2022-11-14T09:22:38-06:00 2021-12-31 RSM US LLP 6 S PATTERSON BLVD DAYTON OH 45402 990 2021-01-01 320121856 CareSource Indiana Inc % JANET FERNANDES CARE 9375313027 PO Box 8738 Dayton OH 454018738 Lawrence Smart CFO 9375313027 2022-11-15 true Lawrence Smart 999009999 Karen O Crim P00368385 9372980201 2022-11-15 3 2021 2022-09-23 18:48:47Z X Erhardt Preitauer Same as C above Dayton OH 45401 990208142 false X N/A X 2004 IN To Make a Lasting Difference in our members' lives by improving their health and well-being. CareSource Indiana Inc. is a Nonprofit HMO licensed by the State of Indiana. 3 0 0 0 0 0 0 0 750157227 989801374 953950 406768 0 0 751111177 990208142 0 0 0 0 0 0 0 0 0 744908345 963967552 744908345 963967552 6202832 26240590 327554719 434368652 265543107 346116450 62011612 88252202 X CARESOURCE INDIANA INC.'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. CARESOURCE INDIANA INC. IS A HEALTH MAINTENANCE ORGANIZATION LICENSED BY THE STATE OF INDIANA AND SERVES MEMBERS THROUGH MARKETPLACE, MEDICAID, MEDICARE ADVANTAGE, DUAL ELIGIBLE SPECIAL NEEDS, HEALTHY INDIANA, AND HOOSIER HEALTHWISE PLANS. true false 846574316 0 989801374 CareSource Indiana Inc. ("CSIN"CareSource Indiana") is a nonprofit organization established under the state law of Indiana. CSIN 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. CSIN 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. CSIN serves members through the following: (1) a Qualified Health Plan offered through the Federal Health Insurance Marketplace, providing low-cost comprehensive coverage for individuals and families; (2) Medicare Advantage, contracting with Medicare to provide all Part A and Part B benefits; (3) Dual Eligible Special Needs Plans (D-SNPs), enrolling individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX); and (4) Hoosier Healthwise and Healthy Indiana Plan ("HIP") Medicaid expansion plans. CSIN is accredited through the National Committee for Quality Assurance ("NCQA") for its qualified Health Insurance Marketplace and Medicaid plans. Accreditation is the most comprehensive evaluation in the industry and the only assessment that bases results on clinical performance and consumer experience. CSIN 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. CSIN 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. Recognized for a commitment to serving at-risk populations, beginning Jan. 1, 2017, CSIN began coordinating care for recipients of state supported programs that provide health services to recipients, through Hoosier Healthwise and HIP. Hoosier Healthwise is available to pregnant women and children, and HIP covers adults 19 to 64 years of age whose incomes are less than 138% of the federal poverty level and do not meet certain eligibility requirements for other health coverage programs. CSIN offers two Medicare Advantage Plans in the State. CSIN primarily enrolls low-income individuals in these plans. CSIN's Qualified Health Plan 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 low monthly premiums, low copays, low annual deductibles, and free generic prescriptions for some members. Members have the choice of buying dental and vision plans in addition to their medical plan. Members can receive assistance through CSIN's many programs designed to remove barriers to health and well-being. CareSource Indiana can, therefore, further its mission as a means of improving the health and well-being of Indiana's low-income populations. In 2015, the CareSource Group created a pilot program called CareSource Life Services, which couples the largest low-income subsidy safety net, Medicaid, with a holistic approach to addressing economic well-being and social connectedness. Life Services coordinates a range of resources through community and employer partnerships. A key component of Life Services is JobConnect, an initiative that helps members to increase skills and attain connections to long-term employment. JobConnect is a program and member benefit designed to serve members that are seeking assistance with education and employment goals. JobConnect is a voluntary program that pairs interested members with a Life Coach that walks alongside them as they identify and address potential barriers to their goals. Once a member decides to participate in JobConnect, they work with a regionally based Life Coach that helps the member identify resource strengths, educational and training goals, and employment opportunities. Prior to employment placement, assessments are completed that may indicate a need surrounding the social determinants of health such as: food stability, housing, childcare, transportation, etc. Together with the member, Life Coaches are able to coordinate, refer, and connect members with community resources and partners that exist to meet particular needs. Once immediate needs are addressed and an educational/employment plan is created, the member sets goals and derives an action plan to accomplish their goals. Some members may be interested in a training program that better equips them for specific employment positions while others may be ready for the workforce and need preparation in the form of resume assistance, interview prep, soft skills, etc. Life Coaches seek to understand the job needs and preferences of members and prepare them for job attainment. The goal is to help members secure long-term employment by connecting them with employers that provide full-time hours, benefits, and the opportunity for growth. JobConnect is designed to work with members for up to 24 months to help members navigate the employment world while balancing their home life. In 2018, CSIN began serving members exiting state prisons through a unique pilot partnership with the Indiana Department of Corrections and the Indiana Family Social Services Administration. The program is designed to support the successful reentry of individuals returning from prisons. As a voluntary and transitional benefit, the program provides the following services: (1) Pre-release care coordination, including in-reach services to assist in transitional planning; (2) A network of community-based substance use treatment providers across the State of Indiana; and (3) Access to recovery services including supported housing, employment services, peer-recovery, community-based care management, and life skills. (3) Access to recovery services including supported housing, employment services, peer-recovery, community-based care management, and life skills. 846574316 true false false true false false false false false false false false false false true true false 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 X 685 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 IN X JANET FERNANDES 9375313027 PO BOX 8738 Dayton OH 454018738 X Erhardt Preitauer President & CEO 8.0 52.0 X 0 7853709 2969682 Jai Pillai Chief Operating Officer 5.0 55.0 X 0 2098405 787344 Daniel McCabe Chief Administrative Officer 1.0 59.0 X 0 1617731 608113 David Finkel EVP, Markets & Chair (To 4/21) 10.0 50.0 X 0 1703154 11601 David Goltz Chief Financial Ofr (To 1/21) 0.0 0.0 X 0 1556240 2783 Scott Markovich EVP, Mkts & Chair (Eff 4/21) 10.0 50.0 X 0 974373 532340 Lawrence Smart Chief Financial Ofr (Eff 1/21) 5.0 55.0 X 0 636903 708351 Steve Smitherman President, Market & Secretary 59.0 1.0 X 0 917471 385606 William Coffin Jr VP Mkt Finance & Treasurer 15.0 45.0 X 0 640317 234075 Pamela Morris Former President & CEO 0.0 1.0 X 0 646015 0 0 18644318 6239895 0 true true false Express Scripts Inc 21653 Network Place CHICAGO IL 60673 Pharmacy Services 181161017 LCP Transportation LLC 4308 Guion Rd INDIANAPOLIS IN 46254 Transportation Svcs 2607367 Superior Vision Services Inc 939 Elkridge Landing 200 LINTHICUM MD 21090 Medical Services 1567372 DentaQuest Group Inc 465 Medford Street CHARLESTOWN MA 02129 Medical Services 1181051 National Imaging Associates Inc PO Box 785341 Magellan BH HP Lockb PHILADELPHIA PA 19178 Medical Services 535722 62 0 MEDICAID 524114 514072096 514072096 FEDERAL HEALTH INSURANCE EXCHANGE 524114 474938053 474938053 MEDICARE ADVANTAGE 524114 791225 791225 989801374 406768 406768 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 990208142 989801374 406768 0 0 0 0 0 0 0 0 0 0 0 496626 5232 491394 136726 15872 120854 40706 687 40019 0 0 23865888 2622417 21243471 4418918 420 4418498 14866884 236385 14630499 1571 39 1532 0 2660166 2660166 124698 5411 119287 0 0 1300000 1300000 0 0 281649 281649 MEDICAL EXPENSES 671679202 671679202 PHARMACY EXPENSES 164966166 164966166 MGMT FEES CARESOURCE MGMT SVCS 58315681 6423386 51892295 HLTH INS PROVIDER & PCORI FEES 15060857 15060857 5751814 619099 5132715 963967552 846574316 117393236 0 X 0 0 273199992 365662007 0 0 41448356 61242990 0 0 0 0 0 0 0 0 669264 527696 0 0 12237107 6935959 0 0 0 0 0 0 0 0 327554719 434368652 97585964 120951119 0 0 146318623 200408454 0 0 0 0 0 0 0 0 0 0 21638520 24756877 265543107 346116450 X 62011612 88252202 0 0 62011612 88252202 327554719 434368652 26240590 X false true X true false X 0 0 0 0 0 0 358378523 793585249 640981578 750157227 989801374 3532903951 0 0 0 358378523 793585249 640981578 750157227 989801374 3532903951 0 0 0 3532903951 236084 2122635 737426 953950 406768 4456863 0 236084 2122635 737426 953950 406768 4456863 0 0 358614607 795707884 641719004 751111177 990208142 3537360814 0.99874 0.99845 0.00126 0.00155 X false false false false false false true 78258 false true 3153 81411 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. Form 990, Schedule C, Part II-B, Line 1i $3,153 is the allocable portion of the Organization's dues paid to Indiana Association of Health Plans for lobbying and grassroots efforts conducted by the trade association on behalf of its members. 0 RELATED PARTY PAYABLE 24756877 24756877 X FIN 48 (ASC 740) Footnote As outlined in CareSource's Audited Consolidated Financial Statements, which include the activity of CareSource Indiana Inc.: 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 2018-2020 are open for audit by the Internal Revenue Service. true true false false false false false false false Erhardt Preitauer President & CEO 0 1222613 0 1803995 0 4827101 0 2932424 0 37258 0 10823391 0 5190112 Jai Pillai Chief Operating Officer 0 598911 0 631709 0 867785 0 768558 0 18786 0 2885749 0 1187751 Daniel McCabe Chief Administrative Officer 0 445289 0 343956 0 828486 0 576681 0 31432 0 2225844 0 1028697 David Finkel EVP, Markets & Chair (To 4/21) 0 134121 0 415073 0 1153960 0 4670 0 6931 0 1714755 0 1216490 David Goltz Chief Financial Ofr (To 1/21) 0 13408 0 454618 0 1088214 0 812 0 1971 0 1559023 0 1121560 Scott Markovich EVP, Mkts & Chair (Eff 4/21) 0 442537 0 439501 0 92335 0 507408 0 24932 0 1506713 0 0 Lawrence Smart Chief Financial Ofr (Eff 1/21) 0 518017 0 0 0 118886 0 680309 0 28042 0 1345254 0 9615 Steve Smitherman President, Market & Secretary 0 307721 0 214951 0 394799 0 346949 0 38657 0 1303077 0 544264 William Coffin Jr VP Mkt Finance & Treasurer 0 311732 0 193549 0 135036 0 211243 0 22832 0 874392 0 258152 Pamela Morris Former President & CEO 0 0 0 0 0 646015 0 0 0 0 0 646015 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 executive compensation committee comprised solely of independent directors. CareSource Management Services LLC ("CSMS"), a related organization, has in place Clawback 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 David Finkel received a severance payment that is 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, Daniel McCabe, David Finkel, David Goltz, Scott Markovich, Lawrence Smart, Steve Smitherman, and William Coffin Jr. 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, Daniel McCabe, David Finkel, David Goltz, Scott Markovich, Lawrence Smart, and Steve Smitherman. 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 vesting period, they forfeit any amounts accrued under this plan. Amounts paid and accrued in 2021 for both deferred compensation arrangements include the following: Erhardt Preitauer $5,810,861, Jai Pillai $1,135,537, Daniel McCabe $1,027,006, David Finkel $828,661, David Goltz $1,087,357, Scott Markovich $233,918, Lawrence Smart $354,435, Steve Smitherman $503,631, and William Coffin Jr. $129,325. Form 990, Schedule J, Part I, Question 6b The following listed persons listed on Form 990, Part VII, Section A, Line 1a are employees of CSMS: Erhardt Preitauer, Jai Pillai, Daniel McCabe, David Finkel, David Goltz, Scott Markovich, Lawrence Smart, Steve Smitherman, and William Coffin, Jr. All of these listed persons are or were eligible for a performance bonus as part of their compensation packages. The performance bonus is contingent on a combination of both company performance and individual performance against goals. 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 Compensation amounts for the listed persons on Schedule J, Part II 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 2 CareSource Indiana Inc. began offering Dual Eligible Special Needs and Medicare Advantage Plans in 2021. Form 990, Part V, Lines 1a In early 2020, CSIN changed the payer of its provider claims payments, resulting in a reduction of the number of Forms 1099 that were reported on Form 990, Part V, Line 1A. Form 990, Part VI, Section A, Questions 6 CareSource is the sole member of CareSource Indiana, Inc. 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 Indiana, Inc., has the authority to appoint CareSource Indiana, Inc.'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 FORM 990: THE ORGANIZATION'S AUDIT COMMITTEE, EACH VOTING MEMBER OF THE GOVERNING BODY OF THE ORGANIZATION, THE CEO, CFO, VP TREASURY, DIRECTOR TAX, MANAGER TAX, AN OUTSIDE CPA FIRM, OUTSIDE LEGAL COUNSEL, AND GENERAL 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 CareSource 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 of CareSource 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 Interest person's interest in the Transaction; (b) CareSource is entering into the Transaction for its own benefit; (c) the Transaction is fair and reasonable as to CareSource; and (d) CareSource 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. 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. The company's articles of incorporation are available on the Indiana Secretary of State's website at www.in.gov/SOS/ for a nominal fee. CareSource PO Box 8738 Dayton OH 454018738 311703368 Supporting OH 501(c)(3) 509(a)(3)II NA false CareSource Kentucky Co PO Box 8738 Dayton OH 454018738 464991603 Kentucky HMO KY 501(c)(3) 509(a)(2) CARESOURCE false CareSource Georgia Co PO Box 8738 Dayton OH 454018738 472408339 Georgia HMO GA 501(C)(3) 509(a)(2) CARESOURCE false CareSource West Virginia Co PO Box 8738 Dayton OH 454018738 473028244 WV HMO WV 501(c)(3) 509(a)(2) CARESOURCE false CareSource Life Services Co PO Box 8738 Dayton OH 454018738 811602217 Inactive OH 501(c)(3) 509(a)(2) CARESOURCE false CareSource Ohio Inc PO Box 8738 Dayton OH 454018738 311143265 Ohio HMO OH 501(c)(3) 509(A)(2) CareSource false The CareSource Foundation PO Box 8738 Dayton OH 454018738 562582561 Grantmaking OH 501(c)(3) 509(A)(3) i CareSource false CSMS HOLDING LLC (EFF 111521) PO Box 8738 Dayton OH 454018738 851588557 Holding Co DE NA CareSource Virginia Co PO Box 8738 Dayton OH 454018738 811727271 Inactive VA NA C Corp CareSource Arkansas Health Plan Co PO Box 8738 Dayton OH 454018738 844476729 Hlth & Med Ins AR NA C Corp Kids' CareAlliance Co PO Box 8738 Dayton OH 454018738 854038326 Hlth & Med Ins OH NA C Corp CareSource Oklahoma Health Plan Co PO Box 8738 Dayton OH 454018738 854038326 Hlth & Med Ins OK NA C Corp CareSource Kansas LLC PO Box 8738 Dayton OH 454018738 873411276 Inactive KS NA C Corp CareSource North Carolina Co PO Box 8738 Dayton OH 454018738 873079479 Inactive NC NA C Corp CareSource PASSE LLC PO Box 8738 Dayton OH 454018738 863112470 Hlth & Med Ins 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 PA NA C Corp CareSource Tennesse Co PO Box 8738 Dayton OH 454018738 874254502 Inactive TN NA C Corp Columbus Medical Services Inc PO Box 8738 Dayton OH 454018738 300975112 Inactive MD NA C Corp false false false false true false false false false false false false true true false true false false false Part III - Related Orgs Taxable as a Partnership - Additional Information - Effective 11/15/2021, CareSource Management Services Holding LLC (EIN 85-1588557) changed from a single member LLC, solely owned by Caresource Holding LLC (EIN 84-4431982), to a partnership. CareSource (EIN 31-1703368) is the sole owner of CareSource Holding LLC and owns an 86.8544% interest in the newly formed partnership. Part IV - Related Organizations Taxable as a Corp - Additional Information - CareSource Kansas LLC (EIN 87-3411276) was incorporated 11/03/2021. - CareSource North Carolina Co (EIN 87-3079479) was incorporated 10/01/2021. - Columbus Organization Holdings LLC (EIN 81-4132952) was acquired 11/17/2021. - Healthedge-Columbus Holdings LLC (EIN 81-4132842) was acquired 11/17/2021. - CareSource Tennessee Co (EIN 87-4254502) was incorporated 12/22/2021. - Columbus Medical Services Inc (EIN 30-0975112) was acquired 11/17/2021.