2021-11-11T13:55:08-06:00 2020-12-31 990 2020-01-01 472408339 CareSource Georgia Co % JANET FERNANDES CARE 9375313027 600 Galleria Pkwy 400 Atlanta GA 30339 Lawrence Smart CFO 9375313027 2021-11-11 Lawrence Smart 999009999 2 2020 2022-09-23 18:48:47Z Erhardt Preitauer PO Box 8738 Dayton OH 45401 883059517 false X N/A X 2014 GA To make a lasting difference in our members' lives by improving their health and well-being. CareSource Georgia Co. is a nonprofit HMO licensed by the State of Georgia. 3 1 0 1 0 0 0 693101343 882554030 909153 505487 0 0 694010496 883059517 0 0 0 0 0 0 0 0 0 684513338 872730991 684513338 872730991 9497158 10328526 171704099 325866124 136750970 280584469 34953129 45281655 X CareSource Georgia 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. CareSource Georgia Co. is a health maintenance organization licensed by the state of Georgia and serves members through Marketplace, Medicaid plans and the PeachCare for Kids and Planning for Healthy Babies programs. true false 790714141 882554030 CareSource Georgia ("CSGA") is a nonprofit corporation established under the state laws of Georgia. On July 18, 2017, CSGA received a determination letter from the Internal Revenue Service, recognizing CSGA as an organization exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code, effective as of the date of CSGA's formation. CSGA is a member of the CareSource group of nonprofit organizations (the "CareSource Group"). The parent of the CareSource Group is CareSource, an Ohio nonprofit corporation that is tax-exempt under section 501(c)(3) of the Internal Revenue Code of 1986 (the "Code"). The CareSource Group's primary activity for the last thirty-one (31) years has been to provide nonprofit Medicaid health maintenance organization ("HMO") services. The mission of the CareSource group is to make a lasting difference in its members' lives by improving their health and well-being. The CareSource Group firmly adheres to this mission, which it terms as the organization's "heartbeat," by providing services that go beyond the delivery of medical benefits. CSGA began providing care to participants in its Medicaid HMO plan on July 1, 2017. CSGA serves individuals meeting the low-income thresholds for Medicaid eligibility. CSGA participates in the State of Georgia's Planning 4 Healthy Babies program, or P4HB, which is a demonstration waiver program for women meeting Medicaid income thresholds designed to help reduce the number of low birth weight babies born each year. Through the P4HB program, CSGA offers family planning services, healthcare coverage for certain pregnancy related chronic conditions, and case management services to women at risk for a low birth weight delivery. CSGA launched a Marketplace plan in 2020, offering affordable individual and family plans tailored for any budget. In accordance with the CareSource Group's charitable mission, CSGA provides numerous programs and policies that encourage its members to obtain preventative and necessary medical care. Many of these programs are educational in nature and intended to make each member aware of their benefits. For example, upon enrollment, each member receives a handbook with an overall explanation of benefits. Members also receive periodic newsletters which include additional information on member benefits and reminders concerning preventative care. Additionally, CSGA contacts members throughout the year to further assist members in understanding their benefits. Finally, upon enrollment, each member will be automatically assigned both a primary care physician ("PCP") and primary dental provider ("PDP"). Assigning a PCP represents the first step in encouraging members to utilize their benefits. Also, because each PCP will be required to contact members to schedule Early and Periodic Screening, Diagnostic, and Treatment ("EPSDT") appointments for children covered by CSGA, it increases the likelihood that CSGA's youngest members receive the preventative care they need. Ensuring members have access to quality dental care is also essential, as dental care is closely linked to the overall health and well-being of members. CareSource seeks input from members about the services they receive and the impact of the enhanced benefits we offer through a Member Advisory Committee. The Member Advisory Committee is convened for in-person and virtual meetings. The Committee meets quarterly and is comprised of members from across the state. They represent special populations that are served by the health plan. Their feedback supports the continuous improvement of benefits and services. CSGA leverages this committee to seek feedback about medical and enhanced benefits, programs like CareSource JobConnect or other social determinant initiatives, understanding the consumer experience, and how to improve marketing and communication. Importantly, CSGA operates under the CareSource Group's unique care coordination models. The primary model is Care4U. Care4U represents an innovative and patient-centered approach to health care, as it focuses resources on improving and maintaining overall population health. Care4U does this through a new digital platform to assist in the management of chronic conditions. As part of Care4U, CSGA undertakes extensive efforts to help educate its members, including providing each individual with a customized wellness plan. CSGA uses Care Transitions, a program specifically tailored to coordinate care as members transfer between different levels of care and different settings, such as between home care and hospital care. In conjunction with Care4U and Care Transitions, CSGA relies on OutcomesMTM to coordinate its members' medication usage. CSGA's OutcomesMTM will collect data on all medications that a member is currently taking. CSGA runs this data through several clinical algorithms to identify possible issues related to cost, safety, and over-utilization. Any issues that are identified are shared with pharmacists, who then provide members with face-to-face counseling. This individualized review of each member's medication usage has been instrumental in improving member health, as evidenced by a reduced number of hospitalizations and emergency department visits. CSGA, along with other members of the CareSource Group, are still among the few Medicaid managed care organizations in the country that voluntarily provide such a comprehensive review of members' prescription medications. To operate its plan, CSGA continues to build a high-performing network that yields efficiencies in the delivery of care. This provider network relies heavily upon federally qualified health centers ("FQHC"). 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. The main purpose of the FQHC Program is to enhance the provision of primary care services in underserved urban and rural communities. CSGA is accredited through National Committee for Quality Assurance ("NCQA") for its Medicaid plan and its Qualified Health Plan ("QHP"). NCQA accreditation is the most comprehensive evaluation in the industry and the only assessment that bases results on clinical performance and consumer experience. CSGA 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. Many of CSGA's activities improve efficiency in the delivery of Medicaid benefits, resulting in an improvement of its members' overall health. CSGA places a considerable emphasis on membership education through wellness plans and other individual communications. Wellness rewards are available for kids, adults, and pregnant women and babies. CSGA provides dental and vision benefits to all members, including those over the age of twenty-one (21). Additionally, CSGA provides members with free access to a nursing hotline twenty-four (24) hours a day, seven (7) days a week. These nurses review a member's symptoms, offer guidance on when to seek medical care, explain any conditions with which a member has been recently diagnosed, provide education on over-the-counter medications, and help members prepare a list of questions prior to a visit with their doctor. This triaging of care both improves the efficiency of the Medicaid program and reduces unnecessary hospitalizations and emergency department visits. CSGA aims to remove poverty as a barrier to achieving good health, and CSGA provides a number of programs designed to meet challenges that are specific to individuals with low incomes. One program is Transportation. Because low-income individuals frequently have difficulty keeping medical appointments due to a lack of transportation, CSGA will augment their transportation benefit. Transportation assistance is a value added benefit to the CareSource Life Services program. CSGA will provide rides to employment and education related activities. In 2020, CSGA offered rides to local grocery retailers for curbside pickup and to community organizations for food distribution events. CSGA provides additional enhanced benefits to members that are above and beyond required benefits defined by state or federal agencies. These benefits include club memberships, health and wellness items, rewards programs, and social determinant support. Together, these enhanced benefits provide CSGA members additional program benefits in order to make a lasting difference in members' lives by improving their health and well-being. In 2020, CSGA paid over $2.9 Million to fund these enhanced member benefits. In 2016, the CareSource Group implemented CareSource Life Services, a program focused on helping members get and keep jobs they need to improve their lives. Life Services offers services and support that can pave the way from where members are to where they want to b 790714141 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 1573 0 true 0 false false false false false false false false false false false false X 3 1 false false false false true false false true true false false true true true true true true false false false GA X JANET FERNANDES 9375313027 PO BOX 8738 DAYTON OH 454018738 X Erhardt Preitauer President & CEO 8.0 52.0 X 0 2239483 3719592 Jai Pillai Chief Operating Officer 3.0 57.0 X 0 1037573 910643 David Finkel Exec VP, Markets & Chair/Dir 10.0 50.0 X 0 736768 797538 David Goltz Chief Financial Officer 5.0 55.0 X 0 949833 574541 Daniel McCabe Chief Administrative Officer 1.0 59.0 X 0 809693 631182 Bobby Jones Pres, Market & Sec/Treas/Dir 59.0 1.0 X 0 688292 540491 Kevin Brown Former Chairperson 0.0 15.0 X 0 212500 0 John Monahan Former Vice Chair 0.0 10.0 X 0 107500 0 Eve Byrd Director 1.0 0.0 X 0 0 0 0 6781642 7173987 0 true true false Express Scripts Inc 21653 Network Place CHICAGO IL 606730673 Pharmacy Services 83653196 Childrens Healthcare of Atlanta - C 1584 Tullie Circle ATLANTA GA 30329 Medical Services 70841945 Northside Hospital Inc Related O 1000 Johnson Ferry Rd NE ATLANTA GA 30342 Medical Services 32566675 Savanna Health Services LLC PO Box 744467 ATLANTA GA 30374 Medical Services 15118626 Northeast Georgia Medical Center Co 743 Spring Street GAINESVILLE GA 30501 13729125 1137 0 MEDICAID 524114 772555792 772555792 FEDERAL HEALTH INSURANCE EXCHANGE 524114 109547582 109547582 VETERANS REVENUE 524114 450656 450656 882554030 505487 505487 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 883059517 882554030 505487 0 0 0 0 0 0 0 0 0 0 0 591605 591605 255126 56055 199071 144689 144689 0 0 21695395 5946747 15748648 2456799 2456799 8166626 164086 8002540 365481 365481 0 2335508 2335508 148079 61479 86600 0 0 4717961 4717961 0 0 213288 213288 MEDICAL EXPENSES 697604477 697604477 PHARMACY EXPENSES 71464196 71464196 MGMT FEES CARESOURCE MGMT SVCS 52638774 13736921 38901853 CLAIMS PROCESSING ADMIN EXP 6495181 1680180 4815001 3437806 3437806 872730991 790714141 82016850 0 X 100129 0 59863238 167344775 0 0 104226896 153402555 0 0 0 0 0 0 0 0 410120 1063089 0 0 7103716 4055705 0 0 0 0 0 0 0 0 171704099 325866124 64905953 114438574 0 0 14573452 101282878 0 0 0 0 0 0 0 0 0 0 57271565 64863017 136750970 280584469 X 34953129 45281655 0 0 34953129 45281655 171704099 325866124 10328526 X false true X true false X 0 0 0 0 0 0 0 307490934 663180751 693101343 882554030 2546327058 0 0 0 0 307490934 663180751 693101343 882554030 2546327058 0 0 0 2546327058 2076 105126 693569 866789 505487 2173047 0 2076 105126 693569 866789 505487 2173047 0 0 2076 307596060 663874320 693968132 883059517 2548500105 0.99915 0.99900 0.00085 0.00100 X false false false false false false true 285379 false true 4000 289379 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 $4,000 is the allocable portion of the Organization's dues paid to the Georgia Association of Health Plans for lobbying and grassroots efforts conducted by the trade association on behalf of its members. 0 RELATED PARTY PAYABLE 64863017 64863017 X FIN 48 (ASC 740) Footnote As outlined in CareSource's Audited Consolidated Financial Statements, which include the activity of CareSource Georgia 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 2017-2019 are open for audit by the Internal Revenue Service. false true false false false false false false false Erhardt Preitauer President & CEO 0 1195469 0 1041550 0 2464 0 3687463 0 32129 0 5959075 0 1041550 Jai Pillai Chief Operating Officer 0 576277 0 300000 0 161296 0 886239 0 24404 0 1948216 0 300000 David Finkel Exec VP, Markets & Chair/Dir 0 510907 0 221045 0 4816 0 776964 0 20574 0 1534306 0 221045 David Goltz Chief Financial Officer 0 603324 0 286058 0 60451 0 552051 0 22490 0 1524374 0 286058 Daniel McCabe Chief Administrative Officer 0 448738 0 216350 0 144605 0 602044 0 29138 0 1440875 0 216350 Bobby Jones Pres, Market & Sec/Treas/Dir 0 415611 0 177094 0 95587 0 519453 0 21038 0 1228783 0 177094 Kevin Brown Former Chairperson 0 212500 0 0 0 0 0 0 0 0 0 212500 0 0 John Monahan Former Vice Chair 0 107500 0 0 0 0 0 0 0 0 0 107500 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, a related organization, has in place Clawback provisions within its executive compensation plans that generally require executives to pay back compensation to CareSource 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, Question 4b The following listed persons listed on Form 990, Part VII, Section A, participate in a supplemental nonqualified retirement plan of a related organization, CareSource: Erhardt Preitauer, Jai Pillai, David Finkel, David Goltz, Daniel McCabe, and Bobby Jones. 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 a related organization, CareSource Management Services LLC ("CSMS"), a disregarded entity of CareSource: Erhardt Preitauer, Jai Pillai, David Finkel, David Goltz, Daniel McCabe, and Bobby Jones. 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 2020 for both deferred compensation arrangements include the following: Erhardt Preitauer $1,866,617, Jai Pillai $425,122, David Finkel $375,369, David Goltz $587,531, Daniel McCabe $359,195, and Bobby Jones $285,001. 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 CareSource Management Services LLC ("CSMS"), a disregarded entity of CareSource, a related organization to CareSource Georgia Co.: Erhardt Preitauer, Jai Pillai, David Finkel, David Goltz, Daniel McCabe, and Bobby Jones. 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 All compensation amounts reported on Schedule J, Part II for all listed persons are paid by CareSource Management Services LLC ("CSMS"), a disregarded entity of CareSource, a related organization to CareSource Georgia Co. Compensation paid to the CEO is pursuant to the terms of a written employment agreement between Mr. Preitauer and CareSource. Form 990, Part III, Question 2 See Attachment 1 for a description of CareSource Georgia Co.'s new Marketplace plan offered through the Federal Health Insurance Exchange, which began in 2020. Form 990, Part V, Line 1a In early 2020, CSGA 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, Question 6 CareSource is the sole member of CareSource Georgia Co. CareSource is recognized as exempt from federal income taxation under Internal Revenue Code ("IRC") Section 501(c)(3). Form 990, Part VI, Section B, Question 11B The Form 990 was provided to the organization's Audit committee for their review of the return prior to the time of filing Form 990. The Form 990 was made available to each voting member of the governing body of the organization for their review prior to the time of filing Form 990. The Form 990 was reviewed by the CEO, CFO, VP Treasury, Director Tax, Manager Tax, an outside CPA firm, outside legal counsel, and by general counsel prior to filing Form 990 with the IRS. 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 sign a statement which affirms that such person has reviewed the Statement of Ethical Behavior and Conflict of Interest and Conflicts of Interest Corporate Governance Principles. In connection with any actual or possible conflicts of interest, an interested person must disclose the existence of his or her financial or conflict of interest and must be given the opportunity to disclose all material facts to the directors and members of committees with Board delegated powers considering the proposed transaction or arrangement. After disclosure of the financial interest and all material facts, and after any discussion with the interested person, he/she shall leave the Board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining Board or committee members shall decide if a conflict of interest exists. An interested person may make a presentation at the Board or committee meeting, but after such presentation, he/she shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in the conflict of interest. The conflicted director has no vote on the matter involved with the conflict of interest. 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 Georgia Secretary of State's website at www.sos.ga.gov. CareSource PO Box 8738 Dayton OH 45401 311703368 Supporting OH 501(c)(3) 509(a)(3)II NA false CareSource Indiana Inc 135 N Pennsylvania St 1300 Indianapolis IN 46204 320121856 Medicaid HMO IN 501(c)(3) 509(a)(2) CareSource false CareSource Kentucky Co 101 Enterprise Drive Frankfort KY 40601 464991603 Exchange HMO KY 501(c)(3) 509(a)(2) CareSource false CareSource West Virginia Co 400 Washington St 401 Charleston WV 25301 473028244 Exchange HMO WV 501(c)(3) 509(a)(2) CareSource false CareSource Life Services Co PO Box 8738 Dayton OH 45401 811602217 Inactive OH 501(c)(3) 509(a)(2) CareSource false CareSource Ohio Inc PO Box 8738 Dayton OH 45401 311143265 Medicaid HMO OH 501(c)(3) 509(A)(2) CareSource false The CareSource Foundation PO Box 8738 Dayton OH 45401 562582561 Supporting OH 501(c)(3) 509(A)(3) I CareSource false CareSource Mgmt Grp Fdn (Dissolved 720) PO Box 8738 Dayton OH 45401 814170497 Grantmaking OH NA C Corp CareSource Virginia Co PO Box 8738 Dayton OH 45401 811727271 Inactive VA NA C Corp CareSource Arkansas Health Plan Co 300 Spring Bldg Ste 900 Little Rock AR 72201 844476729 Inactive AR NA C Corp Kids' CareAlliance Co PO Box 8738 Dayton OH 45401 854038326 Inactive OH NA C Corp CareSource Oklahoma Health Plan Co 14201 Wireless Way Suite D-100 Oklahoma City OK 73134 854038326 Inactive OK NA C Corp false false false false true false false false false false false true true false true true true true