2021-11-12T13:48:09-06:00 2020-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2020-01-01 462602391 ICIRCLE SERVICES OF THE FINGER LAKES INC ICIR 8444247253 860 HARD RD WEBSTER NY 14580 SANKAR SEWNAUTH PRESIDENT/CEO 8444247253 2021-11-11 1 SANKAR SEWNAUTH 999009999 THOMAS J GIUFRE P00841958 3154463600 2021-11-11 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z SANKAR SEWNAUTH 860 HARD RD WEBSTER NY 14580 205537203 0 X WWW.ICIRCLECNY.ORG X 2013 NY TO PROVIDE MEMBERS WITH HIGH-QUALITY HEALTH AND SOCIAL SERVICES THAT ARE CULTURALLY-APPROPRIATE, COMMUNITY-INTEGRATED, AND TAILORED TO THEIR INDIVIDUAL NEEDS, ENSURING A POSITIVE IMPACT ON THEIR PERSONAL HEALTH, LIFESTYLE, AND INDEPENDENCE. 14 14 228 14 0 0 145349 1100759 186540970 204396471 0 38625 0 0 186686319 205535855 16250 21070 0 0 14529193 16209478 0 0 0 195573539 186778213 210118982 203008761 -23432663 2527094 30333774 21004329 61514655 49658116 -31180881 -28653787 TO PROVIDE MEMBERS WITH HIGH-QUALITY HEALTH AND SOCIAL SERVICES THAT ARE CULTURALLY-APPROPRIATE, COMMUNITY-INTEGRATED, AND TAILORED TO THEIR INDIVIDUAL NEEDS, ENSURING A POSITIVE IMPACT ON THEIR PERSONAL HEALTH, LIFESTYLE, AND INDEPENDENCE. 0 0 200905835 21070 204396471 MANAGED LONG TERM CARE INSURANCE - 5,944 INDIVIDUALS SERVED IN 2020. 200905835 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 174 0 1 228 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 0 NY X THE ORGANIZATION 8444247253 860 HARD RD WEBSTER NY 14580 GREGORY GRIBBEN BOARD CHAIR 1.00 X X 0 0 0 DARYL TIFFIN BOARD MEMBER 1.00 X 0 0 0 HILDA ROSARIO-ESCHER BOARD MEMBER 1.00 X 0 0 0 EDWARD HAYES BOARD MEMBER 1.00 X 0 0 0 ROBERT RELPH BOARD VICE CHAIR 1.00 X X 0 0 0 RENE SNYDER BOARD MEMBER 1.00 X 0 0 0 RICHARD YARMEL SECRETARY 1.00 X X 0 0 0 JEFF SINSEBOX BOARD MEMBER 1.00 X 0 0 0 SY ZIELINSKI BOARD MEMBER 1.00 X 0 0 0 JENNIFER CARLSON BOARD MEMBER 1.00 X 0 0 0 RICH FERRARI BOARD MEMBER 1.00 X 0 0 0 WARREN HERN TREASURER 1.00 X X 0 0 0 PIERRE GIRGIS BOARD MEMBER 1.00 X 0 0 0 TIM THANEY BOARD MEMBER 1.00 X 0 0 0 SHARON MARBLE COO 40.00 X 251331 0 14352 SANKAR SEWNAUTH PRESIDENT 1.00 40.00 X 0 809759 17265 ADAM SOUTHCOTT CFO 40.00 X 121456 0 557 DR JOEL HAAS CHIEF MEDICAL OFFICER 40.00 X 374476 0 1248 LAURA KRUSPE VP OF CONTRACT & NETWORK MANAGEMENT 40.00 X 129239 0 8216 HUI CAI MEDICAL DIRECTOR 40.00 X 161602 0 14618 RYAN THOMAS DIRECTOR OF PHARMACY 40.00 X 152822 0 6179 ANDREA VALK VP OF GOVERNMENT RELATIONS 40.00 X 113671 0 6852 ALISON CONDON SENIOR DIRECTOR OF CLINICAL OPERATIONS 40.00 X 110471 0 1248 1415068 809759 70535 8 0 1 0 ELITE CHOICE LLC 1967 MCDONALD AVENUE BROOKLYN NY 112231805 PROVIDER OF SERVICES TO MEMBERS 10808740 BURD HOME HEALTH LLC 274 N GOODMAN STREET SUITE A403 ROCHESTER NY 14607 PROVIDER OF SERVICES TO MEMBERS 8233655 FREEDOM CARE LLC 1979 MARCUS AVENUE SUITE C-115 LAKE SUCCESS NY 11042 PROVIDER OF SERVICES TO MEMBERS 7592016 CENTER FOR DISABILITY RIGHTS INC 497 STATE STREET ROCHESTER NY 14608 PROVIDER OF SERVICES TO MEMBERS 6905723 ST ANN'S HOME FOR THE AGED 1500 PORTLAND AVENUE ROCHESTER NY 14621 PROVIDER OF SERVICES TO MEMBERS 6733140 170 1000000 100759 1100759 MEDICAID PREMIUM REVENUE 524114 190707555 190707555 SPENDDOWN AND NAMI 524114 13405196 13405196 MANAGEMENT SERVICES REVENUE 561000 283720 283720 204396471 39973 1348 38625 38625 38625 205535855 204396471 0 38625 21070 21070 763420 740517 22903 12351088 12316530 34558 182778 177295 5483 1951651 1888619 63032 960541 931724 28817 2094632 902938 1191694 68033 68033 36235 36235 508999 39752 469247 490 490 634881 622183 12698 3377296 3377296 234927 232578 2349 108189 106668 1521 766565 766565 157292 156720 572 73409 73409 MEDICAL EXPENSES 177472347 177472347 BAD DEBT EXPENSE 911882 911882 OTHER 232820 163808 69012 EQUIPMENT RENTAL AND MA 43583 43583 56633 33270 23363 203008761 200905835 2102926 0 8933701 4939388 16264925 8170780 33367 76373 850367 608650 346280 241717 4755501 7576071 30333774 21004329 50057361 19660030 11457294 29998086 61514655 49658116 X -31180881 -28653787 -31180881 -28653787 30333774 21004329 2527094 0 X X 0 1 X 1 0 X 1753740 948331 100000 145349 1100759 4048179 44321122 89412457 128898858 186540970 204435096 653608503 46074862 90360788 128998858 186686319 205535855 657656682 0 0 0 657656682 28493 28493 46103355 90360788 128998858 186686319 205535855 657685175 1.00000 0.99990 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 181627 160180 21447 203254 148136 55118 465486 300334 165152 241717 RESTRICTED DEPOSITS 7576071 7576071 UNSECURED NOTE PAYABLE TO RELATED PARTY 8990040 DUE TO RELATED PARTIES, NET 391369 DUE TO NEW YORK STATE 20616677 29998086 X 205535855 0 205535855 0 205535855 203008761 0 203008761 0 203008761 PART X, LINE 2: ICIRCLE IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS OF DECEMBER 31, 2020 AND 2019, ICIRCLE DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES ARE 2017 THROUGH 2020. ICIRCLE DOES NOT ANTICIPATE ANY UNRECOGNIZED TAX BENEFITS TO CHANGE IN THE NEXT TWELVE MONTHS. 0 CDS WOLF FOUNDATION 860 HARD RD WEBSTER NY 14580 3 21070 ASSISTANCE WITH OPERATIONS 1 0 1 0 0 0 0 0 0 0 SANKAR SEWNAUTH PRESIDENT 0 485646 0 246002 0 78111 0 1248 0 16017 0 827024 0 0 DR JOEL HAAS CHIEF MEDICAL OFFICER 287196 0 73485 0 13795 0 1248 0 0 0 375724 0 0 0 SHARON MARBLE COO 190420 0 43684 0 17227 0 1248 0 13104 0 265683 0 0 0 HUI CAI MEDICAL DIRECTOR 161527 0 50 0 25 0 650 0 13968 0 176220 0 0 0 RYAN THOMAS DIRECTOR OF PHARMACY 125534 0 13608 0 13680 0 0 0 6179 0 159001 0 0 0 PART I, LINE 1A: SANKAR SEWNAUTH, PRESIDENT, PARTICIPATES IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN UNDER IRC SECTION 457(F) SPONSORED BY CDS LIFE TRANSITIONS, INC., A RELATED ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE ORGANIZATION'S FINAL FORM 990 WAS PROVIDED IN ELECTRONIC FORM TO EACH VOTING MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS PRIOR TO FILING THE FORM. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS WRITTEN CONFLICT OF INTEREST POLICY BY REQUIRING ALL EMPLOYEES, VOLUNTEERS, CONSULTANTS, AND BOARD MEMBERS UPON JOINING THE ORGANIZATION AND ANNUALLY THEREAFTER TO REVIEW, COMPLETE AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT TO REPORT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. REPORTS OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST ARE REPORTED TO THE DIRECTOR OF QA, THE EXECUTIVE TEAM, OR TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR RESOLUTION, AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15B THE ORGANIZATION USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSUTANT, COMPENSATION SURVEYS, WRITTEN EMPLOYMENT CONTRACTS, AND APPROVAL BY THE BOARD OF DIRECTORS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN THE PROCESS BY WHICH THE ORGANIZATION OVERSEES ITS AUDIT OR THE PROCESS BY WHICH THE ORGANIZATION SELECTS ITS INDEPENDENT ACCOUNTANT. 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