2025-11-14T17:58:42-06:00 2024-12-31 420714325 RSM US LLP 6 S Patterson Blvd Dayton OH 45402 990 2024-01-01 320121856 CareSource Indiana Inc CARE 9372243300 Po Box 8738 Dayton OH 454018738 Lawrence Smart CFO 9372243300 2025-11-14 1 0 Karen O Crim P00368385 9372980201 2024 2025-03-06 01:10:19Z Steve Smitherman Same as C above Dayton OH 45401 2678091325 0 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 1200967368 1309520427 17700384 15265644 0 0 1218667752 1324786071 0 0 0 0 0 0 0 0 0 1112999592 1304987103 1112999592 1304987103 105668160 19798968 463855622 437371962 303059245 281190899 160796377 156181063 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. (continued on Schedule O)CareSource Indiana, Inc. is a health maintenance organization licensed by the state of Indiana and serves members through Marketplace, Medicaid, Healthy Indiana, and Hoosier Healthwise Plans. 0 1 1147270796 1309520427 CareSource Indiana, Inc. ("CSIN") is a nonprofit organization established under the state law of Indiana. On February 2, 2007, CSIN received a determination letter from the Internal Revenue Service, recognizing CSIN as an organization exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code, effective as of the date of CSIN's formation. CSIN is a member of the CareSource group of nonprofit tax-exempt organizations (the "CareSource Public Charities"). (Continued on Schedule O)The sole member of the CareSource Public Charities 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 Public Charities' primary activity for the last three decades has been to provide nonprofit Medicaid, Medicare, and Marketplace health maintenance organization ("HMO") services.As a mission-driven organization, CSIN follows the guidance of the CareSource Public Charities and is focused on transforming health care with innovative programs that address the social determinants of health, health equity, prevention and access to care. CSIN has served Hoosiers since 2016 with CareSource Marketplace plans. In 2017, CSIN was selected to serve Healthy Indiana Plan ("HIP") and Hoosier Healthwise ("HHW") Members. Since then, the health plan has launched a number of innovative programs including the CareSource Re-entry Program to ensure the successful transition of justice-involved individuals back into communities, as well as initiatives to remove barriers to health care, housing, employment, and maternal and infant health and to improve health equity.The State of Indiana requires all Medicaid plans to offer certain benefits, however, we offer so much more. Members enrolled in our CSIN plans have access to the following services:(1) Life Coaches who work with Members to connect them to community resources, provide support with educational & employment goals, and help coordinate rides to non-medical appointments in the community,(2) CareSource24, nurse advice line, (3) Care managers who can assist with housing, medical equipment, utilities and other urgent basic needs,(4) Rewards programs for all Members,(5) A free message three times per week, timed to the due date or baby's birth date, through pregnancy and up until the baby's first birthday,(6) One-on-one medication review and consultation with the pharmacist to ensure medications are appropriate and safe,(7) Telemedicine access to a doctor using a phone or computer, (8) CareSource mobile app for access to Member ID card, "how-to" videos and a quick search for doctors, and (9) Programs for asthma, ADHD, addiction, autism, behavioral health, chronic kidney disease and more.2024 Highlights:(1) CSIN supported the Bowen Health Clinic's Empowerment Art Competition, which awarded scholarship money to students at Fort Wayne's Northrop High School who created artwork which will be displayed at Bowen Clinic locations.(2) CSIN expanded our Bumps and Babies Fair to 8 locations across the state, connecting pregnant women and new families to critical resources to help them and their families live better lives.(3) CSIN worked with The City League and John Boner Centers in Indianapolis to launch a Health, Job, and Resource Fair connecting the community to resources just in time for Back To School.(4) CSIN supported Back To School events all across the state, including at La Casa De Amistad, Westminster Neighborhood Services, John Boner Center, Shalom Healthcare Center, Shepherd Community Center, Covering Kids and Families and more.(5) CSIN worked with partners at Indiana Pacers, Indianapolis Colts, Indiana University, Gary Railcats, South Bend Cubs, Fort Wayne Komets, Fort Wayne Tin Caps, and Indy Eleven to sponsor various programming that supports underserved populations. These included youth camps, reading programs, school field trips, and more.(6) CSIN hosted several vaccination events across the state, helping to prevent the spread of Covid, Flu, MMR, and other communicable diseases. 1147270796 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 11 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X Lawrence Smart 9372243300 PO Box 8738 Dayton OH 454018738 Erhardt Preitauer Chair/Director 8.00 52.00 X X 0 6076721 6124441 Lawrence Smart CFO, Treasurer/Director 8.00 52.00 X X 0 1657234 1813852 Steve Smitherman President/Director 59.00 1.00 X X 0 1029377 431714 Richard Topping Secretary (To 5/31) 8.00 52.00 X 0 2659280 831276 Edward Stubbers Secretary (Eff 6/1) 8.00 52.00 X 0 1060829 1137246 Stephanie Williams Assistant Treasurer 10.00 50.00 X 0 936707 1020408 Jai Pillai Former Chief Operating Ofr 0.00 0.00 X 0 244761 0 0 13664909 11358937 0 1 1 0 Express Scripts Inc One Express Way St Louis MO 63121 Pharmacy Services 318951966 Scion Dental N92 W14612 Anthony Avenue Menomonee Falls WI 53051 Medical Services 26550216 Superior Vision Services Inc 99 Elkridge Landing 200 Linthicum MD 21090 Medical Services 6185608 LCP Transportation LLC 4308 Guion Rd Indianapolis IN 46254 Transportation Services 4360198 DentaQuest Group Inc 465 Medford St Boston MA 02129 Medical Services 2322771 8 Medicaid 524114 786602958 786602958 Federal Health Insurance Exchange 524114 522917469 522917469 1309520427 15237185 15237185 1353333713 1353305254 28459 28459 28459 1324786071 1309520427 0 15265644 382130 12901 369229 48124 4699 43425 21132 371 20761 248706 248706 41592950 2167248 39425702 4454850 22290 4432560 24382600 4829 24377771 2612371 2612371 668861 59026 609835 651290 651290 Medical Expenses 891106453 891106453 Pharmacy Expenses 239795601 239795601 Mgmt Fees CareSource Mg 81559681 13861117 67698564 Hlth Ins Provider & PCO 11975195 11975195 5487159 236261 5250898 1304987103 1147270796 157716307 0 154743604 137289534 54699249 92564815 75590 109446 254337179 207408167 463855622 437371962 134495335 172832707 162629383 102980764 5934527 5377428 303059245 281190899 X 160796377 156181063 160796377 156181063 463855622 437371962 X 19798968 585718 -25000000 X 0 1 X 1 0 X 750157227 989801374 1029880554 1200967368 1309520427 5280326950 750157227 989801374 1029880554 1200967368 1309520427 5280326950 0 0 0 5280326950 953950 406768 6233053 17700384 15237185 40531340 953950 406768 6233053 17700384 15237185 40531340 751111177 990208142 1036113607 1218667752 1324757612 5320858290 0.99240 0.99440 0.00760 0.00560 X 0 0 0 0 0 0 0 0 1 42264 42264 0 Part II-B, Line 1: Form 990, Schedule C, Part II-B, Line 1i $42,264 is the allocable portion of the Organization's dues paid to Indiana Association of Health Plans and America's Health Insurance Plans for lobbying and grassroots efforts conducted by the trade association on behalf of its members. 0 Related Party Payable 5377428 5377428 X 1324582074 0 1324582074 213637 -9640 203997 1324786071 1304773468 0 1304773468 213635 213635 1304987103 Part X, Line 2: 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 2021-2023 are open for audit by the Internal Revenue Service. Part XI, Line 4b - Other Adjustments: STAT-to-GAAP Adjustment 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 member 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, Lines 4b and Part XII, Line 4b, are comprised of the STAT-to-GAAP adjustments. 1 1 0 0 0 0 0 0 0 Erhardt Preitauer Chair/Director 0 1407328 0 2654031 0 2015362 0 6101217 0 23224 0 12201162 0 3942595 Richard Topping Secretary (To 5/31) 0 279104 0 561640 0 1818536 0 815252 0 16024 0 3490556 0 1122987 Lawrence Smart CFO, Treasurer/Director 0 589886 0 570124 0 497224 0 1794168 0 19684 0 3471086 0 656889 Edward Stubbers Secretary (Eff 6/1) 0 452231 0 322470 0 286128 0 1117562 0 19684 0 2198075 0 441638 Stephanie Williams Assistant Treasurer 0 368179 0 362976 0 205552 0 1003011 0 17397 0 1957115 0 479710 Steve Smitherman President/Director 0 415160 0 343899 0 270318 0 414940 0 16774 0 1461091 0 495984 Jai Pillai Former Chief Operating Ofr 0 0 0 0 0 244761 0 0 0 0 0 244761 0 0 Form 990, Schedule J, Part I, Question 3: CareSource Management Services LLC ("CSMS"), a related entity, utilizes a compensation committee, independent compensation consultant, compensation survey or study, and review of Form 990 of other organizations. Form 990, Schedule J, Part I, Question 4a: CSMS made severance payments to Richard Topping and Jai Pillai during the calendar year. The payments are included in Part VII, Column E and it is reported on Schedule J, Part II, Column B(iii). The terms and conditions of the confidential severance agreements are available to the Internal Revenue Service upon request. Form 990, Schedule J, Part I, Question 4b: CSMS provides certain corporate officers, directors, key employees, and highly compensated executives with a supplemental nonqualified retirement plan. Amounts are accrued monthly for plan participants. The plan provides 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 plan provides for normal terms and conditions contained in a standard nonqualified retirement plan. The following listed person was paid under the plan in 2024: Richard Topping $39,893. The payment is included in Part VII, Column E and it is reported on Schedule J, Part II, Column B(iii). CSMS provides certain corporate officers, directors, key employees, and highly compensated executives with a long-term incentive plan. The plan provides compensation to the participants based on annual and long-term goals. The plan will pay out if these goals, or a subset of these goals, are achieved over a three-year period. The amounts are subject to forfeiture if certain employment conditions and vesting periods are not met. Amounts are included in Part VII, Column F and reported on Schedule J, Part II, Column C when accrued and included in Part VII, Column E and reported on Schedule J, Part II, Column B(iii) in the year paid. The following listed persons participated in and were paid under the plan in 2024: Erhardt Preitauer $1,516,425; Lawrence Smart $371,773; Richard Topping $774,290; Edward Stubbers $188,273; Steve Smitherman $182,442; and Stephanie Williams $128,076. CSMS provides certain corporate officers, directors, key employees, and highly compensated executives with a management incentive plan. The plan provides compensation to the participants based on certain financial measurements of the Company, which are calculated annually. The plan will pay out if the targets are achieved over a three-year period. If a participant leaves their employment prior to this three-year performance period, they may be entitled to a pro-rated payment if the targets are achieved over the three-year period. Amounts are included in Part VII, Column F and reported on Schedule J, Part II, Column C when accrued and included in Part VII, Column E and reported on Schedule J, Part II, Column B(iii) in the year paid. No amounts were paid in 2024 under the plan. Form 990, Schedule J, Part II: All compensation amounts reported on Schedule J, Part II for all listed persons are paid by CSMS. Form 990, Part III, line 3 CareSource Indiana, Inc. ceased offering a Medicare Advantage Plan effective January 1, 2024. Form 990, Part VI, Section A, line 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, line 7a CareSource, the sole member of CareSource Indiana, Inc., has the authority to appoint CareSource Indiana, Inc.'s board. Form 990, Part VI, Section A, line 7b The Audit Committee, Risk Committee, and Compensation Committee of CareSource, the sole member of CareSource Indiana, Inc., have full authority as committees to act on behalf of CareSource Indiana, Inc. to the extent permitted by applicable law. Each Committee's duties, responsibilities, and membership shall be defined by the respective Committee's charter. Form 990, Part VI, Section B, line 11b The Form 990 was provided to each voting member of the filing organization's governing body for review prior to filing. Additionally, the Form 990 was reviewed by CareSource's Audit Committee, VP Treasury, Internal Tax Department, and Internal General Counsel as well as an external CPA firm and legal counsel. Form 990, Part VI, Section B, line 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, line 19 CareSource Indiana Inc.'s ("the Company") 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. Form 990, Part XI, line 9: Distribution to CareSource -25,000,000. CareSource PO Box 8738 Dayton OH 454018738 311703368 Supporting OH 501(c)(3) Line 12b, II N/A 0 CareSource Kentucky Co PO Box 8738 Dayton OH 454018738 464991603 HMO Ins Plan KY 501(c)(3) Line 10 CareSource 0 CareSource Georgia Co PO Box 8738 Dayton OH 454018738 472408339 HMO Ins Plan GA 501(c)(3) Line 10 CareSource 0 CareSource West Virginia PO Box 8738 Dayton OH 454018738 473028244 HMO Ins Plan WV 501(c)(3) Line 10 CareSource 0 CareSource Life Services Co (Dissolved 111524) PO Box 8738 Dayton OH 454018738 811602217 No activity OH 501(c)(3) Line 10 CareSource 0 CareSource Ohio Inc PO Box 8738 Dayton OH 454018738 311143265 HIC Ins Plan OH 501(c)(3) Line 10 CareSource 0 The CareSource Foundation PO Box 8738 Dayton OH 454018738 562582561 Grantmaking OH 501(c)(3) Line 12b, II CareSource 0 CareSource Diversity & Social Impact Investment Fund LLC 50 East 91st Street Suite 213 Indianapolis IN 46240 871811106 Investing DE N/A 0 0 CareSource Midwest Fund LLC 415 12th Ave SE Cedar Rapids IA 52401 883585337 Investing DE N/A 0 0 ImagineCare Holdings LLC PO Box 8738 Dayton OH 454018738 932340017 Holding Co DE N/A 0 0 HAP Empowered Holding LLC PO Box 8738 Dayton OH 454018738 923877012 Holding Co DE N/A 0 0 CareSource Bayou Holding LLC PO Box 8738 Dayton OH 454018738 883042610 Holding Co DE N/A 0 0 CareSource Virginia Co (Dissolved 101724) PO Box 8738 Dayton OH 454018738 811727271 No activity VA N/A C 0 CareSource Arkansas Health Plan Co PO Box 8738 Dayton OH 454018738 844476729 COA Insurance AR N/A C 0 Kids' CareAlliance Co (Dissolved 111324) PO Box 8738 Dayton OH 454018738 854022039 No activity OH N/A C 0 CareSource Oklahoma Health Plan Co PO Box 8738 Dayton OH 454018738 854038326 HMO Ins Plan OK N/A C 0 CareSource Kansas LLC PO Box 8738 Dayton OH 454018738 873411276 HMO Ins Plan KS N/A C 0 CareSource Passe LLC PO Box 8738 Dayton OH 454018738 863112470 RBPO Ins Plan AR N/A C 0 Columbus Organization Holdings LLC PO Box 8738 Dayton OH 454018738 814132952 Holding Co DE N/A C 0 CareSource Tennessee Co PO Box 8738 Dayton OH 454018738 874254502 COA Insurance TN N/A C 0 Columbus Medical Services Inc PO Box 8738 Dayton OH 454018738 300975112 No activity MD N/A C 0 CareSource North Carolina Co PO Box 8738 Dayton OH 454018738 873079479 HMO Ins Plan NC N/A C 0 CareSource Iowa Co (Dissolved 112624) PO Box 8738 Dayton OH 454018738 881429834 HMO Ins Plan IA N/A C 0 CareSource Florida Co PO Box 8738 Dayton OH 454018738 883601120 HMO Ins Plan FL N/A C 0 CareSource Bayou Health LLC PO Box 8738 Dayton OH 454018738 883401520 HMO Ins Plan TX N/A C 0 CareSource Military & Veterans Co PO Box 8738 Dayton OH 454018738 932552094 Tricare CPD OH N/A C 0 GCRE Protected Cell No 3 - CS LLC PO Box 8738 Dayton OH 454018738 933077861 Captive Ins MT N/A C 0 HAP CareSource New Center One Ste 110 3031 W Grand Detroit MI 48202 383123777 HMO Ins Plan MI N/A C 0 CareSource Reinsurance II LLC PO Box 8738 Dayton OH 454018738 872901879 Captive Ins MT N/A C 0 GCRE Protected Cell No 2 - MS LLC (Incorporated 42524) PO Box 8738 Dayton OH 454018738 992726467 Captive Ins MT N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 0