2014-11-14T14:45:28-06:00 2013-12-31 990 2013-01-01 320121856 CareSource Indiana Inc % JANET FERNANDES CARE 9372243300 PO Box 8738 Suite Dayton OH 454018738 Pamela B Morris CEO 2014-11-13 2013 2015-11-30 17:44:51Z Pamela B Morris Same as C Above Dayton OH 45401 3225 false X N/A X 2004 IN To Make a Difference in the lives of underserved people by improving their health care. CareSource Indiana is a Nonprofit Medicaid HMO licensed by the State of Indiana. 4 3 0 0 0 0 0 10202 3225 620 0 0 0 10822 3225 6000 5000 0 0 0 0 0 0 0 9853 41129 15853 46129 -5031 -42904 1912737 1570139 8005 8311 1904732 1561828 TO MAKE A DIFFERENCE IN THE LIVES OF UNDERSERVED PEOPLE BY IMPROVING THEIR HEALTH CARE. CARESOURCE INDIANA, INC. IS A NONPROFIT MEDICAID HEALTH MAINTENANCE ORGANIZATION LICENSED BY THE STATE OF INDIANA. false false 5000 5000 3225 The Company's contract with the office of Medicaid Policy & Planning expired on 12/31/06. The Company has ceased to provide health care benefits to members effective January 1, 2007, but continues to keep its license with the State of Indiana active. 5000 true false false false false false false false false false false false false false false 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 0 0 0 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 X J Thomas Maultsby Chair/Sec/Treas/Trustee 1.0 3.0 X 0 0 0 Kevin R Brown Trustee 1.0 1.0 X 0 30500 0 Steven Smitherman From 1213 Trustee 1.0 0.0 X 0 0 0 Pamela B Morris President/CEO/TRUSTEE 3.0 57.0 X X 0 1664314 1040994 Craig Thiele MD Chief Medial Officer 3.0 57.0 X 0 673263 237793 Bobby Jones Chief Operating Officer 3.0 57.0 X 0 1146255 253693 L Tarlton Thomas III Chief Financial Officer 3.0 57.0 X 0 425661 219710 0 3939993 1752190 0 false true false 0 0 COORDINATION OF BENEFIT RECOVERIES 524114 3225 3225 3225 0 0 0 0 0 0 0 0 0 0 0 3225 3225 5000 5000 0 0 0 0 0 0 0 0 0 0 0 1757 1757 0 0 0 30658 30658 0 0 0 0 0 0 0 0 0 0 0 0 FILING FEES 4871 4871 BANK FEES 1843 1843 BOARD MEETING EXPENSES 2000 2000 46129 5000 41129 0 912737 570139 1000000 1000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1912737 1570139 6755 8311 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1250 0 8005 8311 X 1904732 1561828 0 0 0 0 1904732 1561828 1912737 1570139 X -42904 -300000 X false true X true false X 0 0 0 0 0 0 664198 67660 27769 10202 3225 773054 0 0 0 664198 67660 27769 10202 3225 773054 0 0 0 773054 746 16836 250 620 0 18452 0 746 16836 250 620 0 18452 0 0 664944 84496 28019 10822 3225 791506 0.97669 0.96641 0.02331 0.03359 X 0 RELATED PARTY PAYABLE 0 0 X Schedule D, Part X, Line 2 The Organization annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the consolidated financial statements. As of this filing, tax years 2011-2013 are open for audit by the Internal Revenue Service. X X X X X X false true false false false false true false false Pamela B Morris President/CEO/TRUSTEE 0 801737 0 573000 0 289577 0 1015894 0 25100 0 2705308 0 573000 Craig Thiele MD Chief Medial Officer 0 380816 0 163394 0 129053 0 209465 0 28328 0 911056 0 163394 Bobby Jones Chief Operating Officer 0 384592 0 152385 0 609278 0 228810 0 24883 0 1399948 0 549127 L Tarlton Thomas III Chief Financial Officer 0 266860 0 104756 0 54045 0 193128 0 26582 0 645371 0 104756 Schedule J, Part II The following corporate Officer is an employee of CareSource Management Group Co., a related organization to CareSource Indiana, Inc.: Bobby Jones. All compensation amounts reported on Schedule J, Part II for Mr. Jones are paid by CareSource Management Group Co. The compensation amounts for the remaining listed persons listed on Schedule J, Part II are paid by CareSource Management Services Co, also a related organization to CareSource Indiana, Inc. Schedule J, Part I, Question 4b The following Corporate officers listed on Form 990, Part VII, Section A, participate in a supplemental nonqualified retirement plan of a related entity, CareSource Management Services Co.: Pamela B Morris, Craig Thiele MD, and L Tarlton Thomas III. Corporate Officer Bobby Jones is an employee of CareSource Management Group Co, also a related organization to CareSource Indiana, Inc., and Mr. Jones participates in a supplemental nonqualified retirement plan through that organization. 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 Corporate Officers listed on Form 990, Part VII, Section A, participate in a long-term incentive plan of a related entity, CareSource Management Services Co.: Pamela B Morris, Craig Thiele MD, and L Tarlton Thomas III. Corporate Officer Bobby Jones is an employee of CareSource Management Group Co, also a related entity to CareSource Indiana, Inc., and participates in a long-term incentive plan through that organization. Amounts accrued in 2013 related to both deferred compensation plans include: Pamela Morris $648,801; Craig Thiele MD $152,759; L Tarlton Thomas III $107,817 and Bobby Jones $166,646. Schedule J, Part I, Question 6b The following corporate officers listed in Form 990, Part VII, Section A, line 1a are employees of CareSource Management Services Co, a related organization to CareSource Indiana, Inc.: Craig Thiele MD, and L Tarlton Thomas III. Corporate Officer Bobby Jones is an employee of CareSource Management Group Co, also a related organization to CareSource Indiana, Inc. 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. Corporate Officer Pamela Morris is an employee of CareSource Management Services Co, a related organization to CareSource Indiana, Inc., and Ms. Morris is eligible for a performance bonus as part of her compensation package. Part VI, Section B, Question 11a 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 and was reviewed during the course of a special board meeting prior to the time of filing the Form 990. The Form 990 was reviewed by the CEO, CFO, an outside CPA firm, outside legal counsel, and by general counsel prior to filing with the IRS. 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. Part VI, Section B, Questions 15A and 15B; Schedule J, Part 1, Question 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 Independent Board members' decision and rationale are captured in minutes that are prepared and signed in a contemporaneous substantiation of the deliberation and decisional process of the Independent Board. 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. 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. Part VII, Section A, Avg Hours per Week Devoted to Related Organizations The following listed persons split their time between all the entities of the CareSource family of companies: Pamela Morris, Craig Thiele MD, L Tarlton Thomas III, and Bobby Jones. The total hours worked by each listed person exceeds 60 hours per week for the combined CareSource family of companies, and as a general practice is allocated among the following entities: CareSource, 75%; CareSource Management Group Co, CareSource Reinsurance LLC and CareSource Insurance LLC, 23%; The CareSource Foundation, CareSource Indiana, Inc., and CareSource Management Services Co, 2%. Part XI, Line 9 Distribution to Parent Organization CareSource Management Group Co on 3/31/2013 in the amount of $300,000. FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING FEES TOTAL FEES:30658 CareSource Management Group Co PO Box 8738 Dayton OH 45401 311703368 Support Org OH 501(c)(3) 509(a)(3) I NA false CareSource Illinois (Dissolved 8913) PO Box 8738 Dayton OH 45401 272202797 Dissolved IL Not Determined NA 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 false false false false false false false false false false true false false false true false