Civic Intelligence

Caresource West Virginia Co

990 • Fiscal year 2021 • EIN 47-3028244

Jan 01, 2021 to Dec 31, 2021 • Filed on Nov 15, 2022

PO Box 8738Dayton, OH 45401-8738

(937) 531-3027

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

91st percentile

0.92x

Higher debt load relative to assets than 91% of similar nonprofits.

2021 filings • 501(c)3 • $50M-$100M nonprofits • Source year 2021

Liabilities / Revenue

58th percentile

0.46x

Higher debt load relative to revenue than 58% of similar nonprofits.

2021 filings • 501(c)3 • $50M-$100M nonprofits • Source year 2021

Net Margin

19th percentile

-0.3%

Higher net margin than 19% of similar nonprofits.

2021 filings • 501(c)3 • $50M-$100M nonprofits • Source year 2021

Top Officer Pay

100th percentile

$10,823,391

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 15.4% of source-year revenue.

2021 filings • 501(c)3 • $50M-$100M nonprofits • Source year 2021

Asset Growth

84th percentile

32%

Faster asset growth than 84% of similar nonprofits.

2021 filings • 501(c)3 • $50M-$100M nonprofits • Annualized from 2020 to 2021

Revenue Growth

71st percentile

31%

Faster revenue growth than 71% of similar nonprofits.

2021 filings • 501(c)3 • $50M-$100M nonprofits • Annualized from 2020 to 2021

Assets

Up

$34,850,129

Up $8,482,334 (+32%) from 2020

Net Assets

Down

$2,854,656

Down $220,606 (-7.2%) from 2020

Liabilities

Up

$31,995,473

Up $8,702,940 (+37%) from 2020

Revenue

Up

$70,193,588

Up $16,460,164 (+31%) from 2020

Expenses

Up

$70,414,194

Up $15,864,390 (+29%) from 2020

Net Income

Up

-$220,606

Up $595,774 (+73%) from 2020

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$150M$100M$50M$0Assets 2016: $7,627,426Liabilities 2016: $4,014,222Net Assets 2016: $3,613,2042016Assets 2017: $24,942,499Liabilities 2017: $16,049,004Net Assets 2017: $8,893,4952017Assets 2018: $25,009,769Liabilities 2018: $21,951,252Net Assets 2018: $3,058,5172018Assets 2019: $27,324,026Liabilities 2019: $23,432,384Net Assets 2019: $3,891,6422019Assets 2020: $26,367,795Liabilities 2020: $23,292,533Net Assets 2020: $3,075,2622020Assets 2021: $34,850,129Liabilities 2021: $31,995,473Net Assets 2021: $2,854,6562021Assets 2022: $47,704,956Liabilities 2022: $43,139,701Net Assets 2022: $4,565,2552022Assets 2023: $68,624,913Liabilities 2023: $57,127,379Net Assets 2023: $11,497,5342023Assets 2024: $139,591,982Liabilities 2024: $122,844,410Net Assets 2024: $16,747,5722024

Highlighted filing

2021

Assets$34,850,129
Liabilities$31,995,473
Net Assets$2,854,656

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$300M$200M$100M$0-$100MRevenue 2016: $5,404,593Expenses 2016: $5,947,996Net Income 2016: -$543,4032016Revenue 2017: $32,204,956Expenses 2017: $31,924,665Net Income 2017: $280,2912017Revenue 2018: $50,663,596Expenses 2018: $56,498,574Net Income 2018: -$5,834,9782018Revenue 2019: $52,362,618Expenses 2019: $51,529,493Net Income 2019: $833,1252019Revenue 2020: $53,733,424Expenses 2020: $54,549,804Net Income 2020: -$816,3802020Revenue 2021: $70,193,588Expenses 2021: $70,414,194Net Income 2021: -$220,6062021Revenue 2022: $82,246,044Expenses 2022: $80,534,117Net Income 2022: $1,711,9272022Revenue 2023: $103,332,039Expenses 2023: $96,431,596Net Income 2023: $6,900,4432023Revenue 2024: $214,719,988Expenses 2024: $209,483,593Net Income 2024: $5,236,3952024

Highlighted filing

2021

Revenue$70,193,588
Expenses$70,414,194
Net Income-$220,606
Jump To
Filing Snapshot
Filing Period
Jan 1, 2021 to Dec 31, 2021
Signed
Nov 15, 2022
Return Version
2021v4.2
Gross Receipts
$70,193,588
Mission and Program Overview

Mission

TO MAKE A LASTING DIFFERENCE IN OUR MEMBERS LIVES BY IMPROVING THEIR HEALTH AND WELL-BEING. THE CARESOURCE WEST Virginia Marketplace PLAN WAS SUCCESSFULLY IMPLEMENTED WITH ENROLLMENT BEGINNING ON NOVEMBER 1, 2015, AND AN EFFECTIVE DATE OF JANUARY 1, 2016.

To Make a Lasting Difference in our mem- bers' lives by improving their health and well-being. CareSource West Virginia Co is a nonprofit HMO licensed by the State of West Virginia.

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$22,231,065$31,671,723▲ $9,440,658
Accounts Receivable$2,212,178$1,759,815▼ $452,363
Investments in Publicly Traded Securities$1,924,552$1,418,591▼ $505,961
Cash and Non-Interest-Bearing Accounts$0$0→ $0
Other Notes and Loans Receivable, Net$0$0→ $0
Pledges and Grants Receivable$0$0→ $0
Receivable From Disqualified Prsn$0$0→ $0
Receivables From Officers Etc$0$0→ $0
Investments Other Securities$0$0→ $0
Investments Program Related$0$0→ $0
Land, Buildings, and Equipment, Net$0$0→ $0
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Loans From Officers Directors$0$0→ $0
Prepaid Expenses and Deferred Charges$0$0→ $0
Total Assets$26,367,795$34,850,129▲ $8,482,334
Other Assets Total$0$0→ $0
Liabilities
Deferred Revenue$9,297,543$13,862,011▲ $4,564,468
Accounts Payable and Accrued Expenses$7,196,283$10,355,777▲ $3,159,494
Other Liabilities$6,798,707$7,777,685▲ $978,978
Grants Payable$0$0→ $0
Mortgage Notes Payable Secured by Investment Property$0$0→ $0
Unsecured Notes Loans Payable$0$0→ $0
Escrow Account Liability$0$0→ $0
Tax Exempt Bond Liabilities$0$0→ $0
Total Liabilities$23,292,533$31,995,473▲ $8,702,940
Net Assets / Fund Balance
Net Assets Without Donor Restrictions$3,075,262$2,854,656▼ $220,606
Net Assets With Donor Restrictions$0$0→ $0
Total Net Assets Fund Balance$3,075,262$2,854,656▼ $220,606
Total Liabilities and Net Assets / Fund Balance$26,367,795$34,850,129▲ $8,482,334
Compensation and Service Providers

Board Members and Trustees

NameTitle
Scott MarkovichEVP Markets & Chair (Eff 4/21)
David FinkelEVP, Markets & Chair (To 4/21)
Pamela MorrisFormer President & CEO
Erhardt PreitauerPresident & CEO
Michael TaylorPresident, Market & Secretary
Daniel McCabeChief Administrative Officer
Lawrence SmartChief Financial Ofr (Eff 1/21)
David GoltzChief Financial Ofr (To 1/21)
Jai PillaiChief Operating Officer
William Coffin JrVP, Market Finance & Treasurer

Highest Paid Contractors

ContractorServicesLocationCompensation
Express Scripts IncPharmacy Services21653 Network Place, Chicago, IL 60673$11,324,439
DentaQuest Group IncMedical Services465 Medford Street, Charlestown, MA 02129$112,230
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$70,165,308
Investment Income
$28,280
Other Revenue
$0
Change in Net Assets
$-220,606
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$70,414,194
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Other Expenses$321,961$2,623,807-$2,623,807
Fees for Services Other$127,804$1,831,177-$1,958,981
Office Expenses$5,201$1,064,154-$1,069,355
Interest-$496,543-$496,543
Advertising-$306,381-$306,381
All Other Expenses$16,964$245,233-$262,197
Occupancy-$190,784-$190,784
Fees for Services Accounting-$88,466-$88,466
Fees for Services Legal-$47,997-$47,997
Insurance-$27,727-$27,727
Travel-$14,489-$14,489
Fees for Services Lobbying-$9,864-$9,864
Total Functional Expenses$59,193,696$11,220,498$0$70,414,194
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Fundraising Direct Expenses$0
Fundraising Gross Income$0
Gaming Direct Expenses$0
Gaming Gross Income$0
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
Yes
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Receivables from Disqualified Persons$0$0→ $0
Receivables from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Related Party Payable$7,777,685
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Backup withholding compliance
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section A, Question 6

CareSource is the sole member of CareSource West Virginia Co. CareSource is recognized as exempt from federal income taxation under Internal Revenue Code ("IRC") Section 501(c)(3).

Form 990, Part VI, Section A, Question 7A

Caresource, the sole member of caresource west virginia, co., has the authority to appoint caresource west virginia co.'s board.

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. taken.

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's statutory financial statements are available on the SNL Financial LC website at www.snl.com for a nominal fee. The company's articles of incorporation are available on the West Virginia Secretary of State's website at www.sos.wv.gov/.

Filing and Contact Details

Filer

Filer Name
CareSource West Virginia Co
EIN
47-3028244
In Care Of
% JANET FERNANDES
Phone
9375313027
Address
PO Box 8738, Dayton, OH 45401-8738

Signing Officer

Name
Lawrence Smart
Title
CFO
Phone
9375313027
Signed
2022-11-15
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Erhardt Preitauer
Formed
2015
Legal Domicile
Wv
Voting Board Members
3
Independent Board Members
0
Employees
0
Volunteers
0

Preparer

Firm
Rsm US Llp
Address
6 S PATTERSON BLVD, DAYTON, OH 45402
Preparer
Karen O Crim
Phone
9372980201
Supplemental Narrative

Additional Explanations

Form 990, Part V, Line 1A

In late 2019, CareSource West Virginia 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.

Financial Statement Notes

FIN 48 (ASC 740) Footnote

As outlined in CareSource's Audited Consolidated Financial Statements, which include the activity of CareSource West Virginia Co.: 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.

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IRS990/Desc0CareSource West Virginia Co. ("CSWV") is a nonprofit organization established under the state law of West Virginia. On August 30, 2017, CSWV received a determination letter from the Internal Revenue Service, recognizing CSWV as an organization exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code, effective as of the date of CSWV's formation. CSWV is a member of the CareSource group of nonprofit organizations (the "CareSource Group"). The mission of the CareSource Group is to make a lasting difference in its members' lives by improving their health and well-being. CSWV firmly adheres to this mission, which it terms as the organization's "heartbeat," by providing services that go well beyond the delivery of medical benefits. CSWV is accredited for its Qualified Health Plan ("QHP") through the National Committee for Quality Assurance ("NCQA"). Accreditation is the most comprehensive evaluation in the industry and the only assessment that bases results on clinical performance and consumer experience. In addition to our commitment to quality CareSource offers additional case management services for members at risk for substance use disorder, and in a partnership with the West Virginia department of education, is working to develop a suboxone education program for the state's educators and school nurses. CSWV focuses on prevention with a goal of improving member health, the quality of health care services received, and accessibility of health care services for its members. This is done through an innovative health and wellness methodology. CSWV has built a high-performing provider network to operate as a Health Maintenance Organization ("HMO"). This provider network relies heavily upon Federally Qualified Health Centers ("FQHCs"). FQHCs are generally health care providers that have been recognized by the federal government as providing care to populations that have limited access to medical treatment due to conditions such as poverty and geographic location. CareSource West Virginia's QHP on the Health Insurance Marketplace primarily serves low-income individuals and was designed for those low-income adults who are recently uninsured or have never been insured. The plan is affordable, with a majority of members qualifying for subsidies to lower their monthly premiums or out of pocket costs. Members have the choice of buying plans with only the essential health benefits, or ones that also include adult dental, vision, and fitness supplemental benefits. Members can also receive assistance through CSWV's many programs designed to remove barriers to health and well-being. CSWV can, therefore, further its mission as a means of improving the health and well-being of West Virginia's low-income populations.
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IRS990/Form990PartVIISectionAGrp/PersonNm8William Coffin Jr
IRS990/Form990PartVIISectionAGrp/PersonNm9Pamela Morris
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IRS990/Form990PartVIISectionAGrp/TitleTxt0President & CEO
IRS990/Form990PartVIISectionAGrp/TitleTxt1Chief Operating Officer
IRS990/Form990PartVIISectionAGrp/TitleTxt2Chief Administrative Officer
IRS990/Form990PartVIISectionAGrp/TitleTxt3EVP, Markets & Chair (To 4/21)
IRS990/Form990PartVIISectionAGrp/TitleTxt4Chief Financial Ofr (To 1/21)
IRS990/Form990PartVIISectionAGrp/TitleTxt5EVP Markets & Chair (Eff 4/21)
IRS990/Form990PartVIISectionAGrp/TitleTxt6Chief Financial Ofr (Eff 1/21)
IRS990/Form990PartVIISectionAGrp/TitleTxt7President, Market & Secretary
IRS990/Form990PartVIISectionAGrp/TitleTxt8VP, Market Finance & Treasurer
IRS990/Form990PartVIISectionAGrp/TitleTxt9Former President & CEO
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