2023-11-13T13:46:01-06:00 2022-12-31 RSM US LLP 6 S PATTERSON BLVD DAYTON OH 45402 990 2022-01-01 473028244 CareSource West Virginia Co % JANET FERNANDES CARE 9372243300 PO Box 8738 Dayton OH 454018738 Lawrence Smart CFO 9372243300 2023-11-15 true Lawrence Smart 999009999 Karen O Crim P00368385 9372980201 2 2022 2023-04-26 12:10:37Z Erhardt Preitauer Same as C above Dayton OH 45401 82246044 false X N/A X 2015 WV To Make a Lasting Difference in our mem- bers' lives by improving their health and well-being. CareSource West Virginia Co is a nonprofit HMO licensed by the State of West Virginia. 3 0 0 0 0 0 0 70165308 81725197 28280 520847 0 0 70193588 82246044 0 0 0 0 0 0 0 0 0 70414194 80534117 70414194 80534117 -220606 1711927 34850129 47704956 31995473 43139701 2854656 4565255 X CARESOURCE WEST VIRGINIA CO.'S MISSION IS TO MAKE A LASTING DIFFERENCE IN MEMBERS' LIVES BY IMPROVING THEIR HEALTH AND WELL-BEING. THE ORGANIZATION'S VISION IS TO TRANSFORM LIVES THROUGH INNOVATIVE HEALTH AND LIFE SERVICES. (Continued on Schedule O) false false 67825692 81725197 CareSource West Virginia Co. ("CSWV") is a nonprofit organization established under the state law of West Virginia. On August 30, 2017, CSWV received a determination letter from the Internal Revenue Service, recognizing CSWV as an organization exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code, effective as of the date of CSWV's formation. (Continued on Schedule O) 67825692 true false false true false false false false false false false false false false true true true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 7 0 true 0 false false false false false false false false false false false false X 3 0 false false false false true true false true true false false true true true true true true false false false X JANET FERNANDES 9372243300 PO BOX 8738 Dayton OH 454018738 X Erhardt Preitauer President & CEO 8.0 52.0 X 0 3656889 4253649 Jai Pillai Chief Operating Officer 8.0 52.0 X 0 1235514 871311 Lawrence Smart Chief Financial Officer 8.0 52.0 X 0 1072888 998867 Scott Markovich EVP Markets & Products, Dir 8.0 52.0 X 0 966866 950975 Daniel McCabe Chief Admin Officer (To 4/22) 1.0 59.0 X 0 1505969 14895 Stephanie Williams SVP Chf Actuary/Dir (Eff 4/22) 10.0 50.0 X 0 524391 577351 Michael Taylor President Market, Director 30.0 30.0 X 0 567970 450179 William Coffin Jr VP Mkt Finance, Dir (To 4/22) 10.0 50.0 X 0 524895 22301 David Finkel Former EVP Markets, Director 0.0 0.0 X 0 194579 0 0 10249961 8139528 0 true true false Express Scripts Inc 21653 Network Place CHICAGO IL 60673 Pharmacy Services 12345153 DentaQuest Group Inc 465 Medford Street CHARLESTOWN MA 02129 Medical Services 177360 3 0 FEDERAL HEALTH INSURANCE EXCHANGE 524114 81725197 81725197 81725197 520847 520847 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 82246044 81725197 520847 0 0 0 0 0 0 0 0 0 0 0 60849 0 60849 0 51282 0 51282 0 42399 0 42399 0 0 2654 0 2654 0 3034685 133595 2901090 0 288351 0 288351 0 1226889 1337 1225552 0 0 0 166316 0 166316 0 31217 0 31217 0 0 0 545207 0 545207 0 0 0 43121 0 43121 0 MEDICAL 56833341 56833341 0 0 PHARMACY 9444732 9444732 0 0 MGMT FEES CARESOURCE MGMT SVCS 5221667 1331427 3890240 0 HLTH INS PROVIDER & PCORI FEES 3205741 0 3205741 0 335666 81260 254406 80534117 67825692 12708425 0 X 0 0 31671723 11842504 0 0 1759815 2019277 0 0 0 0 0 0 0 0 0 0 0 0 1418591 33843175 0 0 0 0 0 0 0 0 34850129 47704956 10355777 9725790 0 0 13862011 24534347 0 0 0 0 0 0 0 0 0 0 7777685 8879564 31995473 43139701 X 2854656 4565255 0 0 2854656 4565255 34850129 47704956 1711927 -1328 X false true X true false X 0 0 0 0 0 0 50427213 51977728 53637788 70165308 81725197 307933234 0 0 0 50427213 51977728 53637788 70165308 81725197 307933234 0 0 0 307933234 236383 384890 95636 28280 520847 1266036 0 236383 384890 95636 28280 520847 1266036 0 0 50663596 52362618 53733424 70193588 82246044 309199270 0.99591 0.99697 0.00409 0.00302 X false false false false false false true 84799 false false 84799 false Form 990, Schedule C, Part II-B, Line 1g Lobbyists are retained to provide updates and represent the Organization's interests with federal and state legislators who deal with legislation related to Government sponsored health care programs. 0 RELATED PARTY PAYABLE 8879564 8879564 X 84142314 -1328 1897598 1896270 82246044 82246044 79987713 79987713 546404 546404 80534117 FIN 48 (ASC 740) Footnote As outlined in CareSource's Audited Consolidated Financial Statements, which include the activity of CareSource West Virginia Co.: The Company annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the consolidated financial statements. Currently, tax years 2019-2021 are open for audit by the Internal Revenue Service. Form 990, Schedule D, Parts XI and XII The entity has separate audited financial statements prepared on a statutory ("STAT") basis in compliance with The National Association of Insurance Commissioners ("NAIC") requirements. The entity is also included in the consolidated audited financial statements of the parent entity, CareSource, which are prepared on a GAAP basis. The 990 has been prepared consistent with the GAAP-basis financial statements. The amounts included on Schedule D, Part XI, Line 2d and Part XII, Line 4b, are comprised of the GAAP-to-STAT adjustments. true true false false false false false false false Erhardt Preitauer President & CEO 0 1271556 0 1935465 0 449868 0 4232490 0 21159 0 7910538 0 1935465 Jai Pillai Chief Operating Officer 0 623475 0 478850 0 133189 0 856649 0 14662 0 2106825 0 478850 Lawrence Smart Chief Financial Officer 0 535956 0 424371 0 112561 0 975380 0 23487 0 2071755 0 424371 Scott Markovich EVP Markets & Products, Dir 0 505787 0 354760 0 106319 0 911682 0 39293 0 1917841 0 354760 Daniel McCabe Chief Admin Officer (To 4/22) 0 120152 0 1044619 0 341198 0 7379 0 7516 0 1520864 0 710581 Stephanie Williams SVP Chf Actuary/Dir (Eff 4/22) 0 339884 0 19972 0 164535 0 555141 0 22210 0 1101742 0 0 Michael Taylor President Market, Director 0 302615 0 199228 0 66127 0 423951 0 26228 0 1018149 0 196228 William Coffin Jr VP Mkt Finance, Dir (To 4/22) 0 44311 0 203209 0 277375 0 15188 0 7113 0 547196 0 242999 David Finkel Former EVP Markets, Director 0 0 0 0 0 194579 0 0 0 0 0 194579 0 0 Form 990, Schedule J, Part I, Question 3 The process the Organization goes through to establish the reasonable executive compensation is the same for all the CareSource Family of companies. The organization utilizes a compensation committee, independent compensation consultant, CEO written employment contract, compensation survey or study, review of Form 990 of other organizations, and approval by the board or compensation committee comprised solely of independent directors. CareSource Management Services LLC ("CSMS"), a related organization, has in place Claw back provisions within its executive compensation plans that generally require executives to pay back compensation to CSMS in the event a subsequent legal, accounting, regulatory or compliance issue is discovered over which the executive had direct responsibility and control during the executive's employment. Form 990, Schedule J, Part I, Line 4a Daniel McCabe, David Finkel, and William Coffin, Jr. received severance payments that are properly reported on Schedule J, Part II, Column B(iii). Form 990, Schedule J, Part I, Question 4b The following listed persons listed on Form 990, Part VII, Section A, participate in a supplemental nonqualified retirement plan of CSMS: Erhardt Preitauer, Jai Pillai, Lawrence Smart, Scott Markovich, Stephanie Williams, and Michael Taylor. Amounts are accrued monthly for plan participants. The plans provide compensation to the participants after a vesting period, and the funds are available to the participants after they retire or resign from the organization. The plans provide for normal terms and conditions contained in a standard nonqualified retirement plan. The following listed persons listed on Form 990, Part VII, Section A, participate in a long-term incentive plan of CSMS: Erhardt Preitauer, Jai Pillai, Lawrence Smart, Scott Markovich, Stephanie Williams, and Michael Taylor. The plan provides compensation to the participants based on annual and long-term goals. The long-term incentive plan will pay out if these goals, or a subset of these goals, are achieved over a three-year period. If a participant leaves their employment prior to this three-year performance period, they forfeit any amounts accrued under this plan. Employees must be employed on the date which the long-term incentive plan is paid, which in no event is later than March 15th. Exceptions to this general statement include death, disability, or a qualified retirement, which may result in prorated payment. Amounts paid or accrued in 2022 for both deferred compensation arrangements include the following: Erhardt Preitauer $2,272,354, Jai Pillai $375,388, Lawrence Smart $554,835, Scott Markovich $517,955, Stephanie Williams $288,979, and Michael Taylor $255,192. Form 990, Schedule J, Part I, Question 6b The following persons listed on Form 990, Part VII, Section A, line 1a are or were employees of CSMS: Erhardt Preitauer, Jai Pillai, Lawrence Smart, Scott Markovich, Daniel McCabe, Stephanie Williams, Michael Taylor, and William Coffin, Jr. All of these listed persons are or were eligible for a performance bonus as part of their compensation packages. The amount of this Annual Incentive Plan ("AIP") bonus is based on the degree of achievement of the Companies' goals and the Individual's goals, which is ultimately documented in the year end performance management process. The performance management process documents the company goals and individual goals, the corresponding potential performance bonus, and the progress/outcomes. The performance bonus is based on the employee's calendar year regular earnings. Form 990, Schedule J, Part II All compensation amounts reported on Schedule J, Part II for all listed persons are paid by CSMS. Compensation paid to the CEO is pursuant to the terms of a written employment agreement between Mr. Preitauer and CSMS. Form 990, Part III, Question 1 (Continued) CARESOURCE WEST VIRGINIA CO. IS A HEALTH MAINTENANCE ORGANIZATION LICENSED BY THE STATE OF WEST VIRGINIA AND SERVES MEMBERS THROUGH MARKETPLACE PLANS. Form 990, Part III, Question 4a (Continued) CSWV is a member of the CareSource group of nonprofit organizations (the "CareSource Group"). The mission of the CareSource Group is to make a lasting difference in its members' lives by improving their health and well-being. CSWV firmly adheres to this mission, which it terms as the organization's "heartbeat," by providing services that go well beyond the delivery of medical benefits. CSWV is accredited for its Qualified Health Plan ("QHP") through the National Committee for Quality Assurance ("NCQA"). Accreditation is the most comprehensive evaluation in the industry and the only assessment that bases results on clinical performance and consumer experience. CSWV focuses on prevention with a goal of improving member health, the quality of health care services received, and accessibility of health care services for its members. This is done through an innovative health and wellness methodology. CSWV has built a high-performing provider network to operate as a Health Maintenance Organization ("HMO"). This provider network relies heavily upon Federally Qualified Health Centers ("FQHCs"). FQHCs are generally health care providers that have been recognized by the federal government as providing care to populations that have limited access to medical treatment due to conditions such as poverty and geographic location. CareSource West Virginia's QHP on the Health Insurance Marketplace primarily serves low-income individuals and was designed for those low-income adults who are recently uninsured or have never been insured. The plan is affordable, with a majority of members qualifying for subsidies to lower their monthly premiums or out of pocket costs. Members have the choice of buying plans with only the essential health benefits, or ones that also include adult dental, vision, and fitness supplemental benefits. Members can also receive assistance through CSWV's many programs designed to remove barriers to health and well-being. CSWV can, therefore, further its mission as a means of improving the health and well-being of West Virginia's low-income populations. Form 990, Part VI, Section A, Question 6 CareSource is the sole member of CareSource West Virginia Co. CareSource is recognized as exempt from federal income taxation under Internal Revenue Code ("IRC") Section 501(c)(3). Form 990, Part VI, Section A, Question 7a CARESOURCE, THE SOLE MEMBER OF CARESOURCE WEST VIRGINIA, CO., HAS THE AUTHORITY TO APPOINT CARESOURCE WEST VIRGINIA CO.'S BOARD. Form 990, Part VI, Section B, Question 11B The Form 990 was provided to the following individuals for review prior to the time of filing: The organization's Audit Committee and each voting member of the governing body; the CEO, CFO, and VP Treasury; the internal Tax Department and an outside CPA firm; and internal general counsel and outside legal counsel. Form 990, Part VI, Section B, Question 12C Annually, each director, principal officer, and member of a committee with board-delegated powers ("interested person") shall confirm that they have received a copy of the CareSource Conflicts of Interest policy and have read, understood, and agree to comply with the policy. Interested Persons have an obligation to immediately report any Conflicts of Interest (including any relationships, positions, or circumstances that could contribute to a Conflict of Interest). All relevant information reported through the Conflict of Interest Policy will be sent to the Chairman of the Board for review. If the Interested Person with the Conflict of Interest is the Chairman of the Board, then the required disclosure must be provided to the Chief Legal Officer of CareSource. If it is not entirely clear whether a Conflict of Interest exists, then the person with the potential conflict must disclose the circumstances to CareSource's Chief Legal Officer. The Chief Legal Officer will consult with the Corporation's Corporate Compliance Officer or the Chairman of the Board to determine whether there exists a Conflict of Interest that is subject to this policy. Before Board action or other action by the organization on a Transaction that involves a Conflict of Interest, an Interested Person who knows he or she has a Conflict of Interest must have disclosed to the Board all facts material to the Conflict of Interest. The Chairman of the Board may postpone Board or other corporate action on a Transaction until the Interested Person provides written information relating to the Conflict of Interest. An Interested Person who knows he or she has a Conflict of Interest must not participate in the Board's discussion of the Transaction except to disclose material facts and respond to questions. The Interested Person must not attempt to influence the Board's action on the Transaction, either at or outside the meeting. Prior to voting, the Board must be given an opportunity to discuss the Transaction without the person who has the Conflict of Interest being present. A Transaction involving a Conflict of Interest may be approved by the Board if the material facts as to the Transaction and the Conflict of Interest are fully disclosed or known to the Board and the Board in good faith determines after reasonable investigation that (a) the Board is aware of all material facts concerning the Transaction and the Interested person's interest in the Transaction; (b) the organization is entering into the Transaction for its own benefit; (c) the Transaction is fair and reasonable as to the organization; and (d) the organization could not have obtained a more advantageous arrangement with reasonable effort under the circumstances. The Person with the Conflict of Interest must not vote on the Transaction and must not be present in the room when the vote is taken. Form 990, Part VI, Section C, Question 19 The company's Form 1023 is available for public inspection upon request, and Form 990 is available for public inspection upon request in accordance with IRC Section 6104(d). The company's Form 990 is also available on the U.S. nonprofit database website at www.guidestar.org. The Company's statutory financial statements are available on the SNL Financial LC website at www.snl.com for a nominal fee. CareSource PO Box 8738 Dayton OH 45401 311703368 Supporting OH 501(c)(3) 509(a)(3)II NA false CareSource Indiana Inc PO Box 8738 Dayton OH 45401 320121856 HMO Ins Plan IN 501(c)(3) 509(a)(2) CareSource false CareSource Georgia Co PO Box 8738 Dayton OH 45401 472408339 HMO Ins Plan GA 501(c)(3) 509(a)(2) CareSource false CareSource Kentucky Co PO Box 8738 Dayton OH 45401 464991603 HMO Ins Plan KY 501(c)(3) 509(a)(2) CareSource false CareSource Life Services Co PO Box 8738 Dayton OH 45401 811602217 No Activity OH 501(c)(3) 509(a)(2) CareSource false CareSource Ohio Inc PO Box 8738 Dayton OH 45401 311143265 HIC Ins Plan OH 501(c)(3) 509(A)(2) CareSource false The CareSource Foundation PO Box 8738 Dayton OH 45401 562582561 Grantmaking OH 501(c)(3) 509(A)(3) I CareSource false CSMS Holding LLC (To 122822) PO Box 8738 Dayton OH 454018738 851588557 Holding Co DE NA N/A CareSource Diversity & Social Impact Inv 50 East 91st Street Suite 213 Indianapolis IN 46240 871811106 Investing IN NA N/A CareSource Iowa Opportunity Investment 415 12th Avenue SE Cedar Rapids IA 52401 883585337 Investing IA NA N/A CareSource Virginia Co PO Box 8738 Dayton OH 454018738 811727271 No Activity VA NA C Corp CareSource Arkansas Health Plan Co PO Box 8738 Dayton OH 454018738 844476729 COA Insurance AR NA C Corp CareSource Oklahoma Health Plan Co PO Box 8738 Dayton OH 454018738 854038326 HMO Ins Plan OK NA C Corp Kids CareAlliance Co PO Box 8738 Dayton OH 454018738 854022039 No Activity OH NA C Corp CareSource Kansas LLC PO Box 8738 Dayton OH 454018738 873411276 HMO Ins Plan KS NA C Corp CareSource North Carolina Co PO Box 8738 Dayton OH 454018738 873079479 HMO Ins Plan NC NA C Corp CareSource PASSE LLC PO Box 8738 Dayton OH 454018738 863112470 RBPO Ins Plan AR NA C Corp Columbus Organization Holdings LLC PO Box 8738 Dayton OH 454018738 814132952 Holding Co DE NA C Corp Healthedge-Columbus Holdings LLC PO Box 8738 Dayton OH 454018738 814132842 Holding Co DE NA C Corp CareSource Tennessee Co PO Box 8738 Dayton OH 454018738 874254502 COA Insurance TN NA C Corp Columbus Medical Services Inc PO Box 8738 Dayton OH 454018738 300975112 No Activity MD NA C Corp CareSource Iowa Co (Inc 31822) PO Box 8738 Dayton OH 45401 881429834 HMO Ins Plan IA NA C Corp CareSource Florida Co (Inc 8422) PO Box 8738 Dayton OH 45401 883601120 HMO Ins Plan FL NA C Corp CareSource Bayou Health (Inc 72222) PO Box 8738 Dayton OH 45401 883401520 HMO Ins Plan TX NA C Corp false false false false true false false false false false false true true false false true false false Part III - Related Orgs Taxable as a Partnership - Additional Information 1) Effective 12/28/2022, CareSource Management Services Holding LLC (EIN 85-1588557) changed from a partnership to a single member LLC, whose sole member is another single member LLC, Caresource Holding LLC (EIN 84-4431982). Caresource Holding LLC's sole member is CareSource (EIN 31-1703368). Part IV - Related Organizations Taxable as a Corp - Additional Information 1) CareSource Iowa Co (EIN 88-1429834) was incorporated 03/18/2022. 2) CareSource Florida Co (EIN 88-3601120) was incorporated 08/04/2022. 3) CareSource Bayou Health LLC (EIN 88-3401520) was incorporated 07/22/2022.