360546 437036759 10424768 15933144 18552818 14065616 496013105 0.99840 0.99930 0.00090 0.00050 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2020 AMOUNT: $ 102,475. 2021 AMOUNT: $ 113,618. OXFORD HEALTH INSURANCE REIMBURSEMENT - 2019 AMOUNT: $ 12,053. MUTUAL OF AMERICA REIMBURSEMENT - 2019 AMOUNT: $ 19,874. HEALTH CARE WORKERS BONUS - 2022 AMOUNT: $ 112,526. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 0 0 1 0 1 30000 30000 0 PART II-B, LINE 1: DURING 2022 ICS COLLABORATED WITH THE CIVICS LEAGUE FOR DISABILITIES, A GRASSROOTS, CONSUMER-LED, UNINCORPORATED GROUP, TO ADVOCATE FOR A SPECIALIZED PROGRAM FOR ADULTS WITH PHYSICAL DISABILITIES IN NYS. THIS ACTIVITY INCLUDED VISITS WITH LOCAL MEMBERS OF THE NYS LEGISLATURE AND MEETINGS WITH THE NYS MEDICAID DIRECTOR. ICS ALSO PAID FEES TO GREENBERG TRAURIG, LLP FOR GOVERNMENT REPRESENTATION AT THE NYS LEVEL. 1400574 1036163 364411 3290470 2731025 559445 86689 86689 0 923856 ASSETS, DISCONTINUED OPERATIONS 4169283 SECURITY DEPOSITS 137562 RIGHT OF USE ASSET, OPERATING LEASES 5253162 9560007 LIABILITIES, DISCONTINUED OPERATIONS 219570 OPERATING LEASE LIABILITY 6055724 6275294 X 13919393 -148170 -148170 14067563 -14430 -14430 14053133 15398273 14430 14430 15383843 0 15383843 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -14,430. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 14,430. X X X X 0 0 0 0 0 0 0 0 0 REGINA ESTELA CEO/PRESIDENT 295234 0 0 0 0 0 0 0 23877 0 319111 0 0 0 KERRI O'NEILL SVP-OPERATIONS & INFORMATION SYSTEMS 246656 0 0 0 0 0 0 0 22564 0 269220 0 0 0 RACHAEL STACOM SVP, CLINIC PROG & POPULATION HEALTH 248101 0 0 0 0 0 0 0 0 0 248101 0 0 0 HARRY K BONSU SVP, ADMINISTRATIVE & MEMBER SERVICE 219473 0 0 0 0 0 0 0 0 0 219473 0 0 0 CATHERINE H BARUFALDI VP, HUMAN RESOURCES 191850 0 0 0 0 0 0 0 25071 0 216921 0 0 0 DONNA LOONIE SVP, COMMUNICATIONS & MARKETING 201582 0 0 0 0 0 0 0 0 0 201582 0 0 0 HOPE HENRY-SOULES DIRECTOR, NURSING AND HEALTH HOME 162737 0 0 0 0 0 0 0 0 0 162737 0 0 0 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. PROVIDE COMPLIANCE TRAINING TO THE BOD AND TO HAVE THEM COMPLETE THE COI ATTESTATIONS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE PRESIDENT/CEO AND SVP-OPERATIONS & INFORMATION SYSTEMS ARE BASED ON EMPLOYMENT CONTRACT, WHICH WERE APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION FOR ALL OTHER POSITIONS WERE APPROVED BY THE CEO 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. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES. 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: NET LOSS FROM WIND-DOWN OF DISCONTINUED OPERATIONS -267,478.