Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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 | |||||||||
| 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. | ||||||
| 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). | ||||||






| 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.") . | 0 | |||||
| 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...... | 2,577,064 | 3,088,578 | 2,964,603 | 3,187,367 | 2,540,406 | 14,358,018 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 2,577,064 | 3,088,578 | 2,964,603 | 3,187,367 | 2,540,406 | 14,358,018 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public Support (Subtract line 7c from line 6.) | 14,358,018 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 2,577,064 | 3,088,578 | 2,964,603 | 3,187,367 | 2,540,406 | 14,358,018 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 47,283 | 21,958 | 4,862 | 537 | 670 | 75,310 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 47,283 | 21,958 | 4,862 | 537 | 670 | 75,310 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 67 | 174 | 241 | |||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 2,624,347 | 3,110,536 | 2,969,465 | 3,187,971 | 2,541,250 | 14,433,569 |




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| OTHER INCOME, SCHEDULE A, PART III, SECTION B, LINE 12, 2009 - MISCELLANEOUS REVENUE $67 2010 - MISCELLANEOUS REVENUE $174, |
| Software ID: | 10000128 |
| Software Version: | v2010.1.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Delegation of management duties | Form 990, Part VI, Section A, Line 3 | COMMUNITY ALLIANCE HOME HEALTH, NFP HAS ENTERED INTO A MANAGEMENT SERVICE AGREEMENT WITH COMMUNITY NURSING SERVICE OF DUPAGE COUNTY, ONE OF ITS MEMBERS. |
| Classes of members or stockholders | Form 990, Part VI, Section A, Line 6 | COMMUNITY ALLIANCE HOME HEALTH, NFP HAS TWO MEMBERS: COMMUNITY NURSING SERVICE OF DUPAGE COUNTY (A CLASS A MEMBER) AND RUSH COPLEY MEDICAL CENTER (A CLASS B MEMBER). |
| Members or stockholders electing members of governing body | Form 990, Part VI, Section A, Line 7a | THE COMMUNITY ALLIANCE HOME HEALTH, NFP BOARD OF DIRECTORS IS COMPRISED OF SIX DIRECTORS, WITH THREE DIRECTORS ELECTED BY EACH OF THE TWO MEMBERS. |
| Decisions requiring approval by members or stockholders | Form 990, Part VI, Section A, Line 7b | COMMUNITY ALLIANCE HOME HEALTH, NFP MEMBERS HAVE THE AUTHORITY TO VOTE ON MATTERS INCLUDING: AMENDING OR REPEALING THE ORGANIZATION'S BYLAWS OR ARTICLES OF INCORPORATION, APPOINTMENT OF THE INDEPENDENT AUDITOR, NEGOTIATING CONTRACTS, AND MERGING OR DISSOLVING THE ORGANIZATION. |
| Review of form 990 by governing body | Form 990, Part VI, Section B, Line 11a | THE FORM 990 IS REVIEWED BY EXTERNAL TAX ADVISORS AND THE COMMUNITY ALLIANCE HOME HEALTH, NFP BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS. |
| Conflict of interest policy | Form 990, Part VI, Section B, Line 12c | UNDER THE CAHH CONFLICT OF INTEREST POLICY, CAHH MANAGEMENT TEAM MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST THAT MAY EXIST THROUGH A PERSONAL OR BUSINESS INTEREST IN A REFERRAL SOURCE OR IN ANY BUSINESS PROVIDING SERVICES TO CAHH. IN ADDITION, CAHH BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT SPECIFIC TO THEIR ROLE ON THE CAHH BOARD. POTENTIAL CONFLICTS ARE SUBMITTED TO THE CAHH DIRECTORS FOR DETERMINATION AS TO WHETHER THE POTENTIAL CONFLICT IS AN ACTUAL CONFLICT AND REQUIRES IMPLEMENTATION OF CONFLICT MITIGATION STRATEGIES. CAHH EMPLOYEES ARE REQUIRED TO REVIEW ANNUALLY THE CONFLICT OF INTEREST POLICY OF COMMUNITY NURSING SERVICE OF DUPAGE COUNTY (THE CAHH MANAGEMENT COMPANY) AND TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. IN ADDITION, THE POLICY REQUIRES THAT EMPLOYEES DISCLOSE POTENTIAL CONFLICTS THAT MAY ARISE BETWEEN ANNUAL STATEMENTS THROUGH SUPPLEMENTARY DISCLOSURES. ANY POTENTIAL CONFLICT DISCLOSURE IS REVIEWED AND EVALUATED, FOLLOWING THE PROCESS USED FOR EMPLOYEES OF THE MANAGEMENT COMPANY, TO DETERMINE WHETHER A POTENTIAL CONFLICT IS AN ACTUAL CONFLICT, AND IF SO, CONFLICT MITIGATION STRATEGIES ARE IMPLEMENTED. |
| Public Disclosure | Form 990, Part VI, Section C, Line 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC AT THIS TIME. |
| Software ID: | 10000128 |
| Software Version: | v2010.1.0 |