2011-07-15T13:28:04-05:00 2010-09-30 Maner Costerisan PC 2425 E Grand River Suite 1 Lansing MI 489123291 990 2009-10-01 201477015 NORTHERN HEALTH PLAN NORT 2315477627 220 W GARFIELD CHARLEVOIX MI 49720 BRUCE MILLER 2315477627 2011-07-11 1 David M Raeck CPA 5173237500 2009 2016-02-24 21:20:13Z BRUCE MILLER 220 W GARFIELD CHARLEVOIX MI 49720 3842379 0 X WWW.COMMUNITYHEALTHPLANS.ORG X 2001 MI TO PROVIDE MEDICAL SERVICES TO INDIGENT RESIDENTS OF NORTHERN MICHIGAN. 14 14 0 14 0 0 0 4134015 3839040 5298 3339 0 4139313 3842379 0 0 0 0 0 4311719 3955631 4311719 3955631 -172406 -113252 2829059 2595361 752072 631626 2076987 1963735 THE PLAN PROVIDES MEDICAL SERVICES TO INDIGENT RESIDENTS OF THE NORTHERN PORTION ON MICHIGAN'S LOWER PENINSULA WHO ARE NOT COVERED BY A GOVERNMENTAL HEALTH PROGRAM OR HEALTH INSURANCE. 0 0 3790452 3839040 TO PROVIDE DIRECT MEDICAL SERVICES FOR LOW-INCOME, UNINSURED PEOPLE WITHOUT ACCESS TO OTHER GOVERNMENT HEALTH CARE PROGRAMS. AS OF SEPTEMBER 30, 2010, A TOTAL OF 4,464 PEOPLE ARE RECEIVING MEDICAL SERVICES UNDER THE PLAN. 3790452 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X X BRUCE MILLER 2315477627 220 W GARFIELD CHARLEVOIX MI 49720 X CHRISTINE BAUMGARDNER 0.50 X 0 0 0 JOHN MCVEETY 0.50 X 0 0 0 ELIZABETH GERTZ 0.50 X 0 0 0 CAROL SHAFTO 0.50 X 0 0 0 RICHARD WAKULAT 0.50 X 0 0 0 MARTA OLSoN 0.50 X 0 0 0 MYRNA HOLLAND 0.50 X 0 0 0 JOHN BRUNING 0.50 X 0 0 0 LARRY LOSINSKI 0.50 X 0 0 0 BOB DIESING 0.50 X 0 0 0 JIM BEECH 0.50 X 0 0 0 GERALD CHASE 2.00 X X 0 0 0 BILL JACKSON 1.00 X X 0 0 0 TOM LEMON 1.00 X X 0 0 0 BRUCE MILLER 20.00 X 0 0 0 0 0 0 0 0 0 0 NORTHWEST MICHIGAN COMMUNITY 220 W GARFIELD CHARLEVOIX MI 49726 MEDICAL SERVICES 1115587 DIRECT HEALTH DEPARTMENT #4 825 S HURON ST CHEBOYGAN MI 49721 MEDICAL SERVICES 344178 4D PHARMACY MANAGEMENT SYSTEMS INC 2520 INDUSTRIAL ROW DRIVE TROY MI 48084 PHARMACY SERVICES 332134 INGHAM COUNTY HEALTH DEPARTMENT 5656 S CEDAR STREET STE 110 LANSING MI 48909 MEDICAL SERVICES 205807 4 MEDICAL PROGRAMS 621300 3839040 3839040 3839040 3339 3339 3842379 3839040 0 3339 3 3 24957 24957 1137159 1133106 4053 17471 17471 7845 7845 MEDICAL SERVICES 1949891 1949891 ADMIN. SERVICES/SUPPORT 405340 294490 110850 PHARMACY CLAIMS 370639 370639 ENROLLMENT AND OUTREACH 27335 27335 PREVENTATIVE SERVICES 14991 14991 3955631 3790452 165179 0 2810553 2568478 18506 26883 2829059 2595361 134929 65967 617143 565659 752072 631626 X 2076987 1963735 2076987 1963735 2829059 2595361 X 1 1 1 X 0 X 4158284 5320641 4162571 4134015 3839040 21614551 4158284 5320641 4162571 4134015 3839040 21614551 0 0 0 21614551 72159 89849 52555 5298 3339 223200 72159 89849 52555 5298 3339 223200 4230443 5410490 4215126 4139313 3842379 21837751 0.98980 0.98890 0.01020 0.01110 X 0 CLAIMS INCURRED BUT NOT REPORTED 220000 RISK SHARE PAYABLE 345659 565659 3842379 3955631 -113252 0 -113252 3842379 0 3842379 0 3842379 3955631 0 3955631 0 3955631 Part X: Description of Uncertain Tax Positions Under FIN 48: The Plan is a nonprofit corporation exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code. Accordingly, the financial statements reflect no provision or liability for federal income taxes. In addition, the Plan has been determined by the Internal Revenue Service not to be a "Private Foundation" within the meaning of Section 509(a) of the Internal Revenue Code. There was no unrelated business income for the year ended September 30, 2010. Form 990, Part VI, Section B, line 11 The 990 is reviewed by the Executive Director and the Board President for accuracy. Upon approval, the 990 is also made available to the Board of Directors in electronic format. After any concerns presented by the Board are addressed, the Executive Director signs and files the return. Form 990, Part VI, Section B, line 12c The conflict of interest statement is given annually to Board members who sign a written statement acknowledging that they have received, understand and agree to adhere to the policy. There is also an ethics committee comprised of independent board members. Board members and contracted employees receive information on how to report potential violations of ethical behavior to this Committee. Form 990, Part VI, Section C, line 19 ALL INFORMATION IS AVAILABLE UPON REQUEST. FORM 990 IS ALSO POSTED ANNUALLY ON GUIDESTAR'S WEBSITE. THE 990 IS PUBLIC INFORMATION THROUGH THE MICHIGAN ATTORNEY GENERAL'S OFFICE. FORM 990, PART XI, LINE 2C OVERSIGHT OF AUDIT NORTHERN HEALTH PLAN HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.