Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 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 | ||||||
| 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 | ||||||
| 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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | CHRT ILLUMINATES BEST PRACTICES AND OPPORTUNITIES FOR IMPROVING HEALTH POLICY AND PRACTICE AND SEEKS TO PROMOTE EVIDENCE-BASED CARE DELIVERY, IMPROVE POPULATION HEALTH, AND EXPAND ACCESS TO CARE THROUGH RESEARCH, PUBLICATIONS, AND CONSULTATIVE WORK. |
| FORM 990, PAGE 2, PART III, LINE 4A | GRANT FUNDED PROJECTS: EXPENSES = 4,270,871 CHRT SERVED AS THE BACKBONE ORGANIZATION FOR TWO LARGE COLLECTIVE IMPACT PROJECTS IN 2021 1.) THE PROMOTION OF HEALTH EQUITY (PHE) PROJECT, FUNDED THROUGH MEDICAID MATCH FUNDS; AND 2.) THE MI COMMUNITY CARE (MICC) LIVINGSTON AND WASHTENAW COUNTY COMMUNITY HEALTH INNOVATION REGION (CHIR). PHE: THE U.S. CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) PLEDGED MEDICAID MATCH FUNDS TO LAUNCH A NEW HEALTHY EQUITY PROJECT IN FIVE MICHIGAN COUNTIES, WITH CHRT SERVING AS THE COORDINATING AGENCY. THE PROJECT AIMS TO HELP THESE COUNTIES REDUCE HEALTH DISPARITIES ASSOCIATED WITH PRESSING SOCIAL NEEDS SUCH AS HOUSING INSTABILITY, FOOD INSECURITY, TRANSPORTATION, HEALTH SYSTEM COMPLEXITY, AND OTHER SOCIOECONOMIC FACTORS. MICC: THE THREE-YEAR MI-COMMUNITY CARE (MICC) PROJECT RECEIVES FUNDING FROM MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES (MDHHS) AND FROM THE CARES ACT TO CONVENE LOCAL HEALTH AND HUMAN SERVICE ORGANIZATIONS TO PROVIDE PATIENT-CENTERED, COORDINATED CARE TO INDIVIDUALS WITH COMPLEX MEDICAL, BEHAVIORAL, AND SOCIAL NEEDS. OTHER GRANTS THAT WERE ADMINISTERED DURING 2021 WERE THROUGH THE KRESGE FOUNDATION, MDHHS MICHIGAN MEDICAID LONG-TERM SERVICES AND SUPPORTS (LTSS),MPHI PIPBHC, RRTC, AND AN AGING-FOCUSED GRANT FROM ANN ARBOR AREA COMMUNITY FOUNDATION. |
| FORM 990, PAGE 2, PART III, LINE 4B | DEMONSTRATION PROJECTS: EXPENSES = 619,664 CHRT SERVES AS BACKBONE ORGANIZATION TO THE WASHTENAW HEALTH INITIATIVE, A COLLABORATION BETWEEN MORE THAN 200 INDIVIDUALS REPRESENTING OVER 80 ORGANIZATIONS INCLUDING THE VA ANN ARBOR HEALTHCARE SYSTEM, HEALTH PLANS, COUNTY GOVERNMENT, COMMUNITY SERVICES, PHYSICIANS, AND SAFETY NET PROVIDERS COMMITTED TO DELIVERING BETTER CARE TO LOW-INCOME, UNDER-INSURED, AND UNINSURED POPULATIONS. CO-SPONSORED BY THE MICHIGAN MEDICINE AND ST JOSEPH MERCY HEALTH SYSTEM, CHRT STAFF PROVIDES PROJECT MANAGEMENT AND ADDITIONAL SUPPORT THROUGH DATA AND POLICY ANALYSIS, WORK GROUP PROJECT PLAN DEVELOPMENT AND EVALUATION, AND FACILITATING CONNECTIONS ACROSS MULTIPLE STAKEHOLDERS. IN ADDITION, CHRT HOUSES THE MICHIGAN PRIMARY CARE TRANSFORMATION PROJECT (MIPCT) |
| FORM 990, PAGE 2, PART III, LINE 4D | CONSULTING WORK: EXPENSES = 551,984 CHRT PROVIDED CLIENT DRIVEN WORK IN 2021. PROJECT AREAS INCLUDED: - BLUE CROSS BLUE SHIELD OF MICHIGAN -COVID RESPONSE AND SDOH - DETROIT WAYNE MENTAL HEALTH AUTHORITY - CONSULT ON DWMHA & BCC INTEGRATION METHODS - WASHTENAW COUNTY - DIVERSION AND CMH MILAGE - HURON VALLEY AMBULANCE- COMMUNITY PARAMEDICINE - HURON GASTRO - CONSULTING |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE CENTER FOR HEALTHCARE RESEARCH AND TRANSFORMATION (CHRT) HAS TWO MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE TWO MEMBERS, IN THEIR SOLE DISCRETION, CAN ELECT ALL MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PAGE 6, PART VI, LINE 7B | THE BOARD OF DIRECTORS HAS FULL AUTHORITY TO GOVERN THE AFFAIRS OF CHRT EXCEPT FOR POWERS RESERVED TO THE MEMBERS. THE FOLLOWING ACTIONS REQUIRE THE APPROVAL OF EACH OF THE MEMBERS: A) A MATERIAL CHANGE OF THE CORPORATION'S PURPOSES; B) THE SALE, TRANSFER, OR OTHERWISE DISPOSAL OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; C) ANY MERGER, CONSOLIDATION, OR OTHER SIMILAR AGREEMENT; D) GENERAL ASSIGNMENT FOR THE BENEFIT OF CREDITORS OR FILING OF A PETITION UNDER FEDERAL BANKRUPTCY LAW; E) INCURRENCE OF ANY INDEBTEDNESS; F) ADMISSION OF ADDITIONAL MEMBERS, OR ANY AGREEMENT BETWEEN THE MEMBERS; OR G) TRANSFER OF MEMBERSHIP IN THE CORPORATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 WAS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING WITH THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | EACH BOARD MEMBER IS REQUIRED TO ANNUALLY COMPLETE AND SUBMIT A CONFLICTS OF INTEREST QUESTIONNAIRE AND DISCLOSURE FORM, DETAILING ANY SUCH "OTHER INTERESTS". THE BOARD MEMBER MUST UPDATE THE DISCLOSURE FORM IF ANY MATERIAL CHANGES OR ADDITIONS ARISE DURING THE YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE EXECUTIVE COMMITTEE OF THE CHRT BOARD CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE DIRECTOR, AT WHICH TIME THEY DISCUSS THE SALARY PROGRAM FOR THE UPCOMING YEAR FOR THE DIRECTOR. THE FULL BOARD MEETS IN AN EXECUTIVE SESSION AFTER THE ADJOURNMENT OF THE BOARD MEETING TO REVIEW AND DISCUSS THE DIRECTOR'S PERFORMANCE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | PLEASE NOTE THAT ALTHOUGH THIS QUESTION HAS BEEN ANSWERED 'NO', IT IS, ACTUALLY, NOT APPLICABLE TO THIS ENTITY. THE ORGANIZATION DOES NOT AND HAS NEVER PAID COMPENSATION TO OTHER OFFICERS, DIRECTORS, OR KEY EMPLOYEES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | INFORMATION IS PROVIDED UPON REQUEST. |
| Software ID: | |
| Software Version: |