2021-11-12T11:39:54-06:00 2020-12-31 990 2020-01-01 311143265 CareSource Ohio Inc % JANET FERNANDES CARE 9375313027 PO Box 8738 Dayton OH 454018738 LAWRENCE SMART CFO 9375313027 2021-11-11 LAWRENCE SMART 999009999 2 2020 2022-09-23 18:48:47Z X Erhardt Preitauer Same as C above Dayton OH 45401 9602607274 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 Ohio Inc. is a nonprofit HMO licensed by the state of Ohio. 3 0 0 0 0 5280285 170984 8096836756 9247968012 48092928 24740622 0 0 8150209969 9272879618 89493 972723 0 0 0 0 0 0 0 8094956860 9109445237 8095046353 9110417960 55163616 162461658 1989749142 2518378621 1071661337 1434502238 918087805 1083876383 X CareSource Ohio 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. CareSource Ohio Inc. is a health maintenance organization licensed by the state of Ohio and serves members through Dual Eligible Special Needs, Marketplace, Medicaid, Medicare Advantage, and MyCare Ohio plans. false false 8388805749 9247968012 CareSource Ohio Inc. ("CSOH"), 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. CSOH serves more than 1.4 million members in Ohio. CSOH'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, and (5) a Qualified Health Plan offered through the Federal Health Insurance Marketplace, providing low-cost comprehensive coverage for individuals and families. CSOH Program Services: 1) CareSource Ohio Medicaid: CareSource Ohio Inc. 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. CSOH'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. CSOH has earned 51.2% 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. CSOH 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. CSOH has made an organizational commitment to make evidence-based investments towards improving health outcomes for members. CSOH'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. CSOH 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. CSOH has a broad, statewide network of more than 52,000 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, CSOH incentivizes certain providers through a value-based incentive model. CSOH focuses efforts on creating incentives and reimbursement options to support models that recognize quality at the provider level. CSOH created a program that provides additional incentives to providers for delivering quality based services that impact Healthcare Effectiveness Data and Information Set ("HEDIS") measures. CSOH created a shared savings model that rewards providers for attaining quality targets while sharing savings. In this particular model, CSOH 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, CSOH 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 CSOH 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. CSOH 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, CSOH'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, CSOH 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. CSOH's commitment to quality is demonstrated through the organization's National Committee for Quality Assurance ("NCQA") accreditation. CSOH is accredited by NCQA for its qualified Health Insurance Marketplace and Medicaid Health plans. Accreditation demonstrates CSOH's commitment to quality and enhances CSOH's ability to improve the health and well-being of those we serve. CSOH has implemented an integrated care model to empower members to become engaged and actively participate in their health and well-being. The CareSource Integrated Care Management program is both member-centric and resources-specific and supports a member's holistic physical and behavioral health needs. The Integrated Care Management program has integrated Disease Management, High Risk Obstetrics, and condition-management programs to address member physical and behavioral health needs. CSOH follows evidence-base protocols to identify members with both health needs and chronic conditions to conduct interventions at the appropriate level of care. Disease Management occurs at every programmatic level to ensure appropriate interventions and education of the member targeted to their unique needs. Through targeted programs like Disease Management, Behavioral Health, and transitions of care, we focus simultaneously on achieving health and maintaining wellness to the highest level possible for each member. Any given member may be identified with more than one program. The CareSource integrated care management program incorporates specialty programs such as Women and Children's Health, health management, and transitions of care. In conjunction with other groups within CSOH such as quality, network, and analytics, the integrated care management program utilizes a population-based approach to meet the clinical and social needs of our members. 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. An example of the population health approach is the Women and Children's Health program. Through collaboration between quality, clinical, network, and analytics, CSOH has established a program to target objectives including a reduction in 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, a program available to all pregnant members to provide 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. (2) High Risk Obstetrics, a program to support at risk pregnancy and ensure pregnant members receive high-touch case management support throughout their pregnancy. (3) Early and Periodic Screening, Diagnostic, and Treatment ("EPSDT"), to provide comprehensive and preventative health care services for children under age 21. All eligible members receive EPSDT reminder letters that coincide with the appropriate health care treatment based on their age. Members who are case managed and participate in our prenatal education BUMP 8388805749 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 4826 0 true 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 OH X JANET FERNANDES 9375313027 PO BOX 8738 Dayton OH 454018738 X Erhardt Preitauer CEO & Director (To 6/20) 15.0 45.0 X X 0 2239483 3719592 Jai Pillai Chief Operating Officer 23.0 37.0 X 0 1037573 910643 David Finkel EVP Mkt & Chair/Dir (Frm 6/20) 10.0 50.0 X 0 736768 797538 David Goltz Chief Financial Officer 9.0 51.0 X 0 949833 574541 Daniel McCabe Chief Administrative Officer 15.0 45.0 X 0 809693 631182 Stephen Ringel Pres, Mkt & Sec/Dir (Frm 6/20) 40.0 20.0 X X 0 684262 564544 William Coffin Jr VP Mkt Fin, Trs/Dir (Frm 6/20) 15.0 45.0 X 0 437494 295148 Craig Brown Director (To 6/20) 5.0 5.0 X 0 120000 0 David Miller Director (To 6/20) 5.0 5.0 X 0 105000 0 Michael Ervin MD Chairperson/Director (To 6/20) 10.0 10.0 X 0 105000 0 David Kaelber MD Director (To 6/20) 10.0 0.0 X 0 0 0 Douglas Fecher Director (To 6/20) 10.0 0.0 X 0 0 0 Ellen Leffak Director (To 6/20) 5.0 5.0 X 0 0 0 William F Marsteller Director (To 6/20) 5.0 5.0 X 0 0 0 Gary L LeRoy MD Director (To 6/20) 10.0 0.0 X 0 0 0 0 7225106 7493188 0 false true false Express Scripts Inc 21653 Network Place CHICAGO IL 606730673 Pharmacy Services 2173499170 Childrens Hospital Physicians Net 700 Childrens Drive COLUMBUS OH 432053205 Medical Services 312858055 The MetroHealth System 2500 MetroHealth Drive CLEVELAND OH 44109 Medical Services 254139270 The Cleveland Clinic Foundation 9500 Euclid Avenue CLEVELAND OH 44195 Medical Services 232102301 Ohio State University Hospitals 410 W 10th Ave COLUMBUS OH 43210 Medical Services 211123131 3831 170984 170984 MEDICAID 524114 8878130362 8878130362 PREMIUMS 524114 369059876 369059876 VETERANS REVENUE 524114 777774 777774 9247968012 22656125 22656125 0 0 0 0 0 331812153 329727656 2084497 2084497 2084497 0 0 0 0 0 0 0 0 0 0 9272879618 9247968012 24740622 972723 972723 0 0 0 0 0 0 0 0 0 0 8066538 101268 7965270 478651 478651 232001 7250 224751 0 0 251577903 35817657 215760246 7937948 56684 7881264 83704199 15958944 67745255 0 0 16523326 2753712 13769614 726997 157122 569875 0 0 339643 339643 0 0 3309642 44295 3265347 MEDICAL EXPENSES 6207384949 6207384949 PHARMACY EXPENSES 1971297214 1971297214 MGMT FEES CARESOURCE MGMT SVCS 477044739 133991199 343053540 CLAIMS PROCESSING ADMIN EXP 60374504 17093497 43281007 20446983 3169235 17277748 9110417960 8388805749 721612211 0 X 19591932 0 506326870 1211528818 0 0 695286837 664247851 0 0 0 0 0 405027 0 0 3876296 24328600 0 0 764274266 617868325 0 0 392941 0 0 0 0 0 1989749142 2518378621 1010976945 1260671424 0 0 13806569 155246639 0 0 0 0 0 0 0 0 0 0 46877823 18584175 1071661337 1434502238 X 918087805 1083876383 0 0 918087805 1083876383 1989749142 2518378621 X 162461658 9778358 -6451438 X false true X true false X 0 8170454 114330 5280285 170984 13736053 6408383841 7182270383 7762642282 8090874825 9247968015 38692139346 0 0 0 6408383841 7190440837 7762756612 8096155110 9248138999 38705875399 0 0 0 38705875399 32170503 29468385 40835548 32102562 22656125 157233123 0 32170503 29468385 40835548 32102562 22656125 157233123 0 0 6440554344 7219909222 7803592160 8128257672 9270795124 38863108522 0.99595 0.99545 0.00405 0.00455 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 416899 false true 47103 464002 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 $47,103 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 18584175 18584175 X FIN 48 (ASC 740) Footnote As outlined in CareSource's Audited Consolidated Financial Statements, which include the activity of CareSource Ohio 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 2017-2019 are open for audit by the Internal Revenue Service. true INVICTUS DEVELOPMENT GROUP 400 WAYNE AVE DAYTON OH 45410 815075704 501(c)(3) 400000 COVID RESPONSE NATIONWIDE CHILDREN'S HOSPITAL 700 CHILDRENS DRIVE COLUMBUS OH 43205 311036372 501(C)(3) 361600 COVID RESPONSE 2 0 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. false true false false false false false false false Erhardt Preitauer CEO & Director (To 6/20) 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 EVP Mkt & Chair/Dir (Frm 6/20) 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 Stephen Ringel Pres, Mkt & Sec/Dir (Frm 6/20) 0 412052 0 182494 0 89716 0 525454 0 39090 0 1248806 0 182494 William Coffin Jr VP Mkt Fin, Trs/Dir (Frm 6/20) 0 311522 0 120500 0 5472 0 266010 0 29138 0 732642 0 120500 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, Stephen Ringel and William Coffin Jr. 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 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 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, Stephen Ringel $288,276 and William Coffin, Jr $64,603. 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 CSOH: Erhardt Preitauer, Jai Pillai, David Finkel, David Goltz, Daniel McCabe, Stephen Ringel, and William Coffin, Jr. 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 CSOH. Compensation paid to the CEO is pursuant to the terms of a written employment agreement between Mr. Preitauer and CareSource. Form 990, Part V, Line 1a In early 2020, CSOH 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 4 CareSource Ohio Inc. filed amended Codes of Regulations, effective June 26, 2020 and amended Articles of Incorporation, effective July 1, 2020. Copies of the Amended Codes and Articles were submitted to the Internal Revenue Services in August of 2020. The Amended Articles of Incorporation included the following changes: (1) Changed the name of the organization to CareSource Ohio Inc., (2) Changed the business location to the "City of Dayton, County of Montgomery, Ohio.", (3) Updated the Purpose to include a provision outlining treatment of Net Proceeds from a liquidity event, (4) Updated the sole member to "CareSource" formerly known as CareSource Management Group, Co., (5) Updated the dissolution provision such that all remaining assets upon dissolution are distributed to the sole member, (6) Established the Location and (3) above as Permanent Principles, and (7) Added an Amendment provision to establish that only with sole member approval can the Articles be amended. The Amended Codes of Regulations included the following changes: (1) Established the corporate headquarters and principal place of business as the "Dayton Area", (2) Updated the number of Directors on the Board to be not less than three or more than nine, (3) Updated the Qualifications, Nominations, Vacancies and Removal provisions for Directors to be determined/dictated by the sole member, (4) Removed term limits for directors (5) Made a number of minor modifications to the Article relating to Meetings of Directors, (6) Defined roles and duties of the organization officers: Chair, President, Treasurer and Secretary, (7) Removed Article relating to Duty of the Board and duties relating to appointing trustees of other related CareSource organizations, (8) Removed Article related to Powers of Trustees (oversight of Corporate Property, Gifts, Management and Disbursements, (9) Removed Conflict of Interest policy from being directly included in the Articles (policy is kept separately), (10) Updated Dissolution provision such that all remaining assets upon dissolution are distributed to the sole member, and (11) Established the Dissolution Article as a permanent provision. Form 990, Part VI, Section A, Question 6 CareSource is the member of CareSource Ohio Inc. CareSource 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 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). 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 ($2,392,943) and (2) write off of advances paid to Behavioral Health providers ($4,058,495). The CareSource Foundation was a subsidiary of CareSource Ohio, Inc. for the first half of 2020. Effective July 1, 2020, CareSource became the sole member of The CareSource Foundation. This restructuring is reflected in the change in investment in subsidiary of ($2,392,943) as outlined on Form 990, Part XI, Line 9. Form 990, Part VI, Section A, Question 7a CARESOURCE, THE SOLE MEMBER OF CARESOURCE OHIO, INC., HAS THE AUTHORITY TO APPOINT CARESOURCE OHIO, INC.'S BOARD. The CareSource Foundation PO Box 8738 Dayton OH 45401 562582561 Supporting OH 501(c)(3) 509(a)(3) I CareSource false 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 Georgia Co 600 Galleria Pkwy 400 Atlanta GA 30339 472408339 Medicaid HMO GA 501(c)(3) 509(A)(2) CareSource false CareSource West Virginia Co 400 Washington St E 401 Charleston WV 25301 473028244 Exchange HMO WV 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 Life Services Co PO Box 8738 Dayton OH 45401 811602217 Inactive OH 501(c)(3) 509(A)(2) 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 true false false false false false false false false false true true false true true true true The CareSource Foundation b 2000000