2017-11-15T13:12:44-06:00 2016-12-31 743001153 PMB Helin Donovan LLP 12301 Research Blvd Bldg 5 Ste 160 Austin TX 78759 990 2016-01-01 473641754 C2C Innovative Solutions Inc C2CI 5123341622 5918 W Courtyard Dr Ste 300 Austin TX 78730 Pamela Hoernis Treasurer 5123341622 2017-11-15 1 Kelly Logan P00677048 5122589670 2017-11-15 64.88.174.3 2017-11-15 06:29:14 CS P F51F92EFB232A66CFB20B3FE4CCED7D08AF6D2FD 492A0B02D005BC1433FBCD08222AF8476599CDF2 2016 2017-02-10 21:41:12Z Pamela Hoernis 5918 W Courtyard Dr Ste 300 Austin TX 78730 57631027 0 X www.c2cinc.com X 2015 TX Provide best value administrative services and quality management principles that promote continuous improvement. 5 3 466 0 0 0 0 57629565 11368425 0 0 1462 0 0 11368425 57631027 0 0 0 0 5294825 27186850 0 0 0 4480895 20477842 9775720 47664692 1592705 9966335 18538852 29411707 7592837 6724793 10946015 22686914 Provide best value administrative services and quality management principles that promote continuous improvement. 0 0 47664692 57629565 C2C Innovative Solutions Inc. (C2C) serves as a federal contractor for the Medicare program since the inception of the second-level appeal process in September 2004. As a Qualified Independent Contractor (QIC), C2C adjudicates second-level Medicare appeals called reconsiderations for several jurisdictions with national scope. 47664692 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 0 0 0 1 10 0 466 1 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Pamela L Hoernis 5123341622 5918 W Courtyard Dr Ste 300 Austin TX 787305036 Louis Polise Board of Trustees 1.90 0.00 X 12500 0 0 Donald P Forgione Board of Trustees 1.90 0.00 X 12500 0 0 Gary Crayton Board of Trustees 1.50 0.00 X 10000 0 0 Manley Thomas Chairman 43.80 0.00 X 0 700084 53899 Hoernis Pamela Treasurer 45.40 0.00 X 0 358283 36783 Peterson Jeffrey N President 46.10 0.00 X 410385 0 52434 Stotler Brian Andrew Program Director 53.10 0.00 X 191386 0 39691 Souers Sheri L Program Director 48.20 0.00 X 181902 0 40168 Delli Carpini Frank A Medical Director 53.80 0.00 X 442435 0 43720 Lawrence Janet I Medical Director 46.30 0.00 X 314632 0 43848 King Sherry Anne Medical Director 45.90 0.00 X 289397 0 27249 Cook Scott Associate Medical Director 44.60 0.00 X 249868 0 44571 Owens Michael Medical Director 49.30 0.00 X 270610 0 50262 2385615 1058367 432625 23 0 1 0 Federal Hearings & Appeals Services Inc 117 West Main Street Plymouth PA 18651 A contractor processing QIC appeals 7252289 Incepture Inc 4800 Deerwood Campus Parkway Jacksonville FL 32246 Printing and mailing services 789146 Amkin West Bay LLC 301 West Bay Street Suite 210 Jacksonville FL 32202 Leasing of office space 782176 MCMC LLC PO BOX 809302 Chicago IL 606809302 A contractor processing QIC appeals 654493 American Express PO BOX 650448 Dallas TX 752650448 Corporate credit card provider 323106 8 57629565 57629565 1462 1462 57631027 1462 0 0 2385615 2385615 19256903 19256903 1665148 1665148 2265402 2265402 1613782 1613782 102032 102032 282775 282775 549424 549424 129034 129034 12623 12623 428393 428393 Contractor 13704854 13704854 Intercompany 4135695 4135695 Postage 672149 672149 Maintenance & Repairs 109854 109854 351009 351009 47664692 47664692 0 0 6121336 18112278 9993846 9297200 133511 132037 2664013 1215009 1873991 1449004 50904 55924 365264 365264 18538852 29411707 3394287 3642665 321221 148151 3877329 2933977 7592837 6724793 X 10946015 22686914 10946015 22686914 18538852 29411707 X 9966335 4466 -3 1770101 X X 1 X 1 X 1 0 X 11368425 57629565 68997990 11368425 57629565 68997990 68997990 1462 1462 68999452 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1715027 653151 1061876 851553 480807 370746 97433 81051 16382 1449004 Payable to TMF Health Quality Institute 1561149 Deferred Leases 1372828 2933977 X 57635493 4466 4466 57631027 0 57631027 45894591 -1770101 -1770101 47664692 0 47664692 Part X, Line 2: During 2015, C2C converted to a non-profit corporation and is exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code. Unrelated business income, of which C2C had none for the years ended December 31, 2016 and 2015, is subject to income tax. As a result of the conversion to a not for profit status, C2C paid tax on the fair value of C2C on the conversion date. C2C calculated and paid $6,094,128 in addition of Federal and State income tax expense in 2015. During 2016, C2C recognized a federal income tax benefit of $1,770,101 due to the overpayment of 2015 income taxes. C2C assesses uncertainties in income tax recognition in its financial statements and uses a threshold of morelikely-than-not for recognition and derecognition of tax provisions taken or expected to be taken. C2C is generally no longer subject to income tax examinations for returns submitted after three years. Part XII, Line 2d - Other Adjustments: Prior year Federal Income Tax benefit -1,770,101. X X X X 0 0 0 1 1 1 1 1 0 Manley Thomas Chairman 0 700084 0 0 0 0 0 27060 0 26839 0 753983 0 0 Hoernis Pamela Treasurer 0 358283 0 0 0 0 0 27060 0 9723 0 395066 0 0 Peterson Jeffrey N President 299929 0 110456 0 0 0 27060 0 25374 0 462819 0 0 0 Stotler Brian Andrew Program Director 153467 0 37919 0 0 0 19164 0 20527 0 231077 0 0 0 Souers Sheri L Program Director 140685 0 35473 0 5744 0 18160 0 22008 0 222070 0 0 0 Delli Carpini Frank A Medical Director 363230 0 68271 0 10934 0 27060 0 16660 0 486155 0 0 0 Lawrence Janet I Medical Director 252493 0 62139 0 0 0 27060 0 16788 0 358480 0 0 0 King Sherry Anne Medical Director 235576 0 53821 0 0 0 27060 0 189 0 316646 0 0 0 Cook Scott Associate Medical Director 212254 0 37614 0 0 0 25244 0 19327 0 294439 0 0 0 Owens Michael Medical Director 236139 0 34471 0 0 0 27060 0 23202 0 320872 0 0 0 Part I, Line 5 TMF Health Quality Institute has an executive incentive compensation plan where the payment is accrued and paid that is contingent on the revenues of the organization and it's subsidiary, C2C Innovative Solutions, Inc. C2C Innovative Solutions, Inc. has an executive incentive compensation plan where the payment is accrued and paid that is contingent on the revenues of the organization. Part I, Line 6 TMF Health Quality Institute has an executive incentive compensation plan where the payment is accrued and paid that is contingent on the net earnings of the organization and it's subsidiary, C2C Innovative Solutions, Inc.C2C Innovative Solutions, Inc. has an executive incentive compensation plan where the payment is accrued and paid that is contingent on the net earnings of the organization. Part I, Line 7 TMF Health Quality Institute has an executive incentive compensation plan where the payment is accrued and paid that is contingent on other performance including but not limited to new business goals, profit margin, and compliance requirements of the organization and it's subsidiary, C2C Innovative Solutions, Inc. C2C Innovative Solutions, Inc. has an executive incentive compensation plan where the payment is accrued and paid that is contingent on other performance including but not limited to new business goals, profit margin and compliance requirements of the organization. Form 990, Part VI, Section A, line 6 TMF Health Quality Institute is the only member. Form 990, Part VI, Section A, line 7a Members elect trustees from a slate of candidates chosen by the nominating committee. Form 990, Part VI, Section B, line 11b The Chair of C2C Innovative Solutions, Inc.'s Board of Trustees will receive a copy of the IRS Form 990 tax return prior to its filing with the IRS. The Chair and the CFO will review the form. The review will include the following: * Discussion of new IRS requirements and revisions to the Form 990 from the previous year. * A brief description of schedules and related attachments all members of the Board of Trustees will receive a printed or electronic copy of the completed Form 990 prior to filing of the IRS Form 990. During the next scheduled board meeting, the board will discuss the IRS Form 990. There will be an opportunity for all board members to ask questions regarding the tax return. Any discussions of the completed IRS Form 990 will be documented in the minutes. Form 990, Part VI, Section B, line 12c Each year, Board members, officers and key employees are required to provide C2C with a disclosure of entities and relationships that could give rise to a potential conflict of interest. This information is provided to and reviewed by C2C's compliance officer. Before C2C enters into a contract or other financial relationship with a third party, the contract or substance of the financial relationship is submitted to C2C's compliance officer who conducts a conflicts of interest assessment. If C2C's compliance officer is satisfied that the contract or other relationship would not result in a conflict of interest or the appearance of a conflict of interest, C2C will proceed with the contract or relationship. If a conflict or the appearance of a conflict is determined, C2C will not proceed with the contract or relationship unless an acceptable mitigation plan can be developed and implemented. Form 990, Part VI, Section B, line 15 The board of trustees obtains information from sources it deems relevant and necessary to determine reasonable compensation for officers and key employees. In addition to C2C's HR director, an independent consultant is obtained periodically, to review appropriate levels of compensation for all these people and make recommendations to the board. The consultant was last obtained in 2016. The President reviews the recommendations of the HR director and any independent consultant and advises the board of the determination concerning the compensation of all officers and key employees other than the President. The board may accept the Presidents's determination or modify it. The board sets what it determines to be appropriate compensation for the President. The process and information reviewed in making these determinations is documented contemporaneously. Form 990, Part VI, Section C, line 18 The governing documents, the conflict of interest policy, and financial statements are available upon request. Form 990, Part VI, Section C, line 19 The governing documents, the conflict of interest policy, and financial statements are available upon request. Form 990, Part XI, line 9: Federal Income Tax Expense 1,770,101. Form 990, Part XII, Line 2c: The process of overseeing the audit of the finanacial statements and the selection of an independent accountant has not changed from the prior year. TMF Foundation 5918 W Courtyard Dr Ste 300 Austin TX 78730 463015773 Promote high quality health care TX 501(c)3 509(a)(3) Type I TMF Health Quality Institute 0 TMF Health Quality Institute 5918 W Courtyard Dr Ste 300 Austin TX 78730 521002260 Health care TX 501(c)3 170(b)(1)(A)(vi) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 TMF Health Quality Institute O 9462162 FMV