2016-11-15T02:05:23-06:00 2015-12-31 990 2015-01-01 320121856 CareSource Indiana Inc % JANET FERNANDES CARE 9375313027 PO Box 8738 Dayton OH 454018738 L TARLTON THOMAS III EVP Operations & CFO 9375313027 2016-11-11 2015 2017-02-10 21:41:12Z Pamela B Morris Same as C Above Dayton OH 45401 57072388 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 27 0 0 0 0 0 743 57071760 1204 628 0 0 1947 57072388 3000 5000 0 0 0 0 0 0 0 320400 62812229 323400 62817229 -321453 -5744841 2974336 52383997 733961 44288463 2240375 8095534 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. false false 51998243 5000 57071760 CareSource Indiana Co. (CSIN or CareSource Indiana) is a non-profit organization established under the state law of Indiana. CSIN is a member of the CareSource Family of Companies' non-profit organizations. The mission of CSIN is to make a lasting difference in its members lives by improving their health and overall well-being. CSIN firmly adheres to this mission, which it terms as the organizations "heartbeat," by providing services that go well beyond the delivery of medical benefits. CareSource Indiana received interim accreditation through National Committee for Quality Assurance (NCQA) in 2015 for its Health Insurance Marketplace Just4Me plan. NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accreditation is the most comprehensive evaluation in the industry and the only assessment that bases results on clinical performance and consumer experience. Pursuing NCQA Accreditation demonstrates CareSource Indiana's commitment to quality and improving the health and well-being of our members. 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 Just4Me members. This is done through an innovative health and wellness methodology. CSIN has built a high-performing provider network to operate the Just4Me Plan as an HMO. This provider network relies heavily upon federally qualified health centers (FQHC). 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. The Just4Me Plan 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. The Just4Me plan was successfully implemented with enrollment beginning for CareSource Indiana on October 1, 2014 with an effective date of January 1, 2015. Beginning in January of 2016, CSIN will offer two Medicare Advantage Plans (MA Plans) in the State of Indiana. As with the Just4Me Plan, CSIN intends for its MA Plans to primarily enroll low-income individuals. Recognized for a commitment to serving at-risk populations, beginning Jan. 1, 2017, CSIN will coordinate care for recipients of state supported programs that provide health services to recipients, through Hoosier Healthwise and the Healthy Indiana Plan (HIP). Hoosier Healthwise is available to pregnant women and children, and HIP covers adults 19-64 whose incomes are less than 138% of the federal poverty level, and do not meet certain eligibility requirements for other health coverage programs. CSIN was one of four Medicaid Managed Care plans selected by the Indiana Family and Social Services Administration to begin contract negotiations for the states Medicaid managed care and Medicaid alternative expansion programs. CSIN was the only new plan selected in addition to three incumbent plans. Consequently, more individuals can now receive assistance through CareSource Indianas many programs designed to remove barriers to health and well-being. CareSource Indiana will, therefore, further its mission as a means of improving the health and well-being of Indianas low-income population. 51998243 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 563 0 27 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 true false IN X JANET FERNANDES 9375313027 PO BOX 8738 Dayton OH 454018738 J Thomas Maultsby Chair/Sec/Treas/Trustee 1.0 5.0 X 0 36250 0 Kevin R Brown Trustee 1.0 3.0 X 0 43750 0 Patricia Martin Trustee 1.0 1.0 X 0 30000 0 Pamela B Morris President/CEO/TRUSTEE 5.0 45.0 X X 0 5908941 1953879 Craig Thiele MD Chief Medical Officer 5.0 45.0 X 0 1514932 385779 Bobby Jones Chief Operating Officer 5.0 45.0 X 0 1744871 468397 L Tarlton Thomas III Chief Financial Officer 5.0 45.0 X 0 1235678 405217 0 10514422 3213272 0 false true false Indiana Univ Health Related Entit 1701 Senate Blvd INDIANAPOLIS IN 46202 MEDICAL SERVICES 21506904 CVS CareMark 221 N Charles Lindergh Dr SALT LAKE CITY UT 84116 Pharmacy Services 13037840 American Health Network of IN LLC PO Box 66300 LONDON KY 40742 Medical Services 1144676 Riverview Hospital PO Box 869 HOBLESVILLE IN 46061 Medical Services 1024583 Hendricks Regional Health 1321 Reliable Pkwy CHICAGO IL 60686 Medical Services 926635 42 0 COORDINATION OF BENEFIT RECOVERIES 524114 3614 3614 FEDERAL HEALTH INSURANCE EXCHANGE 524114 57068146 57068146 57071760 628 628 0 0 0 0 0 0 0 0 0 0 57072388 57071760 628 5000 5000 0 0 0 0 0 0 0 0 0 0 17453 17453 70739 12488 58251 47900 7107 40793 0 0 1595032 283362 1311670 1070969 61847 1009122 1929070 9232 1919838 198849 17 198832 0 134888 134888 85344 59758 25586 0 23014 9383 13631 0 0 0 13313 13313 FEES AND ASSESSMENTS 3421600 266 3421334 MGMT FEES CARESOURCE MGMT GRP 3809531 1449929 2359602 MEDICAL EXPENSE 37376101 37376101 PHARMACY EXPENSE 12723753 12723753 294673 294673 62817229 51998243 10818986 0 973187 42997543 1000000 1500000 0 0 1001149 7886454 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2974336 52383997 4533 13433800 0 0 611820 30109313 0 0 0 0 0 0 0 0 0 0 117608 745350 733961 44288463 X 2240375 8095534 0 0 0 0 2240375 8095534 2974336 52383997 X -5744841 11600000 X false true X true false X 0 0 0 0 0 0 27769 10202 3225 743 57071760 57113699 0 0 0 27769 10202 3225 743 57071760 57113699 0 0 0 57113699 250 620 0 1204 628 2702 0 250 620 0 1204 628 2702 0 0 28019 10822 3225 1947 57072388 57116401 0.99995 0.85285 0.00005 0.14715 X false false false false false false true 56352 false false 56352 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. 0 RELATED PARTY PAYABLE 745350 745350 X FIN 48 (ASC 740) Footnote The Separate Company Financial Statements summarize ASC 740 as follows: The Organization annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the financial statements. Currently, tax years 2012-2015 are open for audit by the Internal Revenue Service. false true false false false false true Pamela B Morris President/CEO/TRUSTEE 0 1019059 0 731250 0 4158632 0 1941125 0 12754 0 7862820 0 4525138 Craig Thiele MD Chief Medical Officer 0 373480 0 175589 0 965863 0 355192 0 30587 0 1900711 0 1019433 Bobby Jones Chief Operating Officer 0 486827 0 196371 0 1061673 0 446768 0 21629 0 2213268 0 1084400 L Tarlton Thomas III Chief Financial Officer 0 388782 0 153120 0 693776 0 379212 0 26005 0 1640895 0 767570 Form 990, Schedule J, Part II All compensation amounts reported on Schedule J, Part II for all listed persons are paid by CareSource Management Group Co., a related organization to CareSource Indiana, Inc. Form 990, Schedule J, Part I, Line 4b The following listed persons listed on Form 990, Part VII, Section A, participate in a supplemental nonqualified retirement plan of a related entity, CareSource Management Group Co. (CSMG): Pamela B Morris, Craig Thiele MD, Bobby Jones 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 entity, CareSource Management Group Co.: Pamela B Morris, Craig Thiele MD, Bobby Jones 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 2015 for both deferred compensation arrangements include the following: Pamela B Morris $4,958,965; Craig Thiele MD $1,077,692; Bobby Jones $1,200,070 and L Tarlton Thomas III $824,923. Form 990, Schedule J, Part I, Line 6b 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, Craig Thiele MD, Bobby Jones and L Tarlton Thomas III. All of these officers 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, Line 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, Part VI, Section B, Question 11B The Form 990 was provided to the organization's Finance committee, and was reviewed during the course of a special board meeting 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 the 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 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 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 and Form 990 are available for public inspection upon request. The company's Form 990 is also available on the U.S. nonprofit database website at www.guidestar.org. 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 in December, 2015 in the amount of $11,600,000. CareSource Management Group Co PO Box 8738 Dayton OH 45401 311703368 Support Org OH 501(c)(3) 509(a)(3) I NA false CareSource Kentucky Co PO Box 8738 Dayton OH 45401 464991603 Exchange HMO KY 501(c)(3) 509(a)(2) CSMG false CareSource Georgia Co PO Box 8738 Dayton OH 45401 472408339 Medicaid HMO GA 501(C)(3) 509(a)(2) CSMG false CareSource West Virginia Co (12015) PO Box 8738 Dayton OH 45401 473028244 Exchange HMO WV 501(c)(3) 509(a)(2) CSMG false CareSource Life Services Co (122015) PO Box 8738 Dayton OH 45401 811602217 Life Svcs OH 501(c)(3) 509(a)(2) CSMG false CareSource North Carolina Co (112015) PO Box 8738 Dayton OH 45401 811593512 Medicaid HMO NC 501(c)(3) 509(a)(2) CSMG false CareSource Management Services Co PO Box 8738 Dayton OH 454018738 311703371 Adm Mgmt Svcs OH NA C Corp 0 0 false false false true false false false false false false false false false true false true true true false