2024-10-11T17:57:42-05:00 2023-11-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2022-12-01 743001674 LONE STAR CIRCLE OF CARE LONE 5126860523 205 EAST UNIVERSITY AVENUE 200 GEORGETOWN TX 78626 NICHOLE COOK CHIEF FINANCIAL OFFICER 5126860523 2024-10-11 1 0 MICHAEL LUMSDEN P01262236 4159561500 2024-10-03 2022 2024-10-15 13:58:12Z JON CALVIN 205 EAST UNIVERSITY AVENUE 200 GEORGETOWN TX 78626 105225663 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. 11 11 1008 216 0 0 29399212 36478879 69306938 67709661 2207 762473 83250 39040 98791607 104990053 0 0 0 0 62476761 61694287 0 0 2264208 35278731 34929545 97755492 96623832 1036115 8366221 58374513 82228765 9656049 24814158 48718464 57414607 X LONE STAR CIRCLE OF CARE PROVIDES EXCEPTIONAL & ACCESSIBLE PATIENT CENTERED HEALTHCARE FOR OUR TEXAS NEIGHBORS, FOCUSING ON THE UNDERSERVED. 0 0 68818046 0 57689092 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 121,605 PEDIATRIC PATIENT VISITS, 88,086 FAMILY MEDICINE PATIENT VISITS, 6,349 SENIOR CARE PATIENT VISITS, 39,519 OB/GYN PATIENT VISITS (INCLUDING 2,959 BABY DELIVERIES), 1,635 OPTOMETRY VISITS, 2,822 CONVENIENT CARE VISITS, AND 2,259 MOBILE MAMMOGRAPHY VISITS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION ABOUT THE SERVICES PROVIDED. 7184207 0 6022409 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 55,100 PATIENT VISITS LAST YEAR. 4769455 0 3998160 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 19,706 PATIENT VISITS IN THE PAST YEAR. 80771708 1 1 0 1 0 0 0 0 1 0 1 0 0 1 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 68 0 1 1008 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X NICHOLE COOK 5126860207 205 E UNIVERSITY AVE STE 200 GEORGETOWN TX 78626 STEVE PENA BOARD MEMBER - CHAIR 1.00 X X 0 0 0 AMY MEDRANO BOARD MEMBER - VICE PRESIDENT 1.00 X X 0 0 0 SCOTT ALARCON BOARD MEMBER - TREASURER 1.00 X X 0 0 0 ELIZABETH JOHNSON BOARD MEMBER - SECRETARY 1.00 X X 0 0 0 JOHN GUSTAINIS BOARD MEMBER 1.00 X 0 0 0 JACK HUNNICUTT 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 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 JON CALVIN FACHE CPA CMA CHFP CHIEF EXECUTIVE OFFICER 55.00 X 518583 0 20801 BRANDON TEENIER CPA CFO (THROUGH 10/2023) 55.00 X 305870 0 14610 KATHLEEN V BUTLER MD MBA CMQ CHIEF MED OFFICER / CHIEF QUAL OFFICER 55.00 X 434076 0 16226 TILLERY STOUT JD CHIEF ADMIN OFFICER & GEN COUNSEL 55.00 X 347223 0 17155 MELISSA R VALDEZ MD DIR OF PSYCH AND BEH HEALTH / CCIO 55.00 X 319138 0 17155 LINDSEY TIPPIT MHA MSHCT CHIEF OPERATING OFFICER 55.00 X 288733 0 15470 ADEYOYIN OKUNADE MD FAAFP MED DIRECTOR - FAMILY/ADULT SERVICES 55.00 X 272255 0 20814 RODOLFO SZOKE CHCIO CDHE CSM CSPO CHIEF INFORMATION OFFICER 55.00 X 225370 0 16500 RAJ DIWAN DDS MAGD MBA DIRECTOR OF DENTAL SERVICES 55.00 X 248622 0 13071 ANDREW MAHAFFEY MD VP OF OB/GYN SERVICES 40.00 X 497926 0 19012 SHAYLA MATTHEWS-JACKSON MD MD - OB/GYN 40.00 X 449650 0 19406 RICHARD SHEA MD MD - OB/GYN 40.00 X 346134 0 13604 HELIO ZAPATA MD MD - OB/GYN 40.00 X 315984 0 15772 BETH THAI MD MD - OB/GYN 40.00 X 321114 0 7968 TRACY ANGELOCCI MD FORMER CMIO (THROUGH 6/2022) 55.00 X 134281 0 0 5024959 0 227564 111 1 1 0 CLINICAL PATHOLOGY LABS INC PO BOX 141669 AUSTIN TX 78714 LAB SERVICES 1162641 DAS HEALTH VENTURES LLC 1000 N ASHLEY DR STE 300 TAMPA FL 33602 SOFTWARE / IT SERVICES 858387 ARSENAL ADVERTISING AND PUBLIC RELATIONS 3112 WINDSOR ROAD 327 AUSTIN TX 78703 MARKETING / ADVERTISING SERVICES 538889 PRESS ONE AMP NETWORKS LLC 38-31 CRESCENT ST LONG ISLAND CITY NY 11101 VOICE AND DATA TELECOMMUNICATION SERVICE 402486 CALL 4 HEALTH 2855 S CONGRESS AVE STE AB DELRAY BEACH FL 33445 TRANSLATION SERVICES 319147 22 15950607 20528272 4583339 36478879 PATIENT SERVICE REV 624100 65707990 65707990 PAY FOR PERFORMANCE 624100 2001671 2001671 67709661 851004 851004 39040 0 39040 39040 39040 147079 210082 25528 -63003 -25528 -88531 -88531 104990053 67709661 0 801513 3111671 1341357 1770314 48873384 42254467 5696765 922152 636729 545544 80825 10360 5455653 4548512 823466 83675 3616850 2989618 572764 54468 35874 35874 200652 200652 5633283 4516903 809741 306639 818379 484135 242436 91808 2092298 1237758 619821 234719 2621509 1550828 776594 294087 6699480 5876963 721882 100635 223248 132069 66135 25044 122886 72696 36404 13786 42144 20102 19638 2404 3046376 2645530 387509 13337 516156 82419 433737 MED./PHARMACY SUPPLIES 10141452 10141452 DISPENSING/ADMIN FEES 1342045 1342045 CLAIMS EXPENSE 403753 403753 DUES & SUBSCRIPTIONS 258840 153124 76679 29037 731170 432433 216680 82057 96623832 80771708 13587916 2264208 624440 1212502 19298115 16457725 2196802 12384963 7561587 7602547 2345965 2489092 955166 1532794 42946086 21283674 20336397 21662412 4662235 5013381 393806 13873349 58374513 82228765 7092585 8063123 163849 0 1429218 2451391 970397 14299644 9656049 24814158 X 46271042 43274714 2447422 14139893 48718464 57414607 58374513 82228765 8366221 329922 0 X 0 1 X 1 1 1 X 21158710 28059515 30329782 29399212 36478879 145426098 21158710 28059515 30329782 29399212 36478879 145426098 38148446 107277652 183034 93228 83441 168407 890044 1418154 620530 49805 670335 147514587 336410279 0.72720 0.76220 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: GAIN ON SETTLEMENT - 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 620,530. 2020 AMOUNT: $ 0. 2021 AMOUNT: $ 49,805. 2022 AMOUNT: $ 0. 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 4116990 4116990 9481895 3817201 5664694 8888236 6465572 2422664 14017588 10553739 3463849 6441377 447162 5994215 21662412 ASSETS LIMITED AS TO USE - DEFERRED COMP PLAN ASSETS 373146 OPERATING LEASE RIGHT-OF-USE ASSETS 12811692 FINANCE LEASE RIGHT-OF-USE ASSETS 688511 13873349 DEFERRED COMPENSATION LIABILITY 373146 OPERATING LEASE LIABILITIES 13245800 FINANCE LEASE LIABILITIES 680698 14299644 105853998 329922 534023 863945 104990053 0 104990053 97157855 534023 534023 96623832 0 96623832 PART IV, LINE 2B: THE ORGANIZATION SERVED AS A CUSTODIAN FOR FUNDS RECEIVED FROM ST. DAVID'S FOUNDATION, WHICH WERE USED TO PAY SPECIALISTS TO WHOM LSCC AND TWO ADDITIONAL FEDERALLY QUALIFIED HEALTH CENTERS REFERRED PATIENTS. AS OF 11/30/2023, ALL OF THESE FUNDS WERE PAID-OUT, REFLECTING $0 ON FORM 990, PART X, LINE 21. X X X 0 0 0 0 0 0 0 1 0 JON CALVIN FACHE CPA CMA CHFP CHIEF EXECUTIVE OFFICER 456333 0 62250 0 0 0 6100 0 14701 0 539384 0 0 0 ANDREW MAHAFFEY MD VP OF OB/GYN SERVICES 454921 0 43005 0 0 0 6100 0 12912 0 516938 0 0 0 SHAYLA MATTHEWS-JACKSON MD MD - OB/GYN 393385 0 56265 0 0 0 6100 0 13306 0 469056 0 0 0 KATHLEEN V BUTLER MD MBA CMQ CHIEF MED OFFICER / CHIEF QUAL OFFIC 403694 0 30382 0 0 0 6100 0 10126 0 450302 0 0 0 TILLERY STOUT JD CHIEF ADMIN OFFICER & GEN COUNSEL 314948 0 32275 0 0 0 6100 0 11055 0 364378 0 0 0 RICHARD SHEA MD MD - OB/GYN 328115 0 18019 0 0 0 0 0 13604 0 359738 0 0 0 MELISSA R VALDEZ MD DIR OF PSYCH AND BEH HEALTH / CCIO 301810 0 17328 0 0 0 6100 0 11055 0 336293 0 0 0 HELIO ZAPATA MD MD - OB/GYN 313721 0 2263 0 0 0 6100 0 9672 0 331756 0 0 0 BETH THAI MD MD - OB/GYN 300743 0 20371 0 0 0 6010 0 1958 0 329082 0 0 0 BRANDON TEENIER CPA CFO (THROUGH 10/2023) 279508 0 26362 0 0 0 5689 0 8921 0 320480 0 0 0 LINDSEY TIPPIT MHA MSHCT CHIEF OPERATING OFFICER 266013 0 22720 0 0 0 5770 0 9700 0 304203 0 0 0 ADEYOYIN OKUNADE MD FAAFP MED DIRECTOR - FAMILY/ADULT SERVICES 266009 0 6246 0 0 0 6100 0 14714 0 293069 0 0 0 RAJ DIWAN DDS MAGD MBA DIRECTOR OF DENTAL SERVICES 238126 0 10496 0 0 0 4770 0 8301 0 261693 0 0 0 RODOLFO SZOKE CHCIO CDHE CSM CSPO CHIEF INFORMATION OFFICER 208150 0 17220 0 0 0 4452 0 12048 0 241870 0 0 0 TRACY ANGELOCCI MD FORMER CMIO (THROUGH 6/2022) 134281 0 0 0 0 0 0 0 0 0 134281 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 61867 4583339 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS CONTRIBUTED 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 11/30/2023 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 23 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 334,822 VISITS DURING THE 11/30/2023 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 334,822 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 121,605 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 88,086 PATIENT VISITS. 3) WOMEN'S HEALTH: OBSTETRICS AND GYNECOLOGY, INCLUDING THOROUGH PRENATAL CARE, LABOR AND DELIVERY, AND POSTPARTUM CARE. OB/GYN PROVIDERS PROVIDED 39,519 PATIENT VISITS, INCLUDING DELIVERING 2,959 BABIES THIS YEAR. 4) INTEGRATED BEHAVIORAL HEALTH: PSYCHIATRY, PSYCHOTHERAPY, AND COUNSELING FOR ADULTS, SENIORS, ADOLESCENTS, AND CHILDREN. IN THE PAST YEAR, LSCC PROVIDED 55,100 BEHAVIORAL HEALTH VISITS. 5) SENIOR: MEDICAL SERVICES TAILORED FOR OLDER ADULTS. LSCC PROVIDED 6,349 SENIOR VISITS OVER THE PAST YEAR. 6) CONVENIENT CARE: LSCC PROVIDED 2,822 CONVENIENT CARE VISITS IN THE YEAR. 7) DENTAL: LSCC'S DENTAL CLINIC PROVIDED 19,706 VISITS IN THE YEAR. 8) VISION: LSCC'S VISION CLINIC PROVIDED 1,635 VISITS IN THE YEAR. 9) MOBILE MAMMOGRAPHY VISITS: LSCC PROVIDED 2,259 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.