2012-11-14T14:01:25-06:00 2011-12-31 990 2011-01-01 311703368 CareSource Management Group Co % JANET FERNANDES CARE 9372243300 PO Box 8738 Dayton OH 454018738 L Tarlton Thomas III 2012-11-07 2011 2016-02-24 21:20:13Z Pamela B Morris Same as C above Dayton OH 45401 166767777 false X N/A X 1999 OH CareSource Management Group Co is a supporting organization to CareSource, CareSource Michigan, and CareSource Indiana, all Medicaid health maintenance organizations & 501(c)(3) not-for-profit companies. 9 7 1256 0 0 0 10000000 0 0 10001335 579 126436679 156767198 136438014 166767777 202720 231865 0 0 70307791 84373066 0 0 0 57591371 73469827 128101882 158074758 8336132 8693019 72831747 76488161 47176373 40589785 25655374 35898376 TO MAKE A DIFFERENCE IN THE LIVES OF UNDERSERVED PEOPLE BY IMPROVING THEIR HEALTH CARE. THE SOLE AND SPECIFIC PURPOSE FOR WHICH THE CORPORATION IS FORMED IS TO ACT FOR THE BENEFIT OF, AND TO CARRY OUT, AS A SUPPORTING ORGANIZATION, THE PURPOSES OF CARESOURCE (MEDICAID HEALTH MAINTENANCE ORGANIZATION), CARESOURCE MICHIGAN (MEDICAID HEALTH MAINTENANCE ORGANIZATION), CARESOURCE INDIANA (MEDICAID HEALTH MAINTENANCE ORGANIZATION), AND ANY OTHER CARESOURCE NOT-FOR-PROFIT, TAX-EXEMPT COMPANY WHICH OPERATES CONSISTENTLY WITH THE ABOVE NAMED NOT-FOR-PROFIT, TAX EXEMPT COMPANIES. false false 231865 231865 0 The sole and specific purpose for which the Corporation is formed is to act for the benefit of, and to carry out, as a supporting organization, the purposes of CareSource, CareSource Michigan, CareSource Indiana, and any other CareSource not-for-profit, tax-exempt Company (collectively referred to as "CareSource") which operates consistently with the above named not-for-profit tax exempt companies. This corporation shall operate as a policy-making support organization for CareSource and conduct activities consistent with such purpose, including making distributions to CareSource, in accordance with the nonprofit corporation laws of the States of Ohio, Michigan and Indiana, and Section 501(C)(3) of the Internal Revenue Code, all in furtherance and support of CareSource. The Corporation will provide oversight to the activities of CareSource and ensure that the exempt purposes of CareSource are furthered. The company's mission is to make a difference in the lives of underserved people by improving their health care. In THE SPIRIT OF CARESOURCE Management Group CO'S COMMITMENT TO its charitable purposes, ITS APPOINTED TRUSTEES AND COMMITTEE MEMBERS earn charitable credits for each 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 $54,500 WERE PAID OR Accrued IN 2011 UNDER THIS POLICY BY THE ORGANIZATION. 231865 true false false false false false false false false true false true true 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 true true true false false false true 152 0 1256 true false false false false false false false false false false X 9 7 false false false false true true false true true false false true true true true true true true true false OH X JANET FERNANDES 9372243300 PO BOX 8738 Dayton OH 454018738 X Ellen S Leffak 3.0 X 0 0 0 Thomas G Breitenbach 1.0 X 0 0 0 J Thomas Maultsby 1.0 X 0 0 0 Karey L Witty 1.0 X 0 0 0 Terry G Rapoch 1.0 X 0 0 0 Michael E Ervin MD 1.0 X 0 0 0 Kevin Brown 3.0 X 19500 0 Jocelyn Guyer 1.0 X 0 0 0 Pamela B Morris 60.0 X X 0 1314264 2003018 Craig Thiele MD 60.0 X 0 470831 610038 Bobby Jones 60.0 X 444105 0 565684 L Tarlton Thomas III 60.0 X 0 270309 398184 Mark Chilson 60.0 X 402834 0 645761 Paul Stoddard 60.0 X 286271 0 496913 Janet Grant 60.0 X 0 373106 379276 Gail Croall 60.0 X 355676 0 199189 Sharon Williams 60.0 X 283240 0 131105 David Mezzanotte 60.0 X 248944 0 122549 Stanley Keith Tarter MD 60.0 X 288686 0 82047 James Gartner 60.0 X 228702 0 112685 2557958 2428510 5746449 74 false true false Level 3 Communications LLC Dept 182 DENVER CO 80291 Professional 1399224 CBS Personnel Services LLC 435 Elm St Suite 300 CINCINNATI OH 45202 Professional 848529 The Specta Group LLC 20878 East Eastman Ave AURORA CO 800138494 Professional 664847 Ernst Young LLP 312 Walnut St 1900 CINCINNATI OH 45202 Professional 650208 Outcomes Health Info Solutions LLC 13010 Morris Rd Bldg 2 ALPHARETTA GA 30004 Professional 577667 38 10000000 10000000 0 579 579 0 0 0 0 0 0 MANAGEMENT FEE REVENUE 561000 152964613 152964613 INSURANCE PREMIUMS 524298 3802585 3802585 156767198 166767777 156767198 579 231865 231865 0 0 0 4913891 4913891 0 61461553 61461553 2679252 2679252 10072716 10072716 5245654 5245654 42612 42612 670643 670643 192656 192656 0 0 0 27577025 27577025 1347721 1347721 10185703 10185703 8834355 8834355 0 8687455 8687455 1161209 1161209 0 794378 794378 1036930 1036930 0 7497867 7497867 1152578 1152578 MEMBERSHIP/DUES/FILING FEES 379707 379707 CAPTIVE - CLAIMS 3116446 3116446 ADMIN PROGRAM EXPENSES 429267 429267 MISCELLANEOUS EXPENSE 223271 223271 140004 140004 158074758 231865 157842893 0 1184829 5247443 368280 1029669 0 0 9548013 4197641 0 0 0 0 0 0 0 0 6446344 4092083 8284162 4189469 4429403 4094693 0 0 0 0 19181176 26948255 20255042 19695930 11418660 11182447 72831747 76488161 23096318 31038748 0 0 0 0 0 0 0 0 0 0 13000000 0 0 0 11080055 9551037 47176373 40589785 X 25655374 35898376 0 0 0 0 25655374 35898376 72831747 76488161 X 8693019 1549983 X false true true X false X X X false false false CARESOURCE 311143265 04 true 0 CARESOURCE INDIANA INC 320121856 04 true 0 CARESOURCE MICHIGAN 383252216 04 true 0 3 0 513262 198813 314449 6827502 3558197 3269305 943398 432459 510939 4094693 CARESOURCE INDIANA 1571176 C CARESOURCE MANAGEMENT SERVICES 7777079 C CARESOURCE 17200000 C CARESOURCE INSURANCE LLC 400000 C 26948255 CAPITAL LEASE ASSET 10138587 DEPOSITS 0 AMORTIZATION OF INTEREST 541874 COLI LIFE INSURANCE 501986 11182447 0 CAPITAL LEASE - LONG TERM 6265896 DUE TO RELATED ENTITIES 3720 CAPITAL LEASE - CURRENT 3281421 9551037 FIN 48 (ASC 740) Footnote Schedule D, Part X, Line 2 The Organization follows the provisions of FASB Accounting Standards Codification (ASC) 740-10. 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 2009-2011 are open for audit by the Internal Revenue Service. true Beth Abraham Synagogue 305 Sugar Camp Cir Dayton OH 45409 310550821 509(a)(1) 17000 Women of Valor Downtown Dayton Partnership 10 W 2nd St 611 Dayton OH 45402 341722175 509(a)(1) 5500 Holiday Festival Greater Dayton Public Television (Think TV) 110 S Jefferson St Dayton OH 45402 310858459 509(a)(1) 10000 Womens Health Conf Rebuilding Together Dayton Inc 1056 Brown Street Dayton OH 45409 311457626 509(a)(1) 6000 Rebuild Dayton Dayton Area Chamber of Comm Educ & Public Improve 1 Chamber Plaza Dayton OH 45402 311113395 509(a)(1) 10000 Workforce Development United Way of Greater Dayton Area 184 Salem Ave Dayton OH 45406 310536658 509(a)(1) 62000 Corporate Campaign; general support Epiphany Luthern Church 6430 Far Hills Ave Dayton OH 45459 310709145 501(c)(3) 7500 General Support Juvenile Diabetes Research Foundation 105 Westpark Dr 415 Brentwood TN 37027 231907729 509(a)(1) 11000 General Support Mary Scott Nursing Center 3109 Campus Dr Dayton OH 45406 316010222 509(a)(2) 22340 Fundraising Challenge Health Policy Institute of Ohio 37 W Broad St 350 Columbus OH 43215 300186863 509(a)(1) 20000 General Support 10 Contribution Review Schedule I, Part I, Question 2 The company may provide assistance to other Internal Revenue Code 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. Contributions on Behalf of Board Members Schedule I, Part II In THE SPIRIT OF CARESOURCE Management Group CO'S COMMITMENT TO its charitable purposes, ITS APPOINTED TRUSTEES AND COMMITTEE MEMBERS earn charitable credits for each 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 $54,500 WERE PAID OR ACCRUED IN 2011 UNDER THIS POLICY BY THE ORGANIZATION AND ARE REPRESENTED ON SCHEDULE I IN THE FORM OF GENERAL SUPPORT CONTRIBUTIONS. X X X X X X false true false false false false true false false Pamela B Morris 0 629451 0 448050 0 236763 0 1985668 0 17350 0 3317282 0 448050 Craig Thiele MD 0 335312 0 127536 0 7983 0 590710 0 19328 0 1080869 0 127536 Mark Chilson 355817 0 35000 0 12017 0 644488 0 1273 0 1048595 0 35000 0 Bobby Jones 324060 0 107286 0 12759 0 548937 0 16747 0 1009789 0 107286 0 Paul Stoddard 285443 0 0 0 828 0 481605 0 15308 0 783184 0 0 0 Janet Grant 0 241319 0 74018 0 57769 0 377477 0 1799 0 752382 0 74018 L Tarlton Thomas III 0 209957 0 57298 0 3054 0 378115 0 20069 0 668493 0 57298 Gail Croall 298116 0 56190 0 1370 0 181993 0 17196 0 554865 0 0 0 Sharon Williams 197025 0 70748 0 15467 0 108909 0 22196 0 414345 0 70748 0 David Mezzanotte 173118 0 71641 0 4185 0 101404 0 21145 0 371493 0 71641 0 Stanley Keith Tarter MD 225489 0 57069 0 6128 0 62329 0 19718 0 370733 0 57069 0 James Gartner 196586 0 31447 0 669 0 111716 0 969 0 341387 0 0 0 Officer Compensation Schedule J, Part II The following Corporate officer, Bobby Jones; and other listed persons including Mark Chilson, Paul Stoddard, Gail Croall, Sharon Williams, David Mezzanotte, Stanley Keith Tarter MD, and James Gartner are current employees of CareSource Management Group Co. All compensation amounts reported on Schedule J, Part II for these individuals 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, a related organization to CareSource Management Group Co. Deferred Compensation 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 entity, CareSource Management Services Co.: Pamela B Morris, Craig Thiele MD, L Tarlton Thomas III and Janet Grant. Corporate Officer Bobby Jones and individuals Mark Chilson, Paul Stoddard, Gail Croall, Sharon Williams, David Mezzanotte, and James Gartner are employees of CareSource Management Group Co., and participate in a supplemental nonqualified retirement plan through CareSource Management Group Co. Amounts are accrued monthly for plan participants for both plans. The plans provide compensation to the participants after a vesting period, and 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 Services Co.: Pamela B Morris, Craig Thiele MD, L Tarlton Thomas III and Janet Grant. Corporate Officer Bobby Jones and individuals Mark Chilson and Paul Stoddard are employees of CareSource Management Group Co and participate in a long-term incentive plan through that organization. Payments contingent on Net Earnings Schedule J, Part I, Question 6b The following listed persons listed in Form 990, Part VII, Section A, line 1a are employees of CareSource Management Services Co, a related organization to CareSource Management Group Co.: Craig Thiele MD, L Tarlton Thomas III and Janet Grant. Corporate Officer Bobby Jones and individuals Mark Chilson, Paul Stoddard, Gail Croall, Sharon Williams, David Mezzanotte, Stanley Keith Tarter MD, and James Gartner are employees of CareSource Management Group Co. All of these individuals 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 individual's calendar year regular earnings. Corporate Officer Pamela Morris is also eligible for a performance bonus as part of her compensation package. Form 990 Review 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 CFO, an outside CPA firm, outside counsel, and by general counsel prior to filing with the IRS. Conflict of Interest Policy 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 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 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 Review Part VI, Section B, Questions 15a and 15b 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. Governing Documents 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 Ohio Secretary of State's website at www.sos.state.oh.us. Governing Body Members Part VI, Section A, Question 7a All Trustees of the Board of Trustees of CareSource Management Group Co are elected by the Board of Trustees of CareSource Management Group Co EXCEPT one (1) Trustee is not elected by the Board of Trustees of CareSource Management Group Co. This Trustee is elected by CareSource, a supported organization of CareSource Management Group Co. Reconciliation of Net Assets Part XI, Line 5 (1) Additional Paid in Capital of $400,000 and Cumulative change in net Assets of $544,345 of 501(c)(3), Tax Exempt, Disregarded Entity, CareSource Insurance LLC, and (2) Prior year Goodwill Adjustment of $605,638, for a total adjustment of $1,549,983. Avg Hours Per Week devoted to Related Organizations 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, Bobby Jones, Janet Grant and Mark Chilson. 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, 70%; CareSource Michigan, 10%; CareSource Management Group Co, 10%; The CareSource Foundation, 4%; CareSource Indiana, Inc and CareSource Illinois, 2%; CareSource Insurance LLC, 2%; and CareSource Management Services Co, 2%. The following listed persons split their time between all the entities of the CareSource family of companies: Gail Croall, Paul Stoddard, David Mezzanotte, and James Gartner. 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, 80%; CareSource Michigan, 8%; CareSource Management Group Co, 5%; The CareSource Foundation, 4%; CareSource Illinois and Indiana, Inc, 1%; CareSource Insurance LLC, 1%; and CareSource Management Services Co, 1%. Listed persons Sharon Williams and Stanley Keith Tarter MD devote primarily 100% of their time to related entity, CareSource Michigan. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ellen S Leffak TITLE:Chair/Trustee HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas G Breitenbach TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:J Thomas Maultsby TITLE:Trustee HOURS:4 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Karey L Witty TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael E Ervin MD TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kevin Brown TITLE:Secretary/Treas/Trustee HOURS:1 CareSource Insurance LLC 100 Bank Street Suite 610 Burlington VT 05401 271368371 Captive Ins VT 563134 5128769 CSMG Co CareSource Indiana Inc PO Box 8738 Dayton OH 45401 320121856 Medicaid HMO IN 501(c)(3) 509(a)(2) NA true CareSource Michigan 2900 West Road Suite 201 Lansing MI 48823 383252216 Medicaid HMO MI 501(c)(3) 509(a)(2) NA true CareSource PO Box 8738 Dayton OH 45401 311143265 Medicaid HMO OH 501(c)(3) 509(a)(2) NA false The CareSource Foundation PO Box 8738 Dayton OH 45401 562582561 Grant Giving OH 501(c)(3) 509(a)(3) I CareSource false CareSource Illinois PO Box 8738 Dayton OH 45401 272202797 Inactive IL Not Determined NA true CareSource Management Services Co PO Box 8738 Dayton OH 454018738 311703371 Adm Mgmt Svcs OH NA C Corp -1154332 4969910 1.00000 false true true false false false false false false false false false true true false true false true CareSource Management Services co R, M, 223407 Actual CareSource Michigan c 6000000 Actual CareSource Michigan R, M, 754411 Actual CareSource Management Services Co B 7767079 Actual