Form990
Click to see attachment
Click to see attachment
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 01-01-2021 , and ending 12-31-2021
BCheck if applicable:
CName of organization
CareSource
 
% JANET FERNANDES
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO Box 8738
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Dayton, OH454018738
D Employer identification number

31-1703368
E Telephone number

G Gross receipts $ 995,739,832
F Name and address of principal officer:
Erhardt Preitauer
Same as C above
Dayton,OH45401
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1999
M State of legal domicile: OH
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: CareSource's mission is to make a lasting difference in members' lives by improving their health and well-being by supporting the nonprofit entities in the CareSource Family of Co.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 8
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 5,465
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 335,694 273,125
9 Program service revenue (Part VIII, line 2g) ......... 1,118,408,195 982,844,410
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 7,719,773 12,464,479
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 86,015 99,826
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 1,126,549,677 995,681,840
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 732,174 3,709,910
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 540,456,169 511,980,796
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 474,411,533 328,349,107
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,015,599,876 844,039,813
19 Revenue less expenses. Subtract line 18 from line 12....... 110,949,801 151,642,027
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 897,034,476 699,160,352
21 Total liabilities (Part X, line 26)............. 545,681,284 290,849,368
22 Net assets or fund balances. Subtract line 21 from line 20..... 351,353,192 408,310,984
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: CareSource ("The Company") is a nonprofit organization operating in Ohio. The Company was formed as a supporting organization, to act for the benefit of, and to carry out, the exempt purposes of its nonprofit, tax-exempt affiliates that operate consistently within Section 501(c)(3) of the Internal Revenue Code ("IRC") and are classified as public charities. CareSource, as a supporting organization, provides strategic oversight to CareSource Ohio Inc., CareSource Indiana Inc., The CareSource Foundation, CareSource Kentucky Co, CareSource Georgia Co, CareSource West Virginia Co, and CareSource Life Services Co. The Company operates as a policymaking supporting organization for the supported organizations and conducts activities consistent with such purpose. The Company offers a variety of insurance products in multiple markets across numerous geographical markets. Most offerings relate to Medicaid, Medicare, or the Healthcare Exchange.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 844,039,813 including grants of $ 209,910 ) (Revenue $ 982,844,410 )
CareSource, as a supporting organization, provides strategic oversight to CareSource Ohio Inc., CareSource Indiana Inc., The CareSource Foundation, CareSource Kentucky Co, CareSource Georgia Co, CareSource West Virginia Co, and CareSource Life Services Co (The "CareSource Family of Companies"). CareSource provides committee oversight regarding quality-of-care measures, Healthcare Effectiveness Data and Information Set, National Committee for Quality Assurance, as well as State and Federal quality measures. CareSource's governance oversight also includes financial review, compliance with all applicable healthcare laws, cybersecurity surveillance, and enterprise risk management functions. In March 2012, CareSource signed an Alliance Agreement with Humana, Inc., to jointly participate in state bid opportunities for Medicaid and provide coverage for people who qualify for Medicaid in the Commonwealth of Kentucky. As of December 31, 2019, there were 148,485 Medicaid Members in a Humana - CareSource Medicaid plan. CareSource has a commendable accreditation for this Medicaid plan. The current term of the Medicaid contract with the Commonwealth of Kentucky ended in June 2019 but contained one (1) additional six (6) month renewal period that was mutually agreed upon. CareSource Reinsurance LLC ("CSRE"), a single member LLC of CareSource, continued doing business with Humana in the same capacity through 2019. Effective December 31, 2019, the Company ended its relationship with Humana and will not continue servicing members in the Kentucky Medicaid program. CSRE will continue to process claims runout for effective dates of service December 31, 2019, and prior through December 31, 2022, as agreed upon with Humana. The CareSource Family of Companies' primary activity for over 30 years has been providing nonprofit Medicaid health maintenance organization ("HMO") services. The CareSource Family of Companies started its first Medicaid HMO program in Ohio in 1989. This plan is now one of the largest Medicaid managed care plans in the country. The CareSource Family of Companies has expanded beyond Ohio to operate Medicaid plans in various other states, including Georgia and Indiana. In total, The CareSource Family of Companies plans facilitate access to health care to approximately 2,000,000 low-income individuals. The CareSource Family of Companies refers to these individuals as "Members." Additionally, over the last several years, The CareSource Family of Companies' leadership began to recognize that despite health care reform, many low-income individuals remained uninsured or underinsured. They also realized that the CareSource Group was uniquely positioned to address this problem due to its extensive experience providing managed care to low-income individuals. The CareSource Family of Companies therefore concluded that it was imperative that it expand its operations to states with significant low-income populations which would benefit from the organization's charitable approach to health care. As a result, The CareSource Family of Companies expanded to operate qualified plans on the health care exchange in multiple states, as well as exclusively through several of its other CareSource-related entities that are exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code ("IRC"). As with its Medicaid HMO plans, The CareSource Family of Companies refers to individuals participating in its health care exchange plans as "Members." Through all of its activities, The CareSource Family of Companies strives to make a lasting difference in its members' lives by improving their health and overall well-being. It firmly adheres to this mission by providing services to Members (both of its Medicaid HMO plans and health care exchange plans) that go beyond the delivery of medical benefits, and which remove poverty as a barrier to achieving good health and independence. The CareSource Family of Companies also believes that it can improve the health of its members through educational initiatives. Education empowers Members to take on greater personal responsibility for their own health and the health of their family by encouraging healthy decisions and preventative care. For example, The CareSource Family of Companies prepares a personalized wellness plan for each of its members. Moreover, Members who are pregnant or have a child under the age of one can sign-up for Text4Babies. Members participating in Text4Babies receive three text messages per week that provide advice on proper preventative care. Other educational efforts include a childhood obesity management program for children between the ages of five and 17 years old. At CareSource, we know that social determinants of health are key drivers of healthcare access, utilization, and outcomes. As such, social determinants of health require full integration into the treatment of Members' physical health. What sets us apart from traditional managed care is our record of accomplishments and results in integrating these non-clinical aspects into every interaction we have with our members. The CareSource mission is to make a lasting difference in Members' lives by improving their health and well-being. This has catalyzed our commitment to develop programs that target our members' social needs - nutrition, transportation, housing, jobs, social connectedness, communication, access, and more. We shape our benefits to integrate social and economic solutions seamlessly into our members' care to have maximum impact on their social support, stability, health, and wellness. CareSource Life Services is the umbrella framework through which we address social determinants of health including hunger, housing, social stability, workforce development, and health equity. Within CareSource Life Services, our CareSource JobConnect program addresses the education and employment barriers that many of our members face and that impede their path to self-sufficiency. CareSource JobConnect is widely recognized within the managed care industry for reducing dependence on governmental services by providing Members with life coaching, access to community-based resources, and support setting and reaching their professional and educational goals. CareSource Life Services also participates in the Jobs-Plus Program ("Jobs-Plus"). The Jobs-Plus program was conceived in the mid-1990s by the Department of Housing and Urban Development ("HUD") in cooperation with various private charitable organizations. Jobs-Plus is based on the concept of saturating low-income housing developments with information, services, and incentives to encourage residents to obtain employment. Additionally, in November 2017 CareSource entered into a grant agreement with JobsOhio in order to invest in redevelopment activities, fixed-assets, infrastructure, and workforce training associated with growth of the organization in downtown Dayton, Ohio. JobsOhio was formed under the laws of the state of Ohio and was established to encourage business development in the State. JobsOhio was incorporated on July 5, 2011, as a nonprofit corporation, to promote economic development, job creation, job retention, job training, and the recruitment of business to Ohio. JobsOhio is governed by a Board of Directors appointed by the Governor of Ohio. The CareSource Family of Companies provides enhanced benefits to Members that are above and beyond required benefits defined by state or federal agencies. In order to ensure Members are able to access the most appropriate medical care, The CareSource Family of Companies provides transportation services for office visits to their medical provider's office, ensuring that Members are keeping preventive, sick, or follow-up appointments. Further showing The CareSource Family of Companies' dedication to ensuring that our most vulnerable Members receive needed care, The CareSource Family of Companies does not charge Medicaid Members a copayment for pharmacy products, dental visits, vision examinations, vision hardware or non-emergent emergency department visits, even though regulations allow for such copays. The CareSource Family of Companies is dedicated to motivating its pregnant Members to seek prenatal and postpartum care by participating in the Organization's Babies First Member Incentive Program. Moms-to-be can receive reward cards for attending regular OB/GYN appointments while pregnant and for also attending appropriate follow-up visits after giving birth. The CareSource Family of Companies also provides its members with free access to a hotline staffed by registered nurses, 24 hours a day, seven days a week. Over the phone, nurses review a member's symptoms, offer guidance on when to seek medical care, explain any recently diagnosed conditions, provide education on over-the-counter medications, and help Members prepare a list of questions prior to meeting with a physician. All of these programs are provided to Members fr
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet844,039,813
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part IClick to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................Click to see attachment
32
Yes
 
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
26
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
5,465
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
Yes
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
9
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
8
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
OH
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletJANET FERNANDESPO BOX 8738   Dayton,OH454018738 (937) 531-3027
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Erhardt Preitauer......................................................................
President & CEO, Director
 15.0
.................
45.0 		X   X       7,853,709 0 2,969,682
(2) Jai Pillai......................................................................
Chief Operating Officer
 20.0
.................
40.0 		    X       2,098,405 0 787,344
(3) Daniel McCabe......................................................................
Chief Administrative Officer
 20.0
.................
40.0 		    X       1,617,731 0 608,113
(4) Richard Topping......................................................................
Chief Legal Officer, Secretary
 45.0
.................
15.0 		      X     1,394,529 0 733,533
(5) Devon Valencia......................................................................
Chief Information Officer
 45.0
.................
15.0 		      X     1,348,000 0 641,694
(6) Stephen Ringel......................................................................
President, Market
 20.0
.................
40.0 		        X   1,416,953 0 493,925
(7) David Finkel......................................................................
Executive VP Markets (To 4/21)
 10.0
.................
50.0 		      X     1,703,154 0 11,601
(8) Sanjoy Musunuri......................................................................
EVP, Strategy & Business Dev
 45.0
.................
15.0 		      X     917,885 0 673,303
(9) David Goltz......................................................................
CFO & Treasurer (To 1/21)
 0.0
.................
0.0 		    X       1,556,240 0 2,783
(10) Scott Markovich......................................................................
Exec VP, Markets (Eff 4/21)
 10.0
.................
50.0 		      X     974,373 0 532,340
(11) Robert Losier......................................................................
SVP, IT Infrastructure & Ops
 45.0
.................
15.0 		        X   989,154 0 447,918
(12) Lawrence Smart......................................................................
CFO & Treasurer (Eff 1/21)
 30.0
.................
30.0 		    X       636,903 0 708,351
(13) Steve Smitherman......................................................................
President, Market
 1.0
.................
59.0 		        X   917,471 0 385,606
(14) Bobby Jones......................................................................
President, Market (To 6/21)
 1.0
.................
59.0 		        X   1,253,141 0 29,356
(15) James Voiland......................................................................
Chief Clinical Officer
 45.0
.................
15.0 		      X     1,226,338 0 30,427
(16) Scot Ward......................................................................
Senior VP, Analytics
 45.0
.................
15.0 		        X   828,437 0 407,526
(17) Pamela Morris......................................................................
Former President & CEO
 0.0
.................
1.0 		          X 646,015 0 0
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) David Williams........................................................................
EVP, Chief Med Ofr (Eff 10/21)
 45.0
.......................15.0 		      X     360,247 0 71,861
(19) Anthony Principi........................................................................
Chair, Director
 10.0
.......................0.0 		X           280,000 0 0
(20) Edward Thomas Brodmerkel........................................................................
Director
 8.0
.......................0.0 		X           210,000 0 0
(21) Craig Brown........................................................................
Director
 8.0
.......................0.0 		X           180,000 0 0
(22) Thomas Kelly........................................................................
Director (Eff 1/21)
 8.0
.......................0.0 		X           160,000 0 0
(23) Patricia Martin........................................................................
Director
 8.0
.......................0.0 		X           160,000 0 0
(24) Thomas Edwards........................................................................
Director
 8.0
.......................0.0 		X           150,000 0 0
(25) David Miller........................................................................
Director
 8.0
.......................0.0 		X           150,000 0 0
(26) John Monahan........................................................................
Director
 8.0
.......................0.0 		X           150,000 0 0
(27) Patrice Wolfe........................................................................
Director (To 2/21)
 8.0
.......................0.0 		X           30,625 0 0






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 29,028,685 0 9,535,363
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet1,476
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
LHC Group Inc,
901 Hugh Wallis Rd S
LAFAYETTE,LA70508 		Medical Services 350,000
Beacon Health Options Inc,
55 Water Street
NEW YORK,NY10041 		Medical Services 315,599
Jellico Medical Center,
188 Hospital Lane
JELLICO,TN37762 		Medical Services 175,000
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet3
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e 273,125
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 273,125
Program Service RevenueAmt Business Code
2a MANAGEMENT FEES 561000 949,008,939 949,008,939    
b INSURANCE PREMIUMS; REINSURANCE 524298 33,835,471 33,835,471    
c
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 982,844,410
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 12,472,471     12,472,471
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents   62,127 6a
b Less: rental expenses   0 6b
c Rental income or (loss) 0 62,127 6c
d Net rental income or (loss).......MediumBullet 62,127     62,127
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 50,000   7a
b Less: cost or other basis and sales expenses 57,992   7b
c Gain or (loss) -7,992   7c
d Net gain or (loss).........MediumBullet -7,992     -7,992
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a 0
b Less: direct expenses ... 8b 0
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a 0
b Less: direct expenses ... 9b 0
c Net income or (loss) from gaming activities..MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances ..
10a 0
b Less: cost of goods sold .. 10b 0
c Net income or (loss) from sales of inventory..MediumBullet 0      
Business Code Miscellaneous Revenue
11a SALES TAX REFUND 900099 37,699     37,699
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 37,699
12 Total revenue. See instructions.....MediumBullet 995,681,840 982,844,410   12,564,305
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 3,709,910 3,709,910
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. ............. 0  
4 Benefits paid to or for members ....... 0  
5 Compensation of current officers, directors, trustees, and key employees ........... 30,929,171 30,929,171    
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 0      
7 Other salaries and wages........ 385,693,137 385,693,137    
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 18,949,083 18,949,083    
9 Other employee benefits ....... 46,314,886 46,314,886    
10 Payroll taxes ........... 30,094,519 30,094,519    
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 5,758,541 5,758,541    
c Accounting ........... 503,306 503,306    
d Lobbying ........... 133,321 133,321    
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 20,410,972 20,410,972    
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 148,316,477 148,316,477    
12 Advertising and promotion .... 12,702,796 12,702,796    
13 Office expenses ....... 43,182,330 43,182,330    
14 Information technology ...... 34,370,044 34,370,044    
15 Royalties .. 0      
16 Occupancy ........... 11,486,588 11,486,588    
17 Travel ............ 974,048 974,048    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0      
19 Conferences, conventions, and meetings .... 864,864 864,864    
20 Interest ........... 12,351,739 12,351,739    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization .. 27,395,894 27,395,894    
23 Insurance ... 3,052,277 3,052,277    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a EXCISE TAX 2,051,375 2,051,375    
b CORPORATE MEMBERSHIPS 1,998,437 1,998,437    
c BOARD FEES 1,399,743 1,399,743    
d CLAIMS PROCESSING ADMIN EXP 735,237 735,237    
e All other expenses 661,118 661,118    
25 Total functional expenses. Add lines 1 through 24e 844,039,813 844,039,813 0 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 0 1 0
2 Savings and temporary cash investments ......... 452,515,271 2 288,845,878
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 41,131,410 4 68,577,654
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 0 7 191,010
8 Inventories for sale or use ............ 0 8 0
9 Prepaid expenses and deferred charges ...... 26,558,608 9 218,500
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 117,131,876
b Less: accumulated depreciation 10b 15,807,108 152,666,513 10c 101,324,768
11 Investments—publicly traded securities . 3,383,500 11 7,148,400
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 94,219,765 13 90,930,411
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 126,559,409 15 141,923,731
16 Total assets. Add lines 1 through 15 (must equal line 33)... 897,034,476 16 699,160,352
Liabilities 17 Accounts payable and accrued expenses ..... 257,604,666 17 16,137,596
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 0
20 Tax-exempt bond liabilities ......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 288,076,618 23 274,711,772
24 Unsecured notes and loans payable to unrelated third parties .. 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 0 25 0
26 Total liabilities. Add lines 17 through 25.. 545,681,284 26 290,849,368
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 351,353,192 27 408,310,984
28 Net assets with donor restrictions ........... 0 28 0
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 351,353,192 32 408,310,984
33 Total liabilities and net assets/fund balances ........ 897,034,476 33 699,160,352
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
995,681,840
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
844,039,813
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
151,642,027
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
351,353,192
5
Net unrealized gains (losses) on investments ...............
5
-4,019,960
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-90,664,275
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
408,310,984
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
CareSource
 
Employer identification number

31-1703368
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................6
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
(A) CARESOURCE OHIO INC
  		311143265 10   No 0 0
(B) CARESOURCE INDIANA INC
  		320121856 10   No 0 0
(C) CARESOURCE KENTUCKY CO
  		464991603 10   No 0 0
(D) CARESOURCE GEORGIA CO
  		472408339 10   No 0 0
(E) CARESOURCE LIFE SERVICES CO
  		811602217 10   No 0 0
(F) CARESOURCE WEST VIRGINIA CO
  		473028244 10   No 0 0
Total
6
 0 0
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
No
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
No
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
No
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
No
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
No
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
Yes
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
No
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
No
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
No
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
No
c
Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
No
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
No
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
No
b
A family member of a person described on 11a above?
11b
 
No
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
No
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
No
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2021 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2021 		(iii)
Distributable
Amount for 2021
1 Distributable amount for 2021 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2021:
a From 2016.......  
b From 2017.......  
c From 2018.......  
d From 2019.......  
e From 2020.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2021 distributable amount  
i Carryover from 2016 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2021 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2021 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2021, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2021. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2022. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2017.....  
b Excess from 2018.....  
c Excess from 2019.....  
d Excess from 2020.....  
e Excess from 2021.....  
Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Form 990, Schedule A, Part IV, Section A, Question 1 CareSource is a supporting organization to the IRC Section 501(c)(3) organizations classified as public charities that are members of the CareSource Family of Nonprofit organizations ("CS Public Charities"). CareSource does not specifically name the supported organizations in its Articles of Incorporation; instead, the Articles of Incorporation refer to the CS Public Charities as the "CareSource Companies." The Articles of Incorporation state the sole and specific purpose for which CareSource is formed is to act for the benefit of, and to carry out, as a supporting organization, the purposes of the nonprofit tax exempt organizations which are exempt from taxation under Section 501(c)(3) of the Internal Revenue Code ("IRC") and classified as public charities under Section 509(a)(1) or 509(a)(2) of the IRC. Although not mentioned by name, those organizations include CareSource Ohio, Inc., CareSource Indiana, Inc., CareSource Georgia Co, CareSource Kentucky Co, CareSource Life Services Co, and CareSource West Virginia Co.
Form 990, Schedule A, Part IV, Section A, Question 5a Effective July 1, 2020 CareSource Management Group Foundation merged into The CareSource Foundation, formerly a subsidiary of CareSource Ohio, Inc. ("CSOH"). Also at that time, CareSource became the sole member of The CareSource Foundation. The merger documents were filed with the Ohio Secretary of State in 2020, but the revised Articles of Incorporation were not separately filed with the Ohio Secretary of State until 2021.
Form 990, Schedule A, Part IV, Section A, Question 6 In furtherance of the charitable purposes of the CS Public Charities, which primarily operate to improve the health and overall well-being of low-income populations, CareSource improves the lives of the underserved by providing grants on behalf of the CS Public Charities to other charitable organizations that deliver a broad array of health and human services and programs. The grants are targeted to reach the neediest populations in the communities where the CS Public Charities operate.
Form 990, Schedule A, Part IV, Section C, Question 1 As noted above, CareSource is a supporting organization to the members of the CareSource family of nonprofit entities that are classified as charitable organizations under section 501(c)(3) of the IRC and public charities under section 509(a) of the IRC. During 2021, CareSource and each of the CS Public Charities had the same Chief Executive Officer (Erhardt Preitauer), Chief Administrative Officer (Daniel McCabe), Chief Financial Officer (David Goltz through 01/04/2021 and Lawrence Smart effective 01/05/2021), and Chief Operating Officer (Jai Pillai). Further, boards of the CS Public Charities were almost exclusively comprised of CareSource management-level employees who reported to the CareSource board. Thus, CareSource was "supervised or controlled in connection with" the CS Public Charities, its supported organizations, because control and management of CareSource and the CS Public Charities were vested in the same individuals.
Schedule A (Form 990) 2021


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Name of the organization
CareSource
 
Employer identification number

31-1703368
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2021)
Schedule B (Form 990) (2021) Page 2
Name of organization
CareSource
  		Employer identification number
31-1703368
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page 3
Name of organization
CareSource
  		Employer identification number

31-1703368
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page 4
Name of organization
CareSource
  		Employer identification number

31-1703368
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2021)
Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CareSource
 
Employer identification number

31-1703368
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990) 2021

Schedule C (Form 990) 2021
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................    
c Total lobbying expenditures (add lines 1a and 1b) ............................................................    
d Other exempt purpose expenditures ...............................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ..................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990) 2021


Schedule C (Form 990) 2021
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
Yes
 
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
Yes
 
266,642
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
 
No
 
j
Total. Add lines 1c through 1i ....................................................................................................
266,642
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Form 990, Schedule C, Part II-B, Line 1b Staff attended functions and meetings with government officials and legislators to discuss government sponsored health care programs.
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.
Schedule C (Form 990) 2021


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
CareSource
 
Employer identification number

31-1703368
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   3,512,609 3,512,609
b Buildings ....   112,174,051 15,376,984 96,797,067
c Leasehold improvements   1,445,216 430,124 1,015,092
d Equipment ....   0 0 0
e Other .....   0 0 0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 101,324,768
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 3
Part VII
Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)INVEST CARESOURCE WEST VIRGINI 9,500,000 C
(2)INVEST CARESOURCE OHIO INC 17,200,000 C
(3)INVEST CARESOURCE KENTUCKY CO 0 C
(4)INVEST CARESOURCE INDIANA INC 19,151,342 C
(5)INVEST CARESOURCE GEORGIA CO 32,000,000 C
(6)INV THE CARESOURCE FOUNDATION 1,718,579 C
(7)INVEST CARESOURCE ARKANSAS 360,000 C
(8)INVEST ARKANSAS PASSE 11,000,490 C
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 90,930,411
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)CAPITAL LEASE ASSET - NET 0
(2)SERP PLAN 7,758,523
(3)INTERCOMPANY RECEIVABLES 133,974,065
(4)DEPOSITS 10,000
(5)OTHER TANGIBLE ASSETS 181,143
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 141,923,731
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes 0
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 0
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
FIN 48 (ASC 740) Footnote As outlined in CareSource's Audited Consolidated Financial Statements: 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 2018-2020 are open for audit by the Internal Revenue Service.
Schedule D (Form 990) 2021


Additional Data


Software ID:  
Software Version:  





Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
CareSource
 
Employer identification number
31-1703368
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) The Children's Center Inc
6800 N W 39th Expressway
Bethany,OK73008 		73-0580264 501(c)(3) 50,000       Rehabilitation Hospital - Miracle Stadium
(2) Montgomery County Human Services
110 N Main St
Dayton,OH45402 		20-8840389 Mont Cty 30,000       Levy Campaign
(3) United States Conference of Mayors
PO Box 826902
Philadelphia,PA19182 		53-0196642 501(c)(3) 20,000       USCM Fall Leadership Meeting
(4) Downtown Dayton Partnership Corp
10 West Second St
Suite 611
Dayton,OH45402 		34-1722175 501(c)(3) 10,000       Dayton Holiday Festival
(5) Ohio Association of Area Agencies on Aging
1263 East Broad St
Columbus,OH43205 		31-1242326 501(c)(3) 6,000       Annual Conference on Aging and Disabilities
(6) The Foodbank Inc
56 Armor Place
Dayton,OH45417 		86-1082880 501(c)(3) 200 7,250 FMV Chairs General Support
(7) The CareSource Foundation
PO Box 8738
Dayton,OH45401 		56-2582561 501(c)(3) 3,500,000       General Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
7
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

Schedule I (Form 990) 2021
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Contribution Review The company may provide assistance in the form of charitable contributions to other Internal Revenue Code 501(c)(3) qualified nonprofit organizations, community health organizations, or government agencies that further the charitable purposes of CareSource and its related entities.
Schedule I (Form 990) 2021



Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
CareSource
 
Employer identification number

31-1703368
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
Yes
 
b
Any related organization? ......................
6b
Yes
 
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Erhardt Preitauer
President & CEO, Director 		(i)

(ii)		 1,222,613
-------------
0 		1,803,995
-------------
0 		4,827,101
-------------
0 		2,932,424
-------------
0 		37,258
-------------
0 		10,823,391
-------------
0 		5,190,112
-------------
0
2Jai Pillai
Chief Operating Officer 		(i)

(ii)		 598,911
-------------
0 		631,709
-------------
0 		867,785
-------------
0 		768,558
-------------
0 		18,786
-------------
0 		2,885,749
-------------
0 		1,187,751
-------------
0
3Daniel McCabe
Chief Administrative Officer 		(i)

(ii)		 445,289
-------------
0 		343,956
-------------
0 		828,486
-------------
0 		576,681
-------------
0 		31,432
-------------
0 		2,225,844
-------------
0 		1,028,697
-------------
0
4Richard Topping
Chief Legal Officer, Secretary 		(i)

(ii)		 531,826
-------------
0 		381,990
-------------
0 		480,713
-------------
0 		693,673
-------------
0 		39,860
-------------
0 		2,128,062
-------------
0 		744,490
-------------
0
5Devon Valencia
Chief Information Officer 		(i)

(ii)		 462,358
-------------
0 		339,516
-------------
0 		546,126
-------------
0 		601,010
-------------
0 		40,684
-------------
0 		1,989,694
-------------
0 		788,169
-------------
0
6Stephen Ringel
President, Market 		(i)

(ii)		 411,483
-------------
0 		286,607
-------------
0 		718,863
-------------
0 		460,318
-------------
0 		33,607
-------------
0 		1,910,878
-------------
0 		913,872
-------------
0
7David Finkel
Executive VP Markets (To 4/21) 		(i)

(ii)		 134,121
-------------
0 		415,073
-------------
0 		1,153,960
-------------
0 		4,670
-------------
0 		6,931
-------------
0 		1,714,755
-------------
0 		1,216,490
-------------
0
8Sanjoy Musunuri
EVP, Strategy & Business Dev 		(i)

(ii)		 493,698
-------------
0 		162,141
-------------
0 		262,046
-------------
0 		639,479
-------------
0 		33,824
-------------
0 		1,591,188
-------------
0 		318,993
-------------
0
9David Goltz
CFO & Treasurer (To 1/21) 		(i)

(ii)		 13,408
-------------
0 		454,618
-------------
0 		1,088,214
-------------
0 		812
-------------
0 		1,971
-------------
0 		1,559,023
-------------
0 		1,121,560
-------------
0
10Scott Markovich
Exec VP, Markets (Eff 4/21) 		(i)

(ii)		 442,537
-------------
0 		439,501
-------------
0 		92,335
-------------
0 		507,408
-------------
0 		24,932
-------------
0 		1,506,713
-------------
0 		0
-------------
0
11Robert Losier
SVP, IT Infrastructure & Ops 		(i)

(ii)		 370,399
-------------
0 		267,931
-------------
0 		350,824
-------------
0 		425,087
-------------
0 		22,831
-------------
0 		1,437,072
-------------
0 		525,909
-------------
0
12Lawrence Smart
CFO & Treasurer (Eff 1/21) 		(i)

(ii)		 518,017
-------------
0 		0
-------------
0 		118,886
-------------
0 		680,309
-------------
0 		28,042
-------------
0 		1,345,254
-------------
0 		9,615
-------------
0
13Steve Smitherman
President, Market 		(i)

(ii)		 307,721
-------------
0 		214,951
-------------
0 		394,799
-------------
0 		346,949
-------------
0 		38,657
-------------
0 		1,303,077
-------------
0 		544,264
-------------
0
14Bobby Jones
President, Market (To 6/21) 		(i)

(ii)		 210,695
-------------
0 		283,123
-------------
0 		759,323
-------------
0 		17,400
-------------
0 		11,956
-------------
0 		1,282,497
-------------
0 		1,038,138
-------------
0
15James Voiland
Chief Clinical Officer 		(i)

(ii)		 473,552
-------------
0 		339,516
-------------
0 		413,270
-------------
0 		11,096
-------------
0 		19,331
-------------
0 		1,256,765
-------------
0 		784,736
-------------
0
16Scot Ward
Senior VP, Analytics 		(i)

(ii)		 349,039
-------------
0 		223,464
-------------
0 		255,934
-------------
0 		406,446
-------------
0 		1,080
-------------
0 		1,235,963
-------------
0 		406,745
-------------
0
17Pamela Morris
Former President & CEO 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		646,015
-------------
0 		0
-------------
0 		0
-------------
0 		646,015
-------------
0 		0
-------------
0
18David Williams
EVP, Chief Med Ofr (Eff 10/21) 		(i)

(ii)		 85,606
-------------
0 		256,961
-------------
0 		17,680
-------------
0 		68,836
-------------
0 		3,025
-------------
0 		432,108
-------------
0 		0
-------------
0
19Anthony Principi
Chair, Director 		(i)

(ii)		 280,000
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		280,000
-------------
0 		0
-------------
0
20Edward Thomas Brodmerkel
Director 		(i)

(ii)		 210,000
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		210,000
-------------
0 		0
-------------
0
21Craig Brown
Director 		(i)

(ii)		 180,000
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		180,000
-------------
0 		0
-------------
0
22Thomas Kelly
Director (Eff 1/21) 		(i)

(ii)		 160,000
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		160,000
-------------
0 		0
-------------
0
23Patricia Martin
Director 		(i)

(ii)		 160,000
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		160,000
-------------
0 		0
-------------
0
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Form 990, Schedule J, Part I, Question 1a Five of the board members listed on Schedule J, Part II were reimbursed for travel to and from board meetings utilizing first/business class travel. The amount reimbursed was not treated as compensation as it was business related.
Form 990, Schedule J, Part I, Question 3 All compensation amounts reported on Schedule J, Part II for all listed persons are paid by CareSource Management Services LLC ("CSMS"), a related entity of the reporting organization. Compensation paid to the CEO is pursuant to the terms of a written employment agreement between Mr. Preitauer and CSMS. CSMS has in place Clawback provisions within its executive compensation plans that generally require executives to pay back compensation to CSMS 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 David Finkel and James Voiland each received severance payments that are properly reported on Schedule J, Part II, Column B(iii).
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 CSMS: Erhardt Preitauer, Jai Pillai, Daniel McCabe, Richard Topping, Devon Valencia, Stephen Ringel, David Finkel, Sanjoy Musunuri, David Goltz, Scott Markovich, Robert Losier, Lawrence Smart, Steve Smitherman, and Scot Ward. Amounts are accrued monthly for plan participants. The plan provides 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 plan provides 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 CSMS: Erhardt Preitauer, Jai Pillai, Daniel McCabe, Richard Topping, Devon Valencia, Stephen Ringel, David Finkel, Sanjoy Musunuri, David Goltz, Scott Markovich, Robert Losier, Lawrence Smart, Steve Smitherman, Bobby Jones, James Voiland, and Scot Ward. 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 or accrued in 2021 for both deferred compensation arrangements include the following: Erhardt Preitauer $5,810,861, Jai Pillai $1,135,537, Daniel McCabe $1,027,006, Richard Topping $570,329, Devon Valencia $757,412, Stephen Ringel $860,989, David Finkel $828,661, Sanjoy Musunuri $483,910, David Goltz $1,087,357, Scott Markovich $233,918, Robert Losier $476,903, Lawrence Smart $354,435, Steve Smitherman $503,631, Bobby Jones $755,015, James Voiland $354,597, and Scot Ward $375,595.
Form 990, Schedule J, Part I, Question 6b The following listed persons listed on Form 990, Part VII, Section A, line 1a are employees of CSMS: Erhardt Preitauer, Jai Pillai, Daniel McCabe, Richard Topping, Devon Valencia, Stephen Ringel, David Finkel, Sanjoy Musunuri, David Goltz, Scott Markovich, Robert Losier, Lawrence Smart, Steve Smitherman, Bobby Jones, James Voiland, Scot Ward, and David Williams. All are or were eligible for a performance bonus as part of their compensation packages. The performance bonus is contingent on a combination of both the CareSource Family of Companies' 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.
Schedule J (Form 990) 2021

Additional Data


Software ID:  
Software Version:  

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

SCHEDULE N
(Form 990)

Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet Attach to Form 990 or 990-EZ.
bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
CareSource
 
Employer identification number
31-1703368
Part I
Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36. Part I can be duplicated if additional space is needed. Click to see attachment
1(a) Description of asset(s)
distributed or transaction
expenses paid 		(b) Date of
distribution 		(c) Fair market value of
asset(s) distributed or
amount of transaction
expenses 		(d) Method of
determining FMV for
asset(s) distributed or
transaction expenses 		(e) EIN of recipient (f) Name and address of recipient (g) IRC section
of recipient(s) (if
tax-exempt) or type
of entity
Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? ...........................
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? .....................
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? .....................
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........
2d
 
 
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50087Z
Schedule N (Form 990) (2021)

Schedule N (Form 990) (2021)
Page 2
Part I
Liquidation, Termination, or Dissolution (continued)
Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.
Yes
No
3
Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............
3
 
 
4a
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......
4a
 
 
b
If "Yes," did the organization provide such notice? .....................
4b
 
 
5
Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................
5
 
 
6a
Did the organization have any tax-exempt bonds outstanding during the year? .....................
6a
 
 
b
If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?
6b
 
 
c
If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II
Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.
1(a) Description of asset(s)
distributed or transaction
expenses paid 		(b) Date of
distribution 		(c) Fair market value of
asset(s) distributed or
amount of transaction
expenses 		(d) Method of
determining FMV for
asset(s) distributed or
transaction expenses 		(e) EIN of recipient (f) Name and address of recipient (g) IRC section
of recipient(s) (if
tax-exempt) or type
of entity
Contrib. of Net Assets to Form CSMSH LLC 11-15-2021 109,765,218 FMV 85-1588557 CSMS Holding LLC
PO Box 8738
Dayton,OH45401 		Partnership
Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? .........................
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? .....................
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? .....................
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's significant disposition of assets? ........
2d
 
 
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50087Z
Schedule N (Form 990) (2021)

Schedule N (Form 990) (2021)
Page 3
Part III
Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule N (Form 990) (2021)



Additional Data


Software ID:  
Software Version:  


SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
CareSource
 
Employer identification number

31-1703368
Return Reference Explanation
Form 990, Part III, Line 2 For a description of the organization changes that occurred during 2021, please refer to Attachment 2, which is the response to Form 990, Part III, Line 4a.
Form 990, Part V, Line 1A In early 2020, CareSource changed the payer of its provider claims payments, resulting in a reduction of the number of Forms 1099 that were reported on Form 990, Part V, Line 1A.
Form 990, Part VI, Section A, Question 4 As a Managed Services Organization, CareSource Management Services LLC ("CSMS") provides administrative and management services to CareSource ("CS") and its supported health plans. For federal income tax purposes, CSMS was considered a disregarded entity, as a single member LLC ("SMLLC") of CareSource Management Services Holding LLC ("CSMSH"), which is a SMLLC of CareSource Holding LLC ("CSH"), which is a SMLLC of CareSource through 11/14/2021. CareSource added the following entities to the group during 2021: (1) CareSource PASSE LLC ("CSPASSE") was organized on 4/7/2021, to become licensed as a risk-based provider organization ("RBPO") under Arkansas Code Annotated 20-77-2701, which is sometimes referred to as a Provider-owned Arkansas Shared Savings Entity or "PASSE". Arkansas requires a Provider-Led Organization to administer Medicaid. CSPASSE will begin serving Arkansas Medicaid members 1/1/2022. (2) Gem City Reinsurance LLC ("Gem City") was organized on 6/15/2021 as a Montana captive limited liability company. (3) CareSource Holding II LLC ("CSH II") was organized on 06/29/2021, as an Ohio domestic for-profit limited liability company. CSH II had no financial activity on its books as of 12/31/2021. (4) CareSource Reinsurance II LLC ("CSRE II") was organized on 9/27/2021, as a Montana captive limited liability company. CSRE II had no financial activity on its books as of 12/31/2021. (5) CareSource North Carolina Co. ("CSNC") was incorporated on 10/1/2021 as a North Carolina business corporation. CSNC had no financial activity on its books as of 12/31/2021. (6) CSMSH purchased Healthedge-Columbus Holdings LLC ("HCH"), including Columbus Organization Holdings LLC, Columbus Medical Services LLC, Columbus Educational Services LLC, and Columbus Medical Services Inc (collectively referred to as "The Columbus Organization") on 11/17/2021. The Columbus Organization is a national provider of on-site professional staffing, consulting, and continuing education services to state-operated agencies serving the intellectual and developmental disability community. (7) CareSource Kansas LLC ("CSKS") was organized on 11/3/2021 as a Kansas limited liability company. CSKS had no financial activity on its books as of 12/31/2021. (8) CareSource Tennessee Co. ("CSTN") was incorporated on 12/22/2021 as a Tennessee for-profit corporation. CSTN had no financial activity on its books as of 12/31/2021. The resulting corporate structure of The CareSource Group as of 12/31/2021 is as follows: CareSource is the sole member of CareSource Ohio Inc. ("CSOH"), CareSource Indiana Inc. ("CSIN"), CareSource Kentucky Co ("CSKY"), CareSource Georgia Co ("CSGA"), CareSource West Virginia Co ("CSWV"), CareSource Life Services Co ("CSLS"), The CareSource Foundation ("CSF"), CareSource Network Partners LLC ("CSNP"), CareSource At Home LLC ("CSAH"), CareSource Reinsurance LLC ("CSRE"), CareSource Real Estate Holdings LLC ("CSRH"), CareSource Holding LLC ("CSH"), CareSource Holding II LLC ("CSH II"), and CareSource Virginia Co ("CSVA"). CSOH, CSIN, CSKY, CSGA, CSWV, CSLS, and CSF are nonprofit, tax-exempt organizations. CSNP, CSAH, CSRE, CSRH, CSH, and CSH II are single member limited liability companies that are disregarded for federal income tax purposes. CSVA is a nonprofit corporation that is taxed as a for-profit corporation for federal income tax purposes. CSH is the sole member of CareSource Arkansas Health Plan Co ("CSAR"), a for-profit corporation. CSH owns 49% of CSPASSE and 86.9% of CSMSH. CSPASSE is treated as a C Corporation for federal income tax purposes. CSH II is the sole member of CareSource Reinsurance II LLC ("CSRE II"), a single member limited liability company that is disregarded for federal income tax purposes. Effective 11/15/2021, CSMSH became a partnership for federal income tax purposes. The activity for all single member LLCs that are disregarded for federal income tax purposes for which CSMSH is the sole member will be included on the Form 990 of CS for the period prior to the formation of the partnership (1/1/2021-11/14/2021). The activity for the period 11/15/2021-12/31/2021 for those same LLCs will be reported on the tax return of CSMSH. CSMSH is the sole member of CareSource Management Services LLC ("CSMS"), CareSource Rx Innovations LLC ("CSRX"), CareSource Oklahoma Holding LLC ("CSOKH"), Gem City Reinsurance LLC ("Gem City"), Kids' CareAlliance Co ("KCA"), CareSource North Carolina ("CSNC"), CareSource Kansas LLC ("CSKS"), CareSource Tennessee Co ("CSTN"), and HealthEdge-Columbus Holdings LLC ("HCH"). CSMS, CSRX, CSOKH, and Gem City are single member limited liability companies that are disregarded for federal income tax purposes. KCA, CSNC, CSKS, CSTN, and HCH are treated as for-profit corporations for federal income tax purposes. CSOKH is the sole member of CareSource Oklahoma Health Plan Co ("CSOK"). HCH is the sole member of Columbus Organization Holdings LLC ("COH"). COH is the sole member of Columbus Medical Services Inc ("CMSI"). CSOK, COH, and CMSI Inc are treated as for-profit corporations for federal income tax purposes. COH is the sole member of Columbus Medical Services LLC and Columbus Educational Services LLC, which are single member limited liability companies that are disregarded for federal income tax purposes.
Form 990, Part VI, Section B, Question 11B THE FORM 990 WAS PROVIDED TO THE FOLLOWING INDIVIDUALS FOR REVIEW PRIOR TO THE TIME OF FILING THE FORM 990: THE ORGANIZATION'S AUDIT COMMITTEE, EACH VOTING MEMBER OF THE GOVERNING BODY OF THE ORGANIZATION, THE CEO, CFO, VP TREASURY, DIRECTOR TAX, MANAGER TAX, AN OUTSIDE CPA FIRM, OUTSIDE LEGAL COUNSEL, AND GENERAL COUNSEL.
Form 990, Part VI, Section B, Question 12C Annually, each director, principal officer and member of a committee with board-delegated powers ("interested person") shall confirm that they have received a copy of the CareSource Conflicts of Interest policy and have read, understood, and agree to comply with the policy. Interested Persons have an obligation to immediately report any Conflicts of Interest (including any relationships, positions, or circumstances that could contribute to a Conflict of Interest). All relevant information reported through the Conflict-of-Interest Policy will be sent to the Chairman of the Board for review. If the Interested Person with the Conflict of Interest is the Chairman of the Board, then the required disclosure must be provided to the Chief Legal Officer of CareSource. If it is not entirely clear whether a Conflict of Interest exists, then the person with the potential conflict must disclose the circumstances to CareSource's Chief Legal Officer. The Chief Legal Officer will consult with the Corporation's Corporate Compliance Officer or the Chairman of the Board to determine whether there exists a Conflict of Interest that is subject to this policy. Before Board action or other action by CareSource on a Transaction that involves a Conflict of Interest, an Interested Person who knows he or she has a Conflict of Interest must have disclosed to the Board all facts material to the Conflict of Interest. The Chairman of the Board may postpone Board or other corporate action on a Transaction until the Interested Person provides written information relating to the Conflict of Interest. An Interested Person who knows he or she has a Conflict of Interest must not participate in the Board's discussion of the Transaction except to disclose material facts and respond to questions. The Interested Person must not attempt to influence the Board's action on the Transaction, either at or outside the meeting. Prior to voting, the Board must be given an opportunity to discuss the Transaction without the person who has the Conflict of Interest being present. A Transaction involving a Conflict of Interest may be approved by the Board of CareSource if the material facts as to the Transaction and the Conflict of Interest are fully disclosed or known to the Board and the Board in good faith determines after reasonable investigation that (a) the Board is aware of all material facts concerning the Transaction and the Interest person's interest in the Transaction; (b) CareSource is entering into the Transaction for its own benefit; (c) the Transaction is fair and reasonable as to CareSource; and (d) CareSource could not have obtained a more advantageous arrangement with reasonable effort under the circumstances. The Person with the Conflict of Interest must not vote on the Transaction and must not be present in the room when the vote is taken.
Form 990, Part VI, Section B, Q 15A and 15B; Schedule J, Part I The Compensation Committee consists of Board Members who are Independent. The Compensation Committee establishes the Company's general compensation philosophy and oversees and approves the development, adoption, and implementation of compensation plans and programs for the Company's officers and executives. The Compensation Committee receives a Report of comparability data prepared by an independent compensation consultant 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. Additionally, the Minutes of each meeting are prepared, distributed, and approved at the next regularly scheduled Compensation Committee meeting. The Compensation Consultant does no other business with the CareSource Family of Companies other than determining the reasonableness of compensation and consulting on the compensation plan design. At least annually, the Compensation Committee assesses the work of the compensation consultants.
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 does not make its audited financial statements available to the public. The Company's articles of incorporation are available on the Ohio Secretary of State's website at www.sos.state.oh.us.
Form 990, Part XI, Line 9 Change in Net Assets is inclusive of the following: A. Capital Distribution from CS to CSH LLC $6,000,000 B. Dividend from CareSource Holding LLC to CareSource $11,473,873 C. Change in Investment in The CareSource Foundation $793,156 D. Other Comprehensive Income - Mark to Market Adjustment $833,914 E. Contribution of Net Assets upon conversion of CSMSH LLC to partnership $(109,765,218)
FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:XXX-XX-XXXX
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
CareSource
 
Employer identification number

31-1703368
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) CareSource Reinsurance LLC
PO Box 8738
Dayton,OH454018738
45-4937120 		Captive Ins MT   134,180,561 CareSource
 
(2) CareSource Network Partners LLC
PO Box 8738
Dayton,OH454018738
81-1017455 		Contracting OH   0 CareSource
 
(3) CareSource At Home LLC
PO Box 8738
Dayton,OH454018738
81-1025103 		Home Health OH   0 CareSource
 
(4) CareSource Real Estate Holdings LLC
PO Box 8738
Dayton,OH454018738
82-4834822 		R/E Holding OH   105,804,591 CareSource
 
(5) CareSource Holding LLC
PO Box 8738
Dayton,OH454018738
84-4431982 		Holding Co OH   0 CareSource
 
(6) CS Mgmt Svcs Holding LLC (To 111421)
PO Box 8738
Dayton,OH454018738
85-1588557 		Holding Co DE   0 CSH LLC
 
(7) CareSource Management Services LLC
PO Box 8738
Dayton,OH454018738
31-1703371 		ADM MGMT SVCS OH   206,269,376 CSMSH LLC
 
(8) CareSource Rx Innovations LLC
PO Box 8738
Dayton,OH454018738
85-2689588 		Rx Services OH   0 CSMSH LLC
 
(9) CareSource Oklahoma Holding LLC
PO Box 8738
Dayton,OH454018738
85-3713133 		Holding Co DE   0 CSMSH LLC
 
(10) CareSource Holding II LLC
PO Box 8738
Dayton,OH454018738
87-1688130 		Holding Co OH     CareSource
 
(11) CareSource Reinsurance II LLC
PO Box 8738
Dayton,OH454018738
87-2901879 		Captive Ins MT     CSH II LLC
 
(12) Gem City Reinsurance LLC
PO Box 8738
Dayton,OH454018738
87-1242052 		Captive Ins OH     CSMSH LLC
 
(13) Columbus Educational Services LLC
PO Box 8738
Dayton,OH454018738
23-3052598 		Inactive DE     COH LLC
 
(14) Columbus Medical Services LLC
PO Box 8738
Dayton,OH454018738
75-2690132 		Healthcare DE     COH LLC
 
Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)CareSource Indiana Inc
PO Box 8738

Dayton,OH454018738
32-0121856 		Medicaid HMO IN 501(c)(3) 509(a)(2) CareSource
 
Yes
 
(2)CareSource Ohio Inc
PO Box 8738

Dayton,OH454018738
31-1143265 		Medicaid HMO OH 501(c)(3) 509(a)(2) CareSource
 
Yes
 
(3)The CareSource Foundation
PO Box 8738

Dayton,OH454018738
56-2582561 		Grantmaking OH 501(c)(3) 509(a)(3) I CareSource
 
Yes
 
(4)CareSource Kentucky Co
PO Box 8738

Dayton,OH454018738
46-4991603 		Exchange HMO KY 501(c)(3) 509(a)(2) CareSource
 
Yes
 
(5)CareSource Georgia Co
PO Box 8738

Dayton,OH454018738
47-2408339 		Medicaid HMO GA 501(C)(3) 509(a)(2) CareSource
 
Yes
 
(6)CareSource West Virginia Co
PO Box 8738

Dayton,OH454018738
47-3028244 		Exchange HMO WV 501(c)(3) 509(a)(2) CareSource
 
Yes
 
(7)CareSource Life Services Co
PO Box 8738

Dayton,OH454018738
81-1602217 		Inactive OH 501(c)(3) 509(a)(2) CareSource
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) CS Mgmt Svcs Holding LLC (Eff 111521)

PO Box 8738
Dayton,OH454018738
85-1588557 		Holding Co DE CS Holding LLC
  		Related     Yes     Yes   86.854 %
(2) CareSource Diversity & Social Impact

50 East 91st Street Suite 213
Indianapolis,IN46240
87-1811106 		Investing DE CareSource
  		Excluded -28,857 2,471,143   No 0   No 100.000 %










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) CareSource Virginia Co

PO Box 8738
Dayton,OH454018738
81-1727271 		Inactive VA CareSource
  		C Corp     100.000 % Yes  
(2) CareSource Arkansas Health Plan Co

PO Box 8738
Dayton,OH454018738
84-4476729 		HLTH & MED INS AR CS Holding LLC
  		C Corp     100.000 % Yes  
(3) Kids' CareAlliance Co

PO Box 8738
Dayton,OH454018738
85-4022039 		HLTH & MED INS OH CSMSH LLC
  		C Corp     86.854 % Yes  
(4) CareSource Oklahoma Health Plan Co

PO Box 8738
Dayton,OH454018738
85-4038326 		HLTH & MED INS OK CSOKH LLC
  		C Corp     86.854 % Yes  
(5) CareSource Kansas LLC

PO Box 8738
Dayton,OH454018738
87-3411276 		Inactive KS CSMSH LLC
  		C Corp     86.854 % Yes  
(6) CareSource North Carolina Co

PO Box 8738
Dayton,OH454018738
87-3079479 		Inactive NC CSMSH LLC
  		C Corp     86.854 % Yes  
(7) CareSource PASSE LLC

PO Box 8738
Dayton,OH454018738
86-3112470 		HLTH & MED INS AR CS Holding LLC
  		C Corp     49.000 % Yes  
(8) Columbus Organization Holdings LLC

PO Box 8738
Dayton,OH454018738
81-4132952 		Holding Co DE HCH LLC
  		C Corp     86.854 % Yes  
(9) Healthedge-Columbus Holdings LLC

PO Box 8738
Dayton,OH454018738
81-4132842 		Holding Co PA CSMSH LLC
  		C Corp     86.854 % Yes  
(10) CareSource Tennessee Co

PO Box 8738
Dayton,OH454018738
87-4254502 		Inactive TN CSMSH LLC
  		C Corp     86.854 % Yes  
(11) Columbus Medical Services Inc

PO Box 8738
Dayton,OH454018738
30-0975112 		Inactive MD COH LLC
  		C Corp     86.854 % Yes  
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
Yes
 
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
Yes
 
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CareSource Georgia Co

 a 5,557,056 Actual
(2) CareSource Indiana Inc

 a 1,300,000 Actual
(3) CareSource Management Services LLC

 a 1,071,602 Actual
(4) CareSource West Virginia Co

 a 495,000 Actual
(5) CareSource Georgia Co

 d 60,000,000 Actual
(6) CareSource Kentucky Co

 f 4,250,000 Actual
(7) CareSource Management Services Holding LLC

 f 17,473,872 Actual
(8) CareSource Georgia Co

 l 101,051,838 Actual
(9) CareSource Indiana Inc

 l 87,998,757 Actual
(10) CareSource Kentucky Co

 l 31,468,807 Actual
(11) CareSource Ohio Inc

 l 715,409,977 Actual
(12) CareSource West Virginia Co

 l 7,002,567 Actual
(13) CareSource Management Services LLC

 r 109,765,218 Actual
(14) The CareSource Foundation

 b 3,500,000 Actual
(15) CareSource Kentucky Co

 c 13,750,000 Actual
(16) CareSource PASSE LLC

 b 11,000,000 Actual
(17) CareSource Oklahoma Health Plan Co

 b 511,000 Actual
(18) Kids' CareAlliance Co

 b 1,700,000 Actual
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Part I - Disregarded Entities - Additional Information - CareSource Management Services Holding LLC (EIN 85-1588557) changed from a single member LLC to a partnership effective 11/15/2021. - CareSource Holding II LLC (EIN 87-1688130) was incorporated 06/29/2021. - CareSource Reinsurance II LLC (EIN 87-2901879) was incorporated 09/27/2021. - Gem City Reinsurance LLC (EIN 87-1242052) was incorporated 06/15/2021. - Columbus Education Services LLC (EIN 75-2690132) was acquired 11/17/2021. - Columbus Medical Services LLC (EIN 75-2690132) was acquired 11/17/2021.
Part IV - Related Organizations Taxable as a Corp - Additional Information - CareSource Kansas LLC (EIN 87-3411276) was incorporated 11/03/2021. - CareSource North Carolina Co (EIN 87-3079479) was incorporated 10/01/2021. - Columbus Organization Holdings LLC (EIN 81-4132952) was acquired 11/17/2021. - Healthedge-Columbus Holdings LLC (EIN 81-4132842) was acquired 11/17/2021. - CareSource Tennessee Co (EIN 87-4254502) was incorporated 12/22/2021. - Columbus Medical Services Inc (EIN 30-0975112) was acquired 11/17/2021.
Schedule R (Form 990) 2021

Additional Data


Software ID:  
Software Version: