2011-08-05T14:07:03-05:00 2010-09-30 Maner Costerisan PC 2425 E Grand River Suite 1 Lansing MI 489123291 990 2009-10-01 202717744 CALHOUN HEALTH PLAN CALH 2699696461 190 E MICHIGAN AVENUE No 385 BATTLE CREEK MI 49014 RUTH CLARK 2699696461 2011-07-15 1 David M Raeck CPA 5173237500 2009 2016-02-24 21:20:13Z Community Healthcare Connections RUTH CLARK 190 E MICHIGAN AVENUE No 385 BATTLE CREEK MI 49014 3671346 0 X www.chcconnections.com X 2005 MI TO ENSURE THE DELIVERY OF BASIC PREVENTATIVE HEALTH CARE TO LOW-INCOME PERSONS. 12 12 35 77 0 0 352741 670427 3065650 3000919 1420 0 0 3419811 3671346 0 0 654562 620727 0 0 2919537 3279717 3574099 3900444 -154288 -229098 1017715 862895 410715 484993 607000 377902 TO ENSURE THE DELIVERY OF BASIC PREVENTATIVE HEALTH CARE TO LOW-INCOME PERSONS WITHOUT INSURANCE AND/OR INELIGIBLE FOR OTHER GOVERNMENT PROGRAMS. 0 0 3598541 3000919 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. 3598541 1 1 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 21 0 1 35 1 0 0 0 0 0 0 0 0 0 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 MI X X X Samantha Pearl 2699696461 190 E MICHIGAN AVENUE SUITE 385 BATTLE CREEK MI 49014 MARY ELLEN BENZIK MD 0.50 X 0 0 0 BETH GREEN 0.50 X 0 0 0 MARK BOOTH MD 0.50 X 0 0 0 JOYCE SPICER 0.50 X 0 0 0 JOHN COLLINS DO 0.50 X 0 0 0 JAMES MORENO 0.50 X 0 0 0 JOHN HUNTINGTON MD 0.50 X 0 0 0 BILL MAYER MD 0.50 X 0 0 0 RUTH CLARK 1.00 X X 0 0 0 JEANNIE GOODRICH 1.00 X X 0 0 0 ELAINE HUNSICKER 1.00 X X 0 0 0 BETTY CHRIST 1.00 X X 0 0 0 SAMANTHA PEARL 40.00 X 72034 0 60 72034 0 60 0 0 0 0 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 5 670427 670427 HEALTH & PHARMACY SRVC 621300 3000919 3000919 3000919 3671346 3000919 0 0 76315 76315 544412 418207 126205 6685 6685 45138 2819 42319 425597 425000 597 17380 11441 5939 17876 17876 8450 5220 3230 MEDICAL SERVICES 1779881 1779881 PHARMACY SERVICES 453106 453106 ADMINISTRATIVE 440536 387728 52808 MERGER EXPENSES 64120 64120 DENTAL ACCESS 20948 20948 3900444 3598541 301903 0 970940 635803 22446 21833 3261 15705 211359 21805 21068 189554 1017715 862895 72715 109113 160880 338000 215000 410715 484993 X 607000 377902 607000 377902 1017715 862895 X 1 1 1 X 0 X 352741 670427 1023168 2706458 3386577 2930721 3065650 3000919 15090325 2706458 3386577 2930721 3418391 3671346 16113493 0 0 0 16113493 12376 11596 18928 1420 44320 12376 11596 18928 1420 44320 2718834 3398173 2949649 3419811 3671346 16157813 0.99730 0.99650 0.00270 0.00350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 122350 4078 118272 18255 7056 11199 70754 10671 60083 189554 CLAIMS INCURRED BUT NOT REPORTED 215000 215000 3671346 3900444 -229098 0 -229098 3671346 0 3671346 0 3671346 3900444 0 3900444 0 3900444 Part X: Description of Uncertain Tax Positions Under FIN 48: 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. 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 OVERSIGHT OF AUDIT 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. 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.