2018-11-15T06:02:02-06:00 2017-12-31 990 2017-01-01 320121856 CareSource Indiana Inc % JANET FERNANDES CARE 9375313027 135 N Pennsylvania St 1300 Indianapolis IN 46204 DAVID W GOLTZ CFO 9375313027 2018-11-12 208.90.150.16 31270620183185000000 2018-11-14 P C85B5279DC67EE319A1E363305D92183F51E14D3 0092E3F9704882A60A3E4E8637C91DC6489D1226 2017 2019-02-21 02:37:17Z Pamela B Morris PO Box 8738 Dayton OH 45401 358614607 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 is a Nonprofit Medicaid HMO licensed by the State of Indiana. 4 3 112 0 0 0 0 0 94923412 358378523 36201 236084 0 0 94959613 358614607 3000 6000 0 0 293035 338643 0 0 0 116108438 350433545 116404473 350778188 -21444860 7836419 68699557 166668255 52048883 127181162 16650674 39487093 X TO MAKE A LASTING DIFFERENCE IN OUR MEMBERS LIVES BY IMPROVING THEIR HEALTH AND WELL-BEING. CARESOURCE INDIANA, INC. IS A NONPROFIT MEDICAID HEALTH MAINTENANCE ORGANIZATION LICENSED BY THE STATE OF INDIANA. true false 304373109 6000 358378523 CareSource Indiana Inc. (CSIN or 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. CSIN's membership includes: (1) Hoosier Healthwise (Medicaid) and Healthy Indiana Plan (HIP) Medicaid expansion consumers, (2) Medicare Advantage low-income consumers, and (3) a Qualified Health Plan offered through the Federal Health Insurance Exchange, providing low-cost comprehensive coverage for uninsured individuals and families. CSIN is accredited through National Committee for Quality Assurance (NCQA) for its Health Insurance Marketplace plan. CSIN received interim accreditation through NCQA in 2017 for its Medicaid Plan. 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 offers two Medicare Advantage Plans in the State. 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. JobConnect is a voluntary program for CSIN members. When members opt in to the program, a Life Coach is assigned to them. The Life Coach helps these members identify resource strengths and prioritize areas that need reinforcing, For example: emotional support, food stability, child care, or physical health. Life Coaches coordinate and connect members with community services such as food banks and transportation vouchers, and assist members eligible for public assistance with managing state and federal resources such as Temporary Assistance for Needy Families (TANF) or the Supplemental Nutrition Assistance Program (SNAP). Once immediate needs have been met, Coaches connect members with education or employment opportunities to help them increase skills and attain connections to long-term employment. Life Coaches seek to understand the job needs and preferences of members and prepare them for job attainment. They then work with members for up to 24 months to help them navigate the work world, prepare for their loss of government subsidies, increase their financial literacy, and strategize future career steps. In support of CSIN's commitment to its charitable purposes, some of its appointed trustees and committee members elect to earn charitable credits for board or committee meetings attended. At year-end, trustees and committee members may designate their credits to their Internal Revenue Code Section 501(c)(3) tax exempt charity of choice. Charitable donations in the amount of $6,000 were paid or accrued for in 2017 under this policy by the Organization. 304373109 true false false true false false false false false false false false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 2504 0 true 112 true false false false false false false false false false false X 4 3 false false false false true true false true true false false true true true true true true true false false IN X JANET FERNANDES 9375313027 PO BOX 8738 Dayton OH 454018738 X J Thomas Maultsby Sec/Treas to 08/17; Chair 5.0 15.0 X X 0 55000 0 Kevin R Brown Trustee 4.0 16.0 X 0 136250 0 Patricia Martin Vice Chair from 8/17; Trustee 5.0 10.0 X X 0 50000 0 Pamela B Morris Sec/Treas from 8/17; Pres/CEO 8.0 52.0 X X 0 3626452 1072127 Craig Thiele MD Chief Medical Officer to 6/17 8.0 52.0 X 0 1248029 37111 Daniel McCabe Chief Administrative Officer 3.0 57.0 X 0 811840 239153 L Tarlton Thomas III Chief Operating Officer 8.0 52.0 X 0 1044863 285766 David W Goltz Chief Financial Ofr From 12/17 0.2 59.8 X 0 153601 775 Steve Smitherman VP/Executive Director 60.0 0.0 X 241142 0 97501 241142 7126035 1732433 1 false true false CVS Caremark 9501 E Shea Blvd MC 143 SCOTTSDALE AZ 85260 Pharmacy Services 66492716 Indiana University Health Related 950 N Meridian St 300 INDIANAPOLIS IN 46204 Medical Services 53245018 Parkview Hospital Related Orgs 11109 Parkview Plaza Dr FORT WAYNE IN 46845 Medical Services 13737295 Memorial Hosp South Bend Inc Rela 615 N Michigan St SOUTH BEND IN 46601 Medical Services 7160809 The Health Hospital Corp of Mario 2002 Albany Street BEECH GROVE IN 46107 Medical Services 5755553 251 X 0 MEDICAID AND MEDICARE REVENUE 524114 202726039 202726039 FEDERAL HEALTH INSURANCE EXCHANGE 524114 155652484 155652484 358378523 236084 236084 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 358614607 358378523 0 236084 6000 6000 0 0 0 338643 73244 265399 0 0 0 0 0 0 0 0 138860 28737 110123 36292 859 35433 0 0 23435386 1676847 21758539 151434 291 151143 2259740 462 2259278 38795 130 38665 0 447150 447150 265888 15023 250865 0 34557 7770 26787 1080 1080 0 0 750 750 MEDICAL EXPENSES 247732707 247732707 PHARMACY EXPENSES 52313445 52313445 FEES AND ASSESSMENTS 12079231 12079231 MGMT FEES CARESOURCE MGMT GRP 9417491 2068215 7349276 2080739 449379 1631360 350778188 304373109 46405079 0 X 53167714 500000 2000000 164921843 0 0 13531843 1095579 0 0 0 0 0 0 0 0 0 150833 0 0 0 0 0 0 0 0 0 0 0 0 68699557 166668255 21642152 95335207 0 0 27612627 27972109 0 0 0 0 0 0 0 0 0 0 2794104 3873846 52048883 127181162 X 16650674 39487093 0 0 0 0 16650674 39487093 68699557 166668255 X 7836419 15000000 X false true X true false X 0 0 0 0 0 0 3225 743 57071760 95447251 358378523 510901502 0 0 0 3225 743 57071760 95447251 358378523 510901502 0 0 0 510901502 0 1204 628 36201 236084 274117 0 0 1204 628 36201 236084 274117 0 0 3225 1947 57072388 95483452 358614607 511175619 0.99946 0.99975 0.00054 0.00025 X false false false false false false true 68441 false true 4143 72584 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 $4,143 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 3873846 3873846 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 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 2014-2017 are open for audit by the Internal Revenue Service. X X X X X true true false false false true true false false Pamela B Morris Sec/Treas from 8/17; Pres/CEO 0 1129563 0 0 0 2496889 0 1060343 0 11784 0 4698579 0 1392500 Craig Thiele MD Chief Medical Officer to 6/17 0 181209 0 0 0 1066820 0 12277 0 24834 0 1285140 0 708397 Daniel McCabe Chief Administrative Officer 0 392201 0 0 0 419639 0 216651 0 22502 0 1050993 0 223292 L Tarlton Thomas III Chief Operating Officer 0 482383 0 75019 0 487461 0 260446 0 25320 0 1330629 0 261987 Steve Smitherman VP/Executive Director 232478 0 8664 94115 3386 338643 0 David W Goltz Chief Financial Ofr From 12/17 0 31457 0 121718 0 426 0 0 0 775 0 154376 0 0 Form 990, Schedule J, Part II Compensation amounts reported on Schedule J, Part II for listed person Steven Smitherman is paid by CareSource Indiana, Inc. Compensation amounts for the remaining listed persons on Schedule J, Part II are paid by CareSource Management Group Co. ("CSMG"), a related organization to CareSource Indiana, Inc. Compensation paid to the CEO is pursuant to the terms of a written employment agreement between Ms. Morris and CSMG. 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): Pamela B Morris, Craig Thiele MD, Daniel McCabe, 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.: Pamela B Morris, Craig Thiele MD, Daniel McCabe, and L Tarlton Thomas III. 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 2017 for both deferred compensation arrangements include the following: Pamela B Morris $2,470,918; Craig Thiele MD $817,884; Daniel McCabe $393,869; and L Tarlton Thomas III $466,997. Form 990, Schedule J, Part I, Question 6b The following listed person listed on Form 990, Part VII, Section A, line 1a is an employee of CareSource Indiana, Inc.: Steve Smitherman. The following listed persons listed on Form 990, Part VII, Section A, line 1a are employees of CareSource Management Group Co, a related organization to CareSource Indiana, Inc.: Pamela B Morris, Daniel McCabe, and L Tarlton Thomas III. All of these listed persons are eligible for a performance bonus as part of their compensation packages. The performance bonus is contingent on a combination of both company performance and individual performance against goals. The performance management process documents the company goals and individual goals, the corresponding potential performance bonus, and the progress/outcomes. The performance bonus is based on the employee's calendar year regular earnings. Form 990, Schedule J, Part 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 trustees. 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 Craig Thiele MD received a severance payment that is properly reported on Schedule J, Part II, Column B(iii). 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, 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 trustee, principal officer and member of a committee with Board-delegated powers ("interested person") shall sign a statement which affirms that such person a) has received a copy of the conflicts of interest policy, b) has read and understands the policy, c) has agreed to comply with the policy, and d) understands that the organization is a charitable organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. 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 trustee has no vote on the matter involved with the conflict of interest. At the beginning of each Board Meeting and Committee Meeting, the Board Members and Committee Members are asked to disclose if they have a Conflict of Interest on any item contained in the agenda. In addition, the Board Members and Committee Members are also asked to inform the board chair if a Conflict of Interest arises during the course of the Board or Committee Meeting. When such a conflict is disclosed, then the procedure outlined above is implemented. In addition, a Conflict of Interest Schedule is kept with respect to each declared Conflict of Interest during the course of a Board or Committee meeting. On an annual basis, the Nominating and Governance Committee reviews each Conflict of Interest raised by a Board or Committee Member. Also, the Nominating and Governance Committee conducts a bi-annual evaluation of the Board Members' performance during the course of the Board Meetings and Committee Meetings. The review includes but is not limited to the Board Member's engagement, participation, contributions to board business, attendance, and any absence from a meeting due to a conflict of interest. The Conflicts of Interest declared by the Board Members are reviewed on an annual basis by the Nominating and Governance Committee, and memorialized in meeting minutes, to make sure all policies on Conflict of Interest are adhered to by the Boards, the Committees and the Individual Board or Committee Member. Form 990, Part VI, Section B, Q 15A and 15B; Schedule J, Part 1, Q 3 The Executive Compensation Committee consists of Board Members who are Independent. The process used to determine compensation for the individuals listed on Part VII and Schedule J, Part II include a review by the Independent Board Members after they have received a report of comparability data prepared by an independent company surveying data for comparable organizations' reasonable compensation. The comparability data is presented to the Independent Board members in a written document in advance of the meeting and the independent comparability study is presented by the author of the study during the course of the meeting. In addition, the minutes of each meeting are prepared, distributed and signed within 30 days of the Executive Compensation Committee Meeting. The Executive Compensation Consultant does no other business with the CareSource Family of Companies other than determining the reasonableness of compensation. This compensation consultant's independence is reviewed on an annual basis. This process is followed with respect to all employed corporate officers and the top executives of the CareSource Family of Companies, in order to establish reasonable executive compensation. 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. Form 990, Part XI, Line 9 (1) Change in Net Assets: Capital Contribution from parent Organization CareSource Management Group Co during 2017 in the amount of $15,000,000. Form 990, Part III, Line 2 See Attachment 1. CareSource Management Group Co PO Box 8738 Dayton OH 45401 311703368 Supporting OH 501(c)(3) 509(a)(3)II NA false CareSource Kentucky Co 10200 Forest Green Blvd 400 Louisville KY 40223 464991603 Exchange HMO KY 501(c)(3) 509(a)(2) CSMG false CareSource Georgia Co 600 Galleria Pkwy 400 Atlanta GA 30339 472408339 Medicaid HMO GA 501(C)(3) 509(a)(2) CSMG false CareSource West Virginia Co PO Box 8738 Dayton OH 45401 473028244 Exchange HMO WV 501(c)(3) 509(a)(2) CSMG false CareSource Life Services Co PO Box 8738 Dayton OH 45401 811602217 Inactive OH 501(c)(3) 509(a)(2) CSMG false CareSource North Carolina Co PO Box 8738 Dayton OH 45401 811593512 Inactive NC 501(c)(3) 509(a)(2) CSMG false CareSource Virginia Co PO Box 8738 Dayton OH 45401 811727271 Inactive VA 501(c)(3) 509(a)(2) CSMG false CareSource Mgmt Grp Foundation (82016) PO Box 8738 Dayton OH 45401 814170497 Supporting OH 501(c)(3) 509(a)(3)II CSMG false CareSource Management Services Co PO Box 8738 Dayton OH 454018738 311703371 Adm Mgmt Svcs OH NA C Corp 0 0 0.00000 false false false true false false false false false false false false false true false true true true true