2023-11-13T13:46:01-06:00 2022-12-31 RSM US LLP 6 S PATTERSON BLVD DAYTON OH 45402 990 2022-01-01 320121856 CareSource Indiana Inc % JANET FERNANDES CARE 9372243300 PO Box 8738 Dayton OH 454018738 Lawrence Smart CFO 9372243300 2023-11-15 true Lawrence Smart 999009999 Karen O Crim P00368385 9372980201 2 2022 2023-04-26 12:10:37Z Erhardt Preitauer Same as C above Dayton OH 45401 1127871043 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 989801374 1029880554 406768 6233053 0 0 990208142 1036113607 0 0 0 0 0 0 0 0 0 963967552 1049992612 963967552 1049992612 26240590 -13879005 434368652 478256817 346116450 407715332 88252202 70541485 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) false false 918677750 1029880554 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. (Continued on Schedule O) 918677750 true false false true false false false false false false false false false false true true true 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 12 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 9372243300 PO BOX 8738 Dayton OH 454018738 Erhardt Preitauer President & CEO 8.0 52.0 X 0 3656889 4253649 Jai Pillai Chief Operating Officer 8.0 52.0 X 0 1235514 871311 Lawrence Smart Chief Financial Officer 8.0 52.0 X 0 1072888 998867 Scott Markovich EVP Markets & Products, Dir 8.0 52.0 X 0 966866 950975 Daniel McCabe Chief Admin Officer (To 4/22) 1.0 59.0 X 0 1505969 14895 Steve Smitherman President Market, Director 59.0 1.0 X 0 637575 563955 Stephanie Williams SVP Ch Acty, Dir (Eff 4/22) 10.0 50.0 X 0 524391 577351 William Coffin Jr VP Mkt Finance, Dir (To 4/22) 10.0 50.0 X 0 524895 22301 David Finkel Former EVP Markets, Director 0.0 0.0 X 0 194579 0 0 10319566 8253304 0 true true false Express Scripts Inc 21653 Network Place CHICAGO IL 60673 Pharmacy Services 244202507 Skygen USA LLC W 140 N 8981 Lilly Rd MENOMONEE FALLS WI 53051 Medical Services 21877659 LCP Transportation LLC 4308 Guion Rd INDIANAPOLIS IN 46254 Transportation Svcs 3094405 Axial Healthcare Management Inc 209 10th Avenue South Suite 350 NASHVILLE TN 37203 Medical Services 2780182 Dentaquest Group Inc 465 Medford Street CHARLESTOWN ME 02129 Medical Services 1646988 10 0 MEDICAID 524114 587115657 587115657 FEDERAL HEALTH INSURANCE EXCHANGE 524114 442414596 442414596 MEDICARE ADVANTAGE 524114 350301 350301 1029880554 6306470 6306470 0 0 0 0 0 91684019 91757436 -73417 -73417 -73417 0 0 0 0 0 0 0 0 0 0 1036113607 1029880554 6233053 0 0 0 0 0 0 0 0 0 0 0 485719 31039 454680 0 159591 0 159591 0 45124 503 44621 0 0 111549 0 111549 33090916 2256917 30833999 0 3388679 11367 3377312 0 15911605 211478 15700127 0 0 0 2525375 0 2525375 0 392545 52319 340226 0 0 0 1193472 0 1193472 0 0 0 421792 0 421792 0 MEDICAL EXPENSES 715693475 715693475 0 0 PHARMACY EXPENSES 189612658 189612658 0 0 MGMT FEES CARESOURCE MGMT SVCS 64265208 9609715 54655493 0 HLTH INS PROVIDER & PCORI FEES 15142604 77422 15065182 0 7552300 1120857 6431443 1049992612 918677750 131314862 0 X 0 0 365662007 168650926 0 0 61242990 2540700 0 0 0 0 0 0 0 0 527696 762743 0 0 6935959 305287448 0 0 0 1015000 0 0 0 0 434368652 478256817 120951119 137116539 0 0 200408454 242263771 0 0 0 0 0 0 0 0 0 0 24756877 28335022 346116450 407715332 X 88252202 70541485 0 0 88252202 70541485 434368652 478256817 -13879005 -3831712 X false true X true false X 0 0 0 0 0 0 793585249 640981578 750157227 989801374 1029880554 4204405982 0 0 0 793585249 640981578 750157227 989801374 1029880554 4204405982 0 0 0 4204405982 2122635 737426 953950 406768 6233053 10453832 0 2122635 737426 953950 406768 6233053 10453832 0 0 795707884 641719004 751111177 990208142 1036113607 4214859814 0.99752 0.99874 0.00248 0.00126 X false false false false false false true 88367 false true 1881 90248 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 $1,881 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 28335022 28335022 X 1036219286 -3831712 3937391 105679 1036113607 1036113607 1048687592 1048687592 1305020 1305020 1049992612 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 2019-2021 are open for audit by the Internal Revenue Service. 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 parent 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, Line 2d and Part XII, Line 4b, are comprised of the GAAP-to-STAT adjustments. true true false false false false false false false Erhardt Preitauer President & CEO 0 1271556 0 1935465 0 449868 0 4232490 0 21159 0 7910538 0 1935465 Jai Pillai Chief Operating Officer 0 623475 0 478850 0 133189 0 856649 0 14662 0 2106825 0 478850 Lawrence Smart Chief Financial Officer 0 535956 0 424371 0 112561 0 975380 0 23487 0 2071755 0 424371 Scott Markovich EVP Markets & Products, Dir 0 505787 0 354760 0 106319 0 911682 0 39293 0 1917841 0 354760 Daniel McCabe Chief Admin Officer (To 4/22) 0 120152 0 1044619 0 341198 0 7379 0 7516 0 1520864 0 710581 Steve Smitherman President Market, Director 0 339156 0 226600 0 71819 0 523304 0 40651 0 1201530 0 223600 Stephanie Williams SVP Ch Acty, Dir (Eff 4/22) 0 339884 0 19972 0 164535 0 555141 0 22210 0 1101742 0 0 William Coffin Jr VP Mkt Finance, Dir (To 4/22) 0 44311 0 203209 0 277375 0 15188 0 7113 0 547196 0 242999 David Finkel Former EVP Markets, Director 0 0 0 0 0 194579 0 0 0 0 0 194579 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 compensation committee comprised solely of independent directors. CareSource Management Services LLC ("CSMS"), a related organization, has in place Claw back 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 Daniel McCabe, David Finkel, and William Coffin, Jr. received severance payments that are 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, Lawrence Smart, Scott Markovich, Steve Smitherman, and Stephanie Williams. 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, Lawrence Smart, Scott Markovich, Steve Smitherman, and Stephanie Williams. 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 performance period, they forfeit any amounts accrued under this plan. Employees must be employed on the date which the long-term incentive plan is paid, which in no event is later than March 15th. Exceptions to this general statement include death, disability, or a qualified retirement, which may result in prorated payment. Amounts paid or accrued in 2022 for both deferred compensation arrangements include the following: Erhardt Preitauer $2,272,354, Jai Pillai $375,388, Lawrence Smart $554,835, Scott Markovich $517,955, Steve Smitherman $282,573, and Stephanie Williams $288,979. Form 990, Schedule J, Part I, Question 6b The following persons listed on Form 990, Part VII, Section A, Line 1a are or were employees of CSMS: Erhardt Preitauer, Jai Pillai, Lawrence Smart, Scott Markovich, Daniel McCabe, Steve Smitherman, Stephanie Williams, William Coffin Jr, and David Finkel. All of these listed persons are or were eligible for a performance bonus as part of their compensation packages. The amount of this Annual Incentive Plan ("AIP") bonus is based on the degree of achievement of the Companies' goals and the Individual's goals, which is ultimately documented in the year end performance management process. 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 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 1 (Continued) CARESOURCE INDIANA, INC. IS A HEALTH MAINTENANCE ORGANIZATION LICENSED BY THE STATE OF INDIANA AND SERVES MEMBERS THROUGH MARKETPLACE, MEDICAID, DUAL ELIGIBLE SPECIAL NEEDS, HEALTHY INDIANA, AND HOOSIER HEALTHWISE PLANS. Form 990, Part III, Question 4a (Continued) 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) 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 (3) 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 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. CareSource Life Services coordinates a range of resources through community and employer partnerships. A key component of CareSource Life Services is CareSource JobConnect, an initiative that helps members to increase skills and attain connections to long-term employment. CareSource JobConnect is a program and member benefit designed to serve members that are seeking assistance with education and employment goals. CareSource 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 CareSource 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. CareSource 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. Form 990, Part VI, Section A, Question 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 organization's Audit Committee and each voting member of the governing body; the CEO, CFO, and VP Treasury; the internal Tax Department and an outside CPA firm; and internal general counsel and outside legal 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 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, 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 45401 311703368 Supporting OH 501(c)(3) 509(a)(3)II NA false CareSource Kentucky Co PO Box 8738 Dayton OH 45401 464991603 HMO Ins Plan KY 501(c)(3) 509(a)(2) CARESOURCE false CareSource Georgia Co PO Box 8738 Dayton OH 45401 472408339 HMO Ins Plan GA 501(C)(3) 509(a)(2) CARESOURCE false CareSource West Virginia Co PO Box 8738 Dayton OH 45401 473028244 HMO Ins Plan WV 501(c)(3) 509(a)(2) CARESOURCE false CareSource Life Services Co PO Box 8738 Dayton OH 45401 811602217 No Activity OH 501(c)(3) 509(a)(2) CARESOURCE false CareSource Ohio Inc PO Box 8738 Dayton OH 45401 311143265 HIC Ins Plan OH 501(c)(3) 509(A)(2) CareSource false The CareSource Foundation PO Box 8738 Dayton OH 45401 562582561 Grantmaking OH 501(c)(3) 509(A)(3) i CareSource false CSMS HOLDING LLC (TO 122822) PO Box 8738 Dayton OH 454018738 851588557 Holding Co DE NA N/A CareSource Diversity & Social Impact Inv 50 East 91st Street Suite 213 Indianapolis IN 46240 871811106 Investing IN NA N/A CareSource Iowa Opportunity Investment 415 12th Ave SE Cedar Rapids IA 52401 883585337 Investing IA NA N/A CareSource Virginia Co PO Box 8738 Dayton OH 454018738 811727271 No Activity VA NA C Corp CareSource Arkansas Health Plan Co PO Box 8738 Dayton OH 454018738 844476729 COA Insurance AR NA C Corp Kids' CareAlliance Co PO Box 8738 Dayton OH 454018738 854022039 No Activity OH NA C Corp CareSource Oklahoma Health Plan Co PO Box 8738 Dayton OH 454018738 854038326 HMO Ins Plan OK NA C Corp CareSource Kansas LLC PO Box 8738 Dayton OH 454018738 873411276 HMO Ins Plan KS NA C Corp CareSource North Carolina Co PO Box 8738 Dayton OH 454018738 873079479 HMO Ins Plan NC NA C Corp CareSource PASSE LLC PO Box 8738 Dayton OH 454018738 863112470 RBPO Ins Plan 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 DE NA C Corp CareSource Tennessee Co PO Box 8738 Dayton OH 454018738 874254502 COA Insurance TN NA C Corp Columbus Medical Services Inc PO Box 8738 Dayton OH 454018738 300975112 No Activity MD NA C Corp CareSource Iowa Co (Inc 31822) 505 5th Avenue Suite 729 Des Moines IA 50309 881429834 HMO Ins Plan IA NA C Corp CareSource Florida Co (Inc 8422) PO Box 8738 Dayton OH 45401 883601120 HMO Ins Plan FL NA C Corp CareSource Bayou Health LLC(Inc 72222) PO Box 8738 Dayton OH 45401 883401520 HMO Ins Plan TX NA C Corp false false false false true false false false false false false true true false true false false false Part III - Related Orgs Taxable as a Partnership - Additional Information 1) Effective 12/28/2022, CareSource Management Services Holding LLC (EIN 85-1588557) changed from a partnership to a single member LLC, whose sole member is another single member LLC, Caresource Holding LLC (EIN 84-4431982). Caresource Holding LLC's sole member is CareSource (EIN 31-1703368). Part IV - Related Organizations Taxable as a Corp - Additional Information 1) CareSource Iowa Co (EIN 88-1429834) was incorporated 03/18/2022. 2) CareSource Florida Co (EIN 88-3601120) was incorporated 08/04/2022. 3) CareSource Bayou Health LLC (EIN 88-3401520) was incorporated 07/22/2022.