2023-06-15T07:42:56-05:00 2022-07-31 440160260 FORVIS LLP 999 S SHADY GROVE RD STE 400 MEMPHIS TN 38120 990 2021-08-01 620924699 QSOURCE QSOU 9016820381 8245 TOURNAMENT DRIVE 201 MEMPHIS TN 38125 JASON NESIUS VP OF FINANCE 9016820381 2023-06-14 1 JASON NESIUS 999009999 LAKRISHA J CASTLEBERRY P01677333 9017613000 2023-06-14 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MARY-LYN BALDAUF 8245 TOURNAMENT DRIVE 201 MEMPHIS TN 38125 21159582 0 X WWW.QSOURCE.ORG X 1973 TN SEE SCHEDULE O AT QSOURCE, OUR MISSION IS TO SERVE HEALTHCARE COMMUNITIES BY DRIVING VALUE, IMPROVING QUALITY AND PROVIDING INNOVATIVE BUSINESS SOLUTIONS. 12 12 93 90 0 0 8252395 8230367 1412278 3418760 2464125 909448 0 0 12128798 12558575 0 0 0 0 8832692 9331222 0 0 0 2106613 3436028 10939305 12767250 1189493 -208675 31766060 28235810 1278160 1423769 30487900 26812041 AT QSOURCE, OUR MISSION IS TO IMPROVE HEALTHCARE THROUGH PATIENT-CENTERED, PROVIDER-FOCUSED SOLUTIONS. 0 0 1425845 QSOURCE WORKS WITH HEALTHCARE COMMUNITIES IN THE STATE OF INDIANA TO IMPROVE THE QUALITY OF HEALTHCARE BY ASSISTING PROVIDERS IN MEASURING AND REPORTING QUALITY, PRODUCING AND USING ELECTRONIC CLINICAL IMFORMATION, REDESISGNING CARE PROCESSES, AND TRANSFORMING ORGANIZATIONAL CULTURE TO ACCELERATE QUALITY IMPROVEMENT AND BROADEN ITS IMPACT. TO SUPPLEMENT INDIVIDUAL TECHNICAL ASSISTANCE, WE CONVENE PROVIDERS, PRACTITIONERS AND PATIENTS TO BUILD AND SHARE KNOWLEDGE, SPREAD BEST PRACTICES, AND ACHIEVE RAPID, WIDE-SCALE IMPROVEMENTS IN PATIENT CARE. 2962130 QSOURCE PROVIDES THE STATE OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION WITH AN INDEPENDENT, EXTERNAL REVIEW OF THE QUALITY OF SERVICES AVAILABLE TO TENNCARE ENROLLEES. 1349268 QSOURCE OVERSEES AND IMPROVES THE QUALITY OF CARE DELIVERED TO END-STAGE RENAL DISEASE PATIENTS THROUGH THE DEVELOPMENT AND EXECUTION OF QUALITY IMPROVEMENT PROGRAMS & INTERVENTIONS, THE COLLECTION AND ANALYSIS OF OUTCOMES DATA, AND THE PROVISION OF TECHNICAL ASSISTANCE TO PATIENTS AND PROVIDERS OF DIALYSIS AND KIDNEY TRANSPLANTATION, INCLUDING THE PROCESSING OF COMPLAINTS AND GRIEVANCES. 2270237 3418760 2270237 3418760 8007480 1 1 0 1 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 43 0 1 93 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 TN X JASON NESIUS 9016820381 8245 TOURNAMENT DRIVE 201 MEMPHIS TN 38125 JOHN CHUCK CZARNIK JR IMMEDIATE PAST CHAIR 1.00 X X 7875 0 0 TERRI SABELLA CHAIRMAN 1.00 X X 5750 0 0 LISA TATE NIX TREASURER 1.00 X X 0 0 0 WILLIAM B WAGNER SECRETARY 1.00 X X 5375 0 0 JOANN M BURKE CHAIR ELECT 1.00 X X 4750 0 0 SUSAN R COOPER DIRECTOR 0.50 X 1250 0 0 TERESA L COUTS DIRECTOR 0.50 X 5125 0 0 ERICA L GETTIS DIRECTOR 0.50 X 1250 0 0 MITCH GRAVES DIRECTOR 0.50 X 1250 0 0 CLAUDE PIRTLE DIRECTOR 0.50 X 1250 0 0 PAUL KECKLEY DIRECTOR 0.50 X 5250 0 0 SUSAN SWINFORD DIRECTOR 0.50 X 1250 0 0 CALVIN ROBERSON DIRECTOR 0.50 X 5125 0 0 BRIAN TABOR DIRECTOR 0.50 X 0 0 0 SCOTT SOLCHER MD DIRECTOR 0.50 X 5750 0 0 DAWN FITZGERALD CEO THROUGH 2/28/2022 40.00 X 493585 0 32029 CRAIG T HOFER CFO THROUGH 7/2/2021 40.00 X 201286 0 18402 NANCY ARCHER CHIEF OPERATING OFFICER 40.00 X 184245 0 22252 BENJAMIN HEAVRIN CHIEF MEDICAL OFFICER 40.00 X 249824 0 21988 JASON NESIUS CONTROLLER 40.00 X 167522 0 27742 SHANE PERRY QI ANALYTIC MANAGER 40.00 X 155272 0 9438 JOHN COUZINS EQRO DIRECTOR 40.00 X 142941 0 15871 MITIZ DAFFRON STATE DIRECTOR 40.00 X 140827 0 11973 ANN LEWIS VP BUSINESS DEVELOPMENT 40.00 X 137910 0 8836 1924662 0 168531 9 0 1 0 MYERS AND STAUFFER LC(ACH) 2 MARYLAND FARMS BRENTWOOD TN 37027 ACCOUNTING SERVICES 356819 HEALTH SERVICES ADVISORY GROUP 3133 EAST CAMELBACK ROAD SUITE 300 PHOENIX AZ 850164501 COVER KIDS/EQRO SUBCONTRACTS 354014 TELLIGEN 1776 WEST LAKES PKWY WEST DES MOINES IA 50266 SUBCONTRACTOR ON MEDICARE/MEDICAID GRANT 198900 QUEST ANALYTICS 4321 W COLLEGE AVE APPLETON WI 54914 SUBCONTRACTOR WITH FHCK TO PROVIDE EXTER 152385 INDIANA HEALTH INFORMATION EXCHANGE INC 846 NSENATE AVE 300 INDIANAPOLIS IN 46202 SUBCONTRACTOR ON MEDICARE/MEDICAID GRANT 117450 5 8230367 8230367 CONTRACTS 624100 3418760 3418760 3418760 457414 457414 9053041 8601007 452034 452034 452034 12558575 3418760 0 909448 1646922 1646922 5421275 4565052 856223 285594 212822 72772 1438338 969684 468654 539093 354932 184161 106356 106356 56805 56805 34000 34000 133285 133285 590185 153872 436313 286628 286628 150219 90663 59556 12060 12060 93870 93870 58935 58935 SUBCONTRACTING & CONSUL 1746262 1646895 99367 ALL OTHER - QCP/QNV NON 165923 165923 PASS THRU COSTS 1500 1500 12767250 8007480 4759770 0 6209679 4735481 470373 477227 722198 1659664 172372 117729 1251919 1026716 271308 225203 23864857 20965233 55273 55273 31766060 28235810 1264326 1423769 13834 0 1278160 1423769 X 30487900 26812041 30487900 26812041 31766060 28235810 -208675 -3467184 0 X X 0 1 X 1 1 1 X 18982024 18880507 12908301 8252395 8230367 67253594 18982024 18880507 12908301 8252395 8230367 67253594 67253594 386918 476902 486239 427106 457414 2234579 69488173 13501375 0.96780 0.97360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 0 1 34000 34000 0 PART II-B, LINE 1I, OTHER ACTIVITIES: THE LAW FIRMS FARRIS BOBANGO BRANAN AND BAKER DONELSON LOBBY STATE AND FEDERAL LEGISLATORS ON BEHALF OF QSOURCE. 107014 60198 46816 837543 732445 105098 307362 234073 73289 225203 X 8958106 -3467184 -3467184 12425290 133285 133285 12558575 12633965 0 12633965 133285 133285 12767250 PART X, LINE 2: THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF JULY 31, 2022 AND 2021, AND THERE ARE NO INTEREST AND PENALTIES RELATED TO INCOME TAX ASSESSMENTS. X X X X X 0 0 0 0 0 0 0 0 0 DAWN FITZGERALD CEO THROUGH 2/28/2022 493585 0 0 0 0 0 19947 0 12082 0 525614 0 0 0 BENJAMIN HEAVRIN CHIEF MEDICAL OFFICER 249824 0 0 0 0 0 5101 0 16887 0 271812 0 0 0 CRAIG T HOFER CFO THROUGH 7/2/2021 201286 0 0 0 0 0 8554 0 9848 0 219688 0 0 0 NANCY ARCHER CHIEF OPERATING OFFICER 184245 0 0 0 0 0 11639 0 10613 0 206497 0 0 0 JASON NESIUS CONTROLLER 167522 0 0 0 0 0 10962 0 16780 0 195264 0 0 0 SHANE PERRY QI ANALYTIC MANAGER 155272 0 0 0 0 0 4089 0 5349 0 164710 0 0 0 JOHN COUZINS EQRO DIRECTOR 142941 0 0 0 0 0 9594 0 6277 0 158812 0 0 0 MITIZ DAFFRON STATE DIRECTOR 140827 0 0 0 0 0 5692 0 6281 0 152800 0 0 0 PART I, LINE 3 QSOURCE ENGAGES A CONSULTING GROUP EVERY 2-3 YEARS TO PERFORM A COMPENSATION STUDY IN ORDER TO BENCHMARK CEO, CFO, AND BOARD OF DIRECTOR COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11B RETURN IS GIVEN TO THE CEO TO REVIEW BEFORE IT IS FILED. IN ADDITION, QSOURCE POSTS A DRAFT OF THE TAX RETURN TO ITS BOARD PORTAL AND EMAILS A LINK TO THE TAX RETURN TO EACH BOARD MEMBER LETTING THEM KNOW WHERE IT IS POSTED AND GIVING THEM A DEADLINE BY WHICH TO SEND ANY COMMENTS OR QUESTIONS. IF NO RESPONSES OR ONLY "NO-CHANGE" RESPONSES ARE RECEIVED BY THAT DEADLINE THEN APPROVAL IS ASSUMED AND THE TAX RETURN IS FILED. IF CHANGES ARE RECOMMENDED THEY WILL BE CONSIDERED IN AN EXECUTIVE COMMITTEE MEETING BEFORE CHANGES ARE MADE AND THE TAX RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF DIRECTORS MEMBERS, CEO, CFO, VPS, DIRECTORS AND KEY EMPLOYEES COMPLETE THE CONFLICT OF INTEREST DISCLOSURE ANNUALLY. THE DISCLOSURES ARE REVIEWED ANNUALLY AND ARE UPDATED BY THE VP, CORPORATE COMPLIANCE AND EXCEPTIONS ARE REPORTED TO CENTERS FOR MEDICARE AND MEDICAID SERVICES. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION IS REVIEWED BY INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. SALARY SURVEY OF COMPARABLE ENTITIES ARE CONSIDERED. DOCUMENTATION REGARDING THE PROCESS IS RETAINED. 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: FINANCIAL STATEMENTS AND REPORTING: THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS THIS YEAR.