FURP.ORG / PUBLIC DATA EXPLORER

CARESOURCE INDIANA INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CARESOURCE INDIANA INC (EIN 32-0121856)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-14
IRS object ID
201323189349300522
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-14T08:06:50-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN320121856EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CareSource Indiana IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JANET FERNANDESInCareOfName
Name ControlCARENameControl
Phone9372243300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 8738AddressLine1
Address Line2SuiteAddressLine2
CityDaytonCity
StateOHState
ZIP Code454018738ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameL Tarlton Thomas IIIName
TitleCFOTitle
Date Signed2013-11-12DateSigned
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPamela B MorrisNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1Same as C AboveAddressLine1
CityDaytonCity
StateOHState
ZIP Code45401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts10822GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionCareSource Indiana, Inc. is a nonprofit Medicaid Health Maintenance Organization licensed by the State of Indiana.ActivityOrMissionDescription
Nbr Voting Members Governing Body3NbrVotingMembersGoverningBody
Nbr Independent Voting Members2NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year27769ProgramServiceRevenuePriorYear
Program Service Revenue CY10202ProgramServiceRevenueCY
Investment Income Prior Year250InvestmentIncomePriorYear
Investment Income Current Year620InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year28019TotalRevenuePriorYear
Total Revenue Current Year10822TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year6000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY6000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year11521OtherExpensePriorYear
Other Expenses Current Year9853OtherExpensesCurrentYear
Total Expenses Prior Year17521TotalExpensesPriorYear
Total Expenses Current Year15853TotalExpensesCurrentYear
Revenues Less Expenses Prior Year10498RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-5031RevenuesLessExpensesCY
Total Assets BOY1915877TotalAssetsBOY
Total Assets EOY1912737TotalAssetsEOY
Total Liabilities BOY6114TotalLiabilitiesBOY
Total Liabilities EOY8005TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1909763NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1904732NetAssetsOrFundBalancesEOY
Mission DescriptionCARESOURCE INDIANA, INC. IS A NONPROFIT MEDICAID HEALTH MAINTENANCE ORGANIZATION LICENSED BY THE STATE OF INDIANA.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense6000Expense
Grants6000Grants
Revenue10202Revenue
DescriptionThe 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.Description
Total Program Service Expense6000TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members3NbrVotingGoverningBodyMembers
Number Independent Voting Members2NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJANET FERNANDESNamePerson
Telephone Number9372243300TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 8738AddressLine1
CityDaytonCity
StateOHState
ZIP Code454018738ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
J Thomas Maultsby
Chair/Sec/Treas/Trustee1.03.0X000
Kevin R Brown
Trustee1.02.0X0300000
Pamela B Morris
President/CEO/Trustee1.059.0X014431342016078X
Craig Thiele MD
Chief Medical Officer1.059.00940738565026X
Bobby Jones
Chief Operating Officer1.059.00447413656767X
L Tarlton Thomas III
Chief Financial Officer1.059.00557429373277X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3418714TotalReportableCompFrmRltdOrgs
Total Other Compensation3611148TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionCOORDINATION OF BENEFIT RECOVERIESDescription
Business Code524114BusinessCode
Total Revenue Column10202TotalRevenueColumn
Related Or Exempt Function Income10202RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue10202TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column620TotalRevenueColumn
Exclusion$620ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10822TotalRevenueColumn
Related Or Exempt Function Income10202RelatedOrExemptFunctionIncome
Exclusion$620ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total6000Total
Program Services6000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total700Total
Management And General700ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total3279Total
Management And General3279ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
FILING FEES26972697
BANK FEES23432343
BOARD MEETING EXPENSES834834

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15853Total
Program Services6000ProgramServices
Management And General9853ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY912157BOY
EOY912737EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1000000BOY
EOY1000000EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3720BOY
EOY0EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY0BOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1915877BOY
EOY1912737EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6114BOY
EOY6755EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY1250EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6114BOY
EOY8005EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1909763BOY
EOY1904732EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1909763BOY
EOY1904732EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1915877BOY
EOY1912737EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-5031ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3302CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years664198CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years67660CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year27769CurrentTaxYearMinus1Year
Current Tax Year10202CurrentTaxYear
Total773131Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3302CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years664198CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years67660CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year27769CurrentTaxYearMinus1Year
Current Tax Year10202CurrentTaxYear
Total773131Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509773131PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8419CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years746CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16836CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year250CurrentTaxYearMinus1Year
Current Tax Year620CurrentTaxYear
Total26871Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8419CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years746CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16836CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year250CurrentTaxYearMinus1Year
Current Tax Year620CurrentTaxYear
Total26871Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11721CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years664944CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years84496CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28019CurrentTaxYearMinus1Year
Current Tax Year10822CurrentTaxYear
Total800002Total
FieldValueIRS element (for citing)
Public Support Percentage5090.96641PublicSupportPercentage509
Prior Year Support Percentage0.83564PriorYearSupportPercentage
Investment Income Percentage0.03359InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.16436PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements
EquipmentEquipment
Other Land BuildingsOtherLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionRELATED PARTY PAYABLEDescription
Amount$1,250Amount
FieldValueIRS element (for citing)
Total Of Amounts1250TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierFIN 48 (ASC 740) FootnoteIdentifier
Return ReferenceSchedule D, Part X, Line 2ReturnReference
ExplanationThe 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 2010-2012 are open for audit by the Internal Revenue Service.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierContributions on Behalf of Board MembersIdentifier
Return ReferenceSchedule I, Part I, Line 2 and Part IIReturnReference
ExplanationIn support of CareSource Indiana Inc.'s commitment to its charitable purposes, its appointed trustees and committee members earn charitable credits for each board meeting attended. At year-end, the trustees and committee members 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 under this policy by the organization and are represented on Schedule I in the form of general support contributions.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgstrueCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Pamela B Morris
President/CEO/Trustee06971330487080025892101995427020651034592120487080
Craig Thiele MD
Chief Medical Officer0361439014683104324680536304028722015057640394726
Bobby Jones
Chief Operating Officer0359674074673013066063200602476101104180074673
L Tarlton Thomas III
Chief Financial Officer02367760920070228646034935302392409307060223717

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Officer CompensationSchedule J, Part IIThe 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.
Deferred CompensationSchedule J, Part I, Question 4bThe 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.
Payments Contingent on Net EarningsSchedule J, Part I, Question 6bThe 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.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990 ReviewPart VI, Section B, Question 11aThe 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 counsel, and by general counsel prior to filing with the IRS.
Conflict of Interest PolicyPart VI, Section B, Question 12CAnnually, 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.
Compensation ReviewPart VI, Section B, Questions 15A and 15B; Schedule J, Part 1, Question 3The 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.
Governing DocumentsPart VI, Section C, Question 19The 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.
Avg Hours per Week Devoted to Related OrganizationsPart VII, Section A, Avg Hours per Week Devoted to Related OrganizationsThe 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., CareSource Illinois, and CareSource Management Services Co, 2%.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CareSource Management Group Co
PO Box 8738DaytonOH45401311703368Support OrgOH501(c)(3)509(a)(3) INAfalse
CareSource Illinois
PO Box 8738DaytonOH45401272202797InactiveILNotDeterminedNAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1CareSource Management Services CoBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 8738AddressLine1
CityDaytonCity
StateOHState
ZIP Code454018738ZIPCode
FieldValueIRS element (for citing)
EIN311703371EIN
Primary ActivityAdm Mgmt SvcsPrimaryActivity
Legal Domicile StateOHLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CorpTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg