2020-11-16T08:03:26-06:00 2019-12-31 990 2019-01-01 311143265 CareSource % JANET FERNANDES CARE 9375313027 PO Box 8738 Dayton OH 454018738 DAVID W GOLTZ CFO 9375313027 2020-11-13 208.90.148.16 31250220203215000005 2020-11-16 P E5D0B402C5057AD00F81B6842CF73C21495794A5 8206126091B024FA09C0B25049ACF7F162FD2A36 2019 2021-01-29 14:40:06Z Erhardt Preitauer Same as C above Dayton OH 45401 8442021639 false X www.caresource.com X 1985 OH To make a lasting difference in our members' lives by improving their health and well-being. CareSource offers services for Medicaid, Medicare and Federal Exchange members. 9 6 0 0 0 0 114330 5280285 7762642282 8096836756 56581042 48092928 0 0 7819337654 8150209969 30000 89493 0 0 0 0 0 0 0 7743250827 8094956860 7743280827 8095046353 76056827 55163616 1807957209 1989749142 953260405 1071661337 854696804 918087805 X CARESOURCE'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 IS A MISSION-DRIVEN MEDICAID HEALTH INSURING CORPORATION (COMMONLY REFERRED TO AS A HEALTH MAINTENANCE ORGANIZATION) LICENSED BY THE STATE OF OHIO. false false 7619485967 0 8096836756 CareSource, a leading nonprofit managed care organization based in Dayton, Ohio, has been living its mission to make a lasting difference in members' lives by improving their health and well-being for more than 30 years. CareSource serves 1.26 million members in Ohio. CareSource's membership includes: (1) Medicaid consumers, including families with low income, children, pregnant women, adoption and foster kids, those who are aged, blind or disabled, 2) Medicaid consumers who are eligible for Home and Community Based services through execution of an annual Provider Agreement with the Ohio Department of Medicaid ("ODM"), (3) Dually eligible consumers for Medicare and Medicaid through Ohio's Dual Demonstration program, MyCare, (4) Medicare Advantage consumers, (5) a Qualified Health Plan offered through the Federal Health Insurance Marketplace, providing low-cost comprehensive coverage for individuals and families, and (6) Community Transition Program consumers who are transitioning from the Ohio Department of Rehabilitation and Correction back to the community through a grant from the Ohio Department of Mental Health and Addiction Services. CareSource Program Services: 1) CareSource Ohio Medicaid: CareSource pioneered Ohio's first mandatory Medicaid managed care program in 1989 and is now one of the largest Medicaid managed care plans in the country. CareSource's years of experience in managing Medicaid managed care programs and member-focused approach to care have allowed it the opportunity to forge strong, positive regulatory relationships with state agencies, including departments of insurance. CareSource has earned 52.6% of the statewide Medicaid managed care market share, with the highest voluntary enrollment rate and the lowest voluntary disenrollment rate of all Ohio participating Medicaid Managed care plans. CareSource focuses on prevention with a goal of improving member health, the quality of health care services received, and accessibility of health care services for Medicaid members. CareSource has made an organizational commitment to make evidence-based investments towards improving health outcomes for members. CareSource's approach is one that blends the recommendations of the Triple Aim framework and principles of population health management best practice, while leveraging emerging technological and analytic solutions to make measurable positive impacts in the health of the communities we serve. CareSource also has significant focus on creating social based partnerships with providers and community organizations to support a longitudinal health management effort for members. Providers have the most control and influence on members and thus provide the best opportunity to help capitalize on cost, quality, and experience. Partnering with providers allows us to collaborate on population health strategies such as emergency department diversion, patient-centered medical home implementation, and performance management. Engaging our high-risk members' primary care and specialty providers is particularly critical to achieving successful care management. CareSource has a broad, statewide network of more than 45,000 providers, including primary care and specialist physicians, hospitals, nursing facilities, home health care agencies and other medical providers who provide medical services as well as assist in the coordination of member care. To further drive quality and achieve health outcomes targets, CareSource incentivizes certain providers through a value-based incentive model. CareSource focuses efforts on creating incentives and reimbursement options to support models that recognize quality at the provider level. CareSource created a program that provides additional incentives to providers for delivering quality based services that impact Healthcare Effectiveness Data and Information Set ("HEDIS") measures. CareSource created a shared savings model that rewards providers for attaining quality targets while sharing savings. In this particular model, CareSource established "filters" such that providers have to meet or exceed quality metrics before being eligible to share in cost savings. Value-based incentive models ultimately result in improved member health outcomes as providers continue to deliver quality service with the member's health and safety at the forefront. Effective high-risk case management alone is not sufficient to improve the overall population's health or decrease costs. Therefore, CareSource has created a robust care management infrastructure that consists of three levels of member care to accelerate care transformation for each and every member. Members are assigned to self-management, rising risk, or high-risk based on their unique member risk stratification. CareSource can then tailor the care coordination program to meet those members' needs. Members receive enhanced care coordination services based on their complex physical, behavioral and social health needs. The fluidity of this design allows CareSource to focus on preventing lower-risk and rising risk members from escalating to high-risk over time, while still tending to the one-to-one care management needs of high-risk populations. CareSource collaborates with community partners and providers such as the Area Agencies on Aging ("AAA"), Community Mental Health Centers, local pharmacies, and Federally Qualified Health Centers ("FQHCs") to ensure members receive the services they need. Additionally, CareSource's Enterprise Quality team helps drive improved clinical outcomes for members through a number of HEDIS targeted interventions including member engagement, education and disease management programs. To further enhance our HEDIS metric initiatives, CareSource has an established dedicated Quality team which works hand-in-hand with our Enterprise team as well as across all departments that impact quality clinical outcomes for our members. CareSource offers a 24/7 Nurse Advice Line staffed by Registered Nurses to help members access appropriate care and divert unnecessary emergency department visits. CareSource's commitment to quality is demonstrated through the organization's National Committee for Quality Assurance ("NCQA") accreditation. CareSource is accredited by NCQA for its qualified Health Insurance Marketplace and Medicaid Health plans. Accreditation demonstrates CareSource's commitment to quality and enhances CareSource's ability to improve the health and well-being of those we serve. CareSource utilizes the NCQA disease management definition and ensures the policy of CareSource to conduct appropriate disease management member identification and risk stratification, offering the appropriate interventions and education to the member. Through these efforts, the disease management programs focus simultaneously on achieving health and maintaining wellness to the highest level possible for each member. Any given member may be eligible for more than one condition. CareSource will engage members with the conditions of interest, or the parents/guardians of children with conditions of interest, through disease-specific and preventive care population-based interventions. The Disease Management program contains the following: program resources, program integration, provider notification and involvement, curriculum and content, NCQA requirements, and annual evaluation. The CareSource Women and Children's Health program is part of the corporate Care4U model of care and utilizes a population-based approach to meet the clinical and social needs of the women and children CareSource serves. The goal of the Care4U Women and Children's Health program is to maximize the quality of life and health outcomes of women, infants, children, and their families. The program employs a multi-faceted, evidence-based approach to achieve the best possible health outcomes by utilizing predictive analytics, case management, member incentive and educational programs, and community and provider partnerships. The Women and Children's Health program objectives include reducing the number of preterm births, reducing the risk of maternal and infant mortality and pregnancy-related complications, and reducing complications of health and development in infancy and early childhood. Elements of the program include: (1) Babies First - Babies First is available for all pregnant members. The program provides financial incentives for the completion of timely and ongoing prenatal, postpartum, and well-baby care, allowing the mother the opportunity to earn money for completion of doctor visits for both her infant and herself. Babies First requires that members must complete 5-7 prenatal visits, a post-partum visit within 21-56 days after delivery, the first 6-7 well baby visits prior to 15-18 months, and a lead screening by 15 months of age to receive incentives, and (2) Early and Periodic Screening, Diagnostic, and Treatment ("EPSDT"). The EPSDT benefit provides comprehensive and prevent 7619485967 true true 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 true false true false false false false false false false false false false false false false true true true false false true 11997 0 true 0 false false false false false false false false false false false false X 9 6 false false false false true false false true true false false true true true true true true false false false OH X JANET FERNANDES 9375313027 PO BOX 8738 Dayton OH 454018738 X Erhardt Preitauer CEO/Director 18.0 42.0 X X 0 3061457 1899707 David Goltz Chief Financial Officer 9.0 51.0 X 0 1395705 523051 Jai Pillai Chief Operating Officer 23.0 37.0 X 0 837370 495728 Daniel McCabe Chief Administrative Officer 10.0 58.0 X 0 737231 410495 L Tarlton Thomas III Former Chief Operating Officer 0.0 0.0 X 0 1107296 3517 Stephen Ringel President, Market 59.0 1.0 X 0 640571 361976 Michael Ervin MD Chairperson/Director 5.0 10.0 X X 0 225000 0 Ellen Leffak Director 5.0 15.0 X 0 210000 0 Craig Brown Vice Chairperson/Director 5.0 10.0 X X 0 180000 0 David Miller Director 5.0 10.0 X 0 138750 0 William Marsteller DC Secretary/Treasurer/Director 5.0 5.0 X X 0 82500 0 Douglas Fecher Director 5.0 0.0 X 0 75000 0 David Kaelber MD Director 5.0 0.0 X 0 67500 0 Gary LeRoy MD Director 5.0 0.0 X 0 0 0 0 8758380 3694474 0 true true false CVS Caremark 9501 E Shea Blvd MC 19 SCOTTSDALE AZ 85260 Pharmacy Services 2016196978 Childrens Hospital Medical Center 3333 Burnet Avenue CINCINNATI OH 45229 Medical Services 217476690 Childrens Hospital Physicians Net 700 Childrens Drive COLUMBUS OH 43205 Medical Services 216867534 The MetroHealth System 2500 MetroHealth Drive CLEVELAND OH 44109 Medical Services 211378910 The Cleveland Clinic Fdn Related 9500 Euclid Avenue CLEVELAND OH 44195 Medical Services 203668921 3042 5280285 5280285 MEDICAID 524114 7688021808 7688021808 PREMIUMS 524114 405797742 405797742 VETERANS REVENUE 524114 3017206 3017206 8096836756 32102562 32102562 0 0 0 0 0 307802036 291811670 15990366 15990366 15990366 0 0 0 0 0 0 0 0 0 0 8150209969 8096836756 48092928 89493 89493 0 0 0 0 0 0 0 0 0 0 3230695 15 3230680 341539 341539 233078 4958 228120 0 0 174590656 48577944 126012712 6390063 16279 6373784 41139519 951103 40188416 22420665 22420665 0 20985693 19518 20966175 4958209 1415212 3542997 0 0 634124 634124 0 0 1759759 1759759 MEDICAL EXPENSES 5702154799 5702154799 PHARMACY EXPENSES 1764973864 1764973864 MGMT FEES TO OTHER ENTITIES 338988918 100940668 238048250 PCORI & CMS/FFM USER FEES 11440476 11440476 714803 342114 372689 8095046353 7619485967 475560386 0 X 7739460 19591932 279744753 506326870 0 0 577346188 695286837 0 0 0 0 0 0 0 0 4168201 3876296 0 0 938678229 764274266 0 0 280378 392941 0 0 0 0 1807957209 1989749142 916911802 1010976945 0 0 18950321 13806569 0 0 0 0 0 0 0 0 0 0 17398282 46877823 953260405 1071661337 X 854696804 918087805 0 0 854696804 918087805 1807957209 1989749142 X 55163616 16076753 -7849368 X false true X true false X 0 0 8170454 114330 5280285 13565069 6170508774 6408383841 7182270383 7762642282 8090874825 35614680105 0 0 0 6170508774 6408383841 7190440837 7762756612 8096155110 35628245174 0 0 0 35628245174 28163835 32170503 29468385 40835548 32102562 162740833 0 28163835 32170503 29468385 40835548 32102562 162740833 0 0 6198672609 6440554344 7219909222 7803592160 8128257672 35790986007 0.99545 0.99504 0.00455 0.00496 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 389157 false true 76999 466156 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 $76,999 is the allocable portion of the Organization's dues paid to Ohio Association of Health Plans, America's Health Insurance Plans, and other Trade Associations for lobbying and grassroots efforts conducted by the trade association on behalf of its members. 0 RELATED PARTY PAYABLE 46877823 46877823 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: 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 The Dayton Foundation 500 Kettering Tower Dayton OH 45423 316027287 509(a)(1) 25000 General Support Greene County Community Foundation 3560 Pentagon Blvd Dayton OH 45431 311751001 501(c)(3) 10000 WPCU Sunshine Fund Dayton Contemporary Dance Company 840 Germantown St Dayton OH 45402 237220259 501(c)(3) 10000 General Support East End Community Services 624 Xenia Avenue Dayton OH 45410 311508554 501(c)(3) 10000 General Support Contribution Review The Organization may provide assistance to other Internal Revenue Code (IRC) Tax exempt charitable organizations in the form of charitable contributions. These contributions are unrestricted funds available for use by the charitable organization for the purpose the charitable organization deems necessary. The Organization is a supported organization to The CareSource Foundation (Foundation), a related IRC 501(C)(3) tax exempt organization, and will distribute funds to the Foundation in furtherance of its tax exempt purpose. The Foundation monitors use of these grants as part of its annual review process. Charitable Board Credit Contributions In support of CareSource's commitment to its charitable purposes, some of its appointed directors elect to earn charitable credits for each board meeting attended. At year-end, the directors designate their credits to their internal revenue code section 501(c)(3) tax exempt charity of choice. Charitable donations in the amount of $70,000 were paid or accrued in 2019 under this policy by the organization and are represented on Schedule I in the form of general support contributions. true true false false false false false false false Erhardt Preitauer CEO/Director 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 15441 0 1333098 0 237500 Daniel McCabe Chief Administrative Officer 0 419863 0 164136 0 153232 0 383840 0 26655 0 1147726 0 164136 Stephen Ringel President, Market 0 379585 0 143460 0 117526 0 334760 0 27216 0 1002547 0 143460 L Tarlton Thomas III Former Chief Operating Officer 0 20184 0 0 0 1087112 0 1305 0 2212 0 1110813 0 481103 Michael Ervin MD Chairperson/Director 0 225000 0 0 0 0 0 0 0 0 0 225000 0 0 Ellen Leffak Director 0 210000 0 0 0 0 0 0 0 0 0 210000 0 0 Craig Brown Vice Chairperson/Director 0 180000 0 0 0 0 0 0 0 0 0 180000 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") 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, CareSource Management Group Co. (CSMG): Erhardt Preitauer, David Goltz, Jai Pillai, Daniel McCabe, Stephen Ringel, 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, CareSource Management Group Co.: Erhardt Preitauer, David Goltz, Jai Pillai, Daniel McCabe, and Stephen Ringel. 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, Daniel McCabe $260,419, Stephen Ringel $196,045, 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: Erhardt Preitauer, David Goltz, Jai Pillai, Daniel McCabe, and Stephen Ringel. 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 CSMG, a related organization to CareSource. 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 6 CareSource Management Group Co. ("CSMG") is the member of CareSource. CSMG is a nonprofit corporation that is 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). Statutory financial statements for the organization are available on the Ohio Department of Insurance's website at www.ins.ohio.gov. The company's Form 990 is available on the U.S. nonprofit database website at www.guidestar.org. The company's Articles of Incorporation are available on the Ohio Secretary of State's website at www.sos.state.oh.us. Form 990, Part XI, Line 9 Change in net assets is inclusive of the following: (1) change in investment in subsidiary ($1,887,437) and (2) write off of advances paid to Behavioral Health providers ($5,961,931). The CareSource Foundation PO Box 8738 Dayton OH 45401 562582561 Supporting OH 501(c)(3) 509(a)(3) I NA true CareSource Management Group Co PO Box 8738 Dayton OH 45401 311703368 Supporting OH 501(c)(3) 509(a)(3)II NA false false true false false false false false false false false false false true false true true true true The CareSource Foundation B 2000000 Actual