2020-11-16T08:03:26-06:00 2019-12-31 990 2019-01-01 473028244 CareSource West Virginia Co % JANET FERNANDES CARE 9375313027 400 Washington St Suite 401 Charleston WV 25301 DAVID W GOLTZ CFO 9375313027 2020-11-13 208.90.148.16 31250220203215000000 2020-11-16 P E5D0B402C5057AD00F81B6842CF73C21495794A5 8206126091B024FA09C0B25049ACF7F162FD2A36 2019 2021-01-29 14:40:06Z Erhardt Preitauer PO Box 8738 Dayton OH 45401 52362618 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 0 50427213 51977728 236383 384890 0 0 50663596 52362618 0 0 0 0 0 0 0 0 0 56498574 51529493 56498574 51529493 -5834978 833125 25009769 27324026 21951252 23432384 3058517 3891642 X TO MAKE A LASTING DIFFERENCE IN OUR MEMBERS' LIVES BY IMPROVING THEIR HEALTH AND WELL-BEING. CARESOURCE WEST VIRGINIA CO PROVIDES LOW-COST COMPREHENSIVE HEALTH INSURANCE COVERAGE FOR UNINSURED INDIVIDUALS THROUGH A QUALIFIED HEALTH PLAN ON THE WEST VIRGINIA HEALTH INSURANCE MARKETPLACE. false false 43645109 0 51977728 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. 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 began offering a Qualified Health Plan ("QHP") on the West Virginia Health Insurance Marketplace beginning in January 2016, providing low-cost comprehensive coverage for uninsured individuals and families. CSWV is accredited for its QHP through the National Committee for Quality Assurance ("NCQA"). 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. 43645109 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 0 0 0 false false false false false false false false false false false false X 3 0 false false true false true true false true true false false true true true true true true false false false WV X JANET FERNANDES 9375313027 PO BOX 8738 Dayton OH 454018738 X Erhardt Preitauer President & CEO/Former Dir 5.0 55.0 X 0 3061457 1899707 David Goltz Chief Financial Officer 5.0 55.0 X 0 1395705 523051 Jai Pillai Chief Operating Officer 3.0 57.0 X 0 837370 495728 David Finkel Executive VP, Markets/Chair 14.0 46.0 X X 0 826297 407546 Daniel McCabe Chief Administrative Officer 2.0 66.0 X 0 737231 410495 L Tarlton Thomas III Former Chief Operating Officer 0.0 0.0 X 0 1107296 3517 Michael Taylor President, Market/Sec/Treas 20.0 40.0 X X 0 590016 241858 William Coffin VP, Market Finance/Director 10.0 50.0 X 0 524876 144232 Ellen Leffak Former Director 0.0 0.0 X 0 210000 0 0 9290248 4126134 0 true true false WV University Hospitals Related O PO Box 8034 MORGANTOWN WV 265068034 Medical Services 15772301 United Hospital Center Inc Affili 327 Medical Park Drive BRIDGEPORT WV 26330 Medical Services 14453984 CVS Caremark 9501 E Shea Blvd MC 019 SCOTTSDALE AZ 85260 Pharmacy Services 8450107 St Marys Medical Center Inc Affil 2900 1st Ave Ste H-08 HUNTINGTON WV 25702 Medical Services 8001200 Herbert J Thomas Memorial Hospital 4605 Maccorkle Ave SW SOUTH CHARLESTON WV 25309 Medical Services 2619189 32 0 FEDERAL HEALTH INSURANCE EXCHANGE 524114 51977728 51977728 51977728 384890 384890 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 52362618 51977728 384890 0 0 0 0 0 0 0 0 0 0 0 18649 18649 42056 42056 16000 16000 0 0 1270788 306502 964286 237009 237009 621445 4181 617264 0 0 159020 159020 0 0 52048 2386 49662 543657 543657 0 0 0 MEDICAL 36941802 36941802 PHARMACY 6098100 6098100 MGMT FEES CARESOURCE MGMT GRP 2926163 292138 2634025 HLTH INS PROVIDER & PCORI FEES 2594634 2594634 8122 8122 51529493 43645109 7884384 0 X 100000 100000 22931230 23938785 0 0 1978539 3285241 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25009769 27324026 8139979 7992366 0 0 12848379 9422779 0 0 0 0 0 0 0 0 0 0 962894 6017239 21951252 23432384 X 3058517 3891642 0 0 3058517 3891642 25009769 27324026 833125 X false true X true false X 0 0 0 0 0 0 5403835 32166127 50427213 51977728 139974903 0 0 0 0 5403835 32166127 50427213 51977728 139974903 0 0 0 139974903 12 758 38829 236383 384890 660872 0 12 758 38829 236383 384890 660872 0 0 12 5404593 32204956 50663596 52362618 140635775 X 0.00000 false false false false false false true 32000 false false 32000 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 6017239 6017239 X FIN 48 (ASC 740) Footnote As outlined in the CareSource Management Group Co.'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 2016-2019 are open for audit by the Internal Revenue Service. true true false false false false false false false Erhardt Preitauer President & CEO/Former Dir 0 1026966 0 1250500 0 783991 0 1863100 0 36607 0 4961164 0 1163393 David Goltz Chief Financial Officer 0 555838 0 215000 0 624867 0 502115 0 20936 0 1918756 0 325000 Jai Pillai Chief Operating Officer 0 469413 0 237500 0 130457 0 480287 0 15441 0 1333098 0 237500 David Finkel Executive VP, Markets/Chair 0 433074 0 167500 0 225723 0 389425 0 18121 0 1233843 0 0 Daniel McCabe Chief Administrative Officer 0 419863 0 164136 0 153232 0 383840 0 26655 0 1147726 0 164136 Michael Taylor President, Market/Sec/Treas 0 238033 0 181948 0 170035 0 210664 0 31194 0 831874 0 168198 William Coffin VP, Market Finance/Director 0 301199 0 98746 0 124931 0 123296 0 20936 0 669108 0 0 L Tarlton Thomas III Former Chief Operating Officer 0 20184 0 0 0 1087112 0 1305 0 2212 0 1110813 0 481103 Ellen Leffak Former Director 0 210000 0 0 0 0 0 0 0 0 0 210000 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 Group Co. ("CSMG"), a related organization, has in place Clawback provisions within its executive compensation plans that generally require executives to pay back compensation to CSMG 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 4a L Tarlton Thomas III 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 a related organization, CSMG: Erhardt Preitauer, David Goltz, Jai Pillai, David Finkel, Daniel McCabe, Michael Taylor, William Coffin, and L Tarlton Thomas III. 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, CSMG: Erhardt Preitauer, David Goltz, Jai Pillai, David Finkel, Daniel McCabe, 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 vesting period, they forfeit any amounts accrued under this plan. Amounts paid and accrued in 2019 for both deferred compensation arrangements include the following: Erhardt Preitauer $1,381,150, David Goltz $501,682, Jai Pillai $263,728, David Finkel $328,471, Daniel McCabe $260,419, Michael Taylor $214,925, William Coffin $60,555, and L Tarlton Thomas III $746,689. 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 CSMG, a related organization to CareSource West Virginia Co.: Erhardt Preitauer, David Goltz, Jai Pillai, David Finkel, Daniel McCabe, Michael Taylor, and William Coffin. All of these listed persons are 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 CSMG, a related organization to CareSource West Virginia Co. Compensation paid to the CEO is pursuant to the terms of a written employment agreement between Mr. Preitauer and CSMG. Form 990, Part VI, Section A, Question 4 CareSource West Virginia Co. filed amended ByLaws effective January 1, 2019. The amended ByLaws include the following changes: (1) The independence requirement for Directors was removed; (2) Term Limits for any Director who holds the Director position by virtue of his/her employment with CareSource were removed; (3) The difference between Board Officers and Corporate Officers was explained; (4) The term of Board officers was changed from 1 year to 2 years; (5) Corporate Officers titles, terms, and duties were identified; (6) It was established that the Corporation's Committees operate at the holding company level through CareSource Management Group Co., the sole member of the Corporation; and (7) The recipient of proceeds upon dissolution was changed from The CareSource Foundation to the CareSource Management Group Foundation, provided CareSource Management Group Foundation is exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code at the time of any such distribution. Form 990, Part VI, Section A, Question 6 CareSource Management Group Co ("CSMG") is the sole member of CareSource West Virginia Co. CSMG 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 Finance 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, 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 West Virginia Secretary of State's website at www.sos.wv.gov/. CareSource Management Group Co 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) CSMG false CareSource Georgia Co 600 Galleria Pkwy 400 Atlanta GA 30339 472408339 Medicaid HMO GA 501(c)(3) 509(a)(2) CSMG false CareSource Kentucky Co 10200 Forest Green Blvd 400 Louisville KY 40223 464991603 Exchange HMO KY 501(c)(3) 509(a)(2) CSMG false CareSource Life Services Co PO Box 8738 Dayton OH 45401 811602217 Inactive OH 501(c)(3) 509(a)(2) CSMG false CareSource Management Services Co PO Box 8738 Dayton OH 454018738 311703371 Adm Mgmt Svcs OH NA C Corp 0 0 0.00000 false CareSource Mgmt Grp Foundation PO Box 8738 Dayton OH 45401 814170497 Grantmaking OH NA C Corp 0 0 0.00000 false CareSource Virginia Co PO Box 8738 Dayton OH 45401 811727271 Inactive VA NA C Corp 0 0 0.00000 false false false false false true false false false false false false false true false true true true true