Become A Member - Caresource Mission

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CareSource Mission is a member organization. By becoming a member, you help advocate for CareSource employees, members, and communities with policy makers and political leaders across the country.

CareSource Mission is inviting new and renewal members for 2025.

Are you a CareSource Employee or External Contact?*

CareSource Employee

External Contact (non CareSource employee)

2025 CareSource Mission Membership Application

JOIN CARESOURCE MISSION

CareSource Mission is a member organization. By becoming a member, you help advocate for CareSource employees, members, and communities with policy makers and political leaders across the country.

CareSource Mission is inviting new and renewal members for 2025.

Your membership in CareSource Mission is voluntary and will have no impact, positive or negative, on your employment with CareSource. Annual membership dues are $5.00.

2025 CareSource Mission Membership Application

JOIN CARESOURCE MISSION

CareSource Mission is a member organization. By becoming a member, you help advocate for CareSource employees, members, and communities with policy makers and political leaders across the country.

CareSource Mission is inviting new and renewal members for 2025.

Annual membership dues are $5.00.

Yes, I would like to be a 2025 CareSource Mission Member*

Yes

BECOME A CARESOURCE MISSION PAC MEMBER

As a member of CareSource Mission, you can make an even bigger impact!

CareSource Mission sponsors the CareSource Mission Political Action Committee (PAC). CareSource Mission PAC provides CareSource Mission Members with a collective voice in the political arena, allowing us to support candidates who understand the importance of managed care, and the needs of individuals enrolled in Medicaid, Medicare and Marketplace.

CareSource Mission PAC is not funded by a CareSource company budget. It is funded solely by CareSource employees and other individuals looking to make a difference. CareSource Mission PAC is not aligned with a particular political party and supports campaigns of candidates from both sides of the aisle. The only political interest of CareSource Mission PAC is to advance the benefits of managed care.

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and the name of employer of individuals whose contributions exceed $200 per calendar year.

Please complete the following in its entirety

I understand and certify the following:

My participation in the CareSource Mission PAC is voluntary and my decision to contribute or not, and the amount of my contribution, will have no impact, positive or negative, on my employment with CareSource.
$5 of my contribution will be applied to my membership dues to CareSource Mission. The remainder of my contribution(s) will be used for political purposes.
Annual contributions exceeding $200 will be disclosed to the Federal Election Commission as required by law, and contributions of any amount will be reported as necessary to satisfy state-specific reporting requirements.
My membership dues and contribution(s) are not deductible as a charitable contribution for federal income tax purposes.
I am a U.S. citizen.

BECOME A CARESOURCE MISSION PAC MEMBER

As a member of CareSource Mission, you can make an even bigger impact!

Please complete the following in its entirety

I understand and certify the following:

$5 of my contribution will be applied to my membership dues to CareSource Mission. The remainder of my contribution(s) will be used for political purposes.
Annual contributions exceeding $200 will be disclosed to the Federal Election Commission as required by law, and contributions of any amount will be reported as necessary to satisfy state-specific reporting requirements.
My membership dues and contribution(s) are not deductible as a charitable contribution for federal income tax purposes.
I am a U.S. citizen.

Voluntary Participation in CareSource Mission PAC Acknowledgement*

I acknowledge I am voluntarily participating in the CareSource Mission PAC.

I decline to participate in the CareSource Mission PAC.

Management Level*

CEO Senior Staff

Senior Vice President

Vice President

Associate Vice President

Senior Director

Director

Associate Director

Operations Manager

Team Leader

Individual Contributor

All Employee Contribution Information 2025

Please select Method of Contribution*

Payroll Deduction

Check

Venmo

Payroll Deduction Contribution Amount per payroll. $5 from your first payroll deduction will be applied toward your CareSource Mission membership dues.

Please complete one of the payroll deductions options below.

Payroll Deduction*

$5.00

Other: Per Pay Period Option Complete Other Amount Below

Other: One Time Payroll Deduction Complete Other Amount Below

Suggested Contribution Levels (those contributing at the Suggested Contribution Level receive a CareSource Mission Pin):*

$192.31/per pay period, or $5,000 annually CEO Senior Staff and SVP levels

$76.92/per pay period, or $2,000 annually Vice President and AVP level

$38.46/per pay period, or $1,000 annually Senior Director and Director level

Other: Per Pay Period Option Complete Other Amount Below

Other: One Time Payroll Deduction Complete Other Amount Below

Suggested Contribution Levels (those contributing at the Suggested Contribution Level receive a CareSource Mission Pin):*

$19.23/per pay period, or $500 annually Operations Manager

$5.77/per pay period, or $150 annually Team Leader

$2.88/per pay period, or $75 annually Individual Contributor

Other: Per Pay Period Option Complete Other Amount Below

Other: One Time Payroll Deduction Complete Other Amount Below

Per Pay Period Option Complete Other Amount*

One Time Payroll Deduction Complete Other Amount*

I have read and understand the above certification and authorize CareSource Management Services LLC to deduct from my paycheck the contribution amount I have selected above. I understand that $5 of my total contribution will be applied to my annual Membership Dues to CareSource Mission. I understand that the deductions will be made on the first administratively feasible pay cycle following the date of this authorization. I also understand that this authorization shall remain in effect until I am no longer eligible for payroll deduction or I cancel such authorization. I can cancel this authorization at any time by contacting CareSource Human Resources by creating a case in HR Help Hub in Workday using case type "Payroll-paycheck."

By Selecting Attestation Below: I am Authorizing Payroll Deduction*

I authorize payroll deduction

I do not authorize payroll deduction, I have opted for other form of payment

All Employee Contribution Information 2025

Please select Method of Contribution*

Check

Venmo

Check Contribution: Amount to be submitted via check payable to CareSource Mission mailed to PO Box 103 Springboro, OH 45066.

Check Contribution: Amount to be submitted via 2 separate checks mailed to CareSource Mission PO Box 103 Springboro OH 45066.

If paying by check, 2 separate checks will be required:

One check for $5.00 payable to CareSource Mission for Membership dues and
The second check for the contribution level selected to CareSource Mission PAC.

It is important these checks are separate checks for reporting purposes.

Suggested Contribution Levels (those contributing at the Suggested Contribution Level receive a CareSource Mission Pin):

$500 annually Operations Manager
$150 annually Team Leader
$75 annually Individual Contributor

Check Contribution: Amount to be submitted via 2 separate checks mailed to CareSource Mission PO Box 103 Springboro OH 45066.

If paying by check, 2 separate checks will be required:

One check for $5.00 payable to CareSource Mission for Membership dues and
The second check for the contribution level selected to CareSource Mission PAC.

It is important these checks are separate checks for reporting purposes.

Suggested Contribution Levels (those contributing at the Suggested Contribution Level receive a CareSource Mission Pin):

$5,000 annually CEO Senior Staff and SVP level
$2,000 annually Vice President and AVP level
$1,000 annually Senior Director and Director level

Check Amount*

Amount to be submitted via Venmo. Venmo ID for payment is @CareSourceMission.

Venmo Contribution: Amount to be submitted via Venmo. Venmo ID for payment is @CareSourceMission. $5.00 from your contribution will be applied to your CareSource Mission Membership dues the remainder to the CareSource Mission PAC.

Suggested Contribution Levels (those contributing at the Suggested Contribution Level receive a CareSource Mission Pin):

$5,000 annually CEO Senior Staff and SVP level
$2,000 annually Vice President and AVP level
$1,000 annually Senior Director and Director level

Suggested Contribution Levels (those contributing at the Suggested Contribution Level receive a CareSource Mission Pin):

$500 annually Operations Manager
$150 annually Team Leader
$75 annually Individual Contributor

Venmo Amount*

Member Contact Information 2025

Last Name*

First Name*

Email*

Home Street Address*

City*

State*

Zip Code*

Signature*

Date Form Completed*

MM slash DD slash YYYY

CareSource Mission External Application

CareSource Mission is a member organization. By becoming a member, you help advocate for companies like CareSource and its employees, members, and communities with policy makers and political leaders across the country.

Annual membership dues are $5.00.

External Contact Type*

Vendor/Business

Lobbyist

Individual Donor

Vendor/Business/Employer*

Full name (First, Middle, and Last Name)*

Email*

Job Title (If applying for a Vendor/Business)*

Residential address (including City, State, Zip Code)*

CareSource Mission Membership dues (minimum is $5.00)

$5.00

Other

CareSource Mission Membership Other Amount (minimum $5.01)*

Please enter a number from 5.01 to 999999.

I understand and certify the following:

$5 of my contribution will be applied to my membership dues to CareSource Mission. The remainder of my contribution(s) will be used for political purposes.
Annual contributions exceeding $200 will be disclosed to the Federal Election Commission as required by law, and contributions of any amount will be reported as necessary to satisfy state-specific reporting requirements.
My membership dues and contribution(s) are not deductible as a charitable contribution for federal income tax purposes.
I am a U.S. citizen.

CareSource Mission PAC Contribution Amount*

Please enter a number from 5.00 to 99999.

Voluntary Contribution Options:

Venmo Contribution:Amount to be submitted via Venmo. Venmo ID for payment is @CareSourceMission.

Check Contribution: Check Submitted to CareSource Mission and mailed to PO Box 103 Springboro OH 45066.

I understand and certify the following:

A separate payment is required for each entity.

Annual contributions exceeding $200 will be disclosed to the Federal Election Commission as required by law, and contributions of any amount will be reported as necessary to satisfy state-specific reporting requirements.

My membership dues and contribution(s) are not deductible as a charitable contribution for federal income tax purposes.

I am a U.S. citizen.

Voluntary Contribution Options:

Venmo Contribution:Amount to be submitted via Venmo. Venmo ID for payment is @CareSourceMission. Submit CareSource Mission membership amount (minimum $5.00) and the CareSource Mission PAC payment amount in 2 separate transactions. Our administrative team will distribute the funds through Venmo.

Check Contribution: Amount to be submitted via 2 separate checks: first payable to CareSource Mission for membership amount (minimum $5.00) and second to the CareSource Mission PAC payment.

Voluntary Contribution Options:

Venmo

Check

Electronic Signature*

Date of application*

MM slash DD slash YYYY

BECOME A CARESOURCE MISSION MEMBER

2025 CareSource Mission Membership Application

JOIN CARESOURCE MISSION

2025 CareSource Mission Membership Application

JOIN CARESOURCE MISSION

BECOME A CARESOURCE MISSION PAC MEMBER

BECOME A CARESOURCE MISSION PAC MEMBER

All Employee Contribution Information 2025

All Employee Contribution Information 2025

Member Contact Information 2025

CareSource Mission External Application

I understand and certify the following: