Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
Fallon Community Health Plan Inc
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
10 CHESTNUT STREET
 
Room/suite
City or town, state or country, and ZIP + 4
WORCESTER, MA01608
D Employer identification number

23-7442369
E Telephone number

G Gross receipts $ 1,375,151,528
F Name and address of principal officer:
W PATRICK HUGHES Pres CEO
10 CHESTNUT STREET
WORCESTER,MA01608
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.fchp.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1975
M State of legal domicile: MA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: FCHP'S MISSION IS MAKING OUR COMMUNITIES HEALTHY. FCHP IS COMMITTED TO IMPROVING THE HEALTH AND WELLNESS OF OUR COMMUNITIES THROUGH THE FINANCING AND DELIVERY OF HIGH QUALITY, AFFORDABLE CARE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 11
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 6
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,057
6 Total number of volunteers (estimate if necessary) .... 6 129
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 17,379
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 199,123 181,640
9 Program service revenue (Part VIII, line 2g) ......... 1,059,414,644 1,090,378,600
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 9,148,586 19,904,863
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 24,532 -12,829,907
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 1,068,786,885 1,097,635,196
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 510,867 659,952
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 1,006,012,543 1,006,562,694
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 56,985,122 60,156,727
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 34,463,290 39,061,882
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,097,971,822 1,106,441,255
19 Revenue less expenses. Subtract line 18 from line 12...... -29,184,937 -8,806,059
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 311,552,127 337,631,320
21 Total liabilities (Part X, line 26)............ 171,333,827 202,819,067
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 140,218,300 134,812,253
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: FCHP'S MISSION IS MAKING OUR COMMUNITIES HEALTHY. FCHP IS COMMITTED TO IMPROVING THE HEALTH AND WELLNESS OF OUR COMMUNITIES THROUGH THE FINANCING AND DELIVERY OF HIGH QUALITY, AFFORDABLE CARE. SINCE ITS INCEPTION IN 1977, FCHP HAS WORKED TO IMPROVE THE QUALITY OF LIFE AND HEALTH STATUS OF INDIVIDUALS BY OFFERING ACCESS TO HIGH QUALITY, AFFORDABLE COVERAGE. FCHP IS ALSO A PROVIDER OF CARE FOR FRAIL ELDERS THROUGH SUMMIT ELDERCARE, A PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 1,007,240,662 including grants of $ 659,952 ) (Revenue $ 1,090,378,600 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 1,007,240,662
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
8,532
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,057
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
Yes
 
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
Yes
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
11
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
6
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
Yes
 
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
 
No
14
Does the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
KEVIN MCGOVERN
10 CHESTNUT STREET
WORCESTER,MA01608
(508) 799-2100
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Christopher F Egan
Director
 4.0 X           16,175 0 0
(2) Karen H Green
Secretary
 7.0 X           21,375 0 0
(3) David R Grenon
Director
 4.0 X           20,450 0 0
(4) David W Hillis
Chairman
 10.0 X           24,350 0 0
(5) Richard P Houlihan Esq
Vice Chairman
 7.0 X           22,650 0 0
(6) Sandra L Kurtinitis PhD
Director
 4.0 X           14,900 0 0
(7) Christian W McCarthy
Treasurer
 7.0 X           20,100 0 0
(8) Charles F Monahan Jr
Director
 4.0 X           16,175 0 0
(9) Rev John J Paris SJ
Director
 4.0 X           14,900 0 0
(10) Lynda M Young MD
Director
 4.0 X           13,900 0 0
(11) Eric H Schultz 110 -210
President & CEO
 50.0 X   X       143,060 0 43,968
(12) W Patrick Hughes 210 -1210
President & CEO
 50.0 X   X       561,293 0 158,850
(13) Richard P Burke
Division President, SR CARE
 50.0     X       276,984 0 104,662
(14) Anne E Doyle
Chief Compliance Officer
 50.0     X       207,916 0 29,051
(15) Charles R Goheen 110 -1010
CFO
 50.0     X       359,810 0 66,436
(16) Elizabeth Malko MD
SR VP, Chief Medical Officer
 50.0     X       305,973 0 88,084
(17) Christine Osgood
Chief Human Resources Officer
 24.0     X       160,743 0 44,677
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) R Scott Walker 1010 -1210
CFO
 50.0     X       73,337 0 17,452
(19) Todd Bailey
Vice President, Underwriting
 50.0       X     190,318 0 68,188
(20) Richard Commander
Chief operating Officer
 50.0       X     216,643 0 29,762
(21) Eric Hall
VP Network Development & Mgmt
 50.0       X     181,258 0 51,136
(22) Karen Longo
Executive Dr, Summit Eldercare
 50.0       X     159,997 0 85,572
(23) Kevin McGovern
VP of Finance & Treasurer
 50.0       X     212,293 0 96,134
(24) Janis Liepins
VP of Finance & Treasurer
 50.0       X     185,861 0 52,614
(25) David Przesiek
SR VP Sales & Marketing
 50.0       X     161,815 0 53,894
(26) Mary Ritter
VP of Strategy & Planning
 50.0       X     191,809 0 57,610
(27) Seth Lewin
SR Medical Dr, Medical Affairs
 50.0         X   245,171 0 47,858
(28) John Monte
VP, Business Solutions Support
 50.0         X   258,885 0 38,351
(29) Jean Politakis
VP & CIO
 50.0         X   254,021 0 156,437
(30) Glenn Randall MD
Physician, Summit Eldercare
 50.0         X   255,500 0 26,406
(31) David Wilner MD
PACE Physician & Medical Dr
 50.0         X   274,765 0 41,818
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,062,427 0 1,358,960
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet101
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
FALLON CLINIC
630 PLANTATION ST
WORCESTER,MA01608 		MEDICAL SERVICES 133,658,440
VHS ACQUISITION SUBSIDIARY
PO BOX 3385
BOSTON,MA02241 		HOSPITAL SERVICES 117,324,638
UMASS MED CTR
PO BOX 15492
WORCESTER,MA01615 		HOSPITAL SERVICES 96,177,535
UMASS MEMORIAL MEDICAL GROUP
PO BOX 62
SHREWSBURY,MA01545 		MEDICAL SERVICES 23,718,721
HEALTH ALLIANCE
DEPT 5204 PO BOX 3000
HARTFORD,CT06150 		HOSPITAL SERVICES 14,610,787
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet554
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 168,520
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		13,120
g Noncash contributions included in lines 1a-1f:$ 6,325
h Total. Add lines 1a-1f.......MediumBullet 181,640
Program Service Revenue Business Code
2a PROGRAM SERVICE REVENUE 524,114 1,090,378,600 1,090,378,600    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 1,090,378,600
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 10,161,702     10,161,702
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 287,246,373  
b Less: cost or other basis and sales expenses 277,503,212  
c Gain or (loss) 9,743,161  
d Net gain or (loss)..........MediumBullet 9,743,161     9,743,161
8a Gross income from fundraising events (not including
$ 168,520
of contributions reported on line 1c). See Part IV, line 18 ...
a 13,120
b Less: direct expenses ...b 13,120
c Net income or (loss) from fundraising events..MediumBullet 0   0
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a SUBSIDIARY LOSS & OTHER MISC. 524,114 -12,847,286     -12,847,286
b MANAGEMENT FEE FOR INDEMNITY, COMPANION CARE 561,000 7,574   7,574  
c HOME STAFF INCOME-PERSONAL CARE SERVICES 812,900 9,805   9,805  
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet -12,829,907
12 Total revenue. See Instructions....MediumBullet 1,097,635,196 1,090,378,600 17,379 7,057,577
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 659,952 659,952
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0 0
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0 0
4 Benefits paid to or for members 1,006,562,694 1,006,562,694
5 Compensation of current officers, directors, trustees, and key employees .... 4,822,175   4,822,175  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 43,780,975   43,780,975  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 2,295,375   2,295,375  
9 Other employee benefits ....... 5,293,689   5,293,689  
10 Payroll taxes ........... 3,964,513   3,964,513  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,325,255   1,325,255  
c Accounting ........... 950,430   950,430  
d Lobbying ........... 263,545   263,545  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 587,389   587,389  
g Other .......... 12,143,426   12,143,426  
12 Advertising and promotion .... 2,734,596   2,734,596  
13 Office expenses ....... 3,108,153   3,108,153  
14 Information technology ...... 4,013,371   4,013,371  
15 Royalties .. 0      
16 Occupancy ........... 4,528,859   4,528,859  
17 Travel ............ 82,680   82,680  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 185,536   185,536  
20 Interest ........... 742,818   742,818  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 5,932,716   5,932,716  
23 Insurance .............. 608,195   608,195  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a TEMPORARY HELP CLERICAL 832,529   832,529  
b DUES & SUBSCRIPTIONS 620,387   620,387  
c RECRUITING 134,130   134,130  
d CONMMUNITY BENEFIT-VOLUNTEER 18,016 18,016    
e All other expenses 249,851   249,851  
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 1,106,441,255 1,007,240,662 99,200,593 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... 1,310,963 2 17,339,389
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 24,110,329 4 34,592,413
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges ............ 1,716,477 9 1,878,229
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 53,394,530
b Less: accumulated depreciation. ..... 10b 16,969,198 38,622,012 10c 36,425,332
11 Investments—publicly traded securities .......... 216,533,857 11 234,995,427
12 Investments—other securities. See Part IV, line 11 ...... 20,838,030 12 5,838,030
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 8,420,459 15 6,562,500
16 Total assets. Add lines 1 through 15 (must equal line 34)... 311,552,127 16 337,631,320
Liabilities 17 Accounts payable and accrued expenses . 149,596,296 17 188,696,047
18 Grants payable ..........   18  
19 Deferred revenue .......... 9,237,281 19 14,123,020
20 Tax-exempt bond liabilities .......... 12,500,250 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D.....   25  
26 Total liabilities. Add lines 17 through 25..... 171,333,827 26 202,819,067
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 140,040,138 27 134,808,325
28 Temporarily restricted net assets ..... 178,162 28 3,928
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 140,218,300 33 134,812,253
34 Total liabilities and net assets/fund balances ..... 311,552,127 34 337,631,320
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
1,097,635,196
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
1,106,441,255
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
-8,806,059
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
140,218,300
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
3,400,012
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
134,812,253
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 115,050 109,700 187,555 199,123 181,640 793,068
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... 829,910,364 884,935,739 980,912,291 1,059,414,644 1,090,378,600 4,845,551,638
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5. 830,025,414 885,045,439 981,099,846 1,059,613,767 1,090,560,240 4,846,344,706
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)           4,846,344,706
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6... 830,025,414 885,045,439 981,099,846 1,059,613,767 1,090,560,240 4,846,344,706
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 12,520,892 12,200,590 13,282,385 10,709,853 10,161,702 58,875,422
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.   350 12,292 14,235 7,806 34,683
c Add lines 10a and 10b. 12,520,892 12,200,940 13,294,677 10,724,088 10,169,508 58,910,105
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.). 842,546,306 897,246,379 994,394,523 1,070,337,855 1,100,729,748 4,905,254,811
14
Section C. Computation of Public Support Percentage
15
15
98.799 %
16
16
98.804 %
Section D. Computation of Investment Income Percentage
17
17
1.201 %
18
18
1.196 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
THE ORGANIZATION'S IRS DETERMINATION LETTER INDICATES THAT THIS ORGANIZATION QUALIFIES AS A PUBLICLY SUPPORTED CHAIRITY UNDER SECTION 170(B)(1)(A)(VI); HOWEVER, THE ORGANIZATION QUALIFIES AS A 509 (A)(2) ORGANIZATION. SCHEDULE A HAS BEEN COMPLETED IN ACCORDANCE WITH THE FORM INSTRUCTIONS UNDER THE 509(A)(2) TEST.
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
Fallon Community Health Plan Inc
  		Employer identification number

23-7442369
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
Fallon Community Health Plan Inc
  		Employer identification number

23-7442369
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
Fallon Community Health Plan Inc
  		Employer identification number

23-7442369
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
263,545
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
 
No
 
j
Total. lines 1c through 1i ...................................
263,545
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
DIRECT LOBBYING EXPENSE SCHEDULE C, PART II-B, LINE 1G FCHP PAID LOBBYING EXPENSES TO THE FOLLOWING: ASSOCIATION OF HEALTH INSURANCE PLANS 39,007 SPILLANE & SPILLANE, LLP 48,000 MASSACHUSETTS ASSOCIATION OF HEALTH PLANS 52,386 ALLIANCE OF COMMUNITY HEALTH PLANS 6,712 ------- TOTAL OUTSIDE VENDORS 146,105 EMPLOYEES OF FALLON COMMUNITY HEALTH PLAN, INC. RICHARD BURKE 18,809 CATHERYN COLIN MCEVOY-ZDONCZYK 52,000 ERIC SCHULTZ 1,188 PATRICK HUGHES 6,827 PATRICK JAMES FARRELL 38,616 ------- TOTAL FCHP EMPLOYEES 117,440 ------- TOTAL DIRECT LOBBYING EXPENSE 263,545 ======= ASSOCIATION OF HEALTH INSURANCE PLANS (AHIP) KEY LEGISLATIVE AND REGULATORY ISSUES IN 2010: - LEGISLATIVE ACTIVITY IN THE HOUSE AND THE SENATE PRECEDING THE ENACTMENT OF THE AFFORDABLE CARE ACT (ACA) IN MARCH 2010. - REGULATORY ACTIVITY ADDRESSING IMPLEMENTATION OF NUMEROUS ACA PROVISIONS, INCLUDING INSURANCE MARKET REFORMS, MEDICAL LOSS RATIO REQUIREMENTS, PREMIUM REVIEW, HEALTH INSURANCE EXCHANGES, DELIVERY SYSTEM REFORMS, ADMINISTRATIVE SIMPLIFICATION, HEALTH INFORMATION TECHNOLOGY, ACCOUNTABLE CARE ORGANIZATIONS (ACOS), AND THE COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS (CLASS) PROGRAM. - PUBLIC PROGRAM ISSUES AFFECTING MEDICARE ADVANTAGE, MEDICARE PART D, MEDICAID, AND THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP). - PRODUCT-SPECIFIC ISSUES AFFECTING MEDIGAP/SUPPLEMENTAL POLICIES, LONG-TERM CARE INSURANCE, AND DISABILITY INCOME INSURANCE. - HEALTH ISSUES OUTSIDE OF THE HEALTH REFORM DEBATE INCLUDING ANTITRUST LEGISLATION, COBRA CONTINUATION COVERAGE, DATA SECURITY, MEDICAL LIABILITY REFORM, MEDICARE PHYSICIAN PAYMENT, AND THE ANNUAL APPROPRIATIONS PROCESS. BOTH SPILLANE & SPILLANE, LLP AND MASSACHUSETTS ASSOCIATION OF HEALTH PLANS WORKED ON DIVISION OF INSURANCE MATTERS, OTHER REGULATORY HEARINGS, AND LEGISLATIVE MEETINGS THAT AFFECT HEALTHCARE POLICIES AND GUIDELINES. DURING 2010, FCHP WORKED WITH THESE REGULATORY AGENCIES: DEPARTMENT OF PUBLIC HEALTH - Interpreter Services Working Group & Report - Early Intervention Program - Insurance Coordinators Meetings - Universal Newborn Hearing Screening Program Advisory Committee - Changes to hospital guidelines - Office of Patient Protection- Open Enrollment Waiver Regulations DIVISION OF HEALTH CARE FINANCE AND POLICY - All-Payer Claims Database Implementation - Cost Trends - Total Medical Expenses & Relative Prices Technical Advisory Group Meetings, Consultative Sessions & Regulations - Health Safety Net Surcharge Payments & Funding Regulations - Health Safety Net Eligible Services Regulations - Pediatric Assessment Regulations - FY11 Vaccine Assessment - Bundled Payments Survey - Hospital Financial Reports - Technical Advisory Group Meetings, - Consultative Sessions & Regulations DIVISION OF INSURANCE Special Sessions - Autism - Group Purchasing Cooperatives - Medical Loss Ratio - sessions and regulations - Financial Reporting - Limited & Tiered Networks - Open Enrollment - Plan Termination - Rating Factors - Provider Directories - Provider Contracting - Small Group Rate Reviews - Credentialing OTHER DIVISION OF INSURANCE ISSUES - One-Time Supplemental Funding Payments - Special Commission to Make an Investigation and Study Relative to the Impact of Reducing the Number of Health Benefit Plans - Transparency Informational Hearing - Administrative Simplification Provisions in Chapter 288 (legislative and regulatory issue) - Coding Commission EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES - Patient Centered Medical Home Pilot Initiative HEALTH CARE QUALITY AND COST COUNCIL - Committee on the Status of Payment Reform Legislation - End of Life Care Advisory Panel Report - Uniform Reporting System for Health Care Claims Data Sets Bulletin - Repeal of HCQCC Data Regulations Attorney General's Office - Discussions with the AG's office on recommendations to address provider market power
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............   3,977,887 1,492,640 2,485,247
d Equipment ................   8,467,271 7,727,738 739,533
e Other .................   40,949,372 7,748,820 33,200,552
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 36,425,332
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 1,097,635,196
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 1,106,441,255
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 -8,806,059
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 59
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 59
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -8,806,000
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 1,150,069,000
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d 53,202,833
e Add lines 2a through 2d ..................... 2e 53,202,833
3 Subtract line 2e from line 1..................... 3 1,096,866,167
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a 587,389
b Other (Describe in Part XIV): ........... 4b 181,640
c Add lines 4a and 4b....................... 4c 769,029
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 1,097,635,196
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 1,158,875,000
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d 53,202,774
e Add lines 2a through 2d...................... 2e 53,202,774
3 Subtract line 2e from line 1..................... 3 1,105,672,226
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a 587,389
b Other (Describe in Part XIV): ............ 4b 181,640
c Add lines 4a and 4b....................... 4c 769,029
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 1,106,441,255
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
FIN 48 FOOTNOTE SCHEDULE D, PART X, LINE 2 THE COMPANY ADOPTED FASB INTERPRETATION NO. 48, "ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, AN INTERPRETATION OF FASB NO. 109, ACCOUNTING FOR INCOME TAXES" (FIN 48), EFFECTIVE DECEMBER 31, 2008, WHICH PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE INTERPRETATION REQUIRES THAT THE COMPANY RECOGNIZE IN THE FINANCIAL STATEMENTS THE IMPACT OF A TAX POSITION IF THAT POSITION WILL MORE LIKELY THAN NOT BE SUSTAINED IN AN AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. IN EVALUATING WHETHER A TAX POSITION HAS MET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE COMPANY SHOULD PRESUME THAT THE POSITION WILL BE EXAMINED BY THE APPROPRIATE TAXING AUTHORITY THAT HAS FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. A TAX POSITION THAT MEETS THE MORE-LIKELY-THAN-NOT THRESHOLD IS MEASURED TO DETERMINE THE AMOUNT OF BENEFIT THAT IS GREATER THAN 50 PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT. INCOME TAX POSITIONS MUST MEET A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AT THE EFFECTIVE DATE TO BE RECOGNIZED UPON THE ADOPTION OF FIN 48 AND IN SUBSEQUENT PERIODS. THE ADOPTION OF FIN 48 HAD NO IMPACT ON THE FINANCIAL POSITION OR RESULTS OF OPERATIONS OF THE COMPANY.
SUPPLEMENTAL INFORMATION SCHEDULE D, SUPPLEMENTAL FINANCIAL STATEMENTS, PART XI-XIII SCHEDULE D, PART XI: LINE 8 OTHER "IN THOUSANDS" AUDITED FINANCIALS ROUNDING $-59 SCHEDULE D, PART XII: LINE 2D RECLASS OF SUBSIDIARY INCOME & RELATED ELIMINATIONS $53,203,106 "IN THOUSANDS" AUDITED FINANCIALS ROUNDING -273 ---------- TOTAL OTHER, LINE 2D $53,202,833 SCHEDULE D, PART XII: LINE 4A RECLASS OF INVESTMENT FEES NETTED WITH REVENUE $587,389 INVESTMENT FEES ARE NETTED AGAINST THE INVESTMENT INCOME ON THE FINANCIALS, BUT SHOWN AS EXPENSE ON THE FORM 990. LINE 4B RECLASS OF FUNDRAISING EVENT $181,640 CONTRIBUTIONS ARE MADE TO THE COMMUNITY FROM THE FUNDRAISING EVENT. SCHEDULE D, PART XIII: LINE 2D RECLASS OF SUBSIDIARY INCOME & RELATED ELIMINATIONS $53,203,106 "IN THOUSANDS" AUDITED FINANCIALS ROUNDING -332 ---------- TOTAL OTHER, LINE 2D $53,202,774 LINE 4A RECLASS OF INVESTMENT FEES NETTED WITH REVENUE $587,389 INVESTMENT FEES ARE NETTED AGAINST THE INVESTMENT INCOME ON THE FINANCIALS, BUT SHOWN AS EXPENSE ON THE FORM 990. LINE 4B RECLASS OF FUNDRAISING EVENT $181,640 CONTRIBUTIONS ARE MADE TO THE COMMUNITY FROM THE FUNDRAISING EVENT.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

BUFFET DINNER
(event type) 		(b) Event #2

 
(event type) 		(c) Other Events

0
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 181,640     181,640
2 Less: Charitable
contributions . . . 		168,520     168,520
3 Gross income (line 1
minus line 2) . . . 		13,120     13,120
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . . 6,325     6,325
6 Rent/facility costs . .        
7 Food and beverages . . 6,230     6,230
8 Entertainment . . . 250     250
9 Other direct expenses . 315     315
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 13,120
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow 0
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number
23-7442369
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Meyers Primary Care Institute630 Plantation Street
Worcester,MA01605 		04-3211678 501(c)(3) 70,000       Research
(2) Springfield Day Nursery Corp dba Square One947 Main Street
Springfield,MA01103 		04-2103855 501(c)(3) 35,000       Launching Healthy Habits
(3) Regional Environmental Council IncPO Box 255
Worcester,MA01613 		04-6364350 501(c)(3) 25,000       FOOD JUSTICE PROGRAM
(4) United Way of Central MA484 Main St Ste 300
Worcester,MA01608 		04-2104017 501(c)(3) 21,000       STEPPING UP FOR GIRLS RECEPTION
(5) American Red Cross of Central MA2000 Century Drive
Worcester,MA01606 		04-2141539 501(c)(3) 18,711       DISASTER RESPONSE VEHICLE
(6) Fallon Clinic Foundation100 Front St 14th fl
Worcester,MA01608 		22-2912515 501(c)(3) 18,700       GENERAL SUPPORT
(7) American Heart Association20 Speen St
Framingham,MA01701 		13-5613797 501(c)(3) 15,500       GENERAL SUPPORT
(8) UMass Medical School333 South Street
Shrewsbury,MA01545 		04-3108190 501(c)(3) 13,445       GENERAL SUPPORT
(9) Franklin County Home Care Corporation330 Montague City Rd Suite 1
Turners Falls,MA013762350 		04-2542539 501(c)(3) 11,000       MEALS ON WHEELS
(10) Worcester Regional Research Bureau319 Main St
Worcester,MA01608 		04-2901298 501(c)(3) 10,730       GENERAL SUPPORT
(11) Brain Injury Association of Massachusetts30 Lyman Street Suite 10
Westborough,MA01581 		04-2753269 501(c)(3) 10,000       FALLS PREVENTION PROGRAM
(12) Massachusetts Audubon Society Inc414 Massasoit Road
Worcester,MA01604 		04-2104702 501(c)(3) 10,000       COMMUNITY BENEFIT
(13) Worcester Education Collaborative484 MAIN STREET
Worcester,MA01608 		04-2100017 501(c)(3) 10,000       FUNDING SURVEY
(14) Worcester Art Museum55 Salisbury St
Worcester,MA01609 		04-1988530 501(c)(3) 9,900       ART/EXHIBIT
(15) Mohegan Council BSA19 Harvard St
Worcester,MA01609 		04-2105867 501(c)(3) 6,650       GENERAL SUPPORT
(16) YMCA of Central Mass766 Main St
Worcester,MA01610 		04-2105885 501(c)(3) 6,229       TEAM INITIATIVE
(17) Bottom Line600 Main Street STE 110
Worcester,MA01608 		04-3351427 501(c)(3) 5,250       GENERAL SUPPORT
(18) WORCESTER REGIONAL CHAMBER OF COMMERCE446 MAIN STREET
WORCESTER,MA01608 		  42,125       INDEPENDENCE DAY CELEBRATION & OTHER
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
17
3
Enter total number of other organizations ................................ . Bullet Image
1
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Form 990, Schedule I Description of Organization's Procedures for Monitoring the Use of Grants FCHP GRANTS ARE CLASSIFIED EITHER AS A COMMUNITY BENEFIT GRANT OR A COMMUNITY RELATIONS GRANT. THE COMMUNITY BENEFIT GRANTS ARE VERIFIED TO ENSURE THAT EACH RECIPIENT IS A 501( C)(3) ORGANIZATION. THE COMMUNITY RELATIONS GRANTS ARE VERIFIED TO ENSURE THAT THE RECIPIENT ORGANIZATION'S IRS STATUS IS LISTED AS A TAX-EXEMPT ORGANIZATION IN THE INTERNAL REVENUE CODE SECTION 501( C). EACH RECIPIENT OF A FCHP GRANT HAS SPECIFIC INSTRUCTIONS TO BE FOLLOWED BY EACH GRANT RECIPIENT SUCH AS THE SPECIFIC USE OF EACH GRANT AND THAT THE GRANT IS TO BE EXPENDED WITHIN 1 YEAR FROM THE AWARD. FOR ANY GRANTS IN EXCESS OF $10,000, FCHP REQUESTS A GRANT REPORT DETAILING THE GRANT USES. THESE REPORTS ARE KEPT ON FILE AT FCHP.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Eric H Schultz (i)
(ii)		 66,622
0 		0
0 		76,438
0 		40,861
0 		3,107
0 		187,028
0 		 
0
(2) W Patrick Hughes (i)
(ii)		 494,125
0 		0
0 		67,168
0 		137,379
0 		21,471
0 		720,143
0 		 
0
(3) Richard P Burke (i)
(ii)		 246,153
0 		0
0 		30,831
0 		81,421
0 		23,241
0 		381,646
0 		 
0
(4) Anne E Doyle (i)
(ii)		 194,656
0 		0
0 		13,260
0 		22,433
0 		6,618
0 		236,967
0 		 
0
(5) Charles R Goheen (i)
(ii)		 318,721
0 		0
0 		41,089
0 		41,691
0 		24,745
0 		426,246
0 		 
0
(6) Elizabeth Malko MD (i)
(ii)		 294,543
0 		10,000
0 		1,430
0 		62,400
0 		25,684
0 		394,057
0 		 
0
(7) Christine Osgood (i)
(ii)		 137,187
0 		7,500
0 		16,056
0 		40,246
0 		4,431
0 		205,420
0 		 
0
(8) Todd Bailey (i)
(ii)		 180,815
0 		0
0 		9,503
0 		48,615
0 		19,573
0 		258,506
0 		 
0
(9) Richard Commander (i)
(ii)		 212,426
0 		0
0 		4,217
0 		25,913
0 		3,849
0 		246,405
0 		 
0
(10) Eric Hall (i)
(ii)		 176,683
0 		0
0 		4,575
0 		27,458
0 		23,678
0 		232,394
0 		0
0
(11) Karen Longo (i)
(ii)		 152,343
0 		0
0 		7,654
0 		65,728
0 		19,844
0 		245,569
0 		0
0
(12) Kevin McGovern (i)
(ii)		 197,809
0 		0
0 		14,484
0 		78,390
0 		17,744
0 		308,427
0 		0
0
(13) Janis Liepins (i)
(ii)		 185,011
0 		0
0 		850
0 		35,826
0 		16,788
0 		238,475
0 		0
0
(14) David Przesiek (i)
(ii)		 161,420
0 		0
0 		395
0 		46,155
0 		7,739
0 		215,709
0 		0
0
(15) Mary Ritter (i)
(ii)		 180,859
0 		10,000
0 		950
0 		33,119
0 		24,491
0 		249,419
0 		0
0
(16) Seth Lewin (i)
(ii)		 241,137
0 		0
0 		4,034
0 		21,475
0 		26,383
0 		293,029
0 		0
0
(17) John Monte (i)
(ii)		 180,913
0 		77,117
0 		855
0 		21,179
0 		17,172
0 		297,236
0 		0
0
(18) Jean Politakis (i)
(ii)		 219,306
0 		0
0 		34,715
0 		145,764
0 		10,673
0 		410,458
0 		0
0
(19) Glenn Randall MD (i)
(ii)		 246,409
0 		6,511
0 		2,580
0 		7,717
0 		18,689
0 		281,906
0 		0
0
(20) David Wilner MD (i)
(ii)		 262,343
0 		5,149
0 		7,273
0 		19,071
0 		22,747
0 		316,583
0 		0
0
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES PURSUANT TO A POLICY ADOPTED AND APPROVED BY THE EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE (EECC) OF THE BOARD OF DIRECTORS, THE ORGANIZATION PROVIDED TO THE PRESIDENT & CEO, THE DIVISION PRESIDENT OF HEALTH PLAN OPERATIONS, AND THE DIVISION PRESIDENT OF SENIOR CARE SERVICES, A PORTION OF MEMBERSHIP DUES AND FEES FOR THEIR BUSINESS USE (E.G., OFF-SITE MEETINGS) OF CERTAIN CLUB(S). EACH EXECUTIVE IS REQUIRED TO PAY FOR THEIR OWN PERSONAL USE EXPENSES, AS WELL AS A PERSONAL USE PORTION OF THE MEMBERSHIP DUES AND FEES AS DETERMINED BY THE EECC. SCHEDULE J, PART I, 4B IN 2010, THE FOLLOWING OFFICERS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN, 457(F). Officer Amount Paid Amount Deferred Richard Burke $20,450 $20,450 Anne Doyle $12,450 $12,450 W.Patrick Hughes $60,250 $60,250 Elizabeth Malko, M.D. NONE $30,750 Christine Osgood $6,200 $6,200 Compensation contingent on net earnings Schedule J Part I Question 6A All employees in certain job grades, which include employees listed on Schedule J-2, are eligible for an incentive plan payment. The incentive plan payment is determined by whether certain corporate, department, and/or individual targets are met. The Corporate targets include (I) Net Operating Income, (II) Membership Growth, and (III) Member and Provider Satisfaction. These targets were met in 2010 and incentive payments were accrued in 2010.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) THE MONAHAN GROUP INC FAMILY MEMBER OF DIRECTOR 36,827 SEE PART V   No
(2) ADCARE HOSPITAL OWNERSHIP BY DIRECTOR 171,514 SEE PART V   No
(3) SAINT VINCENT HOSPITAL OVERLAPPING BOARD MEMBER 117,324,638 SEE PART V   No
(4) CHANDLER PEDIATRICS OWNERSHIP BY DIRECTOR 181,130 SEE PART V   No
(5) HOMESTAFF LLC OVERLAPPING BOARD MEMBER 1,129,886 SEE PART V   No
(6) VARIOUS BOARD MEMBERS OFC KEY     SEE PART V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS FORM 990, PART IV, QUESTION 28 AND SCHEDULE L, PART IV FCHP SHARE OF HOME STAFF 2010 EARNINGS WAS $250,000. KAREN H. GREEN FCHP DIRECTOR ERIC H. SCHULTZ FCHP DIRECTOR AND OFFICER W. PATRICK HUGHES FCHP DIRECTOR AND OFFICER RICHARD P.BURKE FCHP OFFICER CHARLES R. GOHEEN FCHP OFFICER TODD BAILEY FCHP KEY EMPLOYEE MS. GREEN, MR. SCHULTZ, MR. HUGHES, MR. BURKE, MR. GOHEEN, AND MR. BAILEY ALL SERVED DURING 2010 ON THE BOARD OF DIRECTORS OF HOME STAFF, LLC, WORCESTER, MA, A JOINT VENTURE BETWEEN FCHP AND THE VNA CARE NETWORK & HOSPICE. NONE OF THESE INDIVIDUALS WERE COMPENSATED FOR THEIR BOARD SERVICE. HOME STAFF CONTRACTS WITH FCHP TO PROVIDE SERVICES TO CERTAIN FCHP PARTICIPANTS. EACH OFFICER AND KEY EMPLOYEE DEVOTES AN AVERAGE OF 5 HOURS PER WEEK TO THE RELATED ORGANIZATION.
DESCRIPTION OF TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV, COLUMN (D) NAME: THE MONAHAN GROUP, INC. RELATIONSHIP: ENTITY OWNED BY THE SISTER-IN-LAW OF FCHP DIRECTOR CHARLES F. MONAHAN AMOUNT OF TRANSACTION BETWEEN FCHP AND THE MONAHAN GROUP, INC.: $36,827 MR. MONAHAN'S SISTER-IN-LAW IS A PRINCIPAL WITH THE MONAHAN GROUP, INC., A SECURITY CONSULTING FIRM THAT PROVIDES CONSULTING SERVICES TO FCHP. CHARLES F. MONAHAN HAS NO INTEREST IN THE MONAHAN GROUP, INC. FCHP'S BUSINESS RELATIONSHIP WITH THE MONAHAN GROUP, INC., PRE-DATES MR. MONAHAN'S SERVICE ON THE FCHP BOARD. NAME: ADCARE HOSPITAL RELATIONSHIP: ENTITY OWNED BY FCHP DIRECTOR DAVID W. HILLIS AND FAMILY MEMBERS AMOUNT OF TRANSACTION BETWEEN FCHP AND ADCARE HOSPITAL: $171,514 MR. HILLIS IS PRESIDENT, CEO AND HOLDS MAJORITY INTEREST IN ADCARE HOSPITAL OF WORCESTER, INC., A SUBSTANCE ABUSE HOSPITAL THAT PROVIDES HEALTH CARE SERVICES TO FCHP PLAN MEMBERS. MR. HILLIS ALSO HAS FAMILY MEMBERS WHO HOLD OWNERSHIP IN ADCARE HOSPITAL. NAME: SAINT VINCENT HOSPITAL RELATIONSHIP: ENTITY IN WHICH FCHP DIRECTOR CHARLES F. MONAHAN SERVES AS AN UNCOMPENSATED BOARD MEMBER. AMOUNT OF TRANSACTION BETWEEN FCHP AND SAINT VINCENT HOSPITAL: $117,324,638 MR. MONAHAN SERVES ON THE BOARD OF SAINT VINCENT HOSPITAL, WORCESTER, MA, WHICH PROVIDES HEALTH CARE SERVICES TO FCHP PLAN MEMBERS. MR. MONAHAN RECEIVES NO COMPENSATION FOR HIS SERVICE ON THE SAINT VINCENT HOSPITAL BOARD. NAME: CHANDLER PEDIATRICS RELATIONSHIP: ENTITY IN WHICH FCHP DIRECTOR LYNDA YOUNG, M.D. IS A PRINCIPAL. AMOUNT OF TRANSACTION BETWEEN FCHP AND CHANDLER PEDIATRICS: $181,130 DR. YOUNG IS A PRINCIPAL IN CHANDLER PEDAITRICS, WHICH CONTRACTS WITH FCHP TO PROVIDE HEALTHCARE SERVICES TO FCHP MEMBERS. NAME: HOME STAFF, LLC RELATIONSHIP: JOINT VENTURE BETWEEN FCHP AND THE VNA CARE NETWORK AND HOSPICE ON WHICH FCHP DIRECTOR KAREN GREEN SERVES AS AN UNCOMPENSATED BOARD MEMBER. AMOUNT OF TRANSACTION BETWEEN FCHP AND HOME STAFF, LLC: $1,129,886 MS. GREEN SERVES ON THE BOARD OF DIRECTORS OF HOME STAFF, LLC, WORCESTER, MA, A JOINT VENTURE BETWEEN FCHP AND THE VNA CARE NETWORK AND HOSPICE. MS GREEN RECEIVES NO COMPENSATION FOR HER SERVICE ON THE HOME STAFF BOARD. HOME STAFF CONTRACTS WITH FCHP TO PROVIDE SERVICES TO CERTAIN FCHP PARTICIPANTS. VARIOUS BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES HAVE HEALTH INSURANCE PURCHASED BY THEIR EMPLOYERS FROM FCHP, OR ARE AFFILATED WITH ORGANIZATIONS THAT PURCHASE THEIR HEALTH INSURANCE FROM FCHP.
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Identifier Return Reference Explanation
PROGRAM SERVICE ACCOMPLISHMENTS Part III, Line 4a FCHP'S PROGRAM ACTIVITIES CONSIST OF PREPAID HEALTHCARE IN THE COMMONWEALTH OF MASSACHUSETTS. THE COVERED POPULATION AT DECEMBER 31, 2010 WAS 169,692. IN 2010, FALLON COMMUNITY HEALTH PLAN MADE OVER $1,200,000 AVAILABLE TO PROGRAMS THAT MAKE OUR COMMUNITIES HEALTHY. THIS WAS ACCOMPLISHED THROUGH THE FCHP COMMUNITY BENEFITS COMMITTEE'S DISTRIBUTION OF GRANTS, OTHER CHARITABLE DONATIONS, AND PROGRAMS THAT INVOLVED DIRECT EXPENSES AND STAFF TIME. FCHP'S REVENUE AND EXPENSES ARE NOT SEGREGABLE BY MAJOR EXPENSE CATEGORIES. FALLON COMMUNITY HEALTH PLAN 2010 COMMUNITY BENEFITS REPORT SUMMARY NARRATIVES COMMUNITY BENEFITS MISSION STATEMENT FALLON COMMUNITY HEALTH PLAN IS COMMITTED TO THE VISION OF CREATING HEALTHIER LIVES. FALLON COMMUNITY HEALTH PLAN WILL WORK COOPERATIVELY WITH HEALTH CARE AND COMMUNITY SERVICE ORGANIZATIONS, AS WELL AS STATE AND FEDERAL AGENCIES, TO LEAD THE CREATION OF INNOVATIVE HEALTH CARE SOLUTIONS, TO SEEK HEALTHY OUTCOMES, AND TO IMPROVE ACCESS TO HEALTH CARE SERVICES. FCHP WILL DEVELOP AND IMPLEMENT PROGRAMS THAT WILL IMPROVE THE HEALTH STATUS OF THE ECONOMICALLY DISADVANTAGED, ELDERS, AND CHILDREN AGED 0-5 WITHIN OUR SERVICE AREA. PROGRAM ORGANIZATION AND MANAGEMENT IN ACCORDANCE WITH THE ATTORNEY GENERAL'S COMMUNITY BENEFITS GUIDELINES FOR HEALTH MAINTENANCE ORGANIZATIONS, THE FCHP BOARD OF DIRECTORS ESTABLISHED THE COMMUNITY BENEFITS COMMITTEE. THE COMMITTEE REPORTS TO THE PRESIDENT & CEO. ALL GRANT APPLICATIONS ARE REVIEWED BY THE COMMITTEE AND GIVEN FINAL APPROVAL BY SENIOR MANAGEMENT BEFORE FUNDS ARE DISTRIBUTED. THIS ENSURES REGULAR EVALUATION AND OVERSIGHT OF THE PROGRAM. COMMUNITY HEALTH NEEDS ASSESSMENT IN 2010, THE COMMUNITY BENEFITS PROGRAM CONDUCTED EXTENSIVE REVIEW OF THE PROGRAM, AND A NEEDS ASSESSMENT OF THE COMMUNITIES SERVED BY THE PROGRAM. CHANGES TO THE GIVING PROGRAM WERE MADE IN ORDER TO BETTER SERVE LOCAL NEEDS. EACH YEAR, THESE AREAS OF FOCUS ARE REVIEWED WITH DATA FROM COMMUNITY AGENCIES. THREE NEW AREAS OF FOCUS WERE IDENTIFIED FOR THE COMMUNITY BENEFITS PROGRAM. THEY ARE: PROMOTING ACCESS TO HEALTHY NUTRITION AND ENCOURAGING PHYSICAL ACTIVITY, PARTICULARLY AMONG VULNERABLE POPULATIONS; PROMOTING GOOD HEALTH FOR SENIORS; AND IMPROVING HEALTH FOR INFANTS AND CHILDREN AGED 0-5. COMMUNITY BENEFITS PLAN FALLON COMMUNITY HEALTH PLAN AWARDS GRANTS AND SUPPORT TO THOSE PROGRAMS THAT IMPROVE THE HEALTH STATUS OF THE ECONOMICALLY DISADVANTAGED, THE ELDERLY AND CHILDREN AGED 0-5. OUTCOMES ARE MEASURED EACH YEAR AGAINST THE GOALS STATED IN THE FUNDED PROGRAMS' GRANT APPLICATIONS. THESE GRANT REPORTS ARE ESSENTIAL IN HELPING THE COMMITTEE ASSESS WHETHER FUNDS HAVE INDEED HELPED THE IDENTIFIED POPULATION AND THEREFORE HELP TO DETERMINE FUTURE FUNDING. KEY ACCOMPLISHMENTS OF THE REPORTING YEAR FALLON COMMUNITY HEALTH PLAN INVESTED JUST OVER $650,000 IN GRANTS, PROGRAMS AND OTHER SUPPORT TO ADDRESS NEEDS AFFECTING POPULATIONS INCLUDED IN THE COMMUNITY BENEFIT PROGRAM'S AREAS OF FOCUS. OTHER CHARITABLE SUPPORT TOTALED APPROXIMATELY $463,700. IN ADDITION, JUST UNDER $104,500 WAS GIVEN TO OUR COMMUNITIES THROUGH PROGRAMMING, SPONSORSHIPS, VOLUNTEER HOURS, AND OTHER SUPPORT. FALLON COMMUNITY HEALTH PLAN HOSTED THE GATHER FORE A GOAL RAISING APPROXIMATELY $182,000 IN GROSS RECEIPTS. NET PROCEEDS EXCEEDING $169,000 WERE DISTRIBUTED TO MORE THAN 90 FOOD PANTRIES AND HUNGER RELIEF PROGRAMS THROUGHOUT MASSACHUSETTS. IN 2010, THE SENIOR WELLNESS PROGRAM HELD MORE THAN 30 SESSIONS IN COLLABORATION WITH LOCAL SENIOR CENTERS, AND OVER 320 SENIORS ATTENDED THESE EVENTS. IN ADDITION, FCHP CONTINUED AND EXPANDED TWO SIGNATURE WELLNESS PROGRAMS: THE ROAD BOWL WALKING CHALLENGE AND COMMIT TO BE FIT. THESE PROGRAMS PROVIDE A WALKING CURRICULUM AND RELATED SUPPORTS THAT ARE TAILORED TO WORKPLACE AND SCHOOL-BASED SETTINGS. PLANS FOR NEXT REPORTING YEAR FCHP'S COMMUNITY BENEFITS PROGRAM WILL CONTINUE FOCUSING ON PROGRAMS THAT WILL IMPROVE THE HEALTH STATUS OF THE ECONOMICALLY DISADVANTAGED, ELDERS, AND CHILDREN AGED 0-5 WITHIN OUR SERVICE AREA.
DESCRIPTION OF RELATIONSHIPS FORM 990, PART VI, QUESTION 2 HOME STAFF, LLC IS A JOINT VENTURE OF FCHP AND THE VNA CARE NETWORK & HOSPICE. THE FOLLOWING FCHP BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SERVED ON THE HOME STAFF BOARD OF DIRECTORS DURING 2010: KAREN GREEN, ERIC SCHULTZ, CHARLES GOHEEN, RICHARD BURKE, PATRICK HUGHES AND TODD BAILEY. FALLON HEALTH & LIFE ASSURANCE COMPANY, INC. (FHLAC), IS A WHOLLY-OWNED SUBSIDIARY OF FCHP. THE FOLLOWING FCHP BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SERVED ON THE FHLAC BOARD OF DIRECTORS IN 2010: DAVID HILLIS, RICHARD HOULIHAN, CHRISTIAN MCCARTHY, KAREN GREEN, ERIC SCHULTZ, PATRICK HUGHES, CHARLES GOHEEN AND SCOTT WALKER. ULTRABENEFITS, INC. (UBI) IS A WHOLLY-OWNED SUBSIDIARY OF FHLAC. THE FOLLOWING FCHP BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SERVED ON THE UBI BOARD OF DIRECTORS IN 2010: ERIC SCHULTZ, PATRICK HUGHES, CHARLES GOHEEN, SCOTT WALKER, AND DAVID PRZESIEK
SIGNIFICANT CHANGES TO ITS GOVERNING DOCUMENTS FORM 990, PART VI, LINE 4 FCHP'S BYLAWS WERE AMENDED IN 2010. MATERIAL CHANGES INCLUDED THE FOLLOWING: - THE AMENDMENT CLARIFIED QUORUM REQUIREMENTS. - THE AMENDMENT REVISED BOARD TERM LIMITS TO PERMIT ADDITIONAL BOARD TERMS FOR THE CHAIR AND VICE CHAIR. - THE AMENDMENT CLARIFIED THE PROCESSES FOR CALLING AND HOLDING ANNUAL AND REGULAR BOARD MEETINGS. - THE AMENDMENT REVISED THE NAME, AND INCREASED THE NUMBER OF DIRECTORS ELIGIBLE TO PARTICIPATE ON, THE GOVERNANCE AND NOMINATING COMMITTEE OF THE BOARD. - THE AMENDMENT CLARIFIED PROCEDURES TO FILL VACANCIES FROM A LIST PREPARED BY GOVERNANCE AND NOMINATION COMMITTEE - THE EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE (EECC) EXISTED AS A STANDING COMMITTEE OF THE BOARD, BUT WAS NOT PREVIOUSLY SPECIFICALLY IDENTIFIED IN THE BYLAWS. THE AMENDMENT SPECIFICALLY RECOGNIZES THE EECC IN THE BYLAWS.
MAILING ADDRESS OF PERSONS TO BE CONTACTED AT A DIFFERENT ADDRESS FORM 990, PART VI, QUESTION 9 ERIC H. SCHULTZ, 10 GABLE RIDGE ROAD, WESTBORO, MA 01581 CHARLES R. GOHEEN, 26 ATWOOD STREET, WELLESLEY, MA 02482 ANNE E. DOYLE, 85 SOUTH GREAT ROAD, LINCOLN, MA 01773
DESCRIBE THE PROCESS USED BY MANAGEMENT AND GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B A DRAFT OF THE 990 WAS PREPARED BY FCHP'S PAID PREPARER USING INFORMATION PROVIDED BY THE ORGANIZATION. THIS DRAFT WAS REVIEWED BY FCHP'S CONTROLLER, VICE PRESIDENT OF FINANCE/TREASURER, AND SENIOR MANAGEMENT, INCLUDING THE CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER, CHIEF HUMAN RESOURCES OFFICER, AND CHIEF EXECUTIVE OFFICER. AFTER THIS REVIEW A FINAL FORM 990 WAS PREPARED, AND THE FINAL VERSION OF THE 990 WAS PROVIDED TO EACH BOARD MEMBER IN PAPER FORM FOR HIS OR HER REVIEW BEFORE THE 990 WAS FILED WITH THE IRS. EACH BOARD MEMBER WAS GIVEN THE OPPORTUNITY AT A BOARD MEETING, SCHEDULED BEFORE THE 990 WAS FILED WITH THE IRS, TO ASK QUESTIONS ABOUT THE FINAL 990. OPPORTUNITY AT A BOARD MEETING, SCHEDULED BEFORE THE 990 WAS FILED WITH THE IRS, TO ASK QUESTIONS ABOUT THE FINAL 990.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C FCHP'S BYLAWS REQUIRE ALL DIRECTORS AND OFFICERS TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AS DEFINED IN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY RELATING TO DIRECTORS, OFFICERS AND MEMBERS OF A COMMITTEE WITH BOARD-DELEGATED POWERS. THIS IS ENFORCED BY THE REQUIREMENT THAT SUCH INDIVIDUALS ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. EACH YEAR THE COMPLETED CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD WHICH REPORTS ANY ACTUAL OR POTENTIAL CONFLICTS TO THE FULL BOARD. ANY BOARD MEMBER OR OFFICER WITH A CONFLICT OF INTEREST IS PROHIBITED FROM PARTICIPATING IN ANY DISCUSSION OF, OR VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. TWO INDEPENDENT BOARD MEMBERS ALSO CONDUCT AN ANNUAL REVIEW OF ANY BUSINESS TRANSACTIONS INVOLVING THE ORGANIZATION THAT COULD POTENTIALLY BENEFIT A BOARD MEMBER OR OFFICER, TO ENSURE THAT THE TRANSACTIONS DO NOT INVOLVE ANY UNDUE INFLUENCE, ARE AT FAIR MARKET VALUE, AND ARE IN THE ORGANIZATION'S BEST INTEREST. THE REVIEWING BOARD MEMBERS REPORT THEIR FINDINGS TO THE FULL BOARD. FURTHERMORE, AT BOARD MEETINGS, INDIVIDUAL BOARD MEMBERS ARE ASKED TO IDENTIFY, AND RECUSE THEMSELVES FROM ANY DISCUSSION AND VOTE ON ANY MATTER BEFORE THE BOARD IN WHICH THEY MAY HAVE A CONFLICT. FCHP ALSO REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES, TO COMPLETE A WRITTEN DISCLOSURE STATEMENT DESIGNED TO IDENTIFY POTENTIAL CONFLICTS. FCHP ALSO HAS GENERAL CORPORATE-WIDE CONFLICT OF INTEREST POLICIES THAT REQUIRE REPORTING OF POTENTIAL CONFLICTS AND MANAGEMENT APPROVAL OF CERTAIN TRANSACTIONS, AND PROHIBITS CERTAIN SPECIFIC TRANSACTIONS. THESE POLICIES ARE ENFORCED BY SENIOR MANAGEMENT, INCLUDING THE CHIEF COMPLIANCE OFFICER.
WRITTEN WHISTLEBLOWER, WRITTEN DOCUMENT RETENTION & DESTRUCTION POLICIES FORM 990, PART VI, QUESTIONS 13 & 14 FCHP CURRENTLY HAS WRITTEN WHISTLEBLOWER AND WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICIES, AND HAS HAD THESE POLICIES FOR A NUMBER OF YEARS. HOWEVER, THESE POLICIES HAD NOT PREVIOUSLY BEEN FORMALLY ADOPTED BY THE BOARD OF DIRECTORS OR A COMMITTEE SO DELEGATED, AND THE BOARD DID NOT HAVE THE OPPORTUNITY TO FORMALLY ADOPT THESE POLICIES BEFORE THE END OF 2010. THE BOARD HAS INITIATED THE PROCESS TO FORMALLY ADOPT THESE POLICIES IN 2011.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED Form 990, Part VI, Questions 15A & 15B FCHP HAS ESTABLISHED AN EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE (THE "COMMITTEE") OF THE BOARD OF DIRECTORS THAT ESTABLISHES POLICIES AND THE COMPENSATION STRUCTURE OF CERTAIN OF FCHP'S EXECUTIVE OFFICERS. THIS COMMITTEE IS RESPONSIBLE FOR ASSURING THAT THE TOTAL COMPENSATION PROVIDED TO THESE EXECUTIVE OFFICERS IS DETERMINED BY A FAIR AND EQUITABLE PROCESS, INFORMED BY CURRENT AND CREDIBLE MARKET PRACTICE INFORMATION, AND COMPLIANT WITH APPLICABLE LEGAL AND REGULATORY GUIDELINES. IN 2010, THE COMMITTEE CONSISTED OF THREE MEMBERS OF FCHP'S BOARD OF DIRECTORS, WHO ARE NOT EMPLOYED BY THE ORGANIZATION. FCHP'S CEO SERVED AS AN EX OFFICIO MEMBER OF THE COMMITTEE WITHOUT A VOTING RIGHT. THE EXECUTIVE OFFICERS OVER WHOSE COMPENSATION THE COMMITTEE IS RESPONSIBLE ARE COMPRISED OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER ("CEO"), DIVISION PRESIDENTS, AND THE EXECUTIVE AND SENIOR VICE PRESIDENT POSITIONS THAT REPORT DIRECTLY TO THE CEO ("EXECUTIVE GROUP"). IN 2010, TO DETERMINE THE COMPENSATION STRUCTURE OF THE EXECUTIVE GROUP, THE COMMITTEE RELIED ON A WRITTEN COMPENSATION SURVEY PRODUCED BY AN INDEPENDENT CONSULTING FIRM THAT ASSESSES EXECUTIVE COMPENSATION AND BENEFITS. THE COMMITTEE MET TO REVIEW THE COMPENSATION STRUCTURE OF THE EXECUTIVE GROUP AND REVIEWED THE COMPENSATION SURVEY PREPARED BY THE INDEPENDENT CONSULTING FIRM. THE COMMITTEE THEN VOTED TO APPROVE THE COMPENSATION OF THE EXECUTIVE GROUP (OTHER THAN THE CEO). FOR THE CEO'S COMPENSATION, THE COMMITTEE (MEETING WITHOUT THE CEO) RECOMMENDED A COMPENSATION STRUCTURE THAT WAS PRESENTED TO FCHP'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS (WITHOUT THE CEO PRESENT), VOTED TO APPROVE THE COMMITTEE'S RECOMMENDATION. ALL THESE DELIBERATIONS WERE CONTEMPORANEOUSLY DOCUMENTED IN THE MINUTES OF THE COMMITTEE AND BOARD OF DIRECTORS. THIS PROCESS WAS USED TO ESTABLISH THE COMPENSATION FOR THE EXECUTIVE GROUP IN 2010. THIS PROCESS WAS NOT USED TO ESTABLISH COMPENSATION FOR THE "KEY EMPLOYEES" LISTED IN SCHEDULE J.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED FORM 990, PART VI, QUESTION 16B SINCE THIS JOINT VENTURE IS MADE UP OF TWO EXEMPT ORGANIZATIONS, UNDER CODE SECTION 501(C) (3), THE POLICY IS NOT NECESSARILY RELEVANT AS THERE IS NO TAXABLE ENTITY INVOLVED AS A PARTNER.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, QUESTION 19 FCHP'S FORM 990 AND ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FCHP'S ANNUAL REPORT IS AVAILABLE ON ITS OWN WEBSITE. FCHP'S FORM 990, FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ANNUAL REPORT ARE ALSO PROVIDED ON REQUEST.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 Unrealized gain on investment $4,335,636 Change in pension plan liability -$935,624 ---------- Decrease in net assets $3,400,012
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Fallon Community Health Plan Inc
 
Employer identification number

23-7442369
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) SUMMIT LIVING INC

10 CHESTNUT STREET

WORCESTER,MA01608
26-1836279 		Asst Living MA 501(c)(3) 9 na
 
 
 












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) HOME STAFF LLC

40 MILLBROOK STREET
Worcester,MA01606
42-1757904 		IN HOME SERVICE MA na
  		Investment 250,000 2,538,719   No 9,805   No 50.000 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) FALLON HEALTH AND LIFE ASSURANCE COMPANY
10 CHESTNUT STREET
WORCESTER,MA01608
04-3169246 		Hlth Life Assur MA FCHP
  		C Corp -13,148,678 16,263,537 100.000 %
(2) Ultrabenefits Inc
29 East Mountain Street
Worcester,MA01606
04-3525752 		3rd Party Adm MA FHLAC
  		C Corp -120,894 1,003,062 100.000 %










Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) FALLON HEALTH AND LIFE ASSURANCE CO INC

 B 11,250,000  
(2) FALLON HEALTH AND LIFE ASSURANCE CO INC

 M 2,624,405  
(3) FALLON HEALTH AND LIFE ASSURANCE CO INC

 N 4,448,909  
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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