2023-10-11T13:49:47-05:00 2022-11-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2021-12-01 743001674 LONE STAR CIRCLE OF CARE LONE 5126860523 205 EAST UNIVERSITY AVENUE 200 GEORGETOWN TX 78626 BRANDON TEENIER CHIEF FINANCIAL OFFICER 5126860523 2023-10-11 1 BRANDON TEENIER 999009999 MICHAEL LUMSDEN P01262236 4159561500 2023-10-02 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JON CALVIN 205 EAST UNIVERSITY AVENUE 200 GEORGETOWN TX 78626 99821928 0 X HTTPS://LONESTARCARES.ORG/ X 2001 TX LONE STAR CIRCLE OF CARE PROVIDES EXCEPTIONAL & ACCESSIBLE PATIENT CENTERED HEALTHCARE FOR OUR TEXAS NEIGHBORS, FOCUSING ON THE UNDERSERVED. 13 13 983 207 0 0 30329782 29399212 68676125 69306938 83473 2207 0 83250 99089380 98791607 0 0 0 0 60910168 62476761 0 0 1993241 34312459 35278731 95222627 97755492 3866753 1036115 60350899 58374513 12422305 9656049 47928594 48718464 X LONE STAR CIRCLE OF CARE PROVIDES EXCEPTIONAL & ACCESSIBLE PATIENT CENTERED HEALTHCARE FOR OUR TEXAS NEIGHBORS, FOCUSING ON THE UNDERSERVED. 0 0 71309029 0 58461958 MEDICAL PROGRAMS: LONE STAR CIRCLE OF CARE (LSCC) HAS MULTIPLE MEDICAL SERVICE LINES THAT PROVIDE PRIMARY & ACUTE MEDICAL CARE INCLUDING PREVENTION, DIAGNOSIS, AND TREATMENT OF CHRONIC CONDITIONS. IN THE PAST YEAR, LSCC PROVIDED 126,538 PEDIATRIC PATIENT VISITS, 84,316 FAMILY MEDICINE PATIENT VISITS, 9,358 SENIOR CARE PATIENT VISITS, 44,468 OB/GYN PATIENT VISITS (INCLUDING 2,174 BABY DELIVERIES), 1,485 OPTOMETRY VISITS, 2,551 CONVENIENT CARE VISITS, 1,710 MOBILE MAMMOGRAPHY VISITS, AND FILLED 170,585 PRESCRIPTIONS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION ABOUT THE SERVICES PROVIDED. 8146991 0 6679225 INTEGRATED BEHAVIORAL HEALTH: LSCC'S INTEGRATED BEHAVIORAL HEALTH MODEL ADDRESSES THE COMPLETE PRIMARY MEDICAL AND MENTAL HEALTH NEEDS OF ADULT, ADOLESCENT, SENIOR, AND PEDIATRIC PATIENTS. BY PROVIDING CONTINUOUS ACCESS TO TREATMENT AND MEDICATIONS, LSCC IS HELPING TO REDUCE EMERGENCY ROOM VISITS AND CRISES RELATED TO UNTREATED MENTAL HEALTH ISSUES. SERVICES PROVIDED INCLUDE PSYCHIATRY, PSYCHOTHERAPY, AND COUNSELING FOR SENIORS, ADULTS, ADOLESCENTS, AND CHILDREN. THE BEHAVIORAL HEALTH CLINICS PROVIDED 64,852 PATIENT VISITS LAST YEAR. 5081183 0 4165755 DENTAL CARE: LSCC PROVIDES GENERAL DENTISTRY SERVICES FOR ADULTS AND CHILDREN IN THE CENTRAL TEXAS COMMUNITY. LSCC'S GCC DENTAL CENTER IN GEORGETOWN AND DENTAL CLINICS IN ROUND ROCK, MARBLE FALLS, BASTROP, AND AUSTIN ARE DEDICATED TO PROVIDING AFFORDABLE, ACCESSIBLE CARE TO THE UNINSURED AND UNDER-SERVED. LSCC PROVIDED 20,387 PATIENT VISITS IN THE PAST YEAR. 84537203 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 47 0 1 983 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BRANDON TEENIER 5126860523 205 E UNIVERSITY AVE STE 200 GEORGETOWN TX 78626 JACK HUNNICUTT BOARD MEMBER - CHAIR 1.00 X X 0 0 0 CINDY BRIEN BOARD MEMBER - VICE PRESIDENT & SECRETARY 1.00 X X 0 0 0 AMY MEDRANO BOARD MEMBER - VICE PRESIDENT 1.00 X X 0 0 0 STEVE PENA BOARD MEMBER - TREASURER 1.00 X X 0 0 0 SCOTT ALARCON BOARD MEMBER 1.00 X 0 0 0 JOHN GUSTAINIS BOARD MEMBER 1.00 X 0 0 0 ELIZABETH JOHNSON BOARD MEMBER 1.00 X 0 0 0 ALTON MCCALLUM BOARD MEMBER 1.00 X 0 0 0 RUDY METAYER BOARD MEMBER 1.00 X 0 0 0 DR QUIANTA MOORE BOARD MEMBER 1.00 X 0 0 0 SOFIA NELSON BOARD MEMBER 1.00 X 0 0 0 MARK SCHROEDER BOARD MEMBER 1.00 X 0 0 0 ROLAND VALLE BOARD MEMBER 1.00 X 0 0 0 JONATHAN CALVIN FACHE CPA CMA CHIEF EXECUTIVE OFFICER 55.00 X 372619 0 28766 BRANDON TEENIER CPA CHIEF FINANCIAL OFFICER 55.00 X 280735 0 22089 KATHLEEN V BUTLER MD MBA CMQ CMO / CHIEF QUALITY OFFICER 55.00 X 438930 0 24590 TILLERY STOUT JD CHIEF ADMIN OFFICER/GENERAL COUNSEL 55.00 X 341855 0 25364 MELISSA R VALDEZ MD DIR OF PSYCH & BEHAV HEALTH / CCIO 55.00 X 325657 0 25364 LINDSEY M TIPPIT MHA CHIEF OPERATING OFFICER 55.00 X 293500 0 23492 TRACY ANGELOCCI MD CHIEF MEDICAL INFORMATION OFFICER 55.00 X 282852 0 26893 ADEYOYIN OKUNADE MD FAAFP FAMILY PRACTICE MEDICAL DIRECTOR 55.00 X 273954 0 28778 ANDREW MAHAFFEY MD VP OF OB/GYN SERVICES 40.00 X 481410 0 27862 KRYSTEL BABARAN MD OB/GYN DOCTOR THROUGH 12/2021 40.00 X 442580 0 22962 SHAYLA MATTHEWS - JACKSON MD OB/GYN DOCTOR 40.00 X 436101 0 20148 HELIO ZAPATA MD OB/GYN DOCTOR 40.00 X 432649 0 19574 RICHARD SHEA MD OB/GYN DOCTOR 40.00 X 321275 0 13362 4724117 0 309244 116 0 1 0 CLINICAL PATHOLOGY LABS INC PO BOX 141669 AUSTIN TX 78714 LAB SERVICES 1224077 ITENTIVE HEALTHCARE SOLUTIONS 1 PIERCE PLACE STE 400E ITASCA IL 60143 SOFTWARE/IT SERVICES 1196084 OTECH GROUP PO BOX 73544 DALLAS TX 753735444 IT SERVICES 811274 PRESS ONE AMP NETWORKS LLC 38-31 CRESCENT ST LONG ISLAND CITY NY 11101 VOICE AND DATA TELECOMMUNICATION SERVICE 430233 ARSENAL ADVERTISING AND PUBLIC RELATIONS 3112 WINDSOR ROAD 327 AUSTIN TX 78703 MARKETING/ADVERTISING SERVICES 367770 22 21718079 7681133 4853698 29399212 PATIENT SERVICE REV 624100 67459555 67459555 PAY FOR PERFORMANCE 624100 1847383 1847383 69306938 134962 134962 33445 0 33445 33445 33445 897566 1004794 25527 -107228 -25527 -132755 -132755 GAIN ON SETTLEMENT 900099 49805 49805 49805 98791607 69306938 0 85457 2963457 1182972 1482934 297551 49303691 44408674 4268980 626037 574726 513643 56794 4289 5959107 5158754 726888 73465 3675780 3155357 470500 49923 63983 63983 137301 137301 6225938 5135698 961626 128614 727334 490806 166066 70462 1869934 1261835 426946 181153 2792141 1884142 637505 270494 6290641 5581734 638645 70262 399870 269833 91299 38738 97536 65817 22270 9449 33019 11557 17795 3667 3325219 2993349 314898 16972 452673 70678 381995 MED./PHARMACY SUPPLIES 10788166 10788166 CLAIMS EXPENSE 484277 484277 DUES & SUBSCRIPTIONS 377144 254497 86110 36537 RECRUITING 350335 236407 79989 33939 863220 589007 192524 81689 97755492 84537203 11225048 1993241 467327 624440 24223642 19298115 5292466 2196802 5757642 7561587 2709070 2345965 739067 955166 39583605 19247208 15278342 20336397 4977996 4662235 905347 393806 60350899 58374513 9312354 7092585 315325 163849 1542089 1429218 1252537 970397 12422305 9656049 X 43342375 46271042 4586219 2447422 47928594 48718464 60350899 58374513 1036115 -246245 0 X 0 1 X 1 1 1 X 19979953 21158710 28059515 30329782 29399212 128927172 19979953 21158710 28059515 30329782 29399212 128927172 29704097 99223075 59664 183034 93228 83441 168407 587774 620530 49805 670335 130185281 328058462 0.76220 0.72900 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: GAIN ON SETTLEMENT - 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 620,530. 2020 AMOUNT: $ 0. 2021 AMOUNT: $ 49,805. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) AND THE TEXAS ASSOCIATION OF COMMUNITY HEALTH CENTERS (TACHC). A PORTION OF THESE DUES MAY BE USED FOR LOBBYING PURPOSES. 0 1 X 4141990 4141990 9481895 3149467 6332428 8025090 5631562 2393528 15066592 10117189 4949403 2868038 348990 2519048 20336397 DEFERRED RENT LIABILITY 576591 DEFERRED COMPENSATION LIABILITY 393806 970397 99033768 -246245 488406 242161 98791607 0 98791607 98243898 488406 488406 97755492 0 97755492 PART IV, LINE 2B: THE ORGANIZATION SERVES AS A CUSTODIAN FOR FUNDS RECEIVED FROM ST. DAVID'S FOUNDATION, WHICH WILL BE USED TO PAY SPECIALISTS TO WHOM LSCC AND TWO ADDITIONAL FEDERALLY QUALIFIED HEALTH CENTERS REFER PATIENTS. X X X 0 0 0 0 0 0 0 1 0 ANDREW MAHAFFEY MD VP OF OB/GYN SERVICES 457667 0 20971 0 2772 0 14500 0 13362 0 509272 0 0 0 KRYSTEL BABARAN MD OB/GYN DOCTOR THROUGH 12/2021 368250 0 73994 0 336 0 14500 0 8462 0 465542 0 0 0 KATHLEEN V BUTLER MD MBA CMQ CMO / CHIEF QUALITY OFFICER 415004 0 22120 0 1806 0 14500 0 10090 0 463520 0 0 0 SHAYLA MATTHEWS - JACKSON MD OB/GYN DOCTOR 354873 0 80850 0 378 0 7385 0 12763 0 456249 0 0 0 HELIO ZAPATA MD OB/GYN DOCTOR 377276 0 55037 0 336 0 11353 0 8221 0 452223 0 0 0 JONATHAN CALVIN FACHE CPA CMA CHIEF EXECUTIVE OFFICER 372241 0 0 0 378 0 14500 0 14266 0 401385 0 0 0 TILLERY STOUT JD CHIEF ADMIN OFFICER/GENERAL COUNSEL 318350 0 22875 0 630 0 14500 0 10864 0 367219 0 0 0 MELISSA R VALDEZ MD DIR OF PSYCH & BEHAV HEALTH / CCIO 312001 0 12690 0 966 0 14500 0 10864 0 351021 0 0 0 RICHARD SHEA MD OB/GYN DOCTOR 306909 0 12560 0 1806 0 0 0 13362 0 334637 0 0 0 LINDSEY M TIPPIT MHA CHIEF OPERATING OFFICER 276524 0 16640 0 336 0 13846 0 9646 0 316992 0 0 0 TRACY ANGELOCCI MD CHIEF MEDICAL INFORMATION OFFICER 268582 0 11948 0 2322 0 14111 0 12782 0 309745 0 0 0 BRANDON TEENIER CPA CHIEF FINANCIAL OFFICER 262757 0 17600 0 378 0 13390 0 8699 0 302824 0 0 0 ADEYOYIN OKUNADE MD FAAFP FAMILY PRACTICE MEDICAL DIRECTOR 272988 0 0 0 966 0 14500 0 14278 0 302732 0 0 0 PART I, LINE 7 THE ORGANIZATION PROVIDED BONUS PAYMENTS TO CERTAIN INDIVIDUALS LISTED IN FORM 990, PART VII AND SCHEDULE J WHICH WERE DISCRETIONARY, AND THUS WOULD BE CONSIDERED "NON-FIXED PAYMENTS". X 70145 4853698 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF VACCINES DONATED IN SCHEDULE M, PART I, COLUMN (B). FORM 990, PART III, LINE 1: ORGANIZATION'S MISSION: LONE STAR CIRCLE OF CARE PROVIDES EXCEPTIONAL AND ACCESSIBLE PATIENT CENTERED HEALTHCARE FOR OUR TEXAS NEIGHBORS. VISION STATEMENT: WE WILL ELIMINATE HEALTH INEQUITIES TO FACILITATE WELLNESS AND OPTIMAL LIVING FOR ALL, HELPING STRENGTHEN OUR COMMUNITIES. CORE VALUES: COMPASSION, INTEGRITY, RESPECT, SERVICE, INNOVATION, EXCELLENCE LONE STATE CIRCLE OF CARE (LSCC) IS A 501(C)(3) NONPROFIT, FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER (FQHC) NETWORK THAT PROVIDES A PATIENT-CENTERED HEALTH CARE HOME TO UNINSURED AND UNDERINSURED RESIDENTS OF CENTRAL TEXAS. DURING THE 11/30/2022 FISCAL YEAR, LSCC OPERATED CLINICS THROUGHOUT WILLIAMSON, TRAVIS, BELL, BASTROP, BURNET, AND HARRIS COUNTIES. SERVICES INCLUDE: PRIMARY MEDICAL CARE THAT IS FOCUSED BY AGE GROUP (PEDIATRICS, ADOLESCENTS, ADULTS, AND SENIORS); COMPREHENSIVE OB/GYN SERVICES; GENERAL DENTISTRY; OPTOMETRY; PHARMACY SERVICES; AND ENABLING SERVICES SUCH AS INTERPRETERS AND INSURANCE ELIGIBILITY SCREENERS. A ROBUST AND FULLY INTEGRATED BEHAVIORAL HEALTH PROGRAM, WITH APPROXIMATELY 26 CLINICIANS ON STAFF, PROVIDES NECESSARY PSYCHIATRIC AND PSYCHOTHERAPY SERVICES TO PATIENTS WHO WOULD OTHERWISE NOT HAVE ACCESS TO CARE. LSCC ACCEPTS MEDICAID, CHILDREN'S HEALTH INSURANCE PROGRAM, MEDICARE AND OTHER PUBLICLY INSURED PATIENTS, AND UNINSURED PATIENTS PAY A SLIDING SCALE FEE BASED ON THEIR INCOME AND HOUSEHOLD SIZE. LSCC IS ACCREDITED BY THE JOINT COMMISSION (TJC) UNDER AMBULATORY CARE AND BEHAVIORAL HEALTH CARE STANDARDS. LSCC ALSO HOLDS PRIMARY CARE MEDICAL HOME (PCMH) CERTIFICATION FROM TJC. SINCE RECEIVING FQHC STATUS IN 2004, LSCC HAS FORGED NUMEROUS STRATEGIC PARTNERSHIPS, LEVERAGING FQHC BENEFITS WITH INVESTMENTS FROM OTHER STAKEHOLDERS, INCLUDING FOUNDATIONS, GOVERNMENT, AND HOSPITAL SYSTEMS. WITH THE SUPPORT OF THESE MANY PARTNERS, CAPACITY HAS GROWN FROM 10,000 VISITS IN 2002 TO 353,955 VISITS DURING THE 11/30/2022 FISCAL YEAR. LSCC WILL CONTINUE IDENTIFYING OPPORTUNITIES TO COLLABORATE AND LEVERAGE ITS RESOURCES TO PROVIDE SUSTAINABLE, QUALITY PRIMARY HEALTH CARE FOR THE REGION. FORM 990, PART III, LINE 4A MEDICAL PROGRAMS: LONE STAR CIRCLE OF CARE (LSCC) HAS MULTIPLE MEDICAL SERVICE LINES THAT PROVIDE PRIMARY AND ACUTE MEDICAL CARE INCLUDING PREVENTION, DIAGNOSIS AND TREATMENT OF CHRONIC CONDITIONS. IN THE PAST YEAR, LSCC PROVIDED 353,955 PATIENT VISITS ACROSS ALL SERVICE LINES. LSCC SERVICE LINES INCLUDE: 1) PEDIATRIC: PRIMARY AND ACUTE MEDICAL CARE FOR CHILDREN AND ADOLESCENTS. IN THE PAST YEAR, LSCC PROVIDED 126,538 VISITS. 2) FAMILY MEDICINE AND SENIOR CARE: LSCC PROVIDES A PRIMARY CARE HOME FOR A LARGE, UNINSURED ADULT POPULATION. PATIENTS HAVE ACCESS TO ROUTINE AND ACUTE CARE AS WELL AS CHRONIC DISEASE PREVENTION, TREATMENT AND MANAGEMENT. IN THE PAST YEAR, LSCC PROVIDED 84,316 PATIENT VISITS. 3) WOMEN'S HEALTH: OBSTETRICS AND GYNECOLOGY, INCLUDING THOROUGH PRENATAL CARE, LABOR AND DELIVERY, AND POSTPARTUM CARE. OB/GYN PROVIDERS PROVIDED 44,468 PATIENT VISITS, INCLUDING DELIVERING 2,174 BABIES THIS YEAR. 4) INTEGRATED BEHAVIORAL HEALTH: PSYCHIATRY, PSYCHOTHERAPY, AND COUNSELING FOR ADULTS, SENIORS, ADOLESCENTS, AND CHILDREN. IN THE PAST YEAR, LSCC PROVIDED 64,852 BEHAVIORAL HEALTH VISITS. 5) SENIOR: MEDICAL SERVICES TAILORED FOR OLDER ADULTS. LSCC PROVIDED 9,358 SENIOR VISITS OVER THE PAST YEAR. 6) CONVENIENT CARE: LSCC PROVIDED 2,551 CONVENIENT CARE VISITS IN THE YEAR. 7) DENTAL: LSCC'S DENTAL CLINIC PROVIDED 20,387 VISITS IN THE YEAR. 8) VISION: LSCC'S VISION CLINIC PROVIDED 1,485 VISITS IN THE YEAR. 9) HEALTH EDUCATION CLASSES: LSCC TEAMED UP WITH VARIOUS LOCAL PARTNERS TO PROVIDE FREE HEALTH EDUCATION CLASSES TO OUR PATIENTS AND THE LOCAL COMMUNITY. THESE CLASSES ARE A VALUABLE RESOURCE TO INDIVIDUALS AND FAMILIES WHO ARE: (I) LEARNING TO MANAGE DIABETES OR ASTHMA; (II) EXPECTING THEIR FIRST CHILD; (III) LEARNING ABOUT BEING ACTIVE AND EATING HEALTHY; AND (IV) TEACHING THEIR CHILDREN TO BE HEALTHY. 10) MOBILE MAMMOGRAPHY VISITS: LSCC PROVIDED 1,710 MOBILE MAMMOGRAPHY VISITS IN THE YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. UPON RECEIPT OF THE FORM 990 FROM THE INDEPENDENT ACCOUNTANT, AND PRIOR TO SUBMISSION TO THE IRS, THE CFO REVIEWS THE RETURN FOR REASONABLENESS COMPARED TO THE FINAL AUDITED FINANCIAL STATEMENTS. THE FORM IS THEN DISTRIBUTED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND FEEDBACK BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS OR EXECUTIVE COMMITTEE SHALL COMPLETE AND SIGN A CONFLICT OF INTEREST CERTIFICATE ANNUALLY, AT THE START OF THE MEMBER'S TERM, OR AT THE START OF THE CORPORATION'S FISCAL YEAR, WHICHEVER COMES FIRST. SHOULD A CONFLICT ARISE, THE BOARD MEMBER WILL ABSTAIN FROM PARTICIPATING IN VOTING RELATED TO THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO COMPENSATION REVIEW WAS CONDUCTED BY THE EXECUTIVE COMMITTEE OF THE BOARD USING THIRD PARTY COMPENSATION RESOURCES FOR COMPARISON AND REASONABLENESS. A FORMAL EVALUATION OF THE CEO BY THE BOARD OF DIRECTORS WAS LAST COMPLETED ON NOVEMBER 10, 2022. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WAS REVIEWED AND APPROVED BY THE CEO, WHO TAKES INTO ACCOUNT INDUSTRY COMPENSATION DATA, ALONG WITH THE SIZE AND COMPLEXITY OF THE COMPARABLE ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE MADE AVAILABLE UPON REQUEST. IN ADDITION, THE FORM 990 IS PUBLIC INFORMATION.