COMMUNITY HEALTHCARE CONNECTIONS: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: COMMUNITY HEALTHCARE CONNECTIONS (EIN 20-2717744)
Tax period: 2009-10-01 to 2010-09-30
Filed: 2011-08-05
IRS object ID: 201142179349300429
Schema version: 2009v1.7
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-08-05T14:07:03-05:00	Timestamp
Tax Period End Date	2010-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Maner Costerisan PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	2425 E Grand River Suite 1	AddressLine1
City	Lansing	City
State	MI	State
ZIP Code	489123291	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2009-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	202717744	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	CALHOUN HEALTH PLAN	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	CALH	NameControl
Phone	2699696461	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	190 E MICHIGAN AVENUE No 385	AddressLine1
City	BATTLE CREEK	City
State	MI	State
ZIP Code	49014	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	RUTH CLARK	Name
Title	PRESIDENT	Title
Phone	2699696461	Phone
Date Signed	2011-07-15	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	David M Raeck CPA	Name
Phone	5173237500	Phone

Field	Value	IRS element (for citing)
Tax Year	2009	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	Community Healthcare Connections	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	RUTH CLARK	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	190 E MICHIGAN AVENUE No 385	AddressLine1
City	BATTLE CREEK	City
State	MI	State
ZIP Code	49014	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	3671346	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c	X	Organization501c
Web Site	www.chcconnections.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2005	YearFormation
State Legal Domicile	MI	StateLegalDomicile
Activity Or Mission Description	TO ENSURE THE DELIVERY OF BASIC PREVENTATIVE HEALTH CARE TO LOW-INCOME PERSONS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	12	NbrIndependentVotingMembers
Total Nbr Employees	35	TotalNbrEmployees
Total Nbr Volunteers	77	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	352741	ContributionsGrantsPriorYear
Contributions Grants Current Year	670427	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	3065650	ProgramServiceRevenuePriorYear
Program Service Revenue CY	3000919	ProgramServiceRevenueCY
Investment Income Prior Year	1420	InvestmentIncomePriorYear
Investment Income Current Year	0	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	3419811	TotalRevenuePriorYear
Total Revenue Current Year	3671346	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	654562	SalariesEtcPriorYear
Salaries Etc Current Year	620727	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2919537	OtherExpensePriorYear
Other Expenses Current Year	3279717	OtherExpensesCurrentYear
Total Expenses Prior Year	3574099	TotalExpensesPriorYear
Total Expenses Current Year	3900444	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-154288	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-229098	RevenuesLessExpensesCY
Total Assets BOY	1017715	TotalAssetsBOY
Total Assets EOY	862895	TotalAssetsEOY
Total Liabilities BOY	410715	TotalLiabilitiesBOY
Total Liabilities EOY	484993	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	607000	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	377902	NetAssetsOrFundBalancesEOY
Mission Description	TO ENSURE THE DELIVERY OF BASIC PREVENTATIVE HEALTH CARE TO LOW-INCOME PERSONS WITHOUT INSURANCE AND/OR INELIGIBLE FOR OTHER GOVERNMENT PROGRAMS.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	3598541	Expense
Revenue	3000919	Revenue
Description	TO PROVIDE DIRECT MEDICAL SERVICES FOR LOW-INCOME, UNINSURED PEOPLE WITHOUT ACCESS TO OTHER GOVERNMENT HEALTH CARE PROGRAMS. AS OF SEPTEMBER 30, 2010, 1,583 PEOPLE WERE BENEFITTING FROM THE PROGRAM.	Description
Total Program Service Expense	3598541	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Balance Sheet Amounts Reported	1	BalanceSheetAmountsReported
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	0	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	21	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	35	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Nbr Voting Governing Body Members	12	NbrVotingGoverningBodyMembers
Number Independent Voting Members	12	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	0	WhistleblowerPolicy
Document Retention Policy	0	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MI	StatesWhereCopyOfReturnIsFiled
Own Website	X	OwnWebsite
Other Website	X	OtherWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	Samantha Pearl	NamePerson
Telephone Number	2699696461	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	190 E MICHIGAN AVENUE SUITE 385	AddressLine1
City	BATTLE CREEK	City
State	MI	State
ZIP Code	49014	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer
MARY ELLEN BENZIK MD
DIRECTOR	0.50	X	0	0	0
BETH GREEN
DIRECTOR	0.50	X	0	0	0
MARK BOOTH MD
DIRECTOR	0.50	X	0	0	0
JOYCE SPICER
DIRECTOR	0.50	X	0	0	0
JOHN COLLINS DO
DIRECTOR	0.50	X	0	0	0
JAMES MORENO
DIRECTOR	0.50	X	0	0	0
JOHN HUNTINGTON MD
DIRECTOR	0.50	X	0	0	0
BILL MAYER MD
DIRECTOR	0.50	X	0	0	0
RUTH CLARK
PRESIDENT	1.00	X	0	0	0	X
JEANNIE GOODRICH
VICE PRESIDENT	1.00	X	0	0	0	X
ELAINE HUNSICKER
TREASURER	1.00	X	0	0	0	X
BETTY CHRIST
SECRETARY	1.00	X	0	0	0	X
SAMANTHA PEARL
EXECUTIVE DIRECTOR	40.00		72034	0	60	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	72034	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	60	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	0	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
4D PHARMACY MANAGEMENT SYSTEMS INC
2520 INDUSTRIAL ROW DRIVE	TROY	MI	48084	PHARMACY SERVICES	432510
CALHOUN COUNTY HEALTH DEPARTMENT
190 E MICHIGAN AVE SUITE A-100	BATTLE CREEK	MI	49014	MEDICAL SERVICES	425000
BLUE CROSS BLUE SHIELD
PO BOX 1538	EAST LANSING	MI	48826	MEDICAL SERVICES	144117
COUNTY OF CALHOUN
315 WEST GREEN STREET	MARSHALL	MI	49068	ADMIN SERVICES	138332
INGHAM COUNTY HEALTH DEPARTMENT
5656 S CEDAR STREET STE 110	LANSING	MI	48909	MEDICAL SERVICES	129471

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	5	NumberOfContractorsGT100K
All Other Contributions	670427	AllOtherContributions
Total Contributions	670427	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	HEALTH & PHARMACY SRVC	Description
Business Code	621300	BusinessCode
Total Revenue Column	3000919	TotalRevenueColumn
Related Or Exempt Function Income	3000919	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	3000919	TotalProgramServiceRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	3671346	TotalRevenueColumn
Related Or Exempt Function Income	3000919	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	76315	Total
Program Services	76315	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	544412	Total
Program Services	418207	ProgramServices
Management And General	126205	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	6685	Total
Management And General	6685	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	45138	Total
Program Services	2819	ProgramServices
Management And General	42319	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	425597	Total
Program Services	425000	ProgramServices
Management And General	597	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	17380	Total
Program Services	11441	ProgramServices
Management And General	5939	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	17876	Total
Program Services	17876	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	8450	Total
Program Services	5220	ProgramServices
Management And General	3230	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SERVICES	1779881	1779881
PHARMACY SERVICES	453106	453106
ADMINISTRATIVE	440536	387728	52808
MERGER EXPENSES	64120		64120
DENTAL ACCESS	20948	20948

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	3900444	Total
Program Services	3598541	ProgramServices
Management And General	301903	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	970940	BOY
EOY	635803	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	22446	BOY
EOY	21833	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	3261	BOY
EOY	15705	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	211359	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	21805	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	21068	BOY
EOY	189554	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	1017715	BOY
EOY	862895	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	72715	BOY
EOY	109113	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
EOY	160880	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	338000	BOY
EOY	215000	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	410715	BOY
EOY	484993	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	607000	BOY
EOY	377902	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	607000	BOY
EOY	377902	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1017715	BOY
EOY	862895	EOY

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	1	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus1 Year	352741	CurrentTaxYearMinus1Year
Current Tax Year	670427	CurrentTaxYear
Total	1023168	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2706458	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3386577	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2930721	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	3065650	CurrentTaxYearMinus1Year
Current Tax Year	3000919	CurrentTaxYear
Total	15090325	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2706458	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3386577	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2930721	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	3418391	CurrentTaxYearMinus1Year
Current Tax Year	3671346	CurrentTaxYear
Total	16113493	Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Amts From Subst Contributors AmtsFromSubstContributors

Field	Value	IRS element (for citing)
Total	0	Total

Support From DQ Ps Etc SupportFromDQPsEtc

Field	Value	IRS element (for citing)
Total	0	Total

Field	Value	IRS element (for citing)
Public Support Total509	16113493	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	12376	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	11596	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	18928	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1420	CurrentTaxYearMinus1Year
Total	44320	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	12376	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	11596	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	18928	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1420	CurrentTaxYearMinus1Year
Total	44320	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2718834	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3398173	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2949649	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	3419811	CurrentTaxYearMinus1Year
Current Tax Year	3671346	CurrentTaxYear
Total	16157813	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.99730	PublicSupportPercentage509
Prior Year Support Percentage	0.99650	PriorYearSupportPercentage
Investment Income Percentage	0.00270	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.00350	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	122350	OtherCostOrOtherBasis
Depreciation	4078	Depreciation
Book Value	118272	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	18255	OtherCostOrOtherBasis
Depreciation	7056	Depreciation
Book Value	11199	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	70754	OtherCostOrOtherBasis
Depreciation	10671	Depreciation
Book Value	60083	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	189554	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	CLAIMS INCURRED BUT NOT REPORTED	Description
Amount	$215,000	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	215000	TotalOfAmounts
Total Revenue	3671346	TotalRevenue
Total Expenses	3900444	TotalExpenses
Excess Or Deficit For Year	-229098	ExcessOrDeficitForYear
Total Adjustments	0	TotalAdjustments
Excess Or Deficit Per FS	-229098	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	3671346	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	3671346	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	3671346	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	3900444	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	3900444	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	3900444	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Part X:	Identifier
Return Reference	Description of Uncertain Tax Positions Under FIN 48:	ReturnReference
Explanation	Income taxes are not provided in the accompanying financial statements since the corporation is exempt from federal and state income taxes under section 501(c)(3) of the Internal Revenue Code and similar state provisions. The Corporation has evaluated the provisions of ASC Topic 740, Accounting for Uncertainty in Income Taxes. The Corporation concluded that there are no significant uncertain tax positions requiring recognition in the Corporation's financial statements.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
Form 990, Part VI, Section B, line 11	The 990 is received by the organization's executive director who reviews the return for accuracy. Upon the executive director's approval, the 990 is made available to the president and treasurer. After any concerns presented are addressed, the president signs and files the return.
Form 990, Part VI, Section B, line 12c	Board members verbally report conflicts of interest as they arise at Board Meetings. Such conflicts are then discussed by the Board before the necessary action is decided upon.
Form 990, Part VI, Section B, line 15a	THE BOARD OF DIRECTORS MEETS TO REVIEW THE PERFORMANCE OF THE EXECUTIVE DIRECTOR ANNUALLY AND DETERMINE THE COMPENSATION OF THE EXECUTIVE DIRECTOR. A RECORD OF THE MEETING AND DECISION BY THE BOARD OF DIRECTORS IS RETAINED BY THE ORGANIZATION.
Form 990, Part VI, Section C, line 19	ALL INFORMATION IS AVAILABLE UPON REQUEST. FORM 990 IS ALSO POSTED ANNUALLY ON GUIDESTAR'S WEBSITE. CALHOUN HEALTH PLAN IS LICENSED TO SOLICIT IN THE STATE OF MICHIGAN AND PROVIDES FORM 990 AND AUDITED FINANCIAL STATEMENTS TO THE MICHIGAN ATTORNEY GENERAL'S OFFICE WHERE IT IS PUBLIC INFORMATION.
FORM 990, PART XI, LINE 2C	CALHOUN 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.	OVERSIGHT OF AUDIT
	form 4562 ELECTION OUT OF BONUS DEPRECIATION EMPLOYER IDENTIFICATION NUMBER: 20-2717744 FOR THE YEAR ENDING SEPTEMBER 30, 2010 CALHOUN HEALTH PLAN, HEREBY ELECTS, PURSUANT TO IRC SEC. 168(K)(2)(D)(III), NOT TO CLAIM THE ADDITIONAL 50% DEPRECIATION ALLOWABLE UNDER IRC SEC. 168(K) FOR THE FOLLOWING QUALIFYING PROPERTY PLACED IN SERVICE DURING THE TAX YEAR ENDING SEPTEMBER 30, 2010. ALL PROPERTY IN THE 5 & 15 YEAR CLASS. SEE ATTACHED FORM 4562.